March-April 2020 Colorado Medicine

VO LU M E 1 1 7 N O . 2 M A R - A P R 2 0 2 0

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

PHYSICIANS INNOVATING HOW YOUR BIG IDEAS CAN CHANGE MEDICINE

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C O N T E N T S

Recognizing and encouraging physician innovators When physicians take the lead, we are the innovators. That’s the key message from CMS President David Markenson, MD, MBA, in his president’s letter, and he identifies just three examples from many around the state. In the subsequent suite of stories are many firsthand accounts by physicians who identified a solution that would make health care more accessible to patients, more valuable to the system, more rewarding to physicians – or all of the above – and how they implemented changes.

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F E A T U R E S I N N OVATI O N 6

F E A T U R E S

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C M S

22 MID-SESSION LEGISLATIVE REPORT Just halfway through a busy legislative session, the CMS government relations staff briefs you on top issues we’re watching on your behalf.

20 CMS CEO reveals “simple trick” to membership

S U ITE

A JOURNEY INTO EMPLOYERSPONSORED CARE A moment of clarity and quiet outrage followed by an invitation to a boardroom led a cardiologist to pitch what he could offer to help a company’s employees stay healthy at a better value for their money.

8 INNOVATION IN TELEMEDICINE WITH PHYSICIAN BUY-IN An emergency medicine physician describes Kaiser Permanente’s Chat With A Doctor platform and how it has opened up communication and access for patients on more than just acute issues.

10 USE OF DIGITAL HEALTH TOOLS IS INCREASING An American Medical Association survey finds physicians are adopting digital health tools rapidly to drive improved efficiency and safety in health care.

12 TELEMEDICINE PLATFORM FACILITATES VIRTUAL CARE COORDINATION One of the physician founders of Hippo Health describes their telemedicine platform that allows for better clinical collaboration, easier referrals and real-time care coordination.

16 CLINICIAN-LED CLINICALLY INTEGRATED NETWORK ENCOURAGES INNOVATION Monument Health on the Western Slope actively encourages providers to propose solutions to drive better health outcomes, improved access to care, fewer inefficiencies and better engagement among their patients.

18 TCPI EXEMPLAR PRACTICE FOCUSES ON IMPROVING PATIENT EXPERIENCE The gynecologist leading Sustaina Center for Women describes how she and her team improved patient outcomes, saved or avoided unnecessary health care costs, and improved patient satisfaction as part of their TCPi practice transformation efforts.

23 MEDICAL STUDENT DAY AT THE CAPITOL Students from both Colorado medical schools came together for public policy training and lobbying on issues important to physicians.

26 LIFT THE LABEL CAMPAIGN NEEDS YOUR STORIES Colorado’s opioid anti-stigma campaign, Lift The Label, asks physicians to contribute stories about recovery from addiction.

28 CORONAVIRUS: WHAT PHYSICIANS NEED TO KNOW CDPHE gives advice to Colorado physicians on how to be prepared should a patient present with suspected 2019-nCoV. 36 FINAL WORD: MEDICAL STUDENT ENGAGEMENT IN PUBLIC POLICY Jacob Leary, Medical Student Component representative on the CMS Board of Directors, reflects on MSC Day at the Capitol and how future physicians can make a difference, even in the era of political polarization.

24 Support COMPAC and the Small Donor Committee 24 Save the date for the CMS Annual Meeting 25 Report from the 2020 AMA National Advocacy Conference 27 CMS Corporate Supporters and Advantage Partners

D E P A R T M E N T S

30 Reflections 31 Medical news ▇ B CMS brings physicians and legislators together for dialogue

▇

olleagues and friends gather C for Alfred Gilchrist’s retirement

▇ COPIC announces promotions 32 Introspections 34 COPIC Comment 35 Advantage Partner Spotlight: Zenith Home Loans

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

BOARD OF DIRECTORS

AMA DELEGATES

David Markenson, MD, MBA President

Cory Carroll, MD Curtis Hagedorn, MD Mark B. Johnson, MD Jason L. Kelly, MD Jacob Leary, MS 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

Sami Diab, MD President-elect Patrick Pevoto, MD, RPh, MBA Treasurer Bryan Campbell, FAAMSE Chief Executive Officer Debra J. Parsons, MD, MACP Immediate Past President

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 Bryan Campbell, FAAMSE Chief Executive Officer Bryan_Campbell@cms.org

Dianna Fetter Senior Director of Professional Services Dianna_Fetter@cms.org

Kate Alfano Communications Coordinator Kate_Alfano@cms.org

Amy Berenbaum Goodman, JD, MBE Senior Director of Policy Amy_Goodman@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Emily Bishop Government Relations Program Manager Emily_Bishop@cms.org

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

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

Krystle Medford Senior Director of Membership Krystle_Medford@cms.org

Ms. Gene Richer, M Ed, CHCP™ Director of Continuing Medical Education Gene_Richer@cms.org Chet Seward Chief Strategy Officer Chet_Seward@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.

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F E A T U R E

P R E S I D E NT ’ S

LE T TE R

When physicians take the lead, we are the innovators David Markenson, MD, MBA, President, Colorado Medical Society

This issue of Colorado Medicine focuses on physician innovating – just a few examples of many around our state where physicians have identified an issue in health care delivery and took the lead to improve care for patients. Physicians are perfectly positioned to innovate and improve health care given the special relationship we have with our patients; our central role in the delivery and coordination of accessible and high-quality care; and our ability to apply scientific method to identify a problem, test solutions and implement change. We at the Colorado Medical Society support and encourage physician innovators like the following three and others in this issue, and will continue to advocate for physicians to be the recognized leaders in health care and the trusted source of guidance to improve care for patients and the health care delivery system.

COMBATING THE OPIOID EPIDEMIC

REDUCING MORTALITY AND MORBIDITY FROM SEPSIS

ASSURING VALUE IN HEALTH CARE FOR PATIENTS

Donald Stader, MD, an emergency physician, innovator and patient advocate who works for CarePoint Healthcare and practices at Swedish Medical Center in Englewood, Colo., is a renowned expert on the opioid epidemic and saw the tragedy of its effect on patients firsthand. In 2017, Stader and the Colorado chapter of the American College of Emergency Physicians launched one of the largest emergency-department-based opioid reduction pilots in the nation. As the physician lead, he developed and tested the opioid treatment guidelines that recommended the use of alternatives to opioids (ALTOs) that the piloting hospitals would use to target specific types of pain, and he trained physicians in 11 emergency departments across Colorado. The pilot returned remarkable results: a 36 percent reduction in opioid administrations when compared to the same time period in 2016, which amounted to 35,000 fewer individual opioid administrations between the 2017 pilot and the 2016 baseline period. He remains a leader in the effort to expand the pilot to other care settings like the primary care office, surgery center and dentist office through Colorado’s CURE initiative.

Gary Winfield, MD, division chief medical officer for HCA-HealthONE/Continental Division, leads clinical and quality initiatives supporting consistent high-quality clinical performance and practice standards across HealthONE hospitals in Denver and HCA hospitals in Wichita, Kan. He conceived the concept of obtaining a first-of-its-kind Joint Commission disease-specific certification for sepsis, implemented a reproducible model for sepsis early recognition and management at all facilities, educated other facilities outside HealthONE on this provider methodology to tackle sepsis and, as a member of the Coalition for Sepsis Survival Board of Directors, advocates for sepsis awareness and best practice treatment for the purpose of reducing sepsis mortality and morbidity.

Michael Pramenko, MD, a family physician leader with Primary Care Partners in Grand Junction, is a champion in valuebased care. PCP is an independent, physician-owned practice and participant in the Comprehensive Primary Care Plus (CPC+) initiative whose providers offer pediatrics, family medicine with obstetrics, sports medicine and behavioral health care. Their ancillar y ser vices include laboratory services, X-ray, dexascan, ultrasound, mammogram, physical therapy and after-hours urgent care, and they developed an embedded behavioral health training program. PCP is a strategic partner and one of three founders of Monument Health, a clinically integrated network that brings together physician practices, St. Mary’s Medical Center and Rocky Mountain Health Plans. Together they collaborate with patients, coordinate as a team, and are accountable for accessible and more affordable care.

4 C O LO R A D O M E D I C I N E

When physicians are allowed to be physicians – advocates for our patients, educators of the public and problem-solvers of the big issues in health care delivery – great things will happen. Let’s assure physicians can continue in this role and be recognized as leaders and innovators who are improving care for our patients. ■

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F E A T U R E

I N N OVATI O N

S U ITE

A journey into employer-sponsored care Mark Napoli, MD, FACC, Founder, Cor Medical

Ten years ago I was watching a man named Ben walk on a treadmill, an activity that I did almost every day. In the hospital, in my office and in the surgical center that I found myself in that day, I helped my own and colleagues’ patients with their tests.

It was there when I experienced a moment of clarity and quiet outrage.

Ben’s family doctor referred him for a nuclear stress test in a hospital that was owned by an insurance company that was owned by physicians. Many of those physicians are employed by the multispecialty group that is also owned by the insurance company. If you, the reader, are confused and irritated by now, then join the club of doctors, patients and employers.

Ben, 35 years old with no risk factors, had a five-minute isolated episode of chest pain at work. He waited two weeks to see the doctor, then waited 70 minutes in the waiting room for a five-minute visit. As soon as he declared chest pain, a nuclear stress test led him to another half day off work for testing and another half day off to review the normal results with his family doctor who then diagnosed him with stress-induced musculoskeletal tension.

Ben’s employer was not insured by the same company that owned the hospital.

The primary care physician is a good doctor, and in a practice where he has to see 40 or 50 people a day to justify payroll and keep the lights on. The doctor who ordered the test, although he owned stock in the insurance company, did not directly profit from the expensive test, but his company did. While the test was costly, the hospital garnered most of the fee from the technical component. The patient’s deductible share was much higher than what he would have incurred at an office, thanks to the HOPPS rule.

You are now a full member of the club.

Also 10 years ago, a sweeping piece of legislation called the Patient Protection and Affordable Care Act passed Congress through a completely partisan vote, and was approved by the United States president. As you know, this law created a massive expansion of government-subsidized health care and changed the rules governing commercial insurance in confusing ways. Few people read or understood the bill, including the legislators who passed it. As a result, everyone in the club (doctors, patients and employers) freaked out. For the next several months, I spent as much time speaking with colleagues and patients about the uncertain changes awaiting us in the health care market as I did practicing medicine.

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

In those discussions and my own research I came to realize few people, even in media, government and business had a clear understanding of the difference between health care and health insurance.

Health insurance is an industrial construct to manage risk and rewards in futures and probabilities, much like equities markets, or bets at the horse track. Health care is a noble service meant to protect the well and assist the infirm. Although the two are intimately related, one cannot conflate the construct with the service and truly understand the universal challenge of the inherent conflict between them.

Some of my patients were senior leaders in a Fortune 150 company, and coincidentally Ben’s employer. And one day, a few months after my encounter with Ben and enactment of the new health care law, those people asked me to come and speak with them in their board room, but I only found out the reason for the meeting once I arrived.

So I sat on one side of a massive table alone, facing a group of very smart executives on the other side of the table and I suddenly realized what a nobody I am.

I have no formal business training. I never published a meaningful paper. And I had no preparation for the meeting. Despite these glaring def iciencies, the CFO introduced me to their problem. They explained that they have lost sight of the value of money they spend on health care. Their talks with health systems, consultants and legislators had largely been unenlightening. For some reason, the private practice cardiologist down the road from the company headquarters kept coming up in the conversations following their meetings because I made more sense than the so-called experts.

You just need the will to make things better, and the guts to take the chance when it comes along.

Go to it.

Luckily the room and where I was sitting gave me a starting point. I said, “OK, l am over here alone on this side of the table. I am health care. I am the family doctor, the specialist, the urgent care, the ER, all of it. And over there on the other side of the table, you are the consumer. The way the system is right now, my job on this side of the table is to make health care cost as much as possible for you, regardless of outcome. And there is nothing you can do about it. What you need to do is simply take the most important part of me on this side of the table, the primary care, and move it to your side. Stop just paying for benefits and insurance and pay for the primary care directly.”

you to do it. Make it happen,” he said.

At first I laughed. But as I was leaving I began to think that it was possible and I knew people who could help. By the time I reached the car I decided to form a company. We had to compete against bigger established vendors for a job that I convinced this publicly traded client they needed in a formal RFP. We had the best plan and we won. We started a worksite fully functional primary care clinic in the client’s headquarters. We lowered the costs and access barriers to the client’s employees and their families. And with the one clinic, we saved this employer millions of dollars. So we opened another, and another. We now prevent escalation of preventable medical, mental health, and physical problems and streamline access to needed resources. We have 70,000 eligible members. We help clients in multiple states.

The CEO immediately understood, “Vertically integrate the system. OK, we want

I am still basically a nobody. But I looked at a flawed system and instead of rage

And they wanted me to explain what they could do to create more value for their money and help their employees stay healthy. Right there. Go to it.

against it I stepped outside of it because like you I love the people we are trying to help. I used the same persistence and curiosity that got me those two precious letters behind my name to scale something new and big. There is plenty of other opportunity to innovate and improve in our irrational segment of the vast economy. You don’t need experience or a certain type of education.

You just need the will to make things better, and the guts to take the chance when it comes along. Go to it. ■ Mark Napoli, MD, is the founder of Cor Medical, a medical management firm based in Monroe, La., that develops and operates on-site and near-site primary care clinics utilizing a team of physicians and other health care providers. Their most recent worksite clinics are located in Littleton and Broomfield. Read more at www.cormedical.net.

Cor Medical

$369 Providing care and an average of 75% savings with patients spending less time away from work

$82 Cor Medical average cost*

•Average cost is based on a flu-like symptoms visit with a nurse practitioner.

Typical convenience clinic average cost*

High deductible medical plan

C O LO R A D O M E D I C I N E 7

F E A T U R E

I N N OVATI O N

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Telemedicine: Why Colorado is a hub for innovation and physician buy-in CPMG PHYSICIAN DESCRIBES HOW TECHNOLOGY HAS ENHANCED TRADITIONAL OFFICE VISITS Kate Alfano, CMS Communications Coordinator

Increasing use of technology in all facets of society has brought new and novel ways for patients and physicians to interact digitally.

Kaiser Permanente and the physicians of Colorado Permanente Medical Group (CPMG) who care for the 620,000 members of Kaiser Permanente have deployed a host of telemedicine tools across their system to enhance access to care. These tools allow physicians and their care teams to enable members to book phone and video appointments with primary care physicians and behavioral health providers, expand remote patient monitoring and management, and enhance their Chat with a Doctor function to allow communication between patients and a local CPMG physician in real time.

Kaiser Permanente’s Chat with a Doctor, specifically, rolled out in November 2016 with the intention to help reduce unnecessary emergency department visits.

“When we first launched it, we intentionally kept it open-ended,” says Ari Melmed, MD, a CPMG emergency medicine physician.

“The initial call-to-action on the website was ‘click to chat.’”

Melmed explains many of the early connections were for basic medical advice but also about navigating Kaiser Permanente’s health care system.

The Chat with a Doctor service has increased in popularity and has expanded to include local financial counselors, pharmacists and additional member services experts. The function will soon allow patients to book appointments for clinic visits and even mammograms.

The overarching question for all of the unique medical concerns is: “Do I need to come in?”

8 C O LO R A D O M E D I C I N E

“Chat started as an experiment of sorts to see how members would use the service – we’ve adapted and continue to meet the unique needs of our members. We’re proud of all our physicians and other experts who took on this challenge and created something truly valuable to our members — from convenience to quality of care, this service is exceptional,” Melmed says.

According to Melmed, the most common medical questions patients ask on Chat with a Doctor are about upper respiratory symptoms, urinary tract infections, rashes, pediatric issues or lacerations, as well as more sensitive concerns about sexually transmitted illnesses or behavioral health concerns.

Users of the Chat feature tend to skew younger, though it appeals to all ages, and now that it’s been added to the Kaiser Permanente mobile app, patients are engaging doctors instantly from wherever they are when it’s convenient for them. The system currently manages 500-600 chats per day with expected growth to more than 1,000 in the near future.

The overarching question for all of the unique medical concerns is: “Do I need to come in?” Melmed estimates 25-30 percent of the chats require an in-person evaluation for a physical exam, laboratory services or radiographic studies, but that most of the questions can be resolved through Chat.

“Patients are more informed – often entering their symptoms in an online search before engaging a physician, but when it comes to informing their decision more specifically, they need that professional contact to contextualize their question and help them understand whether they need to be seen in person, how soon they need to be seen and by whom,” he says. “We can ask a few questions and often we can give specific advice.

That’s the contact the member needs.”

Of course, the whole process is greatly aided by Kaiser Perma-

from convenience to quality of care, this service is exceptional nente’s integrated system with an integrated electronic medical record that allows for use of telehealth tools in a robust manner, Melmed says.

Melmed feels that telehealth services including Chat give physicians the chance to innovate and experiment with what it means to deliver medical care.

Melmed admits that, as a physician, he was skeptical when he first heard the pitch for Chat with a Doctor. He didn’t think there could be enough information transmitted back and forth to make reliable professional decisions.

“I think a lot of the docs have enjoyed the energy of discovery. We communicate with each other to try and maintain best practices, that antibiotics are used appropriately and that we’re giving consistent advice between providers. We’ve found that there has been a robust exchange of ideas among physicians who are discovering ways of asking questions and ways of answering concerns. It has been engaging for the team. We’re in medicine to help our patients feel better and sometimes that means just talking to patients to help put them at ease — Chat is one more way we can help our patients and it’s gratifying.”

“I was shown otherwise,” he says. “Some of the doctors enter with a certain degree of skepticism but the vast majority of them really enjoy the work. It’s a fun way to interact with patients. The patients are so grateful for the opportunity to be treated in such a convenient and personalized way — knowing we’re caring for our members this way, it’s great to be a part of as a physician.”

This kind of digital interaction allows physicians flexibility in their schedule, too. They may have 4.5 days a week of clinic and a few additional hours from home working Chat with a Doctor.

“Increasingly our doctors are more interested in managing their weekly schedule to be just a little bit less regimented than they have been in the past with five straight days a week of full days,” he says.

Reflecting on the overall progress of advancing technology, Melmed says: “I think we’re pushing the traditional boundary a little bit with regard to what we can do and how much we can manage virtually. Given the infrastructure that our system has, we’re able to set in motion plans of care that in the past would have required an in-person evaluation. As we proceed and monitor the quality and the safety of our program, we’ll establish a new set of boundaries and limitations for what can be done in telehealth.” ■

C O LO R A D O M E D I C I N E 9

F E A T U R E

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AMA survey: Digital health tools gain momentum among physicians Adoption of digital health tools has grown significantly among all physicians since 2016 when the American Medical Association first benchmarked the integration of emerging health technology into clinical practice. New AMA research released in early February shows more physicians than ever recognize digital health tools as an advantage for driving improved efficiency and safety in health care.

“The rise of the digital-native physician will have a profound impact on health care and patient outcomes, and will place digital health technologies under pressure to perform according to higher expectations,” said AMA Board Chair Jesse M. Ehrenfeld, MD, MPH. “The AMA survey provides deep insight into the emerging requirements that physicians expect from digital technologies and sets an industry guidepost for understanding what a growing number of physicians require to adopt new technology.”

The AMA Digital Health Research investigates shifts in physician adoption of digital health tools during the last three years, along with current attitudes and expectations among physicians.

The research examines seven categories of digital health tools that engage patients for clinical purposes, interpret and use clinical data, and manage outcomes and other measures of care quality. According to the AMA survey, adoption trends in those categories are helping to propel the digital transformation of health care.

TELE-VISITS / VIRTUAL VISITS Physician adoption doubled from 14 percent in 2016 to 28 percent in 2019, the largest growth among the digital health tool categories. This category includes audio/video connections used to see patients remotely.

REMOTE MONITORING FOR EFFICIENCY Physician adoption modestly grew from 12 percent in 2016 to 16 percent in 2019. This category includes smart versions of common clinical devices such as thermometers, blood pressure cuffs and scales that automatically enter readings in the patient medical record.

2016

2016 14%

2019

12% 28%

R E M OTE M O N ITO R I N G A N D M A N AG E M E NT FO R IMPROVED CARE Physician adoption jumped from 13 percent in 2016 to 22 percent in 2019. This category includes mobile applications and devices for use by chronic disease patients for daily measurement of vital signs, such as weight, blood pressure, blood glucose, etc. Readings are visible to patients and transmitted to the physician’s office. Alerts are generated as appropriate for missing or out of range readings.

2016 13% 2019

22%

98.6

2019

16%

CLINICAL DECISION SUPPORT Physician adoption climbed from 28 percent in 2016 to 37 percent in 2019. This category includes modules used in conjunction with the EHR, or mobile applications integrated with an EHR, that highlight potentially significant changes in patient data, such as weight gain/loss, change in blood chemistry, etc.

2016 28% 2019

37%

PATIENT ENGAGEMENT Physician adoption rose from 26 percent in 2016 to 32 percent in 2019. This category includes solutions to promote patient wellness and active participation in their care for chronic diseases, such as adherence to treatment regimens.

2016 26% 2019 1 0 C O LO R A D O M E D I C I N E

32%

POINT OF CARE/WORKFLOW ENHANCEMENT Physician adoption modestly increased from 42 percent in 2016 to 47 percent in 2019. This category includes communication and sharing of electronic clinical data to consult with specialists, make referrals and/or transitions of care.

2016

CONSUMER ACCESS TO CLINICAL DATA Physician adoption rose from 53 percent in 2016 to 58 percent in 2019, the highest adoption rate among the digital health tool categories.

This category includes secure access allowing patients to view clinical information such as routine lab results, receive appointment reminders and treatment prompts, and to ask for prescription refills, appointments and to speak with their physician.

2016 42%

2019

47%

While all digital health tools have seen increases in physician adoption since 2016, the biggest growth in adoption was among digital tools in the categories of tele-visits/virtual visits and remote monitoring for improved patient care. Driving this adoption is a significant increase in the importance physicians place in providing remote care to patients. To speed implementation of remote patient monitoring, the AMA’s Digital Health Implementation Playbook – available at www.ama-assn. org/amaone/ama-digital-health-implementation-playbook – packages the key steps, best practices and resources to help physicians extend care beyond the exam room.

53% 2019

58%

The AMA is dedicated to shaping a future where digital health tools are evidence-based, validated, interoperable and actionable. Through its ongoing work, the AMA is committed to ensuring physicians play a greater role in leading trustworthy and equitable tech-enabled innovation that enhances patient care, shapes a better health care system, and improves the health of the nation. Learn more about how the AMA is assisting physicians in using advanced technologies by visiting the AMA’s digital health website, www.ama-assn.org/practice-management/digital. ■ Reprinted from a Feb. 6, 2020 AMA press release.

Improved efficiency and increased patient safety remain the most important factors driving physician interest in digital health tools, although addressing patient adherence, convenience and physician burnout have increased in importance as factors driving physician interest.

Liability coverage remains the most important requirement for physician adoption of digital health tools, and this requirement has significantly increased in importance during the last three years.

Electronic medical record (EHR) integration and data privacy rounded out the three most important physician requirements for digital health tools. There was a notable increase in the importance of peer review validation as a physician requirement for digital health tools.

For the first time, the AMA research surveyed physicians about their awareness and current usage of emerging technologies, such as augmented intelligence, blockchain and precision medicine. While levels of awareness greatly exceed adoption rates, more than one-third of physicians intended to adopt emerging technologies within the year. Interest is highest for use with chronic care patients.

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Hippo Health: Working to restore joy to the modern day health care experience Kevin McGarvey, MD, MBA, Co-founder and CEO, Hippo Health

Please let me tell you about Hippo Health, a practice started by myself and a team of seven other physicians all working together clinically for over a decade.

Born from our experience in a frustrating health care system, we have built a new way to deliver virtual care coordination that helps patients and clinicians truly feel cared for. Hippo Health seeks to transform care delivery to work for patients and clinicians, and we are excited about our potential shared journey with you ahead.

Our team is passionate about supporting innovative and dedicated community physicians and we are busting our tails every day to create a superior integrated community care experience. To understand why we are so stoked about the future of health care in Colorado, let me share a story of a patient I got to take care of on our new care network platform last month.

An older gentleman and longtime smoker without an established primary care physician had hurt his neck at work. It got worse for over two weeks and then he started to get vertigo. He was afraid to go to the emergency room and didn’t want to get a huge bill with his high-deductible plan. So he reached out to our care team on our platform. After being able to assess him virtually, I was worried he could have a vascular injury like a vertebral artery dissection and that he needed an in-person exam right away.

While assessing the patient, I was able to talk with a primary care physician whom I know, trust and had invited to our

platform. His care team was able to then reach out the patient directly and get him in that morning. The patient got the care he needed and loved his doctor, who got a new established patient from the referral. Without our clinician-centric care network functionality, I would have had to recommend the patient go to the ER, and he potentially would have gotten a CT angiogram of the head and neck, and then been stuck with a $10,000 bill.

Getting to that simple use case has taken our company three years to achieve.

Trying to successfully change health care for the better is the craziest, hardest thing I have ever tried to do. Many times I have felt overwhelmed and uncertain whether our tiny new business would survive, let alone successfully help patients. Similar to being on call for the first time in residency and facing your first critically ill patient without a clear treatment path forward, I have learned so much and been humbled with every major milestone we have achieved.

As an mid-career emergency physician turned rookie entrepreneur, I had dipped my toe in the water of startups for about 15 years, but had never gone “all in.” The work transition felt like going from casually climbing a well known flatiron in the Front Range to spending the last three years fighting up an unclimbed, remote big wall in a foreign land. While every day has been stimulating and different with my new line of work, going all in on a startup has been incredibly difficult.

The problem we were working to solve seemed simple enough: connect patients and local care teams virtually better than other solutions in the market. We just needed to build a new business model and new software network architecture that providers loved. Simple, right? With every setback and failure, I felt compelled to keep going because I knew we could give patients better care at a lower cost with a superior care experience.

As a physician and son of a physician, I have spent the majority of my life around medicine. In my opinion, camaraderie, empathy for our patients, and trust between colleagues is the life-blood of our professional culture. This “life-blood” is why I love medicine and part of what makes our work so special. It’s also why I left medicine to try to start our company, Hippo Health.

Let me tell you about a guy we all know – Hippocrates. We all took an oath. Unfortunately, health care has gotten complicated, leaving patients and physicians often disconnected. Sadly, the sacred care relationship has become more and more commoditized. We named our company Hippo to try to remind the care professionals we seek to serve to connect on a more human level.

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After working on multiple telehealth platforms, our three emergency physician co -founders started Hippo Health to address a strange void we found in the market.

Better Communication Early Adopters Kickstart Network More Provider Interest in Network

There were no telemedicine platforms that easily allowed us – as the physicians – to connect with our trusted colleagues in the Colorado community for better clinical collaboration, easier referrals and seamless real-time care coordination.

Top Independent Medical Groups

More Referrals

More Market Share Figure A

After more than two years of intense learning and nonstop hard work, we built and finally launched our care networks platform this last summer. With an exciting word-of-mouth local network effect starting to unfold, we are now seeing 26 percent month-over-month user growth since this summer in Colorado. As more top independent groups get on the care network platform, we think the model will ultimately enable those interconnected groups to deliver better care at a lower cost, relative to other options in the market today. Our goal in 2020 is to enable a “flywheel” that helps unite top independent practices in Colorado, as seen in Figure A.

The age-old values of trust, respect, health care system today – almost $1 commitment and excellent commu- trillion according to the last JAMA health nication between care profession- economics article I stumbled across this als are what often save lives and October – but I am an optimist. Personally, I believe the health care delivery models prevent poor health outcomes.

As we all know, there is an incredible amount of waste that is happening in our

of the future that will disrupt our current status quo will likely look very different than the incumbent fixed models that PAGE 14 ⊲

To understand why we are excited about the potential for Hippo is relatively simple.

Not only do we give patients an easy way to talk to their doctor and care team, we also give care teams the ability to talk with other care teams, whether they are in the same practice and whether they are on the same EMR.

By layering on a new service model we call integrated virtual urgent care, we seek to enable independent established practices the ability to give their patients walk-in capabilities 24/7 with doctors who know them to avoid having them go to unaffiliated urgent cares or convenience clinics. We are also seeking to offer on-demand integrated emergency physician services to paramedics seeing patients at home.

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F E A T U R E H I P P O H E A LTH : C O N T

despite there being excellent relationships in place between colleagues. While many health care experts believe this trend will get worse, I think we are ready for top practices to connect in a new way and demonstrate disruptive value in our local health care market.

Patients often feel it is challenging to get easy, convenient access to a physician who knows them. With this frustration borne by patients and physicians alike that seemed to gnaw at my soul, I personally decided to leave medical practice to try to build a unique solution to this problem. After practicing emergency medicine here in Colorado for 10 years and now having spent three years building our care network platform, I can tell you one thing with 100 percent confidence – implementing brand new health care delivery models takes time. continue to drive up costs without seriously improving health outcomes.

One trend the last 10 years has been care group consolidation. Only one in three physicians are still independent.

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Many independent outpatient practices are losing two or more patient visits a day to unaffiliated urgent cares and convenience clinics, as they are busy as hell.

Care coordination is often fragmented between local independent practices,

We are always looking to par tner with for ward-thinking physicians in Colorado. Feel free to email me at ke v i n @ h i p p o h e a l t h .c o m w i t h a n y ques t ions or interes t you have in Hippo Health. ■

F E ATU R E I N N OVATI O N

S U ITE

Clinician-led network moves the needle on health care delivery Stephanie L. Motter, CEO, Monument Health, LLC

When providers are given room to innovate, they can make tremendous gains for medicine and pave the way for the future of health care. I have seen this firsthand as the CEO of Monument Health, a clinician-led clinically integrated network (CIN) and population health services organization, and through my background as a nurse practitioner. Having spent my entire career collaborating with physicians to provide direct care to our patients and working with them on innovative processes and valuebased care arrangements, I deeply understand that clinical training and direct patient care experience give providers a special perspective.

Monument Health started in 2016 in Mesa County – conceived through a collaboration between Primary Care Partners, St. Mary’s Medical Center and Rocky Mountain Health Plans – and our products and services are now available in Mesa, Delta and Moffat counties, supporting almost 15,000 people.

At Monument Health, we invite providers to consider what is most meaningful to them and to innovate on how they believe they can best move the needle in our communities. We get the conversation started during contracting. We ask them to consider what will drive better health outcomes, improved access to care, fewer inefficiencies and better engagement among their patients.

Our primary care practices, most of which are independent and are not part of a hospital or health system, have identified certain opportunities related to improving access to care. They are creating new workflows for new patients to be seen more quickly, and they have created better new-patient intake processes.

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Robert Marinaro, MHS, CLHMS Mary Beth Marinaro, CT (ASCP), CLHMS Broker Associates/Realtors

PEDIATRICIANS An example is helping existing patients get more engaged and seen quickly.

A group of pediatricians wanted to focus on pediatric wellness exams and ensure all their patients were being seen regularly (not just those kids who remain on a vaccination schedule and whose parents are therefore more likely to bring them for visits), so they developed a metric focused on driving pediatric wellness visits.

RADIOLOGISTS Another example of physicians innovating when it comes to process and metric development are the radiologists in our network. They developed a new and locally developed metric to monitor high-cost imaging procedures that are ordered by their colleagues in the community, and these radiologists get involved not just in tracking the data, but reviewing it and engaging their colleagues in the community who appear to be outliers with the ultimate goal of reducing unnecessary imaging tests and procedures.

HEALTH PLAN DESIGN Our physicians also regularly innovate with our health insurance carrier partner and self-insured employer groups on health insurance plan designs. For example, through multiple interactions and robust discussions with the right stakeholders at the table, we now have a Monument Health product through Rocky Mountain Health Plans that offers a handful of “free” (i.e. $0 co-pay) visits to a primary care provider, in addition to the no-cost annual (preventive) visit.

For patients with chronic conditions or those who require primary care visits five or six times a year, the financial barrier related to co-pays has been minimized, and complex, higher-need patients are being seen more regularly.

This plan design and benefit to our members was primarily advanced by our primary care physicians who saw the need and were being responsive to their patients’ feedback. We have seen a few self-insured employer groups adopt a similar approach to plan design.

…innovating by way of rate relief, access to care and highly targeted metrics…

Current actual and proposed legislative activities in Colorado today (e.g., reinsurance, public option, etc.) and the group purchasing alliance (Peak Health) represent a good start to health care reform, but they seem limited and potentially unsustainable because they only focus on reducing price. Health care costs are indeed an issue – and we all have various perspectives on who should be accountable and how to fix the pricing issue – but costs are only the tip of the iceberg. There must also be a focus on health and wellness. Monument Health focuses on both price reduction AND improving health and wellness. We require all contracted providers (hospitals, physician practices, etc.) to lower their rates.

We also insist that providers commit to certain clinical processes and metrics that will improve health outcomes, enhance members’ experience (or their engagement) and/or reduce inefficiencies that exist in the health care ecosystem. It’s this second part that sets us aside from all the other “solutions” that are being discussed and deployed throughout the state, and these processes and metrics are developed by physicians.

In sum, our provider partners – whether independent practices or those who are employed – are innovating by way of rate relief, access to care and highly targeted metrics that improve quality and reduce waste, and enhancing the design of health insurance products. ■

GIVE YOUR PATIENTS A PRESCRIPTION TO AFFORDABLE ENERGY. Help your patients afford electricity for better health this summer. Xcel Energy offers a discounted summer electric rate, through the Colorado Medical Exemption Program (CMEP), to qualified lowincome, customer households with medical needs that require high electric use or life support equipment. Encourage your patients to apply if they have a medical condition that makes it difficult to reduce electric usage in the summer. That way you can offer the help they need in more ways than one.

For more details and an application, visit chroniccarecollaborative.org/CMEP. Hurry! The deadline for application submission is May 1, 2020. © 2020 Xcel Energy Inc.

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2/10/20 4:21 PM

F E ATU R E I N N OVATI O N

S U ITE

Improving care and empowering patients Lisa Lewis, DO, practice owner, Sustaina Center for Women

Transforming Clinical Practice Initiative, which worked with close to 200 practices during its four-year time frame, submitted roughly 20 “exemplar practice” stories to the Centers for Medicare and Medicaid Services directory. TCPi is a federally funded, governor’s office initiative that ended Sept. 30, 2019. The following is an edited version of that story that illustrates some of the work Sustaina Center for Women did to earn the “exemplar” designation.

Sustaina Center for Women is a small practice in Lakewood. Our team includes myself, a gynecologist; a women’s health nurse practitioner (NP); two medical assistants; and a part-time behavioral health specialist.

Our patients are busy working women who are providing multigenerational care and can’t spend extra time in a doctor’s waiting room. We are focused on our patients’ needs and experience. In the end, our focus on patient experience has improved patient outcomes, saved or avoided unnecessary health care costs and inspired team members to work to the top of their scope.

Our patients can “swing by and get things done by people who care” and we take pride in our work. In addition to our cost reductions, increased patient access and better health outcomes, the team’s efforts have improved team morale, attracted providers from across the country (Elizabeth, our NP, moved from Chicago to work in our environment) and caught the attention of the Centers for Medicare and Medicaid Services, which funded TCPi. Sustaina Center for Women has been featured during several national conferences and I was named to the national TCPi faculty to help replicate the success we’ve seen with our practice transformation efforts.

A FEW SUCCESSES: • Drop-in appointments for existing pat ient s w i t h s y mptoms of UTI , vaginitis or a sexually transmitted disease “scare.”

• Same-day urgent appointments for more acute needs such as pain, bleeding or Bartholin cyst drainage.

• Improved access to lower cost generic hormone intrauterine contraceptive devices (IUDs) by improving the method of insertion and creating a faster decision-to-placement time; by providing a lower cost yet potentially more effective device, we saved over $72,000 in 2019.

• Treated abnormal bleeding with medication instead of surgery in 90 percent of cases in 2018.

• Transitioned all surgeries to outpatient with length of stay measured in hours, not days, as patients recover better at home.

• Lowered prescriptions for post-op narcotics to six pills with rare refills (none in 2018).

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IMPROVING ACCESS We revamped the office schedule to include daily drop-in availability for low acuity visits; daily “9-1-1” higher acuity open slots; one-week open slots so patients can be seen within the week; and two-week appointment slots for improved availability over time. There is a patient portal and secure text messaging, and patients use a smart phone application to message the team directly.

Our friendly and empathetic environment also helps ensure women feel comfortable asking for the kind of help they need.

Empathy and understanding improve access when patients feel comfortable.

The team asks every patient if she has a health goal and helps her achieve it.

Other patient engagement tools include checklists that help patients determine insurance benefits for procedures and high-cost contraceptive devices.

The team recently embedded a mental health provider in the office. The hope is that convenient, onsite access to mental

health services will help women and their families get the care they need when and where they need it. This work was supported by Sustaina’s participation in the Colorado State Innovation Model, another health reform initiative funded by the Centers for Medicare and Medicaid Services.

PATIENT EXPERIENCE We engage our patients with checklists to help them navigate their insurance benefits. Our most popular checklist is given to all patients who desire long-acting contraceptive devices. It reminds women to call their insurance companies to confirm benefits before the procedure, which costs $650 to $1,200 per device, is performed. We have nearly 100 percent usage of this checklist.

We have improved our patient surgical experience by creating an atmosphere of comfort and openness in which patients and their families can ask questions to help them reach their goals for surgical outcomes. Patients appreciate the fact

2018 savings $481,936

 Emergency department visits: 192 in 2018 = $257,908

that our services help them reduce time away from work, lower copays for outpatient procedures, and minimize opioid use so they feel empowered to return to their usual routines and are home sooner.

The following patient engagement tools help with this process: • A checklist to prepare for surgery: • Things to arrange for before surgery – childcare, rides, eldercare.

• Instructions for checking benefits and understanding the financial aspect of surgery.

• A checklist for the day before and day of surgery for patients:

Increased generic IUD access = $27,900

All outpatient surgery - length of stay = $124,128

• We have initiated a care coordination agreement with the surgical center that is given to patients so they know what we expect the surgery center to have ready on the day of surgery, what they expect us to have ordered and what the patient will do before surgery.

• An information sheet on “how to recover faster from surger y ” for patients and families.

COST SAVINGS The team’s focus on patient experience generated up to $481,936 in cost savings during 2018 as detailed above.

Our same-day, open appointment slots improve patient access and reduce urgent and emergency room visits. Carefully coordinated, cost-effective services

Surgical tray change = $72,000

90% abnormal bleeding in 2018 treated w/o surgery

that are focused on patient experience have resulted in significant health care cost savings. The team is building a health neighborhood to provide streamlined health care delivery experiences for patients, and we want to partner with highly efficient primary care physicians. ■ This is the second of a series of articles that highlights the work practices engaged in TCPi do to earn “exemplar” status with the federal CMS. LEARN MORE ABOUT THIS FEDERALLY FUNDED, GOVERNOR’S OFFICE INITIATIVE AT www.co.gov/healthinnovation/tcpi, a website that will be maintained as an archive through July 2020.

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C O LO R A D O M E D I C I N E 1 9

www.cms.org/membership

I N S I D E

C M S

CEO reveals one simple trick to improve your CMS membership experience Bryan Campbell, FAAMSE, CEO, Colorado Medical Society

Wow. Don’t you hate those clickbait articles that pop up on Facebook or in Google Ads? Your brain knows that there’s no simple trick for most things … but sometimes … you just click to be sure. And I promise you this, at the end of the article, I WILL give you one simple trick to look into those deceptive ads without clicking through the sometimes dozens of pages, only to be disappointed.

But for now, hopefully I have your attention for just a minute or two for the “obligatory get-to-know-me” article from the new CEO.

Everything will be answered if you just CLICK HERE

YOU NEED TO KNOW THIS! CLICK HERE

I’m Bryan Campbell, husband, father of two, and grandfather of one. I’m also a fan of the Oxford comma, as you can see. I joined the Colorado Medical Society team in January 2020 following the retirement of Alfred Gilchrist. I am a Nebraska native but come to Colorado via Jacksonville, Fla. I served as the CEO of the Duval County Medical Society, one of the largest and oldest county medical societies in America, from 2012 until December 2019. Prior to that, I served as the Director of Public, Media and Industry Relations for the American Association of Clinical Endocrinologists (AACE; try putting all of that on a business card) from 2006-2012.

One of the things that I am most passionate about in organized medicine is the opportunity to create community. Our CMS membership of more than 7,000 physicians range from residents to retired, rural to urban, and from every type of practice model imaginable. Your CMS is here to be a place for your voice to resonate. If you haven’t participated in a committee or work group yet, there’s almost certainly something that meets your personal passion. And if there isn’t, we are here to help make that a reality for you, whether you have the desire to form community with other physicians who are young parents, or who love hiking, or any other interest available.

My path to organized medicine is atypical: mechanical and nuclear engineering major who decided to change his major to broadcast journalism. After a 14-year television career that earned me numerous awards and accolades, I decided to get out of the business in 2006 and stumbled into the public relations job at AACE.

In my experience, we’ve helped create robust communities for such important membership groups as residents, women in medicine, and physician wellness champions. We’ve also set up NCAA March Madness pools and fantasy football leagues … obviously significantly less important in the grand scheme of things, but REALLY important to those involved.

www.cms.org/membership

Honestly, the one simple trick to improve your membership is this: Just ask!

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Just one more click CLICK HERE

Honestly, the one simple trick to improve your membership is this: Just ask! If there’s something you are interested in, it’s a virtual certainty there are more physicians who share that idea – and we can help.

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Honestly, the one simple trick to improve your membership is this:

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Just ask!

Because CMS is you. CMS is the 7,000+ physicians working to improve their patients’ lives every day. Who I am really doesn’t matter. I’m just here to ensure that your voices are heard and represented.

If I do that well, then CMS will thrive as engaged physician members continue to help us fulfill your mission to champion health care issues that improve patient care, promote physician professional satisfaction and create healthier communities in Colorado.

And now, as promised, truly one simple trick for getting through those annoying clickbait articles. Subscribe to the Reddit thread “Saved You A Click” (www.reddit.com/r/savedyouaclick). The moderators on that site take most of the popular clickbait articles and summarize them in one post that you don’t even have to click to get the answer.

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Thanks for a few moments of your attention. I am truly excited to be a part of the CMS team and look forward to helping your voice be heard. Please feel free to reach out to me directly at bryan_campbell@cms.org with any thoughts. I’d love to hear from every member what we are doing right, and how we can be even better. ■

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F E A T U R E

2020 mid-session legislative report THE HEALTH CARE HOT BUTTON ISSUES AT THE COLORADO STATE CAPITOL Emily Bishop, Program Manager, CMS Division of Government Relations

STATE HEALTH INSURANCE OPTION

SCOPE OF PRACTICE

PHARMACEUTICAL COSTS

• One of the most anticipated issues of the 2020 session

• HB20-1212 renews the requirement that naturopathic doctors be registered with DORA. The CMS Scope of Practice Subcommittee is working closely with COL to maintain a collaborative relationship with the NDs while ensuring no scope expansions endanger or mislead patients

• HB20-1160, HB20-1198 and SB20-107, among other bills, all address the skyrocketing prices of prescription medications; they aim to empower the prescriber and patient with tools to keep costs down while still ensuring access

• CMS is committed to being part of the conversation on this bill • The CMS Council on Legislation will be carefully reviewing and determining a position following the anticipated introduction of this bill in early March

THE OPIOID EPIDEMIC • HB20-1085 seeks to address prevention by requiring coverage of alternatives to opioids (ALTOs) by health plans, establishing CME competencies for prescribers, and adding benzodiazepines to the mandatory PDMP check • HB20-1065 seeks to reduce the harm of the opioid epidemic by improving access to clean needles and opiate antagonists

• HB20-1209 continues the Nurse-Physician Advisory Task Force indefinitely; CMS supports the collaborative work of NPATCH • HB20-1216 amends the Nurse Practice Act by reducing prescriptive authority hours from 1,000 to 750 and eliminating articulated plans; CMS is working closely with the sponsors on these changes to find a balance between patient protection and access • CMS is also closely watching the sunsets of chiropractic examiners, audiologist licensing, and occupational therapists, among others, to ensure no scope expansions take place without physician input

• HB20-1017 seeks to expand services for persons in the criminal justice system with substance use disorders IMMUNIZATIONS • SB20-007 seeks to increase insurance coverage of treatment and increase access to treatment services • SB20-028 seeks to provide comprehensive access to recovery services and financial support

• CMS partnered with the Colorado Vaccinates Coalition to support SB20-163. The coalition secured the support of Gov. Jared Polis on this bill to address falling vaccination rates in the state • CMS opposes all anti-vaccination bills introduced this session; four have already been postponed indefinitely

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WORKERS’ COMPENSATION • A CMS-sponsored bill to be filed soon ensures providers have access to the Division of Workers’ Compensation Medical Dispute Resolution process; the bill seeks to promote quick and effective delivery of insurance and fairly reimburse participating providers

MEDICAL LIABILITY • CMS is watching closely for any attempts to jeopardize the current medical liability climate or narrow the corporate practice of medicine to access the deep pockets of health systems, which could endanger physicians’ independent medical judgement and relationships with their patients STAY TUNED FOR A FULL LEGISLATIVE REPORT IN THE MAY-JUNE ISSUE OF COLORADO MEDICINE. ■

F E A T U R E

Colorado medical students storm the Capitol for day of advocacy The Colorado Medical Society Medical Student Component (CMS MSC) held their second annual Medical Student Day at the Capitol on Jan. 21, 2020. Over the course of the afternoon,

students interacted with the CMS lobby team and met with key state legislators influential in health care public policy. The event garnered praise from participants and elected officials. ■

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1 Government Relations Program Manager Emily Bishop, right, briefs students on the schedule for the day. 2 Students and contract lobbyist Dan Jablan talk to Rep. Kyle Mullica (back turned). 3 An aide for Sen. Rob Woodward addresses the students in advance of their meeting.

4 Rep. Dylan Roberts talks with students and physician leader David Downs, MD (right). 5 Rep. Chris Kennedy discusses current legislation with students, CMS CEO Bryan Campbell and contract lobbyist Jerry Johnson. 6 Fourth-year Halea Meese gives advice on lobbying to fellow students.

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7 Rep. Sonya Jaquez Lewis poses for a selfie with students. 8 Legislators and students enjoyed the opportunity to have face-to-face meetings.

9 The group pauses for a photo before splitting off for meetings with legislators.

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C M S

Support Colorado’s pro-physician candidates – donate to COMPAC and the Small Donor Committee We need your help in the 2020 election season to make physician voices heard at the Colorado Capitol. Contribute to the Colorado Medical Political Action Committee (COMPAC) and the Small Donor Commit tee (SDC) to suppor t pro-physician, pro-patient lawmakers across Colorado!

COMPAC is the bipartisan political arm of CMS; SDC gives money only to those who vote 100 percent with physicians on issues of liability. In 2018, COMPAC endorsed 80 candidates with an excellent success rate in the subsequent election. COMPAC and SDC contributed just under $130,000 to candidates who stand for physicians and their patients. These candidates went on to make incredible gains on behalf of organized medicine, thanks to your generous support.

MAKE YOUR VOICE HEARD. CONTRIBUTE TODAY! Go to cms.org/contribute.

Any individual over 18 can donate to COMPAC and the Small Donor Committee.

Contribute up to $625 to COMPAC for the 2019-2020 election cycle.

Contribute up to $50 to the Small Donor Committee for the 2020 calendar year. ■

I N S I D E

CMS is pleased to announce Abyde as our newest Corporate Supporter.

Abyde’s intuitive design makes your practice’s HIPAA program more meaningful and manageable. Focused on HIPAA education, Abyde’s revolutionary software solution guides medical practices through mandatory HIPAA compliance requirements including: • • • • •

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C M S

Save the date!

CMS’s Annual Meeting will be held Sept.

26, 2020 Save the date for the event of the year for Colorado physicians and medical students: the 2020 CMS Annual Meeting.

It will be held Saturday, Sept. 26, 2020, with programming scheduled during the day at CMS/COPIC headquarters in east Denver and the exhibitor reception and inaugural gala that evening at the Wings Over the Rockies Air and Space Museum located on the former Lowry Air Force Base. Watch for more information coming soon. ■

I N S I D E

C M S

Report from the 2020 AMA National Advocacy Conference STAFF REPORT The American Medical Association hosted the 2020 National Advisor y Conference in Washington, DC, Feb. 10-12. A delegation from Colorado that included many physicians and component society staff members from around the state attended. The first part of the conference featured briefings on hot topics in federal health care policy, including featured presentations by Seema Verma, administrator of the Centers for Medicare and Medicaid Services; ADM Brett P. Giroir, MD, assistant secretary for health for the U.S. Department of Health and Human Services; and Alex Azar, II, JD, secretary of the U.S. Department of Health and Human Services.

The second par t of the conference featured hill visits during which the Colorado delegation of physicians and staff met with members of the Colorado congressional delegation or their staff.

Those representatives or staff participating in hill visits included, from the U.S. House of Representatives, the honorable Scott Tipton, Jason Crow, Doug Lamborn and Joe Neguse, and, from the U.S. Senate, the honorable Michael Bennett and Cory Gardner. CMS and the AMA have solid and candid working relationships with long-time congressional delegates and their staff. This visit offered the chance to build similarly strong bonds with new members of congress, Reps.

Crow and Neguse.

The top health care-related issues the doctors and elected officials discussed included surprise billing; Medicare payment (update, PTAC, MACRA fixes and budget neutrality); vaping; Conrad 30; medical marijuana; reducing prior authorization burden; and telemedicine.

Feedback from the visits was positive for all. ■

The Colorado Medical Society delegation to the National Advocacy Conference meets with U.S. Rep. Jason Crow.

Physicians and medical society staff discussed surprise billing, Medicare payment and public health concerns with congressional representatives.

Delegates from Colorado strategized on messaging over dinner the first night of the conference.

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F E A T U R E

Doctors are invited to share stories for the Lift The Label campaign Charlotte Whitney, Director of Policy and Communications, Colorado Office of Behavioral Health “Being treated with genuine compassion and care got me into recovery.”

- Blair H., Denver, CO As medical professionals, you are familiar with stories like Blair’s, where care from a compassionate doctor changed the course of someone’s life. Colorado’s opioid anti-stigma campaign, Lift The Label, has been telling Coloradans’ stories of recovery for almost two years now. Coloradans are living lives in recovery because you and others were there for them when they needed it the most. Thank you.

Unfortunately, stigma continues to be a huge and growing barrier in Colorado for people who need substance use services.

According to the 2019 Colorado Health

Access Survey, 78,513 Coloradans cited stigma as a reason they did not get needed substance use care. That number equates to 85.5 percent of those who needed substance use services but did not receive them, a number that has grown from 59 percent in 2017.

We can all do more – to connect people with services, to ensure they are treated with respect and compassion, and to share stories to reduce stigma and judgment.

Although Lift The Label has had many brave Coloradans step up to share their personal stories about recovery from addiction, we do not have any medical professionals who have shared. Can you help?

The Lift The Label campaign is asking medical professionals to share their stories

about recovery from opioid addiction. We know that one way to address stigma is to hear from people who look and sound like you. By sharing your story with other doctors, you will help reinforce the idea that people want to recover and do recover, a message that the medical community, law enforcement, friends and family members need to hear. In addition, your story will be used to reach people struggling with addiction who may be wondering how they will be treated if they ask their doctor for help.

Please share your story if any of the following fit you.

• Have you struggled with addiction and stigma yourself and are now in recovery?

• Have you supported someone close to you, like a friend or family member, who struggled with addiction?

• Have you helped someone find treatment for their addiction?

• Have you prescribed someone medication-assisted treatment to help recover from opioid addiction?

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Reza Ghafoorian, MD, JD (202) 656 8387 rghafoorian@g2zlaw.com

Reach out to elizabeth.owens@ state.co.us or 303-866-7505 to help someone else by sharing your story for the Lift The Label campaign. You will work with a professional writer to tell your story and you must be willing to have your face and name associated with the story.

We know that you’re already giving a tremendous amount of time, care and thought to your patients. We hope that participating in Lift The Label might be another way to ensure that patients are treated to the best of your ability. Thank you again for the lives you have saved and for the care you provide every day. ■

I N S I D E

C M S

CMS CORPORATE SUPPORTERS AND ADVANTAGE PARTNERS While CMS analyzes the quality and viability of our Advantage Partners and their offerings, we do not guarantee any product or service will be right for you. Before you make a purchase, we recommend you perform your own due diligence.

AUTOMOBILE PURCHASE/LEASE

PRACTICE VIABILITY

US Fleet Associates 303-753-0440 or visit usfacorp.com *CMS Advantage Partner

Abyde 727-683-6198 or visit www.abyde.com

FINANCIAL SERVICES COPIC Financial Service Group 720-858-6280 or visit copicfsg.com *CMS Advantage Partner Gold Medal Waters 720-887-1299 or visit www.goldmedalwaters.com PNC Bank 330-606-8315 or visit pnc.com/hcprofessionals TSI 800-873-8005 or visit web.transworldsystems.com/npeters *CMS Advantage Partner Zenith Home Loans 303-968-4148 or visit www.zenithhl.com *CMS Advantage Partner

INSURANCE PROGRAMS COPIC Insurance Company 720-858-6000 or visit callcopic.com *CMS Advantage Partner Colorado Drug Card 720-539-1424 or coloradodrugcard.com *CMS Advantage Partner Medjet 1-800-527-7478, refer to Colorado Medical Society, or visit medjet.com/cms *CMS Advantage Partner

Carr Healthcare Realty 303-817-6654 or visit carrhr.com *CMS Advantage Partner Eide Bailly 303-770-5700 or eidebailly.com/healthcare Favorite Healthcare Staffing 720-210-9409 or medicalstaffing@favoritestaffing.com *CMS Advantage Partner G2Z Law Group, PLLC 202-549-3906 or visit www.G2ZLaw.com Medical Telecommunications 866-345-0251, 303-761-6594 or visit medteleco.com *CMS Advantage Partner MINES & ASSOCIATES 800-873-7138 or visit minesandassociates.com *CMS Advantage Partner PatientPop 866-586-7207 or visit compare.patientpop.com/cms *CMS Advantage Partner RainTech 844-TEL-RAIN or visit https://rain.tech The Legacy Group 720-440-9095 or visit healthcare.legacygroupestates.com TSYS 877-841-0606 or visit transfirstassociation.com/cms *CMS Advantage Partner Transcription Outsourcing 720-287-3710 or visit transcriptionoutsourcing.net

University of Colorado Hospital/CeDAR 877-999-0538 or visit CeDARColorado.org

C O LO R A D O M E D I C I N E 2 7

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Coronavirus: What physicians need to know Communicable Disease Branch, Colorado Department of Public Health and Environment

The Centers for Disease Control and Prevention (CDC) is closely monitoring an outbreak caused by a novel (new) coronavirus (2019-nCoV) that was first identified in Wuhan City, Hubei Province, China in December 2019. Since then, more than 30,000 cases have been reported, with the vast majority in mainland China. While initially there was speculation of zoonotic transmission, the virus is now spreading between people, including from patients to health care workers. Person-to-person transmission has now occurred in the United States as well.

Coronaviruses are a family of viruses which includes SARS and MERS as well as a number of other common coronaviruses (including HKU1, 229E, NL63 and OC43) which circulate regularly in the United States and generally cause mild upper respiratory infections. Many patients are concerned when they test positive for coronavirus on a respiratory pathogen panel, but according to CDC, 2019-nCoV is not cross reactive with other coronaviruses on PCR panels such as Biofire (meaning if a person has 2019-nCoV they will not test positive for coronavirus on a commercial PCR test).

As of Feb. 6, 2020 there are 12 confirmed cases of 2019 - nCoV in the United States, with cases in Arizona, California, Illinois, Massachuset ts, Washington State and Wisconsin. There have been no confirmed cases in Colorado. The Colorado Department of Public Health and Environment (CDPHE) is asking providers to please contact us or your local public health agency (LPHA) about any patient with fever or respiratory symptoms who reports travel to China in the 14 days before they became ill. We will work with clinicians and patients to determine who needs to be tested for 2019-nCoV; currently CDC is requesting nasophar yngeal and orophar yngeal swabs be collected (details at https://

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www.cdc.gov/coronavirus/2019-ncov/ lab/guidelines-clinical-specimens.html).

All specimens are being sent to the CDPHE laboratory and then forwarded on to CDC for testing, although we anticipate that our state public health laboratory will have the capacity to test for 2019nCoV within the next few weeks. In many situations, those who are identified as Patients Under Investigation (PUIs) who do not require hospitalization can be self-isolated at home while results are pending, but public health will make this determination on a case-by-case basis.

When evaluating a patient with suspected 2019-nCoV, the patient should be masked immediately and moved to a private room with the door closed; an airborne infection isolation room (AIIR) should be utilized if available. If an AIIR is not available, place a facemask on the patient and isolate him/her in an examination room with the door closed. Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration. Health care providers should follow standard contact and airborne precautions with eye protection (e.g. isolation gown, fit tested N-95 or higher respirator, gloves and eye protection or full face shield) while in the examination room. Personal protective equipment (PPE) should be

donned prior to entering the patient room and should be disposed of immediately upon exiting. PPE should not be worn for care of more than one patient. Collecting diagnostic respiratory specimens (e.g. nasopharyngeal swabs) may induce coughing or sneezing and requires the use of PPE as described above. Individuals in the room during the procedure should, ideally, be limited to the patient and the health care provider obtaining the specimen. Patients who require hospitalization should be transferred as soon as is feasible to a facility where AIIR is available. If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate.

As the epidemiology of this epidemic changes, definitions for PUI and indication for testing is likely to evolve.

To keep up to date on coronavirus, we recommend the following resources: • CDC’s Clinician Outreach and Communication Activity (COCA) webinars on 2019-nCoV are posted at the following website: https://emergency.cdc.gov/ coca/calls/2020/callinfo_013120.asp.

The recording of the most recent call from Jan. 31, 2020 is available to watch.

This is not a comprehensive list of re c o m m e n d a t i o n s fo r p re v e n t i n g transmission of 2019-nCoV in health care settings. You can find and review the most current detailed interim infection prevention recommendations for health care settings at the following webpage: https://www.colorado.gov/pacific/cdphe/ resources-local-public-health-agenciesand-healthcare-providers. Clinicians or infection preventionists can use our Initial Assessment Form to collect information to help determine if the patient is at risk for 2019-nCoV (https:// drive.google.com/file/d/1wapi65VeNUx 6KA3OsrPfJZ6ATe1U9y-N/view).

Treatment for 2019-nCoV is primarily symptomatic; in some cases, investigational antivirals may be available through CDC but it is unknown at this time whether they might be effective. CDC has noted that in the case of MERS, use of steroids was associated with delayed clearance of the virus (https://www.ncbi.nlm.nih. gov/pubmed/29161116), and has therefore stated that clinicians may wish to avoid steroids unless they are clearly indicated (for example for underlying COPD or in the case of refractory septic shock).

Report a case or questions: To report a case of 2019-nCoV or if you have any questions about our guidance, please contact CDPHE or your local health department. You can reach an epidemiologist at CDPHE who works on 2019-nCoV by calling 303 - 692-270 0 or 303 -370 -9395.

You can also email Dr. Alexis Burakoff at alexis.burakoff@state.co.us with any questions. ■

• Make sure you are registered to receive CDPHE’s Health Alert Network (HAN) broadcasts. This is where you will find the most updated information on PUI definitions, how to report to public health, and other communications about 2019-nCoV. If you do not currently receive HANs, please email cdphe_epr_sit@state.co.us with your full name, position and county of employment to sign up.

• C D P H E ’ s 2 0 1 9 - n C oV w e b s i t e : ht tps://w w w.colorado.gov/pacif ic/ cdphe/2019-novel-coronavirus.

• CDC’s 2019-nCoV website for health care professionals: https://www.cdc. gov/coronavirus /2019 - nCoV/ hcp/ index.html.

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D E PA R TM E NT S R E F LE C TI O N S

Cadaver lab Kaitlyn Brunworth

Kaitlyn Brunworth is a third-year medical student at the University of Colorado. Prior to medical school, Kaitlyn played NCAA Division II soccer for Wingate University in Charlotte, N.C. Her other hobbies include rafting, hiking, skiing and traveling with friends and family. Next year she plans to match in physical medicine and rehabilitation.

A body once full, hollowed out.

One structure at a time.

The epidermis peeled back, then superficial fascia.

A muscle transected, reflected.

A vein stripped, removed.

Lifeblood will never return to the heart.

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A spirit now full.

Eyes as bright as her brand-new white coat.

May she not be hollowed out, one day at a time.

Countless hours of memorization, late nights, early mornings, frustrating patients, tough teachers, a lack of reflection.

May her hope not be stripped.

May the lifeblood return to her heart, and remind her of why she began. ■

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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BCMS hosts “Legislation 2020” to bring together local legislators and doctors

From left: Contract lobbyists Dan Jablan and Jerry Johnson; Rep. Kyle Mullica; Rep. Jonathan Singer; Rep. Yadira Caraveo; Rep. Edie Hooton; and BCMS President Todd Mydler, MD.

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The Boulder County Medical Society hosted a legislative night on Feb. 4, 2020, to facilitate conversations between physicians and legislators on top health policy issues under consideration by the 2020 Colorado General Assembly.

Elected officials in attendance were Rep. Edie Hooton (D-Boulder), moderating the panel discussion; Rep. Jonathan Singer (D-Longmont), addressing the opioid epidemic; Rep. Kyle Mullica (D-Thornton), discussing vaccination rates and firearm safety; and Rep. Yadira Caraveo, MD, (D-Thornton) addressing the use of e-cigarette and vaping devices among youth. Physicians in attendance asked questions about physician advocacy and engagement. Honored guests included CMS contract lobbyists Jerry Johnson and Dan Jablan, CMS CEO Bryan Campbell and CMS COO Dean Holzkamp. The event was coordinated by BCMS Executive Director Judy Ladd and BCMS President Todd Mydler, MD. ■

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Colleagues and friends gathered to wish outgoing CMS CEO well in his retirement Physicians and friends from around Colorado gathered at Colorado Medical Society headquarters on Jan. 30 to congratulate outgoing CEO Alfred Gilchrist on his retirement. Gilchrist was presented with the CMS Lifetime Achievement Award and, as an avid golfer, a set of personalized golf clubs. CMS will honor his legacy with the Alfred D. Gilchrist Student Leadership Scholarship, to be awarded starting in 2020. ■

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COPIC promotes members of its management team to senior vice presidents COPIC has announced that five members of the company’s management team were recently promoted to senior vice president positions. The promotions include the following: Kristin Stepien Senior Vice President, Sales and Business Development Janel Loud-Mahany Senior Vice President, Underwriting and Policyholder Services Beverly Razon Senior Vice President, Public Affairs

The promotions are part of COPIC adjusting its organizational structure to better meet the needs of our insureds as well as to address market expansion and manage growing business operations. Collectively, this group represents over 60 years of experience at COPIC and they are recognized as leading industry experts in their respective areas.

“A big factor in COPIC’s success is the internal leadership and expertise we have at our company,” said Gerald Zarlengo, MD, COPIC CEO. “These well-deserved promotions are in key areas that support our growth and commitment to high-quality customer service, and we feel that this will better position us to evolve and meet the challenges that lie ahead.” ■

Shelly Waggoner Senior Vice President, Human Resources Sean Gelsey Senior Vice President, Claims and Strategic Partnerships C O LO R A D O M E D I C I N E 3 1

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Practicing mindfulness to process tragedy Jeffrey Beach

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.

Jeffrey Beach is from Rye, Colo., and attained his undergraduate education at Colorado State University - Pueblo. He has a passion for quality patient care and is considering anesthesiology for his future career. In his free time, he loves to hike any trail he can find, cook new and exciting recipes with his wife, and practice mindfulness through sitting quietly.

Obstetrics is a field in which the only certainty is uncertainty – at least that’s what my attending told me upon first introductions.

I was just orienting at the hospital when I was told the schedule for the day included a planned fetal demise delivery. Though this didn’t hit me hard at the time, by the evening it would. By afternoon, lunch was calling, and I rode the elevator down teeming with knowledge of how to perform a new set of clinical skills.

The elevator ride back up was quite a different story. I rode in the elevator knowing that the family sharing the ride with me was tearful not due to a newborn baby birth, but the upcoming delivery for a demise.

Initially, I didn’t think that I would be involved in such a case, but my preceptor asked me to join. There are no right words for a mother who lost her child before it was even born. I did my best to be present for the family. I was there to talk not about medicine but the human connection that we all shared. We discussed vacations, life lessons and even our favorite type of pie: hers was Key Lime. It was a long end to a first day, but it was an even rougher beginning to a month of uncertainty stewing in

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me. Driving home, I began to feel anger about being involved with the case, which I then pushed into denial. I realized in the following days that if I simply did not think of the situation, I wouldn’t be saddened by the loss.

My denial worked: It gave me the presumed strength to make it to the next day, the next question, and the next patient. As the weeks went on, I began to notice subtle changes in my mood. I felt as though I was getting through the days, writing notes, seeing patients, but my satisfaction decreased. My next rotation was psychiatry. I didn’t fully understand the implications of the different types of therapies implemented in the clinic but I wanted to learn what to prescribe to help my future patients.

The first week in, my preceptor asked if I wanted to participate in the mindfulness groups. This was just another task, another way to check a box, another thing that I needed to do.

Upon the first visit with the mindfulness group, I realized that this was not about just sitting in and listening to another lecture; instead it was about self-reflection and being engaged not just

in one’s own mind, but in personal growth. This personal growth did not have to directly revolve around knowing the pathophysiology of an endocrine disorder, but involved the simple act of being present in life. Over the next few sessions, I began to realize that I was no longer being present for patients because I was walled off against those around me, and I was in denial about the trauma I had seen the last month. Instead of taking in the pain and working through it, I held onto the thought that I needed to keep moving. Because I was reluctant to practice wellness in my life, I may have done a disservice to the patients I saw. Patients deserve the right to have a provider who is present and not, as I was, in denial of feelings surrounding patient encounters. Even as medical students, we need to fight burnout.

Implementing wellness as students can make the difference and help prevent the burnout I experienced in a mild form1 . I began to see mindfulness practices as a way to be aware of things happening in my own mind and body.

Had it not have been for my psychiatry rotation, I may not have been introduced to mindfulness. Through mindfulness, I was able to reexperience the pain of seeing the mother deliver and was able to be present with the thoughts and feelings I had around the situation. Despite never meeting this family before, I was in full denial. I avoided the thoughts, I was confused as to why I was present and I refused to try to cope. Since the

mindfulness practices, I have come to accept the tragedy that occurred. I have worked each day in small bits of time to overcome the avoidance of the situation. With mindfulness, I have been able to delve deeper into my feelings and see that though I am under stress, feeling overwhelmed and inadequate, I am enough. What I am doing matters.

I believe that mindfulness and overall wellness checks are the key to being the best patient advocate possible. I have found through my limited mindfulness experience that the best way to connect with patients is by being present. I want to be present not just with patients, but with peers and with myself to avoid the toxic grief and denial that is all too common. I felt alone and abandoned months ago in my rotation, and I never want my peers to feel the same. I feel as though it is my responsibility as a future provider to help my peers with the support they may need. In the future, with wellness and mindfulness exercises, I can continue to fight burnout. Perhaps being mindful for me today can be something as simple as enjoying a bit of Key Lime pie. Through mindfulness, I am able to find new and better ways to be in this world. ■ 1. Minor L. How Medical Schools Can Better Fight Burnout. The Wall Street Journal; September 12, 2017; New York, United States.

Healthcare is complicated.

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Contact me to discuss if owning your real estate is the right fit for you.

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COPIC’s “Three Cs” for improving health care Gerald Zarlengo, MD, Chairman & CEO, COPIC Insurance Company

As our advocacy team was planning for 2020, a standard question came up, “How does COPIC support and improve health care outside the coverage and resources we provide our insureds?” Our answers meandered through long, detailed examples of legislative challenges and sharing our knowledge with other stakeholders throughout Colorado. Due to the complexity of health care, these responses went down a common path. People took the time to fully articulate our efforts, detailed the various obstacles and opportunities, and analyzed how they contribute to the overall good.

It was a good discussion, but it made me realize that the bigger challenge is distilling these complex ideas down to a straightforward explanation. After some back-and-forth that took this into consideration, we hit upon a simple description: COPIC’s external advocacy can be defined in the context of Three Cs – convening, collaborating and contributing.

CONVENING is about serving as a catalyst to connect diverse stakeholders who offer an array of perspectives. Getting the right people in the room is often the biggest challenge, but it is an essential step for examining an issue to better understand the different parts and to recognize how different interests can align or conflict with one another. This collective view generates insight and action beyond what occurs when individual organizations operate on their own.

COPIC’s wide network in health care allows us to bring together voices from physicians, nurses, medical specialty societies, rural health care experts, patient advocates, health care system executives, health insurance providers and more. While technology has enhanced our ability to converse remotely, face-to-face interactions are critical to remind us that even though we are more connected than ever, our views can often be more fragmented and not informed by the valuable perspectives of others.

COLLABORATING focuses on utilizing the strengths and resources of those who come together to move ideas forward and develop the best possible solutions. I’ll admit, the term “collaboration” is often thrown around loosely in health care without much attention given to what it actually means. A recent

Harvard Business Review article1 noted, “One problem is that leaders think about collaboration too narrowly: as a value to cultivate but not a skill to teach.” I like this framing because it reminds us of the key skills needed to support effective collaboration: learn to listen (not just talk), practice empathy, be open to experimenting with others’ ideas, and allow judgment to give way to curiosity.

The article went on to say: “In successful collaborations, each person assumes that everyone else involved, regardless of background or title, is smart, caring and fully invested. That mindset makes participants want to understand why others have differing views, which allows them to have constructive conversations.” In health care, embracing this type of mindset is what will open us up to new, innovative thinking about how we address the challenges we face.

CONTRIBUTING refers to how we apply our expertise and experience to support our partners. COPIC stands in a unique position where the medical and legal worlds intersect. This provides us with access to information, such as claims data and best practices, that is valuable in identifying potential risks and allows us to develop programs or resources to address these.

However, this value is dependent on how well we disseminate our insight throughout the health care community. Every day, COPIC’s medical and legal experts come together to solve problems that our insureds encounter. We continue to take the information from these situations, analyze it on a broader level, and determine how we can contribute to improved care by sharing what we know with others.

The Three Cs represent a simple way to describe the complex work that COPIC and our partners engage in. It also represents one of the things I enjoy most about my role at COPIC – being able to see health care from a broader perspective. My view has expanded to be about “connecting the pieces” and understanding how decisions ripple through the health care system and impact providers and patients. And when we work together, the potential to accomplish great things moves from a lofty goal to a tangible reality. ■ 1. https://hbr.org/2019/11/cracking-the-code-of-sustained-collaboration

COPIC’s external advocacy can be defined in the context of Three Cs – convening, collaborating and contributing 3 4 C O LO R A D O M E D I C I N E

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S P OTLI G HT

What is private mortgage insurance?

Peter G. Garvin, Vice President, Business Development, Zenith Home Loans

The mortgage industry is full of different terms and numerous different types of insurance. We have the following types of insurance that appear in a mortgage transaction: PROPERTY INSURANCE Usually the home and contents; protects the consumer against loss.

FHA INSURANCE Protects the lender from loss in the event the borrower(s) default.

PRIVATE MORTGAGE INSURANCE Protects the lender from loss in the event the borrower(s) default on conventional loans with less than 20 percent down.

This article will focus on the third type of Insurance listed above, private mortgage insurance (PMI).

When you get a conventional loan (not FHA or VA government backed loan) and you put down less than 20 percent, your lender will require you to purchase private mortgage insurance to protect the LENDER in the event that you default on the loan.

The lender charges an annual premium to help minimize the risk associated with a default by the borrower(s). This annual premium is broken into 12 monthly payments and becomes an additive to the PITI monthly payment that you make to your lender.

P: Principal

You may request a cancellation of your private mortgage insurance policy once you reach 20 percent equity in your home.

This is determined by subtracting your outstanding loan amount from the market value of your property. Also, private mortgage insurance is automatically cancelled when your loan balance reaches 78 percent of the original value of your home. There are exceptions to these rules and these exceptions relate to the loan balance, type of loan (conforming or high balance), and past performance on monthly payments and credit of the borrower(s).

In the last issue of Colorado Medicine, we mentioned our newly designed “doctor loan” to assist young medical professionals with obtaining financing for purchasing a new home or to refinance an existing property. We highlighted the benefits of this program (5 percent down, loan amounts to $2,000,000, 720 FICO score, allows for exclusion of student debt and other options with NO PRIVATE MORTGAGE INSURANCE). Private mortgage insurance is not cheap, and it adds another component to your monthly payment. The cost for obtaining PMI can range from 0.5 percent to 5 percent. So, if we do the math and break this down to a monthly amount, let’s use the following example. Let’s say that you borrow $150,000 and the PMI percentage cost is 1 percent. That would be an annual amount of $1,500 or $125 per month added to your PITI payment. Wouldn’t it be great to not have to pay this amount every month?

Some of this may seem a bit confusing and you should always sit down with an experienced loan officer and ask any questions that you may have about private mortgage insurance or any other components of the mortgage loan process.

I: Interest T: Taxes I: Insurance (homeowners)

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From clinic to Capitol: Medical student engagement in the era of political polarization Jacob Leary, MD Candidate, Class of 2022, University of Colorado Medical School

Walking into the Capitol Café, the anxiety was palpable as 50 medical students from Rock y Vista University College of Osteopathic Medicine and the University of Colorado School of Medicine slipped into their white coats to storm the Capitol. Students huddled together, working earnestly to rehearse talking points and understand the language of HB20-1085. As the lunch hour drew to a close, our optimism and confidence grew, but we couldn’t shake feeling nervous to meet with legislators.

Why? Because we wanted to do this right.

As representatives of the Colorado Medical Society and our respective academic institutions, we wanted to make them proud of the student doctors we have become thus far. But more important, we came on behalf of the 578 Coloradoans who died in 2017 from complications relating to opioid overdoses, and the thousands of others struggling to achieve pain relief. HB20-1085: Prevention of Substance Use Disorders would expand insurance coverage of physical and occupational therapy visits or acupuncture visits as viable alternatives to prescription opioid medications for pain relief. Many of us have seen tremendous patient responses with these therapeutic avenues, but prohibitive out-of-pocket costs for these types of treatments can leave patients and providers with few options. We also requested that legislators consider providing resources to update the Prescription Drug Monitoring Program (PDMP) so that it can be integrated into existing electronic medical record systems for 3 6 C O LO R A D O M E D I C I N E

Although members from each party took issue with certain details of the bill, the desire for collaboration and a mutually agreeable solution was evident. ease of physician access in order to provide more time for doctors to interact with their patients. Together, these improvements to the current system would strengthen the physician-patient alliance in the fight against the opioid crisis in Colorado.

We hit the ground running in our meetings with House and Senate members.

Despite our initial worries over pitching our case to legislators, we spoke as convincing and passionate leaders advocating for our future patients. Republican or Democrat, the legislators generously gave us their time and took our concerns seriously. They were genuinely excited to spend time talking with students.

When they disagreed with an aspect of our pitch, it was amazing to see the courage students showed in challenging legislators to justify their stances and to reconsider their positions. Although members from each party took issue with certain details of the bill, the desire for collaboration and a mutually agreeable solution was evident. In a political landscape where aggressive discourse is now the norm, we found it refreshing to see collaborative efforts.

In talking with other students who attended, I was told this was one of the most invigorating things they had done as medical students. They felt empowered to know that legislators were so approachable and that they actually wanted to hear from us to help inform their policy decision-making. It was impressive to see the excitement and enthusiasm evident in

students’ conversations with legislators, and many are already working to make next year an even bigger success with a focus on access to quality health care.

Between adjusting to the fast-paced medical curriculum, studying for board exams and completing clinical rotations, it can be difficult to encourage medical students to participate in policy and advocacy work. But we come anyway because we care – because we know how important it is to show up and be heard, and to build relationships with the people who influence how our future practice takes shape.

In the rapidly changing landscape of medicine, it is imperative that we be at the forefront of shaping the development of health care policy so that we can lend our voices in defense of our patients and of ourselves as practitioners. With the emergence of public insurance options, glaring inequalities in access to care, and staggering health care costs that continue to rise, we are becoming physicians in one of the most exciting and consequential periods in health care history. Engagement now as students trains us to be confident and passionate legislative activists long into our future careers. As the current CMS Board of Directors member representing the Medical Student Component, I feel extremely privileged to serve an organization that continuously strives toward excellence in support of patients and physicians across our great state. ■

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