round-upVolume 60 March 2014Providing news and information for the medical community since 1955.

PRESIDENTS PAGE: The question of who should pay for healthcare is one that has been asked for decades and a true consensus has been hard to find. Frankly, it is one to which an absolute right answer may never be found. Page 6

PUBLIC HEALTH: Community health is more than the absence of disease in individuals; it is the aggregate social, biologic and environmental well being of the community at large. That goal should be the charge of all practitioners. Page 17

HEALTH EDUCATION: Patients stay healthier when they stay informed, which makes communication key. In service to the physician community, included in this issue is an educational sheet about compliance - what it is and why it is necessary. Tear it out, make copies, and distribute to patients in waiting and exam rooms. Page 9

PRACTICE MANAGEMENT Affiliated Dermatology: A practice with a technology focus and family at heart.

PRACTICE MANAGEMENT Affiliated Dermatology: A practice with a technology focus and family at heart.

To learn more visit www.mcmsonline.com

MCMS_Marchcovers_2014.qxp_Layout 1 3/13/14 12:14 PM Page 4

Affiliated Dermatology: A Practice with a Technology Focus and Family at Heart

22 Round-up A monthly publication of the Maricopa County Medical Society March 2014

Photos provided by MCMS Preferred Vendor Paulson Photo/Graphic. Mike offers MCMS members a 10% discount on services, please call oremail for details. Mike can be reached by calling 602.230.1550 or emailing photo@paulson.com.

practice spotlight

left to right: Suzanne Murry, Operations Manager, Stacie Schimke, Chief Histotechnologist, Dr. Richard L. Averitte, Jr., CEO, and Nina Aganovic, Assist Operations Manager

The Maricopa County Medical Societys Round-up ispleased to bring you a new feature series, PracticeSpotlight. Every month we will spotlight a physician orpractice that has made changes to their care model for thebenefit of the patient. If you would like to submit yourself or your practice for consideration, or would like to recommend another physician or practice group for ourspotlight, please contact Jay Conyers at 602.251.2361 orjconyers@mcmsonline.com.

When Richard L. Averitte, Jr., MD, finished his dermatology residency at Case Western Reserve UniversityHospitals of Cleveland in 2002, he knew he was better suit-ed for private practice and had no interest in working forsomeone else. So with the help of his business partner andwife, Marlie Averitte, he set out to build a technologicallyadvanced dermatology practice in the Valley. To do so, Dr.Averitte went all-in with an EHR platform.

From the very beginning, he never wanted paperrecords in his clinic, and despite the cost, we made theinvestment from the onset knowing it would pay off in theend, according to Marlie, Chief Financial Officer forAffiliated and former Administrative Coordinator for theinternal medicine residency program at Banner GoodSamaritan Regional Medical Center. We never cut cornersand spared no expense.

Today, Affiliated Dermatology is one of the largest dermatology practices in the State of Arizona, with fourclinics across the Valley, and caring for more than 3,500patients per month. Of the 17 Affiliated physicians, five areMohs micrographic surgeons and another four are fellowship-trained dermatopathologists. With clinics inScottsdale, Surprise, Anthem, and Deer Valley, Affiliatedemploys more than a hundred people, although everyone theSociety spoke with referred to it as one big family.

MCMS Round-up March 2014_k5.qxp_MCMS_Monthly_Template.qxd 3/13/14 12:12 PM Page 22

practice spotlight

A monthly publication of the Maricopa County Medical Society Round-up 23

In speaking with Dr. Averitte, Our practice is about having lives and families.

World-Class Dermatology Surgery

Affiliated is not about cosmeticdermatology. Its about clinical ser-vices for diagnosing, preventing, andtreating skin diseases, ranging fromsevere acne to malignant melanomas.With five Mohs surgeons on staff andone of the few Slow Mohs facilities inthe Western United States, AffiliatedDermatology is able to handle thetoughest of skin cancer cases. By uti-lizing slow Mohs, surgeons are able tospare cancer-free skin tissue whileachieving near complete removal ofmalignant melanomas.

With nearly 300 sunny days eachyear in Phoenix, there isnt a moreappropriate place in the United Statesto have state-of-the-art skin cancertreatment than the Valley of the Sun.And with the ever-growing popula-tion of snowbirds to our region, the need for highly trained dermato-logical care is on the rise. Affiliated isaddressing this need by ensuring thatits clinics offer the most technologi-cally advanced surgical capabilitiesavailability.

Dr. Averitte adds, Were investingin the best trained dermatologists, andthe best techniques, such as Mohs andslow Mohs, to ensure that our patientsreceive the best care. Anything less issimply unacceptable. We treated 156patients last year using slow Mohs,which is a high number for our region,but its not good enough. We need tokeep pushing the envelope in order toreach more patients.

More than just filling vacancies...Its about matching lifestyles, personalities and practice philosophies.

602-331-1655www.catalinarecruiters.com

Locum Tenens & Physician Staffing

preferred vendor of:

Retirement Illness Sabbatical Maternity Leave CME Vacation

Dr. Travis Lam treating a patient at Affiliateds Scottsdale Clinic

MCMS Round-up March 2014_k5.qxp_MCMS_Monthly_Template.qxd 3/12/14 10:02 AM Page 23

Full-Service Information Services, In House

When Dr. Averitte invested in a full EHR while launch-ing Affiliated in 2002, he saw the value of having hands-onsupport for the entire team.

From the beginning, we demanded a lot from ourAllscripts service engineers, and made sure that our invest-ment was worthwhile, not only for our staff, but also for ourphysicians, according to Dr. Averitte.

He realized the value in working with a limited numberof engineers in order to minimize the learning curve forclient-customer interactions, and eventually convinced theprimary service engineer from Allscripts to join his team.

After working closely with Scott Maniates, who at thetime was a full-time engineer with Allscripts, sinceAffiliateds initial onboarding of its EHR, Dr. Averitte convinced Scott to join the clinic as its in-house EHR specialist. Now Affiliateds Chief Information Officer,Scott oversees the entire IT infrastructure for the group andservices not only the four Valley clinics, but also ensuresthat there are no hiccups with the two home-based CLIAcertified pathology laboratories.

When interviewed by the Society, Scott said, I love theopportunity to work more closely with the users of the sys-tem. I am now able to focus on training the staff on how touse it, and ensure that they feel comfortable knowing thatwe have the support team to respond to any of their needs.

Quality Driven HistopathologyAs is the case with all dermatology practices, especially

those focusing on disease prevention and treatment,Affiliated is heavily reliant upon high-quality histology andpathology. Initially, the clinic took the usual route of sendingspecimens out for processing and analysis, and was unable tohave any input over quality or processing time. Dr. Averittesaw this as a bottleneck, and an impediment to offering hispatients better care, so he invested in building a cutting-edgedermatopathology lab within the Scottsdale clinic.

According to Dr. Averitte, If we couldnt guarantee ourpatients the ideal balance of efficiency and quality, then itdidnt make sense for us to send out our specimens. By

building it all in house, we were able to strengthen that collaborative partnership between the dermatologists andthe pathologists, and ensure that our patients get better care.Thats ultimately what its all about.

Affiliated invested in the resources to provide full service pathology from their Scottsdale clinic, from section-ing to staining to analysis. In addition to the four fellowship-trained dermatopathologists, the Affiliated Laboratoryemploys eight histology technicians, each of whom are crosstrained in sectioning, grossing, and staining.

Stacie Schimke, who manages the histology lab andsupervises the half dozen full-time histotechnicians, joinedaffiliated in 2006 and has nearly 25 years of histology train-ing, which began at the Armed Forces Institute forPathology while enlisted in the Unites States Air Force.

Drs. Jena Auerbach (left) and Sara Estrada (right), two of Affiliateds fellowship-trained dermatopathologists.

24 Round-up A monthly publication of the Maricopa County Medical Society March 2014

practice spotlight

MCMS Round-up March 2014_k5.qxp_MCMS_Monthly_Template.qxd 3/12/14 10:02 AM Page 24

practice spotlight

A monthly publication of the Maricopa County Medical Society Round-up 25

Histotechnicians preparing samples in the Affiliated Laboratory.

Says Stacie, Before coming to Affiliated, I had workedin a few GI and dermatology reference labs. When theyapproached me in 2006, I jumped at the opportunity to havean input over quality. Other places, they largely have mar-ginal quality because of the quick turnaround time, butquality is optimal with Affiliated.

Stacie is also heavily involved in Affiliated non-profitarm for providing care to patients who cannot afford skincancer treatment. She has helped the clinic build a tissuebank for tissues and blood, with the idea that scientists willsoon utilize Affiliated as a resource for marker identificationresearch, and hopefully help advance treatments further.

An Investment in Dermatopathology: An ObviousClinical Partnership

Too often, pathologists spend little time with patientsand instead view the specimens under their microscopes astheir clinical subjects. Thats not the case at Affiliated. Withfour dermatopathologists on staff, and on-site, AffiliatedDermatology embraces the philosophy that the dermatolo-gists and pathologists have to be an extension of one anoth-er. The patients that Affiliated sees arent just patients of thedermatologists, but the pathologists alike.

According to Dr. Sarah Estrada, Laboratory Directorfor Affiliated and board certified in dermatopathology,anatomic pathology, and clinical pathology, We value theability to communicate directly with the dermatologists, aswell as our relationships with our technicians. Dr. Averittehas really helped create a family environment here, and hisvision is unparalleled. He embraces the philosophy that itsabout us looking at patients, not just slides.

Affiliated has one of the few College of AmericanPathologists (CAP) certified dermatopathology laboratoriesin Arizona. When it initially opened in 2006, the laboratoryprocessed more than 10,500 biopsies during its first year ofoperation, and now possess the resources to easily handlethe more than 30,000 it saw last year. Carrying out morethan 5,000 immunohistochemical stains in 2013, AffiliatedLaboratories is now seeing more than 150 melanoma casesper year, and poised to grow even more.

One thing we wont do is compromise on quality, butwe see an opportunity to reach more patients throughoutour state, says Dr. Averitte.

Dr. Jena Auerbach, a fellow dermatopathologist and colleague of Dr. Estradas at Affiliated, says, It takes a lot of money and resources to open up a full-service lab,and it takes a real hand at business to do this. Affiliated isfortunate enough to have six CLIA-certified laboratories,two of which are home office labs. You simply dont seethis anywhere else.

A Family Environment

Affiliated has, and always will be, a family operation,and views each of its employees as a part of the family.Suzanne Murry, Operations Manager at Affiliated, joinedthe clinic in 2005 as an extern while completing her certifi-cation in Medical Assisting. Shes now been with Affiliatedfor nearly a decade, and knows the entire operation fromfront to back. She oversees more than sixty employees anddespite having significant management responsibilities atAffiliated, she was able to recently complete a certificate inBusiness Management with the support of Dr. Averitte.

MCMS Round-up March 2014_k5.qxp_MCMS_Monthly_Template.qxd 3/12/14 10:02 AM Page 25

He and Marlie are family oriented, and truly care for theirown, according to Suzanne. They really invest in theiremployees, treat them as family, and instill in them a confidence that you rarely see elsewhere.

Giving Back to the Community Arizona Skin Cancer Foundation

By 2011, and nearly a decade into Affiliateds inception,Dr. Averitte had already seen the full spectrum of patients individuals with early indicators of skin disease to thosewith fully advanced cancers, to those with the resources toget adequate care and those who simply could not. He sawa need for the delivery of care to the less fortunate, andlaunched the Arizona Skin Cancer Foundation in 2011.Aiming to provide financial assistance to those with skincancer unable to afford treatment, the Foundation waslaunched to not only provide care but also communityawareness and education. In 2013, Arizona Skin CareFoundation enrolled 10 patients in its assistance program,covering all aspects of malignant melanoma treatment,including all follow-up labs as well as transportation.

Nina Aganovic, Assistant Operations Manager atAffiliated, says, We aim to not only treat patients, but alsoreach people before they become skin cancer patients.

Weve rolled out a resource program for students, focusingon educating them about sun safety and skin cancer. If wecan make them more aware of the risks of skin cancer at anearly age, then we believe theyll be more aware of the risksas they grow into adults.

In the next year, Affiliated is poised to create a researcharm to their Foundation through government grants and pri-vate donations, and is working to partner with local univer-sities, research organizations, and laboratories to provide acritical resource for advancing our understanding of how todiagnose and treat skin cancer.

Affiliated is quickly becoming a community leader,and recently hosted the second annual Arizona SkinCancer Foundation 5K run/walk, held December 3rd atThe Shops at Pinnacle Peak. In early March, theFoundation served as the medical sponsor for the PhoenixMarathon and sponsor for the Grand Canyon UniversityRun to Fight Childrens Cancer.

Caring for Patients: Full Circle

In a little more than a decade, Affiliated Dermatologyhas grown from a fledgling private practice group to one of the states leading centers for skin disease and prevention centers.

As Dr. Averitte recently summarized, We see so muchopportunity for growth, and for improving upon the deliv-ery of care. We want to be the leaders in how our stateresponds to skin disease, and we know the keys are educa-tion, early treatment, and cutting-edge intervention. Werepoised to embrace all of these, and hope we can touch morelives for years to come.

26 Round-up A monthly publication of the Maricopa County Medical Society March 2014

practice spotlight

Scott Maniates, Chief Information Officer, performing maintenance on the Affiliated network.

Dr. Jay Conyers is the ExecutiveDirector for MCMS and CEO of theMedical Society Business Services. He can be reached atjconyers@mcmsonline.com or bycalling 602.252.2015.

ru

MCMS Round-up March 2014_k5.qxp_MCMS_Monthly_Template.qxd 3/12/14 10:02 AM Page 26