News

A new pilot program will allow patients to get the specialty rheumatologic care they need, in their own communities from their primary care providers.

Contact: Phyllis Webster, 520-626-9229, pwebster@telemedicine.arizona.edu
Aug. 8 2017

TUCSON, Ariz. – If you need to see a rheumatologist in Arizona, chances are you’re going to have to wait—especially if you’re in a rural area. These specialists are in short supply in the United States, and the demand for them is high as the population ages.

To address this workforce issue without making patients travel long distances or wait months for an appointment to see a rheumatologist, the Arizona Telemedicine Program (ATP) at the University of Arizona College of Medicine – Tucson and the University of Arizona Center for Rural Health(AzCRH) at the UA Mel and Enid Zuckerman College of Public Health partnered to create a program in Arizona that will train primary care providers to treat rheumatic diseases.

The program will use the ECHO (Extension for Community Healthcare Outcomes) model™, developed at the University of New Mexico School of Medicine, which aims to increase workforce capacity by sharing knowledge. Primary care providers in local communities develop skills to deliver specialty-care services to their patients by meeting regularly via videoconferencing with specialists at an academic “hub” site. The specialists share their medical knowledge and expertise, serving as mentors and colleagues.

Unlike “traditional telemedicine,” where the specialist assumes care of the patient, Project ECHO programs provide front-line clinicians with the knowledge and support they need to manage their patients with complex conditions in the patients’ own communities. This dramatically increases access to specialty treatment in rural and underserved areas.

ATP Medical Director Amy Waer, MD, received a $17,700 grant from Lilly to launch a one-year rheumatology ECHO pilot program, based at the ATP and administered jointly with AzCRH. The program begins in September.

“We can leverage and enhance relationships with our primary-care providers, rural and critical access hospitals through our center,” said Dan Derksen, MD, AzCRH director.

Banner Health rheumatologist Dominick Sudano, MD, assistant professor of medicine and a member of the UA Arthritis Center at the UA College of Medicine – Tucson, will meet with as many as 40 primary-care clinicians throughout Arizona by multi-site video conferencing for two hours each month. About 20 minutes will consist of a lecture on a rheumatology topic; the remainder will comprise individual patient case presentations with protected health information removed. Dr. Sudano will advise local clinicians on how to proceed on a case-by-case basis.

“This represents an excellent opportunity to improve patient care across Arizona while simultaneously connecting with and educating primary-care providers about rheumatic diseases,” Dr. Sudano said. 

As Arizona community-based clinicians attend more sessions and learn from Dr. Sudano, and each other, their knowledge and ability to treat rheumatologic conditions locally will increase. Less-severe cases will be treated locally; patients with severe disease still will be referred to a rheumatologist.

The ECHO model works, said Colleen Hopkins, telehealth coordinator at North Country Healthcare in Flagstaff. North Country Healthcare has participated in a hepatitis C ECHO program since 2012, linking its chain of 14 community health centers—extending across vast rural areas in Northern Arizona—with a hepatologist-educator at St. Joseph’s Hospital and Medical Center in Phoenix, 140 miles to the south.

“Our providers feel so much more confident and competent about treating their patients with hep C,” Hopkins said.

For more information about the UA rheumatology ECHO pilot program, visit the website, telemedicine.arizona.edu/echo

This activity is supported by an educational grant from Lilly. For further information concerning Lilly grant funding, visit www.lillygrantoffice.com

About the Arizona Telemedicine Program

Based at the University of Arizona Colleges of Medicine (Tucson and Phoenix), the Arizona Telemedicine Program (ATP) was established in 1996 by the Arizona State Legislature to help provide access to top-quality health care to rural Arizonans. ATP strongly supports the growth of telemedicine throughout Arizona and provides a suite of services to its member organizations, including clinical, administrative and information technology support; telemedicine training; and facility design. More than 60 clinical subspecialty services have been provided through the network, amounting to more than 1.3 million telemedicine cases. ATP is home to the federally funded Southwest Telehealth Resource Center, which serves Arizona, Colorado, Nevada, New Mexico and Utah. ATP has received many national awards for its innovative education and training programs. For more information: telemedicine.arizona.edu

About the University of Arizona Center for Rural Health

The University of Arizona Center for Rural Health, housed in the UA Mel and Enid Zuckerman College of Public Health, has been serving Arizona through its core mission to improve the health and wellness of rural and underserved populations since 1981. The Center is home to many programs including, the State Office of Rural Health, Rural Hospital Flexibility Program, Small Rural Hospital Improvement Program, Western Region Public Health Training Center, Navigator Consortium, Students Helping Arizona Register Everyone and the Prescription Drug Misuse & Abuse Initiative. For more information: crh.arizona.edu

Tucson.com | By Bob Christie The Associated Press
Updated 6 hrs ago

PHOENIX — Federal filings released Tuesday show the largest seller of individual health insurance on Arizona's Affordable Care Act marketplace is seeking price increases of less than 5 percent next year for clients in Maricopa and Pima counties.

The filings by Centene Corp's Ambetter by Health Net mark a big departure from this year's major increases and come a day after Blue Cross Blue Shield of Arizona said its average rates would be rising by only about 7.2 percent next year amid growing market stability.

Health Net offers individual policies in the state's two largest counties that cover about two-thirds of the 140,000 people with marketplace policies statewide. Blue Cross insures in the other 13 counties.

This year's increases for both insurers topped 50 percent. A Blue Cross executive told The Associated Press Monday that a stabilizing market led to its smaller planned boosts. Health Net officials didn't immediately return calls seeking comment Tuesday.

The relatively small increases and market stability undercut some of Gov. Doug Ducey's arguments that the state's marketplace is broken. Ducey was in Washington on Monday to meet with Trump administration officials and a handful of other Republican governors on a possible repeal of former President Barack Obama's health law in the wake of the failure of an effort last week in the U.S. Senate.

Arizona had some of the lowest rates in the nation and robust competition from multiple insurers when the individual marketplaces launched for the 2014 coverage year. But insurers underpriced their plans and saw big losses, leading all but Blue Cross and Health Net to leave the state by this year and premiums to skyrocket.

Ducey spokesman Patrick Ptak issued a statement noting that prior to the Obama law the state had over two dozen companies selling plans on the individual market.

"This year, most Arizonans had only a single provider to choose from in the federal marketplace while facing premium increases on average of 50 percent," he said in a statement. "The governor believes a healthy individual marketplace should provide choice, competition, and lower premiums for consumers."

University of Arizona health insurance expert Dr. Daniel Derksen said that's partially true but neglects pre-ACA issues that showed a troubled marketplace.

"I think a more complete context is that the individual or non-group marketplace has been unstable and volatile for the last 10 years, certainly preceding the ACA," Derksen said.

Blue Cross designed its 2018 rates to reflect the elimination of "cost sharing reduction" payments from the federal government that help lower costs for people earning less than 250 percent of the poverty line.

The law requires insurers to lower copays and deductibles for that group, but President Donald Trump has threatened to withhold the payments and let the Affordable Care Act marketplaces fail.

If Congress passes a bill ensuring the payments, there will likely be no rate increases next year, Blue Cross Blue Shield of Arizona Vice President Jeff Stelnik said.

July 14, 20171:18 PM ET
Heard on All Things Considered

For Heather Gijanto, going to the doctor means taking a day off work and driving at least 60 miles round trip from her home in McNeal, Ariz., to the town of Bisbee. And that is assuming there is a primary care doctor available in Bisbee to get her in.

"You select one doctor and then you find out a few months later that that doctor is no longer going to be available," Gijanto says. "So then you have to start the whole process over again. And then you find that doctor and, for whatever reason, that doctor leaves as well."

Gijanto is frustrated and says she and her husband and their two young kids have had to change family doctors four times recently. Ideally, she says, the family would have one doctor who knew each member's medical history, so "I didn't have to explain my chart every single time or have to go over medications all the time with each new physician."

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TUCSON (KGUN9-TV) - Senate Republicans postponed the vote on the Better Care Reconciliation Act Tuesday.

"The good part of the discussion going on right now is the people are starting to ask a lot of questions about what will happen to me what will happen to my family," said Daniel Derksen, a University of Arizona College of Public Health professor.

Derksen says 70 million Americans are currently covered by Medicaid and two million of those are in Arizona.

"The estimate is either of these bills would cause about 400,000 Arizonans to lose their Medicaid coverage and be uninsured," he explained.

He says in rural communities, health infrastructure depends on small rural hospitals known as critical access hospitals and these would have a hard time providing services if funding was cut.

"In Arizona we have 14 critical access hospitals and they would be particularly hard hit by these drastic cuts," he said.

Derksen says over the next 10 years, $7.3 billion in Arizona's federal Medicaid funding would be cut and with the loss of funding, nearly 25,000 jobs will be cut from Arizona.

U.S. Senator John McCain says Arizona has been nationally recognized for running one of the most efficient and cost-effective Medicaid programs in the country.

He stated this type of legislation should reward the state, rather than penalize it.

Senator McCain stated he supports repealing and replacing Obamacare, but quote, "I will be working hard to include important measures that address the concerns raised by Governor Ducey and other leaders across our state about the bill's impact on Arizona's Medicaid system."

» See video at link below:

THE SUNDAY HERALD (Glasgow, Scotland) | Exclusive by Andrew Purcell
June 24, 2017

WITHIN five days, Trumpcare could well be on the US statute books. It hasn't taken long to get there. The journey began on May 4, when the Republican caucus in the House of Representatives gathered to vote on the American Health Care Act (AHCA). For seven years, they had promised to repeal Barack Obama’s signature legislative achievement, but now they had control of both houses of Congress and the White House, they couldn’t agree on a replacement. To conservative hardliners, the bill was too timid. Moderates worried that supporting it could cost them their seats.

Whips played Eye Of The Tiger on the stereo to harden their resolve, and projected an image of General George Patton urging them to "accept the challenge so that you can feel the exhilaration of victory.” Later, once the bill had scraped through 217-213, Republican Congresswoman Ann Wagner said: “The line of the day was out of Braveheart: ‘Freedom!’”

In their minds, these privileged few were Rocky entering the ring, William Wallace leading the charge at Stirling Bridge. Republican Congressman Jason Chaffetz rode in on a scooter, fresh from foot surgery covered by his subsidised government health insurance, to vote for a bill that will make the same operation unthinkably expensive for tens of millions of Americans. If it becomes law, thousands more will die each year because they cannot afford to see a doctor.

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The Christian Science Monitor| by Francine Kiefer | Staff writer
June 22, 2017

WASHINGTON—Republican senators unveiled their long-anticipated healthcare plan to replace Obamacare on Thursday, and it includes significant changes to Medicaid, the joint federal-state program for the poor, elderly, and disabled.

The bill, which does not yet have the support of enough senators to pass, reflects the ongoing tussle of costs vs. social benefits that sharply divides the two parties as well as Republicans themselves.

Like the Republican legislation that passed the House in May, the draft bill put forward by Senate Republican leaders aims to rein in federal spending on the burgeoning program – a move they say will strengthen it in the long term. But over time, that will mean substantial cuts to some of the country’s highest-need populations, say advocates – though the full scope of those cuts won’t be known until the independent Congressional Budget Office releases its report on the Senate bill early next week.

“Medicaid is fiscally unsustainable,” says Steve Kelly, spokesman for Sen. Pat Toomey (R) of Pennsylvania, the senator who represented the GOP conservative viewpoint on Medicaid as the bill took shape behind closed doors.

Thirty years ago, Medicaid accounted for less than 3 percent of federal spending. Today, it’s nearly 10 percent. About one fifth of the US population is enrolled in it, according to a Congressional Research Service 2015 report. It pays for almost half of all births. It’s the single biggest payer for substance abuse treatment. It helps rural hospitals stay afloat and supports jobs in the health sector. It covers nursing homes for the elderly and long-term care for the disabled.

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