March-April 2015 by Colorado Medical Society

March/April 2015

Volume 112, Number 2

TELEHEALTH

New legislation to improve access to health care across Colorado

Award-winning publication of the Colorado Medical Society

Colorado Medicine for March/April 2015

contents March/April 2015, Volume 112, Number 2

Features. . .

Cover story

A bipartisan bill strongly supported by CMS would expand access to telehealth and, in the process, expand access to care for patients across the state, lower health care costs overall, provide for improved care coordination and improve quality. Read more starting on page 8.

Inside CMS 5 7 30 33 34 38 40

President's Letter Executive Office Update ICD-10 Update Looking Forward Spring Conference Reflections COPIC Comment

Departments 41 45

Medical News Classified Advertising

HIE landscape–Colorado's health information exchanges are creating a robust infrastructure to help improve clinical workflow, point-of-care decision-making and quality.

Legislative update–CMS General Counsel Susan Koontz, JD, presents a midpoint update on the 70th session of the Colorado General Assembly.

Clean Claims Task Force–The task force has asked for a legislative switch, to move oversight of the project to the business committees in both chambers.

National Advocacy Conference–CMS leaders celebrated 2015 Nathan Davis Award winner Sen. Irene Aguilar, MD, and met with congressional representatives on top issues.

Honors and awards–CMS President Tamaan OsbourneRoberts, MD, was named one of Denver's “40 under 40.”

Helping children–Champ Camp empowers children with asthma to better manage their condition during a week of fun in the Colorado mountains.

Physician hero–Robert Fisher, MD, founded a nonprofit to address the needs of breast cancer survivors and educate the professionals who care for them.

Prescription drug abuse–Gov. John Hickenlooper launched the "Take Meds Seriously" awareness campaign to advise the general public on the safest ways to use, store and dispose of prescription medicine.

New medical school dean–John J. Reilly Jr., MD, has been named dean of the University of Colorado School of Medicine and the University’s vice chancellor for health affairs.

Final Word–Reps. Perry Buck and Joann Ginal talk about new legislation to update telehealth in Colorado. Editor’s note: Articles appearing in Colorado Medicine without a byline represent the collaborative work of CMS leadership and staff.

Colorado Medicine for March/April 2015

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and CONNECTION

2014/2015 Officers Tamaan Osbourne-Roberts, MD President Michael Volz, MD President-elect Kay D. Lozano, MD Treasurer M. Robert Yakely, MD Speaker of the House Brigitta J. Robinson, MD Vice-speaker of the House Alfred D. Gilchrist Chief Executive Officer John L. Bender, MD, FAAFP Immediate Past President

Board of Directors JT Boyd, MD Charles Breaux Jr., MD Laird Cagan, MD Leslie Capin, MD Cory Carroll, MD Joel Dickerman, DO Naomi Fieman, MD Greg Fliney, MS Curtis Hagedorn, MD Jan Gillespie, MD Mark Johnson, MD Richard Lamb, MD Tamara Lhungay, MS Lucy Loomis, MD Gary Mohr, MD Brad Moss, MD Christine Nevin-Woods, DO Edward Norman, MD Lynn Parry, MD Daniel Perlman, MD Scott Replogle, MD Floyd Russak, MD Joshua Tartakoff, MS Charlie Tharp, MD

Jennifer Wiler, MD Harold “Hap” Young, MD Lena Young, MS AMA Delegates A. “Lee” Morgan, MD M. Ray Painter Jr., MD Lynn Parry, MD Brigitta J. Robinson, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Kay Lozano, MD Tamaan Osbourne-Roberts, MD AMA Past President Jeremy Lazarus, MD CMS Historian W. Gerald Rainer, MD CMS Connection Mary Rice, President

COLORADO MEDICAL SOCIETY STAFF Executive Office

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

Division of Communications and Member Benefits

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

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

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

Division of Government Relations

Division of Health Care Policy

Colorado Medical Society Foundation Colorado Medical Society Education Foundation

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

Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Adrienne Abatemarco, Executive Legal Assistant, adrienne_abatemarco@cms.org

Mike Campo, Staff Support, Mike_Campo@cms.org

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

Alfred Gilchrist, Executive Editor; Dean Holzkamp, Managing Editor; Chet Seward, Assistant Editor. Colorado Medicine Printed by Spectro Printing, Denver, Colorado

for March/April 2015

Inside CMS

president’s letter Tamaan Osbourne-Roberts, MD President, Colorado Medical Society

CMS leads delegation of physicians to advocate in D.C. It is an often-repeated cliché, particularly among those who are weary of the often-cynical approach to policy change: “money is the lifeblood of politics.” As a former vice-chair and current exofficio member of the COMPAC board, I won’t minimize the importance of carefully measured, ethical and principled donation to the candidates of one’s choice. However, if money is the lifeblood of our system of government, relationships are the fiercely beating heart. Or, if I may take the liberty of extending the metaphor further: monetary donations can be transfused to help keep the work of democracy flowing for a time, but if something is gravely wrong with the relationships between legislators and constituents, things will inevitably stop despite everyone’s best efforts. However, when the relationships work, if empathy and humanity beat strongly across the system, it’s remarkable what can be accomplished with even a bare minimum of monetary resources. This point was made exceptionally clear during my February trip to Washington, D.C. for the American Medical Association’s National Advocacy Conference, a yearly event where physicians from around the country congregate to speak with their legislators. I won’t go too far into the specific events of the trip (which are covered more comprehensively in another article later in this issue), but I will say that in addition to our continued advocacy for repeal of the sustainable growth rate (SGR), one of our chief efforts this year was putting the issue of progressively narrowing insurance networks onto the agenda of the Colorado delegation as an emerging issue that affects countless physicians and patients in our state. Colorado Medicine for March/April 2015

The response was exceptional. In a decade of visiting legislators on the Hill, I’ve never experienced such an immediate, concerned reaction to an issue voiced by our delegation. And it is my firm belief that it was not the facts of the problem that resonated with them so strongly, important as they may be; it was our stories of the patients that have been affected, including my own son, for whom we are delaying needed ear surgery because of confusion as to whether our insurance covers his doctor, his hospital, neither or both. Our positions as physicians, even my position as CMS president, carried little weight; our ability to connect legislators to the concerns of our patients, to my story as a father working hard to get needed medical care for his family, was the thing that made the difference. We were able to reach past the titles, to see each other as people, and to talk about solutions on a human level. We were able to form relationships. Doctors have always been good at relationship building. Consequently, so have our advocacy organizations, and CMS and its component societies have spent years forming relationships with

our state’s policymakers, allowing us to work collaboratively on issues ranging from telehealth to network adequacy, cost accountability and medical liability. But, as our clinical practice instructs

“. . . if money is the lifeblood of our system of government, relationships are the fiercely beating heart.” us, relationships take effort; they require time and attention. So I encourage each of you to help your medical society in this work. Call your legislators. Send them a letter or an email. Come down to the Capitol to meet with them, or find them when they’re at home in their districts. And, yes, show up at their fundraisers, introduce yourself and donate to their campaigns if you feel moved. But above all, start a relationship. Tell them your stories – because all too often that is what makes the critical difference, for us and for our patients. Until next time. n

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

Call 720-858-6310 for more information and to donate. 5

Colorado Medicine for March/April 2015

Inside CMS

executive office update Alfred Gilchrist, CEO Colorado Medical Society

Fun with numbers – not In the fall of 2013, Steven Brill spoke to a Denver audience of business and health policy leaders on his findings and recommendations to flatten the health cost curve. You may recall that Brill also published a widely read issue of Time magazine devoted to his views on health care cost drivers, which exposed and antagonized a wide array of stakeholders in care delivery. Colorado Medicine interviewed Brill while he was in Denver and subsequently launched a yearlong series on health care costs in 2014 with guest opinions drawn from a pool of veterans and experts. Last fall, Brill published his observations in a more comprehensive book version, further warming up the topic just as legislatures across the country were convening and considering how health care costs threaten to crowd out other infrastructure investments in transportation, education, water and energy. As noted in previous columns, a serious debate had been launched that would lead to public policy initiatives, and we intended to engage with all interested stakeholders. The political momentum behind this earnest debate led to the creation of Colorado’s Commission on Affordable Health Care by the 2014 General Assembly, an effort CMS applauded and supported. To further engage professionally with the Cost Commission over its three-year life span, we have created a Task Force on Health Care Costs and Quality, comprised of some of medicine’s most experienced and thoughtful physician experts who will convene for the first time in March. We assessed that absent a more adult, depoliticized, evidence-based approach, the debate could deteriorate into a zero-sum contest of finger-pointing and misdirection. Colorado Medicine for March/April 2015

The state’s Cost Commission can’t hit its stride soon enough. For instance, legislation currently planned to be filed was drafted by one national health plan to cap out-of-network charges to a percent of Medicare and change the way disputes over out-of-network charges are addressed, giving an upper hand to the plans. The spreadsheets eventually provided to us by the health plan fairly screamed “outlier,” so we brought in a national expert on practice analytics and pricing to evaluate and opine. Our expert did not find any case where the average billed charge could be defined as a statistical outlier and concluded that “their claims of unreasonable charge patterns are fatally flawed, based on poor logic and incomplete to the degree that they have left no way to validate and verify their findings.” The last few years have brought unprecedented change in health care. Health plans are engaged in their own zero-sum competition over market share. Hospitals are intensely competitive, expanding and employing more physicians, and some are taking out insurance licenses. HIT-HIE adoption continues. Patients increasingly want full access to their medical information and price transparency. Policymakers want balanced budgets and better value for taxpayer dollars. Physicians, often caught in the middle, are burning out

from increased administrative tasks, insurance complexities and dysfunctional EMRs. Today’s market dynamics are complicated and demand proposals and initiatives tied to evidence and an underly-

“To further engage professionally with the Cost Commission over its three-year life span, we have created a Task Force on Health Care Costs and Quality comprised of some of medicine’s most experienced and thoughtful physician experts.” ing epidemiology. We all have skin in this very serious game – physicians, patients, hospitals, pharmas, medical devices, health plans and public officials. And while the easier path forward is to designate a devil for the crusade and attack, we must step up in the shared responsibility and collaborate in a manner that builds trust and rapport, and most importantly produces solutions that work. n

Join Now! Colorado Medical Political Action Committee Call 720-858-6327 or 800-654-5653, ext. 6327 or e-mail susan_koontz@cms.org 7

TELEHEALTH

New legislation to improve access to health care across Colorado Kate Alfano, CMS communications coordinator

Colorado Medicine for March/April 2015

Cover Story A bipartisan bill likely to be signed into law in Colorado soon would expand access to telehealth – care delivered remotely via computers, cameras, smartphones or other devices – by removing a restriction that limits payment for this technology to rural counties with a population of 150,000 or less and by prohibiting health benefit plans from requiring in-person care delivery if consulting, monitoring and other care can effectively be administered remotely. House Bill 15-1029 would remove the requirement for a provider to demonstrate a barrier to in-person care; prevent health plans from reimbursing providers for telehealth differently than for in-person care; and prevent health plans from charging different deductibles, copayments or co-insurance amounts, or setting different annual or lifetime dollar maximums for telehealth services. It is sponsored by Rep. Perry Buck, RWindsor, and Rep. Joann Ginal, D-Fort Collins, in the House of Representatives and Sen. John Kefalas, D-Fort Collins, and Sen. Beth Martinez Humenik, R-Thornton, in the Senate. The Colorado Medical Society House of Delegates passed a resolution in September 2014 that updated CMS policy on telemedicine and telehealth and directed CMS to push for legislation in the 2015 session. CMS Immediate Past President John L. Bender, MD, who

uses telehealth in his practice, helped draft the bill and recruit its sponsors, and the CMS Council on Legislation voted to support it.

touching because it shows it will help not only the doctor and the patient but the family in general,” Ginal said. One parent told the story of having to take

“I was very honored and very fortunate when Dr. Bender asked me if I would carry this bill,” Buck said. “Through that, the Colorado Medical Society, the Boulder County Medical Society, Children’s Hospital and a lot of different stakeholders all got behind me and helped me to carry probably one of the best pieces of legislation I’ve ever had the pleasure of carrying.”

House Bill 15-1029 would remove the requirement for a provider to demonstrate a barrier to in-person care; prevent health plans from reimbursing providers for telehealth differently than for in-person care; and prevent health plans from charging different deductibles, co-payments or coinsurance amounts or setting different annual or lifetime dollar maximums for telehealth services.

“I have heard just a lot of wonderful opinions that this is so needed for the state of Colorado, and more than anything in the rural areas,” she continued. “That’s why I felt very strongly about carrying this bill, for the rural areas, the elderly and ones who can’t drive to Denver for specialized care.” “I signed on to this bill, first, because telehealth as a new way to practice medicine was brought up at the Northern Colorado Medical Society legislative meeting last year as one of their top priorities,” Ginal said. “Second, because of the shortage of doctors I think it’s really important that we provide ways that people can reach physicians and ways that physicians can reach people.” “The testimony that we heard during a House committee hearing was quite

their child from Durango to Denver once a month for a 15-minute checkup. “What this does is it allows the doctor to see if the child is getting better and it doesn’t take the child out of school or the parent out of work, and it saves the cost of transportation they were using to get to Children’s Hospital and back again. I see it as cost savings not just for our health care community but also patients in general.” As of press time, the bill passed unanimously out of the House and passed the Senate by a wide margin. It is awaiting signature by Gov. John Hickenlooper, but with broad acceptance on both sides of the aisle, this is an expected outcome.

Miramont Family Medicine, with six offices throughout northern Colorado, uses the BeamPro Smart Presence System. With remote control of the robot, John L. Bender, MD, senior partner and CEO, can drop into different offices like he's walking through the door. Colorado Medicine for March/April 2015

“This bill is fairly straightforward; the vast majority of people are in favor of it

Cover story (cont.) regardless of political affiliation because the meat of the bill is about access to health care and everyone across party lines needs access to health care,” said Ryan Westberry, MS, MBA, project manager and business analyst for the Colorado Telehealth Network.

More options for access Proponents name better access and convenience as the top benefits for patients. Clay Watson, MD, an infectious disease specialist and director of infection prevention at Saint Joseph Hospital in Denver, said, “especially if

I happen to be running late and they’re at home or work, it’s much more convenient for us to connect, have the visit, and they’re on their way. They don’t have to sit here in my office waiting and be exposed to other infections.” Watson said it also extends his reach around the state, allowing him to see patients who live several hours away and for more frequent check-ins. “If I have to have someone drive three hours to see me, I’ll push [a follow-up appointment] as far as I can safely. But if I can do a weekly follow-up with a post-op patient over video conferencing, then they have more access and more time with their physician.”

John L. Bender, MD, says the initial market niche will be physicians using telehealth with their own patients. He hopes to open up appointments on the weekend for his patients who would prefer to see him rather than go to the emergency room.

Lower costs across the system Though seemingly counterintuitive, proponents believe wider use of telehealth could drive down costs to the health care system overall. “When care is more accessible, we get people addressing issues far before they need to go to into the hospital or the emergency room,” Watson said. “Our followup care from discharge is much, much better with telemedicine. Then broader disease management like group management diabetes, HIV, or hepatitis C, all of those things can be far cheaper than the traditional one-off visit with your doctor every month or every three months.” Jeff Wagner, MD, a neurologist with HealthOne, agreed. Their telehealth network is centered at Swedish Medical Center in Denver and comprises more than 40 cameras. He receives acute neurology calls from emergency departments and can “beam in” to evaluate the patient and determine whether the patient should be transferred to Denver. The “old-fashioned approach” would be to just transfer everyone – at a great cost. “When we put a camera in we see transfer rates drop about 60 percent,” Wagner said. “Many of those transfers, because it’s for an acute issue, were happening via air. I can’t quote how much an air transfer costs, but it’s a lot. If we can cut down by 60 percent, you’re going to see a huge benefit across the system.”

Colorado Medicine for March/April 2015

Cover Story Opportunity for coordination One of the biggest benefits of telemedicine to the system is care coordination, said Debbie Voyles, MBA, director of clinical operations for telehealth for Colorado Access/Access Care. “You can bring mental health services into a primary care setting where it’s not traditionally offered and offer those services to the clients in that setting. You can coordinate who all is touching those clients and the primary care provider can be kept in the loop as to what other people are doing so they know how to better manage their patients.”

tablished relationship rather than go to the emergency room. “The initial market niche that I think we’re going to see ramping up is physicians using it with their own patients,” he said. He further illustrated the potential of telehealth with a hypothetical blood pressure patient. “Right now I see him in the office and tell him to come back in six months, and I make decisions about his blood pressure medication off of two data points every year. Wouldn’t

it be smarter if I told him to pick up a Bluetooth-enabled blood pressure cuff out of our dispensary that sends the data into our server? Then I could have care coordinators monitor exception reports and I could adjust his medicine if his blood pressure goes out of bounds for more than a week or two. And that would actually be safer because then I would be making decisions based on 100 data points instead of just two.”

“Besides Colorado Access there are other insurance plans looking at how they can better manage clients and provide them the care they need at the right time and at the right place,” she continued. “All of that is huge as far as trying to save costs to the system overall. If we can use technology to be able to do that, we’re all going to win in the long run.” Impact on quality While gaining convenience and cost savings, patients and providers don’t have to sacrifice quality. “Telemedicine is just a modality to provide services,” Voyles said. “It doesn’t alter the way a physician and a patient interact with one another. A physician is going to treat a patient through telemedicine the same way they would if a patient walked through the front door. We want them to meet the same quality, the same standards. We follow the same rules, the same regulations. We equate telehealth to be the same equivalent as a face-to-face in-person encounter.” Some argue that it could actually increase quality. John Bender, mentioned earlier, is the senior partner and CEO of Miramont Family Medicine with six offices throughout northern Colorado. He uses the BeamPro Smart Presence System – an eye-level computer screen mounted on top a mobile two-wheeled platform – for remote patient visits with their diabetic nurse educator and psychologist. Eventually he hopes to expand telehealth so he can open up appointments on the weekend for patients who would prefer to see him – a physician with whom they have an esColorado Medicine for March/April 2015

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Cover story (cont.) Next steps Moving forward, the Colorado Telehealth Working Group (CTWG) – of which CMS is a member – will work with DORA and the Department of Professional Occupations to update their regulations, said Samantha Lippolis, telehealth manager of Centura Health. “Right now they have two particular rules that require a face-to-face encounter prior to being able to prescribe. They don’t count live video conferencing as meeting the standard for a

face-to-face encounter even though the literature and the Centers for Medicare and Medicaid Services do.” Physicians testified in front of the medical board in November and, as a result, DORA hosted a telehealth symposium on Feb. 23 that brought together all regulatory bodies so different practitioners and organizations could explain how telehealth might work in Colorado and the regulatory bodies could consider updates to their licensure.

Another barrier Lippolis identified is how to get paid for telehealth in the home setting. “You get paid for home health right now as long as the patient has been referred into home health, but we need to consider whether we want them coming into a facility or whether we can provide interaction, where clinically appropriate, at home.” “This is an area that is going to require regular re-evaluation,” Bender said. “We want telehealth to be safe. It does have the promise of potentially reducing health care costs and improving outcomes, primarily because of its ability of enhanced remote patient monitoring and enhanced contact. This isn’t going to solve all situations; if a person needs an IV, they’re still going to have to come in. But I’m probably going to be able to take care of a rash, I’ll probably be able to ascertain certain chronic disease conditions like education for a diabetic patient or blood pressure monitoring, psychologist visits, behavioral health; it’s a force multiplier.” n

Serving the CME needs of Colorado physicians Your bridge to quality improvement in health care

Accredited CME is education that matters to patient care. For more information contact the Colorado Medical Society CME office at 720.858.6309 12

Colorado Medicine for March/April 2015

CMS Education Foundation Help send a student through school

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

Call 720-858-6310 for more information and to donate 14

Colorado Medicine for March/April 2015

Features

Morgan Honea, MHA, CEO, Colorado Regional Health Information Organization

Dick Thompson, Executive Director and CEO, Quality Health Network

Colorado’s Health Information Exchange landscape: Partnering to improve health in Colorado We are incredibly lucky to live in a state where health care reform is being approached so comprehensively, but thoughtfully. Colorado’s health information exchanges, Quality Health Network (QHN) and Colorado Regional Health Information Organization (CORHIO), are playing a significant role in these efforts through improved point-of-care decision-making tools, robust clinical data to support quality improvement programs, realtime event notifications, and infrastructure that can improve clinical workflows. In particular, Colorado’s health information exchanges (HIEs) are united in their support for telehealth expansion by providing a more streamlined coordination of the patient’s medical record between health care settings. Due to Colorado’s vast geography, telehealth creates a tremendous opportunity to provide expanded health care services in a local setting, and will likely be a game changer for health care in Colorado. This reduces the burden on patients, providers, and the overall health care system. When coordinated with robust health information exchange, telehealth services only become more efficient and effective by ensuring that providers and care teams have the right information at the right time to support services being provided across vast and challenging geographies. In order to support telehealth expansion, among all of the other initiatives in Colorado Medicine for March/April 2015

Colorado, QHN and CORHIO will continue to expand the bi-directional health information exchange network over the next 24 months. However, as we all know too well, the ability to glean information from these varying data sources requires a tremendous amount of work to normalize and standardize. For this reason, QHN and CORHIO are work-

ing together to develop multiple ways to accomplish meaningful health information exchange that can be scaled across the continuum of care and create the greatest value for our participants. As we develop these mechanisms, we will also be adding functionality to our existing infrastructure in order to continuously improve and simplify clinical workflows. Aside from growing the breadth and depth of the health information exchange networks, QHN and CORHIO are also working with their partners and one another to support delivery system and payment reform efforts. As the pay-

ment system in Colorado shifts from a fee-for-service to a risk-based model, robust health information exchange will be critical to ensuring our providers have a global perspective of their patients’ utilization and clinical outcomes. Colorado’s HIEs are currently working with a number of partners to provide real-time clinical event notifications as well as clinical quality reporting. These are particularly exciting opportunities that only grow in value as the network expands. Most importantly, QHN and CORHIO are working to support various patient engagement strategies throughout the state. Despite the vast industry efforts, true health improvement cannot happen without effective patient engagement. For this reason, we are working with our partners to implement shared care management programs, leveraging HIE data as well as supporting regional care coordination organizations’ patient engagement efforts. These collaborations between Colorado’s HIEs and community-based partners will ensure that patients are able to have their health care needs served in their own communities in the most efficient and effective manner possible. Both QHN and CORHIO are excited about all of the tremendous work going on across this great state and stand ready to support you in your efforts to keep health care local and improve the health of all Coloradans! n

Features

Legislative update Susan Koontz, JD, contributing CMS Generalwriter Counsel Kate Alfano, CMS

2015 General Assembly tackling multiple health care issues The 2015 Regular Session of the Colorado General Assembly has reached the halfway point and committees have had packed hearing schedules as deadlines approach for bills to either be passed out of committee or postponed indefinitely. The Colorado Medical Society lobby team is tracking more than 35 bills this session to ensure legislation benefits physicians professionally and helps improve the health and wellness of Colorado patients. They expect many more bills to be introduced before the end of the session â&#x20AC;&#x201C; including bills concerning the scope of practice of advanced practice nurses, naturopaths and acupuncturists. With staff support, the CMS Council on Legislation (COL) reviews each bill to understand its intent, its possible outcomes and the political landscape to collectively determine how and at what level CMS should engage. Below are a handful of bills of particular interest to CMS members and supporters. Supported by Council on Legislation HB15-1029: Health Care Delivery Via Telehealth Statewide Under current law, health benefit plans issued, amended or renewed in Colorado cannot require in-person health care delivery for a person covered under the plan who resides in a county having 150,000 or fewer residents if the care can be appropriately delivered through telemedicine and the county has the necessary technology for care delivery via telemedicine. Starting Jan. 1, 2016 the bill removes the population restrictions and pre 16

cludes a health benefit plan from requiring in-person care delivery regardless of geographic location of the health care provider. By removing the limitation of a population of 150,000 or fewer residents for telehealth, this bill will allow more Coloradans timely access to high-quality primary and specialty care, regardless of where they reside in the state. The bill also reimburses the treating provider for a telehealth encounter on the same basis as in-person care. Representatives Perry Buck, R-Windsor, and Joann Ginal, D-Fort Collins, have worked diligently on this bill, which the COL voted to strongly support. The bill passed unanimously in the House and passed the Senate and is presently headed to the Governor for his signature. For more on this bill and the promise of telehealth, read the cover story on page 8. SB15-057: Clean Claims Task Force Reporting Under current law, the Colorado Medical Clean Claims Task Force (CCCTF) is required to report to the executive director of the Department of Health Care Policy and Financing; the Health and Human Services Committee of the Senate; and the Health, Insurance and Environment Committee and Public Health Care and Human Services Committee of the House of Representatives. This bill directs that the reports be submitted instead to the commissioner of insurance and to the Business, Labor and Technology Committee of the Senate and the Business, Labor, Economic and Workforce Development Committee of the House of Representatives, since those committees will be

addressing how the standardized claim edits are to be maintained after the task force is sunset. The bill passed out of the Senate and House and is presently headed to the Governor for his signature. HB15-1036: Warn Pregnant Women Medical Marijuana Dangers The bill is sponsored by Rep. Jack Tate, R-Centennial, whose wife is an OB/ GYN, and seeks to warn women of the effects on the fetus caused by smoking or ingesting marijuana while pregnant. HB15-1036 requires the Department of Revenue to promulgate rules requiring that a licensed medical marijuana center display in a conspicuous location a sign that warns pregnant women about the dangers to fetuses. This bill was postponed indefinitely on Feb. 3, 2015. HB15-1147: Require License to Practice Genetic Counseling This bill enacts the Genetic Counselor Licensure Act, whereby on and after June 1, 2016, a person cannot practice genetic counseling without being licensed by the director of the Division of Professions and Occupations in the Department of Regulatory Agencies. CMS Past President Jan Kief, MD, spoke in favor of this bill at a recent COL meeting. In addition, Kief testified on Feb. 19, 2015 before the House Health, Insurance and Environment Committee. The bill passed that committee and subsequently the House Finance Committee and was referred to Appropriations on March 5, 2015. HB15-1194: Authorize General Fund Dollars for LARC Services Starting in 2008 the CDPHE received a multi-year grant to conduct an expandColorado Medicine for March/April 2015

Features ed family planning program, which focuses on access to long-acting reversible contraception, known as LARC, to low-income women in Colorado. This bill requires the CDPHE to continue the expanded program and appropriate $5 million from the state general fund to CDPHE to provide LARC services in the 2015-16 fiscal year. The bill was referred to Appropriations by the House Public Health Care and Human Services Committee. SB15-053: Dispense Supply Emergency Drugs for Overdose Victims Under current law, physicians, physician assistants, pharmacists and advanced practice nurses with prescriptive authority are not subject to civil or criminal liability or professional discipline when they prescribe or dispense an opiate antagonist in a good-faith effort to assist a person who is experiencing an opiaterelated overdose event or to assist a friend, family member or other person who is able to provide assistance to a person who may experience an opiaterelated overdose event. This bill expands the ability to prescribe to an employee or volunteer of a harm reduction organization or a first responder. First responders and harm reduction employees and volunteers acting in good faith would also be immune from professional discipline. The bill passed the Senate and passed its third reading in the House. Opposed by Council on Legislation HB 15-1066: Repeal Health Benefit Exchange The bill sought the repeal of the Colorado Health Benefit Exchange Act, enacted in 2010. The act allows each state to establish a health benefit exchange option through state law or opt to participate in a national exchange. This bill was postponed indefinitely on Jan. 29, 2015. SB 15-074 Transparency in Health Care Prices Act This bill would create the Transparency

Colorado Medicine for March/April 2015

SAVE 06 THE 12 DATE 15 Evidence-Based Solutions For Prediabetes And Hypertension: Shifting the Practice Paradigm Learn evidence-based strategies that can support the prevention and management of cardiovascular-related chronic diseases. Take away tools to translate evidence into practice. This half-day event, designed for physicians, physician assistants, nurse practitioners, nurses and pharmacists, will feature panel presentations on the following topics: • National Diabetes Prevention Program • Self-measured blood pressure monitoring • Medication Therapy Management • Incorporating the Community Health Worker and Patient Navigator in the care team Date: Friday, June 12, 2015 Location: The Inverness Hotel and Conference Center, 200 Inverness Drive West, Englewood, CO 80112 Cost: Free Continuing Education credits will be available Keynote Speakers: Omar Hasan, MBBS, MPH, MS, FACP (Vice President, Improving Health Outcomes, American Medical Association) and Terri Richardson, MD (Internal Medicine, Kaiser Permanente) Visit Colorado.gov/cdphe/chronicdiease2015events for more information.

Legislative update (cont.) in Health Care Prices Act, requiring health care professionals to make available to the public, either electronically or on its website, the following: • Prices they assess for at least the 15 most common health care services, if applicable, they provide. • The 50 most-used diagnosis-related group codes or other codes they use for billing in-patient health care services. • The 25 most-used outpatient CPT or health care services procedure codes used for filing.

Neither a health care facility nor a health care professional is required to report its direct pay prices to any agency for review, filing or any other purpose, nor will there be any disciplinary action against a physician for failing to participate in this reporting. The COL voted to amend physicians out of this bill or oppose the bill. The bill passed the Senate with amendments and is currently assigned to the House State, Veterans and Military Affairs Committee.

Other bills of interest HB15-1135: Terminally Ill Individuals End-of-Life Decisions This bill, known as the Colorado Death with Dignity Act, sought to authorize an individual with a terminal illness to request, and the individual’s attending physician to prescribe to the individual for self-administration by ingestion, life-ending medication intended to hasten the individual’s death. The bill elicited very strong opinions on both sides of the argument. It was heard in Committee on Feb. 6, 2015. On that day hundreds of people listened to testimony and waited to testify at the Capitol where, after 11 hours, the bill was defeated by a vote of 9-4 and postponed indefinitely. CMS expects this bill will come back in upcoming sessions or possibly on initiative. HB15-1151: Floor for Medicaid Provider Rates Current law authorizes the Medical Services Board by rule to establish payment rates for services under Medicaid. On and after July 1, 2015, the State Department rules promulgated for the payment of providers must provide that payment rates for services are not less than 60 percent of the rate for the equivalent service under Medicare, or if there is no equivalent Medicare rate, the average fair market rate for the service. The COL is monitoring this bill to see how the Joint Budget Committee addresses this issue. The Colorado Medical Society continually demonstrates influence at the Capitol thanks to strong lobbying efforts and through the engagement and involvement of dedicated physicians on the Council on Legislation. Active involvement in advocacy is crucial to Colorado physicians and patients, and CMS encourages anyone interested to get involved. Go to www.cms.org/ advocacy for more information. n

Colorado Medicine for March/April 2015

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Clean claims update Kate Alfano, CMS communications coordinator

Clean Claims Task Force seeks legislative change The Colorado Clean Claims Task Force (CCCTF) is approaching completion of the development of a standardized set of payment rules and claim edits that are to be used by providers and payers in billing and processing of medical claims in Colorado beginning Jan. 1, 2017. The task force comprises 28 industry experts representing a variety of stakeholders, including health care providers and employees from a diverse group of settings, persons or entities that pay for health care services, practice management system vendors, billing and revenue cycle management service companies, and government payers.

ing a business entity that will sustain the standardized set of rules after the CCCTF is sunset. Colorado Medical Society strongly supports the work of CCCTF and recognizes that maintaining the Jan. 1, 2017 implementation date is critical. The CMS Board of Directors voted in January to strongly oppose any attempt by any third party to delay or repeal the implementation period of Colorado law requiring the use of a common claims edit set. The board acted out of concern that the two largest companies in the United States that build and sell claims

edits for profit might disengage from CCCTF and thereby force health insurance plans to bring legislation to repeal the clean claims law or to delay its implementation, thereby preserving the claims edit line of business for the vendors and extending the administrative burden caused by private claims edits well into the future. Colorado Medical Society continues to support the finalization of the Colorado common edit set by providing leadership and collaborative interaction with all CCCTF stakeholders, including the claim vendors, to achieve a successful implementation date of Jan. 1, 2017. n

CCCTFâ&#x20AC;&#x2122;s standardized set of payment rules and claim edits will be governed by contract law and affect the business transactions of the providers and payers in the health insurance marketplace. They are projected to save between $80 million and $100 million each year in administrative expenses in Colorado, based on calculations using the report of the Colorado Blue Ribbon Commission for Healthcare Reform (208 Commission) and the American Medical Associationâ&#x20AC;&#x2122;s white paper on administrative waste in the health care system. These savings can be redirected toward reducing the actual cost of care. CCCTF is seeking a legislative change to the oversight of the project. Currently, the health committees in both chambers have jurisdiction over the project, including the final report due in 2016. CCCTF has asked the 2015 legislature to transfer oversight to the business committees in both chambers. CCCTF believes the oversight responsibilities of the business committees are more in line with the final CCCTF reporting and recommendations concernColorado Medicine for March/April 2015

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Nathan Davis Award Kate Alfano, CMS communications coordinator

CMS physicians lobby Capitol Hill at National Advocacy Conference and celebrate Sen. Aguilar’s Nathan Davis Award Colorado Medical Society and component society leaders traveled to Washington, D.C., Feb. 23-25 for the AMA National Advocacy Conference (NAC). Colorado delegates celebrated the 2015 AMA Nathan Davis Award winner Sen. Irene Aguilar, MD, and met with members of the Colorado congressional delegation to discuss the top health policy issues facing doctors in the state and country. Sen. Irene Aguilar wins Nathan Davis Award For the second year in a row, a Colorado public servant was awarded an AMA Nathan Davis Award for Outstanding Government Service: Sen. Irene Aguilar, MD. See the sidebar for her acceptance speech. The 2014 Colorado award

winner, also nominated by CMS, was Susan E. Birch, executive director of the Colorado Department of Health Care Policy and Financing, for work to reform Medicaid into seven regional accountable care collaborative organizations. Nominated by the Colorado Delegation to the AMA, CMS touted Sen. Aguilar’s legislative advocacy and leadership during the last four years, most recently as chair of the Senate Health and Human Services Committee and assistant majority leader, as the single most important factor in assuring delivery system reforms that expanded coverage, reduced administrative burdens, improved patient safety, and addressed health care costs and quality. Specifically, Sen. Aguilar successfully passed legislation

to modernize Colorado’s professional review, expand and reform Medicaid, standardize prior authorization of medications, and address health care costs and clean claims. “What an honor it was to receive this national recognition for the work happening in Colorado,” Aguilar said. “I am just a part of our success, as working collaboratively with invested stakeholders like the CMS and others really helps propel Colorado to the front in the country on issues of health reform and working to achieve quality, accessible and affordable health care for everyone in our state.” Advocating for Colorado physicians on the top issues Led by CMS President Tamaan Osbourne-Roberts, MD, and Presidentelect Michael Volz, MD, the Colorado physician delegation urged the Colorado congressional delegation to act on three critical issues: the trend in health insurance toward “narrow networks,” Medicare physician payment reform, and the regulatory penalties tsunami. “Having participated in this meeting annually for a number of years, I’m always struck by how much the physicians enjoy this grassroots opportunity to engage with their representatives and see how the system works,” said Kathy Lindquist-Kleissler, executive director of the Denver Medical Society.

Colorado Medical Society and component society leaders celebrate Sen. Irene Aguilar, MD, being named a 2015 AMA Nathan Davis Award winner during the AMA National Advocacy Conference (NAC) in Washington, D.C. 20

Physicians first explained the issue of network adequacy, a concept with which the congressional delegation Colorado Medicine for March/April 2015

Features was least familiar. The current trend in the health insurance marketplace is for carriers to offer products with smaller networks for consumers purchasing coverage both on and off the insurance exchange. The result of this trend is that Colorado consumers may lose their providers as insurers sell narrow networks without notice. It is in the best interest of Colorado patients to have a clear understanding of which providers are participating in the various benefit plans. “Everyone that we met with through the day voiced surprise at the depth of the problem when Dr. Osbourne-Roberts and I shared personal experiences,” said CMS NAC attendee Gina Martin, MD. Martin described the experience of an established patient who became pregnant and had to transfer her care to Grand Junction (Mesa County) because her insurance plan through her Delta County employer would not cover Delta County Memorial Hospital for the delivery. Osbourne-Roberts shared that his family recently changed to a new insurance plan through the exchange, and while his son’s pediatric ENT was covered on the plan, the only hospital at which he had privileges was not. CMS NAC attendee Genie Pritchett, MD, said there was “lots of learning” around narrow networks and that all Colorado legislators expressed their willingness to sign a letter in support of appropriate measures to address this issue. Once again, physicians urged Congress to eliminate the flawed sustainable growth rate (SGR) formula; the current Medicare payment patch will expire on March 31. Bipartisan, bicameral legislation developed last year eliminates the SGR and supports innovative delivery and payment models. Physicians asked Congress to consider this legislation again. The Colorado congressional delegation fully understands physicians’ frustration with the SGR but indicated that Congress will likely pass another shortterm patch of six to 12 months before Colorado Medicine for March/April 2015

the March 31 deadline to “give time” to find funds in the budget and wait for a Supreme Court case to be reconciled. However, Volz said a longer-term fix is “indeed expected and should occur.” Doctors asked legislators and policymakers to provide relief from the regulatory penalties tsunami that is burdening their practices and threatening their ability to provide care for Medicare beneficiaries. Peter Smith, MD, shared a personal story about the flood of mandates from the government that places “a clear burden on health information technology.” Attendees asked for changes in meaningful use, the Physician Quality Reporting System and the value-based

modifier, including simplifying and aligning requirements and reducing the threat of financial penalties. “There was agreement that there is too much regulation, but no real discussion on steps forward,” Pritchett said. “The majority of elected officials seemed to have general support for decreasing the burden by trying to be sensitive to multiple reporting systems and limitations of the data without proven benefits to patients,” said CMS NAC attendee Gina Alkes, MD. Thanks to all the physicians and component staff who attended NAC on behalf of the Colorado Medical Society. For more information on this conference, go to www.ama-assn.org. n

Sen. Irene Aguilar’s acceptance speech for the 2015 Nathan Davis Award for Outstanding Government Service Thank you, AMA, for having me, and thank you CMS for nominating me for this honor. I specifically want to thank my good friends Dr. Jan Kief and Dr. Genie Pritchett for hosting the only fundraiser in which doctors give money to politicians. I need to also acknowledge our CMS President Dr. Tamaan Osbourne-Roberts and our President-elect Dr. Michael Volz. And thank you for that wonderful dinner last night. I’m glad you are not registered lobbyists! You know, people often ask me how I went from being a primary care doctor at a county hospital to a state senator, and I say a couple of things. The first thing I say is that unfortunately I found out how health care is financed in the United States and it really angered me. I am one of those idealistic doctors who thinks that access to basic health care is a human right and that it is shameful that the richest country in the world does not guarantee that access for its population. At the end of the day, when people show up in our clinics, our hospital rooms and our ERs in need of care, we are thankfully a humane-enough society that we give it to them. Those of you in medicine know we are just shooting ourselves in the foot by not helping them access that care earlier when they are healthier and can continue to work and live healthy lives. I hope that you will help the legislators in your states design a waiver for the Affordable Care Act. You know it isn’t perfect. Getting 100 politicians in Colorado, getting 50 plus 1 to agree on anything is almost a miracle. I can’t imagine that we can get anything better in Congress. Fortunately, they left us a section that says that if your state can figure out how to cover at least as many people with at least as rich of a benefit plan and not cost the federal government more money, you can apply for a federal waiver. I think that there is no better group of people to tell legislators how to do that than you as doctors. And so I look forward to seeing what we bring forward in the future where state by state we become a country that guarantees health care access for everyone in our country. Thank you again for this honor. 21

Features

Honors and awards Kate Alfano, CMS communications coordinator

CMS president honored as one of Denver's “40 under 40” Colorado Medical Society President Tamaan Osbourne-Roberts, MD, has been selected as one of the Denver Business Journal’s “40 under 40.” This honor recognizes 40 extraordinary metro Denver men and women for their commitment to community and business leadership. In the award’s 19th year, the journal received 550 nominations for 375 individuals. Osbourne-Roberts will be recognized at the annual awards luncheon on March 16 and profiled in a special report on March 20. In an interview for the profile, he was asked about his proudest professional accomplishment. He named his election to the Colorado Medical Society. He was installed as president of the Colorado Medical Society at the 144th Annual Meeting in Vail on Sept. 20, 2014. At age 37, he is the youngest president in CMS history as well as the first black CMS president. “Helping patients individually, every day in the clinic or hospital, is the root of what I do as a doctor. But being given the opportunity by my colleagues to represent them and to potentially change the lives of millions of patients at once through effective policy and advocacy at

such an early point in my career is an opportunity that still leaves me wondering if I’m soon going to wake up from what seems like a wonderful dream.” In 2007, Osbourne-Roberts started his mission to deliver high-quality health care to Colorado’s most vulnerable as a family medicine resident at the University of Colorado Family Medicine Residency Program where he was selected to participate in the inaugural class of the Future of Family Medicine national demonstration curriculum, designed to prepare physician leaders with exceptional clinical, managerial and practice transformation skills. He rose to become one of the designated residency program experts on the PatientCentered Medical Home, which would serve him well in his next position as a board-certified family physician at Salud Family Health Centers from August 2010 to November 2014. In this role, Osbourne-Roberts practiced full-spectrum outpatient care for primarily Spanishspeaking, low-income patients throughout the nine-clinic Federally Qualified Health Center system; his main practice location was in Commerce City, Colo.

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

visit www.cms.org to learn more about the benefits of becoming a member

For more information and an application to join, call Tim Yanneta 720-858-6306 or e-mail Tim_Yanetta@cms.org

He also concurrently practiced inpatient newborn care at Platte Valley Medical Center hospital in Brighton, Colo., while teaching medical students and residents in both clinical settings as volunteer faculty through the University of Colorado Anschutz School of Medicine. In late 2014 he transitioned to work as a founding member of the hospitalist service at Mount San Rafael Hospital, a 25bed critical access hospital in Trinidad, Colo., through Innova Emergency Medical Associates. He named empathy as the personality trait that has served him best in his work life. “While this might be unsurprising as an important trait in a physician, it has also helped me in the business and policy world, where figuratively ‘walking a mile in another’s shoes’ becomes essential in the compromise and teamwork that is critical to getting things done.” Osbourne-Roberts attributes his success to the support of his immigrant family, finding the right path that meshed with his talents, and being born into this “incredible country at such an amazing time in history.” “However, if I had to pick something that is perhaps a bit more particular to me, I would say my openness to opportunity has helped a lot. I’ve long lived under what I’ve come to call the ‘Charmed Life Principle’: that if I continue to keep my eyes open for opportunities that come along and accept them as they declare themselves, good things will continue to happen to me. It hasn’t failed me yet.” n

Colorado Medicine for March/April 2015

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Helping children John Streit, MPH, RRT, Program Director, American Lung Association in Colorado

Champ Camp: Colorado’s asthma action plan for children In Colorado, about one third of hospitalizations for children are due to asthma. For this reason the American Lung Association in Colorado (ALAC) established Champ Camp in 1979 as Colorado’s only summer camp for kids with asthma. At the camp, children ages 7-14 learn strategies to better manage their asthma and are empowered to better manage their asthma. Children are engaged in asthma education throughout the weeklong camp while being afforded the opportunity to participate in fun summer activities in the beautiful Colorado mountains. This camp is particularly unique because of its collaborative and year-round approach, which utilizes asthma management as a way to convene campers, families, schools, and

the health care community, providing both education and recreation to young people and saving millions of intervention dollars. Over the past 35 years of its operation, Champ Camp and ALAC have reached close to 3,400 young people, and strive every year to reach even more Colorado children in need of this invaluable, unique and fun resource. ALAC sees Champ Camp as an opportunity for children with asthma to take what their health care provider has taught them about managing their asthma and put it to practical use throughout the week. On a typical day of camp, these kids get the opportunity to participate in activities such as rock climbing, swimming, canoeing, and in-

Volunteers help campers in the field learn how to manage their asthma in the mountains near the Cherokee and Blackfoot cabins with Asthma Education at Champ Camp. 24

teractive asthma education challenges that are incorporated into the outdoor camp experience, promoting independence, leadership, and the importance of being physically active, despite having asthma. Many of the children that come to Champ Camp are from poor socioeconomic areas up and down the Front Range, and this may be the first time out of their communities and away from home. Campers benefit from the asthma management they learn, which reduces their doctor and ER visits, particularly beneficial since many of them rely on Medicaid, Colorado Health Plan or have no insurance. One of Champ Camp’s long standing volunteers, Ben Wilson, stated, “I witness kids learn from Champ Camp how to take control of their asthma and effectively live their lives. They learn to take control of their bodies, education, and choices, and take steps to learn and be proactive about their treatment and health. Once they are empowered with this knowledge, they realize they can do anything anyone else can do.” ALAC makes this astounding feat possible through the many volunteers that keep coming back every year, often referred to as the Champ Camp family. Volunteers can be heard saying after their first year, “I’m hooked, and will definitely be back next year!” Others describe the experience as “life changing” or “rewarding,” citing that they got more back from the kids they served, paid in smiling faces. With much of the success of Champ Camp resting on the shoulders of volunteers, ALAC is always in need of physicians, physician assistants, nurses, respiratory therapists, and a host of other health care professionColorado Medicine for March/April 2015

Features als. The time that these professionals donate is essential and makes it possible for asthma education to extend beyond the clinical environment. When relating this experience to the camper outcomes, ALAC is often afforded success stories that point to the importance of this program. Consider the story of Elijah (9 years old) and his sister Shani (12 years old), who both attended Champ Camp for the first time two summers ago. Typical of many campers, Elijah and Shani are from a limitedincome family, and neither of them had ever been to camp before. Sadly, this particular family also had experienced tremendous anguish four years prior, when they lost their eldest child (Elijah and Shani’s brother) to an asthma attack at age nine. With patience, determination and support, ALAC staff was able to develop the trust necessary for this family to send their other two children to Champ Camp. This past summer Elijah and Shani returned and brought their sister Naomi with them. These parents cannot stop raving about the impact Champ Camp has had on their children, who not only learned to manage their asthma better but also gained the confidence to play more actively with other kids, even though they have asthma, which they thought was a limitation to their physical activity. Because of Champ Camp, Elijah, Naomi and Shani can have a more positive adolescence, despite their asthma. Champ Camp’s goals are to provide an innovative and motivating educational and recreational camp experience, increase knowledge about asthma, provide the skills and confidence to participate in physical activities without fear or trepidation, and offer resources to families, caregivers, and health care providers to support more systemic and yearround asthma management programs for these children. While the stories of success are abundant and realized with every year’s Champ Camp, ALAC is always in need of new volunteers who can help to ensure the success of Champ Camp, Colorado’s Asthma Action Plan in Action. n

Colorado Medicine for March/April 2015

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Physician hero helps cancer survivors Kate Alfano, CMS communications coordinator

Robert Fisher, MD

Dr. Fisher founds nonprofit to address needs of breast cancer survivors and educate professionals who care for them CMS member Robert Fisher, MD, is a hematologist/oncologist with the Longmont office of Rocky Mountain Cancer Centers. In his 25 years as a medical oncologist, he has maintained an interest in patients’ recovery beyond active cancer treatment and, with the rise of cancer survivorship, recognized a need for an online educational library that would provide high-quality educational materials about the medical and psychosocial issues breast cancer survivors face. That led him to bring together colleagues to found the Pink Ribbon Survivors Network (PRSN) in 2011. He currently serves as its president. The organization provides a robust repository of online resources through its website to aid primary care providers in the transfer of patients; empower breast cancer

survivors in self-motivated learning and self-directed care; and create a synergy of ideas between oncology professionals – physicians, nurses and social workers – to benefit their patients. “At some point in my career, I realized the persons that I would benefit in my medical career were limited to those in my exam room and those in my waiting room about to see me professionally,” Fisher said. “However, given the accessibility and power of the Internet, by creating this educational website, suddenly my reach for the benefit of patient care was extended to anyone and everywhere with Internet access.” Fisher led the creation and assemblage of the website’s resources, and he continues to volunteer hundreds of hours a year to

maintain them. Through his stewardship, more than 1,500 educational articles serve thousands of Colorado patients and reach people across the country and around the world. His patients who have utilized the resources call them “professional, relevant and trustworthy.” The articles are organized in three separate libraries. The Curriculum for Recovery Library houses online articles in 19 categories for breast cancer survivors. The categories include Accepting New Limitations, Identifying Priorities, Diet/ Exercise/Self-Care, Maintaining Family/Married/Partnered Life, Doubt and Hope, and Survivorship When Cancer Recurs, among others. The Cancer Care Professionals Library brings together clinical literature per-

Colorado Medicine for March/April 2015

Features taining to breast cancer survivorship from the professional literature of cancer physicians, nurses and social workers. The Primary Care Providers Library provides a summary of the guidelines for breast cancer patient follow-up and a summary of the medical and psychosocial issues facing breast cancer survivors as they return to the care of their primary health care providers.

Editor’s note: There are several warning signs of professional burnout, including having feelings of being run-down or drained of physical or emotional energy, feeling misunderstood or unappreciated by your coworkers, feeling that you’re under too much pressure to succeed, feeling frustrated by organizational politics or bureaucracy, or feeling that there is more work than you practically have the ability to do.

making in the lives of their patients and community and to recognize extraordinary actions, Colorado Medicine launched the Physician Heroes series. We will profile as many different members as we can who have gone above and beyond in the profession to help their colleagues or community. We hope you’ll see your own values reflected in these stories and be reminded of the joy of medicine.

“At a time when oncology patients are increasingly being returned to their primary care providers for long-term follow up, the Pink Ribbon Survivors Network’s website provides a unique tool to bridge the knowledge and communication gap between the oncology specialty and primary care in Colorado,” Fisher said. “In addition, we have provided women with breast cancer a comprehensive tool for self-education and recovery from the difficulties of breast cancer therapies.”

The Colorado Medical Society recognizes the prevalence of burnout among physicians, particularly in this time of great change in health care. To help our members reflect on the meaningful difference they’re

Members are invited to nominate themselves or a colleague by contacting Dean Holzkamp at dean_holzkamp@cms.org or 303-748-6113 or Kate Alfano at kate_ alfano@cms.org.

PRSN is working on several educational programs built from the online library. The first, a five-session Cancer Survivorship workshop for patients known as “Empower Your Recovery,” is in development with the social work department of Rocky Mountain Cancer Centers. The organization plans to make the course instruction manual available online so it can be offered at any location. “I chose to pursue a career in hematology/oncology to accept the challenge of taking care of patients with potentially life-threatening diseases,” Fisher said. “Many times these illnesses seem destructive and senseless and I want to help patients and their families make sense of these senseless disorders. I think the take-home message from my experience for CMS members would be to play an important role in patient education and providing patient resources. Many of our patients are eager to learn. Help them find high-quality information.” PRSN will send business-card-sized information cards to practices to hand out to patients upon request. Contact Rob@ PinkRibbonSurvivorsNetwork.org to request these cards. For more information about the organization, visit their website: www.PinkRibbonSurvivorsNetwork.org. n Colorado Medicine for March/April 2015

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

visit www.cms.org to learn more about the benefits of becoming a member

For more information and an application to join, call Tim Yanneta 720-858-6306 or e-mail Tim_Yanetta@cms.org

Robert Marinaro, MHS Mary Beth Marinaro, CT (ASCP) 720-440-9095 rmb@legacygroupestates.com www.legacygroupestates.com/physicians

“Your specialty is medicine and serving patients. Our specialty is real estate and serving you.” Each RE/MAX® Ofﬁce is Independently Owned and Operated. Equal Housing Opportunity.

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Prescription drug abuse Kate Alfano, CMS communications coordinator

Gov. Hickenlooper launches “Take Meds Seriously” campaign Colorado is addressing the growing problem of the abuse of prescription medicine with a new public awareness campaign, “Take Meds Seriously.” Gov. John Hickenlooper announced the education effort in a news conference at the University of Colorado Skaggs School of Pharmacy on the Anschutz Medical Campus on Feb. 24. The campaign aims to reduce prescription drug abuse and misuse in the state by advising the general public on the safest ways to use, store and dispose of prescription medicine. Recent statistics and surveys reveal how pervasive prescription drug misuse and abuse is in Colorado. Thirty-five Coloradans died each month in 2013 from unintentional drug overdoses. Nearly 224,000 Coloradans misuse prescription drugs each year. At least one-third of Coloradans surveyed admitted using medicine

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prescribed for someone else. One in six of Colorado’s 12th graders have taken prescription medicine that was not written for them. And Coloradans admit that at least half their households have drugs that are unused or out of date. “Take Meds Seriously” features a new website, TakeMedsSeriously.org, along with statewide advertising and public outreach efforts. The website is designed to educate consumers on three issues: safe use, safe storage and safe disposal. Physician practices and pharmacies can access customizable handouts on the website.

A 2014 survey conducted for the Consortium by National Research Center, Inc., found four in 10 Colorado adults say they’ve misused prescription medicine, mostly painkillers, and a third of those adults used the medicine for recreational purposes. Few Coloradans lock and store their medicine in places children can’t access, and only one in 10 had returned expired medicine to a police or sheriff’s department. Those surveyed expressed strong support for increased state funding in education to address the problem, as well as resources to deal with the “take-back” of drugs by law enforcement agencies.

This public awareness effort grew out of the work of the Colorado Consortium for Prescription Drug Abuse Prevention, of which the Colorado Medical Society is an active participant and strong supporter. Gov. Hickenlooper convened the consortium in 2013 to establish a coordinated, statewide response to prescription drug abuse and misuse. It links the many agencies, organizations, health professions, associations, task forces and programs that are addressing the prescription drug abuse problem.

The new campaign is an integral part of the governor’s Colorado Plan to Reduce Prescription Drug Abuse, which, in keeping with its commitment to making Colorado the healthiest state in the nation, has set the goal of preventing 92,000 Coloradans from engaging in the non-medical use of prescription pain medication by 2016. The Colorado Department of Public Health and Environment (CDPHE) will assist the consortium with a coordinating role in the campaign.

“Colorado ranks 12th in the nation for the abuse and misuse of prescription drugs,” Hickenlooper said. “This campaign is just one part of a coordinated, statewide strategy that simultaneously restricts access to prescription drugs for illicit use, while ensuring access for those who legitimately need them. The messages and tools provided through this effort will help us take on this serious public health challenge as part of our commitment to becoming the healthiest state in the nation.”

Gov. Hickenlooper was co-chairman of the National Governors Association’s efforts, along with Alabama Governor Robert Bentley, to create awareness and regulatory mechanisms to fight the prescription drug abuse problem in the states. Visit TakeMedsSeriously.org for more information. n

Colorado Medicine for March/April 2015

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Kate Alfano, CMS communications coordinator

John J. Reilly Jr., MD

John J. Reilly Jr., MD, named Dean of CU School of Medicine John J. Reilly Jr., MD, has been named the next dean of the University of Colorado School of Medicine and the University’s vice chancellor for health affairs, effective April 1, 2015, the school announced in a press release. Reilly is currently the Jack D. Myers Professor and Chair of the Department of Medicine at the University of Pittsburgh. He joined Pitt in 2008 after more than two decades with Brigham and Women’s Hospital in Boston. He is a prolific researcher who has authored or co-authored more than 100 peer-reviewed research reports and coauthored chapters in two of the most well-known textbooks of internal medicine. His areas of interest include the genetic and environmental factors associated with chronic obstructive pulmonary disease (COPD) and the role of alveolar macrophage enzymes in emphysema, COPD and lung cancer.

lease. “He brings strong leadership and the ability to work constructively with others across disciplines, departments and backgrounds.”

of medical professionals,” Elliman said. “Colorado, our country and the world are a better place because of his careful stewardship.”

Elliman also thanked Krugman for his distinguished career as leader of the CU School of Medicine. During Krugman’s tenure as dean, more than 4,000 physicians, physician assistants, physical therapists and medical scientists earned degrees from the school. “We are grateful for Dr. Krugman’s commitment to creating an environment that nurtured and launched the careers of thousands

Reilly, who will hold the Richard D. Krugman, MD, School of Medicine Dean’s Endowed Chair, graduated from Harvard Medical School after earning an undergraduate degree in chemistry from Dartmouth College. He completed his residency in internal medicine at Brigham and Women’s Hospital and later completed a fellowship there in pulmonary and critical care medicine. n

Reilly was selected after a nationwide search of highly qualified applicants and the announcement of his appointment comes one year after Richard D. Krugman, MD, announced his plan to step down as dean of the University of Colorado School of Medicine when his successor was hired. Krugman became acting dean in 1990 and was appointed dean in 1992. He is the longest-serving medical school dean in the United States. “We are extremely pleased to hire a talented academic leader of Dr. Reilly’s caliber,” said Donald Elliman Jr., chancellor of the University of Colorado Anschutz Medical Campus, in the press reColorado Medicine for March/April 2015

Inside CMS

ICD-10 update Kate Alfano, CMS communications coordinator

AMA outlines ICD-10 concerns in letter to Feds The American Medical Association and state medical associations around the country drafted a letter in late February to Andrew Slavitt, acting administrator for the Centers for Medicare and Medicaid Services (federal CMS), asking the agency to consider and act upon several potential pitfalls with the implementation of the International Classification of Diseases, 10th Revision (ICD-10). The letter stated that the organizations are “gravely concerned” that many aspects

of ICD-10 have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after Oct. 1, 2015 – the implementation deadline for ICD-10. First, the AMA is concerned with limited acknowledgement testing. While they express appreciation for the training, educational tools, and other efforts by the federal CMS to prepare physicians and other health care entities for the ICD-10

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transition, “there still remains a lack of industry-wide, thorough end-to-end testing of ICD-10 in administrative transactions.” Testing in March and November 2014 only tested if the claim was initially accepted through the claims processing system, not how the claim will process completely. And while the federal CMS conducted a more robust end-to-end testing in January and will conduct two more testing weeks in April and July 2015, the three test dates only include a sample size of 2,550 volunteer testers – a small fraction of all Medicare providers that could be skewed toward those most confident of their preparation. Plus, the federal CMS released only a broad overview of data for January; the AMA urges the federal CMS to release more detailed data. Second, the AMA questions the ability to correctly collect and calculate quality data during and after the transition to ICD-10 due to potentially conflicting timelines. As the AMA points out, ICD10 is scheduled to begin on Oct. 1, 2015, but the Physician Quality Reporting System (PQRS) and Meaningful Use (MU) quality reporting periods are based on the calendar year, meaning that physicians will have to report ICD-9 for the first part of the year and ICD-10 for the second. They ask the federal CMS to provide details on how it plans to ensure that the measure calculations for these programs are not adversely impacted by the transition to ICD-10. Third, the AMA asks the federal CMS to mitigate risk to physicians by being preColorado Medicine for March/April 2015

Inside CMS pared with extensive contingency plans in the event significant claims processing disruptions occur that cause physicians to go unpaid for any period of time. They suggest the federal CMS commit to granting “advance payments” as they had previously indicated was possible. In addition, the AMA is concerned that physicians will not have received software upgrades from their EHR vendors and have asked CMS to make information about vendor readiness available. Finally, the AMA asks that the federal CMS confirm and instruct contractors that they are

prohibited from engaging in audits that are only predicated on code specificity and not potential fraud or abuse. The AMA recognizes that implementation of ICD-10 is a massive undertaking. Asking physicians to assume this significant change at a time when they are being required to adopt new technology, re-engineer workflow and reform the way they deliver care will challenge their ability to care for patients and make investments to improve quality. The AMA asks for further dialogue to address concerns. n

Denver-based CMS office names John Hannigan as new associate regional administrator John Hannigan has been named the associate regional administrator for the Consortium for Medicare Financial Management and Fee for Service Operations (CFMFFSO), Centers for Medicare and Medicaid Services, in Denver. He will have a national role among the 10 regional offices of the federal CMS on ICD-10, HITECH, and professional relations, as well as responsibility for all Medicare fee-forservice and financial management operations for federal CMS regions 7 and 8. Each regional office has an outreach component to provide resources and assistance to regional providers through staff who are familiar with national and local issues. Hannigan will act as the conduit between the central office in Baltimore and the regional office in Denver “to help them reach and support providers where they live and work.” “All of the regions have someone local, with an understanding of local influences, that physicians can go to with questions or concerns,” Hannigan said. “The regional offices play a key role in representing the agency, delivering key messages, and gathering input from the field. If we don’t have the answer at hand, we’ll coordinate with the central office to represent regional stakeholders with an understanding of what’s happening in the region and with their business.”

CMS Education Foundation Help send a student through school

From left to right: Jeff Hinson, federal CMS regional administrator; Marilyn Rissmiller, CMS; John Hannigan, associate regional administrator; and Alfred Gilchrist, CMS. Colorado Medicine for March/April 2015

Call 720-858-6310 for more information and to donate 31

Colorado Medicine for March/April 2015

Inside CMS

CMS and COPIC staff report

Dissecting care through interactive discussions Most medical professionals are curious individuals who thrive on problemsolving and determining what is best for their patients. In the pursuit of answers, they understand the importance of established knowledge, but also recognize the need to consider situational factors. They enjoy opportunities to analyze past cases, discuss patient encounters, interact with experts and share their own experiences with others. Interactive case review at this year’s Spring Conference The Colorado Medical Society and COPIC have collaborated to develop one of these opportunities – an interactive case review session for the upcoming CMS Spring Conference, May 1-3 in Vail. Using fictitious medical liability cases that draw upon current medical trends and incidents, attendees are given facts and medical records beforehand to formulate their own opinions. The session starts with the cases being presented by defense attorneys, followed by interactive discussions in small groups that are facilitated by physician risk managers from COPIC. The small group discussions will focus on the cases in terms of appropriateness of care, medico-legal issues, patient behavior and other related aspects. This session also allows attendees the unique opportunity to interact with health law defense attorneys that partner with COPIC. This type of case review received positive feedback from past participants because it allowed them to be actively engaged in the conversation and examine care from all angles – medical, legal and ethical. And while the review does Colorado Medicine for March/April 2015

follow a structured format, unplanned discussions often emerge and lead to interesting questions and innovative ideas. Why are case reviews such an effective way of learning? They force us to apply our knowledge in new ways and often introduce opposing perspectives to solving a problem. A 2011 Advances in Health Sciences Education article1 highlighted how interactions between medical professionals with different experiences contribute to the ability to address problems that arise in diagnosing and treating patients. Per the article: “Consultation with knowledgeable colleagues is a powerful strategy to solve these problems. In these consultations, differences of opinion concerning patient care may also trigger further thinking and lead to substantiated changes in approach.” Breaking barriers The Spring Conference is built around the theme of “breaking down barriers to better patient care,” and one of its main goals is to develop ideas to address the critical issues facing physicians. The ideas that come out of the case review will serve as invaluable insight. The discussions will help attendees to examine their own concerns and provide further understanding of the challenges health care providers face. The learning opportunity a case review provides has also been utilized by COPIC in its medical resident training program. In Patient Safety in Surgery2, Alan Lembitz, MD, a contributing au-

thor and COPIC’s chief medical officer, outlines key factors used in the analysis of a medical liability claim: • Origin of error • Type of error • Contributing factors (human, system, biologic and inherent) • Preventability assessment and strategies He points out that these factors are essential in the review process, but the most important discussion focuses on the effect on the provider and patient. It is vital that residents look at all elements of care, not just medical knowledge, as they prepare for their careers in medicine. In his book, Complications: A Surgeon's Notes on an Imperfect Science, Atul Gawande says: “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.” Gawande is right about medicine being an everevolving world; however, we do know that learning from past outcomes to improve future results is a foundation for better health care. n 1 Adv in Health Sci Educ (2011) 16:81–95 2 Stahel P, Mauffrey C. Patient Safety in Surgery. 2014 Edition: Springer; c2014

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

Inside CMS

Spring conference May 1-3, 2015 Michael Volz, MD, CMS president-elect

This year’s conference seeks to break down barriers As president-elect of the Colorado Medical Society, it is my express pleasure to invite you to the 2015 CMS Spring Conference, May 1-3 at the Sonnenalp Hotel in Vail. The theme this year, “Breaking Down Barriers: Reunifying Physicians and Patients,” draws parallels between the fall of the Berlin wall and efforts to dismantle barriers in health care between patients and physicians. This historic event took place 25 years ago as the result of grassroots political, economic and diplomatic forces that ultimately

broke through the barrier, brick by brick, and reunified Germany. The wall that has grown over that same stretch of time between patients and physicians – systemic, economic, political, and cultural – is being chipped away by the determined forces of medicine. Through the generosity of the Colorado Medical Society, all attendees will receive a special gift copy of “What Doctors Feel: How Emotions Affect the Practice of Medicine” by Danielle Ofri, MD, an internist at New York’s Bellevue Hospital. In the book, Ofri tells stories

of caregivers caught up in the range of emotions – shame, fear, anger, anxiety, empathy and even love – revealing the undeniable truth that emotions have a distinct effect on how doctors care for their patients. CMS will kick off the conference with a social reception Friday evening hosted by the Intermountain Medical Society featuring appetizers, live music, cocktails and dessert. Then we’ll bring in national experts for interactive sessions on Saturday morning and Sunday morning. After kicking off the sessions Saturday with my presentation on the conference theme, COPIC will lead an interactive review of several medical liability cases. The audience will divide into breakout groups to ask in-depth questions about the cases, identify and record the barriers that caused the claim and how they could have been avoided, and then vote on whether the care was appropriate. In addition, each breakout group will make recommendations about what CMS should be doing to improve safety based on the cases. Later Saturday morning, Simon Hambidge, MD, of Denver Health will explore issues facing ambulatory care delivery and how his organization developed “21st Century Care” to address these barriers. Saturday evening we’ll come together for a dessert reception and the Fireside Chat to discuss CMS governance reform. In this open forum, attendees will consider and provide feedback on various aspects of CMS governance as well as ways to enhance physician participation and increase transparency and effective decision-making. The 2014

Colorado Medicine for March/April 2015

Inside CMS HOD directed the board of directors to develop new structures that will move our organization to the next level. Sunday morning Ed Dauer, LL.B., MPH, presents “Improving the Care Experience,” which focuses on barriers to communication in health care. Physicians will learn how to embrace patients’ expectations, frustrations, presumptions and different frames of reference in the medical encounter to achieve effective communication; and share resources for dealing with treatment barriers. The purpose of the conference is to create unity among physicians, attract new faces to CMS, develop ideas to address the critical issues facing physicians, and broaden the view of attendees on relevant policy matters by bringing in outside experts. CMS encourages all members, staff and stakeholders to make plans to attend what continues to be a lively celebration of fellowship in

the Colorado medical community, and a provocative discussion on the howto’s of patient engagement and safety, improving care value and collaboration. CMS extends a particularly warm invitation to physicians who have never experienced one of CMS’ spring conferences before or who haven’t attended in awhile. Registration is free for Colorado physicians and component society staff, and is available online at www.cms.org/events/ spring-conference. Hotel reservations under the hotel group rate at the Sonnenalp can be made by phone through the Sonnenalp reservations department at (800) 654-8312 or online through the link on the CMS website. When booking by phone, be sure to mention that you are with the Colorado Medical Society to receive this group rate. I hope you’ll consider attending to learn, network and be inspired. n

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CMS 2015 Spring Conference

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Inside CMS

Colorado Medical Society Spring Conference Agenda May 1-3, 2015: The Sonnenalp, Vail, Colo. May 1, 2015: Friday 6:00 – 8:00 p.m. Social hour in the Kings Club hosted by the Intermountain Medical Society with appetizers, live music, cocktails and dessert

May 2, 2015: Saturday 7:00 – 8:00 a.m. Breakfast 8:00 – 8:15 a.m. Breaking Down Barriers - Mike Volz, MD, CMS President Elect

8:15 – 9:30 a.m. Vital Signs: An Interactive Review of a Medical Liability Case – COPIC 9:30 – 9:45 a.m. Break and dismiss to breakout sessions 9:45 – 10:45 a.m. Vital Signs: An Interactive Review of a Medical Liability Case Part 2 – COPIC 10:45 – 11:00 a.m. Break and return to general session 11:00 – 11:30 a.m. Medication Therapy: Step by Step – Florida Medical Society 11:30 a.m. – 12:30 p.m. Clinics Without Walls: Denver Health 21st Century Care – Simon Hambidge, MD, Denver Health

12:30 p.m. Afternoon break 6:30 – 7:00 p.m. Dessert reception 7:00 – 9:00 p.m. Fireside Chat – Leadership and Governance: Are there better ways to govern a herd of cats?

May 3, 2015: Sunday 7:00 – 8:00 a.m. Breakfast 8:00 – 8:10 a.m. Welcome back - Mike Volz, MD, CMS President Elect 8:15 – 1 1:00 a.m. Barriers Between Physicians and Patients: Some of Them Self-Imposed – Ed Dauer, LL.B., M.P.H, et.al.

11:00 a.m.

Adjourn

Continuing Medical Education and COPIC ERS points will be awarded The Colorado Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Colorado Medical Society designates this live activity for a maximum of 5.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. COPIC has accredited the conference for 3 COPIC points. Note: This agenda is subject to change. 36

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Inside CMS

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

Shamita Punjabi University of Colorado School of Medicine

Shamita Punjabi is a third-year student at the University of Colorado School of Medicine and a Colorado native. She attended Davidson College for her undergraduate degree in chemistry. Shamita has an interest in the long-term preventative care of pediatric and adult patients and social determinants of health. Her other interests include Indian dancing, playing piano, and singing and arranging a cappella music. Throughout her journey to become a physician, she hopes to explore how the arts and music can act as a lighthouse for students, professionals and patients who are facing difficult experiences.

House Call Green light, red light, yellow light; I tailed her attentively in my car. Leaves on the paved streets yielded as I snaked through the suburbs to an unknown location with my newest patient, destination merely five minutes from departure. Taylor Swift’s piercing screams softened to a whisper as I cut the engine. Double-fisting my belongings, I proceeded in eager anticipation, boots clacking, behind her into an outdoor passageway. The front door of her abode lay hidden behind a bush, and mysteries of her livelihood lay beyond. Though I had never read The Hobbit, I had always imagined it to be something like this. 38

She turned to me, the wrinkles pleating her face. Hair, short and gray, sprouted from her scalp like straw, the bags under her eyes carrying the weight of her experiences. A grin broke across her face. “Welcome to Cat Central, sweetie.” I peered through the door, overwhelmed and astonished by the pristine floors and tables. Tasteful paintings of worldwide travels lined the walls, each speaking of bold endeavors taken in her old age. “Where are your cats?” “Oh, they’re probably hiding under the bed, those precious little cowards.” My eyes continued to drink in the surroundings. Intoxicated by the shades of South America and the flavors of France, I took a left turn and found myself gawking at a giant Big Ben. In the background, I heard her saunter to the bathroom. Moments later the showerhead sputtered to life. Darkness gleamed off the cozy kitchen counters. Not a single dish dozed in the sink nor a crumb coated the granite. Every spoon, fork, and knife housed in its place. Where is all the mess hiding?! My head swished left and right, wondering if I would find anything out of place. But I did not. What had I expected? A 72-year-old woman living alone and helpless in a jumbled apartment with her two soggy cats? Colorado Medicine for March/April 2015

Inside CMS My assumptions were all baseless and I felt nothing but shame for having entertained them. At that moment, I fought the strong urge to join her pets in their hiding place.

pink granulation tissue crept hesitantly from the borders. I searched for pus in vain and exhaled an internal sigh of relief.

The rushing sounds continued to echo from the bathroom. I turned abruptly from the kitchen and ambled down the short, airy passageway to her bedroom. Glancing tentatively at the foot of her bed, I tiptoed so as not to disturb her shy pets.

All the while, she rambled on about her plans to visit family in Florida, her extensive knowledge of Mauritius and India. Her words comforted and encouraged me, as she sensed my comic struggle behind her: hemostat versus sterile packing materials. The hemostat was losing.

Paperwork for the next textbook, crisp, clean and organized lay on her desk waiting for her edits. I easily found a space near the edge of the table available for our medical adventure.

Irrigate, debride, irrigate, pack, sanitize. Minutes later she was re-bandaged and ready for the next 24 hours.

Minutes later, the packing materials stood in a queue when she emerged from the bathroom, wrapped like a burrito.

“Oh, I think I should be fine for my hot date tonight,” she joked.

“Wound’s all cleaned out. Are we ready for the procedure, doctor?”

We traipsed to her door and my eyes raked around her small but humble abode once more; the content spoke loudly of an independent woman whose lifelong journeys had given her courage and endless wisdom. Not to mention two broken ankles.

“Ha! As ready as we’ll ever be,” I responded. I repositioned her by the window. She leaned forward so I could visualize her left scapula. The bloodstained packing materialized piecemeal from the depths of her teardrop shaped incision. Wholesome

Colorado Medicine for March/April 2015

“Is that comfortable for you?”

As I waved good-bye and stepped into the biting cold, a shock of the incredible moments I had just experienced suddenly enveloped me. Valuing that realization sealed the bond I shared with this woman for the next four weeks. n

Inside CMS

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

Practice perspectives – details from our survey data As physicians, we are trained to ask patients relevant questions and then listen to determine the best course of action. This holds true for the relationships COPIC has with its insureds. Understanding their challenges requires that we stay connected to how health care is evolving from different perspectives. On a national level, the 2014 Survey of America’s Physicians conducted by The Physicians Foundation provides some interesting data: • 72% of physicians believe there is a physician shortage, that more physicians should be trained, and the cap on funding for physician graduate medical education should be lifted. • 85% of physicians have adopted electronic medical records. • Physicians spend 20% of their time on non-clinical paperwork. • The two main factors that physicians find most satisfying about their work are: patient relationships (77%) and intellectual stimulation (65%). • Physicians cited the following factors as most likely to contribute to rising health costs: defensive medicine (60%), aging population (37%), and state and federal mandates (37%). Every two years, COPIC conducts its own customer insight survey to gather feedback. This survey involves both insured physicians and practice administrators. It is an important tool in understanding what we are doing right and where we can make improvements. Key overall results from our 2014 survey include: • 100% of respondents said they would “definitely” or “probably” stay with COPIC when it was time to renew their coverage. • 100% of respondents said they would “definitely” or “probably” recommend COPIC to a colleague. • Over 93% of interactions with COPIC were rated as “excellent” or “good.” • Eight out of ten respondents said that “COPIC is well above the competition and is my clear preference.” When asked why they remain with COPIC, here’s what some respondents told us: “I believe we have mutual loyalty. It is easy to speak with a knowledgeable person at COPIC. COPIC is more active than other malpractice insurers at providing education to reduce liability.” “COPIC was formed during a very difficult time for physicians in Colorado. To the extent that it remains a company ‘of, by, and for’ 40

physicians, working hard to do the right thing, I will remain with COPIC.” “Very responsive, reliable physician and practice support. I have been an administrator for many years, and I’ve learned a lot from all of the seminars, Copiscopes, chart reviews, and discussions. COPIC is a collaborative company. Physicians feel supported and staff feel informed.” The survey helps us understand what aspects of COPIC are most relevant to insureds. With regard to the perceived importance of COPIC programs: • 97% of physicians and 99% of practice administrators identified maintaining a stable tort environment. • 89% of physicians and 90% of practice administrators identified initiatives aimed at improving patient safety. • 89% of physicians and 86% of practice administrators identified the 3Rs Program. • 88% of physicians and 91% of practice administrators identified our risk management and patient safety seminars. *Percentages reflect those who responded with “very valuable” or “extremely valuable” regarding the programs listed. When asked about the cost of premiums, 97% of respondents agreed with the following statements: • “COPIC is the best medical professional liability insurance value in the state.” • “I believe COPIC works hard to keep my premiums as low as possible.” • “COPIC gives me understandable information about premiums.” COPIC remains committed to defending good medicine, resisting meritless claims, controlling and reducing expenses, and helping to prevent claims. We will continue to provide a high level of customer service and explore additional ways to support the Colorado health care community. We thank each of the respondents for taking the time to provide their valuable insight. One of the key messages that was echoed throughout the survey was that respondents want us to look toward the future, but remain dedicated to the ideals we were founded upon. The following comment sums it up nicely: “Focus on the core mission of COPIC and continue to deliver exceptional physician and patient-oriented service.” n Colorado Medicine for March/April 2015

Departments

medical news HCPF releases bulletin announcing E&M payment increase delay The Colorado Department of Health Care Policy and Financing (HCPF) released a bulletin alerting physicians that the higher reimbursement rate for E&M and/or vaccination claims has been temporarily delayed. Physicians are advised to continue submitting claims; they will be retroactively adjusted. As a reminder, Colorado Medicaid is reimbursing covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100 percent of the December 2014 Medicare reimbursement rate. The new rate is available to all enrolled providers who submit fee schedule claims for office visits or vaccine administrations. It is not a continuation of the

Colorado Medicine for March/April 2015

previous 1202 Primary Care Supplemental quarterly payments and it does not require providers to attest to providing primary care. This rate is effective from Jan. 1, 2015 to June 30, 2016. The higher rates have not yet been loaded in HCPFâ&#x20AC;&#x2122;s claims processing system because the new rates have not yet been approved by the Centers for Medicare and Medicaid Services. The department does not have an anticipated approval date at this time.

continue to submit charges based on usual and customary rates, when applicable. Automatic adjustments can be made by the departmentâ&#x20AC;&#x2122;s MMIS only if the original submitted charge on a claim is greater than the newly revised rate; otherwise, the provider must resubmit a claim with the higher rate. Once approval by the federal CMS is received, the new rates will be loaded and will be paid upon claim submittal. n

However, as stated above, HCPF will retroactively adjust claims with dates of service on or after Jan. 1, 2015, to reflect the rate increase and providers should

Departments

medical news Centers for Medicare and Medicaid Services announce new EHR attestation deadline: March 20, 2015 Medicare-eligible professionals now have until 9:59 pm MT on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year.

versa) for the 2014 payment year. After that time, eligible professionals will no longer be able to switch programs.

The Centers for Medicare and Medicaid Services extended the deadline to allow providers extra time to submit their meaningful use data. In a Feb. 25 news bulletin, the federal CMS urged providers to begin attesting for 2014 as soon as they can.

Alert: Novitas encountering issues with financial responsibility amounts reported to patients

This extension also allows eligible professionals who have not already used their one â&#x20AC;&#x153;switchâ&#x20AC;? to switch programs (from Medicare to Medicaid, or vice

Medicare eligible professionals must attest to meaningful use every year to re-

All Medicare Administrative Contractors (MACs) are encountering issues with printing incorrect patient responsibility amounts for Medicare claims submitted by non-participating physicians on nonassigned claims that would lead a patient to believe that the physician collected more money from them than they should.

ceive an incentive and avoid a payment adjustment. Providers who successfully attest for the 2014 program year will receive an incentive payment and avoid the Medicare payment adjustment, which will be applied Jan. 1, 2016. n

Novitas Solutions, the MAC for Colorado, alerted providers of the problem in early January and announced in late February that it is a programming issue but have not released information on when it will be fixed. Colorado Medical Society continues to monitor the situation and is pushing for a quick resolution. n

Colorado Medicine for March/April 2015

Departments

medical news ABIM announces immediate and significant changes to maintenance of certification program The American Board of Internal Medicine announced substantial changes to its maintenance of certification (MOC) program and pledged to work more closely with the internal medicine community to improve MOC. ABIM President and CEO Richard J. Baron, MD, MACP, acknowledged in a letter that “we got it wrong” and they need to gather more input on the MOC program from practicing clinicians to ensure that it reflects what physicians are doing today in their practices. “We launched programs that weren’t ready

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and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.” Over the next few months, ABIM will work with a variety of organizations and the physician community to seek input on the MOC program through meetings, webinars, forums, online communications channels and surveys. Their goal is to embrace the value of physician engagement in quality improvement and to use this opportunity to improve the MOC program by embedding it more successfully in the lives of physicians.

pending the Practice Assessment, Patient Voice and Patient Safety requirements for at least two years. ABIM will update the Internal Medicine MOC exam starting in fall 2015 to make the exam more reflective of what physicians in practice are doing. MOC enrollment fees will remain at or below the 2014 levels until at least 2017. ABIM will also start recognizing most forms of ACCME-approved CME as a way for internists to demonstrate self-assessment of medical knowledge, greatly increasing the types of CME activities that can be applied to MOC. n

Effective immediately, ABIM is sus-

Providers’ Clinical Support System For Opioid Therapies (PCSS-O) has launched a new website – www. pcss-o.org – which the organization says features improved navigability, a comprehensive library of resources and an extensive list of experts. PCSS-O is a national training and mentoring project developed in response to the prescription opioid overdose epidemic. The consortium of major stakeholders and constituency groups with interests in safe and effective use of opioid medications offers experience in the treatment of substance use disorders and, specifically, opioid dependence treatment, as well as the interface of pain and opioid misuse. PCSS-O makes available no-cost educational programs on the safe and effective use of opioids for the treatment of chronic pain and safe and effective treatment of opioid use disorder. n

Colorado Medicine for March/April 2015

Departments

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

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Colorado Medicine for March/April 2015

RADIOLOGIST needed part-time to advise general radiography department in small facility in SW Denver. Excellent part-time opportunity. Very flexible. Please contact Debora Din 303866-7050.

MEDICAL OFFICE FOR SUBLEASE LOVELAND – A fully furnished Medical office (1300 Sq ft) for sublease on Tues and Fri at Loveland opposite McKee Med Ctr. Contact: Karen 970 221 2370 /karen@ncaac.com

BOARD CERTIFIED FP MD/DO – needed for well-established, growing practice in Broomfield, CO. EMR, minimal call schedule, no hospital. NCQA Certified, meaningful use. Partnership potential, competitive salary, benefits, bonus. Please fax CV to 303-465-1260 or email to srduxco@yahoo.com

➤ MISCELLANEOUS WASTE REMOVAL – Proper medical waste removal for Colorado physicians. (http://www.biomedicalwastesolutions. com)

SEEKING PRIMARY CARE PHYSICIANS OR CLINICS IN THE DENVER METRO AREA If you are considering: • A new practice opportunity, • Integrating your current practice into a progressive group, • The sale of your practice, or • A change of employment. We offer a unique opportunity: • To be part of a progressive primary care group that has been a Level 3, Patient Centered Medical Home since 2009, • With a competitive compensation package, • Achieve a work/life balance, and • Care for patients without administrative headaches. If interested, contact us at (303) 493-5276. All inquiries will be kept in strict confidence and will receive a prompt response. 45

Features

the final word Rep. Perry Buck, R-Windsor

Rep. Joann Ginal, D-Fort Collins

Reps. Buck and Ginal lead effort to update Colorado telehealth law The telehealth phenomenon – care delivered remotely via computers, cameras, smartphones or other devices – has been pushing back barriers and provoking a national policy debate among physicians, plans and regulators on where to set those lines. Every state has struggled with where to draw the line between face-to-face

Along with our colleagues, we are proud to contribute to this important work of breaking down barriers in health care to assure you have all the necessary tools to provide the right care at the right time, setting and value. and virtual services, in some instances resulting in medical licensure board sanctions, lawsuits and countersuits. In state houses across the country, most legislators understand there is a balancing act between convenience, timely care access and clinically appropriate standards of care. As more studies have come on line assessing efficacy and patient safety, clinical guidance regarding telehealth services has evolved to the point that where we and our colleagues here in Colorado have passed legislation to expand the use of those technologies within a clinically sound framework 46

beyond rural and (by definition) underserved communities, and assure parity between those services and face-to-face care. HB15-1029 will expand access to telehealth by removing a restriction that limits payment for this technology to rural counties with a population of 150,000 or less and by prohibiting health benefit plans from requiring inperson care delivery if consulting, monitoring and other care can effectively be administered remotely. It will remove the requirement for a provider to demonstrate a barrier to in-person care; prevent health plans from reimbursing providers for telehealth differently than for in-person care; and prevent health plans from charging different deductibles, copayments or co-insurance amounts or setting different annual or lifetime dollar maximums for telehealth services. Most importantly, we believe this bill will help to alleviate the stress of Colorado’s doctor shortage by extending your reach around the state, while providing cost savings for the health care community and patients in general. We are pleased to report that as of publication, this bill has passed out of the House and the Senate and is heading to the governor’s desk for signature. Sen. John Kefalas, D-Fort Collins, and Sen. Beth Martinez Humenik, R-Thornton, are our co-sponsors of the bill in the Senate.

islation – to expand telehealth applications – and your Board of Directors subsequently developed an extensive set of guidelines, localizing the Federation of Medicine and the AMA’s broader efforts. Our legislation was built from that excellent policy work. The benefits of telehealth are selfevident. Physicians can reach patients who are housebound, institutionalized, or otherwise unable to drive or ride to their clinic. Telehealth services also permit an unprecedented means of remotely monitoring patients’ conditions, especially those suffering from chronic disease. Acute episodes can be avoided, hospitalizations and readmissions minimized. Care is more readily coordinated with other community-based services, and state-of-the-art digital diagnostic technologies and access to specialists can be deployed in settings that used to be unavailable or significantly delayed. All this is done through secure, encrypted networks. Independent polling has consistently shown strong public support for these kinds of services. Along with our colleagues, we are proud to contribute to this important work of breaking down barriers in health care to assure you have all the necessary tools to provide the right care at the right time, setting and value. Thank you for your support and efforts in this exciting endeavor. n

The Colorado Medical Society has been instrumental in assisting our research as we worked together to develop this legislation. Last fall, the CMS House of Delegates set a framework by formally supporting the basic tenets of this legColorado Medicine for March/April 2015

Colorado Medicine for March/April 2015