Announcements: Final Issue of MMA Bulletin

This will be the final issue of the MMA Bulletin for physicians who are not MMA members. Physicians can continue to receive the MMA Bulletin through a paid subscription or by joining the MMA. Please see page 13 for details.

The MMA Bulletin will continue to capture the latest news impacting physicians and be sent to MMA members at no charge.

In thIs Issue: New Board of Trustees Elected ............... pg 3

MMA Member, Candidate for Lt. Governor .......... pg 5

WWAMI Admissions Seeks Member ............. pg 5, 7

What Exactly is an Estate Plan ................... pg 7

Minimize Malpractice Risk when using a PA ..... pg 9

Physicians Consider Early Retirement ..........pg 12

Volume 65, Number 1

Spring 2012

www.mmaoffice.org

Montana Medical Association2021 11th Ave, Suite 1Helena, MT 59601-4890

406. 443. 4000 877. 443. 4000 (toll free in state)fax: 406-443-4042

mma@mmaoffice.org

Montana Health CO-OPThe Affordable Care Act is a complex attempt to reform many aspects of our health insurance system. One of the main criticisms of the ACA is that it doesn’t do much about controlling health care costs. Some parts of it such as an emphasis on prevention or having provider organizations take responsibility for cost control may help. But these are certainly not quick fixes.

Congress did consider a sort of national insurance plan when putting together the ACA. It was called the “Public Option” but didn’t make it into the final version of the bill. Instead Senator Kent Conrad from North Dakota suggested that health cooperatives could be developed. This idea was incorporated into law and $6 billion was allocated for the formation of these Consumer Owned and Operated Plans, also known as CO-OPs. It was anticipated that one would be started in each state.

The idea behind CO-OPs is not new. The first successful CO-OP was formed in our country by Ben Franklin in 1752 for the “Insurance of Houses from Loss by Fire.” Since that time the idea has spread widely, often in rural states such as ours where we find electric, telephone and farming CO-OPs and Credit Unions. The idea behind these CO-OPs is that they are owned and run by the members that use them. CO-OPs don’t exist to make a profit. They exist to provide a benefit for the members. Any extra income is returned through lower prices or improved benefits.

MontAnA HeAltH-Co-op ContInued on pAge 3

Can One Person Make a Difference?Recently I spent a wonderful evening with twelve of my surgical colleagues. One of our duties that evening was to say something about the practice of surgery or about someone who has participated in the discipline of general, vascular and cardiothoracic surgery. I have always been a fan of presidential addresses by icons in surgery, so I was looking through addresses that the presidents of the American College of Surgeons delivered each year to new initiates to the ACS (vol. 71. No. 12 ACS Bulletin). The title was “Can One Person Make a Difference?” The address was delivered by Doctor Dean Warren, a famous surgeon known for his studies on portal hypertension. The subject was Doctor C.R. Hanlon, on his retirement from director of the ACS in 1986. This had a very personal significance to me because I was trained in St. Louis by Doctor V.L. Willman and Doctor Hanlon right before Doctor Hanlon left to go to the ACS. Some surgical historians believe that Doctor

Hanlon’s career is one of the most important this country has ever witnessed. He carried the ACS into the inner circles of our great universities and medical centers and ultimately into our communities - based on one principle, improvement in the QUALITY of care of the surgical patient. Doctor Hanlon remained an advocate of quality until his death last year.

So what does this all have to do with us in Montana? We recently saw our Congress “kick the can down the road,” as Doctor Bruce Robertson so accurately stated, on failing to fix the SGR. This being the 13th “kick down the road” we are constantly being bombarded by new regulations and requirements in order to be reimbursed. The amount of reimbursement is continually under attack. We are forced to practice defensive medicine because of our litigious society. Our profession is the only one that is held to such high standards by certifying boards, maintenance of certification and continual evaluation by payers. We comply with all of these regulations because we care about our patients. More and more physicians are choosing to be employed by hospitals, better than 50% of our physicians in Montana have chosen this venue to practice medicine. Many physicians are choosing to retire early or change their practice venue because of the present turmoil in health care. Some are just throwing their hands up in the air and not willing to spend the time and energy necessary to work on these difficult issues because they are tired or someone else will do it.

This brings me back to the original question, “Can one person make a difference?” We don’t get our patients well usually in one day; we usually have to do it in an organized plan and be able to change courses as the illness dictates our decisions. We talk with our colleagues and consultants in a respectful way because we want our patients to get better. So with all the difficult issues we are facing, we must be at the table to be part of the solution; we must be respectful of everyone’s opinion; we must be open to change and not act like our present congress and not compromise. The answer to the question, Can one person make a difference? emphatically is YES!!! You can make a difference!!--Paul F. Grmoljez, M.D., President

BULLETINBULLETIN

PAuL F. GRMOLjEz, M.D.

MMA Bulletin Spring 2012 Volume 65, Number 12

Donald J. Palmisano, MD, JD, FACSBoard of Governors, The Doctors CompanyFormer President, American Medical Association

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with

patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical

malpractice insurer. And, local physician advisory boards across the country. Why do we go this far?

Because sometimes the best way to look out for the doctor is to start with the patient. The Montana

Medical Association has endorsed The Doctors Company since 1986. To learn more about our medical

professional liability program for MMA members, call Kristi Benfit at (800) 237-8301 or (406) 252-0049.

3662_MontanaMedAssn_MarApr2012.indd 1 1/25/12 11:28 AM

Volume 65, Number 1 Spring 2012 MMA Bulletin 3

MontAnA HeAltH Co-op ContInued FroM pAge 1Many states, such as ours, now have only very limited choices for obtaining health

insurance. This lack of competition means less pressure to hold down costs while maintaining or improving quality.

Congress subsequently decreased funding for the formation of the CO-OPs and there is now $3.4 billion available. On February 21, the federal department of Health and Human Services announced that 7 of the 26 organizations that applied to form CO-OPs were successful. Montana was among those.

This new health insurance company, the Montana Health Cooperative, was awarded a contract to establish a health CO-OP and provide health insurance coverage for people in Montana, starting in 2014. By the end of the second year all of the Board of Directors will be elected by the members. The loans necessary for starting the company and for reserve requirements will be repaid to the government by the 15th year of selling insurance.

The Board of the Montana Health CO-OP believes that there are many ways to keep costs under control and at the same time improve care quality. Administrative costs can be kept low. Improved primary care access has been shown to lower costs and needs to be emphasized. Wellness and prevention should be a focus. Keeping people healthy is key. Effective management of chronic disease is possible in a way that does not emphasize excessive testing and treatment.

Health care is local and in many respects, the solutions need to be developed locally. This health CO-OP is being developed here in Montana with financial support from the federal government. It is an example of shared cooperation in developing health insurance to benefit the people who use it.--Thomas H. Roberts, M.D., MMA Member-at-Large

Vision Crafted for the MMAYour Association is working hard to advocate on your behalf in many areas to include legislative interim committees and regulatory meetings; being the watchdog of your profession. With the implementation of our 5-year strategic plan the Board of Trustees also adopted a Vision Statement that speaks to where the Association is headed in the future on your behalf:

The MMA will be the recognized voice and keystone organization for Montana’s physician community who practice in all specialties and in all venues. We will be relevant to our membership through proactive interactions, leadership development and highly visible communications.

This will lead to broad based and growing participation of Montana physicians and improvement of the health of all Montanans.

We urge your support in 2012. Join or renew online using our secure website at www.mmaoffice.org.makepayment.htm. The MMA is the only Montana organization looking out for your interests and the interests of all Montana patients.

New Board of Trustees ElectedDuring the 57th Interim Meeting, the Board of Trustees elected Doctor Nicole Clark and Doctor Stephen Bechdolt to complete the

unexpired terms of two Executive Committee positions. The positions were previously held by Doctor John Joyce who resigned due to his acceptance in a fellowship program in another state, and Doctor Roman Hendrickson who was elected to the position of Assistant Secretary-Treasurer on the Executive Committee.

Nicole C. Clark, M.D., is the elected AMA Delegate to the Young Physicians Section. Doctor Clark is a neurologist practicing in Helena. Doctor Clark will be able to quickly step into the role due to her past participation in the AMA Medical Student Section while attending the University of Missouri Columbia School of Medicine. She began her practice in Helena in 2009.

Stephen Bechdolt, M.D., was elected as a Member-at-Large of the Executive Committee. Doctor Bechdolt is a pathologist practicing in Havre and is the Chief of Staff at the Northern Montana Hospital. Doctor Bechdolt attended the University of Minnesota Medical School and began practicing in Montana in 2009.

MMA President Paul Grmoljez welcomed the new members expressing the Association’s appreciation of their anticipated participation on the leadership team.

MontAnA MedICAl ASSoCIAtIonFounded 1878

eXeCutIVe CoMMIttee PRESIDENT

Paul F. Grmoljez, M.D., Billings

PRESIDENT-ELECTShaun J. Gillis, M.D., Bozeman

VICE PRESIDENTMichael S. Brown, M.D., Billings

SECRETARY-TREASURER Carter E. Beck, M.D., Missoula

ASSISTANT SECRETARY-TREASURER

Roman M. Hendrickson, M.D., Sheridan

DeleGATe AMERICAN MEDICAL ASSOCIATION

Timothy J. McInnis, M.D., Bozeman

DeleGATeS AMA YOunG PhYSICIAnS SeCTIOn

Nicole C. Clark, M.D., Helena

Kristopher G. Cunningham, M.D., Lewistown

IMMEDIATE PAST PRESIDENT Jay S. Erickson, M.D., Whitefish

MeMBeRS-AT-lARGeStephen Bechdolt, M.D., Havre

Joan M. McMahon, M.D., Lewistown

Brian D. Sippy, M.D., Ph.D., Missoula

Thomas H. Roberts, M.D., Missoula

CHAIR, MMAHCPTJ. Bruce Robertson, M.D., Bozeman

MMA Bulletin Spring 2012 Volume 65, Number 14

The fateful day a r r ived today. My youngest son got his driver’s license. I had to chuckle, okay it was more of a sweat, as I turned the car keys over to him for the drive

back to the office. While he had traveled the route many times as a passenger, once he got behind the wheel he discovered there were a few turns of uncertainty. Fortunately, I was there with him and we reached our destination.This strikes a similar picture to

what I experienced over the weekend with your MMA Board of Trustees and the presentation of the strategic plan generated by the Executive Committee. Physicians are facing a time of uncertainty and being in the driver’s seat at such a time is a bit unnerving. Yet, the Board of Trustees grabbed the steering wheel this weekend and determined the MMA will move forward in a strategic manner. We listened . Many of you

responded to MMA’s call and participated in a survey that captured needs, concerns and issues. This provided the information needed from which a visionary destination was formed and a road map (strategic plan) was developed. Time to take charge. MMA is

being steered in a direction by the Board of Trustees, your physician leadership team, that supports professional freedom, protects the patient and physician relationship and works to ensure Montanans receive quality health care. Your support of this strategic positioning effort is appreciated and your participation is very much needed.Thank you to the many, many

physicians who completed the survey and congratulations to the MMA Executive Committee and Board of Trustees for their work on the strategic plan. You can find the details of MMA’s strategic plan on the MMA website at www.mmaoffice.org.

In your corner

jean Branscum

Long-time MMA Employee RetiresLinda Edquest retired from her career with the Montana Medical Association on March 1, 2012, after 31 years of service. Linda has been an anchor at the MMA since she accepted the administrative support position in 1980. Over the years she has organized hundreds of meetings, taken thousands of pages of minutes and tackled many special projects for MMA Presidents.

MMA President Paul Grmoljez presented linda with a Resolution of Commendation on behalf of the Montana Board of Trustees at the Interim Meeting recognizing her dedicated service. “We are appreciative of Linda’s commitment in advancing the vision and mission of the Association,” stated Doctor Grmoljez.

Linda’s duties at the MMA included providing support to the Montana Academy of Family Physicians (MAFP). Linda will continue to provide such support as the part time MAFP executive director. The MMA extends their best wishes to Linda and looks forward to working with her and our physician friends at MAFP.

Calling for Award Nominations Recognizing Outstanding Members and Individuals Contributing to the Physician CommunityThe MMA is accepting nominations for two distinct awards that recognize and honor individuals who have made important contributions to the advancement of the physician profession and whose actions have led to the betterment of health care in Montana.

The Award of Merit, established in 1975, honors individuals whose actions have led to the betterment of health care in Montana.Qualifications:

• A commitment to service; • Dedicated to patient health care; and • Substantive involvement in community, state or national policy efforts with a focus on

improving health care delivery or the general health status of Montanans. The Doctor Jack McMahon Service to Montana Physicians Award recognizes individuals who have made important contributions to the advancement of the physician profession.Qualifications:

• Demonstrated commitment to the physician profession through actions taken to promote the profession while collaborating with other physicians to protect the patient-physician relationship; and

• An advocate of the interests of patients.Nominees for either award do not need to be a physician or currently employed in a heath care field and should have a current or past relationship with the MMA. Award nomination forms can be found online at www.mmaoffice.org and will be accepted until July 1, 2012. Recipients will be honored at the Annual Meeting in September.

Now Available: Revised Application for Disable Parking Permits

The Disability Permit/License Plate Application, Form MV5, was recently revised to reflect a change in where the application needs to be sent. Applications are now being processed at Motor Vehicle Division headquarters in Helena. Previously, processing was done in Deer Lodge at the MVD’s Title and Registration Bureau. The updated form is available on the Motor Vehicle Division’s website at www.doj.mt.gov/driving/forms. We encourage applicants and medical practitioners to use this updated form to ensure their requests are processed in a timely manner.

The eligibility criteria and application process have not changed. Individuals wanting to apply for a disabled parking permit or license plate need to obtain medical certification from a physician, chiropractor, or advanced practice registered nurse. Agencies or businesses that provide transportation as a service for people with disabilities may also still apply for special parking permits.

If you have questions about disabled placards, please contact the Motor Vehicle Division at (406)444-3933 or mvdtitleinfo@mt.gov.--Montana Department of Justice, Motor Vehicle Division

LINDA EDquEST

Volume 65, Number 1 Spring 2012 MMA Bulletin 5

MMA Rounds Delivers Timely Information

The Montana Medical Association launched MMA Rounds, our electronic newsletter,

to keep Montana physicians informed of regulatory happenings, health policy news and MMA activities. You will find each issue to be timely and a valuable source of information on issues of importance to your physician profession.

MMA Rounds will be delivered to your inbox twice a month. Since the MMA represents your interests and works each day to ensure the physician voice is heard, the MMA Rounds will also occasionally include surveys to collect your input.

Watch your inbox for the next issue by looking for the subject line “MMA Rounds.” If you have yet to receive this newsletter or have news to share in MMA Rounds or the MMA Bulletin please contact Jean Branscum, MMA Executive Vice President, at jean@mmaoffice.org.

MMA Member, Candidate for Lt. GovernorAl Olszewski, M.D., Kalispell and current MMA member is the running mate of Jim lynch (R) of Kalispell, candidate for Governor.

Doctor Olszewski is a third generation Montanan, the oldest of seven children, born and raised in Great Falls. he graduated maxima cum-laude, from Carroll College in Biology (1984). After graduation, he was commissioned as a Lieutenant in the United

States Air Force Reserve and immediately entered medical school at the University of Washington School of Medicine, graduating in 1988. He entered active duty in the Air Force, practicing in Aerospace Medicine, General, and Orthopedic Surgery. Doctor Olszewski achieved the rank of Major, receiving Air Force Commendation Medals for his roles in providing medical support in the 1995 Oklahoma City Bombing and the 1996 Air Disaster in Manta, Ecuador.

Doctor Olszewski left the Air Force in 1997 to obtain advanced surgical training in Sports Medicine and Adult Reconstruction at the University of Texas Health Science Center in San Antonio. Upon completion in 1998, he entered private practice at Flathead Orthopedics in Kalispell. As one of the pioneers of minimally invasive knee replacement surgery, he taught over 300 orthopedic surgeons from North and South America the concept of less invasive joint replacement and alternative methods of pain management.

In January 2010, Doctor Olszewski traveled to Port-au-Prince, Haiti, joining the Hope Force International Disaster Response Team providing early response trauma care to people devastated by the earthquake.

Currently, Doctor Olszewski is president of Flathead Orthopedics, as well as the Director of Surgery at North Valley Hospital in nearby Whitefish. he is a member of the Board of Trustees for Carroll College and the Montana Delegate to Physician’s Council for Responsible Reform.

More information is available about their campaign at www.lynchforgov.com.

Board of Radiologic Technologists Seeks InputThe Board of Radiologic Technologists is considering a licensing requirement for Ultrasonographers, Nuclear Medicine Technologists and Radiation Therapists in Montana.

The Board of Radiologic Technologists report that many people are surprised to learn that there is no current requirement for licensing approximately 600 healthcare professionals. Oregon recently became the first state to develop licensing for ultrasonography technologists and other states, including Connecticut, New Mexico and North Carolina, are considering this as well. More information and proposed language can be found on our website at www.mmaoffice.org.

The Board of Radiologic Technologists is soliciting comments on this proposal and is asking physicians for their input. Please provide your comments to the Board of Radiologic Technologists. at dlibsdrts@mt.gov.--Jesse Cole, M.D., Butte, Board Member

Champions for quality Patient Driven Leadership EventsMake plans today to join Doctor Brian Wong at the 2012 Regional Champions for Quality Patient Driven Leadership events. Doctor Wong will facilitate a day-long session that focuses on creating patient centered problem solving teams that are designed to have optimal impact toward improving care by enhancing communication and problem solving between sending and receiving facilities in Montana. Champions events are scheduled at the four locations listed below.

• Great Falls, Monday, June 25; hosted by Benefis health System • Missoula, Wednesday, June 27; hosted by St. Patrick Hospital • Billings, Tuesday, July 24; hosted by Billings Clinic • Bozeman, Thursday, July 26; hosted by Bozeman Deaconess

Hospital For more information about this program and Doctor Wong’s

Patient Driven Leadership Program, see the MMA website at www.mmaoffice.org.

WWAMI Admissions Committee Seeks New MemberThe Montana WWAMI Medical Education Program is seeking a physician to serve as one of four Montana representatives on the University of Washington School of Medicine Admissions Com-mittee. The term is for three years with the option of serving an additional three years. The term would begin in the fall of 2012 for the interview season which begins in January of 2014.

The required qualifications for prospective committee members are:

1. An M.D. degree from a medical school accredited by the American Association of Medical Colleges.

2. The ability and willingness to donate without compensation (other than travel expenses) the time necessary to meet the responsibilities of the committee. Usually, this means two trips (of four-five days each) the first being to Bozeman in January followed by a trip to Seattle in February to interview

WWAMI ContInued on pAge 7

MMA Bulletin Spring 2012 Volume 65, Number 16

2021 Eleventh Avenue, Suite 3Helena, Montana 59601(866) 339-7245http://www.mmaoffice.org/MMAHCPT_intro.htm

Marcy McLeanAccount Executive

Health Insurance for Physicians by Physicians

M a n y B e n e f i t P l a n s Av a i l a b l e

• Vi s i o n

• D e n t a l

• P e r s o n a l i z e d S e r v i c e

• P r a c t i c a l O p t i o n s

D e s i g n e d b y P h y s i c i a n s f o r

P h y s i c i a n s

We created a competitive, self funded and self governed health insurance plan for our MMA members, their families and their employees – health insurance for doctors, by doctors.

--J. Bruce Robertson, M.D.MMA HCPT Board Chair

The MMA Health Care Plan and Trust is addressing the needs of member physicians, their families, their

employees and their employees’ families.

“

”

Please contact MMA HCPT for more information and an application packet

Volume 65, Number 1 Spring 2012 MMA Bulletin 7

This two part article gives a brief explanation of what constitutes an “estate plan,” what it should accomplish, and some of the risks or misuse of various techniques.

In general, for individuals with few assets and a minimal net worth, estate plans can be quite straightforward, and may literally be as simple as filling in some names and other basic information on a form. However, for others, such as physicians, with a greater diversity of assets and net worth, and a career that exposes assets to relatively high liability, the process can be more involved – and the cost of a misstep greater.

What is an Estate Plan? In general terms, an “estate plan” consists of a Will (or a Will substitute, such as a living trust (see below), a Financial Durable Power of Attorney, a Health Care Durable Power of Attorney, a Medical Directive (a.k.a. a Living Will), or a combination thereof. The estate plan should not only address who will receive your assets, but under what terms or conditions they will receive the assets, what should occur if you cannot act on your own behalf (i.e. you are incapacitated), minimize any administration costs and hassles, and reduce or address the tax consequences of the transfer of assets.

Does the Will control who gets my Assets? Yes, and No. Your Will controls the disposition of assets that are subject to probate. However, non-probate assets pass according to designations associated with such assets or in documents other than the Will. Non-probate assets generally include

those titled in the name of a living trust, financial accounts with beneficiary or transfer on death designations, insurance death benefits, and assets titled as joint tenant with the right of survivorship (JTROS). Further, certain assets, such as interests in partnerships, LLCs, or corporations often have restrictions on transfers that may override a Will.

Are all Trusts the same? Absolutely not! Every trust, even trusts by the same name, can vary greatly and accomplish vastly different goals. The most common trust, known as a living trust (a.k.a. a family trust), is amendable and revocable during your lifetime and is generally used as a means to avoid probate and allow for the management of assets upon incapacitation. however, for these benefits to apply your assets need to be transferred to the trust prior to your death. What is often missed, and unlike certain other trusts, is that living trusts are a nullity for tax and creditor protection purposes. If properly drafted and funded, certain trusts can be used for tax planning, creditor protection, asset management, or any of numerous other purposes. It is critically important that you understand the terms of the trust and what it will (and will not) accomplish.

In Part Two of this article we will address JTROS in more detail, some basic aspects of asset protection, and estate and gift taxes.

Law Firm oF GarLinGton, Lohn and robinsonmissouLa, montana

candidates and to meet as a committee, as well as time to review written materials before and after those meetings. This is a significant time commitment.

3. Ability to participate in an educational session each December in Bozeman with the Dean of Admissions at the UWSOM and the MT WWAMI Advisory Committed and other WWAMI activities as needed.

4. Interviewing skills.5. A familiarity with current methods of medical education.6. An understanding of those qualities and attributes necessary

to be a successful medical student and a competent and compassionate physician.

It is desirable if committee members have the following additional qualifications:

1. Familiarity with the operation of the University of Washington School of Medicine and the WWAMI Medical Education Program.

2. Previous experience with medical school admissions procedures.

3. Familiarity with the physician workforce needs of Montana and how WWAMI medical school admissions may impact that need.

4. Familiarity with undergraduate education programs.WWAMI and the University of Washington strive to maintain

diversity and balance among its admission committee members with respect to gender, geography and other attributes.

Physicians who may be interested in serving on this committee are encouraged to mail an application consisting of a C.V. and a cover letter explaining their interest and qualifications to: Jay erickson

M.D., 525 Railway Street, Suite 204, Whitefish, MT 59937. If you have questions or need more information, please

contact Doctor Jay Erickson M.D., Clinical Coordinator of the Montana WWAMI program at jerick@uw.edu or by phone at (406) 862-3810. The deadline for applications is April 30, 2012. The selection of the admissions committee member is under the direction of the Commissioner of the Office of the Commissioner of Higher Education of the Montana University System. --Jay S. Erickson,M.D., WWAMI Clinical Coordinator

Montana Healthcare Workforce Plan ReleasedTo address the future healthcare needs of Montana’s population, the Montana Healthcare Workforce Plan has been developed. The plan was initiated with grant support from hRSA/Office of Rural health Policy, and was awarded to the Montana Healthcare Workforce Advisory Committee (MHWAC) and the Montana Department of Labor and Industry, State Workforce Investment Board (MT DOLI—SWIB). In order to develop a plan that addressed the needs of a frontier and aging population, the MHWAC membership was expanded statewide to all persons who wanted to participate. Over 100 committee members have participated in monthly meetings and given input specific to their locations and/or profession or healthcare sector. In addition, ten focus groups were held in locations throughout the state to determine region specific issues or concerns. Fifteen workgroups helped to develop overall strategies, as well as strategies specifically addressing issues within their profession or sector.

What Exactly is an Estate Plan

WWAMI FroM pAge 5

WorkForCe plAn ContInued on pAge 8

N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B. N.B. N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B. N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.N.B.

MMA Bulletin Spring 2012 Volume 65, Number 18

Overall strategies have been developed that focus on four main areas: • Engaging Montanans in understanding and addressing the

State’s healthcare workforce needs• Educating and training Montana’s healthcare workforce • Recruiting health professionals to Montana’s Health

Professions Shortage Areas• Retaining a skilled healthcare workforce

In addition, sector and profession specific strategies were developed with input from workgroups and include strategies for: allied health, behavioral health, community health centers, dental and oral health, direct care, EMS, HIT, medical laboratory science, nursing, pharmacy, physicians, physician assistants and public health.

As the efforts of the MHWAC move forward, priority focus areas include: increasing the number of primary care providers in rural and underserved communities, development of consistent and reliable workforce data for healthcare professions, development of recruitment and retention strategies for allied health professionals, and continuing our partnership with the State Workforce Investment Board in the area of career pathways. We also envision regional plans and strategies that are appropriate for specific needs within certain regions of the state.

The Montana Healthcare Workforce Statewide Strategic Plan can be accessed online at http://healthinfo.montana.edu/MTHWAC/DEC13thEDITS.pdf. We welcome your review and input.--Cindra Stahl, Project Coordinator, MT Office of Rural Health/AHEC

Montana TRuST graduate KayCee Gardner breaks new groundFourth-year medical student KayCee Gardner has always been a trailblazer. Gardner has become the first TRuST (Targeted Rural/

Underserved Track) scholar to sign a residency contract prior to the Residency Match with the Montana Family Medicine Residency in Billings. This integrated residency pilot, authorized by the National Residency Match Program, allows students direct entry into one of the 18 WWAMI family medicine residency network programs.

The residency contract will give Gardner the opportunity to continue with elective experiences in her TRUST community throughout residency. This is a truly unique longitudinal continuity teaching experience—seven years of learning in a single rural or underserved community during both undergraduate and graduate medical education. After a sub-internship rotation in Billings, Gardner and the Montana Family Medicine Residency opted to sign an early contract.

KayCee Gardner entered WWAMI at Montana State university (MSU) in 2007. She grew up on a ranch outside of Hammond, MT and graduated from Broadus High School in 2003. She attended MSU, graduating summa cum laude in 2007 with a B.S. in cell biology and neuroscience. While at MSu, Gardner volunteered with several groups including: Relay for Life, Scramble 4-a-Cure, bone marrow drives, the Child Advancement Project, Expanding your Horizons, Habitat for humanity, eagle Mount Therapeutic Recreation, Bowl for Kids’ Sake, and others.

Gardner entered the Montana WWAMI program in 2007, and was a volunteer participant in the first class of TRuST, a four-year rural/underserved longitudinal continuity medical school experience. Gardner’s TRuST mentor was laura Bennett in lewistown. her introduction to rural medicine started with a two-week pre-matriculation experience with Bennett and continued with five significant teaching experiences in lewistown during the first three years of medical school. This culminated in her third year of medical school with a five-month continuity experience in Lewistown as part of the WRITE (WWAMI

WorkForCe plAn FroM pAge 7

WWAMI truSt grAduAte ContInued on pAge 9

Volume 65, Number 1 Spring 2012 MMA Bulletin 9

montanastatefund.com(406) 495-5362

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We only do workers’ compensation, and only in Montana. Call us and you get a real live human being. One that will help you and your patients, quickly and truthfully.

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Rural Integrated Training Experience) program. During this WRITE experience, KayCee helped initiate a health interest club in the local high school.

In her fourth year, Gardner was presented with the George Saari Professionalism Award at the Montana State University White Coat Ceremony. This award is presented annually to a fourth-year Montana WWAMI student who best exhibits the professionalism and humanitarian characteristics exemplified by the late Doctor George Saari, who combined compassion and clinical excellence that demonstrated the interconnection of the art and science of medicine. This award in the amount of $1000 helps student recipients achieve the excellence in medicine and life that Doctor Saari achieved. --Jay S. Erickson, M.D., Assistant Dean-WWAMI Clinical Phase/Montana, Co-chair WRITE, University of Washington School of Medicine

Minimize Malpractice Risk When using a Physician AssistantAs the practice of medicine evolves in the future it is predicted that more physician practices will add physician extenders in order to increase revenues. This should be done in a way that does not increase the risk for liability claims for the physician.

In Montana, the administrative rules require that a physician assistant complete an accredited training program, have a current NCCPA certificate and have a supervising physician. The supervising physician can provide supervision directly or remotely. The supervising physician must visit the remote site every thirty days to provide education and feedback. It is critical that a physician maintain current knowledge about state rules regarding the supervision of a physician assistant as these can change.

The physician should realize that he/she is at risk of being named in a malpractice claim based on the role of supervising physician to a physician assistant. The way to mitigate this risk is through active supervision of the physician assistant. The initial step in this supervision is a delegation of services agreement. This agreement is made between the physician assistant and the supervising physician. The agreement should specify the types of patients/problems that the physician assistant can see, clarify when in the course of patient care that the physician assistant should seek help from the supervising physician, document the types of patients/problems that the physician assistant will not see, and document how often the supervising physician will see patients (for example, at least once per year, after two PA visits, or after two visits for the same problem and the problem has not resolved). This is a document which should be reviewed and updated on a regular basis. Ideally, the physician and physician assistant can meet and review the physician assistant’s performance and make changes to the document to reflect what the PA does well and in what area the PA needs more supervision. The physician assistant should not perform any procedures or provide any services that are not also performed and provided by the supervising physician. In addition alternate supervising physicians should be named and should be available if the supervising physician is not.

The key to utilizing physician assistants in your medical practice and not increasing your risk of a malpractice claim is to have clear and consistent communication between the supervising physician and the physician assistant. In addition the supervising physician should know and respect the limits of the skill set of the physician assistant.--Patrice F. Hirning, M.D., Medical Director, Utah Medical Insurance Association

WWAMI truSt grAduAte ContInued FroM pAge 8

Mitigate risk through active supervision

MMA Bulletin Spring 2012 Volume 65, Number 110 MMA Bulletin Spring 2012 Volume 65, Number 110

Physician Aid-in-DyingThe Montana Supreme Court ruled in Baxter v. State of Montana that the Rights of the Terminally Ill Act and the consent defense could be used to defend a physician from liability for acting in accordance with a patient’s end-of-life wishes if the terminally ill patient consents to the physician’s aid-in-dying. The full legal implications of this ruling are somewhat unclear and have been debated by our state’s best legal minds. In addition, the 2011 state legislature was unable to pass any clarifying laws.

As a result of this decision, the Montana Board of Medical Examiners has been asked if it will discipline physicians for participating in aid-in-dying. After discussion, reviewing public comment, debate, drafts, and revision after revision, the Board has published on its website Position Paper #20 which addresses our stance. The Board takes this subject very seriously and I would like to explain some of the thoughts and process behind our statement.

First of all, we recognized that we are not legal scholars and cannot debate the ruling’s legality. We believe that at some point, legislation should and will be enacted that delineates the specifi cs of this practice, or denies it altogether.

Secondly, we wanted to hear from physicians and the public at large. We spent multiple committee sessions listening to comment and received many e-mails and letters. Passions run high on this topic from both sides.

Finally, we realized that the ethics of physician aid-in-dying is not simple. The Board itself is conflicted on this issue and will not take a stand for or against. I believe this topic is similar to another polarizing social issue in that legality is based on a Supreme Court ruling, people for and against the practice believe their position is the “correct” one, and ultimately the decision to participate is left to the individual patient and doctor. The Board wanted to respect individuals’ rights as long as good medicine is practiced.

Which takes me to our position. The Board will treat complaints in this matter on an individual basis, similar to all other complaints. We want to ensure that the standards of professional care are met, such as, but not exclusively, a bone-fi de patient-physician relationship, and competency and understanding of both the physician and the terminally ill patient. Of course, if

no complaint is registered when physician aid-in-dying takes place, the Board will not investigate. --Kris Spanjian, Board Members, Montana Board of Medical Examiners

Welcome to our Newest Members of the mmA!Abentroth, Alissa D. HelenaAndrus, Jennifer G. BillingsAufi ero, Thomas X. ButteBargmeyer, Ernest M. MissoulaBuechler-Price, Joni BillingsCahill, Terrence J. BillingsCaldwell, J. Michael MissoulaCampo, Stacie L. MissoulaChernich, Bethany V. MissoulaDanforth, Rebecca L MissoulaDonovan, Janelle L. MissoulaDunham, Douglas L. AnacondaDuwe, Kevin M. BozemanEddy, Meg A. MissoulaFaaborg, Sarah L. MissoulaFreitag, Corby C. BillingsGardner, Ronald S. PolsonGelbke, Martin K. BozemanGlatterer, Milton S. KalispellGregory, Joe K. Buttehumphreys, Aaron G. lewistownIhrig, Bradley J. MissoulaJackson, John Wolf PointJenkins, John BillingsJohnson, Christopher R. Great FallsKinney, Rebecca G. MissoulaKleman, Gail A. Billings

Knight, Jeffrey C. MissoulaKominsky, John M. BillingsLaclair, Robert E. HelenaLakatua, Anthony MissoulaLay, Cathy H. HelenaLittlefi eld, Megan B. BillingsMann, Martha ButteMiller, John B. MissoulaMoeller, Kristy l. BozemanMondloch, Michael C. HelenaMontville, Christopher P. BillingsMorrow, Patrick A. Helenanewsted, Joshua A Great Fallsnichols, Mark O. GlendivePatterson, James L. SuperiorPopwell, Richard E. BozemanReed, Michael C. MissoulaRembert, Frank M. BozemanRobinson, Thomas A. BillingsRobinson, William A. BozemanScheer, Zachary B. BillingsSchoene, Robert B. BozemanSchuett, Amy E. BillingsSheehan, Kevin M. MissoulaShenk, Lynn BillingsSlocum, Eugene A. BozemanSmith, Jeffrey e. Great FallsSorenson, Joan F. BillingsStephens, Bonnie E. MissoulaStilwill, edward W. Gallatin GatewaySwanson, Julie L. BillingsSzekely, Peter C. MissoulaTwigg, Shari J SidneyWeber, David M. KalispellWiswell, Grant MissoulaWoerner, Douglas A. LaurelYahn, Diane MissoulaZazzo, Lawrence J. Wolf PointZehnpfennig, Michael J. Butte

25LINCOLN 257

FLATHEAD

16GLACIER

6TOOLE

2LIBERTY 25

HILL 4BLAINE

1PHILLIPS

9VALLEY

1DANIELS

2SHERIDAN

6ROOSEVELT

14RICHLAND0

MCCONE12

DAWSON

24CUSTER

1PRAIRIE 0

WIBAUX

0GARFIELD

3FALLON

5ROSEBUD

0POWDER

RIVER

0CARTER

0TREASURE

PETROLEUM

0

MUSSELSHELL

0

YELLOWSTONE

523

12BIG HORN9

CARBON

17FERGUS

1GOLDENVALLEY

1CHOUTEAU

0JUDITHBASIN

217CASCADE

1MEAGHER 1

WHEATLAND

SWEETGRASS

23

STILLWATER23

PARK

224GALLATIN

9MADISON

16BEAVERHEAD

3BROADWATER9

JEFFERSON

190LEWIS

AND

CLARK

75SILVERBOW

6POWELL

23DEER

LODGE

0GRANITE

365MISSOULA

67RAVALLI

2TETON

4PONDERA

33LAKE

12SANDERS

3 MINERAL

Total: 2264March 26, 2012 Source: Montana Medical Association

Montana physicians in Active practice by County

Volume 65, Number 1 Spring 2012 MMA Bulletin 11

MMA DIRECTORY of MONTANA PHYSICIANS 2012– 32nd Edition

ORDER FORM

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MMA Member 2012 Directory $40 Prepaid

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Questions? Call the MMA Office at 406-443-4000 or 877-443-4000 - thank You

MMA Directory Now Available Get your 2012 MMA Directory of Montana Physicians today.New this year, the Directory includes a physician assistants section.

Your Association has a limited supply of the 2012 Directory of Montana Physicians. Members of the MMA have been provided one copy of the Directory at no charge. If you have any questions, please contact the MMA by telephone at 877/443.4000 or email tammy@mmaoffice.org.

MMA Bulletin Spring 2012 Volume 65, Number 112

Are you Prepared for a Medical Audit of your Practice?The Physicians Advocacy Institute (PAI) recently developed a white paper to help physicians learn be prepared for medical audits of their practices, whether by the federal government or private payers. One of the greatest challenges facing physicians and their staffs is how to prepare for audits and financial reviews conducted by the Medicare Recovery Audit Contractors (RACs) and private payers and how to appeal adverse audit findings. The PAI has presented this Association with their white paper as part of an effort to assist physicians and their practice staff in understanding and appealing medical audits by RACs and commercial payers.

With ever increasing pressure on both governmental and private payers to reduce healthcare costs, it is inevitable that payers will continue to use audits to identify alleged overpayments and to demand that physicians repay these amounts. Physicians need to prepare for and manage external payer audits just as they manage any other part of the business side of their practices to minimize the risk of being audited and to ensure that any audit findings are fair and accurate. This white paper is designed to provide physicians and their staffs with tools to do just that.

For a copy of this information please visit our website at :ht tp: / /www.mmaoffice.org/pdfs/2012_0208_Public_PAIMedicalAuditsWhitePaperJanuary272012.pdf --Robert Segilson on behalf of the PAI Board of Directors

Contact CMS for ePrescribing Penalty ExemptionsThe American Medical Association (AMA) has yet again secured an opportunity for more physicians to be exempted from the 2012 Medicare e-prescribing penalty. Even if you have already contacted CMS, contact CMS again. They are willing to hear your case.

The AMA has continually raised concerns with CMS that the back-dating of the 2012 e-prescribing penalty program along with the multiple other quality and health IT programs underway left little time for a significant number of physicians to take the necessary steps to avoid the 2012 e-prescribing penalty.

CMS has completed its review of all hardship exemption requests for the 2012 e-prescribing penalty program received via CMS’ Communication Support Page.

Please contact CMS’ Quality Net Help Desk if you have not received a formal notice from CMS regarding the final status of your exemption request or if you believe you are receiving the 2012 e-prescribing penalty in error. The Quality Net Help Desk can be reached at (866) 288-8912 or by email at Qnetsupport@sdps.org.

AMA heard from many physicians who believe that they received the 2012 Medicare e-prescribing penalty in error. Here are some examples of the hardships that physicians faced:• You did e-prescribe in 2011 but due to errors or system/technical

glitches (e.g., your billing vendor/clearinghouse removed the G8553 code from your Medicare Part B claims you submitted), the G8553 code was removed from your Medicare Part B claims that you submitted to Medicare. You also have documentation that shows that you e-prescribed for your Medicare patients in 2011.

• You reported the wrong G-code (e.g., a 2009 e-prescribing G-code) on your Medicare Part B claims in 2011. You also have documentation that shows that you e-prescribed for your Medicare patients in 2011.

• You filed for an exemption request but you included your group NPI rather than your individual NPI number on the exemption request form and your exemption request was denied.

--AMA Federation News

Physicians Consider Early RetirementA recent survey of over 5,000 physicians and surgeons on the Future

of Health Care indicates that the anticipated shortage of health care professionals may be exacerbated by growing physician sentiment. The medical profession has been projecting a shortage for years, but the findings from this survey indicate two compounding factors. First, 43 percent of physician respondents indicated that they are contemplating early retirement within the next five years. Second, nine out of 10 are unwilling to recommend the health care profession to family and friends. In both instances, the responses were attributed to the transformative changes occurring within America’s health care system, more specifically as a result of health care reform.

For those physicians considering early retirement, many cited the demands on their practices resulting from new legal requirements and continued reimbursement reduction as causes to inhibit practice growth, despite the anticipated influx of newly insured Americans into the health care system. In addition, 60 percent of respondents indicated that the pressure to reduce costs, increase volume, and improve quality will have a negative impact on patient care and how doctors practice medicine. Finally, the transformative changes that are causing practicing physicians to consider early retirement are also impacting their desire to recommend the health care profession, a career that is often viewed as a legacy being down from one generation to the next.

“The physician sentiments expressed in the Future of Health Care Survey are deeply concerning and disheartening,” said Donald J. Palmisano, MD, JD, FACS, former president of the American Medical Association and member of The Doctors Company Board of Governors.“Today, we are perilously close to a true crisis as newly insured Americans enter the health care system and our population continues to age. Unfortunately, we may be facing a shift from a ‘calling,’ which has been the hallmark for generations among physicians, that could threaten the next generation of health care professionals.”The survey, conducted by The Doctors Company, is the largest of its kind on the subject and includes responses from over 5,000 physicians and surgeons from across the United States. For more information about the study, please visit the Knowledge Center at www.thedoctors.com/future.

Practice Management Tools AvailableThe American Medical Association (AMA) unveiled a redesigned website for its Practice Management Center, featuring a new layout that is easier to navigate and faster to use. The improved website offers you easy access to the AMA’s wealth of resources, tools and guidance for enhancing the operation of a medical practice.

In addition to the improved design and layout, the website has three new sections: Practice operations, Claims revenue cycle management and Health insurer relations.

The new Knowledge Center provides access to practice management tips, toolkits, guidance and webinars. You can sign up for the popular Practice Management Alerts or join the AMA’s new online community, the Paperless Practice Group, to connect with peers, share best practices and ask questions about how to automate and streamline your medical practice.

The AMA is committed to designing innovative practice management tools with physicians’ needs in mind. All these and more are available to physicians who visit www.ama-assn.org/go/pmc to explore the new Practice Management Center website. The site is free and available to AMA members and non-members.

--AMA Federation News

Volume 65, Number 1 Spring 2012 MMA Bulletin 13

MMA BulletInAdVertISIng rAteS

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The annual subscription rate for nonmembers of the MMA is $25.00/year in the United States. To subscribe, contact the MMA Executive Office at (406) 443.4000 or by email at mma@mmaoffice.org.

The MMA Bulletin retains editorial privileges relative to submitted articles and advertisements.© 2012, Montana Medical Association

Jean Branscum, Executive Vice PresidentCarter E. Beck, M.D., Secretary-Treasurer

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Membership Renewal .................................. $490.00New Membership ......................................... $245.00 (limited to first 2 years of membership)County Medical Society (see below)........... ________ -Encouraged - American Medical Association...........…… 420.00 Physicians may join the MMA without joining the AMA MTMedPAC ………...…...........…………. 99.00Cascade County $ 10 Ninepipe ——Eastern Montana $ 50 Northcentral Montana $25Fergus County $ 10 Northeastern Montana $50Flathead $ 50 Park-Sweetgrass $25Gallatin County —— Silver Bow County $50Hill County —— Southeastern Montana $30Lewis & Clark County $100 Western Montana $25Mount Powell $ 50 Yellowstone Valley $50

MMA Membership: You are important!Just like old friends, sometimes we lose touch- but it is important to keep your relationship and your voice within the Montana Medical Association. The Montana Medical Association is the guardian of your profession and your involvement is crucial for a united voice in Montana.

MMA Bulletin Spring 2012 Volume 65, Number 114

CoMIng MeetIngS In MontAnA

AprIl 2: MedICAl HIStory oF tHe WeSt, 12tH AnnuAl ConFerenCe. BozeMAn. CONTACT WWAMI AT (406) 994-4411 OR BY EMAIL AT WWAMI@MONTANA.EDu FOR MORE INFORMATION.

AprIl 13: CArdIoVASCulAr HeAltH SuMMIt. BIllIngS. HOLIDAY INN GRAND CONTACT MICHELLE quINN AT (406) 243-4866 OR BY EMAIL AT MICHELLE.quINN@uMONTANA.EDu FOR MORE INFORMATION.

AprIl 27-28: prIMAry CAre SyMpoSIuM. BIllIngS. ALICE FORTINE CENTER. CONTACT KRISTINA MCCOMA AT (406) 238-2785 OR BY EMAIL KMCCOMAS@BILLINGSCLINIC.ORG FOR MORE INFORMATION.

MAy 2-3: 2012 WorkSIte HeAltH proMotIon ConFerenCe. HelenA. BEST WESTERN PREMIERE GREAT NORTHERN HOTEL. CONTACT MICHELLE quINN AT (406) 243-4866 OR BY EMAIL AT MICHELLE.quINN@uMONTANA.EDu FOR MORE INFORMATION.

MAy 24: MontAnA CAnCer CoAlItIon StAteWIde MeetIng. MISSoulA. ST. PATRICK HOSPITAL. CONTACT LISA TROYER AT (406) 444-6089 OR BY EMAIL AT LTROYER@MT.GOV FOR MORE INFORMATION.

SepteMBer 7-8: 134tH AnnuAl MeetIng oF tHe MMA And BoArd oF truSteeS. HelenA. CONTACT THE ExECuTIVE OFFICE AT (877) 443-4000 OR BY EMAIL AT MMA@MMAOFFICE.ORG FOR MORE INFORMATION.

IF you Would lIke to See your MeetIng lISted Here And on tHe MMA’S onlIne eVent CAlendAr eMAIl tAMMy@MMAoFFICe.org.

134th Annual Meeting of the Montana Medical

Association and Board of trustees

September 7-8Best Western Helena Great

Northern Hotel

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Limited to 25 words or less - $25 Per ad per issue (nonmembers) ~ $20 Per ad per issue (members) FUN, FABULOUS,FLEXIBLE FAMILY PRACTICE Seeking Studious Primary Care Doctor To Immunize, Inspire and Independently, Heal and Establish Healthy Relationships, Family Practice Clinic, Great Falls, Contact 406-727-5778 or 406-452-8688

FAMILY PHYSICIAN WANTED Bozeman Acute Care Clinic. Full time position with a mix of weekdays (9a-8p) and weekends/holidays (9a-5p). Respond with CV to Dona Anderson-Gonzalez at 120 n. 19th, Ste A, Bozeman, MT 59718

Spring 2012 Solutions to pesky Coding Issues Wednesday, May 15 from 8:30 a.m. to 11:30 a.m.

* Tricky ICD-9-CM Diagnosis Problems * ICD-10-CM update Information * CPT and HCPCS Modifier Review

$75/Members or $150/NonmembersRegistration and more information is available online at www.mmaoffice.org

Brought to you by Montana Medical Association and Brown Consulting Associates

Volume 65, Number 1 Spring 2012 MMA Bulletin 15

No one goes into medicine anticipating a lawsuit, but in the course of providing advanced health care, it can happen. UMIA offers more than just professional liability protection; our physicians enjoy the highest quality coverage and a steadfast commitment to helping them keep their promise.

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MMA Bulletin Spring 2012 Volume 65, Number 116

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PAIDHELENA, MT 59601

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2021 11TH AVENUE, SUITE 1HELENA, MT 59601-4890

Course Levels

100 Diagnosis (ICD-9-CM) Coding 200 Current Procedural Terminology (CPT) Coding 300 Special Coding Topics 400 Modifiers 600 Coding for Specialties 700 Third Party Payer Issues

Continuing Education Units (CEUs)

Participants earn one CEU for each hour of class attendance. Additional CEUs may be earned by completing an optional post-course assessment. Full details will be included in the course materials.

Cost

Each course is $189 and includes 2-3 hours of instruction. Price includes one phone connection and one internet connection.

Coding training without leaving the office! Presented by the Montana Medical Association and Brown Consulting Associates, Inc.

These seminars are live telecommunication classes designed for coders and billers working in health centers and doctors’ offices to further their education related to coding, documentation and billing.

2012 Online Coding Webinars

Refresh your coding knowledge through our web-based seminars!

Details Courses are 2 or 3 hours in length and combine web-based learning with live teleconference lectures. You will need an internet-ready computer and a speakerphone or headset to participate.

Instructors Bonnie R. Hoag, RN, CCS-P Shawn R. Hafer, CCS-P, CPC Donna Monroe, CCS-P, CPC Dana Fox, CCS, CCS-P, CPC Brown Consulting instructors are certified by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Brown Consulting Associates has been providing physician coding consulting since 1989. They conduct seminars for several State and Primary Care Associations. Over the past ten years, BCA has been preparing students for certification through various professional associations and the College of Southern Idaho.

For detailed class information and schedules contact: Montana Medical Association, at (877) 443-4000,

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Webinars Offered Throughout 2012