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November/December 2016

Volume 113, Number 6

Moving CMS forward for physicians and patients

Katie Lozano, MD, FACR CMS President Award-winning publication of the Colorado Medical Society


contents Nov/Dec 2016, Volume 113, Number 6

Cover story Newly inaugurated

president Katie Lozano, MD, FACR, is excited to continue building the Colorado Medical Society into a more grassroots and responsive organization. A suite of stories in this issue explains these member benefits and opportunities to connect with your medical society. Log on to Central Line for a direct connection to your board representative, run for office through the all-member elections, take a course in the new Physician Leadership Skills Series, and schedule or attend a regional forum and make 2017 a year of personal growth and satisfaction. Read more starting on page 6.

Inside CMS

5 Executive Office Update 33 COPIC Comment 34 Reflections 36 Education Foundation 37 Reasons to Participate in Workers’ Comp

Departments 38 40

Medical News Classified Advertising

Colorado Medicine for November/December 2016

Features. . . 11

Annual meeting highlights– Fun, collegial and informative perfectly summarize members' experience at the re-engineered annual meeting in Keystone.

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Become a CMS leader– Consider running or nominating someone for 2017 CMS president-elect, AMA delegate or alternate delegate. Nominations are open until Jan. 31.

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Launching Central Line– CMS invites members to

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Lead the way–Hone your skills with the Colorado Medical Society Physician Leadership Skills Series.

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Amendment 69 survey–Kupersmit Research polled CMS

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COMPAC endorsements–COMPAC-endorsed candidates,

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AMA/COMPAC luncheon– COMPAC honored two exemplary state legislators, Sen. Chris Holbert and Rep. Angela Williams, and brought in nationally-renowned speakers to give insight into the elections.

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Practice Transformation–The Transforming Clinical Practice initiative (TCPi) offers grant-funded support to specialists and primary care physicians to help practices provide better care.

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Prescription drug misuse–Pinnacol Assurance is working with RxAssurance to offer physicians a free, four-month trial of OpiSafe, a new tool for safe and efficient opioid prescribing.

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Final Word–Paul Tauriello, director of the Colorado Division

connect through a first-in-the-nation state medical society web-based communications platform. It is a game-changer in member engagement and transparency.

members to gauge support or opposition for Amendment 69 and heard a resounding call to oppose the proposal but to continue working to improve the health care system.

based on recommendations from its candidate screening process, won 78 of 85 races at the ballot box.

of Workers’ Compensation, celebrates 25 years of the DOWC Independent Medical Examination (DIME) program and 150 current and past physician participants.

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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 STAFF

2016/2017 Officers Katie Lozano, MD, FACR President M. Robert Yakely, MD President-elect Michael Volz, MD

Treasurer

Alfred D. Gilchrist Chief Executive Officer

Board of Directors Sami Diab, MD Curtis Hagedorn, MD Mark B. Johnson, MD Aaron Jones, MSS Richard Lamb, MD David Markenson, MD Gina Martin, MD Edward Norman, MD Patrick Pevoto, MD, MBA Charlie Tharp, MD Kim Warner, MD C. Rocky White, MD

AMA Delegates A. “Lee” Morgan, MD M. Ray Painter Jr., MD Lynn Parry, MD Brigitta J. Robinson, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Katie Lozano, MD Tamaan Osbourne-Roberts, MD AMA Past President Jeremy Lazarus, MD

Michael Volz, MD Immediate Past President COLORADO MEDICAL SOCIETY STAFF Executive Office Alfred Gilchrist, Chief Executive Officer, Alfred_Gilchrist@cms.org Dean Holzkamp, Chief Operating Officer, Dean_Holzkamp@cms.org Dianna Mellott-Yost, Director, Professional Services, Dianna_Mellott-Yost@cms.org Tom Wilson, Manager, Accounting, Tom_Wilson@cms.org

Division of Health Care Financing Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Communications and Member Benefits Kate Alfano, Communications Coordinator, Kate_Alfano@cms.org Mike Campo, Director, Business Development & Member Benefits, Mike_Campo@cms.org

Division of Government Relations Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Adrienne Abatemarco, Program Manager Adrienne_Abatemarco@cms.org

Division of Health Care Policy Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org

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

Colorado Medical Society Foundation Colorado Medical Society Education Foundation Mike Campo, Staff Support, Mike_Campo@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 D. Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Kate Alfano, Assistant Editor; Chet Seward, Assistant Editor. Printed by Hampden Press, Aurora, Colorado


Inside CMS

executive office update Alfred Gilchrist, CEO Colorado Medical Society

Your reinvented medical society goes horizontal

Plug in and play with your peers in the real world of health care policy We are entering the second year of a 21st-century-designed medical society that ties your streamlined board of directors with grassroots in pretty much real time. As one of your board members said, we have evolved from an emeritus to a millennial model for CMS members – homegrown and locally owned. And just in time to mobilize the policies that we will put into play with state legislators and our congressional delegation. Take free, professionally designed skills-based courses for leadership development. It is the duty and privilege of a forward-thinking medical society to develop and offer skills-based courses for physician leadership. The Physicians Foundation awarded CMS a $150,000 grant to administer the Physician Leadership Skills Series (PLSS) over two years. The first program in this members-only series will be held in early 2017. Run for office, recruit a colleague to run, and vote for your CMS officers in our new all-member elections. Gone is the delegated approach to electing leaders through a House of Delegates where a limited number of physicians got to choose who leads your medical society. CMS officers are now truly homegrown. We have an all-member election system for CMS president-elect and AMA delegates and alternates. If you are interested in leading at a high level or if you know a colleague who would liketo sit in that chair, check out our call for nominations for next year’s elections, open until Jan. 31, 2017. Know your CMS board member. They

will soon be online with our powerful new tool, Central Line. Central Line tees up the kinds of conversations that ultimately translate into advocacy with legislators, regulators and all the players in the public affairs space. Central Line is our first-in-the-nation web-based virtual policy platform designed for CMS to connect you and your board member before and after votes on policy. You can share opinions, ideas, speeches and concerns with colleagues on policy proposals they submit to CMS that are of interest to you, and you can submit policy proposals to CMS 24 hours a day, seven days a week instead of once a year at the annual meeting. This revolutionary application provides you with an unparalleled voice in CMS with just a few clicks of a mouse – all from the convenience of your desktop, laptop or mobile device – and makes CMS a more grassroots responsive and effective organization. Registration will open Nov. 18. Take those connections from virtual to real life. We can come to you for an in-person, hometown regional forum. There is no better way to let CMS know what matters to your practice than to meet face-to-face in your community. CMS leaders are ready to travel to your community for a homegrown meeting open to all physicians. Six regional forums were held in 2016 in La Plata, Montrose, Mesa, Chafee, Larimer and Boulder counties. Email president@cms.org to schedule a 2017 regional forum today. Join a committee or work group. Our new streamlined structure allows you to find volunteer opportuni-

Colorado Medicine for November/December 2016

ties that fit your schedule. CMS has transformed most of its committees and work groups away from long-term commitments to targeted and productive short-term experiences based on urgency and relevance. This year several hundred physicians who had never previously participated with the medical society served on various work groups and committees that met both virtually and in person. Opportunities to participate can be found by emailing president@cms.org. Make plans to attend our totally redesigned annual meeting featuring great speakers, free CME, free childcare, and activities for the whole family. Your colleagues have transformed the annual meeting into a forum for collegiality, information sharing, great speakers certified for free CME credit, and brand new family-friendly activities like free licensed childcare and free local activities for everyone. An Annual Meeting Re-Engineering Work Group of physicians used the results of a member-wide survey to design programs and extracurricular activities for the 2016 meeting and will continue their great work for the 2017 meeting in September at the Beaver Run Resort in Breckenridge. The Colorado Medical Society unites us at a time when powerful divisive forces would like to subdivide medicine into convenient packages. By intent and design, CMS will keep the multifaceted profession of medicine working together, communicating and bringing the ideas that result into the Colorado health care system and public policy space. n 5


Moving CMS forward for physicians and patients

Katie Lozano, MD, FACR CMS President

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Colorado Medicine for November/December 2016


Cover Story

I

am honored and excited to be working for you as your president. I consider this service to be a natural and necessary extension of my career, and a legacy passed down from my father and grandfather. My father served for many years on the school board, and has served in Rotary for as long as I have known him, including as president. My grandfather served as Rotary president, treasurer of his county medical society, and as the sole counselor representing his state in his national specialty society for years. My grandfather, who trained in radiology in the 1930s, taught me to always think of the patient behind the film. In these modern days, I always have a genuine concern for the real person behind the hundreds of MR images or thousands of CT images I see as I take care of patients as a radiologist. Likewise, my highest priority in organized medicine is the patient. This was reinforced by a great mentor of mine, Dr. Jeremy Lazarus, past AMA president, who taught me that it’s very easy to consider whether policy issues have merit by considering the following: How does this help patients? I have been told many times in my training and in my career that I am too nice and too ethical. As your president, I won’t be mean or unethical, but I will be tough. I’m certain you can be tough and nice at the same time. CMS members have voiced a strong desire for effective advocacy, bilateral communication and an organization that helps them engage across the spectrum of practice settings in policy development and advocacy; drawing on member expertise from the exam room level to the boardroom; linking membership directly to the board of directors; inviting vigorous, evidencebased, peer-to-peer evaluation of policy options; and cultivating physician Dr. Lozano was photographed with Prince William, a purebred Apaloosa horse, overlooking the Sumac Hill Farm Equestrian Center across the Highline Canal from her home.

activists and leaders who reflect the evolving demographics, interests and diversity of Colorado physicians.

a more grassroots responsive and effective organization. Read more about Central Line on page 16.

Days after returning from a very successful annual meeting, I met with key CMS staff and leadership to craft this year’s work plan. This plan is developed with strong direction from our members and years of work by my predecessors, and incorporates issues and tactics about which I’m very passionate. It’s for that reason that I’m recommending to the board a pro-patient and pro-physician strategy for 20162017. With approval by the board, we will:

To make our organization the best it can be, we need medicine’s best and brightest to run for elected office in our society. We held our first all-member election in August 2016 and the Nominating Committee is beginning recruitment efforts for the next slate of nominees. I encourage all physicians to explore CMS leadership opportunities and consider nominating yourself or a colleague for president-elect, AMA

• Continue transitioning CMS to a 21st century state medical society by growing member awareness of involvement opportunities, features and milestones. • Take full advantage of the postelection public policy environment to advocate changes in the multipayer system, both public and commercial, at the state and national level, particularly those changes that reduce barriers to cost-effective, quality care and increase our professional satisfaction serving patients. • Increase efforts to ensure access to compassionate, evidence-based care for patients who suffer from acute and chronic pain while reducing the potential for medically inappropriate use and diversion of prescribed medications. • Maintain a focus on physician wellness and ensure members feel supported. Very soon CMS will launch Central Line, a first-in-the-nation, web-based communications platform designed to empower members to give input before and after all policy votes by the board of directors, give input on any policy proposal submitted to CMS that interests you, and submit policy proposals at any time from your computer or phone. This is a truly revolutionary application because it not only provides members with an unparalleled voice in CMS; it will also make CMS

Colorado Medicine for November/December 2016

“I have been told many times in my training and in my career that I am too nice and too ethical. As your president, I won’t be mean or unethical, but I will be tough. I’m certain you can be tough and nice at the same time.” delegate or AMA alternate delegate. The nomination period is open until Jan. 31, 2017 for the upcoming election in August 2017. We can provide more information on how to join the CMS board of directors. Read more about the all-member elections on page 15. Those unsure of where to start in organized medicine leadership can find the guidance they need through our new Physician Leadership Skills Series (PLSS). This series will provide physicians with the training and skills to lead organizations with diverse membership and unique goals. We know future governance will need to be even more connected on a grassroots level, given available technologies, and hopefully will be even more relevant and effective for members. Developing and supporting new physician leaders who are enthusiastic about apply-

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Cover story (cont.) ing their skills to achieve the goals of CMS and component medical societies is critical. Read more about the series on page 19. In-person meetings are imperative, particularly during a time when more physicians are feeling isolated and desire more frequent peer interaction. I am committed to continuing the regional forums that we started during Mike Volz’s presidency; we held seven around the state in 2016. The regional forums connect members with CMS leadership and, in turn, make CMS a much stronger, better-connected and more responsive organization. If you are interested in organizing a regional forum in your area – whether or not you have an active or staffed component society – please email me at president@cms.org. Thank you so much for letting me work hard for you as your president. Please don’t hesitate to contact me or one of our dedicated staff on any issue of concern to you. Best Regards, Katie Lozano, MD, FACR Meet your new president Dr. Lozano is board certified by the American Board of Radiology and is a private practice musculoskeletal radiologist with Radiology Imaging Associates and Invision Sally Jobe Imaging in Englewood, Colo. Dr. Lozano has a decorated record of service in organized medicine, having dedicated countless hours of time serving on numerous committees and in leadership positions for the following organizations: • Colorado Medical Society, including as treasurer, and member of the board of directors for eight years, • Arapahoe-Douglas-Elbert County Medical Society, including as president, • American Medical Association, including as chair of the Young Physician Section and sole delegate representing the YPS at the AMA, • American College of Radiology, 8

CMS President Katie Lozano, MD, FACR, left, works with medical students Evan Manning, center, and Leah Kellogg, right, to explore ways for CMS to collaborate with the medical student component society. including on the Council Steering Committee and as chair of the Resident and Fellow Section, • Colorado Radiological Society, including as president, and • Colorado Physicians’ Congress on Health Care Reform. Dr. Lozano currently volunteers on the board of directors for Doctors Care, a nonprofit Denver clinic for uninsured and underinsured patients, and served on the scientific advisory council for Engaged Benefit Design, a collaborative effort in Colorado providing resources and incentives for patients and their health care providers to make health care decisions based on patient values and medical evidence.

an intern. Among her many honors, she was awarded the American Medical Association Young Physician Leadership Award in 2007, fellowship in the American College of Radiology in 2015, the American Medical Women’s Association Janet M. Glasgow Memorial Award and Achievement Citation in 1998, and Alpha Omega Alpha membership. She received honorable mention as one of five nominees for the Gold-Headed Cane award at the University of Texas at Galveston, the highest honor for graduating medical students.

She served on the American College of Radiology Ethics Committee for over a decade, on the CMS Council on Ethics and Judicial Affairs for seven years, and is currently on the Ethics Committee at Regional West Medical Center in Scottsbluff, Neb., one of her group’s partner hospitals.

She was awarded a medical degree with honors by the University of Texas Medical Branch in Galveston, completed a transitional internship year at Christus St. Joseph Hospital in Houston, completed a radiology residency at the University of Washington in Seattle where she was chief resident, and completed a musculoskeletal imaging fellowship at the University of California – San Diego where she was chief fellow.

Dr. Lozano also served as co-director of the St. Vincent Student-Run Free Clinic in Galveston, Texas, as a medical student and on the Patient Advocacy and Ethics committees at Christus St. Joseph Hospital in Houston as

In her free time, she enjoys doing all the volunteer activities listed above, as well as hiking on the High Line Canal Trail with her husband, John, and their three dogs, Reagan, Ziegi and Winston. n

Colorado Medicine for November/December 2016


Colorado Medicine for November/December 2016

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Colorado Medicine for November/December 2016


RE-ENGINEERED BY PHYSICIANS, FOR PHYSICIANS A few notable highlights from the 2016 Colorado Medical Society Annual Meeting First and foremost, this meeting was designed by physicians and for physicians. The Re-engineering the Annual Meeting Work Group met throughout the spring to brainstorm topics and events that would benefit physicians in all stages of their careers. (L-R): Michael Volz, MD; David Markenson, MD; Gina Martin, MD; Rachelle

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Klammer, MD, Charlie Lippolis, DO; Michael Lepore, MD; Brandi Ring, MD; Christine LaRocca, MD (chair); and Leto Quarles, MD.

“My kids had a blast!” Kids’ activities kept the young ones busy throughout the event.

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Outgoing president Michael Volz, MD, and Past President Tamaan OsbourneRoberts, MD, recognized the “50-year physicians,” those who graduated medical school 50 years ago; (L-R): Michael Volz, MD; W. Ben Galloway, MD; Marco Celada, MD; Melvyn Klein, MD; Howard Kerstein, MD; M. Robert Yakely, MD; and Tamaan Osbourne-Roberts, MD.

“The gala was really fun this year!”

“The keynote speaker and her breakout session were great!” Keynote speaker Mary Loverde wove humorous stories illustrating a focus on family, friends and rituals with evidence-based tactics to maintain health.

Expert faculty from around the state and country presented interactive plenary sessions and workshops. Cyrus Mirshab, MD, of CPMG, led a workshop on the importance of physician wellness and how to implement strategies for happier doctors.

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“I really enjoyed the small group sessions.”

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Those attending had a chance to unwind by participating in light-hearted festivities during the conference.

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WE ALL HAD A

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Fun, collegial and informative; these three words perfectly summarize the 2016 Colorado Medical Society Annual Meeting held at the Keystone Resort in September.

The CMS Board of Directors met Friday afternoon for important business and some fun, too.

“The breakout workshops were great and I loved all the family friendly activities.” Childcare professionals entertained the kids Friday evening, and Saturday during the day and evening.

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Outgoing board members were recognized for their service by CMS President Michael Volz, MD, (L-R): Volz; Cory Carroll, MD; Charles Breaux Jr., MD; Scott Replogle, MD; Tamaan Osbourne-Roberts, MD; and Lynn Parry, MD.

“It was all quite good.” <

Attendees had fun with selfie-ready cardboard cutouts of presidential candidates and past presidents of the United States at the president’s dinner.

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Diana L. Moss, PhD, teamed up with Henry Allen, JD, for “Consolidation in Health Care: Reversing the Benefits of Competition.”

The meeting had record attendance by medical students from the University of Colorado and Rocky Vista University.

Colorado Medicine for November/December 2016


GREAT TIME! More than a quarter of the physician members were attending their first annual meeting and all members and their guests experienced the brand-new, re-engineered format that emphasized social events and professional development sessions with a focus on Colorado medicine physicians can’t find anywhere else.

There was plenty of dancing and live entertainment.

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The signature event was Saturday evening, an election-themed president’s dinner, with a cocktail hour.

“A good variety of topics.” “There were deep and diverse conversations with a range of colleagues with passionate opinions and views different from mine.”

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Colorado Medicine

Abraham Lincoln and George Washington impersonators were on hand, having fun with at the president’s dinner. for attendees November/December 2016

Michael Victoroff, MD, led a workshop that helped participants think about potential violent scenarios and how to prevent them.

Henry Allen, JD, received an award in recognition of his extensive work to oppose the health industry mergers.

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Parting shots and thoughts from the

2016 Colorado Medical Society Annual Meeting “Now I know more about the impact of the proposed insurance mergers and the new forum for CMS proposals.”

The work group also planned activities for families and guests.

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Mark Levine, MD, and Carol Vargo, presented a plenary session and workshop on MACRA.

“I enjoyed being able to network with other docs in the state.”

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Nathan Panzer was honored as the Colorado Medical Society’s 2016 junior division winner in the Health and Behavior Sciences category of the 61st Annual Colorado State Science and Engineering Fair. He is pictured with science fair judges Pete Smith, MD, (L), and Cory Carroll, MD, (R).

Incoming CMS President Katie Lozano, MD, congratulated outgoing CMS President Michael Volz, MD.

Mark your calendars and start planning to attend next year’s annual meeting, Sept. 15-17, 2017, in Breckenridge. <

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A fun atmosphere helped medical students network with active physicians.

Colorado Medicine for November/December 2016


Features

Become a CMS leader Kate Alfano, CMS Communications Coordinator

Call for nominations: 2017 president-elect, AMA delegates and alternate delegates The nomination period for the 2017 Colorado Medical Society all-member election will be open through Jan. 31, 2017. The Colorado Medical Society encourages all members to consider nominating a colleague or self-nominating for one of the open leadership positions: president-elect (one position open), AMA delegate (three positions open) and alternate delegate (three positions open). The election guide is available at www. cms.org. This guide provides all the information a potential candidate needs about the duties, eligibility, terms of office and honorarium for each open position, as well as candidate requirements, campaign guidelines and the election process. The position descriptions and qualifications for office are available starting on page three of the election guide and the candidate re-

quirements on page five of the election guide. Past CMS president John L. Bender, MD, FAAFP, described why he chose to run for office at CMS: “I was (and still am!) enthusiastic for the opportunities before the house of medicine and the patients of Colorado as we implement the critical pieces of health care reform. We have a unique opportunity to really influence the legislative and regulatory process compared to many other states, all thanks to the legacy work of those who came before us and the highly skilled CMS staff.” Past CMS president Jan Kief, MD, explained what to expect in an officer position. “As the CMS president, you are given great support from the excellent staff at CMS, proper orientation with the president-elect year, and can work

your CMS duties around your practice schedule. The time you put in at CMS is well spent, and the benefits of feeling truly excited about our profession and contributing to something important come back to you threefold!” “My mentors as CMS president were the past presidents of CMS – too many to name,” Kief continued. “I studied their leadership styles and they were always available to answer my questions, be on a committee, or just meet as colleagues. And I learned so much from watching the teamwork exemplified by the effective CMS staff.” Email CMS CEO Alfred Gilchrist at alfred_gilchrist@cms.org if you have additional questions or if you would like to be connected with a past CMS president to discuss leadership expectations peer-to-peer. n

There is no better way to let CMS know what matters to your practice than to meet face-to-face in your community. CMS leaders are ready to travel to your community for a homegrown meeting open to all physicians.

Work with CMS and/or your component society to schedule an in-person, hometown Regional Forum! Six regional forums were held in 2016, in La Plata, Montrose, Mesa, Chafee, Larimer and Boulder counties.

Email president@cms.org or call 720-858-6321 to schedule a 2017 Regional Forum today. Colorado Medicine for November/December 2016

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Features

Launching Central Line Kate Alfano, CMS Communications Coordinator

A 21st century web-based communications platform The Colorado Medical Society is excited to launch a new and balanced approach to governance and member participation that brings member voices directly into the CMS boardroom. Central Line, a first-in-the-nation state medical society web-based communications platform is designed to empower members to: 1. Give your board representative input before and after he or she votes on policy at CMS board of directors meetings, with no log-in or registration required. Your board member will personally review your input and your comments.

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2. Give input to colleagues on policy proposals they submit to CMS that are of interest to you through Central Line’s “Interest Areas” feature. 3. Submit policy proposals to CMS 24 hours a day, seven days a week instead of once a year at an annual meeting. Central Line ensures real-time member-to-board interaction and serves as an important check and balance on the board of directors. This enhanced member-to-board connection will make CMS a much stronger, better-connected and more responsive, member-driven organization.

It is truly a revolutionary application because it will provide you with an unparalleled voice in CMS with just a few clicks of a mouse – all from the convenience of your desktop, laptop or mobile device. See the graphic on the opposite page to learn more about the functionality of Central Line. CMS will notify members by email when you can register for Central Line, complete your Interest Area profile and tell your preferred method of communication. Watch for the official launch in Nov. 18. n

Colorado Medicine for November/December 2016


Central Line: A win-win Functionality and registration The Colorado Medical Society is excited to launch Central Line, a new and balanced approach to governance and member participation that brings member voices directly into the CMS boardroom.

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1

Central Line empowers members to give your board representative input before or after policy votes, give input to colleagues on policy proposals they submit to CMS, and submit policy proposals virtually 24/7.

Central Line is truly a revolutionary application because it will provide you with an unparalleled voice in CMS with just a few clicks of a mouse — all from the convenience of your desktop, laptop or mobile device – and make CMS a more grassroots responsive and effective organization. It’s a win-win.

2

The CMS Policy Office receives policy proposals and assigns the proposal to an Interest Area. Physicians who have self-selected to an Interest Area have the first opportunity to review and provide input on a proposed policy.

3

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If a majority disagrees with the board, the policy will be reconsidered at the next meeting.

Two weeks before a board meeting that the policy is scheduled for a vote, all members will receive a Central Line email or text from your board member that includes a link for your “yes,” “no” or “maybe” vote with a comment box. There is no log-in required for this step, just use the link in the email you receive.

6 Immediately after the meeting, your board member will notify you of the BOD vote, and you can vote again whether the board “got it right” or not.

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The 18-member CMS board of directors will discuss the proposed policy, informed by member input and comments, and vote.

4 Your board member will personally review your input and your comments before voting at the CMS board of directors meeting on policy proposals.


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Colorado Medicine for November/December 2016


Lead the way HONE YOUR SKILLS WITH THE COLORADO MEDICAL SOCIETY PHYSICIAN LEADERSHIP SKILLS SERIES

As changes in Colorado health care accelerate, it is more important than ever to have well-trained and active physician leaders guiding the way. That is why the Colorado Medical Society is launching the Physician Leadership Skills Series (PLSS) in January 2017. The series will feature eight innovative programs over the year aimed at deepening your awareness, developing crucial skills and equipping you with the tools and experience you need to lead tomorrow’s health care in Colorado.

Program Benefits BLENDED LEARNING APPROACH

CUTTING-EDGE PROGRAMMING

TRUSTED SOURCE

FREE TO CMS MEMBERS

This series will focus on knowledge and skills-based development using dynamic programming by experts in the field who have years of experience working with physicians. Each program can accommodate up to 100 physicians and participants can cycle in and out of programs based on interest and past experience.

At CMS we live by the motto “by physicians for physicians.” We have been educating and engaging physician leaders for years. In fact, the skills series incorporates best practices and key lessons from another CMS flagship leadership development initiative – the Advanced Physician Leadership Program – to provide a less time intensive, robust program to meet the needs of busy, practicing physicians.

The PLSS curriculum was developed based upon physician feedback and recognized gaps in physician business, management and leadership skills. Key topic areas include teamwork, negotiation, conflict management, facilitating meetings, persuasion, public speaking and best practices in board service.

The program is available free of charge to all current CMS members, including medical students and residents. A grant from the Physicians Foundation is helping to support the program.

MAKING THE MOST OF YOUR PRECIOUS TIME

PLSS uses short skills sessions and experiential learning to provide a robust program with a manageable time commitment. The programs will be held at convenient times, like Saturday mornings in person around the state or weeknights via video conference, to minimize disruptions in your practice.

! SIGN UP NOW When was the last time you did something for your professional and personal well being? Now is the time to follow through on the commitment to yourself and your profession. Continue your journey to excellence by developing and enhancing your leadership potential. Join with like-minded colleagues in a dynamic and interactive series where leadership meets medicine.

Learn more and register at www.cms.org/events/leadership-skills


Features

Amendment 69 member survey Benjamin Kupersmit

All-member survey demonstrates need for system change When Kupersmit Research conducted the Amendment 69 survey for the Colorado Medical Society in late August/ early September, the vote among CMS member physicians showed 78% in opposition and 16% in support, with 6% unsure.

• Among the 78% of members voting no, 51% are opposed to single payer health care as a concept, while 40% of those voting no are open to the idea of single payer but oppose Amendment 69 specifically (while 9% say “neither” or “unsure”).

This survey was administered online by the Colorado Medical Society. The survey was in the field from Aug. 6-Sept. 2. A total of 795 Colorado Medical Society members (including 40 medical students) responded to the survey, for a margin of error of +3.5% at the 95% confidence level.

As per Table 1 below, satisfaction is very low with many aspects of the current health care delivery system. However, expectations were that Amendment 69 would make things worse almost across the board. If Amendment 69 failed at the ballot

box (which it did, with 79% of Coloradans rejecting the Amendment), 62% wanted to see CMS aggressively pursue incremental reforms to the current system, while 27% wanted to see CMS pursue sweeping health system reform. Members’ top priorities for reform are: 1. Addressing concerns about abusive commercial payer practices in contracting, authorizing and reimbursing for services, and 2. Ensuring government payers provide predictable, adequate reimbursement while minimizing requirements (such as reporting and

TABLE 1: How satisfied are you with the current multi-payer health care system in meeting each of these goals? Very Somewhat Total unsatisfied unsatisfied Unsatisfied

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Administrative efficiency, simplicity and transparency

46

26

72%

Affordability for patients (premiums, co-pays, deductibles)

30

33

63%

Physicians and patients free to make medical decisions without bureaucratic interference

28

29

57%

Health costs funded via fair, transparent and sustainable sources of revenue

29

28

57%

Coverage for the uninsured

26

26

52%

Adequate reimbursement to run a practice

21

30

51%

A strong, respected profession (e.g., reducing burnout among physicians, while burnishing the image of physicians among the public)

21

25

46%

Patient care that is coordinated effectively (minimal interruptions, accurate information shared between providers, etc.)

17

27

44%

Timely access to care for all patients

15

20

35%

Ongoing improvement of quality and patient safety

8

13

21%

A deep trust between physicians and patients

7

12

19%

Colorado Medicine for November/December 2016


Features or technology) that require further time or investment by providers. Looking to the future, a plurality (40%) want CMS to work to improve the Affordable Care Act, while 33% want to see a full repeal of the ACA and 15% want to see a single payer system. Commentary The survey showed solid opposition to Amendment 69, driven by two core factors: The 31% of members who oppose single payer as a concept, not surprisingly, rejected the proposal on its face. The remainder – members who are open to or undecided on the issue of single payer as a concept – had deep, specific concerns about Amendment 69 that led a solid majority to conclude they should vote “no.” At the same time, the message from this survey could not be more clear. Physicians want the Colorado Medical Society to continue fighting to improve the current system, regardless of the outcome for the Amendment.

Bear in mind, there is very little appetite for major reform and a rehashing of 2008. Furthermore, a solid majority of members (including some who want full repeal of the ACA) reject allowing insurance companies to price coverage based on health condition. Given this reality, CMS’ path forward is clear: Continue to pursue incremental reform to improve the ACA and make sure it works for patients and physicians in Colorado. Members want regulation and oversight that ensures commercial payers treat physicians and their patients with the highest level of respect by eliminating the hassles that interfere in care every day. They also want ongoing advocacy among government payers and regulators, so that administrative and reporting requirements, technology and EHR systems, medical liability laws, and other aspects of the broader health care landscape are supporting, rather than impeding, the ability of physicians to care for their patients.

“Amendment 69’s failure at the ballot box does not mean Colorado’s physicians are happy with the status quo. The survey demonstrates they feel tremendous frustration with the current health care system, just as their patients do. . .” Amendment 69’s failure at the ballot box does not mean Colorado’s physicians are happy with the status quo. The survey demonstrates they feel tremendous frustration with the current health care system, just as their patients do, and that CMS should continue pushing for specific ideas and proposals to improve the health care delivery system in the months and years to come. n

Encourage a colleague to join the Colorado Medical Society and your local medical society today! Visit www.cms.org to learn more about the benefits of becoming a member For more information, call Tim at 720-858-6306 or e-mail tim_yanetta@ cms.org

Colorado Medicine for November/December 2016

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Features

Election Day 2016 Susan Koontz, JD, CMS General Counsel

COMPAC-endorsed candidates win 78 of 85 federal and state election races A presidential result that surprised even the most accurate pollsters sent a clear message that repudiates the Washington establishment and demonstrates that Americans were yearning for a “change” candidate this year. Both houses of the U.S. Congress remain under Republican control although all of the incumbents in the Colorado congressional delegation, both Republican and Democrat, are headed back to the Capitol. On the state level, the political climate did not change much. The Senate Republicans maintained their one-seat majority (18-17), while the House Democrats also kept the majority, gaining three seats (37-28). Since the governor wasn’t up for election this cycle, state politics should remain fairly consistent with the last two sessions. Colorado voters approved the ballot initiative to allow for physician-assisted death and the amendment to make it more difficult to alter the state constitution, while defeating the proposed tax increase on tobacco products and the amendment to create a health care cooperative to replace most other health insurance. Colorado Medical Political Action Committee (COMPAC)endorsed candidates fared very well in the election with 78 of 85 federal and state endorsed candidates winning. This is

largely due to a candidate briefing and interview process that is a model for professional and trade associations. Local physicians, working with CMS and component society staff, brief candidates on medicine’s priority issues. Candidates receive a “Candidate Briefing Document” well before the interview that lays out the background on each issue: Colorado’s stable liability climate, health care reform, managed care, scope of practice, etc. The CMS lobby team is available to answer questions about the issues, and local physicians conduct the interview in the candidates’ district. This process provides for two-way dialogue. Physicians and lobbyists get to hear how a candidate thinks about issues. The candidate learns about the passion that physicians have for issues affecting patients and practice. After the interview of both candidates is complete, physicians vote to recommend the endorsement of one of them to the COMPAC board. Occasionally, the local physicians recommend staying out of the race. COMPAC’s goal is to help all of our elected leaders build relationships with their local medical community leaders, and understand that physicians in the community care and are engaged. n

2016 COLORADO FEDERAL CONGRESSIONAL DELEGATION ELECTION RESULTS U.S. SENATE Sen. Michael Bennet (D) D-1 D-3

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U.S. HOUSE OF REPRESENTATIVES Diana DeGette (D) (Denver, Arapahoe, Jefferson) D-5 Doug Lamborn (R) (El Paso, Park, Chaffee, Teller, Scott Tipton (R) (Alamosa, Archuleta, Conejos, CosFremont) tilla Custer, Delta, Dolores, Eagle, Garfield, Gunnison, D-6 Mike Coffman (R) (Adams, Arapahoe, Douglas) Hinsdale, Huerfano, Jackson, La Plata, Lake, Mesa, D-7 Ed Perlmutter (D) (Arapahoe, Jefferson, Adams) Mineral, Moffat, Montezuma, Montrose, Ouray, Pitkin, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel)

Colorado Medicine for November/December 2016


Features 2016 COLORADO STATE LEGISLATURE ELECTION RESULTS COLORADO SENATE DISTRICTS SD 4 James Smallwood (R) Douglas SD 8 Randy Baumgardner (R) Garfield/Grand/Jackson/ Moffat/Rio Blanco/Routt/ Summit SD 10 Owen Hill (R) El Paso SD 11 Michael Merrifield (D) El Paso SD 12 Bob Gardner (R) El Paso SD 14 John Kefalas (D) Larimer SD 17 Matt Jones (D) Boulder SD 18 Stephen Fenberg (D) Boulder SD 19 Rachel Zenzinger (D) Jefferson SD 21 Dominick Moreno (D) Adams SD 23 Vicki Marble (R) Broomfield/Larimer/Weld SD 25 Kevin Priola (R) Adams SD 26 Daniel Cagan (D) Arapahoe SD 27 Jack Tate (R) Arapahoe SD 28 Nancy Todd (D) Arapahoe SD 29 Rhonda Fields (D) Arapahoe SD 31 Lois Court (D) Arapahoe/Denver SD 33 Angela Williams (D) Denver SD 35 Larry Crowder (R) Alamosa/Baca/Bent/ Conejos/Costilla/Crowley/Custer/Huerfano/Kiowa/ Las Animas/Mineral/Otero/Prowers/Pueblo/ Rio Grande/Saguache COLORADO HOUSE DISTRICTS HD 1 Susan Lontine (D) Denver/Jefferson HD 2 Alec Garnett (D) Denver HD 3 Jeff Bridges (D) Arapahoe HD 4 Dan Pabon (D) Denver HD 5 Crisanta Duran (D) Denver HD 6 Chris Hansen (D) Denver HD 7 James Coleman (D) Denver HD 8 Leslie Herod (D) Denver HD 9 Paul Rosenthal (D) Arapahoe/Denver HD 10 Edie Hooton (D) Boulder HD 11 Jonathan Singer (D) Boulder HD 12 Mike Foote (D) Boulder HD 13 KC Becker (D) Boulder/Clear Creek/ Gilpin/Grand/Jackson HD 14 Dan Nordberg (R) El Paso HD 15 Dave Williams (R) El Paso HD 16 Larry Liston (R) El Paso HD 17 Tony Exum Sr. (D) El Paso HD 18 Pete Lee (D) El Paso HD 19 Paul Lundeen (R) El Paso HD 20 Terri Carver (R) El Paso HD 21 Lois Landgraf (R) El Paso HD 22 Justin Everett (R) Jefferson HD 23 Chris Kennedy (D) Jefferson HD 24 Jessie Danielson (D) Jefferson HD 25 Tim Leonard (R) Jefferson

Colorado Medicine for November/December 2016

COLORADO HOUSE DISTRICTS (cont.) HD 26 Diane Mitsch Bush (D) Eagle/Routt HD 27 Lang Sias (R) Jefferson HD 28 Brittany Pettersen (D) Jefferson HD 29 Tracy Kraft-Tharp (D) Jefferson HD 30 Dafna Michaelson Jenet (D) Adams HD 31 Joe Salazar (D) Adams HD 32 Adrienne Benavidez (D) Adams HD 33 Matt Gray (D) Boulder/Broomfield HD 34 Steve Lebsock (D) Adams HD 35 Faith Winter (D) Adams HD 36 Mike Weissman (D) Arapahoe HD 37 Cole Wist (R) Arapahoe HD 38 Susan Beckman (R) Arapahoe HD 39 Polly Lawrence (R) Douglas/Teller HD 40 Janet Buckner (D) Arapahoe HD 41 Jovan Melton (D) Arapahoe HD 42 Dominique Jackson (D) Arapahoe HD 43 Kevin Van Winkle (R) Douglas HD 44 Kim Ransom (R) Douglas HD 45 Patrick Neville (R) Douglas HD 46 Daneya Esgar (D) Pueblo HD 47 Clarice Navarro (R) Fremont/Otero/Pueblo HD 48 Steve Humphrey (R) Weld HD 49 Perry Buck (R) Larimer/Weld HD 50 Dave Young (D) Weld HD 51 Hugh McKean (R) Larimer HD 52 Joann Ginal (D) Larimer HD 53 Jenni Arndt (D) Larimer HD 54 Yeulin Willett (R) Delta/Mesa HD 55 Dan Thurlow (R) Mesa HD 56 Phil Covarrubias (R) Adams/Arapahoe HD 57 Bob Rankin (R) Garfield/Moffat/Rio Blanco HD 58 Don Coram (R) Dolores/Montezuma/ Montrose/San Miguel HD 59 Barbara McLachlan (D) Archuleta/Gunnison/ Hinsdale/La Plata/Ouray/ San Juan HD 60 Jim Wilson (R) Chaffee/Custer/Fremont/ Park HD 61 Millie Hamner (D) Delta/Gunnison/Lake/ Pitkin/Summit HD 62 Donald Valdez (D) Alamosa/Conejos/ Huerfano/Mineral/ Pueblo/RioGrande/ Saguache HD 63 Lori Saine (R) Weld HD 64 Kimmi Lewis (R) Baca/Bent/Crowley/ Elbert/Kiowa/ Las Animas/ Lincoln/Prowers/ Washington HD 65 Jon Becker (R) Weld

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Advocacy matters Making a difference in your practice

1

Preserving the Liability and Professional Review Climate.

2

Out-of-Network.

3

Network Adequacy Reform.

4

Insurance Commissioner Physician Advisory Group.

5

Physician Satisfaction with Medicare Payment.

6

Vigorous Opposition to Insurance Industry Mergers.

7

Medicaid Physician Payment.

8

Physical-Behavioral Health Integration and Payment Reform.

9

Political Action.

For the twelfth legislative session in a row, CMS and COPIC led the fight to maintain Colorado’s stable liability and profesioanl review climate in the 2016 General Assembly.

While we were disappointed that a professionally facilitated mediation between CMS and the Colorado Association of Health Plans to address out-ofnetwork (OON) and other network adequacy issues concluded unsuccessfully in early 2016, CMS soundly defeated 2016 legislation that would have imposed treble damages on in-network physicians for failure to provide patients with a list of OON providers that might be involved in the patient’s care.

CMS vigorously participated in a Colorado Division of Insurance-convened stakeholder process to address network adequacy. The outcomes were a mixed bag of results, failing to produce meaningful across-the-board reforms but making reasonable progress on some issues.

We held a “listening session” for the Insurance Commissioner with 30 physicians and practice administrators. The “stories” were so persuasive that a physician advisory group reporting directly to the commissioner was appointed and is currently meeting.

CMS passed a resolution at the 2016 AMA Annual Meeting directing AMA to ask the federal Centers for Medicare and Medicaid Services to count physician satisfaction as a Clinical Practice Improvement Activity under the Merit-Based Incentive Payment System (MIPS). The CMS delegation raised the concern that the “Triple Aim” - a term coined by the Institute for Healthcare Improvement - is “jeopardized by the burnout of physicians and other health care professionals.”

On July 21, 2016, the US Department of Justice (DOJ) filed suit in the US District Court for the District of Columbia challenging the proposed mega-mergers between Anthem-Cigna and Aetna-Humana, the culmination of more than a year of methodical research and close collaboration with antitrust experts from the American Medical Association (AMA), the CMS and 16 other state medical associations who worked together and with their physician members to develop a compelling economic and legal case against the corrosive effects of monopsony power on physicians and the patients they serve.

Medicaid E&M code parity with Medicare was widely regarded as “at-risk” in the 2016 state budget. A collation including CMS achieved a partial fix by creating a Primary Care Provider Sustainability Fund and transfers $20 million in cash funds for the continuation of Medicaid rate enhancements in specific areas including primary care office visits, preventative medicine visits, counseling and health risk assessments, immunization administration, health screening services, and newborn care (including neonatal critical care). The State of Colorado qualified for a second round of funding for a federal SIM (State Innovation Model Testing) grant with strong CMS support. Fully100 primary care practices are participating in the first cohort of SIM practice transformation activities. In September Colorado SIM will begin recruitment of the second cohort of practices interested in integrating behavioral and primary care. The federal government also announced that Colorado will be one of 14 regions to participate Comprehensive Primary Care Plus (CPC+) initiative. CPC+ expands CPC classic which provided all payer payment reforms and practice transformation resources to 71 practices across the state. COMPAC, the CMS political action committee, is currently qualifying state legislative candidates on our network adequacy policy objectives. COMPAC only supports candidates who are recommended by local physician screening committees. These committees gain an understanding of the candidates’ philosophies about working with the medical profession on public policy and build relationships with candidates. They are as important as the issues and are at the heart of a successful advocacy program. We project that COMPAC will need to spend $15,000 in the 2016 election cycle to be successful. COMPAC needs $10,000 to meet this target. You can contribute online at our website, www.cms.org/contribute.


Features

AMA/COMPAC luncheon Kate Alfano, CMS Communications Coordinator

Physicians honor two exemplary state legislators, hear forecast of post-election climate COMPAC honored two exemplary state legislators at the 2016 AMA/COMPAC luncheon held during the CMS Annual Meeting in September: Sen. Chris Holbert, a Douglas County Republican and chair of the Senate Business, Labor and Technology Committee, and Rep. Angela Williams, a Denver Democrat and chair of the House Business Committee and the Legislative Black Caucus. Williams was recently elected to the state Senate seat vacated by her term-limited successor. They received the “Champions of Physicians and Patients” award. Mark B. Johnson, MD, COMPAC chair, introduced them by speaking about the ideals of politicians: to have moral courage under pressure, principled stands and skilled advocacy. “These two highly regarded legislators personify these ideals, manifested in this circumstance on health care policy conflicts of immense importance to the medical community.” “Sen. Holbert has been central to diverting to an interim discussion a health plan initiative that would have capped and indexed out-of-network charges, and applied his considerable influence and policy knowledge to persuade the plans and state regulators to take a broader view,” Johnson said. “He sees the long game, and will undoubtedly lead the next iteration of this debate on setting the guidelines for fair, transparent rules of engagement as the plans build and manage their networks.” “Rep. Williams is a comparable profile in political courage, steadfastly taking the defendant’s position in pretty much every effort by Colorado’s trial attorneys

TOP: L-R: COMPAC Chair Mark B. Johnson, MD; CMS General Counsel Susan Koontz, JD; Sen. Chris Holbert; Rep. Angela Williams; and CMS lobbyist Jerry Johnson. BOTTOM LEFT: Richard Deem, senior vice president of the AMA Advocacy Group, speaks about federal issues. RIGHT: Floyd Ciruli gives a forecast of state and federal races in the context of the presidential election. to expand liability or dismantle current protections and process in Colorado tort law. She carried our requested legislation from our Clean Claims Task Force and is an advocate for a range of CMSsupported public health and safety ini-

Colorado Medicine for November/December 2016

tiatives, more recently the 72-hour mental hold bill,” Johnson said. Both legislators thanked COMPAC for

25


AMA/COMPAC (cont.) the honor and spoke of their willingness to work across the aisle and with physicians to affect good legislation for Colorado patients. “We want to make sure that we work with you to have good health care systems that protect physicians and the relationship with your patients,” Williams said. Following the awards were presentations from distinguished political experts. Floyd Ciruli, Ciruli Associates, provides consulting, strategy, policy management, public opinion research, public relations and management to a host of public policy projects and clients. He gave an engaging presentation drawing on his decades of experiences and thencurrent polls to forecast how the U.S. presidential election will affect candidates and proposals far down the ballot. Richard Deem is the senior vice president of the American Medical Association Advocacy Group. In this capacity, he directs the AMA’s federal, state and private sector advocacy efforts, as well as the organization’s health policy func-

26

tions. He gave a useful perspective of how the election would affect the federal agenda in 2017, as well as House and Senate dynamics, leadership changes, and political realities and aspirations. The elections were bound to influence the policy environment, physicians’ practices and the future direction of health reform. Jerry Johnson, CEO, Johnson Consulting Companies, has worked as a contract lobbyist for CMS for the past 26 years. He applied the analyses from Ciruli and Deem down to the state level to specifically speak about state races and probable issues the legislature will face in 2017. “I thought the panel covered a wide range of information to prepare physicians for the post-election environment – federal and state – with excellent context by the state pollster, a solid assessment of state races by your lobbyist and, hopefully, a useful perspective of the federal policy agenda in 2017,” Deem said.

COMPAC will need support going into 2017 to continue to affect positive change for physicians. To join COMPAC, go to www.cms.org/contribute. n

Join Now! Colorado Medical Political Action Committee Go to www.cms.org/ contribute or call 720-8586327, 800-654-5653, ext. 6327

Colorado Medicine for November/December 2016


ght Greenlioffers proudly Medical

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immediately delivers test results for an informed diagnosis. Improve Patient Care: GreenLight tests serve as a first line of defense, an early warning system for the detection of mental illness. We provide physicians the opportunity to test and establish a baseline for all of their patients. Decrease Risk: Increased regulation and legal scrutiny, especially in prescribing pain medication, absolutely demands documentation of mental health testing to protect your practice. GreenLight provides a permanent detailed record of testing. Generate Revenue: GreenLight tests are typically covered by insurance, with the potential to generate thousands of dollars in additional revenue for your practice each month.

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GreenLight, a division of StratMedical Inc. (866) 602-1778 • info@greenlight.md • greenlight.md

To get started, please visit www.greenlight.md today. Colorado Medicine for November/December 2016

27


Features

Practice transformation Carol Greenlee, MD, FACE, FACP

Engaging clinicians in fixing the flawed health care system The Transforming Clinical Practice Initiative (TCPi) was designed to support more than 140,000 clinician practices as they develop their comprehensive quality improvement strategies. The initiative is one part of a strategy advanced by the Patient Protection and Affordable Care Act (ACA) to strengthen the quality of patient care and spend health care dollars more wisely. It aligns with the criteria for innovative models set forth in the ACA: • Promoting broad payment and practice reform in primary care and specialty care. • Promoting care coordination between providers of services and suppliers. • Establishing communitybased health teams to support chronic care management. • Promoting improved quality and reduced cost by developing a collaborative of institutions that support practice transformation. Many of us in the medical field recognize that the health care system is fragmented, disorganized and inconsistent, and it often seems to work against our efforts to deliver high-quality care. Much of this can be attributed to the design of our health care model and its inability to meet today’s demands. The current model was built around acute care needs with silos of care and physicians carrying most of the responsibility for the quality of care delivered. Asking 28

health care workers to try harder in the current system is not the answer. In fact, it is only because our physicians, nurses and other health care staff work so hard, despite the flaws in the system, that we are doing as well as we are with health care. Instead of pounding on medical care providers to try harder and work harder, we need to change the model and the way we do our work to reduce burden and improve effectiveness. This change in the way we deliver care is referred to as practice transformation. We have needed to improve on our care delivery system for some time, but now with the change in payment models from fee-for-service to more value-based payment, physicians who make needed changes will be financially rewarded for their efforts. In addition, they will likely also find practice more enjoyable and less of a burden. We all strive to provide the highest quality of care, but our best intentions can be lost in the process. Learning ways to build in those good intentions, such as use of team care and standing orders, can result in more consistently getting the results we want. With the new payment models, we need to look at how we are doing on practice parameters (such as quality measures and cost of care) and if those parameters are not where we want them, we need to have a method to improve them. This is about ensuring that our patients get the care they need and that we intend them to have. It is also about helping to eliminate waste that drives costs without adding benefit for our patients. Primary care practices have had help

transforming the way they deliver care for about a decade. They have been testing the best ways to change their work so it is less burdensome and more effective, which involves teamwork. Many of these changes have led to an advanced patient-centered medical home model and new methods of paying for primary care that support the additional team members and efforts. A focus on specialists Now we need to determine what transformation changes will benefit the diverse array of specialty practices and the care they provide to patients. We need to discover what practice elements need to be redesigned and how best to do it. We know that improvements are needed in how we work together, how we share the care of patients and how we communicate with each other. We recognize that everyone will benefit from connected care versus silos but we need to discover what else can be redesigned to help specialty practices provide care better. The Transforming Clinical Practice initiative (TCPi) offers grant-funded support to help practices make these changes. This initiative is funded by the Medicare and Medicaid Innovation Center (CMMI) to test new payment models, such as bundled payments and accountable care organizations (ACOs). When the Medicare Access CHIP Reauthorization Act (MACRA) was passed in early 2015, CMMI recognized that many, if not most, clinicians and their practices were not prepared to successfully meet the new requirements, such as managing their quality and costs to meet benchmark goals. In

Colorado Medicine for November/December 2016


Features response, CMMI devoted funding to this initiative to help practices implement needed changes (transformation) to meet the requirements of the new payment models and improve patient outcomes, reduce unnecessary emergency room visits and hospitalizations, as well as help reduce burnout and improve satisfaction for clinicians. CMMI staff members plan to learn from the practices that participate in TCPi as they share what works and what doesn’t work for care delivery redesign. Get the support you need Specialty practices that participate in TCPi will get the support they need to meet the requirements for the meritbased incentive payment system pathway of the MACRA law and the quality payment program that enacts the law. It also will help practices participate in alternative payment models, such as bundled payments or episodes of care, as well as new models on the horizon.

es improve their referral processes and communications, to allow us to work together in the new models of care and payment, to more effectively meet the needs of patients. TCPi participants will get help selecting specialty measures that best reflect what they do. They will get help in how to look at the data on these measures and work to improve any measures that show gaps. Practices will learn how to look at service utilization data as well as cost data to help them prepare for future opportunities to participate in valuebased payment plans. Medicare is moving toward new value-based compensation models, and so are commercial payers and even Medicaid. These shifts in the way health care will be paid for give us an opportunity to shift the way we practice to one more supportive of our efforts. TCPi supports practices as they make the changes re-

TCPi participation also allows a specialty practice to improve operations and to help determine the best way to do things instead of doing what others think is best. In other words, participation in TCPi helps a specialty clinician and his or her practice drive the bus instead of being taken for a ride on how practice work can be done more effectively and efficiently. It will help practic-

Colorado Medicine for November/December 2016

quired for future success; it provides resources to help with new approaches and provides a platform for clinicians to share what works and doesn’t work. Learn more about TCPi, a national initiative that is available to specialists and primary care physicians in Colorado: www.colorado.gov/health innovation/tcpi. Carol Greenlee, MD, FACE, FACP, is the owner of Western Slope Endocrinology in Grand Junction, and serves as state and national faculty for TCPi. Listen to Greenlee talk with Barbara Martin, RN, MSN, ACNP-BC, MPH, director, Colorado State Innovation Model, and Allyson Gottsman, program manager, Colorado Health Extension System about her practice’s transformation efforts and her work with TCPi: https://youtu.be/ U61sRTsOKkg. n

Join Now!

Colorado Medical Political Action Committee Call 720-858-6327, 800-654-5653, ext. 6327, or email susan_koontz@cms.org

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Features

Pinnacol Assurance offers OpiSafe Rick May, MD, senior medical director Pinnacol Assurance

Pinnacol seeks physician testers to pilot software to help address opioid misuse STORY HIGHLIGHTS • Pinnacol Assurance wants to help Colorado’s health care community meet the formidable public health challenge of prescription opioid misuse. • Pinnacol is working with an opioid management optimization company to offer physicians a free, four-month trial of OpiSafe, a new tool for safe and efficient opioid prescribing. • OpiSafe is designed to simplify opioid prescribing, reduce paperwork and save time. The trial runs through the end of the year. Go to opisafe.com/ pinnacol to learn more and participate.

I recently had the good fortune of hanging out with Dr. John Hughes, CMS Prescription Drug Abuse Committee chair. We discussed his ideas on what can be done to help stem the tide of prescription drug misuse, especially as it applies to injured workers in Colorado, who are commonly exposed to opioid pain management through their workrelated injuries. John has strong feelings about addressing the opioid epidemic in Colorado. 30

He’s seen firsthand the helplessness that some people feel when they find themselves on long-term opioids, yet still in pain.

Yes, we’ve all heard a lot about the problem. I’m here because I’ve spent much of my first year as Pinnacol’s medical director trying to find solutions.

John explained to me that the opioidrelated risks for injured workers can extend far beyond the acute phase of treatment. Normally, we expect that patients with musculoskeletal injuries will improve relatively quickly, with consistently decreasing pain and opioid use. Unfortunately, some patients go the other way and develop hyperalgesia that exacerbates their chronic pain and leads to escalating dosages. Others fall into the dependence trap, where the need for the opioids continues regardless of their pain. Those who are temporarily unemployed during their workplace injury can, in John’s words, “get stuck in the purgatory of chronic pain.” Their initial injury prevents them from returning to work, but then their opioids become a barrier, impairing their function and delaying their return even longer.

Pinnacol Assurance wants to help Colorado’s health care community meet the formidable public health challenge of prescription opioid misuse. We’re committed to making it easier for physicians, medical practices, hospitals and health care facilities to provide great care for our injured workers.

Referring to his occupational medicine practice, Hughes said, “I feel strongly that opioids can be problematic and that people can become not only dependent but helpless in the face of prescribed opioids.” A known issue We all know the stats and figures. Here in Colorado, 63 of 64 counties have seen opioid deaths rise over the past 12 years. Twenty to 25 patients will overdose on opioids today in Colorado, and two or three will die.

Our initial focus is to discover, create and disseminate tools, resources and education that can help physicians comply with CDC prescribing guidelines while better and more efficiently managing patients receiving opioids. That’s a big charge. And this is where you come in. We’re asking physicians in Colorado to work with us to test solutions and tell us if they are useful. Pinnacol offers physicians free trial of opioid-prescribing software Our first opioid improvement pilot started a month ago when we began working with RxAssurance, an opioid management optimization company, to offer physicians a free, four-month trial of OpiSafe, a new tool for safe and efficient opioid prescribing. Through our trial, this cloud-based software is free to all health care professionals and facilities that treat Pinnacol-covered injured workers and begin their trial period by Nov. 30. Also, we’re encouraging trial participants to use OpiSafe for all their

Colorado Medicine for November/December 2016


Features opioid recipients, not just Pinnacolcovered patients. The Colorado Medical Society supports these efforts, and COPIC is awarding points for participation. For the record, Pinnacol has no financial stake in OpiSafe. The OpiSafe tool is designed to simplify opioid prescribing, reduce paperwork and save time, making it easy to adhere to the CDC’s recommendations for opioid prescribing. OpiSafe automatically: • Checks the PDMP database initially and weekly thereafter. • Evaluates patients’ risk for opioid misuse. • Assesses patients’ pain level, opioid use and function. • Schedules and monitors drug screening (if appropriate). • Monitors for opioid-related side effects. • Creates and documents billable events for reimbursement. Greeley physician reports better patient outcomes, time and labor savings “OpiSafe has become an integral part of our practice,” says Jan Gillespie-Wagner, MD, of Northern Colorado Pain Management. “The ability to check the state’s PDMP in seconds and manage narcotic agreements digitally has saved our staff hundreds of hours.” Gillespie-Wagner told us OpiSafe has saved her and her staff enough time that it has allowed her to take on 20 percent more patients. OpiSafe automates PDMP checks and assessments, work that once required a full-time employee. But it’s the improved quality of care and patient outcomes that most animates Gillespie-Wagner. We invite you to join Jan and help us out by trying OpiSafe in your practice. Pinnacol is running our trial of OpiSafe through the end of the year for any physicians who are interested. Please go to opisafe.com/pinnacol to learn more and participate. n

Colorado Medicine for November/December 2016

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Colorado Medicine for November/December 2016


Inside CMS

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

Reviewing 2016: COPIC’s commitment to improve health care As another year comes to an end, there is an opportunity to reflect on what we accomplished and where we can do better. This is an essential part of COPIC’s commitment to health care professionals—the support we provide to improve medicine requires us to constantly assess and improve our own resources and services. And as I think about what happened in 2016, I am proud of the many ways we delivered on our commitment. ACCME “Accreditation with Commendation” status COPIC received the highest level of accreditation from the Accreditation Council for Continuing Medical Education (ACCME). This makes us one of a few medical professional liability carriers to receive “Accreditation with Commendation,” and places us among the ranks of several professional societies, certain state medical societies, and recognized medical schools that have achieved this status. Supporting human resources in the medical community During 2016, COPIC hosted its popular “Risky Practices” program for individuals who handle human resource responsibilities. The one-day program aims to reduce the risk of employment practice litigation, and this year included stops in Colorado Springs, Boulder, Fort Collins and Grand Junction. We received positive feedback from attendees such as: • “Details were given that provided a base for excellence in developing correct policies and procedures.” • “Great conversation. Engaging. Covered wide range of topics, and they were all covered thoroughly.” Grant funding for promising initiatives In 2016, the COPIC Medical Foundation provided grants that helped fund the following: • The Patient Reported Outcomes Program at the Rocky Mountain MS Center at the University of Colorado Anschutz Medical Campus. • A classroom-based performance-improvement program called “Foundational Curriculum in Quality and Safety” as part of St. Joseph Hospital’s Graduate Medical Education. Colorado Medicine for November/December 2016

• UTI Decide, a pilot program aimed at increasing the correct diagnosis of urinary tract infections, part of the Division of Health Care Policy and Research at the University of Colorado at Denver. • Kidney Care Kits pilot program overseen by the Colorado Chapter of the National Kidney Foundation. • A pilot program focused on hand and eye motion analysis to assess procedural competency on behalf of the Denver Health Foundation. Steadfast legislative advocacy Every legislative session, health care is at the forefront of issues under debate. COPIC remains diligent in our efforts to monitor legislation and review bills that have the potential to impact health care. These efforts are done in coordination with key partners such as the Colorado Medical Society and the Colorado Hospital Association. During the 2016 Colorado legislative session, we reviewed approximately 50 proposed, amended and draft bills of interest. Of the 50 bills, we provided guidance or input on 20 bills and our team offered amendment language on 10 bills. COPIC’s involvement also extends into the regulatory world, where we work directly with organizations such as the Colorado Medical Board (CMB) and the Colorado Department of Regulatory Agencies. Our unique role in health care enables us to provide trusted, valued input on matters that include oversight of allied health professionals (CMB Rule 400) and the delegation of responsibilities (CMB Rule 800). Other COPIC milestones in 2016 • More than 6,900 physicians have enrolled in our 3Rs Program. • More than 1,800 physician residents have participated in our Resident Rotation. • The COPIC Medical Foundation celebrated its 25th anniversary. As we prepare for 2017, COPIC’s commitment to health care professionals will continue to guide our efforts to support improved care and patient safety. We look forward to serving as a trusted partner for years to come. n

33


Inside CMS

Reflective writing is an important component of the CU School of Medicine curriculum. Beginning in the first semester, medical students write essays, stories or poetry that reflect what they have seen, heard and felt. Reflections is edited by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is dedicated to the memory of Henry Claman, MD, Distinguished Professor of the University of Colorado, founder of the Arts and Humanities in Healthcare Program, and original co-editor of this column.

to make copies of research forms. I glanced up as I walked back to my office. The girl’s knees bounced unnaturally with the compressions.

Eric Sasine University of Colorado School of Medicine

Eric Sasine is a second-year medical student at the University of Colorado School of Medicine. He grew up in Evergreen, Colo., and graduated from the University of Colorado Denver with a bachelor’s in history. Prior to starting medical school, Eric worked as a research assistant at Children’s Hospital Colorado. He enjoys teaching anatomy lab, collecting books and taking walks with his wife around Denver’s historic neighborhoods. Eric loves working with children and plans to pursue a career in pediatrics.

The copier I was standing at the trauma-station copier when the ambulance arrived. As warm sheets of paper stacked into the tray, paramedics burst into the emergency department. A mustached EMT at the front shouted the report as they rolled into the trauma room across from where I stood: “Four-year-old female found down by mother after a nap—unresponsive and asystolic at scene.” The team went into action. Nurses discarded syringe wrappers on the floor. Technicians and residents hoisted the girl from the ambulance gurney to the hospital pram. Epinephrine was given at the attending’s shouted orders. All the while, various staff took turns at chest compressions. As a research assistant, I was just a bystander. I was only there 34

I sat at my computer and picked my fingertips nervously. I had only been present at a patient’s death once before. A couple minutes passed. The nearby computers normally occupied by doctors and nurses – a dozen stations, maybe more – were vacant. And then they returned, their faces silent, defeated. No one said anything. At last, a phone rang and a resident proceeded with the consult she had been expecting from before. Soon the sound of mouse clicks, keyboards and a growing discussion between an attending and a fellow brought the emergency department back to its regular pace. I returned to the copier to retrieve a form I had printed. Curtains had been drawn in front of the trauma room. Dr. L, the attending physician who had led the resuscitation effort, was speaking with a nurse just outside the room. I then saw why Dr. L was still there: behind me, escorted by one of the triage nurses, the girl’s mother approached. She had followed the ambulance and had been delayed by traffic. In an instant, I saw that she did not know the awful truth. Though tearful, she maintained good posture and followed the nurse’s guidance optimistically. Dr. L, a small and spirited woman I admired, had to tell her. She did so the only way one can: she told her all that could have been done was done, that it was too late, and that her child had passed. The mother, not much older than twenty, sank against the trauma desk. One of the techs retrieved a rolling desk chair. The woman sat in it, her face the picture of agony – redness filling her cheeks, a pained grimace from which choked sobs erupted in staggered intervals. Dr. L hunched toward her. She cried and put her hand on the weeping mother’s shoulder. I grabbed the documents I had printed and walked back to my Colorado Medicine for November/December 2016


Inside CMS office, a lump rising in my throat for the woman and her child. Some minutes passed before Dr. L returned to her computer. She wiped tears from her cheeks and returned to charting. Since starting medical school last year, I find myself obsessing on virtues and vices in clinicians. While my habits are beginning to form, I feel compelled to emulate the admirable traits I see in others. In Dr. L, I witnessed something that resonated: she did not hide behind professional boundaries. She did not bottle her feelings. She cried with the mother. Some may argue that health care professionals ought to maintain equanimity â&#x20AC;&#x201C; that to cry is to send patients the signal that the situation is as bad as, or worse than, they feared. But at times like this, in which the worst that could happen does, to not empathize is impossible and to not display emotion would be inhuman. When Dr. L stood hunched over the mother, both women crying, I saw a symbol of the underlying humanity I hope to bring to my career in medicine. Dr. L did not have the lion-proud posture I had seen in oil paintings of William Osler. She did not have the faux omniscience I had seen in Hollywood caricatures of physicians. And she was far from the show-no-weakness bravado I had encountered on the medical school application trail. But she displayed the basic empathy and humanity upon which the finest care is built. As I transition from research to clinical medicine, from research forms to crying mothers, I will follow Dr. Lâ&#x20AC;&#x2122;s example. n

All friends of medicine are eligible to participate. Email susan_koontz@cms.org or call 720-858-6327 or 800-654-5653, ext. 6327 Colorado Medicine for November/December 2016

35


Inside CMS

CMS foundation helping students Michael J. Campo, PhD, support staff Colorado Medical Society Education Foundation

CMS Education Foundation 2015-2016 scholarship recipients STORY HIGHLIGHTS • The Colorado Medical Society Education Foundation gives out annual scholarships to first-year medical 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 to the CMS Education Foundation.

First-year students from the University of Colorado School of Medicine, Karlie Gandee, Margaret Harrison and Kathryn Kalata, were each awarded scholarships from the Colorado Medical Society Education Foundation (CMS EF). Gandee and Harrison each received $5,000 and Kalata received $4,000. CMS EF, a 501(c)(3) private foundation, has a mission to render financial support to select first-year medical students at the University of Colorado School of Medicine based on criteria such as the student’s financial status, academic achievement and desire to practice in rural or underserved areas upon graduation. Beyond scholarships, CMS EF supports education programs such as the Colorado State Science and Engineering Fair and the Education Program. As CMS EF Board Chair Jerry Appelbaum, MD, FACP, stated, “The CMS EF Board is thankful for the generous support and financial contribution from 36

CMS members who make our education scholarships possible.” The scholarship recipients are as follows. Karlie Gandee graduated first in her high school class of eighteen knowing she wanted to become a physician. At that time she also wanted to get as far away from her small hometown as possible, so she attended the University of Miami for two years where she was given the opportunity to study abroad in Europe. While living in Prague, she realized how much she missed her family and the small town community in which she grew up. She transferred to Colorado School of Mines with the continued goal of becoming a doctor. With the realization of how important her rural community was to her, her new aspiration was to return to it after finishing medical school. Margaret Harrison is a Colorado native and a first generation college graduate. She is thrilled to have been given the opportunity to pursue her goal of becoming a well-rounded, dedicated, humanitarian physician at the University of Colorado. Her love for science began many years ago and has since grown into an intense passion for medicine and altruism. To get to this point, she has poured herself into every endeavor: dedicating time to academics, community

service and jobs that have captivated her interest. She believes her background and experiences will serve as a strong foundation to build upon throughout school and well into the future as she continues to learn and grow as a person and as a health care provider. She says she is sincerely thankful for the granting of this scholarship, because without significant financial support she would not be able to realize her dream. Kathryn Kalata grew up in Wisconsin and studied Biology at Northwestern University. As a medical student, she will participate in CU-UNITE and is interested in serving women and children lacking access to health care. After identifying needs in an underserved community consisting mainly of immigrants and refugees, she is creating a health curriculum for an Aurora elementary school and is helping families overcome barriers to health care, such as lack of insurance, language barriers, and other social determinants. She also started a project on racial disparities in infant mortality in which she and other health professions students are researching barriers to prenatal care for African American women. This is being done through community-based participatory research involving members of the affected community to discuss and address disparities. She is also looking forward to pursuing a Masters in Public Health in the coming years to learn about influencing the health of underserved populations on a larger scale. n

Colorado Medicine for November/December 2016


Caring for the injured

7 Reasons to participate in the Workers’ Compensation System Colorado’s workers’ compensation system is considered a model for other states because of its comprehensive and frequently updated guidelines, accessibility and fee structure that pays more than Medicare and private insurers. Yet despite many benefits, a recent survey among CMS members revealed a number of misperceptions by providers who don’t participate in the system. Here are seven reasons to participate in the Colorado workers’ compensation system.

1

The system is continually improving.

2

Increased value of participation.

3

Get support for patient education and shared decision-making.

4

Bill for documenting a patient’s functional progress.

The CMS Workers’ Compensation and Personal Injury Committee (WCPIC) advocates for Colorado physicians who care for injured workers. It is the mission of the WCPIC to reduce administrative hassles associated with the workers’ compensation system and to work with the Division of Workers’ Compensation (DOWC) to seek improvements in education, public outreach, research, legislation, and patient treatment. WCPIC has been actively involved in these enhancements.

Special codes with additional fees exist for completion of required paperwork. The DOWC fee schedule reimburses at a level higher than most health insurance carriers in Colorado. Overall, physicians are compensated fairly for care of the injured workers.

Additional fees through increased E&M coding are available for physicians who spend time with patient counseling and monitoring. DOWC recognizes the complexity of work and reimburses accordingly.

The new Quality Performance and Outcomes Payments section of Rule 18 - Medical Fee Schedule allows certified providers* to bill for documenting a patient’s functional progress, which includes providing a functional assessment and psychological screen. *Certification requirements include attendance at or accreditation in Level I or II, attendance of a QPOP session, a passing score on the QPOP examination, and submission of a sufficient report.

5

Workers’ comp expands your practice.

6

Colorado Workers’ Compensation emphasizes the protection of workers in the work environment.

7

Neither Level I or Level II accreditation is required.

Workers will bring themselves and their families back to your practice for their personal health care needs. Often you will find non-work related issues that patients need to have addressed; i.e. hypertension, smoking cessation, thyroid disease, routine health screening, mammography and colonoscopy. DOWC continues to develop innovative programs to decrease worker injuries.

Level II accreditation is not required to treat patients in the Colorado Workers’ Compensation system. The system works just as well when a physician forms a good relationship with those who specialize in treating injured workers such as an occupational medicine group, PMR group or pain management group. This works particularly well in a rural area where the local physician manages the clinical issues and gets the specialist’s input to guide the workers’ comp case and perform the impairment rating.

FOR MORE INFORMATION:

Go to www.cms.org to learn more about these issues, follow our work and learn how you can get involved. We want to hear from you and are available to answer your questions. Contact CMS President Katie Lozano, MD, FACR, at president@cms.org.

Colorado Medicine for November/December 2016

Colorado Medical Society | 7351 E. Lowry Boulevard, Suite 110, Denver, CO 80230-6083 | (800) 654-5653

37

www.cms.org


Departments

medical news Guidelines for providing patients with disabled parking placards A letter from Mindy Siegel, MD, Colorado Advisory Board for Persons with Disabilities As part of the Governor-appointed Colorado Advisory Council for Persons with Disabilities, we have been directed to focus our efforts on disabled parking. For our marketing campaigns we have distributed signs that say “Think of Me ... Keep It Free,” and handed out various giveaways including car window clings that say “No Plates, No Placards, No Parking.” With our education of the public we are also hoping to refresh or clarify the laws for practitioners (MD, DO, physical therapists and chiropractors), who can sign forms providing the public with the ability to obtain permanent or temporary parking placards or plates.

TABLE 2 Placard Type Permanent

Length A condition that is not expected to change within a person's lifetime, given the current state of medical or adaptive technology.

Extended

A condition that is not expected to change within 30 months after the issuance of an identifying figure, given the current state of medical or adaptive technology. Renewed every third year.

Temporary (lower extremity surgery)

A condition that is expected to last less than 30 months after the issuance of an identified plate or placard, given the current state of medical or adaptive technology. 90-day renewal.

Short Term

A condition that is not expected to last more than 90 days after the issuance of a placard. Can be renewed one time.

TABLE 1 Concern Examples Mobility - cannot walk more than 200 feet Polio, ALS, muscular dystrophy without stopping to rest Assisted mobility - uses mobility aids Lower-limb amputations, ALS, (wheelchairs, walkers, canes, scooters, multiple sclerosis, lower-limb crutches) surgery Respiratory - must have a spirometer measurement of less than 1 liter or artificial oxygen tensions less than 60 mmhg on room air

COPD, cystic fibrosis

Oxygen

Uses portable oxygen 24 hours a day

Cardiac - class 3 or class 4 according to Unable to carry on any physical standards set by the American Heart Assn. activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. Other persons who are severely limited in their ability to walk due to an arthritic, neurological or orthopedic condition 38

Muscular dystrophy, multiple sclerosis, lower limb amputations, cerebral palsy, strokes

Accessible plates and placards: Who gets these signs? Not everyone qualifies! If you are giving these to every person with a disability you may be in violation of the law. Someone who is blind, has PTSD, has a hearing impairment or those with some developmental disabilities (autism) – all would need to be accompanied by a physical disability that limits their ability to walk! Disabled parking plates and placards are only available to those who have at least one of the following: concerns listed in Table 1. Many physicians are under the impression that anyone with a disability qualifies – or that they qualify for a three year minimum placard. Know the timelines and assign the appropriate type of placard (Table 2). Please know that you are certified under penalty of perjury – providers who knowingly misuse or make false statements to help someone obtain or re-

Colorado Medicine for November/December 2016


Departments

medical news

tain a plate or a placard may be fined up to $500,000 for a class 4 felony or $1,000 for a class 1 misdemeanor. DO NOT leave signed forms on your counter or give them out prior to a surgery. If the person cancels their surgery but obtains a placard anyway – or gives the signed form to a friend to obtain a plate or placard – you are liable by law. Local DMV offices take appointments that are easy to schedule and remove the need to stand in line for those who cannot. Place yourself in the position of those who are disabled. Often there are no spaces available to those with disabilities, especially those that need extra space for loading and unloading wheelchairs. Please feel free to contact the Colorado Advisory Council for Persons with Disabilities with any questions or concerns at info@ ColoradoDisabilityCouncil.org. n

Serving the Continuing Medical Education needs of Colorado physicians Your bridge to quality improvement in health care

Accredited CME is education that matters to patient care. For more information contact the Colorado Medical Society CME office at 720.858.6309

Division of Insurance approves health insurance plans for 2017 The Colorado Division of Insurance has approved 277 health insurance plans for the individual market in 2017 and 667 plans for the small group market. The individual market (plans not connected to an employer) makes up about 7.7 percent of the Colorado population who have health insurance (around 450,000 people), while at least 51 percent of Coloradans get their insurance through a small or large employer. DOI reviews the cost of health insurance premiums and checks that they meet state and federal regulations. They do not set insurance premiums. Premiums for individual plans (not from an employer) will increase by 20.4 percent on average. An individual’s age and residential location will impact his or her premium, making it higher or lower from the average. In the small group market (health plans for small employers), increases are more moderate, averaging 2.1 percent. The DOI attributes this to insurers in this market having more experience working with this market and a better understanding of how to price their products. Colorado consumers who receive tax credits for their insurance may see their premiums decrease. A person who currently receives a tax credit for their 2016 insurance and who enrolls in the same plan for 2017 will see an average decrease of 11 percent for their subsidized premium, despite actual premium increases for plans. The Division of Insurance is engaging a workgroup of representatives from Colorado hospitals, physicians and insurance companies to address increasing health care costs. This group will release its recommendations in December.

fewer carriers offering fewer plans on the individual market for the coming year. UnitedHealthcare and Humana Insurance are not offering individual plans, while Anthem Blue Cross and Blue Shield is not offering its PPO (Preferred Provider Organization) individual plans, and Rocky Mountain Health Plans is pulling back all of its individual plans aside from offerings in Mesa County. These changes affect 92,000 people. A new entrant into the 2017 individual market is Bright Health Plans. Here is how the plans break across the individual and small group markets, both on- and off-exchange. Individual Market (plans not from an employer) • 277 plans available (413 in 2016): 132 on-exchange; 145 off-exchange • 11 insurance carriers total, including seven selling on-exchange plans (in 2016: 15 carriers total, with 10 selling on-exchange plans) Small Group Market (plans for small employers) • 667 plans available (660 in 2016): 141 on-exchange; 526 off-exchange • 13 insurance carriers total including five selling on-exchange plans (in 2016: 13 carriers total, with five selling on-exchange plans) For more information, visit the DOI’s health insurance website, www.colorado. gov/pacific/dora/health-insurance-0. n

CMS .ORG ORG CMS CMS CMS.ORG ORG Colorado Medical Society

As reported previously, there will be

Colorado Medicine for November/December 2016

39


Medical news (cont.)

Medicaid “Go Live” date postponed until March 1, 2017 The Colorado Department of Health Care Policy and Finance announced that the conversion date for moving to the new Medicaid Management Information System (MMIS), the Colorado interChange, has been postponed until March 1, 2017. This will allow more time for providers to complete the revalidation process, and allow additional time for training on the web portal as well as testing. The Department wants to ensure that providers are not adversely impacted by the system change. Providers should continue to use their current processes for submitting claims, prior authorization requests and provider enrollment updates to the department. Claims will continue to be processed and paid; there will be no delay this month. Providers should also continue efforts to revalidate. If you have not yet started the process, CDPHE urges you to start immediately. Go to www.colorado.gov/hcpf/ provider-enrollment to find resources and get started. If you have completed your revalidation you are encouraged to begin the online training courses for use of the new web portal. If you missed a live session, the recorded sessions will be available online. Additional provider resources can be found here: www. colorado.gov/hcpf/provider-resources. n

Support the CMS Foundation The Colorado Medical Society established the Colorado Medical Society Foundation (CMSF) as a 501(c) 3 organization in 1997. We strive to administer and financially manage programs that improve access to health care and health services to improve the health of Coloradans.

Consider giving a tax-deductible donation of $25, $50, or more to help CMSF continue its mission. Questions? Call 720-858-6310.

40

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.

➤ PROPERTIES MEDICAL WEIGHT LOSS CLINIC (OBESITY MEDICINE) FOR SALE/LEASE IN SOUTHEAST DENVER This established and reputable practice is being offered for sale or lease by a retiring, double-board certified physician. Located close to Highlands Ranch in an established neighborhood, in a professional medical building. With over 20 years of practice, this clinic grosses over $430K in revenue operating with 18 hours for Care Providers per week. Promising room for growth in this 100% cash practice. Please call 303-913-0720 to inquire or email at inquiries.medicalweightloss@gmail. com.

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, call Tim at 720-858-6306 or email tim_yanetta@cms.org

WESTMED FAMILY HEALTHCARE IS SEEKING A PART-TIME FAMILY PHYSICIAN Westmed Family Healthcare is a well-established Family Practice. We are currently seeking a part-time Family Physician to join our busy practice in a much sought-after location in Westminster Colorado to do strictly outpatient care with no OB. Westmed Family Healthcare offers a competitive salary, excellent benefits including a one-in-ten call schedule. Your work/life balance will be enhanced by a flexible work and call schedule. Please submit your resume to: lori@westmedfamilyhealthcare.com Lori Mehta Practice Manager, Westmed Family Healthcare Colorado Medicine for November/December 2016


Compliments of:

Free Statewide Prescription Assistance Program The exclusive Rx program of the Colorado Medical Society

Attention! New Higher Discounts!

RETAIL PRICE

MEMBER PRICE

MEMBER SAVINGS

MEDICATION

QTY

Losartan 25mg

30

$43.19

$11.66

73%

Azithromycin 250mg Tab

6

$39.99

$18.68

53%

Amlodipine 5mg

30

$40.19

$9.84

75%

Hydrocodone/APAP 10-325mg 30

$23.09

$13.51

41%

Lorazepam 1mg

90

$55.99

$24.27

56%

Oxycodone/APAP 5-325mg

30

$23.99

$11.41

52%

Tramadol HCL 50mg

60

$34.69

$16.82

51%

NOTE: Our price is the average price members paid on that prescription during the month of January, 2015. Retail price was obtained by calling CVS/pharmacy. Pricing varies by pharmacy and by region. Prices are subject to change.

You can help by encouraging your patients to print a free Colorado Drug Card at:

www.coloradodrugcard.com

Customize the Colorado Drug Card for your practice!

Program Highlights: Free to all patients. Cards are pre-activated, no sign-up forms needed. Discounts on brand and generic medications. Helps patients that have high deductible plans or are uninsured. Reduces patient callbacks. Enhances physiciansâ&#x20AC;&#x2122; ability to treat patients with drugs that may not otherwise be affordable. HIPAA Compliant

For more information or to order your free personalized Colorado Drug Card please contact:

Milton Perkins - Program Director Colorado Medicine for November/December 2016 mperkins@coloradodrugcard.com Free Rx iCard

â&#x20AC;˘ 720-539-1424

41

Colorado Drug Card


Features

the final word Paul Tauriello, director, Division of Workers’ Compensation

Celebrating 25 years of the DIME program This year marked the 25th anniversary of the Colorado Division of Workers’ Compensation Independent Medical Examination (DIME) program. To honor this milestone, on Oct. 20 we had the privilege of hosting our firstever DIME Appreciation Soiree, sponsored by the Colorado Medical Society at the governor’s mansion. The purpose of the event was to honor over 150 current and past DIME physicians for their years of service on the panel, and to let them know they are appreciated for the service they provide to the citizens of Colorado. Their dedication has not gone unnoticed. For those unfamiliar with the DIME program, the process was implemented to provide an independent examination of medical issues relating to maximum medical improvement and impairment disputes in a workers’ compensation claim. A party to a claim must first obtain a DIME if they wish to dispute a treating physician’s conclusions at hearing. The process was intended to reduce litigation, and it has proven effective since inception. In fact, statistics from 2015 show 3,205 DIMEs were processed and only 6.08 percent of those cases actually continued on to a hearing before a judge. The impact this has made in the workers’ compensation system is significant, as it has reduced claims costs and made the process more efficient to all parties involved.

TOP: CMS staff and members mingled with DOWC staff at the DIME Appreciation Soiree on Oct. 20. From left to right: CMS CEO Alfred Gilchrist; Daniel Sung, DOWC manager of medical policy; Lynn Parry, MD; CMS President Katie Lozano, MD, FACR; Paul Tauriello, DOWC director; and CMS President-elect M. Robert Yakely, MD. BOTTOM RIGHT: Kathryn Mueller, MD, was humbled to receive special recognition for her work as DOWC medical director to improve the physician experience in treating injured workers. BOTTOM LEFT: Attendees enjoyed a lovely evening. From left to right: Ranee Shenoi, MD, and Kathy MacCranie, MD.

The success of the DIME program would not be possible without our invaluable partnership with the participating physicians across our state. The Colorado Medical Society has been an instrumental part of this relation-

ship through their support in educating physicians and their commitment to improve the workers’ compensation health care system. It is our hope that events like the DIME Appreciation Soiree help promote our common goal

42

of cultivating the best quality health care in Colorado. The Division values the relationship we have developed with CMS, and we look forward to our continued partnership in the future. n

Colorado Medicine for November/December 2016


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November-December 2016