Nov-Dec-13

September/October 2013 November/December 2013

Volume 110, Number 6 5

Right Here Right Now! CMS President John Bender, MD, FAAFP

Colorado Medicine for November/December 2013

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Colorado Medicine for November/December 2013

contents Nov/Dec 2013, Volume 110, Number 6

Features. . .

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Cover story

Right here, right now, there is no other place I want to be . . .

Newly inaugurated CMS President John L. Bender, MD, FAAFP, channels lyrics from the Michael Edwards song to communicate the profound opportunity he sees for the House of Medicine to usher in the new age of health care right here in Colorado. Read more on page 6.

Inside CMS

CMS Annual Meeting–Read more about the highlights of this year's annual meeting in Vail: • Farewell Address from Dr. Kief . . . . . . . . . . . . page 8 • Election results . . . . . . . . . . . . . . . . . . . . . . . . . . page 11 • COMPAC/AMA luncheon . . . . . . . . . . . . . . . . page 12 • Liability climate change . . . . . . . . . . . . . . . . . . page 18 • Prescription drug abuse panel discussion . page 21 • Honors and awards . . . . . . . . . . . . . . . . . . . . . . page 32 • Annual meeting not all business . . . . . . . . . . page 34 • Medical student activities . . . . . . . . . . . . . . . . page 35 14

Legislative shift–Read how the September recall elections could spur a move to the middle on hot button issues.

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Political training–COMPAC, AMPAC and CAFP collaborate to teach physicians how to be effective advocates.

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Governor's Rx Abuse program–CMS applauds launch of Colorado Consortium for Prescription Drug Abuse Prevention.

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Covering the underserved–Medical students champion cause of expanding specialty access to the underserved.

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Physician practice innovation–RAND releases results from study of efficient delivery and payment models.

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Patient Safety Leadership Conference–Attendees discuss burnout in health care and its effect on patient safety.

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Executive Office Update

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ICD-10 update

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Prior Authorization Task Force

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Maintenance of licensure survey

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Reflections

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COPIC Comment

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Departments

Take the Choosing Wisely challenge–Learn to strengthen relationships with patients and improve health care delivery.

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Final Word–John Hughes, MD, discusses reducing drug abuse while preserving access to care for patients in need.

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Medical News

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Classified Advertising

Colorado Medicine for November/December 2013

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

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C OLOR A D O M EDICA L S O CI ET Y 7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902 (720) 859-1001 • (800) 654-5653 • fax (720) 859-7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and CONNECTION

2012/2013 Officers John L. Bender, MD, FAAFP

President Tamaan Osbourne-Roberts, MD President-elect Kay D. Lozano, MD Treasurer M. Robert Yakely, MD

Speaker of the House Brigitta J. Robinson, MD

Vice-speaker of the House Alfred D. Gilchrist

Chief Executive Officer Jan M. Kief, MD

Immediate Past President

Board of Directors Susan Bauer, MS Amy Beeson, MS Charles Breaux Jr., MD Leslie Capin, MD Joel Dickerman, DO Naomi Fieman, MD Carolyn Francavilla, MD T. Casey Gallagher, MD Jan Gillespie, MD Johnny Johnson, MD Richard Lamb, MD Lucy Loomis, MD Randy Marsh, MD Gary Mohr, MD Christine Nevin-Woods, DO Edward Norman, MD Daniel Perlman, MD Lynn Parry, MD Bianca Pullen, MS Scott Replogle, MD Floyd Russak, MD Ranee Shenoi, MD Stephen Sherick, MD

Julia Tanguay, MS Michael Welch, DO Jennifer Wiler, MD Harold “Hap” Young, MD AMA Delegates A. “Lee” Morgan, MD M. Ray Painter Jr., MD Lynn Parry, MD Brigitta J. Robinson, MD AMA Immediate Past President Jeremy Lazarus, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Mark Laitos, MD Tamaan Osbourne-Roberts, MD CMS Connection Mary Rice, President

COLORADO MEDICAL SOCIETY STAFF Executive Office

Alfred Gilchrist, Chief Executive Officer, Alfred_Gilchrist@cms.org Dean Holzkamp, Chief Operating Officer, Dean_Holzkamp@cms.org Dianna Mellott-Yost, Director, Professional Services, Dianna_Mellott-Yost@cms.org Tom Wilson, Manager, Accounting, Tom_Wilson@cms.org

Division of Communications and Member Benefits

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

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Health Care Policy

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

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

Division of Government Relations

Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org

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

Printed by Spectro Printing, Denver, Colorado

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Colorado Medicine for November/December 2013

Inside CMS

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

The evil twins of physician workplace dissatisfaction A growing body of research confirms what most physicians are already painfully aware of, if not routinely experiencing: there is a sharp decline in professional satisfaction correlated with burnout and its equally evil twin, the increased risk of medical errors. A great deal is being done in Colorado, at Duke University and at the American Medical Association to address these evil twins, but more attention is urgently needed at the policy, institutional, cultural and personal levels.

The Colorado Medical Society collaborated recently with the AMA and the researchers at Rand Corporation to assess the contemporary challenges physicians face and the relationship between professional satisfaction and the delivery of patient care. The report, released in October and available at www.cms.org, affirmed the common-sense notion that the same factors drive work satisfaction inside and outside the medical workplace, and include concepts like fairness, positive incentives and the removal of barriers to optimal care. Current attempts to motivate physicians may seem to favor the stick over the carrot, much like the admonishment on the poster by the office copier: "The beatings will continue until morale improves."

The AMA-RAND study was drawn from interviews with a range of specialties and practice settings across the country, including Colorado. The report proposes actions to be taken by payers, employers, hospitals, colleagues and others to reverse the dangerous and unsustainable spiral of professional dissatisfaction: • Address quality concerns that simultaneously improve care to pa-

tients and improve satisfaction and make this a number 1 priority.

• Put a laser beam focus on addressing the issues with EHRs (this is right up there with addressing quality concerns).

• Define and confirm shared values with practice leadership.

• Increase opportunities for collegiality.

• Address negative consequences of what physicians see as “pressure to do more” by giving attention to work quantity and pace of work.

• Strive for stability of well-trained, trusted and capable staff.

• Ensure fair payment arrangements that align with good patient care.

• Provide a knowledge base and resources for internal physician practice improvement.

At our recent annual convening of the Patient Safety Leadership Conference, a joint effort between the Colorado Hospital Association, Colorado Medical Society and our friends at COPIC (see related article on page 28), Duke psychologist and professor Bryan Sexton, Ph.D., presented a deeper analysis into the neuropsychology of burnout and why physicians suffer that risk at greater rates than other professionals.

Sexton got into physicians' collective prefrontal cortex and outlined the top five workplace triggers: condescension and lack of respect, being held to unrealistic deadlines, being treated unfairly, being unappreciated, and not being heard. One can almost hear the neurons firing and exploding.

Not surprisingly, physicians in specialties on the front lines such as emergency medicine, general internal medicine and family medicine are at greatest

Colorado Medicine for November/December 2013

risk. Studies also find what every physician intuitively knows: you work longer hours and experience more difficulty balancing work and personal life than your professional counterparts.

While higher levels of education and professional degrees appear to reduce the burnout risk in other professions, a medical degree increases that risk.

All of these responses translate into less sleep, which the Duke experts warn results in a significant loss of memory capacity, the retention of bad memories and the deterioration of good ones, not to mention the downstream health risks.

While the CMS board of directors and the AMA will help to address longerterm structural remedies, Sexton’s short-term recommendation is to focus on finding three positive things every day, and committing them to memory.

Given all the wonderful things physicians do every day to help patients who are in pain, sick or injured, locking far more than three into the memory bank is, well, a no-brainer.

We’ll continue to focus on preserving your relatively stable liability climate, eliminating delivery system hassle factors, and advocating for fair payment that rewards good care. Be watching next year for the unveiling of our Work and Well-Being Toolkit designed just for physicians by the Behavioral Health and Wellness Program at the University of Colorado School of Medicine.

Let me know how you are doing by emailing me at Alfred_Gilchrist@cms. org. Your perspective is important to us. n 5

Cover Story

Right Here Right Now! CMS President John Lumir Bender, MD, FAAFP

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Colorado Medicine for November/December 2013

Cover Story I was alive and I waited, waited I was alive and I waited for this Right here, right now There is no other place I want to be Right here, right now Watching the world wake up from history.

– Lyrics from Right Here, Right Now, by Michael Edwards Dear Physician, Salutations! Today, I ask you to take a moment to consider the profound opportunity our House of Medicine has in ushering in the new age of health care right here in Colorado. The Affordable Care Act is the “law of the land” as House Speaker John Boehner proclaimed last year upon learning the Supreme Court’s decision to uphold the individual mandate. Yet, as I stressed to the physician attendees at the CMS Spring Conference in Vail in May, assembly is required; although Obamacare exists in statute, it is hardly built as a working, functioning construct for health care reform.

In fact, 2014 will see significant changes for us all, not only as the individual mandate for health insurance rolls out, but also with the implementation of the health insurance exchange projected to add 250,000 people to the list of insured and Governor Hickenlooper’s expansion of Medicaid projected to add 160,000 people to Medicaid. And although these newly insured 410,000 people make up a little less than half of the total uninsured in the state of Colorado, there does seem to be a daunting challenge before us as we learn how physicians will supply the labor necessary for this increased demand.

I am optimistic for physicians in Colorado, and the reason has less to do with Obamacare or the Medicaid expansion, and more to do with market forces that have already been in play for some time.

Health care is undergoing profound changes, especially in the last decade as we transition from a 1970s paper-based, cottage age industry into an information age, digital delivery system. We found that scientific breakthroughs in

pharma and surgery, although impressive, have had less impact on the business of medicine than the impact of the Internet and electronic health records.

And yet we have not even felt but the tip of the iceberg in health care transformation.

The reality is, we have never been positioned so well to leverage technology to lower costs, improve outcomes and become more efficient. Although some may question whether they are truly faster, more efficient or happier in the digital health care world, the fact remains that coordinated team-based care capable of managing entire populations is now realistic through an electronic medical record, and disruptive innovators are finding new ways to address health care access problems that have plagued our state for years.

Having said that, new computer technologies by themselves do not make us more efficient or capable of magically seeing an additional 410,000 people.

Typically, new technologies require new business models (translation: payment reform) and changes in regulations.

Primary care physicians are beginning to see the light at the end of the tunnel with Medicaid. Federal dollars that “bump” Medicaid rates to Medicare rates, Regional Collaborative Care Organizations (RCCOs) right here in Colorado that pay physicians per member per month care coordination fees, and faster claims processing have produced a system that is showing a 10-15 percent reduction in global health care costs!

As CMS president, I will seek to see that the gains primary care physicians are now enjoying that make Medicaid

a viable payer are extended to specialty care. The three asks for my Presidential Medicaid specialist payment reform platform: 1. Pay for telemedicine in all its forms, not just hospital-based technologies, but also for asynchronous, remoteonly visits of cognitive consultations.

2. Enact into statute legislation calling for direct RCCO contracting with specialists; these are specialists who agree to integrated care delivery with health information exchange, referral tracking through iNEXX, etc.

This could be increased reimbursement or gain-sharing, but probably a combination of both. Currently RCCOs are not allowed to contract directly with specialists, and even if they did, there is no payment reform they can offer.

3. Health Care Policy and Finance to pay for Medicaid beneficiaries to have their procedures in private sector ambulatory surgery centers.

Nothing else will compel private sector specialists in Colorado to agree to take more Medicaid in 2014 than this one ask, and nothing else will show such an immediate decrease in costs and return on taxpayer dollars.

Please feel free to share your ideas with me for the Medicaid expansion and how to make it work in Colorado. I can be reached by e-mail at jlbender@ miramont.us.

Sincerely, John L Bender, MD, FAAFP n

Join Now! Colorado Medical Political Action Committee

Colorado Medicine for November/December 2013

Call 720-858-6327 or 800-654-5653, ext. 6326 or e-mail susan_koontz@cms.org 7

Features

Farewell address Jan Kief, MD, CMS Immediate Past President

Outgoing CMS president Dr. Jan Kief thanks delegates Mr. Speaker, fellow Colorado Medical Society members, staff and guests, Thank you for the opportunity to address you for the last time as your president. I will be leaving you in very good hands as I have worked with Dr. Bender this year and know he will be an excellent leader for CMS. The only words adequate to describe this year are incredible and inspirational.

Physicians are resilient. They are always present in their communities in times of need. This was quite evident recently in northern Colorado, Boulder, Estes Park and Aurora with the horrible flooding that occurred. My heart goes out to you and your communities and thank you for always being there.

There has been so much progress and many activities and accomplishments at CMS this year. One only needs to read the board reports, Colorado Medicine or check our website to see the great work that has been done by CMS staff and thousands of hours of physician work.

I want to highlight a few of the initiatives and issues that have meant the most to me. My theme, REV: Relationships, Evolution and Voice has guided my actions and yielded success as we have worked on these issues.

I really appreciated the opportunity to be at the state Capitol this legislative session, interacting frequently with our legislators on many issues. We 8

advocated for Medicaid expansion and reform in accordance with our CMS vision of access to health care for all Coloradans. We worked diligently to get the Prior Authorization bill passed to simplify your ability to get needed treatments for your patients. I advocated that we need “less red tape Jan Kief, MD, CMS Immediate Past President, thanks the and more real-time CMS Board with one last reminder of her REV theme. care” when it comes to our patients. We adhered to our pa- toring Program, to personally combat tient safety principles as we opposed this problem. the rule that would have allowed chiropractors to deliver injections of non- A recent program that has great poFDA-approved substances. We helped tential was working with One Coloour allied health professionals in tes- rado to address health disparities in tifying for the critical care paramedic the lesbian, gay, bisexual, transgender certification program and the continu- (LGBT) population of over 200,000 ing of the physician assistant program in Colorado. Through the process of surveying the LGBT community, then at Red Rocks Community College.

Colorado physicians, an educational It was inspirational to work extensively course has been developed and was with the directors of the seven Med- just released on our cms.org website icaid Regional Care Collaborative Or- that can be used for physician and staff ganizations to explore actionable ways training to help offices become more to coordinate care, improve access and culturally competent and develop awareness of this problem. Because quality, and reduce costs. of this groundbreaking work and colI learned so much working with the laboration between One Colorado, governor’s office and our task force as the Denver Medical Society (DMS) we fought to understand and set up and the Colorado Medical Society, initiatives to overcome the prescrip- we were awarded the Ally Award by tion drug abuse epidemic in Colorado. One Colorado last month and this I ask you to please become aware of the work was just presented at the Gay and causes, proposed solutions and do what Lesbian Medical Association National you can, including registering with Conference in Denver. I personally and using the Prescription Drug Moni- want to thank DMS President Curtis Colorado Medicine for November/December 2013

Features Hagedorn, MD, and DMS Executive Director Kathy Lindquist-Kleissler for their contributions. The Ally Award is for both of us!

seen the important work you are doing in your communities and as I have tried to bring forth the needs you have back to the CMS home office.

Another incredible area of activity was working with the medical students and residents, our great leaders and physicians of tomorrow. I presented a talk to the residents and students as they did their one-week rotation through COPIC about the importance of being involved in organized medicine, using their voice and never forgetting physician wellness as an important issue.

I also listened to their concerns and ideas about how we can advocate on their behalf in the areas of graduate medical education expansion, patient safety, team-based care and more. The most fun official activity during my presidency was to help hood the medical school graduates at my alma mater last May.

So what is next for me? I am continuing to work with Sen. Irene Aguilar on a workforce issue and continue to attend fundraisers for our legislators and foster relationships and dialogue with them about medical issues. I will be representing Colorado in Washington, D.C. at the American Medical Association/American Hospital Association Leadership Conference on New Models of Care, exploring in detail the financial, cultural and operational considerations of these models. I am running for the American Medical Association’s Council on Constitution and Bylaws in June, as I am passionate about policy, governance and advocacy. I will finish my sixth and final year on the Colorado Hospital Association Board of Trustees and begin a term as a member on the University of Colorado School of Medicine Alumni Board.

I have drawn inspiration from visiting your communities around the state.

I thank you for hosting me as I have

Colorado Medicine for November/December 2013

I wish to thank my board of directors, committees, councils and especially the Colorado Medical Society staff for their support, dedication and countless hours of work for the physicians of Colorado and the patients we serve.

Finally, on a personal note, most of you know that due to myasthenia gravis, I am unable to be in my office practicing medicine. I believe that there is no better profession in the world than being a physician and I admire you so much for working each day helping your patients. Always follow your passion, use your voice for positive change, and keep moving forward. I pledge to continue to work for you, our patients and for this great organization. Thank you for one of the best years of my life as your president.

Sincerely, Jan Kief, MD n

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Colorado Medicine for November/December 2013

Features

Election results Kate Alfano, CMS contributing writer

The votes are in – CMS selects, installs new leaders John L. Bender, MD, FAAFP, was installed as the 2013-2014 Colorado Medical Society president at the masqueradethemed Presidential Gala on Saturday, Sept. 21. Bender is a board-certified family medicine physician, a Fellow of the American Academy of Family Physicians (AAFP), and the senior partner and chief executive officer of Miramont Family Medicine based in Fort Collins, Colo. His practice, an NCQA Level

John L. Bender, MD, FAAFP, was installed as the 2013-14 CMS President.

III patient-centered medical home, has been honored many times over the past decade, most recently as a 2013 exemplar model for workforce innovation by the Robert Wood Johnson Foundation.

tificate of appreciation and commemorative CMS silver coin. She will serve as immediate past president in 2013-2014.

He also recognized F. Brent Keeler, MD, who completed his year as immediate past president and will rotate out of the leadership.

On Sunday, the House of Delegates convened for other elections. Tamaan Osbourne-Roberts, MD, was elected president-elect. When he is sworn as president of the Colorado Medical Society at the 144th Annual Meeting, he will be the youngest president in CMS history at age 37. He will also be the organization’s first black president.

Osbourne-Roberts is a board-certified family medicine physician. He is currently a staff physician at Salud Family Health Centers where he practices fullspectrum outpatient care for primarily Spanish-speaking, low-income patients throughout the nine-clinic system. His main practice location is in Commerce City, Colo., and he also practices inpatient newborn care at Platte Valley Medical Center hospital in Brighton, Colo.

Bender also serves on the CMS Board of Directors, is a past president and past chair of the Colorado Academy of Family Physicians (CAFP), and is a past president of the Northern Colorado Individual Practice Association.

Osbourne-Roberts serves as a board member of CMS, the Denver Medical Society and CAFP. He is also chair of the CMS Membership, Unity and Relevance Task Force, a member of the Physician Advisory Committee on LGBT Health Disparities and an inaugural member of the CMS Health Disparities Committee/Diversified Physicians Section.

Bender recognized outgoing president Jan Kief, MD, for her service with a cer-

On the national level, Osbourne-Roberts is an alternate delegate to the Amer-

Colorado Medicine for November/December 2013

Tamaan Osbourne-Roberts, MD, was elected as the 2013-14 CMS President-elect. ican Medical Association House of Delegates. He served as alternate delegate and delegate to the AAFP Congress of Delegates, as co-convener and delegate to the AAFP’s National Conference of Special Constituencies (NCSC), and as member and chair of the AAFP-NCSC Reference Committee on Health of the Public and Science.

Delegates also approved component society and section directors to the CMS Board of Directors and approved members of the Council on Ethical and Judicial Affairs. Three delegates to the AMA were elected: Lynn Parry, MD, Brigitta Robinson, MD, and Ray Painter, MD. Three alternate delegates to the AMA were elected: Dave Downs, MD, Jan Kief, MD, and Osbourne-Roberts.

W. Gerald Rainer, MD, was re-elected to the office of CMS historian.

Congratulations to the new officers and leaders of the Colorado Medical Society. n

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Features

COMPAC/AMA Luncheon Kate Alfano, CMS contributing writer

Rep. Gardner and AMA expert give members federal update After a lively discussion on resolutions in the House of Delegates on Saturday, Sept. 21, Annual Meeting attendees headed to a sold-out luncheon hosted by the political action committees of the Colorado Medical Society and the American Medical Association that featured Rep. Cory Gardner (R) and AMA Director of congressional affairs Todd Askew.

Christopher Unrein, DO, a COMPAC board member, moderated the luncheon and encouraged all in attendance to join COMPAC and AMPAC. “We are always excited about new members and this is a great opportunity for all of you to get involved and help make a difference in medicine,” he said.

Unrein started the meeting with business. Members voted to accept the new COMPAC board members by adopting the COMPAC nominating report and nominated Tamaan Osbourne-Roberts, MD, as vice chair.

U.S. Rep. Cory Gardner, (R), answers questions at the COMPAC/AMA luncheon.

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He then introduced Todd Askew, director of congressional affairs for the American Medical Association, who gave members an overview of federal issues concerning medicine. Much of his focus was on the bill to repeal Medicare’s sustainable growth rate formula currently being considered by Congress.

The AMA has said repeatedly that continued SGR patches are fiscally irresponsible and that a repeal is fiscally responsible. Since 2003, Congress has enacted 15 patches to stop Medicare physician payment cuts, at a cumulative cost of $146.4 billion. The cost of the patches exceeds the $139.1 billion cost of repealing the SGR and freezing Medicare payments to physicians.

A successful transition plan must provide opportunities for physicians to choose payment models that work for their patients, practice, specialty and region; encourage incremental changes with positive incentives and rewards during a defined timetable; and provide a way to measure progress and show policymakers that physicians are taking accountability for quality and costs.

Next, Unrein introduced U.S. Congressman Cory Gardner, who also spoke about health care on the federal level, particularly the overwhelming support for the SGR repeal bill, and answered questions from the audience. Unrein said Gardner has been a champion for physicians in all aspects of health care for many years. “He supported the SGR repeal that came through his committee [the House

Todd Askew, AMA director of congressional affairs discusses federal health care issues.

Committee on Energy and Commerce], supported payment reforms and worked hard to implement patient safety reforms,” he noted.

A Colorado State University graduate, Gardner is a Republican serving the sprawling fourth district of Colorado.

He often speaks about rural issues, and stated his support for tele-health to increase access in rural areas. “We have to make sure medical education is affordable and doesn’t negatively influence the rural physician workforce,” he said.

Gardner said he believes the president’s health care law makes it difficult for the economy to grow and takes away the ability of patients to make health care decisions. “While our health care system needs reform, imposing unpopular and unaffordable mandates is not the solution. Health care should be about patients and doctors, not government and bureaucrats. Through promoting greater competition between insurers and by protecting our providers from

Colorado Medicine for November/December 2013

Features frivolous lawsuits, we can ensure that consumers receive better services at a lower cost. In health care decisions, nothing is more important than patient choice.�

Several audience members asked about the replacement legislation if the law is repealed, which would likely come before Gardner’s House committee. He said he has reviewed several proposals and feels they maintain the positive parts of the health care law while also adding promising provisions to cap medical malpractice damages, among others. Gardner stated support for allowing health insurance policies to be bought and sold across state lines, which he said would lower the cost of health insurance and enable more people to purchase coverage. n

Promoting health care decisions that are non-duplicative, evidence-based, free from harm and truly necessary

Visit www.cms.org/choosing-wisely

Serving the CME 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

Colorado Medicine for November/December 2013

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Features

Legislative shift David Ross, DO, COMPAC chair, and Tamaan Osbourne-Roberts, MD, COMPAC vice chair

Recalls could spur move to middle on hot-button issues The unprecedented and historic recall of democratic state senators Angela Giron of Pueblo and John Morse of Colorado Springs for their support of a package of gun laws brings the partisan balance in Colorado’s upper chamber to a tipping point, with the Democrats still holding a one-vote advantage at 1817.

may produce more legislative compromises on non-partisan issues or, alternatively, foster congressional-style gridlock. Speculation is rampant while the shock waves are still receding. As Yogi Berra once observed, it’s hard to make predictions, especially about the future.

Even more so, we would add, when trying to predict political behavior.

Historically, close partisan divides translate as the Doctrine of Equal Risk – neither side can roll the other – which

Other Senate Democrats, feeling that metaphorical gun pointed at them, may move somewhat further toward the

Welcome new COMPAC board members

Also, thank you to our continuing board members for another year of valuable service.

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The recall effort was heavily financed on both sides by wealthy out-of-state individuals and well-funded organizations. As the analysts and pundits sift through the postmortem evaluations, the underlying political dynamics were complex and not necessarily tied exclusively to the enacted gun control reforms.

If anything, this recall has illustrated the power of constituency and the grassroots in the political arena. COMPAC relies on grassroots physician engagement with local legislators to assure those elected officials will listen to our views long before they have to vote, and your contributions to COMPAC assures that legislators who stand by their medical communities will receive support when medicine’s adversaries come after them in the next election cycle.

Dave Ross, DO, chair Tamaan Osbourne-Roberts, MD, vice chair Kurt Papenfus, MD Mary Vader, DO Tom Wiard, MD Brent Keeler, MD Patrick Pevoto, MD Sidney Adler, MD Warren Pettine, MS

Gina Alkes, MD John Bender, MD John Cletcher, MD Ben Galloway, MD Mark Johnson, MD Jan Kief, MD Lee Morgan, MD Mary Rice Stephanie Sandhu, MS Kathleen Traylor, MD Chris Unrein, DO

right on some issues, or even contemplate a party switch on certain votes if their district swings more that direction.

We extend our sincere thanks to all of our COMPAC members who signed up at the Annual Meeting or through your 2014 dues payment. We could not function without your support. We encourage all CMS members to join COMPAC on our vital mission for our profession, our patients and our community.

As the aftermath of the recall plays out, COMPAC will continue to follow the implications for medicine’s agenda in the 2014 session, including medical liability, Medicaid, managed care and other hot button medical issues. n

Colorado Medicine for November/December 2013

Colorado Medicine for November/December 2013

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Features

Political training Susan Koontz, JD, CMS General Counsel

Physicians learn to be effective advocates for profession CMS members, staff and guests gathered on Saturday, Oct. 12, for the 2013 Regional Campaign and Grassroots Seminar, a semi-annual work session on the art of advocacy hosted by the political action committees of the Colorado Medical Society, the American Medical Association and the Colorado Academy of Family Physicians.

To be an effective advocate, an organization must understand the makeup of the political body. Vance categorized elected officials into four categories: champions, supporters, neutrals and opponents, advising attendees to focus the bulk of time on neutrals as this group is often undecided because they are not adequately informed of an issue.

Keynote speaker Stephanie Vance, also known as the “Advocacy Guru,” presented the rules of political engagement and lobbying, drawing specific tips and examples from her more than 20 years working in a prominent D.C. law firm, as a lobbyist for National Public Radio and in various congressional offices.

Finally, an organization must ensure each goal is “SMART,” an acronym for specific, measurable, attainable, realistic and timely. Using this method, an advocate should know specifically what he or she is asking for, evaluate whether it’s going to be effective, consider the context of the political and fiscal environment and focus on things that are attainable, analyze an organization’s internal resources to gauge what’s realistic, and understand the timeframe to prioritize accordingly.

She stressed the importance of political involvement, differentiating between the “grassroots” and the “grasstops.”

Those in the grassroots may not have much advocacy training but they serve an important role by communicating with their legislators. Those in the grasstops organize the grassroots and identify the issues that need to be addressed. Together they form an effective advocacy team.

Strategic messaging is crucial, Vance said. “You’re going to want to use words that are going to resonate in the legislative environment. One great way to do this is to ask people in the legislature or state agencies what they think will resonate with their colleagues. This is critical because if you don’t have the messaging you’ll often lose the battle when [an opponent] comes up with the compelling message.”

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Jim Wilson, PhD, manager of political education programs for the AMA, spoke about the other side of the “advocacy coin,” fundraising. On one side are the principles Vance outlined: talking to legislators, developing a relationship with them, telling a clear story about how a policy will impact their constituents from your perspective as a care provider. “The flipside of that coin is being in a position to influence who gets elected to those offices in the first place, having a role in deciding who makes the decisions,” he said.

“One of the ways you can be effective at this is to help raise money not only for COMPAC but for candidates who

are going to be amenable to you, people who are hopefully going to become champions for you in the statehouse.”

The most important reason people don’t contribute to a PAC or a political campaign is because no one has asked them, Wilson said. He encouraged physicians to consider talking to peers or hosting a fundraising event. “Even small donations add up. If you can create a culture of people getting involved – even at low levels – and you show them the results, you can make an important difference.”

Jeremy Lazarus, MD, immediate past president of the AMA, gave an update on federal issues, chiefly the movement to repeal Medicare’s sustainable growth rate formula and replace it with effective payment reform. Achieving an SGR repeal is more likely than in years past, he said, because of the “bargainbasement price of only $138 billion,” which is about $100 billion less than it has been in recent years. Lazarus also stressed that even if it seems like Congress is idle, the key committees in the Senate and the House are continuing to work on SGR repeal.

“We need all of you to add your voice to this effort,” he said. The AMA launched an effort last month called Fix Medicare Now. The accompanying website, FixMedicareNow.org, houses videos, talking points and other resources physicians and patients can use to reach legislators. “We need to keep up the pressure. As we get closer to the end of the year and as we see a live bill going forward, we’re going to be

Colorado Medicine for November/December 2013

Features investing a significant amount of AMA resources in key areas around the country to make sure we get this passed this year.”

would reach out to you specifically to ask you to meet him, call him, contact his staff, help us get a message through,” Folk said.

Terri Folk, regional political director at the AMA, presented some of the advocacy resources AMA provides and ways to be involved. She encouraged all physicians – even those who aren’t members of the AMA – to join the Physicians’ Grassroots Network to stay informed of the legislative issues important to organized medicine and be able to send customizable e-mails to legislators. Similarly, she asked attendees to encourage patients to join the Patients’ Action Network so they can receive tailored e-mail alerts to engage them on top issues in health care.

“Members of Congress see [physicians] as a trusted source on health care,” she continued. “You can tell your stories, you can tell the impact of health care decisions on constituents in their district.”

The AMA VIP (Very Influential Physicians) grassroots program is a key contacts program that allows physicians to build and leverage the personal or professional contacts they maintain with their elected officials, a legislative staff person or an elected official’s spouse.

“There are lots of freshman and sophomores in office right now and we want to be sure we have a physician assigned to each member of Congress to make sure we have someone we can turn to when need arises. When needed, we look at our list of VIPs for a legislator like Congressman Cory Gardner. We

State Sen. Irene Aguilar, MD, gave an update on her work in the Colorado General Assembly and what to expect next session. She said she came to the Senate to be a patient advocate, and shared a story about a patient who struggled with the cost of routine diabetes treatment. The patient eventually developed renal failure and left her job. Now a beneficiary of Medicaid and Medicare, the system pays $45,000 a year for her dialysis.

“I always bring that story up to legislators to say that we’re going to pay for it, we just decide when. And the later we wait to pay for it, the more it’s going to cost us not only in the direct cost to that patient’s life but in real actual dollars and their ability to continue to be contributing members of society. That is what my real goal is, to get people down to the bottom line and say, ‘look, if we’re going to pay for it anyway, let’s

Colorado Medicine for November/December 2013

figure out a rational way to do it.’”

Aguilar said the physicians in Colorado have a unique opportunity. “First, there aren’t many state legislatures that have physicians in them. Second, even those that do, there are even fewer who have physicians in leadership.” Aguilar was recently elected assistant majority leader, which puts her in a powerful position to influence her colleagues. She told attendees to consider her to be a resource next session. “You’ll have my ear unless it’s contrary to patients’ interests.”

Vidya Kora, MD, chair of the AMPAC Board of Directors Congressional Review Committee, and John Bender, MD, FAAFP, CMS president, encouraged attendees to join the political action committees of the AMA and CMS. “When we give a PAC check it sends a clear message to the legislator what our concerns are and that’s what makes a PAC effective,” Kora said.

“I came across a statement, ‘If medicine is your profession, politics is your business whether you like it or not,’” he continued. “That’s a fact because so much of what happens in our practices is influenced by legislation passed in our statehouses and in Congress.” n

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Liability climate change Kate Alfano, CMS contributing writer

Legal and policy experts discuss policy options Attendees of the 2013 Annual Meeting participated in a session on Sunday, Sept. 22, on the liability climate, featuring a presentation about recently passed legislation in Oregon that aims to reduce the frequency and cost of lawsuits and a discussion by a panel of incumbent legislators on medical malpractice and patient safety.

Public affairs consultant Kim Ross, the session moderator, set the stage by giving an overview of Colorado’s current political climate: Currently the governor is a Democrat and Democrats control both houses of the legislature, although the Senate party split tightened to 18-17 after the recent recalls. The House remains at 37-28.

“Last year, trial lawyers donated over $750,000 to legislative candidates and leadership funds, while we as physicians did not reach nearly that amount,” he said. “I say this so we can lay the groundwork on what our current political environment is, so we can look to see what it will be in the future thanks to our panel.”

“The Colorado tort system is a disjointed mismatch of negligence and claims,” Ross continued. “There is a roughly 8:1 ratio between compensable adverse events resulting in filed claims, and only 1 in 6 claims pursued involve an actual adverse event. Roughly two-thirds of cases filed are settled without indemnity; two-thirds of cases actually taken to trial are resolved in favor of the defendant and over half of those cases taken to the jury are reduced upon appeal. So we have a very convoluted, complex patient safety scheme that drives cost but 18

in reality does not always provide the recourse that people are looking for: a reason.”

Gwen Dayton, JD, general counsel of the Oregon Medical Association, spoke about a bill recently signed into law in Oregon that creates a program to encourage early discussion and resolution when an adverse health care incident takes place. Senate Bill 483 outlines three phases of the program: early discussion, mediation and litigation.

Notices of an adverse health care incident are filed with the Oregon Patient Safety Commission, an administrative entity for this process. Filing a notice is voluntary and can be done by a patient, provider, health care facility or employer. If the adverse event happens in a health care facility, the facility may file a notice and will notify the patient and the involved provider. If the event happens outside of a health care facility, the health care provider may file a notice and will notify the patient. In all cases except where the provider files the notice, the provider is not identified in the notice.

After the filing, the facility or provider may engage in a discussion with the patient, though this is also voluntary. During that discussion, the filer may communicate to the patient the steps they will take to prevent future occurrences of the adverse health care incident and discuss whether there will be an offer of compensation.

If the early discussion does not resolve the event, the process moves to mediation. The Patient Safety Commission

maintains a list of qualified mediators from whom the parties can choose. At the mediation, the provider or facility can offer payment to the patient. If mediation does not resolve the issue, it moves to litigation. But all communications made during the initial discussion are confidential and are not admissible as evidence except if a statement made during the trial contradicts a statement made in the discussion.

The law also establishes the 14-member Task Force on Resolution of Adverse Health Care Incidents consisting of legislators, physicians, trial lawyers, a hospital representative and a patient safety advocate. The group reports to the legislature each year and may recommend legislation to improve the resolution of adverse health care incidents.

Proponents of the law hope the process will allow for quicker resolution of serious events, less physician anxiety about liability and thus a reduction in the use of defensive medicine to avoid litigation, equitable compensation to patients who often receive nothing, fewer claims filed in court, less risk of huge jury awards, and lower overall costs to the system.

“Oregon’s early discussion and resolution program is an important step for both patients and physicians as we work to improve the way we address and resolve adverse events in care,” Dayton said.

Though the program is new, Dayton provided examples of similar efforts that have achieved real results. The University of Michigan Health System – with a legislatively implemented six-month waiting period to file a lawsuit – saw a

Colorado Medicine for November/December 2013

Features decrease in new claims per year from 53.2 to 31.7, a reduced time to resolution from 20.3 months to eight months, and a decrease in the average cost of lawsuits from $405,000 to $228,000. And Stanford University’s process for early assessment and resolution led to a 36 percent reduction in claim frequency and $3.2 million per year in savings.

The effort to pass the legislation came from Oregon Gov. John Kitzhaber’s commitment to liability reform and his advisory committee on the issue. Another senate bill created the Patient Safety and Defensive Medicine Workgroup.

And the collaboration between the Oregon Medical Association and the trial bar presented a bill that was amendable to both physicians and lawyers.

The panel of incumbent legislators who addressed the audience during the liability session included Sen. Ellen Roberts and Sen. Cheri Jahn, as well as Rep. Joann Ginal, Rep. Clarice Navarro and Rep. Mike Foote.

Roberts stressed that Colorado has a good environment for physicians that we should strive to maintain. “I believe both the existing malpractice caps and COPIC’s proactive role through the three R’s program has made that possible,” she said. “Over the years that I have served at the legislature, we have repeatedly heard from young medical students and physicians that they come to Colorado to practice medicine because of our ability to keep malpractice premiums low and by creating a supportive environment for providers.”

While I appreciate that Oregon is taking a different approach, Colorado is the leader to follow.”

“If we were to look at a change to our laws, we would have to ensure it was crafted specifically for Colorado, and that patients, consumer groups and doctors are all part of any discussion. At the end of the day, our job as legislators is to ensure that we have a system that puts people and patient safety first,” Ginal said.

Foote said that the current malpractice system is inadequate and that while he likes the idea of exploring alternative dispute systems like the one Oregon recently implemented, “any system change we put in place must take into consideration the interests of patients, the interests of physicians, and the interests of public safety and the public’s right to know.” He encouraged attendees to engage with their legislators by phone or an in-person visit.

“It's so important that physicians talk to local legislators,” Navarro said. “Your opinion counts more than you realize.”

Jahn also encouraged members to get to know their legislators to put a face to the issue. “I cannot express enough the importance of our medical professionals having a great relationship with their own legislators and a good understanding of the process,” she said. “We, as legislators, need input from our experts no matter the field. We are here to learn, listen and resolve complex issues and without that expert knowledge we cannot do the job we’ve been elected to do.”

“The doctors in our state truly do maintain a philosophy of the 3 R’s: recognize, respond and resolve. I’m one to believe that if there isn’t a problem we should just leave things alone. It is through dialogues with our great docs and medical teams where we will hear if there are issues to be addressed,” Jahn added.

The Colorado Medical Society thanks all panelists for their participation in the session, providing their insights into the policy implications of medical malpractice and enhancing physician understanding of the liability issue. n

Save the date for 2014 Date CMS Spring Conference changed!

May 16 through May 18, 2014 Sonnenalp Resort, Vail

“Adopting a more bureaucratic and potentially more politically influenced malpractice system would be a mistake,” Roberts added. “Such a change for Colorado would likely raise premiums and negatively impact the supply of providers in Colorado. My primary concern is that this, in turn, would reduce patient access to care, especially in the rural areas of the state like mine. Encouraging physicians to learn from mistakes and creating an open environment for honest patient-physician dialogue is key to better outcomes and less litigation.

Colorado Medicine for November/December 2013

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Features

Where does it hurt?

Kate Alfano, CMS contributing writer

Experts discuss multifaceted Rx drug abuse problem Earlier this year, the CMS Board of Directors voted to make the issue of prescription drug abuse a high priority.

The board directed the Workers’ Compensation and Personal Injury Committee (WCPIC) to review existing CMS policies and recommend new policies to combat misuse. CMS also pledged full cooperation and support for Gov. John Hickenlooper as he and his administration developed recommendations with the National Governors Association.

A panel discussion on Saturday, Sept. 21, at the CMS Annual Meeting explored this multifaceted issue. “As has been widely mentioned through the media, Colorado is No. 2 in the country in terms of prescription drug abuse, and we physicians have a responsibility to address this serious issue,” said WCPIC Chair John Hughes, MD, the panel moderator.

derstand the epidemiology of medically inappropriate use and diversion while developing strategies to address these issues; • Development and promotion of new tools, along with existing resources and education materials that enable physicians to appropriately prescribe opioids and narcotic medications, and to avoid inappropriate prescribing; • Development and implementation of an educational campaign; • Partnering with other stakeholders to obtain the best defined outcomes for the Colorado Medical Society.

A distinguished group of experts served on the panel. Cynthia Coffman, JD, chief deputy attorney general in the Colorado Department of Law, presented the law enforcement perspective. Joel Dickerman, DO, member of the CMS board of directors, gave the physician perspective. Chris Gassen, RPh, PharmD, program manager for the Colorado State Board of Pharmacy, shared the pharmacy perspective. Zach Pierce, the drug policy coordinator for Gov. Hickenlooper spoke about the gover-

“Prescription drugs are an integral treatment option for those who have serious or chronic pain, and their use has helped many people live with debilitating injuries. That being said, what happens when those drugs intended to help people get diverted or individuals begin to doctorshop to get more, just to name a couple of scenarios? This is the problem that we are facing; many people are finding ways to game the system to get more prescription drugs and it is costing taxpayers, citizens and families. We’re here today to discuss what we can do,” Hughes added.

Hughes gave a brief overview of the prescription drug abuse platform developed

by WCPIC and approved by the House of Delegates. Some of the recommendations include the following: • A review of current evidence to unColorado Medicine for November/December 2013

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Rx drug abuse (cont.) nor’s strategic plan to address this issue.

Pierce works with policy advisor Kelly Perez, who has spearheaded these efforts over the past year.

Pierce said that one of the biggest challenges in addressing prescription drug abuse is the PDMP. “Our Prescription Drug Monitoring Program is very limited in its scope and cumbersome to use for health providers. It doesn’t allow access for office staff or others who could speed the process along and protect privacy.” Coffman also addressed the PDMP, and said that if “carefully structured,” it would meet everyone’s needs.

Pierce said physicians have a role in the governor’s vision for this epidemic: To prevent 92,000 Coloradans from misusing and abusing prescription pain medication by 2016. Physicians have already contributed greatly to the Colorado Plan to Reduce Prescription Drug abuse, which was developed through Gov. Hickenlooper’s work as chair of the National Governors Association policy academy to reduce prescription drug abuse. “Physicians know best what their patients need,” Pierce said. “They are the most reliable source of health information for their patients and they will help us to impact this problem.”

“We rely on physicians to provide us with sound clinical advice on appropriate treatment for pain,” he continued.

“They can make medical education recommendations, which would include education about addiction. They can help to assure that people who need pain medication get it, and that patients are well educated about non-prescription treatments for pain.”

“I believe that CMS recognizes the great challenges physicians face in the management of pain – balancing effective pain relief with the safe prescribing of narcotic pain relievers,” added Dickerman. “CMS is working with multiple agencies to assure physicians can treat their patients effectively, and to educate patients, providers and pharmacies on the safe use of controlled medications.” n

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Colorado Medicine for November/December 2013

Features

Governor's Rx abuse program Kate Alfano, CMS contributing writer

CMS applauds launch of Colorado Consortium for Prescription Drug Abuse Prevention On Sept. 24, Colorado took another step forward in its effort to reduce the abuse and misuse of prescription drugs with the launch of the new Colorado Consortium for Prescription Drug Abuse Prevention. The consortium serves as the lead for Gov. John Hickenlooper’s Colorado Plan to Reduce Prescription Drug Abuse with active participation from his administration and various state agencies.

Coordinated through the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, the consortium provides a cooperative, interagency-interuniversity network to enable the health care community, state agencies and others to work together to implement a one-year strategic plan that targets six areas of the prescription drug abuse issue – the Prescription Drug Monitoring Program (PDMP), treatment, prescriber and provider education, safe disposal, public awareness, and data/ analysis. The consortium has assigned a workgroup to each focus area and each group is co-chaired by a representative from a state agency or community group and a university representative.

The Colorado Plan to Reduce Prescription Drug Abuse is the culmination of the yearlong National Governors Association policy academy to reduce prescription drug abuse, co-chaired by Hickenlooper and Alabama Gov. Robert Bentley. Additionally, Colorado State Attorney General John Suthers has pledged resources to fund the public awareness component of this comprehensive approach to reduce drug abuse.

Robert Valuck, PhD, RPh, FNAP, professor in the Department of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy, described the “massive collective effort” required to develop the plan at the consortium launch.

Over the course of the past year, stakeholders gathered for four major events.

First was the NGA Policy Academy in October 2012 where experts discussed five NGA-recommended focus areas and best practices for reducing prescription drug abuse. Next were the Colorado Roundtables in March 2013, which brought together 185 experts to expound upon the five focus areas; they identified and added the sixth area, treatment.

Third was the Colorado In-State Policy Academy in April 2013, to review the recommendations and establish a timeline through May 2014. And, finally was the second NGA Policy Academy in May 2013 to review and finalize the Colorado strategic plan.

“As part of this process, the governor learned what a big problem we have here in Colorado and what broad support from diverse stakeholders we have for an approach that is comprehensive and effective to solve it,” said Kelly Perez, the governor’s human services policy advisor. “We are leaders in the nation according to the National Governors Association due to our diverse stakeholder membership and the process that we have maintained. … We are grateful and eager to see what we can continue to do together to solve this problem the Colorado way.”

Colorado Medicine for November/December 2013

“We applaud the governor’s plan to reduce prescription drug abuse in Colorado and look forward to working with all stakeholders to achieve the plan’s goals,” said CMS President John Bender, MD, FAAFP. Recent data show that Colorado ranks second among all states for nonmedical use of prescription drugs among youth and young adults. More than 255,000 Coloradans misuse prescription drugs, and deaths involving the use of opioids nearly quadrupled between 2000 and 2011. In the State of Health: Colorado’s Commitment to Become the Healthiest State, released in April, Hickenlooper pledged to reduce the prevalence of non-medical use of prescription pain medication in Colorado by 2.5 percent, or 92,000 Coloradans, by 2016. The consortium is designed to serve as the vehicle for implementing the governor’s strategic plan for reducing prescription drug abuse.

“While it is initially a one-year plan, the objective of the consortium is to provide a framework for continued collaboration in the future,” Valuck said. “We plan – and are already starting – to develop longer term objectives for the six work groups, raise funds to support the initiatives specified in the strategic plan, and write grants to establish a long-term Center of Excellence that will focus on this topic and position the state of Colorado as a leader in the effort to reduce prescription drug abuse and misuse, to create the healthiest population in the nation.” n

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Features

Covering the underserved beyond the medical home Amy Beeson and Chris Haas

Collective action problem facing Colorado specialists Despite persistent endocrine dysfunction after the removal of a pituitary adenoma, a young uninsured woman fails to present for follow-up, fearing another bill she can't afford. . . . A child with Medicaid misses four weeks of school while waiting to be seen by a dermatologist for an autoimmune rash that his parents fear is contagious. . . . A 55 year-old man presents to his primary care physician with personality changes and new-onset seizures, but area neurologists aren't accepting new Medicaid patients. . . .

Regardless of practice environment, any Colorado physician who encounters underserved patients – here defined as those without insurance in addition to Medicaid enrollees – is apt to have stories in which gaps in access to specialty care have played a deleterious role in quality of care and long-term health outcomes.

In the recent tide of health care legislation and national, state and local initiatives, much attention has been given to expanding access to primary care services; for example, $11 billion in the Affordable Care Act are aimed at expanding the federally-qualified health center program to meet the increase in demand. There is no such plan, however, to meet the increased number of referrals to specialists that will follow the expansion.

We cannot deny that despite the best efforts of these health centers and other primary care providers to manage and treat disease early on, patients will still require the services of a specialist when a disease progresses beyond the scope of our first-line preventative measures 24

and treatment regimens. Underserved patients have no less need for specialty care than those who are insured outside of Medicaid. It follows that no revision of health care in our communities is complete without taking a hard look at how we can improve the interface between primary care and specialty care services, particularly in the realm of the safety net.

Finally, in some practice environments, specialists may be combating a perception of those who see underserved patients as being less competitive in the private insurance market; thus some doctors or institutions may fear that the very presence of uninsured or Medicaidenrolled individuals in their waiting rooms could be a deterrent to privatelyinsured patients.

Minding the gaps The Colorado Health Institute's 2010 Colorado Safety Net Specialty Care Assessment report states that securing specialty care referrals for Medicaid enrollees and the uninsured is “difficult, inconsistent, and often futile.” One need not look far to understand why the specialty safety net is lacking. The provision of specialty care is resource intensive. Gaps in reimbursement between safety net and insured patients are wider for most specialty visits than those in primary care, and reimbursement may be delayed. Additionally, higher rates of missed appointments among the uninsured and Medicaid patients are missed opportunities both to provide care and to be reimbursed.

Overcoming the collective action problem A collective action problem describes the situation in which Colorado specialty providers find themselves. Such a problem occurs when an entire group would benefit from a particular action, but the action is costly to any one individual to attempt alone, such that coordinated action of the group allows for a collective benefit that would not be possible from individuals acting independently.

Beyond reimbursement, patients in the safety net are more likely to have complex needs, such as language barriers, negative social determinants of health, and co-morbid mental illness. Arranging referrals for uninsured and Medicaid patients is an additive challenge; for example, a neurologist may be willing to see the man with seizures but the patient may eventually require imaging studies that are unaffordable or inaccessible as part of that patient's workup.

Most Colorado specialists have a real desire to be inclusive in their practices and to care for those who are in need regardless of insurance status. Take Doctors Care: south metro Denver physicians in 80 different specialties comprise a volunteer network that serves thousands of patients each year. Specialists around the state provide volunteer services, whether onsite or offsite, and collaborate with primary care physicians who work with the underserved when needs arise.

Some physician leaders seek to innovate by providing electronic consults or pioneering new, interdisciplinary models of care (such as one modeled after the University of New Mexico's Project ECHO) to meet the needs of their communities.

Colorado Medicine for November/December 2013

Features But many also find themselves constrained in their practice environments by institutional and financial factors.

Some choose to place caps on the number of Medicaid patients they will see; others worry that they will have to do so soon or they won't withstand the floodgates of newly-eligible patients who are referred. Though they may feel called to be inclusive, they are unwilling to “carry the burden� of caring for the underserved alone.

Specialty care is naturally fragmented.

There are numerous barriers to developing consensus within such a diverse group. Indeed, there are few occasions when it is necessary that physicians of all specialties come to the table to figure out how they will meet a need, not individually in a patchwork manner, but deliberately in a coordinated manner.

In times of change, however, the health of communities and the stability of the health system depends on this coordinated action. Through physician leadership, collaboration, and participation in organized medicine, we have the potential to create solutions that will allow practices to thrive while covering the gaps in our safety net. We need to come together as a network of providers and hospitals in Colorado to envision a way forward that can be implemented broadly and distribute the time, effort, and cost that is required to ensure that no patient or group of patients is felt to be a burden too heavy to bear. n Amy and Chris are second- and fourthyear students, respectively, at the University of Colorado School of Medicine. We are grateful to the all the Specialty Care Access focus group members from the CMS annual meeting for their insights, as well as Chet Seward, Meredith Niess, and Allegra Melillo for their contributions.

This is part of an ongoing project. We are interested in interviewing specialists about their experiences with underserved patients in their practices. Please contact us if you would like to share your experience or any innovative ideas!

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Features

Physician practice innovation Chet Seward, Senior Director, Health Care Policy

RAND releases results from study of efficient delivery and payment models Physician job satisfaction is primarily driven by the ability to provide high quality care and things that get in the way of providing that high quality care are sources of stress for doctors.

These seemingly simple findings from a recent study by the RAND Corporation in collaboration with the American Medical Association (AMA), highlight many of the vexing problems that physicians in Colorado and across the nation currently face. The study also points the way to areas where solutions have the potential to markedly improve health care quality and safety, while enhancing the joy of medicine for physicians.

The AMA and RAND teamed up to study models of practice that have been shown to improve practice sustainability and physician satisfaction. Thirty physician practices across the nation participated – five in Colorado – representing a broad spectrum of specialties and practice settings.

Researchers began collecting data in December 2012 through three methods: a questionnaire for administrative and clinical leaders to examine the staffing, finances and overall structure of the practice; on-site visits for facility tours to observe staff meetings and to conduct in-person interviews with administrative leaders, clinicians and staff members; and a clinician experience survey.

Customized individual and aggregate reports will be released to the practices soon so they can better understand the key steps and behaviors their peers are using to successfully transform the way care is delivered.

The Colorado Medical Society supported the study because we are keenly interested in finding ways to help physicians better cope with and lead changes in how care is organized, delivered and paid for in the future.

doctors worry that the technology has been more costly than expected and different types of electronic health records are unable to “talk” to each other, preventing the transmission of patient medical information when it is needed.

The findings suggest that the factors contributing to physician dissatisfaction could serve as early warnings of deeper quality problems developing in the health care system. “Many things affect physician professional satisfaction, but a common theme is that physicians describe feeling stressed and unhappy when they see barriers preventing them from providing quality care,” said Mark Friedberg, MD, the study’s lead author and a scientist at RAND, in an AMA press release. “If their perceptions about quality are correct, then solving these problems will be good for both patients and physicians.”

To reduce physician frustration, some practices employ extra staff members to perform many of the tasks involved in using electronic records, helping doctors focus on activities requiring a physician’s training.

“Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts,” Friedberg said in the release. “But at the same time, they report that electronic systems are deeply problematic in several ways.”

The study did not identify recent health reforms as having prominent effects on physician satisfaction, either positive or negative. Most physicians and practice administrators were uncertain about how health reform would affect physician satisfaction and practice finances.

It was clear, however, that a common response to health reform was for physician practices to seek economic security by growing in size or affiliating with hospitals or larger delivery systems.

Among the key findings of the study was how electronic health records have affected physician professional satisfaction. Those surveyed expressed concern that current electronic health record technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes. In addition,

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Researchers said that physicians reported being more satisfied when their practice gave them more autonomy in structuring clinical activities, as well as more control over the pace and content of patient care. Doctors in physicianowned practices or partnerships were more likely to be satisfied than those owned by hospitals or corporations.

The report, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy,” is available at http://tinyurl.com/RAND-AMA-study. n

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Patient Safety Leadership Conference Kate Alfano, CMS contributing writer

Attendees discuss burnout in health care, patient safety It all began with one report, published by the Institute of Medicine in November 1999; “To Err is Human: Building a Safer Health System” launched the entire patient safety movement, said Robert Wachter, MD, professor and associate chair of the Department of Medicine at the University of California San Francisco. He kicked off the 2013 Patient Safety Leadership Congress on Oct. 22, which was jointly sponsored by the Colorado Hospital Association, the Colorado Medical Society and COPIC. When the study’s authors quantified the number of lives lost to medical mistakes as a jumbo jet a day, “it opened the public’s eyes,” he said. “All of a sudden, we realized for everything we’re spending on health care, we’re not getting the products we want.”

The event brought together physicians, hospital executives, patient safety advocates and other professionals to discuss what is happening in patient safety, why it’s happening and what’s likely to happen in the next few years. “It’s easy to lose sight that we’re in the middle of something historic in health care where our system is being forced to transform itself into something wholly different,” Wachter said.

He introduced his session with a quick history lesson on the evolution of the movements toward improved quality, safety and value. In the late ’90s, most people believed that quality and safety in health care were pretty good, he said.

There was no reason to think otherwise until the IOM report came out. Suddenly there was a growing case for safety 28

and quality, though it started with a focus on blame and shame of individual providers. “No one spoke about systems thinking; those were not things that any clinician understood circa 2000. We thought about errors as individual.”

Fast-forward to present thought that increasing quality and getting rid of waste is mostly about systems, not individual perfection. “We’ll only have great systems when we have great people,” Wachter said. “The system is a living, breathing thing and the only way the system gets better is if the humans make it better.”

He stressed that this is a bipartisan movement; most of the key events in his timeline happened under the Bush administration and are independent of the Affordable Care Act. He illustrated this point with the “two Pauls,” U.S. Congressman Paul Ryan and economist Paul Krugman. While they are as far apart on the political spectrum as they can get, they agree that the country needs to get a handle on health care costs.

“What’s happening is the end of health care exceptionalism,” Wachter said.

“The world has looked at us and said you’re not providing a product that is high enough quality and the cost of it is bankrupting our country. In the U.S. we have a fundamental belief that companies succeed when they deliver value.

We want health care to do the same thing.”

“We’re being asked to cut costs and increase quality,” he continued. “I believe they’re the same thing.”

Brian Sexton, PhD, associate professor of psychiatry at Duke University School of Medicine and director of the Patient Safety Center at Duke University Health System, spoke about the importance of physician resiliency in increasing quality and patient safety.

“I want you to come away from this with a need to redefine what we mean as quality. Quality has traditionally meant patient-centered care,” Sexton said. “I’d argue that the way this has evolved is that now, in 2013, we have to do a better job at taking care of ourselves. That’s what the data show very strongly. First, are you taking care of yourself? Second, how are we taking care of each other?”

The health care industry has the highest rate of burnout. With countless studies, he demonstrated the “science of self-care,” paying particular attention to the importance of sleep in memory consolidation and emotional regulation and giving practical exercises to refresh and replenish mental capacity. His point was that there are many great tools in medicine that can increase quality, but until the workers are less burned out they won’t have the ability to implement them.

He presented five categories of resilience: Self-awareness, or understanding strengths and weaknesses to play up one’s strengths; mindfulness, noticing patterns without judging; sense of purpose, knowing how to frame things in a purpose-ridden way; self-care, or fatigue management; and relationships, how to work with others. Good practice of each category can lead to improved wellness.

Colorado Medicine for November/December 2013

Features “Once you’re taking care of yourself and each other, then you can take meaningful care of your patients in a sustainable way,” Sexton said. “But if you just jump into patient-centered care, show up early, stay late, work through lunches, your patients are not receiving patientcentered care. Even though you might think that you are, that’s not what the data bare out if we don’t have resilience where it needs to be.

“I’d argue that it’s the job of the health care worker to show up at work ready to do their job. Leaders have a responsibility to protect the work-life balance of their employees and when they put this balance at risk, that threatens safety and the patient-centered nature of care we’re trying to deliver.”

The fourth strategy is building professional competency, training health care professionals on the strategies to promote effective care coordination across multiple settings. This is closely related to the fifth strategy, forging cross-continuum care teams. This team could include the hospital, outpatient physician practices and home health agencies, and also adult day health centers, mental health providers and quality improvement organizations.

The sixth strategy is improving communication so the transfer summary is concise, contains essential elements and gives perspective on objectives for future care. Finally, the seventh is re-conceptualizing risk identification,

considering factors outside of the diagnosis that might cause readmission like health literacy.

“Patient safety is a collective effort, not a competition,” Coleman said, encouraging teamwork. Many of the conference speakers noted that collaboration is key to progress in patient safety, and encouraged physicians to learn from each other and work together. Wachter said, “One of the most exciting things happening in medicine today is it’s forcing us to speak with each other and learn to collaborate in new ways. We realize we must collaborate in ways we’ve never done before.” n

Eric Coleman, MD, MPH, director of the Care Transitions Program at the University of Colorado Anschutz Medical Campus, talked about the challenge of ensuring patient safety during transitions out of the hospital. These transitions are a time of great vulnerability for lapses in safety and quality, plus the amount of resources dedicated to this area is proportionately small, he said.

Coleman presented seven strategies to ensure safety and quality during care transitions. First, foster greater patient engagement. By default, patients and family caregivers perform a significant amount of their own care coordination but they do this without skills, tools or confidence. Training the patient and the caregiver in their post-hospital care can make a difference. This leads to the second strategy, fostering family caregiver engagement instead of ignoring this important partner. Coleman suggested scheduling discharge instructions at a time when family caregivers can participate.

The third strategy is to foster greater physician engagement and accountability. Readmission penalties are refocusing the discussion on transitions and a new care coordination benefit under fee-forservice Medicare is designed to promote support and pay providers for post-hospital discharge care coordination.

Colorado Medicine for November/December 2013

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Visit www.cms.org to learn more about the benefits of becoming a member For more information and an application to join, call Tim Yanetta 720-858-6308 or e-mail Tim_Yanetta@cms.org

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Colorado Medicine for November/December 2013

Features

Take the challenge Gina Claxton, CMS contributing writer

Strengthen patient relationships and improve health care delivery Saying no to a patient can be one of the most challenging things a physician can do, and if done well it can often be the best thing for patients and physicians alike. The Colorado Medical Society continues to push forward on the statewide Choosing Wisely Colorado campaign created by and designed for physicians. The campaign supports physicians and their work to strengthen relationships with patients, improve health care delivery and change current practice habits.

Facing the challenge Christie Reimer, MD, internist from Fort Collins and president of the Northern Colorado Medical Society (NCMS), knows the constraints all too well that physicians currently face to improve patient care efficiency, effectiveness and engagement. In a recent article for NCMS she not only recognizes these challenges, she also challenged the profession to consider when patients are harmed by too much health care by spotlighting Brandon Combs’ “Do No Harm Project” at the University of Colorado. In thinking about the Choosing Wisely Colorado recommendations she notes that, “I am a general internist who strongly believes that every patient should have a meaningful relationship with a primary care physician…{and these} recommendation{s} make me reevaluate how I best care for well adults.”

Choosing Wisely Colorado (CWC) is the state-level effort championed by the Colorado Medical Society as part of the much larger national Choosing Wisely® movement. The initiative is spanning the country and growing in impact daily.

Originally only nine medical specialty societies were involved in the campaign.

Today, roughly one year from launch, over 50 specialty groups are committed to the campaign’s aim of increased efficiency in the use of our health care resources. CMS was the first state medical society to endorse Choosing Wisely®, and continues to support the efforts of encouraging communication around appropriate care to increase quality in health care delivery.

Doing what is best for Colorado patients and communities is what is at the core of the Choosing Wisely Colorado campaign. Kim Warner, MD, Denver OB/ GYN with the Kaiser Permanente, explains, “The Choosing Wisely Colorado campaign is done with the intent to give you the tools to make the right choices for your patients. The focus is on patientcentered care.” Dr. Warner helped to create a CMS toolbox video for the Choosing Wisely campaign demonstrating some of the tips and techniques she uses to engage patients successfully in “no” conversations.

Perfect timing Taking on the Choosing Wisely Colorado challenge now may be more important than ever. As a physician you have likely felt pressure from all directions to increase efficient use of health care resources, to reduce health care spending, and to protect patients from financially devastating out of pocket treatment costs.

These pressures are not expected to relent because they are a direct by-product of the evolving health care environment and health care reform. While you may not be able to control many of those is-

Colorado Medicine for November/December 2013

sues, Choosing Wisely Colorado provides resources for you to use on something that you have some control over – your relationships with your patients.

Choosing Wisely Colorado provides a vehicle for physicians to demonstrate both leadership and stewardship in the health care system. Taking on the challenge of Choosing Wisely Colorado acknowledges the fact that physicians are the health care experts, and the decisions you make have huge impacts on health outcomes and quality of care. Literature shows that meaningful conversations help to not only enrich physician/patient relationships, but also improves quality and safety.

The challenge also presents an avenue to demonstrate professional responsibility, an area in which Colorado physicians have shown a keen interest. In fact, a recent CMS poll showed the majority (63%) of Colorado physicians believe they have a major responsibility to take the lead in Choosing Wisely conversations.

Colorado Medical Society offers several tools and resources on the CWC web page. Visit www.cms.org/choosing-wisely for videos, articles, brochures, and patient resources surrounding these potentially difficult but very important Choosing Wisely conversations. New resources continue to be developed and added to the website. If your component or specialty society is interested in helping create a new tool or take the lead on the campaign please contact Chet Seward at chet_seward@cms.org n

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Features

CMS honors and awards Kate Alfano, CMS contributing writer

Youth science fair winners recognized at annual meeting Two Colorado State Science Fair winners were honored with cash prizes and certificates in recognition of their achievements before the House of Delegates on Sunday, Sept. 22. Each year the CMS Education Foundation presents the Colorado Medical Society Award for Excellence in the Health and Behavioral Sciences to one student from the junior high division of the science fair and one student from the senior high division. CMS invites the students and their families to the annual meeting to display their projects and receive their awards.

intosh told 9News, the Denver NBC affiliate, in an Aug. 23 interview. “I’m excited to talk with them about their medical experiences and see what suggestions they have for my mouthwash.”

Junior division winner Ellie Mackintosh was honored for her project “Simply Mouthwatering – Development of a Mouthwash to Increase Saliva.” Her inspiration for the product came from her father, who was diagnosed with head-andneck cancer when she was a child. He underwent lifesaving treatment but the radiation damaged his salivary glands and left him with perpetual dry mouth. She consulted with dentists and physicians on

Hartley was the 2012 junior division winner, honored for her in vitro model of Pseudomonas biofilm that tested antimicrobial effects of several agents. She discovered a flaw in her 2012 project, suspecting that the most effective agent last year was due to its ethanol content. That led her to this year’s project, for which she tested her hypothesis, found it true and tested antimicrobial effects of several aqueous agents. She also strived to more closely mimic the lung environment of her test system with the addition of a viscous agent.

Senior division winner Jenna Hartley was honored for her project “Pseudomonas a.

Infections in the CF lung: Inhibition of Bio-encapsulated Pathogens – Effects of Herbal Extracts Compared to Tetracycline on Pseudomonas Biofilm Formation in Presence and Absence of Mucus Analogue.”

CMS Past President Brent Keeler, MD, presented the awards. “These two young women, one a previous winner in the junior division, represent the future in scientific inquiry,” he said. “We celebrate with them and their families.”

Ellie Mackintosh, CMS State Science Fair junior division winner. which sour flavors would best stimulate saliva production and combined these to develop her mouthwash and gel.

“I’m so honored to be able to have the opportunity [to attend the meeting],” Mack 32

net Seeley, MD, PhD, served as the official CMS judge at the 2013 fair. She said it’s important to support youth in sciences because there is a short supply of evidence-based studies that are well de-

“Scientific inquiry is a life-long process.

The scientific mindset begins at an early age. Recognizing the scientific achievements of our young people is the underpinning of their motivation as scientists in the future,” Keeler said.

Jenna Hartley, CMS State Science Fair senior division winner. signed and free of bias. “Part of the idea behind encouraging young people to go into science, especially medically inspired science, is because we need better studies and more studies about medical issues.”

Seeley said there were many excellent projects at this year’s fair and she encouraged other CMS members to come to the annual Colorado State Science Fair and volunteer as a judge to be inspired and encouraged by the questions the students have and how they go about finding their conclusions. n

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

Colorado Medical Society member JaColorado Medicine for November/December 2013

Features

CMS honors and awards Kate Alfano, CMS contributing writer

Gretchen Hammer receives CMS Breakthrough Award The Colorado Medical Society awarded the inaugural Breakthrough Award to Gretchen Hammer, executive director of the Colorado Coalition for the Medically Underserved for her innovative and determined leadership to secure health care for all Coloradans working as chair of Connect for Health Colorado.

CMS Immediate Past President Jan Kief, MD, presented the award before the House of Delegates on Sunday, Sept. 22.

“This house of medicine has been pushing up against the glass ceiling of health coverage for over a decade,” Kief said.

“Breakthroughs take persistence, collaboration and – the most elusive of factors – skilled leadership.”

Hammer. The Colorado Medical Society is presenting this award to Gretchen for her steadfast leadership and diplomacy often under considerable political pressure – not to mention friendly fire – as chair of Connect for Health Colorado.”

blame, Kief said, which leads to the pursuit of the kinds of nationally-recognized delivery innovations leaders like Hammer are building and implementing. n

Gov. John Hickenlooper appointed Hammer to a four-year term on the Connect for Health Colorado board and her colleagues voted for her to serve as chair of the board. The exchange launched on Oct. 1.

Colorado enjoys a political culture that strives to fix problems rather than place

Gretchen Hammer receives the CMS Breakthrough Award from Dr. Jan Kief.

“Sometimes, the breakthrough in the pursuit of expanding coverage for working Coloradans takes a hammer, manifested by the appropriately named Gretchen

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

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

720-858-6306 or e-mail tim_yanetta@cms.org Colorado Medicine for November/December 2013

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Features

Annual meeting not all business Kate Alfano, CMS contributing writer

CMS members socialize and enjoy themselves in Vail One of the main purposes of the annual meeting is to bring CMS members together for fun and fellowship. Friday, Sept. 20, members gathered for a MardiGras-themed reception hosted by the 2013 Exhibitors. Attendees enjoyed Cajun-inspired food and drinks, live music, a photo booth and giveaways.

The masquerade-themed Presidential Gala on Saturday, Sept. 21, honored incoming CMS President John Bender, MD, FAAFP. Also recognized at the gala were outgoing president Jan Kief, MD, and outgoing immediate past president F. Brent Keeler, MD.

50th anniversary of graduating medical school. This year's honorees were M. Herzl Melmed, MD, Gene Bolles, MD, C K Wanebo, MD, Joseph Broughton Jr, MD, David Bagley, MD, Clarence Henke, MD and David Hutchison, MD. Bender thanked his wife and children, his practice staff and CMS as a whole – which he called his three families – for supporting him in his role as president. He also kept true to his COMPAC challenge pledge: if CMS members and friends raised $10,000 for the political action committee of CMS, he would cut his hair during the gala. He surpassed his goal and had a professional give him a Marine-style buzz cut.

Anderson Payne,” a fictional special advisor and consultant to the president’s council on economic development, brought the house to uproarious laughter by sharing his “findings” in current economic trends – a series of one-liners and stories about corporate culture and bureaucrats. The comedian, whose real name is Durwood Fincher, is also known as “Mr. Doubletalk” for his ability to interject gibberish into normal conversation for a comedic effect. For his finale, Fincher showed the audience his pre-taped interviews with annual meeting attendees candidly reacting to his unique interviewing style.

The keynote speaker of the gala, “Dr.

The evening concluded with a dessert bar sponsored by COPIC with music and dancing. n

Physicians celebrating their 50th anniversary of medical school graduation are honored at the inaugural gala (names in above article.)

From left, Theresa and John Bender, MD, and Katherine Blair enjoy Friday night’s exhibitor reception.

Friday’s reception featured a photo booth where attendees could go incognito in a variety of Mardi Gras-themed costumes.

Heather Ogle, MD, and John Ogle, MD, attend Saturday night’s masquerade-themed Presidential Gala.

Durwood Fincher, aka “Mr. Doubletalk,” entertained attendees with his unique brand of comedy.

CMS members gave Dr. Bender a $10,000 haircut at the gala as he fulfilled his pledge to cut his hair to raise money for COMPAC.

One of the time-honored traditions of the inaugural gala is to present 50-year pins to CMS members celebrating their

34

Colorado Medicine for November/December 2013

Features

Medical student activities CMS Medical Student Component Society

Student members gather for networking, policymaking The medical students had a large presence at the 2013 Annual Meeting with more than 80 student members in attendance. Students from the two Colorado medical schools have joined forces to form the CMS Medical Student Component Society. They caucused Saturday morning on the resolutions and reports before the House of Delegates, presented the section’s work to the House of Delegates Saturday afternoon and held a focus group with CMS members on underserved specialty care access.

“We’re approaching policy with great interest – knowing that this organization will have a large part in shaping our future practice conditions – and also with great humility and the attitude that we are here to learn from those who have been out practicing and setting policy,” said Amy Beeson, a medical student at the University of Colorado School of Medicine (UCSOM).

Six students presented to the House of Delegates: Beeson, Bianca Pullen and Warren Pettine from UCSOM, and Julia Tanguay, Susan Bauer, and Brendan Fowler from Rocky Vista University (RVU).

Beeson explained that the UCSOM representatives polled their student body to determine their top five priorities: medical student tuition and loan forgiveness, health access and services for mental illness, medical malpractice laws, single-payer health care in Colorado, and physician pay.

From this poll, they chose to focus first

on improving mental health care in Colorado. “The big initiative right now has to do with integrating physical and behavioral health care,” Pettine said.

“This means that you have your primary care provider and mental health provider working side by side in the same facility, participating in the same patient visit. We [in Colorado] are at the center of where this is happening.”

There are many issues with integrating physical and behavioral health care, but the improved outcomes and improved allocation of health care resources could greatly benefit the state, Pettine noted.

Colorado is working toward solutions by crafting the State Innovation Model (SIM), a federal grant proposal on this issue, and through the work of Colorado Sen. John Kafalas, who is exploring initiatives to facilitate integration.

The students’ second goal is to reduce debt-driven residency choices. Studies have shown that the level of a student’s educational debt can discourage that person from pursuing a primary care specialty. And with an estimated 510,000 new insured patients entering the system between 2014 and 2016, the demand for primary care physicians will only rise. Pullen explained that CU has the fourth lowest level of state support and the 8th highest level of tuition for residents with regard to state funding for medical education. She urged CMS to advocate for increased funding for medical education.

workforce; 58 percent of the 2012 and 2013 RVU graduates pursued primary care residencies. They see that graduate medical education funding has largely fallen on the federal government, and Colorado must be innovative in finding additional avenues for funding, she said.

Sunday morning the students held a breakout session with CMS members on access to specialty care. Lynn Parry, MD, a CMS past president, said the session made her realize that advocates for better access have been asking the wrong questions. “What we’ve been asking is whether specialists take Medicaid or Medicare but we haven’t asked whether they would do it with a different model.”

Beeson said the diverse group of physicians “eagerly shared their ideas on how to improve access across the board, using creative and collaborative solutions such as technology, patient navigators, changing reimbursement, and recruiting physician volunteers.” n

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

Tanguay said that increased funding of RVU could support the primary care

Colorado Medicine for November/December 2013

35

Inside CMS

ICD-10 update Marilyn Rissmiller, Senior Director, Health Care Financing

Payers on target with ICD-10 The Colorado ICD-10 Training Coalition has held monthly webinars since March to help practices form their ICD10 implementation plans to be ready for the Oct. 1, 2014 implementation date.

The September webinar featured four private payers who presented their ICD10 strategies and resources, and answered questions. Representatives from Anthem BCBS, Cigna HealthCare, Rocky Mountain Health Plans and UnitedHealthcare all said that they will be ready to process claims by the ICD10 implementation date and they do not anticipate any delays in payment. They advised practices to be sure any middlemen – such as clearinghouses, vendors or billing services – are also prepared to process claims by the implementation date.

Jolice Smith from Anthem said Anthem will process claims submitted after Oct. 1, 2014 in either ICD-9 or ICD-10 based on the claim’s date of service initially but will not process mixed claims, or claims filed with both code sets on the same claim as is consistent with guide-

lines from the Centers for Medicare and Medicaid Services.

None of the payer representatives said they would be able to test with each physician practice before next year.

However, Anthem will provide a selfguided tool that will give feedback to the claim submitter, likely a clearinghouse, whether a test claim has gone through. Practice staff would then need to communicate with their clearinghouse to receive the outcome of the self-guided test. Anthem’s ICD-10 news and resource page can be found at http:// tinyurl.com/ICD-10-Anthem.

Mark Laitos, MD, and Patti Guerin from Cigna advised practice staff to pay careful attention to the service date and discharge date. Cigna will accept claims submitted with ICD-9 codes if that authorization was requested and services start prior to Oct. 1, 2014, but authorizations for services starting on or after the implementation date will need to be submitted with ICD-10 codes.

Cigna will start testing with trading partners and vendors in the fourth quar-

ter of 2013. They suggested practice staff take one of CIGNA’s ICD-10 e-courses by going to the medical e-courses page of the resources section of www.cignaforhcp.com.

Monika Tuell with Rocky Mountain Health Plans said RMHP has begun internal ICD-10 testing and will start external testing with clearinghouses, direct submitters and application vendors in the second quarter of 2014. She also recommended providers contact their clearinghouses and test directly with them, and encourage their clearinghouse to test with RMHP. To confirm that their clearinghouse has tested with RMHP, practice staff can call either RMHP professional relations representatives or the clearinghouse directly.

Aaron Sapp from UnitedHealthcare said there is no need for contracted physicians to remediate or recontract based on ICD-10. They will begin internal testing in the third quarter of 2013 and will begin testing with providers, vendors and regulatory agencies in the first quarter of 2014. They’ll widely release information from their partners with whom they test so practices will stay informed. Find ICD-10 resources on UnitedHealthCare’s website at http://tinyurl. com/ICD-10-UHC. This transition is perhaps the largest project to date for payers and physician practices. Open communication between all vendors involved in claims processing will be crucial to ensure claims are successfully submitted and processed come Oct. 1, 2014. To view the webinar and access other resources from the Colorado ICD-10 Training Coalition, go to www.cms.org/icd-10. n

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Colorado Medicine for November/December 2013

Colorado Medicine for November/December 2013

37

Inside CMS

Prior Authorization Task Force update Marilyn Rissmiller, Senior Director, Health Care Financing

Prior authorization working group plans the process The Colorado legislature passed the prior authorization reform bill, or Senate Bill 13-277, in 2013 to establish a standardized prior authorization process for prescription drugs. CMS strongly supported the bill, which works to streamline the administrative process and improve patient care by allowing physicians and other providers to devote less time to administrative duties and more time to patient care.

As mandated in the legislation, the Department of Regulatory Agencies, including the Division of Professions and Occupations and the Division of Insurance, formed the prior authorization working group this summer to develop recommendations for how the prior authorization process will work.

Membership includes physicians, dentists, nurses, practice administrators, Colorado Medical Society staff, health plans, pharmacy benefit managers (PBMs), pharmacies and drug manufactures. We are meeting monthly in order to submit our recommendations to the Division of Insurance by Dec. 15.

The law outlines several requirements that must be part of the prior authorization process: • It must be available electronically, but electronic filings are not required.

• Carriers and pharmacy benefit managers (PBMs) must provide certain information on their websites.

• Carriers must use evidence-based guidelines.

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• Providers may submit requests electronically.

• A notice of approval to the provider must include a unique prior authorization number, particular drug approved, date for next review and a link to criteria the provider will need to submit for re-approval.

• A notice of denial to the provider must include appeal rights.

As of our October meeting we are considering five main elements to the process: transparency, timeliness, communication, electronic transactions and consistency of criteria. We want notification to be timely and to limit unnecessary back-and-forth communications between the physician, plan and/or PBM. We also want to ensure the availability of complete information on the plan’s prior authorization requirements, and to ensure consistency between the prior authorization process and basic requirements for the same medications among plans.

Once we submit our recommendations, the commissioner of DOI will consider them in concert with national standards for electronic prior authorization, whether the process should require certain clinical criteria be reviewed, whether the process should require a review of local coverage determinations and specialty society guidelines, and whether the process should include a method that leads to immediate determination. The DOI will also develop a standard prior authorization form.

The commissioner will develop the final process and form by July 31, 2014, and it will go into effect by Jan. 1, 2015. n

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Colorado Medicine for November/December 2013

Inside CMS

Survey results compiled Joanne Wojak, Director, Continuing Medical Education

More than 3,000 Colorado physicians participate The Colorado Medical Board recently distributed a statewide survey to 19,000 Colorado licensed physicians to learn what types of continuing professional development (CPD) and continuing medical education (CME) activities they participate in and find to be most useful to improving the quality of their practice. More than 3,000 physicians responded.

This survey project was part of the Maintenance of Licensure (MOL) collaborative effort between the medical board, Colorado Medical Society and Colorado Society of Osteopathic Physicians, and was developed with staff from the National Board of Medical Examiners, the Federation of State Medical Boards and the American Board of Medical Specialties.

ods to improve the quality of their practice. While the respondents felt overall that all types of methods were either “somewhat useful” or “very useful” to improving the quality of their practices, they also reported that live CME and reading the literature offered the least amount of feedback about their performance in an educational setting or in actual practice.

Top five methods respondents said they had used to improve the quality of their medical practice in the past two years:

Of importance to MOL, the data revealed that over the last two years physicians have used mostly live CME and reading the medical literature as meth-

Types of objective feedback methods include:

1. Conference attendance 2. Reading the medical literature 3. CME programs in person 4. CME programs online 5. Teaching Top five “useful” activities for improving the quality of medical practice: 1. Other (activities not provided in the multiple choice, e.g. audio, CDs, journal editing, clinical research, fellowship, consulting, board review course, etc.)

2. Point of Care Learning 3. Teaching 4. Reading medical literature 5. Conference attendance Of all “useful” methods, the top five that provided useful feedback: 1.

2.

3.

4.

5.

Participation in a data registry Practice audits Improvement/self-assessment modules Clinical/procedural simulation Peer chart review

Colorado Medicine for November/December 2013

Join Now! Colorado Medical Political Action Committee Call 720-858-6327 or 800-654-5653, ext. 6327 or e-mail susan_koontz@cms.org

39

MOL survey (cont.)

• Feedback direct from a live evaluator such as during clinical/ procedural simulation; • Comparison of pre- and post-test results or test scores as found in online CME, case studies, structured clinical examinations or board examinations; • Detailed information about each item-level response such as why it was correct or not; • Immediate item-level responses with direction to relevant reference mate-

rial as found in interactive online activities or self-assessment modules; • Comparison to peers or benchmarks with PI CME or chart reviews; • Suggested improvement activities; or • A detailed report of findings such as from chart reviews or practice audits.

Respondents reported that when they received feedback from activities, it offered insight into their strengths and opportunities.

CME research suggests that if physi-

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cians are expected to change their practice as a result of what they learn in a continuing education activity, the activity should include an opportunity to first practice what they learn and receive objective feedback about their performance (JCEHP 2009, Moore et al.). The fact that physicians typically do not receive feedback from live CME conferences is not surprising given that CME design has not yet caught up to CME research; in-person conferences are held external to the practice setting, largely in a lecture format, and rarely offer physicians an opportunity to practice what was learned and receive feedback.

This is important information for the MOL initiative because an MOL framework based on a continuous learning and improving cycle will require physicians to participate in activities that provide feedback through self-assessments and objective assessments, so they can identify opportunities for improvement and choose learning activities accordingly.

Our future projects related to MOL will need to focus on providing clear communication about the requirements and continue to identify appropriate CME/ CPD tools for physicians to choose.

And, while traditional types of continuing education may still be effective, especially when they offer design characteristics such as interactive components, multiple exposures, and multiformat (AHRQ January 2007), CME providers will need to explore ways to integrate assessments and feedback in their programs ov CME if they want to help support physicians with their MOL and/or MOC requirements.

The respondents were also queried about other things such as how much time and money they spend on continuing education. More than half (53.4 percent) revealed they dedicated 10 or more workdays to CME/CPD activities. Forty-one percent said they spend between $1,000 and $3,000 on these activities in a typical two-year period, with 16.2 percent indicating they spend more than $5,000. n

Colorado Medicine for November/December 2013

Colorado Medicine for November/December 2013

41

Inside CMS

Reflections Reflective writing is an important component of the CU School of Medicine curriculum. Beginning in the first semester, all medical students participate by writing essays or poems that reflect what they have seen, heard and felt. This column is selected and edited by School of Medicine faculty members Steven Lowenstein, MD, MPH and Henry Claman, MD.

that our interactions will translate into a pattern of respect and professionalism with patients.

Gaea Moore

Gaea is currently a fellow in Maternal-Fetal Medicine at the University of Colorado. She enjoys spending time in the outdoors with her husband and two children, Miles and Mikaela. After fellowship, she plans to return to California, where she hopes to join an academic practice and continue teaching.

What humanism means to me: An essay to my mother Dear Mom, One of the things I love about my work is that I see you in my everyday life. You were a teacher before you decided to pursue medicine, and I guess that it is not surprising then that I love to teach residents and medical students in my role as an Obstetric fellow. I get to teach the basics, like risk factors for premature rupture of membranes, or how to beautifully imbricate the second layer of a hysterotomy closure during a cesarean section. More importantly, I get to practice good medicine, and in doing so, teach by example.

I don’t get to be in every room for every encounter with the patients on our service, but I hope that by creating a space for my residents and medical students to practice medicine in an environment where they feel respected and valued, 42

I remember once ordering fast food with you, how the cashier’s “glazed over” eyes suddenly came to life when you asked her if she was Russian, as you had recognized her accent. Her smile practically took over the cash register as she told us, in Russian, to have a nice day. When we walk into a patient’s room on the Labor and Delivery floor, it is often full of very worried people. We refer to the patient by name, and then ask her to introduce us to her family and friends. That tiny gesture, or recognizing peoples’ existence and presence, is one of the first ways we show patients that we are on the same team, and that we care about who they are and what happens to their pregnancy.

In Obstetrics, we get to share both the happiest moments in families’ lives, and the most tragic. It has become my practice to tell patients, before I perform a routine anatomy ultrasound, or place the transducer on a mother’s abdomen who has not felt fetal movement for days, that whatever happens, that I will be there for them. When our first pregnancy resulted in a miscarriage, those were the words that I needed to hear, and they seem to ring true to others. It is also amazing, and I never would have realized it at the time, that having had a miscarriage was in some way a strange gift – that now I can look a patient in the eyes and say “I’ve been there, and it takes time, but you will get through this.”

I love taking care of patients, and I really try to practice in a way that you would be proud of. To me it means taking time to use the translator phone even if I’m really rushed for time. Asking “What questions do you have” instead of “Do you have any questions?” It means validating patients’ fears and saying “I know you know your body better than any of us.” It means spending extra time at a patient’s bedside inquiring about the gender of their baby, or whether they have any special wishes for their delivery. It means respecting Colorado Medicine for November/December 2013

Inside CMS the wishes of my patient with a lethal fetal anomaly, however they decide to manage their pregnancy. It means considering the life circumstances which makes them who they are, and making an effort to understand their medical beliefs.

Your own time was cut short, and you didn’t have the opportunity to practice medicine before you became sick yourself, but I want you to know that I take every opportunity to practice medicine in a way that I imagine you would have – with compassion, inquiry, kindness, and empathy. I hope that in continuing to practice in an academic environment, working with residents and medical students, that I can teach these values, if only in example.

It is truly an honor to be your daughter.

With love, Gaea. n

Colorado Medicine for November/December 2013

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Inside CMS

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

Reflecting back on COPIC’s 2013 focus on improving medicine The political debate surrounding the Affordable Care Act and rollout of regulations and requirements pushed health care to the forefront of national attention in 2013. For physicians, practice administrators, facility risk managers and others in our industry, this meant trying to understand what the future will look like and how to prepare for it.

For COPIC, the last year presented an opportunity to look at our role and responsibility within health care. How do we evolve to best support those we work with and not lose focus of the ideals we were founded upon? It’s a question we consistently look at and one that is part of the conversations we have with our insureds. Some highlights from 2013 that illustrate our approach to this include: We enhanced our coverage to address cyber liability risks Because of the inherent risks involved with sensitive data in health care, COPIC added cyber liability coverage to group and individual professional liability policies. This new level of protection addresses common threats such as stolen electronic records, lost mobile devices, and cyber attacks; it also provides access to resources that help prevent data and privacy breaches.

In 2014, we will be extending this coverage to facility policies.

We invested in ways to improve the educational activities we offer COPIC expanded our selection of on-demand courses, such as interactive case studies and specialty-specific learning, to provide more ways for insureds to gain valuable education in a flexible format. We also redesigned our Education section to make it more user friendly with better search capabilities. In addition, the “Inside COPIC” program entered its second year as a two-day immersive opportunity to learn about the medical liability world through direct interaction with members of our leadership team and attendance at a claims review committee meeting.

We continued our support for health care through our foundation In 2013, the COPIC Medical Foundation provided grant funding for the following organizations and initiatives: • The Colorado Children’s Immunization Coalition is implementing a year-long state leadership engagement and strategic planning process that will improve the immunization rates.

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• Citizens for Patient Safety is launching its Patient Advocacy 101 Program, which recruits health care professionals as volunteers to serve as trainers and patient advocates.

• Colorado Rural Health Center will be assessing rural physicians’ community engagement skills in relation to long-term retention. The data obtained will be used to develop a curriculum for the University of Denver’s Healthcare Leadership program.

• Emily Griffith Foundation received funding for educational equipment upgrades for students in the Phlebotomy, Nursing Assistant and Medical Assistant programs at the Emily Griffith Technical College.

• Hospice and Palliative Care of Western Colorado will be assessing ways to improve the transitions in care of patients and caregivers going through end-of-life experiences, as well as coordinating patient care across treatment settings.

We expanded our leadership team and level of involvement outside of COPIC One of the reasons for COPIC’s success is the involvement of outside physician leaders. In 2013, Dr. Davis Hurley, the CEO of Advanced Orthopedics and Sports Medicine Specialists and a practicing orthopedic surgeon, joined our board of directors; and Dr. Hal Richardson, a family practice physician with New West Physicians, joined our team of faculty consultants.

Internally, key COPIC staff were involved with health care and professional organizations in leadership positions: • Gerry Lewis-Jenkins, our executive vice president, was appointed to the American Hospital Association’s (AHA) Committee on Governance, which advises the AHA Board of Trustees on policy and advocacy issues.

• Dr. Alan Lembitz, our chief medical officer, is a member of a special advisory committee that was formed in Colorado to address the issue of prescription drug abuse.

• Mark Fogg, our general counsel, completed his term as president of the Colorado Bar Association, where he focused on several key initiatives designed to improve the state’s legal system while reinforcing professional leadership.

As I look back, I am proud of what we were able to accomplish as a company and the individuals that made this possible.

Looking forward, I am confident that we can build on our focus of improving medicine through flexible coverage options, trusted guidance, and a commitment to providing the services and resources our insureds need to succeed. n

Colorado Medicine for November/December 2013

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Colorado Medicine for November/December 2013

45

Departments

medical news Bill Pierson inducted into the Professional Broadcasters' Hall of Fame for thirty years, from 1978 to 2008.

Bill Pierson, center, is inducted into the 2013 Broadcast Professionals of Colorado (BPC) Hall of Fame. Presenting the award was BPC President Steve Conklin, left, and Kim Christiansen of 9News, right, who served as the event emcee.

Former Colorado Medical Society Communications Director Bill Pierson was inducted into the Broadcast Professionals of Colorado Hall of Fame on Oct. 18 at the organization’s annual banquet.

Pierson almost single-handedly wrote, edited and published Colorado Medicine

The Broadcast Professionals of Colorado is an organization dedicated to keeping the heritage of Colorado broadcasting alive by honoring the foremost figures that shaped the industry from the 1920s through the present. Professionals with 15 or more years in broadcasting or broadcast-related experience are eligible to join their membership.

“Anyone fortunate enough to listen to Bill Pierson emcee a CMS annual meeting could not help but be mesmerized by his magnificent voice and command of the podium,” said CMS Chief Operating Officer Dean Holzkamp. “All of us

ICD-10 impacts more than electronic transactions The National Uniform Claim Committee (NUCC) released an updated Health Insurance Claim Form, version 02/12.

The NUCC updated the 1500 claim form to accommodate several changes, including the need to accept ICD-10 codes. The updated 1500 claim form allows physicians to identify the version of the diagnosis code set being reported (ICD-9 or ICD-10), expands the number of diagnosis codes that can be reported from four to 12, and improves the accuracy of certain data reported.

Medicare anticipates implementing the 02/12 1500 claim form as follows: • Jan. 6, 2014: Medicare begins receiv-

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ing and processing paper claims submitted on the 02/12 1500 claim form.

• Jan. 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old 08/05 1500 claim form.

• April 1, 2014: Medicare receives and processes paper claims submitted only on the 02/12 1500 claim form.

A sample of the 02/12 1500 claim form is available on the NUCC website at www.nucc.org. Also available is the NUCC’s 02/12 1500 Reference Instruction Manual, which provides instructions for completing the revised fields on the form. n

here at the medical society could not be more proud of Bill's well-deserved honor and his enduring legacy as an icon of Colorado broadcasting.”

Through his 40-year career in broadcasting, Pierson worked as an announcer, newsman, owner and instructor. He spent a decade as a staff announcer at WRIG in Odessa, Texas; KFKA in Greeley; KMAN in Manhattan, Kan.; KRDO in Colorado Springs (while in the Army stationed at Camp Carson); and KVOD in Denver. In 1957 he joined Denver’s KTLN radio as a news reporter, and later as news director he created and hosted one of the first call-in topic-driven talk shows in Denver. He worked at KTVR Channel 2, KBTR radio and KBTV Channel 9 as a news reporter and editor, and KOA radio as a reporter and editor.

In 1965 he launched KBPI (Bill Pierson Incorporated) and served as its president, general manager and news director, housing the studios on the 20th floor of the historic Daniels and Fisher Tower in downtown Denver. Shortly after going on air, the landlord shut the building down with the intention of demolishing the tower. Pierson fought back and kept the station on the air.

Though he sold the station in 1974, both the call letters and the D&F Tower remain in Denver.

In 1977 he became news director and reporter at KOSI and from 1981-1987 he hosted a weekly public affairs program on Channel 4. He also hosted on KRMA TV for more than 20 years.

The Colorado Medical Society extends our sincere congratulations to Bill on this recognition as well as our lasting gratitude for his years of service. n

Colorado Medicine for November/December 2013

Departments

medical news AMA launches Fix Medicare Now campaign The American Medical Association launched a grassroots campaign in September to empower physicians and patients to contact their congressional representatives and urge them to pass legislation to reform the Medicare physician payment system.

A key component of the campaign is an interactive website, FixMedicareNow.

org. There physicians and patients can find videos, online infographics and other resources that illustrate the need to eliminate Medicare’s failed payment formula, the SGR, and move toward a health care system focused on patients, not payments. Advocates can also find email templates to use when reaching out to their elected officials, a place to share personal stories about the need

CMS creates members-only guide to Covering Colorado health insurance marketplace On Oct. 1, Connect for Health Colorado opened for business allowing consumers and small businesses to shop for and purchase health insurance through an online marketplace. Experts hope this phase of health care reform will spur competition among insurers, drive down the cost of insurance and make it easier to bridge the gap for uninsured populations.

CMS policy staff developed a resource to help physician members understand and prepare for the up to 240,000 newly insured patients that are projected in 2014 thanks to the exchange. “Connect for Health Colorado: A Physician’s Guide to the State’s Health Insurance Exchange” covers important topics including:

• Participating health plans; • Patient churn between these new marketplace products and Medicaid; • 90-day grace period and how your practice may not be reimbursed for services delivered to patients who don’t pay premiums; and • Impacts of patient cost sharing.

Go to www.cms.org to access the physician guide to learn about these issues and more. Please note that this content is for members only. Any login questions should be directed to Tim Yanetta, CMS membership coordinator, at tim_ yanetta@cms.org. n

for Medicare reform and a way to share the website with friends through social media.

“Physicians want to work with Congress to move past this broken payment formula and toward a Medicare program that ensures access to care, the best health outcomes for patients and a sustainable practice environment for physicians,” said AMA President Ardis Dee Hoven, MD “There’s strong bipartisan support for repealing the SGR, and I’m optimistic that Congress will pass legislation this year to help make Medicare better for America's seniors.”

The Congressional Budget Office has projected that the cost to eliminate Medicare’s SGR payment formula is about half the price of repeal last year.

In August the U.S. House Energy and Commerce Committee unanimously approved a bill to repeal the SGR, enhance health care quality and make new models of care delivery and payment available. The U.S. House Ways and Means Committee and the U.S. Senate Finance Committee also are expected to issue their own versions of the legislation this fall.

Visit FixMedicareNow.org to add your voice to the debate and keep up the pressure. n

Save the date for Nov. 20 town hall on youth prescription drug abuse

Make plans to attend a town hall meeting on Nov. 20, “A Statewide Discussion on Prescription Drug Abuse Among Youth,” presented by the Community Anti-Drug Coalitions of America (CADCA) in collaboration with the office of the governor and the Prescription Drug Abuse Prevention Program.

The event will be held at the University of Colorado Anschutz Medical Cam-

pus in Aurora and will be streamed live through the Area Health Education Centers in Greeley, Grand Junction, Alamosa, Pueblo and Durango.

The event will start at 6:30 p.m. with hors d’oeuvres. The program will run from 7 - 9 p.m. Topics include: Warning signs and symptoms, national and local solutions, new overdose prevention

Colorado Medicine for November/December 2013

legislation, and personal stories from affected families.

Go to http://tinyurl.com/nov-20-townhall to register for the free event. Go to www.peerassistanceservices.org to register for a live streaming event. n

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Departments

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

➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES

Join Now! Call 720-858-6327 or 800-654-5653, ext. 6327 or e-mail susan_koontz@cms.org

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

FAMILY PRACTITIONER NEEDED IN GRAND JUNCTION, COLORADO - Small physician group seeks additional partner for independent practice opportunity. No hospital or OB. Good income potential. Why work for somebody else when you can be your own boss? Reply with CV to P.O. Box 2067 Grand Junction, CO 81502.

IMAGING CENTER IN LOUISVILLE - CO seeking part-time MD to oversee contrast administration from 7:00 a.m. - 11:00 a.m., Mon. - Fri. Requires active CO medical License and advanced CPR training. No other responsibilities; not required to provide any medical care except to intervene in case of patient contrast reaction. Contact Darlene Molenaar at 303.416.1048.

CHERRY CREEK FAMILY PRACTICE - is looking for an energetic and caring Board Certified Family Practitioner. We offer a comfortable clinic setting serving young families, healthy singles and loyal seniors. We also do a fair amount of Workmans Injuries. Our compensation is competitive with benefits. The clinic staff are lively and together we treat our patients like our friends with compassion and respect. If you are the right one, we look forward to hearing from you at floryq202@comcast.net

DONATE SUPPLIES OR EQUIPMENT Project C.U.R.E. collects donated medical equipment and supplies and organizes them for delivery to people in need in developing countries. Volunteers needed locally to sort medical supplies and internationally to participate in C.U.R.E. Clinics.

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

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Colorado Medicine for November/December 2013

Departments

classified advertising ➤ PROFESSIONAL OPPORTUNITIES ➤ MISCELLANEOUS

➤ PROPERTIES FOR SALE OR LEASE

CHIEF MEDICAL OFFICER - A leading Colorado non-profit managed care company seeks a Chief Medical Officer to lead the administration of behavioral health medical services in the Denver metro area. A respected provider of behavioral health, this position is part of the executive leadership team creating the strategic direction for the organization. This position does not involve any patient contact with 70% of time spent providing administration of services, 15% strategic planning and 15% compliance. The position offers a base salary of $246,000 along with a comprehensive suite of benefits and relocation if needed. Qualified candidates will be a board certified MD or DO with 4 year residency training with an accredited psychiatry program. Eligible for, or hold, a current Colorado license and up to date knowledge of psychopharmacology. All inquiries will be held in strict confidence and should be directed to Tom Boyer, Princeton Associates – tboyer@princetonassoc.com or 303-766-7222.

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

➤ MISCELLANEOUS LOOKING FOR LOCUMS WORK IN COLORADO? - We place physician and mid-level providers with family practice, urgent care, internal medicine, pediatric and occupational medicine clients. Competitive rates. Are you a provider that needs strong locums providers to work in your practice while you are away? Securely e-mail to RMoore@ mednowstaffing.com or visit our website at www.MedNOWStaffing.com FOR SALE - Cast saw w/vacuum- extra blade & bags, wheelchair, exam tables, hot light, lead shield aprons and other items all in excellent condition. Photos can be emailed. Please call if interested.

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Family Medicine Physician needed for Beautiful Southwestern Colorado Practice An exciting opportunity exists for a BC/BE Family Medicine physician in Southwestern Colorado. Montrose is near the San Juan Mountains and we have a golden opportunity for a physician interested in a practice in a growing community.

• Exceptional 90-member medical staff representing 19 medical specialties • 75-bed general acute care hospital that underwent a major expansion within the last 5 years which included a new inpatient tower, a new ICU and telemetry unit, and a new emergency department staffed by board certified emergency medicine physicians • On-site emergency helicopter adds to our capability as a Trauma III medical center • The hospital is a joint venture partner in a cancer treatment center and an outpatient surgery center • Diagnostic and interventional cardiac services in our cath lab • Unassigned emergency room call is covered by an on-site hospitalist program • Highly respected accredited CME program with weekly case presentation conferences and guest lecturers Life in Montrose is made more inviting with easy access to skiing, fishing, biking, hiking, hunting and the majestic San Juan mountain range just to our south. We have family medicine opportunities for group practice or independent practitioner.

Colorado Medicine for November/December 2013

Contact Mary Snyder at (970) 240-7398 or email CV to msnyder@montrosehospital.com.See our website under Physician Services, Physician Recruitment at www.montrosehospital.com

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Features

the final word John Hughes, MD CMS Workers’ Compensation and Personal Injury Committee

Curbing prescription drug abuse and preserving patient care As we’ve seen painfully demonstrated on the federal level, achieving synergy in public policy can be challenging.

But stakeholders across Colorado have successfully shown how various groups with diverse perspectives can come together to address an epidemic issue: the abuse and misuse of prescription pain medication. Reducing its prevalence while preserving access to care will benefit our patients now and in the future, and our teamwork will serve as a model for the rest of the country.

I currently chair the Colorado Medical Society Workers’ Compensation and Personal Injury Committee (WCPIC), and we were asked by the board earlier this year to review current CMS policy on prescription drug abuse and make strategic recommendations for moving forward. As a result, we created the platform “Public Health and Safety Challenges of Treating Chronic Pain: The Medical Perspective,” which encompasses 31 recommendations and was presented to and passed by the CMS House of Delegates at the 2013 Annual Meeting in September.

The platform focuses on five planks: the Prescription Drug Monitoring Program (PDMP), licensing boards standardization, physician education, law enforcement, and prescription drug abuse as a public health issue.

Two days later, Gov. John Hickenlooper released his “Colorado Plan to Reduce Prescription Drug Abuse,” a coordinated, statewide strategy developed through his yearlong leadership as chair of the National Governors Association policy academy. A crucial recommendation in the plan was to create the Colorado Consortium for Prescription Drug Abuse Prevention, which launched the same day.

Led by the University of Colorado School of Pharmacy, the consortium serves as the operational lead for the Colorado Plan to Reduce Prescription Drug Abuse. It brings together the governor’s policy office, a variety of state agencies, and representatives from the medical and education communities including many leaders from the Colorado Medical Society. The group will help

Have an idea you want to share?

Do you like something CMS is doing?

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

E-mail: Letters to the editor dean_holzkamp@cms.org 50

facilitate and implement workgroup recommendations in provider and prescriber education, the PDMP, disposal, public awareness, and data and analysis.

I serve on the provider and prescriber education workgroup and we have two tasks: to change state board policies and/or rules for all prescribers licensed by the Department of Regulatory Agencies (DORA) to include pain management guidelines, and to enlist and support DORA to provide education about the existence and utilization of the PDMP as part of the licensing processes for prescribers and pharmacists.

Tasks of the other workgroups include improving the usability and appropriate accessibility of the PDMP, expanding take-back programs in law enforcement agencies and pharmacies, educating the public through a widespread marketing campaign, and carefully tracking trends in prescription drug abuse to educate the public and other stakeholders.

It is evident that all of the tasks outlined in the governor’s strategic plan complement WCPIC’s recommendations and will advance our common goals to protect our patients and ensure proper use of prescription pain medications. Though the strategic plan only outlines actions over the next year, our collective work builds a strong foundation for continued collaboration on this and other public health issues.

Together I’m confident that we will achieve the governor’s goal of preventing 92,000 Coloradans from engaging in nonmedical use of prescription pain medications by 2016 and we will continue the momentum to make even larger strides. n

Colorado Medicine for November/December 2013

Patient care is your mission. And keeping your practice in top financial health is necessary to fulfill it.

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Experienced and resourceful, our professionals research the industry to find the best possible coverages and precisely tailor them to your unique needs. COPIC Financial facilitates the process from beginning to end, making sure you receive personalized, professional service.

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

COPIC Financial Service Group www.copicfsg.com•(720) 858-6280/(800) 421-1834 Scan here to learn more about COPIC Financial Service Group.

Colorado Medicine for November/December 2013

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Colorado Medicine for November/December 2013