May-June-2012

May/June 2012

Volume 109, Number 3

New peer review law advances patient safety

Strong coalition, bi-partisan support bring legislative success, governor’s signature Award-winning publication of the Colorado Medical Society

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Colorado Medicine for May/June 2012

contents May/June 2012, Volume 109, Number 3

Features. . .

Cover story A strong coalition and

bipartisan support deliver a patient safety win for Colorado after Gov. Hickenlooper signed the new peer review statute into law. Read more starting on page 8.

On the cover: Front row from left Ann McCullough, Sen. Irene Aguilar, MD, Robert Brockmann, MD, Gov. Hickenlooper, Brent Keeler, MD, Rep. Bob Gardner, Chris Lines, Wes Skiles. Back row from left: Bev Razon, Jerry Johnson, Terry Boucher, Ginny Brown, Brian Tobias, JD, Chris Ahmadian Miller, MD, Susan Koontz, JD, Alfred Gilchrist and Sarah Sills.

Inside CMS

5 President’s Letter 7 Executive Office Update 32 Reflections 34 COPIC Comment 37 Annual Meeting Registrations

Departments 40 43 44

New Members Medical News Classified Advertising

Colorado Medicine for May/June 2012

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Supreme Court ruling–The nation’s top court is set to rule on the future of the Affordable Care Act. What does it mean for Colorado physicians?

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Clear voice in health care reform–A new online project aims to ramp up physician collaboration and provide clear ideas about how to increase insurance coverage.

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Transparency in physician profiling–Find out how to demonstrate your value with physician designation/ profiling programs and alternative payment models.

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The rating game–An explosion of online rating systems poses opportunities and threats for physician/patient relationships and doctor reputations.

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2012 Spring Conference–With a focus on the importance of relationships, programming delved into issues ranging from health care reform, to advocacy, to physician wellness.

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Physician wellness–Busy practices, overscheduled lifestyles and constant stress takes a toll on the best of physicians. What can you do to ensure a better balance?

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Colorado Health Benefit Exchange–A new online insurance marketplace will open for business next year designed to expand affordable insurance coverage for Coloradans.

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Maintenance of Licensure–CMS is partnering with the state to participate in Federation of State Medical Board pilots that likely will drive future physician MOL requirements.

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Final Word–Colorado will soon have a new tool to help determine value in health care. The All Payer Claims Database will be a powerful resource and physicians have an important role to play.

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

2011/2012 Officers F. Brent Keeler, MD

President Jan M. Kief, MD

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 Michael J. Pramenko, MD

Immediate Past President

Board of Directors John L. Bender, MD Charles W. Breaux Jr., MD Robert A. Brockmann, MD Ellen M. Burkett, MD David Elison, MS Naomi M. Fieman, MD T. Casey Gallagher, MD Ripley R. Hollister, MD Johnny E. Johnson, MD Donald Luebke, MD Randy C. Marsh, MD Gary Mohr, MD Nora E. Morgenstern, MD Jeffrey A. Moody, MD Edward A. Norman, MD Tamaan Osbourne-Roberts, MD Scott Replogle, MD Stephanie Sandhu, MS Ranee M. Shenoi, MD Alisa B. Lee Sherick, MD Stephen V, Sherick, MD Sean Slack, MS Thomas H. Soper, DO 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-elect 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 Donna Jeakins, Manager, Accounting, Donna_Jeakins@cms.org Dianna Mellott-Yost, Executive Assistant to CEO and General Counsel, Dianna_Mellott-Yost@cms.org

Division of Communications and Member Benefits

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Information Technology/Membership

Tim Roberts, Senior Director, Tim_Roberts@cms.org Genni Pearman, Director, Membership and Professional Services, Geneva_Pearman@cms.org Tim Yanetta, Coordinator, Tim_Yanetta@cms.org

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

Division of Government Relations

Division of Health Care Policy

Colorado Medical Society Education Foundation Colorado Medical Society Foundation

Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org Susan Liptak, Director of Marketing and Health Care Policy Communications, Susan_Liptak@cms.org

Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Chris Lines, Director, Political Affairs and Education, Chris_Lines@cms.org

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 May/June 2012

Inside CMS

president’s letter F. Brent Keeler, President Colorado Medical Society

The pancake analogy In late May each year at the University of Colorado School of Medicine, the Colorado Medical Society president has the honor of participating in the doctoral rite of passage known as “hooding,” in which a ceremonial garment is added to each graduate’s regalia.

On May 25, 2012 this distinct privilege was mine, made especially poignant since I graduated from the CU medical school 35 years ago. I want to thank University Dean Richard Krugman, MD, for the kind invitation. What a class this is, with an amazing group of young physicians at the start of their careers. Congratulations and best wishes!

Peter Moore was this year’s class speaker. Moore’s personal story of triumph over adversity was very inspirational, as he was diagnosed with Hodgkin’s lymphoma during his medical school years. He learned first-hand what it is like to be a patient while experiencing radiation therapy, chemo and surgery.

His description of the support he received from his family, classmates and his team of physicians was particularly moving.

Moore spoke eloquently about the nature of the medical school experience.

With just the right combination of humor and humility, he explained what it is like to be confronted with such a vast body of knowledge. We have all heard medical school compared to drinking from a fire hose. Peter shared his own analogy: What if one was expected to eat pancakes for breakfast every day for four years? What if the minimum expectation was to eat five? What if on some days there were suddenly extra Colorado Medicine for May/June 2012

pancakes? If you didn’t eat your quota, the pancakes didn’t go away - they kept piling up for the next day and the day after that.

qualification for MOL for all physicians who are current with the MOC process of their own specialty board. The MOL validation would be based on “at-

I really like this analogy. The pancakes keep coming after that doctoral hood is placed. Fortunately, with time, the volume abates and one can focus on certain flavors. But it never ends. Such is the concept of “lifelong learning” that is so central to what we physicians pledge to do on behalf of the patients we serve.

What if one was expected to eat pancakes for breakfast every day for four years? . . .

– Peter Moore

Lifelong learning The process of life-long learning touches us all. It ranges from journal reading to attending conferences and meetings and beyond. All specialty boards have a Maintenance of Certification (MOC) process. However, not all physicians are board-certified. Some are grandfathered and exempt from MOC. (It is acknowledged that not everyone agrees with the specifics of each board’s MOC experience. That is a separate subject for another time.)

Your Colorado Medical Society, in collaboration with the Colorado Medical Board (CMB), is embarking on a pilot project for a concept known as Maintenance of Licensure (MOL). The Federation of State Medical Boards (FSMB) has been looking at enhancing the licensure process across the United States. MOL in Colorado is envisioned to begin with a CME requirement. (We are one of only a few states without one.) Additional requirements could be added later.

testation”: when you go to the website to renew your license, you mark a box stating that you are current with your MOC process, or that you have fulfilled the criteria for MOL. You would not need to submit a CME list or other details. Record keeping would be on the honor system. However, if the CMB should conduct an inquiry into a complaint or other issue with your license, you might then be required to provide MOC or MOL records.

The proposal now envisions starting the CME requirement (25 hours of relevant CME per year) with the 2015 license renewal cycle. More on this will appear in future issues of Colorado Medicine as the pilot process unfolds and evolves. Future MOL requirements could be added for the 2017 and 2019 licensing renewal cycles. (Again, remember that being current with MOC would continue to create automatic compliance with MOL.) (Thanks to Peter Moore for your inspirational story.) n

The CMS MOL Subcommittee has been actively working on this idea. Part of the vision is to have an automatic 5

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Colorado Medicine for May/June 2012

Inside CMS

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

Judgment Day? It’s not about policy or politics At some precipitous moment this summer, the U.S. Supreme Court will potentially resolve the hyper-technical legal argument as to whether health care is “commerce” that may be coerced or compelled by the federal government.

In the rare atmosphere of the Supreme Court, it’s not about policy, it’s about law – and hopefully, it’s not about politics.

As our friend Ed Dauer, Dean Emeritus of the DU Law School, argued in an expert panel on this subject at our Spring Conference in early May, judgment day in most respects may have little to do with health care. You can listen to his comments on our homepage at www. cms.org. The fact is, we are going to continue along an already developed policy trajectory to address the challenges of providing health care in our state that is available, affordable and of good value.

The Supreme Court will either limit or confirm the role of the federal government in that critical endeavor.

No matter the ruling, physicians will continue to press the case and lead a

systems-approach to health care delivery. We live in a state that is advanced in the pursuit of care coordination and finding the ways and the means to collaborate on homegrown, locally-owned solutions.

If the “everybody in the risk-pool” concept stays put, we bear down on the development of the Colorado Health Insurance Exchange, a complex undertaking on its own. But if the mandate is ruled unconstitutional, medicine must determine whether to lead, follow or wander—which was the theme of the Spring Conference.

Should we support our own version of a Massachusetts-style coverage scheme, and an accompanying insurance regulatory framework to support it? Should we wait and see what Gov. John Hickenlooper’s TBD Colorado Health Care produces and support his plan? Will a robust cost containment package need to travel with coverage provisions? Will the 2012 election cycle produce a political center that can find answers to these questions instead of blame?

Join COMPAC Now! Colorado Medical Political Action Committee Call 720-859-1001 or 800-654-5653, ext. 6317 Colorado Medicine for May/June 2012

While we have thoughtful polices developed by our Physicians’ Congress for Health Care Reform, we are once again

No matter the ruling, physicians will continue to press the case and lead a systems-approach to health care delivery. engaging our members and asking for additional ideas through an on-line tool developed by a physician spouse (see story on page 15). We’ll bring it all together at the Annual Meeting in September so our top policy making body, the House of Delegates, can give us a consensus.

Presuming the Supreme Court upholds the Medicaid expansion, we are part of a larger debate on how we afford it. The urgency of that objective is reflected in Medicaid’s new Accountable Care Collaborative, a system redesign effort incubated by CMS and a number of state specialty societies that went into effect just this year.

In a digital age and an informationbased economy, health services are just a few keystrokes away from unbridled transparency and accountability. Every aspect of care delivery will experience real time scrutiny. What follows will be a long-term debate over the cost, price and efficacy of every test, procedure and exam.

The Supreme Court’s role is less game changer than game arranger. The Great Game is already on. n 7

Cover Story

New peer review law advances patient safety

Strong coalition, bi-partisan support bring legislative success, governor’s signature 8

Colorado Medicine for May/June 2012

Cover Story Colorado Medical Society’s goal of making Colorado the safest state in the nation for patients moved closer to reality with the reauthorization of The Colorado Professional Review Act. Governor John Hickenlooper signed House Bill 12-1300 on June 5, concluding an often contentious 18-month process that ended successfully thanks in large part to the steadfast support of the bill sponsors, state Rep. Bob Gardner (R-Colorado Springs) and state Sen. Irene Aguilar, MD (D-Denver).

A strong coalition of health care organizations and their lobby teams also championed the effort, which survived an 11th hour negotiation marathon while the sunset legislation was held hostage to a series of demands from the trial attorneys.

“The key to resolving a hostage situation is to hold firm on the fundamentals of the issue, never blink, and seek a fair and rational solution,” said CMS CEO Alfred Gilchrist. “Given the risks of playing chicken with a sunset bill, where an entire body of evolved and complex peer review law drops dead if the clock runs out, our bill sponsors and our coalition lobby team showed remarkable steadiness and judgment under excruciating pressure.”

As signed into law, HB 12-1300: • Without waiver of privileges and without violation of the confidentiality requirements, allows professional review records to be shared with: o Another authorized professional review entity. o Colorado Department of Public Health and Environment in accordance with its authority to issue or continue a health facility license or certification o CMS in accordance with its authority over federal health care program participation o Colorado Medical Board within the scope of its authority over physicians and PAs o Colorado Nursing Board within the scope of its authority over APNs o The Joint Commission or other en-

Colorado Medicine for May/June 2012

tity granted deeming authority by CMS in connection with a survey or review for accreditation • Maintains the confidentiality, privileges and immunities associated with professional review. This has a sevenyear sunset trigger and will be subject to subsequent review.

• Includes a new section that adds advance practice nurses and physician assistants to the statute. (The ANPs and PAs actively lobbied for the entire legislative package).

• Streamlines and updates legislative language to make state and federal laws more consistent and easier to administer.

• Clarifies the legal definition of those records protected under professional review to include letters of reference, interviews or statements, reports, memoranda, assessments, and progress reports developed to assist in professional review activities, and reports and assessments developed by independent consultants in connection with professional review activities.

• Clarifies that the scope of activities of a professional review committee includes investigating and evaluating the competence, the professional conduct of, and the quality and appropriateness of care provided by a physician, APN or PA. • Expands the list of entities that may establish a professional review committee to include a professional services entity, a provider network, an accountable care organization, and a trust organization.

Colorado Medical Society has long recognized that effective peer review is a key component to improving patient safety. Following passage of sunset legislation in 2010 to modernize the state’s Medical Practices Act and to extend the life of the Colorado Medical Board, CMS took the unusual step of requesting the state to review the body of law governing peer review.

“Making the health care system safer over the long haul is a grind, not a sprint,” said Zak Ibriham, MD, who cochairs CMS’ Ad Hoc Work Group on Patient Safety. “We understood there

would be risks associated with putting peer review through the sunset process, but at the end of the day we knew the law needed to be updated to keep pace with the rapidly evolving patient safety movement.”

A broad based coalition of organizations representing physicians, nurses, physician assistants, hospitals, medical schools, and health plans worked together from the inception of the sunset process. The influence associated with

“Peer review is a timehonored practice that is very important and has been around for a long time. It is important for better quality of medicine and patient safety. We (CTLA) agree that confidentiality and privilege should be maintained.”

– Holland Hoskins, CTLA attorney, testifying before the Senate Health and Human Services Committee a large coalition composed of highly regarded professionals and organizations was needed when the state’s most powerful trial lawyers surfaced in the final weeks of the legislative session to insist on lawsuit-friendly last-minute amendments to the bill.

The bill’s sponsors, along with the coalition, successfully fought back trial lawyer “asks” that would have: • Limited statutory immunity thereby increasing exposure to lawsuits for physicians • Exposed all professional review re-

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Cover Story (cont.) cords on a case-by-case basis to judicial scrutiny through in-camera reviews and discovery by trial lawyers • Exposed factual information gathered during the professional review process to legal discovery and admission in court against a physician.

• Provided patients unrestricted access to professional review records.

• Excluded “letters of reference” from the definition of professional review records.

• Eliminated the review of the “competence of physicians” from the activities of a professional review committee thereby exposing those reviews to discovery.

• Held physician groups, carriers, and health plans that perform professional review liable for negligent credentialing and privileging processes.

An accord with Colorado Trial Lawyers Association was reached that does not affect physicians but will impact hospi-

tals and ambulatory surgical centers by allowing these entities to be held liable for negligent credentialing and privileging processes involving an APN, PA or physician. A hospital or ambulatory surgical center can be liable when it fails to act reasonably when making a privileging decision (when it knew or should have known an APA, PA or physician is incompetent, but allows the privileges anyway). It is important to note that professional review participants continue to be immune from liability and that the professional review records remain protected and confidential.

Ultimately, the peer review statute was substantially strengthened and streamlined by being pushed through the sunset process.

Despite the tension that accompanies these kinds of policy debates in a highly politicized environment, the end result was conclusive and established a solid

legal premise for the importance of protecting peer review systems.

Holland Hoskins, an attorney representing the CTLA, testified in support of the sunset legislation to the Senate Health and Human Services Committee and acknowledged “Peer review is a time-honored practice that is very important and has been around for a long time. It is important for better quality of medicine and patient safety. We (CTLA) agree that confidentiality and privilege should be maintained.”

At the formal signing event with Gov. Hickenlooper, CMS President F. Brent Keeler, MD, said: “On behalf of Colorado physicians and the patients and communities we serve, I wish to thank the dedicated work of the bill sponsors, the governor’s office and the many organizations that helped move Colorado’s patient safety movement forward by supporting HB 12-1300.” n

The physicians of the Colorado Medical Society wish to thank the bill sponsors, supportive members of the Legislature, Governor Hickenlooper and the following organizations who have come together as a coalition for their steadfast commitment to improving safety and quality of care by supporting HB 12-1300, the Colorado Professional Review Act.

HB 12-1300 Bill Sponsors

The Honorable Rep. Bob Gardner (R)-Colorado Springs The Honorable Sen. Irene Aguilar, MD, (D)-Denver Members of the Professional Review Coalition American Academy of Pediatricians, Colorado Chapter American College of Nurse-Midwives, Colorado Arapahoe-Douglas-Elbert Medical Society Boulder County Medical Society Center for Personalized Education for Physicians Clear Creek Valley Medical Society Colorado Academy of Family Physicians Colorado Academy of Physician Assistants Colorado Chapter, American College of Emergency Physicians Colorado Hospital Association Colorado Nurses Association Colorado Ob/Gyn Society Colorado Orthopaedic Society Colorado Psychiatric Society

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Colorado Radiological Society Colorado Society of Advanced Practice Nurses Colorado Society of Anesthesiologists Colorado Society of Clinical Specialists in Psychiatric Nursing Colorado Society of Eye Physicians and Surgeons Colorado Society of Osteopathic Medicine COPIC Denver Medical Society El Paso County Medical Society Pueblo County Medical Society Rocky Mountain Health Plan Rocky Vista University, College of Osteopathic Medicine The Doctors Company University of Colorado Anschutz Medical Campus

Colorado Medicine for May/June 2012

Features

Kim Ross, CMS consultant

What the Supreme Court’s health care ruling may – or may not – mean to Colorado As this issue goes to press, the U.S. Supreme Court will rule on the constitutionality of two pivotal features of the federal health care law known as the Affordable Care Act: (1) The mandate that all Americans obtain health insurance by the year 2014 or pay a penalty, and (2) the expansion of Medicaid eligibility to much larger patient populations than currently covered in most states.

Despite the controversial nature of this complex Act – especially these two features – and one unsuccessful attempt by Congress to repeal and replace it, there is bipartisan agreement on at least one key point: the pattern of rising health care costs and diminishing value is unsustainable and must be reversed to assure long-term economic health and global competitiveness.

States will react with varying degrees of enthusiasm to the ruling, regardless of outcome. Meanwhile, a sharply divided, partisan Congress will continue to deadlock over the role of the federal government to coerce and/or incentivize state cooperation in health care coordination and delivery. This year’s presidential campaign and multitude of Congressional and U.S. Senate contests will test voter sentiment on these fundamental questions.

Whatever happens, Colorado Medical Society is positioned to effectively navigate the waters. Years before the emergence of the Congressional deColorado Medicine for May/June 2012

bate and enactment of the ACA, CMS leadership began discussions with its members to garner a policy consensus around fundamental issues such as expanded, if not universal, coverage and the care coordination and other supportive measures that must accompany that principle.

the right time, place and value,” CMS President Brent Keeler, MD, said.

The next iteration of those discussions and subsequent policy options will be drawn from whatever the Supreme Court allows or disallows, but thanks to the foresight and initiative of CMS members and leadership, we will not be starting from scratch.

Insurers collectively argue they cannot afford to offer near-universal coverage without “everybody in.” In “friend of the court” briefs filed as part of the case, the insurance industry warned that the eight states that enacted such coverage without a mandate “experienced severe market disruptions in the form of higher premiums, lower enrollment and a general failure to achieve the goals articulated by (those) … state legislatures.”

“Once we see what the Court sets as the ground rules, medicine will further engage our members and our public officials in Denver and Washington to continue to advocate for systemic reforms that reduce the risk of medical errors and increase the probability that our patients get the right care at

If the Supreme Court takes action on the mandate/commerce clause question, its ruling may determine whether any of the insurance-related provisions linked to the mandate remain in force.

The Solicitor General, representing the

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 Genni Pearman 720-858-6308 or e-mail geneva_pearman@cms.org

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Supreme Court (cont.)

Obama administration’s position, similarly acknowledged that inextricable connection and the need for the court to address both aspects concurrently.

The obvious public policy intent of tying the mandate to vigorous and unprecedented federal oversight of health insurers was to minimize industry practices aimed at risk avoidance and in its more extreme forms, adverse selection.

Like most of the Act, the health insurance sections roll out in stages. The requirements of continued coverage of dependents through age 26 along with a new ban on lifetime limits for certain health benefits went into effect within the same year as enactment. Those were followed shortly thereafter by requirements that consumers get a rebate if their plan fails to spend at least 80% of its premium revenue on actual patient

care (the medical loss ratio section) and a federal trigger mechanism to reduce premiums if the Secretary of Health and Human Services determines the rates are excessive.

are more or less settled. “We anticipate continuing our internal discussions and policy development at our annual meeting in September,” said CMS House of Delegates Speaker Bob Yakely, MD.

Notwithstanding the strong differing opinions on the mandate, medical, health care and hospital organizations, including CMS and the AMA, have formally recognized the “everybody-in” principle, typically expressed in terms of “individual responsibility.” CMS surveys of Colorado physicians historically reflect a similar predisposition by a clear majority, along with a not insignificant plurality in dissent.

The Medicaid expansion ruling hinges on the question of whether the ACA, by providing large federal incentives only to those states that provide coverage to individuals who earn up to 133% of the federal poverty level, is unconstitutionally “coercive.” Constitutional experts seem to agree that the justices will conclude the answer to that question is “no.” As several experts have noted, multiple programs throughout history have provided federal subsidies or incentives to states for their voluntarily compliance. And, the states seeking to invalidate the ACA lost on the Medicaid issue in the lower court.

This, and other critical health care policy choices, will be methodically vetted, determined and deployed by the medical society once the legal challenges

CMS takes the pragmatic view that much work remains, no matter what the justices ultimately decide.

“Regardless of where the pieces of this rise or fall, the marketplace will continue to experiment with communitybased delivery schemes and innovations,” said CMS Past-president Michael Pramenko, MD. “The up or down vote of the Court won’t alter that dynamic or its economic imperatives. Nor will it stop the locally-based, consensus-driven work we in Colorado have been focused on for much of the recent past.” n

Looking?

Whether you’re looking for new opportunities or selling your product or service, CMS’ classified ad section is the place to be seen.

To place your ad call (720) 858-6310 12

Colorado Medicine for May/June 2012

Colorado Medicine for May/June 2012

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The Jane Nugent Cochems Trust Financial help for physicians in need Application deadline: September 1, 2012

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 Donna Jeakins at the Colorado Medical Society, 720-858-6316.

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

Register now CHA Patient Safety Leadership Congress

October 17, 2012 Grand Hyatt Hotel Denver, Colorado Featuring

Thank you to our 2012 Event Sponsors:

Don Berwick, MD Former Administrator, Centers for Medicare & Medicaid Services 14 Register now at cha.com

Colorado Medicine for May/June 2012 With additional support from the Colorado Medical Society

Features

Physicians creating a loud, clear voice in health care reform

Chet Seward, Senior Director Health Care Policy

What if there was a way to get all 11,000 Colorado physicians together and let them quickly hash out one of the toughest questions in health care? And what if it could occur at a time and place that was convenient for everyone, and in a way that ensured each doctor had an equal voice?

It sounds far-fetched. But a new project spearheaded by a Colorado physician is making that scenario possible online – and you’re invited to join the conversation. At issue: how to increase coverage for Coloradans if the U.S. Supreme Court throws out some or all of the Affordable Care Act. “I felt like one physician doesn’t have a strong voice,” said Karen Polsky, MD, who practices internal medicine at the University of Colorado Hospital and is leading the online project. “But if we got our voices together and found common ground, we could have a loud, clear voice in health care reform.”

Polsky is conducting the project as part of the Advanced Physician Leadership Program, a joint project of the Colorado Medical Society and the Regional Institute for Health and Environmental Leadership that is funded by The Colorado Trust.

Her goal is to engage physicians and to raise awareness. It’s particularly timely Colorado Medicine for May/June 2012

because the Supreme Court is expected to issue its decision this month. And, Polsky said, physicians are uniquely positioned to take the lead on these issues because polls show physicians enjoy a high level of trust among the general public.

“This is the crossroads in health care.

Colorado and Colorado physicians are going to have to address these issues,” she added. “It’s important to show patients, legislators and health care experts that physicians care, and that we should have a voice in this.”

All CMS members should have already received a customized email from CMS inviting you to participate in the online collaboration project. If you haven’t received an email, or can’t find it, please email chet_seward@cms.org with the words “join health care conversation” in the subject line.

The project uses a collaborative tool called Codigital, which was developed by a company of the same name that Polsky’s husband, James Carr, co-founded.

The tool allows large numbers of people to submit succinct ideas (users are limited to 275 characters per idea). Other users may then rank the ideas, suggest gradual edits and help evolve or improve the ideas by voting on suggested edits. The ideas are anonymous, and the system is set up to ensure every idea gets voted on –

not just those that appear toward the top of the rankings.

“This can be very dynamic,” Carr said.

“People have described it as an interactive experience similar to all being in the same room, but without the loud voices dominating. And you’re voting on the idea on its merits – without names attached to it – so there isn’t the bias you might otherwise see.”

So far, more than 100 physicians have submitted ideas for what Colorado could do to increase coverage. The ideas have ranged from reducing the number of or standardizing health plans to incentivizing physician quality and healthy behaviors, cost transparency and standardizing claims processing. There also have been different views expressed as to whether Colorado should push for an individual mandate.

“As physicians, we care. I think that’s getting lost a bit,” said Polsky, who as the former owner of urgent care clinics often saw patients who had reached a crisis point because they didn’t have insurance and hadn’t received the continuity of care they needed.

“My dream would be for us to say ‘11,000 practicing physicians in Colorado got together, and this is what we feel. We care, and this is what’s important to Colorado.” n 15

Features

Susan Liptak, Director of Marketing and Health Care Policy Communications

Transparency in physician profiling A 2010 Washington Post investigative report about the nation’s security system unearthed a surprising and alternative geography of the United States. The report spotlighted top-secret areas on maps that were previously hidden from public view. Needless to say, the government wasn’t thrilled to have the lid lifted on classified information. Let’s hope they weren’t surprised.

One group that wasn’t surprised was middle and high school students, who responded with a collective eye roll, because they already discovered the maps on websites titled “Blurred-out stuff you’re not supposed to see on Google maps.”

The days of business, government, school districts or physician practices operating in relative secrecy are over.

The credit goes to the digital age, which arrived with camera phone in hand, amped up on Wi-Fi, Facebook and 24hour Google.

Information hungry The Internet has created a transparency that’s impossible to escape. Physicians are now finding themselves publicly rated and ranked on the Web – not only by patients, but also by public and private payers. Health care in America is moving toward an information-hungry, market-driven model. Survival in this environment requires new systems of care that include performance measurement and feedback, transparency and

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public accountability, and rewards for quality outcomes.

It’s important to remember that for transparency to work in health care, it must be reciprocal. According to CMS President Brent Keeler, MD, all stakeholders, from payers to physicians to patients, must share information openly and honestly. “Ideally, this means patients should not rate or rank a doctor anonymously. Payers must be purposeful in presenting their rating methodologies in a way that can be understood and verified by all,” he says. “And physicians, understanding that it’s in the best interest of patients, should welcome public scrutiny and allow their record to speak for itself.”

Payment reform building blocks Trying to understand physician profiling is much like a dog chasing a car and wondering what to do with it when he catches it. What is clear is that these programs must be reckoned with because they’re not going away. To help physicians make sense of physician profiling and designation programs, Colorado Medical Society (CMS) consolidated, sorted, analyzed and translated 956 performance measures used in 14 different programs by Aetna, Anthem, Cigna, United HealthCare and Medicare. CMS then created a toolkit with instructions, tips and resources to help physicians like you begin to use these programs to your advantage to strength-

en your practice’s viability and to improve your care. If understanding physician profiling programs is like the dog chasing the car, then payer performance measures are the white elephants sitting in the corner of the room. Many physicians, convinced that the measures and methodologies are flawed and the reports are inaccurate, simply choose to ignore the reports. Others are unsure how to proceed so they choose to wait things out. Aurora emergency room physician Jennifer Wiler, MD, understands physicians’ concerns and frustrations, but says, “Even if the claims data is inaccurate, there is still value in the information, which physicians can put to good use. You may not recognize it now but these same measures are likely going to define how you are going to be paid in the future.”

Transparency and accountability programs are part and parcel of new payment systems. Whether it’s pay-for-performance, bundled payments or shared savings, all of the evolving alternatives to the fee-for-service framework require tracking and evaluation systems in order to demonstrate better value for the scarce health care dollar. So in effect, time spent working on transparency and profiling programs, no matter how flawed they may currently be, is an investment in not only better care delivery but also the future of your practice.

Importantly, developing and refining the performance measures to reflect the latest evidence and best practice has

Colorado Medicine for May/June 2012

Features and must continue to be a hallmark of the profession and its commitment to quality innovation.

What you can do now Dig into the data. Read the reports when they arrive and look for inconsistencies. Compare your records against the plan’s data. “It is important that physicians carve out time to examine their report and address any data that is incorrect or misleading,” said Dr. Keeler.

To file an appeal, visit http://www.cms. org/strategic-priorities/practice-viability/ insurance/ for instructions.

Measure. Once practices know how they are being evaluated, they can monitor themselves using the same parameters. According to Wiler, even if you are satisfied with your rating, it’s important to know how payers are evaluating you. And if you’re not satisfied, don’t be a victim; be proactive.

Educate patients and train staff. Share profiling results with staff and assign a project manager to create and oversee a practice-wide improvement plan around the measures. Make sure the entire team understands the ratings, knows what each person’s role is in your improvement plan strategy and can explain to the patient what, for example, one star or no stars next to your name means.

tified 38 performance measures that physicians should consider adopting to help make sense of their profiles and performance improvement strategies.

We analyzed 956 performance measures from six of the major commercial and public payers. From there, we looked for measures that were included in at least four programs and created the following set of crosscutting measures: • Chronic condition monitoring for ailments such as diabetes, coronary artery disease and low back pain • Prevention and screening including age-appropriate screening and prenatal care • Patient safety and experience for issues such as medication monitoring and falls • Resource use measures including readmissions, complications and re-do procedures By focusing on these measures first, physicians can leverage their efforts across

four different programs at once, which may help incentivize the work.

Doctor’s Unite. Begin working and collaborating with other providers and specialists in your community to help focus on core measures and drive unified system improvement activities.

Know that you are not alone. Colorado Medical Society has worked tirelessly on this issue. We helped to pass the nation’s first legislation for health plan physician profiling that set standards for transparency, fairness and accountability. We’ve been advocating on your behalf with payers and making sure physician concerns are addressed.

We’ve created education programs and other tools and resources to help you along the way.

The need for change in health care is striking – but attainable. For questions, contact me at susan_liptak@cms.org or 720-858-6305. n

EHR. Electronic health records are critical to measuring and tracking performance. These clinical data surpass the effectiveness of claims data. Make the investment now, or at least start researching products. Check out Colorado Regional Health Information Organization’s (CORHIO) list of approved EHR vendors at http://www.corhio.org/ co-rec/vendor-information.aspx. Get the help you need to achieve meaningful use by using the CMS/CORHIO Path to Meaningful Use Web portal at www. cms.org. The AMA has a wealth of resources at http://www.ama-assn.org. If you or your staff need training on a new EHR program, make it a priority to get up to speed.

Start small and use available resources. Colorado Medical Society has idenColorado Medicine for May/June 2012

17

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 May/June 2012

Features

The Rating Game Take control of your online reputation Susan Liptak, Director of Marketing and Health Care Policy Communications “Once you get in to see him, you get very good care but it’s impossible to get test results. I stopped going to him because of that.”

“Very good doctor but doesn’t talk much. After my surgery she checked on me often and called me at home after released from hospital.” ★ ★ ★ ★ “He is a kind and caring obgyn. I would recommend him to anyone having a baby!” ★ ★ ★ ★ ★ The last decade has seen an explosion of online information sharing. Visit any of the online physician or consumer rating sites today and you’ll find comments like the ones listed above, which were randomly selected from local sites Yelp. com, Vitals.com and RateMds.com.

For many years, physicians were spared from being rated online, but that is changing as the number of new rating sites grow and consumer sites add physicians to their list. For example, Angie’s List, a popular rating site for home repair type services is now promoting its new physician category. Prominently displayed on the Angie’s List website are reviews of a roofer, flooring contractor, gardener and a physician. The reviews cycle continuously on the site’s home page.

Back in 2001 statements like “trust your physician, not a chat room” epitomized many physicians’ concerns about the effects that the Internet would have on their patients health and the physician-patient relationship. Fast forward to 2012 and we find Americans are not only going online for health information, but also are visiting community networking sites where they find support, swap stories, and share knowledge and opinions.

Colorado Medicine for May/June 2012

The “sharing” piece is proving to be problematic for physicians and is the reason reputation management is necessary.

The social patient People love social media because they can instantly share their life, as well as ideas, opinions, advice, ratings, reviews and knowledge. The new wordof-mouth is peer reviews, social media posts and blogs, which have collectively become a trusted source of information for consumers. Seventy percent of Internet users say they trust online consumer opinions. It is becoming increasingly important for physicians to understand how patients use social media.

Examples of how patients might participate in social media: • Rating a physician on a rating site like Healthgrades.com, Vitals.com, RateMD.com or Ucomparehealth.com • Recommending a physician (or not) on a local review sites like Yelp or Angie’s List • Writing about a health issue on their Facebook wall • Sending a request on Twitter for physician recommendations When a patient rates, reviews or chats about a physician online, it has the po-

tential to be seen by millions of people.

If the comments are negative or if the ratings are low, it could impact a physician’s practice and damage their reputation.

Look at the data For more than 10 years, the Pew Research Center has been reporting how Americans use the Internet for health purposes. (www.PewInternet.org). Their most recent findings are: • Eighty percent of all adults in the U.S. use the Internet.

• In Colorado, approximately 3.6 million adults use the Internet at home, which doesn’t include people using the Internet at work and on mobile devices.

• Searching online for health information ranked third for Internet activities and was more popular than news and shopping.

• Of the total adult Internet users, 80% were specifically searching for health information.

• Forty-seven percent of those health information seekers were researching physicians or health care professionals.

• Caregivers, women and parents with children living at home lead all other groups for online physician searches.

Putting rating sites in their place Physician ratings sites were modeled after a commercial approach that measures performance based on customer satisfaction. The problem with physician rating sites is that, unlike commercial sites, they don’t have enough reviews to provide reliable results. The

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Rating Game (cont.) majority of the physicians who are rated have received just two or three ratings on the site over the span of two or three years. With numbers that low, all it takes is one really low or really high score to dramatically change the rating.

Basically, for ratings sites to provide reliable ratings, they need to have the number of reviews that you see for hotels or online stores like Overstock or Amazon.

Another problem with rating sites is they don’t share their proprietary rat-

ing algorithms. They also lack transparency. Patients are allowed to post anonymously and without proof that they were actual patients or that the complaint is real and truthful.

Five easy ways to manage your online reputation 1. Assess your reputation. To manage your online reputation you must know what already exists about you on the Internet. To find out, enter your name in a search engine such as Google, Bing or

Safari. Try out different search queries that you think patients might use and take advantage of the browser’s suggestions. Search your practice name, the names of your partners, physician assistants and key staff members and then visit each website that appears on page one and two of the search results.

2. Set up automatic monitoring with Google Alerts. A simple, automatic and free way to monitor the Internet is with Google Alerts. You enter key search words, such as your name, practice name, etc., and Google Alerts will comb the Internet and email you when they find a match. To sign up for Google Alerts go to http://www.google.com/ alerts. It’s important to know about comments as soon as they appear so that you can address the situation right away. If too much time passes, the physician may not remember the patient or the incident and patients won’t be able to access their account because of old email addresses or forgotten passwords.

3. Control the search results. Control your reputation. Reputation management is all about competing for search result space. To perform better in search engines, update and add content to your website regularly. Facebook is search engine gold; create a Facebook page (not profile) for your practice, as well as a LinkedIn profile for yourself.

Make sure that your listing in membership websites such as medical societies or directory sites such as Yellow Pages is complete, current and packed with information. Ask your website developer to make sure your site is optimized for search engine requirements.

4. Your Website. A physician’s proprietary website is the most powerful tool in reputation management. It’s one of the few places on the Internet that physicians have total control over the content and message. It’s also the first point of contact for a prospective patient, as well as a continuing source of information for current patients.

5. Make sure your website is optimized for search. For a website to compete against rating sites, it helps to know

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Colorado Medicine for May/June 2012

Features what search engines like, which includes: • New content that has been added to a site • Updated and refresh Web pages • Links to social media sites, such as a Facebook page (not a profile) • Video • News, news, news

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 Genni Pearman 720-858-6308 or e-mail geneva_pearman@cms.org

How to handle negative reviews The best way to deal with negative comments is to avoid getting them in the first place.

1.

Take it offline. Never respond in writing on a rating website or in email. Not only because of patient privacy, but also because it will give the Web page “legs.” Adding comments will cause the Web page to be ranked higher in search results. Contact the patient by phone, work to resolve the conflict, and then ask them to remove the negative comment.

2. Understand that sometimes it’s better to do nothing. Depending on who made the comment, what was written and how old the comment is, it may be best to ignore the comment and do nothing. Responding online is like adding fuel to the search engine fire and will cause the Web page to rank even higher in search results 3. Create a customer service policy.

Instituting customer service policies and training staff can avoid negative comments and ratings. Don’t ignore patients who appear to be unhappy or dissatisfied. Deal with any issues or misunderstandings before they leave. Develop protocols that address common patient complaints, such as being left on hold, not being able to reach a doctor or nurse, phone calls not returned, and so forth.

4. Remove posts. It is very difficult to get the publisher of the site to remove negative content. They are legally protected because they are considered third party content publishers (they don’t own or create original content).

For serious issues, seek professional legal help. n

Colorado Medicine for May/June 2012

21

Features

2012 Spring Conference:

Relationships Matter How making the most of our relationships can help physicians advocate for their patients and their profession Susan Burke, CMS contributor roll, Ross and several other speakers during this year’s Colorado Medical Society Spring Conference, held last month at the Sonnenalp Resort in Vail.

Titled “Lead, Follow or Wander,” the conference reinforced the need for physicians to build relationships and engage in advocacy and gave them the expert advice to CMS President-elect Jan Kief, MD, opens the Spring Condo so. It’s a call that ference by emphasizing the need to cultivate relationships is particularly urgent with patients, peers and communities. as Colorado and the country see changes due to the federal For award-winning journalist and auAffordable Care Act, state laws, private thor Michael Weisskopf, good relationpayer policies and new patient demoships meant becoming the first jourgraphics.

(See page 11 for more on the nalist wounded in war to be treated at ACA and the pending U.S. Supreme Walter Reed National Military Medical Court decision, and the following pages Center. for other updates).

For Cory Carroll, MD, they meant getting the time to sit quietly with a state “It all starts with you because, perhaps legislator and have a thoughtful discus- now more than ever, it is a time for physician engagement and level-headed sion about important issues. leadership in Colorado health care,” And for Dave Ross, MD, they provide CMS President-elect Jan Kief, MD, told the chance to make a difference – to the audience. “We are all in this togethshape the future of medicine and create er and it’s important to recognize that a health care system that works better despite the unknown of the Supreme Court’s impending ruling on the health for patients. care reform law and the discomfort that Whether forged with soldiers in Iraq, health reform is likely causing in many a candidate for elected office or a key of your practices these days, there is no Colorado legislator, relationships mat- better time than now to recommit, stay ter. That was the message that surfaced engaged and learn as much as you can time and again from Weisskopf, Car- so that we can stay unified and make 22

good choices in this new reality.”

The 2012 election cycle provides the perfect opening for doctors to get involved. Colorado is a key swing state in the presidential race, and there are 33 open seats in the next Colorado legislature due to the redistricting process, as well as term limits and attrition. The timing provides a once-in-a-decade opportunity for physicians to exert their influence and support candidates who champion the advancement of health care and patient safety.

View from the trenches Weisskopf, a veteran journalist for Time magazine, led the panel discussion on the value of relationships.

Weisskopf was covering the war in Iraq for Time in 2003 when a grenade dropped in front of him in the Humvee he was riding in along with a Time photographer and four soldiers. Weisskopf picked up the grenade and threw it out, saving himself and the others in the Humvee but losing his right hand. A medic from another Humvee came to his aid, applying a life-saving tourniquet. Back in the United States, colleagues and friends reached out to contacts at the Pentagon, a U.S. senator and, eventually, the Secretary of the Army, to get Weisskopf admitted to Walter Reed.

“It’s called teamwork in the Army, but it’s professional relationships,” said Weisskopf, who later wrote the book Blood Brothers about his coverage of the Iraq war and his recovery alongside fellow amputees at Walter Reed.

Colorado Medicine for May/June 2012

Features CMS President Brent Keeler, MD, offered to sit down and discuss health care issues with a patient who was interested in running for the state legislature – creating a mutually beneficial relationship that allowed both of them to leverage their talents and interests to be politically effective. Stephen Sherick, MD, meanwhile, began his From left, Bill Lindsay, Julie Hoerner-Mowry, JD, Ed involvement in politics by Dauer, JD, Mark Wallace, MD and Kim Ross discuss attending local meetings. the future of health care reform.

He then got nominated to “Iraq was defining and searing as any- committees. Now, Sherick has gotten thing I’ve ever experienced. It taught to know pivotal contacts and has access me resourcefulness and relationships, to elected officials. and not the relationships you would expect.”

Ross, the chairman of the Colorado Medical Political Action Committee, Carroll’s experience was more local or COMPAC, told the audience poli– inside his own home, actually. Car- tics doesn’t have to be intimidating. It roll, a former Larimer County Medical starts small, by supporting the people Society president, first got involved in who have supported you, he said. politics because he wanted to make sure a physician’s voice was at the table. “I’m interested in politics because it’s Colorado Medical Society helped Car- about taking care of the patient and roll put on a fundraiser for a candidate what is best for them and the future of at his home – an event that was very well received, he said.

medicine,” Ross said. “It’s our responsibility and our legacy to leave the world a little better. I’m worried about the future of health care. We have a chance to make a difference. Our challenge is to reach out to those who aren’t involved and get them involved.”

How to “do it right” Joe Gagen, who has been involved professionally in political and legislative matters for more than 30 years and does advocacy training around the country, echoed those sentiments.

Joe Gagen provides expert advocacy tips for physicians.

“Having physicians and legislators in my home provided the quiet setting for getting the chance to discuss the issues in depth,” Carroll said.

The relationships he has established over the years have lead to respectful friendships and sharing of perspectives on local issues, Carroll added. He encouraged other doctors to get to know their local candidates and hold an event of their own.

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From left, Tom Curry, Brent Mulgrew and Gordon Smith discuss efforts to connect with physicians in other states.

Colorado Medicine for May/June 2012

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Spring Conference (cont.)

CIVHC CEO Phil Kalin explains details of the All Payer Claims Database.

Gagen kicked off a training session with the well-known Tip O’Neill quote: “All politics is local.” And physicians, Gagen added, have a unique opportunity to exert their professional position in the local community to both persuade and influence.

But there is a right way and a wrong way, Gagen said. Among his many suggestions on how to “do it right” were: • Support your local lawmaker early and often in his or her career. If you are a friendly face when the candidate is running for office for the first time, that legislator is unlikely to

ever forget you. Also, keep in mind that relationship building is a yearround effort. It doesn’t start when the legislative session does, and it doesn’t end when the session is over.

• Don’t underestimate your influence.

In 2005, the Congressional Management Foundation asked Congressional staffers: “If your member/senator has not already arrived at a firm decision on an issue, how much influence might the following advocacy strategies directed to the Washington office have on his/her decision?”

In-person visits from constituents scored highest, with 60 percent of staffers saying those visits had “a lot of influence.” Only 15 percent said the same thing about visits from lobbyists.

• Remember that lawmakers are incredibly busy. During a recent legislative session, one state senator’s office reported 1,300 phone calls, 600 visitors, 1,800 letters, 6,000 emails and 300 invitations, Gagen said. This makes it even more important that when you have your legislator’s ear, you use the time wisely: Be prompt and keep your message simple.

• Tell stories. Gagen called this “the

Joe Gagen leads a breakout sesssion with medical students. most important rule of all.” Whether you’re testifying before a legislative committee or sitting in a lawmaker’s office, share your personal experiences or the experiences of a patient.

You may view the full slides from Gagen’s presentation, as well as other presentations from the Spring Conference, at www.cms.org.

If you are interested in getting involved politically, Colorado Medical Society has tools and resources to help. Contact Chris Lines, CMS director of political education and advocacy at Chris_ Lines@cms.org or 720-858-6315. n

A Former Legislator’s 10 “Ps” to Effective Advocacy Be professional: The Capitol is a building of dignity. Business attire is expected.

Be prompt: Seconds are valuable. Scheduling may be so tight that you only have a few minutes. Some Senators schedule their office visits before 6 a.m. because that is the only available time in the day.

Be persuasive: Do your homework and confidently state your case. Your may be the only one in the state who knows what you do.

Be patient: Good legislation takes a long time - that’s how unintended consequences are avoided.

Be positive: Your legislator wants to solve problems. Offer positive suggestions. Whining is not becoming.

Be polite: Courtesy implies respect.

Be our partners: Partners are vested in the outcome and share the responsibility. You are the best resource for your legislator.

Be personal: Invest time in developing a personal relationship with your legislator. Everyone wants to help their friends.

Be passionate: Be sure it’s a critical issue – one about which you are passionate - before you ask your legislator to “go to battle” for you. Your enthusiasm will be contagious.

Be precise: Ultimately, the legislator wants to know how he can help you. Make your requests as specific as possible.

- From Joe Gagen’s Spring Conference presentation, titled “The Rules and Realities of Physician Engagement”

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Colorado Medicine for May/June 2012

Features

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 Genni Pearman 720-858-6308 or e-mail

geneva_pearman@cms.org

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In March 1997, Colorado Medical Society established the Colorado Medical Society Foundation (CMSF) as a 501(c) 3 organization. The foundation’s mission is to administer and financially manage programs that seek to improve access to health care and health services, with the potential to improve the health of Coloradans. The Board of Trustees of CMSF is committed to the success of these programs and excited about the possibilities they present for improving health care services in Colorado. The spirit of Colorado is alive in the many ways that we help our neighbors.

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

Colorado Medicine for May/June 2012

Features

Physician wellness

Diversifying your portfolio Susan Burke, CMS contributor

tions across the nation to incorporate physician wellness into its strategic priorities and dedicate resources to establishing an expert panel on wellness.

Doris Gunderson, MD, emphasizes the need for physician work-life balance.

Colorado Medical Society has convened a panel of experts in physician health to better understand the concerns and needs of Colorado physicians, explore quality of life enrichment programs and innovate new ideas to help physicians.

The CMS Expert Panel on Wellness is the latest in the organization’s ongoing efforts to ensure physicians thrive personally and professionally throughout their careers – one of five strategic goals approved by the Board of Directors last year.

“Now more than ever, it is critical that we develop a pathway for physicians to integrate new healthy practices to achieve a work-life balance,” said CMS President F. Brent Keeler, MD. “Fortunately we are supported by an organization that places real importance on our professional and personal success—so much so that it is one of the pillars of strength in the CMS strategic plan.”

CMS is one of the few medical associa-

Colorado Medicine for May/June 2012

The organization was inspired to do this when a member survey revealed the majority of physicians felt they are generally unable to have work-life balance and time for their “life outside of work.” Only half of respondents were satisfied they were able to live a healthy lifestyle with sufficient exercise and healthy diet; fewer were satisfied they were able to find time to relax with yoga, reading or other activities.

“The wellness panel is not only unique but given our survey data, it is also long overdue,” said CMS CEO Alfred Gilchrist. “Developing a wellness program is new to state medical associations and is breaking from the traditional lines of business that have been around for more than 30 years.”

Panel Chair Doris Gundersen, MD, a psychiatrist in private practice who is also the medical director for the Colorado Physician Health Program, also noted a recent AMA survey that found

Expert panel on wellness members Doris C. Gundersen, MD (Psychiatry) Chair, Expert Panel on Wellness Medical Director, Colorado Physician Health Program Private Practice James Duke, MD (Anesthesiology) President Elect of the Medical Staff at Denver Health Denver Health Mark A. Fogg, JD, COPIC General Counsel Jeanette Guerrasio, MD (Internal Medicine) IM Residency, Assistant Director for Physical Exam University of Colorado School of Medicine

Gerard Guillory, MD (Internal Medicine) The Care Group, PC Ruby L. Kadota, MD (Pediatrics) Kaiser Permanente Brent Keeler, MD (OB/GYN) CMS President Private Practice Dianne McCallister, MD, MBA Chief Medical Officer Porter Adventist Hospital Debra J. Parsons, MD, FACP (Internal Medicine/Geriatrics) Post-acute and LTC Medical Director RICCO—East Metro

27

Wellness (cont.) nine out of 10 physicians reported significant stress. Two-thirds of those physicians described their stress as having increased “moderately to dramatically” over the past three years. And the rate of physician suicide is two to four times that of the general population, Gunderson said.

“Reports like these have inspired me to be more involved in the physician community and find ways to implement primary prevention strategies,” she added.

Model program Recently, panel members spent time learning about a wellness program at Porter Adventist Hospital.

Wellness programs that are specific to physicians aren’t prevalent in health care communities, noted Doug Wysockey-Johnson, executive director of Lumunos, a professional facilitation organization that worked with Porter administrators to create the program.

“There are a lot of people out there talking about wellness programs, but not a lot of action is being taken,” he said.

Porter Hospital created its program, Porter Colleagues, after CEO Randy Haffner and CMO Dianne McCallister, MD, started noticing their colleagues were burning out and frustrated. Some were advising their children to go into other professions.

“My heart was breaking for my colleagues,” McAllister said. “The collegiality formed by physicians sharing their thoughts and frustrations in the safe environment of the physician lounge had gone away and there hasn’t been a mechanism to replace it.”

More than 100 physicians participate in the program at some time during the year, and enjoy peer-to-peer camaraderie in social-oriented activities ranging from dinners at the CMO’s house to recreational outings and more formal

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monthly 30-minute meetings, weekly reflection emails and an annual retreat.

Program topics range from life outside of work to grief and loss, patient stories, ethical dilemmas and whatever else may be on physicians’ minds. The variety of programming approaches aims to include more physicians and fulfill the program’s purpose of reconnecting physicians with their vocation, encouraging balance in their lives, and helping doctors to align with the hospital’s strategic efforts.

“It’s about getting to know and supporting one other,” McCallister explained. “It’s not therapy; it’s physicians listening to other physicians. We don’t try to fix anything, the physicians simply listen to one another—and with the same confidentiality that a caring friend would give.”

Physician reaction David Baer, MD, medical director of surgical services at Porter Hospital, described the program as “comforting” and “stress-relieving,” and said it has helped him no longer feel isolated.

“Prior to this program, I never really got the opportunity to get to know (my colleagues) personally,” Baer said. “It has created friendships I wouldn’t normally have and it makes me feel that I am not isolated dealing with issues I’m dealing with because they are dealing with the same types of issues.”

Debra Parsons, MD, a member of CMS’ expert panel, said many physicians don’t realize how out of sync their life balance is. The panel is looking at Porter Colleagues as an example of a program that could be replicated elsewhere.

“It may well be that such regular gatherings (like Porter Colleagues) can help restore the balance by offering a safe forum for physicians to gather, express their thoughts and share stories all the while keeping in mind what drew them to a career in medicine in the first place,” Parson said. n

Colorado Medicine for May/June 2012

Features

New patient relationships The progress and probabilities of the roll out of the Colorado Insurance Exchange The Colorado Health Benefit Exchange will be open for business in October 2013, CHBE Board Chair Gretchen Hammer and Executive Director Patty Fontneau told physicians at last month’s CMS Spring Conference.

The CHBE – an online health plan marketplace – is an evolving program with a mission to increase access, affordability and choices for individuals and small employers purchasing health insurance in Colorado.

While the exchange was created from legislation passed in 2011, it is not a new government health care system. Rather, it is a new gateway to insurance provid-

Susan Burke, CMS contributor

ers that will focus on the unique needs of the state and provide Colorado-specific solutions. It will be supported by a call center and a team of navigators who will be located across Colorado to help businesses and individuals understand their options and find a health plan. In some cases, financial assistance will be available to help with the cost of premiums.

services and devices, laboratory services, preventive and wellness care/chronic disease management, and pediatric services including oral and vision care.

All plans sold inside and outside the exchange in 2014 must provide at least the following 10 categories of services: ambulatory patient services, emergency services, hospitalization, maternity/ newborn care, mental health/substance abuse, prescription drugs, rehabilitative

For more information visit www.getcoveredco.org n

Because the exchange was created from Colorado legislation, it will move forward regardless of what the U.S. Supreme Court decides in regard to the Affordable Care Act.

2016 coverage estimates Total currently insured population (through employersponsored insurance, individual market, public programs)

3.5 to 3.6 million

Total population predicted to be insured in 2016

4.1 million

Total currently uninsured Coloradans predicted to be insured in 2016

510,000

Total currently uninsured Coloradans predicted to obtain employer-sponsored insurance

160,000

Total Currently uninsured Coloradans predicted to gain insurance through individual market inside and outside the Exchange

220,000

Total currently uninsured Coloradans predicted to obtain Medicaid or other public insurance

130,000

Sources: Jonathan Gruber report published January 2012 (http://www.getcoveredco.org/Get-Involved/Workgroups/Data-Advisory-Work-Group), Colorado Health Institute

Colorado Medicine for May/June 2012

29

Features

CMS collaborates on mainentance of licensure pilot projects Colorado Medical Board

JoAnne Wojak, Director, Continuing Medical Education In March 2011 the Colorado Medical Society Board of Directors recommended that CMS work collaboratively with the Colorado Medical Board (CMB) and the Department of Regulatory Agencies (DORA) on maintenance of licensure requirements for Colorado physicians.

This collaboration includes an opportunity for CMS to participate in a Federation of State Medical Boards (FSMB) national pilot project for physician maintenance of licensure (MOL) along with 10 other states that have also volunteered. The FSMB, with input from dozens of stakeholder organizations over many years, developed and adopted the “Framework for MOL,” which is the foundation for the MOL pilot projects and the future re-licensure requirements for Colorado physicians.

CMS took the initiative on demonstrating professional accountability back in 2010 when its committee on patient safety and professional accountability, whose lofty goal is to make Colorado the safest state in the country for patients, determined “patient safety begins with physician licensure” and “part of making Colorado the safest state for patients is demonstrating physicians’ own commitment to continuous improvement and high professional standards.”

A special committee was then formed to research and make recommendations for a continued competency program for physicians in Colorado.

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MOL framework Discovering that a national MOL effort by the FSMB was underway, the subcommittee, chaired by Christine Lamoureux, MD at the time, studied the FSMB framework and determined that while there were challenges, the framework represented a continuous learning and improvement cycle that incorporates self-assessments, CME and practice improvement activities — a model that experts say

is s effective for lifelong learning in medicine. And, given the established guiding principles associated with the MOL framework, it will enable physicians to successfully participate without being overly burdened.

For example, physicians who are board certified and participate in their Maintenance of Certification or Osteopathic Continuous Certification (OCC) most likely will not have to do anything else for MOL due to the very rigorous board certification requirements. That includes the majority of physicians in Colorado.

Additionally, a Colorado MOL program would not require a high-stakes examination to assess a physician’s knowledge and skills. Other types of activities could be used for this, such as hospital procedural privileging or computer-based case simulations, which might produce information about knowledge and skills gaps and guide a physician toward appropriate learning activities. The national health care movement toward quality improvement is already requiring physicians to engage in various performance improvement activities that involve looking at their own data. These types of activities can also be used toward MOL requirements.

Other options the MOL subcommittee proposed included taking a wait-andsee approach and responding to future requirements that may be proposed by the Colorado Medical Board/FSMB, or introduce our own state-specific MOL proposal and timeframe including a legislative bill in 2012 or 2013. The CMS board made the right decision to work in collaboration with the CMS and Colorado Medicine for May/June 2012

Features DORA. It will strengthen the chances of a bill being passed and ensure CMS involvement in the process. Marschall Smith, program director with DORA and who works closely with the medical board, has acknowledged that “Colorado Medical Society is a full partner in this collaboration, and they will have an equal vote.”

MOL pilot studies The purpose of the FSMB pilot studies is to help prepare state medical boards and physicians for successful participation in MOL. The pilot studies will help us to understand the magnitude of MOL by looking at state board readiness, resources, current renewal systems and physician practices. A careful and methodical approach using focus groups, surveys and other activities will help us to identify and address any major issues or obstacles that would prevent MOL implementation. Some pilots will test new tools that physicians could choose to use for MOL. One of the important goals is to ensure

Colorado Medicine for May/June 2012

that there are many choices of affordable tools and activities available in order for all physicians to meet requirements.

According to the FSMB, the first phase of the pilots will begin this summer and will continue through 2013. CMS will be involved in some of the pilot studies and may ask select physician members to participate. An exact date for a MOL legislative bill has not yet been determined, but once MOL is launched we expect to phase in the requirements over five to eight years.

If you are a CMS physician member and are interested in joining the subcommittee on MOL please contact 720-8586309.

“Maintenance of licensure begins with honoring and helping to sustain an individual physician’s life-long commitment to patient safety and wellbeing” – Colorado Medical Society Subcommittee on Maintenance of Licensure. n

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

31

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

Molly Fisher Molly Fisher is a fourth year medical student at The University of Colorado.

She grew up in Pittsburgh, Pennsylvania and studied the biological basis of behavior at The University of Pennsylvania. She is interested in working with under-served populations and helping to improve access to care. She loves spending time in the mountains with her husband Mike, going on long runs, and cooking delicious meals.

Doctors don’t cry

It was a moment that I had dreaded. I had spent a lot of time thinking about the death of my first patient and hoping that it would never come. I was terrified of how I would deal with it, or even worse, not deal with it. I was scared that I would lose control in front of the family. I was scared that the team would look down on me. I thought that my strong emotions were a weakness that had to be conquered. Doctors don’t cry. They provide support for others.

Ms. B was a pleasant 84-year-old grandmother with metastatic lung cancer,who was hospitalized because of pain in her right hip. Since I was the medical student

32

on her primary team, Ms. B and I had plenty of time to get to know each other. I would stop by in the afternoons to spend time with her family, listen to her stories and laugh at her jokes. I learned about her caring relationship with her daughter, her persistent faith, her love for her 11-month-old great-grandson and her desire to attend her granddaughter’s wedding - only one month away. We had several conversations about death and what it meant to her. I was surprised by how comfortable she was with it; however I was not comfortable at all. I wanted her to get better and have more time with her family. My grandfather died shortly before my wedding, and it brought back my own feelings of sadness and loss. I did not want the same thing for her or her granddaughter. Every time we discussed her death, I would tear up, turn my head, and try my hardest not to let her see me cry. Doctors don’t cry. They have to be strong for others.

On hospital day three her MRI showed that 80 percent of her femur was tumor that had metastasized from her lung. She decided to have an operation to stabilize it so that she would be able to walk down the aisle at the wedding. During the procedure, her pain was not well controlled, and the doctors were forced to convert from spinal to general anesthesia. The surgery was successful, but the anesthesiologist was unable to extubate her, and she was transferred to the surgical intensive care unit (SICU).

I came to the hospital the next morning to find her in the SICU, intubated and distraught. She was frustrated by the ventilator, coughing, but completely cognizant of what was going on around her. I was angry and upset. How had her story changed so quickly? It wasn’t supposed to be like this. Why did it seem like things were spiraling out of control and there was nothing that I could do?

My team discussed Ms. B’s options with her and her family. She had made her decision. She wrote a note saying that she wanted the ventilator to be removed, and she did not want it to be replaced if she was unable to breathe on her own. Her ventilator settings were relatively low and we hoped that she might be able to be successfully extubated.

The attending physician was incredible.

He prepared our team, the family, and the patient for what was to come. He explained to me that it was okay to be sad.

I felt that he had given me permission to feel like a human being. Around noon, Ms. B was ready. She chose the song that she wanted to hear on her iPod, wrote a few last-minute notes to her family, and was holding a prayer shawl that had been made by her prayer group. As I stood there watching the scene play out before me, I became incredibly overwhelmed and had to excuse myself. I found a private corner of the ICU, lost control, and cried. I was so disappointed with myself for losing my composure. I told myself to “get it togeth-

Colorado Medicine for May/June 2012

Inside CMS er.” She was not my grandmother, and that was not my role. Doctors don’t cry.

They have to comfort others.

I took a deep breath and returned to the room. It was silent. Ms. B lay at the center, surrounded by her four children, several of her grandchildren and greatgrandchildren, her minister, our medicine team, the palliative care team, the hospital chaplain, and the respiratory therapist. Once the ventilator was removed, we all just stood around watching and waiting. We were waiting to see if she would breathe on her own. At first it was unclear. She cleared her throat and started to speak. She said that she was tired and ready to go to sleep. I watched her daughter become concerned. I watched her call her grandson over to tell him that she loved him. I watched the 13-year-old cry as he realized that he was saying goodbye. I watched the palliative care doctors exchange looks when they realized that they would need the morphine and atropine drops. I watched family members take turns saying their goodbyes. I watched her breathing become irregular.

I watched my own eyes fill up with tears, and I watched Ms. B die.

I was not prepared for what had just happened. I don’t know that I ever could have been. I thought that death was the evil beast that we must always try to defeat. We had to stare it in the face, and do everything possible to win the fight. Ms. B taught me another lesson. Her death was peaceful. She had accepted that her time had come, was surrounded by people who loved her, and did not suffer. It was sad to see her family mourn, but it was not sad for Ms. B. She truly was at rest.

After Ms. B died, and the commotion in the room had settled down, Ms. B’s daughter turned to our team and smiled.

She had just lost her mother, and was clearly overwhelmed by emotion. She stood up out of her chair, came over to our team and thanked us for deeply caring for her mother. She said that the emotion that we expressed that day meant so much to her and her family. She said that doctors were allowed to cry, and that it showed their care and support for others.

Witnessing Ms. B’s death taught me some very important lessons. First of all it really is OK to cry - families may even appreciate it. Medicine is a self-selecting field,

and it generally attracts empathetic individuals. It is essential that we as students do not lose that empathy, and constantly remind ourselves why we chose this path.

Additionally, death is not always a bad thing, and can be viewed as the final stage of life. I had a patient who was about to go to hospice tell me that doctors need to stop seeing the death of a patient as a defeat. Death is an inevitable part of life, and we as health care providers can’t see that outcome as a failure. When a patient does die, we need to find a healthy and sufficient way to process it. It is a very big deal to watch a person die, and it is not something that should be minimized or ignored. As medical students and doctors we have other patients on our service who still need treatment and attention.

Therefore, once the patient has died, we need to walk to the next room and see another patient. But before we move on, we must feel, we must reflect, and sometimes, we must cry.

I would like to acknowledge Ethan Cumbler MD, Adam Trosterman MD, Lilia Cervantes MD, and Steven Lowenstein MD, MPH for their help in creating and editing this reflective piece. n

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Colorado Medicine for May/June 2012

33

Inside CMS

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

COPIC expands its team of physician leaders to improve medicine From its inception, COPIC realized the importance of physician involvement in guiding our efforts to improve medicine in the communities we serve. We have been fortunate to have some of the top physician leaders in Colorado serve on our Board to lend their insight and expertise to help shape our vision over the years. And this collaboration continues to grow stronger with our expanded team of faculty consultants who are working with COPIC in 2012.

These faculty consultants come from a wide range of medical backgrounds and represent different geographic locations, practice sizes] and years of experience. The diversity in the group brings together a collective knowledge that supports our efforts to serve the Colorado medical community as we face today’s health care challenges.

COPIC’s faculty consultants are focused on partnering with us in three major areas: claims review, underwriting and public policy.

An enhanced review process with the right people at the table.

When COPIC-insured physicians face a claim, we want to make sure we have the appropriate medical experts available to review the standard of care. We can match the experts’ knowledge with the specific situation under review courtesy of our expanded group of faculty consultants who are recognized for being at the top of their specialties. From emergency medicine to radiology to orthopaedic surgery, these individuals use their direct experience to work with our claims committee so we can make the best analysis of the care provided.

Solid underwriting that results in fair premiums.

The COPIC underwriting department draws upon insight from our faculty consultants to discuss the factors that go into creating a premium rate based on specialty. Consultants also step in to help with the appeals process. In addition, they help us evaluate new specialty-specific trends or procedures. All of these efforts help us to ensure that premiums are fair and equitable – a process that is a constant challenge, but one that is continuously refined with valuable input from these outside peers.

Public policy efforts supported by health care leaders.

The recent legislative challenge on professional review re-

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minded us of an important lesson: strong voices from leaders in the medical community make a difference. Along with the collective efforts of the Colorado Medical Society, Colorado Hospital Association, COPIC and other health care provider organizations, physician leaders stood firmly beside our coalition. Our faculty consultants serve as an influential group to increase awareness on the issues that matter to our insureds and impact the delivery of health care. Through this grassroots network we can continue to support an environment that allows physicians and health care professionals to focus on what matters most: better medicine, better care and better results.

COPIC is proud to announce the following physicians as part of our faculty consultant team for 2012: • • • • • • • • • • • • • • • • • • • •

Carolyn Abman, MD – OB/Gynecology, Littleton Donald Crino, MD – Anesthesiology, Englewood Stephen George, MD – Radiology, Lakewood Patricia Gill, MD – Infectious Diseases, Longmont Michael Holt, MD – Radiology, Grand Junction Davis Hurley, MD – Orthopaedic Surgery, Denver Angela King, MD – OB/Gynecology, Fort Collins Jennifer Kollman, MD – Anesthesiology, Colorado Springs Peter Koplyay, MD – Radiology, Fort Collins Susan Larson, MD – Pediatrics, Boulder Carla Murphy, DO/FACEP – Emergency Medicine, Wheat Ridge Joan Neighbor, MD – Family Practice, Centennial Michael Otte, MD – Musculoskeletal Imaging, Englewood Dennis Schneider, MD – Internal Medicine, Colorado Springs Susan Sgambati, MD – Colon/Rectal Surgery, Denver James Sprowell, MD – Family Practice, Fort Collins Alan Synn, MD – Vascular Surgery, Denver Farrel Van Wagenen, MD – Radiology, Colorado Springs Bruce Waring, MD – General Surgery, Golden Eric Zacharias, MD – Internal Medicine, Boulder

This group represents some of the top leaders practicing medicine in Colorado today, and we look forward to working with them to continue to improve medicine in the communities we serve. n

Colorado Medicine for May/June 2012

Colorado Medicine for May/June 2012

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Inside CMS

Register Now 2012 CMS Annual Meeting Keystone Resort and Conference Center September 6-9, 2012

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Colorado Medicine for May/June 2012

Inside CMS

2012 Annual Meeting

Accommodations Reservation Form Keystone Resort (September 6-9, 2012)

ACCOMMODATIONS: Please indicate your first (1), second (2) and third (3) choices:

(please use this form for one room only)

OCCUPANCY ROOM TYPE ROOM RATE CHOICE MAXIMUM Keystone Lodge & Spa $150 4 people $120 2 people Conference Village Studio Condo Conference Village One Bedroom Condo $150 4 people Conference Village Two Bedroom Condo $210 6 people The above rates do not include 12.02% tax. Check-in time is 4:00 PM and check-out time is 11:00 AM. Children under 18 stay for free in parent’s room with existing bedding. Extra adult charge is $20 per night.

Rollaway charge is $25 per night. No pets allowed. Per room/per night resort fee at Keystone Lodge and Spa $20, Inn at Keystone Resort $10 NOTE: RESERVATIONS MUST BE RECEIVED BY MONDAY AUGUST 6, 2012 TO BE GUARANTEED SPECIAL COLORADO MEDICAL SOCIETY RATES. REGISTRATION INFORMATION Arrival Date_______________________ Departure Date________________________ Name(s) _________________________________________________________________________ Address__________________________________________________________________________ City_____________________________ State_________ Zip______________ Phone_____________________ Any Special Needs/Requests?___________________________________________________________________ E-mail Address:____________________________________ DEPOSIT AND CANCELLATION INFORMATION

If using individual request forms, a deposit in the form of a credit card equal to one night’s lodging is due together with the room request form. Reservations made by telephone require one night’s deposit in the form of a credit card when the reservation is made. If a reservation is made within 30 days of arrival, full payment is due at such time. After a deposit is received, a confirmation will be sent. Keystone will offer transportation packages to attendees making individual reservations.

Individual cancellations within 30 days of arrival are subject to forfeiture of full deposit amount. Individual cancellations outside of 30 days of arrival will result in return of deposit less a $30.00 processing fee. No shows, late arrivals and early departures will be charged the room rate for the entire reserved stay.

Card Type___________________ Card #____________________________________ Expiration___________ Name of Cardholder__________________________________________________________________________ I authorize Keystone Resort to charge my credit card for the deposit for accommodations listed above. ________________________________________________________

________________________________

Signature

Date

Reservations Phone 800-258-0437 Must refer to group code CK2MED FAX: 970-496-4343 Colorado Medicine for May/June 2012

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Inside CMS

Annual Meeting Registration

Annual Meeting of the Colorado Medical Society/Connection Keystone Resort & Conference Center • September 6-9, 2012

Name (please print) ______________________________________________________________________________ Component Society____________________________________________________________________________ Name of Spouse/Guest(s)___________________________________________ CMS Connection Member q Yes q No q My physician spouse will not attend, please send handbook to my attention

If you are not a member of CMS, please provide the following information and $125 for registration fees:

Company/Organization _________________________________________ Title _________________________ Registration deadline is August 23, 2012. Registrations accepted on a first-come, first-served basis (may be limited for some

programs). For purposes of registration, Connection members and staff of county medical societies are considered members. You must indicate the number of attendees for each function so that we may be cost efficient with food/beverage orders.

Complimentary Events for CMS or Connection Member & Spouse/Guest Except for the COMPAC Luncheon, you and one guest are entitled to attend all events at no charge.

To confirm your reservation, use the boxes below for yourself and one guest and the shaded area for additional guests.

Thursday, September 6 member spouse/guest 7:30 pm

Welcome Reception

q

q

Friday, September 7

member spouse/guest

12:00 pm AMA Forum Lunch

6:00 pm Exhibitor Reception

q

q

Meat q Vegetarian q Vegan q Gluten Free q

q

q

Saturday, September 8 (Complimentary for member & one guest only) 7:00 am 8:00 am 5:30 pm 6:00 pm

Breakfast Buffett Education Program Candidate Reception Inaugural Gala Meat Dinner Vegetarian Dinner Vegan Dinner Gluten Free Dinner

Non-complimentary events Saturday, September 8 12:00 pm COMPAC Luncheon*

charges for additional guests

q q q

q #_______ @ $35/each_________ q q

q q q q

q #_______ @ $105/each_________ q #_______ @ $105/each_________ q #_______ @ $105/each_________ #_______ @ $105/each_________ q

Meat q Vegetarian q

Vegan q Gluten Free q

* Charge per person for ALL members and guests

#________@ $45/each

TOTAL amount enclosed for non-members, additional guests and COMPAC Luncheon.

$

Please make check payable to: Colorado Medical Society and mail this form, or charge ❑ Visa ❑ Mastercard ❑ Am. Express #______________________________________ exp. date____________ Signature _____________________________________________________________________________________ Please mail this form to us at PO Box 17550, Denver, CO 80217-0550 phone it to us at 720-859-1001 or 1-800-654-5653 or fax it to us at 720-859-7509

Email:___________________________________

Hotel Reservation deadline is August 6, 2012. After that date on space available basis.

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Colorado Medicine for May/June 2012

Colorado Medicine for May/June 2012

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Departments

New Members Arapahoe-DouglasElbert Medical Society Brent M Arnold, MD Barry D Blyton, MD Deborah Chen-Becker, MD Michael D Gavigan, MD William J Grande, MD Mark R Groshek, MD, FAAP Ian R Levenson, DO Michael W Lin, MD Tamera L Nelson, MD Michael T Preece, MD

William M Scelza, MD Peter G Stratil, MD Lisa R Swize, MD Aurora-Adams County Medical Society Jeffrey A Arthur, DO Kristin P Beougher, DO Scott J Beougher, DO Rhett H Butler, MD Daniel R Hamman, MD Jennifer J Miller, MD

David M Stocker, MD Boulder County Medical Society Kara D Beasley, DO Todd C Becker, MD Jason A Cannell, DO Laryssa R Dragan, MD Marshall B Emig, MD Julie A Fischer, MD Shaila U Gogate, MD Timothy E Grayson, MD

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Brian J Kingston, MD William V Kinnard, MD Susan A Larson, MD, FAAP Garrett B Lee, MD Michele Y Lee, MD Sarah J McKinley, MD Maurice A Mouchawar, MD Larry C Munch, MD Cristina M Pagett, MD Neva Phair, MD Heidi A Pomfret, MD Robert L Powell, MD Matthew R Quallick, MD Leon Tan Que Jr, MD Craig M Simmonds, MD Christopher Watson, MD Jo A Watson, MD Clear Creek Valley Medical Society Joseph G Abdallah, MD Heather M Carney, MD Chip Davenport, MD Vassily T Eliopoulos, MD Becky B Estill, MD Paul D Fournier, MD Jeffrey K Gori, MD Danna O Gunderson, MD Tyler J Kemmis, MD Karen E Maloney, DO Thomas P Merkert, MD Michael K Miller, MD Derek D Rains, MD Steven D Vath, MD Angela M Walcher, MD Ralph J Wright III, MD CMS Direct Melanie L Hebert, MD Daniel J Holligan, MD Jacob P McKeegan, MD Curecanti Medical Society Annamarie N Meeuwsen, MD Michael A Meeuwsen, MD

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Colorado Medicine for May/June 2012

Departments Denver Medical Society John J Archard, MD Thomas F Barsch, MD Jess B Bartley, MD Joseph O Billig, MD Mark T Calkin, DO Frank E Campanile, MD Anwell Chang, MD Sarah J Conlon, MD Deborah R Cook, MD Joseph E Dall’Era, MD Haidi G Demain, MD David R Fintak, MD Deborah G Fisher, MD Leah E Fuchs, MD Wendy P Gill, MD Aaron M Haug, MD Kristin E-M Head, MD David K Kaneshiro, MD Karng S Log, DO Alice M Luknic, MD Robert C McClay, MD Greg T Mogel, MD Mark H Perlman, MD Sheri A Poznanovic, MD Jeffrey R Preston, MD Michelle K Reeves, MD Terri L Richardson, MD Tony Sangchompuphen, MD Rasheed A Singleton, MD

Irene S Soesilo, DO J Christopher Sohayda, MD Nathan M Spengler, MD Richard L Wang, MD Flora J Waples-Trefil, MD Marc Y Wasserman, MD Kenyon J Weidle, MD Kathleen J Weiss, MD El Paso County Medical Society Pratheep Arora, MD Michael J Baker, MD Timothy D Ballard, MD Vivek Baluja, MD Vipin K Bansal, MD Brett H Bartz, MD Ruth Cano, MD Heidi P Cox, MD Jordy C Cox, MD George M Gallant, MD Luz E Garcia, MD Josh K Griffin, MD Chieh Hsin V Huerter, DO Janelle D Jones, MD Francis F Joseph, MD Ramsey K Kilani, MD Randal C Kumm, MD Kristin A Lachance, MD Gene E Lamonica, MD

Erin A Luna, DO Christopher J Malinky, MD Ginger S Mentz, MD Wendy S Oatis, MD John C Ronning, MD Shireen J Rudderow, MD Jason M Tarno, DO Lalith C Uragoda, MD Maria E Valdez, MD Intermountain Medical Society Patricia H Hardenbergh, MD Keith P Samuels, MD La Plata County Medical Society Jonathan H Delacey, MD Brett M Englund, MD Patrick K Messerli, MD Larimer County Medical Society Daniel D Arguello, MD Ian D Brickl, MD Elizabeth A Ceilley, MD Michele L Clingenpeel, MD Richard P Desruisseau, MD Teresa C Harper, MD Zeljko M Ivanovic, MD

Paul W Johnson, MD Andrew H Kalajian, MD Robert W Lampman, MD Matthew D Pouliot, DO Cherie L Worford, MD Mesa County Medical Society Heather S Bourkovski, DO Kelly L Common, DO Maura Davenport, MD Jessica L Ford, MD Mitchell J Gershten, MD Kyle S Leonard, MD Joshua E Salter, MD Northeast Colorado Medical Society Michael D Lahey, MD Pueblo County Medical Society Jan R Dunn, MD

ANNOUNCING

Free website for Colorado physicians offering EHR tools and resources Your path to meaningful use The Colorado Medical Society and CO-REC are pleased to offer a free online EHR portal that provides the tools, resources and information to help Colorado physicians select, implement and meet “meaningful use” requirements.

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http://www.corhio.org/portal Colorado Medicine for May/June 2012

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Colorado Medicine for May/June 2012

Departments

medical news Mt. Sopris physicians present Sen. White with CMS “Defensor del Paciente” Award for patient advocacy political pressure, and an unwavering commitment to patient advocacy.”

Sen. Jean White (center) receives award from Drs. Chris Tonozzi, Brad Nichol, Kurt Papenfus, Hap Young and Gerry Steinbrecher.

Physicians from Mount Sopris Medical Society joined the Colorado Medical Society in awarding Glenwood Springs Senator Jean White its “Defensor del Paciente” Award for her advocacy in the recently adjourned State General Assembly.

“The physicians of our community, as well our colleagues across the state, are proud to present our senator with the highest honor we can give to a public official,” said Mount Sopris Medical Society President, Kurt Papenfus, MD. “Senator White is the embodiment of public service, steadiness under intense

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Colorado Medicine for May/June 2012

Senator White successfully fought for legislative reforms in Colorado’s medical professional review laws during an often highly contentious series of debates. “Senator White showed unparalleled courage under fire,” said Dr. Papenfus. “She never lost sight of what was most important–the safety of our patients.”

The “Defensor del Paciente” Award, which translates from Latin as “defender of the patient” recognizes public officials and other laypersons whose advocacy and conduct in the public affairs arena contribute significantly to patients’ rights and their safety. The most recent recipient was Denver’s ABC investigative journalist at Channel 7, Theresa Marchetta, for her award-winning series that exposed misleading advertising by a local chiropractor against diabetic patients. n

CMS honored with CPHP’s Spirit of Medicine award

Colorado Physician Health Program (CPHP) Executive Director Sarah Early and Jane O’Shaughnessy, MSW, present the Spirit of Medicine award to CMS President-elect Jan Kief, MD, and CMS President Brent Keeler, MD. The award recognizes CMS’ support of CPHP’s mission, which is to assist physicians, residents, medical students, physician assistants and physician assistant students who may have health problems, which if left untreated, could adversely affect their ability to practice medicine safely.

El Paso physicians support House Majority Leader Amy Stephens

Physicians in the El Paso County Medical Society (EPCMS) stand behind House Majority Leader Amy Stephens.

Both EPCMS and CMS are supporting Rep. Stephens in her June primary because of her demonstrated commitment to affordable, quality and safe health care for Coloradans.

Among her many accomplishments, she sponsored the bill that created the Colorado health insurance exchange to expand access to affordable coverage and avoid federal pre-emption. Rep. Stephens was also a stalwart champion of the new professional review bill. n

Majority Leader of the Colorado House of Representatives Amy Stephens (R-Monument) with El Paso county physicians (l to r) Jack Dillon, MD, Brian Olivier, MD, and COMPAC chair David Ross, MD. 43

Departments

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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.

➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES Masspro - the federally approved Quality Improvement Organization (QIO) for Massachusetts is actively seeking Colorado physician consultants to perform remote medical record review for individuals with active medical conditions to determine eligibility for state programs.

Physicians must have current board certification and an unrestricted license to practice in Colorado with at least five years of post graduate clinical experience and an active clinical practice. At least two years clinical experience treating on or more of the following conditions is required: complex medical conditions, respiratory disease, physical disabilities, developmental disabilities, chronic disease processes, mental illness, and pediatric disease processes. Please contact 781-419-2505 or PRreview@masspro.org for further details.

Rocky Vista Health Center in Parker, Co seeks hard working BC/BE family physicians to provide care for the patients at our multi-specialty medical office. This is an employed position which will include outpatient work at RVHC as well as ¼ time faculty appointment with RVU COM. Interest in teaching medical students and residents is a must. Candidate should be willing to learn and use efficiently EMR system employed by RVHC. Competitive compensation package is offered. E-mail or mail your cover letter and CV to: Dmitriy Pales, D.O., Medical Director of RVHC, 8401 S. Chambers Rd, Suite H-101, Parker, CO 80134, dpales@ rvucom.org mailto:dpales@rvucom.org.

Family Medicine or Emergency Medicine Providers New urgent care clinic opening in July in Brighton, CO is looking for a physician/ provider to join our staff. Typical work week is 3-days of 12-hour shifts and will include some weekends. This no call, no overnight schedule allows time and flexibility for a quality lifestyle in the Northern Denver area. Please email references along with a copy of your curriculum vitae to sarahrip@platterivermed.com 44

Physician owned medical practice - seeking full or part time physicians to join our interdisciplinary team in providing house calls to homebound elderly patients in the Denver area.

We offer a nurse staffed call center and fully integrated EMR. This is a salaried position with benefits. Please mail your CV to PPS, 3025 S Parker Rd, Suite 100, Aurora, CO. 80014-2914.

➤ MISCELLANEOUS 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 email to RMoore@ mednowstaffing.com or visit our website at www.MedNOWStaffing.com Smaller, locally owned and managed Denver Hospice - seeks, .75 – FTE Medical DirectorNamaste Hospice is seeking a Medical Director who is responsible for the following: · Provides medical review of patient/family caseloads, which includes: assessment review, care planning review, documentation phases of the Plan of Care. · Provides consultation to attending physicians regarding services of Namaste and related patient/family issues. · Provides documentation of patient interaction (visits, phone call, team conferences) on the EMR. · Addresses patient care needs with families and significant others. · Communicates appropriate clinical information to the nursing staff and Interdisciplinary Team (IDT) and attending physician. · Acquires and updates appropriate information related to treatment modalities and pharmaceutical treatments currently utilized in palliative care. Provides counsel and education to IDT related to treatment options. · Co-facilitates and acts as a liaison for any

Rocky Vista Health Center in Parker, CO seeks hard working BC/BE general internists to provide care for the patients at our multi-specialty medical office. This is an employed position, which will include outpatient work at the RVHC, inpatient work at the nearby hospitals, and ¼ time faculty appointment with RVU COM. Interest in teaching medical students and residents is a must. Candidate should be willing to learn and use efficiently EMR system employed by RVHC. Competitive compensation package is offered. E-mail or mail your cover letter and CV to: Dmitriy Pales, D.O., Medical Director of RVHC, 8401 S. Chambers Rd, Suite H-101, Parker, CO 80134, dpales@ rvucom.org mailto:dpales@rvucom.org.

CMS ORG .ORG CMS CMS CMS.ORG ORG Colorado Medical Society conflicts with patient’s physicians, promoting a successful plan of care for the patient/ family in Hospice. · Consistently reports changes in patient condition or family situation by notifying care team partners and the rest of the team in a timely manner. · Follows the (IDT) Interdisciplinary Plan of Care for each patient; actively participates in change discussions as needed.

Namaste Hospice is a privately-owned, 14 year old hospice located in Denver, Colorado. Namaste values its hospice philosophy and its family-style culture with its grass roots commitment to serving all patients, including the often disenfranchised populations. ~ Vision ~ We envision a world in which people living fully and dying well on their own terms is an ultimate success. ~ Mission ~ Namaste Hospice exists to shift the dominate paradigm regarding the world view that terminal illness and death is a failure. Please send your resume to ldawson@namastehospice.com or call Lynn Dawson, CEO at (303) 860-9915.

Colorado Medicine for May/June 2012

Departments

➤ SPACE TO BUY OR LEASE Sunny, spacious office – to share with family physician. F/T or P/T. Primary care or specialty. Ample parking. 1370 So Wadsworth, Lakewood.

303.985.8773. $300 Medical office space to share (Castle Rock) - Medical Office space to share with Pediatric Office. One to four offices/exam rooms available. May share waiting room with pediatric office. Excellent for physician or therapist wishing to expand to Castle Rock or build-up a practice. Outstanding opportunity for an Internist, OB or subspecialist as the waiting room is full of parents who may need doctors themselves. One large room with big windows also available with own door. May also rent the entire 757 sq. ft separately.

Please email for further information: dvonfeldtcrpeds@comcast.net.

Location: South Perry Street.

➤ 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 email to nmoore@rm-uc.com.

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.

Fax c.v. to 303-872-1856 or email to nmoore@rm-uc.com.

➤ Practice for sale For Sale - Bustling GYN practice, well-established. Turn-key, efficient.

Priced right, owner needs to leave area.

Excellent location in Broomfield. Outstanding opportunity. Contact 303-9413244 for details.

Colorado Medicine for May/June 2012

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.

NEED A HAND WITH PHYSICIAN STAFFING? ExtraMD, a local locum provides local physicians, reasonably priced with instant availability!

Not ready to hire but need some extra help? Looking for a reasonable alternative to expensive national companies? ExtraMD is Denver based, physician owned and managed.

ExtraMD provides experienced, caring physicians that will cover your practice when you are gone or overloaded. ExtraMD’s physicians cover family practice, internal medicine, urgent care and hospital medicine. Our physicians can work just a single day or months at a time. ExtraMD offers same day/next day coverage for emergencies. Call 720.202.3358, or email: admin@extramd.com

Experienced Psychiatrist Wanted To Care for Our Nation’s Finest

at Evans Army Community Hospital – Fort Carson Humana Clinical Resources is seeking a Psychiatrist to provide a full spectrum of

psychiatric care to military members and their dependents in the Behavioral Health Department of Evans Army Community Hospital, Fort Carson. Fort Carson is the home of the Air Force Academy and the US Olympic training center and is located about 8 miles south of Colorado Springs, CO a city of about 375,000. Provider will work full-time days (no call) alongside a fully staffed team of experienced providers caring for a predominantly healthy patient population.

Requirements include board certification by the American Board of Psychiatry and Neurology, current, unrestricted licensure to practice as a Psychiatrist in any U.S. State, current DEA registration and a minimum of 6 months practice experience within the past year. U.S. citizenship and current BCLS certification are also required prior to start.

Competitive remuneration package available as Independent Contractor including paid time off and $10K sign on bonus. For confidential consideration please send your CV to: cfitzpatrick@humana.com or fax to (502)322-8764, or you may call Mrs. Fitzpatrick tollfree at 1-888-241-1475.

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Features

the final word Jonathan Mathieu, Director of Data and Research, Center for Improving Value in Health Care

The nuts and bolts of Colorado’s All Payer Claims Database What is the APCD? Created in statute in 2010, and administered by the non-profit organization Center for Improving Value in Health Care (CIVHC), the Colorado All Payer Claims Database (APCD) will provide an unprecedented view of health care expenditures and utilization that no other dataset can match. The APCD combines health claims data from all commercial insurers and public payers including Medicare and Medicaid. All data submitted on a claim will be available in the APCD, including amounts paid to physicians and hospitals for specific services and diagnosis; frequency of services provided; location where care is being delivered; and pharmacy information. This comprehensive dataset will offer stakeholders and providers a focused lens to evaluate patterns of care and opportunities to improve care and decrease variation in costs.

With initial reports due to release at the end of the year, the APCD will provide a variety of public reports, with more detailed HIPAA-compliant datasets available to researchers and qualifying organizations. The first set of publicly

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available reports will use aggregated data to provide high-level views of the health care system in Colorado, such as variation in state and regional cost patterns, utilization of services, etc. As the APCD is populated with data from additional private and public payers over the next two to three years, we’ll generate more sophisticated reports such as comparative cost and quality reports at the physician level adjusted for clinical risk and patient illness severity, analysis of the impact of payment and delivery system reforms, rates of adoption of evidence-based care standards, and more.

CIVHC is currently receiving test data from the first round of payers (top 12 commercial insurers + Medicaid) and will be onboarding three years of historical data from the same group this summer. This fall payers will submit monthly data, which will include claims that were generally adjudicated three months prior. It will require another two to three months to process the data and make it available through the APCD. Why is the APCD important for physicians?

As payers move toward value-based payment approaches, and purchasers pursue value-based purchasing and high-deductible plans, they will have incentives to direct patients and dollars toward low-cost, high-quality providers. At the same time, primary care physicians will have incentives to direct patients to high-performing specialists. As you know, comparative data on cost and quality at the individual physician level is already available and will become more so over time and from a growing number of sources. Health plans are providing this information to their

patients, and private sector entities such as Thomson Reuters make physician-specific, comparative cost and quality data available to their clients.

However, unlike currently available physician performance metrics, the APCD reports will allow you to see the underlying cost, services and diagnosis data to identify ways to improve quality and demonstrate value. The data will be riskadjusted using a consistent set of methodologies to most effectively and fairly compare physician performance and allow you to compare your costs of treatment to those of your peers. This will allow you to identify areas where your practice already provides high-value care, as well as opportunities to improve in areas where your costs might be relatively high.

The APCD will also allow you to look at within-practice treatment patterns and “leakage” of patients who receive health services in other care settings.

Many physicians and physician groups are being proactive in their response to the increased availability of comparative cost and quality information. For example, a partnership between the Society of Thoracic Surgeons and Consumer Reports provides ratings for surgeons performing coronary artery bypass graft procedures, which allows consumers to make value comparisons by surgeon. Now is the time for you to begin to think about how you can use the APCD’s expansive data to strategically position yourself in the marketplace.

This is the first in a series of articles regarding the Colorado APCD. Please email jmathieu@civhc.org with any questions or comments to be addressed in future articles. n Colorado Medicine for May/June 2012

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Colorado Medicine for May/June 2012