Colorado Medicine Feb-April 2023

COLORADO MEDICINE

VALUE-BASED CARE NAVIGATING

PEACE OF MIND

COVERAGE BEYOND

As a premier medical liability insurance carrier, we are committed to being there when you need us. Our physicians and other staff serve as extended members of your team to help answer questions or navigate difficult situations. And when it’s urgent, you have 24/7 access to a physician via our Risk Management hotline. Plus, our legal and HR experts help you tackle other issues as they arise. That’s Value Beyond Coverage.

COPIC is proud to be the endorsed carrier of the Colorado Medical Society. CMS members may be eligible for a 10% premium discount.

COLORADO MOVES TOWARD VALUE-BASED CARE

Public and private payers are trying different alternative payment models (APMs) to move health care delivery from volume-based to value-based reimbursement. These efforts do not need to be worrisome to physicians and practices, however. Active participation by physicians will help shape health care delivery to best serve Colorado patients.

8 UPDATE ON THE 2023 LEGISLATURE

The Colorado General Assembly convened in January and the Colorado Medical Society is busy advocating on behalf of physicians and patients.

10 PHOTOS: METRO DENVER LEGISLATIVE NIGHT

Physicians and legislators gathered in January for dialogue on top health care issues. See photos from the event.

24 FINAL WORD: WILL ONE VALUE INITIATIVE WIN?

It is widely accepted that the fee-for-service model is largely flawed. But are any of the alternatives –capitation, blended, bundled or Direct Primary Care – poised to solve problems in health care payment?

3 PRESIDENT’S LETTER: WHAT IS VALUE?

CMS President Patrick Pevoto, MD, MBA, reflects on the concept of value in health care and how examining his metrics compared with top-ranked peers revealed ways he could improve his patient care.

12 REPORT FROM THE AMA INTERIM MEETING

Physician and student representatives from Colorado attended the interim meeting of the American Medical Association in Honolulu, Hawaii, in November to pass new policy and hear from leadership on strategic priorities.

13 UPDATE ON PHYSICIAN WELLBEING EFFORTS

The CMS Committee on Physician Wellbeing has started a new committee year with objectives to support and celebrate all physician members. There are exciting things in store for 2023 and beyond.

14 COPIC Comment: The COPIC Points Program

16 Introspections: Tank 14

18 Partner in Medicine spotlight: Finding a practice lender and bank

20 Medical news

• Passing the gavel

• Celebrating volunteers

• Denver Metro Chamber honors CMS and DMS

• AAMS-DMS Fall 2022

Annual Meeting: An evening celebration to remember

• EPCMS celebrates members at winter social

• CU alumnae honored

• Metro Denver medical societies at the zoo

COLORADO MEDICAL SOCIETY

7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902

720.859.1001 • fax 720.859.7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF

2022-2023 OFFICERS

Patrick Pevoto, MD, MBA President

Omar Mubarak, MD, MBA President-elect

Hap Young, MD Treasurer

Mark Johnson, MD, MPH Immediate Past President

Dean Holzkamp Chief Executive Officer

BOARD

OF DIRECTORS

Caleb Bussard, MS

Brittany Carver, DO

Elizabeth Cruse, MD, MBA

Kamran Dastoury, MD

Amy Duckro, DO

Gabriela Heslop, MD

Enno F. Heuscher, MD, FAAFP, FACS

Rachelle M. Klammer, MD

Marc Labovich, MD

Chris Linares, MD

Michael Moore, MD

Edward Norman, MD

Lynn Parry, MD

Leto Quarles, MD

Hap Young, MD

COLORADO MEDICAL SOCIETY STAFF

Dean Holzkamp Chief Executive Officer Dean_Holzkamp@cms.org

Kate Alfano Director of Communications and Marketing Kate_Alfano@cms.org

Jennifer Armstrong Program Manager, Government Affairs and Communications Jennifer_Armstrong@cms.org

Cindy Austin Director of Membership Cindy_Austin@cms.org

Cecilia Comerford Executive Director, Boulder County Medical Society

Cecilia_Comerford@cms.org

Crystal Goodman Executive Director, Northern Colorado Medical Society Crystal_Goodman@cms.org

Ms. Gene Richer, M Ed, CHCP Director of Continuing Medical Education and Recognized Accreditor Programs Gene_Richer@cms.org

Mihal Sabar Accounting Manager Mihal_Sabar@cms.org

AMA DELGATION

David Downs, MD, FACP

Carolynn Francavilla, MD

Rachelle Klammer, MD

Katie Lozano, MD, FACR

A. "Lee" Morgan, MD

Jan Kief, MD

Tamaan Osbourne-Roberts, MD

Lynn Parry, MD

Brigitta J. Robinson, MD

Michael Volz, MD

AMA PAST PRESIDENT

Jeremy A. Lazarus, MD

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Kim Vadas Assistant Director of Continuing Medical Education and Recognized Accreditor Programs Kim_Vadas@cms.org

Debra Will Director of Business Development Debra_Will@cms.org

Tim Yanetta IT/Membership Manager Tim_Yanetta@cms.org

President’s letter: What is value?

Patrick Pevoto, MD, MBA

The Colorado Medical Society’s vision is to be a leader in making Colorado the best state in which to provide and receive the safest, highest quality and most cost-effective medical care. Said a different way, it is vital that our patients can receive the right care in the right setting at the right time. At its core, this is a value proposition on providing value –but how is the concept of value defined, especially in health care? How does one evaluate others as well as self in this realm?

The University of Utah Health has been working on the definition of value for well over a decade. This consortium came up with a general formula, with the help of Michael Porter from the Harvard Business School, which is: Value is the sum of quality and service divided by the cost incurred. These factors are further delineated as follows.

QUALITY – many health care entities have departments totally devoted to the measure of this metric. Many of us have participated in peer review, protocol creation and other areas further defined by the type of practice in which physicians engage.

SERVICE – most organizations rely upon patient, employer and physician surveys to attempt to place weighted value on how health care is provided.

COST – includes everything from the cost of goods and services to other more ethereal concepts such as “opportunity cost,” the loss of potential gain from other alternatives when one alternative is chosen.

When I was enrolled in the MBA program at the McCombs School of Business at the University of Texas at Austin, I chose an elective on quality. Our class discussed Six Sigma concepts and the many ways businesses attempt to define, then provide, high quality in their respective organizations. My project for the semester involved a study of all OB-GYN physicians in my hospital as it pertained to patient care around the provision of laparoscopic hysterectomies. I perused the data for each physician in the areas of morbidity and mortality (outcomes), length of stay, and overall costs.

I was amazed at how the top-ranked physicians had more streamlined preoperative and procedural practices that I had not quite adapted; I was continuing to do things based on “the way I was trained.” How eye-opening and humbling it was for me to recognize my own deficiencies.

Health care is categorized as a service industry. Metrics surrounding the provision of service mostly involve surveys completed by the participants in the process: patients, physicians and employers. While this method is the most objective way to tease out data, it is fraught with many inconsistencies. For example, how highly is a patient going to rate the service received if their individual needs (that they defined) were not met? In addition, on any given day the care can change depending on things like wait times, triage based on need and other factors that cannot be effectively quantified.

The factor of cost seems to be weighted by business and governmental organizations focused on the bottom line.

Physicians have been singled out the most in this regard, yet many of the financial costs in health care are not directly under physician control. As one example, physician-driven care as opposed to care driven by non-physician providers in the system has shown to be lower cost in relation to number of studies/tests ordered. And, of course, social determinants of health and commercial determinants of health have a tremendous influence on our patients, and the quantity and cost of their care.

I would challenge all Colorado physicians to look for ways to improve care in these three areas – quality, service and cost – thereby increasing value. Be open to doing things differently. Answer that consult requested expediently and communicate findings and recommendations with timely chart entry and verbal feedback. Continue to use evidencebased decisions in the care provided, even if change in these areas is uncomfortable. Invite questions (yes, even Google-researched patient questions) with your patients. I think you will find that it rarely will add more than three to five minutes to a visit, and it will reduce the phone calls after hours.

Above all, continue to participate in organized medicine’s attempt to advocate on your behalf. Call your representatives when that Code Blue alert reaches your inbox. Fill out member surveys so we take your pulse on issues. The Colorado Medical Society exists to represent physicians as they strive to increase value in the provision of health care to our patients; please reach out as needed to provide or receive assistance. ■

Colorado pursues initiatives to move toward value-based care

PHYSICIANS, THROUGH THE COLORADO MEDICAL SOCIETY, ARE UNIQUELY POSITIONED TO DRIVE THIS WORK

Kate Alfano, CMS Director of Communications

Years of work developing current policy and driving advocacy initiatives related to health care value are now leaving the planning stages and entering execution. This work has largely focused on three areas:

Expanding coverage and increasing competition

Enhancing the value of care through delivery and payment system reforms; and

Targeting administrative burdens that inappropriately deter care, drive costs and decrease physician professional satisfaction.

The Colorado Medical Society has been active on multiple fronts to ensure we advance and defend physician priorities within these areas. In alternative payment models (APMs) alone, there are five different initiatives that have affected or will affect Colorado’s health and health care landscape for years to come.

APM ALIGNMENT INITIATIVE

Starting in spring 2021, multiple Colorado state agencies joined the Office of Saving People Money on Health Care in the lieutenant governor’s office to investigate the feasibility of developing a multi-payer statewide APM to align payers’ efforts to shift away from fee-for-service payments to value-based payments – aiming to reduce administrative burden for providers, increase health care value, and improve quality and health equity for consumers – starting with maternity care and primary care.

The subsequently formed Colorado APM Alignment Initiative concluded its advisory work and released a final report in June 2022. CMS, joined by our colleagues in the House of Medicine, submitted a letter that outlined our recommendations focusing on aligned quality measures, common attribution and risk adjustment methodologies, and performance benchmarking, among others – many of which were incorporated into the report with the help of member physicians who participated in the initiative.

One physician who participated in the primary care subgroup is Christie Reimer, MD, an internal medicine physician in Fort Collins. “Learning about APMs feels overwhelming,” she said. “It’s an ‘alternative’ payment model so, by definition, it’s new and different, and that can feel scary.

Achieving multi-payer alignment that includes public and commercial plans both locally and nationally is so very complicated. And we know that primary care will be playing a central role.”

Reimer continued: “My participation in the primary care subgroup felt therefore somewhat reassuring because the discussions were familiar and patient-centric: Initially there was agreement that an APM ‘continuum’ was important in order to meet providers, groups and systems where they and their unique patient populations are, and that common metrics should be aligned to minimize reporting burden. Conversations around defining those quality measures focused on things that we primary care physicians already do – for example, cancer screening, immunizations, depression screening, patient satisfaction and well care. In addition, routine updating of these metrics so that they remain evidence-based and relevant was felt to be important. Lastly, the idea that we need to focus on whole-person and team-based care came through, and there was recognition that we may need support with education, data management, and prospective payments.”

Medicaid Services to participate in the Health Care Payment Learning & Action Network (HCP-LAN) State Transformation Collaborative (STC) initiative to advance value-based payments in health care and accelerate the implementation of multipayer APMs.

In a Dec. 21, 2021, news release, Kim Bimestefer, executive director for the Department of Health Care Policy & Financing, said: “Alternative payment models help health care providers move from volume-based payments to value-based payments. They also align compensation with the achievement of shared affordability and quality results, including reducing health disparities which is a priority goal for our state. This partnership with LAN underscores the importance and efficacy of paying for outcomes, shown by our existing valuebased programs in maternity and primary care.”

HB22-1325

PRIMARY CARE APMS

HCP-LAN STC

Colorado was one of four states – along with Arkansas, California and North Carolina – chosen in December 2021 by the federal Centers for Medicare and

House Bill 22-1325 Primary Care APMs was passed by the 2022 Colorado General Assembly. The Colorado Division of Insurance (DOI) will promulgate rules for primary care APM parameters for primary care services offered through health plans by Dec. 1, 2023. The Colorado Medical Society, guided by the physician volunteers comprising the CMS Committee on Value in Health Care,

provided formal feedback on the draft bill in a letter on Feb. 1, 2022, and provided additional feedback and recommendations as the bill evolved.

APM parameters must include transparent risk adjustment parameters that ensure primary care providers are rewarded for caring for patients with complex health conditions; utilize transparent patient attribution methodologies; include a set of core competencies around whole-person care delivery that primary care providers should incorporate in practice transformation efforts; and require an aligned quality measure set that carriers and providers are engaging in under current state and federal law.

4

PCPRC

The Colorado Primary Care Payment Reform Collaborative (PCPRC) is continuing its work to develop strategies for

increased investments in primary care that delivers the right care in the right place at the right time, and the PCPRC was specifically directed by HB22-1325 to publish a report with recommendations to the DOI regarding primary care APM parameters by Feb. 15, 2023.

5

VALUE-BASED PAYMENTS IN MEDICAID

The Colorado Department of Health Care Policy and Financing (HCPF) is continuing its work to implement and align valuebased payments in Medicaid.  Among HCPF’s 2023-24 budget requests is HCPF R-06: Supporting PCMP Transition with Value Based Payments, which includes a 16 percent increase to reimbursements for Medicaid primary care physicians by enrolling in the Alternate Payment Methodology Two (APM 2) value-based payment program. Initial feedback from the Colorado Academy of Family Physi -

cians (CAFP) and American Academy of Pediatrics – Colorado Chapter has highlighted some positives and negatives.

On the positive side, they identified that HCPF incorporated prior feedback about the need for incentivizing per-memberper-month (PMPM) payments and how important it will be to support practices who are still readying themselves for transitioning to value-based payments. HCPF also includes an opt-out for providers who still need more time or are not interested in value-based payments at this time.

On the negative side, there is still a great need to improve the patient attribution process and standardize training across Regional Accountable Entities (RAEs) to ensure consistency.

“Colorado Medical Society members should know that APMs are part of an ongoing and specific effort of both public and private payers to move health care delivery from a volume- to value-based reimbursement model,” said CMS past president Michael Pramenko, MD, a family

physician in Grand Junction. “For example, we see this in the growth of Medicare Shared Savings Program (MSSP) and Medicare Advantage (MA) models for Medicare that are increasingly using APMs within their contracts.”

“It is important for primary care physicians to know about APMs as they become a greater percentage of their overall reimbursement,” Pramenko continued. “In addition, many practices need to understand that some APMs come in the form of shared savings. Given that these payments are not paid until the following year, cash flow can be an issue. Participating in the design of APMs is critical for primary care physicians’ practices.”

David Keller, MD, a pediatrician and University of Colorado School of Medicine faculty in Aurora, advises primary care physicians to deploy organizational skills they may not have had to maintain a revenue stream under APMs: monitor and report on measures of quality and outcomes; assess

and modify care systems to provide and measure performance; coordinate care in a proactive and cost-effective way for the patients that the payer believes are under your care through some method of prospective or retrospective attribution; and become adept at managing a new kind of risk – not the risk of malpractice, but the risk of population outcomes for your attributed patients.

Alan Kimura, MD, an ophthalmologist in Denver, advises specialists to deploy tactics to commit to value and know how to demonstrate it: start tracking and improving your Net Promoter Score (asking patients if they would refer the practice to a friend or colleague), use financial data and clinical outcomes to generate the unique value proposition of your practice, and practice sharing this value proposition with payers as you renegotiate contracts. “Simply submitting bills for payment without demonstrating value (outcome/cost) is camping out at the ‘complacency barrier,’” Kimura said.

Seizing opportunities to protect and advance physician priorities through these initiatives requires active engagement by practicing physicians and CMS is uniquely positioned to drive this work. Real world, clinical, “bedside” perspectives and expertise are critically needed as these programs are developed and operationalized.

Reimer said: “It would be great to have a crystal ball to see how we will be practicing in the future, but the next best thing seems to be learning as much as we can and actively participating to shape health care delivery in a way that is best for our patients.”

ACKNOWLEDGEMENTS

Special thanks to Amy Berenbaum Goodman, JD, former CMS senior director of policy, and Jennifer Armstrong, CMS program manager for government affairs and communications, for their research for this article. ■

Health care cost landscape: Additional forces at play

MEDICARE REIMBURSEMENT RATE CUTS

Congress failed to prevent end-of-year Medicare cuts and now physicians will face a 2 percent cut in Medicare payment in 2023 when they are already struggling due to the pandemic and rising inflation that is impacting the cost of providing care. When the same fight comes up next year, Congress must do more than simply reduce the planned cuts. Physicians need financial stability that includes automatic, positive, annual updates that account for rising practice costs.

MEDICAID REIMBURSEMENT ADJUSTMENTS

A line item in HCPF’s budget request, R-07: Provider Rate Adjustments, includes an across-the-board rate increase of 0.5 percent (with exceptions), but would also make targeted rate adjustments to bring reimbursements either up to 80 percent of Medicare or down to 100 percent of Medicare. The rate adjustments are based on the Medicaid Provider Rate Review Advisory Committee (MPRRAC) recommendations released on Nov. 1, 2022.

MEDICAID’S ACCOUNTABLE CARE COLLABORATIVE PHASE III

Stakeholder meetings will begin soon to assist HCPF with program development for Accountable Care Collaborative Phase III, which will begin in July 2025 when RAEs will begin new contracts.

POTENTIAL EFFORTS TO AMEND THE COLORADO OPTION

Critical rulemaking on Colorado Option standardized plan revisions, the public hearing process, and rate setting is underway. Carriers have been contracting with providers for their standardized plan networks and Colorado Option plans will become effective in 2023. There is always a possibility that the law can be amended in rulemaking or by the Colorado General Assembly, and CMS is actively monitoring and participating in discussions.

“It would be great to have a crystal ball to see how we will be practicing in the future, but the next best thing seems to be learning as much as we can and actively participating to shape health care delivery in a way that is best for our patients.”

Mid-session legislative update: prior authorization, scope of practice and other priorities

Jennifer Armstrong, Program Manager, Government Affairs and Communications

The Colorado legislature convened on Jan. 9 for the 2023 session. This session has been extraordinarily busy, focusing on the issues average Coloradans face daily. Health care issues – from affordability to administrative burdens to scope of practice – were anticipated and, as expected, these issues have been brought to the legislature for consideration. The CMS Council on Legislation has met weekly throughout session and has taken position on 16 bills as of this publication. To keep up to date on the Council’s positions, visit www.cms.org/ advocacy/bill-tracker

PRIOR AUTHORIZATION

Purposeful work has been performed in past legislative sessions regarding prior authorization but there is still more work to do on behalf of Colorado physicians and their patients. Advocating for an environment in which there are fewer administrative burdens on physicians creates better patient outcomes and improves physician wellbeing. CMS is working with the rest of the House of Medicine on one bill to further reduce prior authorization hassles and is tracking other bills to reduce administrative burden. Watch for more details.

To aid in the work of reducing administrative burdens on Colorado physicians, CMS has initiated a campaign, Health Can’t Wait Colorado, with the purpose of sharing patient stories and furthering the urgency that prior authorization delays needed care. What’s your story? We need to hear from patients. Encourage yours to share how bureaucratic hassles are preventing them from getting the care they need by going to www.cms.org/ advocacy/health-cant-wait-colorado

SCOPE OF PRACTICE

Ensuring safe, effective care depends upon highly trained, multi-disciplinary clinical teams led by physicians that work closely together. Bills that would inappropriately expand the scope of practice for certain health care providers have been considered during the 2023 legislative session and CMS is working closely with the House of Medicine to oppose or amend them.

HB23-1071 LICENSED PSYCHOLOGIST PRESCRIPTIVE AUTHORITY

CMS, with the Colorado Psychiatric Society, the American Academy of Pediatrics - Colorado Chapter and a unified House of Medicine, worked on changes to HB23-1071 that will provide psychologists with prescriptive authority for psychotropic drugs. As a solid front we successfully achieved amendments that provide guardrails for patient safety and care. The amendments include more education and practicum experience, specialized training for pediatrics and geriatrics, better medical board oversight, and

most important, physician collaboration and approval of prescriptions provided by psychologists. Current status as of publication: Passed the House and Senate with amendments; heading to the governor. Council on Legislation position: Amend

SB23-083 – PHYSICIAN ASSISTANT COLLABORATION

Physician assistants (PA) are seeking to expand their scope. Over the past year, CMS has continued to meet with PAs to address some of their concerns, while reinforcing our opposition to independent practice.

Current status as of publication: Introduced in the House

WORKFORCE CHALLENGES

The pandemic has exacerbated long-standing workforce shortage problems. Funding must be used wisely to address immediate needs and lay the foundation for a more robust, resilient and diverse health care workforce for Colorado’s future.

MEDICAL LIABILITY

CMS is always on the lookout for threats to Colorado’s stable medical liability climate that stand in the way of physicians’ ability to do their jobs and serve their patients. CMS works on this issue very closely with COPIC and other strategic partners across the House of Medicine and beyond. We are carefully tracking and assessing impacts and possible next steps given the recent passage of medical liability tort reforms in California. CMS opposes efforts to destabilize the current medical liability stability.

OTHER ISSUES

A host of other issues have been or are expected to be introduced on a wide range of topics: hospital facility fees, prescription drug costs, revising the Colorado Option and Prescription Drug Affordability Board bills from two years ago, opioid epidemic responses, and single payer studies, to name a few. Watch for the latest updates in Policy Pulse, the CMS member e-newsletter that provides breaking news about policy action under the Golden Dome. ■

Metro Denver Legislative Night

Thank you to the physicians and legislators who attended Metro Denver Legislative Night, sharing perspectives on how legislation affects physicians and patients. And thank you to the hosts of this event: Arapahoe-Douglas-Elbert Medical Society, Aurora-Adams County Medical Society, Denver Medical Society and Foothills Medical Society.

Speakers Alwin Steinmann, MD, and Rachelle Klammer, MD, spoke about workforce issues and scope of practice issues and took questions from the audience. CMS President Patrick Pevoto, MD, MBA, also facilitated discussion on prior authorization hassles.

Kate Alfano, CMS Director of Communications and Marketing

From left: Alwin Steinmann, MD, and Rachelle Klammer, MD.

From left: Lynn Parry, MD; CMS lobbyist Jerry Johnson; and Sen. Janet Buckner (D).

From left: Alwin Steinmann, MD; Sen. Rachel Zenzinger (D), Rep. Shannon Bird (D), and Dan Jablan.

From left: Lynn Parry, MD; Sen. Kyle Mullica (D); and Sen. Kevin Van Winkle (R).

Sen. James Coleman (D), center.

From left: Rep. Anthony Hartsook (R), CMS President Patrick Pevoto, MD, MBA, and House Minority Leader Mike Lynch (R).

From left: Chris Linares, MD; Council on Legislation Chair Darlene Tad-y, MD; Rep. Anthony Hartsook (R); and Sing Palat, MD.

From left: Senate Minority Leader Paul Lundeen (R), and Amy Duckro, DO.

From left: Raj Kadari, MD; and Rep. Lindsey Daugherty (D).

From left: Darlene Tad-y, MD, and Rep. Lindsey Daugherty (D).

From left: Patrick Pevoto, MD, MBA; House Assistant Minority Leader Rose Pugliese (R); and Speaker of the House Julie McCluskie (D).

Colorado physicians represent you at the AMA Interim Meeting

Rachelle Klammer, MD, AMA Delegation

This November the American Medical Association Interim Meeting was held November 12-15 in Honolulu, Hawaii, and your Colorado delegation represented the Colorado Medical Society.

We brought forward a resolution that was passed by the AMA House of Delegates that creates a task force to preserve the patient-physician relationship when evidence-based, appropriate care is banned or restricted. The task force will publish an annual report with resources for physicians required by medical judgment and ethical standards of care to act against state and federal laws. The reso -

lution will also ensure these physicians have access to legal support through the AMA Litigation Center.

A member of the Colorado delegation, Carolynn Francavilla, MD, presented on the panel "Protecting our Healers," during which speakers advised how physicians and health care teams can plan to stay safe in an era of increasing violence towards health care workers. She also served as vice-chair to the Private Practice Physician Section where she supported several resolutions at the AMA meeting to help support physicians in independent practice.

We brought forward a resolution that was passed by the AMA House of Delegates that creates a task force to preserve the patient-physician relationship when evidence-based, appropriate care is banned or restricted.

COLORADO HAS SEVERAL MEMBERS SERVING ON AMA COUNCILS:

• Jan Kief, MD, just completed a term on the Council on Long Range Planning & Development (CLRPD).

• Jeremy Lazarus, MD, serves on the Council of Ethical & Judicial Affairs (CEJA).

• Dr. Tamaan Osborne-Roberts, MD, serves on the Council of Science & Public Health (CSAPH). He will be running for a second term at the upcoming AMA Annual meeting in Chicago in June.

We are proud to have two physicians representing Colorado in the Young Physician Section (YPS) of the AMA, Erin Schwab, MD, andKamran Dastoury, MD.

In addition, your delegation is very active in the PacWest Conference which represents the Western state delegations within the AMA. Lee Morgan, MD, serves as chair of District IV on the PacWest Governing Council.

Your Colorado Delegation is also very active in supporting the AMA Foundation which is the charitable arm of the AMA. Our state delegation was one of the few states with 100 percent of the delegation donating to the Foundation. Jeremy Lazarus, MD, and I also serve on the Board of the AMA Foundation.

Your delegation is always looking for resolution ideas to bring to the AMA. Please reach out to any of your delegation members if you have a possible resolution idea.

Find out how to get involved with the AMA by emailing: membership@cms.org ■

Your wellbeing is our priority!

FROM THE CHAIR OF THE COLORADO MEDICAL SOCIETY COMMITTEE ON PHYSICIAN WELLBEING

Clara Raquel Epstein, MD, FICS CMS CPW Chair

The CMS Committee on Physician Wellbeing (CPW) directs the activities of CMS that pertain to physician wellbeing and burnout prevention through recommendations to the CMS Board of Directors. This committee was created in 2011 as the Expert Panel on Physician Wellbeing when “Physician Wellbeing and Success” was one of five CMS strategic goals. It continues to be a strategic priority under “Helping Physicians When They Need Help.”

FOLLOWING IS OUR CURRENT COMMITTEE:

• Clara Raquel Epstein, MD, FICS, Chair

• Donna Sullivan, MD, Vice-chair

• Lise Barbour, MD

• Matthew Husa, MD

• Lucy Loomis, MD

• Lisa Schlitzkus, MD

• Clark Zimmerman, MD

CPW meets monthly on the third Tuesday from 6-7 p.m. MT via Zoom and ad hoc, and uses multiple communication channels for efficiency. All committees are open for all CMS members to attend; go to cms.org/events for more information on how to register. If physician wellbe -

ing is your passion, consider joining us when the call for volunteers goes out in the summer.

We have a commitment to create viable physician wellbeing resources. This year we will be celebrating all CMS members while simultaneously providing members support and resources to build upon, to enhance our practice of medicine and the communities we thrive in and contribute to. We endeavor to provide physical, mental and spiritual health and longevity tools for our present and to be relevant long into each of our futures, thus inspiring positive change into the next generations of medicine. We intend to create a culture shift, a strong foundation to build upon and a legacy that will benefit all of us, those who we love and care for, and those who will follow in our footsteps. Our commitment to wellbeing in our profession will enable each one of us to facilitate our lifelong goals and enjoy our practice of medicine and our personal lives while doing so.

Results from cross-sectional, longitudinal and experimental studies find that well-being is associated with:

• Self-perceived health.

• Longevity.

• Healthy behaviors.

• Mental and physical health.

• Social connectedness.

• Productivity.

• Factors in the physical and social environment.

Excerpt from https://www.cdc.gov/hrqol/ wellbeing.htm

Our committee has prioritized the wellbeing needs of each member of our profession, focusing on resources that can benefit those entering medicine, transitioning in various settings, and ultimately retiring from practice but still desiring to engage in the medical community.

Remember, it takes a village and we need each of you to contribute to our community by becoming the best version of yourself! We look forward to sharing our tools, experiences and resources to enable each physician to optimize themselves. Let’s each experience a life well lived and without regrets. And stay tuned for more coming from the CMS Physician Wellbeing Committee! ■

The CMS Committee on Physician Wellbeing has created the new CMS Physician Wellbeing Resources webpage, cms.org/articles/physician-wellbeing . We welcome your feedback and contributions for consideration by our committee and to be included on this webpage. Please email your thoughts and additions to membership@cms.org

We have created tools and resources to facilitate the best version of you!

The COPIC Points Program

ENHANCE YOUR KNOWLEDGE WHILE REDUCING YOUR PREMIUM

Gerald Zarlengo, MD Chairman & CEO, COPIC Insurance Company

The COPIC Points Program is one of the ways we partner with insureds to offer more than just traditional coverage. Our team works closely to identify educational resources that address issues relevant to your medical practice, which then allows us to offer support designed for your needs.

Participation in the COPIC Points Program allows you to earn CME credit along with “points” that apply toward an annual premium discount of 10 percent.

Attaining the 3 COPIC points needed for the discount can usually be completed in as little as three hours.

Eligible physicians can participate in the program; new COPIC insureds receive the discount in their first year but need to participate in subsequent years.

PLEASE NOTE: the annual cycle for COPIC points has changed and is now November through October (the 2023 cycle ends on Oct. 31, 2023).

Examples of the opportunities to earn COPIC points throughout the year include:

Complete an on-demand course on your own schedule – Choose from more than 40 courses that cover topics such as specialty-specific trends, managing unanticipated outcomes, patient communications, and interactive case studies. Access on-demand courses at www.callcopic.com/education.

Participate in a 3Rs Program training – COPIC’s industry-leading 3Rs Program helps physicians communicate with patients after an adverse outcome to address their needs, preserve the relationship and prevent litigation. We offer a training that focuses on 3Rs disclosure principles and how to effectively utilize the program. Contact Carmenlita Byrd for training information at cbyrd@copic.com or (720) 858-6131.

Participate in one of our scheduled seminars – COPIC hosts virtual and in-person seminars throughout the year that range from legal topics (minors and risk, patient access to medical records, HIPAA) to medical specialty roundtables. Information about upcoming seminars can also be found at www.callcopic.com/ education.

Complete programs offered by other organizations – COPIC will consider approving COPIC points for programs and seminars given by other organizations such as professional societies, medical societies and hospital programs (pre-approval is required).

Complete an on-site, virtual, or self-assessment to identify high-risk areas in your practice or facility – Managed by specially trained nurses, COPIC’s Practice Quality Reviews, Facility Assessments, and Self Assessments offer an objective review based on evidence-based guidelines, and results help you improve your systems and address preventable risks.

Service plans for systems and large groups – For certain systems and large groups that meet criteria for professional review structures, organization for quality improvement, and a scheduled COPIC educational program curriculum, we offer a streamlined process to administer points.

Opioid seminars for 2023 licensure renewal

Two one-hour virtual seminars; attendees will receive 1 COPIC point and 1.0-hour of CME for attending

COPIC is pleased to announce that we will be offering virtual presentations regarding opioids that providers may use to meet the two hours of training requirements as stated by the Colorado Medical Board for licensure renewal in 2023. There is no cost to attend these, and one COPIC point will be awarded per session for eligible insureds. CME for attending COPIC’s opioid seminars will only be issued to providers who are insured by COPIC. Others may attend but will not be eligible for nor will they receive CME certificates for attending.

Per the Colorado Medical Board: Every physician and physician assistant is required to complete at least two cumulative hours of training per renewal period in order to demonstrate competency regarding the topics/areas specified in section 12-30-114(1)(a), C.R.S.

Opioid Management: A Practical Approach to a National Crisis

Attend one:

• March 7 at 12-1 p.m.

• March 21 at 6-7 p.m.

• April 26 at 5:30-6:30 p.m.

Opioid Crisis: Strategies for Reducing the Burden

Attend one:

• March 8 at 12-1 p.m.

• March 22 at 6-7 p.m.

• April 26 at 6:30-7:30 p.m.

For information on these seminars, please contact Cathi Pennetta at cpennetta@copic.com or 720-858-6228. ■

All Medical Answering Service

Owned and operated by the Colorado Medical Society, and backed by history of physician ownership, MTC is uniquely focused on the needs of its clients. Serving medical professionals is all we do.

MTC’s management team has over 50 years of combined experience in medical answering services. Our operators are professional, friendly, and expertly trained to handle any client situation. We offer a full range of customizable services to ensure your patients enjoy personal, timely communication while you stay on top of your busy schedule.

MTC is committed to providing the highest level of customer service. MTC is a member of the Association of TeleServices Int’l (ASTI) and a proud recipient of the prestigious ASTI Award of Excellence for service quality. MTC continually upgrades its technology and our servers and your data are kept in a secured state-of-the art data center with redundant internet and power supply.

Tank 14

Bren Franke

Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University College of Osteopathic Medicine. Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities, and Alexis Horst, MA, writing center instructor.

Bren Franke (he/they) is a first-year medical student at Rocky Vista University College of Osteopathic Medicine in Parker, Colo. Bren was born and raised in Saint Paul, Minn., and completed their bachelor’s degree at University of Wisconsin River Falls. As a first-year student, Bren has yet to narrow down any specialty interests but wants to focus on improving medical care for underserved minorities. Outside of medicine, Bren enjoys playing hockey, writing poetry, and rollerblading.

During the first two months of medical school, I wouldn’t have been surprised if I put my shoes on the wrong feet most days. I experienced a whirlwind of emotions ranging from homesickness to disappointment to pure joy. Every second-year medical student warned the incoming first-year students about most of the feelings I experienced, so I was expecting them and did not feel so alone. But there was one experience I found difficult to process that nobody really talked about. It’s understandable that at our white coat ceremony, the student speaker didn’t get up in front of everyone and talk about what emotions arose for them when dissecting a human body, a cadaver, and how they processed those emotions. Maybe some (or most) medical students don’t react intensely to the cadavers in anatomy lab; maybe it is not their first time. The strong emotions that arose for me during my first cadaver dissection took me by surprise.

When I walked into my first day of anatomy lab, I felt nervous but excited. I remember the strong smell of preservatives seeped through my mask, overwhelming my nose (which I got used to eventually). I shivered as I put on my lab coat, the cold air escaping the vents above me. I was assigned tank 14, which was what my donor (cadaver) was now known as. All we know about each donor is the cause of death and age; everything else is kept anonymous. I met my lab partners, and after a moment of silence for the donors, we began the dissection. I was eager to start, and I felt like this was a crucial moment in becoming a physician: my first day of anatomy lab. With

all the nerves, excitement, and stress of the first two dissections, I was not able to relax enough to think of anything more than the task at hand. Once I got more comfortable with my groupmates and dissection, my mind would start to wander during lab. Who is the person in front of me? Is someone missing them? Why did they decide to donate their body to science? What was their life like? This person’s entire physical form is in front of me, but could there be a nonphysical part of them that persists, a soul of sorts?

Your body in front of me structures uncovered But where is your soul?

I can’t help but wonder Were you someone’s mother? Your body in front of me

In your forever slumber

Known as the fourteenth number

But where is your soul?

You’ve given me an opportunity

So unique and extraordinary

Your body in front of me

It is an abstrusity

To build up immunity

But where is your soul?

No effect on me

I thought so obtusely

Your body in front of me

But where is your soul?

I am not religious, and I never grew up thinking of an afterlife, but for some reason, I couldn’t stop thinking about

what really happens to us after we die –and not just to our physical bodies. Over many hours in anatomy lab, I began to appreciate the human body even more than I thought I could. We are so intricate and delicate, yet tough and resilient. There must be more than this.

I understand that I am not the first person to feel that there must be more than the physical. I know this is not a groundbreaking thought. After all, the basis of all religions is that there is something more to life than what we can perceive through our five physical senses, but this was and still is a new feeling for me. This thought might be comforting for most people, but I had a hard time adjusting to this sentiment. It wasn’t scary or sad or anything like that, but it was such an intense feeling.

I am now six months into my medical education and still exploring this concept, mostly through poetry. I have always used poetry to reflect on my life and analyze my experiences, and medical school is no exception. I do find writing about medical school and this process most interesting though, because what we learn in medical school seems to be so structured. Things are black and white. Through poetry, I can grapple with the gray area where medicine intersects with the human experience. I am still overcome with similar intense feelings about human life and spirituality during anatomy lab (and outside of it), but whereas before I felt ambivalent, I am now comforted by the overwhelming feeling that human life has a larger purpose. ■

Finding a practice lender and bank: Choosing wisely today for your practice tomorrow

Michael Jerkins MD, M.Ed.

We all know it. These are tough economic conditions for both patients and physicians. Nevertheless, I encounter many in our profession that want to enter or grow in private practice but don’t know where to start.

A big part of growing or entering into private practice is finding a banking partner that can support you in your practice needs. Finding a lender that has the best program AND will provide you the best support will allow you to focus on what you do best—patient care—rather than worrying about banking for your practice.

Practice ownership can affect all areas of your life, so before choosing a lender, you should consider your wants and needs in every aspect of your life—personal and professional—to map out your priorities.

Think about your future plans for the practice, how you want to lead your team as an owner, how much you want to work clinically, and how you would bring in other clinicians. Then, use these priorities to help you find a lender that aligns with your long-term plans.

It can be tempting to choose a lender based solely on a low rate, but this can be a dangerous strategy for several reasons. For instance, lenders may lock you into their program for years with a prepayment penalty or charge you exorbitant fees on merchant services for your practice.

They also may not be prepared to support any future growth you have planned for your practice. All of these variables can be more important than simply looking at the interest rate of a loan.

Here are some other things to consider when choosing your banking partner:

Specialty knowledge: Does the lender have specialized knowledge in health care lending to practices? Lending to a medical practice or surgery center is very different from businesses in other industries and requires experience.

Structure and servicing: Understand if there are fees or limits on deposits and services like checking accounts, ACHs and wire transfers, costs for banking equipment, and remote deposit capabilities. Those costs can add up very quickly.

Merchant services (credit card processing): The ability to accept payment from your patients is obviously vital to your practice. This includes credit cards. Some lenders require borrowers to use their merchant services but attach high fees that can counteract any savings you may have gotten from a low rate.

Future support: Ask any potential lending partner if they can support any future lending needs for your practice such as real estate purchases, construction or expansion, equipment purchases and more.

Private practice can be rewarding and I believe Colorado would benefit from more private practices, but I know, ownership can be tough. That is why it is important to work with a true lending and banking partner that can not just support you today but also be able to better support you tomorrow. You and your patients deserve it.

Panacea Financial is a nationwide digital bank built for doctors, by doctors. They can help with personal lending, student loan refinance, or any finance need for your practice. As a participant in CMS's Partner in Medicine program, they have exclusive offerings for CMS members. Visit  https://panaceafinancial.com/ref/ cms/ to learn more. Panacea Financial is a division of Primis, Member FDIC. ■

Passing the gavel

CMS Immediate Past President Mark Johnson, MD, MPH (left), passes the gavel to CMS President Patrick Pevoto, MD, MBA (right), at the Dec. 9, 2022 meeting of the CMS Board of Directors. ■

Celebrating volunteers

CMS hosted a holiday open house after the Dec. 9, 2022 meeting of the CMS Board of Directors to celebrate and thank the physician members who volunteer their time serving on CMS boards,

CME

councils and committees. We are better together when individuals bring their various experiences and perspectives to these groups. ■

Meet the required 2 hours of training for all Colorado clinicians on controlled substance stewardship.

credits for prescribers –learn how to protect yourself and help reduce patient harm in Colorado!

FREE and available on your schedule

Virtual — video modules with Colorado-based instructors Colorado Medical Society has certified these activities for AMA PRA Category 1 CreditTM

Learn more at CORXCONSORTIUM.ORG/ CME

COURSES INCLUDE:

• Introduction to Opioids and Benzodiazepines

• Non-Opioid Pain Management Strategies

• Substance Use Disorder Treatment

• Understanding Rural Populations

• And more!

Funding provided by CoBank.

From left: Lucy Loomis, MD; Deb Parsons, MD, MACP; Clara Raquel Epstein, MD; and Rosemary Yakely.

From left: Marc Labovich, MD; Courtney Olson; Cordelia Tafoya and Zach Miller.

From left: Enno Heuscher, MD; Dave Downs, MD; Amy Duckro, DO; Dean Holzkamp and Chet Seward.

Denver Metro Chamber honors CMS and DMS

The Denver Metro Chamber of Commerce celebrated Colorado companies that have shaped the state’s economy for more than 100 years at the inaugural Centenarian Club Celebration on Jan. 5. Among those honored were the Colorado Medical Society (1871) and Denver Medical Society (1908), represented by CMS CEO Dean Holzkamp and DMS Executive Director Stefanie Carroll, MNM. We wouldn’t be where we are without our members. Thank you to the Colorado physicians of yesterday, today and tomorrow! ■

AAMS-DMS Fall 2022 Annual Meeting: An evening celebration to remember

On Nov. 19, 2022, members of the Aurora-Adams Medical Society and Denver Medical Society gathered at the Denver Art Museum for the AAMS-DMS Annual Meeting.

Physicians and guests celebrated the incredible achievements of both the 50-year service awardees and Kathy Lindquist-Kleissler, who retired from DMS earlier in 2022.

DMS Board President Michael Moore, MD, awarded Ivor Garlick, MD, and Elaine Scholes, MD, certificates for 50 years of excellence in medicine, serving the Denver medical community and beyond. AAMS President Rachelle Klammer, MD, awarded Anthony Tormey, MD, the 50-year service award.

Elizabeth Lowdermilk, MD, DMS Foundation board member and past DMS board president, presented Ms. Lindquist-Kleissler with an award for 32 years of exemplary service to Denver Medical Society.

After the dinner and awards program, attendees enjoyed a private viewing of a new exhibit, “Her Brush: Japanese Women Artists,” which featured never-before-seen artwork from 1600s to 1900s Japan. ■

Dean Holzkamp, CMS chief executive officer, left; and Stephanie Carroll, MNM, DMS executive director, right.

EPCMS celebrates members at winter social

The El Paso County Medical Society and Colorado Medical Society co-hosted an event on Nov. 30 at Brakeman’s Burgers in Colorado Springs to celebrate all local members and practice managers. Members enjoyed drinks, food and raffle prizes. ■

CU alumnae honored

For more than four decades, the University of Colorado School of Medicine and the University of Colorado Medical Alumni Association have hosted the Silver & Gold Alumni Awards Banquet. The event celebrates the role alumni have played in transforming the art and science of medicine.

Two CMS members were honored during the event on Dec. 1, 2022.

• Jan Marie Kief, MD, Richard Krugman Distinguished Service Award

• Lesley Brooks, MD, Recent Graduate Humanitarian Award

Attendees heard remarks from Taylor Triolo, MD, CU Medical Alumni Association president, and Dean John J. Reilly, Jr., MD, followed by the celebration of all award recipients. Congratulations to Dr. Kief and Dr. Brooks! ■

Metro Denver medical societies at the zoo

Metro Denver medical societies gathered for a sold-out Member + Family Appreciation Night at the Denver Zoo on Dec. 11. Members of the Denver Medical Society, Aurora-Adams Medical Society, Arapahoe-Douglas-Elbert Medical Society and Foothills Medical Society enjoyed warm holiday treats and – of course – the brilliant outdoor lights of Zoo Lights. ■

Jan Kief, MD, left, and Lesley Brooks, MD, right

Kyle Leggott, MD

When we consider increasing value in health care, I believe most are trying to achieve the noble goals of better patient outcomes and improved patient experience at lower costs. A bonus to the health care value equation is that if done correctly – by ensuring that care is provided at the right place, time and context, and all of the direct and indirect costs are accounted for – we can also improve the clinician experience by compensating care providers appropriately for doing what they are called and trained to do and eliminating duplication.

It is widely accepted that the fee-for-service model is largely flawed. It incentivizes volume of services, without regard to what is appropriate and without an incentive to control costs. The fee schedule favors procedural over cognitive care, making overall reimbursement inadequate for many sectors of health care including primary care. So, what are the alternatives?

Capitation arrangements – when insurance pays a per-member-per-month fee – can cover just primary care visits, primary care visits plus associated tests, all outpatient services, or all of patient care. This model provides flexibility of funds for non-visit-based care and teambased care and incentivizes cost savings. But it poses an increased financial risk to practices and clinicians, and runs the risk of potential under-delivery of services given limited funds. For capitation to be viable, there needs to be risk adjustments to the per-member-per-month fees based on patient complexity and level of care needed. Determining appropriate risk adjustment has been an elusive goal.

Depending on the arrangement, the capitated payment may be paid directly to the providers or to an intermediary like a managed care organization. The managed care organization may or may not actually pay a practice or health care organization via capitation, and the practice may or may not pay the providers on a capitated basis. In traditional capitation arrangements, payments are based on historical fee-for-service amounts and adjusted based on limited factors such as age and sex. Without adequate risk adjustment for medical complexity and social drivers of health (SDoHs), funds may be insufficient for patients with greater health care needs.

A blended fee-for-service and capitation model somewhat balances the negatives of both traditional models by partially allowing for proactive care, but the predominance of fee-for-service over per-member-per-month fees may not reach a tipping point that enables for the necessary restructuring of a practice. One study using simulation models suggests that at least 63 percent of practice revenues need to be capitated in a blended model to enable a shift in practice structure.

In a bundled payment model , a patient seeks care for a defined episode or medical problem and insurance reimburses a practice with a global payment or expenditures are later reconciled against a target. A budget is set for an episode of care across multiple providers. It incentivizes cost control within the episode and allows for flexibility in how funds are used. But it’s almost impossible to define an “episode” in primary care and there is the possibility of insufficient funds to cover needed services.

Direct Primary Care (DPC) is a contractual arrangement where the practice charges patients a flat monthly fee for their primary care services in lieu of thirdparty insurance billing. Fees for patients in a DPC model are generally set by age and are usually less than $100 a month.

In return, patients usually have access to longer visits with enhanced forms of communication with their physician. Patients often must still buy insurance to cover catastrophic costs, hospitalizations or surgeries. DPC is different from concierge practices, which charge patients an annual retainer and still bill insurance. DPC providers usually see a panel of about 600-800 patients rather than upwards of 2,000, which, as this model becomes more popular, could worsen workforce shortages.

It remains to be seen when we will fully replace fee-for-service and if one of these models or something completely different will rise to predominance. As many practices and organizations are working on payment reform, it remains crucial for physicians to stay involved in these conversations to ensure we achieve the goals of improved patient outcomes, improved clinician experience and lower costs.

Kyle Leggott, MD, is a practicing, board-certified family physician with a deep understanding of health care and pharmaceutical cost drivers and related health policy issues. He is committed to advancing health care affordability and equity. ■

There are many initiatives in health care value, will one win?

SOLUTIONS

COVERAGE BEYOND

At COPIC Financial Service Group, we understand the health care industry and can offer you strategic, customized insurance and financial solutions. We know you have unique needs, and we’ll work with you to navigate employee benefits, cyber protection, coverage options, and any gaps that need addressing to protect your assets. That’s Value Beyond Coverage.