May-July 2021 Colorado Medicine

VO LU M E 1 1 9 N O . 2 M AY-J U L 2 0 2 1

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

UNDER THE GOLDEN DOME:

RELENTLESSLY FIGHTING FOR PHYSICIANS

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C O N T E N T S

FIGHTING FOR YOU UNDER THE GOLDEN DOME The Colorado Medical Society has your back now and in the future. No place is this more apparent than in our advocacy efforts surrounding the Colorado Option and other health care bills being considered by the General Assembly in 2021.

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F E A T U R E S

D E P A R T M E N T S

8 CMS LAUNCHES PARTNERS IN MEDICINE

14 Reflections: Strangers

The new Partners in Medicine Program connects trusted, vetted and valuable companies with CMS members to aid physicians in achieving personal and professional satisfaction. Explore these companies and what they can do for you.

10 AFTER ACTION REPORT The Colorado Medical Society honors the sacrifices physicians and other health care heroes have made in the past year. As things return to some state of normal, this report documents the major projects, products and services produced by CMS for Colorado physicians.

24 FINAL WORD: PARTNERS ON POLICY AND PRACTICE Eric Speer, MBAHA, FACMPE, chief administrative officer for Centeno-Schultz Clinic, explains how he has worked as a practice administrator and board member of the Colorado Medical Group Management Association on legislation and policy to reduce administrative burden and increase patient safety.

16 Reflections: Realizing our truth 18 COPIC Comment: COPIC Medical Foundation 20 Introspections: Ignorance is bliss 22 Partners in Medicine Spotlight: New legislation that impacts your practice 23 Introspections: Poems from the heart of a medical student

I N S I D E

C M S

4 President's Letter

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 2020-2021 OFFICERS

BOARD OF DIRECTORS

AMA DELEGATES

Sami Diab, MD President

Brittany Carver, DO Rachelle Klammer, MD Chris Linares, MD Evan Manning, MD Michael Moore, MD Edward Norman, MD Lynn Parry, MD Patrick Pevoto, MD, RPh, MBA Leto Quarles, MD James Rager, MS 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

Mark B. Johnson, MD, MPH President-elect Patrick Pevoto, MD, RPh, MBA Treasurer Bryan Campbell, FAAMSE Chief Executive Officer David Markenson, MD, MBA 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

Emily Bishop Director of Government Affairs Emily_Bishop@cms.org

Ms. Gene Richer, M Ed, CHCP™ Director of Continuing Medical Education Gene_Richer@cms.org

Kate Alfano Communications Coordinator Kate_Alfano@cms.org

Dianna Fetter Senior Director of Business Development Dianna_Fetter@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Marna Steuart, CPA, CFE, CIDA Director of Finance Marna_Steuart@cms.org

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

Krystle Medford Senior Director of Membership Krystle_Medford@cms.org

Tim Yanetta Manager of IT/Membership Tim_Yanetta@cms.org

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

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

Bryan Campbell, Executive Editor; Kate Alfano, Managing Editor; and Dean Holzkamp, Assistant Editor. Design by Scribner Creative.

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Printed in USA/December 2020

I N S I D E

C M S P R E S I D E NT ’ S

LE T TE R

CMS has your back Sami Diab, MD, President, Colorado Medical Society

We need all of your voices.

I encourage you to spread the word among any colleagues who are not CMS members.

Join us!

The Colorado Option plan, HB21-1232, has dominated the 2021 legislative session, and for good reason. It is a monumental bill that aims to provide a lower-cost option for health insurance on Colorado’s health insurance exchange. Physicians, as the ones who work all hours of the day and night to care for patients, had to have a voice in shaping the plan and its execution.

Fortunately, the Colorado Medical Society is the highly respected voice of physicians at the Capitol. We have been in discussions on the proposal since 2019, working to protect physicians, your patients and your practices from any negative consequences of the bill and work in good faith to ensure it improves access to affordable, quality and safe health care.

I am thankful to all of the physicians who heeded our calls to action to urge legislators through testimony and personal outreach to remove a mandate for physician participation from the Colorado Option. Neither Medicaid nor Medicare, nor any commercial health plan anywhere in the United States mandates physician participation, and we knew it would be problematic to a healthy and robust physician workforce and access for our patients.

Because of the combined efforts of our members and CMS policy and advocacy team, an amendment to the bill passed in the last week of May that eliminates the physician mandate by removing all enforcement, fines and reporting to regulatory boards for health care providers. CMS worked unceasingly with bill sponsors and the commissioner of the Division of Insurance to negotiate the amendment and, as of press time, the bill is awaiting a vote in the House before heading to the governor.

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Importantly, we have committed to working with the Division of Insurance to help educate physicians about the program and how key their voluntary participation will be for patients, while ensuring that their practices remain viable, important parts of the community.

You should feel confident that we have your back as this bill goes through the rule-making process, and we continue to watch out for physicians as other health-care-related bills that will affect the practice of medicine arise this session and in the future. We do think that more work is needed to address the root causes of rising health care costs, such as encouraging better quality and utilizing alternate payment models that focus on patients. CMS will continue to work on these issues so that all Coloradans can get access to the care they need.

The bottom line is CMS works hard on our behalf to ensure the best outcome for our patients and our practices. Your membership makes a difference, adding strength in numbers and opening up opportunities to share your thoughts on how bills affect you and your patients. We need all of your voices. I encourage you to spread the word among any colleagues who are not CMS members. Join us!

Thank you for your commitment to health. Stay well. ■

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C OV E R LE G I S L ATI V E

U P DATE

Under the Golden Dome: A report on the Colorado Option and CMS’s other legislative priorities Emily Bishop, Director, Division of Government Affairs The COVID-19 pandemic wreaked havoc on the legislative session initially, but after a month-long recess in January and February, the Colorado General Assembly has conducted business mostly as usual, save for hybrid arrangements and testimony options to encourage public participation from afar.

With the 120-day session nearly over, health care issues have continued to be a dominant theme, with bills on topics ranging from the public option to public health responses, from prescription drug costs to use of ketamine in law enforcement situations, and from credentialing administrative hassles to alternatives to opioids. The Colorado Medical Society has been actively engaged in myriad issues on behalf of physicians and the patients they serve.

HERE ARE A HANDFUL OF PARTICULARLY INTERESTING BILLS THAT ALIGN WITH CMS’S LEGISLATIVE PRIORITIES:

THE COLORADO OPTION PLAN

SCOPE OF PRACTICE

MEDICAL LIABILITY ATTACKS

CMS has been working tirelessly to represent members’ interests on HB21-1232 Standardized Health Benefit Plan Colorado Option. CMS strongly opposed the early versions of the bill, which included mandatory physician participation and rate setting. Following months of goodfaith negotiations with bill sponsors, CMS successfully secured an amendment eliminating mandatory participation by removing all enforcement, fines and reporting. The success was due in large part to the hundreds of physicians who testified, wrote and called their legislators. CMS remains fully engaged and will closely monitor this bill through the final stages of the legislative process and subsequent rulemakings.

Proponents of HB21-1184 PA Collaboration and Reimbursement cited access issues in underserved and rural communities as justification for this bill, which would have allowed independent practice by physician assistants. CMS successfully killed the bill, highlighting training differences between physicians and PAs and the valuable role PAs play in their current team-oriented positions.

SB21-061 Claims for Economic Damages Claimed by Minors, SB21-073 Statute of Limitations Sexual Assault, and HB21-1188 Additional Liability Under Respondeat Superior all seek to increase the liability exposure physicians and employers may face.

Current status as of publication: Passed the House and Senate; awaiting action in the House CMS position: Neutral after CMS-supported amendment removing mandatory participation was adopted in the Senate

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Current status as of publication: Killed by House Health & Insurance Committee

Current status as of publication: SB21-061: killed; SB21-07: favorably amended and signed by the governor; HB21-1188: some amendments added and signed by the governor

Council on Legislation position: Strongly opposed

Council on Legislation position: Strongly opposed

TIMELY CREDENTIALING OF PHYSICIANS BY HEALTH INSURERS A collaborative effort by CMS, the Colorado Medical Group Management Association, and Colorado Health Plan Association, SB21-126 seeks to streamline the credentialing process for physicians, setting 60-day timelines and requiring communications between the plans and applicants throughout the process. The bill has widespread support and is the result of two years of negotiations.

Current status as of publication: Passed the Senate and the House and is awaiting the governor's signature Council on Legislation position: Strongly support PROTECTIONS AND TRAINING FOR PUBLIC HEALTH OFFICIALS AND EMPLOYEES HB21-1107 Protections for Public Health Workers and HB21-1115 Board of Health Member Requirements are both a result of the COVID-19 pandemic. HB21-1115 seeks to require annual training for health board members, while HB21-1107 prohibits the sharing of public health workers’ personal information, similar to law enforcement officials.

Current status as of publication: HB21-1107 was signed by the governor; HB21-1115 passed the legislature and is awaiting the governor's signature Council on Legislation position: Strongly support

EXPANDING THE PDMP Currently, the PDMP is a tool to prevent substance use disorders in patients.

Proponents of HB21-1012 seek to include all prescription drugs in the PDMP. COL is concerned that this will dilute their program’s effectiveness and potentially increase the cost of administration.

Current status as of publication: Passed the House and the Senate with amendments; awaiting the governor's signature Council on Legislation position: Strongly opposed TELEHEALTH FOR MEDICAL MARIJUANA HB21-1058 Promoting Social Distancing in the Marijuana Industry would allow physicians to recommend medical marijuana via telehealth. CMS has serious concerns about the safety of this proposal and the CMS Board adopted new policy, partly in response to this bill, regarding medical marijuana.

Current status as of publication: Killed by House Finance Committee Council on Legislation position: Strongly opposed

Additional bills that CMS and COL are actively working include drug price affordability measures (SB21-175), state health care reser ve corps suppor t (HB21-1005), telemedicine (HB21-1190, HB21-1256), appropriate use of chemical restraints (HB21-1251) and regulating marijuana concentrates (HB21-1317).

As of publication, COL has taken positions on 37 bills – all of which were identified as priorities through member input.

You can follow the legislative session and work of COL by visiting the CMS bill tracker at www.cms.org/advocacy/billtracker. Watch for a complete analysis of the first regular session of the 73rd General Assembly in the next issue of Colorado Medicine. ■

AN UPDATE ON PEER ASSISTANCE

Two years of advocacy work to ensure conf identialit y of peer assistance counseling for Colorado physicians came to a head at the May 20, 2021, meeting of the Colorado Medical Board when a new policy was approved. This issue has been a critical advocacy priority for Colorado Medical Society this year and the new policy provides important wellbeing and patient safety protections for physicians, physician assistants and medical students.

The new policy, 10-28 Confidential Assessment and Monitoring of Voluntary Treatment through the Designated Peer Health Provider, delivers important safeguards for voluntary participants who comply with treatment plans and have not compromised patient safety or caused patient harm, requiring confidential assessment and monitoring by the peer health provider.

Learn more at dpo.colorado.gov/ Medical/Laws Thank you to the physicians and medical students who have engaged in countless ways to convey the importance of this issue on their profession and ability to ser ve patients. CMS has helped lead the charge to protect confidential counseling services, collecting more than 3,700 petition signatures, testifying at public stakeholder meetings, organizing letter-writing campaigns, and pursuing legislative solutions should the board process fail.

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

F E A T U R E

Colorado Medical Society launches Partners in Medicine BRINGING TRUSTED, VETTED, VALUABLE RESOURCES TO CMS MEMBERS Dianna Fetter, CMS Senior Director of Business Development The Colorado Medical Society is excited to launch its new Partners in Medicine (PIM) Program. Founded in 2020, Partners in Medicine is a forum to develop an open dialogue and connection between industry leaders and physician members of the Colorado Medical Society in the furtherance of patient care and helping physicians achieve personal and professional satisfaction.

CMS has par tnered with a host of respec ted and leading health care industry and wellness providers to offer services in many areas of physician need.

Current offerings cover HIPAA compliance, practice staffing and management, mental health resources, financial assistance and advice, telehealth, billing, transcription and even travel planning.

And we’re growing, adding new Partners throughout the year! View examples on page 11.

CMS created Partners in Medicine to ease the burden on our members by researching member needs and vetting companies to ensure that their offerings and services meet and exceed the standards set by our Society.

In March 2021, 15 partners met on a virtual call with CMS staff to describe their products, vision and enthusiasm about being part of this innovative project. It was clear that they truly respect and admire what physicians do each day. Many have worked with physicians for decades and want to be part of that calling to humanitarian service that is at the heart of delivering quality health care. They also want to take care of health care professionals.

CMS staff and partners alike nodded along on the Zoom call as peers made comments such as “let physicians do what they do best, and we can ease the burden on a physician/practice by providing useful tools and services;” and “we can be a one-stop shop for physicians to save them time and resources;” and “physicians are my people!”

coming together on the March call, many appreciated learning about the broad offerings of other partners. They each look forward to working with physicians and their practices.

There are multiple ways for members to access information about these valuable services, chiefly through our website and brochure. We encourage each physician and practice to take the time to learn about our Partners in Medicine and how they can benefit you! Potential par tners can contact dianna_fetter@cms.org for more information on the application process. ■

The enthusiasm around this partnership is palpable and CMS hopes this endeavor will add great value for our members and truly make a difference in let physicians do what they do best, and we physician wellness and practice satiscan ease the burden on a physician/practice faction. Each partner is unique and,

by providing useful tools and services

Learn more from and about our Partners in Medicine through Lunch and Learn series

PARTNERS IN MEDICINE

Colorado Medical Society is proud to present the new CMS Partners in Medicine Lunch and Learn Series. Join CMS for this monthly virtual program as our partners talk about a hot topic in medicine and medical practice.

Upcoming events: • HIPAA Compliance with Abyde – June 9, 12-1:30 p.m.

• Telehealth with Hippo Health – June 23, 12-1 p.m.

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

Register at www.cms.org/events

VALUABLE CMS MEMBER RESOURCES Go to cms.org/partners for additional services available,

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For additional information on the offerings through the Partners in Medicine Program, contact Dianna Fetter at dianna_fetter@cms.org C O LO R A D O M E D I C I N E 9

E F E ATU R

Kate Alfano, CM

S Communicat

ions Coordinato

r

Summer in Colorado has brought a new sense of relief to many, not just as nature comes back to its fullest vibrancy after the darkness and cold of winter, but as more Coloradans age 16 and over are receiving COVID-19 vaccines, businesses are reopening and people are able to gather again faceto-face. It’s not necessarily a return to normal as physicians bear the battle wounds of a challenging year, but as we move out of the chaos and into the future, the Colorado Medical Society would like to revisit the actions taken to address members’ needs. We have accomplished a lot together and there is still much left to do.

INTERNAL PROCESSES

Created a COVID-19 microsite within CMS.org to provide the latest information in nine categories: Testing, care protocols and guidance, telehealth, PPE/supplies, financial support, workforce issues, physician wellness, payer issues and vaccine updates – with CMS staff curating a different category throughout the year.

12 VIRTUAL PHYSICIANS’ TOWN HALLS 7 VIRTUAL GRAND ROUNDS Became experts in webinars, hosting 12 virtual Physicians’ Town Halls and seven Virtual Grand Rounds on COVID-19 topics, and five focused topic-specific webinars. Physicians who attended all of these events earned up to 16 AMA PRA Category 1 Credits™ and seven COPIC Points.

Published guides and primers for Colorado physicians on how to:

• • • •

apply for PPP loans and financial assistance reopen your medical practice resume elective and voluntary procedures implement new paid leave laws

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500 PHYSICIANS

AND PRACTICE STAFF Launched a COVID-19 discussion forum through the Basecamp platform that, at its peak, allowed more than 500 physicians and practice staff to share best practices, resources and boots-on-the-ground experience – particularly in the early pandemic.

22 MEDICAL

SPECIALTY AND COMPONENT SOCIETIES UNIFIED Unified 22 medical specialty and component societies – the Colorado House of Medicine – to magnify our influence and best serve Colorado physicians. This partnership carried on through the pandemic into our advocacy and public policy work in 2020 and 2021. See page 19 for the members of the House of Medicine.

ADVOCACY

Launched the Policy Pulse e-newsletter to keep members in the know about all the happenings at the legislature.

Fought to defend confidentiality in physician peer assistance counseling through letter w r i t i n g , s i g n a t u re g a t h e r i n g , te s t i m o n y, and preparations for potential legislative or legal challenges.

Supported legislation to help physician practices and improve patient health and safety:

• • • •

expanded telehealth defended physicians from dangerous scope of practice expansions increased regulations around vaccine exemptions worked to protect physicians while increasing access to care in the public option

AIDING PRACTICES

121,980 PIECES OF PPE DELIVERED

Spearheaded a bulk order and distribution of personal protective equipment at competitive prices to Colorado physicians when these materials were in short supply or skyrocketing in price. A total of 121,980 pieces were delivered around the state. Later CMS sought a partnership with ActionPPE to ensure ongoing availability and reliable shipments of PPE; orders can still be fulfilled presently.

Partnered with Children’s Hospital Colorado and the Colorado Department of Public Health and Environment to get physicians and their staffs vaccinated against COVID-19 when vaccine appointments were sparse.

216 VOLUNTEER

Created the Partners in Medicine program and Par tners in Medicine Lunch and Learn webinar series to connect physicians with vetted companies providing services to improve practice operations and personal wellbeing.

Partnered with CDPHE to get COVID19 vaccines into private primary care physicians’ offices to leverage the physician-patient relationship and reach underserved populations.

CONTACT TRACERS

Coordinated a contact tracing volunteer program to mobilize 216 volunteer contact tracers in local health departments early in the pandemic.

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

F E ATU R E S A F TE R AC TI O N R E P O R T: C O N T

MEMBERSHIP

Opened all CMS committee and board meetings to the full membership for greater transparency and engagement.

Developed a strategic plan and operational plan that will prioritize diversity, equity and inclusion; help to protect physicians’ rights to confidential counseling; and focus on membership retention and engagement and increasing membership.

Provided financial help for physicians in need through CMS’s Jane Nugent Cochems Trust.

Created the membership concierge help desk: “Ask us any thing” by emailing membership@cms.org.

EDUCATION OF THE PUBLIC

Released a public service announcement in partnership with the American Medical Association on COVID -19 prevention measures for the general public.

Launched #CMSWhatsYourWhy to raise awareness of the COVID-19 vaccines and reduce hesitancy among patients.

PHYSICIAN WELLNESS

Partnered with the Colorado Physician Health Program, COPIC, Colorado Hospital Association and Colorado Psychiatric Society on the COVID-19 Care Line for Physicians to ensure access to peer support.

Expanded the work of the CMS Physician Wellness Committee.

Began a CMS Physician Mindfulness Group to share strategies for improving quality of life. ■

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CMS shared the stories of many Colorado physicians as they quickly adjusted to public health recommendations and new patient preferences. We followed up with them to see how they had fared over the past year and what changed in their practices.

Vinh Chung, MD, author of “Leaders eat last,” Colorado Medicine May/June 2020, wrote about staff pulling together to help each other.

“When essential services were halted, many on our team voluntarily made sacrifices so that we could make it through as one team. We dug deep into our values of humility, integrity, and excellence. Not only did we come through stronger, but we are more determined to live out our mission to make a positive impact on our patients, our community, and our world. Our team has grown, we have opened more offices, and we have increased our humanitarian work locally and around the world.”

Brandi Ring, MD, author of “Adapting care and protocols during the pandemic,” Colorado Medicine May/June 2020, wrote about providing obstetrics care that could not be halted or delayed.

“Phone and video visits have changed the way patients can interact with their doctors…. Patient convenience and compliance are prioritized, while compassion and caring can still be provided in abundance. Innovation has been created out of necessity and now that the systems have been built, their convenience will continue to keep them operational. While the storm has been destructive, the silver lining has been deeper connections with those closest to us, our families, those families both by blood and by choice. Close friends have become closer and those of us who weathered the storm together have connections only forged through a collective experience of survival.”

John Bender, MD, MBA, author of “In the trenches: COVID-19 in a family medicine clinic," Colorado Medicine May/June 2020, wrote about hunting PPE, spinning up testing and furloughing staff to stay afloat.

“We used our Paycheck Protection Program funds to hire our furloughed staff back, and to transition to an employee-owned company. We used our CARES Act moneys to launch COVID antigen testing and antibody testing; we added contactless prescription vending machines in the lobby where the chairs used to be; and we deployed a medical van that could bring technology to patients who could not access telehealth.”

Mary Jo Heins is a former medical practice manager and past president of Colo MGMA. As an independent Medicare insurance agent, she now helps people with all facets of Medicare – objectively and fee free.

“Over the years I watched my patients struggle with what type of Medicare plans to select for their particular needs. As I approached going on Medicare, I did not relish wading through the choices. My burden was lifted when I started working with Mary Jo Heins.

Working with Mary Jo has been the most pleasant experience I have ever had in selecting an insurance program for me or my practice group. I trust her knowledge and advice so much that I have referred my patients, colleagues, friends and neighbors to her. My office manager was right – she is ‘the best.’”

– Michele A. Velkoff, MD • Enrollment in Medicare Parts A & B • Supplement v. Medicare Advantage • Rx plans – mapping medication regiments to the best formulary • Dental/hearing/vision plans • Education sessions via Zoom 303-916-6992 www.medicareinsurancedenver.com

C O LO R A D O M E D I C I N E 1 3

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

Strangers Samantha Conner

Ref lec tive writing is an impor tant 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.

Samantha is currently finishing her third year of medical school at the University of Colorado School of Medicine, with plans to go into pediatric and adolescent gynecology. She was born in Milwaukee, Wis., and attended Marquette University where she studied psychology and biology, with research focusing on the role of ambivalent sexism in stereotypes against lesbian and bisexual women. She is inspired and supported by her family and partner. Outside of medicine, she loves music, podcasts and practicing art through nail design.

2 a.m., and I heard the overhead announcement right as half a dozen pagers start buzzing, “Trauma Activation: Red 1, 5 minutes out.” I grabbed my N-95 and ran to the emergency department, excited for what I might get to see.

Standing in the trauma bay, as soon as I saw the paramedics bring in the stretcher, my heart dropped. I don’t think I will ever get used to the sight of a naked body being crushed under the force of CPR....

Or at least, I hope I don’t get used to it.

A black male, age in early 30s, had been shot twice in the chest. He had lost spontaneous cardiac activity en route to the hospital, but he had some signs of spontaneous activity in the trauma bay.

Every fluid and blood product in the ED was being pushed through a 14g IV. So many types of medications were pushed,

1 4 C O LO R A D O M E D I C I N E

my third-year medical student brain was spinning. The trauma team did initial stabilization and then rushed him to the elevator to get him up to the operating room, but during transit he crashed again.

In a last-ditch effort, in the elevator, they performed a procedure with a 2 percent survival rate – a clamshell thoracotomy.

As he was brought into the OR, the trauma surgeon was holding this man’s heart in his hands, performing cardiac massage.

I watched for 40 minutes as the team went down every route they could think of to try to save him. They transfused over 30 units of blood and pushed countless bags of crystalloid. They tried every life-supporting med, every maneuver, and they explored his entire thorax looking for something to fix that could bring him back. About 10 minutes in, the trauma fellow yelled across the OR, and asked

the other med student and me, “do you want to come do this cardiac massage?”

The next couple of minutes were a blur as I scrubbed in quickly. But the next thing I remember, something that is burned in my memory forever, I was holding a man’s heart in my hands. With every squeeze, I was forcing blood forward through his vessels.

I remember feeling a chill, even though the room was probably about 85 degrees.

I was looking at this man’s face, his necklace, his tattoos... and holding his heart in my hands. He would never know me.

At some point, the trauma team stopped.

They couldn’t have been silent for more than three seconds, but it felt like an hour.

Despite being only two weeks into my third year, I knew that if a trauma team stopped working, it meant something was wrong.

COLORADO EST.

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members.cms.org/join The fellow looked at the other surgeons and asked, “Anyone have any other ideas?” And one by one they shook their heads. He was then declared dead, just about an hour and a half after I first heard those pagers. I spent the next bit of time helping to clean his lifeless body. I used a wet rag and scrubbed at the iodine, revealing his scars and tattoos; names of people I would never know, symbols that once meant something to this man on the table. Around his neck was a gold necklace. I wiped off the blood and placed it gently around his neck.

I walked out of the room, so this nameless man could be taken to the coroner. I can still see his face and feel the warmth leaving his body. He will never know me, nor will I know him. ■

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C O LO R A D O M E D I C I N E 1 5

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

Realizing our truth Brandi Krieg

Brandi Krieg grew up riding horses, pushing cattle, and stacking hay on a small ranch on the Western Slope. After high school, she went on to study exercise and sports science and ran four years of track and cross country at the University of Tulsa. She knew she wanted to be an orthopedic surgeon the first time she stepped into the operating room. Eventually, she hopes to spend time working in global health and, down the road, return to practicing in the rural Colorado that she still calls home.

Sitting in the pre-op bed, she was lacking the typical apprehension embodied by a person waiting for surgery. My experience was limited to injured athletes and older patients with the hints of doubt that surgery really was the best solution to alleviating pain. Under such circumstances, the notion of being "put to sleep and cut open" might shake anyone’s concept of normal.

After the resident introduced us, the patient asked how we were doing, as if we were long-time friends meeting for a cup of coffee. Something about her was so sincere, I felt I could tell her the truth about my own fear that surgery was a mistake. My mind was fixed on the steps of the surgery and the anatomy, narrowly focused to the task at hand as I had trained myself to be from all my years of racing on the track and on cross-country courses. In meeting her, I had to step back

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and remind myself that she was a human being. This was more than surgery; it was the opportunity of her life.

That day, I experienced the arrogance of thinking I could find a way to relate to anyone. I faced the notion that I was not immune to the hidden bias that comes from making assumptions. I was humbled as I came to the realization that her life experience and decision to have surgery were things I did not understand.

we all show up in life as a culmination of every beautiful and terrible experience that shapes us. We are not exempt from experiencing the pains of our mothers and fathers. To be human is to carry that weight while taking in and giving away as much joy as possible, as we find a way to become our true selves.

I chose to revisit the woman who was challenging my own thinking. I was nervous about taking advantage of her situation, as she was trapped in a hospital bed subjected to the endless inquiries of a medical student.

After the surgery, I was immersed in reflecting on the unsettling thoughts I had to acknowledge. Why could I not find a way to understand her? Though I had We conversed like we were at that coffee long felt that my true calling was to be the shop; and as she shared more of her story hand holding the scalpel, it never stopped with me, I found the courage to ask her, me from being completely fascinated by “How did you know?” She explained to the complexity of the human experience. me that I had to imagine my mind being There is peace in accepting that people trapped in a body that did not make are doing the best they can, and that sense; my mind at odds with my body,

SEPT. 17-18

unable to relate to the flesh to which I was tied. On some level, I was beginning to understand.

Still, there was more to her story that I needed to unravel, “How did you lose all the weight?”

She smiled graciously, “I gained all this weight because I didn’t care about my body. I hated this body and wanted to escape it. Why would I try to take care of something that wasn’t me?” For the first time, she had hope that she could love her body.

The next day, I felt compelled to apologize for putting her on the spot. She smiled at me, “Of course not, I enjoyed our conversation. Still, know that some people won’t want to talk about it. They aren’t comfortable or ready, but it’s okay to ask. I have made peace with who he was.”

She valued the man she was in her past and found the strength to love her body enough to improve her state of health.

She showed me that her grace and kindness came from the scars she wore as part of his struggle to find that she was always her truth.

We are all trying to live our lives in the best way we can. All of us are working with pieces of our lives that we wish were a better fit. We fight battles and wear the scars in our own ways. We strive to accept and understand our fellow human beings for who they are, but in our own internal conflicts, sometimes we fail. Our intentions to be unbiased are imperfect because we have our own stories. We must maintain our humility, be honest with our imperfections, and find the grace to reflect, understand and try. To realize the truth of being human is to acknowledge how we find strength in understanding each other as we see the beauty in living our imperfect lives. ■

151st Colorado Medical Society Annual Meeting (virtual) The annual meeting is the signature event of the Colorado Medical Society, our opportunity to celebrate Colorado physicians with awards and recognitions, and welcome incoming president CMS President Mark B. Johnson, MD, MPH.

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C O LO R A D O M E D I C I N E 1 7

D E P A R T M E N T S C O M M E NT

COPIC Medical Foundation 2021 GRANTS Gerald Zarlengo, MD, Chairman & CEO COPIC Insurance Company

The COPIC Medical Foundation was established in 1991 to provide charitable financial support to programs and initiatives that address health care issues. Over the years, it has provided more than $10 million to improve patient care and medical outcomes, primarily through grant funding. After conducting a comprehensive strategic planning process in 2019, the Foundation implemented a new goal statement: To be a catalyst in improving the quality of health care delivery by reducing adverse outcomes and supporting innovation.

This goal included a refined focus on a more proactive funding model that centered on data analysis and evaluation of projects for grant consideration for the first 12-18 months. This will allow us to learn from these projects about where our support can have the most significant impact in patient safety and reducing adverse outcomes.

The 2021 funding cycle focused on initiatives designed to reduce fragmentation across care settings. A top concern in patient safety, breakdowns in care from a fragmented health care system can lead to readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and reduction in quality of care leading to general patient and provider dissatisfaction.

The 2021 cohort of grantees include five incredible organizations of varied size and scope that impact health care in communities across the country. This year, the COPIC Medical Foundation granted a total of $775,000 in grants focused on reducing fragmentation across care settings. Grants support the following projects:

•

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Children’s Health Fund (New York and national) – A review, update, and dissemination of the successful Referral Management Initiative to incorporate new technologies to enhance care coordination procedures for pediatric populations living in under-resourced communities.

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Children’s National Medical Center (Washington, D.C.) – Improving coordination of pediatric mental care after psychiatric hospitalization.

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Kansas Healthcare Collaborative (Kansas) – AlignAllHealth: A collaborative tool that combines all health information technology with highly trained clinical and care management staff to support innovative and datadriven care management processes for high-risk patients.

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Mile High Health Alliance (Colorado) – The “Orange Flag” Project: Using historic, predictive and real-time data to inform emergency depar tment personnel of a patient’s high utilization of emergency services to aid in care coordination.

Children’s Hospital Colorado Foundation (Colorado) – The ImPACT Navigation Hub: A centralized resource hub to coordinate the transition of young adult patients with pediatric onset conditions to adult care.

“The COPIC Medical Foundation is proud to support those in health care who are making a difference and pushing innovative ideas forward,” said Meredith Hintze, executive director of the COPIC Medical Foundation. “Our grant funding helps support solutions that can improve patient safety in ways that can be replicated across health care and/or create additional opportunities for expanded applications.”

The Foundation plans to remain focused on funding projects that reduce fragmentation across care settings for its next grant funding cycle. We anticipate that the next Request for Proposals (RFP) will be posted in November 2021 with applications due mid-January 2022. For more details on the COPIC Medical Foundation, please visit www.copicfoundation.org. ■ 1 8 C O LO R A D O M E D I C I N E

WITHIN NORMAL LIMITS COPIC'S PODCAST

Within Normal Limits: Navigating Medical Risks – hosted

by Eric Zacharias, MD, an internal medicine doctor and physician risk manager with COPIC – now has more than 20 episodes available. Each episode is around 20-30 minutes and features a discussion with physician leaders and/or medical experts that offers insights to improve care and avoid medical liability issues. Examples of episode topics include: Telehealth: The Evolving World of Remote Care Cultivating a Culture of Safety An Inside Look at How the Colorado Medical Board Responds to Complaints Considerations with Opioids and Pain Management – A Surgeon’s Perspective Within Normal Limits is available on popular platforms such as Apple Podcasts, Google Podcasts, Spotif y, and Amazon. You can also go to www.callcopic.com/ wnlpodcast for more information.

Arapahoe-Douglas-Elbert Medical Society American Academy of Pediatrics, Colorado Chapter Aurora-Adams County Medical Society Boulder County Medical Society Colorado Academy of Family Physicians Colorado Chapter - American College of Cardiology Colorado Chapter - American College of Emergency Physicians Colorado Chapter - American College of Obstetricians and Gynecologists Colorado ENT Society Colorado Medical Society Colorado Orthopaedic Society

Colorado Psychiatric Society Colorado Radiological Society Colorado Society of Anesthesiologists Colorado Society of Eye Physicians and Surgeons Colorado Society of Osteopathic Medicine Denver Medical Society El Paso County Medical Society Foothills Medical Society Mesa County Medical Society Northern Colorado Medical Society Pueblo County Medical Society

United in amplifying our advocacy for Colorado physicians and patients | membership@cms.org C O LO R A D O M E D I C I N E 1 9

D E PA R TM E NT S I NTR O S P E C TI O N S

Ignorance is bliss 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.

Anne George

Anne George is a third-year medical student at Rocky Vista College of Osteopathic Medicine in Parker, Colo. She completed her undergraduate education at the University of Texas at Austin where she received her Bachelor of Science in Biology with a minor in business. She wishes to pursue a residency in internal medicine and perhaps go on to complete a fellowship in geriatrics.

In her free time, Anne loves to go running, play the guitar, or hike anywhere in the beautiful state of Colorado.

There’s that saying, ignorance is bliss. As a medical student, you’re taught differently. You’re told to give the patient all the information – no holding back. But when my grandfather asked me if he was going to get better after returning from an extended stay in the hospital, I felt there to be no truer statement. So, with a big smile plastered on my face and a gentle squeeze of the hand, I quickly assured him that he would be up and about in no time before hurriedly distracting him with his favorite – diet coke and a spoonful of sugar.

We never told him he was on hospice care. Partly because we ourselves didn’t really want it to admit it – as if saying it out loud would finalize the death sentence.

It was the beginning of the COVID-19 pandemic. Tensions were high, hospitals were near capacity, and doctors were functioning on dangerously high levels of caffeine. The plight of an old man who had lived 94 very long and happy years was the least of their concerns. I mean, after all, that’s life, right? You live, over time your body decays, your organs begin to fail, and there is nothing that even modern medication can do to stop it. During his hospital stay, I remember speaking to a physician who shrugged his shoulders and said, “well, he’s lived

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a good long life” before hurrying away to his next patient. He didn’t mean to be insensitive, but it hurt.

It’s funny being a medical student and a patient’s granddaughter at the same time.

As a medical student, you know you’re fighting a losing battle, because all your textbooks say so. As a granddaughter, I wouldn’t let the thought cross my mind.

I was studying for my Step 1 exam at the time. So, I recognized the stroke symptoms when they presented. I understood the pitting edema that was so deep I could sink a fourth of my entire finger into his legs and his arms meant that his heart was failing, and his kidneys too. When he asked for a picture of himself, I filtered, cropped, and edited so he wouldn’t know how bad it looked. I knew all the little transient ischemic attacks that were happening and when they were happing because of the new droop of his mouth or eyelid. And I was there every night and during study breaks to scare away all the snakes, the thieves, the dogs, or the bugs that only his hallucinating brain could see.

During my rotations, I for the first time truly understood the chaos that is the emergency department and the hospital floor. And while every physician would probably like to spend a little extra time

with each patient, it’s almost impossible with the amount of work to be done. So you have to prioritize. Unfortunately, it seems to me that a lot of the time, it’s the elderly population that gets overlooked. And to a certain extent, it makes sense. There is always a younger, more urgent patient on our radar. A patient who can potentially be treated, who has an actual shot at life – and potentially a longer one at that. And for that reason, we very quickly flit in and out of our very old patients’ rooms, partly because it can be frustrating. These patients tend to be more nervous, badgering us with question after question. A lot of times they have memory loss or may even be straight up demented (my grandfather certainly was!). And as physicians there is just not enough time in the day to entertain all these questions or try to convince someone with Alzheimer’s what their next best course of action is.

I remember seeing a patient on the floor, very similar to my grandfather. So similar in fact, I’m embarrassed to admit that I even teared up a little. But when I presented the patient to my attending, he quickly dismissed him – “there’s not much we can do – he’s been here for a long time, we’ll send him home on hospice care. Next patient.” When we finally went

to visit him together, his son was still insistent that we do everything to save his life.

The physician was rushed and frustrated, not understanding why the son wanted to take such extreme measures. The son was angry, not understanding why we weren’t taking the time to do everything to extend his father’s life. Everybody left the room angry, with no one happy about the solution.

Here’s the thing I’ve realized – no one ever believes that they’ve had enough time on this earth. No family is ever completely ready to let a loved one go.

I remember the overnight hospice nurse

tapping at my bedroom door, telling me it was time. And as I stood in the room while my grandfather’s soul passed on to the next life, I remember thinking “man, 94 years – it’s not nearly long enough.”

Maybe it’s because of my Asian heritage and culture that taught me to hold my elders in the highest regard. Maybe I just have come to love all grandparents after living with my own after all these years.

I’m not sure exactly why it is that I have such a soft spot for the geriatric population, but it’s led me to believe that I would like to be a geriatrician someday – or at least get some sort of training in caring

for this particular population. Both my experience in the hospital as a medical student and as a granddaughter have taught me that this particular population is in definite need of trained providers. I wrote this to convey the value of taking the time to provide exceptional care for your elderly patients. Not only because they are human and deserving of that kind of care, but also because, if you’re lucky enough, there will come a day that your aged and tired body may crave the same sort of empathy, time and answers from your very busy doctor. ■

Here’s the thing I’ve realized - no one ever believes that they’ve had enough time on this earth. No family is ever completely ready to let a loved one go.

Written in loving memory of George P. Varkey

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C O LO R A D O M E D I C I N E 2 1

D E PA R TM E NT S PA R TN E R S

I N

M E D I C I N E

S P OTLI G HT

New legislation that impacts your practice David Schmeltzer, Director of Education, Abyde

We’ve all had a lot of adjusting to do over the past year and the rules and requirements we’re expected to follow are no different. As technology and patient needs continue to evolve, it only makes sense that the standards providers uphold progress right along with it. With two new laws passed in just the first few months of 2021 and plenty more still to come, there’s even more adjustments for your practice to make and new requirements to comply with.

The 21st Century Cures Act

More recently, the new set legislation directed by the Office of the National Coordinator for Healthcare Technology (ONC) officially took effect on April 5, bringing several advancements to health care and technology. The 21st Century Cures Act addresses a patients’ right to access their own medical records and prevents information blocking – two top concerns among providers and the catalysts to many of the latest HIPAA The HIPAA Safe Harbor Law fines. These new requirements keep a “patients-first” focus and work to strike the On Jan. 5, the government officially balance between providing easier record kicked off their “new year, new law” reso- access and maintaining data privacy lution by enacting the HIPAA Safe Harbor and security.

Law. After the continued spike in cyberattacks and HIPAA enforcement seen in Proposed changes to the HIPA A recent months, these new requirements Privacy Rule came at a perfect time to provide even more incentives for keeping data secure. Now these two laws aren’t the only new The HIPAA Safe Harbor Law is an amend- requirements you need to have on your ment to the HITECH Act and requires radar – the Office for Civil Rights (OCR) the government to take into account if also proposed modifications to the HIPAA practices have recognized cybersecurity Privacy Rule that are set to be finalized practices in place when investigating a in the coming months. The proposed data breach, and to be lenient with their changes are designed to address barriers fines or other enforcement actions if to value-based health care, particularly the practice has met all the basic tech- those that limit or discourage care coornical safeguard requirements at least dination and case management commu12 months before the incident occurred. nications, as well as amend provisions of This essentially means that if you have the the Privacy Rule that pose “unnecessary right Security Rule basics down including regulatory burdens” without sufficiently a properly documented security risk anal- improving privacy protections. ysis (SRA) to identify risks, and appropriate technical safeguards to mitigate your recognized threats, you’ll be able to save a lot of stress and money when or if an incident occurs.

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So now what?

Wondering how these new laws impact HIPAA requirements? Spoiler alert – they don’t. All of those HIPAA requirements surrounding data privacy and security, proper PHI disclosure, and patient record access are still featured within the new legislation and should not be forgotten.

Having a complete compliance program in place is the groundwork for protecting patient data, and underscores what all of these new requirements and upcoming changes entail.

We know that your practice has enough to worry about as it is and keeping up with complex requirements in an ever-changing legislative environment is becoming increasingly difficult to manage. While having a complete compliance program is essential to avoiding a HIPAA fine, it isn’t something you have to do on your own.

Schedule a complementary one-on-one consultation with a HIPAA expert to see what your practice needs to be doing to comply with all government requirements (including the new ones we just covered) and how Abyde makes keeping up with the latest and greatest, stress-free. Go to abyde.com/hipaaconsultation to schedule your consultation. ■ David Schmeltzer is the director of education for Abyde. Contact him at 727-2652532 or dschmeltzer@abyde.com.

D E PA R TM E NT S I NTR O S P E C TI O N S

Poems from the heart of a medical student Conner Roggy

Conner Roggy is a third-year student at Rocky Vista College of Osteopathic Medicine in Parker, Colo. He has a master’s degree in biomedical science from Colorado State University in Fort Collins, Colo. After competing collegiately in football and continuing running and biking as his main hobbies, Conner has decided to pursue orthopedic surgery and help people return to doing what they love. He hopes to serve communities that have been underserved in the field of orthopedics and provide more access to people in need.

A Student’s Prayer

Perspective

I will pray a prayer of gratitude, for this is all a student can offer.

I will pray a prayer of dedication, for this is all a student can promise.

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I am grateful for the opportunity to learn. To gain skill and knowledge in the hope that it may one day help another.

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I dedicate my life to learning. To never take for granted the privilege of growth.

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I am grateful for the professors and the living word they bring to grow my understanding.

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I dedicate my life to those who are awaiting my care, that I might be prepared to give them the answers they need.

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I am grateful for my colleagues, for the challenge they present to improve myself in every way.

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I dedicate my life to all those who have built me up to the person I am now; for their legacy is all I can hope to live up to.

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I am grateful for the teachers that have passed in spirit but not in body, for they are the ones who allow me to discover knowledge for myself.

I will pray a prayer of hope, for this is all that a student has.

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I hope to change others. Not just in the future but right now, every day that I come to learn.

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I hope to live the life that my professors wish to live vicariously through me, and to exceed their expectations.

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I hope to use the legacy of my fallen teachers, to sacrifice as much in life for others as they have in death for me.

I will pray a prayer of struggle, for this is the student experience.

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Struggle with knowledge for which my capacity is limited.

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Struggle with my colleagues who challenge me every day.

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Struggle with my teachers who expect so much from me.

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Struggle to become the person I want to be and to be that person right away.

Patient Help me!

I’m drowning!

I’m suffocating!

I’m bleeding!

I’m hurt!

Student How do we help them?

Are they drowning?

Are they suffocating?

Are they bleeding?

Are they hurt?

Resident I can’t help them myself.

I’ll drown them.

I’ll suffocate them.

I’ll make them bleed.

I’ll hurt them.

Physician They can only help themselves.

I’m drowning.

I’ve been suffocated.

They are bleeding me.

I’ve been hurt. ■

My struggle and my gratitude are one in the same.

My prayer is that I be reminded of that fact every day.

C O LO R A D O M E D I C I N E 2 3

F E ATU R E F I N A L

WO R D

Partners on policy and practice Eric Speer, MBAHA, FACMPE Chief Administrative Officer Centeno-Schultz Clinic

When it comes to politics and medicine, there is an oft-quoted statement, “if you’re not at the table, you’re on the menu.” Fortunately, the Colorado Medical Society is always at the table shaping legislation and law creation for the benefit of physicians and practices of Colorado. It is no small feat averting the unintended consequences of what is usually … hopefully … well-intentioned legislation.

Good outcomes are achieved through the hard work of the Council on Legislation (COL) – which reviews legislation and recommends positions to the CMS Board of Directors, and CMS policy staff – who are the boots-on-the-ground educators of elected officials on how the health care system functions. Bigger picture, CMS has the unique position and ability to bring together component and specialty medical societies (the House of Medicine), practice staff and other stakeholders to form a united front.

I am the chief administrative officer for Centeno-Schultz Clinic, a board member of the Colorado Medical Group Management Association and a member of COL representing CMGMA. I truly believe that without the COL, we would have a different health care system in which physician-owned practices like mine would struggle to survive. I’ll give two examples of great legislation on which I collaborated with the Colorado Medical Society through my practice and CMGMA: Bills to simplify prior authorization and streamline credentialing.

The prior authorization bill, HB19-1211, was passed in 2019. I knew through my own experience and the experiences of my CMGMA colleagues that prior authorization was not only a hassle but hazardous

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to patients when they had to delay care unnecessarily waiting for prior authorizations. Bolstered by CMS survey data that echoed these concerns, we worked together on bill language and provided committee testimony to eventually see passage of a law that:

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reduces the response time for a non-urgent request from 15 days to five days,

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ensures that services that have been approved cannot be retrospectively denied, and

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ensures that an approved prior authorization request remains valid for at least 180 days and continues for the duration of the prescribed course of treatment.

CMGMA brought the credentialing bill to CMS in 2018. Since then, the CMS Government Relations team has placed their full advocacy muscle behind its success, and I am pleased to report it has a very good chance of passing this year as SB21-126. My practice – like many others – will benefit from timely credentialing by health insurers, especially now as doctors come into the state to provide care during the pandemic or are recruited to our practices and health systems.

One final example of how CMS works for Colorado physicians: Our practice brought our concerns to CMS in 2018 regarding bad actors in stem cell injection therapy who were misusing these therapies and misrepresenting outcomes.

With the guidance of the policy team, one of our physician owners, Christopher Centeno, MD, proposed a policy on stem cells based on guidelines by the Federation of State Medical Boards.

He submitted the policy through Central Line, CMS members weighed in, and it was passed by the CMS Board of Directors. Putting patient safety policies in place with stem cell injections will more easily allow CMS to take legislative action should need arise.

Our practice has found a trusted partner in CMS; experienced medical society staff has listened to our concerns, turned ideas into action and paved the way for physicians and practices like ours to focus on what we do best – provide the best health care for Coloradans. ■

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