Jan-Feb 2019 Colorado Medicine

VO LU M E 1 1 6 N O . 1 J A N - F E B 2 0 1 9

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

C O NTE NT S

Cover Story Physicians face extraordinary challenges and opportunities in the 2019 Colorado General Assembly. Read a preview of the top issues the Colorado Medical Society and our team of lobbyists expect to see this session, from professional review and the Medical Practice Act to health care costs and more.

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F E ATU R E S

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ng professional review n used in Colorado

Professional Review Process At A Glance Reporting

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Adverse incidents and observations for improvements are reported to the Professional Review Committee.

PROFESSIONAL REVIEW AT A GLANCE

CENTRAL LINE IS WORKING

See why professional review is so important Investigation and Thanks to the members who engaged with CMS what a special CMS work group is Incidents doing to are urge the through Central Line in 2018. The one-of-a-kind investigated by the committee renewal of the Colorado ProfessionaltoReview Act. member engagement platform saw a 52 percent determine competence, quality and increase in member involvement over the previous year. appropriateness of patient care,

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12

Number of professional review boards in Colorado that support renewing peer review.

HAIL TO THE CHIEF

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and professional conduct.

Response

The health care professional is “KNOW YOUR LEGAL RIGHTS” CAN HELP YOU The American Medical Association honored given an opportunity to provide CMS CEO Alfred Gilchrist with the AMAfurther information and respond.

Get to know the Know Your Legal Rights database to Lifetime Achievement Award. utilize protections CMS and our allies in the General Assembly have put in place over the last decade for the benefit of physicians, practices and patients.

Hearing

8: 16

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A formal hearing is held to discuss the investigations’ findings and to determine next steps.

er of states with REPORT FROM THE AMA INTERIM MEETING Delegates and Alternate Delegates to the Final Decision sional review laws The peer review board will decideFINAL what WORD: GET INVOLVED IN PUBLIC POLICY American Medical Association represented actions to take with the health professional, Colorado well at the AMA Interim Meeting Physicians already improve health care in the exam and/or forward its recommendationroom. to theBy joining our advocacy efforts, you can affect in National Harbor, Md., in November. state medical board or the board ofchange nursing. on the state level to make health care better for all of Colorado.

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Peer Review

Education

Through the entire process, health care D E PA R TM E NT S I N S I D E C M S professionals work together to hold the profession accountable, and take clear steps to improve the quality 4 President’s Letter 32 In Memoriam: of care in Colorado.

15 CMS Corporate Supporters and Robert Bruce Sawyer, MD

Better Outcomes for Patients!

Member Benefit Partners 26 COPIC Comment 28 Reflections 30 Introspections

34 Medical News 36 Celebrating CMS staff members: Marilyn Rissmiller and Timothy Roberts

CO LOR AD O M E D I CAL SO CI E T Y 7351 Lowry Boulevard, Suite 110 • Denver, Colorado 80230-6902 720.859.1001 • 800.654.5653 • fax 720.859.7509 • www.cms.org

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2018-2019 OFFICERS Debra J. Parsons, MD, FACP President

David Markenson, MD President-elect

Patrick Pevoto, MD, RPh, MBA Treasurer

Alfred D. Gilchrist Chief Executive Officer

M. Robert Yakely, MD

BOARD OF DIRECTORS

AMA DELEGATES

Cory Carroll, MD Sofiya Diruba, MS Curtis Hagedorn, MD Mark B. Johnson, MD Jason L. Kelly, MD David Markenson, MD Patrick Pevoto, MD, RPh, MBA Leto Quarles, MD Brandi Ring, MD Brad Roberts, MD Kim Warner, MD C. Rocky White, MD

A. “Lee” Morgan, MD David Downs, MD, FACP Jan Kief, MD Tamaan Osbourne-Roberts, MD Lynn Parry, MSc, MD

Immediate Past President

AMA ALTERNATE DELEGATES Carolynn Francavilla, MD Rachelle Klammer, MD Katie Lozano, MD, FACR Brigitta J. Robinson, MD Michael Volz, MD

AMA PAST PRESIDENT Jeremy Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF EXECUTIVE OFFICE

DIVISION OF HEALTH CARE POLICY

DIVISION OF GOVERNMENT RELATIONS

Alfred Gilchrist, Chief Executive Officer Alfred_Gilchrist@cms.org

Chet Seward, Chief Strategy Officer Chet_Seward@cms.org

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

Dean Holzkamp, Chief Operating Officer Dean_Holzkamp@cms.org

Gene Richer, Director, Continuing Medical Education Gene_Richer@cms.org

Emily Bishop, Program Manager Emily_Bishop@cms.org

Dianna Fetter, Director, Professional Services Dianna_Fetter@cms.org

DIVISION OF HEALTH CARE FINANCING

Tom Wilson, Manager, Accounting Tom_Wilson@cms.org

Marilyn Rissmiller, Senior Director Marilyn_Rissmiller@cms.org

DIVISION OF COMMUNICATIONS AND MEMBER BENEFITS

Amy Berenbaum Goodman, JD, MBE, Senior Director, Policy amy_goodman@cms.org

Kate Alfano, Coordinator, Communications Kate_Alfano@cms.org

DIVISION OF INFORMATION TECHNOLOGY/MEMBERSHIP

Mike Campo, Director, Business Development & Member Benefits Mike_Campo@cms.org

COLORADO MEDICAL SOCIETY FOUNDATION COLORADO MEDICAL SOCIETY EDUCATION FOUNDATION Mike Campo, Staff Support Mike_Campo@cms.org

Tim Roberts, Senior Director Tim_Roberts@cms.org Krystle Medford, Director, Membership Krystle_Medford@cms.org Tim Yanetta, Coordinator Tim_Yanetta@cms.org Susanna Barnett, Coordinator Susanna_Barnett@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, Colo., and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance.

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

Alfred D. Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Kate Alfano, Assistant Editor; Chet Seward, Assistant Editor.

We Help You Grow Your Practice Let us build you a new website designed to deliver new patients Exclusive offer available for CMS members by calling before 2/28/19 Call 866-539-3059 Visit CMSP.officitesavings.com New clients only. Some restrictions may apply.

P R E S I D E NT ’ S

LE T TE R

PREPARING FOR THE GATHERING STORM OF THE 2019 LEGISLATURE

Debra Parsons, MD, FACP

President, Colorado Medical Society

The midterm election is over and the results are in. Democrats hold narrow leads in both the Colorado House and Senate and the executive branch is exclusively blue, led by newly elected governor Jared Polis and lieutenant governor Dianne Primavera.

Legislators are now preparing to convene the 72nd Regular Session of the Colorado General Assembly on Jan. 4.

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PRESIDEN P R E S I D E NT ’ S LE T T E R

The physicians of Colorado face a multitude of anticipated challenges in the 2019 legislative session and we expect other attacks on the practice of medicine. In terms of health policy politics, the sheer volume of complex and interrelated issues is mind-boggling. The top challenges identified by the CMS lobby team include but are not limited to: 1

Preservation of Colorado’s medical professional liability climate;

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Reenactment of the body of law governing professional review and the Medical Practices Act, as well as assuring the operational integrity and resources for the Colorado Medical Board;

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Preservation of the state-enacted insurance exchange and enhancing aspects of the Medicaid expansion to make the program more attractive to physicians;

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State investments in opioid use disorder intervention, treatment, and rehabilitation infrastructure;

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Health care price transparency;

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Collaborating with the employer community on cost mitigation strategies; and

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Scope of practice issues.

Leading up to the election, COMPAC, on behalf of the Colorado Medical Society, methodically engaged in hot-spot candidate races, either in defense of friendly incumbents or by taking a chance on a pro-medicine candidate as determined by physicians in his or her district. As a result, we saw 94 percent of COMPAC-endorsed candidates elected. CMS is one of the few organizations that endorses candidates from both sides of the aisle in virtually equal numbers.

Additionally, CMS councils, committees, work groups and task forces, which include physician subject-matter experts, are thoroughly examining policy issues, gathering data and discussing solutions.

The nature of this legislative session fits well with CMS’s time-tested strategy of engaging not only legislators but also other stakeholders. From the right, state business leaders, led by the Denver Metro Chamber of Commerce and other employer advocates, have put together a comprehensive package of cost and pricing transparency and accountability measures. From the left, lawyers that sue physicians will ask for new levels of accountability and transparency in terms of medical professional liability and discipline. Sharp differences

will emerge over health care infrastructure investment, especially regarding funding challenges for addressing the opioid crisis as well as the debate over Medicaid spending, coverage and eligibility.

CMS will continue to rely on diverse member involvement in work groups and task forces to advise the board of directors and Council on Legislation. Our member polling reflects the full political spectrum, which further verifies the value and importance of a governance model that relies on extensive grassroots interaction for policy development. CMS’s legislative strategy reflects a pragmatic, evidence-based approach to providing those policy options.

Once again, my ask of you is to prepare to engage in this public policy space; reach out and support each other and bring your ideas, wisdom and concerns to us. Support COMPAC and the Small Donor Committee by contributing online at www.cms.org/contribute. Get to know your legislators and tell them the stories about practicing medicine that only you can tell. It is through active engagements that medicine will fare well in the 2019 legislature. ■

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C OV E R

S TO RY

LEGISLATIVE PREVIEW

A look at the top issues facing physicians in the 2019 General Assembly Susan Koontz, JD, CMS General Counsel

| Physicians face extraordinary challenges and opportunities in 2019 through legislation, regulation, and other marketplace and community initiatives. The sheer volume of exam-room relevant issues is breathtaking in its scope and complexity.

The Colorado Medical Society Board of Directors suspended the 2019 Annual Meeting to supplement funding for 2019 physician-patient advocacy efforts during this critical time. The following issues will be high priorities in the 72nd Regular Session of the Colorado General Assembly from its convening on Jan. 4 until sine die May 3, and beyond.

COLORADO’S MEDICAL PROFESSIONAL LIABILITY CLIMATE, PROFESSIONAL REVIEW AND THE MEDICAL PRACTICE ACT The risk of getting sued and the value of that lawsuit are both at serious risk of exploding in the 2019 General Assembly.

Lawyers that sue physicians and hospitals will attack through votes to make professional review records discoverable in civil litigation and to raise the value of Colorado’s non-economic damage cap.

If these efforts are successful, they will likely mean more lawsuits and higher liability premiums for all Colorado physicians. Taken together or separately, disturbances to the stability and continuity of these highly sensitive processes can compromise proven patient safety measures, spike health care costs, and subsequently restrict the supply and distribution of physicians in high-risk practices, exacerbating provider shortage areas of our state.

CMS advocacy in this area aims to reenact the Medical Practice Act and Professional Review Act to promote the safety of patients while maintaining or improving the professional liability climate, led by the work of the CMS Work Group on Professional Review-Medical Practice Act Sunset.

“As we face the myriad of medical issues the legislature deals with every year it will be incredibly important for physi-

cians to be a part of the process,” said representative-elect Yadira Caraveo, MD (D-Thornton). “As an example, physicians understand the importance of the peer review process to the development of physicians and the safety of the patients they treat in ways that legislators who have not practiced medicine may not. I look forward to providing the perspective of my profession as I serve in the State House so that my fellow legislators understand how the decisions they make affect the day-to-day practice of medicine.”

“The quality, availability and affordability of health care are at stake in the upcoming legislative session,” said Sen. Bob Gardner (R-Colorado Springs). “The protection of the confidentiality of peer review records is absolutely critical for the promotion of quality patient care and if the cap on non-economic damages is removed, professional liability rates will soar, causing higher costs and providers to once again consider leaving the state or retire sooner.”

OPIOID CRISIS

Despite all of the work in Colorado and across the country over the past six years to reverse the public health crisis caused by opioid abuse and misuse, there is still a great deal of work that remains. Experts predict that the epidemic of addiction and death will continue to increase for the next seven years before beginning to decline.

The 2018 House-Senate Opioid and Other Substance Use Disorders Interim Study Committee has met throughout the late summer and fall to continue their work to address the opioid epidemic in Colorado.

Donald Stader, MD, has testified before the committee on behalf of the Colorado Medical Society. At least two bills have been proposed by the committee, one to provide housing assistance to those recovering from opioid addiction and another to make changes in treatment for substance use disorder in the criminal justice system.

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HEALTH CARE COVERAGE AND ACCESS, COSTS AND TRANSPARENCY The discussion surrounding coverage, access, cost and value are inextricably linked. Colorado has consistently shrunk the pool of uninsured individuals living in the state, which are otherwise a significant burden to safety net providers, local tax bases, and even private sector premiums. Several factors have contributed to this decrease: The adoption and implementation of Medicaid expansion, the regionalization of Medicaid services through the Accountable Care Collaborative program, and a state-run insurance exchange.

A ll of t hese measures have been sustained while further federal reform efforts have stalled. CMS will focus efforts regarding Medicaid on maintaining current coverage gains and protections like essential benefits and bans against pre-existing condition exclusions, while working to expand coverage to those still uninsured where possible.

Evidence continues to mount that Colorado has reached the tipping point on rising health care costs. In addition to increased media coverage and the concerns physicians hear daily from patients, frustration within the business community has spurred the Denver Metro Chamber of Commerce to convene a multi-stakeholder group, including CMS, to devise a comprehensive package of cost, transparency and accountability reforms achieved through voluntar y efforts, regulation and legislation. CMS’s goal is to influence reductions in the cost of care while ensuring quality, under the guidance of the CMS Work Group on Health Care Costs and Quality.

Within the category of health care costs falls out-of-network (OON) “surprise” medical bills. CMS has been working on OON solutions for the past five years, and in November the CMS Board of Directors reviewed an OON proposal developed by the CMS Work Group on Health Care Costs and Quality. The proposal will continue to be fine-tuned by the work group through the session.

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C OV E R LE G I S L AT I V E P R E V I E W: C O N T.

“Curbing the rising cost of health care is a bipartisan issue and one I and my colleagues in the legislature take very seriously,” said Sen. Jack Tate (R-Denver).

“Like physicians, I often hear of my constituents’ frustrations with insurance premiums and coverage, ‘surprise’ medical bills and shrinking physician networks. I remain committed to easing the burden of health care costs and empowering patients to make smart decisions about health care.”

SCOPE OF PRACTICE

Each year, in nearly every state including Colorado, non-physician health care professionals lobby state legislatures and regulatory boards to expand their scope of practice. While some scope expansions may be appropriate, others are not.

It is necessary to assess each proposed expansion of scope of practice on a case-by-case basis, led by the physician experts on the Council on Legislation

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SOP Subcommittee and collaboration with specialty societies.

WHAT TO EXPECT THIS SESSION

Advocacy and communications are consistently ranked highest among CMS-member priorities. While CMS staff, lobbyists and leaders will continue to work on behalf of members and the medical community, member involvement is encouraged and necessary. Engage in policy development through CMS’s Central Line platform, cultivate relationships with elected officials through face-to-face interaction, and consider serving on a CMS committee, commission or work group. See other articles in this issue of Colorado Medicine or contact president@cms.org for more information on getting involved, and watch for continued coverage of the 2019 Colorado General Assembly in all CMS publications. ■

WHY IS THE LEGISLATURE CONVENING EARLY?

The 20 1 9 Colorado G eneral Assembly will convene earlier than usual, on Friday, Jan. 4, the first Friday of January. Constitutionally legislators must convene no later than the second Wednesday in January each year. But the constitution requires the newly elected governor, lieutenant governor, attorney general, treasurer, and secretary of state to take office on the second Tuesday of January, which falls on Jan. 7 in 2019. The General Assembly must declare the winners before they take office and the legislature must be in session to declare winners, hence the earlier convening. The General Assembly will adjourn on Friday, May 3.

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F E ATU R E

Physicians urge the renewal the Colorado Professional Review Act Kate Alfano, CMS Communications Coordinator The Colorado Professional Review Act is up for renewal in 2019. The Colorado Medical Society urges legislators to renew the Colorado Professional Review Act. In July, the CMS Board of Directors created a special, one-time Work Group on Professional Review/Medical Practices Act Sunset to help guide the society in our advocacy in the 2019 Colorado General Assembly. The physicians, all with deep experience in peer review, quickly got to work, reviewing the sunset legislation released by the Department of Regulatory Agencies (DORA), discussing in depth what will be needed for the 2019 legislature, and collecting stories by physicians that relate the importance and power of the professional review process to improve care. They will meet throughout the session to continue to monitor the issue and take necessary action.

“The Colorado Medical Society’s work on the Peer Review Sunset legislation is critical as we are trying to maintain the integrity of the Peer Review process to improve systems of care to protect patients from harm,” said work group member Adam Koszowski, MD, an anesthesiologist in Denver.

“Lessons from high-reliability enterprises, such as the airline and automotive industries, demonstrate the importance of a protected and non-retaliatory environment to create a culture of safety that encourages self-reporting of nearmisses and errors. These self-reported errors permit Peer Review committees to educate physicians and modify systems of care to prevent future near-misses and patient harm. If the Peer Review protections sunset and trial lawyers have access to previously protected Peer Review information, then the current culture of safety will erode, self-reporting will decrease, and hospitals will become a less safe place for patients.” ■ 1 0 C O LO R A D O M E D I C I N E

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What is the “professional review” Act?

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Why should it be renewed?

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Why is professional review protected?

Colorado's Professional Review Act (CPRA), or "peer review," improves patient safety by encouraging a candid, comprehensive assessment of health care professionals by their peers. A review: • Evaluates competence, quality and appropriateness of patient care and professional conduct • Focuses on doctors, physician assistants and advanced practice nurses • Triggers when there is a need to evaluate care

Professional review promotes a thorough examination of health care delivery in Colorado. It is a proven, established process that requires the participation of "peers" who are best qualified to review other medical professionals. It is a valuable training tool, disseminating lessons learned to continuously improve health care.

The legal protections ensuring confidentiality of the review promote candid reviews of health care professionals, which are critical to improving the quality of care.

Information provided by

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42Years: How long professional review has been used in Colorado

F E AT U R E S

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Professional Review Process At A Glance Reporting

Adverse incidents and observations for improvements are reported to the Professional Review Committee.

Investigation

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Incidents are investigated by the committee to determine competence, quality and appropriateness of patient care, and professional conduct.

Number of professional review boards in Colorado that support renewing peer review.

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Number of states with professional review laws

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Peer Review Better Outcomes for Patients!

Response

The health care professional is given an opportunity to provide further information and respond.

Hearing

A formal hearing is held to discuss the investigations’ findings and to determine next steps.

Final Decision

The peer review board will decide what actions to take with the health professional, and/or forward its recommendation to the state medical board or the board of nursing.

Education

Through the entire process, health care professionals work together to hold the profession accountable, and take clear steps to improve the quality of care in Colorado.

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F E ATU R E

HAIL TO THE CHIEF

AMA honors Colorado Medical Society executive Alfred Gilchrist with Lifetime Achievement Award Kate Alfano, CMS Communications Coordinator

The American Medical Association honored Alfred Gilchrist, chief executive officer of the Colorado Medical Society, with the Medical Executive Lifetime Achievement Award at the AMA’s Interim Meeting in November. This award honors a medical association executive who has contributed substantially to the goals and ideals of the medical profession.

Gilchrist has served as CMS CEO since November 2004.

“I am deeply touched and humbled to receive this Lifetime Achievement Award,” Gilchrist told the audience at the AMA Interim Meeting in his unmistakable South Carolina drawl. “It is particularly meaningful to me understanding so well as I do that the AMA is the largest and

most influential organization representing physicians in America today. It is also meaningful because AMA’s goals of addressing physician wellbeing and access to care for Americans align with those of the Colorado Medical Society.” “ We u n d e r s t a n d w ha t t h i s aw a rd represents,” Gilchrist continued, also characteristically diverting credit from himself to those he serves. “It represents thousands of volunteer physicians hours.

Doctors showing up time and again with the goal of making care better for patients and the communities they serve.

It represents compassionate and bold physician leadership past and present. It represents the hard work, dedication and long hours of your staff. For when these

three things come together through a vision, a plan, in execution and a little luck, great things can happen. And great things have happened during my career to the point where I can say from the bottom of my heart that I could not have had a more meaningful and rewarding career than going to work and fighting every day for your honorable profession.”

Gilchrist earns the Medical Executive Lifetime Achievement Award for his 39 years of executive leadership in Colorado and Texas – a period in which he has guided, grown and advocated for the medical profession daily.

“A brilliant leader, strategist, team builder, and advocate for patients and medicine,

Top Photo: CMS CEO Alfred Gilchrist, right, receives the AMA Lifetime Achievement Award from Jack Resneck, AMA board chair.

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Alfred Gilchrist has led CMS through an unprecedented period of advocacy and growth,” said AMA President Barbara L. McAneny, MD. “He succeeded in advocating for Medicaid expansion and stabilizing medical liability climates. And his tireless work to prevent insurance mergers that would have harmed patients and physicians alike was instrumental in their defeat.”

During his years of leadership at the CMS, Gilchrist has used his ability to form strong relationships and partnerships to secure numerous legislative victories in Colorado, while advancing the whole organization. In addition to his critical work on Medicaid expansion and insurance mergers, Gilchrist also designed the nation’s first standardized managed care

JOIN THE COLORADO MEDICAL SOCIETY IN THE INAUGURAL F U N DR AI S I NG E F FOR T FOR THE NEWLY FORMED ALFRED

contract law, requiring oversight of payer profiling and rating of physicians, and the first body of law in the country requiring oversight of payer profiling and rating of physician performance. He also played a critical role in securing grants and funding to improve care and ensure public health, including $1.5 million for pandemic flu preparedness.

Prior to joining CMS, Alfred was the lead lobbyist for the 40,000-member Texas Medical Association where he coordinated all state and federal legislative advocacy. He staffed and advised TMA policy bodies on setting policy positions and strategy on approximately 900 pieces of legislation each legislative session for 20 years.

As longtime colleague and friend Kim Ross explains, he is particularly skilled in public affairs: strategy, policy development, communications and message development, grassroots organizing, lobbying and directing lobby teams, fundraising, and coalition politics.

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AMA’s gracious acknowledgment of Alfred’s skill, steadfast devotion and professionalism might be more accurately described as a lifetime of achievements,” Ross says. “Over the course of several decades Alfred was the creator, motivator and retailer of almost countless policy reforms, political fixes and organizational innovations, any one of which could be considered a standalone lifetime achievement in the tumultuous world of physician advocacy; and many were national firsts. Since we first started our collaboration in 1979, I have never known anyone with a stronger heart, steadfast will and moral purpose.”

D. GILCHRIST STUDENT LEADER SCHOLARSHIP. One-time and monthly donations in any amount are gladly accepted and appreciated. Donors are encouraged to check with their employers for matching donation programs. Pledges can be fulfilled at any time with final payments to be received prior to Dec. 31, 2019 for scholarship awards to start in 2020.

Donations can be sent by mail to: Colorado Medical Society; 7351 E. Lowry Blvd., Ste. 110; Denver, CO 80230. Please make checks out to Colorado Medical Society with “Gilchrist Scholarship Fund” recorded on the memo line.

Donors may also make donations by credit card by calling Tom Wilson, CMS accountant, at (720) 858-6316. All donations are being held in a special reserve account at CMS exclusively for the scholarship.

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Phone: 800-873-7138; Email: info@minesandassociates.com Visit: www.minesandassociates.com C O LO R A D O M E D I C I N E 1 3

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F E AT U R E S H A I L T O T H E C H I E F : C O N T.

Top left and bottom left photos: Gilchrist accepts his award.

Right: Many gather to celebrate Gilchrist at a reception Saturday evening. From left, Robin Gilchrist, wife; Ginger Albright, friend; Kathryn Gilchrist, sister from Charlotte, N.C.; and Lee Morgan, MD, CMS leader and friend.

Colorado Medical Society is pleased to announce PNC Healthcare Business Banking as our newest Corporate Supporter.

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Contact: Craig Byers at craig.byers@pnc.com Phone: 303-606-8315 Please visit: www.pnc.com/hcprofessionals

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Gilchrist announced at the 2018 CMS Annual Meeting that he will retire in early 2020. To honor his many contributions to the organization and the development of its physician leaders, CMS has formed and is actively fundraising for the Alfred D. Gilchrist Student Leader Scholarship. Though a steering committee that includes Gilchrist will determine the ultimate focus and criteria of the scholarship, the vision is to recognize excellent medical student leaders with a passion for medical advocacy and policy to further the profession, medicine and the health of patients.

An outpouring of support for Gilchrist and the scholarship has meant CMS is already well on its way to raising the minimum of $100,000 that will allow for an annual award, but contributions will continue to be accepted throughout the year and on an ongoing basis. See the highlight box on page 13 for more information on making a contribution. ■

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Carr Healthcare Realty 303-817-6654 or visit carrhr.com *CMS Member Benefit Partner Dynamic Physician Billing Solutions 303-913-0508 or visit dynamicphysicianbilling.com Eide Bailly 303-770-5700 or eidebailly.com/healthcare Favorite Healthcare Staffing 720-210-9409 or medicalstaffing@favoritestaffing.com *CMS Member Benefit Partner Medical Telecommunications 866-345-0251, 303-761-6594 or visit medteleco.com *CMS Member Benefit Partner MINES & Associates 800-873-7138 or visit www.minesandassociates.com *CMS Member Benefit Partner Officite 866-508-9176 or officite.com/webcheck/cms *CMS Member Benefit Partner RainTech 844-TEL-RAIN or visit https://rain.tec Rx Security 800.667.9723 email: info@rxsecurity.com or visit www.rxsecurity.com The Legacy Group 720-440-9095 or visit www.legacygroupestates.com TSYS 877-841-0606 or visit transfirstassociation.com/cms *CMS Member Benefit Partner Transcription Outsourcing 720-287-3710 or visit transcriptionoutsourcing.net C O LO R A D O M E D I C I N E 1 5

F E ATU R E

AMA INTERIM MEETING

Delegates and alternate delegates to the American Medical Association represent Colorado at the AMA Interim Meeting Kate Alfano, CMS Communications Coordinator The American Medical Association held its Interim Meeting Nov. 8-13 in National Harbor, Md. More than 2,500 physicians, residents and students from all 50 states and over 115 specialties attended. During business of t he House of Delegates, delegates adopted 53 resolutions.

CMS CEO Alfred Gilchrist was also awarded the AMA Lifetime Achievement Award; read more about the award on page 12.

uating physician competency without Maintenance of Certification, wellness for young physicians, opioid rehabilitation

Attendees had the opportunity to attend many educational events on a wide variety of topics, many with CME, including contracting with large employers, eval-

Attendees also heard from AMA leaders.

In an address to delegates gathered at the opening session, President Barbara L. McAneny, MD, said it is time to create a

health care system that values health over money and power. “The AMA is fighting the forces that make the U.S. health system so dysfunctional.”

“The AMA is fighting the forces that make the U.S. health system so dysfunctional.” and care coordination, and providing care for child and adolescent refugees.

She told the heartbreaking story of her patient with metastatic cancer who was denied an opioid prescription due in part to prior authorization and who, wracked with pain and shamed by the episode, nearly died of suicide. “The health plan does not have the chart, doesn’t know the patient, and basically countermanded my orders without even telling me — using the prior-authorization process,” McAneny said.

McAneny also addressed pressing topics such as physician burnout, health industry consolidation, the skyrocketing cost of prescription drugs, access to health insurance and excessive time on EHR. AMA Executive Vice President and CEO James L. Madara, MD, said medicine’s future demands doctors to act as disrupters. “Tensions surrounding health care today are evident to patients and physicians. When it comes to alleviating those tensions and shaping practical changes to improve care, the onus is on physicians to lead the way,” Madara told delegates.

“New solutions must facilitate, not complicate, medical practice,” he said.

“These solutions must save time, not take time.”

Madara highlighted the AMA’s role in “an Uberized approach” to lifestyle change programs to prevent diabetes, as well as the association’s efforts to help physicians accelerate digital health implementation in practice.

1 6 C O LO R A D O M E D I C I N E

| AMA delegates from around the country provided testimony on more than 100 reports and resolutions up for consideration at the meeting. Drawing on their expertise, the best evidence in the medical and health policy literature, and the insights of their state and medical specialty societies, delegates weighed in on proposals that run the gamut of issues affecting patients and physicians.

AMA member groups and sections representing medical students, residents and fellows, and many others across career stages, special interests and more also held gatherings during the Interim Meeting, providing these groups the opportunity to influence policy, attend educational programs and network.

The AMA House of Delegates will hold its Annual Meeting in Chicago June 8-12, 2019, to address health care issues and elect officers. AMA Sections and Special Group meetings will also be held during this time. For more information, go to www.ama-assn.org or contact the Colorado delegates or alternate delegates to the AMA. Members Move Medicine! ■

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C O LO R A D O M E D I C I N E 1 7

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F E ATU R E

CENTRAL LINE

Members making a difference The Colorado Medical Society launched Central Line in November 2016 as part of extensive governance and communications reforms to transition CMS into a 21st-century medical society. Central Line makes our governance horizontal, not vertical; interactive, not linear; and linked directly to every CMS member. CMS is the only state medical society in the country with this innovate and unique membership participation feature. Since its inception, members have responded to our call for engagement in impressive numbers, providing invaluable comments and votes to give members of the board of directors direct peer input before and after votes on policy issues.

“To those who have participated in Central Line, I urge you to continue in 2019, as we face tremendous challenges in the public policy realm,” said CMS President Debra Parsons, MD, FACP. “To those who have yet to participate, this is your opportunity to engage with your medical society for the benefit of your profession, practice and patients. All members’ involvement is critical to guide our society through this year and beyond.”

Colorado Medicine salutes the physicians and medical students who engaged with the board of directors through Central Line in 2018.

Norman O Aarestad, MD Robert T Abbott, MD Baiju Abdulla, MD Brett B Abernathy, MD Alan P Aboaf, MD Joshua Olorunsogo Abolarin Murtaza K Adam, MD Lawrence E Adler, MD Arlis M Adolf, MD Gabriel Mack Aguero Dennis J Ahnen, MD Mark C Alanis, MD Elsa Alaswad, MD Zachary I Albert, DO Leonardo Alfaro, MD Jenny D Allard, MD Brandy M Allen, MD Jason M Allen, DO Krista Allen Russell H Allen, MD Thomas J Allen, MD Robert N Alsever, MD Michael A Ament, MD Jason Aminsharifi, MD Margaret P Amos, MD Pratibha Anand Amanda Andersen Jeremiah J Andersen, MD Vivianne Andersen Braden Anderson Hans Anderson Judson T Anderson, MD Tracy L Anderson, MD Travis C Anderson, MD Kristin K Andreen, MD Francine G Andrews, MD Michael S Anger, MD A Lee Anneberg, MD Stephen J Annest, MD Edwin T Anselmi, MD Brianna Anthony, DO Karen D Anthony, MD Kristina A Anton-Schnell, MD Jonathan D Apfelbaum, MD Ellen F Arendt, MD Gregory A Arfsten, MD Nancy J Arko, MD Pratheep Arora, MD Cristian Arvinte, MD Juhi Asad, DO Richard G Asarch, MD Jordan J Ash, MD Riannon Christa Atwater Isabelle M Audet, MD Jatinder S Aulakh, MD Robert C Austin Jr, MD Marc T Avner, MD Taline N Aydinian Perry B Bach, MD Nelson E Bachus, MD

Linda D Backup, MD Robert M Baer, MD David L Bagley, MD Christopher D Bailey, DO J Scott Bainbridge, MD Erika Baird Kristin M Baird, MD Roland Baiza Jr, MD Eric P Balaban, MD Daniel R Balch, MD David Baldwin Christina M Ballonoff, MD Gina C Bamberger, DO Mehdi Bandali Neil A Banga, MD Brett A Banks, DO Elizabeth A Banwart, DO Anthony S Barber, DO Michael J Barber, MD Nicole E Barberis, MD Juan F Barbero, MD David K Barclay, MD Severn G Barloco, MD Eric D Barnhart, MD Jessica E Barron Essary, MD Patrick C Barry, MD Carl E Bartecchi, MD Roy M Bartee II, MD David L Bartelt, MD Monica L Bartoli, DO Alexandria B Barton Victor L Barton, MD Russell E Bartt, MD Elizabeth M Bassow-Scheve, MD Dennis J Battock, MD Joseph T Batuello, MD Andrew T Bauer, MD Gary W Bauerle, MD Earl D Baumgartel, MD Werner K Baumgartner, MD Rajesh Bazaz, MD Brandon Thomas Bealer Norse R Bear, MD David A Beard, MD Scott I Bearman, MD Benjamin A Beatty, MD Donald W Bechtold, MD Bradley G Beck, MD David D Beck, MD Akin S Beckley, MD Collin Beckstrom Amy M Beeson, MD Kerry L Beinlich, MD Diego F Belardi, MD Travis M Bellville, MD Matthew Belton, MD Edward L Bender, MD John L Bender, MD Alicia E Bennett, DO Alexander B Benson, MD

1 8 C O LO R A D O M E D I C I N E

John M Benson, MD John-Michael Benson Robert J Benz, MD Sally E Berga, MD Scott M Berger, MD Derek S Bergeson, MD Dylan Bergstedt Dale T Berkbigler, MD Mark P Berland, DO Daniel S Berliner, MD Jeffrey C Berliner, DO Gregory W Berman, MD Stephen Berman, MD J Tashof Bernton, MD Andrew R Berry, MD Andrew J Berson, MD Noelle L Bertelson, MD David A Biddle, MD David M Bierbrauer, MD William D Biggs, MD Rodger D Bildstein, MD Joseph O Billig, MD Richard F Bindseil, DO Tylynn Bingham Bernard J Birnbaum, MD Debra A Bislip, MD John H Bissell, MD Carol J Blackard, MD Kara Blaisdell David R Blatt, MD Robert L Blayney, MD Nikki Dyan Bloch Kiara L Blough Kirsten A Bluhm Joshua D Blum, MD Raymond N Blum, MD Barry D Blyton, MD Russell W Bobo, MD Brooks F Bock, MD S Allan Bock, MD Judith K Bodnar, MD Keith O Bodrero, DO Yolanda E Bogaert, MD Robert M Bogin, MD Rachel Renee Bohling Mark Steven Bolinger, MD David L Bolshoun, MD Jesse D Bolton, MD Bryan C Bomberg, MD Genna Bonfiglio Lisa M Bonwell, MD Richard K Book, DO Brock M Bordelon, MD John C Bosley, MD Brian P Bost, MD Remi Boudreau Joel C Boulder, MD Sarah E Boulos, DO Heather S Bourkovski, DO Phyllis A Bouvier, MD

Leah Bowen Charles R Bowles, MD Matthew E Bowles, MD Mary L Bowman, MD William J Bowman, MD James T Boyd, MD Eric S Boyer, MD Kirsten A Bracht, MD Ruediger F Bracht, MD Teresa K Braden, DO Joshua Bradford Ray K Bradford, MD Robert C Bradley, MD William Brandon John S Bratteli, MD Gayle L Braunholtz, MD Lauren C Brave, MD Rebecca S Braverman, MD Vance J Bray, MD Charles W Breaux Jr, MD Gary M Breen, MD Steven A Brenman, DO Janice K Brenneman, MD N Robert Brethouwer, DO Cody H Brevik Diana M Breyer, MD Joshua Bridge David E Bright, MD Nathan L Brightwell, MD Eric N Britton, MD Julie M Brockway, MD Peter S Brodrick, MD Merrick A Brodsky, MD Steven D Broman, MD Andrew E Brookens, MD Lesley C Brooks, MD David W Brown, MD Gerald D Brown, MD J Matthew Brown, MD Kelsi Brown Kevin S Brown, MD Travis M Brown, DO Hillary L Browne, MD Brendon S Browning, DO Richard J Browning, MD Paul K Brownstone, MD Morgan L Brubaker, DO Dina Brudenell, MD Gretchen L Bruno, MD Abigail Mae Bryant Catrina E Bubier, MD Linda L Buckley, MD Brenda A Bucklin, MD John V Buglewicz, MD Hai P Bui, MD Adriana Buliga-Stoian Gregory W Burcham, MD Iris Burgard Ellen M Burkett, MD Mitchell D Burnbaum, MD

Linda A Burnham, MD Patrick I Burns, MD Jesse R Burson Colt Johnson Burtard Leslie T Busby, MD Holly M Buschhorn, MD Patrick J Bushard, MD Jeffrey D Bushnell, DO Lisa R M Butler, DO Marcus A Button, MD Robert C Bux, MD Christine J Byers, DO Gaither D Bynum, MD Martha A Cabeen, MD Laird P Cagan, MD Jeffrey J Cain, MD Dale B Call, MD Debra L Campbell, DO Earl J Campbell, DO Laura M Campbell, MD Velma L Campbell, MD W MacRae Campbell, DO Jason A Cannell, DO Catherine L Cantway, MD Yadira Caraveo, MD Nicole P Carbonell, MD Jesus Adrian Cardenas Stephen F Cardos, MD Elizabeth L Carewe, MD Alyssa S Carlson, MD Ryan William Carney Benjamin T Carpenter, MD Samuel Carpentier Alfred N Carr, MD Gina S Carr, MD Jodi M Carrillo, MD Patrick M Carter, DO Mark D Carvalho, MD Brad A Case, MD Joseph E Cassara, MD Dale B Cassidy, MD Meredith A Cassidy, MD B Andrew Castro, MD Andrew C Catron, MD Brooke A Caufield, MD Kevin C Cavanaugh, MD John C Cawley, MD Chester M Cedars, MD Cindy J Celnik, MD Christopher J Centeno, MD Frank H Chae, MD Amrita K Chager Satoru T Chamberlain, MD Ira Chang, MD Rubens C Chang, MD Michelle A Chapin, MD Carleen A Chartier, MD Kathleen A Chase, DO Isabelle Chatroux Christyna M Chaudhuri, MD

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F E AT U R E S

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Central Line was purposefully designed with the following goals: 1

Empower member participation in Colorado Medical Society policy making and governance

2

Capture broad member input, 24/7

3

Bring individual member perspectives to board decision making

Pakhi Chaudhuri, MD Daniel W Cheek, MD Lakota Justin Cheek Andrea Kathryn Chernau Thomas G Chiavetta, MD Franklin S Chow, MD Khalid Chowdhury, MD Elijah Christensen Jennifer H Christensen, MD Dana L Christiansen, MD Stephanie R Christie, MD Anthony J Christoff, DO Jason Lee Christy Meagan Elizabeth Chriswell Kartiki U Churi, MD Dennis P Cirillo, MD David W Claassen, MD C Dana Clark, MD Gary B Clark, MD John P Clark, MD Phyllis V Clark, MD Sallie B Clark, MD Theodore J Clarke, MD Matthew S Claussen, MD Richard S Clemmons, MD John O Cletcher Jr, MD Claire Clifton Samuel B Clinch, MD Carlton M Clinkscales, MD Andrew Clithero, DO Samuel G Cloud, MD Heidi S Clune, MD Andrew I Cohen, MD Kenneth R Cohen, MD Laurence J Cohen, DO Richard S Cohen, MD William Cohen Elliot J Cohn, MD Chad Cole Jr Christopher R Cole, MD Norman G Cole Jr, MD Danielle C Coleman Michael F Colip, MD Hayden James Collins John A Collins, MD Albert H Colton, MD Jeanine M Compesi, DO Jonathan L Conard, DO Mark J Conklin, MD Melissa Leigh Conklin Donald J Conner, MD Samantha Conner Natalie D Conrad, MD Alexios-Clark C Constantinides, DO S Robert Contiguglia, MD Kendra D Conzen, MD John A Cook, DO Benjamin J Coons, MD Brian E Cooper, MD Bruce D Cooper, MDPH Suzanne S Cooper, MD Kevin R Corey Cristina Cosner Anna F Cosyleon, MD Adam G Cota, MD Richard L Coursey Jr, MD Frederick V Coville, MD Alison D Cowan, MD Eugene M Crafton, MD Joseph A Craig, MD Julia Rachel Craig Vanessa J Craig, MD Jon J Cram, MD Winfield M Craven, MD William Tyler Crawley Stephen M Creer, MD Kent R Crews, MD Chris Cribari, MD Donald G Crino, MD Elizabeth Cruse, MD R Brad Culberson, MD Michael Edward Culliton, MD William G Culver, MD Richard B Cunningham, MD Charles Curtis

James M Cusick, MD R Scott Daarud, MD Mark S Dacey, MD Nathan A Daley, MD Joseph E Dall'Era, MD Kurt T Dallow, MD Herman A Damek Jr, MD Keith C Dangleis, MD Jennifer Lynn Daniels Ariel Kiyomi Daoud Tyler A Darland, MD Thomas J Darrah, MD Farrah M Datko, MD Ira M Dauber, MD Allan B Davidson, MD Brian M Davidson, MD Amy L Davis, MD Ashley A Davis, MD Kent F Davis, MD Linda C Davis, MD Taylor Davis G Kenneth Kenneth Deagman, MD Joel M Dean, DO Julie C Deckerman, MD Christopher R Deig, MD Michael J Deignan, MD Hector E DeLeon, MD Karla J Demby, MD Jessica Demes Thomas D Denberg, MD Christian J Dennis, MD Michael A Deringer, MD Robert S Derkash, MD Robert A Dery, MD Neil J DeSouza, MD Jessica K Devin, MD Douglas B DeYoung, DO Ramnik S Dhaliwal, MD, JD Scott K Dhupar, MD Sami G Diab, MD Arthur J Dichard, MD Joel L Dickerman, DO Elliot C Dickerson II, MD Keith S Dickerson, MD Robin E Dickinson, MD Donald G Dickman, MD Cory L Dietz, MD Mark A Dillingham, MD Jack T Dillon, MD Laura M Dingle, MD Rebecca Dinkel David W Dirks, MD Jon G Dishler, MD Cuong V Doan, MD C Tony Dobija, MD Gerald D Dodd, MD Brian L Dodds, MD Anthony H Doing, MD Casey L Dolen Pawel Doloto, MD Matthew R Donaldson, MD Theresa A Donati, MD Daniel M Donato, MD Jeff Donner, MD Jamie J Doucet, MD Robert M Douglas, MD Tristan J Dow, MD Thomas A Dowgin, MD Thomas R Downes, MD David A Downs, MD J Paul Doye, MD Herman E Doyle, MD John H Drabing, DO Thomas R Drake, MD David A Dreitlein, MD Katherine Drexelius Christopher R Drysdale, MD Nazar Yuriyovych Dubchak Paul T Dube, MD Orest G Dubynsky, MD Dean L Ducnuigeen, MD James R Dudley, MD Timothy E Dudley, MD James P Duffey, MD Susan S Duiker, MD

Frank D Dumont, MD Cory D Dunn, MD Julie A Dunn, MD Michael L Dunn, MD Mark C Duster, MD Thomas F Dwyer, MD Brian J Eades, MD John B Ebens, MD Tobias Eckle, MD Sarah Edgerton Mark A Edson, MD Alysa Edwards James E Edwards, MD Kristin M Edwards Benjamin Ehrlich Brenda C Eiser, MD Meighan W Elder, MD Bryan Lee Eldreth Ethan R Ellis, MD Robert H Ellis, MD Toya A Ellis, MD Philip A Emrie, MD Dawnielle C Endly, DO Sean A Enkiri, MD Clara Raquel Epstein, MD Michael D Erlandson, MD Daniel Ernest Daniela Escobar Richard O Evans, MD James E Fagelson, MD Lane M Fairbairn, DO Frances Fan, MD Jane L Fansler, MD Garrett D Fante Brandon W Farmer, MD Ryan P Farmer, MD Andrea N Fedele, MD Michael E Feign, DO Naomi Y Feiman, MD Michelle Feinberg, MD Daniel J Feiten, MD Kevin A Felix, DO William F Fell Jr, MD Harold A Fenster, MD Margaret A Ferguson, MD Donald C Ferlic, MD Simon Abuhay Feseha Gregory A Feucht, DO Naomi M Fieman, MD Robert R Fierer, MD Johanna L Figge, MD Joseph Fike Robert J Fillion, DO Andy M Fine, MD Richard M Finer, MD Christina A Finlayson, MD Kenneth P Finn, MD Matthew Fioravanti Bruce J Fisch, MD Kerry S Fisher, MD Leslie E Fishman, MD Shira G Fishman, MD Kevin R Fitzgerald, MD Kevin M Fitzpatrick, MD Insley Puma Flaig, MD John P Flanagan, MD John T Fleagle, MD Gordon H Fleischaker Jr, MD Gregory Fliney Richard D Folan, MD Dylan Foley Mynette Foley, MD Isaac A Fonken, MD Paul W Fonken, MD Jack Ford, MD S Lance Forstot, MD Patricia L Foster, MD Brent Fowler Brent T Fowler, MD Carol C Fowler, MD Christopher R Fox, MD Clinton J Fox, MD Jacob Fox Shari C Fox, MD Megan Foy

Carolynn S Francavilla, MD George M Frank, MD Jeffrey W Frank, MD Lance Frank Ryan T Frank, DO Zara P Frankel, MD Nancy J Franzoso, MD Lauren A Fraser, MD Chris H Frazier, MD James Anthony Frazier Gayle A Frazzetta, MD William W Freedman, MD Kristin A Freestone, MD JoEllen Fresia Gretchen A Frey, MD David G Friedenson, MD Micah Friedman Stephen M Fries, MD Robert G Froehlke, MD Mariovisto Frizaldo Tumaliuan Frogozo, MD Carolyn M Fronczak, MD Thomas G Fry, MD Vincent Fu Joseph Robert Fuchs Rebecca Fuhlbrigge James W Fulton, MD Wayne C Furr, MD Brian T Gablehouse, MD R Wayne Gage, MD T Casey Gallagher, MD David Fallon Gamble Ryan G Gamble, MD Kenneth R Gamblin, MD Wael F Garas, MD Barry L Gardner, MD Bennett R Gardner, MD Ivor Garlick, MD James C Garlitz, MD Lauretta F Garren, MD Alisha P Garth, MD Austin E Garza, MD Lawrence J Gaughan, MD Mark J Gaynor, MD Donald P Gazibara, MD James S Gebhard, MD James E Geddes, MD Mindy A Gehrs, MD John H Genrich, MD Timothy J Gensler, MD Derek George John S Geraghty, MD Jeffry N Gerber, MD Charles A Gerk, MD Nancy J Germer, MD Wayne K Gersoff, MD Thomas A Gettelman, MD Bijan Ghaffari Charles E Giarratana, MD Connie H Giarratana, MD Robert H Gibbs, MD George D Gibson, MD Jill E Gibson, MD Fernando J Gil Franco, MD Jimmy G Gilbert, MD Sarvjit S Gill, MD Jan Gillespie Wagner, MD T Scott Gilmer, MD David A Gilmore, MD Paul Glasheen David L Glasscock, MD Richard H Glasser, MD Danielle Glaze Desiree S Gleason, DO Andrew Lawrence Glerum Jamie D Glover, MD John S Goff, MD Carol A Goldberg, MD Helen L Goldberg, MD Louis D Golden, MD Monte E Golditch, MD L Barton Goldman, MD Barbara L Goldstein, MD Charles Goldstein, DO Joel H Goldstein, MD

Denis L Gonyon Jr, MD Fred Gonzales Scott T Goodall, MD Reid A Goodman, MD Martha Zoe Gordon Richard M Gordon, MD Jacquelynn M Gould, MD Elizabeth S Grace, MD Connor W Graham, MD Lee B Grant Jr, MD Paul J Grant, MD Meggan J Grant-Nierman, DO Gary L Grasmick, MD Renee M Gravois, MD C Patrick Green, MD Scott M Green, MD Krista Greenan, MD David I Greenberg, MD Roger Greenberg, MD Dana L Greene, MD Robert A Greene, MD Taylor John Greenwood, MD Joseph E Gregory, MD Thomas G Greidanus, MD Brian C Griffith, MD Sean M Griggs, MD Daniel J Grine Patrizia C Grob Cliff A Gronseth, MD Mark R Groshek, MD John A Grossman, MD Frederick L Grover, MD John P Guenther, MD Charlene D Guggenheim, MD J K Guiter, DO Steven J Gulevich, MD Doris C Gundersen, MD Joy J S Guth, MD Eric Haaland Tracey A Haas, DO Terry L Hackney, MD Thomas A Haffey, DO Susan S Hagen, MD Giora Hahn, MD Saori L Haigo Omar S Hajibrahim, MD Riley W Hale, MD Audrey M Hall, MD Cynthia L Hall, DO Francis K Hall, MD William L Hall II, MD Scott E Hallgren, DO John H Hammer, MD Lee A Hammond, MD Kyle N Hampton, DO Susan M Haney, MD Kevin W Hanley, MD Kathleen A Hannifan, MD Charles A Hanson, MD Jared Hanson Stephanie W Harabaglia, DO Marjie G Harbrecht, MD Gordon S Hardenbergh, MD Mallory T Harling, MD Lisa A Harner, MD Taylor Harp Brian C Harrington, MD Cameron R Harrison, MD Margaret Harrison Timothy S Hart, MD Yuliya A Hartenbower James F Hartman, MD Ryan L Hartman, MD John S Harvey Jr, MD James T Harwood, MD Christine J Hassell Armodios M Hatzidakis, MD Erin Hayes Roxann M Headley, MD Alyssa N Heaton, MD Amilda R Heckman, DO Caleb Hedberg, DO John Hedberg, MD Lauren Marie Heery Steven J Heil, MD

PAGE 20 ⊲ C O LO R A D O M E D I C I N E 1 9

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F E AT U R E S C E N TR A L LI N E : C O N T.

2017 TO 2018 INCREASE IN MEMBER PARTICIPATION

MEMBER PARTICIPATION

> 46% Tad R Heinz, MD Kristine Hembre, DO Douglas E Hemler, MD James D Hendrick, MD Stephen G Henke, MD Theresa Hennesy Treve M Henwood, DO Penelope Anne Herder Mark J Hermacinski, MD Isaac J Hernandez, MD David S Herr, MD Richard A Herrington, MD George L Hertner, MD Stephanie L Hess, MD Enno F Heuscher, MD Mark G Hickey, MD Jarred M Hicks, MD Jason A Hicks, MD Douglas M Hill, DO William M Hilty, MD Erika Hinricher Katherine E Hoekstra, MD Mark W Hoenig, MD Julie A Hoffmann, MD Jason Hofstede James L Hogan, MD Barry W Holcomb, MD Amie L Hollard, MD Ripley R Hollister, MD Justin P Holmes Jamie N Holtz, MD Grace M Holub, MD Bertrand N Honea III, MD Benjamin Honigman, MD Philip L Hooper, MD Pauline Hoosepian-Mer Aaron Z Hoover, MD Jason A Hoppe, DO Michelle Kem S Hor, MD Daniel W Horne III, MD Sandra A Horvath-Dori, MD Mark S Hoskinson, MD Gregory A Hosler, MD Sami Houssin Hourieh Peter G Hovland, MD Kathryn T Howell, MD Robert J Hoyer, MD Joseph T Hsieh Paul S Hsieh, MD Emily S Hsu, DO Julian T Hsu, MD Shirley A Huang, MD Julie K Hubble, MD David Hudson Douglas B Huene, MD Madeline Grace Huey Jeremy M Huff, DO Craig D Hughes, MD John S Hughes, MD Joshua M Hulst, MD Sarah C Humphreys, MD Harold E Hunt, MD Mark A Hunter, MD Robert E Hunter, MD Scott N Hurlbert, MD Davis K Hurley, MD Timothy R Hurtado, DO David E Hutchison, MD Timothy J Hutchison, MD R Kent Hutson Jr, MD Devon E Hutton, MD Mary Olivia Hutton Mai-Lan N Huynh, MD Igor Huzicka, MD Gwang-Yi Hwang, MD Blake J Hyde, MD Zaki G Ibrahim, MD Nuzhat Iqbal, MD Seher Iqbal, MD Laurice Iskander, MD Gustavo Isuani, MD Zeljko M Ivanovic, MD Laura K Ivy, MD

Srinivas Iyengar, MD Ryan K Jackman, MD Alfred V Jackson, MD David M Jackson, MD Joseph P Jacob, MD Prema M Jacob, MD Herbert L Jacobs, MD Andrew Jacobsmeyer Audrey Janette Jaeger Raj A Jain, MD David S James, MD John M James, MD Tyler M James, DO Timothy A Jamison, MD Sunil S Jani, MD Shannon E Jantz, MD Claudia P Jantzer, MD Brian A Jaquette, MD Carlos Michael Jaquez Aaron D Jarrett, MD Sanjay Jatana, MD Matthew A Javernick, MD Omid Jazaeri, MD Andrea M Jazbec-Lake, MD R Lee Jeffrey, MD Herman A Jenkins, MD Joseph X Jenkins, MD Clark L Jennings, MD Eleanor R Jensen, DO Judd M Jensen, MD Vandna Jerath, MD Eugenia Jernick Joseph P Jimenez, MD Daniel B Jinich, MD Jasjot S Johar, MD Stacie L Johns, MD Drew C Johnson, DO Geoffrey E Johnson, MD Joseph D Johnson, MD Katelyn Johnson Melissa Johnson Robin E Johnson, MD Stephen P Johnson, MD Christine G Johnston, MD Aaron Jones Andrew D Jones, MD David W Jones, MD Marklyn J Jones, MD Paul B Jones, MD Caitlin L Jones-Bamman, MD Brian C Joondeph, MD Jon-Paul Jordan, MD Kathleen M Joy, DO Scott V Joy, MD Brian R Juan, MD Sarah E Judkins, MD Timothy R Judkins, MD Robert J Juhala, MD David J Jung, MD Marcel J Junqueira, MD Robert J Kahn, MD Brian L Kaiser, DO Dale C Kaiser, MD H Rai Kakkar, MD David M Kaleugher, DO George E Kalousek, MD Benjamin C Kam Jr, MD Jane S Kano, MD Lakshmipriya Karamsetty Lawrence I Karsh, MD Terese Kaske, MD Louis B Kasunic, DO M Ben Kates, MD Taj M Kattapuram, MD Steven L Kaufman, MD Zachary A Kaufman, MD Bruce L Kautz, MD Kenneth B Kauvar, MD Tyler L Keate, MD Shannon K Keel, MD Bradford R Keeler, MD F Brent Keeler, MD David M Keller, MD

2 0 C O LO R A D O M E D I C I N E

52% Mallory R Kelley Leah R Kellogg Donald L Kellum, MD Jason L Kelly, MD Maureen E Kelly, MD Douglas J Kemme, MD Erin E Kempe, DO Jennifer Kempe-Biermann, MD Alec Edward Kerins Jeffrey A Kerr-Layton, MD Clara Kerwin Sharon M Kessler, MD Masi Khaja, MD Abid D Khan, MD Jibran Khan Shabnam Khoie, DO Lucina A Kidd, DO Jan Marie Kief, MD Julie A Kiley, MD Helen M Kilzer, MD Alisa Kim Chris Y Kim, MD Jalpa "Jenny" B Kim, MD Lawrence S Kim, MD N Curtis Kimball, MD William K Kimble, MD Alan E Kimura, MD Troy Kincaid Pamela R Kinder, MD Kirk Kindsfater, MD Alexandra R B King, DO Angela K King, MD James M Kinsman III, MD Larry W Kipe, MD Aaron D Kirkpatrick, MD Gerald Kirshenbaum, MD Robert H Kiser, MD Rachelle M Klammer, MD Laura L Klein, MD Doris A Kleinert, MD Christy T Kleinke, DO Jackson Kloor Joshua P Klopper, MD Kendal C Knaus, MD Andrew M Knight, MD James C Knight, MD John W Knight, DO Rebecca Knight, MD Sean W Knight Diana E Koelliker, MD Michelle M Kohara, MD Stefanie D Kolpak, MD Tyler Kolstad Kevin T Kong Scott A Kono, DO Alexandra Koontz Todd L Kooy, MD David S Korman, MD Hannah Korrell Andrew S Korson, MD Allan B Kortz, MD Martin A Koschnitzke, MD Adam G Koszowski, MD Glenn E Kotz, MD Elizabeth S Kraft, MD Stephanie K Kraft, MD Kenneth D Krause, MD Jeffrey M Krawcek, MD Nicholas J Krebs, MD Shay Krier, MD Arun R Krishnan, MD Vishal Krishnan Elizabeth L Kudron, MD Micheline A Kuhr, MD Jeffrey T Kulp, MD Elizabeth L Kulwiec, MD Kenneth E Kuper, MD Thomas L Kurt, MD Jean S Kutner, MD Karl A Kuzis, MD Nicholas c Kyriazi, MD Sami Lababidi, DO Marc H Labovich, MD, FCAP

Emily LaCount Michaela B Laird Mark Laitos, MD Eric Lakey Terrance L Lakin, DO Elaine T Lam, MD Robert P Lam, MD Richard C Lamb, MD Astrid S Lampey, MD Rachel Landin Todd P Landin, MD Christina M Lang, MD Sharon I Langendoerfer, MD Daniel A Langer, MD David M Langley Daniel S Lann, MD Mary B Lansing, MD Robin M Larabee, MD Wells Lariviere Christine D Larocca, MD Ammon J Larsen, MD Karl M Larsen, MD Wallace K Larson, MD Deborah S Lasley, MD Brittany A LaVoy, MD Ian Michael Lawrence Barry Lawshe, MD Robert C Lawson, MD Jonathan Layne Ethan A Lazarus, MD Jeremy A Lazarus, MD Mark G Learned, MD Jacob Leary Auna Leatham, MD Logan Price Leavitt Eric H Leder, MD Garrett B Lee, MD Jun Yup Lee Stephen Alexander Lee William H Lee, MD William S Lefler, MD Dwight R Leggett II, MD Mark A Leibel, MD Ann M Leibold, MD Marina Leith Robert H Leland, MD Alan M Lembitz, MD Peter J Lennarson, MD David M Leon, MD Michael L Lepore, MD Kimberly D Lerner, MD Margaret R Lesage-Ausema, MD James W Levine, DO Mark A Levine, MD Robert H Levine, MD Mark B Levinson, MD Leah I Levulis Daniel Landon Levy Michael Justin Levy John M Lewin, MD Frederick W Lewis, MD Heather L Lewis, MD Jeffrey D Lewis, MD Lisa K Lewis, DO Parker C Lewis Peggy B Liao, MD Timothy H Liao, MD Arlene L Libby, MD Mitchell B Liester, MD Raymond Lindsay Lilly Jr, MD Kevin J Limbaugh, MD A Christine Linares, MD Stephen D Lindenbaum, MD Laura A Lindholm, MD James R Lingle, MD Jennifer A Linhorst, MD Alexander Linse Russell A Linsky, MD Ferdinand J Liotta, MD Michael D Lipnick, MD Pia B Lisle, MD Alexa L Litel, MD Charles M Little, DO

Brian Adam Lloyd Michael Loar, MD Kelly T Locke, MD Mark H Loeb, MD Michael R Loew, MD Stephanie Logterman, MD Scott F London, MD Daniel R Long, DO Lucy W Loomis, MD Joseph M Lopez, MD Jonathan G Lord, DO Mark C Loury, MD Kern S Low, MD Steven R Lowenstein, MD Kelly H Lowther, MD Amanda J Luchsinger, MD Gary J Luckasen, MD Donald C Luebke, MD Diana L Lujan, MD Mark G Luker, MD Cynthia J Lund, DO Deborah S Lund, MD Edward G Lundblad, MD William W Lunt, MD Jordan R Luskin, MD Joseph R Lutt, MD Elizabeth S Lycett, MD Megan J Lykke, MD Colton Lynn Stephen J Macdade, MD Margaret E MacDonald, MD Nola A MacDonald, DO Tracy A MacEachern, MD Bruce P Machaffie, MD Bennett I Machanic, MD Adam G Mack, MD Robert P Mack, MD Paul E Mackell, MD Scott H MacKenzie, MD Thomas D MacKenzie, MD William L Madry Paul C Magarelli, MD Matthew J Mahlberg, MD Amy O Maiocco, MD Nancy K Maller, MD Karen E Maloney, DO Michael A Mandrell, MD William K Mangum, MD Robert L Manguso, MD Jonathan C Manheim, MD Kendell L Mann, MD Thomas A Mann, MD Evan Manning Marsha M Manning, MD Helen P Mantila, MD Michael E Margolis, MD Philip C Marin, MD Curtis L Markel, MD Geoff Markowitz Jay A Markson, MD Jennifer L Markus, MD Jack M Markusfeld, MD Heidi N Marlin, MD J Ryan Marlin, MD Julie G Marmon, MD Mary L Marohn, MD Amy S Maroldo, MD Emily S Marsh, MD Dale R Martin, MD Jean T Martin, MD Laura F Martin, MD Sara J Martin, MD Joseph C Martinez, MD Michael A Martucci, MD Gregg G Martyak, MD Donald A Maschka, MD M Marlene Maseberg, MD Eugene Master Lisa Matelich, MD Jaron Nobuo Matsunaka David S Matthews, MD Mark K Matthews, MD Ryan J Maybrook, MD

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Douglas V Mayeda, MD Stephen A Mayer, MD Hossein Maymani, MD Edward C Maynard, MD Jason D McCarl, MD Paul J Mccarthy, MD, FCAP Thomas T McCarthy, DO David W Mccarty IV, DO Michael C McCarty, DO Michael D McClellan, MD Justin A Mccoy, DO Michael S McCracken, MD Colleen R McCreery, DO Richard A Mccreery, DO Robert D Mccurry, DO Logan M McDaneld, MD Louise L Mcdonald, MD Amy E McDowell, MD Hugh P McElwee, MD Douglas M McFarland, MD Robert J McLaughlin, MD Michael P McNevin, MD William C McNitt, MD Peter A McSweeney, MD John H McVicker, MD Laura Jane-Helen Mcwhirter Sara J Meadows, DO Halea Meese Pushpa S Mehta, MD Katja I Meier, MD Julie A Melchior, MD Jose A Melendez, MD Kiel Melkus, MD Ann L Mellott, MD Ari Z Melmed, MD Ben R Mendoza III, MD Olga Mengin, MD Mark D Menich, MD Alexander R Menter, MD Jeannette Y Mercer, MD Andrew H Merelman Lisa N Mettler, MD Michael H Metzler, MD Brian Meyer James I Meyer, MD Kelsey Meyer George J Meyers, MD Jacob Eaton Michalski Renee L Micielli, MD Martha C Middlemist, MD Bradley J Mikaelian, MD Denise M Miller, MD Frederick M Miller, MD Michael K Miller, MD Mindy L Miller, MD Richard A Miller, MD Andrew D Mills, MD Gregg E Minion, MD Barry D Mink, MD Matthew E Misja, MD Kelly E Mistry, MD Garrett S Mitchell, MD Faraz Modirian David J Mohlman, DO Jaclyn D Mohning, MD Gary A Mohr, MD Robert E Mohr, MD Stephen J Mohr, MD Erik M Mondrow, MD Joel R Montbriand, MD Brody D Montoya Jeffrey A Moody, MD Christopher P Moore, MD Joseph P Moore, MD Kristen Moore Larry A Moore, MD Michael L Moore, MD Nicholas J E Moore, MD Richard A Moore, MD Rory R Moore, MD Thomas P Moore, MD Monnica Morales Thomas J Moran, MD

2,794

members voting

Alethia (Lee) E Morgan, MD Richard H Morgan, MD Nora E Morgenstern, MD Joseph M Morreale, MD Travis J Morrell, MD John D Morrison, MD Tyler P Morrissey, MD Andrew J Morse, DO Sarah C Morse, MD G Thomas Morton, MD Richard H Moseley, MD C Eugene Mossberg, MD H Andrew Motz III, MD Michael S. Moubarek Kevin D Muelken, MD Kathryn L Mueller, MD Daniel Muller, MD William Mundo Christine L Munson, MD Brian P Murphy, MD Claire E Murphy, MD Jennifer L Murphy, MD Lawrence E Murphy, MD Garvin C Murray, MD Michael J Murray, MD Krishna C Murthy, MD John B Muth, MD Thomas T Mydler, MD Mallory Myers Steven R Myers, MD Aaron S Nadon, MD Steven D Nafziger, MD Jeffrey M Nakano, MD

 9,202 votes Sherry G Nakano, MD Benjamin Nance Michael T Napierkowski, MD Madhav Narayan Kristian J Narveson, MD Jerry D Nash, MD Robert A Nathan, MD Mark H Nathanson, DO Shane Nau William A Neff, MD Tamera L Nelson, MD Craig L Nerby, MD Michael G Neste, MD Stefanie D Neubauer, MD Mia Nevala Michael K Ng, MD Mai Ngo Jason T Nguyen, MD Margaret Nguyen Brian R Nimer, MD Joseph J Nissim, MD Cameron Niswander Nicholas G Nonas, MD Edwin R Noordewier, MD Edward A Norman, MD Jennifer C Norman, MD Andrew M Norris, MD Crystal M North, DO Riana M North, MD David K Nosan, MD David M Nuhfer, MD Norman D Numerof, MD Paul E Numsen, DO

F E AT U R E S

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707 comments

Julia Nyiro Barry G O'Brien, MD John R O'Brien, MD Dennis J O'Connell, DO Lawrence P O'Connell, MD James A O'Donnell, MD Sean C O'Donnell, MD John S O'Keeffe, MD Jonathan P O'neil, MD Eugene T O'Neill, MD Kevin J O'Toole, DO Barry A Ogin, MD John W Ogle, MD Kenneth M Olds, MD William J Oligmueller, MD Anthony M Oliva, MD Brian D Olivier, MD Eric B Olsen, MD Karl E Olsen, MD Samantha Olsen Anna M Olson, MD Cynthia Omega Pierre T Onda, MD Ndudi O Oparaeche, MD David A Oppenheimer, MD Umberto N Orazi, MD Jeanne P Osborn, MD Luke J Osborne, MD Tamaan K Osbourne-Roberts, MD Charles J Oseroff, MD Tamas Otrok, MD Michael T Otte, MD Merlin G Otteman, MD

Shawn B Otteman, DO Erik L Overby Sameer A Oza, MD R Scott Pace, MD Wilson D Pace, MD Richard J Pacini, MD Ross S Pacini, MD Patrick W Page, MD James F Pagel, MD M Ray Painter Jr, MD Ted E Palen, MDPH Madelyn S Palmer, MD Alfonso F Pantoja, MD Adam Panzer Spyridon G Papadopoulos, MD Kurt F Papenfus, MD John D Papilion, MD Girish A Paranjape, DO Rhonda L Parker, DO Richard K Parker, MD Wendy M Parkinson, MD B Jefferson Parks, MD Stacy L Parra, MD Antigone P Parrish, MD Lynn Parry, MD Karla C Pastrana, MD Bhaktasharan C Patel, MD Mihir V Patel, MD Nishant A Patel, MD Bruce C Paton, MD Donald R Patrick Jr, MD Kenneth M Patrick, DO Kimberly M Patterson, MD

Physicians have different needs, that’s why we’re offering special mortgage financing.

Our doctor loan is designed specifically to meet your needs as a busy physician for the purchase of your primary residence. We will go out of our way to meet the demands of your busy schedule and make sure the mortgage loan process is a positive one.

For information on how you can take advantage of this special home financing program from BBVA Compass, give us a call today.

• Arthur Stine

Mortgage Banking Officer NMLS# 1081791

(303) 229-1049 arthur.stine@bbva.com

• Fred Smith

Mortgage Banking Officer NMLS# 422431

(303) 489-5782 fred.smith@bbva.com

Apply Online: https://www.bbvacompass.com/mortgages/astine https://www.bbvacompass.com/mortgages/fsmith *100% LTV not available on condominiums. Condominiums require a down payment. A contribution toward the transaction's closing costs and prepaid items from the borrower’s own funds is generally required, except in certain circumstances involving parental gifts. All loans subject to underwriting review. All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC and an Equal Housing Lender. NMLS # 402936 Rev. 08/2018 # 463418

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F E ATU R E S C E N TR A L LI N E : C O N T.

>

76% AVERAGE REPEAT USER RATE

AVERAGE NEW USER RATE > 24%

CAREER STAGE PARTICIPATION Early career Mid-career Late career

> 29%

> 28%

> 43%

24/7 VOTING Midnight - 5:59am 6:00 am - 11:59am Noon - 5:59pm 6:00 pm - 11:59pm > 5% > 15% > 54%

> 27%

Johan Pauley Pierre V Pavot, DO Jenna M Peart, MD Ronald W Pelton, MD Katherine Elise Pemberton Ricardo L Pena, MD Richard S Penaloza, MD Richard W Penland, MD Philip A Pennington, MD Robert J Pensack, MD Grant Peoples, MD Hisman H Percival, MD Christopher W Pergrem, MD Jeffrey D Perkins, MD Daniel M Perlman, MD Kerry G Perloff, MD John L Perna, MD Nathan S Persoff, MD Annelisa Pessetto Humphrey George Petersen-Jones Amber M Peterson, MD Dawn M Peterson, MD Richard E Peterson, MD Thomas T Peterson, MD Betty A Petrak-Ron, MD Haylie McKenzie Davis Petrick Michael D Petrucci, MD Arnold E Pfahnl, MD Poorvi C Pfenning, MD Neva Phair, MD Khoi D Pham, MD Barbara A Phillips, MD Kyle Phipps Kasey L Pickard Madelyn Pickle Erik J Pieramici, MD Isaac D Pierre, MD Cleveland Piggott Jr, MD Steven J Pilarski Paul C Pinto, MD Randolph A Pinto, MD William G Plested III, MD Richard G Pluss, MD Sandra Plybon, MD Timothy J Poate, MD David A Podlecki, MD Michael J Podolak, MD Nicholas R Polise, DO Karen Polsky, MD Heidi A Pomfret, MD Matthew C Ponder, MD Paula M Pook, MD Austin I Poole, MD Jerry K Popham, MD Gil Porat, MD Innessa T Porter, MD Robert H Potts Jr, MD Bernard J Powers, MD Nisha Pradhan Amelia Prado, MD Michael J Pramenko, MD Michael T Preece, MD Richard W Presnell, MD Peter Press, MD David W Price, MD Ellen W Price, DO Stuart M Prins, MD Peter B Pruett, MD Kristina Puls, MD Theodore J Puls, MD James L Quackenbush Jr, MD Robert R Quaid, MD Leto Quarles, MD Sejal S Quayle, MD Jay S Rabinowitz, MD Bill G Rainer Jr, MD Vishal Rana, MD Kathleen B Raphael, MD Douglas J Raskin, MD Kathleen Raskob Michael J Rauzzino, MD Sumant Rawat, MD Gary D Rechnitz, MD Paul E Reckard, MD Leif A Redal, MD John C Redfern, MD David G Reed, MD Sharman L Reed, MD Mary A Reeves, MD Robert H Reeves, MD Martha G Regan-Smith, MD Jena L Reichelt, MD Gregory C Reicks, DO Christina M Reimer, MD Bruce L Reimers, MD George N Reinhardt, MD

2 2 C O LO R A D O M E D I C I N E

Quentin Remley Daniel M Renner, MD Lindsey M Rentschler, MD Scott L Replogle, MD Robert Matthew Reveille, MD Judith U Reynolds, MD Nora A Reznickova, MD Mark W Rhine, MD Julia L Rhoden, MD Robert J Rhodes, MD Michael D Ricafort, MD Robin E Richard, MD Abby C Richards, DO Katherine S Richardson, MD A Jason Richter, MD Thomas S Ridder, MD Grant Ridgway Eric O Ridings, MD Michelle A Ridnour, MD Gayle E Riley, MD Kristine M Rivera, DO Christopher J Roach, MD Susan I Roach, MD Nicole M Roberson, MD Gareth K Roberts, MD Susan J Robertson, MD Andrew R Robinson, MD Brigitta J Robinson, MD George G Robinson II, MD Natalie H Rochester, MD Michael A Rocklin, MD William J Rodman, MD Chester T Roe III, MD Olivia Roehling Christine D Rogness, MD Laura A Rokosz, MD Michael D Roller, MD Kathleen D Roman, MD Erica G Romo Anna M Rooney, MD Lynn L Rooney, MD Jason R Roosa, MD Gary B Rosen, MD Lila S Rosenthal, MD Michael J Roshon, MD Annette E Rosling, MD Andrew J Ross, MD David W Ross, DO Heather M Ross, MD Lisa R Rothlein-Naron, MD Mary Rountree Caroline Rowlands, MD Kristen M Royer, MD Jennifer M Rubatt, MD Pamela M Rubner, MD Michael R Rudolph, MD Carol M Rumack, MD Jeffrey S Rumbyrt, MD Floyd B Russak, MD Richard J Russell, MD Ryan L Russell Mary K Russo, DO Jarvis D Ryals, MD Steven E Ryan, MD Shahla Sadegh Mousavi, MD Aaron Jacob Sadowsky Deborah Saint-Phard, MD David E Saintsing, MD Julio C Salimbeni, MD Jeremy P Salsberg, MD David M Salter, MD Theresa M Sanborn Robert L Sancetta, MD Oscar A Sanchez, MD Alison L Sandberg, MD Carolyn J Sanders, MD Julia Sanders, MD Matthew C Sanderson, MD Noel E Sankey, MD Nanette F Santoro, MD Stuart B Saslow, MD Jonathon P Savage, DO Rosalyn Wong Savoie Kathleen D Saxon, MD Michael E Sayers, DO Lisa Hackney Scatena, MD William M Scelza, MD Robert W Schabbing, MD Mark D Schane, MD Mikayla Scharnhorst Robin L Schaten, MD David M Scheider, MD Joshua M Scheidler, MD John E Schiller, MD Michael A Schindel, MD Leslie A Schipper, DO Gregory S Schlessinger, MD

Milton J Schleve, MD Peter M Schmid, DO Alexander Schmidt Janet S Schmidt, MD John Joseph Schmidt, MD Philip M Schmidt, MD Matthew D Schmitz, MD Emily N Schneider, MD Lucas G Schnell, DO Theresa A Scholz, MD Dylan Schoo Chad C Schooley, MD Michael R Schuck, MD Hayden Schuette Martina M Schulte, MD Christopher P Schultz, MD Peter M Schultze, MD John R Schwappach, MD Ivan Schwendt, MD David A Scola, MD David R Scott, MD Miho Toi Scott, MD Mary A Seagraves, MD Florian D Seeberger, MD Steven J Seiler, MD Luke V Selby, MD Graham J Sellers, MD Tamas Seres, MD Stephanie Serva Joseph G Sever, MD David A Severance, MD Rachel L Sewell, MD William A Shachtman, MD Douglas R Shaeffer, MD William R Shaffer, MD Mason S Shamis, MD Richard D Shannon, MD Alexander Shapiro, MD David B Shapiro, DO Anjmun Sharma, MD Ingrid Sharon, MD Jack L Sharon, MD Richard E Sharpe Jr, MD Brian A Shaw, MD M Sarah Sheiner, MD Jonathan Sheldon, MD Mitchell Lee Shellman Brent D Shelton, MD David William Sheneman David C Shepherd, DO Stephen V Sherick, MD M Eugene Sherman, MD Susan A Sherman, MD Rina K. Shinn, MD James E Shira, MD Alison C Shmerling, MD Lee W Shockley, MD Mark A Shucker, MD Jesse Martin Shulman Cameron H Siddens, MD Stanley F Siefer, MD Daniel O Siegel, MD Mindy J Siegel, MD William S Silkworth, MD James J Simerville, MD Mark S Simmons, MD C Kelley Simpson, MD David J Singer, MD Steven A Singer, MD Harmeet Singh, MD Jonathan Singh Patricia A Sinoway, MD Christine F Skorberg, MD Steven P Sloan, MD Donald Slusarenko Stanley F Smazal Jr, MD Bradley W Smith, DO Brian R Smith, MD Edwin R Smith, MD Eric B Smith, DO Jerome I Smith, MD Joshua Smith Peter C Smith, MD Randall W Smith, MD Royal A Smith, MD Stephen A Smith, MD Patrick J Sniezek, MD J Christopher Sohayda, MD Joseph J Soler Jr, MD Bektu Solomon William A Solomon, MD Thomas H Soper, DO Aris M Sophocles Jr, MD, JD Carsten M Sorensen, MD Daniel F Soteres, MD Alexandra Rose Sotiros Michael W Spangler, DO

Mary M Spannring, MD Douglas K Speedie, MD Kimball J Spence, DO Nathan M Spengler, MD Jason T Sperberg, DO Donald G Spradlin, DO Erik W Springer, MD John R Squires, MD Geetika Srivastava, MD John M Stachler, MD Donald E Stader, MD George T Stafford III, MD Jan H Stahl, MD Richard L Staller, DO Alexandra (Ali) V Stamatoiu Carol A Stamm, MD Mariaelena M Stamm, MD Kelly Stanek Michelle K Stanford, MD Lars A Stangebye, MD Anthony A Stanulonis, MD R Holbrook Stapp, MD Michael J Starkey, MD Laurel R Stearns, DO Marshall T Steel, MD Tracey L Stefanon, DO Alwin F Steinmann, MD Julia Stelter Samuel W Steury, MD Eric E Stevens, MD Leslie A Stewart, MD Lora J Stewart, MD Richard M Stewart, MD Kailey D Stiles Brandon J Stilson, MD Andrew P Stoddard, MD Stephen L Stoll, MD Autumn L Stone, MD Dianne C Stone, MD William W Storms, MD Helen M Story, MD James R Strader Jr, MD Jay Michael Straight, MD Arthur K Strasburger, MD Lloyd L Strode, DO Celinde Y Strohl, MD Seth R Strote, MD Adam O Strunk, MD David B Stuart, MD Jamie E Stucker, MD Lynne R Studebaker, MD Jacob Joseph Stuppy Linda Sturtevant, MD Donna L Sullivan, MD Philip J Sullivan, MD Steve R Sunderman, MD Barry R Sundland, MD Jamie G Surovik, MD Karin N Susskind, MD Julie M Sutarik, MD Elizabeth A Swanson, MD Ronald J Swarsen, MD Nathan D Swartz, MD Carl S Swendsen, MD Michael Sydor, DO Paul A Sykes, MD Alan Y Synn, MD Lisa M Szczepanski, MD Hank K Tang, MD Ross G Tanick Malcolm A Tarkanian, MD Kathleen M Tate, MD Jodie H Taylor, MD Randall S Taylor, MD Walter Monroe Taylor Mukanya Tchombela Michael T Tees, MD Margaret E Teets Carolyn Tejirian, MD Daniel T Tell, DO Mark A Teruel, MD Brandon Teska James K Teumer, DO Nicholee R Theiss, MD Alexandra Theriault, MD Thomas J Therrien, DO Rita E Thieme, MD Collin B Thomas Herbert J Thomas III, MD Kyle L Thompson, MD Margret S Thompson, MD Patrick L Thompson, MD Roy W Thompson, MD Ann D Thor, MD Steven J Thorson, MD Martin B Thumim, DO Joshua S Tierney, MD

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F E AT U R E S

272 MEMBERS UTILIZED THEIR EXPERTISE WITHIN INTEREST AREAS 93% PARTICIPATION RATE IN CENTRAL LINE BY INTEREST AREA DOCTORS Katherine E Tiller, MD John W Tillett, MD Briana Tillman Anthony L Timko, MD Christene A Timmons, MD John E Tobey, MD Amanda Frances Tompkins Robert E Tonsing, MD Kevin J Tool, MD Steven M Topper, MD Anthony D Tormey, MD John R Torrent, MD Allee Cristina Torres Maria R Torrone, MD Michael B Tracy, DO Stephen A Treat, MD Karl R Treffinger, MD Jerome Trembley Andrzej T Triebling, MD Gerald W Tripp II, MD Warren I Tripp, MD Allison Trop, MD Susan W Trout, MD Leigh Truitt, MD Weston Frazier Truman Rocci V Trumper, MD Ashley Trumpie Adam G Tsai, MD Tzuhan Tsui Jack W Tubbs Jr, MD Daniel T Turner, MD Katherine Anne Turner Michael B Turner, MD Seth M Turner, MD Wade A Turner, MD George O Tutt Jr, MD Frank E Tuxworth, MD Larry D Underwood, MD Robert Ungerer Christopher J Unrein, DO John A Updike, MD Garrett Urban, MD Jean L Urquhart, MD

Dominick J Utrie J Dale Utt, DO Mary Vader, DO Daniel J Valentino, MD George E Valley, MD Katherine Van Deventer Irina R Vancea, MD Robert E Vander Leest, MD Gary D VanderArk, MD Todd F VanderHeiden, MD Guy P VanderWerf, MD Patricia L VanDevander, MD Scott A Vaneyk, MD Lindy A Vanlandingham, MD David C VanPelt, MD Sarah B VanScoy, MD Alfredo Vargas, MD Usha Varma, MD Dale E Varner, MD Lawrence N Varner, DO Wanda J Venters, MD Walter B Vernon, MD Lynette C Vialet, MD Brock C Vickery, MD Michael S Victoroff, MD Michael C Vidas, MD Sandeep S Vijan, MD Andrew P Villamagna, MD Giovanni Villegas Nikita T Vischer, MD Miles Philip Viseur Joanne M Vitanza, MD Annette D Vizena, MD Robert P Vogt, MD Kenton I Voorhees, MD Martha M Waddell, MD Jeffrey C Wagner, MD Christine Wahlmeier H Dennis Waite, MD Frank J Walch, MD Aaron Richard Walker E Lance Walker, MD Frederic B Walker IV, MD

Jessica J T Walker, MD Katherine L Walker, MD Hilary F Wallace, MD Mark E Wallace, MD Stephen W Wallace, MD Michele Wallendal, MD Peter A Wallskog, MD Andrew L Walshak, MD Angela S Walter, MD Kurt S Walters, MD Taylor Harrison Wand C K Wanebo, MD Mary Wang Prosper L Wang, MD Arazu S Wanna, MD Bruce A Ward, MD Daniel A Wardrop, MD Bruce J Waring, MD D Mark Warren, MD James S Warson, MD Marc Y Wasserman, MD A Tyler Watlington, MD Clifford K Watts, MD Kyle B Waugh, MD Katie M Weatherhogg, MD Cecilia L Weaver, MD S Christopher Weaver, MD Pamela S Webber, MD Ian C Weber, MD Kevin J Weber, MD L Arthur Weber, MD Patricia B Weber, MD Rae A Weber, DO Robert D Weber, MD Suzanne B Weber, MD Douglas S Webster, MD Anna M Wegleitner, MD Kenyon J Weidle, MD Eric R Weidman, MD Tyler A Weigang, MD Jill S Weiner, MD Richard M Weintraub, DO Kathleen J Weiss, MD

Russell J Weister, MD Janice M Weixelman, DO Michael D Welch, DO Ann M Wells, MD G Gray Wells, MD Melanie A Wells, MD Michael J Wempe, MD Catherine C Weng, MD Derek Wengryn David M West, MD Robert R Westermeyer II, MD C Ryan Westfall, DO Kevin L Whaley, MD Ashley E Wheeler, MD Phillip B Whiting, MD Brien J Whittington, DO Thomas D Wiard, MD Christopher J Wibbelsman, MD Sean Trueman Wickers Lars Widdel, MD Marj M Wiedeman, MD Andrzej Wierzbicki Jr, MD James S Wilk, MD Jordan Lee Wilkes Brent Wilkinson David M Williams, MD Fred O Williams, MD Mary E Willy, DO Derek Scott Wilson Fiona A Wilson, MD Richard A Wilson II, MD Louis H Winkler, MD Bradford T Winslow, MD Clara L Winter, MD Kimberly E Winter, MD Diane M Winters, MD Elizabeth G Withers, MD Daniel Witten, MD John P Witwer, MD Tracy M Wolf, MD Kristen K Wolfe, MD Sophia Wolfe John F Wolz, MD

Gail B Womack, MD Emily R Wombacher Bert Y Wong, MD Nicole Wong Rosalyn Poyan Wong Cristina L Wood, MD Peter D Wood, MD Blair J Woodbury, MD W Jeff Wooddell, MD Scott B Woody, DO Tonya N Wren, MD Steven L Wright, MD William G Wright, MDPH Matthew K Wynia, MD Lisa N Wynn, MD John S Xenos, MD Rajesh Yalavarthy, MD Taylor Lindsey Yamauchi Ann K Yanagi, MD Heidi Yen Elesa Yihdego Elizabeth A Yoder, MD Paul T Yoder, MD Grant R Young, MD Harold D Young, MD Liesl G Young, MD Mark D Young, MD Jim A Youssef, MD Elizabeth P Yuen Alan S Zacharias, MD David A Zander, MD Steven J Zeichner, MD Leonard R Zemel, MD Matthew Zemel J Werner Ziegler, MD Darren S Zimbelman, MD Shanta M Zimmer, MD Clark B Zimmerman IV, MD Jennifer A Ziouras, MD Lucas Zornoza Leonid Zukin Lisa Zwerdlinger, MD

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C O LO R A D O M E D I C I N E 2 3

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F E ATU R E

KNOW YOUR LEGAL RIGHTS Are you unsure of your participation status in any of the many products a health plan offers?

If so, legislation that the Colorado Medical Society helped to pass in 2017 can help you.

You can now request and receive from the plans with which you participate a listing of all of their plans / products showing your participation status in each.

C.R.S. 10-16-705.5 Participating provider networks - definition - selections standards - informal reconsideration (4) Upon request, and not more often than quarterly, a carrier shall provide a provider that is participating in one or more of its networks with a complete list of all network plans and products the carrier offers to consumers, with an indication of the provider’s participation status within each network plan or product. The carrier shall respond to a provider’s request within thirty days after it receives the request.

This information is just one example of what is available to CMS members in the Know Your Legal Rights database, launched in May 2018 by CMS and the statewide network of component medical societies. This online tool compiles in one place all of the Colorado laws in place to protect physicians, their practices and patients from unfair, predatory and unscrupulous practices.

These protections have been secured through more than a decade of hard-hitting advocacy by CMS and our allies in the General Assembly and the rule-setting process, but many physicians and their staff were unaware that these laws exist or how to find and use them. With Know Your Legal Rights, practices are just a keystroke from knowing the legal tools at your disposal and how to use them effectively – your instant guide to Colorado physicians’ legal rights.

To access the Know Your Legal Rights database, go to www.cms.org/ kylr. You'll need to sign in with your CMS username and password.

(Users must be logged in with their CMS.org credentials to access Know Your Legal Rights. Staff of CMS members can request a login from membership@cms.org.) Once logged in, scroll through the topic list or enter keywords in the search bar at the top of the page to find laws relevant to your issue, a summary of the law and details about how the law affects physicians. The exact references are available in the sidebar of each entry. Be sure to take advantage of this valuable member benefit. ■

learn more about your legal rights

www.cms.org/kylr 2 4 C O LO R A D O M E D I C I N E

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INSIDE CMS

C O P I C

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C O M M E NT

Stepping Into The Role of COPIC’s Next CEO Gerald Zarlengo, MD Chairman & CEO COPIC Insurance Company

For those who have worked with me in the past, it probably comes as no surprise that I am using an analogy to describe my preparation for assuming the position of CEO at COPIC. Like other physicians, I remember the day when I received the life-changing news of my acceptance into medical school. There was profound excitement (and some nervous anticipation) about the coming years of intense study and a career of helping patients in their times of need. But, there was also a fear of how much information I needed to learn in short order and if I was capable of succeeding.

My experience since I was honored in March 2018 to be named next CEO has been somewhat similar to my early years in medicine. During that time, I started my “residency” in preparing for the task ahead. As physicians think about our careers, we accumulate knowledge in medical school and we hone a skill set in residency affording us a chance to practice our discipline. Then, we mature to an expertise during our years in practice with the need for continuing education. I see my role as CEO as a parallel process of matriculation that is an ongoing acquisition of knowledge and skills over time.

Last year, I had the opportunity to attend the Board of Directors meeting for the MPL Association (the national trade association for the medical liability insurance industry). I was graciously introduced as Dr. Ted Clarke’s replacement and took the opportunity to point out that no one could replace him and his remarkable career at COPIC. Instead, I view myself as his successor and hope to continue pushing for COPIC’s success by supporting those we insure while also striving to improve health care.

“

I see my role as CEO as a parallel process of matriculation that is an ongoing acquisition of knowledge and skills over time.

Returning to my analogy, physicians may recall the beginning of their careers and remember those first days, weeks, and months. I would assume it true that none of us thought to go into our initial workplaces, be it in a small group practice or large system, and try to reinvent the culture. More likely, we each developed our own style by taking the cues of what did and did not work for each of us.

HIGHLIGHTS FROM DR ZARLENGO’S BACKGROUND •

COPIC Board Member since 2009

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Founder/partner of Midtown Obstetrics & Gynecology

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Medical Director of Perinatal Services at Sisters of Charity Leavenworth Health System and Medical Director of Women’s and Children’s Services at Saint Joseph Hospital, Department Chairman OB/GYN at Rose Medical Center

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Education: University of Colorado Health Science Center, M.D.; Saint Joseph Hospital, Residency in Obstetrics and Gynecology

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Professional Associations: Fellow, the American College of Obstetricians and Gynecologists (ACOG)

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Board of Directors: Colorado Physician Health Program and the Zarlengo Foundation (founder)

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Teaching: Assistant Clinical Professor at the University of Colorado Health Science Center

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I embrace this opportunity to work for you in maintaining the excellence COPIC has achieved over the years and under Dr. Clarke’s leadership. This is an incredible organization and as I am learning from my peers, it truly stands out as a unique company. COPIC leads by staying focused on our mission of “improving medicine in the communities we serve.” This is a result of our culture and how we “walk the walk” when it comes to our mission.

In closing, I think of the wonderful opportunity I had in my OB/GYN practice. I worked with the greatest partners who pushed me to be a better physician. I see this similarity in COPIC. The skilled individuals working for you are consistently raising the bar for improving the services we provide. Having just completed an election cycle, we heard promises for change and reformation on many issues.

My promise is that I am committed to continue COPIC’s mission and be available to help those we partner with in any way I possibly can. I am humbled to be given this opportunity to serve you, our insureds, as well as the broader health care community. ■

Gerald Zarlengo, MD, left, a COPIC board member since 2009, assumed the role of COPIC chief executive officer Jan. 1, following the retirement of Ted Clarke, MD, right.

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Did You Know?

For the parents of children in the ICU Emily Hause, MD, MPH

Emily Hause is a second-year pediatrics resident at the Medical College of Wisconsin in Milwaukee and a 2017 graduate of the University of Colorado School of Medicine. She intends to complete a fellowship in pediatric rheumatology and is passionate about expanding access to pediatric rheumatology care. Her inspiration for writing comes from her family, especially her mother and stepmother who have always been a source of love, encouragement and frequent editing.

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

Did you know that you could love a person so much from the second they were born?

Did you know that they would hold your soul in their hands, so small that they barely encircle a thimble?

Did you know that you could feel such joy?

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Did you know at the first breath, the lifetime

of sorrow your baby would endure? Did you know that you would learn things like how to feed your baby through a tube instead of through their perfectly formed lips, how to pound on your baby’s back daily to help them breathe, or how to correctly clean a line connecting your baby’s blood vessels directly to the outside world?

Did you know that you would learn words

and abbreviations – congenital, CPAP, trisomy, CMP, LFTs, idiopathic, PRN, q4, palliative, DNR – a new language to link you and your baby to a foreign, cold, medical world?

Did you see the countless doctor appoint-

ments, calls pulling you away from work, and hours you would spend in the emergency department, pacing the room, waiting for help?

Did you see the holidays spent in the ICU, not even able to remember the last celebration that passed without an admission? Did you see the looks on doctors’ faces the countless times that they thought your baby was too sick to save, and they were scared to let you hope?

Did you hear

the ugly words that people used to describe your child? Did you hear yourself correcting them – telling them not to use these words that imply that your baby is broken, is worthless, is not whole? Did you hear your cries, mixed with your baby’s, in the dark of the night, with the beeps of a heart monitor and the whoosh of a ventilator to punctuate the flow of tears?

Did you feel the rage inside your body? Could

you feel the flames that forged your strength and made you the fiercest advocate? Could you feel your heart grow harder as family and friends stopped coming to care for your baby, as they got lost in the medication schedule, the unruly behaviors of a sick child, and the discomfort of the different?

Did you grieve? Did you scream?

Did you fight? Did you mourn?

Did you learn to tolerate the unbearable space between knowing and the unknown? Sick and well? Life and death? Did you discover new layers of suffering that you never imagined possible?

How could you have known?

Have seen? Have heard? Have felt?

Nothing can prepare you for the struggle, or for the love that rises to combat despair when you encircle your baby in your arms for what you fear may be the last time. For this love, a parent’s love, is the only known antidote for the ravages of disease.

Did you know that you could love a person so much from the second they were born?

Did you know that they would hold your soul in their hands, so small that they barely can encircle an IV cap?

Did you know that you could

feel such joy?

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Making room for healing when treating the difficult patient Ali Rakestraw

Ali Rakestraw is a third-year medical student and junior Pre-doctoral Osteopathic Practices and Principles Fellow who grew up in Longmont, Colo. She plans to pursue a career in family medicine with an emphasis on refugee and immigrant health care. She received a Bachelor of Science in Biology from Abilene Christian University. She enjoys spending time in the mountains and finding the best coffee shops and Thai food in Denver.

While interacting with patients during clinical rotations, I have rarely found myself truly disliking one of them. Even if they are difficult to work with I can rationalize their behavior, or the visit is brief enough that I can quickly leave the discomfort in the past. However, one particular patient challenged my perception of my empathy as well as my understanding of my role as a provider. A woman was admitted for falling and landing on her stomach well into her third trimester of pregnancy.

She was justifiably concerned and visibly upset when I entered her room to get her history and perform a physical assessment. Yet within a few minutes, I became frustrated by her inconsistent stories, demeaning comments, and persistent demands for specific medications and procedures. With subsequent visits to her room, it became increasingly clear that there was an added layer of complexity to the situation. Perhaps it was a personality disorder, drug-seeking behavior, an exceedingly obnoxious personality, or an unfortunate combination of all of the above. Whatever the reason, I mentally labeled this patient “difficult.”

By my fourth consecutive day of being awoken at all hours of night for strange, seemingly self-inflicted symptoms and seeing the strain she was placing on the staff, I was close to my breaking point.

When I entered the patient’s room, I was glad to be with my attending who did all of the talking because it was hard for me to even look at her, much less hear her myriad attempted cover-ups for her inconsistencies. I grew uncomfortable with how much anger I felt toward her and how my thoughts were consumed with her even when I was away from the hospital. I looked up various personality disorders, trying to find a label that would perfectly fit her or help me understand why she was such a difficult patient.

What I found was much more personally convicting than I had anticipated.

While I never snapped at her or had any significant altercation, I started to notice her behavior toward me changing gradually. Every time I entered the room, she acted more sheepish and stopped making as many demands, which I perceived to be a blessing at the time.

But with more reflection, I was troubled by the thought that I made a patient in a vulnerable situation feel uncomfortable in one of the places that might actually be able to help her. Whether she was ill with a physical or a psychological problem should not dictate my willingness

to listen, provide comfort, and take her seriously. Having a label for her behavior would have done nothing for me other than provide the smug satisfaction that I had “figured her out.”

I frequently reflect on this patient and our interactions, wondering what I could have done differently, or if I should have tried harder to understand how she was experiencing this ordeal. I wonder if my comments and facial expressions impacted the staff’s reaction to her, compounding the issue. If I had sole responsibility for the care of this patient, would I have done my due diligence to look for physical causes of her symptoms or to address the psychological problems plaguing her? These questions prompted me to dig deeper into the underlying issue of “difficult patients” and what might be done to facilitate competent care in spite of the trials that they bring.

What I found was much more personally convicting than I had anticipated.

For every article that listed psychiatric disorders, substance use and malingering as risk factors for making “difficult patients,” I found several more that called for a comprehensive assessment of the doctor-patient relationship rather than putting the full burden of blame squarely on the patient’s shoulders. It is vital to

Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University, College of Osteopathic Medicine.

Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities; and Alexis Horst, MA, writing center instructor.

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remember that “the difficulty resides in the relationship, not the patient.” 1 One article posited that since the doctor-patient relationship is fundamentally unequal, the physician has a greater burden to ameliorate the tensions within it.2 While I saw firsthand how easy it is to label patients as “difficult,” it is crucial to develop self-awareness to see how we are contributing to the difficult relationship. Even though a “difficult patient” may create additional hurdles to their care, it certainly does not mean that they are less deserving of quality, compassionate care.2 While it is tempting to spend as little time as possible with these patients, they might be the ones who could benefit most from extra minutes spent reassuring, educating or simply listening. Other articles listed some strategies for managing high-tension relationships such as setting expectations early on in the visit so that both parties feel heard and respected. By setting a considerate and collaborative tone, physicians are more likely to be able to de-escalate any strong emotions that both sides bring to the encounter.1 The final piece of reflection that was the most difficult for me to tackle was assessing what insecurities and biases I was bringing into the relationship. While there were a myriad of small issues that I identified, the largest difficulty that I have is wrestling with my “limited ability as a healer.” 3 I think that since this patient didn’t have a discrete or discernible fix to her struggle and pain, my feelings of inadequacy resurfaced. For me it seemed easier to place blame on the patient and recoil from the situation rather than accepting that even though I couldn’t cure her, there was still room for healing.

While none of these considerations or strategies are quick fixes that will ensure all of my patient interactions go smoothly, I believe they will help me develop my own understanding of what it means to be a good physician and what responsibilities I have to my patients. By foregoing the notion of having “difficult patients,” I am freed to consider my own contribution to seemingly difficult relationships.

With practice and continued introspection, I hope to better partner with my patients in creating a mutually respectful, beneficial environment. ■

REFERENCES 1. Dudzinski DM, Alvarez C. Repairing “Difficult” Patient-Clinician Relationships. AMA Journal Of Ethics. 2017;19(4):364-368. doi:10.1001/ journalofethics.2017.19.4.medu3-1704.

2. Goldsmith ES, Krebs EE. Roles of Physicians and Health Care Systems in “Difficult” Clinical Encounters. AMA Journal Of Ethics.

2017;19(4):381-390. doi:10.1001/journalofethics.2017.19.4.pfor1-1704.

3. Kahn JS. A Difficult Patient. Annals Of Internal Medicine. 2018;168(11):830-831. doi:10.7326/ M18-0691.

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Remembering a Denver physician and community leader: Robert Bruce Sawyer, MD, May 3, 1933 - Dec. 1, 2018 Kate Alfano, CMS Communications Coordinator

Robert Bruce Sawyer, MD, of Denver passed away on Dec. 1, 2018, after an extended illness. He was 85.

The son of prominent Denver surgeon Kenneth Charles Sawyer and Elizabeth McAndrew Sawyer, Bob (aka “Dr. Bob,” or simply “DB” to many) was born during the Great Depression on May 3, 1933 and was raised in Denver. He attended Graland Country Day School, Morey Junior High, Denver East High School, the University of Colorado, Boulder and the University of Colorado School of Medicine. He was a captain in the Colorado Army National Guard and served in the U.S. Army Surgical Research Unit at Fort Sam Houston, in San Antonio, Texas, during the Cuban Missile Crisis.

A top student at East High, Bob was active in many sports and clubs, played on the school’s state championship football team in 1951 under legendary coach Pat Panek, and competed every year in the state wrestling tournament.

While attending CU, he played varsity football under coach Dal Ward until an injury curtailed his athletic career, he remained a lifelong supporter of the university. He was a member of the Phi Gamma Delta fraternity, where he roomed with future Apollo 13 astronaut Jack Swigert, and was a loyal member of the CU Buff Club. In 1976, Bob ran for an at-large seat on the CU Board of Regents, believing the CU Medical School deserved more of a voice in university decisions.

Although he lost that race, he contributed to the school in other ways, including teaching at the University of Colorado Health Sciences Center, where he was a clinical professor of surgery.

In 2005 Bob received the Silver and Gold Award for Excellence in Humanitarianism, Citizenship and Professionalism, the highest honor bestowed by the University of Colorado Medical Alumni Association.

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Sawyer was a general surgeon. He and his father were partners in one of Denver’s most respected general surgery practices, principally working out of Presbyterian Hospital (now HealthONE-Presbyterian/St. Luke’s Medical Center, or P/SL). Following his father’s death in 1977, Bob continued running the practice until retiring from surgery in the early 2000s, from then on serving as medical director of the Denver Wound Healing Center at P/SL. At various stages of his career he was also chief of staff, chief of surgery, and on the board of directors at P/SL; chairman of the HealthONE Foundation; and president and a longtime board member of the P/SL Community Foundation. In addition, he held appointments at many other Denver-area hospitals, including St. Joseph’s, The Children’s Hospital, Denver Health and Aurora Presbyterian.

“He cared for thousands of people over the course of his long career and felt blessed to do work that he truly loved,” says his son, John Sawyer. “He always advocated for his patients, respected the dignity of the human person, and as much as possible without surrender fought against the idea of socialized medicine, believing trained doctors – not the government, insurance companies, lawyers or hospital administrators – should have the most say in determining a patient’s course of treatment.”

Bob Sawyer was a leader.

Throughout his medical career, he worked tirelessly to champion physicians’ causes. He was CMS president, served many years on the COL, and sat on the boards for many community organizations.

He was a surgeon who felt an obligation to serve his fellow man by taking on the responsibility for leadership in health care to the community he served. He was an inspiration to me and many others. His humor and his commitment will be missed.

M. Robert Yakely, MD

Early in my CMS House of Delegate years, Dr. Bob (as he liked to be called) was the ever-present COMPAC chairman. I am now privileged to be carrying on that torch as the current COMPAC chairman and once again in the shadow of Dr. Bob’s mentorship! Dr. Bob has been a true presence and mentor in my life and my career.

Bob had two siblings. His brother, Kenneth Charles Sawyer Jr., also a physician, passed away in 2014.

He is survived by his sister, Patricia Teets, of Los Angeles, Calif., and his wife of 34 years, Clarice V. Sawyer (“Curley”). Children from his first marriage, to Margaret Dolan Sawyer (now Peggy Sawyer Gorsuch), include Robert B. Sawyer Jr. (Hilda),

The Denver medical community and me personally will be forever blessed by his contributions.

Christopher Unrein, DO, FACOI, FACP, CMD

| Bob Sawyer and I shared numerous patients over the years at both P/SL and St. Joseph Hospital. He had incredibly loyal patients—if they needed an operation, it was Bob or no one. Many saw him for their primary care as well. I and many others will remember Bob for his

Patrick D. Sawyer (Julie), John K. Sawyer (Cindy), Mary R. Sawyer (Alyce), Joseph M. Sawyer (former wife Heidi), Michael M. Sawyer, MD (Kate), and the late Margaret E. (“Beth”) Sawyer. He has two step-daughters, Jennie Coulthurst (Tom) and Kellie Allen Strawbridge (former husband Whit), 16 grandchildren, one great-grandchild, and many cousins, nieces and nephews.

steadfast dedication to his patients and to the profession of medicine.

Deb Parsons, MD, FACP, CMS president

Bob Sawyer was the ‘great encourager.’ I remember him for saying, ‘You can do it. Go for it!’

Gary VanderArk, MD

A man of great intellect, keen insight, silliness and quick wit, Bob believed laughter to be the best medicine. Equally well-known for his operating room tirades and his caring bedside manner, he always put his patients first. Bob enjoyed traveling, collecting art, attending the opera and the symphony, gardening, golf, tennis, skiing, and cheering on the Denver Broncos, the CU Buffs and the Denver Nuggets. When not working, volunteering or participating in community

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activities, Bob enjoyed road trips throughout the southwest, and spending quiet time in the mountains at his cabin in Conifer.

In his early religious life, he belonged to what is now Good Shepherd Catholic parish, and later became a member of St. John’s Episcopal Cathedral. Services were held at St. John’s on Dec. 10, 2018. In lieu of flowers, people are encouraged to make donations to Denver Hospice, St. John’s Episcopal Cathedral, the Denver Zoo, 9Health Fair, the East High Friends and Family Foundation, or any charitable health care organization. ■

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The Physicians Foundation’s sixth biennial survey identifies burnout and social determinants as top issues

The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians, released the findings of its 2018 survey of U.S. physicians, showing that physician burnout is on the rise. The survey includes responses from almost 9,000 physicians across the country and underscores the overall impact of numerous factors driving physicians to reassess their careers. Gary Price, MD, president of the Physicians Foundation, dives into the findings.

Q: What factors are driving burnout among physicians?

Empowering Physicians Improving Healthcare

Q: Physician burnout has been an issue the Physicians Foun-

dation has been monitoring for years in its biennial surveys.

What’s changed in this year’s results?

DR. PRICE: A stunning 78 percent of physicians say they expe-

rience feelings of burnout in their medical practices. To give you context, in our 2016 survey results this number was at 74 percent, so we see this figure climbing.

It’s truly alarming that more than three-quarters of physicians are experiencing burnout, particularly because it is causing many physicians to reassess their careers. Forty percent of our survey respondents plan to either retire in the next one to three years or cut back on hours. Equally distressing, 46 percent say they plan to entirely change career paths within the next three years.

Physicians have been silently coping with this burden. It is far past time to do something meaningful to change this negative trend.

DR. PRICE: Physicians responding to our survey report that

the chief culprit contributing to feelings of burnout is the frustration they feel with the inefficiency of electronic health records (EHRs) followed by the burden of regulatory and insurance requirements. All of these have intruded on their time to care for their patients, without significantly improving the quality of that care.

If the health care industry does not confront the significant challenges caused by the inefficiency of EHRs and excessive burden of regulatory and insurance requirements, physicians will continue to experience increasing burnout symptoms – which, in turn, will exacerbate the physician shortage already felt in many areas of our country, and needlessly prolong the sometimes-tragic consequences of burnout.

Q: Do physicians feel able to instigate changes to help allevi-

ate these feelings of burnout?

DR. PRICE: Only 10 percent of physicians who took our survey

feel they have the power to impact the health care system.

The perspective of physicians needs to be at the forefront of discussions around health care policy and regulation.

Physicians are on the front lines of health care every hour of every day, and ultimately are held responsible for their patient’s outcomes.

The Physicians Foundation strives to focus and amplify the voices of physicians. Their insights will be critical to improving our health care system in a successful and sustainable way. Physicians need to feel empowered to contribute their ideas, and planners need to recognize the value of their input.

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Q&A Q: A lot of people are talking about the influence of social deter-

minants on health care outcomes. To what extent are factors like poverty impacting patient care?

DR. PRICE: An overwhelming majority (88 percent) of physicians

report that some, many or all of their patients are impacted by social determinants. In fact, only one percent of physicians taking our 2018 survey report that none of their patients have such circumstances.

Conditions such as poverty, unemployment, lack of education and addiction all pose a serious impediment to a patient’s health, well-being and their eventual health outcomes. These challenges directly impact a physician’s ability to deliver effective care.

Many physicians on our Board of Directors personally witness the impact of poverty among the patients they serve. Social determinants as they relate to health care have been a critical focus of the Foundation for several years now. We have made concerted efforts to address this vital area with like-minded individuals and organizations across the U.S. While patients and physicians must work together to navigate the hardships that hinder proper care and drive up costs, it’s key that health policy experts and regulators actively acknowledge and engage with this issue. Simply ignoring it – or pretending it is not a factor in driving up costs while undermining outcomes – is no longer tenable.

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Q: Many people dealing with social determinants that adversely

affect their care are also patients who have been negatively impacted by the opioid crisis. To what extent has the opioid crisis changed the way that physicians practice medicine?

DR. PRICE: Our survey results report that 69 percent of physicians

are prescribing fewer pain medications in response to the opioid crisis. To put things in perspective, an opioid overdose was the cause of more than 60,000 deaths in 2017 alone – quadruple the number of deaths from an overdose since 1999.

There are many causes of this epidemic, and physicians are seriously engaged in efforts to reduce it, as well as untangle the multiple root causes of this major public health concern.

Q: Anything else we should know about the 2018 Physician

Survey results?

DR. PRICE: Physicians overwhelmingly agree (79 percent) that the

most satisfying part of being a physician are the relationships with patients that they build across their career. We hope policymakers, health care influencers, media and other stakeholders will use the findings of our survey as a valuable resource to better understand the underlying challenges facing physicians and our health care system. This will allow all stakeholders to formulate more effective policies to advance the health and interests of patients through helping physicians focus on what they love and do best – care for patients. ■

To view the full results of the survey, visit

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ACA RULING

Division of Insurance: Judge’s ruling won’t change protections for pre-existing conditions in Colorado On Friday, Dec. 14, a federal district judge And the Trump administration is assuring in Texas issued a ruling stating that the the country that the ACA will remain in Affordable Care Act (ACA) is unconstitu- force during the appeals process.” tional. This was a ruling in the case Texas v. the United States, where 20 state attorneys general filed a lawsuit against the ACA, saying that since Congress ended the law’s mandate to have health insurance, the entire ACA is unconstitutional.

“Even with this ruling, the ACA isn’t going away,” the Colorado Division of Insurance stated in a news release. “This decision will now be part of a long, drawn-out legal process, as it will be appealed and likely work its way to the U.S. Supreme Court.

VS

This case has caused the most concern around the ACA’s protections for people with pre-existing conditions, especially as the Trump administration said it would not defend that part of the law.

“I said it in June when this case first bubbled up, and I’ll say it again: Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law,” Interim Insurance Commissioner Michael Conway said in the release. “The Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens.” ■

Celebrating longtime CMS staff members, Marilyn Rissmiller and Timothy Roberts CMS honored two CMS staff members who have each been employees of the medical society for more than three decades at a retirement party in December. Tim Roberts, left, has served as senior director of the Division of Information Technology/ Membership, and Marilyn Rissmiller, right, has served as senior director of the Division of Health Care Financing. They are pictured with CMS CEO Alfred Gilchrist, center, who told the guests at the retirement celebration that the accomplishments of Marilyn and Tim over their tenure with CMS has made it easier for physicians to practice medicine today.

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AMA STUDY

Competition levels drop for health insurance markets across 25 states Half of all states had commercial health insurance markets that were less competitive in 2017 than during the previous year, based on data from a newly updated study of competition in the U.S. health insurance industry issued by the American Medical Association.

“The AMA continues to urge that competition, not consolidation, is the right prescription for health insurance markets,” said AMA President Barbara L. McAneny, MD. “The slide toward insurance monopolies has created a market imbalance that disadvantages patients and favors powerful health insurers. The prospect of future mergers involving health insurance companies should raise serious antitrust concerns.

There is already too little competition among insurers, to the detriment of patients. Networks are already too narrow, and premiums are already too high.”

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According to the 2018 edition of AMA’s Competition “Competition in Health Insurance: A Comprehensive in Health Insurance: A Comprehensive Study of U.S. Study of U.S. Markets” offers the largest and most Markets, “the majority of health insurance markets in complete picture of competition in health insurance the United States are highly concentrated. Coupled markets for 50 states and the District of Columbia, with evidence on their anticompetitive behavior, this as well as 380 metropolitan statistical areas (MSAs). strongly suggests that health insurers are exercising The study is based on 2017 data captured from market power in many parts of the country and, in turn, commercial enrollment in fully and self-insured health causing competitive harm to consumers and providers maintenance organizations (HMO), preferred provider organizations (PPO) and point-of-service (POS) plans, of care.” consumer-driven health plans (CDHP) and public The AMA study is intended to help policymakers and health exchanges. ■ regulators identify markets where mergers may harm patients and the physicians who care for them. The study also helps identify health insurance markets where antitrust enforcers should monitor for postmerger effects.

The 10 states that experienced the largest decrease in competition levels between 2016 and 2017 were:

1 North Dakota

2 Alaska

3 Louisiana

4 Indiana

5 Utah

6 North Dakota

7 Arkansas

8 Hawaii

9 Alabama

10 Mississippi

The 10 states with the least competitive commercial health insurance markets were:

1 Alabama

2 Hawaii

3 Louisiana

4 Delaware

5 South Carolina

6 Michigan

7 Alaska

8 Kentucky

9 Vermont

10 North Carolina

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FINAL WORD

Physicians of all specialties and career stages will be needed this legislative session Lee Morgan, MD, Chair, CMS Council on Legislation

You have no doubt read in this issue of Colorado Medicine and in much of our communications to members over the past few months that the 2019 Colorado legislative session will be one of the most challenging in decades, if not the most challenging ever. A perfect storm is on the horizon that will stretch our resources to the max as we address issues that have been building over the past decade and

Physicians sharing their experiences in medicine is the best way to influence policy. are now at a boiling point, as well as respond to other issues sure to arise but not yet known.

We are fortunate to have developed relationships with legislators through tried-and-true methods like COMPAC’s candidate screening process that demonstrate to elected officials and other health care advocacy groups that the Colorado Medical Society is a trusted source on the experience of Colorado physicians in the health care system, and that we are willing to work toward the best result for Colorado patients.

I have been privileged to have served as the chair of the Council on Legislation for eight years and will complete my final term at the end of 2019. The dedicated members of the COL analyze legislation as it is developed, revised and considered by the General Assembly, and determine our position based on CMS policy

and the recommendations of our lobby team. The COL meets twice a month during the legislative session. If you are interested in volunteering to sit on the COL, in person or connecting online, I urge you to do so. We need the input of physicians from all specialties and career stages for our deliberations. Contact emily_bishop@cms.org for information on vacancies.

Paramount to our advocacy efforts are our COMPAC donors. I urge all members to contribute to COMPAC and consider becoming a regular dues-paying member.

Dues are the fuel by which we can help support our endorsed candidates. The secure, online payment system is available at www.cms.org/contribute, and the two-year contribution cycle reset in December 2018. In addition to COMPAC, you can donate up to $50 annually to the CMS Small Donor Committee, which exclusively works to elect candidates who support medicine’s efforts to preserve Colorado’s stable tort environment.

I invite you to develop relationships with your elected officials. Physicians sharing their experiences in medicine is the best way to influence policy. One easy way to do this is by downloading and using the free CSAE Colorado Legislative App from the Colorado Society of Association Executives (CSAE), or through the Colorado General Assembly’s Find Your Legislator tool on the General Assembly’s website: https://leg.colorado.gov/find-my-legislator.

COMPAC periodically sends email alerts asking members in key districts to contact legislators regarding critical pieces of legislation. I strongly encourage you to respond to these alerts as soon as you can. When our voice is strong and loud at the capital through these grassroots outreach efforts, it makes a difference.

Thank you for all that you do for your patients. Together we can affect change on the state level to make health care better for all of Colorado. ■

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