July-August 2016 by Colorado Medical Society

July/August 2016

Volume 113, Number 4

2016 ANNUAL MEETING Redesigned meeting to resonate with physicians in all stages of career Award-winning publication of the Colorado Medical Society

contents July/August 2016, Volume 113, Number 4

Features. . . 12

Annual Meeting programming–An impressive slate of

AMA Annual Meeting report–The Colorado delegation to the AMA brought and passed an important resolution on physician wellness.

Q&A on health plan merger effects–BCMS President Leto Quarles, MD, led the charge for physicians in Boulder by penning a letter to the U.S. Department of Justice urging the department to block the Aetna-Humana merger.

Special advisory committee on ColoradoCare– Colorado Medical Society formed a special advisory committee to analyze and compare ColoradoCare and the current multi-payer system.

ColoradoCare pro/con analysis–The CMS Special

Multi-payer system pro/con analysis–A companion

National health plan merger update–Read about organized medicine's success fighting the proposed health plan mergers in Missouri and California.

Let's get engaged!– CMS is nearly ready to launch Central Line, our new virtual policy engagement system designed to allow CMS members to collaborate directly with other members, staff and board members about proposed or existing policy ideas and concepts.

Final Word– CMS President-elect Katie Lozano, MD, talks about the deliberative process to analyze the ColoradoCare/ Amendment 69 proposal as well as the current health care delivery system.

2016 ANNUAL MEETING

Cover story We’re counting down

the days until we reveal the re-engineered CMS Annual Meeting, Sept. 16-18 in Keystone. We can’t wait to welcome you and your families to this grand reunion that will provide a space to unwind, engage and reconnect with the reason you chose medicine. Read more starting with the cover story on page 8, as well as the agenda, programming preview and more throughout this issue.

Inside CMS

5 President’s Letter 7 Executive Office Update 38 Clean Claims Task Force 39 COPIC Comment 40 Reflections

Departments 42 45 49

Medical News CMS Elections Classified Advertising

Colorado Medicine for July/August 2016

speakers will confront the hottest topics in medicine at the 2016 Annual Meeting. Get a sneak peek into the meeting sessions and workshops. See the full agenda on page 14, registration form on page 16, seven reasons to attend on page 17, and a list of sponsors and exhibitors on page 19.

Advisory Committee on ColoradoCare worked diligently to create a thoughtful pro/con analysis on the proposal to inform the CMS membership. piece to the ColoradoCare analysis, the advisory committee developed a list of pros and cons of the current health care delivery system.

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

2015/2016 Officers Michael Volz, MD

President

Katie Lozano, MD President-elect J.T. Boyd, MD

Treasurer

Alfred D. Gilchrist Chief Executive Officer Tamaan Osbourne-Roberts, MD Immediate Past President

Board of Directors Charles Breaux Jr., MD Laird Cagan, MD Sami Diab, MD Curtis Hagedorn, MD Mark B. Johnson, MD Aaron Jones, MS Richard Lamb, MD David Markenson, MD Gina Martin, MD Christine Nevin-Woods, DO Edward Norman, MD David Richman, MD Charlie Tharp, MD Kim Warner, MD

AMA Delegates A. “Lee” Morgan, MD M. Ray Painter Jr., MD Lynn Parry, MD Brigitta J. Robinson, MD AMA Alternate Delegates David Downs, MD Jan Kief, MD Katie Lozano, MD Tamaan Osbourne-Roberts, MD AMA Past President Jeremy Lazarus, MD

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

Division of Health Care Financing Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

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

Division of Government Relations Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Adrienne Abatemarco, Program Manager Adrienne_Abatemarco@cms.org

Division of Health Care Policy Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org

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

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

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

Inside CMS

president’s letter Michael Volz, MD President, Colorado Medical Society

Advocacy in action: addressing health plan pain points Advocacy works. That is what I was thinking about as I walked into the first meeting in July of a special Physician Advisory Group convened by Colorado Division of Insurance Commissioner Marguerite Salazar charged with making recommendations to address some of the problems that physicians are facing with commercial health plans. If you are a regular reader of Colorado Medicine then you know that CMS has devoted a lot of time and energy to resolving these pain points and getting policymakers to hear what the current realities of doing business with health plans are like for physicians and patients. Commissioner Salazar listened.

from around our state, different settings and many specialties about what interacting with health plans is really like today. The meeting was particularly timely as the DOI is considering whether or not to block the AnthemCigna merger, in addition to wrapping up a stakeholder process to help develop new network adequacy regulations. The stories were candid, concerning and sometimes even heart wrenching. And as Commissioner Salazar said, the stories are troubling. As a result she created the Physician Advisory Group and her work and leadership now represents another important step in our fight to remove barriers to good care.

We continue to listen. We have heard from you and physicians like you from across the state about problems doctors are facing, like unfair contracting, prior authorization, claims payment, delayed payment and network selection/de-selection. We have also heard from patients about their often exasperated and sometimes desperate need to have health insurance that actually works. That is why CMS designated payer issues as an organizational priority and why our advocacy on these issues has only just begun.

Now is the time Marketplace changes, mega-mergers, sweeping national and state legislative and regulatory reforms are only intensifying the need to understand and solve these problems. We have always held that physician practices are one of the best barometers for how well the system is working to serve patients’ and communities’ needs. Right now physician workplace dissatisfaction is at an all-time high and continues to rise. It is well documented that much of this dissatisfaction is the direct result of third party interference resulting in the inability of physicians to provide good care. The fact is that if Colorado’s health insurance system was a patient, then she would need a doctor.

We are grateful that the Hickenlooper administration is both actively listening and engaging with us to not just better understand but to solve these problems. Division of Regulatory Agencies Executive Director Joe Neguse, Commissioner Salazar and Hickenlooper senior health policy advisor Kyle Brown, PhD, all participated in a physician listening session in April that featured first-hand experiences from almost 35 physicians Colorado Medicine for July/August 2016

Will the new Physician Advisory Group be the prescription to cure all of these ails? No, of course it won’t. But it can serve as a critical next step in addressing key issues including network adequacy, provider directo-

ries, access plans, continuity of care, contracting/payment issues and prior authorization. Importantly, given all that she has heard recently from physicians, Commissioner Salazar has also expressed interest in exploring how the DOI could begin taking provider complaints rather than having to be exclusively reliant on consumer complaints in order to investigate and act upon inappropriate health plan behavior. In addition to myself, the group is comprised of some of the profession’s best minds from different specialties, practice types and settings including Drs. Christina Finlayson, David Friedenson, Davis Hurley, George Kalousek, Alan Kimura, Glen Madrid, David Markenson, and Peter Ricci. Standing up This is what advocacy is all about. Championing a just cause to solve a challenging and complex problem, using a thoughtful, methodical, evidence-based, professional and persistent process with input from our membership. As the summer heats up and campaigns begin the sprint toward November elections, I understand all too well that politics can sometimes appear maddeningly complex and frustratingly slow. I also know that your Colorado Medical Society is very good at advocacy. This is what we do – we stand up for our physician colleagues and the patients we serve. We are here for all of you. The new DOI Physician Advisory Group and our other work on payer issues is the latest demonstration of resolve in order to make a difference. n

THE STRENGTH TO HEAL

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Colorado Medicine for July/August 2016

Inside CMS

executive office update Alfred Gilchrist, CEO Colorado Medical Society

A rare circumstance: health care politics will be local and national this November We may be witnessing the rare – as in, pretty-much-never – circumstance in this general election where a national debate on the financing and delivery of health care is both local and national at the same time. Voters will be subjected to a barrage of paid advertising, volunteer door-knocking and the resulting media coverage across at least two, and possibly three, well financed fronts: the presidential contest in a crucial “battleground” state, where the nominees have sharply divergent views on health care policy, ColoradoCare/Amendment 69 (see pro/con analysis staring on page 25) and a probable ballot initiative regarding physician-assisted death. Health care policy will be debated in living rooms, boardrooms and break rooms from now through Election Day. Unless Coloradans choose to tune out (refraining from TV, smart phones, newspapers or computers), there will be no avoiding health care policy questions raised in this election cycle, and the subjects are among the most intimate and personal that could be contemplated. As voters go down-ballot to local contests for congressional and state legislative candidates, they may also measure those races in health care terms, asking where their state legislative or congressional candidates fall on these large, contentious questions. This rare, prettymuch-never situation provides a series of remarkable opportunities for physicians to engage with candidates and build relationships in the heat of an election cycle where health care is being discussed with the same passions and concerns ordinarily reserved for other more provincial or ideological issues. The arcane world of health policy is no longer an abstraction, but rather a politically relevant and Colorado Medicine for July/August 2016

localized debate. In that environment, your ideas can have long-term consequences over the next several sessions of the Colorado General Assembly and in the 115th (2017-18) Congress.

2017 may very well be more galvanized as the serious questions of coverage, current law and the impending radical realignments of Medicare reimbursement are rinsed through the elections.

By engaging local physicians in the screening and support of candidates and incumbents through the primaries, we have advanced the balance of legislators and prospective legislators who will defend Colorado’s hard-earned liability and professional review climate, and started a process of building relationships with key legislators and candidates who will listen to our side of things on restoring balance in the transactions between physicians and health insurance companies. On the federal side, health politics beginning in

Questions of oversight, transparency, accountability and fairness in the business side of physician and insurance company relationships will be guaranteed more than a public hearing. If physicians engage their area legislators this summer and fall, a larger pool of informed legislators will emerge with dispositions anchored in their local medical communities. This is a moment when all health care politics are local, and local relationships are as important as the issues yet to be debated. n

...because

2016 ANNUAL MEETING Redesigned meeting to resonate with physicians in all stages of career By Christine LaRocca, MD Chair, Annual Meeting Re-engineering Work Group

Cover Story STORY HIGHLIGHTS • The 2016 CMS Annual Meeting will be held in Keystone, Colo., Sept. 16-18. • A work group of your peers worked to redesign the entire meeting to fit the needs of Colorado physicians in all stages of careers and lives. • There is something for everyone: A wide range of programming on the hottest topics in Colorado medicine, a guided hike and other fitness opportunities, social events, and more. There’s more emphasis on physician wellness, collegiality and camaraderie than ever before. • Register online at www.cms. org/register.

You should come to the CMS Annual Meeting this September. As chair of the Annual Meeting Re-engineering Work Group, I’m personally inviting you, whether or not you have attended this meeting before. The fun and dedicated physician and medical student members of the work group have worked over the past six months to completely redesign the meeting into a highly energized forum so it resonates with Colorado physicians in all stages of our careers and lives. This year’s meeting will be relevant and meaningful, representing Colorado culture at its finest. It will be laid back and relaxed, innovative and smart, and – best of all – will fully embrace picturesque Keystone, Colo. Physicians are increasingly being asked to do more, particularly when it comes to payment reform, health care policy and technology. We ask you to take a break; give us a weekend to engage with you on the hottest topics in medicine in a way that leaves you rejuvenated. Colorado culture prizes the journey, not just the destination, and your medical society and peers Colorado Medicine for July/August 2016

are here to support you. Join us at the signature gathering of Colorado physicians, the 2016 Colorado Medical Society Annual Meeting. A big change for 2016 The biggest difference between this year’s meeting and previous years is that it will be the first without a House of Delegates function. Last year’s delegates changed the way CMS will set policy from now to the foreseeable future; in The New CMS, we no longer have to make a year’s worth of policy decisions over one weekend. Colorado physicians didn’t take that responsibility lightly and, as a result, it dominated the annual meeting. Uncoupling governance from the meeting opened up endless possibilities for programming, giving us on the work group the opportunity to thoughtfully consider what Colorado physicians want and need in social events and education. At the same time, we wanted to be sure we kept the many opportunities to exchange ideas and concerns with fellow members since we have so few occasions to connect face-to-face these days. All structured social activities – Friday’s Exhibitor Reception, Saturday morning’s early riser hike, that evening’s Presidential Gala and Reception, and Sunday’s Breakfast with the Board of Directors – will be great forums to network and converse. Most plenary panel discussions and lectures will employ real-time voting with results shared with the Board of Directors, and small-group breakouts will facilitate meaningful brainstorming in a relaxed setting. For the techsavvy, we will embrace online interactions through social media. You spoke, we listened In early 2016, CMS sent an email survey to all members asking you to rank the importance of certain conference features – things like CME, collegiality, expert speakers and free time to spend with family or friends – as well as programming ideas. We were overwhelmed by your insightful responses and have worked hard to integrate your comments and suggestions where

we could while keeping the rest on file for the future. We have exciting programming with the top experts to bring you a panel discussion on the ins and outs of ColoradoCare/Amendment 69, the single-payer initiative on the ballot in November; a panel discussion on health insurance mega-mergers and network issues; a keynote speech and follow-up sessions on how to be well

“Physicians are increasingly being asked to do more, particularly when it comes to payment reform, health care policy and technology. We ask you to take a break; give us a weekend to engage with you on the hottest topics in medicine in a way that leaves you rejuvenated. Colorado culture prizes the journey, not just the destination, and your medical society and peers are here to support you.” and stay well; workshops on opioids and dangerous patient encounters; a panel of experts on navigating MACRA, the new physician payment program; and a breakdown of the latest political issues and candidates. And, making the most of your time, many of the programs will offer either CME or COPIC points. See briefs on each program starting on page 12 and the full agenda starting on page 14. Take a hike – really! The work group talked at length about

Cover story (cont.) why CMS members – who are business owners, professionals, parents, community leaders and innovators – should give up a weekend to come to this conference, and, since it’s held in the mountains, how to incorporate time to enjoy our surroundings. We also wanted to make the event family-friendly for those with children or spouses joining them. We’re proud to say that there’s something for everyone. The early risers can enjoy a hike or yoga on Saturday morning. Kids of all ages can have fun Saturday biking, paddle boating and crafting at the children’s activity center. Fitness enthusiasts can participate in a 5K walk/run. And anyone can take a gondola ride to the mountain summit for excellent views and photos. Even though our schedule is jam-packed with education and social events, we encourage you to take time to pause and breathe in the fresh mountain air. There’s more emphasis on physician wellness, collegiality and camaraderie than ever before.

Join us! I was absolutely delighted to be asked by President Mike Volz to chair the Re-engineering the Annual Meeting Work Group. It has been a highlight of the year for me to be more involved in the medical society and to help plan this meeting. I know there’s so much going on in our lives that it’s often difficult to get away. I’m a big Carly Simon fan and there’s a line in one of her songs that says, “how to turn down the noise in my mind.” I hope that’s what this weekend can be for you – time to hit the pause button, relax and remind yourself why you chose medicine and why it’s the best profession in the world. n

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

Register: www.cms.org/register Hotel accommodations: Reserve your room online at tinyurl.com/2016-CMS-AM-hotel or by phone at 800-258-0437, Group Code CL2M16 NEW THIS YEAR: The Children’s Activity Center! Register your children for a funfilled activity day on Saturday while you are enjoying the conference. Snacks and lunch will be provided. Parents/ guardians are encouraged to attend and participate, though not required. Children will be grouped by age and will participate in age-appropriate activities that may include arts and crafts, paddle boating and bike rental. More info: www.cms.org/ events/annual-meeting

Colorado Medicine for July/August 2016

STANDING TOGETHER WE MAKE A DIFFERENCE R

M E D I C A

CMS

SEPT. 16-18, 2016 • KEYSTONE RESORT

Come together to engage the experts, both state and national, across the most pressing subjects of immediate relevance and concern to our medical community. Share, debate and learn from the best of the best.

T Y I E

CMS ANNUAL MEETING

N U A L

MEETING HIGHLIGHTS

FRIDAY, SEPT. 16

SATURDAY, SEPT. 17

SUNDAY, SEPT. 18

• EXHIBITOR RECEPTION

• EARLY RISER YOGA OR HIKING

• COLORADOCARE/AMENDMENT 69 PANEL DISCUSSION

• KEYNOTE SPEAKER:

• BREAKFAST WITH THE BOARD OF DIRECTORS

MARY LOVERDE On work-life balance and staying connected to what matters most • BREAKOUTS/WORKSHOPS ON ACTIVE SHOOTER PREPAREDNESS, OPIOIDS, MERGERS, MACRA AND WELLNESS • “ VOTERS HOLD THE TRUMP CARD” COMPAC LUNCHEON WITH FLOYD CIRULI, RICH DEEM, JERRY JOHNSON AND MARK JOHNSON, MD

• COPIC EDUCATIONAL SESSIONS (ERS POINTS) • COPIC PRESENTATION WITH COPIC CHAIRMAN AND CEO TED CLARKE, MD

• PANEL DISCUSSION ON PHYSICIAN-ASSISTED DEATH

• PRESIDENTIAL GALA AND COPIC DESSERT RECEPTION

KEYNOTE SPEAKER Mary LoVerde

ON WORK-LIFE BALANCE AND STAYING CONNECTED TO WHAT MATTERS MOST Mary has traveled from Bangkok to Biloxi sharing her innovative strategies for staying connected to what matters most. She has published four books in three languages and has appeared four times on Oprah, a 20/20 special on stress, and was featured on ABC World News Tonight. Her blog is read in

35 countries. Her original work is published in the Wall Street Journal, the New England Journal of Medicine, and the Ladies Home Journal. She served on the faculty of the University of Colorado School of Medicine for 15 years as the Director of Hypertension Research Center.

HELP US — PEER TO PEER — REMEMBER WHY DOCTORS ARE DOCTORS.

REGISTER TODAY AT WWW.CMS.ORG Colorado Medical Society | 7351 E. Lowry Boulevard, Suite 110, Denver, CO 80230-6083 | (800) 654-5653

Features

STORY HIGHLIGHTS • Our expert speakers will confront the hottest topics in medicine and present them with a Colorado-focused, exam-room perspective. Topics include all sides of the ColoradoCare November ballot initiative, what’s being done to restore balance and fairness with the health plans, how to manage your pain patients, case studies on how to stay out of the courthouse and protect the safety of your patients, and more. • CMS will employ real-time straw polling to get your opinion and ideas on all the hot topics to share directly with your board of directors. Your ideas translate into policy and advocacy at the statehouse and other points of influence. • Many of the sessions offer CME credit and/or COPIC points, increasing their value. This September, Colorado physicians will come together as a community in Keystone for the first annual meeting absent a House of Delegates governance process to engage the experts – state and national – across the most pressing subjects of immediate relevance and concern to our medical community. A dedicated one-time physician work group built the agenda from the ground 12

up, drawing from a statewide physician survey of what is keeping medical professionals and your advocates up at night, and a methodical series of interviews and conversations with peers. An impressive lineup of speakers will give you insider’s knowledge you can’t just pull off the web, and our workshops bring the biggest issues down to an intimate scale. Plus, we will employ real-time straw polling to get your opinions on all the hot topics to share directly with your board of directors. You are more than an attendee at this annual meeting; you’re an integral part of our network. It all begins following the exhibitor reception Friday evening, Sept. 16, with a panel discussion: The Ins and Outs of ColoradoCare: Implications for Providers. ColoradoCare is a proposal to create universal, government-run health care in the state, that will be on the November election ballot as Amendment 69. “ColoradoCare would be a massive change in Colorado’s health care system,” said speaker Michele Lueck, president and CEO of the Colorado Health Institute. “No other state would have a system like ours. The election could be close, and doctors need to know how to separate fact from speculation when it comes to this amendment.” Other speakers include Sen. Irene Aguilar, MD, D-Denver; Cody Belzley, policy director for Coloradans for Coloradans: No on 69; Michael Cooke, representative of the Metro Denver Chamber of Commerce; and Benjamin Kupersmit, president of Kupersmit Research.

“Physicians attending this panel discussion will gain deep insight into the potential benefits and drawbacks of Amendment 69 from a wide range of perspectives, and will be among the first to review the results of member polling,” Kupersmit said. “Frustration with the current delivery and funding system is at a boiling point; is ColoradoCare the answer physicians are looking for?” Saturday morning begins with a humorous and fast-paced presentation: Physician Heal Thyself, presented by Mary LoVerde, who served on the faculty of the University of Colorado School of Medicine for 15 years as the director of the Hypertension Research Center. You’ve organized, prioritized and delegated. You’ve made friends, linked in and have clout. You’re a veteran of the time-management wars, fighting for the life-balance ideal – and you’re losing! LoVerde’s presentation will teach you a new work-life balance approach. You’ll leave armed with “works in real life” ideas for staying connected to what matters most. Following the keynote are concurrent workshops. LoVerde will lead a presentation titled: I Used To Have A Handle On Life But It Broke! “Most of us feel that the only way to manage the mounting chaos in our lives is to take control. If only we could get a handle on life! No wonder we have overwhelming to-do lists that leave us feeling exhausted and powerless,” LoVerde said. In this heartwarming and funny program, you’ll learn straightforward, innovative techniques for keeping balance no matColorado Medicine for July/August 2016

Features ter what comes up and will leave armed with ideas that work in real life and can be implemented immediately. A corresponding workshop on physician wellness will be led by the CPMG Section, “Yeah, But...” Organizational Challenges in Physician Wellness. It will focus on how to implement the language, metrics and return on investment that make business and operational sense for physician wellness, and how to get buyin for culture change for physician wellness. Interested in another topic? Our other workshops span a wide range of issues: • Dangerous Patient Encounters, with Michael Victoroff, MD. • Avoiding the Pitfalls of Opioid Prescribing, with Abigail Anderson, MD. Managing a patient’s chronic pain is complex. Anderson will discuss the latest recommendations for opioid prescribing and teach you how to help your patients avoid dependence and abuse. • Consolidation in Health Care – Reversing the Benefits of Competition, with Henry Allen, JD, and Diana Moss, PhD.

sess the down-ballot consequences of the presidential contest and speculate on the various win-lose scenarios and their respective influence on the direction of state and federal health policy. We’ll even have two surprise awards presentations. “You may gain some insight into exactly what is driving this crazy election – or you may leave as confused as ever,” Johnson said. “But either way, you will be able to recognize and thank our two legislative award winners who have made medicine a priority and who support physicians and patients at the state capitol every day!” Sunday morning features our final panel discussion of the weekend: Physician Aid in Dying – Perspectives and Priorities. This topic is sure to stimulate fascinating discussion informed by the results of a recent all-member survey. Attendees will gain a better understanding of the perspectives and priorities of CMS physicians on this difficult, often polarizing, topic with the hope of identifying areas

of common ground where we can work together to protect our patients and our colleagues. “Physicians across the nation are grappling with the implications of an expanding movement to enact PAD laws, most recently in California,” said speaker Kupersmit. “At this panel, we’ll explore deep differences, as well as areas of strong agreement among CMS members on this difficult issue. Your peers working with patients in end-of-life care, as well as patients and their families who face these issues, need physicians like you to be informed and ready should efforts to legalize PAD advance in Colorado.” Joining Kupersmit on the panel are CEJA Vice Chair Lynn Parry, MD, and CHI’s Lueck, with moderator CMS President Michael Volz, MD. We can’t wait to dive into the annual meeting programming. Find more information and register at www.cms.org. We’ll see you in Keystone the weekend of Sept. 16-18. n

And don’t worry if you’re interested in more than one; these workshops will be repeated Saturday afternoon. Following the workshops is an interactive program: MACRA – The New Physician Payment Program; Tools and Resources to Support the Transition presented by Mark Levine, MD. The SGR is gone; are you ready for its replacement? Come learn how to succeed with Medicare’s new quality payment program. Also speaking is Carol Vargo, American Medical Association director of physician practice sustainability. The COMPAC lunch on Saturday, The Voters Hold the Trump Card, will feature a lively panel discussion moderated by COMPAC Chair Mark B. Johnson, MD. A distinguished panel featuring Colorado’s top nonpartisan analyst, Floyd Ciruli; the AMA’s federal and congressional affairs guru, Rich Deem; and our veteran lobbyist, Jerry Johnson, will asColorado Medicine for July/August 2016

MEETING AGENDA: DAYS 1 & 2 FRIDAY, SEPTEMBER 16 12:00 p.m. - 12:45 p.m. 12:00 p.m. - 1:00 p.m. 1:00 p.m. - 5:00 p.m. 3:00 p.m. - 3:30 p.m. 3:00 p.m. 5:30 p.m. - 7:30 p.m. 7:45 p.m. - 9:30 p.m.

LOCATION

Finance Committee BOD Lunch Board of Directors BOD Exhibitor Break and refreshments Registration opens Exhibitor Reception, including appetizers and cash bar The Ins and Outs of Colorado Care: Implications for Providers (CME available) Sen. Irene Aguilar, Cody Belzley, Benjamin Kupersmit and Michele Lueck

SATURDAY, SEPTEMBER 17 7:00 a.m. - 8:00 a.m. 7:00 a.m. 7:00 a.m. 8:00 a.m. - 8:45 a.m.

Healthy Choice Breakfast Early Riser Yoga Early Riser Hike with Dr. Osbourne Keynote: Physician Heal Thyself (CME available) Mary LoVerde

9:00 a.m. - 10:00 a.m. Workshops (CME available) I Used To Have A Handle On Life But It Broke! Mary LoVerde

CPMG Section: “Yeah But...” Organizational Challenges in Physician Wellness

Castle Peak 1 Castle Peak 3-4 Foyer Castle Peak 3-4 Shavano Foyer Registration Desk Shavano Foyer Red Cloud/Shavano LOCATION Shavano Foyer Studio K – Lakeside Village Gazebo – Lakeside Village Red Cloud/Shavano

Crestone II Crestone III

• Talk the Talk: Language, metrics, and return on investment that make business and operational sense for physician wellness. • Challenges in Culture Change: How do we get people on board with physician wellness in a changing landscape. • Piloting Programs: Taking small steps towards a bigger end goal.

Dangerous Patient Encounters Michael Victoroff, MD

Torreys I

• Categorize violent encounters that health care providers and facilities should prepare for (e.g., patient, non-patient, unarmed, edged weapon, firearm, active shooter, suicide). • Identify vulnerabilities and assets that factor into the response to a dangerous encounter in health care settings (e.g., physical security, communications, training, rehearsal). • Review current concepts and guidelines for survival in active shooter and other violent scenarios.

Avoiding the Pitfalls of Opioid Prescribing Abigail Anderson, MD

Torreys II

• Common pitfalls of opioid prescribing that can lead to poor patient outcomes and/or sanction by a privileging or licensing body. • Current guidelines and best practices, such as the Colorado Quad-Regulator Joint Policy for Prescribing and Dispensing Opioids, and the new CDC Guideline for Prescribing Opioids for Chronic Pain, and how to apply these in your own practice. • Tools – including prescription drug monitoring programs – that are appropriate for monitoring patients on opioids and other controlled substances, and how to use them.

Mergers: Consolidation in Health Care: Reversing the Benefits of Competition Henry Allen, JD, and Diana Moss, PhD

Torreys III

• Understanding the importance of competition in the health care supply chain • When does health care consolidation harm consumers, medical professionals, and innovation? • Why are large health insurance mergers likely to trigger additional consolidation?

10:00 a.m.-10:45 a.m. Exhibitor Break 11:00 a.m.-12:00 p.m. MACRA: The New Physician Payment Program; Tools and Resources To Support the Transition Mark Levine, MD, and Carol Vargo (CME available)

Shavano Foyer Crestone I

• Be able to answer the question, “What is the Medicare Quality Payment Program/ MACRA?” • Explain the difference between MIPS, an alternative payment model and an advanced alternative payment model • Describe clinical practice improvement activities and available resources for your practice Colorado Medicine for July/August 2016

MEETING AGENDA: DAYS 2 & 3 SATURDAY, SEPTEMBER 17 (CONTINUED)

LOCATION

12:15 p.m. - 1:45 p.m. COMPAC Luncheon: The Voters Hold the Trump Card Floyd Ciruli, Rich Deem, Jerry Johnson and Mark Johnson, MD

Red Cloud/Shavano

1:45 p.m. - 2:00 p.m. Virtual Policy Presentation 2:15 p.m. – 3:00 p.m. Breakout Sessions Repeated (CME available) • MACRA: The New Physician Payment Program; Tools and Resources To Support the Transition Mark Levine, MD, and Carol Vargo • CPMG Section: “Yeah But...” Organizational Challenges in Physician Wellness • Dangerous Patient Encounters Michael Victoroff, MD • Avoiding the Pitfalls of Opioid Prescribing Abby Anderson, MD • Mergers: Consolidation in Health Care: Reversing the Benefits of Competition Henry Allen, JD and Diana Moss, PhD • Virtual Policy Engagement System: Digital Assets 3.15 p.m. - 4:15 p.m. Exhibitor break with giveaway drawings 4:15 p.m. - 5:30 p.m. Free time 5:30 p.m. - 6:00 p.m. Reception 6:00 p.m. - 11:00 p.m. Presidential Dinner COPIC Dessert Reception

Red Cloud/Shavano

SUNDAY, SEPTEMBER 18 7:00 a.m. - 8:00 a.m.

Crestone I Crestone III Torreys I Torreys II Torreys III Crestone II Shavano Foyer Red Cloud/Shavano Foyer Red Cloud/Shavano

LOCATION

Healthy Choice Breakfast

Shavano Foyer

Non-Verbal Communications in Medicine: Let Me See Your Body Talk Dennis Boyle, MD (CME and COPIC Points available)

Red Cloud/Shavano

• Review the importance of non-verbal communication in medicine. • Develop a toolkit to improve non-verbal skills. • Examine non-verbal communication in others.

8:00 a.m. - 9:00 a.m.

Alumni Breakfast

Torreys I

Breakfast with the BOD

Crestone I&II

Medical Divorce: What To Do Before, During and After a Practice Break-Up or Change Dean McConnell, JD (CME and COPIC Points available)

Red Cloud/Shavano

• Identify Prenuptial Issues: Steps to take before there is a problem. • Define Legal Separation: Steps to take upon the departure of a physician in the practice. • Analyze the Divorce Proceeding: Tips for dealing with litigation between partners in a practice.

9:15 a.m. - 9:30 a.m.

COPIC Update

Red Cloud/Shavano

• Science fair winners

9:30 a.m. - 10:45 a.m.

Physician Aid in Dying: Perspectives and Priorities Michael Volz, MD, Daniel Johnson, MD, Lynn Parry, MD, Benjamin Kupersmit and Michele Lueck (CME and COPIC Points available)

Red Cloud/Shavano

• Understanding the perspectives and priorities of CMS physicians on this difficult, often polarizing topic, with the hope of identifying areas of common ground where we can work together to protect our patients and our colleagues.

10:45 a.m.

Closing comments Katie Lozano, MD

CME Accreditation The Colorado Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Colorado Medical Society designates this live activity for a maximum of 7.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Colorado Medicine for July/August 2016

**Agenda is subject to change**

Annual Meeting Registration Now Open

Colorado Medical Society Annual Meeting • Keystone Resort • Sept. 16-18, 2016 Visit www.cms.org/events/annual-meeting to register online. It’s quick, simple and secure. NEW: The Children’s Activity Center on Saturday. Go to the meeting webpage for details and to register your kids. Name (please print)

Component Society Name of Spouse/Guest(s) CMS Connection Member q Yes q No Registration deadline is September 5, 2016. Registrations accepted on a first-come, first-served basis (may be limited for some pro-

grams). For purposes of registration, Connection members and staff of county medical societies are considered members. You must indicate the number of attendees for each function so that we may be cost efficient with food/beverage orders.

Friday, September 16

member

spouse/guest

5:30 p.m.

Exhibitor Reception

Saturday, September 17 (Complimentary for member & one guest only)

CHARGES FOR ADDITIONAL GUESTS

7 a.m. 12:15 p.m. 5:30 p.m. 6 p.m.

Breakfast Buffet COMPAC Lunch Reception Presidential Gala Meat dinner Vegetarian dinner Vegan dinner Gluten-free dinner

Sunday, September 18 7 a.m.

Breakfast Buffet

q q q

#_______ @ $35/each_________ #_______ @ $35/each_________

q q q q

#_______ @ $105/each_________ #_______ @ $105/each_________ #_______ @ $105/each_________ #_______ @ $105/each_________

member

spouse/guest

TOTAL amount enclosed for non-members and additional guests.

#_______ @ $35/each_________

Please make check payable to: Colorado Medical Society, or charge ❑ Visa ❑ MasterCard ❑ Discover ❑ Am. Express

#exp. date

Signature Register online at www.cms.org or e-mail this form to dianna_mellott-yost@cms.org; mail it to PO Box 17550, Denver, CO 80217-0550; or fax it to 720-859-7509.

Hotel Reservations Reservations must be received by Monday, August 8, 2016, to be eligible for the group rate. Visit www.cms.org/events/annual-meeting, or call 800-258-0437 to reserve your room today. Remember to use Group Code CL2M16 to secure the conference group rate. ROOM TYPE Keystone Lodge and Spa Inn at Keystone Hotel Room Conference Village Studio Bedroom Condominium Conference Village One Bedroom Condominium Conference Village Two Bedroom Condominium Evergreen Neighborhood One Bedroom Condominium

RATE $159 $139 $171 $159 $249 $159

Check in is 4 p.m. or after and check out is 11 a.m. or earlier.

REASONS 7 REASONS

There are many more than just seven There are many more than just seven reasons reasons to join your colleagues at the to join your colleagues at the reinvented reinvented annual meeting of the Colorado annual meeting of the Colorado Medical Medical Society. This year’s meeting, our Society. This year’s meeting, our very first very first without a House of Delegates without a House of Delegates governance governance structure, will be entirely structure to work around, will be entirely devoted to celebrating the community of devoted to celebrating the community of medicine. It will bring Colorado physicians medicine. It will bring Colorado physicians together for social, clinical and intellectual together for social, clinical and intellectual

11 22 33 44 55 66

ATTENDTHE THE TOTOATTEND CMSANNUAL ANNUALMEETING MEETING CMS

stimulation that will be part therapy, part stimulation – part therapy, part policy policy exploration and part insider briefings exploration and part insider briefings on the on the hot spots in health care politics, hot spots in health care politics, policy and policy and downstream consequences of the downstream consequences of the November November elections. We can’t wait to unveil elections. We can’t wait to unveil the new the new annual meeting for you and your annual meeting for you and your families families. Find more information and register Sept 16-18. Find more information and at www.cms.org. We’ll see you in Keystone register at www.cms.org. We’ll see you in the weekend of Sept. 16-18. Keystone.

You need a break You a breaksatisfaction engaging with your peer group on the hottest clinical and political topics You'llneed find tremendous

You'll tremendous satisfaction engaging with peer group oncountry. the hottest clinical and political topics with find insight from the top experts in the state andyour from around the It's like shooting the breeze around with from the topor experts the state and from around It's Keystone, like shooting the breeze around the insight office water cooler in the in doctors‘ lounge, except you‘llthe be country. in beautiful Colo. the office water cooler or in the doctors‘ lounge, except you‘ll be in beautiful Keystone, Colo.

Your family and friends will have plenty to do Your and friends plenty dofamily and friends can re-energize at yoga, enjoy While family you‘re interacting with yourwill peershave and the experts,to your While interacting with participate your peers in and thewalk/run, experts, your family and friends can re-energize yoga, for enjoy milesyou‘re of biking and hiking, a 5K or take a gondola ride to the mountain at summit miles of biking and hiking, participate in worry, a 5K walk/run, or time take a ride and to the mountain summit for excellent views and photos. (And don‘t you‘ll have togondola sneak away join them, too.) excellent views and photos. (And don‘t worry, you‘ll have time to sneak away and join them, too.)

You will be amazed by the depth and breadth of expertise of the speakers You betalking amazed the depth andpolicy breadth of expertise speakers With will so many headsby often getting medical and politics topics wrong,of youthe will amazed by the

With so and many talkingof heads oftenof getting medical policy and topics topics wrong,you youcan’t will amazed depth breadth expertise our slate of speakers whopolitics will confront just pullby offthe the web depth and breadth of expertise of our slate of speakers who will confront topics you can’t just pull off the web – all sides of the ColoradoCare November ballot initiative, what‘s being done to restore balance and fairness – with all sides of the ColoradoCare ballot initiative, what‘s being done to restore and fairness the health plans , how to November manage your pain patients, case studies on how to staybalance out of the courthouse with the health plans , how to manage your pain patients, case studies on how to stay out of the courthouse and protect the safety of your patients. And that‘s just the beginning. and protect the safety of your patients. And that‘s just the beginning.

You will be among friends – your peers You willbebe among friends your peers You will among your friends, your – peers to talk about the big picture and all the small stuff you sweat every You will be among your friends, your peers to talk about the big picture and all the small stuff you sweat every day. It’s like a group therapy session – where you will make new friends and reconnect with old friends – but day. It’s like a group therapy session – where you will make new friends and reconnect with old friends – but with good food and lots of laughs. with good food and lots of laughs.

Youropinion opinionand andideas ideasmatter matter Your We will employ real-time straw polling to get your opinion and ideas on all the hot topics to share directly with We will employ real-time straw polling to get your opinion and ideas on all the hot topics to share directly with your board of directors. Your ideas translate into policy and advocacy at the statehouse and other points of your board of directors. Your ideas translate into policy and advocacy at the statehouse and other points of influence. influence.

You’llattend attendworthwhile worthwhileworkshops workshops You’ll We have worked hard to put together workshops that bring to an intimate scale how to get and stay well,

We have worked hard to put together workshops that bring to an intimate scale how to get and stay well, how to manage your pain patients and help them recover, how to get ready for the radical shift in Medicare how to manage your pain patients and help them recover, how to get ready for the radical shift in Medicare payments, and more. payments, and more.

Youcan canrecapture recaptureyour yourlove loveofofthe theprofession profession You You will remember why you chose this noble profession, immerse yourself in the community of medicine You will remember why you chose this noble profession, immerse yourself in the community of medicine and all that you care about, and know you are never alone. and all that you care about, and know you are never alone.

THENEW NEWCMS CMS THE

MORE INFORMATION VISIT WWW.CMS.ORG FORFOR MORE INFORMATION VISIT WWW.CMS.ORG

Colorado Medicine for July/August 2016 Colorado Medical Society | 7351 E. Lowry Boulevard, Suite 110, Denver, CO 80230-6083 | (800) 654-5653

Colorado Medical Society | 7351 E. Lowry Boulevard, Suite 110, Denver, CO 80230-6083 | (800) 654-5653

Features

AMA Annual Meeting report Kate Alfano, CMS Communications Coordinator

Colorado delegation passes resolution on physician satisfaction The Colorado delegation to the American Medical Association brought and passed a resolution at the 2016 AMA Annual Meeting of the House of Delegates to add physician work-life balance to provider experience measures for evaluating how well alternative payment models function.

call for background checks and a waiting period for all firearms purchasers, expanding on a previous AMA policy of requiring the same for only handguns.

discrepancies between various demographics and the need for further research. This resolution was adopted as AMA policy.

Other new AMA policies span a range of issues, from radon testing to powdered alcohol to school start times.

The delegation raised the concern that the “Triple Aim” – a term coined by the Institute for Healthcare Improvement – is “jeopardized by the burnout of physicians and other health care professionals.” As originally conceived, the Triple Aim seeks to improve patient experience of care, health of populations and reduction in per capita costs.

In other Colorado delegation news, Brandi Ring, MD, in private practice at Mile High OB/GYN in Denver, was elected to the YPS governing council in the position of the chair-elect. It is a three-year position with the first year as chair-elect learning from and assisting the current chair. The second year is as the chair leading YPS and the third year is as immediate past chair to help guide and advise the new leadership. “I am very excited to be elected to this position and am even more excited to follow in so many of my Colorado colleagues’ footsteps such as Steve Sherick, Katie Lozano and Brigitta Robinson,” Ring said.

Another MSS-authored resolution asked the AMA to recognize the practice of immediate postpartum and post-pregnancy long-acting reversible contraceptive placement as a safe and cost-effective way of reducing future unintended pregnancies. The resolution also asked for the support of coverage by Medicaid, Medicare and private insurers, and that these services be billed separately from the obstetrical global fee. It was adopted.

The new AMA policy, which was debated, amended for clarity and purpose and approved, changed the Triple Aim to the Quadruple Aim. The AMA will ask the Centers for Medicare and Medicaid Services to count physician satisfaction as a Clinical Practice Improvement Activity under the Merit-Based Incentive Payment System (MIPS). One of the most controversial issues at the AMA meeting concerned a late resolution authored by the Young Physicians Section (YPS) following the recent mass shooting in Orlando, Fla. The final adopted policy directed the AMA to call gun violence in the United States “a public health crisis” requiring a comprehensive public health response and solution. Additionally, the AMA resolved to actively lobby Congress to overturn legislation that for 20 years has prohibited the Centers for Disease Control and Prevention from researching gun violence. And the AMA will 18

Medical student update The Medical Student Section (MSS) authored and passed several resolutions, and held several caucus meetings as well as a joint caucus meeting with the Resident/Fellow Section (RFS) and YPS. Eric Bendixen, a first-year medical student at Rocky Vista University, represented Colorado at the meeting. A MSS-authored resolution asked the AMA to study potential educational efforts concerning organ donation in demographic groups with low organ donation rates. It received unanimous supportive testimony at the reference committee meeting, citing statistical

One resolution that received some of the strongest support from the MSS asks the AMA to work with the Federation of State Medical Boards to eliminate USMLE Step II CS/Complex Level II PE from medical licensure, and develop national standards for schools to reliably test their own students. MSS felt the exam has not been shown to be a reliable source in predicting future physician outcomes and it is time consuming, detracts from students’ clinical experiences and is “unreasonably” expensive. Other meeting highlights • The AMA HOD affirmed a comprehensive update of the nearly 170-year-old AMA Code of Medical Ethics, the conclusion of a meticulous project started eight years ago to ensure that this ethical guidance keeps pace with the demands of the changing world of medical practice. • Several new policies were put into place by the HOD addressing factors Colorado Medicine for July/August 2016

Features that are critical to reducing opioid medication misuse, overdose and death, including prescription drug monitoring programs (PDMP), access to naloxone and addiction medicine as a sub-specialty. • AMA President Steven J. Stack, MD, gave his outgoing presidential address, pointing out the “world of contradictions” in which physicians live: It’s a profession of rewards and privilege amid the toll of frustration and burnout, borne of administrative hassles and bureaucratic overreach. The challenge is to persevere and lead the way for others, he said. • Incoming AMA President Andrew W. Gurman, MD, an orthopedic hand surgeon in private practice in Altoona, Pa., issued a call to action for physicians to be leaders and advocates for their profession. “Let this be the year we tell our colleagues about all that we are doing on their behalf and on behalf of our patients, so that more may join in our fight.” • Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, said that the driving factor behind many of the changes in the new Medicare payment system was physician input. He encouraged physicians to continue to work to improve the system. n

CMS 2016 Annual Meeting Sept. 16-18 • Keystone Resort • Keystone

CMS thanks the following sponsors and exhibitors for their support of this year’s annual meeting

Presenting Level Sponsor COPIC Gold Level Sponsors CIGNA HealthCare Colorado Drug Card Greenlight UnitedHealthcare Silver Level Sponsors Michelle Morin, Waddell & Reid, Inc. Exhibitors

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, call Tim at 720-858-6306 or e-mail tim_yanetta@cms.org

Colorado Medicine for July/August 2016

Center for Personalized Education for Physicians ColoradoCare Colorado Physician Health Program First Healthcare Compliance First National Denver Flatirons Practice Management Medical Telecommunications Radiology Imaging Associates Sharkey, Howes & Javer TransFirst

Features

Health plan mergers The negative effect insurance company mega-mergers will have on Boulder County Q&A with Leto Quarles, MD, President, Boulder County Medical Society STORY HIGHLIGHTS • A survey of Colorado physicians showed they are concerned about the impact the proposed mega-mergers between Anthem and Cigna and Aetna and Humana may have on their patients and their practice. The Colorado Medical Society has been in staunch opposition of these mergers, with the support of the American Medical Association. • In opposing the mergers, our survey data has been shared with the U.S. Department of Justice and the state insurance commissioner, both deciders on whether the mergers move forward. DOJ has interviewed physicians in the high concentration areas, including Boulder. • BCMS President Leto Quarles, MD, sent a letter to the DOJ urging the Department to block the Aetna-Humana merger. In a 14-page letter dated June 3, 2016, the Boulder County Medical Society, with the full support and backing of Colorado Medical Society and the American Medical Association, urged the U.S. Department of Justice to block the AetnaHumana merger and to disregard and reject Colorado Division of Insurance’s (DOI) approval of the merger. 20

Colorado Medicine sat down with BCMS President Leto Quarles, MD, to discuss this letter and the expected impact the insurance company mega-mergers could have on her patients, practice and community. Colorado Medicine (CM): Data from the AMA and federal Centers for Medicare and Medicaid services show a high market concentration in Boulder County should the Aetna-Humana proposed merger-acquisition be approved. What would be the practical consequences to Boulder physicians should this merger be approved? Leto Quarles (LQ): In plain English, the sheer number of patients in Boulder County covered under Aetna and Humana is a huge proportion of the total population for which we provide care. If Aetna and Humana are allowed to merge, we are one step closer to a monopoly, and this new Super Aetna would have the power to dictate reimbursement rates and terms to physicians, leaving us with little or no negotiating power. It becomes a take-it-or-leave-it deal for doctors. So, what would that look like? Physicians in general, and certainly my colleagues here in Boulder County, view our work not just as a job, but as a calling, a relationship and a responsibility toward our patients and our community. If we are told that in order to continue taking care of many of our patients we have to accept lower reimbursement

rates and even more arbitrary administrative burdens, most of us will feel we have no choice, financially or ethically, but to accept whatever pittance is being offered. Most of us would sigh and grumble, and roll up our sleeves and continue to do the best we can with what we have for those who need us. But let’s take a closer look at that. Historically, physicians have been sighing and grumbling and rolling up our sleeves and making do more and more over the past several decades. And what has been the result? Years of published evidence is very clear on this. Each time we accept lower reimbursement for our services, that burden gets greater – not only on each of us personally as physicians, but on our patients and our communities. We cannot afford as much staff support, so we do more of the non-doctoring work ourselves – work we are not trained for, are not necessarily very good or efficient at, and that takes up more and more of our time. We cut visit times shorter, trying to squeeze more patients into a day to make up for the lost reimbursement. With less time to spend with our patients, and fewer (or fewer highly trained) professional staff, our patients are left with less support to understand and manage their health between visits, and their health and sense of well-being suffers. When our practices are financially strapped, we are less able to serve the community in other ways: we accept fewer Medicaid or indigent patients; we have less time and energy to engage in Colorado Medicine for July/August 2016

Features community leadership roles, educate the public about our specialty, sponsor or support healthy community projects, lend our voices, our ears and our hearts to the community causes we care about. When doctors are less engaged with our communities, when we no longer have the time and energy to coach that Little League team, or sit on the board of the local Rotary chapter, or emcee the LGBT Seniors Ball, or whatever our passion – when we are no longer connected with our communities, not only do we as individuals suffer, but we are also more likely to drift away. Physician mobility is at an all-time high. A generation ago, it was almost unheard of for a doctor to pick up and move to a new community once we were established in practice. Today it is not uncommon for a physician to change jobs six or more times in a career, often relocating with these changes. We are retiring younger and younger, and those of us who can’t afford to retire yet are more often transitioning to “non-clinical career tracks.” It pains us to walk away from our patients. But at the end of the day, we have to go where we can thrive – a broke, broken and burned-out physician is no good to anyone, and even we are starting to recognize that.

arbitrary and minimal-recourse processes of prior authorizations and mandated formularies and facilities they choose to impose. As I just described, physicians and our practices would be economically pushed to cut even more corners, further reducing the time we can spend with each patient and the quantity and quality of professional support our practices can provide to each individual seeking our care, both at and between visits. The most serious consequence of these preferred network referrals, restricted formularies and panels, and poor reimbursement is that, ultimately, they disincentivize us to properly care for our sickest, most medically complex, and therefore most expensive patients. CM: As you know, the Colorado Division of Insurance did not hold any public hearings or otherwise solicit commentary from the affected health care communities, including physicians, and approved the merger through inaction. If you could have had an oppor-

tunity to testify, what would you have said to the department? LQ: I have to say I was disappointed in the Division’s decision to not provide notice to the public or give us an opportunity to participate. The business of health care today is complex to say the least, and the Division of Insurance is, ideally, one of our key partners in working to ensure that all Coloradans have reasonable and equitable access to appropriate medical care. To not be a part of this conversation around issues that so vitally affect our everyday practices and ability to care for our community was upsetting on many levels. It’s important to keep in mind that all care is delivered locally, not globally. These concentration levels of any one commercial insurer at the MSA level are by definition monopsonistic (giving the insurance company, as “purchaser” of health care, control over price and therefore quality), and it is vitally impor-

An Aetna-Humana merger would leave Boulder County physicians in a financially perilous position, one in which neither choice – staying in-network and accepting lower reimbursements and further imbalanced terms, or walking away and losing a large bulk of our patients – is viable or acceptable. It would significantly add to physician attrition through retirement, relocation and transition to non-clinical careers – and these are substantial losses that our growing Boulder County population can ill afford. CM: How would these circumstances translate to patients? LQ: Under this proposed new Super Aetna, clinical decision-making between physician and patient would be further disrupted. One very powerful insurer would channel the bulk of our patients though whatever convoluted, Colorado Medicine for July/August 2016

Merger Q&A (cont.) tant to consider this reality as our state decides how the business of health care will be allowed to operate in our communities. If I’d had the opportunity to be at the table for this decision, which so impacts how we Boulder County physicians care for our patients, I would have thanked the Division, as the one state regulator charged with oversight of such a powerful industry, for hearing the voices of patients and physicians in affected communities. We would have reminded the Division that the decision to approve this merger will directly influence care value and efficacy. We would have presented the same antitrust issues to the department that we recently made in our plea to the US DOJ. CM: This is not Boulder County’s first antitrust rodeo. What were the dynamics when you successfully persuaded the DOJ to divest Pacificare when UnitedHealth Group was proposing to acquire them back in 2006? LQ: Déjà vu all over again! The most vital thing that the United-Pacificare experience taught us was to underscore the critical importance of working together in organized medicine. Individually, our practices felt frustrated and threatened. But by pooling resources and standing together, Boulder County Medical Society, with the Colorado Medical Society and the AMA at our back, was able to take on that Goliath and hold our ground. Working together in organized medicine is a powerful thing. Just like last time, Boulder County physicians have enjoyed the strong support of the AMA and its robust team of experts as well as the full backing, in terms of logistics, legal expertise, lobbying power, technical advice and amassed critical data of the Colorado Medical Society. Boulder County is a diverse, dynamic, passionate, creative and very bright community of physicians and our patients. But ultimately, we are one small fish in the giant sea of health care in the U.S. Without the powerful and un 22

wavering support of organized medicine in the form of CMS and the AMA, we could never have realized the successes and stability of our practice environment that we do enjoy today. CM: Do you have any other thoughts in terms of a comparison between the United-Pacificare merger and the mergers proposed at this time? LQ: This is the beauty of being one part of the greater whole of organized medicine. I was brand new to Boulder County in 2006. But as a part of the Boulder County Medical Society, I have had the opportunity to be briefed a number of times by our experts, and talked with many colleagues locally, gaining the shared benefit of their expertise and experience. In the United-Pacificare proposed merger, the DOJ required a divestiture based on monopsony concerns in Boulder, even though the merged entity would not necessarily have had market power in the sale of health insurance. In that case, we successfully argued that even though consumers might not see their direct prices (premiums, etc.) immediately rise, that merger would have led to decreased physician-practice compensation, and therefore diminished services and quality of care. The DOJ rightfully recognized that a local threat to the health and well-being of health care consumers existed in our community, and took action to safeguard our practices and our patients. The AMA has been instrumental in helping us help the DOJ clearly understand our concerns. In the past, we have opposed health insurance mergers on the basis of these monopsony concerns, and this pattern compelled the AMA to draft a model physician survey, which we were able to administer here in Colorado as well as in numerous other highconcentration states, to demonstrate these concerns and their implications. With the power of the AMA behind us, all of this data has now been amassed and is being presented to individual state insurance commissioners as well as directly to the DOJ. Our profession is therefore even better prepared than

before, and our efforts are coordinated across Colorado and across the nation, thanks to the AMA. CM: What else would you like to tell us? LQ: While I’m inquisitive by nature, I knew almost nothing about insurance and antitrust law less than a year ago when I stepped into this role as BCMS president. In addition to fighting these insurance mega-mergers, our Boulder County Medical Society has been very active with a number of other issues and conversations of importance to physicians in our community, and as a family physician, I see patients of my own full-time. I knew fighting these mergers would be critically important for all of us physicians in Colorado and especially in Boulder County, but as one finite doctor and human being, the task seemed daunting, even overwhelming and impossible. Instead, as a member and local leader within the unified body of organized medicine, I am hugely relieved and grateful to be one small part of an incredible engine to get this done. Our CMS CEO Alfred Gilchrest, our CMS President Dr. Michael Volz, our CMS legal counsel Susan Koontz and the entire CMS legal team, the full executive and administrative permanent staff at CMS, the crackerjack legal team at the AMA and the full general staff of the AMA, our local Boulder County Executive Judy Ladd, and every Boulder County and Colorado Medical Society member, as well as the full breadth and power of the AMA have made it possible to take this stand together. I am grateful to each of you for getting me up to speed, answering my questions and arming BCMS with all of the data, arguments and fortitude to take on this fight. And thank you, especially, to my fellow physicians in the trenches who take time out to share your opinions, experiences, insights and anecdotes that arm us to tell our story. It is the work each of us do, day in and day out, with our patients and our community, that makes this battle worth fighting. n Colorado Medicine for July/August 2016

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Features

Amendment 69 advisory committee Kate Alfano, CMS Communications Coordinator

CMS creates pro/con analysis of ColoradoCare and current multi-payer system Colorado faces an important vote this November about the future of the stateâ&#x20AC;&#x2122;s health care system. Physicians will not only need to understand what the proposed constitutional amendment on ColoradoCare means for the profession; they must also be prepared to answer questions about Amendment 69 from their patients. Thatâ&#x20AC;&#x2122;s why Colorado Medical Society (CMS) formed a special advisory committee (SAC) to analyze and compare ColoradoCare and the current multi-payer system. Thirty-seven physicians from across the state came together to create the pro/con documents that follow starting on page 26 of this magazine. Please carefully review this and other information on Amendment 69 so that you can make an informed vote this fall. This analysis was reviewed and vetted by the CMS Board of Directors to be distributed to CMS members in advance of an all-member survey on ColoradoCare that CMS will launch in August. Learn more about the process the Board will be taking before taking a formal position on ColoradoCare on page 50 of this magazine in a column written by CMS President-elect Katie Lozano, MD This analysis would not have been possible without the assistance of the Colorado Health Institute and most of all the commitment, time and expertise of the following members of the SAC. Colorado Medical Society is grateful for their service. n Adam Asarch, MD Dermatology, Englewood Erik Bartholomew, MD Internal Medicine, Denver J Tashof Bernton, MD Internal Medicine, Aurora Mark Bolinger, MD Family Medicine, Evergreen Richard Book, DO Family Medicine, La Junta Christyna Chaudhuri, MD Internal Medicine, Denver Paul Cutarelli, MD Ophthalmology, Englewood Michael Dunn, MD Family Medicine, Denver Christine Ebert-Santos, MD Pediatrics, Frisco Christopher Fellenz, MD Family Medicine, Westminster John Fleagle, MD Oncology, Boulder David Gilmore, MD Emergency Medicine, Denver

Colorado Medicine for July/August 2016

Eric Harker, MD Internal Medicine, Boulder Tracy Hofeditz, MD Family Medicine, Lakewood Jeremy Huff, DO Anesthesiology, Ft. Collins Mark Hunter, MD Otorhinolaryngology, Boulder Igor Huzicka, MD Internal Medicine, Lone Tree Scott Joy, MD Internal Medicine, Denver Alan Kimura, MD, MPH Ophthalmology, Denver Lisa Lewis, DO OB/GYN, Lakewood Evan Manning Medical School, Aurora M Ray Painter, MD Urological Surgery, Denver Debra Parsons, MD Internal Medicine, Denver William Plested, MD Thoracic Surgery, Durango

Mikhal Schiffer, MD Pediatrics, Colorado Springs Susan Sipay, MD Emergency Medicine, Littleton Julia Tanguay Medical School, Aurora Steven Thorson, MD Family Medicine, Ft. Collins Michael Tracy, DO Physical Medicine & Rehab, Lafayette Adam Tsai, MD Internal Medicine, Denver W Ben Vernon, MD General Surgery, Denver Patricia Weber, MD Dermatology, Grand Junction David West, MD Family Medicine, Grand Junction Juliana Wilson, DO Emergency Medicine, Greenwood Village John Woodward, MD Neurology, Wheat Ridge Matthew Wynia, MD, MPH Internal Medicine, Aurora

Features

COLORADOCARE: A PRO/CON ANALYSIS

CMS Special Advisory Committee (SAC) on T heColoradoCare diligently worked to create a thoughtful

pro/con analysis of ColoradoCare. The committee was purposefully composed of 36 physicians from across the state from different specialties, practice types and philosophical views regarding health care reform. A primary challenge of this analysis stems from the fact that while the proposed constitutional amendment establishes a

tax to pay for a new health care system and governing board process to oversee that system, the amendment does not establish many of the specific rules under which the system will operate. Consequently, many of the aspects reviewed within this analysis are decidedly conditional as they depend on the decisions that will be made in the future by a board that does not yet exist.

SOME BASIC FACTS ABOUT THE PROPOSED SYSTEM THAT ARE KNOWN INCLUDE : ColoradoCare would be a cooperative authorized by the state constitution that would replace most other health insurance. A small private insurance industry would likely remain. ColoradoCare would pay for health care for most Coloradans; every person who lives in the state would be eligible to receive benefits. Medicare and Veterans Administration coverage would remain in effect, with ColoradoCare potentially providing supplemental coverage. An initially appointed interim 15-person board and then elected 21-person board would determine details of the benefits package, set rates for licensed Colorado health care providers, hire managers and approve annual budgets. ColoradoCare would not be subject to oversight by any executive or legislative branch agency. All those covered by the program would vote to elect the board (but would not be able to recall them) and any

PROS AND CONS OF COLORADOCARE

Members of the CMS Special Advisory Committee (SAC) on ColoradoCare compiled the following list of the pros and cons of the proposed ColoradoCare system. The Colorado Health Institute compiled the statements and grouped them into six categories. The statements in this document all come from the working sessions of the SAC and they reflect the input of the 36 physicians in that group. This analysis is not intended to be an exhaustive list, but

PROS

tax increases necessary to fund the program. ColoradoCare would be funded by a combination of new taxes and current state and federal government support for health care programs. The proposed, new TABOR-exempt taxes to support the system are: 10% tax on all payroll and non-payroll income up to $350,000 for an individual and $450,000 for couples who file taxes jointly. For payroll income, the 10% tax would comprise an employer contribution of 6.67% and an employee contribution of 3.33%. Non-payroll income includes partnership distributions, self-employment, interest and dividends, capital gains, retirement/pension account distributions, and Social Security benefits. These new taxes would be levied on top of existing state taxes, which are unchanged by the ColoradoCare proposal.

rather provide a clinician’s view of some of the issues proposed in ColoradoCare. An overarching theme from the committee’s analysis of ColoradoCare centers on hope and faith. Proponents hope it would offer a better future, while detractors say its lack of specificity requires too great a leap of faith.

PRACTICE ADMINISTRATION

CONS

One set of rules for most patients could be easier to deal with than today’s fragmented system.

This simplification has the potential to lower costs for providers. The cost impact is uncertain and depends on a balance between new administrative burdens and simplification of administration.

COST OF RUNNING A PRACTICE

Practices with retaining a Practices’ highly paid tiered system. systems are employees adapted to Amendment would pay more 69 does not the current in taxes than environment. say who they save in Change could would pay for premiums. be challenging. technological Conversion Patients could innovations or purchase extra new equipment. costs to the new system insurance, could be steep, hence failing with uncertain to reduce payment for administrative these costs. complexity for physician practices and

EHRs could be simplified under ColoradoCare.

EHRs can be both a pro and a con, depending on how they are overhauled, how they are paid for, the degree to which they are interoperable, and whether they become an unfunded mandate.

ELECTRONIC HEALTH RECORDS (EHRS)

Practices might have to There is a lot of change their EHR systems. uncertainty around what Amendment 69 offers the new EHR would be. no plan on how the new EHRs would be paid for, or who would pay.

Colorado Medicine for July/August 2016

Features

COLORADOCARE: A PRO/CON ANALYSIS (CONT.) QUALITY HEALTH OUTCOMES PROS ColoradoCare improvement. ColoradoCare could offer a The new system might make single source could be more it possible to for most health consistent. have a rational care data. It conversation Simplifying could be a about value in quality valuable source medicine. measures could of population lower longlevel, term costs for longitudinal providers. data to power quality Physicians could be judged on a single set of performance measures for most patients. This could increase quality outcomes in innovative ways.

The system Physicians evidence and is could offer could be held to safer. better a higher, clearer Health continuity of standard. information care. Outcomes Patients exchange could could be more could expect improve. equitable in integrated care a system that that better offered access adheres to the to care for all.

DATA

QUALITY METRICS

CONTINUITY, ACCESS AND OUTCOMES FOR PATIENTS

CONS The costs for reporting quality measures and adopting a standardized data system could increase. Costs for providers are not clear at this point.

A poorly constructed system would impede physician workflow.

Those quality metric Reduced variance in measures are not defined quality measures could in Amendment 69. limit innovation.

Some providers may It’s not clear how depart Colorado, creating ColoradoCare would access problems. cover orphaned diseases.

PROFESSIONAL LIABILITY • Amendment 69 does not address this issue.

REIMBURSEMENT RATES PROS Providers would Some practices be reimbursed might flourish for the care under the new they currently system. give to the uninsured and undocumented.

The new system could save money overall, allowing for better physician compensation.

Medically ColoradoCare supported could alter guidelines could reimbursement be used. by RBRVS.

Some specialty physicians could be paid more or less (could be a positive).

Colorado Medicine for July/August 2016

GENERAL

WHAT’S REIMBURSED?

CONS Some practices might close due to low reimbursement rates. If ColoradoCare ran low on funds, then rules would allow the board to adjust benefits and

payments to providers. The treatment portion of the workers comp system would disappear and be subsumed into ColoradoCare.

One buyer of services (a monopsony) would reduce market power for physicians.

Amendment 69 anything specifnated primary does not estabic about pay for and preventive lish rates. The value. care services.” board would Unless made up Rules created determine rates. by the board in some other There is uncerway, provider would prevent tainty over phyrevenue would providers from sicians’ ability to therefore decharging conegotiate their crease payments when rates with the doing so “will Some specialty ColoradoCare cause financial physicians could board. hardship for be paid more or Amendment a beneficiary” less (could be a 69 does not say and for “designegative).

ColoradoCare (cont.)

COLORADOCARE: A PRO/CON ANALYSIS (CONT.) SYSTEMS ISSUES

PROS

Eliminating high-deductible including deductibles and plans. workers comp. waiving certain Access to The number of copays will providers would bankruptcies lower barriers be simplified due to to care, helping for patients, unexpected both those because they health care least able to would have expenses could afford care and to worry less be reduced. increasingly about provider those networks, purchasing

PATIENTS/ CONSUMERS

FINANCIAL

Physicians might gain improved ability to negotiate with ColoradoCare by forming a statewide union.

CONS

Lowering the cost of care is likely to increase demand for care, a proportion of which is of low-value.

In general, there is not enough information on how Amendment 69 will be operationalized if it passed to say that it will improve health care. It requires too much faith in future decisions by the board and others.

Jobs would be lost in Physician unions might administration and be complicated or insurance. ColoradoCare undesirable for providers would need a large and the system as a bureaucracy to run it. The whole. system could attract a lot of lobbying.

ERISA The federal Employee Retirement Income Security Act (ERISA) broadly limits a state’s ability to regulate health plans offered by self-insured employers. It is unclear if selfinsured employers could opt out of the program, but if they did such an ERISA preemption would significantly impact ColoradoCare. Amendment 69 is silent on ERISA. The 21-member The board board would be would be locally elected insulated and responsive from partisan to local needs. politics within the executive and legislative branches.

The elected board could include medical representation.

GOVERNANCE/ BOARD OF DIRECTORS

As a political Board The 21-member subdivision of composition board could the state, the is uncertain place too much program’s board and there is no power in too would have no requirement for few hands. gubernatorial board members or legislative to have medical oversight. Recall expertise. has specifically been excluded.

ACCESS TO CARE PROS Increased ColoradoCare coverage likely could could bring create a better increased access ratio of primary to specialists. care and nonBetter access procedural would bring specialists to more equal procedural treatment for all specialists, as patients. we see in other developed countries.

Patients and physicians could have predictable and transparent rules and appeal policies, and one formulary for most patients.

GENERAL

CONS ColoradoCare Amendment 69 There could be fewer options might decrease lacks provisions for out-ofthe number of for social state referrals physicians – services aimed to centers of both specialists at reducing excellence. and primary health care care providers. utilization. Market forces Utilization can be an might be efficient way increased – to distribute and access resources. decreased – There’s no from migration guarantee that of patients ColoradoCare needing care to would Colorado. distribute Formulary resources choices could equally or be restricted. equitably.

Colorado Medicine for July/August 2016

Features

COLORADOCARE: A PRO/CON ANALYSIS (CONT.) ACCESS TO CARE (CONT.) ABORTION The Colorado state constitution bans the use of taxpayer funds for most abortions. While it appears that abortion services would not be covered, it is unclear whether courts would decide this ban applies to ColoradoCare. Amendment 69 does not specifically mention abortion services. Better ability to plan Potentially lower costs facilities based on patient for durable medical needs. equipment and drugs.

PROS

FINANCE AND COSTS

Having fewer facilities could create roadblocks to access to care.

PHYSICIAN SATISFACTION

ColoradoCare Medicaid stigma considerations would be could allow would be eliminated, physicians to eliminated. since everyone do “doctoring” Under would be in the instead of ColoradoCare, same network. “figuring.” there is a high-deductible potential for The board plans. might redesign less disruption the current A single of the doctorsystem in formulary would patient a way that simplify life for relationship. physicians. Narrow network might improve doctors’ lives.

GENERAL

The board could seek to control costs with a limited drug formulary and limited coverage for durable medical equipment.

CONS

Physicians could have less freedom about how they run their practices. It’s uncertain if physicians could limit their practices by number or type of patients. There could be less control over quality metrics. At the same time, this

would not be a true single payer system. There would not be a single formulary, and there would be multiple payers. So physicians would still have to deal with negative aspects of the current system, while dealing with reduced choices for most patients.

Colorado Health Institute. ColoradoCare: An Independent Analysis, April 2016. Colorado Secretary of State. Proposed Initiative measure 2015-2016, #20. Section 6, (4). pp. 7.Found at http://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/filings/2015-2016/20Final.pdf 3 Ibid., Section 6, (3) 1 2

Colorado Medicine for July/August 2016

Features

CURRENT SYSTEM: A PRO/CON ANALYSIS A ColoradoCare developed the following list of pros and cons of the current health care system over a series of meetings. s directed, the CMS Special Advisory Committee on

The Colorado Health Institute compiled the statements and grouped them into six categories. This analysis reflects the consensus views of the 36 physicians on the committee

that was purposefully constructed to represent physician perspectives from across the state from different specialties, practice types and philosophies regarding health care reform. This is not intended to be an exhaustive list. Nor is it intended to focus on only those problems of the current system that ColoradoCare aims to address.

PROS AND CONS OF THE CURRENT SYSTEM PROS

PRACTICE ADMINISTRATION

All practices currently maintain a system that functions in the current environment. There are no conversion costs, which will surely be required of a new system.

Current EHRs can provide some helpful information on clinical data and patient outcomes.

Physicians currently have the freedom to choose which EHR to implement, and there is a competitive marketplace of solutions from which to choose.

COST OF RUNNING A PRACTICE

ELECTRONIC HEALTH RECORDS (EHRS)

to participate pricing of Physicians can or not with insurance effect change any specific products. through insurance plan. lobbying. Competition Physicians between Robust have the ability different payers competition to negotiate could enhance between health payment levels, innovation and plans and albeit limited, improvement. appropriate regulation Some physicians with insurance carriers. can create have the option reasonable

COST OF RUNNING A PRACTICE

EHRs have made this Practices have adapted highly complex, variable, to current billing systems inconsistent process more and each practice has manageable. an ongoing operational system without any additional conversion costs.

BILLING

PROS

Clinics have Value is started to make starting to be safety a priority recognized in with evidence of payment. improvement. Innovation, research and development is rewarded and advanced.

Implementation Data often and are not timely maintenance enough. are expensive and time consuming.

INSURANCE

PROS

SYSTEMS

POPULATION LEVEL

It’s challenging to get various EHR systems to work together and the systems show mixed results on success.

CONS It’s difficult for practices to understand what services are covered and what are not.

Complying with insurance paperwork gets more complicated and expensive every year. It’s very confusing to identify co-pays and drug formularies, and it’s burdensome to obtain prior authorization from insurers for courses of treatment that doctors and patients want to use.

Billing is complicated, labor intensive and expensive. The current system is set up for fee-for-service reimbursement and unable to process alternative payment methods.

QUALITY HEALTH OUTCOMES Worker’s Compensation Medical Treatment Guidelines in Colorado are extensive and serve as a model for other states.

CONS

Administrative costs can be burdensome, especially for small practices.

CONS

The country has Access to care The current poor population is uneven and system is so health inequitable complicated outcomes across different that physicians compared with socio-economic are making other advanced groups. And many innocent/ nations. 1,2 continuity of unintended Recent rankings care is poor, mistakes in of population with patients reporting their health often bouncing services. This outcomes among process is very for advanced providers time consuming nations rate or going and creates Britain first and untreated. extra cost and th America 11 . frustration.

Colorado Medicine for July/August 2016

Features

CURRENT SYSTEM: A PRO/CON ANALYSIS (CONT.) PROS

QUALITY HEALTH OUTCOMES (CONT.)

Overall, private insurance Equal access to care has enrollees are satisfied been a problem, but with their medical care. access is improving. The system provides choices for some patients.⁴

Providers receive excellent training.

American medical technology is often among the most advanced in the world. Innovation is rewarded financially.

PATIENT LEVEL

HEALTH SYSTEM LEVEL

PROS

VARIATIONS

There is an increasing movement toward quality and cost transparency that could help patients, physicians and purchasers make better health care decisions.

TRANSPARENCY

Physicians can choose to take on an increased workload in exchange for increased reimbursement.

The system allows for consumer choice, or at least the appearance of choice.

The workers compensation reimbursements are generally reasonable and do cover the services required in this area.

PROS

Patients are becoming increasingly aware of costs.

Quality of care is inconsistent and methodologies to measure and improve quality are incredibly complex, frequently flawed and often not meaningful, thereby driving extra cost, frustration and more lost time.

REIMBURSEMENT RATES

Consumer choice, preferences and competition drive prices charged in the market. Employers can exercise choice on the insurance plans they offer. The current system allows economic self-determination for doctors. It rewards efficiency.

WHAT’S REIMBURSED

Colorado Medicine for July/August 2016

PATIENTS/ CONSUMERS

The U.S. spends twice as much money as any other country on health care with poor performance on many measures of quality and population health compared to peers.

CONS

Physicians’ work is not reimbursed based on the value of their contributions. Specialists are paid much more than primary care providers. Pay also varies widely by location, which contributes to regional shortages of providers. Contracts for doctors with Patients are confused by insurance payers are often costs, prices and their unclear. share of the payments.

Providers still are paid on volume and many of them do not get shared savings from reducing costs. Suppliers often can induce demand for high-cost services and

SYSTEMS ISSUES People who have good coverage can receive good care.

CONS

Patients often have an Too many patients are inaccurate perception of guided (or misguided) how to measure quality by prescription drug of care. advertising in the mass media. The system gives patients little incentive to take Increasing use of high personal responsibility deductible health plans for the cost of their health delays needed treatment, care treatments. affects outcomes and may increase overall costs.⁵

The system does not assure all Coloradans have health insurance coverage and access to care. Patients have a poor understanding of care, quality and costs of coverage,

drugs. Medicare making it hard reimbursement to implement for doctors telehealth and (through the other physicianRelative Value patient Unit, or RVU, contacts that formula) favors could increase specialists and efficiency. proceduralists. Only four Often, payers percent of cover only medical traditional facespending goes to-face visits, to prevention.

CONS

such as the consequences of high deductible health plans. Patients often don’t know they are underinsured until they need expensive care. Patients can be

blindsided by high prices from out-of-network providers, even though it is very difficult to determine which providers are in-network.

Current system (cont.)

CURRENT SYSTEM: A PRO/CON ANALYSIS (CONT.) PROS

SYSTEMS ISSUES (CONT.)

The status quo is a known quantity. The system allows for provider autonomy.

Innovation Some and an physicians have extraordinary the ability to level of care are structure their characteristic of practice–which the upper end patients to see, of the system. which disorders to treat and what insurance to accept.

DELIVERY SYSTEM

The health care industry is a significant employer.

The free-market The system system holds provides appeal for many incentives for people. certain types of innovation. Some physicians, especially specialists, are paid very well.

PAYMENT/ FINANCIAL

Patients generally have a choice of providers.

PROS

Services are generally provided quickly, with relatively short wait times.

Treatment is cutting-edge. Attractive new clinical facilities are being built, with access to an array of medical equipment.

FINANCES

Our nation still has 20 million uninsured and the uninsured have limited access to care. Underinsurance is rising. Some people are losing coverage and benefits for many others are unclear. There is poor access to

FINANCE AND ADMINISTRATION

CONS

primary care and nonprocedurebased specialists. Access to care in Medicaid continues to be a problem. Availability of medicines and devices is fragmented based on type of coverage.

Economic Rising deductconsiderations ibles are forcing too often trump patients to cut quality of care. back their use of beneficial Insurance benservices. efits and payments remain confusing and complicated.

PHYSICIAN SATISFACTION

Physicians retain the New models of teamability to independently based care show structure their practice to promise for better meet the needs of their patient interactions patient population – and and physician to change the insurances satisfaction, such as use they accept. of scribes, expanded medical assistant roles, integration of pharmacists into the team, etc.

AVAILABILITY OF CARE

CONS

among different Provider insurance networks are companies lead narrowing to confusion. and becoming inadequate for The system many patients. incents a “call 911” mindset Poor outcomes that leads to on metrics people seeking such as safety, care in the timeliness and highest-cost equity. settings and times.

The cost of There is a lack administrative of transparency overhead can regarding consume a third insurance of revenues in a company clinic. practices.

ACCESS TO CARE

Patients with either high quality insurance or personal resources generally have access to high quality care in a timely manner.

PROS

The number of uninsured individuals is still significant, despite gains under the ACA. Care is fragmented and care coordination is poor. Inconsistent requirements

Approximately 600,000 bankruptcies per year in our country are due to medical costs.8

There is little continuity of care, with a movement away from the medical home model. More patients are performing self-diagnosis and relying on Google searches for medical advice.

Low reimbursement rates put an unfair burden on Medicaid providers.

CONS

Administrative Reimbursements that is being generated. overhead is too are unfair. high, and time is Pharmaceutical Physicians wasted on loads are dogged coverage is of paperwork by frivolous confusing. and other menial lawsuits It is difficult to tasks. Payers’ deal with the credentialing large volume processes are of medical data burdensome.

Colorado Medicine for July/August 2016

Features

CURRENT SYSTEM: A PRO/CON ANALYSIS (CONT.) PHYSICIAN SATISFACTION (CONT.) PROS

Physicians derive a number of benefits from their profession: access to knowledge and an academically engaging life, collegial relationships, mobility and residential choice, a choice to be an independent practitioner or work for a salary, and most of all, the reward of seeing one’s work make a real difference in patients’ lives.

Physicians general enjoy spending time with patients and solving problems. More patients are now able to see physicians because they have gained coverage through the ACA.

ATTITUDE

PATIENT RELATIONS

CONS

Physicians tions placed on struggle with a them. lack of respect, a Physician burnloss of profesout has become sional control a worsening from a rapidly problem espechanging health cially over the care system, last five years. work-life Corporatizabalance and an tion and profit inability to live seeking have up to expecta-

progressively defined the practice of medicine and the delivery of health care. Financial well-being is enhanced by this but professional well-being is degraded.

The narrowing Constraints on Patients bargain of insurance doctors and hunting and networks is patients mean it focusing on causing a conisn’t always posthe price of stant churn of sible to provide health care is new and depart- the best quality problematic. ing patients. of care.

See OECD health statistics for 2015. http://www.oecd.org/health/health-data. 6 American Public Health Association. The Prevention and Public Health Fund: A htm. Critical Investment in Our Nation’s 2 Commonwealth Fund. U.S. Health Care from a Global Perspective Spending, Physical and Fiscal Health. June 2012; available at http://www.apha.org/ Use of Services, Prices, and Health in 13 Countries. October 2015. http://www. NR/rdonlyres/8FA13774-AA47-43F2-838B-1B0757D111C6/0/APHA_Prevcommonwealthfund.org/publications/issue-briefs/2015/oct/us-health-careFundBrief_June2012.pdf 7 from-a-global-perspective Institute of Medicine. Best Care at Lower Cost: The Path to Continuously 3 Commonwealth Fund. Mirror, Mirror on the Wall, 2014 Update: How the Learning Health Care in America. September 6, 2012. 8 U.S. Health Care System Compares Internationally. June 2014. http://www. LaCapria, Kim. Money, Cash, Throes. Snopes. April 23, 2016. http://www. commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror snopes.com/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/ 4 Kaiser Family Foundation. 2015 Employer Health Benefits Survey. September 9 American Medical Association. Specialties with the highest burnout rates. 22, 2015. http://kff.org/report-section/ehbs-2015-section-four-types-of-plans- AMA Wire. January 15, 2016. http://www.ama-assn.org/ama/ama-wire/post/ offered/ specialties-highest-burnout-rates 5 Islam, Ifrad. Trouble Ahead for High Deductible Health Plans? Health Affairs Blog, October 7, 2015. http://healthaffairs.org/blog/2015/10/07/troubleahead-for-high-deductible-health-plans/ 1

Support the CMS Foundation with your tax-deductible donation The Colorado Medical Society established the Colorado Medical Society Foundation (CMSF) as a 501(c) 3 organization in 1997. We strive to administer and financially manage programs that improve access to health care and health services to improve the health of Coloradans. The CMSF Board of Trustees is committed to the success of these programs and excited about the possibilities they present for improving health care services in Colorado. We need your help to meet our goals. Consider giving a tax-deductible donation of $25, $50, or more to help CMSF continue its mission. Questions? Call 720-858-6310. Colorado Medicine for July/August 2016

Colorado Medicine for July/August 2016

Features

National update: Health plan mergers John Conklin, Esq., Martin Conklin, PC

Recent action shows need for localized market analysis As affected states continue to review the Aetna-Humana and Anthem-Cigna mergers, recent actions by regulators in Missouri and California underscore why localized market analysis is necessary to gauge the actual competitive impact of the proposed mergers. Like Colorado, regulators in Missouri determined as a threshold matter that the proposed Aetna-Humana merger violates the statutory competitive standard in multiple health insurance lines of business. In contrast to Colorado, Missouri regulators went further, however, undertaking a thorough local market analysis that showed the proposed merger would significantly reduce health insurance market competition in that state. Missouri regulators issued an order for Aetna and Humana to cease several lines of health insurance business in the state. Addressing the impact of the proposed Anthem-Cigna merger, the California insurance commissioner sent a lengthy, detailed letter to the United States Department of Justice outlining the anti-competitive effects of the proposed

merger on that stateâ&#x20AC;&#x2122;s health insurance market. In Missouri, regulators issued a highly detailed report examining the affected health insurance lines in each county of the state. The primary affected health insurance lines were: Comprehensive Individual, Comprehensive Small Group, Individual Medicare Advantage, and Group Medicare Advantage plans. With just four health insurance carriers, including Aetna and Humana, issuing over 88 percent of comprehensive small group health insurance policies, Missouri regulators readily determined that the proposed merger would greatly reduce competition and result in an unhealthy concentration of bargaining power to the disadvantage of the health insurance marketplace. The Medicare Advantage numbers were even more extreme, with the four largest health insurance carriers, again including Aetna and Humana, controlling 96 percent of the market. Aetna and Humana combined control over 52 percent of the Medicare Advantage market in Missouri. Missouri regulators rejected opinion testimony offered by

Join Now! Colorado Medical Political Action Committee Call 720-858-6327, 800-654-5653, ext. 6327, or e-mail susan_koontz@cms.org Colorado Medicine for July/August 2016

Aetnaâ&#x20AC;&#x2122;s economist expert that Medicare Advantage plans are designed to compete with Medicare, finding instead that the proposed merger would create an anti-competitive effect in each of the primary lines of health insurance. Missouri regulators ordered Aetna and Humana to cease selling health insurance in each of those health insurance lines in 65 counties. The California insurance commissioner conducted public hearings on the proposed Anthem-Cigna merger, including reports by expert economists who conducted a county-by-county review to address the likely impact of the merger on the health insurance marketplace. The commissioner determined that there will likely be a substantial anti-competitive impact if the proposed merger is approved. The commissioner also opines that the proposed Anthem-Cigna merger would pose a risk for decreased quality of patient care and that the alleged efficiencies created by the proposed merger are unsubstantiated. The commissioner requests the Department of Justice, which is conducting an ongoing investigation of the proposed mergers, to prohibit the merger under federal law. In Colorado, the Aetna-Humana merger was approved by the insurance commissioner last fall with no public hearings or action. The Anthem-Cigna merger remains pending with a public hearing anticipated sometime this year. CMS will be prepared to encourage Coloradoâ&#x20AC;&#x2122;s insurance regulators to look at the local competitive market impact of the proposed Anthem-Cigna merger and reach conclusions similar to the regulators in Missouri and California. n 35

Colorado Medicine for July/August 2016

Features

Let’s get engaged! Kate Alfano, CMS Communications Coordinator

CMS nearing launch of Central Line, a new virtual policy engagement system for member/board collaboration It’s almost time for CMS members to get engaged. Central Line is coming soon. As many of you know, CMS has been working diligently over the past six months on the design and development of our new virtual policy engagement system named Central Line. Central Line is a web-based communications platform designed to allow CMS members the ability to collaborate directly with other CMS members, staff and board members on proposed or existing policy ideas and concepts.

board will then use this feedback to determine what ideas will be included on upcoming board meeting agendas. The new virtual policy engagement system promises to greatly increase participation among members as well as increase the agility of the society, as CMS will be able to more quickly respond to the rapidly evolving legislative and regulatory health care landscape. We hope you are as excited about this

new communications tool as we are, as we expect it to revolutionize the efficiency and strength of our organization. With that said, it is extremely important for all members to be involved in the process, utilize the new tool and be engaged. The target launch for the Central Line is at the CMS Annual Meeting in September 2016. Keep your eyes and ears open for more information as the launch date gets closer. n

This revolutionary application will provide our members with an unparalleled voice in CMS by enabling them to propose new policy ideas 24 hours a day, seven days a week. They will also have the ability to collaborate and provide feedback on other members’ policy ideas, with just a few clicks of a mouse – all from the convenience of their desktop, laptop or mobile device. This new platform will provide all CMS members with a vehicle to speak and be heard like never before. Members will be notified of new policy submissions and policy status changes via text or e-mail, based on their self-designated areas of interest. Members will then be asked to provide feedback on new policy ideas, and all member feedback will be statistically tallied and posted for all members, staff and board members to see and review. The CMS staff and Colorado Medicine for July/August 2016

Inside CMS

Clean Claims Task Force Kate Alfano, CMS Communications Coordinator

General Assembly repeals Medical Clean Claims Transparency Uniformity Act; honors task force members After working for the past five years toward the development of a standardized set of claim edits, the Colorado Clean Claims Task Force (CCTF) has completed its work. The 2016 Colorado General Assembly passed a bill – SB16-127: Repeal of the Medical Clean Claims Transparency Uniformity Act by Sen. Jack Tate, R-Centennial, and Rep. Jeni Arndt, DFort Collins – repealing the CCTF. The bill was signed into law by Gov. John Hickenlooper on April 5. Both the Senate and the House passed Resolution SJR16-029 – by Sen. Tate and Sen. John Kefalas, D-Fort Collins, and Rep Arndt and Rep. Dan Nordberg, R-Colorado Springs – which recognizes the work of the CCTF. In 2010, the general assembly passed the “Medical Clean Claims Transparency and Uniformity Act” as part of the state’s effort to streamline administration within the health care system. It required the executive director of the Department of Health Care Policy and Financing to establish a task force of industry and government representatives to develop a standardized set of payment rules and claim edits to be used by payers and health care providers in Colorado. Task force members deliberated in a fully transparent process for five years, sought input from stakeholders, and worked by consensus to develop a set of recommendations. “The task force’s work resulted in recommendations that achieve major accomplishments for Colorado and that reach consensus on the descriptions of diverse types of edits and payment,” said Marilyn Rissmiller, CMS senior director 38

in the Division of Health Care Financing, and task force co-chair. “The task force has demonstrated that payers and providers can work together to develop a transparent and collaborative process to simplify professional edits for medical claims. The task force has moved the process as far as a single state can in light of the limitations imposed by the national governance of Medicare, Medicaid, and ERISA (the Employee Retirement Income Security Act of 1974).” The task force finalized a document that describes the governance and dispute resolution process, providing a detailed description of the transparent and inclusive process for developing rules to arrive at a final edit set. This was one of its most significant and valuable accomplishments. Per the joint resolution, the members of

the Colorado general assembly recognize all of the accomplishments of the task force and commend its nonprofit and private-sector participants who donated thousands of hours of volunteer time over a five-year period. They recommend that the federal Department of Health and Human Services (DHHS) accept the work product of the task force, adopt its rules as the basis for the development of a common edit set for professional claims, make this edit set available for adoption in all states, and assume the oversight and funding of the process for development of a common set of edits for professional claims. Colorado Medical Society has strongly supported the work of CCCTF since its inception by providing leadership and collaborative interaction with all CCCTF stakeholders. We join our elected officials in applauding their achievement. n

Sen. Jack Tate, R-Centennial, honors CMS Senior Director Marilyn Rissmiller, representing all task force members, for the work of the Colorado Clean Claims Task Force. Colorado Medicine for July/August 2016

Inside CMS

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

COPIC Medical Foundation celebrates its 25th anniversary Twenty-five years is a good amount of time, and when that time has been spent helping others improve health care, that is truly something to celebrate. This year, we are recognizing the accomplishments, milestones and people connected to the COPIC Medical Foundation. The Foundation is a 501(c)(3) organization that is part of the COPIC Family of Companies, and it supports health care in three major ways: grant funding, the annual COPIC Humanitarian Award and scholarships. Background The idea to create a foundation was championed by Harold “Hal” Williamson, COPIC’s first external non-physician board member. He was passionate about philanthropy and encouraged the COPIC Trust Board of Directors to consider giving back to the Colorado health care community in real and meaningful ways. In 1991, the creation of the COPIC Medical Foundation was approved by the Board. Sadly, Hal passed away in 2001, but his spirit lives on in what the Foundation has become over the years. Today, its efforts extend across both Colorado and Nebraska, and it has impacted the lives of many. Grant funding The Foundation is dedicated to supporting promising health care initiatives that focus on improving outcomes through: • The education and training of health care professionals and health care teams • Development, implementation or changes in health care-related systems, tools and processes • Pilot programs designed to improve the delivery of medicine Grant recipients represent a wide array of organizations and, in the last several years, grants have been presented to fund the following: • Birthing simulators used for training at the University of Colorado School of Medicine’s Center for Advancing Professional Excellence. • The Healthy Living Initiative, overseen by the Colorado Pediatric Collaborative, which brings partners together to focus on a sustainable health management program. • Research by the Colorado Hospital Association to evaluate compliance and the use of surgical site checklists.

COPIC Humanitarian Award In 2001, the Foundation established an award in honor of Williamson. Each year, the COPIC Humanitarian Award recognizes a physician going above the scope of his or her practice to volunteer in the community. The award provides a $10,000 grant to be given to a health-related nonprofit of the recipient’s choice. The COPIC Humanitarian Award has been awarded to more than 20 physicians and has provided more than $270,000 to nonprofits in Colorado and Nebraska. The accomplishments of these physicians range from helping establish urban clinics that care for underserved patients to tackling challenges in rural communities. Do you know of a physician who should be considered for this award? The Foundation is currently accepting nominations for the Colorado 2016 COPIC Humanitarian Award through August 31, 2016. Scholarships The Foundation provides scholarships to students in health-related areas of concentration. In Colorado, there are currently scholarship programs through the University of Colorado School of Medicine, Rocky Vista University and Regis University. The Foundation has provided more than $600,000 in student scholarships. Studies show that medical providers who represent a specific culture are often able to communicate more effectively with patients from that culture, resulting in improved outcomes. Our COPIC Diversity Scholarship Program at the University of Colorado School of Medicine and Rocky Vista University provides scholarships to Colorado residents who demonstrate a commitment to medicine and community involvement, and display the skills and tenacity needed to succeed in medicine. Because managing health care in today’s environment is a team effort, the Foundation also provides scholarship funding for the graduate certificate program in Health Care Quality and Patient Safety at Regis University in Denver. The COPIC Medical Foundation has become an integral part of COPIC and our mission to improve medicine in the communities we serve. We look forward to another 25 years of providing support and making a difference. n

Overall, the Foundation has provided $5.8 million in grant funding to more than 100 organizations since its inception.

Colorado Medicine for July/August 2016

Inside CMS

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

“You’re not dying.” She asked me again if I had been doing drugs and turned back to her work.

Julie Highland University of Colorado School of Medicine

Well, I sort of was dying. When I got to the hospital I was rushed to emergency surgery and I was in the hospital for a week. A lot of that day was a blur, but I think back to that moment in the ambulance often. Why didn’t she hold my hand?

Julie Highland is a third-year medical student at the University of Colorado School of Medicine. She is a Colorado native who spends all of her free time exploring the beautiful outdoors in the Rocky Mountains. She graduated from the University of Colorado at Boulder in 2011 with a degree in Integrative Physiology, and spent the next three years learning Spanish and working in a primary care clinic at Denver Health before medical school. She loves children and plans on going into a sub-specialty of pediatrics.

A simple touch I was riding in the back of an ambulance – lights flashing, sirens blaring, tubes and wires hanging in all directions. But this time, I wasn’t the student; I was the patient. I had never felt this awful in my entire life. I couldn’t breathe, I was drenched in sweat, the muscles in my body were contracting uncontrollably and the room around me was fading. Something was seriously wrong and I was really, really scared. An EMT was sitting beside me, and with all of the energy I had left, I said “I think I’m dying.” In all my confusion and intense pain, the only thing I needed in that moment was for another human to be with me – to just hold my hand. I reached out my hand to her. She didn’t take it. She muttered, 40

A few months later, when I was feeling much better, I was spending a typical day with my preceptor, a neuro-oncologist. I met with a patient who had just found out her brain cancer was back. After taking her history, a long silence came. She looked down at her hands and tears began rolling down her face. I didn’t know what to say. I thought back to that moment when I was in the ambulance, and how badly I just needed to be touched. So I took her hand, and I held it. For a while. And she cried, and we didn’t say anything. n

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Colorado Medicine for July/August 2016

Inside CMS

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medical news Components hold regional forums to present The New CMS Component societies from around the state have welcomed elected Colorado Medical Society leaders for interactive presentations on The New CMS. These regional forums, the result of a broader governance reform package, bring socialization and dialogue on governance changes and on Colorado’s hottest public policy issues with CMS leaders. Since September, CMS President Michael Volz, MD, has traveled to Fort Collins, Grand Junction, Montrose, Durango, Clear Creek Valley, Salida and, most recently, Boulder County. Each component chooses a venue based on their preferences. For example, Boulder held their event at Fiske Planetarium, the highest resolution planetarium in the world and the most fitting place to

host a meeting about the launch of The New CMS, said Boulder County Medical Society President Leto Quarles, MD. “BCMS leaders and members are excited to engage in The New CMS and be active partners with our state society as we embark on this new model of robust, responsible, member-driven representation and advocacy,” Quarles said. The New CMS focuses on what members have been asking for: Effective advocacy, bilateral communications and helpful information. The policy issues members have discussed at the regional forums include out-of-network, network adequacy and access, insurance mergers, Medicaid reform/TABOR, Colorado Care/Amendment 69, medical aid in dy-

ing, opioids and patient safety. While the issues will always change based on members’ needs, The New CMS will continue to hold advocacy, communications and providing helpful information paramount. The regional forums demonstrate CMS’s commitment to reaching out to all members and engaging them in new and novel ways. Interested components can schedule a regional forum by emailing president@cms.org. n

CMS shares MACRA concerns with feds The Centers for Medicare and Medicaid Services called for comments on its proposed rule on the implementation of the quality payment program, which includes the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs). The Colorado Medical Society joined the American Medical Association and many other state, national, and specialty medical societies to submit our concerns on the proposed MACRA rule. Our comments seek to: • simplify the proposed MIPS program to ensure that it facilitates meaningful opportunities for performance improvement while decreasing administrative and compliance burdens; • provide a more robust APM pathway that can support physicians who want to make the transition to new delivery and payment models; and • accommodate the needs of physicians in rural, solo, or small practices in order to enhance their opportunities for success and avoid unintended consequences. Read the letter on CMS.org. n

Colorado Medicine for July/August 2016

Departments

Organizations achieve highest CME accreditation The Colorado Medical Society Committee on Professional Education and Accreditation has awarded the highest accreditation level, â&#x20AC;&#x153;Accreditation with Commendationâ&#x20AC;? to three organizations: South Denver Heart Center Foundation (SDHCF), located in Littleton; Memorial Hospital: University of Colorado Health, Colorado Springs; and Rocky Mountain Health Plans, Grand Junction. This honor, Accreditation with Commendation is awarded to CME institutions that adhere to all ACCME criteria. CMS is recognized by the ACCME to accredit CME providers in Colorado and the surrounding region. To receive commendation, organizations must demonstrate that they use CME as a tool to improve quality performance and that they collaborate with internal or external stakeholders to further improve quality. With commendation, these organizations will receive a sixyear term of accreditation rather than the usual four-year term. n

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CMS elections Candidate statement: Robert Yakely, MD, CMS President-elect

Robert (Bob) Yakely, MD, candidate for Colorado Medical Society President-elect. When my wife asked me why I have decided to run for the office of PresidentElect of the Colorado Medical Society now, after all the years I have been involved, I thought it was a good question and deserved an honest answer. It’s because I am excited about working on developing “The New CMS” that you have been reading about in Colorado Medicine. For the past two years, I have been working with a creative group of our colleagues, developing the concepts that will be implemented in the next several years to revitalize the governance of our society. We are initiating groundbreaking reforms that only a few other state medical societies have had the courage to tackle. I believe that the ideas that we are implementing will allow more members to be engaged. They can be confident that their voice will be heard and their concerns will be addressed by the society. As with any new process, the devil is in the details. I would like the opportunity to work on these details. I have been actively involved in organized medicine since the 1980s. Please review my C.V. for specifics; I will mention some of the highlights. I was president of the Clear Creek Valley Medical Society from 1989-90. I was president of Colorado Medicine for July/August 2016

the Rocky Mountain Urologic Society from 1987-89. I have been a delegate to the CMS House of Delegates (HOD) representing CCVMS, most years since 1980. I was the chair of the CMS Council on Legislation from 1983 to 1987, when we passed the tort reform legislation that has kept our malpractice premiums at reasonable rates. Since I was elected Vice-Speaker of your HOD in 2006 and Speaker in 2011, I have been involved in holding off the trial attorneys’ attempts to undo that legislation. I have served on the CMS Board of Directors since 2006. I was appointed to the Finance Committee in 2014. In 2014 I was on the committee that revised the CMS bylaws. I have been on the Governance Reform Task Force for the past two years and served as co-chair of a subcommittee charged with developing the Virtual Grassroots

Policy Forum. The Policy Forum will be designed to allow any member to submit a concern or an issue they feel our society needs to address. I believe that my many years of experience working in many positions in the Colorado Medical Society are an asset. Over the years I’ve learned a few things about working with my colleagues to get things done. I have a thorough knowledge of the issues in which CMS is currently representing the best interests of Colorado physicians. I also retired from the Kidney Stone Center on Jan. 1, 2015, and now have the time to devote to CMS that I would not have had when I was practicing. I ask for your vote in order to continue to serve this excellent organization and complete the transformation, for which I have great enthusiasm. n

Colorado Medical Society all-member election The Colorado Medical Society will hold its first-ever all-member election during the month of August. Watch your email for instructions on how to cast your electronic ballot starting Aug. 1 and ending Aug. 31. If CMS does not have your email address, email tim_yanetta@cms.org or call (720) 858-6306. The following physicians have announced their candidacy. Read their candidate statements here and through page 47. President-elect (one-year term) M. Robert Yakely, MD AMA Delegate (elect one) (One, two-year term beginning Jan. 1, 2017, ending Dec. 31, 2018) Alethia (Lee) Morgan, MD AMA Alternate Delegate (elect one) (One, two-year term beginning Jan. 1, 2017, ending Dec. 31, 2018) Kay (Katie) Lozano, MD

Departments

CMS elections

Candidate statement: Lee Morgan, MD, for AMA Delegate I have had the honor and privilege to serve the physicians of Colorado in multiple capacities over the past 29 years. I have served as president of the Colorado Medical Society (CMS), the Pueblo County Medical Society and the the Colorado Gynecology and Obstetric Society. I have participated on every major council of CMS. I currently serve as chair of the Council on Legislation and am immediate past chair of the COMPAC Board of Directors. I have served on the Physicians Congress and the ad hoc Committee on Patient Safety and Physician Accountability, to mention a few. I have been a member of the AMA since 1978 and an active member of our AMA delegation for 13 years. I served as co-chair of the Colorado delegation to the AMA for two years and four years as its chair. At the AMA I have been active within the Western Mountain States Conference having

served as treasurer and chair and am currently serving on the Executive Committee. My practice experience includes a large multispecialty group as well as a smaller single specialty group. I have practiced in both a large urban environment and a more rural environment. As an obstetrician/gynecologist I am at times in primary care and others a specialist. This varied background gives me the ability to look at all sides of an issue. Though I no longer practice full time, I do volunteer work at Drs. Care regularly. My full time position as a physician risk manager, doing patient safety and risk management at COPIC, I travel the state regularly and have the opportunity to visit with physicians in a variety of practice situations, thus able to stay up to date with the concerns of Colorado physicians. I have the leadership experience, the experience of listening to multiple points of

view and helping forge consensus, as well as strong interest and concern about the issues that affect the practice of medicine today. This last decade has been a time of many changes and challenges for physicians. It is more important now than ever that we work together as a cohesive force in organized medicine on a local, state and national level. I have a long interest in legislation affecting physicians in Colorado and the nation. One of my aspirations is to become a member of the AMA Council on Legislation. I believe that, with your support, I can continue to contribute significantly to organized medicine on a local, state and national level. It is for this reason that I ask for your vote to return me to the AMA as one of your delegates so that I can continue to represent you as we move forward in these interesting times. n

Colorado Medicine for July/August 2016

Departments

CMS elections

Candidate statement: Katie Lozano, MD, for AMA Alternate Delegate Thank you so much for electing me to serve on your board of directors since 2008, as your treasurer from 2010 to 2015, and as your president-elect since September 2015. I have significant relevant experience in advocacy, leadership, and networking in CMS and the AMA, and I respectfully ask for your vote for me to continue to represent you at the AMA. I ran successful campaigns on a national level to serve as delegate and chair of the AMA Young Physicians Section, serving for five years on their executive council from 2008 to 2013. After serving for two years as the sole delegate representing the AMA YPS as a young physician and coordinating our testimony across the AMA, I have extensive experience representing a diverse group of physicians with different practice types and different practice goals. Effective work with and within the AMA is a long-term investment, and I have invested many hours, days, and years in both the AMA and CMS. One of the strengths I will continue to bring to the Colorado delegation is broad networking contacts across the house of medicine in the AMA, given my partnership over years with physicians of all specialties when we worked together in the Young Physicians Section.

sured. Given my work with the CMS Council on Ethical and Judicial Affairs from 2006 to 2015, my specialty societyâ&#x20AC;&#x2122;s Ethics Committee since I was a resident in 2002, Ethics and Patient Advocacy Committees when I was an intern, and currently with the Regional West Medical Center Ethics Committee, one of my goals in the AMA is to someday serve on the AMA Council on Ethical and Judicial Affairs.

communities, through your daily (and nightly) work, and through your work with your county and specialty societies, patient advocacy and volunteer organizations, and CMS. I ask for your vote for me to continue to represent you and your patients in the AMA. n

We have a number of challenges before us at CMS and at the AMA, but we also have many opportunities to improve care. We also have a strong history of turning challenges into opportunities to improve patient care and the practice of medicine.

All CMS members are eligible to vote for this year's medical society officers. Look for your electronic ballot from CMS on Aug. 1. Voting will be open until Aug. 31 with results verified and released in September.

I would like to thank you all for everything you do for your patients and

Colorado Medical Society all-member elections

My service to the medical profession through my work with numerous boards, committees, commissions, task forces, and legislators is carefully considered as an investment in enhancing communication between and amongst those organizations and the people and patients involved. As a strong patient advocate with an interest in medical ethics, I served as codirector of a medical-student-run free clinic in Galveston in the late 90â&#x20AC;&#x2122;s, and have served since 2007 on the board of Doctors Care, a nonprofit Denver area clinic for the uninsured and underinColorado Medicine for July/August 2016

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the final word

Katie Lozano, MD, FACR CMS President-elect

Special Advisory Committee physicians analyze ColoradoCare, current delivery system In November, Colorado voters will be deciding the fate of ColoradoCare/ Amendment 69, a universal health care coverage proposal for all Coloradans. In September 2015, the CMS House of Delegates approved policy asking CMS to perform an in-depth review of the pros and cons of ColoradoCare compared to Colorado’s current public-private multi-payer coverage system. Based on this policy, the CMS board of directors created a Special Advisory Committee on ColoradoCare/Amendment 69. This 37-member group of your colleagues was carefully selected from 85 volunteer physicians to ensure a broad range of viewpoints and experience, including multiple practice types, specialties, ages, geographic areas of Colorado, and delivery system philosophies. Over three months, with a total of at least 320 hours of volunteer physician time, the advisory committee carefully and extensively debated the pros and cons of both systems, and prepared an evaluation of ColoradoCare’s relative strengths and weaknesses as well as an evaluation of the relative strengths and weaknesses of the current multi-payer system. See those documents starting on page 26. Our experienced CMS pollster is now working with committee members, including information from the analysis they created as well as a broad representation of opinions, to draft a survey of CMS members that will be administered in August to measure the magnitude and intensity of medicine’s views and concerns on Amendment 69 and their views 50

of the current system. Then, to kick off the annual meeting in Keystone on Sept. 16, 2016, CMS will convene the top experts and advocates from both sides of the debate for a Friday evening plenary session. Earlier in the day, the CMS board of directors will likely make a final determination to support, oppose or stay neutral on the amendment based on the allmember survey results as well as other information such as the position of component and specialty medical societies. We will also have real-time polling during the discussion at the annual meeting. Many organizations have already chosen sides. However, as a grassroots physician organization, the board felt strongly that, given the passionate member views both for and against the amendment, a full hearing and a methodical vetting of the amendment and the current system of care was in order. CMS has consistently and persistently advocated for optimal coverage expansion as a matter of practical economic and moral consideration, but until now had not formally engaged on the question of a unilateral shift away from the current mixed system of public and private sector delivery and financing models. The two documents produced by the advisory committee reflect just how potentially divisive this idea is from the exam-room level, and committee members managed to filter out most of the doctrine and emotion that physicians will endure soon in the impending media storm.

The advisory committee’s analysis, our all-member survey, the Friday night plenary session, and our open invitation to members to share their views will assure a fully considered evaluation and optimal medical society participation in testing Amendment 69 and how physicians think about the delivery system for health care in our state, a deliberative process similar to the methodical approach doctors take before making a diagnosis and evaluating treatment options. Regardless of the outcome of the vote of Coloradans on Amendment 69 in November, this initiative raises the debate over health care coverage, value and fairness in the complex world of health care delivery and finance to all Coloradans, and raises significant questions as to the role of state and local governments and commercial markets in the pricing, allocation and value of health care within the boundaries of cost, medical need and priority. In its simplest reduction, voters – including the medical profession – will decide whether the health care delivery system is mostly a commercial commodity or a public utility in our state. Through this process, we will have a more comprehensive understanding of the views of our members and what action should be taken on Amendment 69, as well as what action should be taken after the votes have been counted. n

Colorado Medicine for July/August 2016

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