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Health Reform Driving Local Changes

Regardless of the Supreme Court decision this summer about specific aspects of the controversial Patient Protection and Affordable Care Act (PPACA), otherwise known as “Obamacare,” the health care industry is changing and local health care organizations are preparing for those changes. To stay ahead of the curve, Flagstaff organizations are implementing new IT systems, coordinated and preventative care initiatives and other measures in preparation for major shifts in health care paradigm and practice.

One overarching shift in health care is increasing incentives and penalties toward value-based care. What this means is that almost everything being done under healthcare reform is driven by a need to improve patient health outcomes and satisfaction at a competitive cost. According to Steven W. Lewis, M.D., FCCP, chief medical officer at Flagstaff Medical Center (FMC), “Changes in health care are being driven by the health care industry. The industry is changing to a fee-for-value system, meaning payments will be tied to outcomes; payers are recognizing that these are the changes we need to make.”


New IT Initiatives and Patient Benefits

In order to increase efficiency, track patient outcomes and save money, health care facilities around the country are adopting new technologies. New Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs will provide payments to eligible organizations and hospitals as they adopt, implement and demonstrate “meaningful use” of EHR technology, further motivating the move toward electronic medical records and the data collecting, analyzing and sharing they make possible.

In Flagstaff, FMC just went live in April with a new Computerized Physician Order Entry (CPOE) program in which physicians enter all medication and care orders into a computer system. Dr. Lewis explained that FMC’s CPOE provides simple alerts, including warning providers about patient allergies and drug interactions. It also sends orders directly to the appropriate unit; if a patient comes into the ED and needs an MRI, that order goes straight to the imaging department. According to Dr. Lewis, the CPOE has also significantly decreased time the pharmacy spends interpreting orders.

Dr. Lewis said that although FMC is still working out some bugs and getting used to the new system, they “hope to connect the program to clinical decision support in the future. If a lab test suggests a certain med shouldn’t be used, or used less, the system will let us know. There are many more sophisticated uses for this system on the horizon.” For example, Dr. Lewis said FMC hopes to use the system for retrospective analytics, which will allow physicians to quickly query a large database to determine best practices. Dr. Lewis explained that, for example, “if a physician wants to look in detail at practice patterns, both nationally and locally, regarding patients with congestive heart failure, the physicians will be able to access a database cross-mapped by diagnosis, patients, their tests, patterns of care, medications and other variations in treatments to make more informed decisions and thereby improve patient care.”

Barbara Ladon, M.S., founder and executive of Newpoint Healthcare Advisors, explains why systems like CPOE will be so important in the new healthcare climate. “We need data to help us understand what works – what practices produce the best patient outcomes. That’s necessary under the new system, but it’s also good patient care,” she said. “The shift in health care, away from quantity of care and toward quality of care, is a real challenge and an opportunity and it requires a major culture change as well as better collection and utilization of data.”

Dr. Lewis reported FMC’s strategic plan for technological readiness for healthcare reform is “to get most of our physicians on Electronic Medical Records (EMRs), then to create a Health Information Exchange (HIE) from site to site for patient care. Once that’s done, we hope to create a data warehouse to collect and access data from that system,” he said. “In terms of the timeline, we are working on getting doctors on EMRs now, a HIE will be initiated over the next 12 months and the data warehouse is probably 18-24 out.”

According to Michael Zervas, CEO of Mountain Heart, “there is a lot of regulatory uncertainty about healthcare reform, but most organizations are building infrastructures to capture, share and report better patient data in preparation for the changes. We don’t know what the future of healthcare law will bring, but we took the gamble and became meaningful use certified last year.” Zervas reported that only about three percent of healthcare organizations eligible for meaningful use funds received certification in the first year it was available.

Both Lewis and Zervas said that emphasis is moving away from intervention and emergent care toward prevention. Zervas reported that Mountain Heart “now has wellness counselors, a dietitian, smoking cessation program and a partnership with Summit Health and Fitness. We hope there will be financial incentives for preventative care, but our doctors believe it’s the right thing to do regardless.”

Dr. Lewis agreed some changes are worth making now, despite regulatory uncertainty. “Setting aside the specifics of reform, from a strategic perspective, we do anything we can that has increased value for our patients,” he said, “meaning we are creating systems to support more quality of care for less cost.”


Looking to the Future

Zervas did express concern about the possible unintended consequences of the changes. “If the PPACA goes through as expected, there will be a huge increase in patient volume, a decrease in reimbursement rates and more pressure on primary care doctors to see more patients for less money. Organizations will have to become more efficient at tracking outcomes, but will they be as efficient at seeing patients?” Zervas asked. “Also, a lot of older doctors, those with the most experience, are sunsetting because they don’t want to meet the new requirements. Some of us are concerned about what it will look like when we have a huge increase in patients and decrease in experienced doctors.”

But Ladon said many in health care believe the changes are necessary. “We want patient involvement, lower hospital readmissions and a focus on patient outcomes over the amount of care. We are seeing more focus on patient education and disease management. These are positive changes, but they do take adjustments,” she said. “We must ask the questions: Are the outcomes, costs and patient experiences what we expected and hoped they would be?”

Like Dr. Lewis, Ladon said she believes these shifts in health care are good ones, although there will be implementation challenges. “There’s a lot of work putting these systems in place,” she said. “It may take a couple of years to adjust, but once the changes are made, I believe there will be a lot of buy-in.”

According to Dr. Lewis, “Most of us in health care think our system is wonderful, but agree it needs to get better. The move to a value-based system is a good move, the question is how to do it.”

Written by Kate Beles

Flagstaff Business News


NAU Undergrad Itching to Discover How Fleas Spread Plague


Health officials in the Four Corners region continue to wrestle with a persistent plague pandemic that has the potential to infect humans.

Northern Arizona University undergraduate Bret Clawson is tracking the plague in prairie dog populations to better understand the bacterium’s persistence and prevent widespread outbreaks.

Clawson, a chemistry and biomedical science double major, collected two species of fleas that live on prairie dogs to learn more about the genetic structure of the plague. It is research that may provide insight into how fleas move in rodent populations.

“Any population of rodents can have a plague outbreak,” Clawson said. “This research helps county health departments determine if insecticidal dustings are necessary and when to treat to minimize the likelihood of an outbreak.”

Between 1,000 and 2,000 cases of human plague are reported worldwide each year, and plague is present in wild rodent populations throughout the United States. And there may be a connection between rodent outbreaks and human infection – 14 percent of human plague occurrences in the United States coincide with plague outbreaks in prairie dogs.

“Previous studies have shown the greatest density of contemporary human cases of plague in the U.S. occurs in the Four Corners region,” Clawson said. “And prairie dog ranges overlap with the greatest concentration of plague cases.”

Clawson’s research builds on the work of Paul Keim, director of NAU’s Center for Microbial Genetics and Genomics, and Dave Wagner, NAU assistant professor of biological sciences, who published a study that traced the plague from China along its path around the world.

Keim and Wagner pinpointed the plague’s introduction to the Western United States to the arrival of infected rats that scurried off ships in the ports of San Francisco more than a century ago. Clawson employed Keim and Wagner’s research methods of genome mapping to better understand how plague persists in the region.

This spring, Clawson was selected to present his findings at the National Conference on Undergraduate Research at Weber State University in Ogden, Utah. He also recently earned the award for best undergraduate poster at the American Society for Microbiology’s Arizona and Nevada chapter conference.

“I felt honored to be given the opportunity to present my work at both events,” Clawson said. “One thing I took from the experiences was a great sense of pride for belonging to the scientific community.”

Clawson has been involved in every step of his undergraduate research project – from collecting the fleas to completing the genetic mapping – an opportunity he said makes his undergraduate experience at Northern Arizona University enriching and meaningful.

“NAU has such a great environment for studying in the sciences,” Clawson said. “I’ve benefitted from the individual mentorship of faculty members and I’ve had exceptional opportunities. ”

Clawson said his research will lead to better understanding of vectors for plague in flea species, and that he plans to apply the skills he gains at NAU toward the medical field in virology or endocrinology. He will graduate in May of 2013.



Popular Nursing Partnership Expedites Graduation, Ushers Students into Vital Jobs


A popular Northern Arizona University health professions partnership is delivering college degrees faster and filling a demand for health professionals.

From an initial enrollment of 38 students in summer 2011, a concurrent enrollment nursing degree program conducted by Northern Arizona University and Maricopa Community Colleges has grown to about 400 students, including 98 new students who begin this fall.

“President Obama, the Arizona Board of Regents and the governor are all calling for more baccalaureate degrees and for partnerships with community colleges, and that’s exactly what we’re doing,” said Debera Thomas, dean of the School of Nursing at NAU.

Providing even more motivation, the Institute of Medicine of the National Academies, in a 2010 report, called for 80 percent of registered nurses to be baccalaureate prepared by 2020.

“Hospitals in Phoenix and Tucson preferentially hire them,” Thomas said. “Moving from an associate’s degree to a bachelor’s degree, students learn more about public health, community health, research and leadership, and they get a foundation in nursing theory.”

Students in the program complete their associate’s degree during four semesters and one summer in a Maricopa County college while concurrently studying for their bachelor’s degree through NAU online courses. In just one additional semester, they earn their bachelor’s degree from NAU.

Community colleges participating in the program include Glendale, Gateway, Scottsdale, Estrella Mountain, Mesa and, most recently, Paradise Valley. Pima Community College in Tucson will join the program in January.

“Maricopa Nursing is pleased and privileged to partner with Northern Arizona University to offer this innovative program,” said Susan Mayer, Nursing Department chair at Glendale. “One of the goals of the Arizona State Board of Nursing is to increase the number of Arizona nurses with associate’s degrees who complete their bachelor’s degree, and we are certain that this program will help these nurses to achieve this goal.”

To qualify, students must already be accepted in the Maricopa nursing program, have a 3.0 GPA, and have completed the concurrent enrollment prerequisites.

Thomas said at least half of the initial group of 38 is expected to graduate in May 2013 with their associate’s and bachelor’s degrees because they chose to accelerate their studies with additional summer courses at NAU.

“Economically, that’s good for them,” Thomas said. “We use summers really well in this program.”

Thomas teaches the program’s introductory course, Nursing as a Discipline and Profession, in person, traveling to Phoenix once a week throughout the fall semester. Two sections of the initial course are also offered in the summer, with Thomas teaching one and NAU assistant dean Sally Doshier taking the other.

“We talk a lot about what nursing is, which is not like what most people think,” Thomas said. “Nursing is more about the relationship between the nurse and the patient than it is about doing something.”

The program is “very intense,” Thomas said, but there are rewards waiting for those students who make it through. “They all get jobs.”




Arizona Oncology’s Flagstaff Office Currently Enrolling Patients In Cancer Clinical Trials


Trials available for breast, colon, lung and pancreatic cancers

Arizona Oncology’s Flagstaff Office, locatedattheFlagstaffMedicalCenter campus in the building of the Northern Arizona Cancer Center, is currently conducting multipleclinicaltrials.Oneofthemisopento patients who require chemotherapy following breast cancer surgery. The other clinical trials are for patients with colon, lung, pancreatic, and other solid tumors. These trials are being offered locallythroughArizonaOncology. Becauseof Arizona Oncology’s affiliation with The US Oncol- ogy Network, it has access to US Oncology Research, which gives patients access to cutting- edge nationwide research and clinical trials. US Oncology Research has played a role in the de- velopment of 43 cancer-fighting drugs approved by the Food & Drug Administration (FDA).

Current trials run by the Flagstaff office include: • Twochemotherapytrialsforbreastcancer

patients, who have just had their surgery. One is a national trial looking at whether adding either Adriamycin or Avastin to basic chemotherapy is of any further benefit for the patients. The other trial looks at a new IV drug that may be better tolerated than most chemotherapy drugs, in combination with an

oral chemotherapy drug. • Twotrials,oneforHER-2positiveandone

for HER-2 negative breast cancer that has spread, each using a new oral agent that is not considered chemotherapy.

• Onetrialusinganewnot-yetreleased chemotherapeutic agent to combat early metastatic breast cancer.

• Twotrialsusinganot-yet-releasedbiologic drug in combination with chemotherapy— one for lung cancer that has spread and another for colon cancer that has spread.

Othertrialsavailableincludeoneforpatients with all types of cancer to study ways to prevent nausea in those undergoing chemotherapy for the first time; one to study results of oral treatments for chronic myelogenous leukemia; and yet another to study any cancers for the presence of a protein on the cells, that if positive, offers yet another new alternative biological treatment.

“FlagstaffandNorthernArizonapatients who are fighting cancer don’t need to travel far to receive the most comprehensive care. It is all available right here in Flagstaff,” said Peter Mathern, MD, medical oncologist. “Thanks to our affiliation with US Oncology Research, we are able to provide these clinical trials, which offer new treatment options and renewed hope


Dr. Paul Kuefler Dr. Peter Mathern

Serving Northern Arizona for over 20 years.  Arizona Oncology’s Flagstaff office is staffed by Paul Kuefler, MD and Peter Mathern MD (photo above,) both physicians who specialize in medical oncologyandhematology.

Dr. Keufler is a fellow of the American College of Physicians and has held a clinical assistant professorship at the University of Washington School of Medicine in Seattle. His articles have been published in a variety of medical journals, including Clinics in Hematol- ogy and the American Journal of Physiology. He received his medical degree from the University of Southern California and completed his intern- ship and residency at the University of Oregon Health Sciences Center, as well as a fellowship inhematologyandmedicaloncologyatthe University of Colorado Health Sciences Center.

Dr. Mathern is originally from Kosice, Czechoslovakia and is a former captain in the Czechoslovak Army. He received his medical degree from the Charles University Medical School in Prague and then completed his residency in medicine at the Vanderbilt University Medical Center. He did his research fellowship at the National Institutes of Health in Bethesda, Maryland and his clinical fellowship in oncology at the Boston University MedicalCenterinMassachusetts. Hisresearch has been widely published in journals including Journal of Clinical Immunology, Cytogenetics and Cell Genetics, Journal of Immunology, Pediatric Research and the Journal of Neuroimmunology.

The Arizona Oncology practice is located at 1329 N. Beaver Street in Flagstaff. For more information or to schedule an appointment, call (928) 773-2260. For more information, visit www.arizonaoncology.com.

About Arizona Oncology

Arizona Oncology is the largest group of medical professionals in Arizona devoted exclusively to cancer care. With more than 50 practicing physi- cians, we serve patients at more than 24 loca- tions throughout Arizona, including Cottonwood, Deer Valley, Flagstaff, Glendale, Green Valley, Marana, Nogales, Oro Valley, Phoenix, Prescott Valley, Safford, Scottsdale, Sedona, Sierra Vista and Tucson. We are proud to provide compre- hensive, compassionate, cancer care in a patient- focused, cost effective, community-based setting. Arizona Oncology provides patients with access to the latest treatments, state-of-the-art technology and access to cutting edge nation- wide research and clinical trials. We believe it is beneficial when these therapies are provided in a community setting, close to patients’ home and your support system. Our physicians are sup- ported by talented clinical staff members who are sensitive to the needs of cancer patients and their caregivers. For more information, please visit www.ArizonaOncology.com.


Arizona Oncology Encourages Sun Safety In Fight Against Skin Cancer

The month of May is set aside nationally to raise awareness of skin cancer, the most commonly diagnosed form of cancer in the United States. In fact it is estimated that more than two million people in the United States will be diagnosed with skin cancer. Dr. Paul Kuefler and Dr. Peter Mathern of Arizona Oncology encourages everyone to be aware of skin cancer year round.

Exposure to ultraviolet (UV) rays has been identified as the leading factor that increases a person’s chance of getting the disease. UV rays, which are produced by the sun, are more intense in the summer at higher altitudes and in areas closer to the equator. Overexpo- sure UV radiation from the sun causes sunburn (erythema), skin cancer, premature aging (skin wrinkling), cataracts (gradual clouding of the lens of the eye), immune system suppression, DNA damage and dilated blood vessels.

The most important way for a person to lower his or her risk for skin cancer is to avoid the exposure to the UV radiation, either from the sun or other sources such as tanning lamps. Arizona Oncology recommends the following practices for sun safety.


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