A new pilot program will allow patients to get the specialty rheumatologic care they need, in their own communities from their primary care providers.
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
The Arizona Daily Sun (Flagstaff) | July 28, 2017
Imagine living in an area that has no traditional medical care facility for 40 miles. Imagine that the only medical care near you was a rural facility for Medicare and Medicaid services that is understaffed and unequipped.
Access, staffing and other issues such as mental health dominated the 44th annual Arizona Rural Health Conference attended by nearly 200 in Flagstaff this week.
The biggest issue, said Dr. Daniel Derksen, is the hiring and retention of medical care staff in rural communities like St. John, Springerville and other areas across Arizona.
“Something like 70 percent of the population lives in the greater Phoenix area or Tucson, but 80 to 85 percent of health providers live in those areas," Derksen said. "So there is a mismatch and it is really hard to recruit and retain health care professionals to serve in the areas they are most needed.”
Rural medical care providers were also worried about the new health care bill, which has stalled in the Senate. The draft bill would have cut 400,000 Arizonians’ Medicaid coverage and 100,000 Arizonians would lose subsides that help them buy health insurance.
“The net loss of people who are currently covered in Arizona are about 500,000 Arizonans who would become uninsured over the next 10 years,” Derksen said. “About 40 percent of that would be in the first year, so there would be a dramatic drop in the insured rate…it would reverse our progress.”
Those cuts to Medicaid would have been “devastating” to patients in rural areas as well as to clinics and hospitals, Derksen said.
The bill would have caused a string of closures of Medicaid facilities in rural areas at a rate that has not occurred since the 2008 recession.
Poor access is already a problem, said some participants.
“In our research we are trying to find what services are available to rural people, and in some cases they are so far away from some medical services that they are really limited in the choices they can make,” said Emeka Iloegbu, an intern with Area Health Education Center (AHEC). “You see stories on the news but you don’t know the back story.”
Getting to talk with the medical staff of rural areas also was a learning experience.
“We are not from the region or the nation so we don’t know what topics they wanted us to talk about," said Nina Williams. “So actually having those intimate discussions with health care staff was crucial to developing our curriculum.”
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.
Stephanie Innes Arizona Daily Star | Stephanie Innes
Jul 15, 2017 Updated Jul 16, 2017
Universal health care is far from the plan Republican leaders are proposing, but it’s getting some love in Southern Arizona.
» Full article at link below:
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."
» Continued at link below.
Arizona Public Media | Andrea Kelly | June 30, 2017
Health Care: Judy Rich, president and CEO of Tucson Medical Center discusses the impact of the proposed U.S. Senate changes to health care policy. Dr. Daniel Derksen, of the University of Arizona's College of Public Health, says it could raise health care costs for all Arizonans.
At 4min:24sect to about 9min:55sec at:
Airdate: June 22, 2017 0min:0sec to 11min:10sec
Senate Republicans released their version of a health care bill to replace the Affordable Care Act. University of Arizona health policy expert Dr. Daniel Derksen will talk about the new plan.
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:
TUCSON.COM | By Stephanie Innes Arizona Daily Star
Jun 26, 2017
The turnout at Tucson Medical Center’s forum about federal health reform Monday night underscored local concern about the issue — there were 700 people, twice what organizers expected.
A livestream of the event on Facebook drew 1,900, organizers added.
“I’m floored,” TMC spokesman Jim Marten said of the attendance numbers. “With the heat and everything. ... We had to keep adding chairs.”
Here are five takeaways from the event:
1. The sentiment at the forum was against both the Senate and House bills.
Judy Rich, CEO of TMC, made it clear at the beginning of the program that she thinks the American Health Care Act (House bill) and the Better Care Reconciliation Act (Senate bill) should be set aside, and that efforts should be made to move to a bipartisan solution that will be better for communities.
The audience members were also predominantly either concerned about both bills or had made up their minds against them. A group greeted attendees with information about a single-payer “Medicare for All” alternative. One woman held a sign that said “Healthcare Not Wealthcare.”
2. The opposition was not solely partisan.
Dr. Dan Derksen, a health-policy expert and professor at the University of Arizona’s Mel & Enid Zuckerman College of Public Health, pointed out impacts that both bills could have, particularly on Arizona’s rural and low-income populations. He said they would be devastating and, after the event, called the proposals “too vindictive.”
But he also disclosed to audience members that he is a lifelong registered Republican.
3. The Senate bill is not too different from the House bill.
Under both bills, Medicaid as we know it could end. And congressional budget reports on both bills predict that under their provisions, more Americans will be uninsured.
» View video on YouTube (Dr. Derksen speaks from 26min:00 sec to 35min:00 sec)
» Continued 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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Two policy experts talk to MedPage Today about the no longer secret plan
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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Daniel Derksen and Will Humble | AZ We See It
Even if the governor vetoed it, Nevada's plan to allow anyone to buy Medicaid coverage may be the way forward for Arizona and the nation.
Last week, the Nevada state Legislature handed Gov. Brian Sandoval an innovative opportunity to replace the Affordable Care Act at the state level. Unfortunately, he didn’t take advantage of the opportunity.
The Nevada Legislature sent Sandoval a bill that would have allowed any Nevadan to “buy in” to their state’s Medicaid program. On Friday, he vetoed the legislation. Had he signed it, and the Centers for Medicare and Medicaid Services approved the plan, any Nevadan could buy Medicaid coverage — regardless of income.
Why we need 'Medicaid for Many'
Assembly Bill 374 would have directed the Nevada Department of Health and Human Services to ask for a CMS Waiver (called an 1115 waiver) to allow any Nevadan to buy a Medicaid managed care plan. Nevadans eligible for an Affordable Care Act tax credit (called an advance premium tax credit) or cost-sharing reductions based on income could have used them to help pay their share of the premium.
Polling shows that most Americans want reasonably priced health insurance regardless of having a pre-existing condition. Nevada’s Medicaid plan would have done that, avoided a complicated health-system overhaul and could be tailored to fit other state programs.
“Medicare for All” is getting a lot of national attention again these days. Perhaps it’s time to add “Medicaid for Many” to the discussion, as the U.S. Senate is poised to vote on a bill in the next few weeks. Medicaid infrastructure exists in all states.
How it could work in Arizona
Arizona’s Medicaid program, called AHCCCS, operates through a CMS-approved 1115 Medicaid waiver. Medicaid is re-channeled through private health insurers through a multiyear bid process. Insurers compete for the Medicaid business, and are assured of enrollees for several years. Consumers are not subjected to the yearly volatility of changes in price, plans and benefits.
Insurers have time to build a contractual network with participating clinics, physicians, hospitals and other health providers; consumers can make sure their provider is participating. Arizona’s Medicaid program has the eighth lowest per-person expenditures of the 50 states, with two million AHCCCS enrollees among our population of seven million.
To make Nevada’s approach work in Arizona, our Medicaid 1115 Waiver needs amendment and CMS approval. With ACA tax subsidies and cost-sharing reductions, the out-of-pocket costs per person would be less than plans currently offered in Arizona’s Marketplace, with far less year-to-year volatility in pricing.
Let's take this debate nationally
Medicaid payment to hospitals and physicians tends to be lower than even what Medicare pays. To assure that there are enough hospitals, clinics, physicians, dentists and other health providers in the network, insurance vendors offering Medicaid plans would have to negotiate more reasonable payment rates with providers.
Jun 14, 2017 | Mohave Dalily News
PHOENIX (AP) — The only two insurance companies offering individual health plans on federal exchanges in Arizona have filed paperwork to continue selling coverage in 2018, raising hopes that the state can avoid a repeat of last year’s crisis when one county was briefly left without a health insurance provider.