FAMILYPHYSICIANS Strong Medicine for Utah

UTAH ACADEMY OF FAMILYPHYSICIANS Strong Medicine for Utah

Health Care and Mobile Tech

Although mobile technology can make many aspects of patient care easier and more efficient, never forget the importance of the direct communication between patients and physicians. That’s one aspect of medical care that hasn’t been replaced.

Congratulations to 2019our Family Medicine Resident Graduates! Day on

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CONTENTS2019

Executive Director’s Message 4 President’s Message 5 2018/2019 Utah Academy of Family Physicians Board of Directors 6

Class of 2019 8

2019 Match Results for Family Medicine 10 Getting to Know Outgoing President Dr. Nikki Clark 11 CME & Ski Conference 14 14 UAFP Members in the News 16 Member Spotlight: Dr. Mahana Fisher 18

Resident Spotlight: Dr. Tyson Schwab 20 Student Spotlight: Dr. Jordan Albrich 21 Back To (Medical) Basics in Guatemala 24 Don’t Put Off That Checkup! 26 Legislative Session 2019 28 Lunch with a Legislator 29 24 Family Medicine Day on the Hill 30 America Needs More Family Doctors: 25 X 2030 32 In Memoriam 33 Rural Roots 34 Utah Medicaid Expansion 37 Health Care and Mobile Tech 38 Effect of the Utah Medical Cannabis Act on Private Employers 40 29 Participation by advertisers does not constitute endorsement by the UAFP

© 2019 Utah Academy of Family Physicians | The newsLINK Group, LLC. All rights reserved. UAFP is published two times each year by The newsLINK Group, LLC for the Utah Academy of Family Physicians, and it is the official publication for this association. The information contained in this publication is intended to provide general information for review and consideration. The contents do not constitute legal advice and should not be relied on as such. If you need legal advice or assistance, it is strongly recommended that you contact an attorney as to your specific circumstances. The statements and opinions expressed in this publication are those of the individual authors and do not necessarily represent the views of Utah Academy of Family Physicians, its board of directors, or the publisher. Likewise, the appearance of advertisements within this publication does not constitute an endorsement or recommendation of any product or service advertised. UAFP is a collective work and as such some articles are submitted by authors who are independent of Utah Academy of Family Physicians. While Utah Academy of Family Physicians encourages a first-print policy, in cases where this is not possible, every effort has been made to comply with any known reprint guidelines or restrictions. Content may not be reproduced or reprinted without prior permission. For further information, please contact the publisher at: 855.747.4003. EXECUTIVE DIRECTOR’S MESSAGE

Maryann Martindale

As the new Executive Director of UAFP, I am excited to help direct the future of the organization.

L to R: Barbara Muñoz, Program Director; Kyle Jones, MD, FAAFP, UAFP Board President; and Maryann Martindale, Executive Director.

s Heraclitus said, “The only sible for multi-million-dollar budgets, improve practice management, and also thing that is constant is and presiding over communication address issues that impact the general change,” and the Utah Acad- and public relations efforts. health and welfare of our patients. emy of Family Physicians has seen significant change in After 20 years, I finally decided to make Joining me on this journey is our new A the past few months. the move to where I had been passion- Program Director, Barbara Munoz. I ately volunteering and filling in with my had the opportunity to get to know As the new Executive Director of UAFP, spare time — nonprofit work. I first Barbara several years ago and have I am excited to help direct the future joined Planned Parenthood of Utah, been consistently impressed with of the organization. I would be remiss after which I began my five-year tenure her knowledge, creativity, commit- in not acknowledging the good work of at Alliance for a Better Utah as their ment, and compassion for helping long-time executive director, Jennifer first executive director. others. Barbara has spent the past Dailey-Provost, who left UAFP last fall decade working in the nonprofit sec- after being elected to the Utah State I am excited about the future of the tor and brings a wealth of experience Legislature. academy. The work our academy is do- and great ideas to our programmatic ing ranges from our CME & Ski, that work, and is an invaluable partner in My journey to UAFP was indirect. I be- provides a fun educational opportunity, our joint efforts. gan my professional career in the cor- but also has the potential to be a signifi- porate sector, working primarily in tech cant money-maker for us, to our legisla- I look forward to getting to know more and publishing while managing large tive work, where we help craft and pass of you and working with you to grow numbers of employees, being respon- legislation that serves family physicians, the practice of family medicine.

| 4 www.UtahAFP.org PRESIDENT’S MESSAGE

Nicole Clark, MD

hange. codes that will decrease the burden of documentation, but also change the payment for these new codes. There For some of us that is a positive word. For many is a new blended model which is more beneficial to primary of us, we cringe when we hear it — especially in care than the original proposal to essentially average levels medicine. Regardless of which group you fall into, 2 through 5 E/M codes to one payment for new and estab- Cchange is inevitable in the world of medicine. The things we lished patients. Furthermore, the rollout has been delayed used to prescribe for our patients 15 years ago to treat diabe- until 2021. More to come on that in the future. tes mellitus has changed. Every time there is an “update” in my EMR, something changes. And let’s not even start with insur- Another big change the AAFP has worked on is the challenge ance companies and formularies! Sometimes the changes are of maintaining certification for most family physicians. Time welcomed and other times it makes you question your choice and time again, the membership voiced their frustrations of career. Change is the best word to describe the past year with the financial and time burden all of the MOC activities for me as president of the Utah Academy of Family Physicians. required AND the test every 10 years. The AAPF leadership has worked closely with the ABFM (a completely separate en- At the state level, there were some big changes. Voters turned tity) to come up with the new Family Medicine Certification out in the midterm elections to legalize medical marijuana. I personally think this is a BIG change for our state. It has raised Longitudinal Assessment (FMCLA) pilot as an alternative track as much excitement as concern over what this means among to the traditional MOC and test. Currently this is only available both the general population and medical communities. It is to those who are due to certify in 2019 but if it is successful, still a work in progress in terms of who will qualify for it, who this may change the way we maintain our board certification. will be prescribing it, who will produce it, and how it will get to patients. I do think it will result in changes for some family The UAFP has had big changes this year within our own office. medicine practices. It also may change the lives of many of In 2018 we said a sad good-bye to both our Executive Direc- our patients. I have had several of my patients ask about it, as tor and Program Director within a few months of each other. I am sure many of you have had as well. Where are we going We were very fortunate to welcome Maryanne Martindale as to get the information to decide how it will fit in our practices? our new ED and Barbara Muñoz as our PD. Both come from The UAFP can and will be a resource to turn to, to help with strong backgrounds of working for nonprofit organizations. many of these questions. They bring a wealth of knowledge and experience to help us move forward to grow the UAFP and provide more services Another big change in the state as a result of the voter’s voice to our members and patients. Already they have started the was Medicaid expansion. This will likely have a major impact “Weekly Beat” on Fridays to keep you updated on quick, but on our practices as 70,000-90,000 adult Utahns will now have relevant information — check your email, it’s there! The UAFP coverage under Medicaid. Many new enrollees will seek care website will be getting an update and many of the changes in our offices who have not been eligible in the past. They will that are coming will make it easier to navigate. Hopefully it will bring new problems and new challenges to already stretched become a go-to resource for everything family medicine in the providers. It may cause some practices to consider capping state of Utah. They are working on improving our CME & Ski the number of Medicaid patients they accept. How will your to meet your educational needs. Please reach out to Maryann practice adjust? The UAFP can be a resource for you. and Barb with any questions; they really are fabulous. Finally, a bill passed allowing pharmacists in the state of Utah the ability to dispense OCPs to patients without a prescrip- I have been very honored to be your president, but my year has tion from a physician. This has led to concerns in the family come to an end. Like I said, change is inevitable. In this case, I medicine community on encroachment on our practice of can promise you that this change will be very beneficial to all of medicine as well as concern for our patients. The UAFP was you. Your new president for the next year, Dr. Kyle Jones, is an able to work with the legislature to assure that there were exceptional leader, physician, and person. He will be a power- some criteria and limitations put in place to address many ful voice for you on the local, state, and national levels. of the concerns you raised in a survey we sent out last year. Thank you. On the national level, there are always changes. The AAFP has worked with CMS on the future changes to the E/M Nicole A. Clark, MD, FAAFP www.UtahAFP.org 5 | 2018/2019 Utah Academy of Family Physicians Board of Directors Thank you for your service on the UAFP Board! Executive Committee

Nicole Clark, MD, FAAFP Kyle Jones, MD, FAAFP Chad Spain, MD John Berneike, MD President President-Elect Treasurer Past President

At-Large AAFP Delegates and Alternates John Berneike, MD Rob Mehl, DO, FAAFP Chad Spain, MD AAFP Alternate-Delegate James Besendorfer, MD, FAAFP Isaac Noyes, MD Daniel Chappell, DO Darlene Petersen, MD Kirsten Stoesser, MD, FAAFP AAFP Delegate Nicole Clark, MD, FAAFP Brent Pugh, MD Vanessa Galli, MD Sarah Scott, MD Peter V. Sundwall, MD, FAAFP AAFP Alternate-Delegate Dave Grygla, DO, FAAFP Kathy Shen, MD Tyler Hansen, DO Chad Spain, MD Sarah Woolsey, MD, MPH, FAAFP Nicholas Hanson, MD Jesse Spencer, MD AAFP Delegate Anne Hutchinson, MD, FAAFP Karyn Springer, MD Kirsten Stoesser, MD, FAAFP Kyle Jones, MD, FAAFP McKay-Dee Family Medicine Marlana Li, MD, FAAFP Peter V. Sundwall, MD, FAAFP Resident Representative Jacob Saunders, MD Michael Magill, MD, FAAFP Sarah Woolsey, MD, MPH, FAAFP St. Mark’s Family Medicine Resident Representative Ian McDaniels, MD Mission Utah Valley Family Medicine The mission of the Utah Academy of Family Resident Representatives Bethany Jackson, MD Physicians: To improve the health of all Utahns by Michael Chen, MD advocating for and serving the professional needs of family physicians. University of Utah Family Medicine Resident Representatives Zoë Cross, MD Vision Benjamin Brown, MD The vision of the American Academy of Family Medical Student Representatives Cooper Feild Physicians and the Utah Chapter: To transform Jordan Albrich health care to achieve optimal health for everyone. Daniel Payne

| 6 www.UtahAFP.org

Class of 2019 Congratulations to our Family Medicine Resident Graduates!

University of Utah Family Medicine Residency

Ben Brown, MD Briana Rueda, MD Jason Lippman, MD Julia Kammel, MD Early Career Sabbatical Allina Health in Burnsville, MN University of Utah Sports University of Utah Sports with Future Career doing Family and Integrative Medicine Fellowship Medicine Fellowship Plans Pending Medicine

Rachel Caspar, MD Rachel Goossen, MD Rebecca Curran, MD Zoe Cross, MD University of Utah Clinical Attending at the StARR Program at the University of Utah Family Addiction Medicine University of Utah/Family University of Utah Medicine OB Fellowship Fellowship Medicine Residency Program

St. Mark’s Family Medicine Residency

Jessica Wilkinson, MD Alec Kitch, MD Ian McDaniels, MD Brent Shepherd, MD Foothill Family Clinic Urgent Care physician University of California, University of Utah Draper, UT with Intermountain San Francisco, HEAL Occupational Medicine Healthcare, SLC, UT Initiative Fellowship, Residency, SLC, UT Oakland, CA

| 8 www.UtahAFP.org McKay Dee Family Medicine Residency

Jeffery David, DO Valeria Dias, MD Derrick Hall, MD Weber Human Services Locum Tenans Portland, Oregon Ogden, Utah Texas

Jonas Peterson, MD Rusty Stodtmeister, MD Derek Wille, MD Weber Human Services Reno, Nevada Cody, Wyoming Ogden, UT

Utah Valley Family Medicine Residency

Holly M. Anderson, MD Craig B. Batty, DO Michael K. Chen, MD Bobbie L. Christiansen, DO Foothill Family Clinic Ashley Regional Medical University of Utah South Jordan University of Utah Geriatrics Salt Lake City, Utah Center Health Center Fellowship Vernal, Utah Salt Lake City, Utah Salt Lake City, Utah

Scott R. Curtis, MD Michael Lon Henderson, MD Christopher V. Robertson, MD North Sevier Clinic and Sevier United Regional Physician Group. Billings Family Clinic Valley Hospital Wichita Falls Tx Cody, Wyoming Salina, Utah

www.UtahAFP.org 9 | 2019 Match Results for Family Medicine

Congratulations to the following University of Utah medical students who matched into family medicine:

• Maryana “Ana” Boulos: Contra Costa Regional Medical Center – Martinez, CA

• Chad L. Roberts: St. Mary-Corwin Medical Center – Pueblo, CO

• Jacob (Jake) Mitchell: Utah Valley Hospital – Provo, UT

• Andrew O’Farrell: Manitoba – Canada

• Alexys Allen: Forbes Family Medicine – Monroeville, PA

• Jordan Albrich: PeaceHealth Southwest Medical Center – Vancouver, WA

• Brian Espiritu: UT Medical Branch, TX

• Cooper Feild: Indiana University Health Ball Memorial Hospital – Muncie, IN

• Daniel Payne: Utah Valley Hospital, Provo, UT

• Zac Flinders: Utah Valley Hospital, Provo, UT

• JD Marett: HealthONE – Lone Tree, CO

• Gabi Cash: Harrison Medical Center – Bremerton, WA

• Marco Valdez: Idaho State University – Pocatello, ID

| 10 www.UtahAFP.org Getting to Know Outgoing President Dr. Nikki Clark

combines both. I practice medicine and I What made you decide to teach medical students during their three- become a physician? Did you year family medicine residency. always aspire to be part of Describe your education the medical industry? background. Why did you I was exposed to the world of medicine at a very young age. Both my parents were specialize in family medicine? nurses, and my uncle was a doctor, so the I got my undergraduate degree at the Univer- dinner table conversation was either really sity of Colorado. I took two years off to work, cool or really gross, depending upon your travel and play, and then went to medical perspective. school at the University of Vermont.

My mom was the ultimate nurse; she had the white dress and the matching cap, and Are there any specific indi- she was dedicated to the patients in her viduals who had a major im- care. She was a nurse for 45 years, and I remember her frustration with some of the pact on your career decision? doctors when she made suggestions about Well, other than my parents, it would be patients. For me, the career path was al- Dr. David Flinders. He’s retired now, but, he ways that of a doctor — or nothing. was the ultimate family doctor. As students, we all wanted to be him. He did it all — he I grew up in a VERY small town in Vermont. delivered babies, saw patients in clinic, did We had a wonderful family doctor in our rounds in the hospital and performed mi- town. Everyone knew everyone and when nor surgery. He was also very involved with it came to medical care, our doctor was at the Academy on a national level as well as the center of it all. In medical school I was the UAFP. He set the bar very high. able to spend a rotation with our family doctor and I loved it. I also really enjoyed I have also been fortunate to meet amaz- my rotation in the emergency room, but I ing people — I call them “minute mentors.” quickly learned that I enjoyed the relation- They are the colleagues who are there when ships with patients — I was always the one I need them, and then they move on. I think asking about the progress of a patient once we all have these people in our lives, and I they left the E.R. think the challenge is to recognize them and learn from them. I thought about becoming a teacher, and the cool thing is that my career these days Dr. Nikki Clark | Continued on page 12 www.UtahAFP.org 11 | Dr. Nikki Clark | Continued from page 11 What is the most rewarding part of your career? I think a really big realization is this: This is a two-part thing for me. Working working harder won’t make it better. as a member of the residency faculty, I When we as physicians feel stressed still see patients. I love that I can cel- ebrate the best times with my patients and anxious, it’s time to refocus and and I have the honor of guiding them take care of ourselves, so we can through the hardest times. It’s such a take great care of our patients. range of care, and I really like that. It’s up close and personal — I see the impact, firsthand, in what I do.

As a fulltime faculty member, I get to Another big trend is the aging of our dustry. Sometime in the 80s, insur- teach brand new doctors and follow their population. I’ve heard it called the “sil- ance became a business, with profit growth as they become leaders within ver tsunami,” and it will affect health margins and stockholders, and sadly, I their field and their communities. Medical care in all areas. For instance, years think the patient part got lost. I can’t school teaches students the science of ago, the baby boomers were the top af- tell you the number of times I’ve had medicine, and a residency teaches them fected demographics for breast cancer, to change a treatment plan because in- the art of being a doctor. It’s an exciting and billions went into research, treat- evolution — especially when your former surance wouldn’t cover it — and that’s ment and cures. Today, the survival rate student becomes your boss! a big frustration for every doctor. for breast cancer is higher that it has I love teaching. Back when I was de- ever been. As the baby boomers are I also think that electronic medical ciding on a career, teaching was right aging, they again are the affected de- records need to be more doctor- alongside medicine. mographic for geriatric illnesses, most centered. I’m optimistic that this is a notably Alzheimer’s and dementia. The fixable concern, but insurance and baby boomers are the wealth genera- EMR systems don’t interface. Making What do you think will be tion — they wield a great deal of money the complete care picture available, a some of the dominant — and I believe that we will see billions problem. pouring into research and treatment trends within the medi- again for dementia related conditions. What is the most impor- cal industry in the next The question will be about who will provide the care. I think it’s safe to say that tant aspect of being a 5–10 years? many geriatric patients will be under the care of family physicians. UAFP member? I think the business of medicine will be I believe it’s about having a voice. A completely altered in many ways. As Family medicine has been dubbed the united voice. Family medicine is a busy some patient conveniences emerge, “womb to tomb” specialty, so I think a specialty, and it’s easy to be focused on like online RX and video conference ap- great deal of the care of these patients our individual practices and patients. pointments, the concern would be for will fall to family physicians. After 15 The UAFP represents us as a collec- scattered care, especially with the per- years in practice I went back and com- tive group, and makes sure that our ception of less access to primary care pleted a fellowship in geriatric medi- concerns get to the right ears. On a na- physicians. We are seeing a big growth cine at Maine Medical Center in Port- tional level, the AAFP has over 135,000 in nurse practitioners and physician as- land, ME. In the future I fully believe family physicians, and together we can sistants — all of which we need — but that we, as family physicians, will be the focus will need to be on how to work stepping more into geriatric care. accomplish so much more than we together, as a team, with the doctor as ever could alone. the team leader. There needs to be clar- ity between the differences of physi- If you could wave a mag- With the UAFP, we can be a part of the cians, nurse practitioners, and physician ic wand, what would be change we need in this industry, and assistants and what they can and can’t on a level that fits. We can participate do. We are NOT the same. I don’t like be- the one thing you would as we can, when we can, and we’re still ing referred to as a “provider.” I didn’t go like to see change im- effective because there’s a group. to “provider” school, I went to medical school: I am a physician. mediately in the medical What inspired you to That being said, we’re on the upswing industry? serve as a leader within with medical students choosing family I’m going to need more than one magic the association? practice. By 2030, the AAFP has a goal wand! I would like to see patient care that 25 percent of all medical students be dictated by what is best for the That would be more of a “who” than will choose to go into family medicine. patient, and not by the insurance in- a “what”! I’ve been involved with the

| 12 www.UtahAFP.org UAFP for seven years. A mentor of mine, Dr. Flinders, sug- gested that I might enjoy becoming involved with the na- Are you involved in any civic or chari- tional Congress as a delegate. He was right, and for the next table organizations? six years, I was heavily involved and loved it. Jennifer Dailey- Provost convinced me to look towards board membership, Yes. I am a big supporter of Planned Parenthood. In my life and here I am. I’ve moved through the chairs and it’s been a I have written only one “Letter to the Editor” for my local very rewarding experience. paper, and it was an opinion piece defending this organization. Along with patient care, it provides a training site for In looking back at this year, what stands comprehensive women’s health to family medicine and OB/ GYN residents around the country. I personally believe that out for you? Are there any accomplish- 99 percent of what they do, we need more of. Planned Par- ments that you are especially proud of? enthood is women and family centric in their services, and in today’s climate, I think their services are valuable. This year was a really big transition year for our association. Right before a very busy time, we brought on a new I am also a big supporter of the Humane Society and Best executive director (Maryann Martindale) and a new pro- Friends Animal Sanctuary. gram director (Barbara Muńoz) — and I’m going to say this here, we were very lucky in finding the right people. Both Maryann and Barbara dove right in and the results have If you look at your career and life, been impressive. what would be three things you have So what am I proud of? Well, nothing fell apart! I think that learned that you would pass onto a I am leaving the association in great hands. I believe that we are moving forward and we will grow. I am very proud student choosing their specialty? of what we have done in the past, and what we have the First, choose the area of specialty that you truly love, not the potential to accomplish in the future. one that will pay off your student debt the fastest. I think doing what you love is paramount to a long and successful ca- There are many stressors for health- reer. Medicine is demanding and we all spend a lot of time at care providers, specifically physicians. work so make it something that brings you happiness and joy. What do you do to keep a healthy per- Second, take care of yourself. Sleep. Make sure you get a lot spective and to maintain balance? of sleep. Good decisions are made when you are well rested. I think the big thing is to remember that you are a person And finally, never stop learning. Medicine, more than any before you are a doctor. It’s like parenting, really; before you industry, I think, moves at lightning speed. A lot of what we were a parent, you were a person. And people — all people, were learning or what was being advocated even five years including physicians — need certain things, like hobbies and ago in the medical field is now outdated. The only way to interests outside of work, vacations, and time with family keep up with Dr. Google is to stay educated. and friends.

I also tell others in the medical field, including myself, that If you could describe the best day in every once in a while it’s helpful to return our thoughts to why we are in this field. I think the answer, for the most part, your practice, what would it look like? is that we want to help people and we want to make a differ- My best day would be about time. Extra time. I would spend my ence in people’s lives, and to do that, we need to be present morning seeing patients — with plenty of time to chart. Maybe a and be with the patient in the moment, and let the outside walk during my lunch break. And then, either seeing more patients stuff disappear. or teaching. I would finish on time, go home while it’s still light and actually be home, without charting or making notes. I would also I believe that being centered and grounded is a skill worth developing. It’s really easy to pick up the stress and anxiety cook something yummy to eat — that would be a luxury! of others and make it your own — especially when we’re seeing patients all day. Tell us about your family. There’s a new AAPF CME course that specifically addresses It’s just me and my two Australian Shepherds, Jemma and Jasper. physician burnout. I had a colleague sign up, and for him, it was life-changing. The tools he learned improved his life, What is your favorite way to spend his practice, and his relationships with his patients — he was able to enjoy his practice again, and his life. your free time? Any unusual hobbies?

I think a really big realization is this: working harder won’t I spend a lot of time walking my dogs. I like to read nonmedi- make it better. When we, as physicians, feel stressed and cal books — mostly exciting adventure/spy stories; I love to anxious, it’s time to refocus and take care of ourselves, so cook, and travel to visit friends. I am lucky that I have a lot we can take great care of our patients. friends all over the country with extra guest rooms! www.UtahAFP.org 13 | CME & Ski ebruary 21-24, 2019 marked another successful CME & Ski at the Westgate Resort in Park City, Utah. For the fourth year, UAFP hosted doctors from Utah and around the country to engage in educational topics such as ADHD, urgent care, dermatology, and diagnosing dementia. It also F included a pre-conference KSA on women’s health. This CME conference is gaining some loyal attendees who come each year to learn from some of the best physicians in the country, who work and live right here in Utah. It doesn’t hurt that while they learn, attendees and their families are able to ski at a world-class resort and enjoy the many amenities of Park City.

UAFP is committed to continuing the CME & Ski as well as providing other CME opportunities for our members. We hope that you will join us next year, February 20-23, 2020 in Park City for another weekend of fascinating topics, presenters who are experts in their fields, and the greatest snow on earth!

Be sure to join us again in next year February 20-23, 2020! Details soon at our website at www.utahafp.org.

| 14 15 | UAFP Members in the News

Dr. Woolsey named to AAFP Commission

r. Sarah Woolsey was recently named to the Health (formerly HealthInsight,) Utah’s quality improvement American Academy of Family Physicians Com- activities and regional health improvement collaborative. mission on Quality and Practice. The Quality and She co-chairs the Utah Partnership for Value, a multistake- Practice Commission is one of eight commissions holder group that forwards value healthcare delivery and that direct implementation of AAFP policies and patient engagement in Utah. She has worked in primary Dprograms. The commission works to improve the practice care for 20 years with underserved populations in Salt Lake environment of family physicians. It directly supports the City as a full-spectrum family doctor. Dr. Woolsey is pas- AAFP's Strategic Objective on Practice Enhancement, an sionate about patient engagement in chronic disease man- area of expertise for Dr. Woolsey, and we are fortunate to agement and empowering primary care providers in these have her involved in shaping national policy. times of change. She was chosen as a Centers for Medicare & Medicaid Innovation Advisor in January 2012. Sarah Woolsey, MD, MPH, FAAFP, is board-certified in family medicine and a current Medical Director with Comagine

Dr. Stoesser named Residency Director

r. Kirsten Stoesser has been named the new Kirsten Stoesser, MD, FAAFP, is board-certified in family University of Utah Family Medicine Residency medicine. She joined the faculty of the University of Utah Director. after completing a fellowship, faculty development participating as a core curricular faculty member. She continued The University of Utah Family Medicine Resi- in that role for 10 years before being named Associate Pro- Ddency program trains family physicians in dynamic and in- gram Director. She was named as interim Program Direc- novative practices. She is already looking at ways to expand tor in April 2018 and formally named as Program Director the programmatic offerings of the residency with goals for in January 2019. Her clinical interests are broad spectrum suboxone treatment and the development of ultrasound family medicine, including hepatitis C care and transgender training curriculum over the next year. We are confident care. She has been a board member of UAFP since 2017 and Dr. Stoesser’s experience and passion will be a great as- represents the Utah chapter as a Delegate to the AAFP Con- set in furthering the University of Utah’s Family Medicine gress of Delegates for 2018-2019. Residency program.

| 16 www.UtahAFP.org Despite living with osteogenesis imperfecta (brittle bone disease), Dash can boogie down! When he was born, his family wasn’t sure he’d ever walk. But surgery and regular treatments at Shriners Hospitals for Children — Salt Lake City make him stronger, enabling him to walk, run and even dance. Now his family believes in miracles. Shriners Hospitals for Children — Salt Lake City has been changing the lives of children like Dash since 1925 through state-of-the-art pediatric orthopaedic care. Services include inpatient and outpatient surgery; physical, occupational and speech therapy; custom wheelchairs; orthotics and prosthetics; outpatient clinics; low radiation imaging and a motion analysis center. All care is provided regardless of a patient’s ability to pay. Learn more at ShrinersSLC.org. Member Spotlight Dr. Mahana Fisher By Barbara Muńoz

ong before opioid addiction was making national He came across information about a training in Salt Lake City headlines as a healthcare crisis, Dr. Mahana Fisher for medication-assisted treatment (MAT) and started reading was seeing the devastation of substance use disor- up about the process and the medications involved. He be- der in his hometown community. came waiver-trained in 2002 and began providing MAT in his practice. Dr. Fisher struggled to convince other providers to LA lifelong resident of Utah, Mahana Fisher graduated from join him, however, in the early days of providing the treatment the University of Utah School of Medicine and completed of SUD, primarily due to a lack of understanding and diag- his residency in family practice at the University of North nosing, very limited resources, the difficult nature of treating, Dakota SW Campus in Bismarck, North Dakota. One of the and the incredible amount of provider time consumed. It can primary reasons he chose family medicine as a specialty also take many years of tremendous effort on the part of the was that he hoped to return to a rural community like the healthcare team and the patient to see results. one he had grown up in, Blanding, Utah, and practice the whole scope of medicine. When asked why he continued to provide MAT despite the level of effort involved, Dr. Fisher says, “MAT gives people Dr. Fisher returned to his hometown community that he their lives back. You have a lot of failures and many patients knew and loved, where friends, family, and even his par- just aren’t ready for it. But it’s the few who have struggled, ents still lived. He worked for seven years for the San Juan and then finally break through and become productive after County Health District and then Utah Navajo Health System spending many years of their lives bound by their illness, from 2007 to 2017. As the area has a history of experiencing that keep us motivated as providers.” a shortage of healthcare providers, he was able to gain a wide range of medical experience in family practice, ER, and Fortunately for Dr. Fisher, Lori Wright felt the same way he did. in-patient medicine. When members of his family began to When Wright and Dr. Fisher met they discussed two of her pri- move to the St. George area, he looked to move his practice mary goals for Family Healthcare: to provide MAT to patients to be closer to them and that’s when he met Lori Wright, struggling with addiction to opioids and to practice integrated CEO of Family Healthcare, a Community Health Center lo- behavioral health. Dr. Fisher says what he was trying to de- cated in southwestern Utah. They both knew very quickly velop for his practice in Blanding was integrated behavioral that Family Healthcare was going to be a good fit for the healthcare, he just did not know what it was called at the time. ambitious doctor. When working with his patients with SUD in Blanding, Dr. Fisher wanted to bring a counselor in at the point of care. Problems in His Hometown At Family Healthcare, this kind of integrated care is now When he began his medical career after residency, return- standard practice. ing to the community with so many people he had grown up with in Blanding and Monticello, Dr. Fisher was surprised at the number of people who were struggling with substance Integrated Health Care and MAT use disorder (SUD). Even more alarming was the number of When a patient comes in for an MAT initial consult at Fam- those addicted to prescription medications. People he had ily Healthcare, a behaviorist, Dr. Fisher, and a case manager never treated before were coming in just for pain medica- all see the patient. Each meets individually with the patient tion and that trend continued to evolve and worsen over and then all three conference before they go back in and see the next decade. the patient together. Dr. Fisher says his part in treating SUD

| 18 www.UtahAFP.org Dr. Fisher was surprised at the number of people who were struggling with substance use disorder (SUD), and even more alarming was the number of those addicted to prescription medications. People he had never treated before were coming in just for pain medication and that trend continued to evolve and worsen over the next decade.

with medication “is easy” with a limited SUD team spent months delving into tors are seeing the benefits of becom- choice of medications. He prescribes other underlying trauma and comorbid ing waiver-trained and offering treat- the medication to prevent withdrawals conditions, she is finally taking control of ment. “After providers start treating and cravings while allowing the patient the diabetes. Uncontrolled diabetes with patients with SUD and these patients to become functional and allow time many ER visits and hospitalizations was stabilize, they are so much easier to for the brain to heal. The behaviorist her way of dealing with the other prob- work with and manage than they were works with the patient, developing skills lems. One treatment recommendation before treatment.” and providing tools to cope with life’s of a behaviorist was obtaining a service challenges, which allows the patient animal. As an only child with a history Providing treatment for opioid addiction to return to full functioning. The case of trauma, she needed a “sibling.” And it also means helping patients manage manager works closely with the patient, has helped tremendously. pain differently. Dr. Fisher says if those providing additional resources, and struggling with pain can try different also helps to track the patient’s pro- alternatives, in many cases that is all it gress. The case manager also serves as Barriers to Treatment takes to prevent them from requiring a contact and resource for patients to One of the things that has most drawn opioid pain medication. Behaviorists can access when they are struggling. him to working within the Community also help patients understand that near- Healthcare Center setting is the abil- ly everyone experiences some pain, and Dr. Fisher emphasizes that co-morbid ity to treat patients, including patients they help them live everyday life with conditions are nearly always present with SUD regardless of their ability to realistic expectations with some pain. in someone struggling with SUD. Many pay. The number one reason for not Sometimes simply working with the pa- people have a psychological predis- seeking care, according to a study tient to try a modality such as stretching position for addiction, but then some- done by the American Academy of Ad- and exercising is enough, but for the pa- thing in that person’s life sets it off. He diction Psychiatry, was funding,” ex- tients they cannot help, they refer them also sees trauma as one of the primary plains Dr. Fisher, “70 percent said they to the pain management clinic to try to underlying conditions that sets some- didn’t seek help because they could find nonaddictive alternatives. one on the path to SUD. Family Health- not afford it.” At Family Healthcare, care also employs a full-time Psychiat- they see a large number of uninsured ric APRN, who does a comprehensive patients who benefit from MAT. They The Journey Continues psychiatric evaluation to determine continue to treat those patients, even accurate diagnoses and specific treat- though they are losing money on the Despite the funding issues, the time it ments for the patient, with or without program. Dr. Fisher emphasizes, “We, takes to work with patients with SUD, SUDs. The comorbid conditions fre- as a healthcare community need to and the setbacks they often face dur- quently seen in SUD include illnesses find ways to funds patients who need ing treatment, Dr. Fisher is committed such as having bipolar, experiencing treatment.” to MAT and integrated health care. “My treatment-resistant depression, ADHD, whole journey — it’s been almost two and many personality disorders. decades now — was to help patients MAT and Managing Pain get the treatment they needed and Having the mental health providers as Differently to learn myself how to treat those pa- part of the healthcare team has helped tients. That was the initial mission, and Dr. Fisher better recognize the mental The number of eligible providers re- since I’ve been at Family Healthcare, health issues in other patients as well ceiving MAT waiver training has grown the second half of my journey is to help — particularly trauma. His experience significantly since Dr. Fisher started providers understand substance use, is helping him and other providers to providing the treatment in 2002. the patients suffering from this illness, be more aware of, screen for, and treat “There are no longer other alternatives and offer appropriate medically-assist- trauma as well. He tells the story of a for patient seeking opioids,” Fisher ed, multidisciplinary-integrated care.” young women who has type I diabeties. says. “The door is being closed for pa- She was frequenting the ER every week tients who are ‘Doctor shopping’ to go Mahana Fisher, MD, is the Associate Medical Di- with blood sugar levels either soaring or to other providers just to get an opioid rector of Family Healthcare, in St. George, Utah crashing. After Dr. Fisher and his entire prescription.” Dr. Fisher believes doc- where he also lives with his family. www.UtahAFP.org 19 | Melissa V. See, MD, MPA Resident Spotlight Tyson Schwab, MD

quality improvement projects this year in patient satisfaction and technology, I feel more confident as a physician with new ideas, possible solutions, and evidence-based medicine.

An additional academic experience this year has involved forming and researching a clinical question following the PICO format (patient/problem, intervention, compare/control, outcome). I have been able to pursue a musculoskeletal topic that I am interested in learning more about and becoming a potential expert on. During this experience, residents work closely with one of our faculty members who is an expert in teaching and training residents to utilize databases to research evidence-based answers to clinical questions and scholarship. The primary objective of this experience is to think critically, communicate expertly and create professional development. The ultimate goal for the resident is to generate and publish the final report with the Family Physician Inquiries Network. n 1940, President Franklin D. Roosevelt proclaimed, “In American life the family doctor performs a service which Residency has provided some of the most priceless experiences we rely upon and which we trust as a nation.” Although of my life. I have always appreciated speaking with seasoned many aspects of family medicine have changed since attending physicians about their life and the significant role 1940, this quote remains true today. In my personal and residency played in personal development. As a residency Iprofessional opinion, I believe the future of family medicine is family, my co-residents and I have experienced some of the extremely bright with endless opportunities. highs and lows life has to offer. In many instances we have enjoyed the magnificent experience of bringing new life into My co-residents and I are consistently learning about what it the world. Most recently I had the wonderful opportunity to means to be a family physician and how to fulfill this incredible personally deliver my third child. It was a special experience to role and responsibility. The role of a family physician use my new skills as a physician to bring my daughter into the involves adapting to frequent shifts in responsibilities such world. This experience was amazing to share with the nursing as continually acquiring knowledge, mastering practice staff and family medicine residency faculty and other staff who management, participating in community involvement, have supported me in all aspects of my life. making and sustaining multiple relationships and teaching duties; all while balancing a healthy personal life. Overall, I’m a firm believer in the idea of working hard and playing these collective experiences are the origin of a family hard. It has been easier to maintain a solid work-life balance medicine resident’s professional identity. with my co-residents, with activities such as movie nights, dinner dates, pickle ball, sporting events, and everything For me, residency has provided many enjoyments, outdoors — to name a few. successes, and challenges. It has been interesting, and sometimes frustrating, to navigate the challenges of patient In my opinion, this is the best time in history to be practicing care. There have been growing pains as I have internally medicine. There has never been a time with more challenges wrestled about how I can best improve compliance issues, and potential. The future of health care will go one of two poor social situations, addictions, poor prognosis, financial directions. One direction is to continue to muddle through struggles, or mental disabilities. As a young physician, I have the existing system. The second option is to improve the benefited from the advice and experiences of my senior system by focusing on value-based care, consumerism, attending physicians and mentors. clinical outcomes and both patient and physician satisfaction. I am grateful for the opportunity to help contribute to future One specific challenge during residency has been the solutions. I’m grateful for my experiences in residency as continual pursuit of becoming more efficient and effective for unique opportunities to refine and build my professional my patients. Even through a constant effort to practice high identity as a family health physician. quality medicine, the task remains complex and multifactorial. Dr. Tyson Schwab is a resident physician at Intermountain Healthcare. Like other residents from around the country, we work on He is beginning his second year as a resident at the Utah Valley Fam- longitudinal quality improvement projects that provide an ily Medicine Residency program. His medical interests include primary opportunity to conduct in-depth academic research while care, innovation, technology, health policy and improving medical testing practical application and creating potential solutions to quality. Dr. Schwab grew up in Bountiful, Utah. He and his wife have clinical needs. These experiences have been vital to learn and three children. He enjoys international traveling, college football, the solidify the mindset of quality medicine. After completing two Utah Jazz, Disney, making sushi, and spending time with his family.

| 20 www.UtahAFP.org Melissa V. See, MD, MPA

Jordan Albrich, MD Student Spotlight By Barbara Muñoz

leadership, and support as well, as they recently awarded him the F. Marian Bishop Award of Excellence. This honor, voted on by a student’s peers, recognizes a senior who exemplifies the core elements in family medicine and who has been involved to further family medicine at the med-school level.

Jordan knew before he came to medical school that he wanted to pursue family medicine. He uses the example of a retired family doctor in Silverton, who is 92 and is well-known in the community, as someone who inspired his career pursuits. The idea of being a family doctor in a small community like the one he grew up in is incredibly appealing to Jordan. After his rotation in obstetrics and gynecology, he considered that as a career, especially since his mother is a labor and delivery nurse and she loved the idea of the two of them working side-by- side. However, as Jordan continued through the remainder of his rotations, he realized he had a hard time shutting the door on other specialties and knew that family medicine is the route that allows doctors to do a “little bit of everything.”

During his rotations, Jordan had the opportunity to see a pregnant mother for her prenatal visits for several weeks and got very close to the family. And by fortunate coincidence, he was able to be there when she delivered her baby and was even able to participate in the delivery. “Listening to [the baby’s] heart the last couple of weeks and then here they are! Bringing them into the world was the craziest, coolest experience.”

When asked about reasons students might not choose to pursue family medicine, Jordan said, “A lot of students were very interested in family medicine and could have seen themselves going into the specialty and they loved it when they were on the rotation ... but I also think sometimes they sacrifice what they want to do because of financial reasons.” Jordan had those same concerns and spoke with his mother oming from a small town of Silverton, Oregon with a population of only about 10,000 people, the about them. Her response, according to Jordan: “You have to biggest adjustment for graduating medical student think long term because you’re going to be doing this for the Jordan Albrich was the size of Salt Lake City and rest of your life. Would you be willing to make the sacrifice for the surrounding area. “Even the sounds at night — status or pay to do something you didn’t enjoy — to not be Cwhen you try to go to sleep back home it’s dead quiet except the best, happiest version of yourself?” Jordan was not willing for the sound of frogs or insects. For the longest time it was to make that decision. “So I stuck with my gut feeling, which really hard for me to get to sleep because I could hear noise was confirmed coming out of my family medicine rotation that outside. As ridiculous as that sounds, it’s completely true!” I really wanted to do this.”

Before coming to Utah, Jordan graduated from the University Jordan’s next step in his family medicine journey is residency of Portland, a smaller University located on the northwestern in Vancouver, Washington at Southwest Washington Medical edge of the city, with his undergraduate degree in biology. Center. When asked if he ever sees himself returning to Another difficult adjustment coming to Utah was leaving Utah, he talks about the geographical wonders that he behind friends and family, most of whom live in Oregon. didn’t have time to see while in school, such as Capitol Reef or Canyonlands. Whether Jordan returns just to visit Utah or One of only 12 students in his class that are from out-of-state, practice medicine here, or starts his practice in his hometown Jordan relied on his classmates for support to learn his way of Silverton, Oregon, this bright, passionate young doctor will around Utah. It seems the group appreciated his friendship, make a tremendous difference in any community he serves. www.UtahAFP.org 21 | Trust the specialists. Helping physicians reach their financial goals since 1993.

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www.rqn.com 801.532.1500 Back To (Medical) Basics in Guatemala By Blake Taylor, DO

ello, my name is Blake joy that comes from being their doctor. medications, and on return visits the Taylor. I am a second year Naturally, when the opportunity to pro- paper tracks the patient’s care. family medicine resident vide medical care to the people of Gua- training at the Utah Valley temala presented itself, I was more than Each morning we would meet to set up Hospital in Provo, Utah. In excited to get involved. teams. One team stayed at our clinic HNovember 2018, a small team of pro- and the other gathered supplies to viders including myself, Chris Robert- We arrived in Guatemala and were travel to a remote part of the country son (a fellow resident), Rob Mehl, MD met by two large vans who picked up for the day. On the first day, Rob and I, (Utah Valley Family Medicine Program our team and traveled a few hours (with two nurses and a support team) Director) and Susan Chasson, NP to the site of our clinic in the smaller traveled two hours to the highlands of participated in a 10-day international town of Los Robles, near Lake Atit- Guatemala. Upon our arrival, we were medical trip to Guatemala, organized lán. The clinic is a standalone build- greeted by the villagers who were wait- by Humanitize Expedition. ing adjacent to an orphanage. It has a ing to be seen. Almost every woman single exam room with one table (do- we saw had a chief complaint of head- During medical school I was drawn to nated years ago). Inside the clinic is aches. It was apparent that most suf- family medicine for many reasons, one an almost fully-functional pharmacy fered from dehydration as they all re- of which included the opportunity to be that grows with each visit. The won- ported only drinking 1-2 cups water a involved with international medicine, derful thing about the clinic is that day while walking in the hot sun, usual- especially in Central and South Ameri- every three months, Humanitize and ly with a child on their back and supply ca. Over 15 years ago I was exposed to other teams return to provide care. basket on their heads. Tylenol, to these the Latino culture while serving an LDS Therefore, there is a small patient women, is a miracle drug. We educated mission in California and it was during panel with chronic conditions such as them on the importance of drinking this time that I developed a deep love diabetes and hypertension that are water, but even I knew in the moment for the Latino people. Now as a resident managed by the clinic. Each patient that they most likely would not be able physician, I see roughly 50-60 percent is given a piece of paper that con- to fulfill this recommendation as run- Latino patients, and there is a sublime tains their medical history and recent ning water is not a readily accessible

| 24 www.UtahAFP.org resource and requires daily transport from the local well. on pig feet in a three-hour training course. We were also able In addition to water, the men of the village could not afford to provide the volunteers with basic suture supplies. Hope- socks and each of them suffered from severe cases of ath- fully, with basic skills and supplies, the firefighters can now lete’s foot. We distributed a lot of fungal cream this day. provide basic laceration care to the community.

Later that week in our clinic at Los Robles there was a gen- The trip to Guatemala reminded me that everyone wants tleman in his 40s who had sustained a knee injury while working in the fields. They had no way to get help and he to be healthy; however, many are either unaware of how to was crippled by this injury. He most likely had a meniscal obtain it or live in a place where resources are limited. In tear contributing to significant hemarthrosis. I drained 60 cc either case, my training as a family physician allows me the of blood from his knee and immediately his pain improved. ability to provide resources to the individual so that they He was fitted with a knee support brace and given crutches. can meet their basic health needs. Over the last year as a He was relieved and hopeful to return to the field and con- resident, I had forgotten, amid never-ending message logs tinue working for his wife and three daughters who were and encounter notes, that the joy of being a family physician also seen in our clinic that day. comes from providing for the basic needs of the individual. Hopefully this reminder will travel with me back to Utah and The people in Guatemala have limited resources. For example, only last year did the volunteer fire fighters acquire fire linger throughout my career. hoses that would attach to their fire trucks. The volunteers lack simple suture skills and supplies and thus transport pa- Blake Taylor, DO, grew up in Alpine, Utah. He completed undergrad stud- tients two hours to the hospital for simple laceration repairs. ies at BYU and medical school at Campbell University in North Carolina. The highlight of our trip was teaching roughly 20 local fire- Medical interests include procedural, rural, and urgent care. He currently fighters basic suture techniques, then practicing these skills lives in Springville with his wonderful wife and five beautiful kids.

www.UtahAFP.org 25 | Don’t Put Off That Checkup! By David J. Castleton

It is common knowledge that a regular medical checkup is important for many reasons. A checkup can: • Prevent illness or disease • Identify risk factors for common diseases • Detect disease that has no apparent symptoms • Provide an opportunity for medical professional to counsel patients and to promote healthy behavior • Update clinical data

Just as medical checkups are important to monitor a patient’s health, legal checkups for medical practices are important to: • Identify areas of risk in your operations • Ensure compliance with federal and state regulatory, licensing and operational requirements • Identify areas of the practice that expose you to loss, penalties, violations, overpayments or exclusion from certain payors • Coordinate counsel of advisors and consultants • Prevent liability

Practice checkups are key to insuring your practice does not get blindsided with problems that are avoidable and preventable. It also can help you identify a treatment for those issues that have a cure early on. A checkup can be simple or detailed, depending on the scope of protection you want.

Some of the areas of review or questions to be asked include the following:

1. Organizational Documents (e.g., Articles of Incor- poration, Bylaws, Certificate of Organization, Op- erating Agreement) a. Are the organizational documents up to date? b. Are the organizational documents being followed? c. Do the organizational documents need to be amend- ed to reflect current or anticipated courses of action?

2. Books and Records a. Is the minute book up to date? b. Are the stock certificates properly issued and ac- counted for?

| 26 www.UtahAFP.org c. Is the stock/membership ledger up to date? d. Do you have a record retention policy and is it being This checklist is by no followed? means comprehensive. It 3. Filings does give you an idea of a. Has the annual report been filed with the Division of the numerous areas that Corporations and Commercial Code? b. Have DBAs been registered and renewed? need to be addressed. c. Have proper business licenses been obtained and renewed? when there has been a breach? 4. Real Property g. Do you ensure subpoenas served on you are HIPAA a. Are all leases properly documented? compliant before disclosing patient records? b. Are the premises in compliance with city and county h. Do you insure that only those with a need to know ordinances? have access to patient records? c. Have taxes been paid? i. Are your security systems in place and adequate? d. Is insurance up to date? j. Do you have a security officer and privacy officer who e. Have any actions been taken that require lender or are trained, active in their duties and who have the landlord approval? necessary authority to perform their duties?

5. Employee and Labor Relations 9. Medicare/Medicaid Compliance a. Are your employment contracts adequate and up to a. Is all billing and coding properly documented? date? b. Have you complied with all supervision requirements? b. Have appropriate background checks been made? c. Do you have a written compliance plan, and is it up c. Are employee handbooks up to date and complete? to date? d. Have you properly characterized the employees (ex- d. Have you done an internal or external audit recently empt, nonexempt, independent contractor, etc.)? to analyze and determine compliance? e. Are all necessary written employee policies drafted e. Have you trained and educated all employees regard- and in place? ing compliance issues? f. Have you developed effective lines of communication 6. Benefit and Retirement Plans for employees to identify problem areas? a. Are all plans properly documented and managed? g. Do you have well-publicized disciplinary guidelines for b. Are existing plans adequate or do they need to be enforcement? modified or replaced? c. Have summary plan descriptions and annual reports 10. Medicolegal Forms been prepared and distributed to participants? Do you have adequate and up to date forms for: d. Have new employees been properly enrolled? i. Termination of physician/patient relationship? e. Have all reports and returns been filed? ii. Authorization to transfer records? iii. Consent to disclosure? 7. Stark/Anti-kickback iv. Consent to treatment? a. Is there proper documentation for all related party v. Debt collection notice? transactions, including office leases, employment relationships, equipment rentals, independent contrac- This checklist is by no means comprehensive. It does give tor agreements? you an idea of the numerous areas that need to be ad- b. Is the allocation of ancillary service income in accord- dressed. Running a medical practice is full of traps. Notwith- ance with current regulations? standing your excellence as a practitioner, regular checkups c. Have you tested related party transactions to insure can help to make sure that you are in compliance with the they meet safe harbors or exclusions? many requirements placed on your practice that go beyond d. Have you identified and analyzed all referral patterns patient care. By addressing them early and regularly, you and financial relationships to identify possible issues? avoid the liabilities, penalties, damage to reputation and financial devastation that can result from inattention. 8. HIPAA a. Have you established written HIPAA policies and David J. Castleton. Mr. Castleton is a shareholder at Ray procedures? Quinney & Nebeker. He is the chair of the Firm’s Health- b. Have you given employees adequate initial and care Law Practice Group and a member of the Corporate continuing training about HIPAA? and Real Estate Sections. Mr. Castleton has extensive experience representing healthcare providers in all aspects c. Have you done a risk analysis recently to identify ar- of their practice, including joint ventures, regulatory com- eas of concern? pliance, licensing, contracts and employment matters. He d. Do you have written business associate agreements represents clients in a wide variety of business and real estate transac- with all parties having access to PHI? tions, including business formations, purchases and sales, joint ventures, e. Do you have a Notice of Privacy Policy, and is it up mergers and acquisitions, leasing, and development. Mr. Castleton also to date? advises clients in tax and estate planning matters and is a Fellow of the f. Have you complied with all notification requirements American College of Trust and Estate Counsel. www.UtahAFP.org 27 | Legislative Session 2019

By Darlene Petersen, MD and Maryann Martindale

patients. • HB 443 and SB 265 Health Care Transparency — two bills written under the guise of “transparency” but would have prevented physicians from collecting on services provided if the amount presented prior to treatment was more than anticipated, and also would have caused onerous reporting requirements to physicians and healthcare systems. Fortunately, both of these bills failed. • HB 337 Professional Competency Standards Amendments — this bill would have negated a good law from the 2018 session that prohibits physician cognitive testing based on age and that is not aligned with nationally recognized standards. We worked diligently in opposition to this year’s proposed changes, and our work paid off. Although the bill passed, it was changed significantly — only making very minor changes that will not impact the protection against discrimination for our aging doctors. • HB 324 Tobacco Age Amendments — The UAFP has been a consist- ent supporter of strong tobacco legislation. This bill follows what is quickly becoming a trend across the country — raising the age to 21 to very year during the Utah State egates that supported easing the purchase tobacco products. While Legislative Session, the UAFP administrative burden placed on there are a few exceptions we op- Legislative Committee meets physicians and their patients by in- pose, this is an important bill that regularly to discuss bills that surance prior authorizations. This will save lives. Smoking is the lead- may have an impact on family session, after several changes, SB ing cause of preventable deaths Ephysicians. Bills are reviewed and the 264 passed. It requires greater and the majority of smokers start at committee decides to support, oppose, transparency by insurers including ages younger than 21. This new law or stay neutral, and our executive direc- a requirement to post online cov- will have a significant and positive tor is on Capitol Hill, every day, lobbying ered drugs, devices, procedures impact in the lives of Utahns. on behalf of the UAFP. that require prior authorization and standardizing prior authori- If you would like to be involved, join During the 2019 session, there were zation forms, including a 72-hour the UAFP Legislative Committee. It is several bills of interest to UAFP. Below turnaround time for urgent re- a great way to learn more about the are a few of our priority bills: quests. While this is not all that impact the legislature has on family was requested, this is a big step in medicine, and to get involved working • SB264 Medical Treatment Au- the right direction to ease the ad- for positive change. thorization Amendments — three ministrative burden placed upon years ago UAFP presented a reso- physicians and frees us to do what For a complete list of all bills during the 2019 lution to the UMA House of Del- we do best — taking care of our legislative session, visit le.utah.gov.

| 28 www.UtahAFP.org Lunch with a Legislator

ver wanted to break bread with your legislator? UAFP can make that happen.

Each year, prior to the start of the legislative session, UAFP holds a Legislative ELunch. Legislators, UAFP members, students, and residents come together for a lunch and a short presentation on the issues we’re planning to work on during the upcoming session. In a relaxed setting, our members get quality time to talk to legislators, discuss concerns with laws and regulations, and help legislators understand how they can help advance family medicine in Utah. Politics are personal, and having an opportunity to make a personal connection with your legislators can make all the difference in gaining their support and understanding for the issues concerning family medicine.

Join us next year for our Legislative Lunch and let us help you make that personal connection with your legislator.

www.UtahAFP.org 29 | Family Medicine Adv ocacy Day on the Hill

ach year, doctors, students, and residents visit the Utah State Capitol to advocate for family medicine. This year just happened to fall on Valentine’s Day, so we spread the love by learning how to advocate, hearing from elected officials — including one of our own members, EDr. Ray Ward, and meeting with legislators to discuss important issues and concerns, lobbying on behalf of family medicine and the patients we serve. This is an invaluable opportunity to meet with legislators on their own turf and gives both members and elected officials a unique one-on-one opportunity to help better understand our positions on a variety of bills.

Keep an eye out for news about next year’s Day on the Hill — you won’t want to miss it!

| 30 www.UtahAFP.org Family Medicine Adv ocacy Day on the Hill

www.UtahAFP.org 31 | to 20 percent. We have increased the length of our family medicine clerkship from four weeks to six weeks, providing more extensive exposure to our specialty for the students. We hope this helps to move the needle of student interest in family medicine.

Twenty-five percent is an ambitious target. While this collaborative will be working at a high level with medical school administrations and admissions offices, as well as highlighting schools with higher than average numbers of students matching in family medicine, let us consider what can be done locally. Students frequently cite mentors as having the most impact on their decision to match in a particular specialty. How can you become a mentor? • Take a clerkship student. This is an excellent opportunity to influence students and highlight the breadth and depth of family medicine. Preceptors who take a student are eligible for CME credit as well as their PI credit (aka MOC part IV). • If you know a student interested in a medical career, offer to let them shadow you — show them how di- verse and exciting a future in family medicine can be. • Get involved with the Utah Academy of Family Phy- sicians. Our state chapter is an incredible partner in helping connect students to family physicians outside the university. • Students who would match in 2030 are currently in junior high. Look at students in your community. Can you speak at your local school? Can you talk at a library or other community event? Look at your patients, ask your neighbors, and talk to your own kids. You might know a future family physician right now! By Karly Pippitt, MD, FAAFP

25 x 2030 — To match 25 percent of medical school gradu- At the University of ates into family medicine by 2030; this is more than double the current rate. Utah Family Medicine Residency, with the help This is the ambitious goal of eight national and interna- of the state legislature, tional family medicine organizations that are launching the America Needs More Family Doctors: 25×2030 Collabo- we have been able to rative. The United States is facing a shortage in primary increase the size of our care providers, one which family medicine graduates are residency program to uniquely suited to fill. train two additional family As this collaborative moves forward, consider what we in physicians each year. family medicine have done and what we can continue to do to achieve this goal. At the University of Utah Family Medi- cine Residency, with the help of the state legislature, we have been able to increase the size of our residency pro- This movement starts with us. America needs more fam- gram to train two additional family physicians each year. ily doctors. Be a part of this vital, exciting movement in Other family medicine training programs in the state have changing the future of health care. How else can you also been able to increase their numbers of trainees. advocate for the future of family medicine? At about 12 percent, the University of Utah is close to the national average for students matching into family medi- Karly Pippitt, MD, FAAFP, is an Associate Professor (Clini- cine. Over the last thirteen years, the University of Utah cal) in the Division of Family Medicine in the Department of has contributed almost 150 students to family medicine, Family and Preventive Medicine at the University of Utah but we have room to grow. The medical schools with the School of Medicine. Her areas of interest include pediatrics, most students matching into family medicine are closer women’s health, headaches, and contraception.

| 32 www.UtahAFP.org In Memoriam

The Utah Academy of Family Physicians extends condolences to the family, friends, and colleagues of Sarah Hawley, M.D. 1991 – 2019

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www.UtahAFP.org 33 | According to health care advocacy nonprofit the Lown Insti- tute, about 20 percent of Americans live in rural areas, yet only 11.4 percent of physicians practice in rural locations. And while in 2016, Massachusetts had 134.4 primary care doctors per 100,000 people, Utah had only 64.7, marginally ahead of Mississippi with 64.4.

One UROP volunteer visiting Lyman’s class was from the central Utah town of Beaver and had played football against San Juan High. Talking to him, Lyman realized that medical Rural students were, he says, “normal people, not geniuses. All By Stephen Dark medical school takes is dedication and hard work.”

Lyman, who became an MD in 2016, attended med school at the U, returning to Blanding himself as a UROP representative to promote medicine to students, including his little broth- ers, sister, and friends. “I felt like I could really connect with students there because I knew their teachers, all the doctors who were providing them care, and even other students they Roots knew who had been able to get into health care,” he recalls. The idea behind UROP, he says, is that contrary to Thomas Wolfe’s famous dictum, you actually can go home again. While big-city residents might turn their noses up at small- town practice, a fifth-generation Blandingite like Lyman knows the beauty of rural life and the benefits of working in such locations: good money, a wide variety of procedures, and a broader scope of practice.

Indeed, Lyman is a poster child for UROP. He, his registered- nurse wife, and their two small children currently live in Los Angeles, where he is a third-year resident at a Level 1 trau- Lower Calf Creek – PC: Dave Titensor ma center. He plans to return to Blanding as an orthopedic surgeon. “I want my children to grow up in the same close- knit and supportive community I did,” he says. hen 15-year-old Kade Shumway Lyman told staff at San Juan High School that he wanted From a small basement office housed in the U’s Department of to be a doctor, their response was not the Family and Preventive Medicine building, longtime UROP advi- verbal high five he expected. sor Bob Quinn (BS, 1986) keeps a watchful eye on the 17-year- old program, which runs on an $8,000 annual budget. In 2017, WIt had been 10 years since a student from the Blanding, first-and second-year medical students visited 40 high schools Utah, high school had gone to medical school, they told in 15 different counties, accumulating more than 70 hours of him in 2004, and it was an expensive and demanding ca- classroom presentations for a total of 1,566 students. Medical reer. Consider podiatry or becoming a physician assistant students sign up for all sorts of reasons, ranging from wanting instead, was their advice. to go home for the holidays to seeing a national park.

A small town midway between red-rock tourism mecca Moab In late 2018, 40 students signed up to spend much of their and the desolate beauty of Monument Valley and the Navajo winter break visiting as many high schools as they could in Nation territory, Blanding struggles with poverty and isola- the state’s rural and frontier counties. That included two tion. As a teenager, Lyman had to drive 90 minutes to Cortez, first-year students, Jen Christiansen and Kassie Amann. They Colorado, just to buy a pair of socks. While now, more than picked visiting some of the state’s most isolated schools dur- a decade on, there are a few shops, other issues remain the ing a four-day road trip from Salt Lake City to the epic splen- same: with no specialist care, a serious medical problem still dor of Monument Valley. requires an AirMed flight to the University of Utah. Christiansen and Amann’s journey, in the latter’s silver SUV, Two years after Lyman shelved his physician plans, several with a cooler full of cow hearts and pig lungs in the trunk, University of Utah medical students visited Blanding to meet revealed the challenges distance imposes on rural commu- with juniors and seniors. They were volunteers with the Utah nities and the importance of UROP in terms of encouraging Rural Outreach Program (UROP), which recruits medical stu- students to pursue medicine. Christiansen summed up the dents to crisscross the state during the winter and spring trip’s meaning for her and Amann over a late-evening burg- breaks. Their mission is to address a long-standing dearth of er in a family-run diner. “I just want them to look at Kassie doctors in rural counties by encouraging local high schoolers and me and know that, ‘No matter what I want to do in life, to consider the rewards of health care careers. regardless of if that is medicine, it’s worth the work.’ ”

| 34 www.UtahAFP.org Kade Shumway Lyman – Jen Christiansen and Kassie Amann – San Juan High School – PC: Kim Montella PC: Shara Lyman PC: Shara Lyman

(UNHS), which currently has multiple clinics and hospitals A One-Stop Town in the region. At 5 a.m. on Monday, Dec. 15, Amann had stopped to pick up Christiansen in Salt Lake. They needed to make Moab’s “It has totally changed the landscape,” says Monument Val- Grand County High before the 9:53 a.m. bell to meet their ley High principal Spencer Singer, whose mother, Donna, first class, anatomy students. There are two key elements to founded the nonprofit. “The majority of boys [on the res- UROP’s pitch: one is a presentation, the other dissections. ervation] aspire to be welders, or in the construction trade. Why? That’s what dad does, what their uncle did. Now their Their presentation began by asking, “Why medicine?” Then they aunts and uncles work for UNHS, and it’s created a different detailed the wide variety of health careers, comparing the aver- avenue for jobs. ‘I can do that,’ the students say. ‘I can be a age debt to become a doctor ($161,000) against average salaries nurse or a doctor that works in the clinic.’ ” ($189,000 for a family doctor, $450,000 for a surgeon). When Christiansen and Amann pulled out the organs for dissection, Despite the burgeoning local medical industry, the value of excited students pulled out their phones to take pictures. UROP remains the same: letting high schoolers know medicine is within their reach. Afterwards, Christiansen and Amann drove to their lodgings at Bullfrog, Utah, near Lake Powell. Daylight revealed few Tugging On (a Cow’s) Heart Strings houses but many dry-docked house boats. At Lake Powell, their class was seven male students from the seventh and When Christiansen and Amann put out cow hearts, 50 stu- eighth grade, half of whom were Navajo. dents lined up for the dissection. Amann struggled with the scalpel as she cut open the muscle. “They gave us the Next on the itinerary was San Juan High School in Bland- world’s smallest scalpel to do this with,” she laughed. ing. And while it turned out to be larger than they expected, Blanding still amounted to a small town with one blinking As teenagers pulled on purple plastic gloves, the quips red light swaying over the main intersection. came hot and fast. “They’ve stolen my heart,” said a native student. “This is the definition of playing with someone’s heart,” joked another. One student was more concerned Money Fears about his impending lunch. “This has ruined my appetite,” “How did you want to handle this?” Christiansen asked he muttered. Amann as 130 students filed into San Juan High’s auditorium, a quarter from Tracy Johnson’s anatomy class. After the Roughly half of those considering medicine thought they’d seven students of Lake Powell, it took the visitors a moment return to practice in Blanding. “I think there are deep family to adjust to the shift in scale. ties that make you want to come back,” Johnson says. Christiansen and Amann left for Whitehorse High in Mon- “The point we’re trying to get across is, there’s a shortage tezuma Creek, 45 minutes away, to find 40 tired students of medical practices across the state,” Christiansen told the who’d just finished their state exams. Once the organs came hall. “We’re trying to inspire you guys to fill this need.” out of the cooler, eyes widened in interest, especially among the female students. It turned out that some had already heard the call. When Chris- tiansen asked how many wanted to be medical students, a doz- Amann enjoyed the buzz students got from the dissections. en students raised their hands, citing career interests ranging She had one question she wanted the students to take away from becoming a family practice doctor to an anesthesiologist. from their visit: “Do you want to do this more than just today?” Such ambitions reflected how many of them had relatives working for the 19-year-old Utah Navajo Health System Rural Roots | Continued on page 38 www.UtahAFP.org 35 | Convenience Store –PC: Shara Lyman

Rural Roots | Continued from page 37 As the students passed a pig trachea from one fingertip to another’s, most said they wanted to go into medicine. For Caring For Their Own some, it was relatives pushing them to go into health care. The U students stayed at a motel in Mexican Hat perched on For others, it was personal. the red-rock banks of the San Juan River. As they dined on beef stew and Navajo fry bread, they reflected on how the Kaelo Atene talked about being offered a football scholarship trip was “about giving these kids an intro to things,” Amann to Lewis & Clark College in Oregon. He was weighing whether said, “This is a slice of how cool medicine can be.” Both val- that would help him achieve his long-term goal of studying medicine. His drive to become a medical provider is driven by ued modeling health care careers for young women. “You illness within his family. His grandfather has Parkinson’s, he can’t be what you can’t see,” Amann says. says, and he’d like to know its cause. Another close relative has medical issues that mean he faces going into a nursing The next morning’s drive out to Monument Valley High took home. Atene plans to return post-residency to practice medi- them over the river and through a bleak landscape of black cine in his own community so he can care for him at home. rock towering over tiny, one-story houses with concrete floors and wood stoves, standing unprotected against the weather. In between palpating the memory-foam-like texture of the pig’s Very few of these homes have electricity or running water. lungs, other students agreed that community was the thread that would draw them back. “This is our home,” said one. Despite the challenges of getting and keeping teachers in what is a deeply isolated, poorly resourced location, Monument Val- Third-year resident Lyman argues that, much like the rest ley High has seen a dramatic turnaround under Principal Singer, of the state, there continues to be a deep need for UROP in going from a long-standing F to a C in the 2017-18 academic year. San Juan County. “You don’t have the same resources as a That’s with a 220-strong student body of whom 70 percent are larger school,” he says. “So, when a well-respected institu- classified by the state as homeless and 60 percent with English tion like the University of Utah decides to devote resources as their second language. Many of them live in situations where to you, I think it’s really impactful.” Especially since what trauma from abuse, alcoholism, drugs, and neglect is ongoing. Blanding high schoolers know about the U comes mostly from visiting relatives who’ve gone there by AirMed. In the school auditorium, Amann and Christiansen made their last presentation to 12 Navajo students. None of the As the med students packed up the cooler for the last time, students had questions, but when they moved to the caf- school counselor Jeff Fitzgerald asked them to pass on a eteria for the dissections, their standoffishness dissolved message to future generations of UROP ambassadors. into enthusiasm and inquisitiveness. Not that handling ani- “We appreciate it,” he said, “every year. Please come.” mal organs was necessarily novel to them. Recently, a live sheep had been brought to the school, its throat slit in front —Stephen Dark is a writer for University of Utah Health. of the hogan and the students taught butchering so that This article was previously published in the University of Utah every piece of the animal was used. Continuum, Spring 2019 Issue.

| 36 www.UtahAFP.org Utah Medicaid Expansion By Kolbi Young Public Information Officer Division of Medicaid and Health Financing Utah Department of Health

n April 1, 2019, more Utah program will decrease, as some adults Per Capita Cap Plan. If approved, this adults gained access to will elect to enroll in the newly created plan will replace the plan implemented Medicaid than ever before. expansion Medicaid rather than TAM. on April 1, 2019. The Per Capita Cap Under the newly approved Plan covers adults up to 100 percent Medicaid Expansion plan, Under this new expansion program, FPL and requests the following provi- Oapproximately 70,000–90,000 Utah resi- parents will receive the Non-Tradition- sions: self-sufficiency requirement, dents became newly eligible for Medicaid. al Medicaid benefit package. Adults enrollment cap, up to 12-month con- without dependent children will re- tinuous eligibility, employer-sponsored Adults who earn up to 100 percent of ceive the Traditional Medicaid benefit insurance enrollment, lock-out for in- the federal poverty level, about $12,492 package. Both programs cover doctor tentional program violation provision, for an individual or $25,752 for a family visits, prescriptions, hospital care, am- and a per capita cap. This plan will also of four, is eligible to receive full Medicaid bulance, behavioral health services, request 90 percent federal/10 percent benefits. Additionally, eligible individu- specialty care and more. state funding. The State is optimis- als must be a Utah resident between tic that the Centers for Medicare and the ages of 19 and 64, and be a U.S. This new eligibility group comes at the Medicaid Services (CMS) will provide citizen or legal resident. For more infor- direction of Senate Bill 96 (2019 Legis- greater flexibility as Utah crafts its own mation or to apply online, visit https:// lative Session), sponsored by Sen. Allen Medicaid Expansion solutions. medicaid.utah.gov/apply-medicaid. Christensen and Rep. Jim Dunnigan. Through these waivers, many new in- Submitting an application for benefits The bill supersedes previous Medicaid dividuals will now be eligible for Med- does not guarantee coverage. Expansion efforts and replaces Propo- icaid coverage in Utah. The State has sition 3 (2018 General Election). Under prepared communication tools to help Enrollees in the Primary Care Network the current waiver, the federal govern- spread the word. You can download (PCN) (approximately 15,000) were ment will cover approximately 70 per- flyers, posters and FAQs on the Medic- auto-enrolled in Medicaid as part of the cent of the cost of the new program; aid website: https://medicaid.utah.gov/ expansion population, as PCN closed the State of Utah will cover the remain- expansion. on March 31, 2019. The Targeted Adult ing 30 percent. Medicaid (TAM) program will continue For more information and regular updates, to operate as it does today. The State This spring, the State also submited visit the Medicaid website: https://medicaid. estimates that enrollment in the TAM a new 1115 Waiver to CMS called the utah.gov/expansion www.UtahAFP.org 37 | Healthcare and Mobile Tech By TriTel Networks

hysicians are using mobile • Some 46.6 percent of respond- Some systems have already begun ad- tech to boost productivity. As ents are educating themselves dressing the problems. For example, of November 2018, almost about clinical issues. ProHealth Care is a healthcare system half of all medical profession- being used in Waukesha, Wisconsin als relied on laptops, tablets, Physicians and other medical profes- and the surrounding area. It offers an Pand smartphones to expand their abili- sionals are especially quick to adopt app that has the ability to keep voice ty to work away from the office; on aver- anything that will help them reduce the and text communications secure. age, they use four separate mobile ap- number of communication errors and plications to help them. Physicians are increase productivity. Physicians generally move around a adopting the use of mobile devices at a great deal during the work week. What rapid pace, especially when it comes to These are not surprising results. After they want is information that can move accessing EHRs. all, why should physicians be any dif- with them, especially since they don’t ferent than anyone else when it comes tend to spend much of their time sit- At more than 60 percent, the percent- to integrating technology into their ting at desks. The easier the access, age is even higher in hospitals, even lives? The surprise is that the technol- the better they like it. Anything that is though some hospital organizations ogy is falling short of what physicians slow, hard to read, distracting, or diffi- have banned the use of mobile tech. need. Health technology companies cult to navigate is a problem. A simple It’s a battle they are going to lose. Ac- are listening and adapting their mobile interface that presents data clearly, and cording to a survey that was published solutions in a direct response to the preferably in just one format, is a must. online by Physicians Practice magazine feedback they are getting. • Artificial intelligence is becoming in 2018, 76 percent of those who were more important to mobile soft- surveyed said they use mobile tech at What else might be a problem? Pa- ware. The ideal is for the artifi- least once a week. Some 90 percent tient privacy is one obvious answer. cial intelligence to select relevant of healthcare systems are working to Too many physicians share patient data in a timely way and then pro- transform their clinical practices by data on servers that are not secure, or vide it to clinicians at exactly the making big investments in mobile tech- they use text messages to exchange right time. nology. Nobody wants to miss out. private information. This provides an • Another significant improvement opportunity for hackers that will have is creating mobile tech that doesn’t How are medical professionals using to be addressed. It’s important for care what the origin is of the EHR. tech in their practices? The 2018 Mobile practices to determine reasonable Providers want, and need, to be Health Survey from Physicians Practice protocols and expectations for those able to get patient information re- magazine provides some answers. who use mobile devices. And what gardless of where it was entered. • Nearly 70 percent of those who happens when a device is lost or sto- • Imaging technologies are making use mHealth are communicating len? Maintaining security measures is it possible to see real-time medi- with other staff members. harder when a medical professional cal imaging studies that are three • Some 51.1 percent of respondents say does not have control of a particular dimensional. they are using the mobile EHR app. device. These are all issues that are • Working in real time is also impor- • Approximately 50 percent use easier to deal with if the potential tant when it comes to collaborat- mobile tech to communicate with harms have already been minimized ing with other medical profession- providers. as much as possible. als. Being able to put notations on

| 38 www.UtahAFP.org How can a medical practice get ahead of the curve when it comes to its telecommunications system? The obvious starting point is finding a business partner with telecommunications skills. That partner can help your practice implement the right tech so you can provide the best possible medical care for your patients.

For more information:

images, dictate notes accurately, and to hold meetings It’s a good idea for medical practices to think about how by video conference are vital. they look from the point of view of their patients and pro- spective patients, and to come up with an online strategy. The long-term goal is to create solutions that give provid- This is about more than just having a social media strategy. ers everything they need to know about their patients, from If someone is looking for your practice, or for a specialty be- home to medical office to hospital. ing offered by your practice, how hard is it for them to find you? What can you do to make that search easier for them? Mobile software can already pair with the software that man- How much control do you exercise over what they see? Can ages EHRs, as well as platforms that manage revenue. Email you do more, or is the information controlled by a third par- and text messages allow physicians to follow up with a pa- ty? Is the information about your practice and about insur- tient after an appointment. Sending a prescription to phar- ance up to date? How hard is it to schedule an appointment? macists has also never been easier. In addition, patients and If a patient’s only option is calling the number for a landline medical staff can communicate through patient portal apps. phone that lands them in an automated menu system, well, All these once-impossible conveniences are now something you can do better. patients expect. Even older patients are becoming more tech savvy, and (ac- Part of the mobile revolution is its involvement in personal cording to a Visual Networking Index created by Cisco), the health apps. It has always been difficult to coordinate a pa- world now has more mobile devices than there are people. tient’s activities with what the physician wants that patient to That doesn’t mean patients are necessarily coming into the do. But by using weight loss apps and fitness tracking, physi- office armed with accurate information. It’s a good idea to cians finally have a chance to see whether their patients are review medical information with patients to ensure that taking their advice. Patients can use smartphones and tab- their understanding of their particular situation is correct. lets; they can also wear devices. The result is a way to combat Many times, patients are actually misinformed when they a lack of exercise or a too-sedentary lifestyle. Just how big arrive for a visit and can therefore benefit from what the is the market? The Global mHealth Solutions Market had a physician can teach them. value of $21.3 billion in 2017, but expects to make approximately $160.5 billion by 2024. How can a medical practice get ahead of the curve when it comes to its telecommunications system? The obvious Smaller medical practices can expect to benefit the most from starting point is finding a business partner with telecommu- mobile tech because it can make communication easier and nications skills. That partner can help your practice imple- can increase collaboration, boosted by the fact that mobile ment the right tech so you can provide the best possible devices are just not that expensive. Even practices that don’t medical care for your patients. have deep pockets can generally afford to implement tech that will make the entire practice more effective in its work. Although mobile technology can make many aspects of patient care easier and more efficient, never forget the impor- That low price is also part of what has caused patients tance of the direct communication between patients and to take an interest. Patients can pick from many different physicians. That’s one aspect of medical care that hasn’t health apps (in December 2016 there were almost 100,000 been replaced. of them). It’s possible for patients to better manage their diabetes or their nutritional choices. Yet. .

www.UtahAFP.org 39 | Medical Cannabis Act on Private Employers

number of our clients have asked us what effect, if any, Utah’s new marijuana law will have on their drug-testing policies, and relatedly, whether they must accommodate use of medical marijuana by their employees. As discussed below, the answer Ais currently unclear; however, it appears unlikely that the new law will have a significant legal effect on private employers.

As a reminder, in November, Utah voters passed Proposition eral funding for the employee’s position.” (Utah Code 2, legalizing medical marijuana. Weeks later, the Utah Legis- Ann. s 26-61a-111(2)(a), (b)).) lature passed a compromise bill, the Utah Medical Cannabis Act (the “Act”), which revised and superseded Proposition 2. Some states outside of Utah that recently adopted marijua- The Act was signed into law on December 3, 2018. na laws have provided employers with much more certainty by including specific carve-outs for employer drug testing Initial versions of the Act prohibited discrimination in em- and discipline. For example, both Vermont and Michigan ployment based solely on an individual’s status as a medi- passed ballot initiatives legalizing the recreational use of cal cannabis cardholder. Specifically, the proposed provi- marijuana by persons 21 years of age or older. Michigan’s sion stated: new law specifically states that employers need not “permit or accommodate [use of medical marijuana] in the work- An employer may not refuse to hire, suspend, terminate, place or on the employer’s property,” and may discipline take an adverse employment action against, or otherwise employees for violating “workplace drug policy or for work- penalize an individual solely for the individual’s status as a ing while under the influence” of marijuana (Mich. Comp. medical cannabis cardholder, unless failing to do so would Laws Ann. § 333.27954(3)). Vermont’s law similarly provides cause the employer to lose a monetary or licensing-related that employers are not required to “accommodate the use, benefit under federal law. consumption, possession, transfer, display, transportation, sale, or growing of marijuana in the workplace” and may See Draft Utah Medical Cannabis Act (2019FL-4444/020), discharge “an employee for violating a policy that restricts dated October 4, 2018, at lines 1442-45. or prohibits the use of marijuana by employees.” (Vt. Stat. Ann. tit. 18, § 4230). Importantly, the version of the Act that was signed into law only prohibits discrimination with regard to government Unfortunately, Utah’s new law is silent with respect to employment (Utah Code Ann. s 26-61a-111). It states that private employers and drug testing. This raises some the state or any political subdivision must treat “an employ- concern because individuals eligible for a medical canna- ee’s [legal] use of medical cannabis. . . in the same way the bis card are also likely to be protected by the Americans state or political subdivision treats employee use of opioids with Disabilities Act and the Utah Antidiscrimination and opiates” except where doing so “would jeopardize fed- Act. See Utah Code Ann. § 26-61a-104(2)(a)-(p) (listing

| 40 www.UtahAFP.org Medical Cannabis

qualifying conditions for medical cannabis card). That being said, employers interested in taking a more con- Although there are open questions regarding how servative approach should, at the very least, engage in an the Act will be interpreted and applied, it appears un- interactive process with the applicant or employee to eval- likely that Utah courts will, as a result of the Act, require uate other options, such as different medications, before private employers to change their drug testing policies making employment decisions. See Barbuto v. Advantage and/or accommodate the use of medical cannabis. Sales & Mktg., LLC, 477 Mass. 456, 466 (2017) (stating that even if the accommodation of the use of medical marijuana To begin with, the Utah Legislature’s consideration and re- were facially unreasonable, Massachusetts employers are jection of a provision prohibiting discrimination by private still obligated to participate in the interactive process to employers against medical cannabis cardholders gives Utah explore whether there was an alternative, equally effective, companies an argument that the Act should not affect their medication the employee could use that was not prohibited current drug-testing policies. Further, unless expressly pro- by the employer’s drug policy). vided for by statute, most courts have concluded that the de- criminalization of medical marijuana does not shield employ- If you have a fact-specific inquiry, including regarding your ees from adverse employment actions. Compare, e.g., Roe v. drug testing policy or a requested accommodation, you TeleTech Customer Care Mgmt. (Colorado) LLC, 171 Wash. 2d should consult legal counsel. 736, 752 (2011) (recognizing that statutory silence supports the conclusion that private employers are not required to accommodate off-site medical marijuana use) with Whitmire Jascha Clark practices in Ray Quinney & Nebeker’s Em- v. Wal-Mart Stores Inc., No. CV-17-08108-PCT-JAT, 2019 WL ployment & Labor Law and Litigation Sections. Mr. Clark 479842, at *8 (D. Ariz. Feb. 7, 2019) (recognizing the “drastic advises clients on an array of personnel-related matters dissimilarity” between medical marijuana statutes that do involving compliance with federal and state labor and not apply to private employment and Arizona’s statute, which employment laws – from day-to-day human resource is- prohibits employers from terminating medical marijuana us- sues (such as employee discipline, employee leave, wage ers unless they used, possessed, or were impaired by mari- and hour questions, and disability accommodation) to juana on-site and during work hours). Because Utah’s statute defending employers from claims involving employment discrimination is silent as to accommodation of medical marijuana use, such and harassment. Mr. Clark also drafts and revises handbooks and other accommodation does not appear to be required. employment-related policies and procedures. www.UtahAFP.org 41 | STRONG MEDICINE FOR UTAH

ADVERTISING in your association’s trade journal is a solid approach to business development. in your association’s trade journal is a solid approach to business development. Business publications are rated the an average ROI of $7.81 for every $1.00 first choice for staying in touch with spent on print ads. Almost half of those what’s going on in their sector by surveyed preferred to look at an ad in 61% of decision makers. print, and only 1 in 10 preferred to see 83% of managers would recommend that same ad in a digital version. And no to people starting a career in their sector one wanted to see it in an app. to read the business publications. Print is tangible, it’s engaging, it’s A recent Nielsen Catalina study shows readable, but most of all… it works!

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| 42 www.UtahAFP.org I’D LIKE AN ADVISOR WHO UNDERSTANDS HEALTHCARE

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