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SOMBREROP i m a C o u n t y M e d i c a l S o c i e t y

Home Medical Society of the 17th United States Surgeon General

A P R I L 2 0 1 4

ACAs flawed economics A successful Mix-at-Six

Taos Pueblo artists visit Tucson

2 SOMBRERO April 2014

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PrintingCommercial Printers, Inc.Phone: 623-4775E-mail: [email protected]

PublisherPima County Medical Society5199 E. Farness Dr., Tucson, AZ 85712Phone: (520) 795-7985 Fax: (520) 323-9559Website: pimamedicalsociety.org

EditorStuart FaxonPhone: 883-0408E-mail: [email protected] do not submit PDFs as editorial copy.

Art DirectorAlene Randklev, Commercial Printers, Inc.Phone: 623-4775Fax: 622-8321E-mail: [email protected]

Pima County Medical Society OfcersPresident 7LPRWK\0DUVKDOO0President-Elect0HOLVVD/HYLQH0Vice President6WHYH&RKHQ0Secretary-Treasurer*XUXSUDVDG5DMX0Past-President&KDUOHV.DW]HQEHUJ0

PCMS Board of Directors(ULF%DUUHWW0LDQD%HQHQDWL01HLO&OHPHQWV0

0LFKDHO&RQQROO\20LFKDHOHDQ0+RZDUG(LVHQEHUJ0$IVKLQ(PDPL05DQGDOO)HKU0$OWRQ+DOOXP0(YDQ.OLJPDQ0.HYLQ0R\QDKDQ06RKHLOD1RXUL0:D\QH3HDWH06FRWW:HLVV0/HVOLH:LOOLQJKDP0*XVWDYR2UWHJD05HVLGHQW6QHKDO3DWHO25HVLGHQW-RDQQD+ROVWHLQ25HVLGHQW-HIIUH\%URZQ6WXGHQW-DPLH)OHPLQJ6WXGHQW

Members at Large RQDOG*UHHQ09HURQLFD3LPLHQWD0

Board of Mediation7LPRWK\)DJDQ07KRPDV*ULIQ0*HRUJH0DNRO00DUN0HFLNDOVNL0(GZDUG6FKZDJHU0

Arizona Medical Association Ofcers7KRPDV5RWKH0 SUHVLGHQW0LFKDHO)+DPDQW0 VHFUHWDU\

At Large ArMA Board 56FUHYHQ)DUPHU0

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Delegates to AMA:LOOLDP-0DQJROG07KRPDV++LFNV0*DU\)LJJH0DOWHUQDWH

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson, AZ. POSTMASTER: Send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily repre-sent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Ofcers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright ' 2014, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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Executive DirectorBill FearneyhoughPhone: 795-7985Fax: 323-9559E-mail: bill [email protected]

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On the CoverLooks like August 2013 had true dog days at New Mexicos Taos Wo}U`Z}.r}]o]vPZ}}(}u]oovv]uX^Z]u}vZ[Behind the Lens(}Z`}l}(d}`Z}]]d}vvo (Dr. Hal Tretbar photo).

#$%*)%

Established

Established

Medical SocietyExchange

Authorized Answering Service for

Se Habla Espaol2434 N. Pantano

WE ANSWER FOR YOU!* Pagers* Voice Mail* I.V.R. (InterActive Voice Response)

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((("#"#!!""%#!((("#"#!!""%#!((("#"#!!""%#!

) PCMS News: z}v`]WD^}]}vX

11 Valley Fever: Dr. John N. Galgiani has a cocci o}oovv}voo X

14 Behind the Lens: Dr. Hal Tretbar visits with Taos Wo}]v}`v(}Z^}Z`/v]vArts Fair at the Arizona State Museum.

17 In Memoriam: Dr. Diane Bracht, 59.

18 Makols Call: X}PDl}o.vu}Zvo]'o]}v]vZ>L[}v}u]}]}(ZRight.

20 WDvPuvW^v}}](}Po}Z(}u[(}u]oX

22 Mix-at-Six: The inaugural PCMS social at W]vd]u}ZDZoo[Z}u`(oX

23 WWtZ}[}]]vPZ]Uv`MX:}v&}uv}vZ[G`economics.

25 CME: dKD&[^}Z`v}v(v}vMedicine is here this month; AAPS says you can P]v}v}o}(}X

Inside


Healthcare Stang, Inc.Favorite

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/(+#-%-"+-7!,+/#!Pima County and the Arizona "%-"+(&&.#-1,#oers top quality personnel and (&)+",#/,-7!,+/#,0#-"preferred rates and pricing for Pima County Medical Society members.

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The 23rd Annual

Southwestern Conference on MedicinefiApril 24 - 27, 2014 | JW Marriott Starr Pass Resort & Spa | Tucson, Arizona

Register online at www.tomf.org/cme


Superior medical care, right in your neighborhood!

Steven JBlatchford, MD

A. J. Emani,MD, FACS

James A. Gordon,MD

Adam D. Ray,MD

David T.MiyamaMD

OFFICES LOCATED IN:

Call our office today to schedule an appointment!

(520) 792-2170

Valley ENT is proud to offer Southern Arizonaresidents the most comprehensive treatment of the diseases of ear, nose and throat (ENT).

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^hv]o,oZ^]]}v}(Zv}v[oPZ}]o}uv]U}vPu}ZvZ]}oZoZ(]o]in 37 states, including two in Arizona. The company brings v]Z]}oZoZ]vv}Z]}uuv] Uv]}}]]Pv].v}Pv]P}`Z(}W]u}vv]vu}(vuv]vZ]}}(o]v]oXE}o Uh,^`]oolooking to expand child and adolescent behavioral health ]vv}(Pv]v^}Zv]}vX

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dDWô,W}PuP]}}vTucson Medical Center reports that it has has launched a Structural Heart Program that expands cardiovascular services, ûl]vPdD}vr}]v}v(}oo}(]uvX/}](oovP}((}Z]vPo]l}vPv]oZ(Uo}ouU}]}u}Z Uwhich includes problems with the heart muscle.

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THE PCMS A LLIANCE

Cordially Invites You To Join Them For:

WineCountry

6:00-9:00 p.m.Saturday, May 3

St. Philips Plaza (Courtyard)4280 N. Campbell Ave.

For Information / Tickets / Sponsorships:

https://itrulycare.com/events/wine-country-in-the-desert

Contact: Anastasha LynnEmail: [email protected] or Phone: 520-820-1622

Please join us for wine tasting and tapas as we raise money forMobile Meals of Tucson and honor the hardworking PCMSA members.

Tickets are $75. Sponsorships available.

In The Desert


Valley Fever

Cocci gets some national props, but how about here?By Dr. John N. Galgiani

Arizona has not always been the coccidioidomycosis epicenter, as it is today.

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REFERENCES

,]Zuvv:sXdZoZ]}}(}]]}]}u}]Wr1945. o]v/v(]V~WrX

&vK:UD]ootX}]]}]]v(}vW}(]u]v(}v]vZovP`]Z](}u}vvZo]vPXuZTuberc VWrX

,}Z&UZZ(}tUdvPUZ>DUD}'KU]vPU&PvdU>]uvUoX}]]}]}u}]}uu}v}(}uuv]racquired pneumonia. uP/v(]V~WrX


Native American art drops in on TucsonBy Hal Tretbar, M.D.

Behind the Lens

/.uZd}Wo}Uuul&vlD]ovZ]v]U}'Pam Lujan-Hauer, at the 2014 ^}Z`/v]v&]

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tZv&v]}s}}v}[]}vZZin 1540, the pueblo was described as having adobe houses built o}}PZvl.}]}]Z]PZXdZhomes became narrower as they rose, with each level providing G}}v(}Z}}X_/o}}lZu} X

The Rio Pueblo, also called Red Willow Creek, starts in the (}}Z]oo}(Zvd}D}v]vX/G}`Z}PZZu]o}(Z}u}vU]]]vPZo}]v}v}Zv}Z}(}]o]vPX

K]P]vooZ`(``]v}ànd no doors. The rooms were entered through square holes in the }}(Zo]u]vPo}vPwooden ladders, which could be `]Z`v]v}('lX}}v'`]v}`v}òo}`'Xòooo}vthe pueblo, and electricity, running water and indoor plumbing are }Z]]XY](`(u]o]o]elsewhere, but visit their two-room Z}u}LvXDv}(Zuvv]vUvgallery is open to the public.

Kv}(ZPoo]}}Zv/o}}l]v}(uuFrank Mirabal and his nephew Bobby oX&vl](u}(}Z]}o]}(Z]uXdZ]vuvu}Eu]vvP}(}u]vPZu]v(}uvXtZv}}ouZZ'vZ^}Z`/v]v&](}uv U/}oZ]u``}oo}}lZuX

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/vv(}uv/vv]v] UZ]Z]}Z}}(Z`}l]vul]vPuW^dvl}(vv}'}v`}}Zv}`vPZUo}l}+Uvoo}`}(}ou}vZ}Uv]vP}vZ]}(Zo}PX,]}(UolU+o}U}}`]Urhaired, and soaked. Hides are then cut, stretched over the Z}oo}`r}o}PUvXdZZ]uooPZ}Zu[]o]vvZ}vYdZ]Z}(Zuv}vZ]uvZ}(ZuUZvPZ}(ZUZ}(Z`}}Uvv}(Z`}}X_

Mirabal has won many awards around country and has been included in a û]Z}v]vZ]]X/v}^}Z`v/v]v&]}Pv]Z]LuvZ]`]ZZ`}(oov]vd]}voTribal Arts.

^/]Z}'}v`}}}ZZ}v[o]U_&vl}ouX^/[uZvU}/o]l}u}`volZ]X/o``]Zr}`vZ}vP(}'Z}oX_>Z]U^Kv}(u]PPu`(}urr}o}'}v`}}}(]v]uX/}o]]v^}v(}UX_

&vl[v]Wu>ivr,ZZ}'}v]o}}ZvZvvXuu}(d}Wo}Zul]vP}'a child. She was inspired by two great-v`Z}`]}vo}'X^Z'v}ooPZ/v}(u]v/v]v]vAlbuquerque, N.M.

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Pam digs and processes her own clay. She u]vol}o]vvu]}ov}v]v]vP]}(lou]vv}Northern New Mexico. She told me her car Zu]v}(]}`vvoo}`Zv]goes past a clay deposit! She uses the coil uZ}}(}vPv.Zu]v]}kilns with burning cedar.

For several years Pam made microchips at Sandia Labs at Albuquerque. During a process }v}+v`vuo}vZZ][(UZv}Z}o}Z(}uXLv]]ov}UZ(uZ}}(.]vP]o]vo]vZo XtZv.]vv}v`]Z]temperature control, minerals that are present combine with the heated silver to ]v}`}(}o}X

Wu>ivr,[`r`]vv]vP`}l]available in galleries in Taos, Santa Fe, oUvZ/v]vL^Z}Zuv}(Z/v]}]vtZ]vP}vUXX/v]}vZ}vpurchased at the Heard Museum in Phoenix, v]vd}vZ/v]vX

d}Wo}}oU&vlMirabal, and Pam Lujan-Hauer have all commented about what an outstanding vZ^}Z`/v]v&]]Uvall plan to return next year. Q

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J O H N D . L E V I N , C L U 6 0 1 1 E . G R A N T R D . T U C SO N , A Z 8 5 7 1 2

5 2 0 . 7 5 1 . 2 0 0 0 J O H N @ WM SA S S OC I A T E S . C O M

W W W . W M ST R A T . C O M

DI SAB ILI TY LI M I TS ON THE RI SE YOU EXAMINE YOUR PATIENTS EVERY DAY, OFTEN DISCOVERING RISKS NOT OUTWARDLY APPARENT. BUT HOW OFTEN DO YOU EXAMINE YOUR OWN RISKS? IT MIGHT BE TIME TO TAKE A CLOSER LOOK.

Pi m a Co u n t y M ed i ca l So c i et y an d W e a l t h M an agem en t St r a t e g i e s a r e p r o u d t o o +e r m e m b e r s a n ew d i sab i l i t y i n co m e i n su r an ce p l an . Th i s exc i n g p l an o +e r s d e e pl y d i sco u n t e d i n d i v i d u a l an d b u si n ess d i sab i l i t y p l an s , an d u n l i k e m a ny p l an s , t h e sa m e l o w p r i c i n g ap p l i es t o b o t h m en an d w o m en . Dep e n d i n g o n y o u r n e e ds , y o u can ch o o se a pl an o r co m b i n on o f p l an s t h a t can h e l p y o u : Pr o t ec t y o u r i n co m e i f y o u ar e u n ab l e t o w o r k , o r u n ab l e t o r e t u r n t o y o u r f u l l d u t i es Co n n u e r e r em en t co n t r i b u o n s o n y o u r b eh a l f Co v e r b u s i n es s e xp en ses Pr o t ec t an y b u s i n es s p a r t n e r s Pr o t ec t y o u r r ev e n u e i f a key em p l o y e e i s d i sab l e d

Associates of Wealth Management Strategies o+er securies through AXA Advisors, LLC (NY, NY 212-314-4600), member FINRA, SIPC. Investment advisory products and services o+ered through AXA Advisors, LLC, an investment advisor registered with the SEC. Annuity and insurance products o+ered though AXA Network, LLC. Wealth Management Strategies is not a registered investment advisor and is not owned or operated by AXA Advisors or AXA Network. AXA Advisors and AXA Network are not a8liated with Pima County Medical Society. PPG 69384 (07/12)














Dr. Diane Bracht 1954-2014

In Memoriam

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]v>XZUDXXU}}vovuPvu]]vphysician who joined PCMS in 1997, died Feb. 28 in hospice in Tucson. She was 59. Sidelined by illness, she had been an Associate Member since 1999.

]v>}]Z`}vXU]vZZvU^]]XdZ(u]o}]vZ]}v]o^ that she P]v(}uô}]vZ}o],]PZ^Z}}o]vd}vUand earned her undergraduate degree in 1975 at The University }(]}vX

^ZP(}udZhv]]}(]}v}ooP}(D]]vin 1978, and interned at Maricopa County General Hospital. She `}r.]vuPvu]]vv]WZ}v]vov}}[,}]o]vWZ}v]U}vrdZ}Hospital in Carson City, Nev., and Barton Memorial Hospital in ^}Z>ldZ}Uo](X^Z}}vou]]vv]u`]ZZ]U/vX]vô]vUEXU]PvodZ}t}uv[]v^}Z>ldZ}UvPvv}}vou]]vdZ}ur]D]ovin Tucson.

XZ[(}uZv]WDûuXZ}W'}v}(Z}ooW]]X,Z]ovD]Zovoo]}vW'}vUvher mother, sister Mary, and brother Michael survive her.

uu}]o]`P]vDZ]&vo,}u[o}vZoXdZ(u]oZuu}]o}v}vu}EKZvZE}voKPv]}v(}Z]}(rarediseases.org) Q


Makols Call

Perchance to dreamBy Dr. George J. Makol

My maternal grandmother o]]v}ZUL]uu]PvP}Zhv]States in the late 1890s. I used to take long drives with her Z}PZZ}vvcountryside, as she reminisced about events she had experienced in her long o](uX

^Z}ou}Z.electric lights coming to her home and street, seeing the

.ur}}u}]oZZv]}]vZuoo}uuv] UvZ]vP}]uvvP(}uZradio in her own living room.

My mother is now in her 90s, and one of the things she says most }Lv]ZZ`}oo]l}(ooov}ulin the future for just one day to see the wonders that she can only imagine now. Perhaps medicine will have conquered most disease, people will live in excess of 100 years in good health, `}o`]ooZvZ]U}o]]v`]ooZ}vYwell, at least a couple of those are more likely.

I, however, have no such grandiose thoughts. I cannot imagine what could occur more than 100 years in the future. But how about just six years?

>[}(ooo(}Z]voo}v]vUv`}li]o]vXvi(}(vUo}`}ov`]Z}voZZo]vr}](}uZ]U`]Zoovuv}o]ooXdZchallenge would be to correctly ascertain which candidate won Z]voo}vUv`Z]Z}v}oo}vPUjust by analyzing the headlines:

Headline No. 1, The Wall Street JournalU:vXW^Kv]vZpeople experienced poverty for at least two months between vX_&Z]vPZ}`hX^XvZ}`Z}o]u(}u`vvv]vU}v} Uv]v}(}vXdZ[an easy one: the investment banker rich guy must have bested the community organizer, the only way such a travesty could occur.

,o]vE}XUThe Wall Street JournalU&XWdZ}Zo]v^dZZ}Z}vv_oZZ]Z}vv}(v}`l]vv}(v}voZ}Z}o]v}u~v}`Xv}]vP}

updated census data), even though they add up to only one u]oo]}v}v}}(u}Zvu]oo]}vu]vXP]vUthis is easy, because only the investment banker would favor the ]Z}ZPU}ZuZ`}vZo}vJ

,o]vE}XU(}uZ}(>}ÛDZWôlvuo}uvvX_dZ]]}oZvwhite unemployment rate, with black teens showing an vuo}uv}(vXdZ]]PvP}}JdZrich white guy must have won, and thus we have this predicable awful outcome.

>[oo,o]vE}X}u]o}v}(]}}W}vP]oo]v}}+}ZoZ]vv}P}oou]vX,}ÙZv}o]v}`}ZoZvo] Uv}u'Z}ùnlikely to occur, sharply driving up insurance premiums for more Zv.u]oo]}vu]vU}o]vPZuv]vX/vv}uv]`]oovi}}}.U}o]]}vo}o]}o}oZv`}v}(Z}o}v`]oov}`ZvX&ZUZW]vZ}]]vv^vZ_ZPv]vv}uv}.Uo]vPZtaxpayer to foot the bill if they do not enjoy a windfall. Boy, only a corporate raider or a Wall Street guy would let this happen; this }ov}}v,r(}Zmiddle class.

,o]vE}XUThe Wall Street Journal:vW^^](}u}]vPZ}v}u X_dZ]}v}ZZ]ou]oouv`Z}`}l(ooruuoZvZ]}Z}u]v`Zvi(}]vG}v~UXUXvvvo(u]o]v}uZ}ou}U(}u}Xdol}ourvlXKvoW]v`Z}did not care about the middle class, like some rich investment vlU`}o}Zv}v}u XdZvKoWmust have controlled both chambers under such a President, for what else could account for this?

Well, we only have three more years of this kind of leadership, and then perhaps some history or law professor can become President, and due to his friendly nature there will be world X&Zu}U}v`]ooulZu Uo]]vZsame kind of houses, and be safe from those Wall Street types who I guess ran the country while I was asleep.

I can dream, cant I?

Sombrero }ouv]}P:XDl}oUDXX`]ZAlvernon Allergy and Asthma, 2902 E. Grant Rd., and has been a PCMS member since 1980. Q


Medical professional liability insurance specialists

providing a single-source solution


A perfect storm for medical practices^v}}]

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dZ}vui}}u(}]Z+}o[u}o]}v}(Z]vP]vv}uvZoZ}vsystem as we have known it. Companies like mine, with uo}}PZZvu}Zv(}Uvov}.ZZ}P}v}uZ^v}(Z+}o_v`]ooZ(}vooZv}(Z}o]]}XK8Z}ZZ]+}vvoZl]vPo]P]]o] UZ}}/Uvvv]vPl}]vPoo]vv(}v`]v(}u}vUu]oo]}v}(vZvv}.}(voo}vUvZ}vo}v]^}(`Z_M

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Now youreThinkin SmartSimplify your communications with Simply Bits state-of-the-art managed voice and data services

ROC #278632


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{}v[}v}vZD}}}v}VDv}`vu}}(]u}vZ}PZoo]vPvo}]vP}voo}(Z}uv]vP]v}v}}lXLD(}Zu]}}(Z+}owhen no one knew what would really be involved in it, AMA membership dropped sharply.

{&]voo U}v]]vP]vP}]oo]vPback to a local company, so that you lv}``Z}v]U`Z]o}o}}vPZd}veconomy.

/vovo& UD]]Zo]v}(}u}]vPthe Medicare Sustainable Growth Rate (SGR). KZU}v}vW,}`Zo}(Zo}.vvMdZ]uP}uv} UZ]oo]v(}u}}`Z}](}}]}become mandatory unless the repeal actually is enacted.

AMA has talked about this permanent repeal (}uvX/Z}/[u`}vPUZZPooP}u}.X

^v}}]]]v}(W}(]}voD]oDvPuvU/vX^Z`}l`]Z(}u]}vZX]+}Uv^vX>+}]vPoP]o}vZ.v^uouv_]v]}vo U}}u]o(}uZZvro]o}(uv(}]X^ZZ]v}(Z]}vD]ooo]vvZd}v^uZ}v Uv^}Zv]}vZ}[]]P}v}]vrX,Zv]]]]vv(}uD]vZ}v}}]UDXX Q

We oer comprehensive

tinnitus consultations.

Your patients deserve the best hearing care possible

We are preferred providers on most insurance plans.

Learn more about why we are a preferred audiologistplease visit our website: www.arizonahearing.com

Janis Gasch, Au.D. Doctor of Audiology, Founding Director

520.742.2845 # )+("

520.742.2845 ("%&%+("

520.648.3277 512 E Whitehouse Canyon Rd, Ste 196

Green ValleyHelping you hear your best.

The Faces of Casa are the

Agnes C. Poore, RN, Co-founder and Chief Clinical Ofcer

Hospice is a special eld of work. I love hospice because we can truly

make a difference for individuals and

their families at a very precious time

in their lives.

520.544.9890 | www.casahospice.comHospice services are paid for by Medicare


WD^W]vXd]uDZooò}u}ooPvv`]vv}Z]o}o(}}Z]ooZ}uDZ(}Z[.D]rr^]}]o(Dennis Carey photo)X

X:vK]vvX]loU(}P}vUP}lv}`}v}(XDZoo[`}Z]PZo}or(]vo}ov]U`]v[Z`ZZZ]]E]}}Z]}vZ(Dennis Carey photo).

]ò}uPZD]rr^]DZ`}o]v}`]vZo]v(}}Z]oo]]o(}uXd]uDZoo[Z}uX(Dennis Carey photo).

Mix-at-Six

dZ.WD^D] rr^]}]oUDZZ(}}Z]ooZ}u}(PCMS President Timothy Marshall, M.D., was a resounding XXDZoovZ]`](Uv]Uò}uu}ZvuuvP(}vv]vP}(]v(}uo}v}vvo}vX

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Dr. Marshall and Denise put together a `}v(ov]vPU_WD^]}]oo&vZ}PZ]X^/ZvlZu(}}]vPZPi}v(}]vPoutstanding hosts. By all accounts the event was a huge success. We received many compliments, and many guests thought Mix-r^]`P]X_

Future Mix-at-Six socials will be given Z}PZ}ZXE}.}v}coming events will be in ^}u}, on the Society website pimamedicalsociety.org, and sent by e-mail. Q

First Mix-at-Six successful


Who will provide the careunder the Affordable Care Act?X:}v&}uv

&}uZP]vv]vPU}ZWvW}}vv+}o~Z(}}vZ}v}u]v}o]ou].}v}(ZoP]o}vU`Z]oZo`[o]v]oconsequences cannot be underscored enough.

t]ZZ[G`}u]vP]ou}vU][u(}a long-overdue discussion on the impact ACA will have on u]oU}}UvZ]vX/[uU(}u,}^lEvWo}](u}o](}]Ù(}}^.v}`Z]]v]X_

}Z]oo]}o}v}]u}ZoZo]vo}`}U]oo}v]ZX/}v}ZoZ]vv(}}uU'benchmark than than this would be actual access to healthcare. dZ]u}(ZoZ(}u}vZv]v]vat best.

As interpreted by the U.S. Supreme Court, ACA gives states an }}v}vo]P]]o](}D]]}}o`]ZZ}Z}o]v}u}v}(Z&oW}>o~&W>U`]ZZ(oP}vuv}vPv}(v]}v}]vZ}PZXLZUZ(omatch will gradually decrease, reaching 90 percent by 2020.

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/[oP]u}vUv]o}vZvPv]voZ}]vP}]u}(}Zu}vuv`(}P}]vP}`vZ]ZXZ]}}[`]ZoZXP}ZZ}`vUZl(}}high just to wing it.

Medicaid is beleaguered by bureaucracy, ballooning expenditures, poor access, and low-quality care. The current D]]o}o]rul`]Zo]'o}}u}control costs other than by paying Medicaid providers less. }]vP}u](o]]}ZoZ]vvX/u]v}v`Z}(vZov]vZZvP`]oo}+X

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/v(UZ]o}]]o]ZZZvP`]oo(}^}Z}'}u_vZZ]ov`]oovoov(}u]v}^D]]o]U_`]Zuv}(ZuGànd drawbacks that plague Medicaid.

P}vuv(}ZoZov]vZZvP}}+u}]Uvo]u]Z]o]}(Zov}]vu]uUZ]vu}o(}Z}uv]}v]Pand maintain solvency in this regulatory climate are limited. One P]}'}vPUZoZvvZPZuu}X,}Ù}uv]}vv}]u]u}vZ]u}PZ]Uuv}(Z}vPvZoZ]vo]lo}oZulv}}Z]v]]ouv[penalty instead because it will be cheaper than the premiums.

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ZvPv}v}o]u}vP(`}}UZoZplans will likely have more market power to drive reimbursements down. This will make providers even less willing to take these

vvUo]lZ}]vD]]UZv}ov}v]vovPZ`]uU(}]vPZu}v}vuPvuv(}care.

A September 2013 Medical Group DvPuv}]}v}(u}ZvUP}(}vZZmedical community shares these }vvXK(ZU}vo29.2 percent planned to accept exchange products, while 14.4 percent had already ]ZZ`}ov}XdZ}(the surveyed medical groups were ovPZ}}]}vvl}`v]XK(Z}v}ovv]vP}]]vZZvPUv]}vv}Zu]v]ZoUXv]}vv}}oo}vUvv]}vvabout reimbursements.

States, health networks, hospitals, and }]vZG]]o]}o}`}vuZv]ZoZv}(Z]}uuv]U]oo(}Z}vwho are the most medically needy and .vv]ooovoX

While it is certain that the ACA will change u]o(}uvvU]]u}uncertain at this point whether the impact }(Z}ZvP`]oo(}Z'X

WD^uu:}vX&}uvUDXXU](vZoZ}ouv](}Daily Callerv}Ztv]vo]}vUvZ}v}uuv(}]}odsv`}PuX}r.]v/DUZvZ]vPP]v}v}u](}udZ:}Zv,}l]vhv]] UvZ]DXX(}uo]v]v}ooP}(D]]vX,],oZW}o]&oo}`}(Z,]P&}v}vXdZ]].]vZ:}vo}(Z:uD]}v/vX Q

We are Tucson.

W

Barry Kirschner

Williams Centre | 8th Floor | t 520.790.5828

An independent member of LAW FIRMS WORLDWIDE

www.learnabout wechv.com


CME

AprilApril 24-27:dZd}vK}Z]D]o&}v}v]vi}]vsponsorship with Cleveland Clinic present the 23rd ^}Z`v}v(v}vD]]v:tD]}'^WZ}v^UP]vv]vPWXuXdZvvv]vPZ}PZWp.m. Sunday.

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Members ClassiedsPHYSICIAN NEEDED: HealthySkin Medical and Cosmetic Dermatology is seeking a dedicated professional to join our growing practice! We are a team of 9 providers committed to our patients, staff and each other. Were looking for a compassionate, personable BC/BE Dermatologist interested in practicing clinical dermatology. Our group consists of 4 general dermatologists, 1 Mohs Fellowship trained surgeon, 4 physician assistants, an on-site radiation therapy department, clinical and cosmetic lasers, and a fully staffed skin care department. HealthySkin Dermatology has been established in Southern Arizona for over 20 years with 4 main practice locations. We offer a 4-day work week (no nights, no weekends), a competitive guaranteed salary, production bonuses, comprehensive benets including insurance, disability, 401(k), prot sharing, CME time and allowance, vacation time, and an opportunity for partnership. You will enjoy instant success with our EMR, established patient base and new ofces encompassing over 20,000 sq. ft. of state of the art facilities. Call today for details, Samantha Marques, Practice Administrator (520) 293-5757, ext. 7113 or [email protected]. Visit our website at www.healthyskinderm.com. (1-14)

PRACTICE OPPORTUNITY: Growing Sub acute and long-term care practice is looking for part time, full time or per diem Physicians (MD/DO-Internal medicine/Family Practice) to provide care in Post-acute care facilities (SNFs), assisted living, adult care homes in Tucson and Green Valley. Experience in these settings is a plus. Flexible hours, competitive salary, make your own schedule. Contact: Harbir Singh, MD, Pinnacle Healthcare. Phone: 247-7665, Fax: 204-1940.


For eighty years, Radiology Ltd. has been working with community

physicians to provide the highest quality care for those closest to you.

Patients are welcomed by our Guest Services staff who help them feel comfortable

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World Class Imaging Services

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We take care of those closest to you.

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