Action: June 16, 2014

TMA Action June 16, 2014   News and Insights from Texas Medical Association

INSIDE: Secret Service to Make Arrests in Tax Refund Fraud Case  

Enlist Now to Serve Our Veterans
Secret Service Expects to Make Arrests in Tax Refund Fraud Case
Free TMA Publication: Business Basics
Apply for the TMA Leadership College by July 2
Sunshine Act Physician Registration Process Has Begun
Physicians Receive ACA Grace Period Notice Letters
July 1 Meaningful Use Exemption Deadline Approaches

Patients Continue to Ask Doctors for Unnecessary Tests, Study Finds
CMS Proposes Flexibility for Meaningful Use Program
AccessMedicine Replaces MD Consult in TMA Databases
Independent Contractor or Employed Physician?
Free Bike Helmets for Pediatricians, Family Physicians
Custom Ringtones Added to DocbookMD
This Month in Texas Medicine

Enlist Now to Serve Our Veterans

Here's your opportunity to join with physicians across the state and provide medical care to veterans caught in a scandal-plagued and overloaded system. Enlist today.

Texas Medical Association has joined with the American Medical Association and medical societies around the country to help bring a temporary resolution to the crisis in access to health care for our nation's veterans. At the urging of Texas physicians, the AMA House of Delegates voted overwhelmingly to ask President Obama to provide timely access to entitled care for eligible veterans using the health care sector outside of the U.S. Department of Veterans Affairs (VA) health care system until the VA can provide health care in a timely fashion. Further, AMA will also urge Congress to rapidly enact long-term solutions so eligible veterans can always have timely access to entitled care.

"Our veterans have stepped up and served our country, so physicians want to be able to step in and serve them," said Austin I. King, MD, TMA's president. "It is tragic that our veterans have been forced to wait for the health care they need and deserve, so Texas physicians and our colleagues across the nation want to help care for them until the VA can right the ship."

As part of this plan, TMA is creating a registry of private physicians across the state who would be willing to see veterans in their offices. (We don't know payment specifics yet. However, when physicians currently agree to treat veterans, those payments are typically made according to the Medicare fee schedule.) TMA will share the registry (name, specialty, office address, and phone number) with community groups that work with Texas veterans and with the medical directors of VA facilities in Texas.

Sign up today for the registry. Check the "I am willing to serve veterans" box and click "SAVE." Or call the TMA Knowledge Center at (800) 880-7955. TMA will pull the additional information from our membership database.

Secret Service Expects to Make Arrests in Tax Refund Fraud Case

Last month, the Texas Medical Association first reported Texas physicians are victims of a tax refund/identity theft fraud scheme making waves across the nation. The association has since learned the crime's victims also include physician assistants, advanced practice registered nurses, dentists, podiatrists, and pharmacists. Texas is one of 49 states and the District of Columbia affected by this con. 

New Hampshire Medical Society Executive Vice President Scott Colby shared with TMA the following update from the U.S. Secret Service: 

  • The agency is developing leads nationally and internationally.
  • In addition to the Secret Service, federal agencies involved in the investigation include the U.S. Department of Health and Human Services, the Social Security Administration, and the Internal Revenue Service.
  • The Secret Service has identified several suspects and expects to begin making arrests. 
  • The Secret Service said finding those committing the fraud is critical in determining the ultimate source of the suspected data breach. 
  • At this time, there is no solid evidence pointing to the source of the suspected breach. 

The Secret Service recommends all physicians visit www.experian.com/fraud and place themselves on a 90-day credit fraud alert. This could potentially slow or halt further attempted identity theft activities. While not every physician is at risk of identity theft, this is a suggested precautionary measure. 

So far, TMA has learned more than 60 Texas physicians have fallen prey to this scam. Please notify TMA if you have been victimized by this scheme. The association can then convey the scope of the situation to the proper authorities. Email the TMA Knowledge Center or call (800) 880-7955. 

The majority of physicians who are victims of this scam first learn of it when they receive an IRS 5071C letter advising them of possible fraud. Others receive a rejection notification when attempting to file their tax return electronically, indicating the tax return cannot be submitted because a return has already been filed under the physician's Social Security number.

The 5071C letter from the IRS has instructions for providing information via the IRS identity theft website. Affected physicians can call the IRS at (800) 830-5084 to let the agency know they did not file the return referred to in the IRS letter. 

In February, the IRS issued a report titled "Dirty Dozen" Tax Scams for 2014 on identity theft affecting tax payers. 

The American Medical Association has the following guidance for fraud victims: 

  • File a paper return, and attach a Form 14039 Identity Theft Affidavit to explain what happened. 
  • Attach copies of the 5071C letter and any other notices from the IRS on this issue.  

Physicians who did not receive a 5071C letter or already have received confirmation of legitimate tax return acceptance most likely are not victims of this year's scam.

If you have not received notice from the IRS but believe your personal information may have been used fraudulently or worry you may have been victimized, call the IRS Identity Protection Specialized Unit at (800) 908-4490. 

If you learn your Social Security number has been used fraudulently, contact the following agencies: 

  • File a complaint with the Federal Trade Commission (FTC), which recommends other immediate steps and provides helpful information on its website
  • Consider filing a police report locally. Provide all documentation available, including any state and federal complaints you filed. This likely will be necessary if financial account fraud occurred as a result of the identity theft. If the only fraud is tax-related, however, the police report will be necessary only if the IRS requests it.
  • Call the Social Security Administration's fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you also can request your Personal Earnings and Benefit Estimate Statement or call (800) 772-1213. Check it for accuracy.
  • Consult the U.S. Department of Justice website for additional information. 

Also, the FBI has tips to help you protect your personal identity from thieves.  

Free TMA Publication: Business Basics

Thanks to a generous grant from The Physicians Foundation, you can download Business Basics for Physicians, TMA's newest publication, free.

Business Basics for Physicians guides you through essential business skills like hiring and managing staff, developing a budget, crafting administrative policies and procedures, and promoting the practice. Learn more on the TMA website.

Apply for the TMA Leadership College by July 2

TMA is now accepting applications for the TMA Leadership College Class of 2015. The deadline to apply is July 2.

The TMA Leadership College, established in 2010 as part of TMA's effort to ensure strong and sustainable physician leadership within organized medicine, is geared toward active TMA members younger than 40 or who are in the first eight years of practice.

TMA Leadership College graduates serve as thought leaders who can close the divide among clinicians and health care policymakers, and as trusted leaders within their local communities. Many also receive priority consideration for appointment to TMA councils and committees.

Visit the TMA Leadership College webpage for full program details, a class schedule, and application. 

For more information, contact Christina Shepherd in the TMA Membership Development Department by email or by calling (800) 880-1300, ext. 1443, or (512) 370-1443.


    TMLT Action Ad 4.13  

Sunshine Act Physician Registration Process Has Begun

Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services (CMS) will make public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs.

Most of the information contained in the reports will be available on a public, searchable website.

The law, which took effect Aug. 1, 2013, is part of the Affordable Care Act and requires manufacturers and group purchasing organizations to report ownership interests held by physicians and their immediate family members.

Earlier this year, CMS opened payments registration and data submission for applicable manufacturers and group purchasing organizations for the 2013 reporting year. 

Beginning June 1, physicians could register in the CMS Enterprise Portal, which allows physicians to sign up for notification when their financial disclosures are available for review and dispute. CMS says it will provide physicians access to their consolidated financial disclosures for the prior calendar year. 

Phase two of the access process — registration in the CMS Open Payments system — is set to begin in early July. According to the American Medical Association, CMS will release most of the data on a public website by September.

The Open Payments Mobile for Physicians app allows you to capture and confidentially collect information on reportable transfers between you and industry representatives. This information comes in handy should you need to challenge any inaccurate information reported to the government. Download the app on your Apple or Android device.

According to CMS, you will not be able to access the Open Payments system before phase two begins in July. The agency says physicians who attempt to access Open Payments through the Enterprise Portal will discover the functions on the "Welcome to Open Payments" main screen will not be operational until the system opens for phase two.

AMA's online toolkit features a webinar on preparing for the Sunshine Act, an overview of the financial interactions and ownership interests that will be reported, an explanation of the excluded financial interactions, answers to frequently asked questions, and a summary of the act's key provisions. 

AMA advises physicians to:  

  • Ensure all financial and conflict-of-interest disclosures required by employers and other entities that provide funding are current and updated regularly;
  • Update professional information and ensure the correct specialty designation; 
  • Learn what financial transfers and ownership interests must be reported by drug and device manufacturers and group purchasing organizations; and
  • Ask industry contacts to provide transfer information in advance for an opportunity to correct the information before it's transmitted to the government.  

Note: The Sunshine Act stipulates payments or other transfers of value provided as compensation for speaking at a continuing medical education (CME) program are not required to be reported if the following conditions are met:  

  • The activity meets the requirements of the continuing education accrediting agency, e.g., the Accreditation Council for Continuing Medical Education;
  • The pharmaceutical or device company does not pay the speaker directly; and 
  • The pharmaceutical or device company does not choose the speaker or give the CME provider a group of speakers to consider for the activity.   
 

Physicians Receive ACA Grace Period Notice Letters

Some Texas physicians have notified TMA they have received letters from Blue Cross and Blue Shield of Texas (BCBSTX) notifying them that a patient is in the second or third month of the Affordable Care Act (ACA) 90-day grace period. The grace period is triggered once a patient with subsidized marketplace coverage misses a premium payment. Instead of immediately terminating the policy, health plans must give the patient 90 days to catch up. 

Federal rules allow health plans to pay, hold, deny, or later recoup payment of claims for services incurred in the second or third month of that window if patients are delinquent on their premium payments. However, insurers must pay physicians for services provided to a patient in the first 30 days of the grace period, and insurers still must comply with Texas law requiring prompt payment of claims submitted at any point in the grace period. 

Federal regulations require exchange plans to notify affected physicians "as soon as is practicable when an enrollee enters the grace period." This includes whether the enrollee is in the second or third month of the grace period and the names of all individuals covered by the policy. The notice also must tell doctors the health plan may ultimately deny payment.

Grace period notification is also available when verifying patient benefits, both online and over the phone.

Physicians who have signed a BCBSTX contract have agreed to limit the reasons for which they may terminate the patient-physician relationship. The payer's February 2014 Blue Review newsletter includes a provision that states:

"Your agreement with BCBSTX requires the provision of services to members and prohibits advance payment for such covered services except for member’s required cost sharing, if any. You may notify your patients that they will be responsible for payment for the full cost of provided services, up to billed charges, if their health care coverage terminates at the end of the grace period. You can encourage your patients to make their premium payments to avoid termination of their health insurance policies. In addition, the terms of your BCBSTX agreement prevent you from refusing to provide services to a BCBSTX member, irrespective of where they purchased their coverage."

TMA President Austin King, MD, iterates physicians' ethical responsibilities to the patient despite payment problems. 

"Unlike insurance companies, we can't ethically tell patients that suddenly we cannot care for them since they did not pay their premium. In fact, if the patient has a complex condition such as cancer, heart problems, or many other serious conditions then we may have to care for that patient for many months until their condition stabilizes and only then can we think about discontinuing care," Dr. King said.

TMA encourages physicians to educate themselves about the ACA exchange plans. TMA has the following helpful resources on its website: 

TMA, AMA, and more than 80 state medical societies and specialty organizations have asked the Centers for Medicare & Medicaid Services (CMS) to revisit its policy that allows plans to pend and deny claims for months two and three of the 90-day grace period. The groups say insurers who offer health plans on the ACA exchanges should provide immediate notice when patients enter the first month of the 90-day grace period.

In addition, the Texas Delegation to the American Medical Association took a resolution to the AMA House of Delegates, which convened in Chicago this month, asking the AMA to work to prevent recoupment if an ACA marketplace insurer has not notified the physician a patient is in the last 60 days of the grace period for not paying his or her premiums. 

July 1 Meaningful Use Exemption Deadline Approaches

Physicians who are not participating in the Medicare electronic health record (EHR) incentive program, also known as meaningful use, will be penalized by Medicare beginning Jan. 1, 2015. To prevent the penalty, physicians must either attest to meaningful use by Oct. 1, 2014, or apply for a hardship exemption by July 1, 2014.

Physicians who meet the following criteria are automatically exempt from the program and do not need to file an exemption application: 

Specialties: If you're classified in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) as one of these five specialties, you don't need to file an exemption and will be exempt for payment year 2015:  

  • Diagnostic radiology, 
  • Nuclear medicine, 
  • Interventional radiology, 
  • Anesthesiology, and 
  • Pathology. 

New to practice: If you are in your first year of practice, you do not need to claim an exemption. Based on Medicare data in PECOS, the Centers for Medicare & Medicaid Services (CMS) says it will know you are new to practice and will automatically exempt you. 

Hospital-based: If you perform more than 90 percent of services using place of service codes 21 or 23 (hospital), then you will automatically be exempt from the Medicare penalty. 

Other exemptions are available, but you must take the time to fill out the 14-page application and submit it to CMS by July 1, 2014. If multiple physicians at one practice are applying, be sure to include the multiple NPI addendum.

You can apply for a hardship exemption if your circumstances fall under one of the following categories: 

  • Infrastructure: You must demonstrate that your practice is in an area without sufficient Internet access to comply with meaningful use and that you face insurmountable barriers to obtain such connectivity. 
  • Unforeseen circumstances: This exemption can be claimed in the case of a natural disaster, closing of a practice, bankruptcy, or if the EHR vendor goes out of business. 
  • Lack of face-to-face patient interactions: If your specialty isn't listed above as exempt and you lack face-to-face interactions with your patients, you can claim an exemption. 
  • 2014 EHR vendor issues: If your EHR vendor was unable to obtain a 2014 certification by July 1, 2014, you should file an application for exemption. 

Exemptions must be renewed annually, and you may not claim an exemption for more than five years.

For more information on penalties and exemptions, please refer to TMA's one-pager. Contact TMA's Health Information Technology Department with questions by email or by calling (800) 880-5370. 

TMAIT Action Ad 4.13  

Patients Continue to Ask Doctors for Unnecessary Tests, Study Finds

Two-thirds of physicians say they have a great responsibility in making sure their patients do not receive unnecessary tests and procedures, yet even more say American physicians today are ordering these exams every week, a new survey finds.

Conducted for the ABIM Foundation, the study has helped gauge physicians' attitudes about the issue of inappropriate medical tests and procedures in the U.S. health care system. 

The Choosing Wisely® campaign promotes healthy dialogue between physicians and their patients. Commencing in 2012, this physician-led movement attempts to eliminate unnecessary tests and procedures for patients based on evidence-based recommendations. These recommendations come from leading medical specialty societies that have identified the most salient issues patients should discuss with their physicians. 

TMA is working with the ABIM Foundation to make physicians and the public more aware of the lists and to encourage their use.

This study reveals physician opinions on unnecessary tests and procedures. Physicians are trying to steer their patients in the right direction, yet only 27 percent of physicians say patients listen to their advice half of the time. On the other hand, more than 1 in 3 physicians (36 percent) say they order unnecessary tests and procedures for patients "just to be safe." With rising health care costs and patients continuing to ask for unnecessary medical tests and procedures, communication between patients and physicians is more important than ever.

On the positive side, the survey found physicians are beginning to speak more to prevent their patients from undergoing unnecessary tests and procedures. The research found physicians who have seen Choosing Wisely material are more likely to refuse to order patient testing (44 percent) than those who have no knowledge of the movement (37 percent). "Physicians with exposure to the Choosing Wisely campaign are 17 points more likely to have reduced the number of tests or procedures they have done in the last 12 months," the study authors wrote. 

Through the help of the ABIM Foundation and the Robert Wood Johnson Foundation (RWJF), more Texas physicians are continuing to use Choosing Wisely to guide patients in their decisionmaking on tests and procedures. Along with TMA, the ABIM Foundation has awarded 20 other state medical societies, specialty societies, and several regional health institutions to help promote positive conversations between physicians and patients on the overuse of medical tests and procedures. More Texas physicians continue to learn ways to decrease health care costs as well as effective ways to speak with patients about the medical care they need. 

The survey was administered via phone interview with 600 practicing physicians nationwide, including Texas physicians. RWJF, a supporter of the Choosing Wisely campaign, funded this analysis. 

CMS Proposes Flexibility for Meaningful Use Program

The Centers for Medicare & Medicaid Services (CMS) released proposed rules that allow flexibility for electronic health record (EHR) certification and extend Stage 2 meaningful use. TMA will carefully review the proposal and submit comments by July 21, the end of the comment period. 

TMA views this as a positive step as many EHR vendors have not yet achieved their 2014 certification, required for meaningful use attestation in 2014, regardless of stage. The timing of the proposed rules is less than ideal as many physicians need to take action by July 1, 2014, to prevent an EHR penalty in 2015. As with many regulations, the devil is in the details. 

Stay tuned for more information and guidance on how physicians should proceed with these newly announced proposed rules. 

AccessMedicine Replaces MD Consult in TMA Databases

As of June 30, MD Consult will no longer be offered by Elsevier. The TMA Knowledge Center is now offering AccessMedicine from McGraw Hill. AccessMedicine is an innovative online resource that provides TMA members more than 75 medical titles from the best minds in medicine, updated content, thousands of images and illustrations, interactive self-assessment, case files, time-saving diagnostic and point-of-care tools, a comprehensive search platform, and the ability to view from and download content to a mobile device.

Updated frequently and expanded continuously by world-renowned physicians, AccessMedicine provides fast, direct access to the information necessary for completing evaluations, diagnoses, and case management decisions, as well as for pursuing research, medical education, or self-assessment and board review.

AccessMedicine, as well as other TMA database offerings, can be found on the TMA Databases page. These are free to TMA members as a benefit of membership. For more information, email the TMA Knowledge Center or telephone (800) 880-7955.

Independent Contractor or Employed Physician?

Disputes over independent contractor status can be tricky, says Regina Williams, a board-certified human resources lawyer in Austin.

"There have been cases in which a physician goes to work for a medical group as an independent contractor and then claims he or she was actually a full-time employee entitled to certain health insurance and financial benefits," she said.

Having a contract with independent contractors is helpful but not enough to defend a potential lawsuit, according to Ms. Williams.

Under the law, an individual could be considered an employee if he or she doesn't work for any other entities and conforms to the same rules and standards as all other employees.

Determining independent contractor status involves a test, Ms. Williams says.

The Internal Revenue Service (IRS) consolidated its "Twenty Factor" test for determining independent contractor status into 11 main tests. The IRS organized them into three groups: behavioral control, financial control, and the type of relationship of the parties. (See the IRS' "Employer's Supplemental Tax Guide.")

For more information about the tests, visit the Texas Workforce Commission website, which defines each type of control: 

  • Behavioral control covers instructions the business gives the worker about when, where, and how to work, as well as training the business gives the worker;
  • Financial control covers the extent to which the worker has unreimbursed business expenses, the extent of the worker's investment, the extent to which the worker makes services available to the relevant market, how the business pays the worker, and the extent to which the worker can realize a profit or loss;
  • Type of relationship delves into written contracts, the provision of "employee-type benefits," the permanency of the relationship, and "the extent to which services performed by the worker are a key aspect of the regular business of the company."  
 

    

Free Bike Helmets for Pediatricians, Family Physicians

The Texas Pediatric Society (TPS) and the Texas Academy of Family Physicians (TAFP) support TMA's Hard Hats for Little Heads program by purchasing up to 50 helmets for their members to host helmet giveaway events. TMA matches the purchase, so TAFP and TPS members receive up to 100 helmets at no cost for their giveaways.

Hard Hats for Little Heads is celebrating 20 years of keeping kids safe. In celebration of that milestone, the program wants to set a new record of giving away 34,000 helmets. Help with meeting the goal by signing up for a Hard Hats event today. 

Hosting a Hard Hats for Little Heads event is easy and rewarding. TMA provides everything you need: free helmets, banners, event signage, promotional flyers, educational handouts, and media relations support. The program will provide up to five free anniversary t-shirts for volunteers.

Here are some great opportunities for hosting a helmet giveaway:

  1. Back-to-school events or giveaways in connection with your local school. 
  2. Summer and fall health fairs.
  3. October, during TMA's statewide Hard Hats giveaway. We need more than 50 events lined up to meet our 5,000 helmet giveaway goal during that month.
  4. During the December holidays in conjunction with local bike giveaways. 

Email TMA's outreach coordinator or call (800) 880-1300, ext. 1470, or (512) 370-1470 to learn more about hosting an event. Be sure to mention if you're a TAFP or TPS member.

Hard Hats for Little Heads is made possible through a grant from the TMA Foundation thanks to top donors — Blue Cross and Blue Shield of Texas, Prudential, and two anonymous foundations — and generous gifts from physicians and their families, and friends of medicine. 

Custom Ringtones Added to DocbookMD

Physicians can now customize their iOS ringtones to differentiate new DocbookMD messages from other messages they receive. The new feature resides in the Settings menu within the app. Choose from 40 different sound notification options, and assign a different tone to each of the three message priority times. From an iPhone or iPad, tap on Settings from the main menu, and decide which ringtone you want for messages sent with the following priorities: 5 minutes, 30 minutes, or none.

Beyond the new ringtone customization feature, the settings section of DocbookMD has additional tools, including: 

  • Enable messaging: Turn DocbookMD messages receipt on and off.
  • Enhanced notifications: Enter an email address and/or phone number to be notified of an unread DocbookMD message waiting for your attention. No protected health information is sent via email or standard text, simply a notification that you have a pending DocbookMD message.
  • Lock app with PIN: An additional level of HIPAA security allows you to create and use a PIN to gain access to the DocbookMD app. It's a quick way to further protect yourself and your patients.
  • Refresh data: Tap to ensure the most up-to-date TMA directory is at your fingertips.

DocbookMD is available to all TMA members as a free member benefit. Across the country, more than 25,000 physicians in 40 states use DocbookMD, further connecting the community of medicine. 

DocbookMD is available for iPhone, iPad, and Android devices as well as PC and Mac via the new web version. The app can be downloaded using the Apple App Store or Google Play.

Docbook Enterprise offers a secure way for groups and hospitals to meet a wide variety of workflow needs and enhance existing technology systems. To bring the Enterprise version of DocbookMD to your hospital or large group, contact DocbookMD Director of Partnerships Chad Shepler by email or phone at (512) 383-5822.

This Month in Texas Medicine

The June issue of Texas Medicine delves into Congress' decision to patch the flawed Medicare Sustainable Growth Rate payment formula for the 17th time and highlights the publication of physician quality data, resources to reduce electronic health record errors, recommendations aimed at reducing cesarean sections, the release of Medicare physician payment data, and evidence-based decisionmaking tools physicians can share with patients.

Click to launch the full edition in a new window.  

Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed.

E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action.  

 This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.   

Deadlines for Doctors 

TMA's Deadlines for Doctors alerts you and your staff to upcoming state and federal compliance timelines and offers information on key health policy issues that impact your practice.  

7/1/14

HIT: Last Day For First-Year Participants to Begin the 90-day Reporting Period for the 2014 Medicare EHR Incentive Program

TMA Education Center 

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online. 

Seminars  

New NPP Regulations: Rules You Need to Know
6/17     Fort Worth
6/18     Dallas
6/19     Tyler

On-Demand Webinars

Dealing with Difficult Patients 
Making Discussions About Death and Dying Easier 
Meaningful Use: Information Technology Bundle  

Physician Health and Wellness, ext. 1342

 Physician Well-Being for Life  
10/24-25 Dallas                  

Healthy Physicians: Healthy Patients 
9/27    El Paso  
10/4    Tyler  

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

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If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Crystal Zuzek, Action editor.


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