May-June-July 2023 Colorado Medicine

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COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

CMS LAUNCHES NEW SERVICE TO SUPPORT PHYSICIAN WELLBEING

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B E YO N D C O V E R A G E

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C O NTE NT S

CMS LAUNCHES NEW SERVICE TO SUPPORT PHYSICIAN WELLBEING

Physicians choose medicine to help others and know that it is a challenging profession, but extra stressors that get in the way of patient care can greatly impact wellbeing. CMS has launched Doc2Doc Wellbeing Consulting to help members find support from a peer without an extensive evaluation.

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FINDING JOY IN MEDICINE

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PHYSICIAN HEAL THYSELF

14 2023 CMS LEADERSHIP ELECTION

Colorado Springs dermatologist and Mohs surgeon Vinh Chung, MD, draws from his own life journey to present strategies for finding joy in your career.

Clara Raquel Epstein, MD, FICS, chair of the CMS Committee on Physician Wellbeing, writes about the epidemic of loneliness and its threat to public health, with advice from the U.S. surgeon general on addressing loneliness.

PRESIDENT’S LETTER

CMS President Patrick Pevoto, MD, MBA, reflects on burnout and compassion fatigue, and offers some techniques to try.

Get to know the candidates running for CMS leadership positions by reading their candidate statements.

One candidate is running for president-elect and six candidates are running for AMA Delegation.

10 2023 LEGISLATIVE REPORT

The Colorado General Assembly has adjourned and once again in 2023, health care policy was at the forefront of a whirlwind session. Your CMS advocacy team, physician leaders and friends in the House of Medicine were your boots on the ground, advocating on your behalf on many bills that affect your patients, practice and profession.

WORKERS’ COMPENSATION

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13 TAKE ANOTHER LOOK AT WORKERS’ COMP

Members of CMS WCPIC outline a new rule that took effect recently that will make it easier for physicians to participate in DIME reviews.

28 FINAL WORD: BREAKING THROUGH OUR FEARS

CPHP Medical Director Scott Humphreys, MD, has witnessed that fear is a major player throughout a physician’s career. Seeking mental health care should not be one of those fears thanks to the confidential support available to Colorado physicians.

D E PA R TM E NT S

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Guest editorial: This is still our lane

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Partner in Medicine spotlight: How Ditto Transcripts helps physicians be more productive

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COPIC Comment: COPIC Medical Foundation 2023 grants

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Introspections: Opioids in medicine, a double-edged sword

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Reflections: Sleeping better

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Medical news • Staff updates: Welcome new membership program manager, component executive and CME director • BCMS hosts event to raise awareness of fentanyl epidemic, drug poisonings

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 • fax 720.859.7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2022-2023 OFFICERS

BOARD OF DIRECTORS

AMA DELGATION

Patrick Pevoto, MD, MBA President

Caleb Bussard, MS Brittany Carver, DO Elizabeth Cruse, MD, MBA Kamran Dastoury, MD Amy Duckro, DO Gabriela Heslop, MD Enno F. Heuscher, MD, FAAFP, FACS Rachelle M. Klammer, MD Marc Labovich, MD Chris Linares, MD Michael Moore, MD Edward Norman, MD Lynn Parry, MD Leto Quarles, MD Rhonda Parker, DO Hap Young, MD

David Downs, MD, FACP Carolynn Francavilla, MD Rachelle Klammer, MD A. "Lee" Morgan, MD Jan Kief, MD Tamaan Osbourne-Roberts, MD Lynn Parry, MD Brigitta J. Robinson, MD Michael Volz, MD

Omar Mubarak, MD, MBA President-elect Hap Young, MD Treasurer Mark Johnson, MD, MPH Immediate Past President Dean Holzkamp Chief Executive Officer

AMA PAST PRESIDENT Jeremy A. Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF Dean Holzkamp Chief Executive Officer Dean_Holzkamp@cms.org

Dorcia Dunn Program Manager, Membership Dorcia_Dunn@cms.org

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

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

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

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

Cindy Austin Director of Membership Cindy_Austin@cms.org Cecilia Comerford Executive Director, Boulder County Medical Society Cecilia_Comerford@cms.org

Kim Vadas Assistant Director of Continuing Medical Education and Recognized Accreditor Programs Kim_Vadas@cms.org Debra Will Director of Business Development Debra_Will@cms.org Tim Yanetta IT/Membership Manager Tim_Yanetta@cms.org

Mihal Sabar Director of Accounting Mihal_Sabar@cms.org Chet Seward Chief Strategy Officer Chet_Seward@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. 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. Guest editorials and letters to the editor are published at the sole discretion of the Colorado Medical Society on a space-available basis.

Dean Holzkamp, Executive Editor, and Kate Alfano, Managing Editor. Design by Scribner Creative.

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Physician wellbeing – Nothing is either/or Patrick Pevoto, MD, MBA

A patient of mine made a frantic call to my office asking for an add-on appointment, on a Monday of course. She was a single mother of two energetic boys, both of whom I delivered. She was at the proverbial “end of her rope,” compounded by a deadbeat ex-husband who was not doing his fair share. She was an engineer at an Austin, Texas, high-tech company and was on probation for anger issues with co-workers. She begged me for medication, preferably alprazolam, to help her through the crisis.

In preparing this article, I asked myself, “was Mother Teresa ever burned out?”

Indeed, she was, experiencing not only burnout but compassion fatigue. She required her co-workers to take off one year out of five for healing and rejuvenation. I found the following article: “The Mother Teresa Effect: the Modulation of Spirituality in Using the CISM Model With Mental Health Providers” (Mark Newmeyer, et al., Int.J.Emerg.MentHealth 2014, 16(1): 251-8). The Mother Teresa effect is:

Her appointment was at the end of my morning clinic. The pathway of least resistance would have been to write the prescription and send her on her way.

However, I was reminded of an audio tape

by Andrew Weil, MD, called “Breathing: The Master Key to Self-Healing,” in which he relates a relationship with a very successful attorney in Manhattan who was taking three times the recommended dose of alprazolam and still needing more.

Dr. Weil worked with him for several years until he was able to wean the attorney completely off the benzodiazepine and solely use breathing techniques when needed.

“Spirituality may not only serve as a protective factor in moderating compassion fatigue but also increases compassion satisfaction among professional caregivers.”

I recommended the audiobook and I took my patient through a couple of the breathing exercises. Since I do not believe in “either/or” but “both/and,” I gave her a prescription for 30 alprazolam tablets and had her make an appointment for the next week. She understood the concept that medication alone would most likely not work for the long term and she worked on the breathing exercises. Within two months she was not only off probation, but she was promoted to a new-product team as lead engineer! She realized that she “owned” the techniques, once learned and practiced, no prescription was required, and they were effective alone without the need for medication.

One might define “spirituality” as reaching beyond material or physical things and embracing the recognition of things that might be a feeling, sense or belief that there is something greater than myself.

Bear with me as I ask you to do a quick survey of yourself in the following areas. Are you:

• Feeling exhausted, • Having little tolerance for others and becoming irritated easily,

• Becoming overly involved with others, • Feeling as though little is accomplished but working harder than ever,

• Feeling ill and/or having physical pain, • Wanting to avoid work, • Feeling disconnected from others, • Feeling as if you did not sleep, upon awakening,

• Exhibiting stress responses to situations that feel traumatic,

• Having difficulty with boundaries with others and with one’s self, or

• Becoming indif ferent or lacking compassion for others?

If the answer is yes, then there is help available. Here are some tips of things to try:

• Find a confidante or therapist and talk to them regularly,

• Write a daily gratitude list, • Look for fun activities and hobbies and do them,

• Take vacations and mini-getaways, • Eat healthfully, • Exercise daily, • Meditate, • Avoid drinking alcohol or using drugs to “take off the edge,”

• Identify personal strengths, • Take daily breaks to step out of the •

situation, breathe, wash your hands, walk the block, stretch, Acknowledge your own feelings.

The Easter Center for Family, Bellevue, Washington

In addition, I am excited and pleased to announce the launch of a new wellbeing program through the Colorado Medical Society on Doctors’ Day, March 30, 2023: Doc to Doc Wellbeing Consulting.

In partnership with the Colorado Physician Health Program (CPHP) as well as the hard work of the CMS Committee on Physician Wellbeing and our component societies, Colorado physicians and medical students can use this pre-clinical service to obtain three free consultations with a physician trained in mental health.

There is more information on this program located in this current issue of Colorado Medicine. Please do not hesitate to contact members of our CMS staff if you have questions or need further guidance with the use of this program. One of the core strategic initiatives of CMS at this time is the promotion of physician wellbeing; let us help! ■

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CMS launches new service to support physician wellbeing UTILIZE DOC2DOC WELLBEING CONSULTING TO CONFIDENTIALLY TALK TO A PEER WHO UNDERSTANDS Kate Alfano, CMS Director of Communications

A study published by the American Medical Association, the Mayo Clinic, and Stanford Medicine in December 2022 showed an alarming 62.8 percent of physicians experienced symptoms PHYSICIANS EXPERIENCE of burnout in 2021, up from 38 percent the previous year. This follows similarly SYMPTOMS OF BURN OUT concerning studies that indicated one in every five physicians planned to leave practice within two years, while one in three a difference and to help others. It is a autonomy, encroachment on personal anticipated cutting back their hours. calling, and it is inherently filled with highs time and other demands – that get in the and lows as you guide patients and their way of caring for patients, erode joy in Burnout is not a new issue, but trends are loved ones through life and death. What medicine and contribute to burnout. worsening while awareness of the symp- is sometimes not anticipated are the toms and causes of burnout are increasing. extra stressors – challenges in practice “In nearly four decades of practice, I have Physicians choose the profession to make workflow, administrative burden, lack of witnessed first-hand the steady increase

62.8%

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COLORADO PHYSICIAN OR MEDICAL STUDENT CALLS 720-810-9131.

24/7 line answered by a Masters-Level Licensed Clinician (LCSW, LPC) to assess the clinical need of the caller, including life-threatening situations.

CONFIDENTIALITY IS REVIEWED AND PEER SUPPORT SERVICES ARE INITIATED. Only in circumstances where an individual is a threat to self or others or as outlined in the Medical Practice Act would confidentiality be breached. Doc2Doc Wellbeing Consulting has the same reporting obligation as all licensed Colorado physicians.

PHYSICIAN CALLER RECEIVES WELLBEING SUPPORT FROM A PEER PHYSICIAN. If Doc2Doc Wellbeing Consulting is the best fit based upon the caller’s presentation, a physician will return the physician’s call for the first of three free peer consultations.

If CPHP traditional comprehensive evaluation services are a best fit based upon caller’s presentation OR if more help is needed at the end of three free Doc2Doc Wellbeing Consulting sessions, CPHP’s process will commence to PAGE 6 ⊲ ensure client has appropriate treatment supports in place.

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P H YS I C I A N W E LLB E I N G : C O N T

“While we must address the underlying drivers of burnout, it is also important to provide services that can help to ‘care for the caregivers.” in stressors on practicing physicians, and the toll it can take on their wellbeing,” said Lucy Loomis, MD, MSPH, a family physician in Denver and member of the CMS Committee on Physician Wellbeing.

“While we must address the underlying drivers of burnout, it is also important to provide services that can help to ‘care for the caregivers.’”

The Colorado Medical Societ y also acknowledges that seeking mental health care carries a stigma, especially in the health care sector. To remove as many barriers as possible, we launched Doc2Doc Wellbeing Consulting on National Doctors’ Day – March 30, 2023.

Doc2Doc provides three free confidential peer consultation sessions for any Colorado physician or medical student. The objective is to provide an opportunity to discuss pre-clinical matters such as stress, burnout and situational concerns.

Any physician or medical student can call a dedicated phone number, 720-8109131, and the 24/7 line is answered by a masters-level licensed clinician. This clinician then schedules a one-hour follow-up appointment in person, or by video or phone call with a physician trained in psychiatry. CMS is partnering with the Colorado Physician Health Program (CPHP), an organization with decades of expertise in physician health, to provide the daily management of Doc2Doc. “Burnout among medical professionals is widespread,” said CMS President Patrick Pevoto, MD, MBA. “Seeking help can be difficult for physicians due to stigma, feelings of failure or fear of losing their license. The Colorado Medical Society wants to make it easy for doctors to seek support so they can provide the best care to patients immediately and in the future. We encourage physicians to reach out before a problem gets too big. Utilize these free peer consultation sessions whenever you need them.”

CMS believes many physicians having workplace or situational concerns would benefit from peer-to-peer support from a physician wellbeing expert. Doc2Doc provides pre-clinical assistance to any Colorado medical licensee or medical student without lengthy documentation or extensive evaluation. Those with any further concern or health condition

THREE FREE SESSIONS

continue to have access to experienced peer support through CPHP; Doc2Doc is meant to supplement the comprehensive evaluations offered by CPHP. “CPHP is thrilled to collaborate with CMS on this venture,” said CPHP Executive Director Sarah Early, Psy.D. “Physicians are most comfortable seeking support and assistance from other physicians.

Doc2Doc is a resource that is palatable to doctors, in which physicians are directly assisting their peers.”

Because CMS also recognizes the importance of physician wellbeing on patient safety and access to care, those who are not CMS members have access to this program.

“After many years in practice it has become clear to me that physician wellbeing is a vital pillar of successful health care delivery,” said Clark Zimmerman, MD, a family physician in Parker and member of the CMS Committee on Physician Wellbeing.

“When the doctor is well, they can deliver quality, thoughtful health care while at the same time providing themselves with the care they need to maintain mental and physical health. This serves to improve and extend our career which then better serves a growing group of patients.”

Find more information at www.cms.org/doc2doc. ■

Three free, one-hour, confidential, pre-clinical peer wellbeing consultation sessions for any Colorado physician or medical student Call 720-810-9131 24/7 to reach a masters-level licensed clinician Schedule one-hour confidential follow-up (in person, video or phone call, depending on your preference) with a peer wellbeing consultant – a physician trained in psychiatry Discuss any concern: Burnout, stress or situational issue If more support is necessary or treatment is recommended, your peer wellbeing consultant will assist in finding what help is best for you

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F E ATU R E

Finding joy in medicine

Kate Alfano, CMS Director of Communications and Marketing “Why did you choose medicine?” Vinh Chung, MD – a board-certified dermatologist and fellowship-trained Mohs surgeon – asked a room of physicians gathered for a CME presentation hosted by the El Paso County Medical Society (EPCMS) on April 26, 2023, at the Ent Administration Building in Colorado Springs. Chung presented “Finding Joy in Medicine,” weaving evidence-based research and personal experiences into an inspiring and relevant program.

After a moment of contemplation, attendees offered their answers: They became physicians to make a difference, to save lives, to connect with patients. No one responded that they became physicians to earn a paycheck, to meet productivity goals, to enter diagnostic codes, or to be evaluated.

“The reason we burn out is not because there’s anything wrong with us,” Chung said. “It’s because we’re human beings.

If you have these symptoms [of burnout: emotional exhaustion, depersonalization/ cynicism or lack of efficacy], don’t feel ashamed. Burnout doesn’t mean you’re working too many hours. It doesn’t mean you’re not paid enough. Physicians burn out because you’re prevented from practicing medicine how you idealized it.”

“We agree that the crux of medicine is human-to-human contact. We know it’s wrong to dehumanize the patient. But what happens when we dehumanize the doctor? Isn’t this what’s causing burnout?”

Chung reviewed the structure of human needs in a pyramid similar to Maslow’s.

Humans must fill physiological needs, which is the base of the pyramid, and psychosocial needs, which are at the second level. But the most important human need, at the top of the pyramid, is to find meaning and purpose. Within this model, he offered the following practices for finding (or rediscovering) joy in medicine.

• Pursue meaning and purpose in your life and work

• Focus on workplace culture and mission

• Lead and shape workplace culture • Embody gratitude He advised the audience to accept what you cannot change and work to change what falls within an individual’s sphere of influence – even those who are in an employed setting or aren’t the top decision makers for the practice. “Doctors need to learn how to lead effectively.

They need to learn to lead at the level of culture. Lead by trust. Lead by the highest level of leadership – inspiration.”

“I started medicine not because I needed a job but because it was a calling,” Chung said. “It’s a long journey; it’s not easy.

The summary of my talk is connection: connection with people; connection with patients; connection with past, present and future.”

“I hope we at EPCMS can come together and connect; inspire one another. We can go farther because we go together.” ■

Clockwise from left: Vinh Chung, MD, presents "finding joy in Medicine." EPCMS CEO Natalie Myers welcomes physician members to the event. An expert panel answers questions after Dr. Chung's presentation. EPCMS President Nicholas A. Piantanida, MD, addresses the audience.

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Medice, cura te ipsum, “Physician Heal Thyself” FROM THE CHAIR OF THE COLORADO MEDICAL SOCIETY COMMITTEE ON PHYSICIAN WELLBEING Clara Raquel Epstein, MD, FICS CMS CPW Chair

Are you lonely? You can be quite busy and surrounded by many people daily but still suffer from the symptoms of loneliness and isolation. U.S. Surgeon General Dr. Vivek Murthy recently released a Surgeon General’s Advisory, available at hhs.gov, on the epidemic of loneliness and isolation facing our country, the destructive impacts it has on our collective health, and the extraordinary healing power of reigniting our personal relationships. The epidemic of loneliness in the U.S. threatens public health. Dr. Murthy was recently interviewed by Maria Shriver and in the interview, he openly discusses his perspective and personal experience and the impact of loneliness on his professional life and self-identity. It’s worth a visit: mariashriversundaypaper.com.

“Loneliness is more than just a bad feeling. When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29%), dementia (50%), and stroke (32%).”

Excerpt from https://www.bmj.com/ content/381/bmj.p1017 “Research has shown that loneliness and isolation are linked to sleep problems, inflammation and immune changes in younger adults.

In older people, they’re tied to symptoms such as pain, insomnia, depression, anxiet y and shor ter life span. In people of all ages, they may be associated with higher risks of heart disease, stroke, diabetes, addiction, suicidality and self-harm, and dementia.” Excerpt from https:// www.cnn.com/2023/05/02/health/ murthy-loneliness-isolation/index. html

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It’s important to develop and nurture our community. One needs to experience friendships, not just have a list of friends.

Building connections is a very important way to make a difference in our sense of fulfillment. It is important for us to build and reinforce social infrastructure.

Social costs are critical considerations in our communities and directly affect our emotional IQ. Health care providers need to be aware that loneliness is as important as other issues such as obesity, tobacco and substance use disorders that affect us and our patient populations.

Loneliness and isolation are associated with a premature mortality on par to daily smoking of up to 15 cigarettes. In addition to affecting our mental health and wellbeing, connected communities are more likely to be economically prosperous, have lower violence rates, have higher resilience in the face of natural disasters, and have more productive people and show better academic achievement in schoolchildren. These are just some of the benefits of addressing the epidemic of loneliness and isolation. We must also remember our connections have to be informed by our core values – kindness, generosity, service and love. Loneliness is much like hunger or thirst that indicates our body needs to be fed or hydrated; it is a signal that our soul is yearning for a connection with others. Surgeon General Murthy has suggested a six-pillar strategy to address this.

1. Strengthen social infrastructure in communities 2. Create more “pro-connection” public policies

3. Engage public health and health care delivery systems to address social connection – physician engagement and education is critical 4. Implement more data transparency from tech firms, as well as the establishment and implementation of safety standards such as age-related protections 5. Deepen knowledge of the impact and resolution of loneliness and isolation; stakeholders such as officials, policymakers, health care providers and researchers should collaborate on a research agenda to address gaps in the data 6. Evolve a culture of connection in which Americans “cultivate values of kindness, respect, service, and commitment to one another” The CMS Committee on Physician Wellbeing (CPW) is proud to guide activities of CMS that pertain to physician wellbeing and burnout prevention. This past quarter we facilitated oversight for the new Doc2Doc program sponsored through a collaboration between the Colorado Medical Society and Colorado Physician Health Program (CPHP). This is an opportunity for all Colorado physicians and medical students to engage in their wellbeing. Call 720-810-9131 for your three free peer consultation sessions.

How are you doing? Please contact us at membership@cms.org if you have any recommendations for the CMS CPW committee or have a wellbeing need that is unfulfilled. ■

Dr. Tracy Cerniglia Joined in 2001

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©2023 Optum, Inc. All rights reserved.

F E ATU R E

2023 legislative report

COLORADO MEDICAL SOCIETY NAVIGATES TRICKY SESSION TO ADVOCATE ON BEHALF OF PHYSICIANS AND PATIENTS Chet Seward, CMS Chief Strategy Officer Jennifer Armstrong, CMS Program Manager for Government Affairs and Communications

The final gavel has dropped and another whirlwind legislative session has ended. Colorado Medical Society presents our sine die report, briefly summarizing our work leading up to and through the 2023 Colorado General Assembly. Your CMS advocacy team, along with physician leaders and friends in the House of Medicine, touched many bills that affect your patients, practice and profession. We took positions on 36 bills, worked with elected officials to revise language before bills were introduced, ensured amendment language was added to bills in-process, and provided testimony in many hearings.

SEVERAL KEY HEALTH CARE THEMES EMERGED THIS SESSION, INCLUDING: Who should be doing what (HB231071: Licensed Psychologist Prescriptive Authority, HB23-1077: Informed Consent to Intimate Patient Examinations, HB231295: Audits of Department of Health Care Policy and Financing Payments to Providers, SB23-083 Physician Assistant Collaboration Requirements, SB23-167: Board of Nursing Regulate Certified

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Midwives, SB23 -170: Ex treme Risk Protection Order Petitions, SB23-188: Protections for Accessing Reproductive Health Care, SB23 -189: Increasing Access to Reproductive Health Care, SB23-190: Deceptive Trade Practice Pregnancy-related Service); Affordability and transparency (HB231002: Epinephrine Auto-Injectors, HB231201: Prescription Drug Benefits Contract Term Requirements, HB23-1215: Limits on Hospital Facility Fees, HB23-1225:

Extend and Modify Prescription Drug Affordability Board, SB23-195: Calculation of Contributions to Meet Cost Sharing); and Increased coverage (HB23-1130: Drug Coverage for Serious Mental Illness, HB23-1136: Prosthetic Devices for Recreational Activity, SB23-033: Medicaid Preauthorization Exemption, SB23-144: Prescription Drugs for Chronic Pain).

BELOW ARE SOME KEY BILLS FOR MEDICINE Prior authorization reform – CMS, in collaboration with our allies, worked for months with friend of medicine Rep. Shannon Bird on a bill that we hoped would address our core priorities of preventing disruptions in approved care, providing alternatives or exemptions to prior authorization, and improving transparency to prevent confusion and waste. Time and other unrelated priorities worked against us and it was decided not to advance the bill this session. It is important to note that another bill that we supported (SB23-033) did pass to prohibit prior authorization, step therapy and fail-first requirements in Medicaid for prescriptions to treat serious mental health disorders. We remain committed to removing unnecessary prior authorization burdens and will pursue all advocacy options to achieve reform including potential legislation in the 2024 session.

Physician assistant scope of practice (SB23 - 083) – SB23 - 083 changed the supervisory relationship between physicians and physician assistants to a collaborative agreement. Amendments were added to the bill to ensure that agreements are only made between PAs and physicians or groups actively practicing in Colorado. The amendments also ensure that PAs provide care within their education, experience and competency levels, and maintain a supervisory relationship with physicians at level I and II trauma centers. Sen. Kyle Mullica and other legislative champions for medicine were key to securing these amendments to protect Colorado patients.

Psychologist prescriptive authority (SB23 -1071) – Colorado’s ongoing mental health crisis drove momentum for the passage of this bill that enables prescriptive authority for psychotro-

pic medications for specially trained psychologists. Intense lobbying, a united House of Medicine, and more great help by legislative leaders secured critical amendments to increase the level of training, requiring further education to treat pregnant people, geriatric and pediatric (only with parental consent) populations, and requiring physician oversight and collaboration.

Consumer protection standards (HB231192) – This bill would have destabilized the liability climate and increased more inappropriate lawsuits by lowering the standard for how consumer protection⊲ PAGE 12 claims are filed. It would have created incredible exposure for physicians and how they engage with patients because of the threat of treble damages and attorney fees. CMS actively opposed this bill

CMS’s Health Can’t Wait Colorado campaign continues to be a driving force for our future efforts. Visit www.healthcantwaitco.org to share your prior authorization stories and to join the coalition.

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2 02 3 LE G I S L ATI V E R E P O R T: C O N T

and achieved victory after leaders like Sen. Dylan Roberts helped to remove the key, problematic section of the bill.

tient relationships and eliminate care mandates, particularly those based on arbitrary pain management standards.

Regulatory Audit Contractors (RAC) audits (HB23-1295) – In the months preceding this legislative session CMS heard from numerous practices facing inappropriate audits seeking to recoup “overpayments.” CMS engaged with the Colorado Department of Health Care Policy and Financing (HCPF), which manages Health First Colorado (Medicaid), to pause the latest series of audits due to flawed logic and inappropriate processes that require an extraordinary amount of time for physicians and practice staff to defend. As more questions arose, the legislature became involved and this bill aims to enhance transparency to the RAC process. Strong legislative leadership by the Joint Budget Committee – Vice Chair Rep. Shannon Bird, Chair Sen. Rachel Zenzinger, Rep. Rod Bockenfeld, Sen. Jeff Bridges, Sen. Barbara Kirkmeyer and Rep. Emily Sirota – coupled with support by the House of Medicine and the Colorado Hospital Association helped to pass HB23-1295 that funds a rigorous and detailed audit of the Medicaid RAC program with results to be reported back to the legislature for future policy action.

Copay calculator (SB23-195) – We supported this bill to prohibit co-pay accumulator programs by health plans so patients can receive payment assistance to help pay for their medications.

Heartbreaking patient testimony that highlighted the need for lifesaving medications propelled the passage of this bill.

CMS continues to support efforts to lower prescription drug costs for Coloradans.

Prescription drugs for chronic pain (SB23-144) – This bill fixes a flaw in the response to the ongoing opioid epidemic, which has negatively impacted patients and their families coping with chronic pain. The polic y response, though well-intentioned, has imposed unhelpful care restrictions. CMS supported this bill, which enables health care providers to prescribe medications for chronic pain treatment safely and effectively, without the fear of regulatory discipline. We collaborated with Sen. Joann Ginal and patients to strengthen physician-pa-

Virtual credit cards (HB23-1116) – We supported this bill that protects physicians from unnecessary processing fees when being reimbursed for billed claims. Sponsored by Rep. Anthony Hartsook, the bill prohibits health plans from charging fees when they pay providers for covered services or limiting how reimbursement is made to just credit card methods.

Timely certified death certificates (SB23-020) – This bill was prompted by families unable to obtain timely death certificates for their loved ones due to a lack of physician certification. Initially focused on enforcement, CMS highlighted system and process issues that can legitimately cause delays in certification. Thanks to the leadership of Sen. James Coleman, amendments to the bill extended the timeframe for processing requests from 48 to 72 hours, upon receipt of the request, clarified which physician is responsible for certification, and limited Colorado Medical Board enforcement actions to cases of willful or repeated failure without reasonable cause.

CLOSING THOUGHTS

budget, TABOR rebates, guns, and abortion. Before the session started health care was not supposed to be one of the marquee issues, but once things got rolling the continued importance of health policy rose to the forefront of the 74th General Assembly.

While every session lasts for 120 days, managing the legislative calendar became more of a feat this year. Of the 617 bills introduced, 486 passed. Within the current legislative environment, close to 80% of the bills pass, showing the impor tance of get ting the best amendments CMS can negotiate. The Democrats with super-majority status in the House and just shy of super majority in the Senate had a list of priorities to get through. Republicans in the minority were sometimes left with using delay tactics to get their voices heard. Disagreements between and within the political parties meant that of the 131 bills that failed many were due to lack of funding or the clock running out (e.g. a single-payer study bill, HB23-1209, died on the calendar).

There were also contentious moments as rarely utilized power to cut off debate was wielded.

The strength of Colorado Medical Society advocacy lies with members like you who engage in the work at the Capitol to influence legislation in a skillful and respectful way. CMS hopes all physicians will continue to remain engaged with us in advocacy. Sharing with your elected representatives how a bill will affect your practice and patients often makes the difference between passing a good bill, amending a bill with promise, or defeating a bad bill. ■

The 2023 legislature tackled a number of hot topics including property taxes, housing and land use, a tight state

Your Colorado Medical Society advocacy team comprises: CMS Chief Strategy Officer Chet Seward CMS Program Manager for Government Affairs and Communications Jennifer Armstrong Contract lobbyists Jerry Johnson and Dan Jablan Outside counsel John Conklin and Amy Cardone With close partnership with lobbyists contracted by other organizations in the Colorado House of Medicine and leadership by physician volunteers on the Colorado Medical Society Council on Legislation – especially COL Chair Darlene Tad-y, MD, and Vice Chair Ramnik Dhaliwal, MD, JD 12

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F E ATU R E

Take another look at workers’ compensation

NEW RULE REMOVES HURDLES PREVIOUSLY EXPERIENCED BY PHYSICIANS

Kathryn Mueller, MD, Chair, CMS Workers’ Compensation and Personal Injury Committee (WCPIC); and John Hughes, MD, and Paul Ogden, MD, WCPIC members

In Colorado, the workers’ compensation system provides medical coverage of work-related injuries and medical conditions. It is also a claim-based system that can generate disagreements between parties at the conclusion of treatment.

The Colorado Division of Workers’ Compensation (DOWC) has developed a specific program where independent medical examiners can address these disagreements at the request of one or the other parties to a particular claim.

These medical examiners are termed “Division Independent Medical Examiners,” or DIMEs. These are true independent medical examinations and do not establish a doctor-patient relationship with the examinee.

A revised rule in the workers’ compensation program that took effect on March 1, 2023, intends to remove hurdles for physicians conducting DIME reviews to encourage more to participate.

Physicians must be accredited by the Colorado Division of Workers Compensation (DOWC) to participate, and most physicians who treat workers’ compensation patients are already accredited.

There are many advantages to becoming accredited and participating in the

WORKERS’ COMPENSATION

program. The conversion factors for E&M coding are generally higher than those of other contractual arrangements you may have outside of workers’ compensation.

There is no preauthorization requirement if you are within the treatment guidelines set forth by DOWC, and these guidelines have been set by community standards and are strongly evidence-based. If there is a peer-to-peer call regarding preauthorization because the insurer is not clear that you are within the guidelines, you may charge for your time.

There are also ways to send assurances to the insurer that you are within the guidelines and, therefore, avoid any discussions around preauthorization.

Many physicians were previously discouraged from participating in the DIME program because of the voluminous number of records received. The new rules require that the organizing entity provide a clear table of contents as well as page numbers, making record review much easier. Records must be in chronological order, with date and provider listed.

Inpatient records require specifically indexed admission notes, discharge summaries, operative reports and diagnostic tests other than blood tests. The remainder of an inpatient record can be a single listing and frequently doesn’t require review.

Payment for performing a DIME is typically $1,000 as the base pay, with additional pay based on the number of pages above 500 within the medical record report.

And physicians now have the right under Rule 11 to send non-compliant packets back to the insurer.

Although there are many forms and requirements to perform a DIME, a new concierge service set up by DOWC – Physician Education and Support, or PES – is meant to take away all hurdles for new and returning DIME physicians. If there are any issues with third parties or insurers, you or your staff can speak to your personal concierge within the DIME unit and they will assist you.

The Colorado Medical Society Workers’ Compensation and Personal Injury Committee (WCPIC) wishes to thank the Division of Workers’ Compensation and the self-insured employers for working with us to develop the new requirements for medical records within the DIME system. This is a very important service to our patients and workers as it allows for an independent second opinion regarding the need for any continuing care, misdiagnosis and impairment rating.

CMS encourages physicians to consider or reconsider participating in the program.

We will share educational resources developed from the DOWC DIME Unit to help physicians with Rule 11 as these resources are available. Find more information for providers at cdle.colorado.gov/ dwc/medical-providers. ■ C O LO R A D O M E D I C I N E

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I N S I D E

C M S

2023 CMS leadership election

Get to know the candidates running for CMS leadership positions by reading their candidate statements in this magazine. See their CVs on the CMS election page, cms.org/articles/2023-cms-election.

THE FOLLOWING CMS PHYSICIANS ARE RUNNING FOR OFFICE. PRESIDENT-ELECT (one candidate running for one position)

AMA DELEGATION (six candidates running for six positions; listed alphabetically)

Kim Warner, MD

Carolynn Francavilla, MD, incumbent AMA Delegation

Jan Kief, MD, incumbent AMA Delegation

Tamaan Osbourne-Roberts, MD, incumbent AMA Delegation

Lynn Parry, MD, incumbent AMA Delegation

Brigitta Robinson, MD, incumbent AMA Delegation

Mike Volz, MD, incumbent AMA Delegation

The election will be held in August and all ballots will be cast electronically. Do you receive CMS e-newsletters and email blasts? If not, you may need to update your contact information to receive a ballot. Email membership@cms.org with any new information.

All CMS members are encouraged to use this opportunity to vote. We also ask you to consider seeking a leadership position next year. More details on the 2024 nomination period will be available in September. Taking the opportunity to vote affirms the commitment of our organization to engage all members in the governance process. Do you have questions about voting, nominations or leadership opportunities? Don’t hesitate to reach out to membership@cms.org.

CANDIDATE FOR PRESIDENT-ELECT

KIM WARNER, MD, FACOG Anyone who knows me has heard me say that I was put on this earth to take care of girls and women. I feel grateful every day that I chose to be a physician.

I am basically a Colorado native. My parents moved to Colorado from California when I was very young, and after attending the University of Vermont for my undergraduate education and to play two Division 1 sports, I returned to Colorado. I briefly taught chemistry and physical science and coached a few sports before attending medical school at the University of Colorado. I met my husband, Richard May, in med school and we have been together ever since.

We have three amazing daughters who challenge me every day to be a better woman. I love to run, ski, dive, dabble

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in cooking and travel. I have traveled to Africa on several occasions to provide health care to women.

I’ve been with the Colorado Permanente Medical Group (CPMG) since finishing my OB-GYN residency at Saint Joseph Hospital in 1999. I practiced general obstetrics and gynecology until approximately five years ago when I became an OB-GYN hospitalist, and I run the placenta accreta team at Saint Joseph Hospital. I have been on many boards, chair of our OB-GYN department, chair of our Colorado Section of the American College of OB/GYN, and chair of our Colorado Permanente Medical Group Board.

I have worked in government relations for our medical group for several years. I understand medicine at many levels.

I’ve been a member of the Colorado Medical Society since I began residency, which is now almost three decades ago.

I’ve been actively involved in CMS since that time on many levels. I’ve been on several committees and the board of directors. I’ve worked with and chaired the Council on Legislation. I also was the support person to my husband when he was CMS president. This organization has evolved in tremendous ways and we must continue to change as the forces driving health care demand. I understand Colorado medicine, I understand the legislative process, and I’m very familiar with CMS. I know I can represent this medical society with passion, courage and my whole heart.

CANDIDATE FOR AMA DELEGATION

CAROLYNN FRANCAVILLA BROWN, MD I became an active member of the Colorado Medical Society almost the day I joined medical school. I was immediately drawn to this organization that championed the care of our patients and the betterment of our profession. I have always been a “big picture” person and identified organized medicine as the way to improve many issues in health care.

One year after residency, I decided to start my own practice, from scratch, with a partner. I have a small private practice in Lakewood, Colo. While many of my friends are already burned out and are disenchanted with the medical field, I love what I do and truly feel I get to help my patients every day. Starting a practice has been very educational and there have, of course, been many challenges along

the way. I now consult with physicians starting their own practices and serve as chair-elect for the AMA’s Private Practice Section. I am committed to ensuring private practice remains viable for all patients and physicians and in any model which works best for both parties.

I have been encouraged by the changes we have made in health care in my career.

At the same time, the day-to-day work of being a physician continues to become more burdensome; more physicians are employed by large medical groups and physician burnout is a serious problem.

And, of course, more changes are coming.

The AMA is a powerful voice in shaping health care evolution and I have a strong voice to represent Colorado doctors at the AMA. We need to protect access to

care while at the same time improving quality and reducing the cost of care.

For the Colorado delegation, I bring a “boots-on-the-ground” perspective of the daily struggles of practicing medicine in a small practice. As someone who is still early in my career, I am aware to the realities facing the next generation of physicians. I am passionate about ensuring that physicians can still go into business for themselves and patients can access independent physicians.

Thank you for letting me serve you in the Colorado AMA Delegation for the past four years. I respectfully ask for your vote so I may continue to represent Colorado physicians.

PAGE 16 ⊲

SAVE THE DATE

Vail Co lo rado Med ica l Societ y

2023 Annual Meeting Sept. 22-23, 2023

The Colorado Medical Society is planning our signature event of the year, the Annual Meeting. Save the date -- Sept. 22-23 -- and plan to join your peers and colleagues for sessions on hot topics in medicine, exhibits, networking and much-anticipated events like the President's Gala. Once again, CMS will host a poster competition for medical students, residents and physicians, and child care will be provided (advance registration required).

More details will be available soon at cms.org/events.

Don't miss this opportunity to enhance your wellbeing and enjoy the mountains in the fall.

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INSIDE CMS

2 02 3 C M S LE A D E R S H I P E LE C TI O N : C O NT

CANDIDATE FOR AMA DELEGATION

JAN M. KIEF, MD

A decade of dedication serving on your Colorado AMA Delegation has earned me a seat to serve on the AMA National Council on Long Range Planning and Development where the Board of Trustees tasks us with vital work on initiatives that ensure the relevance of AMA as your voice as a unified House of Medicine.

I humbly ask for your vote to continue to serve as a member of the Colorado AMA Delegation so I will be able to remain on this important Council for up to four more years. I also work hard for you in a leadership position in the influential Pac West Conference that represents physicians for the entire Western United States where I am the elected chair of one of the four standing committees in that conference.

It has always been part of my mission to be very active at the AMA meetings and get to know delegates from all areas of the Federation of Medicine and hear their concerns so that I understand the breadth and depth of the challenges and opportunities that we all share as physicians.

I truly believe that the AMA is our best vehicle to represent all of the physicians in our country, advocate for our patients, assist our students and residents on their journey, and be an example for our society.

It definitely takes time to be known and to be effective and to have your voice and face recognized at the AMA. I have been an invited speaker at the Organization of Medical Association Presidents (OSMAP) and also at the National Advocacy Conference (NAC), both of which are very prestigious events of the AMA. I

have taken time to listen closely to other delegations and it has been my pleasure to meet people and form great relationships over the years so that if I have questions on issues that might affect different states or specialties, I know where I can go to obtain information or answers. I know who to call upon if I need assistance to support an initiative that we need support for here in Colorado. It was through decades of involvement at Colorado Medical Society and also my work as its president that I learned much about leadership and collaboration.

I have belonged to the AMA my entire career as a physician, and I now feel that I am at the ideal time where I am making the most influence. So, once again, I am humbly asking for your vote to serve on the Colorado AMA Delegation so that I might continue this very important national work.

CANDIDATE FOR AMA DELEGATION

TAMAAN OSBOURNE-ROBERTS, MD, FAAFP There is much currently challenging the House of Medicine: novel payment models, changing systems of care, new and growing threats to public health, protecting the viabilit y of independent practice, supporting the growing numbers of employed physicians. Within this context, physicians are too often separated from each other.

The AMA has become a critical nexus of physician unity, a place where all voices can come together, share innovative ideas, and seek agreement to move forward. It has been my privilege to serve as a member of Colorado’s delegation to the AMA for the past 10 years, including my recent election to the AMA’s Council

on Science and Public Health; and I once again ask for your vote to continue as AMA delegate and councilor.

My medical career, serving the underserved in both outpatient and inpatient settings throughout urban and rural Colorado, has given me an on-the-ground appreciation for the work of practicing physicians in multiple settings, at the same time as honing my skills in finding creative solutions to the often difficult and intractable problems physicians face in the current business environment.

My policy experience, as past president of the Colorado Medical Society, past president of the Colorado Academy of

Family Physicians, alternate delegate to the AAFP Congress of Delegates, former trustee of the Colorado Hospital Association board, and in multiple other roles, has given me a deep well of policy experience from which to draw. In addition, my work as CMO for both HCPF and CIVHC has allowed me to work to reshape Colorado’s, and America’s, health care system from the ground up, with a view to keeping physicians at the center of it.

I hope that you will allow me the privilege of continuing to serve you, and our entire House of Medicine, during such a critical time. I ask for your support, and your vote.

CANDIDATE FOR AMA DELEGATION

LYNN PARRY, M.SC., MD I am delighted to ask you for your vote to remain on the AMA Delegation for Colorado. The AMA is a federation of physicians representing state medical societies, as well as national specialty 16

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societies. I am proud to have worked as your delegate in bringing Colorado advocacy to the AMA House of Delegates and supporting Colorado representatives on AMA Councils and Committees.

As a practicing neurologist in solo practice in Lakewood, Colo., I am acutely aware of the challenges in patient access, administrative burdens, barriers to affordable medication and the struggles of keeping

your doors open while having time for your family. These are all areas that can be partially addressed at a state level – and I am on the Colorado Medical Society Board of Directors, our Diversity, Equity and Inclusion (DEI) Committee, Council on Legislation and Chair of the CMS Council of Ethical and Judicial Affairs.

I am passionate about the AMA and the number of advocacy resources available to us as we work at a state level to battle scope of practice with data on decreased value and increased cost, where scope

has been expanded injudiciously. To address the opioid crisis by supporting evidence-based pain management, telehealth, and mental health parity and resources. To put forth model legislation for decreasing administrative burden.

There are a number of other areas where the AMA has provided leadership and assistance, especially in their new powerful Health Equity projects, which we have utilized to inform the CMS DEI Committee.

Scope expansion, tort reform and access to women’s health are state issues. But

reimbursement equity, the loss of physician leverage with increasing corporate consolidation and addressing private health insurance practices are national issues. The AMA is our national advocate for all physicians.

Please allow me to continue advocating for patients and physicians in your AMA Delegation. I am always available to talk to you individually or to present the work your AMA Delegation does. Become or remain an AMA member and bring your voice to the national level.

CANDIDATE FOR AMA DELEGATION

BRIGITTA J. ROBINSON, MD, FACS I have been active in organized medicine since I was a first-year medical student.

Over the last 32 years, I have held many positions in organized medicine. I was the president of the Indiana State Medical School Section delegation, regional delegate from Ohio in the Resident and Fellow Section during my surgery residency at the Cleveland Clinic, and chair of the Young Physician Section at the AMA level after I moved to Colorado to practice. I was fortunate to be elected to be part of the Colorado Delegation to the AMA.

I continue to enjoy debating the pros and cons of resolutions that are brought to the AMA HOD and making good policy that will benefit all physicians. I am not too shy to speak out and will happily bring any issues we have and that should be shared at the AMA. I am also quick to point out the benefits of being an AMA member and wish all Colorado physicians would join.

I most recently chaired a Reference Committee at the last AMA meeting and also serve on the Physician Satisfaction

Committee to the AMA. I am also chair of surgery at Rocky Vista University and teach the surgery course and third-year didactics there as well as my day job as trauma surgeon at Littleton Hospital.

On my to-do list is CMS president, but with two teenagers I must first see them though high school.

I am hopeful that I can continue to serve as your AMA delegate as it has been a pleasure to do so, and I feel that I have helped make practicing medicine better for all physicians.

CANDIDATE FOR AMA DELEGATION

MICHAEL VOLZ, MD

As physicians we share the same goals, mission and purpose as the American Medical Association – to promote the art and science of medicine and the betterment of public health – and the Colorado Medical Society – to promote the science and art of medicine, the betterment of public health, and the welfare of the medical profession and the patients it serves.

understand and make changes in our efforts to overcome or mitigate these barriers. Connecting with our colleagues to best define areas and opportunities to unify and work has been and will continue to be at the core of being successful in these efforts. What is at stake is just too important to Colorado for us to not be fully engaged in an organized manner.

We trained hard, work hard and pursue what is in the best interest of our patients.

Today, there are more challenges and complexities in achieving these results than ever before. Single voices are not as well positioned, able or effective as organized groups of physicians to hear,

Throughout my career, my love and passion for medicine has been strengthened by caring for patients and being involved in CMS and the AMA. I have had the honor to serve as president of CMS, in my component society, and nationally and locally in my subspecialty of allergy

and asthma.

My solo practice has provided me with a rich source of experiences managing a practice and interacting with stakeholders critical to the day-to-day realities of providing medical care in the Denver metropolitan area and in my Kansas outreach clinic I’ve attended twice per month for 27 years.

I believe my qualifications will continue to provide the effective voice and mechanisms that Colorado physicians want and need to give to the AMA. I ask for your vote to serve you as a member of the Colorado AMA Delegation. ■ C O LO R A D O M E D I C I N E

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G U E S T

E D ITO R I A L

Remembering Tyre Nichols THIS IS STILL OUR LANE Leto Quarles, MD

Editor’s note: One of the Colorado Medical Society’s five strategic priorities is to be a force for change across Colorado to drive inclusion and belonging for all physicians, residents, and medical students while advancing public health and health equity for our patients.​Much of this work is guided by the CMS Committee on Diversity, Equity and Inclusion at the direction and approval of the CMS Board of Directors. DEI Committee member and CMS board member Leto Quarles, MD, of Boulder submitted this guest editorial after Tyre Nichols was killed in January 2023 in Memphis, Tenn. She says “Tyre Nichols could have been my son.” “This is our lane” refers to a 2018 Tweet by the National Rifle Association in 2018 that criticized an American Colorado of Physicians position paper on gun control by saying physicians should “stay in their lane.” This prompted a viral response from physicians on Twitter using the hashtag #ThisIsOurLane. CMS from time to time publishes guest editorials and letters to the editor from members to promote discussion among Colorado physicians. Email submissions to kate_alfano@cms.org.

As a physician, I am tired.

As a mother, I am anguished.

As a human being and a member of my community, I am horrified and sickened.

As a healer, I am grieved, and angry, and fueled by my pain.

By our pain.

Months ago, families and allies watched as RowVaughn Wells buried her son.

Months ago, a tiny solemn team of our colleagues watched as the monitors went flat and dark, as the zippered black vinyl closed around a life cut short.

Months ago, the world watched in horror the footage of a man, yet another young Black man, being beaten and pulverized, just paces from his mother’s front door, his last words a cry for her help, for the comfort of her hand.

And when we all got to see the patient as a full person, they got better care, and they had a better shot at leaving our care alive and continuing to heal Who, more than we physicians, are trained and steeped in the uncomfortable arts of fighting against all odds for Life, and of facing Death?

Who, more than we physicians, bear witness to the broader trends and issues of society (“Public Health”) as they play out across the bodies and the souls of our individual, unique, fragile, magnificent, human patients?

Who, more than we physicians, are trained and steeped in the uncomfortable arts of delving into all of the complex, tender and contradictory nuance of the sicknesses that rend apart human life?

Tyre Nichols is dead.

Who, more than we physicians, are faced each day with the frustrations of a society that resorts to medicalizing our social problems whenever they feel too much to face head-on?

Protests came and went.

So yes, this *is* our lane.

Speeches came and went.

What can we, as Colorado physicians, do about a death at the hands of some twisted, bitter fruit off the tree of law enforcement a thousand miles away in Memphis?

Politicians and photo ops came and went.

Our profession didn’t say much.

But this *is* our lane.

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We can show up, speak up, and add our voices to the cry that this is not okay, that it’s [past] time to do better. Those two little letters at the end of our names carry a lot of weight, and our solidarity matters.

Whether it’s a press release, a lapel pin,

or joining a local community conversation, our presence lends our power to so many who need to be heard.

We can show up to listen and learn. To our communities and the larger conversation, of course. And also to our patients.

How often do we ask our patients how they’re doing, really? As physicians, we are experts in asking the uncomfortable questions. Does Mrs. Z really need a third antihypertensive added to her regimen, or would it perhaps do her heart more good for her physician to hear her pain and fears and worries for her own Black sons? Does it help Officer X to let him just grit his teeth stoically through his prostate check, or what would it look like to offer him an opportunity to unload his own heavy heart?

We c a n a d vo c a te a n d a d v i s e o n suggested solutions (within the limits of our own expertise), and lend our voices and our stature to spotlight the community experts who bring their own deep wisdom, born of lived experience, to wrangle with questions and issues that may be far beyond the experience of some of our own lives and careers.

We can be there for the patients we serve, beyond just the exam room or operating suite.

Tyre Nichols lived a full and rich 29 years before his life was snuffed out in a barrage of fists and boots and billyclubs.

He was an artist, a hardworking, law-abiding, passionately contributing citizen, a beloved son, and a loving father. He was a human being before he became a tragic headline.

As physicians, it is a rare blessing when we get to know our patient as a human being in their life beyond patienthood.

And when that happens, it does flavor our care, designed more carefully now to fit the uniqueness of that patient’s life.

All Medical Answering Service

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Years ago, I used to moonlight picking up extra shifts at an LTACH facility. It wasn’t glamorous, but it helped give so many of those patients a fighting chance to get back to Life. Of all my contributions there, one intervention stood out for making the biggest measurable difference in outcomes: lower mortality and morbidity, fewer medication errors, more staff time spent in the room, greater patient and family satisfaction. It wasn’t some fancy tweak of the ventilator, or floating a Swan-Ganz catheter, or even better wound debridement techniques. It was much simpler: asking loved ones to bring in an old photo of the patient living life to the fullest, and taping these photos to the wall at the entry to their rooms. Making the lump of flesh under a tangle of tubes and wires back into a human being, someone we could all see as a real person. And when we all got to see the patient as a full person, they got better care, and they had a better shot at leaving our care alive and continuing to heal.

And that’s all we’re asking for, really. That our Black patients – children, parents, spouses, partners, teachers, students, friends, rivals, colleagues – be seen as full human beings. ... a better shot at leaving our care alive and continuing to heal. ■

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

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D E PA R TM E NT S

PA R TN E R

I N

M E D I C I N E

S P OTLI G HT

How Ditto Transcripts helps physicians be more productive Ben Walker, CEO and Founder, Ditto Transcripts

Trends in physician burnout are worsening and the bulk of daily administrative work largely contributes to this problem. Although an essential part of the job, doctors don’t have time to create lengthy documents and fill out paperwork – you were trained to diagnose, treat and give patients the best care possible. You weren’t trained to be data entry specialists.

Doctors have extremely busy schedules, and completing bureaucratic tasks hinders productivity. Ditto Transcripts can help doctors become more productive thanks to our EHR/EMR transcription services. It can take a significant amount of data entry work off of the physicians’ hands, so you can dedicate more of your energy to patient care.

How EHR/EMR transcription boosts productivity for physicians EHR/EMR transcription lessens tedious paperwork for doctors and allows you to focus on what matters most – caring for your patients.

Here are the main ways integrating a transcription service into your EHR/EMR system can help increase productivity.

Saves time Doctors who dictate their notes through a recording device, an iPhone App or a call-in system can easily document important information in 90 seconds or less. To further save time, hiring a transcription company like Ditto to convert these audio files to text and enter them into your EHR/EMR is recommended.

Reduces expenses Outsourcing EHR/EMR transcription to an external provider like Ditto Transcripts can also reduce expenses. With less money spent on administrative tasks, or medical scribes, your practice can allocate a bigger chunk of its budget to patient care, allowing you to do more for them.

Increases accuracy of medical records Some details can get lost in translation when doctors constantly have to ask medical assistants to edit charts or forget to do it yourself. An EHR/EMR transcription service can help prevent that by maintaining the accuracy of your records.

Improves coordination of patient care Many patients see doctors with different specialties across multiple clinics and hospitals. In such cases, medical records are essential so that each provider can accurately understand their patient’s needs. Because their charts will be done in full by a trained medical transcriptionist the chance for inaccuracies is less than 1 percent.

Expedites the reimbursement process Integrating EHR /EMR systems with medical transcription can help address reimbursement issues that your practice may encounter. That’s because the more accurate your records, the more accurate your billing.

The advantage of accurate billing is that your practice can request reimbursement faster, preventing delayed or missed payments.

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Our four-step EHR/EMR integration process Ditto Transcripts can securely interface with almost any EHR system. We offer physicians convenient traditional dictation/transcription that delivers the transcribed reports straight to your practice’s EHR or EMR. Upon receipt, doctors can review and approve the transcription directly within the EHR. This interfacing technology leverages an EHR’s benefits, such as instant retrieval of reports, patient records and demographics. With it, you can say goodbye to hours of typing and sitting in front of a computer.

Here’s how our EHR interface works: 1. Providers dictate chart notes, SOAP notes, letters, pre-ops, post-ops, etc.

2. The dictations are accurately transcribed and proofread by our skilled medical transcriptionists.

3. T h e t r a n s c r i b e d d i c t a t i o n s a re converted into a format, often RTF, that can be read by your EHR/EMR system.

4. Finally, the properly formatted EHR/ EMR transcriptions are sent to your practice’s EMR/EHR, automatically populating the appropriate text fields with the transcribed notes using an HL7 interface. You’ll be glad to know that everything is 100 percent HIPAA compliant.

EHR and EMR systems have come a long way since entering the health care scene, and the industry is continuously finding ways to harness their full potential.

Whether you’re looking to adopt an EHR/ EMR technology or upgrade your current system, Ditto Transcripts can elevate your practice by helping you achieve optimum productivity and efficiency in your everyday work. ■

D E PA R TM E NT S C O M M E NT

COPIC Medical Foundation 2023 GRANTS

Gerald Zarlengo, MD Chairman & CEO, COPIC Insurance Company One of the ways COPIC continues to invest in improvements in health care is through grant funding from the COPIC Medical Foundation. Established in 1991, the COPIC Medical Foundation focuses on providing charitable financial support to programs and initiatives that address health care issues. Over the years, it has provided more than $11 million to improve patient care and medical outcomes, primarily through grant funding.

This year’s funding cycle continued to focus 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 COPIC Medical Foundation resides in a unique position to identify and champion meaningful initiatives. I continue to be inspired by the dedication driving these initiatives and the innovative thinking that has the potential to improve health care for individual patients and on a broader, systematic level,” said Sophia Meharena, DO, FAAP, COPIC Medical Foundation Board chair.

The 2023 cohort of COPIC Medical Foundation grantees includes four remarkable 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 $511,000 in grants focused on reducing fragmentation across care settings.

Grants support the following projects:

• Metropolitan State University of

Denver (Colorado) – Funding EMT and Nursing Interprofessional Education Pilot and Launch focusing on Interprofessional Education to reduce fragmentation and improve patient outcomes.

• AIRnyc (New York) – A project reduc-

ing Fragmentation in Prenatal and Postpartum Clinical and Social Care for High-Risk Black and Latinx Pregnant Persons: AIRnyc, in partnership with Mount Sinai Health Partners, will aim to improve birth outcomes by convening and co-leading an interdisciplinary, multi-stakeholder co-design process that will identify and address points of fragmentation. This will include developing, testing, and implementing a Community Health Worker-Doula model that will help high-risk patients navigate and address clinical and social care needs, from the prenatal through 90-day postpartum periods in New York City.

• Black Doulas for Black Mamas

(Texas) – Work that increases access to perinatal community health workers to fill gaps in maternal health, improve birth outcomes and lower morbidity and mortality in rural Texas.

• Kansas Healthcare Collaborative (Kansas) – Supporting an approach to improving care transitions for patients dismissed from a hospital emergency room visit or inpatient stay through use of health information exchange technology and data across the state of Kansas.

“The COPIC Medical Foundation is honored 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. “Each year, our grant funding continues to support solutions that can improve patient safety in ways that can be replicated across health care and/or create additional opportunities for expanded applications.”

We anticipate that information about the next round of funding along with Request for Proposals (RFP) will be posted in November 2023 with applications due mid-January 2024. For more details on the COPIC Medical Foundation, please visit www.copicfoundation.org. ■

WITHIN NORMAL LIMITS: COPIC’S PODCAST

Within Normal Limits: Navigating Medical Risks – hosted by Eric Zacharias, MD, COPIC’s director of medical education – now has more than 35 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. Recent episode topics include: • Dealing with Potentially Violent Patients • Scope of Practice Risks with APPs Within Normal Limits is available on popular platforms such as Apple Podcasts, Google Podcasts, Spotify, and Amazon. You can also go to www.callcopic.com/wnlpodcast for more information.

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Opioids in medicine: A double-edged sword Nastassja Michel

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 Depar tment of Medical Humanities, and Alexis Horst, MA, writing center instructor.

Nastassja Michel is a second-year osteopathic medical student at Rocky Vista University. She is a Colorado native and is passionate about teaching fentanyl education and naloxone administration to her community through her volunteer program, “Still I Rise.” She looks forward to harnessing these experiences into her career in medicine through providing holistic and compassionate patient care. In her free time she loves to embroider, paddle board, travel, and spend time with her Siberian cat, Basil.

Prior to starting medical school, I didn’t know how much the opioid epidemic and fentanyl crisis had infiltrated Colorado. I never could have imagined that in my first year of medical school, one of my best friends would die of a fentanyl overdose from a “Percocet” she was given by a close friend. The day she died, her prescribed medications were untouched in her cabinet and her work clothes were carefully laid out on her dresser in preparation for the day, her family close by in their rooms. When I received the news, it took me a long time to understand how one pill had killed her. It would have been impossible for several prescribed Percocet to kill her, let alone one of them. I truly had to understand that, like the coroner reported, that pill had no Percocet in it, 22

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only fentanyl and filler. I later learned that shortly before she died, she had asked her psychiatrist if she could be put back on her Xanax prescription since her anxiety was becoming severe again; the doctor denied her request. Would I, as a future physician, have prescribed her Xanax for her anxiety knowing the risk of dependency? As I came to terms with how serious the fentanyl crisis had become, I learned that her story was similar to so many others. A 16-year-old girl in her same townhouse complex had overdosed on a fentanyl-laced pill just several months prior.

The opioid epidemic’s third wave began in 2013, with illicit fentanyl causing a large number of deaths. Overdoses

increased 30 percent from 2019 to 2020.1 A December 2022 CDC report showed a 109 percent increase in average monthly overdose deaths in individuals 10-19 years old during the period from July-December 2019 to July-December 2021. 2 It is understandable that the medical community and local legislation have not yet been able to get ahead of this epidemic given its complexity, having components within international drug trafficking and previous overprescribing of opioids.

Having experienced chronic anxiety that has greatly interfered with my quality of life, I understand how desperate one can feel for relief, which has given me more insight into how the opioid epidemic was

able to spiral out of control. I developed debilitating anxiety after the loss of my friend, which was compounded by the stress of my medical school classes and upcoming boards examination. For months, I would have episodes of shaking, sweating and panic attacks. I had mixed opinions from my psychiatrist and my therapist on whether or not a benzodiazepine would be appropriate. Ultimately, my psychiatrist encouraged me to push through my panic attacks until they found the correct medication regimen for me. I understood why there were hesitations to prescribe me a benzodiazepine because of the possibility it could cause dependency. At the same time, I understood my therapist’s recommendation, since benzodiazepines have been shown to be effective in treating generalized anxiety disorder. Fortunately, working closely with my psychiatrist, therapist and focusing on self-care, I am able to effectively manage my anxiety and have excelled in my last few months of didactics before rotations. It was not until I experienced the dilemma of potentially being prescribed a benzodiazepine, which has the potential for dependancy similar to an opioid, that I began to understand the complexity of prescribing these medications.

felt for pain relief, I can imagine how abandoned they may have felt by their health care providers.

Whether due to addic tion or pain management, a large population in our society has been impacted by the opioid crisis. After recovering from the initial grief of losing my friend, I decided that I needed to harness my sadness and disillusionment into equipping young people with Narcan and trying to create a space of empathy for those who face addictions.

I have named my volunteer program after my friend’s tattoo: Still I Rise. We have been able to teach high school, undergraduate and graduate students as well as teachers about overdose prevention through harm reduction. We recently spoke at the school that the 16-year-old girl who overdosed had attended, a talk I hold close to my heart as I witnessed the grief the faculty were enduring. It has been rewarding to educate adolescents, a population that has fallen victim to the opioid crisis over recent years.2 When I talk about how my friend passed, it is hard to remove the stigma from it; many

assume she was addicted to narcotics and likely took massive amounts leading to her overdose. With the opioid and fentanyl crisis continuing to increase in Colorado, it is important that we, as a medical community, remove the stigma around opioids in order to have productive conversations with our patients about it. I realize that future physicians like myself will need compassion and empathy to have difficult conversations with their patients about the risks of addiction and the current fentanyl crisis: a challenge I am ready to tackle. ■ References: 1. Hedegaard H, Miniño AM, Spencer MR, Warner M. Drug overdose deaths in the United States, 1999–2020. NCHS Data Brief, no 428. Hyattsville, MD: National Center for Health Statistics.

2021. DOI: https://dx.doi.org/10.15620/ cdc:112340.

2. Kuehn BM. Fentanyl Drives Startling Increases in Adolescent Overdose Deaths. JAMA. 2023;329(4):280-281. doi:10.1001/jama.2022.23563

Some patients aren’t able to manage their conditions the way I am able to manage my anxiety, and the dilemma providers face about prescribing opioids affects these patients especially. For example, par t of our immunohematology unit involved patients with cancer discussing their experiences going through treatment. Two speakers discussed the most disheartening truth about their chemo and radiation treatments: the patients were in immense pain that doctors would not treat with narcotics. One patient described how he will be on chemo for the remainder of his life, but his doctors denied narcotics due to the concern for addiction. I could see that in this circumstance, these oncologists were in a similar dilemma as my psychiatrist; this challenge is evident in the dramatic shift that physicians all over have made in their stance on narcotics. The patients, one of them a physician, explained they had been treated like drug addicts seeking narcotics to tend to their addiction rather than minimize the constant pain they were enduring due to treatment. Gaining insight on the desperation these patients C O LO R A D O M E D I C I N E

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Sleeping better Medha Gudavalli

Medha Gudavalli is a fourth-year medical student at the University of Colorado. She developed an interest in medicine at a young age, playing dress-up in her mom’s white coat in the suburbs of Littleton and Aurora. As an undergraduate, she studied public policy and Spanish and also became an advocate and activist on behalf of victims of sexual assault. Medha has served as a policy specialist for the Colorado Coalition against Sexual Assault and also as a Hotline Responder for the Blue Bench. She hopes to become a family physician, caring for underserved populations and providing compassionate, traumainformed and victim-centered care to her patients. As a physician and as an educator, researcher and advocate, Medha is committed to increasing awareness of intimate partner and gender violence.

There will be many nights of lost sleep in the year ahead. Some from the dreaded trauma of overnight shif ts (a future primary care doc speaking), some from

worrying about a patient’s acid-base disturbance or ventilator settings, or thinking through a particularly complex constellate of symptoms and social

factors. Lost sleep is a price we pay for pursuing this challenging career.

All this I knew. What I did not know when I started my clinical training were the sleepless nights spent thinking about an interaction where I could have been more kind instead of efficient, a hand I did not hold, or a joke an attending made about the “insufferable patient” who was actually just suffering. These nights are particularly hard, because losing our humanity is too high a price to pay, no matter the career.

So, my advice for you this year is simple: Yes, run through UWorld questions to ace that shelf exam; practice your oral presentations with your resident; work on your prioritized differential diagnoses; and practice tying surgical knots with both hands. But do not get so sucked into the importance of learning these skills that you forget the importance of kindness, integrity, hope and the human spirit. Aim to always recognize the light in another person, no matter how faintly it is shining, or how insignificant that interaction might seem. You will learn. You will grow. And I promise you, you will sleep a little better. ■

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Staff updates: Welcome new component executive, membership program manager and CME director The Colorado Medical Society hired three new employees to aid in our mission to champion health care issues that improve patient care; promote physician professional satisfaction; serve as a place of inclusion and belonging for all Colorado physicians, residents and medical students; and create healthier communities in Colorado.

CECILIA COMERFORD was hired as executive director of the Boulder County Medical Society (BCMS) and Colorado Society of Eye Physicians and Surgeons (CSEPS). She moved to Colorado in August 2022 with her partner and pets for new experiences and to be closer to family. She is also an Ohio native and previously worked in the Ohio governor’s office as well as for a regional community foundation.

DORCIA DUNN was hired as program manager for the membership department. An Ohio native, she comes to our organization with more than 20 years of management, front-office classroom instruction and physician relations experience. She has served as a department head with UCHealth - South (formerly Memorial Hospital) within the revenue cycle to include the areas of registration, scheduling, authorization and staff training. Most recently, Dorcia worked as the operations manager of the El Paso County Medical Society, individually coordinating the 2021-2022 EPCMS physician membership renewal season.

KIM VADAS, MABMH, CHCP, FACEHP, was hired as assistant director of continuing medical education and recognized accreditor programs. She is working with Gene Richer, MEd, CHCP, who is the

current director of CME and recognized accreditor programs, to transition the oversight and daily operations of the CME department, as Gene plans to retire this summer.

Kim has more than 20 years of experience in the continuing professional development industry. In previous roles, she provided senior managerial-level support for the portfolio of skills and experiential learning courses, developing new skills courses/tracks, grant writing, and identifying funding sources to support programs.

She managed the accreditation process, needs assessments and transition to Joint Accreditation through the ACCME at several different medical specialty societies. Kim is a Fellow of the Alliance for Continuing Education in the Health Professions (FACEHP), as well as a Certified Healthcare CPD Professional (CHCP).

She has a background in bioethics and Medical Humanities, with a concentration in ethical analysis and problem solving for complex health-related issues. Additionally, her undergraduate work was in social and behavioral science. ■

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BCMS hosts event to raise awareness of fentanyl epidemic, drug poisonings The Boulder County Medical Society (BCMS) hosted an event on April 26, 2023, to spread awareness on drug poisonings, the fentanyl epidemic, and naloxone usage in the community. Attendees, including BCMS members and guests, heard from and asked questions of an expert panel including:

• Don Stader, MD, FACEP, an emergency

medicine physician, executive director of the Naloxone Project and founder of Stader Opioid Consultants; Michael Dougher t y, Esq., district attorney of the 20th Judicial District (Boulder County)

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• Rob Valuck, PhD, RPh, executive direc• •

tor of the Colorado Consortium for Prescription Drug Abuse Prevention; Rachel Hastings, a Longmont police officer; and Racquel Garcia, YRC, CAC, founder of Hard Beauty.

The panelists discussed topics ranging from the frequency of 911 calls, litigation, addiction, naloxone and personal stories in recovery.

“The current opioid crisis is affecting society like nothing we have seen before, crossing all socioeconomic, racial and

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political boundaries,” said BCMS President Cliff Gronseth, MD. “With our role in society and public health, physicians and their staff are uniquely positioned to educate, promote appropriate use of opioids in health care, and prevent needless deaths from grade school to grandparents.”

The Boulder County Medical Society continues to provide information to physicians on drug poisonings to the community and support physicians who are diligently supporting patients. Visit the BCMS website at www.bouldermedsociety.org for more information on upcoming events and initiatives. ■

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1 BCMS President Cliff Gronseth, MD, speaks with BCMS member physicians before the event. 2 Attendees enjoyed dinner before the program began. 3 Longmont police officer Rachel Hastings. 4 District Attorney Michael Dougherty, Esq. 5 Rob Valuck, PhD, RPh. 6 Speakers addressed a packed venue. 7 Raquel Garcia, YRC, CAC. 8 Don Stader, MD, FACEP. 26

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Breaking through our fears

Scott Humphreys, MD, Medical Director, Colorado Physician Health Program (CPHP)

Fear. It is a tremendous force. A distressing emotion aroused by impending danger, evil, pain, etc., whether the threat is real or imagined. After speaking with hundreds of fellow physicians, most of which have specifically sought help with the Colorado Physician Health Program (CPHP), I have witnessed that fear is a major player throughout our careers. Fear that we won’t match for residency, palpable imposter syndrome, the impending uncertainty of medicine as a field, even the fear of our lives after medicine. Each fear expressed takes a toll. But we chose to be physicians because the reward of helping others outweighs those fears.

The foremost fears that arise during conversations are concerning confidentiality of seeking care and the stigma associated with mental health. “Will the licensing board (or my employer) find out that I came to get help?” is asked almost every single time I meet with a physician who is struggling. If our passion, our career, our calling could be taken from us we adamantly resist. These two fears, confidentiality and stigma, are plaguing our ability to get help. Earlier this year, Medscape detailed that 51 percent of surveyed physicians believed “depression says something negative about me.”

Additionally, the Lorna Breene Founda-

tion found the No. 1 and No. 2 reasons for doctors not seeking care were fear of licensure and then credentialing.

All of this is why I come to you with tremendous excitement. As you read throughout this edition of Colorado Medicine, we are introducing a program that helps breakdown those fears and helps remove the perceived barriers. One phone call. One conversation. Sometimes that’s all we need to feel supported. Perhaps that is all we need to overcome our fear. As a physician, I completely understand your hesitation, your fears in seeking help. But I came to you today to assure you that we are here. You may access support that is completely confidential, with no judgement. Through the newly established Doc2Doc Wellbeing Consulting program you are connected to a fellow physician who has expertise in how to stay well and how to thrive in medicine.

My colleagues and I are here to listen. We understand. I know your fears, am familiar with why this career is so challenging and am excited to help you find your love for medicine again!

In the words of your peers: "I cannot emphasize enough how valuable a resource CPHP has been, and I continue to encourage colleagues who are struggling either personally or professionally to reach out and make contact. I can say unequivocally that it saved my life, my family, and my career."

"The team of professionals at CPHP were professional, understanding and efficient. With their support and perspective, my love for medicine returned. I recognized that in order to provide the best possible care to my patients and their families, I also needed to care for myself." ■

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