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September/October 2012

Volume 109, Number 5

“Start your engines . . .� Revving up to meet new year of challenges CMS President

Jan Kief, MD

Colorado Medicine for September/October 2012

Award-winning publication of the Colorado Medical Society

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Colorado Medicine for September/October 2012


cont n ent nt ns nt Sept/Oct 2012, Volume 109, Number 5

Features. . . Cover story Recently inaugurated

CMS President Jan Kief, MD, encourages physicians to “start their engines” and rev up to meet a new year of challenges. Read her inaugural address in its entirety starting on page 8.

Inside CMS 5 31 33 35 36

Executive Office Update Practice Evolution - Transparency Practice Evolution - Payment Reform Reflections COPIC Comment

Departments 37 38 41

New Members Medical News Classified Advertising

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2012 CMS Annual Meeting – CMS elects new officers, sets policy and educates physicians at its 2012 annual meeting.

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AMA luncheon – Learn more about physician practice transformation by leveraging AMA resources from Catherine Hanson, JD, AMA VP of private sector advocacy.

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“When we pull together we can be extremely powerful” Colorado’s own Jeremy Lazarus, MD, AMA President, delivers the annual meeting keynote presentation.

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Leveraging through strategy – CMS physician delegates give direction on policy priorities with interactive live polling at the annual meeting.

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Clean Claims Task Force–Task force seeks physician input on standard set of payment rules and claims edits. Specialty society input particularly needed.

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Medicine and the 2013 legislative session–A packed COMPAC luncheon honored two Colorado legislators with the CMS “Defensor del Paciente” award.

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COMPAC announces candidate endorsements – After extensive interviews conducted by physicians statewide, COMPAC releases state and federal candidate endorsements.

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Colorado, CMS weigh major Medicaid expansion – CMS Board of Directors encourages physicians to provide input and consider options for the medical society.

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Final Word–COMPAC Chair Dave Ross, MD, shares why in politics, “not knowing your right from your left” is a very good thing for political advocacy.

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

Colorado Medicine for September/October 2012

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and CONNECTION

2011/2012 Officers Jan M. Kief, MD

President

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

Treasurer

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

Board of Directors Charles W. Breaux Jr., MD Robert A. Brockmann, MD Ellen M. Burkett, MD David Elison, MS Naomi M. Fieman, MD T. Casey Gallagher, MD Ripley R. Hollister, MD Johnny E. Johnson, MD Donald Luebke, MD Randy C. Marsh, MD Gary Mohr, MD Lucy Loomis, MD Jeffrey A. Moody, MD Edward A. Norman, MD Tamaan Osbourne-Roberts, MD Scott Replogle, MD Stephanie Sandhu, MS Ranee M. Shenoi, MD Alisa B. Lee Sherick, MD Stephen V, Sherick, MD Sean Slack, MS Thomas H. Soper, DO Kayla Steffensmeier, MS

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

COLORADO MEDICAL SOCIETY STAFF Executive Office

Alfred Gilchrist, Chief Executive Officer, Alfred_Gilchrist@cms.org Dean Holzkamp, Chief Operating Officer, Dean_Holzkamp@cms.org Donna Jeakins, Manager, Accounting, Donna_Jeakins@cms.org Dianna Mellott-Yost, Executive Assistant to CEO and General Counsel, Dianna_Mellott-Yost@cms.org

Division of Communications and Member Benefits

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 Policy

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

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Information Technology/Membership Tim Roberts, Senior Director, Tim_Roberts@cms.org 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 Education Foundation Colorado Medical Society Foundation Mike Campo, Staff Support, Mike_Campo@cms.org Donna Jeakins, Staff Support, Donna_Jeakins@cms.org

COLORADO MEDICINE (ISSN-0199-7343) is published bimonthly as the official journal of the Colorado Medical Society, 7351 Lowry Boulevard, Suite 110, Denver, CO 80230-6902. Telephone (720) 859-1001 Outside Denver area, call 1-800-654-5653. Periodicals postage paid at Denver, Colorado, and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance. COLORADO MEDICINE magazine is the official journal of the Colorado Medical Society, and as such is also authorized to carry general advertising. COLORADO MEDICINE is copyrighted 2006 by the Colorado Medical Society. All material subject to this copyright appearing in COLORADO MEDICINE may be photocopied for the non-commercial purpose of education and scientific advancement. Publication of any advertisement in COLORADO MEDICINE does not imply an endorsement or sponsorship by the Colorado Medical Society of the product or service advertised. Published articles represent the opinions of the authors and do not necessarily reflect the official policy of the Colorado Medical Society unless clearly specified.

Alfred Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Brad Pierson, Art Director, Assistant Editor; Chet Seward, Assistant Editor. Printed by Spectro Printing, Denver, Colorado

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Colorado Medicine for September/October 2012


Inside CMS

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

Ideological agnosticism fundamental rule of engagement This issue’s Final Word guest column by COMPAC Chairman Dave Ross, DO, emphasizes not only the inherent value of physician engagement in the political process, but also hits on one of the most fundamental rules of engagement: ideological agnosticism. To borrow from former U.S. Speaker of the House and Texas lawmaker Sam Rayburn, the vote of the politician of questionable judgment and personal character is the same as that of the debutante. Separating personal beliefs In my three-decade tenure as a physician advocate, I have found that physicians consistently and understandably struggle with separating their personal political beliefs from the more hardnosed pragmatism that dictates medicine’s support of an elected official (or candidate) whose track record or predisposition is demonstrably pro-medicine even when at odds with local doctors’ own partisan or ideological leanings. I understand that it may seem counter intuitive in a world defined in terms of clinical science, but the process that ultimately sets public policy has its own logic and, yes, ethics. Legislators who stand in harms way and support, or even champion, medicine’s issues will logically expect a certain level of reciprocity from their medical communities, regardless of whether they come from the left or the right, and regardless of whether they are likeable or not. I have also found that most physicians who master the art of political engagement, from the ballot box all the way into the halls of the statehouse and Congress, are the most effective advocates for their profession and the causes we pursue and defend. In the course of campaigns and on into the often con-

tentious give-and-take of legislative sessions, they have forged sustained working relationships with their members of the Legislature and Congress. The sustainable relationships develop and exist not because there is an agreement on all matters of policy, although that doesn’t hurt, but because those politicians consider them a reliable, unimpeachable resource on the complexities of health policy, and know that those physicians will stand by them when they are inevitably challenged. Making decisions These are subjective matters but, again, there is a logical construct for evaluating the relative disposition of an incumbent or the more speculative assessment of a candidate seeking office. It falls into three interdependent components. First the lobbyists’ and political professionals’ rating: This is how they stand on the issues and the subjective “grade” by those who are immersed in the process. This goes beyond record votes to include the many nuanced ways a legislator can help or harm – sharing inside-the-caucus intelligence, arguing on our behalf behind those closed doors, speaking on the floor, or working their colleagues before a crucial vote, to mention a few of the more obvious measures. They will also take into consideration the X factors – to what extent the legislator can reasonably be expected to go against the current and stiff powerful constituencies or leadership and caucus pressures. When the review pertains to the office-seeking candidate or challenger, this assessment has as much to do with what the candidate doesn’t say as what he or she pronounces. In our candidate screenings, truth and accu-

Colorado Medicine for September/October 2012

racy are not always the same thing, and the political pros can tell the difference. Second, the similarly subjective views of the local medical community are

“Pragmatism also means we will stand by those who support us, regardless of their party, fashion choices or personality disorders.” dropped into the equation. Area physicians are not likely to know the insiders’ take on the incumbent, and may well fall back on word-of-mouth sources and their own partisan leanings. If the lobby grade is relatively high, but the incumbent risks being tarred and feathered if he or she were to show up at a medical society reception, that dissonance has to be resolved, usually by putting the political pros in the room with the local doctors to try to level up perceptions— closing those truth-versus-accuracy gaps. The third interdependent factor is race intensity. If the A+ pol is equally beloved by the local medical community, but hasn’t had a serious challenge since his/her first term, then resources should be diverted to the race where the incumbent has walked the plank with medicine and incurred the considerable wrath of the trial attorneys. Pragmatism means we rarely indulge in

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Executive office (cont.) the luxury of getting angry – though we have that capacity when circumstances dictate. Pragmatism means we pick fights where our voices can make a difference. But that doesn’t mean just betting on sure things. It means an adversary will know when he or she has been in a fight, and opposing us means we won’t back down or be intimidated.

Pragmatism also means we will stand by those who support us, regardless of their party, fashion choices or personality disorders. Pragmatism also means there is no one vote and no one issue that defines a friendly incumbent or a candidate worthy of our support. Health care policy veers right and left of center, and there is plenty of room for debate.

In this election, we will find friends and adversaries in high and low places and in both parties. Our success will be directly proportional to the degree of local medical community engagement and the follow through into Denver when the Legislature convenes in 2013. n

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

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Colorado Medicine for September/October 2012


Inaction vs IN ACTION We understand the difference The Litigation Center of the American Medical Association and the State Medical Societies fights to protect doctors and uphold the highest standards of patient care. In courtrooms across America, we are achieving legal victories that preserve the rights of physicians, promote public health and protect the integrity of the profession. Whether we are challenging managed care organizations’ payment practices or preserving the autonomy of the hospital medical staff, one thing remains constant: The Litigation Center is an active force fighting for physicians’ rights. Learn more on how The Litigation Center can help you.

ama-assn.org/go/litigationcenter

Membership in the American Medical Association and the Colorado Medical Society makes the work of The Litigation Center possible. Join or renew your memberships today by calling the CMS at (800) 654-5653.

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

ama-assn.org 2012 Colorado Medicine for September/October

cms.org

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Cover Story

“Start your engines . . .� Revving up to meet new year of challenges CMS President

Jan Kief, MD

Jan Kief, CMS President 8

Colorado Medicine for September/October 2012


Cover Story “Ladies and Gentlemen, start your engines!” We are revving up to embark upon a new year of challenges and opportunities at the Colorado Medical Society. Those traditional words and the theme of racing and acceleration have special meaning to me, as my father was a professional race driver, and they are a reminder of what we need to accomplish this year. The racing profession has many parallels with the medical profession. The race driver trains as we did – often alone and yes, there was competition – but in the professional race venues, as in the delivery of health care, you can never do it alone. Some of the vital components are the raising of capital, to the state-ofthe-art technology and equipment with which to demonstrate your professional skills, the emphasis on safety, and that professional pit crew that literally keeps you going. Our pit crew may be the professional staff at CMS, our operating room team, and our hospital and office staff. It truly takes a team effort to make it to the finish line. My theme this year is the acronym REV: Relationships, Evolution and Voice. The word rev means to accelerate, and in this age of rapid change, that is exactly what we must do. You should always write down your goals and reflect upon them daily and I encourage you to write down REV and keep its components in mind as we forge ahead in medicine this year. I hope that REV – Relationships, Evolution and Voice – will be a personal call to action for every physician in our organization. First REV principle The first REV component is Relationships. Our Spring Conference 2012 focused on the importance of relationships, especially in these times. Even in our technical society, relationships are how we make progress, collaborate and achieve consensus. Last summer at the Colorado Health Foundation Symposium, we defined collaboration as “working with a group with different agendas but sharing some common principles.” This concept applies to our neighbors in insurance, hospital administration, con-

sumers, business, allied health groups, foundations, legislators, community groups, educators and more. Without hearing the diverse opinions of affected stakeholders, we cannot understand the dynamics that our new systems will require. By knowing and educating each other about areas where we have expertise, we can innovate together to solve problems. Silos are structures that keep things separated and do not work well in health care or relationship building. I challenge you to make a list of the following: a colleague of another specialty whom you can take to lunch; a community organization you can join or to which you can present a talk; a committee you can join at CMS; or a “breakfast club” you can form in your community with legislators or business leaders. These breakfast clubs are in the process of being formed at CMS. Call us to get your club formed! Second REV principle The second principle of REV is Evolution. Just as the racer always loved his first car and we loved our first office setting, we must realize that things are changing at a very rapid pace and we all must adapt and evolve. With technological information in our world doubling in a matter of months, not years, the cost of health care out of control, the population of elderly soaring, and health disparities widening, bold innovation and evolution in health and health care is an imperative. The only constant is change right now. Uncomfortable as change can be, think of how improved systems can help you personally enjoy the practice of medicine more. Past perspectives are an important part of our background knowledge, but we must KEEP MOVING FORWARD. Our keynote speaker at the Spring Conference, Mr. Michael Weisskopf, author of “Blood Brothers” taught us to “look back, but don’t stare.” Keep moving forward. We are smart problem solvers who care about people and our profession. We are capable of being in the driver’s seat as we tackle topics such as medicaid expansion, scope of practice, SGR, liability reform, new systems of care and

Colorado Medicine for September/October 2012

payment models, coordinated care and many other challenges that will come to us this year. It is time for pilots and innovative approaches from workflow redesign, telemedicine, systems of care, global and bundled payments, patient responsibility and wellness initiatives and much more. The CMS staff has great resources to help your practice flourish and can connect you to the pilots and projects in the state to help you get your incentives and designations, and to meet your performance measures. Colorado is ahead of the curve compared to many states,

“I hope that REV Relationships, Evolution and Voice - will be a personal call to action for every physician in our organization.” but the U.S. is behind many other countries in some areas of health care delivery. This may be the decade where we can take back the lead! As your president, I promise to be at those tables discussing the critical changes that have to be made in prevention and health care, but I need you to communicate with me and others about what is happening in your situation and community that can impact the process. Sometimes the best ideas come from unexpected sources. TEAM CMS will be there at the racetrack each week. On the circuit, you don’t win every race, but you don’t take your car and stay home; you make modifications as a team and you get back out there. Get a colleague to join CMS; join the AMA and your specialty society and BE THERE for this important time. These organizations are vital to our evolution in medical practice.

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Cover Story (cont.) Third REV principle Our final REV principle is Voice. First you must find your voice. What are you passionate about? Where is your expertise? Is it safety, technology, systems, workflow redesign, prevention, population health, access to care, legislation, community empowerment, promoting health teams, mentoring students? Whatever it is, identify and make a plan to use your voice. That is challenge #3.

Our survey this year confirmed that physicians are in the top four of trusted groups of people. Others will listen to you and are open to hear your ideas. CMS is a diverse group of physicians, 7500 voices strong. We can and must come together and harmonize and make a strong statement that will be listened to for the welfare of physicians and the patients and communities that we serve. Let us keep the CMS vision in mind.

“CMS will be the leader in making Colorado the best state in which to provide and receive the safest, highest quality and most cost effective medical care.” I pledge my best efforts to you this year as we REV up to make this a reality. n

ANNOUNCING Free website for Colorado physicians offering EHR tools and resources

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

• Step-by-step training with tools to track meaningful use progress

• Establish your own free account - quick registration • Self-guided and interactive content developed for Colorado physicians and staff

• Information and links to statewide resources • Online forms and downloadable documents to guide you through the meaningful use EHR process

Creating your free account is easy. Sign up today by logging on to

http://www.corhio.org/portal

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Funded by a grant from the Physicians Foundation

Colorado Medicine for September/October 2012


CMS Education Foundation Help send a student through school About the CMS Education Foundation Founded in 1982, the Colorado Medical Society Education Foundation (CMS EF) is a non-profit, tax-exempt charitable foundation established primarily to support educational and charitable programs in Colorado. Since 1993 the Foundation has dedicated itself almost exclusively to the funding of scholarships to incoming first-year medical students at the University of Colorado School of Medicine. Scholarships are awarded to students who come from underserved areas, have high academic credentials, demonstrate a financial need, and anticipate practicing in a rural or underserved area. Call 720-858-6310 for more information and to donate

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ALN Medical Management is a different type of partner. No matter how you choose to use us, the goal is the same: move your practice forward.

Let’s start a conversation today. Call 1-866-611-5132 Visit www.alnmm.com Join our WhatMatters programs

Colorado Medicine for September/October 2012

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Features

2012 CMS Annual Meeting Medical society elects new officers, sets policy at 142nd annual meeting Delegates at the 142nd Colorado Medical Society Annual Meeting inaugurated Jan Kief, MD, as president and elected John Bender, MD, as president-elect. In addition, M. Robert Yakely, MD was elected as speaker of the House, Brigitta Robinson, MD, vice-speaker of the House, Lee Morgan, MD, AMA delegate, Mark Laitos, MD, AMA alternate delegate and W. Gerald Rainer, MD, CMS historian. Outgoing CMS President Brent Keeler, MD, delivers final address to delegates.

Newly inaugurated CMS President Jan Kief, MD, was all smiles during the gala.

Dr. Kief presents Dr. Keeler with CMS’ highest honor for service to the society. 12

Important policy discussions from the meeting included the approval of a major plan to ensure the future relevance of CMS to all physicians regardless of practice setting and active debate on whether the state of Colorado should voluntarily expand Medicaid via federal health care reform.

juana use. The House of Delegates did, however, pass policy recognizing the published scientific data that the recreational use of marijuana has a deleterious effect on the health of individuals and public health, particularly on the developing brains of adolescents. Resolutions calling on CMS to halt physician gag orders relating to hydraulic fracturing operations and to oppose unfair non-compete or liquidated damages clauses in physician employment contracts were referred to the CMS Board of Directors for decision after additional legal research on the two issues is completed.

With regard to Referendum 64 concerning the recreational use of marijuana, CMS decided to take no formal position on the criminality of recreational mari-

Read the official disposition of resolutions, the CMS discussion paper on Medicaid expansion, view a video of Colorado’s major health plans discussing payment and delivery system reform and more coverage from the annual meeting at www.cms.org. n

COPIC Chairman and CEO Ted Clarke, MD, delivers good news on 2013 premiums.

CMS President-elect John Bender, MD, thanks colleagues for opportunity to lead.

Colorado Medicine for September/October 2012


Features

Judy Zerzan, Joan Henneberry and Chris Adams facilitate Medicaid discussion.

Tamaan Osbourne-Roberts, MD, and Rick May, MD, lead membership breakout.

Patty Fontneau seeks feedback from physicians on health benefit exchange.

CIVHC’s Jonathan Mathieu leads focus group on All Payer Claims Database.

Jennifer Wiler, MD, facilitates session on AMA’s payment reform toolkit.

Laird Cagen, MD, leads performance measures breakout session.

Alan Kimura, MD, moderated an interactive plenary session with the state’s top health plan medical directors that detailed new private and public payer payment reform strategies, how each plan seeks to align quality with payment and identified marketplace requirements physician practices must consider in order to succeed under payment reform. Alan Kimura, MD, President, Colorado Retina Associates.

Mark Laitos, MD, Medical Executive for Mountain States Region, Cigna.

Cissy Kraft, MD, Chief Medical Officer, Anthem.

Judy Zerzan, MD, Chief Medical Officer, Colorado Medicaid.

Kevin Fitzgerald, MD, Chief Medical Officer, Rocky Mountain Health Plans.

Jack Weiss, MD, Regional Chief Medical Officer, UnitedHealthcare.

Mark Levine, MD, Chief Medical Officer, Medicare Region 8.

Bill Wright, MD, President, Colorado Permanente Medical Group.

Colorado Medicine for September/October 2012

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Features

AMA luncheon Marilyn Rissmiller, Senior Director Health Care Financing

Physician practice transformation: leveraging AMA resources Both the American Medical Association and Colorado Medical Society are committed to helping physicians navigate the transformation from feefor-service to the new world of “budget-based” payment systems, such as bundled payments and shared savings.

The reality, Hanson said, is that as health care spending in the United States increases to unsustainable levels (even as physician incomes have dropped in the past decade), fee-for-service is quickly becoming an unsustainable payment model.

During the AMA luncheon at last month’s CMS Annual Meeting, Catherine Hanson, vice president of private sector advocacy and the Advocacy Resource Center for the AMA, had some reassuring words for physicians: “If you want to succeed in this world, you can.”

Instead, more focus is being directed toward population health and “valuebased” or “risk-adjusted” payment systems are being used more and more to supplement (if not replace) fee-for-service. Some of these programs already in place include Medicare’s shared savings program or the Prometheus payment system.

“There are a lot of physicians in this country who love this model because it gives them complete flexibility to manage a budget,” Hanson said. “There are people who have really benefitted, but in order to do that, you have to have a whole new set of tools.” Hanson introduced several of those tools – now available from AMA – during her discussion. She also provided information on the various payment systems, offered some recommendations and answered questions from the audience. (Slides from her presentation are available in the annual meeting section at www.cms.org).

AMA’s Catherine Hanson, JD, helps physicians succeed in new payment climate. 14

To be successful in these models, Hanson added, physicians must be able to: • • • • •

understand actuarial predictions and risk adjustment methodologies; track detailed patient demographic and health status information; track IBNR (incurred but not reported) claims; compare actual utilization against utilization budgets; and fairly limit their risk.

Physicians also need the skills and tools to evaluate the likely impact of any proposed payment system so they can decide whether to accept it, Hanson said. And they need to maintain accounting systems that are capable of accurately tracking, reconciling and reporting on the true economic impact of the payments received pursuant to those systems. To help physicians understand and make the transition to these budget-based payment models, AMA has created a new “how-to” manual titled “Evaluating and

Negotiating Emerging Payment Options.” Developed by the AMA and experts in physician payment issues, this series of resources discusses each of the various payment options now being offered and sets forth the key issues physicians must consider when determining whether to agree to a particular payment system, how to determine a fair price and how to reconcile any payments received to ensure that they are accurate. This supplements AMA’s “how-to” manual discussing new delivery systems, titled “ACOs, CO-OPs and other Options: A “How-To” Manual for Physicians Navigating a Post-Health Reform World.” AMA also has tools available on physician profiling programs, and has worked closely with Colorado Medical Society on model legislation that ensures physicians may get access to the data that health plans are using for these designations. The two organizations also have collaborated on efforts to reduce administrative waste, and AMA has resources available that include archived webinars and free online toolkits on each electronic transaction. All of these tools may be accessed through the AMA at www.ama-assn.org. Hanson also took time during her address to applaud Colorado Medical Society, saying AMA appreciates organizations such as CMS that “are really working to figure out how to make it all work better.” “It’s a whole new world out there” Hanson said, “but physicians are the only people that can fix what’s going on.” n

Colorado Medicine for September/October 2012


photo by Ted Grudzinski

Features

AMA President Jeremy Lazarus, MD delivers keynote

Sara Burnett, CMS contributing writer

“When we pull together we can be extremely powerful” American Medical Association President Jeremy Lazarus, MD, knows a thing or two about sticking it out for the long run.

An athlete who has competed in marathons and triathlons, the former Colorado Medical Society president now is guiding the nation’s largest physician organization through a time of historic change. And the way he sees it, in this 26.2-mile race, we’re at about mile four. “I think the good news is we’re not at the starting line anymore. We moved it along,” Lazarus told CMS members at the 2012 Annual Meeting. He cited several items in the Affordable Care Act

that AMA worked to improve for physicians and their patients, such as higher Medicaid payments for primary care and rules surrounding accountable care organizations (ACO) that have resulted in more ACOs being physician-led.

And while Lazarus noted that there’s still a long way to go on the journey, he also said Colorado is well positioned to be successful. “I think Colorado has a history of solving problems at the local level. It’s an amazing process where community has come together to try to deliver care in a better way,” he said. “You are seen as a leader with what we’re trying to do.”

Lazarus, who was sworn in as president during the AMA’s June annual meeting, said the organization recognizes that “one size doesn’t fit all,” and that physicians across the country have varying opinions on health care reform. He pledged that AMA is working to incorporate the views of everyone, and he encouraged all physicians to get involved. “When we pull together we can be extremely powerful for organized medicine,” Lazarus said. “It really is a historic time to try to create a better, more equitable health care system for all Americans – not just for the benefit of physicians but for the patients we serve.” n

Ensuring faster physician payment

IS

The American Medical Association is proud to work with the Colorado Medical Society to educate physician practices on how to streamline their claims process. Getting billing information quicker—and paid faster—is a prescription for efficiency. The AMA and the CMS support physicians in your practice, in the state house and in the courthouse. Working together with the CMS, the AMA will continue to make a difference.

Be a part of it. ama-assn.org/go/memberadvocate

© 2012 American Medical Association. All rights reserved.

Colorado Medicine for September/October 2012

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Features

Leveraging through strategy Sara Burnett, CMS contributing writer

CMS physician delegates give direction on policy priorities The Colorado Medical Society’s (CMS) 2012 Annual Meeting focused on leveraging relationships. Defined as the action of a lever or the mechanical advantage gained by it, leveraging can take many forms, outgoing CMS President F. Brent Keeler, MD, told members on the meeting’s opening day. “A medical group’s size may give it leverage in dealing with hospitals and health plans,” Keeler said. “A physician’s popularity with patients may give her great leverage in dealing with her employer. And CMS uses the respect that policy makers, patients and others have for the organization’s physician members to leverage better public policy.” That kind of leveraging occurs every day at CMS to help improve patient care. It is rooted in frequent and thorough member input and put into action via strategy sessions with physician leaders and CMS staff. During the annual meeting, physicians in attendance were able to sit in on one of those strategy sessions and weigh in on pressing issues via live polling (using keypads at their seats) and open microphone discussions.

What follows is the outcome of some of that polling on a series of issues that are either currently before CMS or are considered “emerging issues,” which will be pressing in the months to come. “It’s about creating a policy consensus that can serve as leverage through a unified physician voice over the coming year,” Keeler said. Which issues do you think are most important for CMS to spend resources on in the 2013 Legislature? The top three issues of importance for CMS to spend resources on in the 2013 Legislature are the Medicaid expansion and program improvements to Medicaid, preserving Colorado’s stable liability climate and investigating alternatives to the flawed litigation system through the cerebral palsy demonstration project. Who’s your daddy? In the next three years, which forces will have the most influence on your practice? Physicians reported that hospital systems, private sector managed care companies, trial lawyers, Medicare and issues related to the implementation of the Affordable Care Act (aka Obamacare) as the forces that will have the most influence on their practice. When it comes to advancing patient safety and professional accountability, which approaches do you favor ?

Over fifty medical students actively participated in this year’s annual meeting. 16

Once again, physicians reported that pursuing state legislation to create alternatives to the tort litigation process

Pollster Benjamin Kupersmit conducts survey of CMS delegates on policy issues. should be a top priority along with a commitment to work with other physicians, clinics and hospitals on programs that prevent harm and avoid litigation. In October, CMS and the Colorado Hospital Association are co-hosting a Patient Safety Congress. If you could make one patient safety-related suggestion to hospital management on behalf of your peers, what do you think is most important to emphasize? Physician sentiment centered around four suggestions they would like to make to hospital management: 1) Better communication with physicians through such ideas as regular cordial meetings with bilateral dialogue instead of edicts and mandates. 2) Recognizing that physicians should guide patient safety. 3) Creating a reporting culture of nonpunitive and open systems that should include a secure hot line to report events to management. 4) Committing to remain focused on reforming the liability climate which still impedes physicians being more proactive and transparent.

Colorado Medicine for September/October 2012


Features What ideas do you think CMS should pursue as a component of health care reform? This question revealed similar levels of support for the following five ideas. 1) Standardize billing processes among all insurance companies and require participation from all plans. 2) Develop a basic level of safety net coverage provided through insurance companies, backed and funded by the government. 3) Limit and simplify health insurance plan options to three or four standard benefit plans informed consumers can understand, easily compare and choose for themselves. 4) For any standard health insurance offered to Coloradans, include financial incentives to encourage healthy choices (e.g. prenatal care) 5) Create a system of cost transparency for health care facilities, providers and pharmaceutical companies. n

The Jane Nugent Cochems Trust Financial help for physicians in need The Colorado Medical Society administers all grants with the average amount ranging from $5,000 to $10,000. The application process is simple and the review processes are completely confidential. For more information or to obtain an application form, please call Donna Jeakins at the Colorado Medical Society, 720-858-6316. Visit http://www.cms.org/about-cms/cochems-trust/ to download an application form.

LOOkiNG? Whether you’re looking for new opportunities or selling your product or service, CMS’ classified ad section is the place to be seen. To place your ad call (720) 858-6310

Colorado Medicine for September/October 2012

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Features

Clean Claims Task Force Sara Burnett, CMS contributing writer

Task force seeks physician input on standard set of payment rules, claims edits A Colorado task force is seeking physician input to create a standard set of payment rules and claims edits to help ensure claims are coded, submitted and processed “cleanly” the first time. This first-of-its-kind project has the potential to free up millions of dollars in administrative burdens that could be reallocated to patient care in Colorado. It also could become a model for the rest of the nation – where the savings could be in the billions of dollars. But to be successful, the task force needs help from physicians and specialty medical societies. “The involvement of physicians and their specialty societies will ensure the task force’s final product does not just meet the goal of administrative simplification but is also clinically relevant,” said Barry Keene, co-chair of the task force and the president of KEENE Research & Development. The Colorado Clean Claims Task Force was created in 2010 under legislation signed into law by then-Gov. Bill Ritter, and with the support of the Colorado Medical Society. It is intended to relieve administrative burdens, improve transparency and reduce health care costs by creating a consistent set of edits and rules that everyone knows and uses. The standard set would be used by all payers in Colorado with the exception of Medicare. (The task force will not address edits used in utilization review or to detect abuse and fraud). 18

The task force is made up of key personnel from the major private payers and vendors affecting physician health care claims across the country, as well as the American Medical Association, Colorado Medical Society, the state of Colorado and local physician billing personnel. Members meet monthly as a group and more frequently as subcommittees. The legislation laid out a framework for the group’s work: “The base set of rules and edits shall be identified through existing national industry sources that are represented by the following: (I) The NCCI; (II) CMS directives, manuals and transmittals; (III) the Medicare Physician Fee Schedule; (IV) the CMS National Clinical Laboratory Fee Schedule; (V) the HCPCS Coding System and directives; (VI) the CPT coding guidelines and conventions; and (VII) national medical specialty society coding guidelines… The task force shall consider standardizing the following types of edits, without limitation: (A) unbundle; (B) mutually exclusive; (C) multiple procedure reduction; (D) age; (E) gender; (F) maximum frequency per day; (G) global surgery; (H) place of service; (I) type of service; (J) assistant at surgery; (K) co-surgeon; (L) team surgeons; (M) total, professional or technical splits; (N) bilateral procedures; (O) anesthesia services; and (P) the effect of CPT and HCPCS modifiers on these edits as applicable.” The task force wants to ensure transparency in the method used to establish its

complete edit set. In its deliberations, it will work to base the edits on a national source, including special societies when that information is available. Although Medicare is considered a national data set, the Act recognized that there may be gaps and inconsistencies in the edits and rules used by this program and gave the task force the flexibility to look beyond Medicare. The task force’s Specialty Society Outreach Committee is working directly with physicians and their specialty societies to identify some of those areas. They are seeking input on any specific coding guidelines, conventions or code pair edits that the specialty societies have developed. Additionally, if there are existing edits or rules in use by Medicare or commercial payers that are of concern, this committee would be the point of contact to insure the task force gives them consideration in its deliberations. To date, the task force has received direct input from two of the national specialty societies. The American College of Surgeons provided information regarding procedures that generally require the presence of an assistant at surgery, and the American College of Radiology provided documentation in opposition to Medicare’s application of the Multiple Procedure Percentage Reduction (MPPR) formula to the physician component of radiological procedures. Tammy Banks, director, Practice Man-

Colorado Medicine for September/October 2012


Features agement Center & Payment Advocacy with the AMA, is the co-chair of the Specialty Society Outreach Committee and the point of contact for physicians and specialty societies. She has been joined by James Borgstede, MD, a practicing radiologist in Colorado, in an effort to reach out to physicians in Colorado as well as the national specialty societies. Banks may be contacted via e-mail

at Tammy.Banks@ama-assn.org or by phone at 312-464-4792. She will be able to answer questions and/or facilitate a conversation with Dr. Borgstede. In order for suggestions to be fully considered, the task force asks that you provide a clear statement of the edit and/or rule you would like to address, your recommendation and supporting documentation. The Specialty Society Outreach Committee will review the

request and convey the information to the appropriate sub-committee and/or full task force for consideration. The Colorado Medical Clean Claims Task Force has a website at http:// hb101332taskforce.org/ where you can find more information including the Act, meeting agendas and minutes, and an e-mail contact. n

Colorado Medical Society “Advocating excellence in the profession of medicine”

Open letter to Colorado specialty physicians and specialty societies Invitation to provide input on standardized payment rules and claim edits Dear Colleague, I wanted to be sure that you were aware of a Colorado initiative to relieve administrative burdens, improve transparency and save millions in health care costs. The Colorado Medical Clean Claims Transparency and Uniformity Task Force has been working for over 18 months to develop a standardized set of payment rules and claim edits to be used by payers and health care providers in Colorado. The task force was formed in December 2010 as a result of House Bill 10-1332, which was sponsored by state Rep. Joe Miklosi and supported by the Colorado Medical Society during the 2010 legislative session. The group’s co-chairs are Barry Keene, a consumer and engineer who led the effort to get legislation passed, and Marilyn Rissmiller, senior director of CMS’ health care financing division. Other task force members include key personnel from all major payers in the state, the American Medical Association, and vendors including McKesson and OptumInsight, as well as experienced coders and billers representing Colorado physicians. As the task force works toward its goal of one consistent set of edits, they are reaching out to physicians in Colorado and nationally to seek input from all stakeholders. The fact that this is a state-based initiative, and an open process, gives physicians a unique opportunity to contribute to the development of a comprehensive set of claim edits. Participation by physicians and specialty societies is key to the success of the task force. I would encourage you to make sure your specialty society is involved either locally or at the national level. Please feel free to contact Marilyn Rissmiller on the CMS staff at (720) 858-6328 or me if you have any questions on the work of the task force. Sincerely, Jan Kief, MD President P.O. Box 17550 • Denver, CO 80217-0550 • 720-859-1001 or 800-654-5653 • fax 720-859-7509 • www.cms.org

Colorado Medicine for September/October 2012

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Features

Medicine and the 2013 legislative session

Sara Burnett, CMS contributing writer

Packed COMPAC luncheon at annual meeting honors two Colorado legislators and looks ahead to next year Rep. Bob Gardner, R-Colorado Springs, told the crowd. “It is interested in your pocketbook, how you conduct your business, what roads you drive to work on, and on and on and on.”

COMPAC Chair Dave Ross, DO, moderates 2013 health issues panel. The Colorado General Assembly will consider several issues that will have a major impact on physicians, their patients and the state’s health care system when lawmakers reconvene at the Capitol in January, legislators and physician leaders told attendees at the 2012 Colorado Medical Society Annual Meeting. Those issues – ranging from a major expansion of Medicaid to a pilot project that will test an alternative to medical malpractice litigation for children with cerebral palsy – make it even more critical that physicians get involved in the November election and stay involved in the political process. “You may not be interested in politics, but politics is interested in you,” state

Sen. Aguilar, Rep. Gardner, Dr. Ross and Jerry Johnson discuss health issues. 20

Gardner was honored with the “Defensor del Paciente” (Defender of the Patient) award along with state Sen. Irene Aguilar, MD, D-Denver, for sponsoring peer review legislation this past session that was supported by CMS. Physician advocacy was key to getting that legislation – known as House Bill 1300 – signed into law, Gardner said, as he urged attendees to get involved in CMS’ political action committee, COMPAC. “The prime way that you as physicians have to make your voices heard is through COMPAC,” Gardner added. “It made a difference in House Bill 1300, it’s going to make a difference in the November election, and it will make a difference on Medicaid expansion and other issues (next session).” Gardner and Aguilar joined COMPAC chairman Dave Ross, DO, and CMS’ longtime lobbyist, Jerry Johnson, for a discussion about the upcoming legislative session during the 2012 COMPAC luncheon in Keystone. They also discussed the upcoming election, and how it could affect not just which party controls the two chambers of the state legislature but more importantly, how many “friends of medicine” – those who vote with CMS on key issues – will have seats in each. (Democrats currently have the majority in the state Senate, while Republicans control

the House. (Colorado Medical Society endorses candidates in both parties). The presidential race between President Barack Obama and former Gov. Mitt Romney also will have an impact, most notably because Romney, a Republican, has pledged that if elected he will get rid of Obama’s signature health care law, the Affordable Care Act. That act, among many other things, provides funding for states to expand el-

Sen. Irene Aguilar, MD, (D) and Rep. Bob Gardner (R) receive patient defender award. igibility for Medicaid. If states choose to participate, the additional federal funding will cover the full cost of expansion for the first two years (2014 to 2016). Starting in 2017, states that opt into the expansion would have to pay a portion of the cost. (For more specifics on the expansion and what Colorado Medical Society is doing around this issue, see page 24). Aguilar, who worked closely with Gardner on the peer review bill and has partnered with him on other legislation, joked that Medicaid expansion is an issue “where maybe our friendship starts to break down.” She supports it; Gardner does not.

Colorado Medicine for September/October 2012


Features I see this as a huge opportunity for Colorado to expand its Medicaid population in a way it otherwise wouldn’t be able to (fiscally),” Aguilar said. While she agreed with many physicians that provider fees paid by Medicaid are insufficient, Aguilar also said that the current work being done in Colorado around Regional Care Collaborative Organizations (RCCOs) is promising, and could provide a way for the state to address some of the problems with the Medicaid program. Gardner, meanwhile, said the prevailing Republican view is that Colorado should not participate in the expansion because the state cannot afford it. Republicans don’t have any confidence that four to six years from now the funds from the federal government will continue, he said, and if that occurs the too-easy solution from the Joint Budget Committee would be to cut provider fees. “It is not a function of what people would like to do, it’s a function of what we can afford and what the budget would allow,” Gardner said, adding that if Republicans keep control of the House and take over the Senate, he doesn’t see any chance that the Medicaid expansion will occur.

Another perennial issue at the state legislature is tort reform/medical malpractice – an area that pits physicians against the very well funded trial lawyers’ lobby. This session, lawmakers also will be asked to support legislation for a demonstration project developed by Cerebral Palsy of Colorado (CP Colorado) that would serve as an alternative to medical malpractice litigation. The project would create a “birth fund” that will cover the lifetime medical costs of children born with certain neurological impairments. The fund would give parents a fair and reliable mechanism to cover their care, and an alternative to rolling the dice by filing a lawsuit, when the vast majority of those children were likely not harmed through physician error. Aguilar, who is a parent of a child with cerebral palsy, said she has some trouble with any system that takes away a parent’s right to sue. She would like to explore other options, such as a threetier system used in Oregon. That system starts with disclosure then moves into mediation before the right to sue is invoked. “I think I’d be interested in seeing if that’s something there’s an appetite for (in Colorado),” Aguilar said.

Gardner, an attorney who sits on the House Judiciary Committee, called the recent fights over raising the cap on noneconomic damages (which CMS successfully fended off) “some of the most memorable battles we had” on the committee. He also acknowledged physicians’ frustrations with the current medical liability system, but implored them not to give up. “There are things that you just have to lobby and lobby and lobby, and eventually their time will come,” Gardner said. To that end, Johnson announced CMS is starting a “Breakfast Club,” which will pair groups of physicians with lawmakers to discuss key issues in a casual but thoughtful way. The goal is to get every lawmaker to meet with a group of doctors and help them better understand medicine’s issues. “Our issues do not lend themselves to sound bites,” Johnson said. “They are complex issues that require thoughtful discussion.” CMS and the component medical societies will provide more information on the breakfast meetings in coming months. For more information on COMPAC and the 2012 candidate endorsements, see page 20. n

Join COMPAC Now!

Colorado Medical Political Action Committee Call 720-859-1001 or 800-654-5653, ext. 6321 Colorado Medicine for September/October 2012

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Features

COMPAC announces candidate endorsements

CMS staff report

Physicians urged to consider recommendations The Colorado Medical Political Action Committee, or COMPAC, has endorsed 82 candidates for state and federal office this year. Physicians and all friends of medicine are encouraged to consider the recommendations that follow and, above all, be sure to vote. For help identifying the candidates running in your district, visit the who’s my legislator link on the CMS home page at www.cms.org. COMPAC does not endorse based on political party. Instead, endorsements are made following a screening process that takes into account the views of the local medical community, the position of a candidate or incumbent on medical issues important to the medical society, the demographics of the district and a candidate’s ability to win. Read the full candidate briefing document available on the CMS website at www.cms.org.) COMPAC instituted the local physician screening process in the 2006 election cycle and several hundred physicians have participated in the process since then. This has proven instrumental in developing relationships between local constituent physicians and members of the Colorado Legislature. For more insight into the CMS political process, be sure to read the Final Word on page 42 of this magazine, written by COMPAC Chair Dave Ross, DO, and the Executive Office Update on page five of this magazine written by CMS CEO Alfred Gilchrist. For more information about COMPAC visit www.cms.org/ public-affiars/compac.

2012 General Election COLORADO STATE SENATE RACES COMPAC-endorsed (accepts PAC money) SD 4 (Douglas) Mark Scheffel (R) SD 8 (Moffat, Summit, Garfield, Grand, Jackson, Routt, Rio Blanco) Randy Baumgardner (R) SD 10 (El Paso) Owen Hill (R) SD 14 (Larimer) John Kefalas (D) SD 17 (Boulder, Broomfield) Matt Jones (D) SD 18 (Boulder) Rollie Heath (D) SD 19 (Jefferson) Lang Sias (R) SD 22 (Jefferson) Ken Summers (R) SD 23 (Broomfield, Weld, Larimer) Vicki Marble (R) SD 25 (Adams) Mary Hodge (D) SD 27 (Arapahoe) David Balmer (R) SD 28 (Arapahoe) Nancy Todd (D) SD 29 (Arapahoe) Morgan Carroll (D) SD 33 (Denver) Mike Johnston (D) COMPAC-endorsed (does not accept PAC money) SD 12 (El Paso) Bill Cadman (R) SD 31 (Denver, Arapahoe) Pat Steadman (D) SD 32 (Denver) Irene Aguilar (D) Senate races with no COMPAC endorsement SD 21 (Adams) Jessie Ulibarri (D) v Francine Bigelow (R) SD 26 (Arapahoe) Linda Newell (D) v Dave Kerber (R) SD 35 (Pueblo) Crestina Martinez (D) v Larry Crowder (R) v William Bartley (Lib)

All friends of medicine are eligible to participate. Call 720-859-1001 or 800-654-5653, ext. 6321

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Colorado Medicine for September/October 2012


Features

HD 2 HD 3 HD 5 HD 7 HD 8 HD 9 HD 10 HD 11 HD 12 HD 13 HD 14 HD 16 HD 17 HD 18 HD 19 HD 20 HD 21 HD 23 HD 24 HD 25 HD 27 HD 28 HD 30 HD 31 HD 32 HD 34 HD 35 HD 36 HD 37 HD 38 HD 39 HD 40 HD 42 HD 43 HD 44 HD 45 HD 46 HD 47 HD 48 HD 49 HD 50

COLORADO STATE HOUSE RACES COMPAC-endorsed (accepts PAC money) (Denver) Mark Ferrandino (D) HD 51 (Larimer) Brian DelGrosso (R) (Denver, Arapahoe) Brian Watson (R) HD 52 (Larimer) Joann Ginal (D) (Denver) Crisanta Duran (D) HD 53 (Larimer) Randy Fischer (D) (Denver) Angela Williams (D) HD 55 (Mesa) Dan Robinson (D) (Denver) Beth McCann (D) HD 56 (Adams, Arapahoe) Kevin Priola (R) (Denver, Arapahoe) Paul Rosenthal (D) HD 57 (Garfield, Moffat, Rio Blanco) Bob Rankin (R) (Boulder) Dickey Lee Hullinghorst (D) HD 58 (Dolores, Montezuma, Montrose, San Miguel) (Boulder) Jonathan Singer (D) Don Coram (R) (Boulder) Mike Foote (D) HD 59 (Archuleta, La Plata, San Juan, Gunnison, Ouray, (Boulder, Clear Creek, Grand, Jackson, Gilpin) Hinsdale) J. Paul Brown (R) Claire Levy (D) HD 60 (Custer, Chafee, Fremont, Park) Jim Wilson (R) (El Paso) Dan Nordberg (R) HD 61 (Gunnison, Pitkin, Summit, Delta, Lake) (El Paso) Janak Joshi (R) Millie Hamner (D) (El Paso) Mark Barker (R) HD 62 (Alamosa, Conejos, Costillo, Huerfano, Mineral, (El Paso) Jennifer George (R) Pueblo, Rio Grande, Saguache) Edward Vigil (D) (El Paso) Amy Stephens (R) HD 63 (Weld) Lori Saine (R) (El Paso) Bob Gardner (R) HD 65 (Logan, Phillips, Sedgwick, Weld, Morgan, Kit (El Paso) Lois Landgraf (R) Carson, Cheyenne) Jerry Sonnenberg (R) (Jefferson) Rick Enstrom (R) (Jefferson) Sue Schafer (D) COMPAC-endorsed (does not accept PAC money) (Jefferson) Cheri Gerou (R) HD 4 (Denver) Dan Pabon (D) (Jefferson) Libby Szabo (R) HD 15 (El Paso) Mark Waller (R) (Jefferson) Amy Attwood (R) HD 41 (Arapahoe) Jovan Melton (D) (Adams) Jenise May (D) (Adams) Joseph Salazar (D) House races with no COMPAC endorsement (Adams) Dominick Moreno (D) HD 1 (Denver, Jefferson) Jeanne Labuda (D) v (Adams) Steve Lebsock (D) John Kidd (R) v Mike Law (Lib) (Adams) Cherylin Peniston (D) HD 6 (Denver) Lois Court (D) v Robert Hardaway (R) v (Arapahoe) Su Ryden (D) Morton Brooks (Lib) (Arapahoe) Spencer Swalm (R) HD 22 (Jefferson) Mary Parker (D) v Justin Everett (R) v (Jefferson, Arapahoe) Kathleen Conti (R) Lynn Weitzel (Lib) (Douglas, Teller) Polly Lawrence (R) HD 26 (Routt, Eagle) Diane Mitsch Bush (D) v (Arapahoe, Elbert) Cindy Acree (R) Charles McConnell (R) (Arapahoe) Rhonda Fields (D) HD 29 (Jefferson) Tracy Kraft-Tharp (D) v (Douglas) Frank McNulty (R) Robert Ramirez (R) v Hans Romer (Lib) (Douglas) Chris Holbert (R) HD 33 (Weld, Boulder, Broomfield) Dianne Primavera (D) v (Douglas) Carole Murray (R) David Pigott (R) v W Earl Allen (Lib) HD 54 (Mesa, Delta) Jared Wright (R) v Tim Menger (Lib) (Pueblo) Leroy Garcia (D) (Pueblo, Otero, Fremont) Clarice Navarro-Ratzlaff (R) HD 64 (Baca, Bent, Huerfano, Las Animas, Otero, Prowers, (Weld) Stephen Humphrey (R) Crowley, Elbert, Lincoln, Washington, Kiowa) (Weld, Larimer) Perry Buck (R) Timothy Dore (R) v Nick Schneider (Lib) (Weld) Skip Carlson (R) COMPAC FEDERAL CONGRESSIONAL DELEGATION ENDORSEMENTS

D-1 D-2 D-3

D-4

(Denver, Arapahoe, Jefferson) Diana DeGette (D) (Summit, Eagle, Clear Creek, Boulder, Gilpin, Larimer, Jefferson, Broomfield) Jared Polis (D) (Moffat, Routt, Pueblo, Jackson, Rio Blanco, Garfield, Montrose, San Miguel, Dolores,Montezuma, La Plata, Rio Grande, Alamosa, Conejos, Costilla, Huerfano, Custer) Scott Tipton (R) (Weld, Logan, Sedgwick, Phillips, Morgan,

Colorado Medicine for September/October 2012

D-4 (cont.)

D-5 D-6 D-7

Washington, Yuma, Adams, Arapahoe, Elbert, Douglas, Lincoln, Kit Carson, Cheyenne, Kiowa, Crowley, Otero, Bent, Prowers, Baca) Cory Gardner (R) (El Paso, Park, Chaffee, Teller, Fremont) Doug Lamborn (R) (Adams, Arapahoe, Douglas) Mike Coffman (R) (Arapahoe, Jefferson, Adams) Ed Perlmutter (D)

23


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Colorado Medicine for September/October 2012


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Features

Colorado, CMS weigh major Medicaid expansion Board of directors encourages physicians to provide input, consider options As Colorado considers whether to expand Medicaid eligibility to 200,000 or more new participants, the Colorado Medical Society should remain at the forefront of the conversation while continuing to advocate for changes to make the program work better for physicians and patients alike, CMS members overwhelmingly agreed in recent forums. Neither the state of Colorado nor CMS has taken a position on the expansion, which would cover all individuals living in families below 133% of the federal poverty level ($30,657 for a family of four in 2012). Because the General Assembly and Gov. John Hickenlooper would likely have to approve any expansion, the issue is expected to be a major one during the legislative session that will convene in January. The CMS Board of Directors, recognizing the importance of physicians being at the table for any debate, recently created a process to gather and consider member input. In addition to online polling conducted over the summer, the process included discussions at the 2012 Annual Meeting in Keystone and other opportunities for physicians to provide feedback. Next month, the CMS Council on Legislation and Committee on Physician Practice Evolution will hold a joint meeting to discuss the issue. The two physician-led groups will forward a recommendation to the board for consideration at its Nov. 16 meeting. “The board recognizes that whether we support the expansion or an alternative 26

approach, we are uniquely positioned to share our knowledge and insight with key policy makers,” said CMS President Jan Kief, MD. “That’s why it’s so critical for members to let their voices be heard.” “As physicians, we see every day what a difference access to care can make in the lives of our patients. We also understand the challenges of delivering that care in a system that doesn’t always work as well as it could,” added CMS Immediate Past President F. Brent Keeler, MD. “This is an opportunity for us to have considerable influence in both areas.” Background The Medicaid expansion originally was mandated by the Affordable Care Act (ACA), President Obama’s signature health care reform legislation, and scheduled to occur by Jan. 1, 2014. But earlier this year, the U.S. Supreme Court ruled it should instead be optional, with officials in each state making the decision as to whether to expand. Several governors have stated they intend to expand Medicaid by the 2014 target date, while several others have stated they do not plan to expand. Most, including Colorado’s, have either been silent or are studying the implications of expansion. Colorado’s program has been reforming and transforming since early 2007, first as part of the state’s health reform agenda and later to prepare for implementation of the ACA. These reforms included myriad initiatives, including adopting medical homes for children in

CMS staff report

Medicaid and CHP+; expanding Medicaid eligibility for pregnant women and children; increasing reimbursements to pediatricians and other primary care providers; implementing new models of care for individuals with chronic conditions and high cost claims (now known as “hot spotters”); developing loan repayment programs and instituting quality incentive payments for nursing homes. With the support and collaboration of provider organizations including the Colorado Medical Society, the state took further steps to expand coverage, develop new models of service delivery, and initiate payment reforms. The capstone was the passage of House Bill 1293 in 2009. The bill created a financing mechanism to expand Medicaid for the first time in Colorado to additional populations, including adults without dependent children, through a hospital provider fee. Simultaneously the state had been working on new service models, moving away from fee-for-service. CMS strongly supported the development of a hybrid plan for Colorado that took the best ideas from other states. These efforts culminated in the creation of the Accountable Care Collaborative (ACC) that is now the foundation of the Medicaid service delivery system and delivering promising preliminary results. As Colorado considers whether to participate in this latest expansion, however, there are several factors to consider – not the least of which are cost and whether there are enough providers

Colorado Medicine for September/October 2012


Features willing and able to participate in the program to meet the increased need. The ACA calls for the federal government to fund the expansion for the first three years. Thereafter, however, the state would have to provide a portion of matching funds (5% in 2017, 6% in 2018, 7% in 2019 and 10% in 2020). Colorado is still working to estimate how much money from the state’s coffers that could mean, and how much of it could be offset by savings realized in other state and local agencies, such as the Department of Corrections, local public safety, behavioral health, human services and public health. Options Colorado’s options may extend beyond an all-or-nothing expansion. Until the U.S. Department of Health and Human Services issues further guidance, it is assumed that states’ options include: •

Expand Medicaid but propose doing so in phases, i.e. up to 100% federal poverty level (FPL) by 2014, 125% FPL in 2015, to 138% FPL in 2016. Or expand to specific populations such as non-elderly dually eligible individuals. Examine the use of a Basic Health Plan (BHP) for individuals up to 200% FPL. The ACA gives states the option to put adults between 133 and 200% of FPL into a health plan with minimum essential benefits versus sending those individuals to the health benefit exchange for subsidies.

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Medicaid expansion (cont.) (2014-2016), then roll back eligibility when the state has to provide a funding match beginning in 2017. •

Request a waiver (prior to 2017) to cover everyone with a state-designed approach instead of ACA models. The federal Health and Human Services (HHS) secretary has authority to allow a state to develop its own coverage model if it achieves the same coverage and financial goals of the ACA.

Kupersmit told members gathered at the annual meeting last month. Thirty one percent strongly (10%) or somewhat (21%) opposed it, while 9% said they were unsure. Asked what the organization’s top priorities should be as the discussion evolves, members responded with four clear areas: reimbursement rates, encouraging patient responsibility to achieve cost savings, streamlining/standardizing administrative procedures and liability reform.

Many of these options would require federal approval through a state plan amendment or waiver and it is not clear if the HHS secretary would have the authority (or willingness) to grant waivers for all of these options.

“You can’t expand Medicaid and have the support of the majority without addressing at least three of these four things,” Kupersmit said. “It is absolutely urgent for that conversation to happen.”

CMS feedback An online “flash” poll of CMS members showed the majority (60%) either strongly (38%) or somewhat (22%) supported the expansion, pollster Benjamin

In live polling during the annual meeting, 57% of physicians said “making the Medicaid program work better for physicians and patients” is the most important factor for CMS to consider when

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?

Telephone: 720-859-1001 or 800-654-5653

CMS is a physician-driven organization and we want to hear from you! Mail: Colorado Medical Society 7351 Lowry Blvd. Denver, CO 80230 28

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

taking a position on the expansion. Access to care for Medicaid recipients was the response of 14%, while “financial impact on medical practices,” “concerns about the state budget” and “the role of government in health care” each received 8%. Former CMS President Gary VanderArk, MD, told members that expanding Medicaid would save lives. Several physicians expressed concern, however, that without additional reforms and reimbursement that better covers the cost of providing care, there won’t be enough physicians participating in the program to meet the increased need. Joan Henneberry, the former director of Colorado’s Health Care Policy and Financing department, told CMS members that the state recognizes physicians will need help from “an army” of health educators, social workers and others who will support doctors and work with them as a team. She also encouraged CMS members to share suggestions for innovative change as the conversation moves forward. Mark Wallace, MD, president of the North Colorado Health Alliance in Weld County, noted that people who are not currently covered by Medicaid but would be under the expansion already are getting sick and getting care, but are doing so in “the most expensive places.” Physicians and policy makers shouldn’t forget that fact as they weigh how to proceed, he said. “Cost shifting is happening all the time, and I think to ignore it and to assume the uninsured aren’t getting sick and aren’t getting care …. is a fallacy in this discussion,” Wallace said. “The hardest time to innovate is when there’s absolutely no funding.” CMS is continuing to gather input from members and is available to answer your questions. Please contact chet_seward@ cms.org for more information. n

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Colorado Medicine for September/October 2012


Colorado Medicine for September/October 2012

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Colorado Medicine for September/October 2012


Inside CMS

Leveraging your clinical expertise Putting performance measurement to work for you and your patients

Transparency

Sara Burnett, CMS contributing writer With reporting of performance measures becoming a more widespread reality of an evolving health care system, physicians must leverage their data both to improve patient care and their practice’s bottom line. That was the message of a series of presentations sponsored by the Colorado Medical Society and the state’s component medical societies in recent weeks. The presentations were part of a new CMS initiative to educate physicians about performance measurement and give them the tools to use their data effectively. “Once you know how you perform, it puts you in the power seat,” Karen Frederick-Gallegos, director of quality improvement and analytic services for the Colorado Foundation for Medical Care, told physicians at the 2012 CMS Annual Meeting in Keystone last month. Performance measurement – once largely the purview of private health plans and known as “physician profiling” – has become so prevalent that during the Colorado Medical Society’s most recent strategic planning process, the CMS Board of Directors made helping physicians “turn data into intelligence” one of the organization’s five major goals. As Rick May, MD, told participants at an August workshop convened by Denver Medical Society, Arapahoe-Douglas-Elbert Medical Society (ADEMS) and CMS, “just about everybody” is now looking at physicians’ quality measures. And more often than not, the data have financial consequences.

Private payers such as Anthem, Aetna, UnitedHealthcare and Cigna all have programs – and in some programs, how a physician “scores” may affect how much co-pay a patient must pay to see a particular physician. Medicare has at least a half dozen programs, ranging from the Physician Quality Reporting System to the health information technology incentive program. Many of these programs provide additional payment to physicians who meet certain requirements – and a growing number already are or will soon impose penalties for doctors who do not participate. Patients also are able to look up information about physicians – their own or someone they are considering seeing – on various websites, before they make a decision on where to spend their health care dollars. And Colorado’s All-Payer Claims Database, which will compile physicians’ claims data from multiple payers, will begin public reporting in fall 2013. The proliferation of these programs is one good reason for physicians to track their own data and be aware of it. Just as compelling is that doing so has been shown to improve patient care, Frederick-Gallegos said. “Focus on improving the outcomes for patients,” she added. “It’s easy to get distracted by the fight (with payers). It’s easy to get distracted by the very complicated methodology … focusing on the patient is your high ground.”

sures used. While that number can be overwhelming, Frederick-Gallegos and May offered some specific steps and advice to make measuring your own performance and navigating the multitude of programs easier and more beneficial: 1.

2.

3.

4.

5.

6.

Identify relevant measures. Start small, with just a few measures, but select measures that are high-impact. Suggested high-impact measures are included in a toolkit being developed by CMS. Collect and validate your data. This will establish your baseline and, if you select measurements with evidence-based guidelines, tell you where you have opportunities for improvement. Identify the team. The physician cannot do this alone. There are many people in your practice who work with each patient; get them involved. Target interventions. For example, foot exams may be delegated to a medical assistant with some training. When you begin delegating tasks, there’s a higher probability everything will get done. Report data back. Make sure you understand the measurement methodology: who is in the numerator, denominator and exclusions. Identify crossover benefits. Find chances to “ring a lot of bells with fewer measures.” For example, there are 38 measures that are used in four or more programs.

In addition to providing a toolkit and Between 14 programs from private payers and Medicare, there are 956 mea-

Colorado Medicine for September/October 2012

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Transparency (cont.) educational opportunities, CMS continues to work with health plans and the all-payer claims database to support transparency in physician performance programs. Here’s how you can help: • Provide feedback to CMS on measures that aren’t relevant or don’t make clinical sense so CMS can share that information with the health plans. • Work with CMS to define a standardized measure set and reports that drive population health

• Proactively participate in programs by selecting clinically relevant measures and demonstrating improved outcomes. The following are available to support your work: • Colorado Medical Society: CMS contacts are chet_seward@cms.org and Marilyn_rissmiller@cms.org. Or visit www.cms.org and watch your electronic newsletters for information about tools and upcoming programs.

• • • •

Component medical societies Specialty society websites AMA Colorado Foundation for Medical Care: Karen Frederick Gallegos, kfgallegos@cfmc.org • Health TeamWorks: www.healthteamworks.org • Commercial payer sites n

CMS Education Foundation Help send a student through school About the CMS Education Foundation Founded in 1982, the Colorado Medical Society Education Foundation (CMS EF) is a non-profit, tax-exempt charitable foundation established primarily to support educational and charitable programs in Colorado. Since 1993 the Foundation has dedicated itself almost exclusively to the funding of scholarships to incoming first-year medical students at the University of Colorado School of Medicine. Scholarships are awarded to students who come from underserved areas, have high academic credentials, demonstrate a financial need, and anticipate practicing in a rural or underserved area.

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

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Colorado Medicine for September/October 2012


Inside CMS

Colorado selected for highly competitive demonstration project

Payment reform

Primary care initiative will pay practices to improve, better coordinate care Sara Burnett, CMS contributing writer More than 300 physicians in 73 Colorado primary care practices have been selected to participate in a highly competitive federal demonstration project that seeks to provide higher quality, better coordinated and more patientcentered care – and provides the funds to help make it happen. The Comprehensive Primary Care Initiative (CPCI) is an initiative of the Center for Medicare and Medicaid Innovation, but brings Medicare together with private and other public payers. The demonstration project is being conducted in just 500 practices in seven markets nationwide. “Our state’s selection for this much sought-after initiative is a testament to all the work that already has been done to ensure patients across Colorado are receiving high-quality, cost effective care,” said CMS President-elect John Bender, MD, a strong supporter of patient-centered medical homes whose Fort Collins practices are among the participants. “It’s also a recognition of the work that remains here and across the country, and that we as physicians cannot transform the health care system on our own,” Bender added. “We need coordination with private and public payers as well as our patients, employers and everyone else involved in the care team if we are going to truly change the way we deliver and receive health care.” The CMS Innovation Center was created by the Affordable Care Act to find new ways to deliver and pay for care that will improve care and health while

lowering costs. The center modeled the CPCI off of successful practices developed by large employers and others in the private sector that have invested in primary care. For example, the Community Care of North Carolina program decreased preventable hospitalizations for asthma by 40% and reduced emergency department visits by 16% by focusing on care coordination and primary care. CPCI offers bonus payments to physicians who better coordinate care for their patients. According to the Innovation Center, this means practices will: • Manage care for patients with high health care needs: Practices will deliver intensive care management that “uniquely fits each patient’s individual circumstances and values.” • Ensure access to care: Primary care practices must be accessible to patients 24 hours a day, seven days a week and be able to use patient data tools to give real-time, personal care information to patients in need. • Deliver preventive care: Practices will be able to proactively assess patients to determine needs and provide appropriate and timely preventive care. • Engage patients and caregivers: Primary care practices will have the ability to engage patients and their families in active participation in their care. • Coordinate care across the medical neighborhood: Practices are the first point of contact for many patients and take the lead in coordinating care; doctors and nurses will work as a team with a patient’s other physicians

Colorado Medicine for September/October 2012

and health care providers. Access to and meaningful use of electronic health records should be used to support these efforts. CMS and other payers will pay primary care providers for the improved care and care management. Practices will be paid a risk-adjusted, monthly care management fee that will average $20 per-beneficiary, per-month (PBPM) in the first two years. The average fee will be $15 PBPM in years three and four of the project. In addition, after two years, practices will have the opportunity to share in a portion of the savings generated in their market. The seven markets were chosen based on where a preponderance of payers applied and were selected, and with the goal of having geographic diversity. In Colorado, the participating payers are Anthem Blue Cross Blue Shield, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Humana, Rocky Mountain Health Plans, Teamsters Multi-Employer Taft Hartley Funds and UnitedHealthcare. Practices were selected through a competitive application process based on several factors: Use of health information technology; demonstrated recognition of advanced primary care delivery (i.e. NCQA patient-centered medical home accreditation); participation in practice improvement activities; diversity of practice size; geography; and ownership structure and service to patients covered by participating payers.

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Payment reform (cont.) In Colorado, the Center for Improving Value in Health Care and HealthTeamWorks worked with payers and practices to share information and help coordinate the application process. Applicants stressed many of the innovative programs already underway here and the number of NCQA accredited practices and practices that have achieved meaningful use of health information technology. The Colorado practices selected are located statewide, and include 335 physicians who serve an estimated 41,000 Medicare beneficiaries. Nationwide, the 500 practices selected represent 2,144 providers and an estimated 313,000 Medicare beneficiaries. (The other six markets are: Oregon; Arkansas; New Jersey; the Capital District/Hudson Valley region of New York; the greater Tulsa region in Oklahoma; and the Dayton/Cincinnati region spanning Ohio and Kentucky). A list of all practices participating, and more information about the program, is available at innovations.cms.gov. n

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LOOkiNG? Whether you’re looking for new opportunities or selling your product or service, CMS’ classified ad section is the place to be seen. To place your ad call (720) 858-6310

Colorado Medicine for September/October 2012


Inside CMS

Inside CMS

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

kept me in the hospital hours past when I should have gone.

Melissa Noble Selling Melissa Noble is a fourth-year medical student at the University of Colorado. She grew up in Colorado Springs and studied biomedical sciences and Spanish at Colorado State University in Fort Collins, Colorado. Melissa is planning a career in Family Medicine. She loves any activity as long as she can share it with her parents, younger brother and dog, Bella.

Home

Excited, yet aware of the uneasy feeling in the pit of my stomach, I arrive at the apartment of a patient. The word patient sounds dry and void of the emotion that this person stirs in me. He was the first person I cared for on the wards, and will therefore always be a part of me. I have noticed that certain people fade from memory as they transiently pass through my care. Others manage to become part of who I am. I can feel them, see their faces when I close my eyes and remember what their hands feel like in mine. I’m not sure why that is. But this man is, and will always be, that way. It may have been his daily joking with me that brought us together, his stories that

Or the fact that, although I did not want to accept it, I knew that his cancer only granted him nine more months of life. Something may also be said for the fact that medical school is a traumatic experience at times and, although it is no comparison to the difficulties that face those we care for, the struggling promotes powerful bonds. Whatever the reason, something about our experience together moves me, and I know that here, at his home, the place he lives, I will lose the protection the hospital offers. The hospital allows us, as health care providers, to imagine people’s lives in an idealized fashion. We hear of their hardships and feel like we attempt to address what they face on discharge, but it is impossible to truly understand what daily life is like for a person without experiencing it. Here the line will be crossed. I will see, feel, taste, smell and touch his world. A wave of sadness washes over me as I face the apartment complex head on. This lifeless brick structure with narrow hallways and low ceilings is his home. He deserves so much more. The moment I enter the apartment, however, my anxiety subsides and I am happy to be surrounded by photo frames, decorations and even the giant stuffed animal that was surely won at a fair. Outside the confines of the hospital, I am slipping comfortably into the reality of his world and gaining an un-

Colorado Medicine for September/October 2012

derstanding of who this man truly is. The most shocking of all moments is when, near the end of my stay, he asks me to feel his neck mass to see how it compares to when he was in the hospital. I am abruptly and uncomfortably taken out of the role of guest and thrown back into my white coat, which hangs in my closet. Feelings of inadequacy swell up inside my throat as I palpate his neck. I can thankfully say the mass is shrinking, but I remain hopelessly clueless about what that means. How dare my incomplete knowledge be sufficient? Maybe it is because we both know it is the best I have. We both know I always give him the best I have. As I leave, I know I may never see him again. To this day those thoughts are the hardest. How many people will I fall in love with? How many hands will I hold during difficult decisions, and then let go? How many will look to me as their “doc” and then lose me to this unstable whirlwind of training? Will each loss of a human life, not necessarily to death but to the unknown, leave me with this same uneasy feeling that I will never feel sufficient closure? These people stay with me; this man stays with me. Most difficult is the realization that our interaction although powerful, is but a moment of millions of moments that is shaping the doctor I am becoming and will be. n

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Inside CMS

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

COPIC’S 2013 premiums remain at competitive, stable levels Maintaining stable premiums is a goal that COPIC always strives for and one that our insureds contribute to with their commitment to patient safety and risk management. Through participation in ongoing education and the utilization of COPIC-provided resources, insureds continue to demonstrate a shared dedication for improving patient care.

range from $34 to $1,797 per year. Certain specialties will see an increase in 2013 rates, mostly due to increasing frequency and severity of claims. Approximately threefourths of this group will see a rate increase of less than 6%, ranging from $10 to $2,192 per year. The majority of the remaining specialties will see increases ranging from 6 to 13%.

COPIC is happy to announce that overall premiums for 2013 remain stable. There are two major trends that drive premiums: frequency and severity. The frequency in the number of claims has remained steady while there is early indication of upward pressure on the severity of claims. In addition, a few specialties have shown above average levels in either (or both) frequency and severity.

Notification of 2013 premiums Each policyholder and individual physician will receive a letter specifying the percentage change for 2013. They will receive this approximately 90 days before their policy renews.

Factors that impact premiums COPIC continues to monitor the factors behind rate trends and uses this information to determine proactive ways to work with insureds and reinforce stable premiums. In addition, it is important to remember the historical impact COPIC distributions have had on premiums. Our 2012 distribution equated to a nearly 17% premium credit for eligible physicians. Our Board of Directors declares a distribution when COPIC’s financial position is strong and when we experience favorable loss development—meaning we did not pay out as much in claims as we anticipated. Another factor in rate stability is COPIC’s year-round advocacy efforts that focus on maintaining a strong tort environment in Colorado. It’s a collaborative approach that involves coordinating with key organizations in the health care community as well as garnering support from legislators and other stakeholders. Overview of 2013 rates Approximately one-third of specialties will see no change or a decrease in their 2013 rates. Decreases will

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Collaboration is key to stability As always, COPIC works diligently to do what we can to ensure stable rates. A main factor in achieving this is our solid partnerships with insureds and medical leaders. From our board members and faculty consultants to individual physicians and group practices, COPIC stays connected to health care on multiple levels. Because of this, we are able to gain insight that supports our efforts to keep premiums manageable and still deliver high-quality service along with trusted resources. We look forward to working with all of our insureds during the coming year to improve medicine in the communities we serve. Please note: The premiums and increase/decrease figures listed in this article refer to average increases or decreases in gross annual preferred premiums for mature policies with limits of $1 million/$3 million. n

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

Colorado Medicine for September/October 2012


Departments

New Members Arapahoe-DouglasElbert Medical Society Lisa Haynes, MD Sara C Herstad, DO Ann M Wells, MD Aurora-Adams County Medical Society Gerald D Dodd, MD Carolyn Green, MD Courtney N Hall, MD Brian A Jaquette, MD Ashley L Pyle, MD Sharman L Reed, MD Elizabeth G Sweeney, MD Boulder County Medical Society Katherine I Aberle, MD Matthew J Gawart, MD Brian D Hess, MD Jeffrey M Hrutkay, MD Kimberly D Lerner, MD John G Massone, MD Rebecca A Myers, MD Daniel R Sarko, MD Chaffee County Medical Society Harry H Payton Jr, DO Clear Creek Valley Medical Society Valerie A Bain, MD Cortney R Bosworth, MD Kristen C Garcia, MD William L Gillaspie, MD Craig J Kilpatrick, MD Jason T Nguyen, MD Vy B Rossi, MD Jeremiah E Yerton, MD Denver Medical Society Alison C Agner, MD Brandy M Allen, MD Jason M Bellows, MD Jonathan L Brandon, MD Gretchen L Bruno, MD Stacy W Colodny, MD Richard E Crockett, MD J David Gilliland, MD

Joyce E Gottesfeld, MD Elizabeth M Harry, MD Scott V Joy, MD Michael J Podolak, MD Miriam G.S. Reece, MD Nathan A Roesner, DO Carlos A Rueda, MD Kevin M Rufner, MD Bradley L Schuster, MD Andrew J Sweatt, MD El Paso County Medical Society Michael D Ross, MD Frank Samarin, MD Intermountain Medical Society

Colorado Medicine for September/October 2012

Stephen J Mohr, MD Connie K Wolf, MD Larimer County Medical Society Breanna R Berry, DO Harrison D Blanton, MD Michael B Brown, DO Michael W Carter, MD Joshua A Dekker, MD Elizabeth E Hauslein, MD Russell R Heath, MD Sharon L Montes, MD Joshua S Rusk, MD Jeffrey C Schwartz, MD Stephen D Slauson, MD Tracey L Stefanon, DO

John A Ullrich, MD Mesa County Medical Society Geoffrey M Scriver, MD Morgan County Medical Society William H Sammond, MD Northeast Colorado Medical Society J Kevin Belville, MD Northwestern Colorado Medical Society Jason R Stuerman, MD Pueblo County Medical Society Adam O Strunk, MD

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medical news Michael J. Campo, PhD, support staff Colorado Medical Society Education Foundation

CMS Education Foundation presents 2011-2012 scholars Colorado Medical Society Education Foundation (CMS EF) awarded $37,500 in student scholarships during 2011/2012. The mission of CMS EF, a 501(c)(3) private foundation, is to render financial support to select first-year medical students at University of Colorado School of Medicine based on criteria such as the student’s financial status, academic achievement, and desire to practice in rural or underserved areas upon graduation. CMS EF also supports education programs such as the Colorado State Science and Engineering Fair and the Education Program at the CMS annual meeting. “The CMS EF Board appreciates the generous donations and support from CMS members who make our scholarships possible,” explains W. Gerald Rainer, MD, CMS EF, Board Chair. Dr. Rainer is a Distinguished Clinical Professor of Surgery at the University of Colorado Anschutz Medical Campus. The CMS EF proudly awarded scholarships to these outstanding freshman medical students who are shown below. Claire Bovet, student at the University of Colorado School of Medicine class of 2016, was born in Boulder, ColoClaire Bovet rado, and grew up on her family’s farm outside of Longmont. She learned to ride horses before she could ride a bike, and has always loved animals and the outdoors. Her passions for science and the humanities led her to Middlebury College in Vermont, where she developed a strong interest in medicine. The combined scientific and personal appeal of being a physician drew her into the field. Claire 38

hopes to practice internal medicine in Colorado, and looks forward to becoming a caretaker and leader in her community. Jason (JD) Williams obtained a B.S. in Biology with minors in chemistry and general business from the UniverJason (JD) Williams sity of Denver. JD continued his education at the University of Denver, obtaining a M.S. in Finance and M.B.A. Throughout his education, JD has also gained valuable experience as a researcher at the University of Colorado Health Sciences Center and National Jewish Health Center and as a volunteer at Stout Street Clinic, The Bridge Project, and There with Care. Prior to beginning medical school in the fall of 2012, JD utilized his business and scientific education as a Business Development Associate for Sharklet Technologies, a local biotechnology company committed to improving human health. JD’s prior leadership experiences have inspired him to leverage his diverse skill set, medical education and passion for innovation to improve health outcomes for all patient populations, particularly the underserved. Anireddy (Ani) Reddy is from Fort Collins, Colorado, and attended the University of Colorado at Anireddy (Ani) Reddy Boulder. During her college tenure, Ani had the opportunity to learn in a variety of clinical settings, ranging Children’s Hospital

to a pediatric HIV/AIDS clinic in Botswana. These experiences ignited her passion for medicine, particularly for the education and health of children. After graduating Summa Cum Laude in Molecular Biology and Neuroscience, Ani devoted one year to school turnaround and education reform in Denver Public Schools through the AmeriCorps program. She now serves as the co-president for the School of Medicine Class of 2016 and is participating is the CUUNITE urban underserved track. With her medical degree, Ani hopes to be a pediatrician for underserved populations. Matthew (Matt) Iacovetto, class of 2016, grew up in a small mountain town in northwest Colorado as the son Matthew (Matt) Iacovetto of a machine operator and childcare worker. After high school, he enrolled at the University of Northern Colorado and later earned a Bachelors of Science degree in Sports Medicine. Matt feels especially fortunate to pursue a degree in medicine, understanding the lack of educational opportunities that were available to his family in the past. During his time at the University of Colorado School of Medicine, Matt looks forward to becoming increasingly involved in health policy discussions through the Colorado Medical Society and other analogous organizations.

Samantha Tarshis

S a m a nt h a Tarshis grew up in Colorado, and has held a job

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medical news Scholars (cont.) since the age of 16. Some of those jobs included being a snake handler, nursery attendant, and high school chemistry teacher. She attended Pomona College where she studied Neuroscience and wrote her senior thesis: “Investigating novel treatments, permanence of cognitive effects, and gendered reactions to hypobaric hypoxia and resulting vascular permeability, vasogenic edema, and HACE,” in hopes of someday helping to protect young and elderly Coloradans from high altitude sicknesses. Currently as a first year student at the University of Colorado School of Medicine she is working to make connections with University of Colorado’s Altitude Research Center to continue pursuing this goal. n

CMS honors state science fair winner Colorado Medical Society delegates honored the senior high school science fair winner, Jenna Hartley, at this year’s annual meeting. Janet Seeley, MD, PhD, represents CMS on the Colorado State Science and Engineering Fair Board of Directors and selected Hartley’s project on Engineering a Novel Inhibitor for Encapsulated Pathogens after reviewing hundreds of entries at this year’s science fair. n

Janet Seeley, MD, presents award to CMS senior science fair winner Jenna Hartley.

AMA President Jeremy Lazarus, MD, congratulates Jenna Hartley.

Colorado Medical Society delegates honor 50- and 60-year physicians Robert D. Buchanan, MD, William G. Plested III, MD, and Gary D. VanderArk, MD were honored at the 142nd annual meeting of the Colorado Medi-

William G. Plested III, MD, and Gary D. VanderArk, MD honored at annual meeting.

Robert D. Buchanan, MD, drove from Wray, CO to receive his 50-year pin.

cal Society when CMS President Brent Keeler, MD, presented each of them with a gold pin marking their 50th year of medical practice since graduation from medical school. Also honored at the meeting was Allan B. Kortz, MD, who was celebrating his 60th year of medical practice since graduating from medical school. Two of the honorees have held significant positions in organized medicine in their careers with Dr. Plested being a past president of the American Medical Association and Dr. VanderArk a past

Allan B. Kortz, MD, was on hand to celebrate his 60th year out of medical school.

Colorado Medicine for September/October 2012

president of the Colorado Medical Society. Dr. VanderArk has also established a long legacy of commitment to serving uninsured and under-insured populations in Colorado while Dr. Buchanan has spent significant time on medical missionary trips to different regions in Africa. n

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. 39


Departments

medical news New Medicare Administrative Contractor Novitas Solutions visits Colorado Effective November 19, 2012, Novitas Solutions will be the Medicare Administrative Contractor for processing of Medicare Part B claims. The week of October 22nd members of the Novitas Transition Team met with physicians and their staff in Grand Junction, Pueblo, Boulder and Fort Collins. This round of meetings was in addition to their earlier visit to Denver and Colorado Springs in August. All of the meetings were well attended and well received. The Transition Team provided background information on their company, their transition plan, customer service

contacts and some key things for the physicians/practices to do: • Be sure to send Novitas a current electronic funds transfer (EFT) agreement prior to the cutover date of 11/19/12. • If you use a billing service or clearinghouse to submit your claims, be sure they have tested with Novitas and are ready to begin transmitting claims to the new contractor. • Visit the Novitas transition website for details and to review the Local Coverage Determination (LCD) policies that will be effective for dates of service beginning 11/19/12. https://

www.novitas-solutions.com/transition/jh/index.html If you were unable to attend one of the Novitas meetings you can view their presentation at www.cms.org. n

Aug. 21 Novitas meeting at CMS offices.

Medicare Recovery Audit Contractor (RAC) to begin auditing E&M services The Centers for Medicare & Medicaid Services (CMS) has alerted the AMA that it has approved the Medicare Region C Recovery Auditor (RAC) Connolly to begin conducting audits of coding for E&M services in physician offices, specifically CPT code 99215. We have been informed that in the next several weeks, Connolly will begin complex medical review of CPT code 99215, and will be permitted to extrapolate their findings based on a statistical sample of such claims. Connolly is the Medicare FFS RAC contractor who conducts RAC audits in AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico and the U.S. Virgin Islands. However, it has not yet been announced if all or only a subset of these states will be under review.

These reviews are expected to begin imminently in Region C and, according to CMS, are likely to be approved in other Medicare regions in the near future. The AMA has sent a letter to CMS Acting Administrator Marilyn Tavenner strongly objecting to these audits and urging CMS to rescind approval of RAC review of E&M codes. We also have alerted CMS staff that there will be significant opposition and questions about these audits among medicine and have requested that they provide briefings for state medical societies and specialty societies in the next few weeks to hear these concerns directly. We have yet to confirm these briefings but will inform you of their status once confirmed. Recently, however, there has been in-

November is AMA’s Heal the Claim month The “Heal the Claims Process”™ campaign’s goal is to eliminate administrative waste from the claims revenue process. This year’s campaign focuses on helping physician practices stay financially sound by using newly avail40

able, patient-specific insurance eligibility information to provide point-of-care pricing and collect from patients at the time of service. Are you ready? http:// www.ama-assn.org/resources/doc/psa/ htc-physician-audience.pdf n

creased pressure on CMS to review physicians’ coding of E&M services. The HHS Office of Inspector General (OIG) issued a report https://oig.hhs.gov/oei/ reports/oei-04-10-00180.asp in May on this topic that specifically urged CMS to encourage its contractors to conduct these reviews and “if CMS determines that inappropriate claims have been paid, it should take steps to recover those overpayments.” The AMA will continue to keep the Federation informed of this development and of our advocacy on this front, and in turn we will alert you. Physicians and their staff can find more information and resources on audits on the AMA’s Practice Management Center website at http://www.ama-assn.org/ ama/pub/physician-resources/practicemanagement-center/practice-operations/compliance-risk-management/audits.page. In addition there is a recording of an earlier webinar on Medicare and Medicaid audits: What physicians need to know. https://cc.readytalk.com/cc/ playback/Playback.do?id=hpiv6k. n

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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 ➤ PROFESSiONAL OPPORTUNiTiES HOSPICE PHYSICIAN - Looking for a Change? Pikes Peak Hospice & Palliative Care (PPHPC) is looking for a compassionate physician to join us and help care for patients at the end-of-life. PPHPC has been the community leader in hospice and palliative care for 32 years, founding the hospice movement in the Pikes Peak region in 1980. We are the only nonprofit, communitybased hospice in El Paso County, and we have an immediate opportunity for a full-time Hospice Physician to join our Palliative team. Work with a mission-driven team of professionals – physicians, nurse practitioners, nurses, CNA’s, counselors, chaplains, pharmacists, and volunteers. Position allows practice variety and a chance to jump off the treadmill – house calls, visits in Assisted Living Facilities, Long Term Care, and rotations in our acute hospice inpatient care setting – the Pikes Peak Hospice Unit at Penrose Hospital. More time with patients at their greatest time of need. Full time (MondayFriday) preferred, but we are willing to consider alternative schedules (4 x 10 hour days), etc. Salaried with benefits. Hospice or palliative medicine experience preferred, but we are willing to help train you in prognostication, hospice regulations, and advanced symptom management if you are ready to learn and bring an empathetic bedside manner! To apply, please e-mail your resume to: jobs@pikespeakhospice.org or Fax, Attn: Sarah Macy, Human Resources, to: (719) 457-8140. For more information about Pikes Peak Hospice & Palliative Care, please visit our website: www.pikespeakhospice.org. You may also submit your application online, if you’d like, by clicking on “Join Our Team” and “Employment Opportunities” tabs.

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

ROCKY MOUNTAIN FAMILY MEDICINE – is seeking Board-eligible/Board-certified family medicine and pediatric physician providers. Join a vibrant group of primary care providers with 8 locations in the Denver metro area. Full scope of out-patient practice with no OB. Less than 2 weeks call/ yr. Pay and benefits are competitive. Fax c.v. to 303-872-1856 or e-mail to nmoore@rm-uc.com. SEEKING MEDICAL PHYSICIANMD/DO part time or full time position in new multi-disciplinary clinic located in Greenwood Village, CO. Competitive salary. Please e-mail resume to dajobhunt749@gmail.com or call 720316-2202. Confidential calls only. SEEKING FULL/PART TIME - SE Aurora, Family Medicine Walk-In Clinic. Contact manager Monica 303766-1006, fax 303-766-1023, pcm77@ yahoo.com IM OR FP, PART TIME - Seeking IM or FP for H&Ps and medical consults 2-3 days/week (ideally weekends plus occasional weekdays, but open to other scheduling options) at private psychiatric hospital in Louisville CO. Contact Richard Wills, MD at rbwills5@gmail. com. FAMILY PRACTICE PROVIDER Platte River Medical Clinic is seeking a Family Practice provider for opportunities in the great family community of Brighton, Colorado. This established family practice north of Denver, Colorado is looking for a physician/provider to join our growing practice. This position is for a 4-day work week with no hospital calls. Phone calls are 1 in 4 basis. Schedule will vary from 25-30 patients per day. We are a Patient-Centered Medical Home (PCMH) and are in process for the National Committee for Quality Assurance (NCQA) recognition. Qualified for Meaningful Use.

Colorado Medicine for September/October 2012

Please e-mail references along with a copy of your curriculum vitae to sarahrip@platterivermed.com

➤ PROPERTIES FOR SALE OR LEASE WE BUY MEDICAL PRACTICES – Looking to sell your practice or join a larger locally-owned group? Want to continue to practice without the hassles of administration? Would you like to join a non-hospital-owned group with a proven track record to offer better benefits for yourself and your staff? Increase your referral base and utilize specialists within our group. Securely fax information to 303-872-1856 or e-mail to nmoore@rm-uc.com. RATHER OWN THAN RENT? Medical Office Bldg Condo-Wheat Ridge, $99,500, 1061 SF. Great set-up & floor plan. Call 303-696-0450.

➤ 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 OBGYN OFFICE EQUIPMENT FOR SALE – Exam tables, Powered exam table, exam stools, and lights, fetal dopplers, autoclaves, colposcopes, Ultrasound machines, cryotherapy set, LEEP machine with loops and speculums, NST machines, waiting room chairs, chart shelving, various speculums, colposcopy instruments and more. Most available after Nov. 21. Littleton. Contact lmclauchlan@thewomensgroup.com for more information. 41


Features

the final word David Ross, DO, Chair Colorado Medical Political Action Committee

In politics, not knowing your right from left is a good thing While none of us were trained as political activists in medical school or residency, and for many of us it’s probably not even in our DNA, one need look no further than our almost annual clashes with the trial lawyers or the SGR debacle to embrace the political engagement imperative. Politicians are making calls that impact our patients and practices in a tribalized partisan environment. Otherwise thoughtful public officials can face the unrelenting demands of party leaders and major donors. Absent our presence in the political arena others have, and will continue to, take up our slack. The rules of engagement require us to have working, sustainable relationships with the public officials on both sides of the aisle who are responsible for setting the course of health policy. Adhering to this rule is an imperative during this time of rapid transformation and upheaval in our profession. At CMS we, like other medical societies, struggle with political crosscurrents that sharply diverge between the more traditional conservative policy options, such as medical liability, and the decidedly center-left polices that drive health care spending, like Medicaid reimbursement, coverage and eligibility. The basis of medicine’s support of a candidate or incumbent takes into careful consideration the balance of those views-respecting their constitutional duty to make choices that can’t possibly please every constituency or interest group. Whatever our personal beliefs, COMPAC simply does not have the luxury of accommodating all of our individual views in determining CMS’ political 42

course if we want to achieve “the art of the possible,” as past CMS president Lynn Parry, MD, puts it. Physician advocacy in the public policy space requires a level of pragmatism and partisan agnostics that will make some of us uncomfortable on any given position. This is because our policy agenda spans such a wide range of issues, from liability reform one day, to Medicaid reimbursement the next. When I meet with national and state legislators, I am sometimes asked why CMS’ official policy may differ from that politician’s view on an issue. I always preface my reply by stating that CMS is a politically pragmatic organization that advocates for what works in the real world of medicine. This has less to do with doctrine and more to do with the pursuit of evidence-based policies. We know from experience as clinicians, the conventional scientific wisdom will evolve and require revision--and it has to be that way. But that certainly doesn’t mean we don’t listen to the political views of our members. They are vitally important. Based directly on our members’ local review and recommendations, we have defended our legislative champions not just at election time but also from those in their own party in their primaries. And, when we have encountered legislators whose views are sufficiently and unrelentingly anti-physician, right or left, we have staunchly opposed them. We have taken these positions regardless of payback risk or our prospects of winning. The choices COMPAC makes to sup-

port, or oppose, are home grown and locally-owned by our participating members and drawn from the legislator’s voting and non-voting record - actual or anticipated. There are no wrong choices, merely consequences for each fight we pick, or avoid. We look for a pattern of support for medicine and patients - right and left. Our choices are never drawn from a purely partisan or ideological well. Whether you want to participate individually or join our movement, there is a graduated scale of political activism: 1. Join our movement financially. A modest contribution to COMPAC and the special Small Donor Committee are funds we tailor for specific candidate needs. They are vital to the success of our friends at the ballot box. 2. Join your local “Breakfast Club” by contacting CMS. You will be surprised how much more you have in common with your area legislators, well beyond being carbon-based organisms. 3. Host or co-host local support events for the legislator of your choice (even if we haven’t taken sides). Receptions, coffees, block walks, mini internships, and all the varied means of engaging your legislator/ candidate in the face-to-face interactions during the election season strengthen those relationships and the mutual understanding that follows. At COMPAC, your perspective and participation are critical to us. Thanks for all that you do and be sure to vote in the 2012 general election. n

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Colorado Medicine for September/October 2012


Sept-Oct-2012