Jan-Feb-2012 by Colorado Medical Society

January/February 2012

Volume 109, Number 1

Taking a closer look Evolving your practice for the future

Colorado Medicine for January/February 2012

Award-winning publication of the Colorado Medical Society

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Colorado Medicine for January/February 2012

cont n ent nt ns nt Jan/Feb 2012, Volume 109, Number 1

Features. . .

Cover story Making sense of

where your practice needs to go in the future and how you are going to get there is challenging. We break things down into manageable pieces to ensure your practice thrives. Read more starting on page 8.

Inside CMS 5 7 24 27 28 33

President’s Letter Executive Office Update CMS polling results Continuing medical education Spring Conference COPIC Comment

Departments 35 37

Medical News Classified Advertising

Practice evolution timeline–Learn more about the major issues and milestones that any practice should be tracking in the future.

Physician practice treatment plan–Know where to start your practice’s evolution and stay on track by using this simple one-page checklist.

Physician employment–CMS launches new initiative to serve all doctors regardless of where they work, as more physicians choose employment over private practice .

ICD-10 training–CMS creates a coalition to help physician practices navigate the ICD-10 maze with a series of training seminars to prepare pracitces for October 2013 deadline.

Prior authorization concerns–Prior authorization policies can impede proper care and a new collaboration with the health plans aims to address these issues.

New online EHR and meaningful use resource–Get your one-stop resource for achieving meaningful use through this new online portal available to Colorado physicians.

Meaningful use and HIPPA–Implementation of EHRs raise a host of HIPPA issues physicians should already be addressing. Are you?

PQRS program update–Big changes are coming to PQRS in years to come. Learn what your practice needs to do to prepare in 2012.

Final Word–Groundbreaking Cerebral Palsy Care Bill seeks to model a new framework for public health and patient safety .

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

Colorado Medicine for January/February 2012

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and CONNECTION

2011/2012 Officers F. Brent Keeler, MD

President

Jan M. Kief, 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 Michael J. Pramenko, MD Immediate Past President

Board of Directors Tyler Anstett, MS John L. Bender, MD Claudia Bouvier, MS Charles W. Breaux Jr., MD Robert A. Brockmann, MD Ellen M. Burkett, MD David Elison, MS Naomi M. Fieman, MD T. Casey Gallagher, MD Ripley R. Hollister, MD Johnny E. Johnson, MD Christine A. Lamoureux, MD Alisa B. Lee Sherick, MD Donald Luebke, MD Randy C. Marsh, MD Nora E. Morgenstern, MD Jeffrey A. Moody, MD Edward A. Norman, MD Tamaan Osbourne-Roberts, MD Stephanie Sandhu, MS Ranee M. Shenei, MD Stephen V, Sherick, MD, MD Thomas H. Soper, DO

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

COLORADO MEDICAL SOCIETY STAFF Executive Office

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

Division of Communications and Member Benefits

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

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Health Care Policy

Chet Seward, Senior Director, Chet_Seward@cms.org

Division of Health Care Policy (cont.)

JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org Karen Frederick-Gallegos, Director, Quality Initiatives, karen_frederick-gallegos@cms.org Susan Liptak, Program Assistant, Susan_Liptak@cms.org

Division of Information Technology/Membership

Tim Roberts, Senior Director, Tim_Roberts@cms.org Genni Pearman, Director, Membership and Professional Services, Geneva_Pearman@cms.org Tim Yanetta, Coordinator, Tim_Yanetta@cms.org

Division of Government Relations

Susan Koontz, General Counsel, Senior Director, Susan_Koontz@cms.org Chris Lines, Director, Political Affairs and Education, Chris_Lines@cms.org

Colorado Medical Society Education Foundation Colorado Medical Society Foundation Mike Campo, Staff Support, Mike_Campo@cms.org Donna Jeakins, Staff Support, Donna_Jeakins@cms.org

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

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

Colorado Medicine for January/February 2012

Inside CMS

president’s letter F. Brent Keeler, President Colorado Medical Society

A different kind of PAC: The UnitedHealthCare story This is not an article about a political action committee. This is the story of the UnitedHealthCare (UHC) Physician Advisory Council (PAC), the result of six years of largely successful collaboration with the largest health coverage insurer in Colorado. It is “largely successful” because not every problem has been resolved; there are differences and issues that remain. We physicians have not gotten everything we have wanted, nor has UHC. New issues will arise. Yet, at its most-recent meeting, the members of the PAC agreed that it was time to tell the story. I was pleased to volunteer to use this space in Colorado Medicine. (Please don’t interpret this piece as an endorsement of UHC. My intent is to show that Colorado’s physicians have a proven track record of engaging in collaboration in lieu of confrontation.) In December of 2005, UHC was in the process of acquiring Pacificare. The Colorado Medical Society leadership and staff were concerned about how this merger would affect our ability to care for patients who would be covered by the merged plans. We were able to present these concerns to the Division of Insurance, and on December 20, 2005 the Insurance Commissioner issued an order directing UHC to engage in a PAC process with selected Colorado physicians. The original purpose was to address issues arising from the merger. The PAC physician membership was chosen by physicians – not by UHC. The DOI order was for a three-year time period. The first meeting was in March of 2006. The first PAC meetings involved some adversity. Fortunately, everyone agreed to an evolution of the format. Each side

named a co-chairman, and the agenda was jointly developed. The meeting venue was moved to CMS headquarters. The scope of work was widened to include all issues of concern to either party, not just those arising directly from the merger. Some of this evolution occurred as national leadership at UHC changed.

Here is a partial list of some subjects the PAC has considered: • Shortly after the merger, UHC contracted with LabCorp (nationally) for clinical laboratory work for its members. Many physicians had poor prior experience with LabCorp and there was a lot of concern about satisfactory service. Complaints and concerns were aired freely at the PAC. LabCorp management attended PAC meetings. Service gradually improved, with the PAC deserving some of the credit. • UHC rolled out its Physician Designation Program (PDP) in Colorado in 2006. The PDP has its flaws and inaccuracies, and it is still claims-based as opposed to clinical outcome-based. Still, the PDP has gone through several iterations for which the PAC can take partial credit. Of note, UHC sent national software experts to several PAC meetings and, as a result, the latest iteration allows a physician to use the UHC website to drill down to the individual patient level. For instance, physicians can ask questions such as whether Patient X actually received a hemoglobin A-1-C test even though no claim came through to trigger a credit in the PDP process. • UHC has a physician advocacy program office for Colorado. At least

Colorado Medicine for January/February 2012

three full-time staffers work with physician offices on a variety of issues ranging from claims processing to prior authorization. This direct contact function is unique. I have personally used it, with very good results.

• UHC’s Medical Director for Colorado Chris Stanley, MD, has been invaluable as a PAC member and co-chair. He was recognized with a Strange Bedfellow Award at the CMS Annual Meeting in September of 2009 for his service. Thank you Chris. • When the DOI order expired, the PAC could have disbanded. Instead, by mutual agreement, the PAC was extended voluntarily and indefinitely. We now meet quarterly. The atmosphere is friendly and collaborative. We do not always agree, but the style is not one of confrontation. We’ve learned you can catch more flies with honey than with vinegar. Any physician interested in joining the PAC should contact Marilyn Rissmiller at Marilyn_Rissmiller@cms.org. n

Join COMPAC Now! Colorado Medical Political Action Committee Call 720-859-1001 or 800-654-5653, ext. 6317

Colorado Medicine for January/February 2012

Inside CMS

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

The SGR pony For those of you keeping score, and by now most physicians have probably stopped counting, it’s year nine of the SGR debacle, where Congress takes us to the brink of the apocalypse, then kicks another balloon-financed can down the road. But this year, we may see the beginning of the end of this ritual hazing. Our most recent pilgrimage to Washington for AMA’s annual national bracing of Congress, a time-honored ritual whereby physicians from across the country convene and systematically go door-to-door to lobby their respective congressional delegations, may be approaching a tipping point. Here’s why. Bipartisan consensus We now have a broad, bipartisan consensus – including our congressional delegation – that the SGR in fact never worked, never will, and further cuts will be catastrophic. It is now universally recognized that it is financially irrational and irresponsible to continue to fund patches that have provoked a budget hole that is now $300 billion-deep. Peace dividend There is currently an offset funding source that has the consensus support of AMA and all the major specialty organizations, a windfall opportunity created by the drawdown of our military presence in Afghanistan and Iraq. Congress allocates discretionary funds annually, called the Overseas Contingency Operations fund, that we are arguing have been freed up. Call it a peace dividend, or a war-wind-down windfall, regardless, it presents a one and only shot at a clean slate, wiping the books and setting the stage for a substantive retooling of how to truly reform Medicare’s payment

policies, volume controls, and cost curve bending efforts. Evidence-based policy options Our CMS, along with our AMA and the major medical specialty organizations, have put on the table an array of evidence-based policy options that can bend the cost curve, realign reimbursements around value and performance, support physicians during the transition, and reverse this unsustainable trend. Congress has demonstrable, viable options, many drawn from real world practice. Many members of Congress, certainly most in our congressional delegation, support that notion. The doctrine of equal risk It is a tipping-point election year, and neither party collectively wants to risk the political consequences of the disruptions to a large and largely voting senior population. I know, “duh,” but this Congress has the lowest public confidence ratings since Gallup started polling nearly four decades ago. In politics we call it the “doctrine of equal risk.” Neither side gains from the corrosive, partisan finger-pointing and name calling, so the opportunity to fix problems instead of blame rises. Foundation for serious reform of Medicare policy We are seeing and hearing a shift toward bipartisan problem solving in the byzantine world of Medicare policy. The always thoughtful and innovative Senator Ron Wyden (D- OR), who headlined the CMS annual meeting a couple of years ago, has teamed up with his political polar opposite Paul Ryan (R-WI) to come up with what the health care policy experts are calling the “foundation for serious Medicare Reform.”

Colorado Medicine for January/February 2012

The proposal is an artful balancing of market strategies favored by Republicans with coverage and care continuity concerns pressed by Democrats. It is an outline more than a policy at this point, but it shows leadership on the two most daunting barriers to real reform: po-

“It is now universally recognized that it is financially irresponsible to continue to fund SGR patches that have provoked a budget hole that is now $300 billion-deep.” litical feasibility and controlling costs. More about this later. We have invited Senator Wyden to our 2012 annual meeting for an encore presentation and analysis of their work-in-progress. Our conversations with the Colorado delegation, both at home in their districts and on the Hill, emphasize what is already a strong disposition toward collaborative, team-based care, a willingness to pilot and test cost-curve-bending ideas, and to stay out of the partisan swamp where good ideas go to get stuck. Among the many colorful barnyard metaphors about politics, there’s one about optimism when things seem most bleak I heard often in Texas: “With a pile of manure this high, there must be pony at the bottom of it.” While the odor is still strong, I can also hear that pony climbing out. n

Cover Story

Taking a closer look Evolving your practice for the future

Sara Burnett, CMS contributing writer Colorado Medicine for January/February 2012

Cover Story Trying to keep up with all of the changes in heath care today – much less anticipate what’s coming next – is enough to make any physician’s head spin. There’s physician profiling and payment reform, EHRs and ACOs, plus ICD-10 and the ACA – and those are just for starters. (*See the copy box below for a glossary of terms to serve as a guide to this paragraph). “It’s a lot of moving parts,” says Jennifer Wiler, MD, an emergency physician at University of Colorado Hospital and a Colorado Medical Society member who speaks nationally on reimbursement issues. “The concerns I hear from my friends are that it’s hard enough day-to-day just to keep the door open … So trying to think about all of these other changes that are coming is overwhelming.” But with health care costs continuing to rise, there’s no doubt that change is on the way and, in many cases, already has arrived. For several years, CMS has worked with component and specialty societies and other stakeholders to help physicians navigate this new, often uncertain environment, a process CMS has come to refer to as “practice evolution.” Understanding how critical this work will be for physicians and their patients, CMS leaders formed the Council on Physician Practice Evolution. The council is made up of 20 physicians from across the state, representing specialists and primary care physicians from multiple practice settings. The council’s aim is to inform physicians, help them prepare and evolve their practice, and to ensure they have a voice in how these changes occur. Four key areas Practice evolution may be broken down into four key areas: transparency, payment reform, delivery system redesign and administrative simplification. Colorado Medicine will delve deeper into each of these areas in future issues, but here is a brief explanation: Transparency: Public and private payers want physicians to prove they’re providing high-quality, cost-efficient care. Through

profiling, or designation programs, private payers are rating doctors, largely using claims data, and putting those designations on their websites. (CMS has been working with health plans to develop a fair and consistent process for these programs). Medicare also is making data from PQRS (Physician Quality Reporting System) available online. And an effort also is underway to utilize an All-Payer Claims Database, which would compile data from all public and private payers. These efforts make it more important than ever that physicians be able to track and use their own data. Payment reform: There is a growing consensus that the fee-for-service reimbursement model is not the best way to provide quality, safe, cost-effective care, particularly in cases of chronic conditions and high-risk patients. Instead, options such as bundled or episodes of care payments, gain sharing and global payments are actively being explored. Delivery system redesign: Linked closely with payment reform, delivery system redesign looks to provide better-coordinated, more patient-centered care. It includes the use of electronic health records (EHRs), health information exchange and models such as the patient-centered medical home and medical neighborhood. CMS also has done work around a “care compact,” which helps facilitate better care coordination. Administrative simplification: A major way to cut waste in the health care system is to reduce the administrative burden on physician practices. CMS is working on an initiative that would create a uniform system for claims edits and is helping physicians make the transitions to HIPAA Version 5010 and ICD-10. Facing the future Michael Keller, MD, a primary care physician in private practice and immediate past president of the Denver Medical Society, sees value in many of these changes, such as the need for physicians to prove through data that they’re providing quality care. “It’s good for the patient and it’s good for me and it’s ultimately good for the system,” Keller says. But Keller, who also sits on the Council on

Colorado Medicine for January/February 2012

Physician Practice Evolution, said he’s living proof that what may sound like a great idea in theory doesn’t always translate easily into one’s practice. Because of concerns about cost and productivity, his six-doctor practice hasn’t invested in an EHR. “It is very difficult to bring changes to the individual level,” he says. Dennis Waite, MD, chair of the council and chief medical officer at The Medical Center of Aurora, hears from physicians every day who are so frustrated and anxious that they’re talking about quitting medicine. Waite likes to use an analogy of a sailboat tied to a dock. Many physicians today have one foot on the boat, he said, and the other safely planted on dry ground. “You tend to say, ‘Well, I’m gong to hold on to my position on the dock a bit longer until I figure out where this sailboat is going,’” Waite says. Still, there are things physicians can do to prepare, from having conversations with colleagues about how to better coordinate care, to coming up with a system to track quality and cost measures to seeking guidance from state, local and specialty societies. “No one really knows for certain what’s going to happen, but in some way, changes are going in this direction,” Keller says. “We have to make sure that it doesn’t come as a shock.” Thoughts? Questions? Contact Dennis Waite, MD, chairman of the Council on Physician Practice Evolution at Howard.Waite@hcahealthcare.com. n Glossary of terms Physician profiling: Programs used by payers to “designate” physicians based on quality and efficiency measures. Payment reform: Changing the way that health care is reimbursed. EHRs: Electronic Health Records ACOs: Accountable Care Organizations ICD-10: New diagnosis and procedure codes; must be used as of Oct. 1, 2013 ACA: Affordable Care Act

Features

Practice evolution timeline Chet Seward, Senior Director, Health Care Policy Key dates to remember It is challenging to keep track of the myriad issues and deadlines associated with the continually changing health care system. Here is a list of major topics and milestones that are color coded to help you organize the pieces of your practice’s evolution. Green pieces represent payment reform. Purple signify delivery system redesign, while blue are for transparency and accountability issues. Yellow pieces represent administrative simplification. SGR cut Thanks to the flawed Medicare sustainable growth rate (SGR) formula, a 27.4% reduction in physician payments is scheduled to take place March 1. Unless Congress acts to avert it, thousands of Colorado physician practices and the patients they serve will be affected. Value-based payment modifier Medicare will soon begin to apply a value modifier to physician payment rates under the Medicare physician fee schedule based upon the quality and cost of

= payment reform = delivery system redesign = transparency and accountability = administrative simplification Feb. 2012 – Data begins to flow from 12 carriers and Medicaid into APCD 2012 - Medicare episode grouper developed and tested

care delivered. This process will begin with specific physicians and physician groups in 2015 and expand to all physicians by 2017. Physician performance during 2013 will be used to calculate the modifier for 2015 physician fees. The value-based modifier builds on the Physician Feedback Program, created in 2008, that provides confidential feedback reports to physicians about the resource use and quality of care they provide to their Medicare patients. (Source: Centers for Medicare & Medicaid Services) Physician Quality Reporting System The Physician Quality Reporting System (PQRS, formerly PQRI) is a voluntary reporting program established in 2007 by the Centers for Medicare & Medicaid Services. The program creates a financial incentive for eligible professionals to report data on certain quality measures for Medicare Part B services. Beginning in 2015, those eligible physicians who do not satisfactorily submit PQRS data will have their Medicare payment rates reduced by 1.5%. Physicians must satisfactorily report PQRS data during the 2013 reporting period (January 1 – December 31, 2013) in order to avoid the 2015

March 16 and May 31, 2012 – Shared savings program (ACO) applications approved

June 30, 2012 – Last day to report 10 e-Rx events to avoid 1.5% payment penalty in 2013

Feb 29, 2012 - Last day for physicians to register and attest to receive a Stage 1 MU incentive payment for CY2011

All Payer Claims Database The All Payer Claims Database (APCD) is a secure database that will be the comprehensive source for claims data from all public and private payers in Colorado. It was created via legislation in 2010 and is administered by the Center for Improving Value in Health Care (CIVHC). The APCD will provide valuable data on Colorado health care costs and utilization to highlight gaps and spot opportunities for improvement. Claims data from 12 carriers and Medicaid will begin to flow in February 2012. The first set of aggregate reports (Tier 1) on the incidence and variation of targeted medical conditions, state and regional cost patterns, and utilization of services will be available in the fall of 2012. Tier 2 reports will be out in July 2013 and will allow for comparisons of providers on things like cost of procedures and quality of care provided by different provider. Tier 3 reports are expected in 2014 and will feature enhanced analytics to spotlight individual provider level data, episode groups and model the effects of alternative payment strategies. (Source: Center for Improving Value in Health Care, CIVHC).

Jan. 1, 2013 – Last year to report PQRS data without being penalized starting in 2015

July 1, 2012 – Anticipated expansion of Medicaid ACC to all appropriate Medicaid clients

2012 Jan. 1-Dec. 31, 2012 – e-Rx reporting period, eligible for 1% payment bonus

penalty. (Source: Centers for Medicare & Medicaid Services)

2013 – MU Stage 2 expected to be implemented

Oct. 1, 2013 – All encounters and discharges must use ICD-10 codes or they will be rejected

2013

April 1, 2012 – Enforcement begins, electronic claims submitted must use Version 5010 standards or they will not be processed June 30, 2012 – Last day to apply for e-Rx exemption for 2013

Aug. 2012 – Tier 1 APCD reports on state and regional cost patterns and service utilization available

Jan. 1-Dec. 31, 2013 – Performance period for Medicare VBPM

July 2013 – Tier 2 APCD reports on cost and quality comparisons of health care providers available

Colorado Medicine for January/February 2012

Features E-prescribing The E-prescribing (e-Rx) program began in 2009 and provides incentives for eligible professionals who are successful electronic prescribers. Physicians do not need to participate in PQRS to participate in the e-RX Incentive Program. The reporting period for the 2012 e-Rx incentive payment is January 1, 2012 – December 31, 2012, and physicians can choose one of three e-Rx reporting options, including claims-based, registry-based and electronic health record (EHR)-based systems. For 2009 and 2010, e-Rx incentives were 2% of a provider’s total estimated allowed Medicare charges for covered professional services during the reporting period (one calendar year). Incentive amounts for e-Rx have been reduced to 1% in 2011 and 2012 and will decrease to to 0.5% in 2013. Physicians may be subject to a 1.5% payment adjustment (penalty) in 2013 unless they successfully report ten unique e-Rx events before June 30, 2012. Those who successfully achieve the 2012 e-Rx incentive will also be considered a successful ePrescriber for purposes of avoiding the 2% payment adjustment in 2014. (Source: Centers for Medicare & Medicaid Services) Meaningful use of EHRs Physicians who implement and “meaningfully use” a certified electronic health record (EHR) are eligible to receive incentive payments from the government through the 2009 HITECH Act. Physicians can receive up to $18,000 in 2011 or 2014 – Last year to initiate participation in Medicare EHR incentive program

2014 2014 – Tier 3 APCD episode grouper and other advanced individual provider level performance reports available

Jan. 1, 2015 – Medicare VBPM begins for some physicians

2012 and up to a total of $44,000 through 2015 if they continue to qualify. (Source: American Medical Association, Centers for Medicare & Medicaid Services) Medicaid Accountable Care Collaborative The Colorado Medicaid Accountable Care Collaborative (ACC) is a central part of the state’s strategy to reform the Medicaid system from one that pays for a high volume of services to one that rewards value-driven health outcomes. Colorado Medicaid caseloads have increased by 72% since 2008 to over 650,000 patients. More than 100,000 of them are currently enrolled in the ACC, which relies on Regional Care Collaborative Organizations to support providers in seven different regions across the state. The ACC uses both fee-for-service and other payment methods to drive care system transformation. The state expects to net 7% savings in the current fiscal year on this program and, if all goes as planned, stepwise expansion of the ACC to other Medicaid patients not in other managed care options will begin on July 1, 2012. (Source: Colorado Department of Health Care Policy and Financing) ACOs, bundled payments and other payment reforms The passage of the Affordable Care Act accelerated a number of payment reform programs already underway, in addition to creating a few new initiatives. Federal programs launched in 2012 include the Medicare Shared Savings Program (ACO), the Pioneer ACO program, the

2015 – Medicare payment penalties begin for those who are not MU of EHRs

2015 Jan 1, 2015 – 1.5% payment penalty for those not reporting PQRS data

Colorado Medicine for January/February 2012

Advance Payment ACO Model, the Bundled Payment for Care Improvement program and the Comprehensive Primary Care Initiative. Private payers are also stepping up payment reform activities, including pilots in three Colorado communities that are using the Prometheus episode of care model to use a gainsharing approach to reducing potentially avoidable complications. CIVHC has developed a plan for payment and delivery system reform in Colorado that includes a 2015 midway milepost where fee-forservice is no longer predominant. Their 2018 goal is to have a high penetration of global payments and highly integrated health systems across the state. (Source: CIVHC) ICD-10 & Version 5010 Standards These two transitions will require significant system and business changes throughout the health care industry. Everyone covered by the HIPAA, not just those who submit Medicare claims, must transition to ICD-10 by October 1, 2013. Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed after that date. Version 5010 HIPAA electronic transaction standards are intended to improve standardization for administrative and clinical data compared with the current Version 4010/4010A standards. It is not possible to create or transmit electronic claims using ICD-10 codes without transitioning to Version 5010 HIPAA transaction standards. (Source: Centers for Medicare & Medicaid Services). n

2016 – Last year to receive a Medicare EHR incentive payment and last year to start participating in Medicaid EHR incentive program

2016 2015 – CIVHC midway milepost – less fee-for-service, more bundled payments in Colorado

2017 Jan. 1, 2017 – Medicare VBPM applies to all physicians

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Colorado Medicine for January/February 2012

Features

Physician practice treatment plan Chet Seward, Senior Director, Health Care Policy

Colorado Medicine for January/February 2012

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Colorado Medicine for January/February 2012

Features

Making CMS the “go-to place” for all physicians Sara Burnett, CMS contributing writer

New initiative to identify, address needs for employed physicians As more and more physicians choose to become an employee instead of owning their own practice, Colorado Medical Society is launching a new initiative to ensure the organization remains relevant to all doctors, regardless of where they work. The initiative will include interviews and surveys of physicians in multiple practice settings, including those employed by health systems, hospitals, federally qualified health centers and the University of Colorado. It will seek to determine where these physicians currently find value in CMS, and what more CMS could be doing to help and appeal to them. “It’s important to ensure that CMS addresses the needs of all physicians in Colorado,” says Tamaan Osbourne-Roberts, MD, a member of the CMS Board of Directors. Osbourne-Roberts, who practices at a community health clinic in Commerce City, will lead a task force appointed by the board to oversee the initiative. The group will present its findings and recommendations to the board for discussion at the 2012 CMS Annual Meeting in September. Changing practices Traditionally, the majority of CMS members have been physicians in small, private practices. But in recent years, the number of those physicians who have gone to work in other settings has increased. So has the percent of final-year residents in the past decade who say they would prefer hospital

employment to partnership or group practice, according to the Merritt Hawkins 2011 Survey of Final-Year Medical Residents.

medical societies in other states, and will work with May to conduct physician outreach meetings – essentially “Employed Physician Town Halls.”

During a retreat in the fall of 2010, CMS and component society leaders identified this trend as a “mega-issue” that the organizations must address, both to ensure their relevance and to promote unity among existing members as well as physicians statewide.

All of this research and analysis will inform the new strategies that will ultimately be implemented by the board.

Osbourne-Roberts believes there are several issues that are important to all physicians, regardless of practice setting, such as the liability climate, patient safety, physician well-being and professional ethics. CMS has been a leader and provided valuable advocacy in all of these areas, he notes. But physicians who aren’t in private practice may have other needs or may like to have access to member benefits that aren’t currently offered, OsbourneRoberts says. What physicians need To determine what those needs are, CMS is contracting with former CMS President Rick May, MD, who will conduct interviews and focus groups with employed physicians and their employers. Pollster Benjamin Kupersmit will provide analysis from several years of CMS member surveys and create and administer surveys of non-member physicians employed by the 15 largest physician employers in Colorado. The task force appointed by the board will also seek to gather information from

Colorado Medicine for January/February 2012

CMS President Brent Keeler, MD, stresses that the process will be a thoughtful one aimed at truly learning about and offering the services and benefits physicians need. “We would like to see CMS be the goto place for all physicians in Colorado,” Keeler says. “The hope is that a year from now we’ll have doctors at Kaiser or Denver Health or in other work models who say ‘You know what, CMS has done some good things for my colleague down the hall, and I want to be a member too.’ That’s the ultimate message.” n

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Colorado Medicine for January/February 2012

Features

International Classification of Disease Marilyn Rissmiller, Senior Director, Health Care Financing The Colorado Medical Society has organized a statewide training coalition to ensure physicians and their staff are prepared for the implementation of ICD-10 on October 1, 2013. The coalition is comprised of educators, consultants and physician/ practice representatives – including the component medical societies, Colorado Medical Group Management Association, the Pikes Peak Chapter of the Professional Association of Health Care Office Management and Colorado Health Information Management Association – as well as the Denver Regional Office of the Centers for Medicare and Medicaid Services and other stakeholders.

This page will also centralize and categorize resources developed by the coalition and other publically available ICD-10 information. Look for a link on the CMS website.

For more information, contact Marilyn Rissmiller at marilyn_rissmiller@cms.org or by phone at 720-858-6328. n

The statewide training coalition will make ICD-10 resources and training accessible to physicians and their staff via an organized multimedia educational campaign. The coalition will provide a progressive training curriculum through a modular approach beginning January 2012 and running through October 2013. On the third Tuesday of each month a new program or resource will be made available to help practices prepare for the transition. The modular approach will allow practices to do much of the preparatory work now, such as project planning, impact analysis and documentation evaluation. This does not replace the need for intensive coding training, but delays it until early 2013 when the actual implementation is closer. (Think of ICD-10 as a new language; you want to be able to use it or you won’t remember it.) The coalition will establish a dedicated ICD-10 Training Resource web page that will spotlight a calendar of upcoming events and archived program recordings. Colorado Medicine for January/February 2012

Features

Medical community unites over patient prior authorization Susan Burke, Director, Communications

Task force to address physician concerns At the start of the 2012 Legislative session, the Colorado Medical Society Council on Legislation (COL) convened to discuss the prior authorization bill sponsored by Senate Majority Leader, John Morse (D-Colorado Springs). Proposed Senate Bill 12-065 requires prescribing providers and health plan benefit plans to use a uniform prior authorization form for purposes of submitting and receiving requests for prior coverage of a prescription drug. If the health plan benefit plan fails to use or accept the prior authorization form or

“We could not be more pleased that a pro-patient advocate like Senator Morse will be monitoring the process and the progress of the meetings. It’s all coming together.” – Brent Keeler, MD

engaging with the resources in our medical and legislative communities is working. While we reserve the right to take our case to the legislature, a voluntary engagement with the health plan medical directors will get more issues impacting physicians on the table, involve a thoughtful, thorough discussion of the problems and give us an opportunity for well-reasoned, meaningful solutions.”

The Colorado Association of Health Plans (CAHP) comprised of Aetna, Anthem Blue Cross/Blue Shield, CIGNA, Colorado Access, Colorado Choice Health Plans, Denver Health, Humana, Kaiser Permanente, Rocky Mountain Health Plans and UnitedHealthCare convened with the Colorado Medical Society and Senator John Morse (D-Colorado Springs) to begin addressing the issues and expedite solutions.

fails to respond to a request within two business days, the request is deemed granted. An approved prior authorization form would be valid for 12 months after the date of approval.

“We are excited that the Colorado Medical Society will work with us to convene a task force with members of the Colorado Association of Health Plans to address physician concerns with prior authorization procedures mandated by health plans for certain medical services, procedures, devices, medications, supplies, and equipment,” says Ben Price, Colorado Association of Health Plans executive director.

Concurrent to the introduction of the bill, and at the request of the COL, CMS made the decision to assemble a voluntary work group of practicing physicians to engage with the health plan medical directors to review the bill, expand the scope beyond prescription prior authorization and propose solutions. According to CMS President F. Brent Keeler, MD, “The process of

A recent poll of CMS members indicated that the majority of physicians found the current pre-authorization policies too limiting and impeded their ability to deliver prompt and individualized medical attention to patients. Many members view prior authorization as having a negative impact on patient care. Clearly, physicians want a simpler, standardized approach for payers.

“We are committed to determining the scope of the issue and to develop solutions that are in the best interest of the patients we both serve, the physicians, as well as the businesses that pay the bills,” adds Price. The task force will take a phased approach to addressing prior authorization issues, beginning with prescription drugs, and in subsequent phases, addressing medical services, procedures, devices, medications, and potentially supplies and equipment. Additionally, the task force will address standardization among health plans to reduce redundancies and “hassles” for the physicians, a clear priority for physicians according to CMS surveys. Electronic submissions will be discussed and evaluated as well. Over the next couple of months, CMS and CAHP will remain committed to working together to implement agreed upon solutions to prior authorization. Sen. Morse, who will attend the first task force meeting, has agreed to stay involved in this highly collaborative process. “We could not be more pleased that a pro-patient advocate like Senator Morse will be monitoring the process and the progress of the meetings. It’s all coming together,” says Keeler. Progress updates and opportunities for physicians to engage in the process will be communicated electronically through the website in the award-winning magazine, Colorado Medicine. n

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

Colorado Medicine for January/February 2012

Features

New online resource for EHRs and meaningful use Susan Burke, Director, Communications

The Colorado Medical Society, COREC (Colorado Regional Extension Center) and CORHIO (Colorado Regional Health Information Organization) have developed a free, self-guided educational online tool, or portal, that provides resources to help medical practices better understand “meaningful use.”

training and educational modules to help them select, implement and meaningfully use certified EHR technology. It is designed to help physician practices track their work to achieve meaningful use over time. During each portal visit, users will often add or edit information in the portal.

Meaningful use stems from the American Recovery and Reinvestment Act and provides physician practices monetary incentives for the implementation of electronic health records (EHRs). Requirements of meaningful use include electronic prescribing, quality reporting and the capability of exchanging information with other systems.

The portal is available to all Colorado physicians or practice staff members. “We wanted to provide all of Colorado’s providers with a robust portfolio of resources that they could access on their own time in a self-directed way,” said former CO-REC Director Robyn Leone.

The new online portal takes physicians and their staff through step-by-step

No matter where you are on your path to meaningful use, the portal can help. It contains interactive tools including an EHR readiness assessment, EHR

selection criteria assessments, EHR contract considerations, and pre- and postimplementation checklists necessary for success. The portal has numerous downloadable documents and resources in easy to use formats like MS Word, MS Excel and PDF. It also has links to statewide resources and information on critical success factors and the most common “failure modes” that drive EHR and health information exchange implementation, as well as detailed HIPAA privacy and security requirements. The portal was created through a grant from the Physicians Foundation. For more information about meaningful use incentives as well as physician attestations, go to http://www.corhio.org/ portal. n

ANNOUNCING

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

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

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

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

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

Funded by a grant from the Physicians Foundation

http://www.corhio.org/portal Colorado Medicine for January/February 2012

Features

HIPAA privacy & security David Ginsberg, President, PrivaPlan Associates, Inc.

What physicians must do to achieve meaningful use Most physicians are aware that the American Recovery and Reinvestment Act (ARRA) provided substantial funding to encourage the adoption of electronic health records (EHR). Less well known is that ARRA also strengthens the Health Insurance Portability and Accountability Act (HIPAA). Additionally, HIPAA compliance is tied to earning ARRA incentives for implementing an EHR! Physicians must demonstrate they have achieved meaningful use as a qualification to earn the Medicare incentive and as a second year requirement for the Medicaid incentive. Currently, physicians are required to achieve the Stage 1 meaningful use objectives. There are fifteen core objectives and 10 “menu set” objectives, of which physicians can select five and defer five. The fifteenth core objective requires practices to “protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.” This speaks to HIPAA privacy and security rule compliance for the underlying infrastructure necessary to protect electronic health information. Electronic health information is synonymous with “electronic protected health information or ePHI.” The safeguarding of PHI (protected health information in any form – written, electronic or verbal) and ePHI are core principles of the HIPAA Privacy and Security Rules. Physicians demonstrate they have achieved the fifteenth core objective by the following measure: 20

Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. While meaningful use focuses on an electronic health record, this measure encompasses both the use of the EHR as well as basic HIPAA security compliance. In other words, pursuit of meaningful use reinforces a basic HIPAA requirement (45 CFR 164.308) that any covered entity must comply with – conducting a security risk analysis and maintaining a risk management program or process that corrects security deficiencies. What is a HIPAA security risk analysis? A HIPAA security risk analysis is a comprehensive review and audit of HIPAA security compliance. The HIPAA security rule states that the risk analysis is a requirement for compliance and specifies that covered entities: Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity. Unfortunately the process of a security risk analysis is neither simple nor fast. It requires careful evaluation of administrative, physical and technical safeguards. Thus a security risk analysis goes beyond simply looking at your EHR and includes examining the technical controls behind the EHR (for example your firewalls and Internet connections). It also requires

examining how you physically secure the EHR (such as the security of your server room or how workstations are protected). Administrative safeguards such as your hiring and termination practices, how you authorize access to the EHR, training and even your contracts with business associates must all be factored into the security risk analysis. A security risk analysis cannot be accomplished by reviewing a checklist alone; Centers for Medicare and Medicaid guidance is clear that the risk analysis would include both the analysis and findings (such as a criticality or impact analysis). Meaningful use further clarifies that physicians implement security updates as necessary and correct identified security deficiencies as part of its risk management process. This means you must also develop a plan to correct deficiencies. While these are meaningful use clarifications, it is important to note that any physician who is a covered entity under HIPAA is non-compliant if they have not already conducted a risk analysis. The HIPAA security rule has been in effect since April 2005. Other meaningful use applicability The Centers for Medicare and Medicaid (CMS.gov) specify that physicians who qualify and attest for ARRA incentives must conduct or review a security risk analysis of certified EHR technology and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR

Colorado Medicine for January/February 2012

Features reporting period. However, a new review would have to occur for each subsequent reporting period. This means that a new review is necessary for year two and subsequent periods of meaningful use. Additionally, CMS.gov instructs that a security update would be required if any security deficiencies were identified during the risk analysis. A security update could include updated software for certified EHR technology to be implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action that needs to take place in order to eliminate the security deficiency or deficiencies identified in the risk analysis. HIPAA changes under ARRA There are a number of HIPAA changes mandated by ARRA. Some have already been implemented such as: • New enforcement rules; • Applicability (enforcement) of HIPAA to business associates; and • Breach notification in the event of a breach of unsecured PHI. Additional changes are expected to be finalized in a soon-to-be-released omnibus regulation. n Mr. Ginsberg is a noted authority on HIPAA compliance and electronic health records. PrivaPlan offers several resources including a do-it-yourself HIPAA Privacy and Security Toolkit. Mr. Ginsberg is also the senior advisor to the Colorado Rural Health Center and ClinicNet-two of the CORHIO regional extension center contractors assisting physicians and small hospitals in meaningful use.

HIPAA help is here CMS and component medical societies are sponsoring a series of seminars across the state through a grant from the Physicians Foundation focusing on meaningful use and HIPAA privacy and security. Register for these seminars and find other resources at www.cms.org. • February 27, 6:00-7:30, Grand Junction • February 28, 6:00-7:30, Longmont • February 29, 6:00-7:30, Denver • March 1, 6:00-7:30, Colorado Springs Colorado Medicine for January/February 2012

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Features

PQRS program update

How to report and qualify for 2012 Marilyn Rissmiller, Senior Director, Health Care Finance Background: The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the Centers for Medicare and Medicaid Services (CMS) to establish a physician quality reporting system, including an incentive payment for eligible professionals who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI). The PQRI was further modified as a result of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) (Pub. L. 110-275) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). In 2011, the program name was changed to Physician Quality Reporting System (PQRS). For each program year, CMS implements Physician Quality Reporting through an annual rulemaking process published in the Federal Register. For 2012 the final rule was published on November 28, 2011 as part of the Medicare Physician Fee Schedule Final Rule. The Medicare Improvements for Patients and Providers Act (MIPPA) requires the Secretary to post on the CMS Web site, in an easily understandable format, a list of the names of eligible professionals (or group practices) who satisfactorily submitted data on quality measures for the Physician Quality Reporting System and the names of the eligible professionals (or group practices) who are successful electronic prescribers. Going forward: As Medicare moves from a passive payer to an active purchaser of higher quality more efficient healthcare through the implementation of the Physician Value-Based Payment Modifier (PVBPM), there will be negative payment adjustments if quality reporting 22

does not occur. PQRS will continue to provide incentive payments through 2014. However, in 2015 eligible professionals will receive a 1.5% reduction in charges if satisfactory reporting does not occur. In addition, the PVBPM will begin to affect physician payment starting in 2015, when payments for some physicians will be adjusted based on quality measures reported through PQRS. The 2015 PVBPM will utilize 2013 PQRS reporting for determining who is eligible for payment adjustments – positive or negative. This means that 2012 is your last chance to become familiar with PQRS and learn how you can incorporate and capture the information within your practice and begin reporting it to Medicare without incurring a penalty. And if you successfully report, you could qualify for an incentive payment for 2012. Program details can be found at http:// www.cms.gov/PQRS/. Dr. Mark Levine, Medicare’s chief medical officer for the Denver Region answers questions regarding the 2012 PRQS program: Q: Who can participate in PQRS? A: Eligible professionals who bill under the Medicare Part B Physician Fee Schedule (PFS) can participate. This includes physicians (MD’s/DO’s, etc.), practitioners (nurse practitioners, physician’s assistants, etc.) and therapists (physical therapists, etc.). A complete list of eligible professionals who can participate in PQRS can be found on the PQRS website at http://www.cms. gov/pqrs Q: What are the different reporting mechanisms? A: For 2012 there are four options for reporting of individual measures by in-

dividual eligible professionals, five options for reporting of measures groups by individual eligible professionals, and one option for group practices. Depending on which option is selected, the measures must be reported for either a twelve-month reporting period that begins January 1, 2012 or a six-month reporting period that begins July 1, 2012. Q: What is the reporting period for each? A: A full year reporting period for 2012 (January 1, 2012 to December 31, 2012), exists for all reporting options but one. PQRS also has a 6-month reporting option (from July 1, 2012 to December 31, 2012), though only for measure groups reported via a qualifying registry. Q: How many patients/measures do I need to report on to be “successful”? A: The criteria differ per reporting option selected. An implementation guide is available on the PQRS website that provides a decision tree that guides new users through PQRS reporting. This can be found at: http://www.cms. gov/PQRS/03_How_To_Get_Started. asp#TopOfPage Q: What is the bonus payment for this year and in 2013? A: The incentive payment for 2012 through 2014 is 0.5% of the eligible professional’s, or group practice’s, estimated total allowed charges for covered Medicare Part B Physician Fee Schedule services provided during the reporting period. Q: Have the quality measures changed for 2012? A: Yes. There are now a total of 210 individual measures that can be reported as well as 22 measures groups. Q: Explain the difference between individual measures and group measures.

Colorado Medicine for January/February 2012

Features A: Measures groups are a set of measures surrounding a particular condition, such as diabetes, heart failure, etc. Reporting with measures groups allows the eligible professional to report on the same measure group for either a percentage or a set of their patients throughout the year. Whereas with individual measures, an eligible professional can select

any three that apply to their practice to report on a percentage of their patients throughout the year (the reporting requirements differ by reporting option). Q: What would you tell physicians first if they are interested in participating in PQRS? A: First, no sign up or registration is re-

quired. All an eligible professional needs to do is select their measures, determine how they will report and start reporting. The best place to start is at the PQRS website with the 2012 PQRS Implementation Guide. This can be found at http://www.cms.gov/PQRS/03_How_ To_Get_Started.asp#TopOfPage. n

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Colorado Medicine for January/February 2012

Inside CMS

Polling results

CMS members make their voices heard on important issues Benjamin Kupersmit, Kupersmit Research The Colorado Medical Society recently surveyed its members regarding a range of public policy issues facing Colorado in the near term. Our survey results found: • CMS physicians continue to support strong involvement by CMS on achieving coverage and access for all Coloradans, and continue to express a strong belief that tort reform must be at the center of health system reform and efforts to improve quality and safety. • CMS physicians want simplicity and standardization from payers, and continuing support and education from CMS, on the challenges surrounding payment reform. • CMS physicians place great priority on strengthening advertising standards and enforcement, with a substantial majority reporting they have personally seen false or misleading advertising from a health care professional.

that members want CMS to continue making this a major strategic priority in the years to come. • Nearly all CMS physicians (91%) agree that ”all Coloradans should have access to needed medical care,“ including 64% who “strongly” agree. Three-quarters of CMS physicians (70%) agree that achieving access to care for all Coloradoans should be a major strategic priority for CMS; another 23% say this issue deserves at least “some” attention. • We have seen little change in your opinions on these topics since the 2008 member survey. • There is cautious optimism that access to care for all Coloradans is achievable, with 81% of CMS physicians agreeing that “by working together with businesses, insurers, governments and patient groups, we can achieve access to care for all Coloradans who need it.”

Our members participated in this year’s survey at a record rate: 981 of you filled out the current survey, which included the highest number of CMS physicians and medical students responding to date. As always, thank you to everyone who took the time to complete the survey.

Medical liability system reform We see equally intense levels of support for reform of the medical liability system; which is seen as being critical to improving patient safety and the quality of care, as well as being central to comprehensive health system reform.

Expanding coverage and access to care We continue to see widespread support for expanding coverage and access to care for all Coloradans, and it is clear

• CMS physicians agree almost unanimously that reforming the liability system is critical to improving patient safety and the quality of care, with fully 88% in agreement

(including agree).

62%

who

“strongly”

• We also see very high levels of agreement that tort reform must be at the center of health system reform, with 91% in agreement, including 64% who “strongly” agree. Payment reform As payment reform becomes reality, CMS physicians want a uniform, standardized approach from payers, and express significant concern – and want help from CMS – regarding the organizational and technological challenges reform will bring. • Fully 90% of CMS physicians agree with the statement that payment reform demands a “consistent, uniform approach by all payers,” with 53% saying they “strongly” agree. Future doctors agree: 81% of medical students agree with this statement as well, despite having had no direct experience in the system as of yet. • We see fairly substantial levels of concern about the need for practices to move toward “sophisticated technological systems, management of people, and leadership by physicians and staff” as part of payment reform, with 60% of CMS physicians saying they are concerned about this, including 26% who are “very” concerned. • Solo practitioners, owner/partners in small to medium practices and those age 46-64 are more likely to say they are “very” concerned.

Colorado Medicine for January/February 2012

Inside CMS • Three-quarters of CMS physicians (72%) say they are “very” interested (30%) or “somewhat” interested (42%) in support from CMS on meeting the challenges that payment reform presents to their practice. Advertising standards CMS physicians strongly support strengthening advertising standards for health professionals in Colorado, with a significant majority reporting that they have seen false or misleading advertising from a health care professional. • Fully 83% of CMS physicians believe it is “extremely” important (43%) or “very” important (40%) that Colorado has strong and effective regulation of advertising by health providers.

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• Currently, 92% of CMS physicians want to see advertising laws strengthened, with fully 60% “strongly” supporting such as move. • Two-thirds of CMS physicians (67%) say they have seen advertising by a medical professional in Colorado that they consider to be misleading or false. Methodology This survey was conducted online among 981 CMS members, including 803 CMS physicians and 178 CMS medical student members, from December 14, 2011 to January 10, 2012. The margin of error for the overall results is +3.1% at the 95% confidence level, and is +3.5% for the physician sample and +7.4% for the medical student sample. n

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Colorado Medicine for January/February 2012

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Colorado Medicine for January/February 2012

Inside CMS

JoAnne Wojak, Director, Continuing Medical Education

Colorado Medical Society approved by Accreditation Council for Continuing Medical Education to provide CME for physicians Colorado Medical Society has been approved as an accredited provider of continuing medical education after a 15-month CME application process with the Accreditation Council for Continuing Medical Education (ACCME). As a result, in addition to accrediting institutions as providers of CME, CMS is now able to accredit individual CME activities for AMA category 1 credit, says JoAnne Wojak, CMS CME director. While CMS was familiar with the accreditation process due to its ACCME “Recognized Accreditor” status, the application process was nonetheless quite an undertaking. It was our turn to walk the walk with respect to developing a CME program that demonstrates compliance with the strict new CME criteria. The CMS CME Committee, co-chaired by Clara Raquel Epstein, MD, (Boulder) and Mike Pramenko, MD, CMS immediate past president (Grand Junction) led the CME program and policy development effort. Dr. Pramenko was president-elect when the CMS board of directors took action to approve pursuing CME accreditation. “I’m very committed to continuing medical education and believe this CME effort will be important and beneficial to doctors in Colorado,” Pramenko says.

example, board certification now requires 25 CME credits annually, in addition to performance improvement activities. In 2010 the Federation of State Medical Boards adopted a Maintenance of Licensure (MOL) Model Framework Policy, a new roadmap for states to implement continued competency requirements for physicians. CMS and the Colorado Department of Regulatory Agencies are working collaboratively on a MOL program for physicians in Colorado. Additionally, Ongoing and Focused Professional Practice Evaluation requirements for Joint Commission hospital accreditation requires assessment of physicians’ performance, and appropriate interventions will most likely require CME. The CME mission statement consists of five components – purpose, content

areas, target audience, formats and expected results – which will guide the CME committee in its charge to assess educational needs, and review and approve CME activities and policies. “The mission statement must be universal and applicable to our entire CMS membership and their team, and will be reviewed periodically,” Epstein says. CMS plans to offer a wide variety of CME topics, both clinical and nonclinical, either directly or through joint sponsorship with other organizations. If your organization develops medical education for physicians and you wish to offer CME credit through joint sponsorship with CMS please contact the CMS CME office at 720-858-6309. Also visit our website at www.cms.org and click on CME for more information. n

Recent national events that will impact specialty board certification requirements, state medical licensure and hospital privileges required CMS to look at the accessibility and affordability of CME programs for its members. For

Colorado Medicine for January/February 2012

Inside CMS

Lead, follow or wander

Making the case for physician engagement Jan Kief, MD CMS President-elect

CMS Spring Conference – May 4-6, 2012 – Sonnenalp Resort, Vail CO As CMS president-elect, it is my responsibility to lead the planning of the Spring Conference. I consider this to be a great honor and I am very excited about this year’s conference agenda. The CMS Spring Conference theme, “Lead, follow or wander” will bring physicians from across the state together for relevant and topical discussions, workshops and camaraderie. This year’s focus is on ways you can make a difference by participating in the political process to make our medical community stronger. Relationship building with public officials is instrumental to helping us achieve our collective goals of preserving our practice, providing quality health care for our patients and creating a greater impact on the health of Colorado. The conference will kick off with Friday evening’s dessert reception and discussion about health care reform and the constitutionality of the individual

mandate. This thought provoking discussion will address the what-ifs during an open-mic discussion with thought leaders regarding the probable consequences and respective course corrections to contemplate should the U.S. Supreme Court uphold or declare invalid the individual coverage mandate. On Saturday and Sunday, attendees will shape the future of physician engagement through active participation in interactive work sessions and discussions. Highlights of this year’s Spring Conference include: • Political trainer Joe Gagden, JD, will lead an interactive session: The Rules and Realities of Physician Engagement. • Michael Weisskopf, award-winning journalist for Time magazine and the Washington Post, will share his insights on the value of relationships – organic and acquired. • Prepping for local engagement in the

•

2012 election cycle: Structured work sessions will prepare local physicians to engage their peers, communities and the candidate of their choice. A health insurance exchange progress and probability discussion will be led by Colorado Health Benefit Exchange Board Chair Gretchen Hammer. A session titled Defending Your Online Reputation in the Age of Transparency will teach physicians the importance of knowing and managing what is being said about them on the Internet. Cleaning up our Advertising Act(s): A discussion led by COPIC General Counsel Mark Fogg, JD, will focus on the current and prospective laws governing marketing and advertising in Colorado, and physician dos and don’ts. An updated prognosis of reimbursement realignments will also be presented.

Equipped with new ideas, inspiration and knowledge, you will be able to lead your practices into new territory by following the urgent and relevant issues associated with practice evolution, including legislative advocacy, reputation management and health care policy. And no one will wander alone with physician-to-physician outreach. Join me May 4-6 at the Sonnenalp Resort in Vail! Please return your completed registration form today and plan on an eventful and memorable weekend. n

Colorado Medicine for January/February 2012

Inside CMS

2012 CMS Spring Conference Agenda

Conference attendees, through a series of interactive, expert-led discussions and case studies, will understand the importance of local engagement with public officials – why politicians still listen to their local medical community, why patients still listen to their doctor, and the significance of collective engagement. There is more that unites physicians than can divide their beliefs and duty to their patients that makes medicine still a community no matter where physicians work.

Learn the rules and relevance of physician engagement: • • •

How to expand your reach and relevance at home How to transfer that reach into public policy relevance How to take care of your patients, practice and your peers in a world of radical transparency

Program key topic areas to include: • • • • • • •

Constitutionality of the Individual Mandate; Preparing For 2012 Election Engagement; Colorado Health Insurance Exchange; Reimbursement Realignment; Employed Physicians and Advocacy; Online Reputation Management and Social Media; Advertising & Marketing Laws for Physicians

Friday Evening, May 4 7:00 pm-9:30pm:

Health Care Reform and the Constitutionality of the Individual Mandate: Prepping for the what-ifs of the next mediquake aftershocks – an open mike discussion with thought leaders regarding the probable consequences and respective course corrections to contemplate should the US Supreme Court uphold or declare invalid the individual coverage mandate.

Saturday Morning, May 5 8:00am-8:15am: 8:15am- 9:30am:

9:30am-10:00am: 10:00am-10:30am: 10:30am-11:15am:

11:15am-12:15pm:

Why We are Here: Jan Kief, MD, CMS President-elect The Rules and Realities of Physician Engagement: An interactive session led by political trainer Joe Gagen JD The Value of Relationships: Case studies and experiences – their relevance, and consequences: a discussion led by veteran journalist Michael Weisskopf Wellness Break: Doris Gunderson MD Breaking through Breakouts: Prepping for local engagement in the 2012 election cycle: A highly localized set of structured work sessions to prepare local physicians to engage their peers, communities and the candidate of their choice New patient relationships: The progress and probabilities of the roll out of the Colorado Health Insurance Exchange: A focus group discussion led by Health Insurance Exchange Chair Gretchen Hammer

Saturday Evening, May 5 7:00pm-9:30pm:

A Fireside Chat with Michael Weisskopf: “What I’ve learned, unlearned, and relearned about life and the value of relationships – organic and acquired”

Sunday Morning, May 6 8:00am-8:10am: 8:10am-9:15am:

9:15am–10:15am: 10:15am–10 :45am: 10:45am-11:15am:

10:45am-Noon:

Noon:

Setting up the morning discussions: Jan Kief, MD Been There, Still There – Doing, undoing, redoing physician advocacy in the brave new world of medical disruption: A discussion led by CMS former President Rick May, with Brent Mulgrew JD, CEO Ohio State Medical Association and Gordon Smith, JD, CEO of Maine Medical Association Defending Your Online Reputation in the Age of Transparency: Learn the importance of knowing and managing what is being said about you on the Internet. Break and Wellness Break: Doris Gunderson, MD Cleaning up our Advertising Act(s): A discussion led by COPIC General Counsel Mark Fogg, JD on the current and prospective laws governing marketing and advertising in Colorado, and physician do’s and don’ts Reimbursement Realignments – An updated prognosis: A focus group discussion led by Center for Improving the Value in Health Care (CIVHC) on the march toward a world without or at least less Fee-forService and what we and you can do to adapt Wrap up and Next Steps: Dr. Kief

Colorado Medicine for January/February 2012

Inside CMS

Colorado Medical Society

2012 Spring Conference Registration Form May 4 through May 6, 2012 • Sonnenalp Resort, Vail

❏

I plan to attend the Spring Conference to be held May 4 – May 6 at the Sonnenalp Resort in Vail, including the Fireside Chat on Saturday night. I plan to arrive on:

❏ Friday May 4th

❏ Saturday May 5th

❏

My spouse/guest will attend the Conference.

❏

My spouse/guest will not attend the Conference but will attend the evening events.

________________________________________________________ Name

_____________________________ Component Society

________________________________________________________ Name of Spouse/Guest (if attending)

Mail to CMS, P. O. Box 17550, Denver, CO 80217 or fax to (720) 859-7509

Sonnenalp Resort of Vail Group Name: Colorado Medical Society Name: __________________________________________________________ Phone #: __________________________ Address: ___________________________________________________________________________________________ City: ___________________________________________________________ State/Zip: __________________________ Number in Party: ___________________

Arrival Date: _________________ Departure Date: ____________________

Credit Card Information: Please Note: All reservations must be guaranteed for their full length of stay. Early departures and/or late arrivals will be charged the contracted nightly rate per night dropped. Check one:

❏ Master Card ❏ Visa ❏ American Express ❏ Diners Club ❏ Discover

Credit Card Number: _________________________________________________ Expiration Date: _________________ Cardholder’s Name: ___________________________________________________________________________________ Special Seminar/Conference rate will be extended to attendees for longer stays. Valet parking $10/day. Free parking available in town of Vail parking structure. Desired Accommodations: Sonnenalp Resort of Vail Junior Suites:

❏ King Bed

$150 (plus 9.8% tax) per night, Single or Double Occupancy – Number of Units:

❏ 2 Double Beds

Sonnenalp Resort of Vail suites all contain gas-log fireplace, large baths with soaking tub big enough for two, separate shower, heated tile floor, walk-in closet, TV, TV Internet access, hand-carved pine Bavarian furniture, and down comforters on all of our beds. There will be an additional charge of $25.00 per night for each person over 12 years of age exceeding Double occupancy. (Note: most suite types cannot accommodate more than 3 adults.) Reservations received after April 4, 2012, will be taken on a space available basis only. Cancellation Policy: In the event of cancellation 14 or more days prior to arrival, you will receive a full refund. If you cancel less than 14 days prior to arrival, you will forfeit the deposit of one night room and tax. As of day of arrival, early departures will be charged a $50.00 change fee.

Reservations will be taken with this form or call our Reservations Department at (800) 654-8312. Register Online at www.sonnenalp.com • 1) Go to www.sonnenalp.com 2) Click top right tab “Reservations” 3) Enter group Code – 37J9FV 4) Enter your dates 5) Press continue at bottom of page 6) Review & ensure information is correct then press continue at bottom 7) Complete page noting your contact information, special requests & payment information 8) Bottom of page click book reservation

Please mail this form to:

Medicine January/February 2012 Sonnenalp Resort of Vail, Attn: Group Reservations, 20 Colorado Vail Road, Vail,forCO 81657

Colorado Medicine for January/February 2012

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 Genni Pearman 720-858-6308 or e-mail geneva_pearman@cms.org

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 720-858-6312 for more information and to donate 32

Colorado Medicine for January/February 2012

Inside CMS

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

COPIC expands role for 2012 legislative session: What we are monitoring and how we are providing active support COPIC spends time ensuring that Colorado maintains an environment that keeps your liability premiums stable and increases patient safety. We have been keeping busy during the 68th Colorado General Assembly. Typically, COPIC keeps you informed about legislation that could affect your ability to provide care and interrupt a patient’s ability to seek care. Recently, we have expanded our role to provide active support for legislation that positively and proactively impacts our health care system. Monitoring the session We will be monitoring any legislation that could increase your medical liability premiums and thereby affect a patient’s ability to access care. Of particular concern is the shortage of primary care physicians. Incredibly, 57 of Colorado’s 64 counties have been designated as primary care shortage areas. While the cost of medical liability insurance is a concern for all physicians, we know that significant cost increases for rural physicians can result in the closing of physician practices, causing decreased access to care for rural Coloradans. Proactively affecting health care in Colorado In recent years, we have supported legislation that will improve patient safety and keep the liability environment stable. In COPIC Topics (Dec. 2011), our Legislative Landscape column discussed the expiration of the Colorado Professional Review Act, the law that enables confidential peer review of physicians and the care they provide. We believe the discussions this Act protects are vital. During this session, the legislature must act on the Department of Regulatory Agencies’ (DORA) recommendation to extend the law to 2019. While we are reasonably confident that the Act will be extended, we have concerns as the DORA recommendation allowed for the expiration of the Committee on Anticompetitive Conduct (CAC). The CAC reviews allegations of anticompetitive conduct made by physicians who underwent peer review. Essentially, this means that the physician feels that the peer review committee (or a member of the committee) made his or her decisions about the care in question in order to remove a “competitor” from the market. The CAC determines whether the integrity of the professional review activity was tainted by anticompetitive conduct. COPIC and a group of health care organizations support the continuation of the CAC and have advocated for its expansion. The group suggests that the CAC handle every objection to adverse

Colorado Medicine for January/February 2012

professional review actions. By expanding the jurisdiction of the CAC, its expertise will be enhanced and it will keep such cases out of our court system, avoiding costly and lengthy proceedings. Despite advocating the expansion and continuation of the CAC, COPIC eventually concluded that the likelihood of success is poor because DORA remains committed to its elimination. The potential exists that a stalemate on the CAC could threaten the re-enactment of the peer review act altogether. There is ongoing discussion to address this matter. We are also excited about a proposal that will be introduced later in the session. The Cerebral Palsy Care Act would create a system that provides a certain class of children born with Cerebral Palsy (CP) with a greater opportunity to achieve their full potential. It also will provide us with a learning opportunity. The CP Care Act will be introduced by Cerebral Palsy of Colorado with support from COPIC and other organizations. Although CP affects a small percentage of babies, the families and children affected by CP face many challenges, especially financially. And because the causes of CP are largely unknown, this Act places Colorado at the forefront for researching CP and attempting to increase patient safety in this area. The Act accomplishes three things: 1) One-hundred percent of qualifying CP cases will be reviewed by a panel of experts to learn more about the causes of CP and what we can do to prevent its occurrence; 2) Each family affected by CP will receive a care coordinator to help the family navigate available benefits and resources. The Act allows families to request financial support for unmet needs, like purchasing a handicap van or modifying the family home for accessibility; and 3) Determine if someone caused the harm and hold that person(s) accountable. Should the committee determine that there was fault, the responsible party would be referred to the appropriate regulatory agency for evaluation, education and more. I have first-hand experience with cases of CP, and I can tell you that no one benefits from a lawsuit. It may be an ambitious goal, but we can do better by those affected by CP. We have a lot to learn, and this Act is a step in the right direction. Because legislation has the potential to greatly impact the health care community – positively and negatively – we encourage you to get involved and stay informed. Staying informed is easy. Sign up for alerts by visiting the Legislative Action Center at callcopic. com. n

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Colorado Medicine for January/February 2012

Departments

medical news Growing together The Colorado Medical Society is pleased to announce the appointment of five new members to the CMS team. Director of Communications Susan Burke leads the internal and external c om mu n ic ations for CMS, including membership r e c r u it m e n t and retention, media relations, public relations and Susan Burke branding. She specializes in strategic and integrated communications and has worked with several non-profits to cultivate their membership, increase awareness for their mission and implement new communications initiatives. CMS Director of Political Education and Advocacy Chris Lines represents COMPAC and the small donor committee by engineering grassroots involvement of physicia n s and spouses. He also lobbies during sessions of the Colorado legislature. Chris Chris Lines has served as a public policy liaison to the governor’s office, elected officials, DORA and other state agencies as well as organizations

within the education and business communities of Colorado. The Health Care Policy and Health Care Financing departments benefit from the addition of program assistant Susan Liptak. Susan provides collaborative program and project assistance to team members of the health care finance Susan Liptak and health care policy divisions including data collection and reports, meeting planning, project management and educational outreach. Susan also provides assistance to the communications division with website management and design. Lastly, she also brings marketing and event planning experience to CMS. Dianna Mellott-Yost, executive assistant to Alfred Gilchrist, CEO, and Susan Koontz, general counsel, coordinates programs and projects within the executive, legislative and legal funcDianna Mellott-Yost tions of CMS. Members of the society who serve on boards, committees, councils and county medical societies appreciate her

Join COMPAC Now! Colorado Medical Political Action Committee

Colorado Medicine for January/February 2012

ability to keep participants organized and informed as they attend wellplanned meetings and events. Tim Yanetta, coordinator for information technology and membership, supports CMS’ i n fo r m a t i o n technology needs, including database maintenance, IT support services and membership Tim Yanetta segmentation for targeted print and electronic communications. Tim has helped several companies with the design and development of websites, developed and maintained inventory tracking systems and set up database management and tracking systems. “We are thrilled to have these talented people on board,” Gilchrist says. “Each person will be making a vital contribution directly tied to the CMS strategic plan. Their work will help us to move closer to achieving our goals as we position CMS to be at the forefront of the rapidly changing health care environment, providing critical information, resources and legislative advocacy to our physician members.” New or seasoned, the CMS staff welcomes your thoughts, concerns and recommendations. Call anytime. n

Call 720-859-1001 or 800-654-5653, ext. 6317 35

Departments

medical news CMSEF scholarship winners announced The Colorado Medical Society is proud to award six medical scholarships to incoming first-year medical students at the University of Colorado School of Medicine. “The mission of the Colorado Medical Society’s Education Foundation (CMSEF) is to render financial support to selected freshman medical students based upon the student’s financial status, the inclination of the student, upon graduation, to serve rural and underserved areas, the student’s academic record, and we strive for diversity,” explains W. Gerald Rainer, MD, Education Foundation president. Dr. Rainer presides at the University of Colorado Health Sciences Center as the Distinguished Clinical Professor of Surgery. Winners of the 2011/2012 scholarships include: Caitlin Fernandez, Erin Gonzales, Ryan Martyn, Robert McLeroy, Jason Pfaffy and Julius Ngaile. “The program has been gratifying to the members of the Colorado Medical Society Education Foundation Board and we feel particularly honored to serve in this worthwhile endeavor,” adds Rainer. In addition to funding scholarships, the Colorado Medical Society Education Foundation supports education programs such as the Colorado State Science and Engineering Fair and the Education Program at the CMS annual meeting. n

ONC director honors Colorado physicians for meaningful use

Director of the Office of the National Coordinator Farzad Mostashari, MD, (fourth from left) shares a celebratory moment with John Bender, MD, Julie DeSaire, Greg Sharp, MD, Tracy Hofeditz, MD, Bruce Carmichael, Chet Cedars, MD, and Marjie Harbrecht, MD. These meaningful use vanguards (MUVers) were honored as leaders helping to shape Colorado’s HIT landscape.

Experienced Psychiatrist Wanted To Care for Our Nation’s Finest

at Evans Army Community Hospital – Fort Carson Humana Clinical Resources is seeking a Psychiatrist to provide a full spectrum of

psychiatric care to military members and their dependents in the Behavioral Health Department of Evans Army Community Hospital, Fort Carson. Fort Carson is the home of the Air Force Academy and the US Olympic training center and is located about 8 miles south of Colorado Springs, CO a city of about 375,000. Provider will work full-time days (no call) alongside a fully staffed team of experienced providers caring for a predominantly healthy patient population. Requirements include board certification by the American Board of Psychiatry and

Neurology, current, unrestricted licensure to practice as a Psychiatrist in any U.S. State, current DEA registration and a minimum of 6 months practice experience within the past

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

year. U.S. citizenship and current BCLS certification are also required prior to start. Competitive remuneration package available as Independent Contractor including paid time off and $10K sign on bonus. For confidential consideration please send your CV to: cfitzpatrick@humana.com or fax to (502)322-8764, or you may call Mrs. Fitzpatrick tollfree at 1-888-241-1475.

Colorado Medicine for January/February 2012

Departments

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

➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES MOBILE PHYSICIAN NETWORK– delivers primary care services to underserved community seniors. We are seeking a physician with house call and skilled nursing facility experience. Flexible schedules. No first call duty. Strong medical background with excellent people skills required. Email resume to gdunlopmd@ mobilephysician.net WANT TO MAKE A DIFFERENCE IN A PROFESSIONAL SETTING? Mobile Doctors of America (http://www. MDARX.org) is interviewing doctors (MD’s and DO’s with unrestricted licenses and DEA certification) for part-time opportunities along the front range and Colorado’s rural communities to fulfill our mission of providing accessible alternative health care solutions to chronic pain sufferers. Responsibilities include initial and follow-up evaluations in a non-narcotics clinic. Organization is led by a philanthropic group of professionals focused on a multi-discliplinary approach to healing. CNN coverage: http://mmapa.us/2011/ cnn-report/ To schedule an interview, call John at 855-632-7987. JOIN OUR GROWING HOSPITALIST TEAM! - Large primary care medical group seeking hospitalists to join our inpatient team at local Denver-metro hospitals. Competitive salary and benefits with incentive plan. E-mail CV and references to human.resources@nwphysicians.com

FAMILY PHYSICIAN – FORT COLLINS Established practice seeks family physician for immediate opening. Employment/Partnership Track. No OB/Inpatient. Fax CV to (970) 295-0036 or email to officemgr@ftcollinsfp.com. PRACTICE INTERNAL MEDICINE IN A DYNAMIC NEW MULTISPECIALTY UNIVERSITY-BASED OUTPATIENT SETTING. The Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine seeks master clinicians committed to providing high quality care for patients in an innovative new University-based multi-specialty practice in the Denver metro area. Integrated electronic medical record. Teaching opportunities available. Opportunity to be a part of a shared governance structure for the practice. Build a new practice or bring your existing patients with you. Candidates must be board certified or board-qualified in internal medicine. Salary commensurate with skills and experience. Applications accepted until position filled. The University of Colorado is committed to diversity and equality in education and employment. Apply at www.jobsatcu.com, job posting 816468.

EXECUTIVE DIRECTOR–HEALTH & COUNSELING CENTER, UNIVERSITY OF DENVER – The University of Denver Executive Director (ED) - Health and Counseling Center is a senior–level administrator responsible for the comprehensive leadership, vision and management of the HCC Cluster team and the integration of these areas (medical services, counseling services, health promotion and administration) for the optimal benefit of students, faculty and staff at the University of Denver. The ED is also the liaison to the medical and mental health community in Denver and local and state health department. The ED oversees the selection, training, supervision, evaluation, recognition/ appreciation, and management of the HCC department (a team of 34-36 professional and graduate staff). Application are made exclusively on-line at - www.du.edu/ hr/employment/jobs.html

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Colorado Medicine for January/February 2012

Project C.U.R.E. collects donated medical equipment and supplies and organizes them for delivery to people in need in developing countries. Volunteers needed locally to sort medical supplies and internationally to participate in C.U.R.E. Clinics. For more information, visit http://www.projectcure.org, call 303-792-0729, fax 303-792-0744, or e-mail projectcureinfo@projectcure.org.

Features

the final word Edward A. Dauer, LLB, MPH, George D. Dikeou, JD, and Judy Hamm

The Cerebral Palsy Care bill: Advocating for families within a framework of public health and patient safety A coalition of physicians, patient safety groups, care providers and insurance companies have worked for more than two years to develop what has come to be called “The CP Bill.” CP denotes both the bill’s purpose – it is more formally titled the Cerebral Palsy Care Act – and one of its principal architects, Cerebral Palsy of Colorado. When enacted by the Colorado legislature – hopefully, this year – it will redefine birth-related cerebral palsy in the framework of public health and patient safety. The bill offers a multi-pronged approach to the financial and personal challenges families face when a child is born with what is often a profoundly debilitating condition. Accessing and coordinating the existing medical, educational, rehabilitative and other resources is by itself daunting where it is not overwhelming; and even when all of that can be achieved substantial unfunded needs remain. Health insurance, for example, does not cover mobility, special furnishings, or any aspect of family needs such as respite care. And because the largest majority of CP births are not attributable to provider error, the law’s liability system almost never contributes in a positive way. The overall structure of the CP bill comprises three main goals: compensation for otherwise-unmet and CP-related needs provided in an efficient and individually tailored way; a patient-safety focus designed to provide learning from every eligible birth; and a link to existing professional review systems which balances accountability where that is necessary with non-punitive health care quality improvement where that would be even better. In outline, the bill provides the following: Eligible births: All families resident in 38

Colorado and whose delivery occurs in a Colorado birthing facility are eligible if the child’s birth weight is at least 2500 grams (about 5.5 pounds), if the child exhibits defined neurological deficits predictive of CP within the first seven postpartum days, and if the child is diagnosed with CP at any time within the next eight years. While some of these criteria may seem limiting, each is necessary to make the program workable. The program’s funding will come entirely from malpractice insurers and self-funded insurance trusts which now pay to defend and, rarely, to indemnify lawsuits alleging provider negligence in connection with birth-related CP. The 2500 grams excludes low birth weight babies whose problems are significant but not birth-related. The seven-day record likewise excludes injuries resulting in CP-type consequences which occur years after the birth. And restricting eligibility to cerebral palsy is appropriate given the demonstration purpose of the program. If it proves successful in its time others may consider broadening its scope. Benefits: The benefits will be secondary to a family’s private or public health insurance. The program will fill in where there is unmet medical and related need, and will provide for care and living needs the family requires but which existing programs do not cover. All of the benefits will be afforded on an “as needed” basis. There will be no lump-sum awards, and therefore no risk of compensating some families too little and some too much. Existing legal protections will be available in cases where there are differences of opinion in the evaluation of needs. Equally important, from the moment an eligible birth is noted (and reporting of those cases will be mandatory) the family will be provided a dedicated case manager

– an expert in coordinating medical care as well as in navigating the complex public and private benefits terrain. While financial savings is one objective of effective care coordination, far more valuable will be the expected improvement in life-long outcomes. Learning and Accountability: The bill will create a new health care quality review capability, staffed by experts in pediatrics, neurology, obstetrics, and others whose knowledge can be helpful in case review – including experts in patient safety and systems performance, and the family itself. The review panel’s findings will be made available to the hospital or other facility for its own QA or professional review. Aggregated and de-identified findings will be widely published and brought to the attention of hospitals, physicians, and others both in health care and the public. The review process will not pursue questions of negligence or fault. Its focus is on learning and where possible remediation or education, using today’s adverse events to prevent tomorrow’s. Speaking legally, the CP Care program will be available to affected families as their complete and exclusive remedy, i.e. malpractice lawsuits against health care providers will not be available to families otherwise eligible for the CP program. The trade-off is expected to be entirely favorable. Exceedingly few families are successful with birth-related CP cases in the courts today, yet physicians’ and hospitals’ insurers spend literally millions every year winning lawsuits and defending against families’ claims. The vast majority of families gain nothing from the existing legal process. Under the Cerebral Palsy Care Act every affected family will have its needs met; and everyone in Colorado will benefit from its focus on safety, quality, and the prevention of future harm. n

Colorado Medicine for January/February 2012

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