November-December 2019 Colorado Medicine

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COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

THE 20,000-FOOT VIEW: PHYSICIANS’ ROLE IN SOCIETY DAVID MARKENSON, MD, MBA CMS PRESIDENT

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Celebrating the sacred bond between physicians and patients, and honoring our role in society Meet your new CMS president, David Markenson, MD, MBA. Sworn in at the annual meeting in September, he promises to strengthen what has eroded over the years – the sanctity of the doctor-physician relationship – and inspire physicians by reflecting on the unique calling to be a physician and physicians’ role in society. Photographed at the Centennial Airport to illustrate his second passion, aviation. PAGE 4 ⊲

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18 RECOGNIZING ALFRED GILCHRIST FOR SERVICE TO CMS CMS CEO Alfred Gilchrist will retire at the end of January 2020. Over his 15 years in leadership he has navigated countless challenges to the profession and made real gains for Colorado physicians.

CMS CELEBRATES MEMBERS AT ANNUAL MEETING CMS members and their guests from around the state gathered in Denver for a fun day of exploration, education and socializing. See photos from the event.

10 STATE RELEASES PROPOSAL FOR PUBLIC OPTION INSURANCE The Colorado Division of Insurance and Department of Health Care Policy and Financing released their proposal for a state option for health insurance coverage with rate-setting for hospitals but not physicians.

Doctors are expected to “step up.”

12 NEW MEMBER BENEFIT: GROUP DENTAL INSURANCE PLANS CMS is pleased to collaborate with COPIC Financial Service Group and Delta Dental of Colorado to offer CMS members a new member benefit: an affordable dental benefits program for employees and their families.

14 DOCTORS CELEBRATE LEGISLATIVE CHAMPIONS CMS hosted the annual Legislative Reception and Awards Ceremony to celebrate the legislators who championed physicians’ issues in the 2019 Colorado General Assembly.

See photos from the event.

36 FINAL WORD: ALFRED GILCHRIST REFLECTS ON A LIFETIME OF HEALTH CARE ADVOCACY Outgoing CMS CEO Alfred Gilchrist reflects on a long career representing the medical profession in the public affairs space, and gives his thoughts on what has worked and can work moving forward.

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16 Celebrating the physicians behind Central Line 20 CMS names new CEO: Bryan Campbell, FAAMSE 21 CMS Board of Directors sets operational plan 22 CMS Education Foundation names scholarship recipients 31 CMS Corporate Supporters and Advantage Partners

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24 Introspections 26 Reflections 28 COPIC Comment 29 Advantage Partner Spotlight 30 Medical News 30 Physician saves baby’s life at zoo 32 Former Denver Health CEO honored with NAM award 32 CMS board member wins lifetime achievement award 33 CMS and components honor Pueblo, Boulder legislators 34 Report lauds statewide efforts to end opioid epidemic 35 CMS recognizes state science fair winners 35 Classifieds

CO LOR AD O M E D I CAL SOCI E T Y 7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902 720.859.1001 • 800.654.5653 • fax 720.859.7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2019-2020 OFFICERS David Markenson, MD, MBA President Sami Diab, MD President-elect Patrick Pevoto, MD, RPh, MBA Treasurer Alfred D. Gilchrist Chief Executive Officer Debra J. Parsons, MD, MACP Immediate Past President

BOARD OF DIRECTORS

AMA DELEGATES

Iris Burgard, MS Cory Carroll, MD Curtis Hagedorn, MD Mark B. Johnson, MD Jason L. Kelly, MD Lauren Loftis, MD Evan Manning, MD Patrick Pevoto, MD, RPh, MBA Leto Quarles, MD Brandi Ring, MD Brad A. Roberts, MD Kim Warner, MD Hap Young, MD

A. “Lee” Morgan, MD David Downs, MD, FACP Jan Kief, MD Tamaan Osbourne-Roberts, MD Lynn Parry, MSc, MD

AMA ALTERNATE DELEGATES Carolynn Francavilla, MD Rachelle Klammer, MD Katie Lozano, MD, FACR Brigitta J. Robinson, MD Michael Volz, MD

AMA PAST PRESIDENT Jeremy Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF Alfred Gilchrist Chief Executive Officer Alfred_Gilchrist@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Kate Alfano Communications Coordinator Kate_Alfano@cms.org

Susan Koontz, JD General Counsel, Senior Director of Government Relations Susan_Koontz@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Krystle Medford Senior Director of Membership Krystle_Medford@cms.org

Emily Bishop Government Relations Program Manager Emily_Bishop@cms.org

Gene Richer Director of Continuing Medical Education Gene_Richer@cms.org

Mike Campo Director of Business Development and Member Benefits, and staff support for CMS Foundation and CMS Education Foundation Mike_Campo@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Dianna Fetter Senior Director of Professional Services Dianna_Fetter@cms.org Amy Berenbaum Goodman, JD, MBE Senior Director of Policy Amy_Goodman@cms.org

Tom Wilson Manager of Accounting Tom_Wilson@cms.org Tim Yanetta Manager of IT/Membership Tim_Yanetta@cms.org

COLORADO MEDICINE (ISSN-0199-7343) is published bimonthly as the official journal of the Colorado Medical Society, 7351 Lowry Boulevard, Suite 110, Denver, CO 80230-6902. Telephone (720) 859-1001 Outside Denver area, call 1-800-654-5653. Periodicals postage paid at Denver, Colo., and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance.

COLORADO MEDICINE magazine is the official journal of the Colorado Medical Society, and as such is also authorized to carry general advertising. COLORADO MEDICINE is copyrighted 2006 by the Colorado Medical Society. All material subject to this copyright appearing in COLORADO MEDICINE may be photocopied for the non-commercial purpose of education and scientific advancement. Publication of any advertisement in COLORADO MEDICINE does not imply an endorsement or sponsorship by the Colorado Medical Society of the product or service advertised. Published articles represent the opinions of the authors and do not necessarily reflect the official policy of the Colorado Medical Society unless clearly specified.

Alfred D. Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Kate Alfano, Assistant Editor; Chet Seward, Assistant Editor. Design by Scribner Creative.

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Celebrating the sacred bond between physicians and patients, and honoring our role in society David Markenson, MD, MBA

I am honored and humbled to be installed as president of the Colorado Medical Society at this challenging and exciting time in our profession. We fight for all Colorado physicians in the public and private sectors to help improve the practice of medicine and protect important patient safety and quality measures. While we will continue to address singular issues as they arise, what I think is most challenging to our profession at this current time and what I will focus on during my presidential year is the unique role of the physician, the role of the physician in society and the patient-physician relationship.

There is something very unique about the calling to be a physician. But when fighting the small battles, it is easy to forget the big picture of why we became physicians and why society traditionally has held physicians in a very special place. I want to reflect on that unique role.

Most people relate physicians to Hippocrates and the oath that many of us recited in some form when we graduated from medical school. Some of the things mentioned in the original Hippocratic oath are commitment to our art, our education, and our patients. If you think about it, this has been eroding. How often do you hear patients referred to as customers?

Are they really customers shopping for products like at a high-end store they frequent? How many salespersons, after fitting a customer for a new coat, tossed in bed that night questioning whether they made the right color choice for that person? “Did I get the size right?”

Conversely, how many of you have stayed up at night thinking about a patient or conferred with colleagues to ask if you did the right thing by your patient? While we have to provide excellent service in our interactions, they are not customers; they are patients and our rela-

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tionship transcends a simple transaction.

While we have to provide excellent service in our interactions, they are not customers; they are patients and our relationship transcends a simple transaction.

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We need to reinforce that there is a sacred bond given to us by the patient and received and returned by physicians that, as a result, makes us well suited to advocate for the things they need in society and the things society should present them.

And while many may think of Hippocrates, many of you who know me well know that I went to yeshiva and I have a real love of Judaism and medical ethics. So in addition to looking to Hippocrates for an example, I also look to a person named Maimonides.

Maimonides was most known as a Jewish philosopher in the middle ages, but he was also a physician, and while people often talk about the great Jewish studies he wrote, in actuality he wrote some of the most central books of Jewish law and about medicine. To me his writings illustrate the multiple roles a physician can have in society: an educator, a learned person, an advocate for society and an advocate for patients’ needs.

He truly represented a unique nature. Maimonides had an oath himself and a prayer for physicians that I would like to share with you.

The prayer is actually fairly long so I won’t print it in full but I think there are a few passages that we can reflect upon as we think about the message we want to give to society.

From the prayer of Maimonides: Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death. …

Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed.

Here is an excerpt from the oath of Maimonides: The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

May I never see in the patient anything but a fellow creature in pain.

Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.

Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

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Even in his times, he thought about ethics and he combined them with medicine. He talked about the unique role of the physician, how one must be humble to continually seek knowledge, and how sacred the bond is between a physician and patients. What I always find amusing is that one of his books, when translated, has an exceptional title for physicians. It was known as “The Guide of the Perplexed,” which is how I often talk about medicine.

In all seriousness, what I find when I study Maimonides are truths of our profession: Always yearning to learn more, to advance ourselves, to speak on behalf of our patients and recognize that our calling is the care and life of patients above our own, and that our efforts and learning are directed for the betterment of patients and the unique role of the physician. As physicians we have many roles to use our heart and knowledge to advance society and to serve and to educate. If we protect these roles, then the singular issues we have to face flow easily.

Bringing the focus back to these things is my commitment to you as your president and the centralizing theme of my presidency. I appreciate all you have done and all that you do. Thank you for this honor to serve you.

Markenson maintains a pilot’s license and enjoys taking to the skies when his schedule allows. He was photographed in September at the Centennial Airport.

Markenson’s passion for aviation was sparked by his grandfather, George. The elder Markenson served in the Army Air Corps in World War II. He is shown above with students from an engine class he taught.

MEET DR. MARKENSON David Samuel Markenson, MD, MBA, is a health care physician executive, researcher, educator and advocate with more than 20 years of experience in leadership roles. His career has been dedicated to improving hospital and health system quality, improving the approach to pediatric care, disaster medicine and health care emergency management, and advancing EMS and emergency medicine. He currently serves as the chief medical officer of Red Cross Training Services and chair of the National Scientific Advisory Council for the American Red Cross.

Prior to his role as CMO with the American Red Cross, Markenson was divisional vice president of graduate medical education for the Continental, Mid-America and Mountain Divisions at Hospital Corporation of America Physician Services Group, which included over 30 hospitals covering seven states. Prior to that, he served as the chief medical officer at Sky Ridge Medical Center. Before joining Sky Ridge Medical Center, Markenson was based at New York Medical College (NYMC) and Westchester Medical Center Health Network (WMCHealth) as vice president and medical director for regional emergency services and director of partnership for patients, quality data and special projects. During the same period, Markenson held the titles of professor of pediatrics and clinical public health, and director of the Center for Disaster Medicine at NYMC. Markenson received his MD from Albert Einstein College of Medicine and his MBA from the University of Massachusetts at Amherst. He completed his residency in general pediatrics followed by a pediatric chief resident year and fellowship training in both pediatric emergency medicine and pediatric critical care. He is board certified in Pediatrics, Pediatric Critical Care, Emergency Medical Services and Clinical Informatics.

In addition to medicine, he has had a love of aviation from a young age, sparked by his grandfather’s service in the U.S. Army Air Corps. He has his pilot’s license including an instrument rating and has over 3,000 flight hours.

Markenson is the son of Alicejane Lippner, MD, JD, a pediatric hemotologist/oncologist, and Joseph Markenson, MD, MACR, a rhematologist. He is married to Heidi Markenson, PhD, a brilliant research scientist, and together the couple have three children: Emily, Rachel and George. ■

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A day of fun, collegiality and celebration of the unique role of physicians: 2019 CMS ANNUAL MEETING, PRESIDENTIAL CELEBRATION AND INAUGURAL GALA Physicians, medical students and component society leaders from around the state gathered at the Denver Museum of Nature & Science on Saturday, Sept. 14 to celebrate the unique role of physicians in society. Members and guests enjoyed the museum, conducted business at the CMS Board of Directors meeting, learned through COPIC educational sessions, and had a ball at the red-carpet gala where we thanked outgoing president Debra Parsons, MD, MACP, for her service and welcomed incoming president David S. Markenson, MD, MBA.

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1. The Denver Museum of Nature & Science is an elegant venue for the 2019 Inaugural Gala. 2. Jean Martin, MD, JD, presents an update on the Candor Act during the afternoon’s COPIC educational sessions. 3. Members and guests enjoy the exhibitor reception before the Gala opens. From left, Kimberly Thorn; Rosemary Yakely; Chester Cedars, MD; and Kathy Cedars. 4. Harmeet Singh, MD, is one of many recipients of raffle prizes donated by sponsors, exhibitors and CMS. 5. Outgoing CMS President Parsons reflects on the work of leaders and members over the past year. 6. Parsons, far left, recognizes the physicians celebrating 50 years since medical school graduation. From left: Philip Sullivan, MD; Usha Varma, MD; Gordon Ehlers, MD; Chester Cedars, MD; Robert Foster, MD; Walter Robinson Jr., MD; Fred Williams, MD; Bennett Machanic, MD; James Hogan, MD; and M. Robert Yakely, MD. 7. Lee Morgan, MD, presents an educational session on safe and effective practice with mid-level practitioners. 8. Physicians and medical students enjoy the Inaugural Gala. 9. Parsons, right, receives her certificate of service as outgoing president from Markenson, left. 10. Outgoing president Parsons presides over her final CMS Board of Directors meeting as board chair. From left: Yakely, Markenson, Parsons and Patrick Pevoto, MD, RPh, MBA. 11. Markenson gives his inaugural address. 12.

Pevoto and wife Deletha walk the red carpet to the Inaugural Gala. ■

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State releases proposal for public option for health insurance coverage CMS BOARD OF DIRECTORS VOTES TO SUPPORT DRAFT PROPOSAL, WITH COMMENTS PROVIDED Kate Alfano, CMS Communications Coordinator

After months of stakeholder meetings over the summer and fall, the Colorado Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) issued a draft report in early October outlining a state option for health insurance coverage. CMS has been actively involved in the stakeholder process by providing testimony and other comments, advocating for CMS’s goal to support a public option plan that increases competition in health insurance markets, reduces insurance premiums, facilitates quality improvement and administrative simplification, and inspires physician network participation.

Further, CMS and allies believe the public option should harness innovative strategies to reduce costs by incentivizing the delivery of efficient care, delivery of high-value services, avoidance of low-value services, streamlined administration and healthy behaviors.

Following months of member engagement and comments to the state, and in addition to a full analysis of the draft proposal, the CMS Work Group on Health Care Costs and Quality recommended that CMS should support the proposal, while recognizing some legitimate questions. After further deliberation the CMS Board of Directors agreed.

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The proposal is a result of HB19 -1004, passed by the 2019 Colorado legislature, which directed the two agencies to create a plan for a state option that would increase the affordability and availability of coverage, increase coverage and ensure quality. Under the plan, state option insurance coverage would be administered by insurance companies and sold on Connect for Health Colorado, the state’s health insurance exchange.

The plans will initially only be available to those who buy insurance on the individual market, roughly 7 percent of the state population. State leadership has expressed interest in scaling a successful option to the small group market in the future.

The DOI estimates that those who buy coverage on the individual market will see a reduction in premiums of between 9 and 18 percent once coverage starts in January 2022.

The plan aims to achieve those reductions by setting hospital rates at 175 to 225 percent of Medicare; physician rates are not set in the current plan.

HCPF Executive Director Kim Bimestefer said at the official release on Oct. 8, “We spent some time yesterday with...the Colorado Medical Society and we challenged them to step up and [to] bring the things to the table that [physicians] can do to be part of the solution, especially in the area of empowering physicians to be able to better control cost and quality.”

Both Insurance Commissioner Mike Conway and E xecutive Direc tor Bimestefer thanked CMS for our active engagement on this initiative and encouraged our continued collaboration.

In the comments CMS submitted on October 25, CMS President David Markenson, MD, MBA, relayed the society’s support and goals for the state option, recognized some important issues that need further work, and presented additional ideas. “It is more important than ever to ensure that physician clinical autonomy and quality patient care is protected,” he wrote.

All Medical Answering Service Markenson put forth the following ideas, committing to collaborate actively with the state to achieve them: • Use evidence-based benefit design to construct health benefits that drive the provision and use of high-value care.

• Drive the use of common, evidencebased performance measures and adminis trative processes across payers to reduce or eliminate administrative burdens on physician practices.

• Get actionable data into physicians’ hands with user-friendly tools to empower physicians and their patients in their decision-making: digitize referrals, scale the advance directive registry, and provide practice-level reports to build out value-based payment models, to name a few.

• Accelerate the use of value-based payment models using input from key stakeholders, including physicians.

• Target social determinants of health to improve individual and population health, and reduce overall health care spending.

In closing, Markenson expressed CMS’s commitment to remain actively engaged and the society’s hope to continue to support the proposal as it works its way through the Colorado legislature. ■

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B E N E F IT

The Colorado Medical Society is pleased to announce a new member benefit: GROUP DENTAL INSURANCE PLANS THROUGH DELTA DENTAL Poor oral health can lead to and escalate serious overall health issues. That’s why dental insurance is important and why the Colorado Medical Society (CMS) has collaborated with COPIC Financial Service Group and Delta Dental of Colorado, the state’s leading dental benefits provider, to offer CMS members an affordable dental benefits program for their employees and their families.

( Rate guaranteed until Jan. 1, 2022, regardless of start date

Designed for small- to medium-sized organizations, this plan offers a combination of flexibility and cost savings to fit your group’s needs. CMS worked closely with COPIC Financial Service Group to develop this association plan for its members.

( Plans include Right Start 4 Kids®, a unique plan enhancement that removes most of the cost barriers to dental care by providing coverage for children up to their 13th birthday at 100 percent co-insurance when in-network providers are seen (subject to limitations)

A PRODUCT WE BELIEVE IN If you’ve been thinking about adding dental insurance as a benefit for your medical practice employees, now is the time to explore your options. The leadership team at CMS has been working hard behind the scenes to offer this kind of benefit for members, and has found an excellent provider.

HIGHLIGHTS OF THE DELTA DENTAL PLAN ( An association plan with effective dates starting Jan. 1, 2020 ( Offered for groups of two people or more

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( Choice of two benefit plan options ( Plans include preventive, basic and major services, and child orthodontia is included in the High Option Plan (12-month wait if no prior orthodontics coverage)

( Members who are part of the High Option Plan may visit any licensed provider, but will get the greatest out-of-pocket savings if they see a Delta Dental PPO™ provider from the nationwide network The Delta Dental plan is available through your current agent or contact John Kaufman at COPIC Financial Service Group: jkaufman@copic.com or 720-858-6287.

It’s not too soon to start the conversation in order to put the plan in place by Jan. 1, 2020 or after.

ABOUT DELTA DENTAL Delta Dental of Colorado is a nonprofit dental benefits company with a mission to improve the oral health of the communities they serve…something they take very seriously. Delta Dental gives its more than 1.3 million members the power to use and manage their dental benefits easily.

Through innovative plans, large dentist network and expert customer service, they make dental care accessible, affordable and simple, leading to a healthier smile and life. And through the Delta Dental of Colorado Foundation and corporate social responsibility initiatives, they are active in the community, giving to organizations that support their mission and helping expand access to quality dental care. Creating healthy Colorado smiles is what drives Delta Dental of Colorado.

As part of a national association, Delta Dental adheres to the strictest accuracy standards for their provider networks.

That means that when members select a provider in their network, they will be able to see that provider. Approximately nine out of 10 of all Colorado providers are part of their network.

COLLABORATION WITH COPIC FINANCIAL SERVICE GROUP COPIC Financial Service Group is an independent insurance brokerage and consulting firm that works with physicians, dentists, members of the health care community, and other professionals. They provide customized planning to make sure you are adequately insured, allowing your professional career and personal life to flourish. COPIC Financial Service Group is a strategic partner of the Colorado Medical Society as an administrator for its members’ business and personal insurance needs. For more information, please contact your current agent or John Kaufman, CMS’s dedicated agent for this product: 720-858-6287 or jkaufman@ copic.com. ■

THE COLORADO MEDICAL SOCIETY IS PLEASED TO ANNOUNCE

A NEW MEMBER BENEFIT CUSTOMIZED PLANS FOR CMS MEMBERS

COLORADO EST.

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GROUP DENTAL INSURANCE PLANS THROUGH DELTA DENTAL, THE STATE’S LEADING DENTAL BENEFITS PROVIDER. A new collaboration between Delta Dental of Colorado, Colorado Medical Society and COPIC Financial Service Group.

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Available with effective dates starting Jan. 1, 2020

Competitive rate guarantee until Jan. 1, 2022, regardless of start date

Intended for groups of two people or more

Choice of two benefit plan tiers

The Delta Dental plan is available through your current agent or contact John Kaufman at COPIC Financial Service Group: jkaufman@copic.com or 720.858.6287

COPIC Financial Service Group, Ltd www.copicfsg.com

COPIC Financial Service Group is an independent insurance brokerage and consulting firm that works with physicians, dentists, members of the health care community, and other professionals. We provide customized planning to make sure you are adequately insured, allowing your professional career and personal life to flourish.

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CMS celebrates legislative champions at annual Legislative Reception and Awards Ceremony Work has already begun to prepare for the 2020 legislative session

Legislators and physicians gathered at Walker Fine Art in Denver on Sept. 26 for an upbeat CMS Annual Legislative Reception and Awards Ceremony. Attendees met the legislators that championed physicians’ issues during the 2019 session, and enjoyed refreshments and live music. The advocacy arm of the Colorado Medical Society – Government Relations staff Susan Koontz, JD, and Emily Bishop, contract lobbyists Jerry Johnson and Dan Jablan, and other CMS staff – are already working with physicians and legislators to support good public policy for patients and oppose bad policy. Contact Emily Bishop at emily_bishop@cms.org for more information on getting involved in health care public policy. ■

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From left: Sen. Angela Williams, Rep. Kyle Mullica, Rep. Yadira Caraveo, Sen. Joann Ginal, Sen. John Cooke, Sen. Rhonda Fields, Rep. Hugh McKean, House Majority Leader Alec Garnett, and Rep. Kevin Van Winkle.

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1. From left, Sen. Cooke; CMS Immediate Past President Deb Parsons, MD, MACP; Denver Medical Society Executive Director Kathy Lindquist-Kleissler; Sen. Fields; Dave Downs, MD, FACP; Sen. Ginal; Rep. Van Winkle; and Rep. McKean.

2. CMS Senior Director of Membership Krystle Medford, left, and Government Relations Program Manager Emily Bishop.

3. From left, Boulder County Medical Executive Judy Ladd and COMPAC Chairman Christopher Unrein, DO.

From left: Lobbyist Jerry Johnson; Sen. Fields; Sen. Cooke; CMS General Counsel Susan Koontz, JD; and CMS Senior Director of Policy Amy Berenbaum Goodman, JD, MBE.

From left: Rep. Mullica; Mark Johnson, MD, MPH; House Majority Leader Garnett; Parsons; Downs; and Michael Moore, MD.

Majority Leader Garnett gives comments on the Sen. Fields praises the work of the Colorado work of the Colorado House of Representatives. General Assembly in 2019, particularly her colleagues in the Senate.

Guitarist Mason Howell entertains attendees during social time at the venue, Walker Fine Art in Denver.

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CENTRAL LINE

Celebrating the physicians behind Central Line: Bob Yakely, MD, and Ray Painter, MD Kate Alfano, CMS Communications Coordinator Physician leaders and staf f conceived the idea for Central Line as a response to member surveys that indicated the desire for greater input, participation and engagement with the medical society. A committee of physicians, led by Ray Painter, MD, and Robert Yakely, MD, envisioned the platform as a virtual grassroots policy communications process available for members to take action any time on issues important to them and on issues being addressed by the CMS Board of Directors.

The Colorado Medical Society has undergone a powerful transformation since embarking on cutting-edge communications and governance reforms in 2014. These changes have moved the organization from vertical to horizontal, empowering all members to be engaged, informed and more empowered than ever before.

The heart of this effort is Central Line, CMS’s virtual policy engagement platform. With a few clicks of a mouse and from the convenience of a mobile device or computer, members can use Central Line to propose new policy ideas, collaborate and provide feedback on members’ policy ideas, and keep the CMS Board of Directors accountable for representing the interests of Colorado physicians.

Yakely served as the last Speaker of the CMS House of Delegates and presided

over the vote to dissolve the House of Delegates in favor of a new governance model. “It was designed to be almost a virtual method of duplicating what we’d done for many years to set policy for the medical society: A doctor comes up with an issue, writes a resolution and the resolution goes to the House of Delegates.

Now all of our members are delegates; they comment on a proposed policy and ultimately the Board of Directors acts on it. But now you don’t have to give up a weekend to go to a meeting to influence the medical society.”

“It’s exciting when a plan comes together,” said Painter, who, like Yakely, is a CMS past president. “Af ter the Colorado Medical Society decided to terminate the annual meetings in their traditional form, conducting society business electronically was the obvious choice for many reasons. First and foremost, the younger generation of physicians grew up with and prefers emails, texts and other types of electronic communication to phone calls and in-person meetings. Since they are the future of the society, the idea was to make important communication from the society and the necessary business that needed to be conducted simple, easy and quick. The staff has done an excellent job of developing, organizing and managing communication.”

“If you look at the numbers, it has far exceeded what we had hoped to achieve just in terms of member participation,” Yakely said. “Instead of 150 people making decisions for the entire membership, now thousands are able to participate.”

“It’s been very gratifying to see the increased number of physicians participating statewide,” Painter said. “Medical organizations, with the exception of specialty societies, are struggling

1 6 C O LO R A D O M E D I C I N E

nationwide with lack of participation and decreasing membership. Central Line has allowed CMS to communicate with members on their terms, improving participation and hopefully assisting in retaining membership.”

Yakely said the tremendous interest from other state medical societies affirms that CMS is on the cutting edge of how we’re working as an organization.

Painter agreed: “If CMS can be successful with person-to-person communication and assisting physician-to-physician communication, I think the entire experiment will continue to be successful.” ■

CENTRAL LINE PARTICIPATION CALENDAR YEAR 2019

S ER

TO T

MEMB AL

1456

C

VOTES

ME

8

S BER VO M

D TE

POSAL RO

S

P

7188

MENT S OM

442

AT USE PE

USER EW S N

RE

RS

4127

1092

364

ME

S THROU TE

224

GH

359

TH

ERS W I MB

VO

INTEREST AREAS

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I S S U E

H I G H LI G HT

Honoring Alfred Gilchrist CMS CEO TO RETIRE AFTER 15 YEARS AT THE HELM Kate Alfano, CMS Communications Coordinator Alfred Gilchrist, the “fast-walking, slow-talking” CEO of the Colorado Medical Society will retire at the end of January 2020, leaving behind a legacy as a brilliant leader, strategist, team Longtime CMS CEO Alfred Gilchrist receives the AMA builder and advocate for patients and medicine. He achieved a Lifetime Achievement Award in November 2018. striking number of extraordinary goals since he was hired at CMS in 2004, and in 20 years prior at the Texas Medical Association, and he was key to nance and communications reforms that establishing the two medical societies as credible voices for physicians in the public helped CMS evolve into a model 21st-cenand private sectors. In his inaugural Executive Office Update column in the Decem- tury state medical society. While other ber-January 2005 issue of Colorado Medicine, he credits physician leaders as the organizations were struggling to retain single most important ingredient to all of the successes of organized medicine. Many members and relevance, CMS developed would argue that his ability to bring the right people together for a common good ways to give members ownership of the organization and increase value. The plan was the overarching reason for the victories described in that column and all since. meant launching Central Line, a first-inEarly in his career in Colorado, in 2007, first physician profiling bill. CMS was the the-nation web-based virtual policy plathe led the charge for legislation to estab- first medical society in the country to form that engages all members in policy lish the nation’s first fair and transparent persuade state legislators to enact stat- creation; opening nominations and voting managed care contracting bill, SB07-79, utory protections for profiled physicians. for leadership elections to all members; the result of a mediated agreement that A national model governing physician creating a series of skills-based courses served as a model for how physicians and designation by health plans, the bill was for leadership development; streamlining health plans can collaborate to overcome the fruit of constructive dialogue between committees or workgroups to targeted and seemingly polarized positions to pass CMS and health plans. It requires plans productive short-term experiences based to disclose the process and data used to on urgency and relevance; and redemeaningful legislation. designate physicians and creates appeals signing face-to-face meetings for optimal In late 2007 and early 2008, as health care mechanisms for physicians who believe collegiality and information sharing. Most recently, CMS relaunched our brand and reform was on the minds and newscasts of they have been inappropriately profiled. modernized the look of all publications; all, he brought together a diverse group of CMS-member physicians for the Physi- 2012 marked the end of the first battle chiefly, CMS.org and Colorado Medicine. cians’ Congress for Health Care Reform. for the reauthorization of the Colorado This group met every six weeks for 18 Professional Review Act, with victory “Alfred is a brilliant strategist who cares months to develop a consensus voice for achieved after an often-contentious passionately about making doctors’ pracColorado physicians on health care reform. 18-month process that involved building a tices satisfying, and making our patients’ The congress’ evaluation matrix, still refer- coalition of health care organizations and care as good as it can be,” wrote CMS enced in present day, measures health their lobby teams to champion the effort. Past President Mark Laitos, MD, in his care policy proposals against the values The Act survived an 11th-hour negotiation president’s letter in 2010, reflecting on of the medical community. The work of the marathon while the sunset legislation was Gilchrist’s first five years as CMS CEO. congress was incorporated into the output held hostage to a series of demands from Gilchrist very briefly left Colorado for of the Blue Ribbon 208 Commission and the trial attorneys. Then again, in 2019, another position, only to be welcomed Gov. Bill Ritter’s “Building Blocks for Health another victory came despite a session- back a few months later. Laitos’ reflection Care Reform” package. A critical element long campaign by plaintiff attorneys to at the time still rings true today. “Just as of the package for Colorado’s doctors was breach the privileged nature of profes- we’ve dedicated our skills and careers to increased Medicaid reimbursement for sional review activities. Gilchrist and the taking care of our patients, he has dediprimary care services that came directly government affairs team coordinated cated his considerable skill and career from the recommendations of the CMS/ a strategic coalition of CMS, COPIC, to taking care of doctors. The doctors in Specialty Medicaid Reform Task Force, the Colorado Hospital Association, and Colorado have benefitted enormously by and represented a good-faith effort on specialty and component medical societ- his presence.” the part of the governor to respond to ies to ensure physicians were successful.

Laitos continued, “not only did Alfred physicians’ needs.

More than just legislative accomplish- advise and organize us very skillfully, he Another key achievement came in 2008 ments, Gilchrist championed “the new has also successfully mentored your CMS with the signing of SB08-138, the nation’s CMS,” a comprehensive package of gover- staff, along with a sizable corps of physi1 8 C O LO R A D O M E D I C I N E

1 Gov. John Hickenlooper signs the 2012 reauthorization of the Professional Review Act into law.

cians in this organization. We are a much more savvy society now. Our physician leaders and staff learned a clear understanding of our opportunities and, more importantly, how to accomplish our goals for achieving better patient care.”

In November 2018, Gilchrist was awarded the American Medical Association’s Medical Executive Lifetime Achievement Award for his 40 years in executive leadership at CMS and TMA, with key achievements in Texas in helping the organization respond to challenges in rural health, border health, managed care and liability reforms, among many others. When

IN THE WORDS OF THE PRESIDENTS What Alfred has accomplished in his career and especially his work at the Colorado Medical Society has been monumental. I cannot put into words the dedication he has given to our organization, tireless efforts, and truly raising CMS to high levels of respect and effectiveness in our state advocating for physicians and the patients served. His perseverance, vision and collaborative leadership style has truly inspired anyone who has had the opportunity to work with him.

— Jan Marie Kief, MD Alfred always showed the utmost respect for the physicians of CMS and worked tirelessly to collaborate with the American Medical Association and other state and specialty societies to improve care for patients and for the profession of medicine. His influence will be felt for many years to come.

— Jeremy Lazarus, MD Alfred Gilchrist has exemplified “5-Star” leadership on behalf of physicians and patients. His legacy will endure long past his tenure at CMS. Thanks, Alfred!

— Michael Pramenko, MD

accepting the lifetime achievement award, he told the audience: “We understand what this award represents. It represents thousands of volunteer physician hours.

Doctors showing up time and again with the goal of making care better for patients and the communities they serve.

It represents compassionate and bold physician leadership past and present. It represents the hard work, dedication and long hours of your staff. For when these three things come together through a vision, a plan, in execution and a little luck, great things can happen. And great things have happened during my career to the point where I can say from the bottom of my heart that I could not have had a more meaningful and rewarding career than going to work and fighting every day for your honorable profession.”

As Laitos said in 2010, “we’ll miss Alfred; he’s been a good friend, mentor and advisor. We thank him for his great work; CMS has accomplished much under his leadership.” ■

What separates Alfred from the other CEOs I have worked with in my 46 years of being involved in CMS is his ability to be creative and think out side of the box to imagine new ways to structure our organization to better respond to the changing times we live in.

— M. Robert Yakely, MD Alfred always said to me “politics drives the process that sets policy.”

It took me three years on the CMS executive track to understand what this means, but it was very powerful once I did.

— John L. Bender, MBA, MD, FAAFP The word that best characterizes Alfred is caring. He cares about all the people around him: his family, his staff, the physicians. He is dedicated to putting himself wholly into making us all better.

— Lynn Parry, MD Alfred has a tremendous ability to successfully predict and navigate the health policy and legislative system.

He is the single individual who has had the greatest impact on ensuring the success of physician practices in

Ritter signs the physician profiling bill into law.

Colorado, ensuring physicians are able to provide the care their patients need, ensuring a longstanding trusting relationship with legislators and community leaders, ensuring CMS members are well-represented and leading in quality of care, legislative issues, and solving critical crisis issues. There is another way that Alfred is different from other CEOs and leaders: he not only cares about the doctors and staff in the medical society, but he also reaches out to them and helps them on a regular basis. He is always there, always ready to help find a solution to a problem, and he is an expert in guiding us to not just solve problems, but also prevent and avoid them.

— Kay Denise Spong Lozano, MD, FACR Alfred Gilchrist’s gift, shared unselfishly with our medical society, is a mastery of the art and science of politics. “If you see a turtle on the top of a fencepost, you know he had some help getting there” was how he challenged us to discover the reasons behind events. His best encouragement for our success was his personal north-star of leadership, “we will just out-cooperate them.”

— Ben Vernon, MD C O LO R A D O M E D I C I N E 1 9

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Colorado Medical Society names new CEO: Bryan Campbell, FAAMSE Kate Alfano, CMS Communications Coordinator Bryan Campbell, FAAMSE, has been named Chief Executive Officer of the Colorado Medical Society, effective January 2020. A Nebraska native and graduate of the University of Nebraska – Omaha, he is returning home after two decades on the west and east coasts.

“I am honored to have been chosen to lead the Colorado Medical Society,” Campbell said. “Time and again, Colorado physicians, other health care leaders and elected officials have committed to innovative solutions to improve Colorado health care. I look forward to working with physicians and staff to achieve CMS’s mission and continue great strides for patients.”

Bryan moves to CMS from his most recent position as the CEO of the Duval County Medical Society (DCMS) in Jacksonville, Fla. DCMS is the oldest and largest county medical society in Florida, founded in 1853 and with nearly 2,000 members. In his time at DCMS, Bryan was recognized as one of Jacksonville’s 40 Under 40 and 40 Most Influential People in Healthcare, and was named the Chairman of the Jacksonville Mayor’s Council for Fitness and Wellness for consecutive terms. Bryan is currently the Secretary/Treasurer of the American Association of Medical Society Executives,

and earned the “Fellow” designation in 2018 (FAAMSE). “ Br yan’s exemplar y leadership demonstrated at DCMS and throughout his career, exceptional knowledge of advocacy and relationships with legislators, and deep understanding of the issues facing physicians and associations make him a fantastic choice to lead CMS into the future,” said CMS President David S. Markenson, MD, MBA, FAAP, FACEP, FCCM.

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2 0 C O LO R A D O M E D I C I N E

“CMS conducted a nationwide search for our next CEO,” Markenson said in his announcement letter. “The culmination of the search was a full day of interviews with four finalists. The interviews included a broad representation of the CMS leadership and membership including but not limited to the Board of Directors, past presidents, young physicians, medical students, residents, component society leadership and staff.

The selection process and interviews reflected the priorities of CMS including public policy, communications and organizational excellence.”

Bryan spent 14 years as a broadcast television executive before moving into organized medicine in 2006. He has worked at television stations from Oregon to Florida, and was the senior producer for more than 200 hours of live television around Super Bowl 39 in Jacksonville in 2005. Outside of work, Bryan is active in a number of civic and public health organizations, most significantly Rotary, and is passionate about sports, board games, music and singing. He is married to Sarah Campbell, his high school sweetheart, and they have two children, Lauren (22) and Nathan (19). They also have one grandson, Lincoln (1).

Outgoing CMS CEO, Alfred Gilchrist, will retire in Jan. 2020 following 15 years in this position and 20 years at the Texas Medical Association. CMS wishes Alfred well in his retirement. ■

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CMS operational plan illustrates strategies for public policy, communications and organizational excellence Kate Alfano, CMS Communications Coordinator

2019-2020 organizational excellence

CMS communications will continue to strive for dynamic exchange of information with members to ensure timely action on their priorities. Central Line is the paramount tool for members, allowing for direct engagement and involvement with CMS governance. The Know Your Legal Rights database helps physician practices take advantage of statutory and regulatory protections related to public and private payers by providing members with meaningful information and actionable tools about current legislative and regulatory protections.

Colorado Medicine is a foundational piece of the CMS communications platform and will continue to keep members, legislators and other stakeholders informed on CMS priorities and provide helpful information and future trends. And e-newsletters ASAP and Livewire, periodic presidential communications, and the CMS website keep CMS members informed on important issues.

The Colorado Medical Society Board of Directors approved the 2019-2020 operational plan at their meeting in September. It will drive our work within three key areas in the coming year: public policy, communications and organizational excellence.

Health care today is complex and multi-faceted, and this plan puts a priority on the issues that are critical for physicians and the patients they serve.

In the public policy section, CMS will focus on member priorities to positively impact rewarding physician careers. Given the convergence of several factors – an activist legislature and governor, a public anxious about the impacts of rising costs on affordability of coverage, concerns about access and safety, and a profession burdened by administrative complexity and burnout – top priorities will be addressing cost of care, the liability climate and the opioid crisis; reducing administrative burden; empowering physicians in all clinical settings to maintain autonomy and professional viability; and advocating for appropriate scope of practice.

public policy

communications Finally, in the organizational excellence section, the goal is to continue innovation

by CMS to increase membership value and make CMS meaningful and relevant to a diverse physician population.

Focal points are: membership retention and recruitment; enhancing physicians’ professional satisfaction; enhancing and implementing best practices in board governance; continuing to improve the CMS advocacy program; sur veying members regularly to gain insights on priority projects; recruiting, training and deploying leaders, especially medical students and the Delegation to the American Medical Association; continuing to work with component societies on joint priorities; providing and accrediting high-quality CME; maintaining the excellent work of the two CMS charitable foundations; and maintaining and seeking new non-dues revenue to help fund operations. ■

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CMS Education Foundation HELPING FIRST-YEAR MEDICAL STUDENTS Michael J. Campo, PhD, support staff, CMS Education Foundation

CMS EDUCATION FOUNDATION 2018-2019 SCHOLARSHIP RECIPIENTS Congratulations to first-year students from the University of Colorado School of Medicine – Taylor Neilson and Breanna Stafford – who were each awarded scholarships from the Colorado Medical Society Education Foundation (CMS EF). Taylor Neilson is a recipient of the Dr. Gerald W. Rainer Memorial Scholarship. First-year students from Rocky Vista University – Thomas Coyle, Kendra Downer and Nadira Matin – were also each awarded a scholarship from CMS EF. Each student from UCSOM and RVU received $4,000.

CMS EF, a 501(c)(3) private foundation, has a mission to render financial support to select first-year medical students at the

University of Colorado School of Medicine and Rocky Vista University. Student scholarships are based on criteria such as the student’s financial status, academic achievement and desire to practice in rural or underserved areas upon graduation.

Beyond scholarships, CMS EF supports education programs such as the Colorado State Science and Engineering Fair and the education program at the CMS annual meeting.

As CMS EF Board Chair Jack Berry, MD, stated, “The CMS EF Board is thankful for the generous financial contribution and support from CMS members and others who make our education scholarships possible.”

THE 2018-2019 SCHOLARSHIP RECIPIENTS THOMAS COYLE Thomas Coyle received a B.S. in biochemis t r y and philosophy from Eas tern University, where he graduated from the Templeton Honors College in 2015. He studied abroad at New College, Oxford, where he focused on G.E.M. Anscombe’s and Alasdiar MacIntyre’s contributions to bioethics as well as J.R.R. Tolkien’s philosophy of language.

He received his Master of Science in biomedical science from Rocky Vista University in 2018 and is currently a member of the osteopathic medical school class of 2023. He lives in Englewood, Colo., with his wife Alicia, daughter Josephine, and dogs Dante and Beatrice.

KENDRA DOWNER Originally from Canada, Kendra Downer grew up in the Midwest and received a Bachelor of Arts degree in International Studies from the University of Wisconsin-Madison in 2012. After graduating, she moved to South America and spent four years working with nonprofit organizations to improve access to housing, education and health care for underserved communities in Peru and Colombia.

Witnessing the consequences faced by those lacking access to health care abroad drove her to advocate for health care as a human right and pushed her to pursue a medical education that would provide her with the skills to do more to improve the 2 2 C O LO R A D O M E D I C I N E

health of underserved communities. Since moving to Colorado in 2016, Kendra has volunteered as a medical interpreter for the DAWN clinic in Aurora, working to eliminate the cultural and linguistic barriers to health care faced by Colorado’s Latino community. Kendra is particularly passionate about reproductive rights and spent the year before starting medical school working as a medical assistant at Planned Parenthood of the Rocky Mountains. She hopes to spend her career advocating for and providing comprehensive reproductive health care to Colorado’s most vulnerable populations.

NADIRA MATIN Nadira Matin was born in the United Kingdom and grew up in Denver, Colo.

She received her Bachelor of Science in Biochemistry from the University of Denver and a Master of Science in Modern Human Anatomy from the University of Colorado Anschutz Medical Campus.

She has spent time working for the Centers for Disease Control, mentored children at the Eating Recovery Center in Denver, worked as an Emergency Medicine scribe and, more recently, was the student director of a mental health outreach program that worked with high school students in Denver and Aurora public schools. In her free time, she enjoys hiking, spending time with her family, celebrating her Bengali culture and traveling.

She is excited to become a compassionate physician who can give back to the community.

TAYLOR NEILSON Taylor Neilson was raised in Meeker, Colo. on her family’s commercial sheep operation. Her early years were spent helping at the family’s veterinary clinic, exhibiting 4H livestock projects, and on the basketball court. Following high school, she attended the University of Nebraska at Kearney.

While attending school there she competed as a member of the NCAA basketball team. Taylor then transferred to Oklahoma State University, earning a dual degree in Biochemistry and Molecular Biology as well as Animal Science. From as early as she recalls Taylor hoped to pursue a career in medicine, thanks to the inspiration of her rural health care physician.

Her shadowing and volunteer experiences allowed her to realize the vast opportunities to help improve the quality of life of others as a physician. Taylor looks forward to exploring these opportunities while attending CU School of Medicine.

BREANNA STAFFORD Breanna Stafford grew up in a rural town in eastern Colorado – a town so small the class sizes ranged anywhere from one to 17 students per class. Despite living in an area with little to no opportunity, Breanna worked with her local hospital board to construct a medical internship program for local high school students. During this experience, she learned of the immense health professional shortage in the area and how it negatively affects the community. With aspirations to reverse this shortage, combined with an affinity for science, Breanna went on to continue her education at the University of Colorado - Colorado Springs (UCCS) and graduated with a bachelor’s in biomedical science. Outside of college, Breanna scribed in the emergency department, deployed for Disaster Relief with American Red Cross, volunteered with Poverty Immersion in Colorado Springs (PICOs), and served coffee as a barista. She also enjoys hiking “fourteener” mountains, visiting national parks, traveling abroad, playing sand volleyball, and doing CrossFit. With her love for adventure and spontaneity, Breanna aspires to become a rural emergency medicine doctor. ■

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I NTR O S P E C TI O N S

Doughnuts with Abe Kate Wilcox

Kate Wilcox is a fourth-year medical student who was born and raised in Fort Collins, Colo. She received a Bachelor of Science in Environmental Health from Colorado State University. She is currently applying for combined Internal Medicine and Pediatrics residency programs, and she hopes to someday work with patients born with congenital heart disease. Kate spends her free time whitewater kayaking, mountain biking and skiing.

It was a Saturday in December and I was tired. I had been on clinical rotations for nearly six months – long enough that the novelty and excitement of clinical work had started to wear off, but not long enough to have any real idea what was going on. I was an exhausted deer in the headlights, pulling myself out of bed at 4:50 every day to show up on time for the anxious ritual of pre-rounding.

That Saturday morning felt especially painful – it had snowed a foot overnight and I was missing out on a powder day. I remember that because one of the patients admitted overnight had decided to come to the emergency department for evaluation of a cough he had had for six months. His name was Abe, and what finally pushed him into a trip to the ED was the cold outside.

Abe was in the hospital with pneumonia. This was winter in Utah, and we had no shortage of patients with pneumonia. Abe was a grumpy guy who had experienced stints of homelessness and struggled with drug and alcohol abuse. He didn’t get along well with the nurses and would pick fights with the nurse aids and lab techs. He was more than six feet tall, but by the time he checked into the hospital, he weighed as much as the average 12-year-old. He could have a sharp tongue, but we eventually established a good rapport. He had the kind of deadpan humor that you really appreciate when you’re feeling a little jaded.

Unfortunately, Abe wasn’t getting better. Initially, we thought he had an especially nasty pneumonia, requiring drainage with chest tubes and heavy antibiotics. Eventually, we found out he had advanced lung cancer. Our team jumped into action consulting surgeons and specialists. We ordered ultrasounds and stared at his lung CTs, trying to imagine how any surgeon could even think about going in and picking out all of the masses, hidden in corners and stuck across Abe’s lungs like burrs nestled into a pair of fuzzy socks.

Not too long ago I read a story about a woman studying endangered birds. In the story, she says, “It turns out, if you want to save a species, you don’t spend your time staring at the bird you want to save. You look at the things it relies on to live instead.” 1 I was re-writing Abe’s progress note one morning when I got hit hard with a thought. In the ritual of examining and note-writing and measuring, we forgot about Abe’s true and immediate needs. Although we had spent a decent amount of time explaining to Abe his prognosis and his choices, we forgot how lonely and scared he probably was. In all of the time I had spent in his room charting physical exam findings or obsessing over vitals and labs, I never asked him what he wanted from all of this. I had been so focused on looking at the bird, I had forgotten to look at its surroundings. I had lost track of the big picture.

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.

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I went into Abe’s room to ask him some more questions. He knew about the long road of surgeries and recovery ahead of him. He knew that the statistics said he was still probably going to die. He knew that we were going to do everything we could to help him.

I asked him what he needed from us, what would make this whole process more bearable for him. I braced for the usual demands of pain medication or to get the chest tube out of his side, but he looked down at his hands for a long time and finally told me that he really wanted a doughnut. One of the square ones with maple inside, he said. He usually eats them once a week and had been thinking about them ever since he came to the hospital.

I brought him a doughnut the next day, square and maple just like he wanted. I brought myself one too, and I sat in his room and ate it. I couldn’t stay too long, but I remember that we talked about the snow. I wish I could say I brought Abe a doughnut every Saturday until he was better and got to go home, that he

became sweet and open and was nice to the nurses. The truth is, I have no idea how his story ended. A few days after we shared that moment, it was time for me to move on to my next rotation.

Abe reminded me that in medicine, it’s easy to lose track of the big picture. Humanism is remembering that people count on small things to keep them going. It’s remembering that humans can be good if you give them the chance to be.

Medical school has been a truly exhausting experience. While I’m sure that I absolutely made the right choice taking this path, I’m also sure that I’ll feel burned out again on another Saturday morning in December when it’s dark and cold outside. Maybe I’ll be bogged down in vital signs and labs and CT scans, desperately in need of a reminder of why I picked medicine in the first place. If that happens I know just the thing to make me feel better: a doughnut. The square kind, with maple inside. ■ 1. Hauser CJ. The Crane Wife. The Paris Review. https://www. theparisreview.org/blog/2019/07/16/the-crane-wife/. Published July 30, 2019. Accessed Aug. 16, 2019.

10111 Inverness Main Street, Suite P | Englewood, CO 80112

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R E F LE C TI O N S

Together Mackenzie Whitesell Garcia

Mackenzie Whitesell Garcia is an MD/MPH student at the University of Colorado School of Medicine and Colorado School of Public Health. She is passionate about health equity and improving health systems, and plans to become a primary care internist working with people who are underserved and marginalized. She is grateful to her family and all the people who have challenged her, supported her and inspired her to work towards a more just world.

I don’t know your name, but

I held your heart.

I’ve held some before, but

yours was alive.

It was.

It moved so beautifully, but

it was tired.

Tired from this trauma, but

maybe also from much more.

I wish I could ask you:

What made your heart ache?

What made your heart full?

Who did you love, and who loves you?

What were you doing out so late?

Why has no one come for you?

Are they looking?

Why were you alone?

I tried to make sure you weren’t alone when you died.

You were surrounded by people, but we all had masks.

Shielded from the blood.

Shielded from the pain?

You were not alone, but

when I placed my gloved hand on your knee,

you felt lonely.

I tried to comfort you

as I watched your

heart beat and lungs expand

into the open air.

As I listened to everyone say there was nothing more we could do.

My eyes filled with tears.

I tried again to comfort you.

I was trying to comfort me.

Someone asked if I was okay.

I lied.

I swallowed my tears and summoned my bravery.

I heard them pronounce you.

I watched your heart beat for the last time.

Reflective writing is an important component of the CU School of Medicine curriculum. Beginning in the first semester, medical students write essays, stories or poetry that reflect what they have seen, heard and felt. Reflections is edited by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is dedicated to the memory of Henry Claman, MD, Distinguished Professor of the University of Colorado, founder of the Arts and Humanities in Healthcare Program, and original co-editor of this column.

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They had me sew you up.

You weren’t going to get an infection or see the scar, but

it still felt like my precision mattered.

I wanted you to know that someone cared about you in the end.

I wonder who is missing you, other than me.

I’m sorry that I was the last one to touch your heart;

you will always have a place in mine.

The blue threads made a simple design across your chest.

I tried to see your face before we left.

I saw it, but

I didn’t know if it looked like you.

Your eyes were swollen and taped shut.

I wonder about the last thing you saw.

Maybe it was a light –

not one that would save you, but

one that would take you.

I wonder what you believed and if you wanted to go anywhere next.

I wonder who believed in you.

I hope you lived a beautiful life.

That you had fulfillment and

joy and

that you overcame the worst challenges and pains.

I hope people cared about you.

I wish I could have met you.

I will always wonder who you were.

I don’t know your name, but

your blood is on my shoes. ■

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My first year – success through interconnected values and aligned interests Gerald Zarlengo, MD, Chairman & CEO, COPIC Insurance Company

As I near the end of my first year as COPIC’s CEO, there are a few things on my mind. Foremost is recognizing the remarkable support I have received from those around me.

They have made my transition into this role possible, and I am inspired by their dedication to improve medicine and the different ways they do this.

What have I learned in the past year? My journey has taught me just how interrelated the various aspects of health care are.

I knew this at a certain level, but didn’t fully understand and appreciate it until I became CEO. A strong and stable health care environment requires a commitment to patient-centered care, evidence-based guidelines, patient safety measures, access to quality care, and support for those who provide care. All of these elements are connected, and when broader decisions about health care are made, we need to consider how each aspect affects others.

I’ve also realized the footprint of impact COPIC can have. As one who likes to use metaphors, I would say that when I was at my OB/GYN practice, my efforts to improve patient safety were akin to using a paintbrush – precise and focused. Now, at COPIC, I feel I am using a larger paint roller to contribute across several areas beyond clinical practice such as public policy, regulatory matters, and the business of health care.

Several times, I was also reminded of an important lesson – the value of keeping my mouth shut and really listening to what others have to say. In health care, we are surrounded by smart, compassionate leaders who will tell you what you need to know.

Their insight is integral to how we look forward and deliver on our mission to improve medicine in the communities we serve.

As we prepare for 2020, the following are some key ideas that will be guiding COPIC’s efforts: Continue to be at the forefront of state-level health care issues — In 2019, we faced several legislative challenges that connected to the foundation of health care in Colorado. These included the Colorado Professional Review Act and Colorado Medical Practice Act. The involvement of COPIC and our partners on these issues contributed to positive outcomes, in particular, the passage of the Colorado Candor Act. This process highlighted the importance of stakeholders coming together based on aligned interests, rather than standing apart because of perceived differences. The Act brought us together because it was about advancing patient safety – a shared belief that we can all get behind.

Enhance our resources with guidance designed for different medical specialties — Physicians know that there are common risk management guidelines that apply to all specialties, but they also need to know how to address the challenges that are specific to their specialty. COPIC stands in a position to help identify what these are based on our claims data and experience. This knowledge creates opportunities to work directly with physicians to develop resources tailored to their specialties.

Explore ways in which we can help support quality improvement — One of COPIC’s roles is to serve as a hub that identifies and shares best practices across all aspects of health care. This includes an enhanced focus on proactive efforts that can be implemented to prevent adverse outcomes, not just reactionary steps to take after issues arise. The programs and resources we offer can have a direct impact on medical outcomes, and this, in turn, allows us to play a role in supporting quality improvement.

As a company, we have a commitment to our insureds along with a commitment to our community — A company’s success is not just based on positive financial results. Since COPIC was founded, we have embraced the values of community engagement and service, and in 2019, we were named an honoree of The Civic 50 Colorado (by CSR Solutions of Colorado in partnership with Points of Light, the world’s largest organization dedicated to volunteer service). The award recognizes COPIC as one of the 50 most community-minded companies in Colorado based on corporate citizenship and how we use our time, skills and resources to impact local communities. ■

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5 myths your landlord wants you to believe Perry Bacalis, Carr Healthcare Realty It can be difficult to discern fact from fiction when dealing with landlords. A misunderstanding of these key issues can have serious consequences for your practice. The following information should help dispel some common myths and prevent costly mistakes in your next lease negotiation.

MYTH #1

THE LANDLORD IS ON YOUR SIDE

Many landlords attempt to befriend their tenants, making it difficult for tenants to remember the landlord’s primary goal is financial gain. They are seeking to secure a lease with the tenant paying as much as possible. Even the friendliest landlord wants to make the maximum profit on his space, just like the nicest tenant seeks the lowest possible lease rate so his business can thrive. Financial burdens quickly arise for tenants who place undue trust in their landlord and fail to properly negotiate their lease. By having representation, you can learn how your lease compares to the market and ensure you are getting the best possible terms.

MYTH #2

YOU’RE NOT ENTITLED TO REPRESENTATION

Some landlords employ intimidation, instead of friendliness, to achieve their goal. The intimidation tactics may include telling tenants they are not allowed to have representation. This is not true. Lease negotiations are different than negotiating the price of a car or trying to haggle for a better price at a flea market.

They are complex transactions, layered with hidden opportunities for landlords to take advantage of anyone not represented by an expert. Landlords are professionals who are aware of these complexities. If a landlord says you are not allowed to have representation, that is a clear signal they do not respect your desire to be treated fairly.

MYTH #3

YOU’RE ALREADY GETTING THE BEST POSSIBLE RATE FOR YOUR SPACE

There are many conditions that factor into lease rates for a commercial space. Things such as current building vacancy, length of the lease, amount of tenant improvement allowance, building condition and many other considerations impact the appropriate rate for a particular space. Several of these considerations are specific to spaces for health care tenants, highlighting the need for a real estate professional who has expertise in health care. Health care practices are often told they are getting the best possible rate for their space, yet they can receive a much better offer from the landlord when an expert assesses these mitigating factors.

MYTH #4

YOUR RENEWAL IS NOT NEGOTIABLE

Most leases provide an option for the tenant to renew their lease when it expires, and may even detail the exact terms of the renewal. However, it is important to understand that your renewal is negotiable, even if you have renewal terms specified in your current lease. A landlord who says you cannot renegotiate the terms for your renewal is usually doing so because they can get you to pay more by exercising the option to renew instead of negotiating new terms. The only way to be certain you have the best possible terms for your renewal is to compare those terms with current market rates in the area, a vital step often missed by health care professionals entering this process alone.

MYTH #5

YOU HAVE NO OTHER OPTIONS; THE LANDLORD HAS MANY

This common myth might be the most important to address, because it is fundamental to how landlords operate. The landlord wants you to believe that his property is the only suitable location for your practice. The truth is there are likely several other properties that would fit the needs of your practice, and the landlord should be competing to keep you in his building.

The landlord also wants you to believe he has several potential tenants ready to occupy your space if you don’t take it. This position is used to force a tenant to rush into signing an unfavorable lease, when, in fact, it usually takes months or years to fill a commercial space. Each leasing situation is unique, and a health care real estate professional who knows your strengths as a tenant can help you understand what type of leverage you have.

This information represents a few of the many misconceptions involving landlords in health care real estate transactions. Using a real estate professional with expertise in health care will help protect you from falling victim to these and other common landlord myths.

Carr Healthcare Realty is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust Carr to achieve the most favorable terms on their lease and purchase negotiations. Carr’s team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases, and practice transitions. Healthcare practices choose Carr to save them a substantial amount of time and money; while ensuring their interests are always first. Email Perry Bacalis at perry.bacalis@carrhr.com to learn more. ■ C O LO R A D O M E D I C I N E 2 9

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Francavilla Brown helps save baby’s life at Denver Zoo Carolynn Francavilla Brown, M D, a famil y p hysician, founder of Green Mountain Par tners for Health and longtime Colorado Medical Society leader, was in the right place at the right time to help save a two-week-old who nearly died while visiting the Denver Zoo. The child’s parents were strolling around when they noticed the baby, Hadley, started to look blue, the baby’s mother told CBS4 News. The parents started screaming for help and among the group who answered the call was Francavilla Brown.

Handing off her own one-year-old daughter to a bystander, Francavilla Brown jumped into action, joining an off-duty Denver Health paramedic to perform CPR for 12 minutes until an ambulance arrived to take the baby to Rocky Mountain Hospital for Children. Hadley had coarctation of the aorta (CoA), they later learned.

“It was that CPR that saved this baby’s life and got this baby to us in a condition where we could help her,” Sue Kirelik, MD, a pediatric emergency physician at Rocky Mountain Hospital for Children, told CBS4 News.

Francavilla Brown reunited with the family to participate in the Congenital Heart Walk in Denver, one of a series of fundraiser walks for congenital heart disease. ■

Francav illa B row n recalled the scene: “It was the longest, scariest 12 minutes of my life. I couldn’t let the mom next to me lose her baby. Honestly, I was crying at one point while doing CPR. When the baby left with a heartbeat, I was so relieved – but still so worried about what would happen next for this baby and her family. Through the power of Facebook I was able to connect with the family and hear that the baby is doing quite well after surgery.”

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2020 CMS Election: Call for Nominations The nomination period for the 2020 Colorado Medical Society all-member election is open through Jan. 31, 2020.

The Colorado Medical Society encourages all members to consider nominating a colleague or self-nominating for one of the open leadership positions: president-elect (one position open), AMA delegation (two positions open).

The election guide is available on CMS.org. This guide provides all the information a potential candidate needs about the duties, eligibility, terms of office and honorarium for each open position, as well as candidate requirements, campaign guidelines and the election process. Questions? Email dean_holzkamp@cms.org.

As of Nov. 11, 2019, the following CMS physicians have announced their candidacy.

President-elect • Mark Johnson, MD, MPH AMA Delegation • Alethia (Lee) Morgan, MD, incumbent • Katie Lozano, MD, incumbent To nominate yourself or a colleague, go to tinyurl. com/2020-cms-election to download templates for the candidate profile, CV and personal statement, complete the documents and email to president@cms.org. Thank you for your participation.

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Gabow honored by National Academy of Medicine Patricia Gabow, MD, professor emerita of the University of Colorado School of Medicine and former CEO of Denver Health, was named the recipient of the Gustav O. Lienhard Award for Advancement of Health Care. The award is the presented annually by the National Academy of Medicine in honor of Gustav O. Lienhard, chairman of the Robert Wood Johnson Foundation’s Board of Trustees from 1971 to 1986.

Gabow is being honored for her nearly 50-year career as a hospital administrator, clinical investigator, professor, board member and advocate for improved health care delivery. For 20 years, Gabow was CEO of Denver Health.

“To be honored by the most prestigious group in medicine is an incredible gift,” Gabow said. “I had many mentors and advocates who made this award possible. I would not have been considered for this award without having had the good fortune to spend my career at Denver Health, which is a unique institution that embodies what American health care can and should be.”

The award, which includes a medal and $40,000, was presented at the National Academy of Medicine’s annual meeting in Washington, D.C. on Oct. 21.

“Dr. Gabow has changed the notion of what a local safety net hospital can be by transforming Denver Health into a highly integrated health care system that serves everyone,” said

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Patricia Gabow, MD, center, received the Gustav O. Lienhard Award for Advancement of Health Care at the National Academy of Medicine’s annual meeting in October. With her are NAM President Victor J. Dzau, MD, left, and John Zaven Ayanian, MD, MPP, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, right.

National Academy of Medicine President Victor J. Dzau. “Not only did she make Denver Health a national model of success, she created a culture where all employees embodied the best values of health care – respect, collaboration, and relentless commitment to continuous improvement. She is most deserving of this prestigious award.” ■

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JeffCo Public Health executive director wins Lifetime Achievement Award MARK JOHNSON, MD, MPH, WILL RETIRE FROM DEPARTMENT NEXT SUMMER Jefferson County Public Health Executive Director Mark Johnson, MD, MPH, has received the Lifetime Achievement Award from Public Health in the Rockies. The award honors an individual who has retired from full-time employment in public health and recognizes significant contributions and leadership in public health. Johnson plans to retire from his position in June of next year. “(The award) is kind of the culmination of a long time here in JeffCo and I think the piece that means the most to me is that it was given to me by my peers. They’ve known me over the 30 years I’ve been here,” Johnson told the Arvada Press, a community newspaper published by Colorado Community Media. “A lot of the things I have done in my career were working with policy and legislature.”

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His key achievements include helping write and pass the Colorado Public Health Act in 2008 and working to establish the Colorado School of Public Health, which operates collaboratively on the campuses of the University of Colorado Anschutz Medical Campus in Aurora, Colorado State University in Fort Collins and the University of Northern Colorado in Greeley.

In retirement, he plans to spend more time with his grandchildren, stay active in his church, and write about medical and public health issues, according to the Arvada Press. He has also declared his candidacy for Colorado Medical Society president-elect in 2020 and currently serves on the CMS Board of Directors. ■

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Colorado Medical Society and component societies honor Senate President Leroy Garcia and Rep. Edie Hooton The Colorado Medical Society, Pueblo County “We were honored to recogMedical Society and Boulder County Medical Soci- nize Rep resen t a t i ve Edie ety presented CMS Legislative Leadership Awards Hooton,” said Leto Quarles, to Senate President Leroy Garcia of Pueblo and M D, a family phy sician in state Rep. Edie Hooton of Boulder in their home Boulder, BCMS past president districts in October, in recognition of their support and BCMS representative on of physicians’ health policy issues in the 2019 the CMS Board of Directors.

Colorado General Assembly – specifically work “She is highly regarded by our on the Professional Review Act Sunset bill. society, Boulder physicians, patients and the public, and stood up for our physician members during the last legislative session to protect this critical patient safety program.”

“We value the work of Sen. Garcia and our partnership with him, and look forward to our continued work on behalf of the patients and physicians of Colorado in the 2020 legislative session,” said Brad Roberts, MD, an emergency room physician in Pueblo and PCMS representative on the CMS Board of Directors.

The award presentation to Senate President Leroy Garcia occurred at Solar Roast in Pueblo on Oct. 4. From left: Gordon Rheaume, DPM; Cheryl Walker, DO; Senate President Leroy Garcia; Brad Roberts, MD; and Kendall Rockler, MD.

Colorado’s Professional Review Act (CPRA) encourages candid peer evaluations of health care professionals, assessing their competence, quality and appropriateness of patient care in a conf idential and cons truc tive way. Professional review promotes a culture of safety between health care professionals and their patients and is consistent with the overarching goals of quality improvement, expanding access to health care and containing costs. CPRA was renewed in the 2019 legislative session despite a push from opponents to weaken it – thanks to the work of these legislative champions. ■

The award presentation to Rep. Edie Hooton occurred at Breadworks Bakery & Café in Boulder on Oct. 23.

From left: BCMS President Mark Menich, MD, Rep. Edie Hooton, and BCMS Past President Leto Quarles, MD.

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National Opioid Policy Roadmap highlights state efforts helping end the epidemic

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The American Medical Association and Manatt Health released an analysis in September identifying effective state policies used to combat the opioid epidemic. The analysis looked at the response to the epidemic in four states and determined which policies increased access to evidence-based treatment for people with a substance use disorder.

The national roadmap highlights six key areas where regulators, policymakers, and other stakeholders can take action.

• Improving access to evidence-based treatment for opioid use disorder.

Remove prior authorization and other barriers to medication-assisted treatment (MAT) for opioid use disorder – and ensure MAT is affordable.

• Addressing net work adequac y and enhancing workforce. Ensure adequate networks that allow for timely access to addiction medicine by physicians and other health care professionals; this includes payment reforms, collaborative care models, and other efforts to bolster and support the nation’s opioid use disorder treatment workforce.

The AMA and Manatt originally reviewed policies in Colorado, Mississippi, North Carolina and Pennsylvania and used those analyses along with additional work to develop recommendations for state health care policy.

• Enforcing parit y laws. Increase oversight and enforcement of mental health and substance use disorder parity laws.

• E x p a n d i n g p a i n m a n a g e m e n t options. Enhance access to comprehensive pain care, including non-opioid and non-pharmacologic options.

• Improving access to naloxone.

Reduce harm by expanding access to the overdose-reversing drug and coordinating care for patients in crisis.

• Evaluating policy success and barriers.

Evaluate policies and outcomes to identify what is working, building on successful efforts and identifying policies and programs that might need to be revised or rescinded.

“We are at a crossroads in our nation’s efforts to end the opioid epidemic, and states are being creative on how they respond,” said AMA President Patrice A. Harris, MD, who is also chair of the AMA Opioid Task Force, in a statement. “It is time to end delays and barriers to treatment; time for payers, PBMs and pharmacy chains to revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to help all patients access evidence-based care for pain and substance use disorders. Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying.” ■

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CMS honors state science fair award winners for exceptional projects in health and medicine Willow Schulz and the team of Demi Brown and Grace Hardwick won the Colorado Medical Society Award for Excellence in Medicine & Health in the junior and senior divisions, respectively, of the 64th Annual Colorado State Science and Engineering Fair held in April in Fort Collins, Colo. It was hosted by the College of Natural Sciences Education and Outreach Center at Colorado State University.

A longtime supporter of the science fair, the CMS Education Foundation presents an award each year to one student or team from the junior high division and one student or team from the senior high division. These students receive $100 and an invitation to the CMS Annual Meeting to display their project and receive recognition before physician attendees.

Colorado Medical Society members Cory Carroll, MD, and Donna Sullivan, MD, served as the official CMS judges at this year’s fair.

The junior division winner, Willow Schulz, then a seventh grader at Ingacio Middle School in Ignacio, presented her project, “Effective Communication to Adolescents About Vaping.”

She was inspired to learn more about vaping after reading a news article in the Durango Herald and aimed to determine which was the best method to communicate to other adolescents about the dangers of vaping: a survey conducted during the school day, brief videos or simply an FAQ sheet. She found that parents and other adults can be an important influence on adolescent perception of vaping but peers influencing peers would likely be most effective. She concluded: Implications for the public health sector and school districts for targeted anti-vaping initiatives need to focus on proactive education and involve youth voice.

Senior division winners, Demi Brown and Grace Hardwick, former seniors at Monarch High School in Louisville, presented their project, “A Method for Prevention of Heart Failure by Switching Substrates from Glycolysis to Oxidative Phosphorylation to Strengthen Mitochondrial Function in the Heart Cell.”

As they explain in their project summary, within the cardiomyocytes of the heart, there exists cardiolipin, which holds fatty acid side chains. In an optimal functioning heart, linoleic acid is the fatty acid present in the cardiolipin. Yet during heart failure, for reasons that are unknown, the fatty acid side chain switches from linoleic acid to oleic acid. Oleic acid in the heart impairs cellular respiration because the bonds are spaced out, causing electrons to escape during oxidative phosphorylation, which causes minimal ATP production. With reduced ATP in the heart, there is less energy to contract the cardiac muscle, which ultimately leads to heart failure. They treated cells first with one of three fatty acids – linoleic acid, oleic acid or a bovine serum albumin control – then analyzed the cells. Findings showed that linoleic acid cells consumed the most oxygen, while the oleic acid treated cells consumed even less than the control. They determined that a diet rich in linoleic acids (ie. avocados, canola oil, pumpkin seeds) is recommended. ■

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FINAL WORD The moral clarity that grows from experience (and making mistakes) Alfred Gilchrist, CMS CEO

It has been my good fortune to represent the medical profession in the public affairs space almost continuously since 1978. I have been on the inside of many health policy initiatives – both good and bad – debated in the Texas Legislature, the U.S. Congress and the Colorado General Assembly that affected the practice of medicine and the care of patients. It is unknown whether the cumulative effect of long and, at times, painful experiences from a lifetime of health care advocacy is scar tissue, wisdom or both.

The lines and cracks that delineate the legitimate economic interests of medical communities have widened and complicated physician advocacy. There is less-than-zero in the complex, rigorous world of medical training that prepares physicians for the non-linear chaos of a universe where politics drives the process that sets policy. Physicians would be well served to address this deficit given that health care politics in Colorado has been elevated to almost militant levels of activism both in the consumer and stakeholder communities, driven across the board by the rising cost of care.

The economic pressures and administrative burdens that are splintering organizations and galvanizing physician views along demographics, practice types or specialty alignments weaken your collective ability to persuade and sustain a unified position, much less make a fist and throw a punch. This is a vulnerability that politicians readily exploit. They can smell these intramural differences from across the dome. The same pressures that have provoked alarming levels of work dissatisfaction and burnout also 3 6 C O LO R A D O M E D I C I N E

suppress physician engagement in the politics of health care. Throughout my career, bandwidth, ideology and partisan bias have also conspired to limit the reach of medicine to influence the policies that govern.

During my formative years and into adulthood, physicians played critical roles at various times of my life. Dr. Bundy came to our home when we were sick. Roderick McDonald saved my right eye. Gaines Entreken got me through two difficult hospitalizations. Uncle Doc, Robert Patton and Jack Ward were inspirations. When Larry Frederick roared up hospital hill a half block from my home, I knew he was going to the emergency room and I often wondered what he’d find. The daily, even hourly professional sacrifice and heroics of physicians have always amazed me, and they served to motivate me during my career. God bless you all.

Surely, there is still more that unites than divides your profession. We might start thinking of unity as areas of moral clarity; a space where advocacy comes into sharp focus for sustainable, meaningful consequences for patients and society as a result of organized and methodical consensus building.

We must recognize that the widening gaps between medical communities render professional advocacy more daunting and complicated than I could have ever imagined in 1978. Paul Starr warned us about these sea changes in his 1982 Pulitzer Prize winning epic “The Social Transformation of American Medicine.”

Physician advocates across the country avidly read and discussed it back then, yet we continue to struggle with how to adapt medical society governance so that form anticipates function in a meaningful and unified way. While it’s more challenging than ever before to be Gretzky in today’s medical rink, I offer my bias as to what has worked and can work moving forward.

1. Medical society governance across the country has to flatten into a shareholder model. Our first-in-the-nation virtual policy forum, Central Line, is a step in the right direction. It connects across the spectrum of medicine to engage in evidence-based debates that are grown

into a consensus. Horizontal engagement does not imply forgoing the fundamentals of local, face-to-face engagement. It is more a sociogram than a flow chart.

2. Medical society priorities should also target root causes of population health failures – the social determinants – as well as aligning incentives that assure care value is optimized.

This implies as an organization saying “no thanks” to agendas that can’t prove value or advance the broader task of improving population health.

3. Priorities are not an annualized box to check in a board report. The art of advocacy is in the set-up – strategic considerations that should be incubated over time – in cycles that might require years to gestate. It incubates in local elections and grows into grassroots when the General Assembly convenes. This transitions the “Gretzky rule” – skate to where the puck is going – from concept to reality.

4. Pick your fights carefully and sustain them. An adversary needs to know the organization will persist, notwithstanding counterpressure and, in some cases, friendly fire.

5. Always look to accommodate. No organization has bulletproof wisdom.

No matter how well developed the policy, it will need to be revised over time. There is far more to lobbying than lining up votes and running over an adversary.

6. Stare down your outliers – residing in the areas of moral clarity means not accommodating or defending the indefensible regardless of who is antagonized. This also requires acknowledging whether the outlier is actually a game-changing catalyst. Is the outlier going where the puck is headed?

7. The preservation of clinical autonomy and balance in the practice ecosystem is paramount. Assuring practice choices and legitimate competition must center on the value of care.

Thank you for what you do every day in communities across our great state and nation and, once again, for the honor and privilege of serving as your advocate. ■

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Advantage Partner

LET USFA HELP YOU GET INTO A NEW CAR

By special arrangement with commercial fleet purchasing requirements in Colorado, individual members are allowed to buy or lease a new car under this program.

• NO CAR SALES PERSON • OVER THE PHONE • TYPICAL SAVINGS $1,000-$7,100

Visit USFACORP.COM to find out more.

Or call 303.753.0440

33 YEARS IN BUSINESS • 10,000 MEMBERS SERVED SINCE 1989 • LICENSED & BONDED