March-Apr-2013

March/April 2013

Volume 110, Number 2

“ Where does it hurt? �

Curbing abuse and preserving patient care

Colorado Medicine for March/April 2013

Award-winning publication of the Colorado Medical Society

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Colorado Medicine for March/April 2013

cont n ent nt ns nt Mar/Apr 2013, Volume 110, Number 2

Features. . .

Cover story A January 2013 report

revealed that Colorado has the secondhighest rate of non-medical prescription drug abuse in the nation. Learn more about the issue and CMS plans to support Gov. Hickenlooper’s efforts working on the National Governor’s Association’s Prescription Drug Abuse Policy Academy.

Coverage starts on page 8.

Inside CMS 5 7 28 33 36 38 40 42

President’s Letter Executive Office Update Spring Conference Committee on Physician Practice Evolution Physician Quality Reporting System ICD-10 Training Reflections COPIC Comment

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Medicaid expansion moves forward–Gov. Hickenlooper’s support for the Medicaid expansion virtually assures Colorado will add 160,000 uninsured to the program.

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Chiropractic injection rule stopped–CMS leads a successful effort to roll back a dangerous rule that would have allowed chiropractors to perform injections in Colorado.

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Legislative update–Learn more about important issues facing the house of medicine during the 2013 legislative session.

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Colorado leaders take concerns to D.C.–More than a dozen Colorado physicians traveled to our nation’s Capitol to lobby Congress on important health care issues.

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Maintenance of licensure–Colorado physicians are encouraged to influence the process by participating in a survey released this spring by DORA.

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Colorado Clean Claims Task Force–Learn of the many accomplishments of the task force and its plans to develop a standardized set of claims edits and payment rules.

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“We’re all in this together” – AMA President Jeremy Lazarus, MD, emphasizes the importance of teamwork as he outlines a series of physician-led initiatives both national and local.

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Final Word–Governor John Hickenlooper discusses a number of topics related to Colorado gaining momentum as the healthiest state in the country.

Departments 44 46 49

New Members Medical News Classified Advertising

Colorado Medicine for March/April 2013

Editor’s note: Articles appearing in Colorado Medicine without a byline represent the collaborative work of CMS leadership and staff.

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C OLOR A D O M EDICA L S O CI ET 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 CONNECTION

2012/2013 Officers Jan M. Kief, MD

President

John L. Bender, MD, FAAFP President-elect Kay D. Lozano, MD

Treasurer

M. Robert Yakely, MD Speaker of the House Brigitta J. Robinson, MD Vice-speaker of the House Alfred D. Gilchrist Chief Executive Officer F. Brent Keeler, MD Immediate Past President

Board of Directors Amy Beeson, MS Charles W. Breaux Jr., MD Robert A. Brockmann, MD Ellen M. Burkett, MD Naomi M. Fieman, MD T. Casey Gallagher, MD Jan Gillespie, MD Ripley R. Hollister, MD Johnny E. Johnson, MD Donald Luebke, MD Randy C. Marsh, MD Gary Mohr, MD Lucy Loomis, MD Jeffrey A. Moody, MD Edward A. Norman, MD Tamaan Osbourne-Roberts, MD Bianca Pullen, MS Scott Replogle, MD Ranee M. Shenoi, MD Alisa B. Lee Sherick, MD Stephen V, Sherick, MD Sean Slack, MS Richard C. Lamb, MD Kayla Steffensmeier, MS

Board of Directors Michael Volz, MD H. Dennis Waite, MD Michael Welch, DO Jennifer Wiler, MD Harold “Hap” Young, MD AMA Delegates A. “Lee” Morgan, MD M. Ray Painter, Jr., MD Lynn Parry, MD Brigitta Robinson, MD AMA President Jeremy Lazarus, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Mark Laitos, MD Tamaan Osbourne-Roberts, MD CMS Connection Mary Rice, President

COLORADO MEDICAL SOCIETY STAFF Executive Office

Alfred Gilchrist, Chief Executive Officer, Alfred_Gilchrist@cms.org Dean Holzkamp, Chief Operating Officer, Dean_Holzkamp@cms.org Dianna Mellott-Yost,Director, Professional Services, Dianna_Mellott-Yost@cms.org Tom Wilson, Manager, Accounting, Tom_Wilson@cms.org Donna Jeakins, Manager, Accounting, Donna_Jeakins@cms.org Janine Hahn, Administrative Assistant, Janine_Hahn@cms.org

Division of Communications and Member Benefits

Brad Pierson, Art Director/ Manager, Communications, Brad_Pierson@cms.org Mike Campo, Director, Business Development & Member Benefits, Mike_Campo@cms.org

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Health Care Policy

Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org

Division of Information Technology/Membership Tim Roberts, Senior Director, Tim_Roberts@cms.org Tim Yanetta, Coordinator, Tim_Yanetta@cms.org

Division of Government Relations

Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Chris McGowne, Program Manager, Chris_McGowne@cms.org

Colorado Medical Society Education Foundation Colorado Medical Society Foundation Mike Campo, Staff Support, Mike_Campo@cms.org Donna Jeakins, Staff Support, Donna_Jeakins@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, Colorado, and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance.

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

Alfred Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Brad Pierson, Art Director, Assistant Editor; Chet Seward, Assistant Editor.

Printed by Spectro Printing, Denver, Colorado

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Colorado Medicine for March/April 2013

Inside CMS

president’s letter Jan Kief, President Colorado Medical Society

Boards sets aggressive 2013 agenda It’s hard to believe that we’re already well into a new year and nearly halfway through my tenure as your CMS president. I’m continually impressed with our volunteer leaders and CMS staff who work to ensure we move our strategic initiatives forward for the benefit of Colorado physicians.

Your CMS Board of Directors met on Jan. 18 to discuss current issues, take action and set the course for the year.

I can assure you that after robust discussions among a diverse representation of members from various practice settings and specialties, we are poised to make great gains in 2013.

Perhaps the most complex issue we discussed at the board meeting was Medicaid expansion. Last September the House of Delegates approved a multistep process for arriving at a decision on Medicaid expansion that included the development of a policy document vetted by the Council on Legislation, the Committee on Practice Evolution, and the board; a member survey; and many meetings with component societies and the Colorado Department of Health Care Policy and Financing. During the meeting we heard from Sue Birch, a member of Gov. Hickenlooper’s cabinet, on the state’s efforts to enhance value in the program and contain costs.

We feel that the expansion is an historic opportunity to close the coverage gap and to further reform the Medicaid system, but we also feel that it must take place under strong physician leadership and concurrently with systemic reforms.

We have a seat at the table and will use it to usher in a system that better serves the patients of Colorado.

Colorado Medicine for March/April 2013

Prominent media issues demand our attention. We’re at the center of the prescription drug abuse debate as our members strive to mitigate pain while also managing risk and educating patients on the dangers of misusing these powerful medications. The CMS Workers Compensation and Personal Injury Committee and 12 special advisors are working to draft a policy on prescription drug abuse and WCPIC members have committed to assist the governor’s staff with its efforts to craft a statewide strategy to address this epidemic.

Another high-profile topic is firearm safety. Physicians have a role in identifying and treating patients at risk for violence, but we must do this with an integrated mental health network. The board approved the Council on Legislation’s decision to support Gov. Hickenlooper’s proposal to strengthen Colorado’s mental health system in response to violent crime and also suggested the addition of more mental health workers and patient beds, more emergency mental health workers, more mental health workers that are available to treat dual diagnosis of substance abuse and mental health illness, and more emphasis on pediatric mental health care.

These focus areas and more will be brought before the Colorado General Assembly this session, presenting a powerful opportunity for CMS to provide resources and expert testimony on the practice of medicine, while building on relationships fostered with our elected officials over the past decade.

Through this busy year we will continue to advocate for improving the practice environment through payment reform, administrative simplification and liability reform. We are actively developing collaborations with other health care organizations to advance initiatives targeting patient safety, quality and efficiency. And we are actively working to guard against those who threaten to disrupt the patient-physician relationship.

I encourage you to stay up to date on these issues and participate in the discussion. All members should consider attending our Spring Conference, which will present a comprehensive program on practice transformation and will be strengthened with broad member involvement. CMS has the momentum to make this a banner year for Colorado physicians. Let’s keep it going. n

Join COMPAC Now!

Colorado Medical Political Action Committee Call 720-858-6326 or 800-654-5653, ext. 6326 or e-mail chris_mcgowne@cms.org

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Inaction vs IN ACTION We understand the difference The Litigation Center of the American Medical Association and the State Medical Societies fights to protect doctors and uphold the highest standards of patient care.

In courtrooms across America, we are achieving legal victories that preserve the rights of physicians, promote public health and protect the integrity of the profession.

Whether we are challenging managed care organizations’ payment practices or preserving the autonomy of the hospital medical staff, one thing remains constant: The Litigation Center is an active force fighting for physicians’ rights.

Learn more on how The Litigation Center can help you.

ama-assn.org/go/litigationcenter

Membership in the American Medical Association and the Colorado Medical Society makes the work of The Litigation Center possible.

Join or renew your memberships today by calling the CMS at (800) 654-5653.

The Litigation Center is proud to have Alfred Gilchrist, CEO of the Colorado Medical Society, serve on its executive committee.

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ama-assn.org

cms.org Colorado Medicine for March/April 2013

Inside CMS

executive office update Alfred Gilchrist, Chief Executive Officer Colorado Medical Society

Colorado in epicenter of non-medical prescription drug abuse Colorado is in the epicenter of the prescription drug abuse epidemic with the dubious distinction of having the second highest rate of non-medical prescription drug abuse in the nation, at 6% of people over the age of 12. As a result, we are squarely in the middle of the emergent national debate on what states should do about it.

As physicians, our members will be integrally linked to the policy proposals that emerge. This is why we are in high gear trying to determine where current practices and policies go wrong and what can reverse these dangerous, even fatal, diversions and misuse, while making sure compassionate, evidence-based care is always there for patients suffering from pain.

Gov. John Hickenlooper and Alabama Gov. Robert Bentley, MD, are co-chairing a seven state pilot project launched by the National Governor’s Association to address this issue. In Colorado, a series of roundtables will involve the entire range of stakeholders in this process, from public health and clinical experts to patient advocates and caregivers.

In a recent letter to the governor (reproduced on page 11 of this magazine), CMS committed itself to this urgent matter, explaining that the threat to patient safety suggests the current methods of pain management and opioid prescribing practices require an exhaustive review and examining the epidemiology of these abuses, whether from street diversion, overprescribing, doctor shopping or any other means of diversion and abuse is of paramount importance in setting a course for reform.

contemplated is on the table. Some options will be thoughtful and grounded in painful experience (pun intended).

Other options will be punitive, and still others will eventually fall into the been-there-don’t-do-that category. With AMA support, we are already convening the leadership of the other six state medical societies in the NGA pilot to level up our mutual understanding of the best (and worst) practices and to share insights. We are enthusiastically working with Gov. Hickenlooper’s team and our many friends across the spectrum of pain management and addictionology. This work will move from the governor’s roundtables scheduled for March and into the statehouse in 2014.

The time-honored legislative wisdom that “hard cases make bad law” is a risk we will be assuming as the tragedies continue to pour onto the front pages of the Denver Post, other major daily newspapers and prime time television.

The coverage has already driven one

state legislature to consider and even enact ideas that upon more sober reflection don’t move the needle in the right direction. There is also an often-repeated wisdom to “fix the problem, not the

Colorado . . . has the dubious distinction of having the second highest rate of nonmedical prescription drug abuse in the nation, at 6% of people over the age of 12. blame,” a value that has in my experience been deeply embedded in the body Colorado politic.

If there is a state that can find the longterm fix, it will be Colorado. n

Encourage a colleague to join the Colorado Medical Society and your local medical society today!

Visit www.cms.org to learn more about the benefits of becoming a member

For more information and an application to join, call Tim Yanneta 720-858-6306 or e-mail tim_yanetta@cms.org

Every policy option ever enacted or Colorado Medicine for March/April 2013

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Cover Story

“ Where does it hurt? �

Curbing abuse and preserving patient care

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Colorado Medicine for March/April 2013 Kate Alfano, CMS contributing writer

Cover Story

A January 2013 report revealed a disturbing statistic: Colorado has the second-highest rate of non-medical prescription drug abuse in the nation.

The National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration shows that 6 percent of Coloradans ages 12 and older report having abused prescription pain relievers in the past year compared to a national average of 4.57 percent. The highest rate of abuse occurs in the young adult population; 14 percent of Coloradans between the ages of 18 and 25 reported misuse of the drugs in 2010-2011 compared to 10.43 percent nationally.

As prescribers of these medications, physicians play a central role in this issue. This is why, far before the study’s publication, the Colorado Medical Society began to study the relationship between pain management, prescribing practices and patient safety.

Most recently, the CMS board of directors voted at their Jan. 18 meeting to make the issue of prescription drug abuse a high priority and directed the society to work proactively with the governor, his staff and appropriate state agencies and stakeholders on effective strategies to reduce prescription drug abuse in Colorado.

Though several agencies within state government have taken on this issue and the Colorado Prescription Drug Abuse Taskforce has been active for many years, Colorado’s efforts gained national attention when the National Governors Association selected Colorado Gov. John Hickenlooper as the co-chair of a national prescription drug Colorado Medicine for March/April 2013

abuse project that brings together seniorlevel policymakers in seven states – Colorado, Alabama, Arkansas, Kentucky, New Mexico, Oregon and Virginia – to develop and implement both comprehensive and coordinated strategies that leverage available tools and resources to address prescription drug abuse.

They will examine building a prescription drug monitoring program coordinated between states and within regions, assess regulatory and legislative barriers, examine best practices, coordinate education, and guide proper medication disposal and enforcement. Participating states are scheduled to release a report by the end of February.

Kelly Perez, human services policy advisor for Gov. Hickenlooper, says that the public perceives these medications as safe because they’re prescribed by doctors but that we – physicians and the state – need to educate the public on the dangers of these substances when not used properly.

“Doctors have a role in advising state efforts, creating policies and adopting safe prescribing,” Perez says. “You’re the ones who will know the best medical education opportunities and how to make them available for physicians. We’ll work on usefulness of resources and safe disposal, and how to develop uniform messaging so we aren’t giving different messages to the public.”

Naming Colorado’s Prescription Drug Monitoring Program database, the Colorado Medication Take-Back Pilot Project and efforts by the attorney general and others, she says that the state has all of the pieces we need to move forward.

“I think it’s our responsibility to unify these projects and to come up with a state plan.”

Leading CMS’ effort is the CMS Workers Compensation and Personal Injury Committee, or WCPIC. CMS President

Jan Kief, MD, named 12 special advisers to the committee who have demonstrated expertise on the subject, and these advisers will also work with the governor’s office to provide insight and feedback on policies. Chaired by occupational medicine physician John Hughes, MD, WCPIC held its first meeting on prescription drug abuse on Jan. 17.

Dr. Hughes says WCPIC will focus on three points initially, beginning by endorsing the Colorado Medication TakeBack Pilot Project, coordinated by the Colorado Department of Public Health and Environment, and encouraging its expansion. Since its launch in December 2009, the program has collected more than 25,000 pounds of medications and has increased awareness of the environmental and public health concerns related to improper medication disposal with overwhelming public approval. But Greg Fabisiak, CDPHE environmental integration coordinator, says, “identification of sustainable funding sources is the greatest challenge facing existing programs and efforts to expand them.”

Second, WCPIC will focus on the dilemma faced by physicians who treat patients for chronic pain and who must change a patient’s medication midway through the previous prescription.

“They have to do some sort of take-back to reacquire custody of the unused medication,” Dr. Hughes says. “Currently this is a problem. There needs to be some rule-making that protects physicians who do chronic pain management and allows us to take back medications.”

“The third takeaway point is that we need to increase physician education regarding using the Prescription Drug Monitoring Program database. We need to refine guidelines that are already developed under the supervision of the Colorado Division of Workers’ Compensation pertaining to controlled substances. Their narrow application to workers’ compensation doesn’t help most Colorado physicians, so we need to broaden those guidelines and make them more available to educate physi-

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Cover story (cont.) cians, promulgating guidelines for when physicians should query the PDMP.” “One of the reasons that providers need to be in the forefront is because it’s the providers who were pushed to give all these pain medications to begin with based on things that happened 10 years ago,” says Kathryn Mueller, MD. She’s a WCPIC advisor and also medical director for the Division of Workers’ Compensation and professor in the Department of Emergency Medicine and School of Public Health at the University of Colorado School of Medicine.

“The policy for providers was that you’ll be punished if you don’t treat pain, and we need to treat pain but we need to do it properly.”

Dr. Mueller supports developing new education and building on existing education for physicians and providers managing chronic pain rather than imposing additional screenings and regulations. CMS must be the moving force, she says, because physicians will be the ones implementing new policies and using the resources. “Particularly with the PDMP, the providers have to be the ones telling us what works best for them and how they are going to use it more because right now it’s underutilized.

Providers need to be the leaders because other sources don’t really understand how clinics work and how physicians practice. We’re going to be the ones doing it; we’re the ones responsible.”

The willingness for physicians to prescribe narcotic therapy with suboptimal indications is one factor of prescription drug abuse, and the solution will be “predominately a matter of physician education and having physicians understand that for nonmalignant, nonterminal patients, chronic narcotic therapy just doesn’t have great outcomes in a majority of patients,” says Ken Cohen, MD, F.A.C.P. Dr. Cohen is a WCPIC advisor, internal medicine physician and chief medical officer for New West Physicians. Selfobservation and assessment helped his Denver-area primary care group practice take action to ensure proper prescribing.

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Several years ago, the group identified a provider who had been prescribing large doses of narcotics without well-described indications and came together as a group to set their future procedure.

“We encouraged narcotics to be used for short-term use only,” Dr. Cohen says. “If long-term narcotics are being used for treatments other than cancer pain or terminal illness, we require consultation with a specialist who has a direct relationship to whatever indication the narcotic is for; by that I mean, if it’s intractable back pain we consult with an orthopedic surgeon. We don’t want any of our physicians prescribing chronic narcotic therapy for nonmalignant pain in the absence of consultation.”

New West Physicians also mandates that every patient of chronic narcotic therapy have a narcotic contract. They look at the past two years of narcotic prescribing for all new physicians in the group to make sure to identify appropriate narcotic prescribing practices.

Lastly, for any patient new to the group who comes in with chronic narcotic use, PDMP use is mandated to make sure that there’s only one physician prescribing narcotics.

CMS will continue to work with the state to develop appropriate policies to reverse the escalating trend of opioid abuse and its often-tragic consequences. WCPIC advisors will participate in roundtable discussions this spring hosted by CDPHE, the governor’s office and the Colorado Department of Human Services, focusing on drug disposal, physician and provider education, public awareness, the prescription drug monitoring program and epidemiology.

In a Jan. 29 letter to the governor, CMS urged consideration of strategies that significantly reduce the potential for diversion to recreational or medically inappropriate use and risk of overdose and the resulting range of medical, psychological and social consequences, while assuring compassionate, evidence-based care for patients who suffer from chronic non-cancer pain. n

Educational resources As the prevalence of prescription drug abuse increases, organizations are developing continuing professional development activities to keep physicians up to date on identifying and treating patients suffering with chronic pain, and on warning signs and risk factors for abuse.

The Colorado School of Public Health has developed an online, evidence-based activity accredited for two credits of CME and approved for COPIC points that examines the best practices and universal precautions for treating chronic pain. “The Opioid Crisis: Guidelines and Tools for Improving Chronic Pain Management” was developed specifically for Colorado health care providers. The interactive course leads the learner through guidelines for assessing patients, developing a comprehensive treatment plan, initiating an opioid trial and regimen, monitoring patients, and strategies to manage the risk of opioid abuse, overdose and diversion.

An accompanying chronic pain toolkit includes resources for clinicians to help them manage chronic pain patients including sample patient questionnaires and contracts, assessment tools, applications for calculating morphine equivalent doses, and more.

Go to http://tinyurl.com/b8v9fo9 to access the CME activity and toolkit.

Additionally, physicians can earn continuing medical education credit through an AMA online module, “Prevention of Prescription Drug Misuse and Diversion.” Part of the AMA’s Educating Physicians on Controversies and Challenges in Health program, the activity provides an overview on prescription drug abuse and offers tips for physicians on how to educate and counsel patients.

Physicians will learn how they can help their patients avoid prescription drug diversion, learn to identify three strategies to suggest to patients to prevent the use by others, and be able to give advice for medication safety and maintenance.

Go to http://tinyurl.com/8tgbazp to access the CME activity.

Colorado Medicine for March/April 2013

Cover Story

Colorado Medical Society

"Advocating excellence in the profession of medicine”

January 29, 2013 The Honorable John Hickenlooper Governor, State of Colorado State Capitol Denver, CO 80203 Dear Governor Hickenlooper: On behalf of the 7,700 members of the Colorado Medical Society, we wish to convey our strong support for your efforts on behalf of the National Governor’s Association’s Prescription Drug Abuse Policy Academy to reverse the escalating trend of opioid abuse and its often tragic consequences.

Among the wide range of policy options that may emerge, some may have a proven track record in other cities and regions, while still others, notwithstanding political appeal, may have failed or worse, expanded the already large pool of patients suffering from intractable, chronic pain. Clearly, the threat to patient safety suggests that the current methods of pain management and opioid prescribing practices require an exhaustive review and where indicated reforms. Examining the epidemiology of these abuses, whether from street diversion, overprescribing, doctor shopping, or any of the other means of diversion and abuse is of paramount importance in setting a course for reform.

We respectfully urge your consideration of those strategies that significantly reduce the potential for diversion to recreational or medically inappropriate use and risk of overdose and the resulting range of medical, psychological and social consequences, while assuring compassionate, evidence-based care for our patients who suffer from chronic non-cancer pain.

We have established a special advisory panel on this issue to assist you and to guide policy proposals within CMS. Thank you for your leadership. We look forward to the collaboration.

Sincerely,

Jan Kief, MD, President Copies to:

John Bender, MD, President-elect John Hughes, MD, Chair, Special Advisory Committee on Opioid Abuse Kelly Perez, Policy Adviser Katherine Blair, Health Policy Adviser Chris Urbina, MD, CMO CDPHE Susan Koontz, JD General Counsel Alfred Gilchrist, CEO CMS Jerry Johnson, Legislative Consultant P.O. Box 17550 • Denver, CO 80217-0550 • 720-859-1001 or 800-654-5653 • fax 720-859-7509

Colorado Medicine for March/April 2013

http://www.cm s.org

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Features

Chet Seward, Senior Director, Health Care Policy

Medicaid expansion moves forward In early January, Gov. John Hickenlooper announced his support for the expansion of Medicaid coverage for low-income Coloradans as called for by the Affordable Care Act. The January 3 announcement ended months of speculation about the fate of Medicaid in Colorado and accelerated work on a number of fronts to ensure access to cost-effective, quality health care for low-income Coloradans.

Two weeks later the CMS board of directors voted to support the expansion based upon a policy platform that strongly supports the ongoing transformation of Medicaid through the Accountable Care Collaborative, (ACC) while underscoring the need for work on other critical areas including increasing physician reimbursement, liability protections, administrative simplification and enhanced patient engagement.

The governor’s announcement kicked off a flurry of policy and political work to develop a bill for consideration by the legislature. While no bill has been officially released at press time, it is clear that it will have strong legislative champions with Sen. Irene Aguilar, MD, expected to serve as lead sponsor in the senate and Speaker Mark Ferrandino as lead sponsor in the house. Both have indicated an interest in not rushing the development of the bill in order to craft it in a way to meet Colorado needs and obtain bi-partisan support. Political tensions continue to break along two camps, with some leaders arguing that this is the best deal possible to cover the uninsured and substantially limit cost shift to private payers, while others assert that the expansion repre12

sents a huge government overreach that threatens the state budget.

What the expansion means CMS physician members are similarly concerned about what the expansion means for Medicaid and health care in Colorado (see sidebar for details). That’s why the expansion policy platform approved by the CMS board of directors is so important given its emphasis on improving upon the ACC, the state’s pivotal initiative to reform Medicaid using seven regional care coordination organizations, payment reforms and providing information technology and data support to drive informed decision-making. The platform also serves as a clarion call to develop and follow a clearly defined path to address urgent, systemic issues that threaten the success of the expansion including appropriate physician reimbursement rates, enhancing patient engagement, simplifying administrative requirements and preserving and innovating liability protections.

Sue Birch, executive director of the Colorado Department of Health Care Policy and Financing, which oversees the Medicaid program, spotlighted current work on some of these issues during her presentation to the CMS board of directors on January 18. She touted the state’s work on the “Medicaid Five,” five efforts to enhance the value of the program including: • Strengthening efforts to prevent unnecessary or duplicative services; • Ensuring the most effective services are delivered at the lowest cost; • Increasing the effectiveness of care

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delivery through the ACC; Evolving payment systems to reward value instead of volume; and Leveraging health information technology to improve quality and efficiency of care, and redesigning administrative infrastructure.

More questions, more work Many questions remain about how the Medicaid expansion in Colorado will ultimately look and work. Details of the bill (or bills) that is expected to be released in the next month are still being hashed out and therefore its impact on the ACC and a myriad of other state programs has yet to be assessed. These programs will play a central role in attaining much-needed cost savings, while ensuring access to high quality care. The fate of the 2009 hospital provider fee as a funding mechanism for the expansion will also generate much interest, especially given Gov. Hickenlooper’s pledge that the expansion will not cost the state another dime of general funds.

While many questions remain, one that seems to be settled is whether or not the bill will pass given Gov. Hickenlooper’s support and the Democrats’ control of the House and Senate. In a statement responding to the governor’s announcement, CMS President Jan Kief, MD, emphasized the importance of the work ahead: “We may not see another opportunity in our lifetimes to close the coverage gap and to reinvent Medicaid in innovative ways that guarantee a meaningful return to taxpayers and to our patients.” n

Colorado Medicine for March/April 2013

Features

Members weigh in on CMS position to support Medicaid expansion Kate Alfano, CMS contributing writer

In early January, Gov. John Hickenlooper announced that the state would expand Medicaid coverage for adults as called for under the Affordable Care Act. Experts estimate this would add roughly 160,000 Colorado adults to the program. Colorado Medical Society’s support of the expansion hinged on a months-long process to develop and broadly vet a policy platform that emphasizes the need to accelerate transformations currently underway in Medicaid thanks to the Accountable Care Collaborative and the need for increased physician reimbursement, liability protections, administrative simplification and patient responsibility.

CMS polled physician membership on this position in December, asking if CMS was on the right track. Nearly 700 physicians from around the state responded to this survey, which showed substantial support for the expansion; full results are available on the CMS website.

Respondents were also given the opportunity to share comments about the expansion. They fell into two general categories in support or opposition of the policy, either reflecting a personal philosophy or focusing on operational factors, with some responses in between. Across all categories, Colorado physicians favor increasing physician payment for Medicaid services and ensuring patient accountability, and many express concerns with payment reform.

Expressing support for expansion and CMS’ position were comments similar to this: “Access to care is one of the single biggest ethical and economic issues facing our state and our nation. By supporting this expansion and calling for sensible changes to payment structures and utilizing pilot programs, CMS has struck just the right chord in terms of expanding access while not jeopardizing payments. Hopefully this will be widely supported and the people of Colorado will reap the benefits.”

Expressing concern with expansion were comments similar to this: “I think it is right on as an idea, but I am doubtful that it can actually be implemented. Our system is so broken that I don’t know that it can be fixed and just adding more people to the already bulging ranks does not lend itself to making the system work better. I hope it does, but I am doubtful.”

Other members voiced their opposition to the expansion as summarized by this comment: “I disagree with supporting bureaucratic nonsense.

Yes, CMS needs to support cutting the red tape, establishing standardized forms and streamlining approval processes. Additionally, CMS must push back on government involvement. Remember, we are the experts on health care.”

After reviewing the survey results, the board voted to approve the advocacy position developed by the Council on Legislation and the Committee on Physician Practice Evolution to support the expansion and urgently address the necessary systemic reforms. Read more about the board discussion and action at www.cms.org.

Colorado Medicine for March/April 2013

CMS Education Foundation

Help send a student through school About the CMS Education Foundation Founded in 1982, the Colorado Medical Society Education Foundation (CMS EF) is a non-profit, tax-exempt charitable foundation established primarily to support educational and charitable programs in Colorado.

Since 1993 the Foundation has dedicated itself almost exclusively to the funding of scholarships to incoming first-year medical students at the University of Colorado School of Medicine.

Scholarships are awarded to students who come from underserved areas, have high academic credentials, demonstrate a financial need, and anticipate practicing in a rural or underserved area.

Call 720-858-6310 for more information and to donate 13

Features

CMS leads successful effort to roll back rule allowing chiropractic injections CMS staff report The Colorado Medical Society marked another victory in its ongoing mission to improve patient safety when the state chiropractic board – facing intense pressure from CMS and its partners in organized medicine – backed down from an attempt to allow chiropractors to perform injections.

The decision came weeks after CMS and 14 component and specialty societies filed a lawsuit against the Colorado Board of Chiropractic Examiners, accusing the board of exceeding its authority and putting patients at risk. The attorney general’s office also issued an opinion stating the board didn’t have the authority to make the rule change, and a legislative committee, responding to concerns from the physician community, signaled it would oppose the rule.

CMS President Jan Kief, MD, said the chiropractic board’s emergency vote to not let the rule take effect averts what would have been bad public policy and a potential danger to patients. This unanimous decision was made less than a month after the lawsuit was filed.

“CMS has a long-standing commitment to making Colorado the safest state in the country for patients to receive medical care. Over the years we have demonstrated our willingness to work with our colleagues in health care to achieve that goal,” Kief said.

“But when that goal is threatened, it’s our responsibility as physicians to advocate vigorously on behalf of our patients. That’s what we’ve done in 14

this case, and what we will continue to do.”

The fight over injections is just the latest skirmish to stem from the chiropractic board’s actions. CMS also has raised concerns about a board decision that would allow chiropractors to diagnose and treat the endocrine system.

CMS Chief Executive Officer Alfred Gilchrist said the moves have many health professionals concerned about the motivations of some members of the chiropractic board, which is responsible for certifying doctors of chiropractic.

“It appears some members are putting the interests of chiropractors ahead of patient safety,” Gilchrist said. “That’s obviously cause for alarm, and something we will be monitoring closely.”

Patient safety Since CMS drafted its first strategic plan, the organization has been focused on improving and advocating for patient safety. In recent years, CMS has formed a Patient Safety and Professional Accountability Task Force and, along with component medical societies and other partners, has advocated for initiatives that improve peer review and provide more disclosure and transparency for patients.

height of his or her training, but also opposing attempts by professions to exceed their scope.

It was against this backdrop that CMS voiced concern beginning in 2011 about a chiropractic practice that was operating as a “Functional Endocrinology Center.” Reporters for ABC7 news said they received more than 100 calls and e-mails from patients who said they were misled about the chiropractor’s qualifications to treat diabetes and thyroid disorders.

The Colorado Medical Board’s licensing panel reviewed the case and found the chiropractor performed the “unlicensed practice of medicine.” The panel referred the case to the attorney general for legal review because it believed patients were at risk.

Last year, the attorney general’s office drafted a Notice of Charges detailing 25 counts against the chiropractor’s license. The charges included negligent chiropractic practice, false or misleading advertising and unethical advertising. But the decision of whether he should lose his license or be punished was left to the state chiropractic board.

As part of these efforts, CMS also has stressed appropriate scope of practice.

CMS argued that the endocrine system is a complex set of organs and glands and that diseases such as diabetes are best treated by endocrinologists – physicians with more than 10 years of training who are specially trained to diagnose and treat this system.

This has meant encouraging each medical professional to work at the

But last fall, the chiropractic board opted not to take action against the Colorado Medicine for March/April 2013

Features chiropractor’s license, issuing only a letter of admonition for incomplete documentation of patient interactions.

The board also concluded that chiropractors could diagnose and treat the endocrine system, stating, “The scope of chiropractic practice includes diagnoses and treatment of human ailments, including those affecting the endocrine system.”

Legal battle CMS was working with legislators to address that finding when the chiropractic board began considering a change to an existing rule.

The change authorized chiropractors to administer drugs topically, orally, and by inhalation and injection after completing just 24 hours of study and a certification exam. The rule did not restrict the medical conditions to be treated or where in the human body the injections could be administered.

CMS objected to the change, arguing that the chiropractic board was exceeding its authority by essentially trying to change state law regarding which professions may practice medicine. CMS also noted that the General Assembly did not approve 2010 legislation proposed that would have allowed chiropractors to perform injections.

Medical Society and Larimer County Medical Society.

The groups also took their case to the General Assembly’s Legal Services Committee. This committee of state lawmakers reviews rule issues and can vote to not allow a rule to continue, though such a vote must also be affirmed by the full legislature and the governor.

Ken Spresser, DC, joined those opposing the rule change, and said that only a minority of Colorado chiropractors backed it.

Spresser, who has been a chiropractor for 30 years and has served in leadership for both the American Chiropractic Association and the Colorado Chiropractic Association for decades, said the 24 hours of study and instruction chiropractors receive in the administration of drugs by injection is “woefully inadequate.” He said the rule, as proposed, could allow for injection of drugs such as digitalis, morphine, cocaine and penicillin.

“Please protect the public from this small interest group and the Chiropractic Board of Examiners that only wants to make more money by exceeding their statutory boundaries,” Spresser said.

Kief outlined several concerns about the rule, including the fact that anything of pharmaceutical grade that is to be injected must be done by prescription. Since chiropractors cannot prescribe, and would be injecting nonFDA approved compounds, Kief said.

“We urge the chiropractic board to take a step back, re-examine the issues and what their profession wants to treat,” she said. “As a physician, I do what I have been trained to do with excellence. Health professionals should each be proud of what we do; but first, do no harm and keep patient safety as a central tenant. Isn’t that what you would want of your healthcare provider?”

The Legal Services Committee voted unanimously against the rule. Weeks later, the chiropractic board voted to not let the rule take effect.

CMS leaders said they continue to stress collaboration and evolution in health care, as well as patient safety.

“We believe in health teams and would be happy to collaborate with the chiropractic community about these issues,” Kief said. n

Despite the objections, a majority of the chiropractic board voted in December to change the rule. It was to go into effect Jan. 14.

CMS filed suit in Denver District Court in late December. The following organizations joined in the lawsuit: Colorado Society of Osteopathic Medicine, Weld County Medical Society, Clear Creek Valley Medical Society, Aurora-Adams County Medical Society, Denver Medical Society, Mesa County Medical Society, Colorado Radiological Society, Colorado Chapter of American College of Emergency Physicians, Colorado Orthopaedic Society, Colorado Society of Anesthesiologists, Boulder County

Colorado Medicine for March/April 2013

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Features

Early legislative issues Kate Alfano, CMS contributing writer The CMS Board of Directors meeting on January 18 featured a discussion of public policy and House of Delegates referrals on topics that included firearm safety, hydraulic fracturing, non-compete clauses and naturopath licensure.

The CMS Council on Legislation and the board were tasked with implementing HOD policy on firearm safety in response to the shootings in Aurora and Newtown. CMS has long recognized firearm violence as a public health crisis, and the board voted to support Gov. John Hickenlooper’s proposal to strengthen Colorado’s mental health system, as it is in line with existing CMS policy expanded by the HOD in 2012.

On Thursday, Jan. 17, the CMS Council on Legislation also suggested supporting more mental health workers and patient beds, more emergency mental health workers, more mental health workers that are available to treat dual diagnosis of substance abuse and mental health illness, and more emphasis on pediatric mental health care.

Gun violence The board supports the enactment of “reasonable laws” that seek to regulate the sale and distribution of firearms to protect public health and safety. Laws will be evaluated on a case-by-case basis, with recommendations made after their analysis.

“While it is clinically difficult if not impossible for physicians and other mental health experts to consistently anticipate violent behavior, it is not difficult to reduce that risk by expanding our mental 16

health system capacity, especially in terms of caregivers and support systems, and especially for our children and adolescents,” said CMS President Jan Kief, MD. “Gun ownership per se is not the risk – it is illegal or irresponsible gun use, and the irresponsible sale and distribution of firearms to those who lack the competency and maturity to own any kind of loaded weapon. But that aspect is problematic, a symptom, unless we take care of those who by no choice of their own are burdened with treatable mental disorders,” she added.

Hydraulic fracturing On the topic of hydraulic fracturing, the board adopted a motion from a November meeting of the COL that directs CMS to pursue a written explanation from the Colorado Oil and Gas Conservation Commission stating that they agree that a physician should have access to specific proprietary or confidential information – above what is available in the public domain – if it is necessary to care for a patient.

The council also recommended that the written explanation include a provision to allow a physician to share the information with the patient and other physicians and providers involved in the care of the patient. The purpose of the request for explanation is to clarify a COGCC rule detailing trade secret disclosure and procedure for requesting proprietary information.

The COL recommendation directed CMS to pursue legislation should

COGCC not agree to this policy, but meetings with the group indicate that they will comply with the request.

Non-compete clauses The board approved a COL motion to pursue legislation that makes non-compete (liquidated damages) clauses unenforceable in instances when a physician is terminated from an employment contract using the “without-cause” reason for termination.

This resolution is the result of a health system’s without-cause termination of several physicians and enforcement of the non-compete clause. A special committee of the CMS Board of Directors will continue to study and refine the issue. The HOD will take final action on the board’s recommendation in September.

Naturopath licensure At the January 17 COL meeting, the group discussed a bill under consideration by the Colorado General Assembly that would create a state board under the Department of Regulatory Agencies for the licensure of naturopaths. Under the bill, a person who attends a school of naturopathy would be allowed to diagnose, treat, operate and prescribe for disease, pain, injury or other physical or mental conditions.

The COL voted to oppose this bill as it stands, citing concerns with patient safety, but leaders and staff have committed to work with legislators to craft legislation to recognize the work of naturopaths while upholding the mission of CMS and its members. n Colorado Medicine for March/April 2013

Colorado Medicine for March/April 2013

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Features

Colorado leaders take concerns to Washington, D.C. Kate Alfano, CMS contributing writer More than a dozen Colorado physician leaders and CMS and component chapter staff members traveled to Washington, D.C., for the American Medical Association’s National Advocacy Conference, Feb. 11-13, where they heard from political insiders and industry experts, interacted with peers from other states, and lobbied members of Congress on health system reform, fiscal concerns, and efforts to combat firearm violence and prescription drug abuse.

CMS President Jan Kief, MD, says it’s important for physicians to get involved on the federal level because the work the congressional delegation does in Washington greatly affects “our realm.”

“Our members benefit from the conference because we gain insights from great AMA speakers and get to talk with physicians from around the country to find out what’s happening in other states.

We also get to see what goes on in DC and gain a better understanding of what our congressional leaders are doing everyday. It gives you a better appreciation of the process and allows you to bring

that local perspective to them. It takes resolve. You have to be proactive, let them know you’re engaged and offer to work with them.

Then you can affect positive changes.”

The conference opened Monday afternoon. Attendees heard an overview of AMA’s priority issues from a panel of leaders that included AMA President Jeremy Lazarus, MD, of Den- Colorado Sen. Mark Udall listens to CMS physicians and staff share CMS polling data on firearm safety. ver and they received talking points on top federal issues that budget, specifically deficit reduction and they would take to meetings with their the strong partisan divide over the ‘balcongressional leaders on Tuesday and ance’ between revenues and spending Wednesday. cuts.”

Attendees also heard an address by Chuck Todd, NBC News’ political director and chief White House correspondent. He focused on the impending federal budget sequester scheduled to take effect March 1 that will slash federal funding for defense and domestic programs. It includes a 2 percent decrease in Medicare payment for physicians.

CMS CEO Alfred Gilchrist says that much of the focus during meetings with the Colorado congressional delegation was on stopping the Colorado Sen. Michael Bennet meets with the CMS delegation to proposed 2 percent reiterate his commitment to support a permanent fix to the SGR. Medicare cut. “It is a 18

viable threat and prospects for further delay are uncertain,” he says. “The major driver in the 113th Congress is the

“The SGR fatigue is apparent in the Capitol,” Mr. Gilchrist says, “but a draft proposal to permanently fix the SGR is being circulated among the two health care committees in the House of Representatives. It was encouraging to learn that a proposal is being circulated and discussed on both sides of the aisle.”

Kevin Fitzgerald, MD, medical director of Rocky Mountain Health Plans and president of Mesa County Medical Society, participated in the meetings with Sen. Mark Udall and Sen. Michael Bennet. He says that in addition to the SGR, they “talked about sequestration and said it probably won’t be fixed, at least not for a couple of weeks after the March deadline. They thought that Congress would probably figure it out and get it fixed pretty fast. That means Colorado Medicine for March/April 2013

Features we may have to suffer a 2 percent decrease in Medicare reimbursements temporarily.”

First-time AMA-NAC attendee Floyd Russak, MD, an internal medicine physician in Denver and current president of the Arapahoe, Douglas and Elbert County Medical Society, says another focus issue was gun safety. “We talked about the importance of preserving the right for physicians to talk to their patients about whatever they think is important about safety and also about releasing information from the CDC and other organizations that collect information on gun violence so we can identify the problem and make a decision on what to do next.”

CMS President-elect John Bender, MD, presented data from a recent CMS member poll on firearm safety that was well received by both senators. Christie Reimer, MD, an internal medicine physician in Fort Collins and president of the Larimer County Medical Society, says, “They felt it was representative of the general population of Colorado, which is why I think they said they could support all of our views.”

A recurring sentiment from congressional leaders and top agency officials throughout the conference was encouragement for physicians to continue leading the effort to improve the health care system on behalf of their patients.

for us to help [federal agencies] know what to do,” says Dr. Reimer. “She requested feedback on innovative methods that work, and even pilots that don’t work, to determine the best way to practice medicine. She seemed open-minded and interested in learning.”

“Two of our delegation, Congressman [Ed] Perlmutter and Congresswoman DeGette, are on the committee dealing with violence in society,” Dr. Kief continues. “So we know that they have heard our message and we know they’re going to be working on gun safety very diligently.”

Dr. Bender says CMS has a long history of having a strong relationship with the Colorado delegation that has allowed us to influence policy at both the state and national level. He stresses the importance of continued physician advocacy.

“Legislators are responsive to their constituents. When doctors are actively engaged in making phone calls, sending e-mails, and making personal visits at both the Colorado office and the offices here in DC, legislators hear the message.

Their’s

“Her message to doctors seemed to be

Colorado Medicine for March/April 2013

“It’s an exciting time in medicine,” he continues. “We’re just on the brink of implementing the Affordable Care Act and though it’s going to be a lot of work it appears the Colorado delegation fully supports our efforts back home in Colorado. We’re looking forward to implementing the exchange, Medicaid expansion, and other reforms in a way that’s meaningful for patients and for physicians in Colorado.” n

Our’s

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In an address on Tuesday, Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, talked about new payment and delivery models taking shape across the country.

If we don’t do those sorts of things they figure we’re okay with the status quo. If we don’t advocate for our patients and our profession, other special interests will take over.”

Which one are you using?

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Rep. Ed Perlmutter participates in NPR radio interview with CMS physician members.

Rep. Mike Coffman encourages CMS physicians to lead effort to improve health care.

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Features

Maintenance of licensure Influence the process by completing spring survey JoAnne Wojak, Director, Continuing Medical Education Maintenance of licensure, or (MOL) is a process in which licensed physicians will periodically provide evidence that they are actively participating in a program of continuous professional development that is relevant to their area of practice.

Initiated by the widespread movement toward quality improvement and increased patient safety, the process is intended to ensure continued professional development over the length of a physician’s career. With physician input, the nation’s state medical licensing boards began developing the new system as a way of strengthening patient safety and ensuring the highest standards of medical quality as the practice of medicine evolves.

The Colorado Medical Society along with the Colorado Society of Osteopathic Medicine has partnered with the Colorado Medical Board, the Federation of State Medical Boards, the American Board of Medical Specialties and the National Board of Medical Examiners to guide the development of the Colorado Physician Maintenance of Licensure program to ensure it meets the needs of Colorado patients and physicians.

DORA will release a physician acceptability survey for maintenance of licensure this March; doctors will be notified about the survey when they receive their license renewal notices. The online survey will be made available only to physicians who hold a license to practice medicine in Colorado and will collect information anonymously about a physician’s participation in and opinion of various types of continuous professional development activities that may be approved for fulfilling future MOL requirements.

assessing performance and making improvements. Notably, the components will not include a “high-stakes examination.”

MOL components There are three components to an MOL program: reflective self-assessment, assessment of knowledge and skills, and performance in practice. Self-assessment will require the physician to spend time reflecting on his or her practice, attending continuing medical education activities, and reading journals and medical literature. Assessment of knowledge and skills will require an objective assessment and demonstrated competency through various activities. And performance in practice will require a physician to demonstrate accountability in his or her practice by obtaining benchmarks,

A review by a CMS subcommittee determined that while there were challenges, the framework represented a continuous learning and improvement cycle that is effective for life-long learning without overburdening physicians. This process also helps to sustain an individual physician’s life-long commitment to patient safety and wellbeing.

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Call 720-858-6326 or 800-654-5653, ext. 6326 or e-mail chris_mcgowne@cms.org 20

Board-certified physicians who participate in their maintenance of certification or Osteopathic continuous certification programs most likely will not have to take additional action to satisfy MOL requirements. Physicians working in non-clinical positions will have specific pathways that take into account their unique situations.

Though the three-component framework has been set and likely will not change, Colorado physicians who complete the survey will help shape the “toolbox” of continuous professional development activities for the MOL process. The survey will ask physicians about the continuous professional development activities they currently pursue, which activities are important for improving health care and health outcomes, and which activities are important to assessing physician competency.

CMS encourages all members to take time to complete this important survey.

Your input is valuable and will help to inform the MOL process. Pending legislative approval, the Colorado MOL program is expected to go into effect by the 2017-2019 renewal cycle. n Colorado Medicine for March/April 2013

Encourage a colleague to join the Colorado Medical Society and your local medical society today!

Visit www.cms.org to learn more about the benefits of becoming a member For more information and an application to join, call Tim Yanetta

720-858-6306 or e-mail

tim_yanetta@cms.org

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Colorado Medicine for March/April 2013

Features

Colorado Clean Claims Task Force Marilyn Rissmiller, Senior Director, Health Care Finance

Citing unprecedented progress, task force seeks extension to finish developing standardized set of claims edits and payment rules administrative costs. The group estimates its work could save Coloradans $80 million each year in costs related to claims processing.

Sen. Irene Aguilar, MD with task force cochairs Marilyn Rissmiller and Barry Keene.

A Colorado task force has made unprecedented progress toward developing a standardized set of health care claims edits and payment rules, and is recommending lawmakers approve an extension to allow the group to finish its work.

The Colorado Clean Claims Task Force presented a report to legislators and the executive director of the state’s Department of Health Care Policy and Financing late last year. In it, the group noted it has had more success getting and keeping key stakeholders at the table and achieving consensus on difficult issues than any other state or national initiative of its kind.

Walter Suarez, co-chair of the National Commission on Vital Health Statistics’ committee on administrative simplification and health reform, agreed.

“Colorado’s effort remains the only significant work in this area,” Suarez said.

The task force was formed in 2010 through legislation supported by the Colorado Medical Society. Its goal is to help ensure claims are coded, submitted and processed “cleanly” the first time – a critical element of the state’s strategy to reduce health care Colorado Medicine for March/April 2013

“By creating uniform medical claim edits and payment rules to be shared among all payers in Colorado, both payers and providers will be unburdened of tens of millions of dollars of administrative redundancy and outright waste, which can be redirected toward reducing the actual cost of care,” said Barry Keene, co-chair of the task force and the president of KEENE Research & Development.

The task force hopes to be a model for the rest of the nation – where the savings could be multiplied across many states. Its work also is intended to provide greater transparency across payers and to make it easier for patients to determine the cost of treatment and their financial obligations.

The group comprises representatives of major private payers and vendors working with claims across the country, as well as Colorado Medical Society, the American Medical Association, local physician billing personnel and the state of Colorado.

Between December 2010 and November 2012, the task force held 25 meetings. Four committees also have met via conference call – one meeting as often as every other week.

Among the task force’s accomplishments: • Developed guiding principles that focus on administrative simplicity, consistency, transparency, standardization and improved system efficiency; • Conducted an analysis of, and made a determination that, the Medicare

•

•

•

• •

•

•

edit set, which is an important source of edits for the standardized set, does include edits to support commercial claims; Confirmed that, for the most part, the national medical specialty societies are comfortable with how Medicare develops its edits; Reached consensus on definitions for most of the types of edits the task force is required to consider. These definitions will drive selection of the edits in the standardized set; Compiled definitions and associated payment rules from several sources for 32 payment rule modifiers and began working through the process of finding consensus on which rules to use; Put together a detailed list of data sustaining repository responsibilities and essential functionalities; Issued and received responses to a request for information about potential strategies for, and the cost to design and develop, an online data repository; Drafted a request for proposals and approved criteria to select a contractor to compile the universe of existing edits and conduct analyses to inform development of the standardized set; and Identified alternative procedures for updating and making other changes to the standardized set after it has been implemented.

The legislation that created the Clean Claims Task Force required it to file a report by Nov. 30, 2012 detailing recommendations for a uniform, standardized

23

Clean claims (cont.) set of payment rules and claim edits that would be used by all payers to process Colorado claims. It also required a final report be submitted in December 2013.

In its report to the General Assembly, the task force recommended it be allowed to continue its work to develop a standardized set. It also asked that the deadline for the task force’s final report be extended by one year, and that most payers have until Jan. 1, 2015 to implement the standardized set within their claims processing systems (the deadline for domestic nonprofit plans would be Jan. 1, 2016).

“Despite coming to the table with different concerns and perspectives, task force members have demonstrated their commitment to finding consensus on a standardized set and are well on the road to fulfilling their legislative charge but need more time to finish the job,” the report’s authors wrote.

The task force also recommended that the General Assembly’s health and human services committees and HCPF Executive Director Sue Birch write to the Secretary of the Department of Health and Human Services to ask for public access to the rationales for Medicare’s edits. The report noted that Medicare’s edits are a major source of edits for the standardized set but that the task force’s work was made more difficult because it hasn’t been able to determine the rationales for the edits. Nor is the group aware of any compelling reason for Medicare not making them public.

State Sen. Irene Aguilar, MD, is expected to file legislation this session that would extend the task force’s deadline by one year, as recommended. Aguilar and Birch also indicated they will draft letters to HHS Secretary Kathleen Sebelius seeking access to the rationales for Medicare’s edits.

The task force is always interested in physician input or questions. Please contact Marilyn Rissmiller, Colorado Medical Society senior director of health care financing, at Marilyn_rissmiller@cms.org.

Agendas and minutes for all meetings are available on the task force website: http:// www.hb101332taskforce.org. n

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Features

“We’re all in this together” Jeremy Lazarus, MD, AMA President damages for medical liability cases, and other bills that would weaken the Colorado peer review statute, which outlines requirements for people who testify as expert witnesses.

We are also supporting CMS with analysis of proposed state legislation that aims to prevent deaths from unintentional abuse/misuse of prescription painkillers.

Jeremy Lazarus, MD, AMA President In recent years, “teamwork” has become the byword for the future of medicine. The idea that by working together under a physician’s leadership, a group of medical and health care professionals can treat more patients, more effectively, and hopefully at lower cost makes profound sense for the complexities of health care today.

But teamwork is nothing new to American medicine. Since 1847 physicians have understood the value of working together to achieve broad important goals. In the early days, members of the AMA joined forces to create a code of ethics and standardize medical education. Today’s focus is on assuring that legislation and regulations support physicians’ ability to serve our patients.

For as long as I can remember, the American Medical Association and the Colorado Medical Association have worked together to address problems facing physicians in Colorado and in Washington.

The AMA is working with CMS right now to protect Colorado’s medical liability laws. This effort includes fighting bills in the state legislature that would weaken or totally remove the cap on

26

And we are collaborating in efforts to get the Colorado Legislature to repeal Chiropractic Board Rule 7c that gives chiropractors the authority to administer non-FDA approved compounds by injection.

During the past year, the AMA’s collaborations with state and specialty societies have achieved more than 70 legislative victories for medicine. These included implementing the ACA in six states, advancing medical liability reforms in nine states, defeating legislation that would have encroached upon the physician-patient relationship in seven states, demanding insurer fairness and transparency in five states and advancing public health in more than 10 states.

In these collaborations, the AMA’s Advocacy Resource Center (ARC) has been a key resource. Six state legislative attorneys and a host of AMA content specialists are the arms and legs of the ARC. They create state-ofthe-art model legislation, testimony, talking points and white papers for use by medical societies across the country and provides research support and consulting wherever it is needed.

Even more important, our ARC Ex-

ecutive Committee includes 20 state medical association CEOs, lobbyists and general councils, including Susan Koontz of CMS. This ensures that our advocacy efforts are closely linked to local public policy realities and the needs of the state and specialty societies.

The AMA hosts its annual State Legislative Strategy Conference each January to ensure our focus is on the right topics. This conference is the only meeting in which the AMA, the American Osteopathic Association and the majority of state and national medical specialty societies get together to focus on the toughest state-level issues in health care. As part of this year’s meeting, CMS president-elect John Bender, MD, spoke on state-based delivery and payment reform, one of the issues highlighted at the meeting.

Besides legislative advocacy, the AMA’s Advocacy Resource Center also has been successful in developing strategic collaborations to influence national state policy-making organizations like the National Association of Insurance Commissioners, National Governors Association and others. We are currently assisting CMS in the National Governors Association Prescription Drug Abuse Project. We are also benefitting from this effort: CMS leadership in reaching out to the governor and key stakeholders on this issue is providing the AMA with best practices that we can share with other states confronting the nation’s drug abuse and diversion crisis.

In another related area, the Litigation Center of the AMA and state medical societies have participated in more

Colorado Medicine for March/April 2013

Features than 250 cases since the Center was created in 1995, and in many instances have achieved precedent-setting results. In Colorado we are currently supporting the lawsuit filed late last year to stop the chiropractic rule that I mentioned above.

National advocacy On the national level, the AMA in association with state and specialty societies helped shape what became the Affordable Care Act (ACA). As part of this effort, our advocacy efforts secured physician representation on health insurance exchanges, an area where Colorado is a leader. Colorado has not only set up a health exchange well ahead of 2014, but also applied for a $43 million grant to build the infrastructure for an Internet health insurance marketplace.

I also applaud Colorado for including Mike Fallon, MD, on the board of directors of the Colorado Health Benefit Exchange.

Today we continue working to affect much that the ACA failed to address, including the broken medical liability system and the flawed Medicare physician payment formula.

Even though Congress did take action to avert the 26.5 percent cut on January 1, this only extended the instability of the Medicare program for another year.

That’s why the AMA, CMS and more than 100 other leading medical associations have called on Congress to not only eliminate the SGR formula but also to provide for a high-performing Medicare program. In a letter we sent lawmakers in the fall, we outlined core principles and elements that should lay the foundation for a system that is good for patients, physicians, taxpayers and the Medicare program overall.

Every February the AMA sponsors a National Advocacy Conference in Washington, D.C. to zero in on top issues for the medical profession. CMS President Jan Kief, MD, is scheduled to be a keynote speaker this year.

We will keep you informed as the year progresses. The AMA will be in Wash-

Colorado Medicine for March/April 2013

ington, Colorado and elsewhere to support and incentivize better health outcomes and improve our health care system.

Long term While we work in our public arenas to protect physicians and patients, the AMA is also playing a long game to shape a better health care future for our nation.

The AMA’s long-range strategic plan is focused on three core areas that we believe are vital to improving the future of health care in the country: 1) Improving health outcomes for patients and populations; 2) Accelerating change in medical education to meet evolving needs of the health care system; and 3) Enhancing physician satisfaction by shaping delivery and payment models.

These are ambitious goals, and achieving each one will require collaboration.

However, we’re already coming together to advance important health care issues. A good example of this approach is the joint CMS-AMA-United Health Care Colorado Collaborative Quality Improvement Project.

A more recent example is the Million Hearts Initiative, a multi-medical organization effort to improve America’s cardiac health. This ambitions HHS plan seeks to prevent 1 million heart

attacks and strokes over the next five years. The goal is for 30 million more Americans to get their high cholesterol or hypertension under control and for 4 million people to quit smoking by 2017.

As part of the Million Hearts project, CMS plans to incorporate relevant performance metrics into both the Physician Quality Reporting System and electronic medical record meaningful use criteria. Additionally, community health centers are being asked to report annually on cardiovascular disease prevention measures. Health information technology grants will help nearly 100,000 primary care physicians track and improve their performance on these metrics. Other parts of the initiative directly targeting patient behavior include graphic health warnings on cigarette packs and new menulabeling requirements.

Whether we are involved in long-term projects like the Colorado Collaborative Quality Improvement Project or Million Hearts, in a legislative drive to protect Colorado’s medical liability laws, or the push in Washington to ensure all Americans have access to affordable health care coverage, we are working together to shape a better future for patients, medical students and physicians.

Together we are stronger. The AMA is looking forward to continuing our collaborative successes throughout 2013 and beyond. n

Join COMPAC Now! Colorado Medical Political Action Committee

Call 720-858-6326 or 800-654-5653, ext. 6326 or e-mail chris_mcgowne@cms.org

27

Inside CMS

2013 CMS Spring Conference Gold Level Sponsors Cigna Healthcare COPIC Financial Services United Allergy Services Wells Fargo Silver Level Sponsors Aetna Rocky Mountain Health Plans UnitedHealthcare

May 3 through May 5, 2013 Sonnenalp Resort, Vail Learn to leverage practice transformation to improve your bottom line at the 2013 CMS Spring Conference The Colorado Medical Society invites you to attend the 2013 Spring Conference, May 3-5, at the Sonnenalp Resort in Vail. The theme is “Assembly Required: A User-Friendly Blueprint for Practice Transformation,” and attendees will learn what to do to improve the care experience and provide greater value for the premium dollar through an interconnected compilation of hands-on practice transformation sessions.

Physicians often understand the fundamentals of practice transformation– and its importance–but often lack the technical and practical support and mentoring to initiate and implement them. With narrow margins and unprecedented external pressures, most physicians cannot afford the luxury of trial-and-error experimentation.

This conference breaks down practice transformation into the five logical components listed below, and brings together national and regional experts with demonstrated experience in team-based care, lean processes, value stream mapping and health information technology to give practical

28

advice on how to assemble these interdependent pieces.

• Component 1: Practice Transformation and Workflow Redesign • Component 2: Team-based Approach to Care • Component 3: Metrics Reports and Population Management • Component 4: Health Information Exchanges • Component 5: Access for All (Medicaid Expansion and Insurance Exchanges) Some of the presenters include CMS President-elect John L. Bender, MD, who will demonstrate how his own practice improved patient care and obtained greater value; Ellen Batchelor, who will apply “lean processing” methods to practice transformation; Jane Brock, MD, who will provide insight into the horizontal integration of team-based care; and Jason Hwang, MD, MBA, who will discuss what’s coming in health care economics and why physicians will determine new models of health care delivery.

CMS will kick off the conference with a fireside chat at 7 p.m. Friday evening.

Sessions will take place Saturday and Sunday 8 a.m. to 12 p.m., with an additional fireside chat at 7 p.m. on

Saturday. The schedule leaves plenty of time to explore Vail and enjoy the amenities of the world-class Sonnenalp. After the professional development sessions each morning, attendees have the opportunity to experience exceptional dining and shopping in Vail Village, relax in the Sonnenalp’s spa or enjoy the private 18-hole golf course.

The hotel group rate of $150 per night for a junior suite is available until April 4, 2013. Reservations received after this date will be accepted on a space-available basis. Reserve a room through the Spring Conference registration form or by contacting the hotel at (800) 654-8312 or online at www.sonnenalp.com. Go to www.cms. org for more information and to download the conference registration form.

No matter your practice situation–solo, group, part of an integrated network or one of the many other iterations– or your place on the transformation trajectory, the interaction with your colleagues and the conference faculty will be relevant, adaptable and affirming. This conference will give you the knowledge to take your practice to the next level. Join us. n

Colorado Medicine for March/April 2013

Inside CMS

Colorado Medical Society

2013 Spring Conference Registration Form May 3 through May 5, 2013 • Sonnenalp Resort, Vail

❏

I plan to attend the Spring Conference to be held May 3 – May 5 at the Sonnenalp Resort in Vail, including the Fireside Chat on Saturday night.

I plan to arrive on:

❏ Friday May 3th

❏ Saturday May 4th

❏

My spouse/guest will attend the Conference.

❏

My spouse/guest will not attend the Conference but will attend the evening events.

________________________________________________________ Name

_____________________________ Component Society

________________________________________________________ Name of Spouse/Guest (if attending)

Mail to CMS, P. O. Box 17550, Denver, CO 80217 or fax to (720) 859-7509

Sonnenalp Resort of Vail Group Name: Colorado Medical Society Name: __________________________________________________________ Phone #: __________________________ Address: ___________________________________________________________________________________________ City: ___________________________________________________________ State/Zip: __________________________ Number in Party: ___________________

Arrival Date: _________________ Departure Date: ____________________

Credit Card Information: Please Note: All reservations must be guaranteed for their full length of stay. Early departures and/or late arrivals will be charged the contracted nightly rate per night dropped.

Check one:

❏ MasterCard ❏ Visa ❏ American Express ❏ Discover

Credit Card Number: _________________________________________________ Expiration Date: _________________ Cardholder’s Name: ___________________________________________________________________________________ Special Seminar/Conference rate will be extended to attendees for longer stays. Valet parking $10/day. Free parking available in town of Vail parking structures.

Desired Accommodations: Sonnenalp Resort of Vail Junior Suites:

❏ King Bed

$150 (plus 9.8% tax) per night, Single or Double Occupancy – Number of Units:

❏ 2 Double Beds

Sonnenalp Resort of Vail suites all contain gas-log fireplace, large baths with soaking tub big enough for two, separate shower, heated tile floor, walk-in closet, TV, TV Internet access, hand-carved pine Bavarian furniture, and down comforters on all of our beds. There will be an additional charge of $25.00 per night for each person over 12 years of age exceeding Double occupancy. (Note: most suite types cannot accommodate more than 3 adults.)

Reservations received after April 4, 2013, will be taken on a space available basis only.

Cancellation Policy: In the event of cancellation 14 or more days prior to arrival, you will receive a full refund. If you cancel less than 14 days prior to arrival, you will forfeit the deposit of one night room and tax. As of day of arrival, early departures will be charged a $50.00 change fee.

Reservations will be taken with this form or call our Reservations Department at (800) 654-8312.

Register Online at www.sonnenalp.com 1) Go to www.sonnenalp.com 2) Click top right tab “Reservations” 3) Enter group Code – 37L58B 4) Enter your dates 5) Press continue at bottom of page 6) Review & ensure information is correct then press continue at bottom 7) Complete page noting your contact information, special requests & payment information 8) Bottom of page click book reservation Please mail this form to: Colorado Medicine forSonnenalp March/AprilResort 2013 of Vail, Attn: Group Reservations, 20 Vail Road, Vail, CO 81657

29

Inside CMS

2013 CMS Spring Conference Agenda May 3-5, 2013: The Sonnenalp, Vail CO

Assembly Required: A User-Friendly Blueprint for Practice Transformation What physicians need to do to improve the care experience and provide greater value for the premium dollar May 3, 2013: Friday 7:00 – 9:00 p.m.

COMPONENT TWO: TEAM-BASED APPROACH TO CARE

Friday night’s program, emphasizing the importance of leadership and teamwork as a key for success in health care both today and in the future, features the emergency care programs at University Hospital and Medical Center of Aurora. Thirty-eight of the fifty-eight victims of the Aurora shooting on July 20, 2012 were transported to these facilities. Learn about the culture of collaboration, leadership, and teamwork that won official praise for fast and efficient work by police, firefighters, and medical personnel.

May 4, 2013: Saturday 8:00 - 9:00 a.m.

COMPONENT ONE: PRACTICE TRANSFORMATION AND WORKFLOW REDESIGN

John L. Bender, MD, FAAFP, CMS President-elect

The Affordable Care Act is the law of the land yet physician assembly is required for health care reform to succeed. He will emphasize opportunity and Colorado pride and encourage leadership and participation. And his message will emphasize the ability of all physicians, primary care and specialist, private and public sector, to effect definitive, necessary economic changes in health care. Using the transformation of his own practice as an example, he will demonstrate how Miramont Family Medicine improved patient care and obtained greater value.

9:00 - 9:30 a.m.

Practice Transformation LEAN Processing Ellen Batchelor

Ellen will discuss the philosophy of why and how to achieve practice transformation using “lean processing” and the Toyota production model. Physicians can reduce waste and inefficiencies in terms of motion, inventory, over- and under-production, waiting, and other dysfunctional aspects of the everyday management of care delivery.

9:30 - 10:00 a.m.

Physician Leadership in the Practice: Developing a Culture of Quality Improvement Nicole Deaner, MSW, Program Manager HealthTeamWorks

What does it take to be an effective leader within the practice? Here are some practical tips.

10:00 - 10:15 a.m.

Break

10:15 - 11:00 a.m.

Workflow Redesign with Value Stream Mapping Jane Brock, MD, MSPH

Dr. Brock is a national expert on the details of practice transformation and care coordination and will provide insight into the horizontal integration of team-based care and why they add value and productivity to a teamwork delivery model.

11:00 a.m. - Noon

The Innovator’s Prescription: A Disruptive Solution to Health Care Jason Hwang, MD, MBA

Co-Author of The Innovator’s Prescription, Dr. Hwang will discuss the science behind what changes can be expected in health care economics and why physicians – not hospitals or large insurers – will ultimately determine new models of health care delivery.

Afternoon break 30

Colorado Medicine for March/April 2013

Inside CMS

Spring Conference Agenda (cont.)

Saturday evening fireside chat 7:00 - 9:00 p.m.

COMPONENT FIVE: ACCESS FOR ALL

Colorado’s Medicaid Expansion: Bridging the Coverage Gaps in Colorado and Your Practice Sue Birch, HCPF executive director, will lead a panel of experts in interactive dialogue on the Medicaid expansion and how physicians can lead the way for sustainable, expanded Medicaid in Colorado.

May 5, 2013: Sunday 8:00 - 8:05 a.m.

8:05 - 9:05 a.m.

Welcome back – John L. Bender, MD, FAAFP, CMS President-elect COMPONENT THREE: METRICS REPORTS AND POPULATION MANAGEMENT

Dale Glenn, MD, Medical Director, Health Advantage, Hawaii Pacific Health

Dr. Glenn will give an overview of quality metrics – past, present, and future – and explain why metrics and public physician reports can work for you.

9:05 - 10:00 a.m.

CIVHC’s All-Payer Claims Database – Managing total costs of care and populations: The power of your data

Jay Want, MD, Medical Director, Center for Improving Value in Health Care and Phil Kalin, CEO, CIVHC Dr. Want and Mr. Kalin will discuss the APCD and its value to physicians and patients.

10:00 - 10:30 a.m.

Effective Data Management

Marjie Harbrecht, MD, CEO HealthTeamWorks

Dr. Harbrecht will show how effective data management is foundational to operating the modern medical practice. Her perspective is informed by years of practice and community transformation involving hundreds of practices.

10:30 - 10:45 a.m.

10:45 a.m. - Noon

Break COMPONENT FOUR: HEALTH INFORMATION EXCHANGE

Larry Wolk, MD, CORHIO

Dr. Wolk will discuss how the Colorado Regional Health Information Organization will connect Colorado’s protected health information for physician accessibility at the point of care. Bring your computer or tablet for a real-time test drive of how this will work in your practice.

Conference Goals

The purpose of our spring conference is to help physicians transform their practices so they can prosper in the new health care reform environment. Moving beyond the basic fundamentals of health care reform this conference will show physician leaders why it’s beneficial to embrace the ideals of the Affordable Care Act and how to provide better patient care at lower costs. Experts in team-based care, Lean processes, Value Stream Mapping, and health care technology will provide information that is useful, encouraging and stimulating for all physicians. Interactive dialog with authorities on Colorado’s Medicaid Expansion and All Payer Claims Database will cultivate an understanding and appreciation of these entities value to physicians and their patients. “Assembly Required” will provide physicians in all specialties and settings with how-to instructions including local case-based studies and relevant and timely information for modernizing your practices.

Conference Objectives

• Examine local case-based examples of practices transformed • Initiate a team-based approach to managing your practice through the integration of inter-professional patient care • Explain how Lean processes and Value Stream Mapping can reduce waste and increase efficiencies in your practice • Demonstrate how Colorado’s health information exchange system can help to manage your patients’ care more efficiently and effectively • Recognize the positive impacts both health and fiscal of Colorado’s Medicaid expansion on medical practices, patient care and the public Colorado Medicine for March/April 2013 31

CMS Education Foundation Help send a student through school About the CMS Education Foundation Founded in 1982, the Colorado Medical Society Education Foundation (CMS EF) is a non-profit, tax-exempt charitable foundation established primarily to support educational and charitable programs in Colorado.

Since 1993 the Foundation has dedicated itself almost exclusively to the funding of scholarships to incoming first-year medical students at the University of Colorado School of Medicine.

Scholarships are awarded to students who come from underserved areas, have high academic credentials, demonstrate a financial need, and anticipate practicing in a rural or underserved area.

Call 720-858-6310 for more information and to donate

Colorado Medical Society is pleased to announce IC Systems as our newest Corporate Supporter.

Intelligent Collections Since 1938; ask about the 75th Anniversary Discount!

CMS members receive a 20% DISCOUNT; FLAT FEE and contingency programs are ENDORSED by nearly 500 societies. Skilled healthcare collectors and custom programs for early-stage through intensive recoveries with NATIONAL credit bureau reporting, legal services, etc. Dedicated Client Service Reps and 24/7 Online Tools.

Call 800-279-3511 and/or visit www.icmemberbenefits.com for FREE RESOURCES. 32

Colorado Medicine for March/April 2013

Inside CMS

Big data in Colorado health care Chet Seward, Senior Director, Health Care Policy

CMS partners to enhance all payer database frequently opaque private-payer approaches irrelevant in Colorado.

CIVHC Medical Director Jay Want, MD, (left) emphasizes that the APCD will be a powerful tool for physicians as Drs. Mark Levine, John Bender, Matthew Szvetecz and David Beuther consider next steps.

Health care has always been a data rich endeavor, intent upon picking up patterns within often-disparate mounds of information to improve care. New technologies and data bases are rapidly disrupting the status quo and when Silicon Valley leaders like Yahoo CEO Marissa Mayer use clinical terms to describe this era of “big data” as “watching the planet develop a nervous system” one wonders what’s next for health care.1 Turning data into intelligence is a diagnostic staple for physicians. It’s also a strategic priority for the Colorado Medical Society (CMS) and a new initiative that kicked off in January aims to have a big impact on the ability of Colorado physicians and patients to make informed health care decisions using big data.

Enter the APCD Physician performance measurement and public reporting programs are not new. Public and private payers have been using them to varying effect for many years. However, the development of an all payer claims database (APCD) by the Center for Improving Value in Health Care (CIVHC) holds the promise of making the currently siloed and Colorado Medicine for March/April 2013

That’s why CMS has begun working with CIVHC to help develop the processes, methodologies and specifics of physician performance public reporting by the APCD. Launched in November 2012, the APCD is the only comprehensive source of health care claims data from public and private payers in Colorado, encompassing 90% of covered lives in the next few years. It will become a powerful resource in the years to come, because as CIVHC President and CEO Phil Kalin asserts, “The APCD encourages us to start asking the right questions, and provides a tool that facilitates drilling down to determine what’s driving variation in cost, utilization and certain quality measures.”2 Some general reports, like total costs of care, high cost imaging and hospital readmissions across Colorado, are already available on the APCD website (www. cohealthdata.org). These reports come in response to intense demand for cost and quality information by employers and the public given seemingly everescalating costs. They have also sparked much media interest as evidenced by the front page Denver Post story after the initial APCD roll out. Physicians can expect even more specific public reports to be released later this fall detailing appropriate quality and comparative cost and utilization data on a named payer, facility and provider group basis.

CIVHC has reached out to CMS for assistance in developing these “tier two reports,” and in January the CMS Committee on Physician Practice Evolution (CPPE) initiated a months-long, physician-driven process to develop a detailed set of recommendations to the APCD regarding what quality and cost effec-

tiveness performance measures should be used, how to enable appropriate attribution and risk adjustment methodology, how to ensure open data sharing processes and how to standardize report formats.

Importance for physicians The impending publication of detailed practice level reports by the APCD provides an opportunity to shape efforts to improve care using standardized, evidence-based performance measures and methodologies. For years CMS has focused on key components to physician practice evolution, most notably physician performance measurement and the interplay between these data, practice redesign efforts and payment reform.

Using the APCD, patients, other providers, payers and purchasers will be able to compare costs and quality. Importantly, the CMS partnership with CIVHC will help the APCD give physicians valuable information: • To use with payers if you have question about their profiling or designations; • To show you how you compare to peers to drive quality improvement activities; and • To support discussions on advanced payment methods (e.g. bundles of care).

Making the most of imperfect data The shortcomings of using claims data to evaluate health care cost effectiveness and quality are well documented.

Colorado physicians have long struggled with these programs and that’s why CMS drove the effort in 2008 to pass the nation’s first physician designation disclosure act that mandates that these systems utilize quality not just cost

33

APCD (cont.) measures, and that there is an appeals mechanism to ensure that physicians can correct inaccurate information.

CPPE Chair Dennis Waite, MD, acknowledges the employer-driven pressure that insurers are under to develop measures of cost and quality, but he argues that despite their efforts to convince their customers that they have a handle on it, the truth is that they don’t. “The urgency here is around the probability that these corporations will begin encouraging employers and their employees to use certain physicians based on information that is not always accurate.”

Wilson Pace, MD, professor and GreenEdelman Chair for practice-based research at the University of Colorado Denver Department of Family Medicine, believes these systems will also increase interest in other kinds of data.

“I think this will drive the demand for more meaningful clinical data from electronic health records, which is critical.” He is quick to add that billing data is an important piece of the over arching puzzle of what actually happens at the bedside.

outreach, and other special feedback methods and meetings. This iterative and inclusive process, essentially a giant physician focus group, will serve as a critical next step in CMS efforts to advance meaningful payment reforms that support practical delivery system redesign efforts.

It is critical that this collaborative process with CIVHC provides meaningful and accurate data for informed decisionmaking. “I actually want to know how I compare to my peers,” says CMS President-elect John Bender, MD. “That’s how my practice has improved. The whole key to this isn’t so much that we tell physicians ‘here’s what you do with your data.’ We don’t know what they need to do with their data. What they have to do is figure it out themselves with a dedicated process improvement team. They have to troubleshoot the solution internally,” he says.

Mathieu agrees, “A fundamental concept with this from the beginning has been no ‘gotchas.’ “We don’t want gotchas. We want the people who will use and be affected by this information to provide input and help determine what to report and how to report it.”

Watch for more information on this initiative and be sure to share your thoughts. Physician feedback is essential. Contact me at chet_seward@cms. org if you would like to learn more. n ENDNOTES: 1. Hernandez, D. (Oct. 16, 2012). Big Data Is Transforming Healthcare. Retrieved Feb. 7, 2013, from http://www.wired.com/wiredscience/2012/10/big-data-is-transforming-healthcare/ 2. Kalin, P. (Nov. 6, 2012). All Payer Claims Database Debut Supports Colorado’s Health Care Journey. Retrieved Feb. 7, 2013, from http://www.civhc.org/Voices-On-Value/November-2012/All-Payer-Claims-Database-DebutSupports-Colorado’.aspx/

Flawed or not, these proprietary, claimsbased, commercial-insurer programs are not going away. Indeed, it’s a safe bet that they will become even more sophisticated and complex. Think ICD-10 in 2014.

That’s why the CMS collaboration with CIVHC is important. Jonathan Mathieu, CIVHC’s director of data and research, emphasizes that the APCD aims to consolidate data across payers to provide a more complete picture for physicians and patients. “The APCD is going to fundamentally make more sense than what we have right now, which is payers all going about this differently in a way that doesn’t work and isn’t necessarily transparent to you.”

Open and transparent Over the next seven months CMS will work to develop a set of APCD recommendations using the CPPE, component society and specialty society 34

Colorado Medicine for March/April 2013

TO MAKE A POSITIVE CHANGE PERSONAL HEALTH RECORDS

CUSTOMIZABLE HEALTH AND WELLNESS PROGRAMS

PATIENT ELIGIBILITY AND BENEFITS INFORMATION

REAL-TIME ADJUDICATION FOR CLAIMS PROCESSING

UnitedHealthcare supports the physicians of the Colorado Medical Society.

People count on you every day, even your staff. We understand that you are the one who takes care and takes charge – but you’re not alone. UnitedHealthcare offers you the support and resources you need so that you can focus on what’s most important – your patients.

We can help you, your staff and your patients navigate the health care system with greater efficiency and quality of care.

To learn how UnitedHealthcare can better serve you and your patients, visit UnitedHealthcareOnline.com.

uhc.com ©2013 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of Colorado, Inc.

Colorado Medicine UHCCO508022-0020

for March/April 2013

35

Inside CMS

PQRS It’s time to get with the program The Physician Quality Reporting System (PQRS) was introduced in 2007 as the Physician Quality Reporting Initiative (PQRI). Through a series of legislative and regulatory updates, this initiative of the Centers for Medicare and Medicaid Services has evolved from a voluntary program offering incentives for reporting, to a mandatory program with penalties for not reporting beginning in 2015.

Physicians still have an opportunity to earn a 0.5% incentive bonus for successful PQRS reporting during 2013 and again in 2014. However, penalties begin in 2015 for physicians who have not reported PQRS measures during the base reporting period of 2013. The Centers for Medicare and Medicaid Services reports that the majority of eligible profes-

Marilyn Rissmiller, Senior Director, Health Care Finance

sionals currently are not participating in PQRS, yet the payment adjustment will apply to all eligible professionals who are not satisfactory reporters during the reporting period for the year.

In implementing the PQRS payment adjustment, the Centers for Medicare and Medicaid Services seeks to achieve two overarching policy goals. The first objective is to increase participation in PQRS and to implement the payment adjustment in a manner that will allow eligible professionals who have never participated in the program to familiarize themselves with it. Second, the initiative aims to align the reporting requirements under the PQRS with the quality reporting requirements of its various programs, such as the value-based payment modifier.

To avoid the penalty in 2015, an eligible professional or group practice will need to meet the requirement to satisfactorily report data on quality measures for 2013 incentives. Or, the physician/practice must make a good faith effort to report at least one measure or measures group during the applicable payment adjustment-reporting period (2013) using claims, qualified registry or an EHRbased reporting mechanism.

Medicare’s Physician Quality Reporting System is not going away; this is part of the overall strategy to move to valuebased purchasing. If you haven’t already done so, learn how to get started with PQRS by visiting the Centers for Medicare and Medicaid Services website at CMS.gov. n

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Colorado Medicine for March/April 2013

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WHAT’S YOUR PATH TO MEANINGFUL USE? Find out with the free tool: www.corhio.org/portal CORHIO and the Colorado Medical Society, with grant funding the Physician’s Foundation, developed this self-guided tool to assist Colorado medical practices with many of the tools and resources needed to help make the Path to Meaningful Use a success.

The new and improved tool includes: Information for your specific stage of EHR adoption A Practice Readiness Tool, with self-guided questions on five capacity areas: management, finance/budget, operational, technology and organizational A Meaningful Use Gap Analysis to assess your practice’s knowledge of meaningful use and direct you to the right post-launch tools Helpful information on EHR tools and resources in the Document Library Self-guided training in different modules Information and links to Colorado-specific resources Online forms and downloadable documents to guide you through the meaningful use EHR process

Find out with the free tool: www.corhio.org/portal Colorado Medicine for March/April 2013

37

Inside CMS

Marilyn Rissmiller, Senior Director, Health Care Finance

ICD-10 training for physicians and their staff The Colorado ICD-10 Training Coalition has reconvened and is working to ensure physicians and their staffs are prepared for implementation of ICD-10

by October 1, 2014. In 2011, the Colorado Medical Society organized a statewide training coalition of interested educators, consultants and physician/ practice representatives, including the component medical societies, Colorado Medical Group Management Association, Pikes Peak Chapter of the Professional Association of Health Care Office Management, Colorado Health Information Management Association, the Denver Regional Office of the Centers for Medicare & Medicaid Services and other stakeholders in an effort to make ICD-10 resources and training accessible via an organized multi-media educational campaign.

Coalition members are committed to the original goal of providing ICD-10 resources and training that is easily accessible and affordable. We will utilize a modular approach to provide a progressive training curriculum beginning early 2013 and running through October 2014. Each month a new program or resource will be made available to help practices prepare for the transition. A modular approach will allow practices to do much of the preparatory work now, such as project planning, impact analysis and documentation evaluation. This does not replace the need for intensive coding training, but that can be delayed until early 2014 when the actual implementation is closer. The programming and schedule is currently being finalized.

Training will emphasize the increased role physicians will play in accurate di38

agnosis coding. Documentation elements are the foundation of the ICD-10 coding structure, and separate physician programming is under development for this in the coming year. More information will be available in early 2013.

Information on Coalition activities will be posted on the CMS website, including a calendar of upcoming events and archived program recordings. Sign up at http://www.cms.org/news/livewire/ to join our mailing list and receive this information directly.

The Coalition is a voluntary effort and is open to any organization or individual who shares our goal of providing an organized, affordable approach to statewide ICD-10 training. We would like to thank the individuals who are currently spearheading these efforts: Arlene Andrew , Colorado Springs Chapter AAPC; Ann Bellah , Pueblo Health

Care; Janet Burch, Debbie Carlson, Chris Hall, Susan Ogden and Sandra Robben-Weber, Pikes Peak PAHCOM; Amy Burnett, Memorial Hospital; Dee Cole, Colorado Department of Health Care Policy & Finance; Helen Collins and Lyla Nichols, Centers for Medicare and Medicaid Services; Debbie DeBaun, Accountable Medical Practice Consulting; Emily Bidwell and Denny Flint, Complete Practice Resources; Sandy Gianagreco, Colorado Health Information Management Association; David Ginsberg, Priva Plan; Triche Guenin, Partners Through Change; Robin Linker, The Association of Health Care Educators and Auditors; Julie Painter, Physician Reimbursement Systems; Jennifer Sounders, Colorado Medical Group Management Association; Rebekah Gatti and Todd Welter, R.T. Welter and Associates; Susan Whitney, Centura and Marilyn Rissmiller, Colorado Medical Society. n

From left to right, members of the ICD-10 coalition: Sandra Robben-Weber and Chris Hall, Pikes Peak PAHCOM; Lyla Nichols, the Centers for Medicare & Medicaid Services; Julie Painter, Physicians Reimbursement Systems; Denny Flint and Emily Bidwell, Complete Practice Resources; and Susan Whitney, Centura.

Colorado Medicine for March/April 2013

Colorado Medicine for March/April 2013

39

Inside CMS

Reflections Reflective writing is now a regular portion of the CU School of Medicine curriculum, beginning in the first semester. All medical students participate by writing essays or poems that reflect what they have seen, heard and felt. This column is selected and edited by Henry N. Claman, MD and Steven R. Lowenstein, MD, MPH, from the new Medical Humanities Program

He stayed in the hospital for another day for observation and was discharged home. It turns out that he likely had an esophageal spasm.

Kori Neessen

Kori Neessen is a third-year medical student at the University of Colorado. Following a career in funeral service, he completed his BS at Metro State College of Denver. He intends to pursue a career in emergency medicine, with specific interests in wilderness medicine and increasing access to healthcare for impoverished populations.

My first patient

Mr. Johanssen drank some orange juice on Tuesday morning, just like he always does. This time, though, something was different. He started feeling chest pain immediately. He got dizzy. He became short of breath. He vomited a little bit.

The staff at the nursing home where this elderly gentleman volunteered his time became concerned and called 911.

He was taken to the hospital and given a complete cardiac workup, including stress tests.

I met him for the first time that morning after he had finished walking on the treadmill. Mr. Johanssen is a tall man with a wrinkled face and hands worn from a lifetime of hard labor.

He’s soft spoken; he asks few questions. His skin is pale, almost ghostly; his hair is the same.

40

He came to the clinic of my preceptor one week later for follow-up. I was happy to see him, and I think he was happy to see me – or at least that’s what the smile on his face said.

We chatted and I learned that he had been short of breath the past week. I asked appropriate questions, I monitored his oxygen saturations.

In the course of this encounter, Mr. Johanssen and I became well acquainted. We talked about where we were from, the events that had brought us together that day, and what we had for lunch. His blood sugar was a little low so I shared my orange with him. It turns out this gentleman has autoimmune hemolytic anemia and had been treated for it for a number of years.

Over the course of the next three weeks I met with this patient seven more times and we became friends.

He was my last appointment on the last day of my rotation at this clinic. I went through the necessary doctoring maneuvers.

At the end I told him it was my last day. I told him it had been a pleasure to meet him; I told him I wished him well. When he asked if I had to leave, I explained that I had a test on Friday and was starting another rotation in a different city starting on Monday. Then he started to cry and with a few simple heartfelt tears this kind man said, “I wish you didn’t have to go” as he grasped my seemingly small hand in his giant one for a final handshake.

I hadn’t really done anything for this man, at least not from a medical standpoint. The most important medical treatment I provided was an Albuterol nebulizer that he couldn’t tolerate

Colorado Medicine for March/April 2013

Inside CMS and stopped using the day after he got it.

What I did do was spend time with him.

I took the time to listen, to learn about him and his family, and his life. And he took the interest to learn about mine.

This man who never learned to read, had never held a job more prestigious than a handyman, and who likely has only a few years left in an already long life, had put his trust in me. He took my word as gold, not caring that I was “only” a third-year medical student.

This was my first patient as a thirdyear student. I have seen hundreds of patients since--many who moved me during the moment, but many whom I have forgotten or only associate with a disease. This soft spoken, white-haired, humble, kindhearted man crosses my mind routinely. Not because he was an interesting case, but because he became my friend. I hope he is doing well. n

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Colorado Medicine for March/April 2013

41

Inside CMS

Ted J. Clarke, MD Chairman & CEO COPIC Insurance Company

2013 legislative outlook: protecting stability in Colorado’s medical liability environment Continuing importance of the Health Care Availability Act (HCAA) This year marks the 25th anniversary of the Health Care Availability Act (HCAA), a landmark law passed by the Colorado Legislature that ushered in an era of medical liability insurance stability that endures today. This may be something we take for granted at times, but maintaining stability requires active involvement year after year. That’s why COPIC’s advocacy efforts continue to focus on collaboration among health care organizations and constant outreach to legislators.

Prior to the HCAA being passed in 1988, medical liability premium rates in Colorado experienced several years of double-digit increases. In 1989 these rates stabilized, demonstrating the significant impact the HCAA had on preventing a medical liability crisis.

Shortly before the passage of HCAA, University of Colorado research found that more than one in five obstetricians and family physicians had stopped delivering babies during the previous five years due to rapidly rising medical liability insurance premiums. The CU study also found that 63 percent of the physicians still doing obstetrical work at that time would have dropped those services if the premium increases had continued.

While access to primary care and obstetrical services is still a concern, the reforms in the HCAA help to mitigate this. But what the legislature gives, it can also take away. The HCAA and the medical liability reform it provides could be completely upended by our legislature or judicial interpretation. Therefore, COPIC’s efforts have a comprehensive focus on all aspects of public policy and their potential impact on insureds.

COPIC’s legislative involvement COPIC’s mission to improve medicine in the communities we serve is aligned with our purpose of “allowing the health care community to devote the greatest possible proportion of its resources to patient care.” Because of this, COPIC often supports bills proposed before the Colorado Legislature that further this goal and reinforce a medical liability environment that allows for quality improvement. With the added involvement of our insureds, a collective voice of medical professionals sends a strong message to legislators.

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COPIC carefully monitors proposed legislation to identify and respond to bills that would undermine this goal. That requires constant vigilance, including sifting through hundreds of bills annually and constant communication with partners in the health care community.

Legislative focus for 2013 In the 2013 session of the Colorado Legislature, COPIC is focused on preserving medical liability reforms and demonstrating how they support access to care and patient safety protections that have benefited Colorado. This includes maintaining a non-economic cap for pain and suffering (and other non-measurable aspects) awarded in medical liability lawsuits.

Although the protections established under the Colorado Professional Review Act (CPRA) have been extended until 2019, opponents to CPRA will continue to look at ways to erode these protections. COPIC remains devoted to working with its partners to prevent this from happening. Professional review is crucial to ensure honest, open reviews of care in the interest of improving patient safety and understanding what resources are needed to implement change.

Getting involved Much is at stake in this changing health care environment, and COPIC and its insureds cannot afford to be complacent. States are tasked with the responsibility of implementing the federal health care reform law, which includes expanding the enrollment for Medicaid services to 160,000 Coloradoans, according to a recent announcement by Gov. John Hickenlooper. As legislators consider adding more individuals to the health care system, we need to reinforce how a stable tort environment and robust reviews of care contribute to access to care, improvements in patient safety and better medicine for our communities.

Improving the health care delivery system requires a coordinated and thoughtful approach that recognizes the economic realities of expanding access to care. Medical professionals across our state cannot provide care to more individuals if they see their expenses increase and reimbursements decrease. In addition, we need to ensure that protections under professional review remain in place and that unnecessary challenges don’t impede the implementation of patient safety improvements.

When COPIC becomes aware of specific legislative priorities, Colorado Medicine for March/April 2013

Inside CMS we alert our insureds so they can be informed and involved. You can always find the latest information by visiting callcopic.com, clicking on the Resources link and then the Legislative Action Center. When you’re on the Legislative Action Center page, scroll to the bottom of the page and make sure you are signed up for the Action E-List. You will receive e-mails when important issues arise and have an opportunity to make your voice heard to help educate legislators.

We have all benefitted from our colleagues who helped establish the HCAA in the 1980s. Obtaining tort reform for medical liability is an important benchmark for health care improvement, and maintaining this requires an ongoing commitment by all involved with health care. Please take a moment to review your e-mail alerts to see how you can help protect the liability reforms achieved 25 years ago. n

Colorado Medical Society is pleased to announce Solve IT as our newest Member Benefit Partner.

Healthcare organizations are facing greater demands than ever to provide higher quality care. At Solve IT, we have the necessary expertise to help your healthcare organization meet these challenges. Our team of professionals has extensive experience and knowledge in healthcare operations as well as the various technologies utilized at all levels of patient services. Visit http://www.solveit.us or contact Mary Jo Heins, Healthcare Manager, mjheins@solveit.us, 303.800.9300.

Colorado Medicine for March/April 2013

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Departments

New Members Arapahoe-Douglas-Elbert Medical Society Jennifer J Aregood, MD Susan R Brion, MD Renee J Carson, MD Jennifer J King, MD Vongpheth Luangphaxay, MD Clear Creek Valley Medical Society William J Peace, MD Curecanti Medical Society Renata M Raziano, MD El Paso County Medical Society Shelly Asbee, MD Randall W Day, MD Benjamin A Delano, MD Jeremy E Jarecke, DO

Matthew Javernick, MD Kendell L Mann, MD Minta Mathew, MD Vernesha Montgomery, MD Lindsay K Sanders, MD Paul Stanton, DO Autumn Stowe-Quain, MD Thomas B Strandness, MD Stephen H Thatcher, MD Larimer County Medical Society Kevin T O’Connell, MD Mesa County Medical Society Stacia C Baker, MD Steven R Gammon, MD Lynda S Hamner, MD Tessa M Landa, MD Roy O Mears, DO

Andrea L Nederveld, MD Ross S Pacini, MD Pamela S Williams, DO Pueblo County Medical Society Robert L Holman, MD Victor A Nwanguma, MD Kevin J Weber, MD Weld County Medical Society John M Borkert, MD Samuel W Davis, MD Sean T Filipovitz, MD Alyssa L Gonzalez, DO David A Knierim, MD Kelli A Larson, DO Jacob J Miller, MD Rochelle M Palmiscno, MD

The Jane Nugent Cochems Trust Financial help for physicians in need The Colorado Medical Society administers all grants with the average amount ranging from $5,000 to $10,000.

The application process is simple and the review processes are completely confidential.

For more information or to obtain an application form, please call Tom Wilson at the Colorado Medical Society, 720-858-6316.

Visit http://www.cms.org/about-cms/cochems-trust/ to download an application form.

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Colorado Medicine for March/April 2013

Departments Have an idea you want to share?

Do you like something CMS is doing?

Are we heading on the right or wrong track with our strategic plan?

Serving the CME needs of Colorado physicians

CMS is a physician-driven organization and we want to hear from you!

Mail: Colorado Medical Society 7351 Lowry Blvd.

Denver, CO 80230

E-mail: Letters to the editor: Dean Holzkamp: dean_holzkamp@cms.org

Your bridge to quality improvement in health care Today’s CME is new and improved. It is based on practice gaps, thoughtfully designed formats and collaboration with other stakeholders, to address and overcome barriers to improved care. The new model of CME can serve as a bridge to quality health care.

Colorado Medical Society accredits CME that addresses physician core competencies, ensures evidence-based content developed independently from commercial interests, and evaluates change in competence, performance or patient outcomes.

Accredited CME is education that matters to patient care.

For more information contact the Colorado Medical Society CME office at 720.858.6309

Colorado Medicine for March/April 2013

With years of experience partnering with the medical community, we’re committed to delivering sophisticated products and services to make you a success.

True expertise and financial solutions free you to succeed, personally and professionally.

Tel 720.264.5630 cobizbank.com Part of CoBiz Bank Member FDIC

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Departments

medical news Seven area hospitals join Colorado Health Information Exchange The Colorado Regional Health Information Organization, (CORHIO) announced Feb. 13 that HealthONE has signed an agreement to participate in its secure health information exchange (HIE) network. The seven HealthONE hospitals join 28 other hospitals around the state already connected to CORHIO, including Centura Health which operates 13 hospitals connected to the HIE network, of which seven are located in Metro Denver. HealthONE is a subsidiary of the Hospital Corporation of America (HCA), which is the nation’s largest private hospital system.

The CORHIO HIE is a highly protected electronic network that links the medical records systems of doctors and other health care providers throughout

Colorado. The HIE allows providers to exchange patient information, including lab test and pathology results, x-ray, MRI and other imaging reports, and physician transcription reports, when needed for patient care. To view a video that describes HIE, please visit http:// youtu.be/9iO8NaVt6Sw. Hospitals and health care providers that participate in HIE help to improve the overall quality of care that patients receive, including reducing delays in treatment and the need for redundant testing, which can be costly – and sometimes painful – for patients.

For patients who go to a hospital for care, studies have shown that coordinated after-hospital care is critically im-

portant to avoid serious complications.

Too often, patients can end up back in the hospital within 30 days, something referred to as a “hospital readmission.” By joining the CORHIO HIE, HealthONE and Centura Health have demonstrated a strong commitment to the health and wellbeing of Denver area patients because HIE will improve their communication with community-based physicians, home health nurses, skilled nursing facilities and other providers who can help patients regain their health and avoid unnecessary trips back to the hospital.

The HealthONE system includes seven metro Denver hospitals, all of which are joining the CORHIO HIE: • The Medical Center of Aurora • North Suburban Medical Center • Presbyterian/St. Luke’s Medical Center (P/SL) & Rocky Mountain Hospital for Children at P/SL • Rose Medical Center • Sky Ridge Medical Center • Spalding Rehabilitation Hospital • Swedish Medical Center The added connections to its HIE represent part of CORHIO’s three-pronged effort to improve healthcare delivery and care coordination in Colorado. According to its mission statement, the state-designated entity has set itself three goals to achieve by 2015: • HIE in every community • 85% of all primary care providers and safety-net providers achieving meaningful use • 85% of all providers statewide becoming meaningful users of EHRs The Colorado Medical Society is a strong supporter of CORHIO and applauds the continued growth of the Colorado Health Information Exchange. n

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Colorado Medicine for March/April 2013

Departments

medical news Grand Junction, Pueblo hospitals achieve highest CME accreditation level The Colorado Medical Society Committee on Professional Education and Accreditation has awarded the highest accreditation level to two Colorado CME providers, Community Hospital in Grand Junction and the Colorado Mental Health Institute at Pueblo.

Community Hospital in Grand Junction is a full-service, acute-care hospital licensed for 78 beds, offering outpatient diagnostic services and inpatient care for the Western Slope region of Colorado and eastern Utah.

The Colorado Mental Health Institute at Pueblo is one of Colorado’s two stateoperated inpatient psychiatric hospitals,

serving clients in the civil mental health system. The 450-bed hospital is under the direction of the Colorado Department of Human Services, Office of Behavioral Health.

This honor, “Accreditation with Commendation,” is awarded to CME institutions that adhere to all 22 CME criteria of the Accreditation Council for Continuing Medical Education, or ACCME. The first 15 criteria fall into three “essential areas”: purpose and mission, education and planning, and evaluation and improvement. To receive commendation, organizations must also demonstrate that they use CME as a tool to

improve quality performance and health outcomes, and that they collaborate with internal or external stakeholders to further improve quality. With commendation, these organizations will receive a six-year term of accreditation compared to the standard four-year term.

CMS has awarded commendation to 20 percent of its CME providers. A survey of other state medical societies shows that an average of 17 percent of state CME providers have received this award and 23 percent of national CME providers accredited directly by the ACCME have been awarded commendation. n

WHAT’S YOUR PATH TO MEANINGFUL USE? Find out with the free tool: www.corhio.org/portal CORHIO and the Colorado Medical Society, with grant funding the Physician’s Foundation, developed this self-guided tool to assist Colorado medical practices with many of the tools and resources needed to help make the Path to Meaningful Use a success.

The new and improved tool includes: Information for your specific stage of EHR adoption A Practice Readiness Tool, with self-guided questions on five capacity areas: management, finance/budget, operational, technology and organizational A Meaningful Use Gap Analysis to assess your practice’s knowledge of meaningful use and direct you to the right post-launch tools Helpful information on EHR tools and resources in the Document Library Self-guided training in different modules Information and links to Colorado-specific resources Online forms and downloadable documents to guide you through the meaningful use EHR process

Find out with the free tool: www.corhio.org/portal Colorado Medicine for March/April 2013

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Colorado Medicine for March/April 2013

Departments

classified advertising Publication of any advertisement in Colorado Medicine is not an endorsement by the Colorado Medical Society of the product or service. Colorado Medicine magazine is the official journal of the Colorado Medical Society and is authorized to carry general advertising.

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For more information, visit http://www.projectcureorg, call 303-792-0729, fax 303-792-0744, or e-mail projectcureinfo@projectcure.org.

ROCKY MOUNTAIN FAMILY MEDICINE - is seeking Board-eligible/ Board-certified family medicine and pediatric physician providers. Join a vibrant group of primary care providers with 8 locations in the Denver metro area. Full scope of out-patient practice with no OB. Less than 2 weeks call/ yr. Pay and benefits are competitive.

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➤ PROPERTIES FOR SALE OR LEASE WE BUY MEDICAL PRACTICES - Looking to sell your practice or join a larger locally-owned group? Want to continue to practice without the hassles of administration? Would you like to join a non-hospital-owned group with a proven track record to offer better benefits for yourself and your staff? Increase your referral base and utilize specialists within our group. Securely fax information to 303-872-1856 or e-mail to nmoore@rm-uc.com.

➤ MISCELLANEOUS SEEKING PRIMARY CARE PHYSICIANS / PRACTICES IN THE DENVER METRO AREA We are a Primary Care Practice with a clinic serving the South Denver Metro Area.

We are seeking quality physicians to join our existing clinic or Primary Care Practices that could add to our geographic coverage of the metropolitan area.

LOOKING FOR LOCUMS WORK IN COLORADO? - We place physician and mid-level providers with family practice, urgent care, internal medicine, pediatric and occupational medicine clients. Competitive rates. Are you a provider that needs strong locums providers to work in your practice while you are away? Securely e-mail to RMoore@ mednowstaffing.com or visit our website at www.MedNOWStaffing.com

If you are a physician or group that would like to: • Join a group with a fully integrated Electronic Health Record, • Be a part of an NCQA Recognized Level 3 Medical Home Practice, and • Make a change but do not want to relinquish your current patients We offer a unique opportunity for you (and your patients) to join our group. We are not a broker and will not respond to broker inquiries. If interested, contact Cindy at (303) 493-5272. All inquiries will be kept in strict confidence and will receive a prompt response.

Colorado Medicine for March/April 2013

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Features

the final word Governor John Hickenlooper

Gaining momentum as the healthiest state Coloradans are known for enjoying a healthy lifestyle.

Open spaces and natural beauty offer Coloradans the opportunity to lead active and healthy lives. But health – and illness – does not impact everyone equally. And not everyone stays healthy by enjoying great recreational opportunities.

For Colorado to become the healthiest state – and not just the thinnest state, we need a broad and comprehensive strategy that draws on both public and private sectors. Individual responsibility also plays a critical role.

At the state level, we are pursuing a number of goals.

First, we are promoting prevention and wellness to help people stay healthy and become healthier.

We’ve identified several “winnable battles” focusing on obesity, oral health, mental health and substance abuse. In each of these efforts, we are working with partners in the private, public, and nonprofit sectors to help people – especially kids – live healthier lives.

Insurance coverage is a critical piece of the puzzle. Colorado’s bipartisan support in launching a Health Insurance Exchange puts us ahead of other states. We are expanding Medicaid eligibility, but in conjunction with efforts to reduce costs. We have proposed a Medicaid provider rate increase in next year’s budget, and we are working with regional and local partners to pilot new payment methods that create savings.

The Accountable Care Collaborative (ACC) is a partnership between local providers, regional care coordination organizations and Medicaid. This effort will expand access to care by using provider resources more effectively. The ACC will be the foundation of Medicaid’s delivery system and payment reform efforts, as we plan to transition up to 70 percent of Medicaid clients into this model by 2018.

Third, we are integrating the ways we deliver care to improve quality and drive efficiency.

Terrible incidents of gun violence last year brought mental health to the forefront. In response, we are improving our crisis- and community-based services to treat mental health and substance abuse challenges.

We’ll also tackle the problem of prescription drug abuse by sponsoring a National Governor’s Association (NGA) summit in Denver this year.

We believe the most effective way to deliver healthcare is by treating the “whole person”, which means better integration of traditional physical and medical health systems with behavioral health, public health, oral health, and long-term services and supports. Health information technology – including electronic medical records, health information exchange, and tele-health capabilities – is a core component of our strategy. We are also evaluating and redesigning the long-term care system to meet the coming needs of the “silver tsunami,” a 54 percent increase in Colorado’s senior population by 2021.

Second, we are expanding access to healthcare and increasing capacity to help ensure that when people need care, they have a place to go.

Finally, we need to support innovation, control costs and harness the creativity of the private sector to link health and economic progress.

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Since its inception in 2011, the Accountable Care Collaborative has enrolled 250,000 Medicaid members and reduced expenses by $20 million – including an 8.6 percent reduction in readmissions and a 3.3 percent decrease in high-cost imaging – which allowed for the return of $3 million to state and federal taxpayers.

We also recently announced a five-point plan to save $280 million in Medicaid over the next 10 years. These savings will be achieved by aligning coverage policies with evidence-based practice, transforming the statewide delivery systems to encourage practice-level integration, transitioning payment systems from volume-based to value-based, improving Medicaid’s IT infrastructure, and streamlining administrative systems to provide more effective, efficient and elegant services with less fraud and waste.

We are building health and wellness into Colorado’s economic development strategy, attracting companies whose business interests – and the interests of their employees – align with Colorado’s vision.

Working with Colorado Workers for Innovations and New Solutions, we are also looking at innovative ways to improve health outcomes and lower expenses for state employees.

Healthcare professionals are important allies in all these efforts. Whether you accept new Medicaid patients in your practice, link your EMR to a health information exchange network, help us shape strategies to improve health outcomes, or work to reduce prescription drug abuse, we need your vision and your voice.

In coming months and years we look forward to your participation in making Colorado the healthiest state in America. n

Colorado Medicine for March/April 2013

While you’re taking care of patients, we’ll be taking care of you.

COPIC Financial Service Group www.copicfsg.com•(720) 858-6280/(800) 421-1834 Colorado Medicine for March/April 2013

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Member Benefit Partner

Wells Fargo Healthcare Services Whether you’re preparing for ownership or planning for growth, Wells Fargo can help you achieve your practice goals.

Are you working with a specialized Healthcare Banker?

At Wells Fargo, we have a dedicated Healthcare team that understands the unique challenges that can impact your practice’s bottom line. To help you establish a foundation for a more sound future, we offer an outstanding variety of business products designed to help you meet those challenges.

As a practice owner, you have a single point of contact with a dedicated Healthcare Business Banker who can provide you with “one-stop” access to a range of financial solutions that will help your practice run smoothly. You’ll have more time to focus on treating patients and building your business.

Chris Strabala

Senior Vice President / Healthcare Market Manager 303-863-6014 | christopher.j.strabala@wellsfargo.com

© 2013 Wells Fargo Bank, N.A. All rights reserved. Wells Fargo Practice Finance is a division of Wells Fargo Bank, N.A. Commercial real estate financing is provided by Wells Fargo SBA Lending and is subject to credit approval and SBA eligibility rules.

All practice financing is subject to credit approval.

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Solutions include: Practice financing · Practice acquisition and start up financing · Expansion, relocation, and renovation projects · Debt consolidation and business refinance · Commercial real estate financing · Practice equity loans Credit services · Business credit cards and rewards programs · Unsecured lines and loans · Business real estate financing · SBA loan programs · Equipment financing Business services · Business payroll services · Merchant services · Patient financing · Business insurance Deposit services · Business checking · Business savings · Comprehensive treasury management services

Colorado Medicine for March/April 2013