September-October 2020 Colorado Medicine

VO LU M E 1 1 7 N O . 5 S E P T- O C T 2 0 2 0

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

CAST YOUR BALLOTS FOR MEDICINE’S CHAMPIONS UNITE WITH COLLEAGUES THROUGH COMPAC

C O N T E N T S

Unite In this divisive political atmosphere, the Colorado Medical Political Action Committee (COMPAC) unites physicians in common goals. It’s time to bring our voices together for the good of our profession and patients. Read about priority issues, the candidate interview process and reasons to donate to COMPAC. PAGE 6 ⊲

F E A T U R E S

D E P A R T M E N T S

8 COMPAC ANNOUNCES CANDIDATE ENDORSEMENTS

18 COPIC Comment

COMPAC presents a list of candidate endorsements for consideration in advance of the 2020 election. This list was created following a process where local physicians interviewed and educated those running for office in their area, made a recommendation to the COMPAC Board of Directors, and the board voted on the final endorsement.

10 THE DUTY TO VOTE: THE CASE FOR A CIVIC ENGAGEMENT CURRICULUM IN MEDICAL EDUCATION Second-year medical student Monica Patten lays out the reasons medicine and politics are connected and why it’s crucial to teach and practice civic engagement in medical school, throughout one’s career and beyond.

12 SOUTHWEST HEALTH ALLIANCE: BRINGING PRICE

20 Reflections 21 Medical News • Colorado physicians elect CMS leaders • CMS working for you: • Order PPE supplies to • protect your practices • AMA report shows 37 percent decline in opioid prescriptions, but an evolving and deadlier overdose epidemic 22 Introspections

RELIEF AND ACCOUNTABILITY TO HEALTH CARE The Southwest Health Alliance brings together patients, businesses and providers in a new health care cooperative to drive down health insurance premium costs, improve transparency and increase satisfaction.

14 MEMBER SPOTLIGHT: NONPROFIT CLINIC PIVOTS TO HOME VISITS WITH THE HELP OF CMS-COORDINATED PPE ORDER Jeff Berliner, DO, co-founder of a nonprofit clinic that provides uninsured individuals with disabilities access to rehabilitation services, has quickly pivoted to continue caring for patients during the COVID-19 pandemic and called upon the Colorado Medical Society for help securing PPE. 24 FINAL WORD: COVID HAS CHANGED EVERYTHING, EVEN POLITICAL FUNDRAISING Incoming COMPAC Chair Patrick Pevoto, MD, RPh, MBA, issues a challenge to all CMS members: Contribute to the bipartisan CMS political action committee today to enable our organization to continue its good work fostering relationships with elected officials and ensuring they are educated on medicine’s top priorities.

I N S I D E

C M S

4 President’s Letter 16 The Colorado Medical Society Annual Meeting is on (virtually!): Sept. 25, 2020

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2019-2020 OFFICERS

BOARD OF DIRECTORS

AMA DELEGATES

David Markenson, MD, MBA President

Danielle Coleman, MS Curtis Hagedorn, MD Mark B. Johson, MD Jason L. Kelly, MD Evan Manning, MD Edward Norman, MD Patrick Pevoto, MD, RPh, MBA Leto Quarles, MD Brandi Ring, MD Brad A. Roberts, MD Kim Warner, MD Hap Young, MD

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

Sami Diab, MD President-elect Patrick Pevoto, MD, RPh, MBA Treasurer Bryan Campbell, FAAMSE Chief Executive Officer Debra J. Parsons, MD, MACP Immediate Past President

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

AMA PAST PRESIDENT Jeremy Lazarus, MD

COLORADO MEDICAL SOCIETY STAFF Bryan Campbell, FAAMSE Chief Executive Officer Bryan_Campbell@cms.org

Emily Bishop Director of Government Affairs Emily_Bishop@cms.org

Ms. Gene Richer, M Ed, CHCP™ Director of Continuing Medical Education Gene_Richer@cms.org

Kate Alfano Communications Coordinator Kate_Alfano@cms.org

Dianna Fetter Senior Director of Professional Services Dianna_Fetter@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Tom Wilson Manager of Accounting Tom_Wilson@cms.org

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

Krystle Medford Senior Director of Membership Krystle_Medford@cms.org

Tim Yanetta Manager of IT/Membership Tim_Yanetta@cms.org

COLORADO MEDICINE (ISSN-0199-7343) is published bimonthly as the official journal of the Colorado Medical Society, 7351 Lowry Boulevard, Suite 110, Denver, CO 80230-6902. Telephone 720-859-1001; outside Denver area, call 1-800-654-5653. Periodicals postage paid at Denver, Colo., and at additional mailing offices. POSTMASTER, send address changes to COLORADO MEDICINE, P. O. Box 17550, Denver, CO 80217-0550. Address all correspondence relating to subscriptions, advertising or address changes, manuscripts, organizational and other news items regarding the editorial content to the editorial and business office. Subscriptions are available for $36 per year, paid in advance.

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

Bryan Campbell, Executive Editor; Kate Alfano, Managing Editor; and Dean Holzkamp, Assistant Editor. Design by Scribner Creative.

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I N S I D E

C M S P R E S I D E NT ’ S

LE T TE R

Rising to the challenge David Markenson, MD, MBA, President, Colorado Medical Society As my presidential year comes to a close I have reflected on what a challenging year this has been for our members and patients, and also how Colorado physicians have risen to what once seemed like impossible challenges during the COVID-19 pandemic.

By serving on the front lines and pivoting our practices quickly, we have again highlighted to the world the unique role of the physician in society as we have cared for patients, educated the public and protected the patient-physician relationship.

The Colorado Medical Society’s promise to our members is to support physicians in all career phases. I am proud of the resources and programs our staff and leadership developed over the past few months, sometimes with just days to plan. I’m thinking specifically of the more than 12,000 continuing medical education hours and many COPIC Points earned by physicians through our Town Halls, Virtual Grand Rounds and topical webinars; opportunities to order personal protective equipment when shortages, quality issues and price spikes plagued the process and kept individuals from placing orders through their normal channels; and unifying the Colorado House of Medicine in advocacy for physicians to be sure we were as effective as possible in the public policy sphere.

Speaking of advocacy, an issue of top importance is the tumultuous situation surrounding the contract to provide physician peer assistance services, which eliminated confidentiality for voluntary self-referral. You have received several updates from CMS and me about what we are doing to sound the alarm on the harmful consequences for both physicians and patients; DORA’s decision to issue a request for proposal (RFP) that required the awardee to have physicians sign releases for voluntary self-referral is counter to patient safety, mental health care and support, and physician well-being. It extends beyond our profession and sets a dangerous precedent for anyone voluntarily seeking care.

As I continue to tell top officials, confidentiality is key for physicians who voluntarily self-refer. Without this confidentiality, physicians will not feel comfortable getting the help they need.

When physicians can’t get the care they need, it can turn into a patient safety issue. Assuring the health, wellness, and ability of physicians to seek confidential support and treatment has been repeatedly proven to improve the quality of patient care.

We must have a provider of support services and evaluation for physicians with experience in this type of support and evaluation with physicians as part of the leadership team.

It has been a privilege to have served this past year as your president. I have heard from many of you regarding the challenges but also the opportunities we all face. I have seen the benefit of uniting all physicians through CMS, having one voice speak for us and such an exceptional organization behind all of us to assure we continue to improve the practice of medicine for all physicians, which improves the care and health of all Coloradans. I have also had the opportunity to work with physician and staff leaders of the component societies and specialty societies across our state. I have been heartened to see the great work the entire House of Medicine has accomplished when we are unified – CMS, component societies and specialty societies – in our advocacy and communication. I look forward to this continued unified approach, as the work of these groups on behalf of the physicians we serve is so much stronger together as one House of Medicine.

As I had said in my inaugural address, a central theme of my presidency was reestablishing and reinforcing to all the unique role and place in society of a physician, including the physician-patient relationship and the calling to be a physician.

While in all we do every day the special role of a physician is reinforced, I could never have anticipated a pandemic during my year as president and how it would highlight the importance of physicians to society.

COVID-19 has presented incredible challenges for all of us but it has reinforced our role as caregivers, leaders, educators and advocates for our patients and public health.

Once again, thank you for giving me the honor of being your president and representing you this past year. It has been a privilege and an experience like no other and has, for me, shown again why it is such a special calling to be a physician. ■

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

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C O V E R

Unite WHEN POLITICS SEEM DIVISIVE, COMPAC CONNECTS PHYSICIANS TO MAKE A DIFFERENCE FOR OUR PROFESSION AND PATIENTS Emily Bishop, Colorado Medical Society Director of Government Affairs

I hardly need to tell you that the November election feels urgent. Every time we look at the news or consider the current state of the pandemic, it is easy to feel overwhelmed. The novel coronavirus has exposed and exacerbated myriad weak spots in our society. Politics have become more divisive and uglier than we thought possible. This year has felt like we’ve been walking on a knife-edge, with the 2020 election looming like a critical tipping point.

Under that weight it can be difficult to know where and how you can make a difference. Becoming involved in the Colorado Medical Political Action Committee (COMPAC) is a good place to begin. As a physician, this is where your voice is loudest and your influence greatest.

“In the past, physicians have often been a group who are reluctant to get involved in politics. Our priorities are to our patients and it can be difficult to see how much influence we can have in our communities,” said outgoing COMPAC Chair Christopher Unrein, DO. “I’m here to tell you that if you’ve been looking for a sign, this is it. Our profession and our patients are not exempt from political influence and, in these uncertain times, uniting our voices is critical.”

Through COMPAC, the Colorado Medical Society is the only organization in Colorado fighting for our profession and what physicians value. No one else is going to stand up for you.

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

Our presence at the Capitol on your behalf is critical as we face attacks on medical liability, unprecedented budget cuts, attempts to strip confidentiality from counseling services, and numerous other challenges.

With your support, we begin to build our legislative firewall early through a candidate interview process. Partnering with local physicians we thoroughly educate and vet candidates on key issues developed by staff, our lobby team, and with the input of partners and the COMPAC Board. The COMPAC Board then endorses pro-physician candidates based on three factors:

•

The candidate’s positions on COMPAC’s identified key issues;

•

The sentiment of physicians who reside and vote in the district; and

•

The demographics of the district and a candidate’s ability to win.

“COMPAC was one of the first lobbying groups to engage me as a candidate when I first ran for the Colorado House of Representatives in 2015-2016,” said Sen. Chris Hansen, D - Denver. “The group of doctors involved included me in a thoughtful dialogue on health care policy – helpful to me since I was originally drawn to public service to make a difference in energy and the environment. As a legislator you have to have a working knowledge on the many issues facing the state and this can seem impossible, but forming relationships with physicians early in my candidacy and throughout my term in office has been invaluable to my understanding of health care.”

Interviews during the 2020 election cycle have educated candidates on medical liability, including retroactive liability protections for physicians facing the challenges of practice during COVID-19; ensuring that parents seeking non-medical immunization exemptions for their school-age children are better educated about vaccinations; maintaining the telehealth coverage expansions mandated

by Gov. Jared Polis’s executive order during the public health emergency even after it ends; the importance of quality care when considering cost-reducing measures; and much more.

“Fundraising is a necessar y par t of campaigning,” said Rep. Colin Larson, R-Littleton. “And because representatives in the state House of Representatives are elected to two-year terms, it is a nearly constant process. I was honored to receive COMPAC’s endorsement and support in my 2020 re-election, and more importantly, to have access to doctors and CMS representatives at the Capitol as expert resources when health care policy issues arise.”

The interview process, endorsements, contributions and – most important – relationships built between participating providers and candidates are unique to COMPAC and part of the reason that CMS is such a respected organization at the Capitol. If you are interested in participating in future candidate interviews with COMPAC, please contact me at emily_bishop@cms.org.

5 REASONS TO DONATE TO COMPAC

5 REASONS TO DONATE TO THE SMALL DONOR COMMITTEE

1 We educate candidates on the key issues and secure commitments before there’s even a bill.

1 We only give money to candidates who commit to never raise the noneconomic damages cap.

2 Actively contribute to and participate in your community.

2 A little goes a long way: your $50/year contribution enables us to contribute big – $5,350 compared to COMPAC’s $400.

3 Our endorsed legislators consider us the leading experts and turn to us first when it comes to health care issues at the Capitol.

4 You have enough on your plate right now. Let us protect against liability attacks by building a legislative firewall.

5 This work on behalf of your profession, practice and patients isn’t possible without your contribution. Visit cms.org/contribute.

3 It took a lot of work to establish Colorado’s stable liability climate.

It takes just as much work to maintain it each year.

4 Your medical malpractice insurance premium will increase unless we are able to block the trial lawyers.

5 This work on behalf of your profession, practice and patients isn’t possible without your contribution. Visit cms.org/contribute.

Contribute by visiting cms.org/contribute; contact Emily Bishop with any questions at emily_bishop@cms.org As we face down the ongoing pandemic, a social reckoning, political upheaval, and a world that is placing ever more demands on our time and attention, it is important to remember there is strength in community. COMPAC offers you an opportunity to unite with your peers to advocate for positive change in your profession and on behalf of your patients.

The reputation of CMS at the Capitol as the trusted voice of physicians and

COMPAC’s work to build strong legislative allies is only possible if you are an active member in our community. Volunteer for candidate interviews, attend events for legislators and candidates in your area, and perhaps most importantly of all, contribute to COMPAC by visiting cms.org/contribute. Your voice matters; ensure it is being heard. ■

Through COMPAC, the Colorado Medical Society is the only organization in Colorado fighting for our profession and what physicians value.

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

F E A T U R E

COMPAC announces candidate endorsements Staff report Physicians across the state have been hard at work interviewing candidates from both parties and helping the Colorado Medical Political Action Committee (COMPAC) make decisions on which candidates to support in the upcoming election. Endorsements are based upon candidate positions on priority policy issues for physicians.

Through Sept. 1, 2020, COMPAC has endorsed 91 candidates for state office this year. Physicians and all friends of medicine are encouraged to consider the recommendations in advance

of ballot distribution. This list represents endorsements made by press time; more may be selected before the election. For an updated list, visit cms.org/advocacy/compac-endorsements.

For help identifying the candidates running in your district, visit leg.colorado.gov/find-my-legislator.

For more information on the inter view and endorse ment process, or with ques tions about contributing to COM PAC , contac t Emily Bishop, CMS Direc tor of Government Affairs, at emily_bishop@cms.org.

COLORADO STATE SENATE

COLORADO HOUSE DISTRICTS

SD 1 - Jerry Sonnenberg (R) Cheyenne, Elbert, Kit Carson, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma

SD 16 - Tammy Story (D) Boulder, Denver, Gilpin, Jefferson

HD 1 - Susan Lontine (D) Denver/Jefferson

SD 2 - Dennis Hisey (R) Clear Creek, El Paso, Fremont, Park, Teller

SD 17 - Sonya Jaquez Lewis (D) Boulder

HD 2 - Alec Garnett (D) Denver

SD 18 - Stephen Fenberg (D) Boulder

HD 4 - Serena Gonzales-Gutierrez (D) Denver

SD 19 - Rachel Zenzinger (D) Jefferson

HD 5 - Alex Valdez (D) Denver

SD 21 - Dominick Moreno (D) Adams

HD 6 - Steven Woodrow (D) Denver

SD 22 - Brittany Pettersen (D) Jefferson

HD 7 - Jennifer Bacon (D) Denver

SD 24 - Faith Winter (D) Adams

HD 8 - Leslie Herod (D) Denver

SD 25 - Kevin Priola (R) Adams

HD 9 - Emily Sirota (D) Arapahoe/Denver

SD 26 - Jeff Bridges (D) Arapahoe

HD 10 - Edie Hooton (D) Boulder

SD 28 - Janet Buckner (D) Arapahoe

HD 11 - Karen McCormick (D) Boulder

SD 29 - Rhonda Fields (D) Arapahoe

HD 12 - Tracey Bernett (D) Boulder

SD 30 - Chris Holbert (R) Douglas

HD 13 - Judith Amabile (D) Boulder/Clear Creek/Gilpin/ Grand/Jackson

SD 3 - Leroy Garcia (D) Pueblo SD 4 - Jim Smallwood (R) Douglas SD 5 - Kerry Donovan (D) Chaffee, Delta, Eagle, Gunnison, Hinsdale, Lake Pitkin SD 6 - Don Coram (R) Archuleta, Dolores, La Plata, Montezuma, Montrose, Ouray, San Juan, San Miguel SD 7 - Ray Scott (R) Mesa SD 8 - Bob Rankin (R) Garfield, Grand, Jackson, Moffat, Rio Blanco, Routt, Summit SD 9 - Paul Lundeen (R) El Paso SD 10 - Larry Liston (R) El Paso SD 11 - Pete Lee (D) El Paso SD 12 - Bob Gardner (R) El Paso SD 13 - John Cooke (R) Weld SD 14 - Joann Ginal (D) Larimer SD 15 - Rob Woodward (R) Larimer

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

SD 31 - Chris Hansen (D) Arapahoe, Denver SD 32 - Robert Rodriguez (D) Denver SD 33 - James Coleman (D) Denver SD 34 - Julie Gonzales (D) Denver SD 35 - Cleave Simpson (R) Alamosa, Baca, Bent, Conejos, Costilla, Crowley, Custer, Huerfano, Kiowa, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache

HD 14 - Shane Sandridge (R) El Paso HD 15 - Dave Williams (R) El Paso HD 17 - Thomas Exum Sr. (D) El Paso HD 18 - Marc Snyder (D) El Paso HD 19 - Tim Geitner (R) El Paso HD 20 - Terri Carver (R) El Paso

HD 22 - Colin Larson (R) Jefferson

HD 49 - Michael Lynch (R) Broomfield, Larimer, Weld

HD 23 - Chris Kennedy (D) Jefferson

HD 50 - Mary Young (D) Weld

HD 24 - Monica Duran (D) Jefferson

HD 51 - Hugh McKean (R) Larimer

HD 26 - Dylan Roberts (D) Eagle/Routt

HD 52 - Cathy Kipp (D) Larimer

HD 27 - Brianna Titone (D) Jefferson

HD 53 - Jeni Arndt (D) Larimer

HD 28 - Kerry Tipper (D) Jefferson

HD 54 - Matt Soper (R) Delta/Mesa

HD 29 - Lindsey Daugherty (D) Jefferson

HD 55 - Janice Rich (R) Mesa

HD 30 - Dafna Michaelson Jenet (D) Adams

HD 56 - Rod Bockenfeld (R) Adams/Arapahoe

HD 31 - Yadira Caraveo (D) Adams

HD 58 - Marc Catlin (R) Dolores/Montezuma/Montrose/ San Miguel

HD 33 - Matt Gray (D) Boulder/Broomfield HD 34 - Kyle Mullica (D) Adams HD 35 - Shannon Bird (D) Adams HD 36 - Mike Weissman (D) Arapahoe

HD 59 - Barbara McLachlan (D) Archuleta/Gunnison/Hinsdale/La Plata/ Ouray/San Juan HD 60 - Ron Hanks (R) Chaffee/Park/Fremont/Custer HD 61 - Julie McCluskie (D) Delta/Gunnison/Lake/Pitkin/Summit HD 62 - Donald Valdez (D) Alamosa/Conejos/Huerfano/Mineral/ Pueblo/Rio Grande/Saguache HD 63 - Dan Woog (R) Weld HD 64 - Richard Holtorf (R) Baca/Bent/Crowley/Elbert/Kiowa/Las Animas/Lincoln/Prowers/Washington HD 65 - Rod Pelton (R) Cheyenne/Kit Carson/Logan/Morgan/ Phillips/Sedgewick/Yuma ■

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HD 37 - Tom Sullivan (D) Arapahoe HD 38 - David Ortiz (D) Arapahoe HD 39 - Mark Baisley (R) Douglas/Teller HD 40 - Naquetta Ricks (D) Arapahoe HD 41 - Iman Jodeh (D) Arapahoe HD 42 - Dominique Jackson (D) Arapahoe HD 43 - Kevin Van Winkle (R) Douglas HD 44 - Kim Ransom (R) Douglas

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C O LO R A D O M E D I C I N E 9

F E A T U R E

The duty to vote: The case for a civic engagement curriculum in medical education Monica Patten, second-year medical student, University of Colorado School of Medicine, and Colorado Medical Society Student Chapter Co-President, UCDenver Steven Lowenstein, MD, MPH, University of Colorado School of Medicine

If medicine is really to accomplish its great task, it must intervene in political and social life.

- Rudolf Virchow, 18491 As our nation grapples with the ongoing consequences of the COVID-19 pandemic, health care professionals are faced with an uncomfortable truth about medicine: Politics controls our local, national and global public health responses. With every “stay-athome” order lifted, every social distancing measure adopted or rejected, and every dismissal of the efficacy of wearing a mask by elected officials, we are reminded that those who possess the medical or scientific knowledge required to lead the nation through a health crisis of this magnitude are not endowed with the power to do so. Those who make policy decisions regarding COVID-19 must choose to heed the expertise of health care professionals when it comes time to allocate PPE, negotiate contracts for ventilator production and, most important, communicate public health information.

The connection between medicine and politics did not begin with the current pandemic. Access to health care is political.

Vaccine acceptance is political. Violence prevention is political.

The social determinants of health – housing, the environment, education, food security, employment and racial inequality – are political.

Indeed, it is more apparent than ever that health care is not an apolitical undertaking. In order to successfully promote the health and safety of our communities, the complex relationship

1 0 C O LO R A D O M E D I C I N E

between the medical profession and politics necessitates a foundation of trust. Traditionally, it would seem, this foundation of trust has been assumed by the medical community. We cannot rely on every elected public official to have the best interests of our patients and our colleagues in mind when making health policy decisions. Rather, health professionals must engage in the political process as key stakeholders. Importantly, they must vote. Yet, a 2007 study on physician professionalism demonstrated that physicians have lower adjusted voting rates than the general population and also lower voting rates than other professions, such as lawyers.2 This is why civic engagement must be a core component of the professionalism we teach in U.S. medical schools and residency programs. A survey of seven U.S. medical institutions found that medical students feel a professional responsibility to engage in health policy. 3 Students understand that health policy decisions directly impact the way they will practice and the health of their future patients. Students understand that in a country where health care makes up about one-fifth of the gross domestic product and voters consistently identify health care as one of their main concerns, it would be short-sighted to dismiss civic engagement as less than a core component of medical education. However, it is not as clear what “civic engagement” looks like.

Voting is one critical component of civic engagement that is often overlooked. In 2012 the National Study of Learning and Voting Engagement began collecting data on student voter registration and voting rates at colleges and universities. The study found that a campus culture of civic engagement and discourse on public issues are the primary predictors of voting by students.4

According to the Liaison Committee on Medical Education (LCME), the accrediting body for all U.S. medical schools, medical school curricula must address not only the biomedical and behavioral sciences, but also the “socioeconomic sciences,” “societal problems” and the “recognition of the impact of disparities in health care … and potential methods to eliminate health care disparities.”5 Therefore, civic engagement, including the responsibility to vote, must be a core component of the professionalism curriculum for medical students, not only to meet the requirements of the LCME, but more broadly, to fulfill the trust that society places in physicians.

Encouraging medical students to vote and promoting civic engagement through consistent and mandatory medical education curricula is the first step in solidifying voting as a core professionalism standard for physicians. If we cannot train future physicians to utilize their unique experiences and medical expertise in selecting our government leaders, we will miss the moment we have now to influence politics, address longstanding societal ills, and safeguard our patients from the devastating toll of future global health crises. ■

1. Virchow R. 1849. Quoted in Farmer P. Pathologies of Power.

Health, Human Rights and the New War on the Poor. University of California Press Books, 2004.

2. Grande D, Asch DA, Armstrong K. Do doctors vote?. J Gen Intern Med. 2007;22(5):585-589. doi:10.1007/s11606-007-0105-8 3. Rook JM, Winkelman TNA, Fox JA, et al. Looking to the Future: Medical Students’ Views on Health Care Reform and Professional Responsibility. Acad Med. 2019;94(9):1361-1368. doi:10.1097/ ACM.0000000000002621 4. Matto E, Millett McCartney A, Bennion E, Simpson D. Teaching Civic Engagement Across The Disciplines.; 2017:47-53.

5. Liaison Committee on Medical Education. Functions and Structure of a Medical School. Standards for Accreditation of Medical Education Programs Leading to the MD Degree. March, 2020: Association of American Medical Colleges and American Medical Association. Washington, D.C.

Health professionals must engage in the political process as key stakeholders.

Importantly, they must vote.

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

F E A T U R E

Southwest Health Alliance: Bringing price relief and accountability to health care Monique DiGiorgio, Executive Director, Local First Foundation, Durango, Colo.

If you live along the Western Slope of Colorado, it will come as no surprise that health care costs, and premiums in particular, are akin to paying a second mortgage payment for many families. To add further salt to the wound, spending for outpatient services on the Western Slope’s insurance region is about 87 percent higher than the state average, according to analyses by the state’s Division of Insurance and the Colorado Commission on Affordable Health Care. This disparity is on top of what is already an expensive market. In the 10-year stretch between 2008 and 2017, the Colorado Division of Insurance reported that health insurance premiums rose 50 percent for people who had coverage only for themselves through an employer. For families with employer-sponsored insurance, premiums rose more than 60 percent to an average of nearly $20,000 per year.

These staggering numbers were, in part, the motivation and inspiration behind the Southwest Health Alliance (SWHA). The story began in January 2018 when Local First received impassioned feedback from the local, independent business community at our annual meeting about the rising and unaffordable cost of health care. As we began to explore an issue for which we had a limited track record, the importance of the “Look Local” lens in the complex world of health care became obvious.

Much like the challenges facing our downtown retail shops, our health care system and its local practitioners are threatened by the national trend toward consolidation of providers, which research shows leads to higher prices without measurably improving the quality of care.

The corporatization and consolidation of health care typically results in fewer independent local health care providers in an increasingly complex system that lacks transparency and equity. Decisions are made in far-away corporate headquarters, making it harder to understand how to have a voice in decision-making. According to a 2019 report by the Colorado

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Health Institute, counties with the least competition among both hospitals and insurance carriers have the state’s highest insurance premiums. Hospitals have considerable bargaining power in many places because of health system consolidations and their purchases of many physician practices. The low-competition, high premium counties are in rural and mountain areas, like the La Plata County region in southwest Colorado.

To tackle this trend, Local First teamed up with the local, independent health care practitioners of The Durango Network to listen to the community and explore options to support local, independent health care in the La Plata County region including Montezuma, Dolores and San Juan counties. Based on our findings from a 2019 community needs assessment, the Southwest Health Alliance formed to: 1) increase health literacy in the La Plata County region, and 2) develop a cooperative, local health care solution that increases access to care while also reducing insurance premiums.

This is when we found Peak Health Alliance (peakhealthalliance.org) and their innovative health care cooperative hailing from the mountains of Summit County, Colo. Similar to an agricultural cooperative,

Peak Health Alliance uses the power of community purchasing to bring down the cost of health care while bringing the voice of the community back into the health care system to support transparency. The ultimate goal of this cooperative, which is officially licensed by the Colorado Division of Insurance, is to provide affordable, high-quality, and locally responsive health insurance products in the marketplace.

As the locally-led partner of Peak Health Alliance, Southwest Health Alliance was formed to expand the purchasing alliance model to the region for the 2021 plan year.

Fast forward to 2020, and we are pleased to announce that our goal of offering this type of plan in the marketplace by January 2021 is on track and heading to the La Plata County region, to serve both business owners and individuals looking for affordable, local health care. With the incredible support and expertise of Peak Health Alliance, we have chosen to work with Bright Health, which already offers coverage to Peak members in the northern part of our state. Bright Health will be new to our region for 2021, and we are pleased that our efforts appear to have driven greater marketplace diversity and lower prices in this remote corner of Colorado.

“As a small business owner and local, independent family physician, I was eager to help the SWHA in their efforts to offer a new health insurance product for our rural corner of the state,” said Jay R. Ciotti, MD, president, Cottonwood Family Health in Durango. “The opportunity for a local community to combine its purchasing power was long overdue.

I am very pleased with the outcome, as they can now offer my patients and my business a comprehensive and competitive option for health insurance.”

“From the beginning it was focused on local needs and important issues such as mental health parity,” he continued.

“It should deflate some of the pressure brought on by the few insurance companies who have monopolized coverage in the last several years and it offers opportunities for broader coverage and more cost savings moving forward. I strongly advise all providers, business owners and patients to investigate their coverage options for 2021.”

“I appreciate the contracting process; it’s one of the most straightforward contracts I’ve ever seen working with insurance,” said Karen Zink, CNP, MS, of Southwest Women's Health Associates.

“I appreciate the relationship and being involved in the process. I’m looking forward to working with Southwest Health Alliance and Bright Health.”

As we prepare for health insurance plans being available in January 2021, with rates and plan designs available this fall, we are now talking with the community about the details of engaging with us.

We are communicating now with local brokers to ensure they are fully equipped with information regarding the Southwest Health Alliance and Bright Health. Brokers will continue to assist both individuals and employer groups with their health care decision-making. View our participating brokers at peakhealthalliance. org/preferred. Simultaneously, we are reaching out to 5,000 individuals in the business community that expressed interest in the Southwest Health Alliance plan. We are also speaking to the public at large about unique offerings such as $0 co-pays for mental health visits.

Along the way, we all get to uphold our values of transparency, choice, local self-reliance and evidence-based deci-

sion-making. We are pleased that the Southwest Health Alliance insurance product will offer a choice of local providers as well as enhanced primary care and mental health benefits, while delivering cost-savings through partnerships with Centura (owner of Mercy Regional Medical Center), Animas Surgical Hospital, and local health care providers. We are still hopeful that Southwest Health System in Cortez will agree to join the Bright Health network so that Montezuma County residents can enjoy unfettered access to local care in their community.

THE TRADITIONAL MODEL insurers negotiate prices with hospitals and providers

insurers set prices consumers will pay based on negotiations with providers

employers and individuals enroll

THE PEAK MODEL

gather community buy-in and support Peak

You can find out who sits on the Steering Committee of the Southwest Health Alliance, the incredible support we have received from local governments and corporate sponsors, and how you can engage by visiting the Local First Foundation website at foundation.local-first.org/ health-care. Physicians in our region can sign up for the Southwest Health Alliance newsletter by visiting our new website at southwesthealthalliance.org or learn more by contacting Elise Neyerlin, director of outreach at Peak Health Alliance at elise@peakhealthalliance.org. ■

collect and analyze local claims data

negotiate rates directly with hospitals & providers Peak

solicit bids from carriers for group & individual markets Peak

employers & individuals enroll in Peak-designed and negotiated plans Peak

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F E A T U R E

Member spotlight: Nonprofit clinic pivots to home visits with the help of CMS-coordinated PPE order Jeff Berliner, DO The onset of the COVID-19 pandemic changed many practices in an instant, and Rehabilitation Services Volunteer Project (RSVP) is no exception.

Co-founders Bill Niehaus, MD, Christina Draganich, DO, and I opened the 501(c)(3) nonprofit clinic in 2017 to provide uninsured individuals with disabilities in our Colorado community access to rehabilitation services.

Along with 200 other volunteers, we donate our time and skills to provide care for patients with spinal cord injury, brain injury, stroke and amputation.

The vision of RSVP is to build a community in which people with disabilities lead lives of maximum independence, inclusion, and meaning. Recognizing that rehabilitation can contribute to this outcome, our mission is to provide outpatient services – physical therapy, occupational therapy, speech therapy, nursing care, social work and case management, wound care and physician care – and medical equipment to people who lack access to these services.

Since opening three years ago, RSVP has provided care in clinic space donated in-kind by Craig Hospital in Englewood.

When Craig stopped all outpatient ser vices in March as a response to COVID-19 they also closed the RSVP clinic to this at-risk patient population.

We created a virtual clinic platform on Zoom and provided iPads to our patients to use for the week of the clinic and then return. The clinic also provided monetary support for patients at risk of losing their housing and to help with food insecurity.

However, we eventually felt that our patients required in-person services and that our virtual platform was not fulfilling all of our patients’ needs.

It was at that point that we decided we would create a COVID team that would go into patients’ homes to provide services for those who had suffered catastrophic injury.

There are many situations in rehabilitation that require an in-person approach as opposed to services rendered online.

For example, you can’t fit someone for a wheelchair or fix a wheelchair virtually.

However, personal protective equipment (PPE) was scarce.

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We were very fortunate to be able to order PPE in May through the Colorado Medical Society (CMS) to provide in-home care safely.

As of Aug. 24, 2020, Craig Hospital decided that we could once again provide 50 percent of our services in person, or five visits per clinic, which we are thrilled about. We will prioritize seeing patients with the most needs in-clinic and continue to see some patients virtually, especially for follow-up visits. Access to PPE will be more critical than ever with our return to in-person clinic services and we plan to use the remaining PPE from CMS during this time.

Before the opportunity to order PPE I had not interacted much with CMS. I have been a member since I moved to Colorado six years ago, but before COVID-19 I had attended just one in-person program. As the pandemic ramped up, I participated in the virtual Town Halls and was able to place the PPE order when my volunteer team and patients needed it most. I am grateful to CMS for the resources they provided during the public health emergency and look forward to continuing my membership and work with CMS. CMS should continue to advocate for individuals with lack of access to health care and encourage physicians and other organizations to do the same. It is the belief of RSVP that providing health care to the uninsured is noble, but that the medical community must not overlook the circumstances of economic injustice that made our clinic necessary.

We have all seen the high unemployment rate and related high number of patients who have lost their health insurance coverage.

I encourage all physicians to keep in mind those who are struggling and consider the social determinants of health when providing health care.

Too of ten health care professionals provide medical care without understanding the psychosocial ramifications that societal events may have on a person and community. A patient might be on our clinic schedule but does she have transportation to come in that day? We might write another patient a prescription but does he have the ability to pay to fill it?

We can’t leave the people who are on the periphery of the health care community, who really need care, in the wilderness of medicine. We are called to help.

Rehabilitation Services Volunteer Partnership is available for referrals, and accepts volunteers and donations at our website, www.coloradorsvpclinic.org. ■

THE COLORADO MEDICAL SOCIETY IS PLEASED TO ANNOUNCE

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I N S I D E

C M S

The Colorado Medical Society Annual Meeting is on

(virtually!)

JOIN US: FRIDAY, SEPT. 25, 2020

The Colorado Medical Society is proud to present the 2020 CMS Annual Meeting the evening of Friday, Sept. 25. As 2020 is a year like no other, the meeting is shortened and virtual – and scrub pants are welcome! – but as always, the meeting is our signature celebration of you and your colleagues. Those who have joined us for in-person meetings will recognize some things from previous years: the swearing in of a new CMS president and the recognition of members’ notable achievements. Some things will be totally new (and lots of fun): games, prizes and perhaps a surprise guest or two. The entire event is free for CMS members to attend.

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Scrub pants are welcome!

The CMS Board of Directors will meet earlier in the day starting at 1 p.m. and the meeting is open to all members to attend. Email membership@cms.org for an agenda or with questions about participating. Then we’ll move to our main event, with a keynote by American Medical Association President Susan Bailey, MD, and remarks from incoming president Sami Diab, MD, outgoing president David Markenson, MD, MBA, and CMS CEO Bryan Campbell. Finally, we’ll have fun and build camaraderie with a facilitated team trivia game hosted by an experienced facilitator and conducted over Zoom. No need to have your team already set, we’ll split into teams when we begin!

Throughout the program we’ll recognize all of our members, who are without question the most important part of our membership association. We hope many of you have sent photos to CMS CEO Bryan Campbell that show what you’re passionate about: your tremendous team, family or friends, or perhaps you and your furry friends. We look forward to sharing the faces of our members with all Colorado physicians as we celebrate the amazing feats you have all accomplished in this unprecedented year. There is still time to send in a photo or two; reach Bryan by email bryan_campbell@cms.org.

ITINERARY

Friday, Sept. 25, 2020 *subject to change 1 p.m. CMS Board of Directors meeting Open to all CMS members to attend 6 p.m. Main program Welcome by CMS outgoing President David Markenson, MD, MBA

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Keynote address from AMA President Susan Bailey, MD Address from CMS CEO Bryan Campbell, FAAMSE Inauguration of Sami Diab, MD and recognition of David Markenson, MD, MBA 7 p.m. Conclusion Team trivia with prizes!

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D E P A R T M E N T S C O M M E NT

COPIC resources for implementing professional review at your practice Gerald Zarlengo, MD, Chairman & CEO, COPIC Insurance Company

Professional review is a key component that supports continuous improvements in health care. It is also an issue that COPIC has focused on with our legislative advocacy efforts. Last year, we worked with partners in the health care community, including the Colorado Medical Society, to maintain the legal protections of peer review when the Colorado Professional Review Act (CPRA) was renewed.

Under Colorado law, physician practices that follow a formal professional review process have the same legal protections as peer review activities at a hospital or other health care facility.

Professional review activities that are privileged and confidential under CPRA include evaluating the competence,

Peer review is recognized and accepted as a means of promoting professionalism and maintaining trust. The peer review process is intended to balance physicians’ right to exercise medical judgment freely with the obligation to do so wisely and temperately.

— American Medical Association Code of Medical Ethics Opinion 9.4.1

professional conduct of, or the quality and appropriateness of patient care provided by a physician, physician assistant (PA), or advanced practice registered nurse (APRN) employed by or under contract with the practice to provide health care services. This can range from routine reviews of cases identified through screening by quality indicators to addressing concerns about a possible impaired provider.

COPIC has developed templates to assist practices in establishing a formal professional review process through appropriate policies and procedures. These templates are consistent with the requirements for professional review under state and federal law. The templates should be reviewed by an attorney who can add information specific to the practice. The templates are also in a Word document format that allows them to be easily integrated and customized for your medical practice.

The following resources are available at callcopic.com/resource-center/guidelines-tools/practice-management-resources

review review

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• An overview of the benefits of establishing a formal professional review process for physician practices.

• Templates of professional review p olicies and p ro ce dures for COPIC-insured practices to use:

• Professional Review Checklist that includes the steps a practice should consider when establishing a formal professional review process.

• Professional Review Policy and Fair Hearing/Corrective Action Policy

• A confidentiality agreement that should be signed by all professional review par ticipants and be maintained on file.

• Practitioner Health Policy

• Practitioner Behavior Policy

COPIC’s COVID-19 information and resources COPIC has posted an open-access COVID-19 page on our website at callcopic.com/covid-19-information-and-resources We continue to update this information; here are some of the resources available: • Det ails for CO PI C polic y holder s that include: • COVID -19 Physician Program, which provides temporary liability coverage to physicians who do not have other available insurance coverage, who are not currently a covered physician under a COPIC policy, and who will be providing professional ser vices to a COPIC-insured practice or facility to assist with addressing COVID-19.

The program has been extended through Dec. 31, 2020

• COPIC’s HR Services, which offers guidance on employer/employee related issues such as understanding and ensuring compliance with the Coronavirus Aid, Relief and Economic Security (CARES) Act and the Families First Coronavirus Response Act (FFCRA).

• A summary of Colorado COVID-19 orders and guidelines released by governor executive orders and Department of Regulatory Agencies, Division of Professions and Occupations (DORA), as well as the state’s liability immunity laws. ■

• Risk management and legal/regulatory guidance on areas such as telehealth, reopening medical practices/ resuming elective procedures, and recommended disclosures if caregivers test positive for COVID-19.

• A “special consent form” template that COPIC developed for elective surgeries and procedures performed during the COVID-19 crisis. The form complements standard consent forms, sets forth the information and risks associated with COVID-19, and when used in tandem with patient education materials, helps emphasize the importance of shared decision-making that underlines the informed consent process.

Physician practices that follow a formal professional review process have the same legal protections as peer review activities at a hospital or other health care facility

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D E PA R TM E NT S R E F LE C TI O N S

Disease; be not proud Kelly Stanek Kelly Stanek is a third-year medical student at the University of Colorado School of Medicine, hoping to pursue pediatric medicine. She completed her undergraduate education at Biola University in the Torrey Honors Institute, studying biology and classical literature. In her free time, she enjoys writing poetry, backpacking with her fiancé, snowboarding with her brother, and long walks with her parents.

Disease, flee from here. Your dirty schemes fail to impress the lowly, nor the innately dressed. You glide from child to child, thinking you can conquer the small. But within them your presence invites your own demise. Your soldiers – bacteria, viruses, and fungi – often turn on you, defending us instead. We map

your blueprints, your every move. We even see how you work inside me. How you started a civil war within; but, you will never reach my soul. Disease, you may snake yourself around the living Earth, but we will thrive in spirit, more and more with every birth. ■

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

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D E PA R TM E NT S M E D I C A L

N E W S

Colorado physicians elect CMS leaders The full membership of the Colorado Medical Society was invited in August to vote in the 2020 CMS Leadership Election. Mark B. Johnson, MD, MPH, was elected CMS president-elect and will be installed as CMS president in September 2021.

Katie Lozano, MD, FACR, and A. Lee Morgan, MD, were re-elected to the AMA Delegation, joining other delegates David Downs, MD, FACP; Jan Kief, MD; Tamaan Osbourne-Roberts, MD; Lynn

Parry MSc, MD; Carolynn Francavilla, MD; Rachelle Klammer, MD; Brigitta Robinson, MD, FACS; and Michael Volz, MD. Finally, the slate of nominees for the COMPAC Board of Directors was affirmed.

The new board members are Eric Balaban, MD; David Beck, MD; Rachel Landin, DO; Lucy Loomis, MD; Claire Murphy, MD; Lynn Parry, MD; Sean Pauzauskie, MD; Jim Regan, MD; Carol Stamm, MD; Christopher Unrein, DO; Michael Volz, MD; and William Wright, MD. They join current

D E PA R TM E NT S M E D I C A L

board members John “Jack” Cletcher, MD; Taj Kattapuram, MD; Jibran Khan; Katie Lozano, MD; A. Lee Morgan, MD; Edward Norman, MD; and Patricia Weber, MD; as well as ex-officio board members Sami Diab, MD; Mark B. Johnson, MD, MPH; and Kim Warner, MD. Thanks to all of the physicians who voted this year and for these physician leaders for volunteering their time to the Colorado Medical Society and all Colorado physicians and patients. ■

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CMS working for you: Order PPE supplies to protect your practices The Colorado Medical Societ y has teamed up with ActionPPE.org to once again give CMS members access to medical-grade PPE supplies. All items are already in a warehouse in the United States, preventing any delays through

customs, and orders ship quickly and directly to your office.

Available products are KN95 or disposable tri-fold masks, disposable gowns, face shields, gloves and hand sanitizer.

D E PA R TM E NT S M E D I C A L

V isi t t he C M S order page here – actionppe.org/3/cms/ – and share this link with your colleagues. Plus, use discount code cms-save5 for 5 percent off all orders through the link above. ■

N E W S

AMA report shows 37 percent decline in opioid prescriptions, but an evolving and deadlier overdose epidemic The American Medical Association the opioid epidemic in Colorado. The (AMA) released its Opioid Task Force AMA’s report and existing Colorado data 2020 Progress Report in late July that emphasize that more work is needed. shows that, nationally, physicians have reduced opioid prescribing by 37 percent, “Since 2013, physicians have been at the increased use of state prescription forefront of this fight against the opioid drug monitoring programs (PDMP), and epidemic and we are committed to increased the prescribing of naloxone. continuing that critical work on behalf of However, the report also shows that our patients and communities,” said CMS there has been a dramatic increase in President David Markenson, MD, MBA. fatalities involving illicit opioids, stimulants (e.g. methamphetamine), heroin The effects of the COVID-19 pandemic and cocaine. Colorado data shows similar have exacerbated t he challenges trends. This report highlights the import- that many Coloradans face, which has ant work of physicians and others, offers important data to help target next steps, and should serve as a stark reminder that continued focus on the opioid epidemic is necessary.

increased the need for continued action on opioids. “Colorado must take steps to continue its positive momentum and maintain its place as a forward-thinking leader in the fight against the opioid epidemic,” Markenson said. “Now is the time to revisit the plan that physicians put together as part of CMS’s Multi-Specialty Convening on Opioids, which, among other things, emphasizes the need to remove administrative and other barriers to comprehensive, multimodal, multidisciplinary pain care and rehabilitation programs.” ■

Colorado has taken a number of positive steps toward addressing the opioid and drug overdose epidemics over the last several years, including important bills passed by the Colorado General Assembly as well as collaborative, provider-led initiatives like CO’s CURE, which is developing nationally recognized, evidencebased guidelines to address and resolve

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D E PA R TM E NT S I NTR O S P E C TI O N S

Considering social determinants of health for compassion and activism Ilma Chowdhury Emilie Mathura Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University, College of Osteopathic Medicine. Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities, and Alexis Horst, MA, writing center instructor.

Ilma Chowdhury is a second-year medical student at Rocky Vista University College of Osteopathic Medicine. She completed her undergraduate degree in Human Nutrition from Virginia Tech before acquiring a Master’s in Science of Education from Johns Hopkins University and a Master’s in Science from Georgetown University. Having worked as a middle school teacher in Baltimore and having seen the lack of health care access in urban underserved populations, Ilma hopes to practice as an internist one day, focusing on preventative medicine and on improving access to health education.

Emilie Mathura is a second-year medical student at Rocky Vista University College of Osteopathic Medicine in Parker, Colo. She completed her undergraduate degree in Human Biological Sciences at North Carolina State University and wishes to pursue a residency in obstetrics-gynecology. In her free time, she serves as the Officer of Diversity for the Student Government Association at RVU and looks forward to helping create a more inclusive future for medicine.

All the teachers told me to beware of my sixth-period class, which was supposedly the “class from hell.” It was my first day as a middle school science teacher in Baltimore, and I was terrified. Going into this job, I knew that I would be working in an underserved and forgotten part of the city, in a school where 98 percent of my students were Black or Hispanic, and where resources such as books, and even air conditioning, were only luxuries.

Of course, working with preteens, I knew that behavior management would be a large portion of my role. However, little did I know that this “misbehavior” in some of my students rooted from years of being failed by the health care system.

At the beginning of every month, Tyler* would behave well for a couple of weeks before running out of his psychiatric medications. Lack of health insurance

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and reliable transportation meant that his psychiatrist only saw him once every six months, and he couldn’t afford the medications he needed. Instead, Tyler was given more potent drugs that sedated him. Once those medications ran out, Tyler would stir up a storm, going around breaking glass and picking fights with older students. My attempts at contacting his parents failed, which I later learned was because his father was in jail and his mother was an alcoholic. Tyler had a combination of mental health illnesses that prevented him from focusing and behaving appropriately in class. While he was almost a perfect student when on medication, without it he became disrespectful and volatile. And that’s how a complex combination of systems designed to catch this 14-year-old boy allowed him to fall through the cracks.

The prison-like environments in urban schools, with zero-tolerance policies, surveillance cameras, metal detectors, and local police on campus mean that s tudent s like Tyler encounter earlier and more frequent disciplinary action.1 Researchers have studied differences in disciplinary actions against both Black and White students, finding that Black students are more likely to be punished for the same offense than their White counterparts. This pattern begins at a startlingly young age: even though there are fewer Black children enrolled in preschool, they are 3.6 times more likely to be suspended from school as White children. Children who are expelled are three times more likely to end up in the juvenile justice system. Once caught within the juvenile justice system, the psychological and economic consequences can have a lasting and burden-

some impact on children while simultaneously decreasing their educational and financial opportunities and increasing their chances of reincarceration.2 Several studies have found that therapists working with youth involved in the juvenile justice system tend to rate the behaviors of Black adolescents as indicating a criminal orientation, while White adolescents were seen as having potential mental health concerns. These dif ferences may lead to youth from minority backgrounds not being identified as having mental health conditions but receiving interventions (like incarceration) that do not address the underlying concerns. These punishments open up the school-to-prison pipeline, and incarcerated youth are nearly 70 percent more likely to be in jail again by age 25. 3 Currently at medical schools across the nation, systemic racism and its impact on the health of affected populations is not strictly part of the curriculum. However, there is limited evidence that demonstrates the current models of education lend themselves to positive outcomes and implementation in clinical practice; in fact, 20 percent to 25 percent of recent medical school graduates feel unprepared to provide specific components of cross-cultural care.4 As future physicians, we have a duty to understand public health issues that impact populations across the country.

Whether from a lack of access to health care or inadequate support from the education system, Black people across the nation constantly face barriers that prevent them from succeeding in the same ways as their White counterparts.

Studies have found that providers spend less time, have fewer discussions about treatment options and provide fewer opportunities for participator y decision-making with people from minority backgrounds, 5 and one-third of African Americans surveyed said that racism was a major problem in health care.5

inevitably make a diagnosis using the significant risk factor of race, we hope to remember for ourselves, our colleagues and our future patients, that statistics are used to describe populations and stories are meant to describe people. While we learn the cases, the disease etiologies, and the protocol for treating, I ask that we continue to look for the signs of stories in the medical history and to treat patients with humanity as well as medicine. In deepening this understanding about the causes of illnesses and their roots in racial health disparities, we can advocate for our patients by allowing them to be more than a statistic.

As medical students and physicians, instead of asking, “What is wrong with you? ” we must learn to ask, “ What happened to you?” when examining our patients. Considering the social determinants of health in case management is not only an act of compassion but also an act of activism that can produce concrete changes in our patients’ lives that go beyond the exam room. ■ 1. The School-to-Prison Pipeline: Brochure. Advancement Project. https:// advancementproject.org/resources/ school-prison-pipeline-brochure/.

Published Sept. 3, 2013. Accessed Aug. 17, 2020.

2. Buchanan L-A. Report, Recommendations, and Preliminary Report. January 2018.

3. Marchbanks, Miner, and Blake, Jamilia J. Assessing the Role of School Discipline In Disproportionate Minority Contact With the Juvenile Justice System, Texas, 1999-2008. Inter-university Consortium for Political and Social Research [distributor], Dec. 19, 2018. https://doi.org/10.3886/ ICPSR37186.v1 4. Kripalani S, Bussey-Jones J, Katz MG, Genao I. A prescription for cultural competence in medical education.

Journal of General Internal Medicine.

2006;21(10):1116-1120. doi:10.1111/j.15251497.2006.00557.x 5. Holm-Hansen C. Racial and ethnic disparities in children’s mental health.

Wilder Research. 2006. *Name changed for privacy protection

Black children from underserved communities with mental health disorders are half as likely to receive adequate mental health care, a statistic we see played out in real time with Tyler. In recounting his story, we aim to put a face and a narrative behind statistics. That way, when we

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F E ATU R E F I N A L

WO R D

COVID has changed everything, even political fundraising Patrick S. Pevoto, MD, RPh, MBA, incoming Chair, COMPAC Board of Directors

I am honored to have been named the new chair of the COMPAC Board of Directors with my term beginning Sept. 1.

When I moved to Colorado in 2012, I was leaving a 20-year participation in organized medicine with the Texas Medical Association. I was not familiar with the workings of the Colorado Medical Society, and I was fortunate to have several members of CMS sponsor me to serve on the COMPAC board and begin to bring me up to speed. I have so much to still learn, and I look forward to continuing the great work put forward

by Dr. Christopher Unrein, as well as all the chairs who preceded him.

larly Emily Bishop, our CMS Director of Government Affairs. They coordinated countless interviews between teams of physicians and legislators by way of Zoom calls. The COMPAC board members, as well as the candidates, were gracious to participate by way of this virtual tool, ensuring the COMPAC Board didn’t miss a step in getting through the vetting process. The questions asked of the candidates were challenging and full of texture, and the physicians should be proud of the way they were represented.

The COMPAC Board has chosen the best slate of candidates to represent the interests of our physicians.

One unique and valuable practice of COMPAC is the extensive inter view process. COMPAC does not endorse based on political party; we work hard to have working, sustainable relationships with lawmakers on both sides of the aisle who are responsible for setting the course of health policy.

When it comes down to it, CMS is a politically pragmatic organization that advocates for what works in the real world of medicine based on evidence-based policies, which evolve and require revisions just as medical practice does. Physicians understand this. A considerable amount of strategy goes into COMPAC endorsements that emphasize the inherent value of physician engagement in the political process and the ability to consider both sides of an issue to make the best determination for our profession and patients.

The campaign interview process was greatly affected, as everything was, by the emergence of COVID-19. CMS staff members were up to the task – particu-

Northern Colorado Medical Society poses COMPAC fundraising challenge COMPAC would like to recognize the Board of Directors of the Nor thern Colorado Medical Society for committing to have 100 percent participation in COMPAC among their board members.

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NCMS President Claire Murphy, MD, challenged each board member to donate at least $100 to COMPAC. “The role of the physician as an advocate is integral to forwarding our medical profession,” Murphy said. “Investing in COMPAC and developing relationships with your local legislators is paramount.

The Northern Colorado Medical Society has made this a priority, through interviewing candidates for endorsement, our annual legislative night, and the

We must now move with great and determined speed toward contributing to these races. Unfortunately, due to many unforeseen circumstances beyond anyone’s control, we are far behind with the funding we need to make these contributions and candidates are largely unable to hold in-person campaign fundraising events.

I call on each CMS member to consider giving at least $100 to COMPAC or the maximum $625 for the two-year contribution period that ends with the November election.

COMPAC funds are vital to the success of our endorsements at the ballot box and we must receive these contributions as soon as possible. By doing so, we can fulfill and complete the great work COMPAC has accomplished to date.

Go to cms.org/contribute or contact e mil y_ b i s ho p @ cm s .o r g f o r m o re information on getting involved. Your perspective and participation are critical to us. ■

board COMPAC contribution challenge.

This aspect of medicine can go unseen by many, but to keep Colorado the best place to practice medicine, we can’t forget that we need to support our profession in every way possible.”

Thank you, NCMS Board of Directors!

Would you like to join them in their suppor t of COMPAC’s work? Go to cms.org/contribute to make a donation today! ■

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