Mcms round up 8 2014

To learn more visit www.mcmsonline.com

PRESIDENT’S PAGE: “Will care be there?” That was the question being asked by physicians across the state of Arizona ten years ago at the Medical Liability Insurance Crisis Rally on October 21, 2004. Perhaps the question for 2014 is not whether or not care will be there, but will quality care be there? Dr. Anand shares her thoughts on the state of organized medicine today. Page 6

PUBLIC HEALTH: This is a very exciting and interesting time for patients with Hepatitis C (HCV) and for those who are involved in providing their treatment. The future looks even brighter in the coming months as newer and even better drugs are developed. Read Dr. Richard Manch’s article. Page 22

round-up Volume 60 • August 2014

Providing news and information for the medical community since 1955.

THE LEGAL ISSUE:

Steve Perlmutter, MD, JD From the Operating Room to the Courtroom.

How How does does aa physician physician make make the the transition transition from from being being aa patient patient advocate advocate to to aa defender defender of of physicians? physicians?

Read Read Dr. Dr. Perlmutter’s Perlmutter’s story. story. Page Page 16 16 FROM THE EXECUTIVE DIRECTOR: What does legal mean to doctors?

What do doctors think of when they think of the legal community? What do doctors think of the AZ Medical Board? Jay Conyers, PhD, asks those questions and explains how the MCMS is answering them. Page 12

R TAX RULES — PROPERTY PURCHASE: Thinking of buying, leasing or buildin to suit for your practice? Tracy Altemus, CCIM and Zandra building O’Keefe, CPA, recommend physicians take note of significant tax exemptions. Page 38

RESTRICTIVE COVENANTS: When forming a professional relationship, one question for both the physician and practice group to carefully consider is whether to enter into a restrictive covenant agreement. Read attorneys Stacy Gabriel and Barrie Stachel professional suggestions. Page 30

REGULATORY COMPLIANCE: Attorneys Andrew Plattner and Marcie Damisch present HIPAA 101 – some of the basic requirements applicable to physicians under HIPAA and focus on its three primary components: the Privacy Rule; the Security Rule; and the Breach Notification Rule. Page 40

INTELLECTUAL PROPERTY: A ha! It is that moment when an idea strike for that next great medical device or medical application. Attorney Steve Lawrence provides physicians with a summary of potential pitfalls and best practices when considering a new invention. Page 34

BANKRUPTCY: It is no secret that physicians around the country are feeling greater financial stress. Many in the healthcare field will be forced to participate in the bankruptcy process in one way or another – as a debtor, creditor, or as an employee of an insolvent group. Ethan Minkin and Andy Harnisch acquaints the reader with the bankruptcy process by way of a hypothetical Chapter 11 case. Page 46

round-up

august 2014

the legal issue

6 12

16 22 30 34 38 40 46 52

president’s page

Will care be there? Is the question still relevant 10 years later?

from the executive director

What’s in a word: What does legal mean to doctors?

member profile

Steven B. Perlmutter, MD, JD: From the operating room to the court room.

public health

Hepatitis C treatment in 2014: We’ve come a long way!

restrictive covenants

To compete or not to compete? That is the question.

intellectual property

Physician inventions: When that great idea strikes – start here.

tax rules: property purchase

Thinking of buying space for your practice? Take note of significant tax exemptions.

regulatory compliance HIPAA basics for physicians.

bankruptcy

What every doctor should know.

viewpoint

Dr. Jarrett shares his thoughts on a medical group’s recommendations against routine pelvic exams for women.

Correction: In the July 2014 issue of Round-up, page 17, Dr. Jay Crutchfield’s name is missing the “t” in the photo

caption. Our sincerest apologies for the error.

In every issue

New Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Maricopa County Healthcare Happenings . . . . . . . . . . . . . . . .26

Minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

Patient Education Handout . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Letters to the Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

In Memoriam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Marketplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54

4 • Round-up • August 2014 • A monthly publication of the MCMS

On the cover: Dr. Steve Perlmutter, JD examining law briefs in his office.

Photo courtesy of Mike Paulson, Paulson Photo/Graphic Communications.

Round-up Staff

Editor-in-Chief Miriam K. Anand, MD Editor Jay Conyers, PhD

Advertising Candice Scheibel

Production Candice Scheibel Karen Hellwig Advertising

To obtain information on advertising in Round-up, contact MCMS.

phone: 602-252-2015 advertising@mcmsonline.com

Postmaster

Send address changes to: Round-up, 326 E. Coronado Rd., Phoenix, AZ 85004 www.mcmsonline.com

facebook.com/MedicalSociety twitter.com/MedicalSociety

linkedin/Maricopa County Medical Society

Periodicals postage paid at Phoenix, Arizona.

Volume 60, No. 8, August 2014.

Round-up (USPS 020-150) is published 12 times per year by the Maricopa County Medical Society, 326 E. Coronado, Phoenix, AZ 85004. To subscribe to Round-up Magazine please send a check for one-year subscription of $36 to Round-up Magazine, 326 E. Coronado Rd., Phoenix, AZ 85004 or visit mcmsonline.com/subscribe.

MCMS 2014 Officers

President Miriam K. Anand, MD President-Elect Ryan Stratford, MD

Vice President Elizabeth McConnell, MD Secretary Suzanne A. Sisley, MD Treasurer Mark R. Wallace, MD

Immediate Past-President Daniel Lieberman, MD

Board of Censors

Nathan Laufer, MD, Chair Daniel Lieberman, MD

Michael R. Mills, MD, MPH Ryan Stratford, MD

Thomas E. McCauley, MD James R. Meador, Jr., MD Anthony T. Yeung, MD

Board of Directors 2012-2014

Tanja Gunsberger, DO

Jennifer Hartmark-Hill, MD Kelly Hsu, MD

Susan Whitely, MD

2013-2015

Adam M. Brodsky, MD John L. Couvaras, MD

Steven R. Kassman, MD

Robert J. Standerfer, MD

2014-2016

Lee Ann Kelley, MD

Richard Manch, MD

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

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.

May Mohty, MD

Anita Murcko, MD

A monthly publication of the MCMS • August 2014 • Round-up • 5

president’s page

Will care be there?

Is the question still relevant 10 years later?

Miriam K. Anand, MD

Tom Purdon, MD holds up a patient brochure packet that was used for patient surveys and medical liability education.

“Will care be there?”

That was the question being asked by physicians across the state of Arizona 10 years ago at the Medical Liability Insurance Crisis Rally on October 21, 2004 (photos to the right). The rally was hosted by the Maricopa County Medical Society (MCMS), at the direction of then president, Bryan Updegraff, MD, and was co-sponsored by the Arizona Medical Association (ArMA).

The goals were to a) alert practitioners and the public to the liability crisis and the threat to healthcare, b) effect the 2004 election to elect candidates at the state and federal level who understood the medical liability issue and pledged to fix it, and c) garner support from physicians around the state. The event was attended by c. 2,400 physicians and stimulated my personal interest to become more involved in organized medicine and its effort to protect our profession.

Many may remember the rally, but I wonder how many have followed the outcomes from the calls to action made there over the past decade. At the time, there was a call to put a cap on non-economic damages (pain and suffering) at the state or federal level based on the success of such caps in states such as California. The Arizona State Constitution prohibits setting a cap on non-economic damages and the federal measure failed. Despite this, significant steps have been accomplished at the state level to reduce frivolous lawsuits and make the process more fair to physician defendants. For example, plaintiffs now require an “affidavit of merit” in order for the case to be eligible to be heard in court. This has raised the bar and has made it more difficult for non-meritorious cases to be brought against physicians. Furthermore, clear and convincing evidence is now required in cases involving emergency care rather than a “preponderance of evidence,” which was the old standard. Finally, testimony by expert witnesses must now be held to the higher Daubert standards versus 6 • Round-up • August 2014 • A monthly publication of the MCMS

“The goal of the rally is to activate the medical community, inform the public and elect those people who support our position.”

Bryan R. Updegraff, MD, President, 2004

The entire panel stands and joins hands to show unity. Drs. Tom Purdon, Phil Keen and Brian Updegraff are shown.

Physicians sign in for the event.

president’s page the less stringent Frye standards that were previously acceptable. The Daubert decision establishes criteria to evaluate whether top-rated witnesses are using validated, peer-reviewed scientific information versus so-called “junk science” or personal opinion in their testimony.

Dr. Updegraff’s call to action, therefore, has continued to have a slow but sure positive impact on reducing the risk of frivolous medical liability claims in Arizona. Each of the achievements above, however, represents hard fought victories on behalf of ArMA with the support of the MCMS. If you have not followed these advances over the years, you have surely noticed that your liability premiums have come down and, if you are insured by the Mutual Insurance Company of Arizona (MICA), you have even received dividends back over the past few years. If you are not aware of this, I would urge you to compare rates from 2004 to those today, even if your employer pays for your liability insurance. Still, despite the fact that these savings would likely pay for MCMS and ArMA dues many times over, many are choosing not to become members or are letting their membership lapse. I saw an interesting quote recently: “Some quit due to slow progress, never grasping the fact that slow progress is progress.” It seems that those who ask what membership does for them are not paying attention to progress that is made, perhaps because it doesn’t meet the need of instant gratification we have all become used to.

Dear Readers,

The announcement that the University of Arizona Health Network (UAHN) and Banner Health are in negotiations regarding a potential 30 year agreement came out after the submission of my last editorial.

The UAHN is a private entity which owns the University of Arizona Medical Center in Tucson and a number of other U of A affiliated medical sites, whereas the University of Arizona runs the medical college campuses in Phoenix and Tucson. Banner Health runs the largest not-for-profit hospital system in the state.

The agreement, which ultimately needs to be approved by the Board of Regents, is expected to include a 30 year collaboration and affiliation in which Banner would provide considerable financial support to both college campuses. Banner would purchase the land associated with the University Medical Center in Tucson. In addition, Banner Good Samaritan Medical center would be converted to a faculty-based academic medical center.

Some speculate that this could represent the early stages of what the future could hold for other state academic medical centers that are struggling financially in the current climate.

What are your thoughts on this potential merger? Email your comments to manand@mcmsonline.com.

Miriam K. Anand, MD President

Given the advances that organized medicine in Arizona was able to achieve above, is the question “Will care be there?” still relevant today?

While requiring an affidavit of merit, A monthly publication of the MCMS • August 2014 • Round-up • 7

president’s page Excerpts from a few of the featured speakers at the Medical Liability Insurance Crisis Rally on October 21, 2004

“People ask me what the heck does the Medical Society do for me? Tonight’s meeting is exemplary of the Medical Society. We care about every physician in the county and state and the provisions of the healthcare of our patients.” − Marc J. Rosen, MD, MCMS 2005 President

“ You cannot answer the question, is this system better than one of reform? You have to acknowledge that it needs to be reformed. This is work worth doing, so let’s get to it!” − Senator Jon Kyl

“You need to make it a grassroots effort. You have to organize and get physicians around the state to participate.” − Peter Bernardo, MD

clear and convincing evidence, or holding expert witness testimony to a higher standard would seem logical to most readers, others would argue that it makes it more difficult for patients who may have a legitimate claim to pursue it and be properly compensated. The use of the Daubert standard was already challenged by an appeal, but was ultimately upheld by the Arizona Supreme Court. The November ballot in California will include a measure to raise the cap on non-economic damages from $250,000 to $1.1 million. There will always be those on the other side that will look for opportunities to overturn or get around advances that are made in reducing frivolous liability claims.

We face numerous other challenges that affect our ability to care for our patients, some of which are due to laws passed by state and federal legislators. While everyone is aware of the Affordable Care Act, surely the most sweeping legislation to affect our profession in decades, many may not be aware of numerous bills proposed each year that could impact us and how we provide care. They may also be unaware of the efforts of your local organizations to fight those that can be detrimental.

2015 budget proposal would reportedly cut it even further.

This could translate into fewer continuing eduction options to provide trained physicians. More nurse practitioners and physician assistants are being used to fill the vacancies and, while many of them provide excellent care, their training requires much less clinical exposure than that for physicians. Furthermore, those in other professions, such as naturopaths and chiropractors, are lobbying to be considered primary care providers. This is despite the fact that they also have little to no post-graduate training and would be the equivalent of having MDs and DOs bypass internships and residencies and start practicing right out of medical school. Primary care physicians are responsible for managing chronic medical conditions and must also be familiar with appropriate cancer and disease screening.

Most of us required three years of post-graduate training to be considered eligible to provide this care. To site a quote I saw recently on the issue of the disparity in clinical training, “you don’t know what you don’t know.”

Physicians have less and less time to spend with patients.

Legal and legislative changes, such as the ACA and meaningful use, have not only failed to change this fact, but in many ways have worsened the issue. Perhaps the question for 2014 is not whether or not care will be there, but will quality care be there?

The answer to this question remains to be seen. Your membership in organizations such as MCMS and ArMA, however, indicates your dedication to ensuring that quality care will be there. You likely have colleagues who believe in the MCMS mission of promoting excellence in the quality of care, the health of the community, and the importance of a strong and collective physician voice. Despite this, they are not members. Please help them to understand that our strength lies in our membership and the more members we have, the more powerful we become. ru

The issue of physician burnout is well known and is a reason that many physicians choose to retire earlier than they might have otherwise. Physicians are also choosing to move to non-clinical positions or seek other careers altogether. In the meantime, funding for Graduate Medical Education is already inadequate and President Obama’s 8 • Round-up • August 2014 • A monthly publication of the MCMS

Dr. Miriam Anand is an Allergy and Immuology specialist practicing in Tempe.

She is the Maricopa County Medical Society’s 120th President, and has been a MCMS member since 1998.

Contact her by email to manand@mcmsonline.com

Compliments of the:

Free Physician Referral service: Call: 602-252-2844 mcmsonline.com/provider search

What is a PCP and why do I need one?

The abbreviation “PCP” is often used to refer to a “primary care physician” or “primary care provider.” A primary care physician focuses on your overall health and well-being over the long term. Many primary care physicians work with nurse practitioners and physician assistants to provide your care.

Ideally, everyone should have a PCP, even if you are healthy. In the past, people were often cared for by the same physician for many years. Maintaining this valued relationship has become more difficult because many health insurance plans require that you see a contracted physician.

This may mean that you must change PCPs. Research demonstrates that people who have a PCP they know and trust stay healthier and get treated earlier. It is important to find a PCP with whom you have a good relationship.

What are the benefits of having a PCP? • Having a PCP allows you to establish ongoing care with a provider who knows you and is familiar with your health history.

• PCPs can identify and treat many common illnesses and chronic diseases. When needed, your PCP will coordinate referrals to specialist physicians for further treatment and care.

• PCPs can perform or coordinate periodic health screenings. Screenings can diagnose certain diseases earlier so they can be appropriately treated. The type of screening you will need depends on your age, gender and other factors.

• PCPs can provide and coordinate preventive healthcare. This includes vaccinations, smoking cessation, healthy diet, exercise and other issues that affect your health.

There are 5 types of physicians who train to provide primary care.

• Family Physicians complete three years of training in Family Medicine after graduating from medical school. They train to take care of children and adults. They also train to treat women during pregnancy, deliver babies, and perform some surgical procedures, although some may choose not to offer these services in their practice. They can provide primary care to all members of the family.

• Internists complete three years of training in Internal Medicine after medical school. They train to take care of adults. They do not perform surgery or deliver babies; they specialize in providing primary care to adults of all ages.

• Pediatricians complete three years of training in Pediatrics after graduating from medical school. They train to take care of infants and children. They do not perform surgery or deliver babies; they specialize in caring for patients from birth to age 18.

• Obstetricians/Gynecologists (OB/Gyn) complete four years of training in Obstetrics and Gynecology after graduating from medical school. Their training focuses on pregnancy, childbirth, and the medical and surgical management of problems of the female reproductive system. They provide routine primary care for women. However, if you have multiple chronic illnesses, such as diabetes, high blood pressure and high cholesterol, your OB/Gyn may suggest that you also visit an Internist or Family Physician.

• Internal Medicine/Pediatrics complete four years of training in both Internal Medicine and Pediatrics after graduating from medical school. They do not perform surgery or deliver babies; they specialize in primary care of infants, children, and adults.

How do I choose a PCP? If you have health insurance, it’s a good idea to start with the doctors covered on your insurance plan (unless you are willing to pay more for care). Good referral sources include your friends, family or co-workers.

MCMS also provides a FREE physician referral service. You can reach them by calling 602-252-2844 or email to mcms@mcmsonline.com. On the internet, visit www.mcmsonline.com/providersearch. The physician referral service can provide you with names, phone numbers and practice address that are located in the area where you live. The representatives can also tell you where the doctor went to medical school, where he/she completed their training, if they speak other languages and more.

For more information about the types of physicians who provide primary care, you may visit the following websites: • Pediatrics: http://www.healthychildren.org/English/ages-stages/ prenatal/decisions-to-make/Pages/A-Pediatricians-Training.aspx • Internal Medicine: http://www.acponline.org/patients_families/ about_internal_medicine/ • Obstetrics and Gynecology: http://www.abog.org/faq.asp • Family Practice: http://www.aafp.org/about/the-aafp/ family-medicine-specialty.html

Can the physicians in the Emergency Department or Urgent Care be my PCP? Physicians working in Urgent Care facilities and Emergency Departments should not be considered primary care physicians. Additionally, providers employed by retail drugstore and grocery store clinics are not primary care providers. These providers treat patients for “acute” illnesses or medical issues that started within the past few days. They generally don’t perform preventive care or screening. Going to the emergency room should be reserved for medical conditions that shouldn’t wait until you can see your primary care provider (such as chest pain or shortness of breath). Those physicians treat acute conditions and injuries, such as pneumonias, broken bones, and wounds needing stitches. While urgent care facilities can treat these as well, they can also treat ear infections, sinus infections, and other illnesses that don’t require a trip to the emergency room. If you have an acute medical issue, you should call your PCP first.

He or she should be able to provide home care advice, see you in the office the same or next day, or refer you to an urgent care or the emergency department. Your PCP will follow-up on and coordinate the care you receive from specialists, the emergency department and urgent care.

letters to the editor Bhushan H. Pandya, MD AMA-IMG Governing Council Secretary Treasurer, Medical Society of Virginia Danville, Virginia Dear Editor:

I was asked to present a CME lecture on Organized Medicine for my Alumni association and Residents at my hospital. I reviewed material from many sources including the American Medical Association (AMA) and our State Society. Many presentations seem to highlight the organization’s achievements on behalf of its members. Sometimes it felt like these organizations were selling a service and the physicians did not see the value in terms of return for their membership dues in them. There seems to be a lack of understanding of how these organizations work. The issues and concerns originate from individual physicians, are brought up to the local societies and then to the State societies or AMA to influence policies and laws. By not being members of these organizations, many physicians give up their privilege and opportunity of being a part of that grass root effort and influence policy and outcome. It is similar to giving up your privilege to vote for elected officials and then complain about them not representing your concerns.

I developed my presentation to educate the audience about how local, state and national organizations work and try

to make a positive difference. Failure to achieve some objectives does not reflect any lack of effort on the part of these organizations but a need for more participation.

Together we are strong.

This is where comments by Dr. Nathan Laufer [MCMS Past President, 2011] on “Organized Medicine: Why it Matters - Part I” [Round-up, April 2011] struck a cord for me. If physicians choose not to be a part of organized medicine, the chance of failure to achieve desired goals is 100%. Being a part of AMA and leadership in the Medical Society of Virginia, I know that many adverse issues and policies affecting physicians are averted every year. Without these organizations we would certainly be burdened with bad policies and laws. Physician participation will not only help lead the changes in medicine now, but will help preserve physician leadership for our profession in future.

Respectfully submitted, Bhushan H. Pandya, MD

Connect with your Society.

Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to page 5 for our usage statement.

Editor: Miriam Anand, MD manand@mcmsonline.com

Managing Editor: Jay Conyers, PhD, jconyers@mcmsonline.com

Fax: 602-256-2749 Write: Round-up, 326 E. Coronado Rd., Ste. 101, Phoenix, AZ 85004

Click: www.mcmsonline.com/contact A monthly publication of the MCMS • August 2014 • Round-up • 11

from the executive director

W

What’s in a word: what does legal mean to doctors?

Jay Conyers, PhD

hat do doctors think of when they think of the legal community? Do they think of it as a separate profession? Do they think of it as a safeguard for protecting them in how they care for their patients? Do they think of a shark tank waiting for the slightest sign of blood? Do they think of it as the legislative bodies that determine how they can practice medicine? When I first posed this question, I was unsure of what the answer might be.

Perhaps it’s the media that sensationalizes physician malpractice issues (my opinion), but I found that a significant number of physicians think of Board complaints when they think of the legal system. Many think of tort reform and the hard-fought battles waged on their behalf by organized medicine to protect the profession. Many think of patients filing frivolous complaints about the care provided by their doctors.

It’s only fitting that going to the principal’s office (by way of the Arizona Medical Board) was a common response when I asked our members what ‘legal’ means to them. When I was fortunate enough to be offered

this position last September and start working for you in October, it was at exactly the same time that the Arizona Republic ran a number of stories covering concerns about the licensing process at the Arizona Medical Board.

For those of you who missed it,

the Arizona Ombudsman-Citizens’ Aide found that the Board violated a number of state laws in how new licensing applications for physicians are reviewed. In their report released October 9, 2013, the agency substantiated nearly all twenty allegations brought by current and former Board employees and issued a number of recommendations for the Board to become compliant. In their report, the Ombudsman-Citizens’ Aide suggested that the state Auditor General assist

12 • Round-up • August 2014 • A monthly publication of the MCMS

the Board with a review of all physicians licensed by the Board since September 2011.

Almost immediately, my phone began ringing. On a nearly daily basis, I was fielding calls from physicians, patients, and members of our community, who were calling to inquire about the stories reported in the Republic.

Physicians were concerned about their own licenses and the licenses of their colleagues; patients were asking if their doctors were on the “list” of doctors licensed during the period in question; members of the community were asking if these doctors would have their licenses pulled. There was general concern, but for the wrong reasons (again, my opinion). People were questioning the credentials of approximately 3,000 physicians, each of whom had spent more than a decade training to care for the citizens of our great state.

Almost immediately, the Society realized that this was a crisis for the profession. Would the credentials of all Arizona doctors licensed beyond September 2011 be questioned? Would these same doctors be deemed suitable to treat patients? Would the state require these doctors to be re-licensed?

Would they still be able to practice?

from the executive director So much for easing into the job and getting acquainted with the lay of the land (since not only was I new to this job, but also to Arizona)! Having a background in health policy and seeing politics play out firsthand during my three years in Washington, DC, I knew that in order to truly understand the nature of the problem – assuming that there actually was a problem – I needed to understand every angle of the issue. For every story, there are two sides. For every policy, there are at least four. Seriously. Especially when it comes to policies pertaining to healthcare.

I first asked our physicians – you – how you felt about the issue. Most of you see tremendous value in the Board and understand that the medical profession cannot exist without a governing

body that holds physicians to the highest of standards. You appreciate the need to regulate licenses in accord with state laws and know that if your licenses and/or the ways in which you practice medicine are ever questioned, then the state has a way in which to measure how care is/was provided.

But physicians also recognize that there has to be efficiency and accountability. There has to be a way to get a medical license in Arizona in a reasonable amount of time, and there is also a need for a process whereby physician practices and/or hospitals can fill physician slots with the best physicians available throughout our nation.

If physicians outside of Arizona know that it takes longer to get licensed here, they simply won’t come.

We have a physician shortage here in Arizona. We need to fill it, but it cannot come at the expense of allowing “bad doctors” come to Arizona to care for our citizens. This is what I heard when I asked about this issue last October. I’ve yet to meet a bad doctor here in Arizona, but I’m sure there are some out there. Now that the media has published the list of all doctors licensed since September 2011 (information which, by they way, is easily accessible to anyone), there is a “black cloud” hanging over those that were licensed during this timeframe.

I also asked legislators what they thought about the issue. Most, as would be expected, were of the opinion that the purpose of the Board was to serve the public. Honestly, I was unsure as to what the true role was, so

A monthly publication of the MCMS • August 2014 • Round-up • 13

from the executive director I looked it up. From their website, it says, “The Arizona Medical Board is committed to serving the public through the honest, fair, and judicious licensing and regulation of physicians.” Our elected officials know this.

They truly do.

After speaking with those who would take my call, I came to the following conclusions. One, our physicians feel that the licensing process has improved in recent years and that it is now easier to recruit doctors to Arizona. Two, our elected officials understand the need to modernize our licensing process – but not at the expense of our citizens. And three, something has to change.

In the spring of this year, our elected officials responded to the Arizona Ombudsman-Citizens’ Aide report and passed Senate Bill 1381. This bill calls for the review of those medical licenses issued since September 2011 to ensure that they comply with state law for the issuance of medical licenses.

More specifically, SB 1381 appropriated $855,000 for the Board to contract with an in-state credentials verification service to review all licensing applications processed during this time period. In a nutshell, this bill requires someone to check the work of the Board and ensure that all licensing issued during the period dating back to September 2011 are legitimate.

For those of you who don’t know, we run a business service here at the Society that has been credentialing physicians in Arizona for nearly three decades. We have many of you in our database – which now exceeds 30,000 physicians – and have carried out the “grunt work” that goes behind verifying the credentials of physicians. The Greater Arizona Central Credentialing Program (GACCP) does primary

source verification of physician credentials, utilizing the most current technology, including secured databases via the internet to streamline the credentialing process. We adhere to the same standards as other states and other credential verification organizations (CVOs).

In May, after Governor Brewer signed SB1381 into law, the Society responded to a competitive state bid to audit the medical licenses in question and submitted an official quote to compete for the contract. On June 19th, the Society was notified that it was being awarded the contract to perform a “look back” at these licenses and confirm that all doctors licensed during these periods have credentials that comply with state law.

We are a month into the contract and have finally completed all training required to assist the Board. We are at the point where we will finally start reviewing each license issued during this time period, and reaching out to those physicians for whom the state will require additional documentation.

We are working closely with the Arizona Medical Board to ensure that the messaging behind this effort is crafted in a manner so that it assures the physician community that we are working to protect their licenses and not in any way putting valid licenses in jeopardy.

Through this contract we are hoping to be part of the solution. We want to help restore the public’s confidence in the validity of the licenses of Arizona physicians, while also ensuring that our state’s physicians are licensed appropriately and in compliance with all laws. Our goal to complete this review by the end of the year is ambitious, but we are confident that we have the manpower and know-how to

14 • Round-up • August 2014 • A monthly publication of the MCMS

get the job done. In the end, we hope to show that all 3,000+ physicians licensed during this time period are more than qualified to care for Arizona’s citizens, and in the event we find one that “slipped through the cracks,” we’ll step aside and let the Board do its job of regulating.

It is our hope that this effort of organized medicine (the Society) working closely with the regulatory body (the Board) will help ease the concerns of our physician community when they hear the word legal. That it will not only restore the confidence of our members that the Board can be looked to as a safeguard rather than just a watchdog, but also prove to our members that the Society – and organized medicine collectively – is looking out for the greater good of the profession.

It’s our mission to protect the profession, and we hope that through this audit process we are able to prove to you that we’re serving the greater good. ru Jay Conyers, PhD is the Executive Director for the MCMS and CEO of the MCMS Business Services.

He has prior experience as a healthcare executive in Washington, DC and previously served on the faculty at the University of Texas Health Science Center at Houston. Dr. Conyers holds a PhD in physical/ analytical chemistry from the University of Utah and a bachelor’s degree in chemistry from Trinity University.

Contact him at jconyers@mcmsonline.com or call 602-251-2361.

THE MARICOPA COUNTY MEDICAL SOCIETY

2014 ANNUAL EVENT

SAVE THE DATE FRIDAY, OCTOBER 17, 2014 6-9 PM EL CHORRO

SPECIAL GUEST

REP. HEATHER CARTER

member profile

Steven B. Perlmutter, MD, JD: JD

From the Operating Room to the Courtroom

H

Round-up Staff

ow does a physician transition from being a patient advocate to a defender of physicians? For most, the thought of putting medicine on hold and going back into the classroom for another three years to complete a Juris Doctor isn’t particularly appealing, especially after enduring the rigors of a decade long (or longer) journey through medical school, residency, and fellowship. So how did Dr. Steve Perlmutter get there? It’s not how you’d expect.

Life changed dramatically for Perlmutter in late 2006.

For more than twenty years, he was a busy clinician tending to his ophthalmology practice. “My neurologist dropped the bomb that my days of practicing ophthalmology were numbered. He suggested that I make plans for my next career. At first,” Perlmutter confessed, “I thought he was grossly exaggerating my medical issues. I vowed I would not retire until I was lying on the floor of the operating room, unable to move. As it turns out, on May 30, 2007, I was lying on the floor of the operating room, unable to move. That was my last eye surgery. One week later, I saw my last patient.”

Photos courtesy of Mike Paulson, Paulson Photo/Graphic Communications.

Mike can be reached at photo@paulson.com or call 602-230-1550.

16 • Round-up • August 2014 • A monthly publication of the MCMS

member profile Fast forward to today and you’ll find Perlmutter running a boutique law practice that focuses solely on representing and defending healthcare professionals who have licensing board complaints against them. In addition to physicians, he represents nurses, dentists, psychologists, behavioral therapists, pharmacists, chiropractors, podiatrists, optometrists, occupational and physical therapists, acupuncturists, midwives, and massage therapists.

Perlmutter explains that, “Each profession has its own licensing Board with distinct statutes and rules. So, while defending professionals with Board complaints appears to be a fairly discrete area, there is a considerable amount of law involved when dealing with over a dozen different regulatory boards.”

When Round-up asked him about his path to medicine, Perlmutter credits his father, who decided early on that his son would be the first doctor in the family and bought him a Littman stethoscope when he was only six. Also influential was his teacher for “fifth-sixth,” a program his school district created for children selected to combine two school years into one. Perlmutter adds, “We were encouraged to

expand our minds in ways that became foundational for me.

Today, it would be called thinking outside the box.”

For Perlmutter, medicine was a good fit, as he was drawn to science and the notion of helping people. He admired his family doctor and was influenced by what he saw while being examined. Perlmutter recalls, “I drew pictures of his office — tongue depressors, ophthalmoscopes, and syringes. My then and still best friend was the product of generations of doctors. We used to shoot hoops and talk about practicing together.”

By age fourteen, Perlmutter was already preparing for a career in medicine by volunteering in the ER and OR of the local hospital.

“On my first day,” he explains, “the nurses tersely explained how to don scrubs. I had my scrubs on, but I walked into the operating room without a mask. I was mesmerized by an appendectomy when someone yelled at me to go get a mask. I was mortified. After the case, I went over to the surgeon and apologized. I still remember his remark, Don’t worry about it. I didn’t even wash my hands.”

A monthly publication of the MCMS • August 2014 • Round-up • 17

member profile After completing undergrad at Sarah Lawrence College in Bronxville, NY, Perlmutter anticipated a career geared towards medical research. He headed south to Washington University Medical School in St. Louis, MO and did his best to carve out time to explore his research interests.

“Virtually every research project I was involved in produced negative results,” Perlmutter recalls. “Whether it was

the self-assembly of microtubules at Yale or treatment of feline spinal cord injuries at the Einstein School of Medicine, nothing worked. I did have a bit more success with clinical research, publishing a paper on Laryngeal Radiation after Hemilaryngectomy in Laryngoscope and presenting a poster on Accommodative Esotropia at the Association for Research in Vision and Ophthalmology.”

Endorsed by the Maricopa County Medical Society as an Honor Roll Activity. www.mcmsonline.com 18 • Round-up • August 2014 • A monthly publication of the MCMS

member profile “In my opinion, physicians should not defend their own board complaints; they must enlist the help of attorneys. Boards have their own culture. There are both written and unwritten rules of etiquette and articulation. Boards like their questions answered in certain ways.

They have certain expectations from their respondent physicians. To paraphrase an old aphorism, A good attorney knows the law. A Perlmutter explains. “I was much more interested in great attorney knows the Board.” surgery. The old saying, ‘a chance to cut is a chance to — Dr. Steve Perlmutter, JD Perlmutter gravitated towards ophthalmology for a number of reasons. Treating people with vision disorders was especially gratifying, since, according to Perlmutter, “Vision is arguably the number one factor affecting quality of life.” He also found it appealing that ophthalmologists could help most of their patients most of the time, and also admitted an attraction to the “toys” available to the practice.

The opportunity to utilize technologically advanced tools, including lasers, diamond knives, and high-powered microscopes, and perform cutting-edge procedures such as radial keratotomy, LASIK, and intraocular lens implants made the specialty an easy choice.

After completing his residency and internship at Barnes Hospital (now Barnes Jewish Hospital and Medical Center) in St. Louis, a warm climate became the first priority for Perlmutter after living in New York and St. Louis. “I joined a very progressive practice in a small town in central Florida. My wife did not like the town,” Perlmutter explains, “and I did not see eye-to-eye with the boss (ophthalmology humor).”

Within eight months, Perlmutter packed up and headed west, settling in Arizona and joining a large practice group.

Within a few years, he opened Hope Eye Center in Phoenix and expanded the practice to five office locations in Phoenix, Chandler, Scottsdale, Sun City, and Camp Verde.

He eventually consolidated the practice down to just two offices, and began serving as the medical director of an ophthalmic outpatient surgery center.

“My practice was predominantly surgical. Strange as it may sound, I never liked refracting patients for glasses,”

cure,’ always resonated with me. My practice was medical and surgical ophthalmology, mostly cataracts, glaucoma, and oculoplastics.”

All was sunny for Perlmutter until that diagnosis in 2006. Even though he was convinced of his own invincibility, he made a backup plan just in case the neurologist was correct. He knew his heart wouldn’t be in medicine if he couldn’t operate, but being only fifty-three, he wasn’t ready to retire. Perlmutter explains, “I decided to try a completely different field, one that was challenging and intellectually stimulating. Law was a natural choice. I went to the bookstore, purchased an LSAT prep book, and devoted part of a weekend to studying.”

Seeing the end of his medical career in sight, he applied to Arizona State University School of Law and started classes soon thereafter. But after a week, he realized that studying for law school while continuing to run the Hope Eye Center was impossible. He withdrew from classes and sold his practice within six months, leaving him with nothing to do. He tried some community college courses but felt they were too elementary, so he reapplied to ASU’s law school. This time, he had the rhythm down and finished in two years.

He now spends his time defending healthcare professionals and seems to have seamlessly traded in scrubs and scalpels for suits and legal briefs. He heads Perlmutter Medical Law and focuses largely on defending providers who have board complaints pending against them. While he does not defend medical malpractice cases, he is often peripherally involved in those cases, either whenever there is a negotiated settlement or a verdict against a doctor or when a plaintiff attorney clandestinely files a complaint on behalf of a client. Explains Perlmutter, “The act of filing of a complaint against a doctor is sometimes a test balloon to determine if a potential medical malpractice case has merit.

A monthly publication of the MCMS • August 2014 • Round-up • 19

member profile

Dr. Perlmutter and his “gal Friday,” Nora.

Nora is his office assistant and the Mrs. to the JD.

If the board dismisses the complaint, the attorney may choose not to file a malpractice action. On the other hand, if the board finds fault with the physician, that is a positive sign to the plaintiff attorney that the case has legs.”

Perlmutter is convinced that his medical background is a significant advantage when representing physicians.

While Phoenix abounds with very bright, talented, and experienced lawyers who similarly defend physicians who have complaints filed against them, Perlmutter is the only attorney in healthcare licensing defense who is also a physician. When asked how this provides a home-field advantage of sorts, he explains, “First, I have an immediate rapport with physicians based on commonality of experience. I know what it is like to have a devastating complication and have to explain it to the patient and family. I know what it is like to be called to “BOMEX” to answer questions. In other words, I have walked many miles in those doctor’s shoes. Second, my background as a physician is very helpful in bridging the natural chasm between doctors and lawyers. There is often acrimony and cognitive dissonance between the professions. Doctors and lawyers have vastly different worldviews and thought patterns. For me, it is a joy and a thrill to be able move seamlessly and comfortably between legal and medical thinking.”

He adds, “Third, much of the work I do involves defending doctors who have allegedly practiced below the standard of care. To defend against that allegation, one must ascertain the standard of care and prove that the doctor met or exceeded it. An attorney has to read and understand the information presented by journals, textbooks, and experts and then use that information to persuade the Board of the propriety of the doctor’s actions. I believe that a physician/attorney is in the best position to provide the optimal representation of the physician/client.”

Three years into his second career, Perlmutter has noticed that most physicians do not accord Board complaints the

degree of gravitas they demand, and do not see the potential for a complaint to become a career-altering, life-changing event. Perlmutter explains, “Doctors are often paralyzed by anger and disbelief, unable to respond to complaints with the same thoroughness and care they use in the practice of medicine. If anything, Board complaints ought to be handled with extreme circumspection and exactitude.” He adds, “In my opinion, physicians should not defend their own Board complaints; they must enlist the help of attorneys. Boards have their own culture. There are both written and unwritten rules of etiquette and articulation. Boards like their questions answered in certain ways. They have certain expectations from their respondent physicians. To paraphrase an old aphorism, A good attorney knows the law. A great attorney knows the Board.”

When Round-up asked Perlmutter what advice he had for physicians in receipt of that dreadful letter from the Board, he responded by saying, “First, retain an attorney early, preferably the instant you receive the complaint. The attorney should write the initial response for you. The response not only answers the initial complaint but also puts the case on the proper course in the event it goes to a formal hearing. Just like chess, you make a move, but that move provides the strategy and context for the moves that follow later in the game. Second, do not simply hand the case to the attorney and say, ‘Here. Go fix this.’ No matter how devoted your legal representative is to your case, you are still your own best advocate. You need to work with your attorney at each step, explaining what you did, uncovering the relevant medical literature, and offering your own thoughts and ideas.”

Perlmutter admits that there are proactive measures physicians can take to reduce the likelihood of a Board action in response to a complaint, but points out the measures are often simple but rarely easy. He advises his clients to focus on documentation – of findings, of informed consent, of phone calls. He also emphasizes the importance of telling the truth, as simple as it sounds. “Facts can usually be defended,” says Perlmutter. “Lies are often indefensible.”

Too often, Perlmutter hears of physicians modifying medical records, but explains that the techniques for finding alterations are too sophisticated. “If the records are altered,” he explains, “the case is doomed, whether in front of the Board or in court.”

20 • Round-up • August 2014 • A monthly publication of the MCMS

member profile His last piece of advice for physicians is to beware of prescribing opioids. He explains, “As a physician, I understand the importance of the treatment of pain. As an attorney, I know the risks and liabilities in prescribing controlled substances for pain relief. In my view, unless you are committed to scrupulously following the rules of prescribing chronic opioids (pain contracts, pharmacy audits, lifestyle inquiries, urine drug screens, random pill counts, and others), I would not recommend treating patients with chronic pain.”

Hopefully, few readers of Round-up will ever be in a position where they need to defend how and why they care for their patients, but the reality is quite the opposite. Each year, the Arizona Medical Board receives around 1,000 complaints. Fortunately, the vast majority are found to be without merit, but with Maricopa County accounting for more than 65% of the state’s licensed physicians, it goes without saying that many of the complaints filed each year happen here in our own backyard.

While more Board complaints means more work for Perlmutter, he’d be happy to see business decline if physicians were able to better protect their livelihood and, thereby, reduce the number of frivolous complaints filed against physicians each year. He offers, “Be kind to your patients.

They may be having a worse day than you are. Apologies go a long way. Explanations of complications intermixed with empathy and concern are important.”

While Perlmutter’s career in medicine was cut short by – ironically – a medical issue, he’s committed to making the most of his second career and gaining fulfillment by helping people. Only this time, helping people who help people.

He concludes, “With increased longevity, we have the opportunity to practice our professions for a longer period of time. I am fortunate to be able to practice two dynamic professions in one lifetime. My first 25 years was spent helping patients. My second 25 years will be spent helping doctors so that they can continue helping patients.” ru

A monthly publication of the MCMS • August 2014 • Round-up • 21

public health

Hepatitis C Treatment in 2014: We’ve Come a Long Way! Richard A. Manch MD, FACP, FACG

This is a very exciting and interesting time for patients with Hepatitis C (HCV) and for those who are involved in providing their treatment. While the virus which causes HCV and treatment with interferon have been known since the early 1990’s, it is only now when we can say that the vast majority of people with HCV can be cured of their chronic infection with treatments that are far better tolerated and take much less time to complete.

In December 2013 two new agents for the treatment of HCV were approved by the Federal Drug Administration (FDA) for prescribing in the U.S., namely sofosbuvir and simeprevir. These are not the first new direct acting antivirals (DAA’s) but are far superior to what had been available previously.

Hepatitis C virus exists in various types, called genotypes, which are each treated somewhat differently and respond to treatment differently. The key to curing this chronic viral infection is to stop the virus from “replicating” which means stop it from multiplying. All the new therapies available now and those being readied for release in the next two years have the ability to do this, but none of them are fully effective by themselves and have to be combined with at least one other medication to be effective. The older and now nearly obsolete interferon injections worked by stimulating the body’s own immune response to the HCV virus, and ribavirin, the other drug which has been used, works in various ways not fully understood. Some current and all future treatments will be without these two drugs, which were responsible for most of the side of effects of previously available treatments, but for now, they are still used for some patients to improve the effectiveness of the new drugs.

At this time, patients with genotype 1 (which comprise about 75% of Americans with HCV) are treated with sofosbuvir, an oral drug given once daily for 12 weeks, along with interferon injections weekly and ribavirin twice daily, also for 12 weeks total. The cure rates (we call a “cure” a

22 • Round-up • August 2014 • A monthly publication of the MCMS

public health sustained virological response or SVR) are about 90%, which is far better than we have ever been able to do before, and with far less in the way of side effects or weeks of treatment! If the patient’s provider feels that they cannot tolerate interferon, an alternative is 24 weeks of just the sofosbuvir and ribavirin without the interferon shots, but the SVR rates may be slightly lower. Another alternative for genotype 1 patients is to give sofosbuvir and simeprevir together for twelve weeks. Most of these regimens have been reported to achieve SVR rates in excess of 90%, which is fantastic!

companies are working to simplify these therapies to as few pills as possible in most cases. Therapies in the near future will be pills only, few or no side effects, few or no interactions with other medications, and will need to be taken for no more than twelve weeks and in some cases as few as six to eight weeks.

All of this will change in the coming months as newer and even better drugs are developed for Hepatitis C patients.

The concept which guides clinical researchers is to combine two or more oral drugs which work on different parts of the viral replication process. Most of these drugs block certain enzymes that the virus needs to replicate and survive, but to prevent the virus from developing resistance to the drugs, they are given together with other drugs that work in different ways against the virus. The pharmaceutical

• At this time the best, most effective and therefore most desirable treatments (especially for Genotype 1) are also the most expensive, and sometimes patients insurance will deny payment or specify one of the less expensive interferon-based treatments. It is important to discuss all of the various treatment options with one’s provider to look for alternative sources of payment for the medications or for advice regarding waiting for therapies currently in development.

Genotype 2 patients are currently prescribed sofosbuvir and ribavirin for 12 weeks (no interferon) and SVR rates up to 95%, and genotype 3 patients require the same treatment for 24 weeks, with SVR rates about 10% less in the clinical trials. Genotypes 4, 5 and 6 are far less common in the US, but are treated similar to genotype 1.

Patients should seek out providers who have a genuine interest in the treatment of Hepatitis C and can keep them informed of the almost month-to-month changes going on in the field. Several concerns remain at this time: • While most and eventually nearly all patients with Hepatitis C will be cured, those with significant liver damage (severe fibrosis or cirrhosis) still need to be closely monitored by their providers for the risk of developing liver cancer or other complications fromtheir liver disease.

A monthly publication of the MCMS • August 2014 • Round-up • 23

public health • As great as these new treatments are, some patients will experience return of their HCV virus infection after treatment. It is called a “relapse” when it occurs within the first three months following treatment completion. This may be caused by the virus becoming resistant to certain of the medications, and we do not know to what extent this may impair the success of future therapies that are developed.

Some scientists have predicted that Hepatitis C as a world-wide health problem could be completely eradicated, once therapies can be made available to all that need them.

In the meantime, patients with HCV can know that a cure is likely for them, either with what is available now or in the very near future. A healthy lifestyle, with attention to proper diet, exercise and avoidance of alcohol is important for all patients with Hepatitis C, before, during, or after they are cured of their disease. ru

Dr. Richard Manch is a hepatologist specializing in liver diseases such as hepatitis, cirrhosis and liver cancer.

Currently, he holds the positions of Chief of Hepatology, St. Joseph’s Hospital and Medical Center, Phoenix Arizona; Clinical Professor of Medicine, University of Arizona College of Medicine – Phoenix; and Professor of Medicine, Creighton University. He has lectured extensively throughout the region and serves as an advisor to many organizations and companies involved in the care and treatment of liver disease. Dr. Manch serves on the MCMS Board of Directors and has been a member since 1977.

He can be reached by calling 602-406-7564 or email to richard.manch@dignityhealth.org

24 • Round-up • August 2014 • A monthly publication of the MCMS

maricopa county — healthcare happenings MCMS Sponsors Two White Coats at the Ceremony Held for Eighth Class at UA College of Medicine – Phoenix

Eighty students symbolically entered the medical profession on July 18 with the annual White Coat ceremony for the newest class at the University of Arizona College of Medicine – Phoenix.

The eighth class of first-year medical school students on the downtown Phoenix campus completed orientation and participated in the traditional White Coat ceremony at the Orpheum Theatre. The ceremonies celebrate an important milestone in the lives of first-year medical students, who begin a new chapter in their journey of lifelong learning. White coats are symbolic of the professionalism that is expected of students during medical school and as physicians.

In support of the educational process that prepares future healthcare professionals for practice, the Maricopa County Medical Society (MCMS) sponsored two coats this year. The recipients, Erin L. Barker and Antoine Azar, sent lovely thank you notes we wanted to share with the Round-up readers. ru

Photos: Stuart D. Flynn, MD, dean of the UA College of Medicine – Phoenix with Erin L. Barker (top) and Antoine Azar (bottom) at the White Coat ceremony.

Dear Maricopa County Medical Society Board Officers, Board of Directors & Membership Staff: I’d like to sincerely thank you for sponsoring my white coat at the University of Arizona College of Medicine – Phoenix’s White Coat Ceremony on July 18, 2014. I am honored to wear such a symbolically significant coat, and promise to always do so with respect and enthusiasm. I am truly grateful for your support and generosity, Erin L. Barker, Class of 2018

Maricopa County Medical Society Board Officers, Thank you for your generous donation of my first white coat.

As a first year medical student, this gift is very meaningful to me as it symbolizes my entry into the medical profession. I hope I will put it to good use while serving my patients and the community over the next four years. Thank you for your kindness, Antoine Azar, Class of 2018

Your best asset in business is a strong silent partner.

We’ve invested over 40 years in learning how to partner with our customers to achieve the most successful results.

Let us know what we can do to help you do what you do best — by doing what we do best!

Digital and Offset Printing • Fast Turnaround • Competitive Pricing

www.impressionmakers.com

480-967-2180 • 1505 West 10th Place, Tempe

Your Local Print Partner

26 • Round-up • August 2014 • A monthly publication of the MCMS

MCMS Members receive

15% Off all In-House Services.

maricopa county — healthcare happenings Congratulations to the following MCMS members on their recent achievements:

David Notrica, MD, member since 1999 and a board member in 2013, was nominated as a Phoenix Business Journal Healthcare Hero 2014.

These awards recognize and celebrate the “unsung heroes of the Valley’s healthcare community.” He was recognized at an awards breakfast in August. ru

Mercy Gilbert Launches Platform to Help Medical Staff Cope with Emotional Aspects of Caregiving

Healthcare providers often grapple with complex emotions in caring for Mercy Gilbert Schwartz Group their patients. However, internal support that allows nurses and physicians to take time to care for themselves in the process is not always available.

This realization led to the creation of The Schwartz Center Rounds, an interdisciplinary program to help medical staff openly discuss and cope with the most challenging emotional and social issues that occur when caring for seriously ill patients. Here in the Valley, Dignity Health’s Mercy Gilbert Medical Center is an early adopter of this unique platform, which also promotes compassionate care to help patients and their caregivers relate to one another.

The Schwartz Center Rounds features a series of open forums attended by hospital staff. The platform gives hospital staff the opportunity to participate in open dialogue, providing them a place to share their vulnerabilities and obtain insight into the nonclinical aspects of patient care. The Rounds are expected to help attendees better connect with their patients emotionally, provide a higher level of compassionate care, and enhance their own understanding of the effects that illness might have on patients and their families. For more information contact Marty Breede, VP of Mission Integration, Dignity Health Arizona 480-728-8377 or martin.breeden@dignityhealth.org. ru

Anthony Yeung, MD, MCMS member since 1978, President 1995, was named as a Distinguished Alumni for 2014 by The University of New Mexico School of Medicine.

This award recognizes alumni who have made significant contributions to society, and whose accomplishments, affiliations and careers have honored the legacy of the UNM School of Medicine. ru

A monthly publication of the MCMS • August 2014 • Round-up • 27

new members

Welcome to the MCMS Family!

MCMS would like to recognize our new educational members who are attending the A.T. Still University and the University of Arizona College of Medicine - Phoenix.

Please reach out to one or more of our new members, welcome them aboard, and share with them your insight on the importance of organized medicine and how the Society can be of service.

TIANA BLANK Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

MEGHAN BROMBACH Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 CHRISTINE CHUNG Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 ALDO ESTELLA Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 FIONNA FELLER Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

JESSICA GASCOIGNE Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

MAR HAYWOOD Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 ALEXANDER HIGGINS Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 CHELSEY HORATH Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 JENNIFER HUNTLEY Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

28 • Round-up • August 2014 • A monthly publication of the MCMS

RAGHU KANUMALLA Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 JAYMUS RYAN LEE Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

HERMAN LEUNG Medical School: A.T. Still University, Mesa, AZ Graduation Year: 2017

TEAGAN LUKACS Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

SOFIA MANI Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

new members SOWMYA PADAKANTI Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

KATIE SAMMONS Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

RAVI PATEL Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

JOSEPH SHORTALL Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

ARIELLE RUBIN Medical School: University of Arizona College of Medicine – Phoenix, Phoenix, AZ Graduation Year: 2018

RODNEY TILL Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

JESSICA RYDBERG Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

PHONG TRUONG Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

ESTHER QUINTERO Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

DANIELLE RUMSEY Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

ARZOO SADIQI Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

ZUMA SPEAKMAN Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

RANDY TINGLE Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

MICHAEL VAN TIENDEREN Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

KATHRYN WEBER Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

ERIC YANG Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018 SYED ZAIDI Medical School: A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, AZ Graduation Year: 2018

MCMS Member since 1992:

Steven Oscherwitz, MD at the 2013 ACT Health Fair

Giving back through public health outreach initiatives, education, mentoring, and philanthropy.

JOIN US

as we continue our work toward positive change.

Membership Information Call: 602-252-2015 Click: www.MCMSonline.com

A monthly publication of the MCMS • August 2014 • Round-up • 29

the legal issue — restrictive covenants

To compete or not to compete?

That is the question.

Stacy Gabriel, JD and Barrie Stachel, JD

When forming a professional relationship, one question for both the physician and practice group to carefully consider is whether to enter into a restrictive covenant agreement. The term “restrictive covenant” is often used interchangeably with the term “non-compete,” but they have distinct meanings. Restrictive covenant is a broad term encompassing an individual’s continuing obligations to a business following the end of an employment or contract relationship. Those obligations may include a commitment not to: compete; solicit customers or employees of the business; interfere with the business’ relationship with its customers or employees; disclose confidential business information; or disparage the business and its employees. In Arizona, restrictive covenants are generally disfavored, but particularly so when it comes to non-competes — a specific type of covenant that restricts an individual from working in his/her chosen profession.

Arizona courts apply an even more exacting standard when reviewing the enforceability of non-compete covenants against physicians.

30 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — restrictive covenants In the 1999 seminal restrictive covenant case, Valley Medical Specialists v. Farber, the Arizona Supreme Court did not go so far as to prohibit all non-competes as applied to physicians, but it came close. In Farber, a pulmonologist, whose practice included treating HIV patients with brachytherapy, entered into a non-compete that prohibited him from practicing medicine for three years within a five-mile radius of any of the practice’s medical offices.

The Court emphasized the unique nature of the physicianpatient relationship and the right of patients to freely choose their doctor. The Court struck down the noncompete, finding that the duration and geographic scope were unreasonably broad and, further, that the employer’s business interest in limiting competition was far outweighed by the public’s interest in protecting the sanctity of the physician-patient relationship.

The ramifications of Farber are unclear since there have been virtually no published decisions interpreting the breadth of the decision as applied to physicians. But there is no question that post-Farber physician non-compete

covenants will be subjected to a higher level of scrutiny as compared to other types of employment relationships.

Arizona’s dim view of restrictive covenants in general became even more apparent with the recent Arizona Court of Appeals decision in Orca Communications Unlimited v.

Node. Orca, a public relations firm, sought to constrain the President’s post-employment pursuits with several different types of restrictive covenants. Adopting a rigorous standard of review, the Court struck down the restrictive covenant provisions in the President’s employment agreement as overly broad. Reading Farber and Orca in conjunction will make the task of enforcing restrictive covenants against any employee an uphill battle, but particularly so against physicians.

So what does this mean if you are hiring physicians for your practice or you are a physician being asked to sign a restrictive covenant agreement as a condition of employment? Given the less than hospitable environment around restrictive covenants, medical practices should consider

A monthly publication of the MCMS • August 2014 • Round-up • 31

the legal issue — restrictive covenants whether to forgo non-competes altogether, and instead put in place a narrowly drafted non-solicitation, confidentiality and/or non-disparagement covenant to which the courts are more receptive. A non-solicitation covenant, for example, could prevent a former physician-employee from affirmatively soliciting the practice’s patients, referral sources, and medical staff. The best chance for any of these covenants to survive a challenge will be to reasonably tailor the terms to the particular circumstances of the practice, specialty, and geographic area, to name a few.

A physician who is required to enter into a restrictive covenant agreement should consider whether to enter into such an agreement or whether to negotiate its terms. For example, if you plan to bring patients, staff, or referral sources with you when you join the practice, you may want to request that such pre-existing relationships be carved out of the non-solicitation clause. If you are being asked to sign a non-compete, you may want to negotiate a more limited duration and geographic scope. Also, the prospect

“...In Arizona, restrictive covenants are generally disfavored, but particularly so when it comes to non-competes — a specific type of covenant that restricts an individual from working in his/her chosen profession.

Arizona courts apply an even more exacting standard when reviewing the enforceability of non-compete covenants against — Stacy Gabriel/Barrie Stachel physicians. “ of being bound by a restrictive covenant may impact the compensation terms. You may be justified negotiating a higher salary or bonus, severance upon termination, and/or an equity interest in the practice in exchange for entering into an agreement that restricts your ability to practice medicine or see your patients for a period of time after you leave the practice. If you already are bound by a restrictive covenant agreement with a medical practice, you should carefully review the terms to ensure you don’t commit a violation if/when you move on to your next position.

Regardless of whether you are seeking to bind someone to a restrictive covenant or being asked to sign one, you

should consult with legal counsel to make sure you fully understand the terms and ramifications and avoid a legal dispute. While the outcome of these disputes is hard to predict, it is certain the litigation process will be extremely costly and highly disruptive to both sides.

In sum, the answer to the question: “To compete or not to compete” is not straightforward; keep in mind that the Arizona courts have adopted a hostile view of restrictive covenants, particularly those governing physicians. As such, physician restrictive covenants will be subjected to a high standard of scrutiny and must be narrowly tailored to have any chance of enforcement. ru Stacy Gabriel is the founder and managing member of a law firm focused on employment law matters. She regularly advises and represents both medical practices and physicians in negotiating employment contracts, drafting personnel policies, and resolving workplace disputes. She can be reached at stacy@gabrielashworth.com.

Barrie Stachel, a graduate of Arizona State University law school, advises employers and individuals on employment related matters, including harassment, discrimination, wrongful termination, wage and hour and contract disputes.

Her practice also includes drafting handbooks, personnel policies, employment contracts and restrictive covenant agreements. She represents individuals and employers in administrative charges of discrimination filed with the EEOC and before other state and federal agencies. Contact her at barrie@gabrielashworth.com.

For more information, see the ad on page 27.

32 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — intellectual property

Physician Inventions: When that Great Idea Strikes – Start Here.

Steven T. Lawrence, JD

A ha! It is that moment when an idea strike for that next great medical device or medical application. For many physicians, the problem is not in coming up with new ideas, the confusion and difficulty comes in analyzing what to do next once an idea for an invention has hit. The process for protecting a medical invention can be a maze — not unlike the healthcare system itself — with dead ends and trap doors.

The purpose of this article is to provide physicians with a summary of pitfalls and best practices when considering a new invention.

Pitfalls and Best Practices.

1. Who owns the invention? When a physician creates an invention, a key question is “who is the owner of the invention?” If the invention was made during the course and scope of the physician’s employment, the employer may be the owner of the invention. However, an employment agreement may provide otherwise. Was the invention created on the physician’s own time, using the physician’s own materials? If so, there may be argument that the physician exclusively owns the invention apart from his or her employer.

2. Consider establishing a new entity and separate bank account for the business of the invention. If the invention is the physician’s own work, a protective early step to take is to form an entity to own the invention. Once the entity is established, an assignment should be made of the invention from the physician (and/or any other owners of the invention)

34 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — intellectual property to the new entity. The creation of the entity creates a layer of liability protection from the physician’s assets and those of the new business (absent fraud or other wrongdoing). With a new entity created, a new bank account can be established and funds can be deposited. This bank account should be kept wholly separate from any personal account.

3. Don’t engage an independent contractor without a written agreement that contains an intellectual property assignment provision. This can be an expensive error that is typically made right at the beginning of the development of a new idea. An inventor has a great idea and then hires an artist or computer programmer to work on the new idea based on an oral agreement. Then, the inventor, without an understanding of copyright law, pays the artist or programmer for the work and both sides go on their way.

Unfortunately, under copyright law, absent an employer-employee relationship or a written agreement transferring ownership, the creator of copyrighted material is the owner of the work. In the example above, the artist or the programmer walked away with both payment for the work and the ownership of the copyright! Now, imagine that 10 years go by and the inventor is on the verge of a sale of the invention for a significant sum. The first item of diligence that the buyer will conduct will be on the title chain of the intellectual property. The buyer will ask — was the work created by an employee or an independent contractor? If an independent contractor developed the work, was a written agreement obtained? If not, the buyer will likely demand that the inventor go back to the artist or programmer to obtain an assignment of all associated

intellectual property rights. Given that the invention is now worth a significant amount of money, the inventor will have put the artist or the programmer in the position of being able to demand a ransom in order to sign the assignment, when the artist or programmer likely would have signed an assignment without hesitation back when the work was performed.

Save yourself from significant grief and expense – whenever you have work conducted on an invention, make sure that the work is performed by an employee or that you have a written agreement transferring ownership of the work of the independent contractor to you.

4. Conduct a patent search. Many inventors assume that their invention must be the only thing like it ever conceived of in the world. Today, wholly new (otherwise referred to as “novel”) inventions are generally rare — inventions usually build upon an existing platform of prior inventions. Before

running out and filing a patent application, an inventor would be well-served by having a patent search conducted and the results analyzed by a patent lawyer. This initial search will provide key insight into the state of the marketplace and the differentiation that will be required in order to secure a patent. Without such a search, an application would be filed without any strategic considerations and will have a much more difficult time making its way to registration. Patent work can be expensive, but an initial search is the starting place to know whether further steps in prosecuting a patent will be worthwhile.

5. Don’t use a name for the product without a formal trademark search.

Similarly, a preliminary trademark clearance search is an important step in analyzing and then securing protection for a trademark. Many companies think up a new brand name or logo and immediately rush into the marketplace with the brand name or logo without an assessment of whether the new

Leading Provider in Equipment Financing for HEALTHCARE PROFESSIONALS Global Financial & Leasing Services, a Veteran owned Scottsdale based company, provides innovative equipment financing solutions to physicians, clinics and imaging centers.

• New or used equipment

• Covers a wide array of medical related equipment • All credit grades considered

• Fast and responsive service Preferred Business Partner

Contact us today!

Free credit review and consultation with application.

Judi Jenks, EVP • judi@gfrservices.com 480-478-7405 • www.gfrservices.com 6263 N. Scottsdale Road, Suite 222 • Scottsdale, AZ 85250

A monthly publication of the MCMS • August 2014 • Round-up • 35

the legal issue — intellectual property trademark infringes on others’ intellectual property rights. A relatively inexpensive initial trademark search will serve to help analyze the question of whether the proposed trademark infringes or has the potential to infringe on the intellectual property rights of a third party. While any search has limitations, the search results will present the best information available as to possible competing marks. The development of a brand name, logo or trademark can cost thousands, tens of thousands, hundreds of thousand or even millions of dollars. Intellectual property litigation costs are skyrocketing and the fees associated with average cases are deep in six figures. Before making a big investment or risking litigation, a trademark search report, along with analysis of that report by a trademark attorney, represents a wise investment that can mitigate the risks of potential infringement claims in the future.

6. Use a confidentiality agreement to protect conversations with third parties about the invention. Inventors are often so excited about their invention that they have a burning desire to tell others about what they have done.

This reaction is contrary to the inventor’s best interest.

Letting everyone know about the invention eliminates the possibility of trade secret protection and heightens the risk that someone will take the idea and try to commercialize

it and protect it. Before disclosing the invention to anyone, ask them to sign a confidentiality agreement that documents your ownership of the intellectual property and confidentiality obligations.

7. Don’t sell interests in your invention without considering the securities law implications. Inventors are sometimes quick to use equity like a checkbook. They pay the consultant working on the prototype “10% in return for a working model,” or the newly hired sales person “5% in stock.” Even more problematic can be the sales of “8% of the Company” to a cousin for $50,000. The sale of ownership is generally considered to be the sale of securities.

The basic definition of a security under federal and state law is (a) an investment, (b) made in an enterprise, (c) with the expectation of profit, (d) through passive activity of the investor. Once it is determined that what was sold is a security, the basic premise of the securities laws in the United States is that a sale of securities must be registered with the Securities and Exchange Commission, unless an exemption from registration exists. Exemptions from federal and state securities registration requirements can often be found to exist for early sales, but it important that an analysis on those issues be performed. A key exemption is found under

36 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — intellectual property Regulation D under the Rules promulgated under the Securities Act of 1933, which creates a safe harbor for certain sales of securities. Penalties for violation of the securities laws can be extreme, including criminal penalties in certain instances.

From an inventor’s perspective, it makes both legal and business sense to carefully consider grants of ownership in the invention or the entity that owns the invention. Owners become permanent partners that may be difficult or impossible to remove in the future. In addition, the risks associated with improper sale of securities make compliance an absolute must for a new entity.

8. Keep records of your invention. Record keeping at the early stage of an invention can be a problem. Inventors are generally more concerned about the novelty and technical aspects of their invention rather than maintaining a record of when the invention was first created. As discussed above, the date of creation of intellectual property, the date of first commercial use or the date of publication can be critical to protection of the intellectual property. Inventors should keep careful records of their inventions and when certain events occur in the life of the invention.

Steven T. Lawrence is a shareholder in Milligan Lawless, P.C. and focuses on the legal and business needs of companies and individuals.

Steve has extensive experience in a wide range of corporate and transactional matters, including mergers and acquisitions, licensing, securities offerings, entity formation and business structuring. Steve also has a deep background in healthcare transactions, including co-management agreements, physician employment and practice acquisitions.

He completed his undergraduate degree at California State University, Sacramento, obtained a Master of Laws (LLM) at Loyola University, an Master’s of Business Adminstration from Arizona State University, and his Juris Doctor from the University of the Pacific – McGeorge School of Law. He can be reached by phone at 602-792-3536 or email Steve@MilliganLawless.com.

9. Mark the invention with appropriate notices. When an inventor rushes to get a product to the market, steps in the process can be ignored. One important step that should be observed is the marking of the product with appropriate notices. As discussed above, a copyright notice may be appropriate. It also may be Perspective Financial necessary to mark the product with customs or other regulatory notices.

Services, pick up July 2014, pg 29

Conclusion.

Intellectual property protection for physician inventions is filled with tricks and traps. Missteps in the early stages can be expensive, if not fatal, for a new enterprise. However, by carefully managing the process of protecting intellectual property, a physician can turn a late night idea into a force to be reckoned with in the marketplace. ru

A monthly publication of the MCMS • August 2014 • Round-up • 37

the legal issue — tax rules: property purchase

Thinking of Buying Space for your Practice?

Take Note of Significant Tax Exemptions.

Tracy Altemus, CCIM Zandra O’Keefe, CPA

S

hould I lease, buy or build to suit? That is a question that many physicians consider. The idea of making payments to a facility you own as opposed to paying rent to a landlord can certainly be an attractive option for some that have the financial wherewithal. That said, it tends to make sense if the payments you are making and your related tenant improvement investment are equivalent or less than what you would pay leasing from someone else and - even more importantly - that you have an exit strategy (e.g., future sales potential with appreciation in value as an added bonus). There are many factors to consider when making the decision to lease or own. An attorney, accountant, banker and real estate broker can prove invaluable in helping you gather the information needed to help you evaluate options.

Lease?

Buy?

Build? ????

38 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — tax rules: property purchase If you do decide to own, we recommended that your operating entity (i.e., medical practice), sign a lease with your building related ownership entity, and charge fair market value rent (consider compliance with STARK law regulations, if applicable),1 even if both entities have common ownership. One benefit of this structure is that the operating entity generally can deduct the rent as a business expense. The ownership entity records rent as income, deducts depreciation and pays the loan payment, if applicable, and any net income can be distributed to the owner(s) after operating capital retention needs are met. Typically, either party can pay the deductible operating expenses, but the responsible party should be specifically identified in the lease. Selecting the appropriate entity is also important; an LLC or partnership is often the entity of choice.2,3

Another recent tax benefit you may be able to take advantage of: if you lease an office where a related person or company owns at least 80% of the landlord entity, you may be eligible for a transaction privilege sales tax exemption on commercial lease rent.4 This applies throughout Arizona, and several cities subscribe to this exemption, as well. It can save you between 2% - 3% of your rent, which can translate to thousands of dollars per year.

If you own a commercial building, you will need to understand and comply with the new IRS tangible property regulations taking effect in 2014; the time to plan is now.

Consider engaging an expert to: optimize depreciation deductions, perform a cost segregation study and tactically plan to avoid potential dry income effects to owners.5 Dry income results when an owner is allocated taxable income without a corresponding cash distribution. Unintended income allocations can result over time when partners are entering and exiting the partnership, depreciation deductions are allocated up front and debt remains to be paid in the future. Partners who remain invested can incur dry income without proper ongoing management.

Remember also to consult a real estate insurance and valuation expert to help you determine the coverage that best suits your needs. The policy should be based on an accurate replacement value, which is updated at least every other year and when values substantially change. A CPA firm can provide you with integrated tax, insurance and other professional advisory services to provide seemless advice in helping you make the best decision.6,7

Each situation is different. Talk with experts to help you strategize the optimal structure for your particular situation; answer questions about the sales tax exemption or to discuss your commercial real estate needs. ru Tracy Altemus is Executive Vice President, Healthcare Brokerage Services at Ensemble Real Estate Solutions, a preferred partner with MCMS.

Tracy is involved in leasing, sales and development of healthcare facilities. She assists her clients with everything from leasing space, acquisition and sales to providing real estate consulting services. Email her at taltemus@ensemblere.com.

Zandra O’Keefe is a Managing Director for CBIZ and shareholder of Mayer Hoffman McCann, PC. She provides accounting, tax planning and compliance services as well as extensive business management consulting to a diverse group of closely held businesses, their owners and high net worth individuals for the Phoenix office tax division. Contact her at zokeefe@cbiz.com.

1. http://starklaw.org/investment.htm 2. http://www.cbiz.com/page.asp?pid=8632 3. http://www.cbiz.com/page.asp?pid=9606 4. http://www.azdor.gov/News/tabid/74/newsid530/457/House-Bill2324Commercial-Lease-Exemption/Default.aspx 5. http://www.cbiz.com/page.asp?pid=11126 6. http://www.cbiz.com/page.asp?pid=10938 7. http://www.cbiz-onesource.com/valuationgroup/page.asp?pid=1368

Copyright © 2014, CBIZ, Inc. All Rights Reserved. To ensure compliance with requirements imposed by the IRS, we inform you that unless specifically indicated otherwise, any tax advice in this communication is not written with the intent that it be used, and in fact it cannot be used, to avoid penalties under the Internal Revenue Code, or to promote, market, or recommend to another person any tax related matter.

A monthly publication of the MCMS • August 2014 • Round-up • 39

the legal issue —regulatory compliance

HIPAA Basics for Physicians.

Andrew Plattner, JD Marcie Damisch, JD

HIPAA, short for the Health Insurance Portability and Accountability Act, consists of federal regulations that govern the use, disclosure and security of patient’s medical and financial information, also known as protected health information (PHI).

The HIPAA regulations are not new, and physicians have maintained various levels of understanding of the impact of such regulations. Recently, HIPAA has become a more commonplace term in the healthcare industry due to increased government enforcement activities and the publicity surrounding such enforcement. HIPAA’s expansive regulations and numerous acronyms can be overwhelming to those protected by HIPAA and those subject to it. While HIPAA resources are abundant, distilling down the content into useable, practical information for physicians (and other providers to whom the regulations apply) can be challenging.

This article presents some of the basic requirements applicable to physicians under HIPAA and focuses on its three primary components: the Privacy Rule; the Security Rule; and the Breach Notification Rule.

40 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — regulatory compliance The Privacy Rule establishes national standards to protect individual medical and other personal information through the use of appropriate safeguards and sets limits on the use and disclosure of patient medical information. The Privacy Rule also gives patients certain rights in relation to their medical and personal information.1 The Security Rule establishes national standards to protect individual’s elec-

tronic personal health information that is created, received, used or maintained by a provider subject to HIPAA through the use of appropriate administrative, physical and technical safeguards.2 The Breach Notification Rule requires that providers subject to HIPAA give certain notices upon the occurrence of a breach of individual’s unsecured medical and personal information.3

A monthly publication of the MCMS • August 2014 • Round-up • 41

the legal issue — regulatory compliance HIPAA applies to all healthcare providers who transmit any health information in electronic form in connection with a transaction covered by the Privacy Rule.4 “Transaction” is defined to include the transmission of information between two parties to carry out financial or administrative activities related to healthcare.5 It includes, but is not limited to, transmissions of healthcare claims or equivalent encounter information.6 If your practice transmits healthcare information electronically, as almost all practices do, your practice will be a Covered Entity (CE) under HIPAA.

As a CE, your practice is required to abide by HIPAA with respect to how it uses and discloses the PHI of its patients. In addition, your practice will be required to inform patients of how their PHI can be used and disclosed by the practice as well as the patient’s right to access, amend and limit access to his/her PHI. This information is provided to patients in a document called a Notice of Privacy Practices (NPP).

The following guidelines should be followed by your practice with respect to its NPP. The practice should: (1) provide the NPP to its patients no later than the first date of service and make a good faith effort to obtain the patient’s acknowledgement of receipt (emergencies excepted); (2) make its NPP available to any person who requests it; (3) post its NPP in a prominent location in its office;

(4) maintain a website that provides information on its services and the NPP should be posted on the website; and (5) update the NPP whenever there is a material change to the uses or disclosures discussed therein, individual’s rights, the practice’s legal duties or other privacy practices stated in the notice.7

42 • Round-up • August 2014 • A monthly publication of the MCMS

If your practice is not utilizing an NPP with its patients, it should take immediate steps to develop and implement an NPP. A model NPP is available for review at www.hhs.gov/ocr/ privacy/hipaa/modelnotices.html.

Don’t forget, your practice will be held accountable for abiding by what it puts in its NPP. Do make sure your practice can comply with its obligations in the NPP.

HIPAA allows a CE to use and disclose PHI (i) to the patient, (ii) for treatment, payment or healthcare operations, and (iii) pursuant to a valid authorization.8 (There are other limited exceptions which allow CEs to use and disclose PHI under certain circumstances, and those exceptions are beyond the scope of this article.)

As a general matter, patients will always be entitled to their own medical information. There are a handful of exceptions to this rule, including exceptions for (i) psychotherapy notes, (ii) information compiled in reasonable anticipation or for use in civil, criminal or an administrative action or proceeding, or (iii) if in the judgment of a licensed healthcare professional, the access is reasonably likely to endanger the life or physical safety of the individual or another person.9 The application of the exceptions is very narrow and requires certain notice be given the individuals who will, in some cases, have a right to have the decision not to release their records reviewed by another party. To the extent your practice seeks to rely on one of these exceptions to limit or refuse to release an individual’s protected health information, it is recommended that you consult an attorney knowledgeable about HIPAA.

the legal issue — regulatory compliance

“In the event your practice believes it has experienced a breach of PHI (in any form), it is important not to panic. Breaches happen to the best providers. How your practice responds to the breach is critical. The first step is to determine whether your practice is the source of the breach. In some cases, this will be clear. In others, it may not be possible to determine the source. Don’t forget that multiple providers have access to the same patient information.

Thus, you should never assume that your practice is the source of the breach.”

- Andrew Plattner/Marcie Damisch As relates to the right for CE/practices to use PHI for purposes of treatment, payment or healthcare operations, the scope of this language is quite broad and generally allows practices to use PHI for the provision, coordination or management of healthcare and related services by one or more providers to seek payment for the practice’s services and in its daily operations to include quality assessment activities, business planning, and development and business management and general administrative activities.10 However, PHI may not be used for marketing purposes or be sold without specific authorization from the patient.

Practices are also permitted to release PHI to third parties upon obtaining an authorization from the individual who is the subject of the PHI. HIPAA dictates that authorizations must contain certain provisions to be valid. Release of PHI without an authorization or with an invalid authorization can expose the practice to liability under HIPAA. Your practice should have a HIPAA complaint authorization form readily available for patients to utilize.

The use and disclosure of PHI by a CE is subject to the minimum necessary rule. This means that the Covered

Entity must make reasonable efforts to limit the amount of PHI being used/disclosed to the minimum necessary to accomplish the intended purpose of the use, disclosure or request. This limitation does not apply to (i) disclosures or requests to disclose PHI by a healthcare provider for treatment or (ii) to disclosures made to the patient.11

Business Associates (defined in the HIPAA regulations) of CEs may also use PHI in the course of providing services to the CE. In the context of a medical practice, Business Associates are most frequently subcontractors that create, receive, maintain or transmit PHI on behalf of the CE. Common examples include electronic medical record software companies

More than just filling vacancies...

It’s about matching lifestyles, personalities and practice philosophies.

Locum Tenens & Physician Staffing Retirement • Illness • Sabbatical • Maternity Leave • CME • Vacation

602-331-1655 www.catalinarecruiters.com preferred vendor of:

A monthly publication of the MCMS • August 2014 • Round-up • 43

the legal issue — regulatory compliance and billing companies. HIPAA requires that CEs execute Business Associate Agreements (BAA) with all of their Business Associates that further describe how a business associate may use and disclose the CE’s PHI and the Business Associate’s obligation in the event of a breach.

All practices should have a template BAA and should routinely review their vendor relationships to ensure that they have a signed BAA on file for those vendors who have access to the practice’s PHI. Model BAA provisions are available for review at www.hhs.gov/ocr/privacy/hipaa/ understanding/coveredentities/contractprov.htm.

In the event your practice believes it has experienced a breach of PHI (in any form), it is important not to panic.

Breaches happen to the best providers. How your practice responds to the breach is critical. The first step is to determine whether your practice is the source of the breach. In some cases, this will be clear. In others, it may not be possible to determine the source. Don’t forget that multiple providers have access to the same patient information.

Thus, you should never assume that your practice is the source of the breach.

Of course, you cannot ignore the breach either. Steps should be taken to investigate the breach and determine (i) the responsible party, (ii) how it occurred, and (iii) whether anything can be done immediately to remediate the breach.

The first priority should always be remediating the breach.

For example, if PHI is openly available on a website, the website should be “closed” until the PHI can be removed.

Thereafter, a more complete investigation should be conducted and documented to determine how the breach occurred and the steps that need to be taken to ensure that it does not re-occur. The investigation should also determine whose PHI may have been compromised and what the practice’s notification obligations are to those individuals. The notification and reporting obligations of the practice will be dependent upon the nature and scope of the breach and should be assessed promptly. If the practice is unfamiliar with the notifications requirements, it is recommended that the practice consult an attorney familiar with HIPAA to assist in the process. It is important to act quickly with respect to any suspected breach to mitigate potential harm to the individuals whose PHI has been breached as well as to the practice.

The foregoing addresses only some of the many HIPAA obligations of medical practices. It is recommended that practices have written HIPAA policies and procedures in place

that can be used as a resource for staff and management, for training employees, and to provide guidelines when questions arise or a breach occurs. Well trained employees behaving in a consistent and compliant manner are key factors in reducing risk under HIPAA for any practice. ru Attorney Andrew Plattner of Sherman & Howard LLC advises physicians, group practices, medical clinics and ambulatory surgical centers on corporate and business transactions, on the impact of Medicare regulations, Stark Law and the Anti-kickback Statute, and on the practice of medicine in Arizona and nationally. He can be reached at aplattner@shermanhoward.com.

Attorney Marcie Damisch of Sherman & Howard LLC represents physicians and healthcare providers on a broad spectrum of healthcare topics including, but not limited to business organizational and transactional matters, regulatory compliance (e.g., Stark, Anti-Kickback, HIPAA), corporate compliance, and strategic analysis and advice in the management of issues and conflicts. Contact her at mdamisch@shermanhoward.com.

1. The full text of the Privacy Rule can be found at 45 C.F.R. Part 160 and Part 164 Subparts A and E. 2. The full text of the Security Rule can be found at 45 C.F.R. Part 160 and Part 164 Subparts A and C. 3. The full text of the Breach Notification Rule can be found at 45 CFR Sections 164.400 – 414.

4. 45. C.F.R. Section 160.102.

5. 45 C.F.R. Section 160.103.

6. Id. 7. 45 C.F.R. Section 164.520.

8. 45 C.F.R. Section 164.502(a)(1).

9. 45 C.F.R. Section 164.524.

10. 45 C.F.R. 164.502(b).

11. Id.

44 • Round-up • August 2014 • A monthly publication of the MCMS

WHAT DO PHYSICIANS AND BME HAVE IN COMMON? Services include:

Both of our creeds are “first, do no harm.”

Ongoing ACA International Training Program HIPAA Certified Agents Professional Collection Specialist (PCS) Certified Agents Free Account Evaluations

Philosophically aligned with the medical profession, the Bureau of Medical Economics (BME) will maximize a physician’s recovery of delinquent patient accounts.

We’ll collect unpaid debt while protecting your good name and preserving your relationship with the patient.

Want to save 20% collecting on your deliquent accounts?

To find out how* call Cydnee at 602-251-2395.

We stake our reputation on it. *MCMS members only.

Preserving your positive image with effective medical account recovery.

the legal issue — bankruptcy

Bankruptcy: What Every Doctor Should Know.

Ethan Minkin, JD Andy Harnisch, JD

Introduction1

It is no secret that physicians around the country are feeling greater financial stress. The reasons are varied, but at least part of the blame rests with the President and Congress. As one paper noted, the Affordable Care Act “is speeding the demise of the American small-business institution; the one-doctor medical practice.”2 To add insult to injury, Arizona is one of the top five states for doctors involved in risk-based contracts (e.g., capitation payments).3 Also, PriceWaterhouseCoopers noted that 10 percent of the medical groups in California are operating under Chapter 11, and up to one-third of the medical groups in California are at or near bankruptcy.4 Statistics such as these do not portend well for physician groups in Arizona.5

It is clear that many in the healthcare field will be forced to participate in the bankruptcy process in one way or another – as a debtor, creditor, or as an employee of an insolvent group. And while “bankruptcy” is a term that carries much negative baggage, it is also a powerful remedy that can help a business shed debt and reorganize as a healthier going concern.

The aim of this article is to acquaint the reader with the Chapter 11 process by way of a hypothetical Chapter 11 case. While a thorough discussion of Chapter 11 of the Bankruptcy Code (the Code) is not possible in an article as brief as this, the following hypothetical illustrates some of the remedies that are available under the Code to a practice that is struggling financially.6

Modification of Secured Debt

One of the most powerful tools in bankruptcy is the ability of a debtor/borrower to restructure and reduce its secured debt without the consent of its lender. This tool can only be found in the confines of a bankruptcy proceeding – there is no corollary outside of bankruptcy.

Assume you have a radiology practice, Penniless Imaging Partners (PIP). PIP has a loan with Mean Street Savings & Loan for $1,000,000; the loan was originated

46 • Round-up • August 2014 • A monthly publication of the MCMS

the legal issue — bankruptcy on August 1, 2012 and the loan matures on July 31, 2017. Repayment of the loan is secured by an MRI machine located in your office; the current value of the MRI machine is $400,000 and the interest rate for the loan is 7%. Under the current or unmodified loan terms your monthly payment to Mean Street is $19,801 and your current principal balance (as of August 1, 2014) is $641,290.81 (assuming 24 months of payments of principal and interest).

Unexpectedly, Medicare reimbursements are reduced by 15% for the procedure codes that makeup the majority of your practice (and, not surprisingly, the private insurers decide to follow Medicare’s lead on reimbursement reductions). Suddenly, your net income goes from positive to negative.

Given the current set of circumstances, you need to reduce your practice’s expenses to survive financially. You do everything you can to reduce expenses – you lay off staff, you negotiate reductions in your office leases, you scour your other expenses to eek out some savings, and you beg Mean Street for a loan modification or debt relief, to which they politely say “no.”

After all of your efforts, you are still losing money. Is bankruptcy an option for PIP?

Let’s consider what the Code allows you to do. First, under the Code, Mean Street’s claim (loaned amount) is bifurcated – its secured claim equals the value of its collateral (i.e., the MRI machine) and the unsecured claim equals the difference between the value of the machine and what you owe on the loan.7 So, Mean Street’s secured claim is $400,000 (the value of the MRI machine), and its unsecured claim is $241,290.81 (the

“It is no secret that physicians around the country are feeling greater financial stress. The reasons are varied, but at least part of the blame rests with the President and Congress... To add insult to injury, Arizona is one of the top five states for doctors involved in risk-based contracts (e.g., capitation payments).” — Ethan Minkin/Andy Harnisch remainder of the debt). You convince the bankruptcy court that the current interest rate (7%) is excessive. You hire a financial expert who opines about a “market” interest rate, and Mean Street hires a financial expert who likewise opines about a “market” interest rate. Ultimately, the bankruptcy court decides that the interest rate for the loan should be 5% (a 200 basis point reduction, or almost a one-third reduction in the interest rate).8

Third, the bankruptcy court, based upon expert testimony, decides that the term of the loan should be seven years from the effective date of a plan of reorganization.9 Based upon the foregoing involuntary loan modifications, your monthly secured debt service payment is now $5,654 ($400,000 principal, at 5% interest, paid over 7 years). Thus, you will

save over $14,000 per month in payments to Mean Street ($19,801 minus $5,654 = $14,147). PIP still has an unsecured debt of $241,290.81 which can be modified by paying less than the entire claim, repaying without interest, and/or stretching the debt out over time.

Dealing With Onerous Leases

Unfortunately, the problems of a financially distressed practice are rarely limited to one intractable creditor. So, let’s extend the hypothetical.

Let’s say that PIP expanded aggressively to multiple locations, but now regrets the move. While most of the offices support themselves, two locations are problematic.

PIP’s office in the high-end enclave of Snottsville is beautiful, state of the art, and far too expensive. The rent is

TRANSPORTATION • TREATMENT • DISPOSAL

• Tracking and Documentation • Flexible Service Schedule including On Call Service • Regulatory Compliance • Trained Service Technicians • Approved Packaging Supplies For information please call toll free

1-866-846-HMWS (4697) or email us at hmws@cgmailbox.com

A monthly publication of the MCMS • August 2014 • Round-up • 47

the legal issue — bankruptcy too high, and you now regret signing a long-term lease. In Chapter 11, you have the option of rejecting the Snottsville lease and surrendering the space. Rejection results in a breach of the lease, and the landlord is entitled to damages.10 However, those damages become an unsecured claim (like the unsecured portion of Mean Street’s claim), subject to the same reductions and modifications in repayment.11 By rejecting the lease, your practice sheds an unprofitable location and softens the blow of the resulting damages.

PIP’s office in the far-flung suburb of Apple Junction is also struggling. In the depths of the recession, you negotiated an amazing deal on the space. However, business is slow and your partners hate the drive. You are going to shed this lease too, and the Code gives you an opportunity to benefit from your below-market lease while you are at it.

The rent is well below market, and you have identified a tax preparer, Uncle-Sam-Be-Damned (USBD), who would love to take over the remainder of the lease, and who is even willing to pay you for it. Outside of bankruptcy, the anti-assignment provision in the lease prevents you from assigning the lease to a new tenant without landlord approval. However, the Code voids the anti-assignment provision and allows PIP to assume and assign the lease to USBD over the landlord’s objection, allowing PIP to shed a poorly performing location and cash in on a valuable asset at the same time.12

Conclusion

Chapter 11 was designed to provide relief from burdensome debt and onerous contracts, so that enterprises like PIP can stay operational and pay back at least some of their debts – an outcome far better for all parties than simply shutting their doors. In our hypothetical, PIP was able to right-size its balance sheet and start turning a profit again, meaning that PIP’s doctors can continue to practice medicine, employ staff, and help patients.

The foregoing was, of course, an illustrative example free from many of the complications that affect every struggling business. The decision to file Chapter 11 is momentous and involves considerations far beyond those presented here. Volumes have been written on the benefits and drawbacks of bankruptcy. However, providers in the current economic climate are sure to encounter the bankruptcy system, as a debtor, creditor, or employed professional.

Providers would do well to have a basic understanding of the bankruptcy system and its goals. ru

Ethan Minkin is a seasoned bankruptcy and commercial litigation attorney. In addition to his private practice experience in bankruptcy and insolvency law, Ethan was in-house counsel to a large Medicaid HMO. He also holds a Masters of Science in Public Health with a concentration in health policy from the University of North Carolina at Chapel Hill. He can be reached at ethan@mhlawaz.com or call (602) 308-9986.

Andy Harnisch practiced bankruptcy law and commercial litigation with large national and regional law firms before founding Minkin & Harnisch PLLC with Ethan Minkin. He has extensive experience with healthcarerelated insolvency matters.

Email him at andy@mhlawaz.com.

To learn more about Minkin & Harnisch, PLLC, see their ad on page 7.

1. This article should not be construed as legal advice. Bankruptcy is a very complex area of the law, and each case is unique. This article covers a few discrete issues – an actual bankruptcy filing would encompass many more issues. If you are considering filing bankruptcy or are involved in a bankruptcy proceeding, you need the input of a skilled bankruptcy attorney.

2. http://m.utsandiego.com/new/2014/apr/26/obamacare-deals-blow-toone-doctor-medicine/.

3. http://pbs.org/wgbh/pages/frontline/shows/doctor/care/stats.hml.

4. Like Arizona, California has a very high rate of risk-sharing contracts for physician services – in fact, California is in the top five states for risksharing contract penetration.

5. http://pbs.org/wgbh/pages/frontline/shows/doctor/care/stats.hml.

6. The healthcare industry is one of the most regulated industries in the U.S. If you are seeking bankruptcy advice, it is important to find an attorney that is literate in healthcare insolvency issues.

7. See 11 U.S.C. § 506(a)(1).

8. See 11 U.S.C. § 1129(b)(2)(A)(i).

9. See, e.g. 11 U.S.C. § 1129(a)(11).

10. In most cases, the damages are capped at one year’s worth of lease payments. See 11 U.S.C. § 502(b)(6).

11. See 11 U.S.C. § 365(g)(1).

12. See 11 U.S.C. § 365(f)(1).

48 • Round-up • August 2014 • A monthly publication of the MCMS

Services to

BENEFIT YOU

and your practice.

preferred partner program

CATALINA MEDICAL RECRUITERS www.catalinarecruiters.com • 602-331-1655

HEALTHCARE MEDICAL WASTE SERVICES hmws@cgmailbox.com • 1-866-846-HMWS (4697)

Physician search and locum tenens services to healthcare facilities throughout Arizona; coverage for vacations, CME, sabbaticals, medical leaves and retirement.

HealthCare Medical Waste Services is a privately owned regulated medical waste company, providing transportation, treatment and disposal of medical waste, sharps and documents. They are licensed, insured and a full service management firm using methods that exceed applicable federal, state and local requirements.

MCMS members receive a 3% discount on locum tenens placement and 7% discount on a traditional search agreement.

MCMS Members enjoy a 2% discount.

CINTAS HEALTHCARE INFORMATION MANAGEMENT www.cintas.com • 602-393-7815 Cintas designs, manufactures and implements corporate identity uniform programs, and provides entrance mats, restroom supplies, tile and carpet cleaning, promotional products, first aid, safety, fire protection products and services and document management services.

ENSEMBLE REAL ESTATE SOLUTIONS www.ensemblere.com • 602-277-8558 A full service provide of healthcare real estate services, including brokerage services (tenant representation and leasing), asset and property management, development and construction management, consulting services, acquisition and sales.

Special discounts available only to MCMS Members: Ensemble Real Estate Solutions will meet with MCMS Members to discuss their needs and will provide a follow-up complimentary market survey (valued at $250).

Please call for additional information and/or discounts.

GLOBAL FINANCIAL SERVICES www.gfrservices.com • 480-478-7400 Global Financial is an independent equipment lessor and a trusted financial service provider. With combined experience in all areas of more than 90 years, Global Financial’s team is well respected within the financial marketplace.

At Global Financial customers come first. Global Financial provides tailored solutions for a variety of equipment and all types of credit ranges.

MCMS Members receive a free credit review and consultation with application.

MEDJETASSIST www.medjet.com/mcms • 800-527-7478 If you become hospitalized 150 miles or more from home, Medjet will arrange medical transfer to the hospital of your choice. All you pay is the Medjet membership fee.

Members of the MCMS receive discounted annual rates: $205 for individual and $325 for a family.* *Rates listed are for travelers under age 75.

When calling mention MCMS for discounted rates.

PLAZA COMPANIES www.theplazaco.com • 623-972-1184 A full-service real-estate firm specializing in the development, leasing and property management of medical office properties throughout Arizona.

MCMS members receive complimentary leasing market research.

PRINCIPAL LIFE INSURANCE AND DISABILITY Bob Castellani, 602-957-3200 Michael Abbate, 602-734-1153 www.principal.com Committed to, and passionate about, serving the healthcare industry and understanding the specific needs of healthcare organizations, Principal offers a wide range of financial products and services, including insurance, investment, group benefits and retirement plan for a physician’s practice.

The Principal Financial Group is proud to support the MCMS and offer its members a 10%-20% discount on our Individual Disability Income Insurance portfolio. Call for more information.

To learn more about the MCMS Preferred Partner Program, contact us at 602-252-2015 or at mcms@mcmsonline.com.

in memoriam Thank you for your contributions to the medical profession.

You will be missed. Rest in peace.

George Arthur Gentner, MD

George Arthur Gentner, MD, age 96, passed away peacefully on November 12, 2013. Born on September 6, 1917, in Buffalo, New York, he was a recent graduate of the University of New York at Buffalo medical school when he joined the Army Medical Corp in 1942. En route to Guadalcanal with the 25th Infantry Division (Tropic Lightning), he met his future wife Mariel Sharp in San Francisco, who predeceased him in 1985. Captain Gentner saw action in the South Pacific and was later transferred to the European Theatre of war with the 3rd Army. He left the Army with the rank of Major.

Following the War, and a few years of general practice in Buffalo, Dr. Gentner and Mariel moved to New Orleans, where he spent seven years at the Touro Infirmary and decided to specialize in radiology. In 1958, he and Mariel moved their family to Arizona. Dr. Gentner spent many years at the old Maricopa County Hospital, where he established its Radiology Department. There he mentored many Valley physicians doing their residency at the County. Dr. Gentner, a Fellow of the American College of Radiology, was passionate about and dedicated to his profession and later joined Drs. Kennedy, Tolone and Cook at Valley Radiologists, where he worked until his retirement.

He was an avid sailor, taking the Isla Mariel on many cruises to Catalina Island and up and down the Southern California coast and Mexico with family and friends. He became a Master Navigator and taught the navigation course offered by the Coast Guard Auxiliary. He was a golfer well into his 90’s and generally sent the ball straight down the fairway. He spent much time in Southern California, but his heart and his home were in the Arizona desert, first encountered during a medical convention when he and Mariel took a ‘57 Chevy convertible from Phoenix to Tucson, over roads less traveled, the desert in full bloom, and fell in love with what they saw.

Dr. Gentner was an accomplished individual who achieved much in life, enjoyed a long and rich life, and who was a treasured and beloved father, grandfather and great-grandfather. He will always be missed.

Dr. Gentner is survived by his daughter Kathy Maison Fachet and son-in law Bob of Phoenix; his grandsons Matthew and his wife Anna; Tom and his wife Rachael; and Michael; son Brian and daughter-in law Myra of Newport Beach, CA; his granddaughter Kate Sanders and her husband Tim; his great-granddaughters Leah and Shelby; and grandson Harrison, son George, Jr. of Melbourne, Australia; and granddaughters Megan and her husband Josh, and Sarah. ru

Charles Eugene Davis, MD

Charles Eugene Davis, MD, age 83, also known as Dr. C. Gene Davis, died in Phoenix, Arizona on July 26, 2014.

Dr. Davis was born August 29, 1930, in Miami, Arizona to Charles and Ruth Davis. He graduated from Miami High School in 1948, Arizona State College (ASU) in 1952, and Cornell Medical College in 1956. He was married to Constance Hand on June 6, 1955 in Cape May, NJ.

Dr. Davis continued his medical training at St. Joseph’s Hospital for four years. Beginning in 1960, he served as a physician in the United States Air Force at Ellsworth Air Force Base in Rapid City, South Dakota for two years. He practiced Obstetrics and Gynecology for 32 years and taught residents at St. Joseph’s Hospital. His passions included, God, his family and friends, his medical profession, singing, playing the alto saxophone, fly fishing in the White Mountains, and playing tennis with colleagues and family. He was an elder at his church for many years and counselor to many.

Dr. Davis is survived by his wife, Connie Davis, his children: Pam Grant, Laurie Davis-Dziwak, Terry and Bryan Martin. He was blessed with nine grandchildren, and one great grandchild and many nieces and nephews. ru

50 • Round-up • August 2014 • A monthly publication of the MCMS

viewpoint

Viewpoint Paul B. Jarrett, MD

“Medical group recommends against routine pelvic exams for women.”

This to me is incredible!

The recommendation would appear to eliminate “Pap” smears for cervical cancer, but how does one obtain material for testing without a pelvic exam?

It would make as much sense to proclaim that listening to the heart is useless unless symptoms of heart disease are present. Why not eliminate taking a patient’s blood pressure if there are no complaints of stroke or heart failure? It would save a lot of time.

I have discovered ovarian tumors in routine examinations where there were no symptoms, and subsequent surgery eliminated the possibility that cancer would develop in a Cystadenoma.

It would appear that there is a rush to eliminate demand in the face of increasing costs and shortage of Doctors.

Only the wealthy will be provided adequate care under “Fee for Service” in times to come. This is the epitome of backward progression. Obama-care will get you in and out in a hurry, but you will be the same as you went in.

That the American College of Physicians would lend themselves to this is as I said, absolutely incredible.

I do not believe that in today’s milieu, a physician could protect himself against a “failure to look” claim because pelvic exams are no longer routine. But that is not the concern! What is our Mission? Our reason for being?

Physician Assistants are fine if you do not need a Physician. Some envision themselves as gate-keepers whose job is to see that as few as possible get to the doctor.

Maybe we ought to be trying to figure out how to train more physicians.

A bad mistake the Profession made was to deny our professional ties as a collegium. We permitted the government to tell us that we could not treat our colleagues pro-bono. We were even delighted. If we call a colleague today, we are told he or she is with a patient. If we call for an appointment for ourselves, we are told we will be seen six weeks from this coming St. Swithin’s Day.

If you want to see a Group hang separately, watch them stop hanging together!

The Medical Profession is becoming “Exhibit A” in that regard! The consequences wholly predictable.

Dr. Paul B. Jarrett is a retired physician living in Phoenix. Prior to joining the MCMS in 1946, he served as a Surgeon in WWII, receiving a Bronze Star for his meritorious service. He received numerous awards during his career, and held several appointments including President of ArMA in 1966, Chief of Staff at Good Samaritan Hospital in 1968, and served on The Secretary’s Commission on Medical Malpractice in 1970. Contact him by email to pbjmd@cox.net.

Do you have a viewpoint? Share it with us and we’ll share it with our readers!

Email mcms@mcmsonline.com 52 • Round-up • August 2014 • A monthly publication of the MCMS

Filling out credentialing paperwork?

Let our team do the work for you.

GACCP’s Central Application Service will establish a portfolio of documents needed for credentialing allowing quick, easy and inexpensive access to the information.

These documents can be used for one-time or re-current filings; initial credentialing and re-appointments.

Don’t get caught unprepared.

Contact GACCP today to learn how our services will work for you.

www.azcvo.com 602-528-7749 MCMS members receive a discount off services.

marketplace REAL ESTATE

PHYSICAL THERAPY SUITE AVAILABLE PLAZA DEL RIO MEDICAL CAMPUS, PEORIA Located just west of Loop 101 & Thunderbird, 1,804 sf with large open PT area, 4 offices, breakroom, 2 RR’s. Located on a medical campus with over 90 physicians. Located near Boswell, Thunderbird, and Arrowhead Hospitals. Aggressive rates.

Contact Margaret Lloyd Plaza Companies 623-344-4558 TEMPE-MESA AREA Medical Office Suites for lease in beautiful garden office complex.

1200 or 1800 sq. ft. includes covered doctor parking. Excellent location with easy access to 101 & 60 freeways & close to Desert Samaritan & Tempe St Luke’s Hospitals.

Best rates in area 602-625-6298.

FOR SALE Family Practice Physician retiring.

Beautiful office building on Ray Rd. in Chandler.

Ideal for 1-2 docs or satellite.

Practice also available for purchase, if interested.

Contact rjpadelford@cox.net

MEDICAL OFFICE CONDOS FOR SALE. I-17 freeway access. Next door to Pediatrix. Northview Professional Plaza.1120-2800 SF. Contact Beth Jo Zeitzer/Justin Cirell, R.O.I. Properties, 602-319-1326

MOVE-IN READY MEDICAL SUITE LOOP 101 AND THUNDERBIRD, PEORIA 1,489 RSF, 4 exam rooms, doctors office w/ private entry on large Medical campus. Located between Boswell, Thunderbird, and Arrowhead Hospitals. Aggressive rates and concessions.

Contact Margaret Lloyd, Plaza Companies 623-344-4558.

MEDICAL OFFICE BUILDING AVAILABLE FOR LEASE $12.00 SF. Just north of downtown Phoenix, walking distance to Phoenix Light Rail. Includes 7 plumbed and 7 non-plumbed office/exam rooms, kitchen, break room, and reception area. Suites ranging from 2,000-7,500 SF. Contact Beth Jo Zeitzer/Justin Cirell, R.O.I. Properties, 602-319-1326

FREESTANDING BUILDING IN ANTHEM OFFICE, MEDICAL OR DENTAL Newer 9,211 RSF shell building ready to be finished to tenant’s specifications. Freeway visibility, turnkey TI’s. Aggressive rates and concessions. Contact Margaret Lloyd, Plaza Companies at 623-344-4558 TEMPE CROSSINGS II Beautifully built-out medical office available for immediate move-in.

Desirable Tempe location with excellent proximity to shopping and restaurants with immediate access from I-10. Contact Marina Hammersmith, CCIM, 602-954-8414 or Autumn Storm 602-385-2854 at Ensemble Real Estate Solutions.

54 • Round-up • August 2014 • A monthly publication of the MCMS

DUNLAP MEDICAL BUILDING/LINCOLN MEDICAL PLAZA II Medical office space available with immediate occupancy on the John C. Lincoln North Mountain campus.

1580 to 8350 SF available.

Ample patient and staff parking.

Contact Tracy Altemus, CCIM, 602-443-4030, Marina Hammersmith, CCIM, 602-954-8414 or Autumn Storm, 602-385-2854 at Ensemble Real Estate Solutions.

BROADWAY EAST MEDICAL CENTER Join two busy primary care practices and a great mix of specialists in the Broadway East Medical Center at Broadway and Sossaman in Mesa.

Located near three major East Valley hospitals with easy access from US60. Contact Marina Hammersmith, CCIM, 602-954-8414 at Ensemble Real Estate Solutions.

SCOTTSDALE MEDICAL BUILDING/SCOTTSDALE OLD TOWN Quality second generation medical and/ or general office space available in these beautifully landscaped buildings. Excellent patient flow and ample parking. Just minutes from Scottsdale Healthcare Osborn Medical Center.

Contact Marina Hammersmith, CCIM, 602-954-8414 or Autumn Storm, 602-385-2854 at Ensemble Real Estate Solutions.

marketplace REAL ESTATE

MEDICAL OFFICE TIME SHARE IN GLENDALE (NE Union Hills/59th Ave) Excellent time share opportunity.

Surgery practice with well-appointed 3300 sq. ft. office condominium.

Conveniently located in Arrowhead Ranch one mile from Loop 101.

The office includes private office for the Practitioner, support staff work space, 2- 3 full exam rooms, and a spacious waiting area. Mon., Wed. and Thurs. available. Utilities included.

Arrowhead Commons, 18275 N. 59th Ave, Glendale. Contact admin@doctorangelchik.com for more information.

EMPLOYMENT

SEEKING PT GENERAL PRACTICE PHYSICIAN TO WORK 20 HRS A WEEK. Days/time flexible. Small patient load. Prefer own malpractice insurance. No billing. Please contact 602-353-9531, 623-734-6796 or celsatjain@cox.net for details.

PHYSICIANS - FT & PT Occ Med clinics in Phx & Tucson. Excellent hours, CME, salary, benefits. Fax CV to Heather @ 602-773-0287 or e-mail h.wahl@mbiaz.com

MORTGAGE SERVICES

Professional Program

• 5% down up to 1 MILLION loan amount • NO MORTGAGE INSURANCE • Eligible borrowers include: Resident or Practicing Physicians, Attorneys, Oral Surgeons, Dentists and CPAs Warren Potter

BBVA Compass, Mortgage Banking Officer - NMLS# 221747 warren.potter@bbva.com

Branch: 7335 E Doubletree Ranch Rd, Scottsdale, AZ, 85258 Direct: 480-356-1507 g Mobile: 480-694-6444 g Fax: 205-524-1859

FULL-TIME MEDICAL DIRECTOR for dynamic charity clinic. Job description available at www.stvincentdepaulnet.

Link at bottom of page “careers.”

For more information contact Janice Ertl, Clinic Director, at 602-261-6880 or jertl@svdp-phx-az.org.

MED. EQUIPMENT AFFORDABLE MEDICAL EQUIPMENT Low priced, high quality new & used equipment for: PHYSICIAN OFFICES, HOSPITAL RADIOLOGY We buy, sell, consign, service, and finance your CAPITAL MEDICAL EQUIPMENT NEEDS. GLOBAL MEDICAL SOLUTIONS Contact: Don Creedon TEL. (480) 874-0333 FAX (480) 626-4366 Member AIUM www.igogms.com

ADVERTISE HERE!

Looking for targeted traffic and exposure to your product, service or company?

Call 602-252-2015 or email roundup@mcmsonline.com

A monthly publication of the MCMS • August 2014 • Round-up • 55

minutes The Maricopa County Medical Society

BOARD OF DIRECTOR’S MEETING June 9, 2014 • 6 pm

BOARD MEMBERS AND MCMS STAFF Board Members: Drs. Miriam Anand, Suzanne Sisley, Mark Wallace, Ryan Stratford, Adam Brodsky, John Couvaras, Tanja Gunsberger, Jennifer Hartmark-Hill, Kelly Hsu, Steve Kassman, Lee Ann Kelley, Richard Manch, May Mohty, Anita Murcko, and Sue Whitely MCMS Staff: Jay Conyers.

GUESTS Dr. Jim Meador (Society member), Rich Schneider (UBS), John Shultz (UBS), Mary Read (Pentegra), and Ken Jackson (Pentegra).

WELCOME At 6:09 pm, meeting called to order by Dr. Anand.

MCMS RETIREMENT PROGRAM The Board heard a presentation by Pentegra, a national retirement services company that develops multiple employer plans (MEPs) for organizations similar to the Society.

Representatives from Pentegra and UBS, a financial services firm working to structure a MEP with Pentegra, presented a slideshow and addressed questions from the Board.

As an example, Pentegra representatives described a similar plan that had been put together for the Arizona Technology Council and the benefits its members were receiving.

The Board agreed to consider Pentegra’s strategy for helping the Society offer a retirement program that would offer Society members an opportunity to pool assets with other smaller plans to enhance retirement plan options and have an experienced firm assume the fiduciary responsibility.

CONSENT AGENDA Dr. Anand summarized the Consent Agenda, containing the May minutes and membership report for May 2014. The Consent Agenda was approved.

Meeting Minutes

FINANCIAL COMMITTEE Dr. Wallace presented a slide showing a breakdown of the profitability of the Society and individual business units for the month of April. He highlighted certain revenue centers and costs for the business units, comparing actual to budgeted. The Board approved the April 2014 financials, as presented.

POLICY COMMITTEE Dr. Stratford addressed the Board and discussed the recent survey that the Society had conducted, asking its members various questions pertaining to gun safety and the role of physicians in disseminating safety information. He suggested that the Board consider the best direction to take on this topic, and consider what concerned members felt about the survey.

Dr. Jim Meador attended as a guest and provided the Board with some educational materials that could be considered as a resource. The Board discussed the mental health tie-in with gun safety and agreed that the Society’s website have a section for educational materials on the topic.

MEMBERSHIP COMMITTEE Dr. Couvaras addressed the Board and described a recent meeting that had been held by the Membership Committee, whereby the committee discussed the various membership categories.

The Board discussed ways of engaging the medical students more, possibly through “white coat sponsorships” or other ways of affording students the opportunity to engage Society members. It was suggested that the Society consider a Student Chapter and also positions on the Board specifically for students and/or residents.

ADJOURNMENT Dr. Anand adjourned the meeting at 8:23 pm. ru

56 • Round-up • August 2014 • A monthly publication of the MCMS