tucson.com | The Arizona Daily Star | June 26, 2015
By Stephanie Innes
After the U.S. Supreme Court’s decision on the Affordable Care Act Thursday, Tucson insurance broker Raymond E. Magnuson had one reaction — a huge sigh of relief.
By Associated Press | June 25, 2015
The U.S. Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama's health care overhaul, in a ruling that preserves health insurance for millions of Americans.
The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law.
The decision means the 126,000 Arizonans receiving tax subsidies won’t have to find another means of paying for health insurance.
The outcome is the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement.
Dan Derksen, director of the Arizona Center for Rural Health at the University of Arizona, said this will likely be the last time the ACA will be challenged in the Supreme Court.
"I think at this point we’ll be seeing efforts to try to fine tune the patient protection and affordable care act there may be efforts to try to change the way it’s financed and budgeted certain portions," Derksen said.
Earlier this year, lawmakers in Arizona passed a law barring the state from setting up it’s own exchange. Arizona is one of 34 states that don't run their own marketplace for health insurance.
Chief Justice John Roberts again voted with his liberal colleagues in support of the law. Roberts also was the key vote to uphold the law in 2012. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority on Thursday.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion.
Nationally, 10.2 million people have signed up for health insurance under the Obama health overhaul. That includes the 8.7 million people who are receiving an average subsidy of $272 a month to help pay their insurance premiums.
Of those receiving subsidies, 6.4 million people were at risk of losing that aid because they live in states that did not set up their own health insurance exchanges.
The challenge devised by die-hard opponents of the law, often derided by critics as "Obamacare," relied on four words — established by the state — in the more than 900-page law.
The law's opponents argued that the vast majority of people who now get help paying for their insurance premiums are ineligible for their federal tax credits. That is because roughly three dozen states opted against creating their own health insurance marketplaces, or exchanges, and instead rely on the federal healthcare.gov to help people find coverage if they don't get insurance through their jobs or the government.
In the challengers' view, the phrase "established by the state" demonstrated that subsidies were to be available only available to people in states that set up their own exchanges. Those words cannot refer to exchanges established by the Health and Human Services Department, which oversees healthcare.gov, the opponents argued.
The administration, congressional Democrats and 22 states responded that it would make no sense to construct the law the way its opponents suggested. The idea behind the law's structure was to decrease the number of uninsured. The law prevents insurers from denying coverage because of "pre-existing" health conditions. It requires almost everyone to be insured and provides financial help to consumers who otherwise would spend too much of their paycheck on their premiums.
The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrollment, a growing proportion of less healthy people and premium increases by insurers.
Several portions of the law indicate that consumers can claim tax credits no matter where they live. No member of Congress said that subsidies would be limited, and several states said in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits.
The 2012 case took place in the midst of Obama's re-election campaign, when he touted the largest expansion of the social safety net since the advent of Medicare nearly a half-century earlier. But at the time, the benefits of the Affordable Care Act were mostly in the future. Many of its provisions had yet to take effect.
In 2015, the landscape has changed, although the partisan and ideological divisions remain for a law that passed Congress in 2010 with no Republican votes.
The case is King v. Burwell, 14-114.
KJZZ's Carrie Jung contributed to this report.
Updated 6/25/205 at 10:30 a.m.
Cochise Regional Hospital wins Corporate Turnaround of the Year in a Small Market, awarded on June 23, 2015 at the Turnaround Atlas Award Gala & Dinner in Chicago, IL.
TURNAROUND ATLAS AWARDS honoring the best value-generating transactions, outstanding firms, teams and influential leaders, worldwide.
tucson.com | Arizona Daily Star June 15, 2015 By Stephanie Innes
Rural hospitals across the country are closing, but a newly formed organization in Southern Arizona is looking to buck that trend.
WHY THE WALK?
A bipartisan grassroots movement to petition Congress, state legislatures, and Governors to pass measures to ensure the sustainability of rural hospitals in America. The Walk will begin on June 1, 2015 in Belhaven, North Carolina and end on June 15, 2015 on the US Senate lawn in Washington, DC. This is a 14 day, 283 mile walk, each mile representing the 283 rural hospital in danger of closure, from Belhaven, North Carolina to Washington, DC. The Walk will be led by Civic Rights Legend Bob Zellner and Belhaven Mayor Adam O’Neal.
By Stephanie Innes
With the number of local deaths from drug overdoses now outpacing that of motor vehicle crashes, there’s a growing concern both in Tucson and nationally about prescription pain medications.
Arizona ranks sixth highest in the nation for individuals misusing and abusing prescription drugs, says Alyssa Padilla, a special projects coordinator at the University of Arizona’s Mel and Enid Zuckerman College of Public Health.
The Pima County Medical Examiner in 2013 handled 327 deaths due to overdoses, with the vast majority occurring because of opiate drugs, including oxycodone, morphine, heroin and hydrocodone.
By comparison, the office completed 197 autopsies on people who had died due to a motor vehicle accident in 2013, the most recent year for which complete data was available.
MultiPlan, Inc. today announced the recipients of its 2015 Rural Health Outreach Grant.
TUBA CITY, Ariz. - The American College of Surgeons (ACS) in March designated Tuba City Regional Health Care Corporation as a level III trauma center enabling the hospital to see and take care of more critically injured patients.
ACS has only verified one other Native American Level III trauma center. That one is located in Anchorage, Alaska.. The designation moves TCRHCC up a ranking.
Four and a half years ago when Dr. Ralph Zane Kelley, a trauma surgeon and also the chief of surgery and trauma medical director at TCRHCC, arrived he said the hospital was designated by the state of Arizona as a level IV trauma center. The designation by ACS is a national ranking.
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. ACS is dedicated to the ethical and competent practice of surgery, according to its website.
In a recent statement, ACS emphasized that the allocation of trauma centers should be based on the needs of the population, rather than the needs of individual health care organizations or hospital groups. And, at their core, trauma systems are developed to achieve care that is optimal for injured patients.
In the state of Arizona there were only 11 verified Level III ACS trauma centers. Tuba City is now number 12 on that list. By comparison, Flagstaff Medical Center is a Level I.
"The others are ... big names that you don't normally see Tuba City on that list with," Kelley said.
He said the designation is a big deal across Indian country because of the amount of trauma on reservations, which has been verified by studies.
"I'm Native American and I was trained in Las Vegas in trauma on the agreement that I would come out here because they have such a need for trauma surgeons on the reservation," Kelley said, adding that four of the five trauma surgeons in Tuba City are Native American. The hospital employs a Native American hand surgeon and an ER doctor as well.
In trauma terms, Tuba City sees everything from car crashes, ATV accidents, assault, gunshot and knife stab wounds, patients who were bucked off a horse, gored by a bull and elderly patients falling.
"We even see a number of trauma's that are from international tourists at Monument Valley or Grand Canyon," Kelley said. "The majority are native traumas."
Shannon Johnson, RN director of trauma program services, and Kelley worked the last few years for the current Level III designation with an initial visit by ACS in 2013 and the final visit coming a year and a half later. ACS specifically looks at the trauma patients an emergency department cares for - whether they are cared for or operated on at the hospital or whether they are shipped somewhere else. The organization also looks at how the ER department tracks care of patients, how they do peer reviews of all trauma patients, how the surgeons receive trauma credentials, and the equipment and infrastructure each hospital has.
Even with the new designation, TCRHCC still has limitations on head and spine injuries - those patients are still treated in Flagstaff or Phoenix.
In addition to providing a higher quality of care, trauma surgeons and orthopedic surgeons are on call 24-7, the trauma process is tracked so it is up to the standard that ACS sets for trauma centers.
"It definitely increases the quality and competency of care that trauma patients receive here," Kelley said. "Tuba City is probably the only place on the rez that has ER residency trained board certified ER physicians. Also we have general surgeons who are advanced trauma trained."
Johnson said, in addition, the hospital has trauma nurse core curriculum certified nurses and emergency pediatric certified nurses as well.
One of the biggest things that Johnson and Kelley want people in the region to know is that the designation means something because it is one of a limited number in the state and only the second Native American hospital to be designated.
"We're accredited by a national organization and we do care for a high level of patients and definitely care for and have a higher acuity of care than the majority of other reservation facilities," Kelly said. "Tuba is constantly adding new services and new specialties to keep patients on the reservation rather than having to ship them to Flagstaff or Phoenix where it is an inconvenience for themselves but also their families."
Governor Doug Ducey signed Senate Bill 1194 on February 24, 2015 which enhances the Arizona State Loan Repayment Program by expanding the types of providers who can receive loan repayment assistance, increasing the award amounts for the initial and succeeding commitment years, and removing the 4-year service cap. This bill will become effective on July 2, 2015.
The Arizona State Loan Repayment Program qualifies primary care providers working in underserved areas of the State. Through this new legislation, mental health providers, pharmacists and geriatrics will be added to the list of eligible providers joining the currently eligible primary care physicians, dentists, and advanced practice providers like nurse practitioners, physician assistants, and nurse midwives. The new law provides up to $65,000 of loan repayment assistance to physicians and dentists for a 2-year service commitment (a $25,000 increase from $40,000 previously). Advanced practice providers can qualify for up to $50,000 for a 2-year service commitment (up from $15,000). The incentives even get better as providers stay longer in the program. For each year of continued service in the underserved area after the first two years, physicians and dentists can receive up to $35,000 from $25,000 and for advanced practice providers, up to $25,000 from $10,500. Please check our website for any future announcements about the implementation of the new legislation that includes the application cycle opening for the added disciplines. Any questions or comments, please email Ana Roscetti.
By Mary Linker Arizona Sonora News Service
Doctors are becoming a scarce commodity in rural Arizona, and despite recent legislation, it seems like money isn’t the real answer.
In February, Governor Doug Ducey signed a bill which enhances the Arizona State Loan Repayment Program. The program is set in place to entice healthcare professionals, including physicians, general dentists, nurse practitioners, physician assistants and certified nurse midwives, to underserved areas by paying back their student loans.
The bill gets rid of the 4-year service cap on the program, as well as increasing the reward for physicians and dentists to $65,000 for a 2-year commitment and a continued award of $35,000 past those two years in a qualifying health professional shortage area. The bill will become effective 91 days after the legislative session ends.
According to Arizona Health Services, there are an estimated 400 designated health professional shortage areas in Arizona. Out of those, 153 are primary care HPSAs. A primary care shortage area meets qualification by having 3,500 or more people to every one primary care provider or a high need population of about 3,000. This means that Arizona has a primary care shortage that requires 442 new primary care providers to fill.
Ana Roscetti, a workforce section manger and overseer of the loan repayment program for Arizona Health Services, thinks the money will definitely help reduce those numbers.
“Salary is extremely important when you’re looking at a job, that’s just basic,” said Roscetti.
According to the Arizona Academy of Family Physicians, graduating physicians have an average debt of $170,000.
“That means if they commit for four years to this program, they can have most, if not all, of their student loans paid off. That’s a huge relief,” said Roscetti.
“We’ve already seen an increase in participants, just this year,” she said. “We had only 17 participants last year, and we have 34 this year. That’s a 100 percent increase, even before this legislation.”
Click on the link for the full article »
Story by Zac Baker; Part one of a two part series
Arizonans are feeling the effects of a doctor shortage that health care experts expect to worsen nationally in the next ten years.
According to a report by the Association of American Medical Colleges, the nation will face a shortage of at least 46,000 physicians by 2025, and Arizona is currently 500 to 750 doctors short, said Dan Derksen, director of the Center for Rural Health at the University of Arizona.
General access to medical care in rural areas and access to specialty care throughout the state are most affected by the shortage said Chic Older, executive vice president of the Arizona Medical Association.
Getting into a specialist’s office can be determined by several factors, “particularly if you’re in certain places or have certain needs or are of a certain age or a certain insurer,” Older said.
The aging population is also causing higher demands for specialty care. Chief Health Care Officer of the Association of American Medical Colleges Janis Orlowski said the percentage of the national population that is older than 65 is increasing, and aging people need more specialty care to stay healthy.
An increasing number of Arizonans that are now insured is also adding stress to the health care system, Derksen said.
About 500,000 people got health insurance in Arizona through the Affordable Care Act and Medicaid last year that previously went without it. The influx of people now covered is creating problems in rural areas, where doctor shortages have already been an issue, he said.
“A lot of the smaller communities around the state really have trouble recruiting and retaining nurses, dentists, physicians, allied health professionals,” Derksen said.
Many doctors choose to stay in large cities because that is where they completed their residency programs, he said. They are settled and comfortable in an urban center, and do not want to give that up.
To expose medical students to life and work in smaller communities, Derksen said new residency programs are being created in rural areas where shortages are most acute.
“The data is very strong that when you train people in underserved and rural areas they end up more often practicing in those areas where they’re most needed,” he said.
Derksen also said existing student loan repayment and scholarship programs are luring medical students to shortage areas. Doctors commit to working in rural or underserved communities in to receive significant financial aid.
Efforts to recruit health care professionals from rural areas are also important, Older said. A doctor from a small town is more likely to return and practice there.
A combination of these efforts and programs influenced James Duncan, a dentist, to practice at the Mariposa Community Health Center, which has facilities in Rio Rico and Nogales. Click on the link to read more »
Physicians (including a former CMS administrator) talk about their experiences with Medicare.
by Richard Peck
Contributing Writer, MedPage Today
This is the last in a four-part series, Medicare at 50, on the history and possible future of Medicare.
Focusing on the historic relationship of Medicare with practicing physicians, this series would not be complete without direct comments from physicians and policy experts familiar with physicians' issues. MedPage Today contacted practicing physicians and policy experts for their opinions on the program's achievements and problems. Some have already been cited elsewhere in these articles, some appear here for the first time:
Brobson Lutz, MD, Internal Medicine and Infectious Disease, New Orleans: "I've been in a partnership in practice since 1978, and we took a real hit with the fee freezes under President Reagan. I understand why they happened -- some specialists were increasing their fees to the stratosphere. Also, for something like back pain, a patient can't leave an orthopedic surgeon's office without studies of all kinds for something we treat all the time, and much less expensively. Physicians who do unnecessary tests have their consciences to live with -- I just won't send patients to them."
- continued at MedPage Today:
Wednesday, April 1, 2015
By NIHAL KRISHAN
WASHINGTON – The number of people with health insurance in Arizona rose even as the state economy was falling from 2007 to 2010, when both trends reversed direction, according to a recent report by the Census Bureau.
The report said the number of people with health insurance in the state improved slightly in the period from 2006 to 2013, going from 21.8 percent uninsured to 20 percent without insurance. That moved Arizona from fifth-worst in the nation to eighth-worst, the Census numbers showed.
Rural areas have higher mortality rates
BISBEE — So that emergency crews, nurses, doctors can provide the best treatment possible as quickly as possible, Copper Queen Community Hospital hosted a special training event in January.
Claudia Romo, RN and Emergency Department Infection Prevention Department with CQCH, arranged the special Rural Trauma Team Development Course (RTTDC) in connection with Banner Health and the AZFlex Program. The course was focused on developing a “trauma team” that would work together for the best possible outcome for injured rural residents.