Mar-April-2012 by Colorado Medical Society

March/April 2012

Colorado Medicine for March/April 2012

Volume 109, Number 2

Award-winning publication of the Colorado Medical Society

Colorado Medicine for March/April 2012

cont n ent nt ns nt Mar/Apr 2012, Volume 109, Number 2

Features. . .

Cover story The drive to make

Colorado the safest state in the nation to receive health care steps up as the professional review sunset bill advances. A strong coalition of stakeholders is supporting the effort, but the personal injury lawyers are once again threatening needed reforms. Read more starting on page 8.

SGR advocacy–CMS leaders head to Washington to press for a permanent fix to the flawed Medicare sustainable growth rate formula.

Making friends in politics–Redistricting and a big election in November drives urgency for physician political engagement. Find out what you can do.

Payment reform gets real–Colorado payment reforms are spotlighted in a continuing series on what physicians need to do to evolve their practices for the future.

Colorado health plan payment reforms–Those who mistakenly thought that payment reform is a thing of the future, should check out this grid of current reforms.

Specialty physician perspectives–Vascular surgeon Alan Synn, MD, reflects on what Colorado payment reforms mean to specialist physicians.

Primary care perspectives–Internist Alan Aboaf, MD, reviews current health plan payment reforms and their impact on primary care.

CIVHC driving payment reform–Physicians have a clear role in accelerating the work on alternate payment methodologies by the Center for Improving Value in Health Care.

Medicaid expansion–Some needy Coloradans are now eligible for Medicaid thanks to an expansion of eligibility. Here’s what you need to know.

Final Word–Rep. Bob Gardner (R)-Colorado Springs and Sen. Irene Aguilar, MD, (D)-Denver urge physicians to contact legislators to support HB 12-1300 on peer review.

Inside CMS

5 7 32 34 37 41 45

President’s Letter Executive Office Update Who takes care of the doctor? Reflections Spring Conference Annual Meeting COPIC Comment

Departments 47 49

Medical News Classified Advertising

Colorado Medicine for March/April 2012

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

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and CONNECTION

2011/2012 Officers F. Brent Keeler, MD

President

Jan M. Kief, MD President-elect Kay D. Lozano, MD

Treasurer

M. Robert Yakely, MD Speaker of the House Brigitta J. Robinson, MD Vice-speaker of the House Alfred D. Gilchrist Chief Executive Officer Michael J. Pramenko, MD Immediate Past President

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

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

COLORADO MEDICAL SOCIETY STAFF Executive Office

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

Division of Communications and Member Benefits

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

Division of Health Care Financing

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Division of Health Care Policy

Chet Seward, Senior Director, Chet_Seward@cms.org

Division of Health Care Policy (cont.)

JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org Susan Liptak, Program Assistant, Susan_Liptak@cms.org

Division of Information Technology/Membership

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

Division of Government Relations

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

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

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

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

Colorado Medicine for March/April 2012

Inside CMS

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

What about you? Physicians learning to care for themselves Third place? The bronze medal? Which physician aims for that distinction? What if I told you that there is a syndrome that we recognize first in our patients, second in our colleagues, and only a distant third in ourselves? There is no vaccine or new-fangled drug to prevent or treat it. There is no high-tech scan to diagnose it. My goal in writing this column is to raise awareness about the importance of physician health and wellbeing. This syndrome has denial written all over it, and diagnosis requires those old-fashioned skills of listening, awareness and empathy.

A couple of years ago, I spent three hours on a Saturday afternoon listening to a distressed colleague share his story. His depression was readily evident and he was unfamiliar with the tools available to help him. I tried to assist by providing him with resources, including services available through the Colorado Physician Health Program (CPHP). I hope I made a friend in the process. This was a real eye-opener for me and I began to take notice. I soon realized that this was not an isolated incident. The concept of physician wellness is gaining national attention. The need for physicians to care for themselves was a major element of our Colorado Medical Society Spring Conference in 2011 and physician wellbeing and success remains a major CMS strategic goal. A newly formed CMS expert panel on physician wellness will guide CMS leadership in promoting physician wellbeing throughout the state. We are blessed to have a wealth of local expertise to bring to bear on this issue. Doris Gundersen, MD, medical director for CPHP, is a nationally known expert Colorado Medicine for March/April 2012

in this field. I want to personally thank Doris for her role in the planning and presentation of the 2011 Spring Conference. She also played an active part in the 2011 Annual Meeting last September, and she has generously agreed to chair our new expert panel on physician wellness. Our goal is NOT limited to addressing physician addiction. While alcohol and drug dependence can contribute to the syndrome, other conditions including stress, anxiety, depression, burnout, difficulties maintaining a work-life balance and physical illness factor heavily into its development. We docs actually do a pretty good job recognizing this in our patients. (After all, we are trained to do this). We might also recognize it in our friends and colleagues. However, we seldom recognize the signs in ourselves. Physicians are highly susceptible to selfcare neglect. We experience more suicides, more depression and burnout and greater risk for certain types of physical illnesses than observed in the general population. We are reluctant to make time for ourselves. We are even more reluctant to seek help. Many of us do not have a personal physician. Some of us get little or no exercise. We can be so focused on being a doctor that we lose sight of other valuable aspects of life. Information from COPIC tells us that physicians who put self-care on the back burner are susceptible to a variety of medical-legal issues, including State Medical Board complaints, poor patient communication, greater rates of actual patient problems and complications and even liability actions. What action can we take at the individ-

ual physician level? An important first step is to develop a greater awareness of the problem. Is your friend, colleague or partner showing signs of depression,

Physicians are highly susceptible to selfcare neglect. . . We are reluctant to make time for ourselves. distraction or irritability? Sometimes simply inviting a colleague for a cup of coffee and casual conversation can help an otherwise bad day feel better. Other times, it may be necessary to give that doc a gentle push toward action. Suggest a medical check or share information about CPHP – it may be the nudge that a stressed doc needs to seek counseling or medical care. Not all of us actually have a primary care physician or we may not have been to ours in years. Physicians have a degree of reluctance in assuming a “patient” role. Privacy is a concern. Embarrassment about having neglected one’s health may also create a barrier to seeking help. Some of us find it more comfortable to seek help outside of our own local medical community. Take a friend for coffee. Have a quiet conversation. Raise awareness. Don’t be afraid to ask for help! Consider contacting CPHP. The majority of CPHP referrals are self-referrals. See your PCP. Don’t let life pass you by. Special thanks to Dr. Doris Gundersen for her gracious assistance with editing this article. n 5

Colorado Medicine for March/April 2012

Inside CMS

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

Climate change: physicians and plans warming to collaboration In our last issue, we discussed a work group on prior authorization jointly appointed by Colorado Medical Society and Colorado Association of Health Plans that includes practicing physicians and health plan medical directors. At the first meeting, when CMS President Brent Keeler, MD, was making introductions, he grinned and offhandedly noted to a health plan physician representative, “My wife taught you in grade school.” Despite the technical and serious nature of the discussions during the course of the work group, the conversations have been peppered with humor and remarkable candor. I was not surprised, nor were the physicians in the room, that competitors and potential rivals would share a sense of community and common purpose. Maybe it’s the cosmic influence of the snow-capped mountain peaks as a backdrop to the almost year-round pleasant temperatures, or maybe it’s the Rocky Mountain way, but it seems Colorado leans toward fixing problems rather than blame. The prior authorization work group is having open, honest and realistic conversations about what needs to be accomplished and what can be accomplished. Everyone in the room understands that there could be an end point that requires political debate and resolution by elected officials at the state capitol, but there is also a strong commitment to a process that minimizes that outcome. Many state medical associations weather recurring storm systems between and among health plans and sometimes find themselves drained of political capital as battles are waged on multiple fronts. Fortunately, the CMS leaders have shown a strong inclination toward Colorado Medicine for March/April 2012

evidence-based policy debates and continue to find creative solutions to complicated policy questions. Our climate change began with a formal experiment in plan collaboration seven years ago with the CMS-UnitedHealth Group shotgun marriage imposed through a legal order by thenInsurance Commissioner David Rivera. The United PAC (physician advisory committee) was a condition of UnitedHealth Group’s state-approved acquisition of Pacificare. That transformative period challenged our leadership to view the future of health care with a more complex view of the business as well as professional relationships. From 2005 through 2009, CMS passed a series of first-of-its-kind managed care reforms that standardized contracts, established legal criteria and physicians’ rights when profiled and updated the state’s insurance industry merger and acquisition statute. Subsequently, CMS instituted a “Strange Bedfellows” award to recognize these vital collaborations. The first recipient was Mike Houtari, then CEO of the Colorado Association of Health Plans, and who now is legal counsel and chief lobbyist for Rocky Mountain Health Plans. He also currently chairs the Colorado Association of Health Plans. Chris Stanley, MD, formerly a practicing Denver-metro area pediatrician, was also awarded this rather unique distinction for all his steadfast work with CMS through United’s PAC. These physician and health plan relationships are increasingly interwoven and interdependent; while they reside locally in this great state, their influence extends to nothing short of global collaboration.

Take Kevin Fitzgerald, MD, CMO for Rocky Mountain – he’s the incoming president of Mesa County Medical Society and recently represented Colorado in a CMS delegation of physicians in Washington DC who pressed the congressional delegation for a fix to the flawed Medicare funding formula known as the SGR. And CIGNA, now ramping up its own PAC, recently “acquired” CMS past-president Mark Laitos, MD, as its CMO. With 28 years of private practice under his belt, Mark is an American Medical Association alternate delegate. Then there’s Anthem’s Elizabeth (Cissy) Kraft, MD, who chairs HealthTeamWorks, formerly the Colorado Clinical Guidelines Collaborative. Cissy is an ardent champion of the patient-centered medical home. Chris Stanley, MD, is a CMS delegate and co-chairs our PAC with CMS pastpresident Lynn Parry, MD. There’s a spirited song in the Broadway musical “Oklahoma” about the need for cooperation, set to the conflict between ranchers and farmers, that might be an appropriate metaphor for Colorado: “Oh, the farmer and the cowman should be friends, The cowman ropes a cow with ease, The farmer steals her butter and cheese, That’s no reason why they can’t be friends.” (chorus) “Territory folks should stick together, Territory folks should all be pals, Cowboys dance with farmer’s daughters, Farmers dance with the rancher’s gals.” n

Cover Story

Susan Koontz, JD, General Counsel and Senior Director of Government Relations Chris Lines, Director, Political Education and Advocacy

Colorado Medicine for March/April 2012

Cover Story Colorado Medical Society is leading an effort to improve the state’s professional review system – the latest step toward ensuring Colorado is the best place in the nation in which to provide and receive safe, high-quality and cost-effective medical care. CMS and an array of partners worked together with legislators on a professional review (also known as peer review) bill that is currently moving through the General Assembly. House Bill 12-1300 enjoyed bipartisan support in the House of Representatives, where it passed in March. At press time, it is still being considered in the state Senate. Among other things, the bill would maintain the confidentiality, privileges and immunities associated with professional review activities for seven years. It would authorize professional review of physician assistants and advanced practice nurses for the first time, and would specify sharing of professional review information with entities such as the Colorado Department of Public Health and Environment, the Centers for Medicare and Medicaid Services, and the Joint Commission, in addition to the Colorado Medical Board and the Colorado Nursing Board. The law would prohibit further disclosure of the records provided to these agencies and organizations. The legislation is sponsored by physician and CMS member Sen. Irene Aguilar, MD, D-Denver and Rep. Bob Gardner, R-Colorado Springs. (See the Final Word on page 50 for more from the two bill sponsors). Aguilar said she hopes the legislation will help more physicians and other professionals feel comfortable referring cases to

peer review, and that those cases will lead to safer care and improved systems. She also hopes more professionals will serve on peer review committees if the bill becomes law.

tion’s first strategic plan in more than a decade. The board didn’t miss the opportunity to include advancing patient safety and quality of care among its five banner goals.

“Whenever you conduct peer review it helps you improve your own practice, because you look at a case and think ‘I could have done that, I might have done that.’ I think it makes you a better practitioner,” said Aguilar, who served on the state’s Board of Medical Examiners (now known as the Colorado Medical Board) from 1993 to 2001, and has done case review since then. “We can be our own best advocates,” she added.

Since then CMS has been working methodically on projects and programs to advance the goal, from encouraging better care coordination and continuing medical education to forming the CMS Workgroup on Patient Safety and Professional Accountability and making patient safety

Gardner told his colleagues during a hearing before the House Judiciary Committee that the bill has more moving parts than any he has worked on in his six years at the legislature, and praised the collaboration among its supporters. Among them are Rocky Mountain Health Plans, University of Colorado School of Medicine, Rocky Vista University, COPIC, the Colorado Psychiatric and Ob/Gyn societies, Colorado Academy of Family Physicians, Colorado Nurses Association, Colorado Hospital Association and Colorado Society of Advanced Practice Nurses. “There is an important public policy reason for professional review, and you have to get it right,” Gardner said. “The interplay between the professions has been productive, not adversarial, and it has brought the very essence of how we are going to deliver care to the forefront.” Years-long commitment Improving patient safety has long been a CMS priority. In 2005, the CMS Board of Directors gathered to draft the organiza-

HB 12-1300 status at press time At press time, with less than 30 days remaining in the Colorado Legislature, the trial lawyers have surfaced late in the process with objections to the bill. Valid objections are being addressed, while others are unclear and threaten to kill the bill. Watch for CMS electronic communications to learn what you can do to help. Colorado Medicine for March/April 2012

“We wish to express our appreciation to DORA for yet another excellent review process and work product,” – Brent Keeler, MD CMS President the focus of our 2009 Spring Conference, as well as a component in each of CMS’ major conferences. Legislatively, CMS has advocated for changes in the Medical Practice Act, including maintenance of licensure, to help improve patient safety. Though Colorado’s professional review system was not yet scheduled for sunset review by the state legislature, CMS and its partners recognized that it was time to move forward with changes to this critical issue, and asked the Department of Regulatory Agencies and lawmakers to work with us. “House Bill 1300 will enhance patient safety by upgrading and modernizing the body of law governing professional review,” said CMS President Brent Keeler, MD, who has more than 25 years of experience in professional review, having served as department chairman, chair of credentials and as a chief of staff at The Medical Center of Aurora. “It benefits patients by creating a mechanism for prompt evaluation by informed evaluators, and uses the findings of that

Cover Story (cont.) assessment to improve systems of care and professional practice,” Keeler said. More than just physicians are committed to raising the bar on patient safety and quality improvement through this process. “The APN community welcomes the opportunity to engage with their health care colleagues in robust professional review processes to promote high quality health care,” said Linda Siderius, legal counsel for CNA. “We were proud to be part of the coalition that worked together with CMS in the legislative process to achieve the necessary changes to the Colorado Professional Review Act to include the advanced practice nursing community.”

Benefits Maintaining confidentiality was a critical piece of the legislation for CMS and other supporters, because it is the lynchpin for good reviews and ensuring physicians and others will participate in the process. However, if professional review results in an adverse action against a physician – such as suspension or revocation or limitation of privileges – this modernized law does allow for the sharing of professional review records and information with other hospitals and clinics where the physician practices for the purpose of improving care. The bill requires professional review en-

tities to register and report their activities – in the aggregate and without identifiable information – to the Division of Registrations. This reporting includes the number of investigations completed during the year as well as the results of these investigations, including the number of investigations that resulted in no action, the number of investigations that resulted in written involuntary requirements for improvement sent to the physician, APN or PA, and the number of investigations that resulted in written agreements for improvement between the physician, APN or PA and the entity. The bill requires professional review entities to report on an annual basis to the Medical and Nursing Boards the number of final professional review actions relating to physicians, APNs and PAs in each of these categories: adversely affecting the individual, in which an entity accepted the individual’s surrender of clinical privileges; membership or affiliation in return for not conducting an investigation, in which an entity accepted the individual’s surrender of clinical privileges; membership or affiliation in return for not conducting an investigation, and in which the professional review committee made recommendations following a formal hearing. The boards will forward the reports to the Division in a de-identified manner. The information will then be consolidated by DORA for the state of Colorado and reported to the public (also in aggregate and without identifiable information). This data may be particularly valuable because it will show trends, set benchmarks and show outlier data so systems may be improved. “This legislation is well researched, the product of a highly collaborative process and most importantly, represents choices that are good for patients and patient safety,” Keeler said. To follow the bill, visit cms.org or keep an eye out for e-mail updates via ASAP, our electronic newsletter. n

Colorado Medicine for March/April 2012

Cover Story

The physicians of the Colorado Medical Society wish to thank the bill sponsors, supportive members of the Legislature, and the following organizations who have come together as a coalition for their steadfast commitment to improving safety and quality of care by supporting HB 12-1300, the Colorado Professional Review Act. HB 12-1300 Bill Sponsors

The Honorable Rep. Bob Gardner (R)-Colorado Springs The Honorable Sen. Irene Aguilar, MD, (D)-Denver Members of the Professional Review Coalition American Academy of Pediatricians, Colorado Chapter American College of Nurse-Midwives, Colorado Arapahoe-Douglas-Elbert Medical Society Boulder County Medical Society Center for Personalized Education for Physicians Clear Creek Valley Medical Society Colorado Academy of Family Physicians Colorado Academy of Physician Assistants Colorado Chapter, American College of Emergency Physicians Colorado Hospital Association Colorado Nurses Association Colorado Ob/Gyn Society Colorado Orthopaedic Society Colorado Psychiatric Society Colorado Radiological Society Colorado Society of Advanced Practice Nurses Colorado Society of Anesthesiologists Colorado Society of Clinical Specialists in Psychiatric Nursing Colorado Society of Eye Physicians and Surgeons Colorado Society of Osteopathic Medicine COPIC Denver Medical Society El Paso County Medical Society Pueblo County Medical Society Rocky Mountain Health Plan Rocky Vista University, College of Osteopathic Medicine The Doctors Company University of Colorado Anschutz Medical Campus

Colorado Medicine for March/April 2012

Features

CMS physicians lobby for SGR fix Susan Koontz, JD, General Counsel and Senior Director of Government Relations Chris Lines, Director, Political Education and Advocacy

Delegation goes to Capitol Hill In February, physician leaders from the Colorado Medical Society and local county medical societies visited with each and every member of Colorado’s nine-member congressional delegation in Washington D.C. The meetings focused on the matter of repairing the flawed Sustainable Growth Rate (SGR) Medicare payment formula. “The meetings were friendly and at times almost jovial, but they mainly focused on the matter of repairing the flawed SGR (Sustainable Growth Rate) Medicare payment formula,” said Jan Kief, MD, CMS President-elect. “We explained to each of our congressional members that we would report back to Colorado physicians about this issue,” said F. Brent Keeler, MD, CMS president. “We asked, ‘so what should we tell them?’ The question opened a candid and confirming conversation.” Meanwhile, the House-Senate conference committee was working behind closed doors with a March 1 deadline on a potential agreement. Issues in play included the payroll tax extension, unemployment benefits and the SGR. At the time, there was great speculation as to the outcome: a meltdown, a shortterm patch, or something long-term and meaningful. During their visit, Colorado’s physician leaders were briefed by the AMA’s top lobbyists, who shared the message: persistence pays off. 12

“We can’t let up. And considering the staggering financial implications and political uncertainty – now is the time,” Keeler said. “We have endured nine years of lobbying and the emotional rollercoaster of short-term patches, near misses and cuts.” U.S. Sens. Mark Udall and Michael Bennett jointly hosted the February visit, a testament to the importance the two senators place on their relationship with Colorado physicians. Udall pledged to support a long-term fix with available funds from the Overseas Contingency Operations. Bennett reassured the physicians that he would continue to work for a long-term fix, as he has done in the past. “The takeaway from the meeting was that our U.S. senators get it. They not only support the fix, they are working on a solution,” said Denver Medical Society President Lucy Loomis, MD. While physicians gathered on Capitol Hill for a full day of meetings with their members of the House, rumors were surfacing that the conference committee had struck a bargain. Early details began to unfold throughout the day. “By mid-afternoon, we learned there was to be a 10-month patch, so we adjusted our message to one of appreciation but also disappointment,” Keeler said. “The gratifying aspect of attending the meetings in D.C. was that all of our members of congress, regardless of party, understand that the SGR must be

fixed,” said Daniel Perlman, MD, MBA, Arapahoe Douglas Elbert Medical Society president.

CMS CEO Alfred Gilchrist, who is also a long-timeAlfred Washington medical lob- Medical Society Gilchrist, CEO, Colorado byist, said the Colorado physicians did a great job of conveying a sense of urgency about a long-term fix when they shared with their legislators “that the troops back home are beyond restless.” Colorado physicians stressed in each meeting that any advancement on improving value in health care is being held hostage by the lack of progress on Medicare payment reform. A fact sheet provided to each member of the congressional delegation shared the great strides being made in Colorado on health information technology, health information exchange and payment reform. “We made the case that the early adopters are taking all the risk while many physicians continue to hang back, waiting to see if there is going to be a sustainable business model to support practice redesign that comes along with HIT implementation,” explained Mesa County Medical Society Presidentelect, Kevin Fitzgerald, MD. While there is understandable disappointment in Congress’ decision to postpone a permanent fix of the SGR, the CMS community remains strong, motivated and influential, and will continue to be tenacious in its efforts to rally support to fix the SGR once and for all. Check the CMS website at www. cms.org, for updates. n Colorado Medicine for March/April 2012

Features

CMS President Brent Keeler, MD, and Sen. Michael Bennet.

CMS President-elect Jan Kief, MD, Sen. Michael Bennet and ADEMS President Dan Perlman, MD.

MCMS President-elect Kevin Fitzgerald, MD, MCMS President Juan Barbero, MD, and Rep. Scott Tipton.

Rep. Diana DeGette and DMS President Lucy Loomis, MD.

DMS President Lucy Loomis, MD, (left), Rep. Ed Perlmutter, (right), and Perlmutter staff (center).

Rep. Jared Polis, CMS Board Member Frank Dumont, MD, and Polis staff.

Sen. Mark Udall, CMS President Brent Keeler, MD, and Sen. Michael Bennet.

CMS President-elect Jan Kief, MD, DMS President Lucy Loomis, MD, Sen. Mark Udall, and CMS President Brent Keeler, MD.

CMS President Brent Keeler, MD, (left), Rep. Doug Lamborn, (right), and Lamborn staff, (center).

Rep. Ed Perlmutter, ADEMS President Dan Perlman, MD, and CMS Presidentelect Jan Kief, MD.

Rep. Mike Coffman, CMS Treasurer Katie Lozano, MD, and CMS Presidentelect Jan Kief, MD.

Sen. Michael Bennet, Larimer County ED Barb Brown, and CMS Board Member Frank Dumont, MD.

Colorado Medicine for March/April 2012

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Colorado Medicine for March/April 2012

Features

Making friends in politics The urgency and opportunity for local physician political engagement thanks to redistricting in 2012 David Ross, DO, Chair, Colorado Medical Political Action Committee Like most carbon-based organisms, legislators and other elected officials cultivate during their life spans a safe environment to work and grow. They methodically vote and campaign in patterns that are intended to assure they have more friends than adversaries. Over time, at least up to the time they are term limited, legislators can accumulate a lot of both. But every decade they are constitutionally compelled to make new friends and start over through a process benignly called “redistricting.” Redistricting is a cannibalistic, intensely political effort

that reapportions voters into new legislative districts according to population growth and demographic shifts that have evolved over the previous 10 years. This process can be a nightmare for politicians. They can be paired in death matches with a colleague, wake up to find their “safe” district has received a potentially fatal injection of hostile voters or, just as likely, ambivalent voters who have never heard of them. And, in at least 30 places in Colorado, legislators have seen their districts evaporate underneath them. Both the endangered incumbent and the open-seat candidate are looking for “new” friends.

Colorado Medical Society is pleased to announce GL Advisor as our newest Member Benefit Partner.

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And this is where Colorado physicians must seize opportunity. In a part-time, lightly staffed General Assembly like ours, legislators can’t possibly acquire the expertise to make judgments on the literally hundreds of voting options they must annually consider. Logically and understandably, they are disproportionately reliant on the advice and insights of professional advocates, and more importantly, those of friendly and well-informed constituents. When the survivors of the 2012 election cycle convene in the 2013 legislature, they will be making some hard-core choices on things that will directly influence how we practice. Here’s a quick quiz to underscore the need for physician engagement in the 2012 election cycle: 1. Who is most likely to get a phone call returned, or legislative “ask” carefully considered? a. The trial lawyer who has given big bucks to that legislator and now threatens to transfer that largesse to another candidate/challenger. b. The physician who met his/her state rep once and gets an appointment in the capitol office the day before a big vote. c. The physician who organized local medical and health care community support – wrote letters, block walked, opened his/her home or office up for a meet and greet during the election cycle for this legislator. d. The physician who has never had any contact with the legislator.

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Colorado Medicine for March/April 2012

COMPAC (cont.) 2. For the politically active physician, when is the optimal time to get involved locally in support of a medicinefriendly candidate or incumbent legislator? a. When they are first seeking office. b. When they are facing a potentially career-ending challenge. c. Right after a legislative session, to thank them for their efforts. Hopefully the answers to this quiz are self evident. When it comes to legislative policy influence:

1. Relationships are as important as the issue – and probably more valuable than financial donations. 2. Relationships are cultivated, and are best planted when the political circumstances are most fertile – when candidates are seeking to gain or retain office. That’s when they need real friends who will step up and stand by them. 3. Once every 10 years, the political landscape is scrambled and the opportunity to make solid, enduring relationships with candidates and incumbents locally increases exponentially.

There are three kinds of friendships, or “grassroots relationships.” 1. Organic: The physicians who knew the incumbent or candidate before their political careers – family, neighbor, friend (and yes, patient) or business partner. These are by definition close, and the most likely sought by the legislator/candidate. 2. Home grown: This is typified by physicians who at some point, engage in the array of political support work for their soon-to-be-friend. These constitute the majority of most physician/ legislator relationships, and are grown on an episodic, opportunistic basis. This once-in-a-decade window is the quintessential opportunity. 3. Artificial turf: These are the cyclical gestures of support that while less intimate have long-term importance and value. Examples include contributions to the political funds managed by COMPAC, signing a letter in support of the local candidate or incumbent or attending a reception or meet and greet with colleagues and friends. COMPAC and CMS are in the middle of a systematic series of physician and component society staff training sessions in support of local legislative candidate screenings. The objective is to identify candidates organized medicine will endorse in the wide array of contested race opportunities before us. Over the remaining months of this vital election cycle, we are aggressively pursuing the cultivation of the grassroots relationships in as many of these seats as we can possibly achieve. What we do now, not next January, will determine the course of everything medicine has on the table and at risk for the rest of this decade in the Colorado General Assembly. We must engage in this process for the betterment of our patients, our practices and for the patients and physicians of the future. Contact me at Dave_Ross@COMPAC. org and I’ll get back to you with the relationship building opportunities in your area. n

Colorado Medicine for March/April 2012

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Colorado Medicine for March/April 2012

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Payment reform gets real Cuba Gooding Jr.’s famous “show me the money” line in the movie Jerry McGuire underscored his confidence in his abilities as a football player and his frustration with the NFL’s flawed contract system. Many physicians are similarly struggling with the health care payment system. Rather than rewarding care coordination, quality improvement and patient-centeredness, the current fee-for-service model often penalizes physicians for doing what’s right for patients. Not for long. The January/February issue of Colorado Medicine introduced the concept of practice evolution, which aims to help you and your practice identify necessary changes and implement plans to achieve success in the ongoing transformation of the health care system. Practice evolution can be broken down into four key areas: payment reform, transparency, delivery system redesign and administrative simplification. Together, these elements provide a framework for understanding the needs of our health care system today, and in the future. In this issue, we zero in on the payment reform component of practice evolution and debunk the myth that payment reform will only happen in the future. Our interviews with major private and public health plans show that carriers are actively exploring or have already rolled out alternative reimbursement methodologies for physicians across the state. We asked several Colorado health plans about their new payment models, how that payment model ties into their strategic plans and what methodologies and measures they are using within these models to evaluate physician performance. On pages 20-23 you will find a grid that summarizes responses from Anthem Blue Cross Blue Shield, Cigna, Kaiser Permanente, Colorado Medicaid, Rocky Mountain Health Plans and UnitedHealthcare. Colorado Medicine for March/April 2012

Chet Seward, Senior Director, Health Care Policy

These initiatives suggest that payment reform is here to stay. But what does that mean for physicians? On pages 25 and 27 Denver vascular surgeon Alan Synn, MD, and Aurora internist Alan Aboaf, MD, discuss whether Colorado physicians are actually ready for reform and hint at ties to broader practice evolution issues than just payment reform. The Center for Value in Health Care (CIVHC) is stepping up efforts to coordinate statewide payment efforts that will accelerate changes and drive Colorado toward “Triple Aim” objectives to improve population health, enhance the patients’ experience of care and bend the per capita cost curve. CIVHC Payment Reform Implementation Work Group member Alan Kimura, MD, details current work and makes the case for significant physician involvement in these initiatives. It is important for physicians to familiarize themselves with the various health plan payment reform programs. It is challenging for most physicians to make practice changes for just one payer. But by focusing on opportunities that apply across multiple programs, these changes can be more meaningful and incorporate redesigning workflow, aggregating appropriate data and utilizing similar performance metrics. Whether or not you are currently eligible for these programs, it is important to re-

member that the health care system is indeed changing. It’s changing because the status quo is unsustainable. Your practice must change with it in order to meet the needs of your patients and the community. Are you ready? What you can do now The health plan payment reform grid on the following pages underscores the need for a set of core competencies and capabilities that all physicians must have, no matter your practice or employment setting, in order to thrive in the future. Consider the following: • Invest in electronic medical record and other information systems. • Appreciate the fact that performance assessment methodologies (as flawed as they may be) are becoming more prevalent through the use of clinical and claims data. Payers, as well as patients, will utilize this information to assess which physicians are performing at the highest levels. • Gather data on how you compare locally or nationally to your peers. Collect and use your own performance information and compare that to the information provided by payers. • Build or align yourself with a high-performance health care team. Teams beat individuals in performance because they can broadly and continuously manage complexity. n

BREAKING NEWS Colorado selected for major Medicare PCMH initiative On April 12 Colorado received news that it is one of just seven markets nationwide selected by the Centers for Medicare and Medicaid Innovation (CMMI) for the Comprehensive Primary Care Initiative (CPCI). This landmark, four-year, multipayer project aims to strengthen the primary care system while improving health care outcomes and controlling costs through a patient-centered medical home approach. Project launch is conditional on the signing of memoranda of understanding between CMMI and each participating payer. Seven major Colorado commercial plans, as well as the state’s Medicaid office, applied to participate in CPCI. Medicare will work through these payers to make significant “care management” payments to primary care practices to support enhanced primary care services for their patients. Details on how physician practices can apply to participate in the CPCI will be available soon. Watch www.CMS.org for more details. . 19

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Colorado Health Plan Payment Reforms Within the next 12 months do you have any plans to roll out new payment models for physicians? Anthem Cigna Kaiser • AQI program for primary care providers (PCPs) has been in place since 2009. Initially rolled out on a limited basis, all network PCPs were eligible and participating in the program in 2011. • PC2 aimed at key physician groups in the market (those that can handle upside and downside risk) planned to begin 7/1/2012. Designed to build off of AQI, but more explicitly target more advanced primary care practices. Wave 2 practices will be identified and rolled out in 2013. Description: • AQI is an enterprise-wide P4P program based upon meeting quality, utilization and incorporation of technology into daily practice. Program rewards participation in local initiatives (e.g. Health TeamWorks PCMH Foundations program). AQI uses a potential 3-5% increase upside on fee schedule. • PC2 –utilizes per member per month (PMPM) care management fees. Practices are also eligible for shared savings, pending success on quality metrics.

• Rolling out Collaborative Accountable Care program to accomplish the same population health goals as ACOs with a strong focus on high-risk individuals focused on expanding patient access to health care, improving care coordination, and achieving the Triple Aim goals. Aims to empower PCPs and specialists to improve quality, reduce costs and reward them for doing so. Description: • Coordinated care program to use embedded care coordinator who works for the practice to use patientspecific data provided by Cigna to identify in-need and high risk patients and reach out to them for anything ranging from controlling blood sugar, to referrals to specialists, to help with home care and also help with health education on chronic conditions. • Year one contracts will be based upon an enhanced monthly PMPM. In year two, practices/groups will get to “share in the savings” with an enhanced PMPM if performance metrics are hit. All upside risk. No plans to use down-side risk currently within this program.

• While Kaiser Permanente is well known for their high performance employed permanent medical group of 950 physicians in the Denver-metro area, they have also done business in Colorado Springs and Pueblo using a traditional PPO model (non-employed, private practice community physicians) for 15 years. Kaiser is in the process of transitioning these networks to value-based contracting based on other well-known models like the Geisinger system in Pennsylvania. Kaiser Permanente is also expanding its book of business in northern Colorado . Description: • Value scorecards with metrics tied to performance, task and service will be part of contractual relationship from outset. Their focus is on finding physicians with whom they can effectively partner.

Does this tie into a larger strategic plan for your company to improve value and reduce costs? Anthem Cigna Kaiser • Focused on big picture payment and delivery reform that utilizes a strong primary care base to manage wellness and chronic conditions. This is a Triple Aim centric approach that seeks to get patients to right level of care at the right time.

• Yes, the underlying purpose of Cigna’s Collaborative Accountable Care (CAC) is to move from a delivery system focused on volume to one that’s focused on value. Improved quality will drive lower costs.

• These changes support Kaiser’s pursuit of the Triple Aim and an emphasis on population management, proactive care and medical homes. It seeks a balance of quality, cost and service.

Will any physician in your network be eligible for this new payment model? Anthem Cigna Kaiser • Primary care physicians who participate in the program will be paid more for their service and, additionally, those who achieve cost savings while maintaining or improving quality will have the opportunity to earn additional revenue through a shared-savings model.

• Intend to include both primary care and specialty care physicians. It will have a strong primary care base. Physicians or physician groups must have a sufficient number of Cigna patients to participate.

• 950 Permanente physicians. Contracted physicians must meet the same standards (dashboard) as salaried physicians.

Is there a focus on a specific specialty (e.g. PCP vs. specialists)? Anthem Cigna Kaiser • Anthem programs are focused almost exclusively on primary care at this time. Specialists that are part of multispecialty groups that are participating in PC2 may be affected.

• Focus on primary care but will not exclude specialists. PCPs do not have to be a medical home. However those that are medical homes or have medical home-like systems in place will likely be better positioned to participate.

• Primary care focused on patient-centered medical homes. Specialty uses Triple Aim.

Colorado Medicine for March/April 2012

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Colorado Health Plan Payment Reforms Within the next 12 months do you have any plans to roll out new payment models for physicians? Medicaid Rocky Mountain Health Plans UnitedHealthcare • The Accountable Care Collaborative (ACC) utilizes a case management fee (PMPM) for individual providers associated with medical home activities and for Regional Collaborative Care Organizations (RCCOs) that assist with care coordination. Currently they are modeling shared savings models for PCPs. This year’s Governor’s budget proposes an increase in PCP funding per the ACA, developing a pilot primary care shared savings program and developing bundled payments for specialists and primary care physicians. Description: • Pending successful evaluation the ACC is slated to expand to entire Medicaid population. Medicaid is expected to cover approximately 25% of the population, or about 1.2 million patients, by 2014 making Medicaid one of the largest payers in the state.

• Exploring new payment models for physicians that will include their entire network. To date, most of the work done regarding physician reimbursement has been on the Western Slope. Their primary focus has been on quality improvement rather than on payment–except where they have risk sharing relationships. Description: • Moving away from a volume driven system to one that builds and pays for quality and efficiency in a practice. • Focusing on providing resources to primary care physicians to help them develop efficient infrastructures and move toward a patient-centered medical home model. Additionally, looking into additional incentives for general practice improvements and that will vary based on practice’s needs and abilities. RMHP is also focused on their communities • They received an $11 million grant from the U.S. Department of Health and Human Services that created the Colorado Beacon Consortium, a health information technology pilot project in Western Colorado.

• United plans on expanding its value-based contract models so that by 2015 50-75% of their network will be on these incentive-based models. These contracts could include financial rewards for care United considers high-quality and efficient, and potentially withhold expected increases if certain standards aren’t met. Description: • Performance based contract model for hospitals and physicians done on prospective basis, tied to future year increases. Evaluation criteria based on quality and efficiency measures that tie to future year reimbursements. Targeting achievements of both quality and efficiency goals tied to that specific provider. • Evaluate every physician based on quality first. • Use quality criteria from existing and recognized industry standards, i.e. board certified and specialty society guidelines. They aligned benefit design and structure of insurance benefits selling in the market to support those primary care physicians to be most effective working with their patients.

Does this tie into a larger strategic plan for your company to improve value and reduce costs? Medicaid Rocky Mountain Health Plans UnitedHealthcare • ACC is a major initiative to transform delivery and payment to incent and reward outcomes rather than paying for volume. “We want to enable physicians to practice medicine the way they want, while incentivizing improved client outcomes,” said Judy Zerzan, MD, CMO Medicaid.

• Plan is to harness best practices identified through the Beacon Consortium and develop a master’s-type of program that will move even more practices to the medical home model. It will be funded using grants and health plan dollars and piloted on the Western Slope.

• The new payment initiative is part of the company’s broader efforts to improve value in health care delivery, and includes sharing data and other resources with providers and consumers.

Will any physician in your network be eligible for this new payment model? Medicaid Rocky Mountain Health Plans UnitedHealthcare • Must be a contracted Medicaid provider. Primary care physicians are eligible for PCMP incentives.

• RMHC has some limitations based on their geography. Without any other funding they will be limited to high performers in their Colorado Beacon Consortium.

• Encourage all physicians to understand their performance and working to develop tools and/or performance based programs for all physicians.

Is there a focus on a specific specialty (e.g. PCP vs. specialists)? Medicaid Rocky Mountain Health Plans UnitedHealthcare • Currently focused on primary care. As ACC expands will include specialists.

Colorado Medicine for March/April 2012

• Again, RMHC has some limitations based on their geography. Without any other funding they will be limited to high performers in their Colorado Beacon Consortium.

• UHC programs focus on PCPs and specialists.

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What are the eligibility criteria/requirements in order to participate in this new model? Anthem Cigna Kaiser • National Committee on Quality Assurance (NCQA) recognition in any program they get some credit. • PC2 - Must meet quality measurements.

• Be committed to Triple Aim. • Have a sufficient number of Cigna patients. • Demonstrate experience and plans to ensure value. • Have prior/current use and experience with utilization management, disease registries, HIT, PCMH recognition (a plus) and extended office hours. • Physicians do not have to be in the Cigna care designation program in order to participate in the CAC. • Performance measures for the CAC will have “some overlap” with the designation program measures.

• Willingness to participate in connectivity (HIT) with Kaiser. • Must share data and monitor outcomes • Must use proactive care and focus on care coordination

Does it apply to specific member benefit plans or is it enterprise-wide? Anthem Cigna Kaiser • AQI and PC2 apply to all members other than Medicare and Medicaid.

• Enterprise wide program that will apply to all benefit plans and products in traditional Cigna. • Not yet available for GreatWest plans.

• Enterprise-wide.

If your new payment models are based upon performance/outcomes, then what methodologies and measures are being used to evaluate physicians? (i.e. risk adjustment, attribution, performance measures) Anthem Cigna Kaiser • Patients will be attributed to primary care physicians via attribution methodologies. The new patientcentered primary care program will measure quality care through benchmarks – some established, some evolving – in patient safety, health improvement and patient satisfaction. Anthem will continue to measure quality in tandem with clinically driven, evidencebased guidelines established by, but not limited to, NCQA, national specialty societies and others. • To participate in shared savings, physicians must meet plan quality requirements such as percentage of people receiving recommended preventive care screenings.

• CAC program will use evidence-based performance measures (e.g. HEDIS). • Focused on claims data-driven measures. • Data will begin to flow to CAC contracted providers as soon as the contract is signed. Data will be provided at regular intervals to participating practices.

• Quality and service dashboards utilizing evidencebased measures will be utilized by every physician.

Have you engaged with physicians about other alternative payment models? Anthem Cigna Kaiser • Yes. We are working with physicians now about alternative payment models related to our PC2 initiatives.

• Currently in discussions with some groups and IPAs around the state.

Anthem

Contact information Cigna

• Janet Pogar, Regional VP of Provider Engagement & Contracting – e-mail: janet.pogar@anthem.com 22

• http://newsroom.cigna.com/KnowledgeCenter/ACO

• “KP is not just looking for a warm body. We are looking (for) demonstrated physician commitment to controlling costs, delivering quality health care and being connected through HIT,” said Bill Wright, MD, CPMG Executive Medical Director and President.

Kaiser • For more information contact: CFO – Dan.A.Oberg@kp.org – (303) 344-7608 Colorado Medicine for March/April 2012

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What are the eligibility criteria/requirements in order to participate in this new model? UnitedHealthcare Medicaid Rocky Mountain Health Plans • Must be a participating Medicaid provider • Any PCP can participate • Purposefully made it as easy as possible for any PCP provider to get in so that RCCOs can support practices in transforming to new models of care • Signed contracts with Medicaid and local RCCO

• In Western Colorado, practices utilizing the Quality Health Network are eligible to participate. • When starting incentivized quality improvement programs, RMHP asks local physicians what is important for practice or process improvement to set performance measures that are practice and community based. • RMPH expects physicians will implement their programs for RMPH patients and their entire practice. • RMPH receives patient information blinded to track performance.

• Any requests in future fee schedules will assess past performance. Quality measures will always be considered, never just cost alone.

Does it apply to specific member benefit plans or is it enterprise-wide? UnitedHealthcare Medicaid Rocky Mountain Health Plans • Only currently applicable to approximately 107,000 patients in the seven regions statewide. Significant expansions are expected next year.

• Applies to all products and members.

• Performance based contracting is being deployed to support all commercial products, including self-funded programs but does not apply to Medicare products. Scalability and consistency are key.

If your new payment models are based upon performance/outcomes, then what methodologies and measures are being used to evaluate physicians? (i.e. risk adjustment, attribution, performance measures) UnitedHealthcare Rocky Mountain Health Plans Medicaid • Risk adjusted attribution of clients. • Initially specifically targeting three measures including hospital readmissions, ER utilization and imaging volume. • National adult/child quality measures will begin to be used next year (HEDIS and NQF) to align with the national quality strategy that was created in 2011 per the ACA.

• Wants every patient in a practice to be in the Quality Health Network registry. • Evaluation methodologies will vary from HEDIS metrics to performance to quality improvement programs in place to community wide initiatives. • In Mesa County, will help fund a portion of the cost if a practice had a quality improvement component that was new and can be shared with the entire provider community. Additional resources include practice transformation coaches and physician-to-physician consultation. • Other evaluation methodologies are developed in collaboration with the Mesa County Physicians IPA.

• Performance based contracting, future reimbursement tied to performance – specific to the doctor/practice’s opportunities. • IT, ER, total episode costs, HEDIS measures, some Premium Designation Program, board certification, etc. • Physicians can access their premium designation status via the UHC website and pull down their quality and efficiency results today. UHC is actively developing other tools that will give physicians even greater visibility into their performance.

Have you engaged with physicians about other alternative payment models? UnitedHealthcare Rocky Mountain Health Plans Medicaid • Welcome physician feedback and participation in the development of these new payment models. • Come to the meetings, help shape this program.

Medicaid • Colorado.gov/hcpf

Colorado Medicine for March/April 2012

• Focus on comprehensive primary care with patient care advocates to help navigate health care system. Believe physicians should be paid more for those efforts. Achieving goal requires changing from a volume-based approach to a non risk-adverse approach. • Believe there should be a reimbursement differential for those complex patients in place–similar to Medicare for high cost cases, and for practices that have systems that manage those patents more effectively.

Contact information Rocky Mountain Health Plans • Kevin Fitzgerald, MD, CMO RMHP Kevin.fitzgerald@rmhp.org

• Encourage all physicians to understand their performance and working to develop tools and/or performance based programs for all physicians.

UnitedHealthcare • Contact your Network Manager, or direct your questions to Susanne Hindes, Susanne_Hindes@uhc.com 23

Colorado Medicine for March/April 2012

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Alan Synn, MD

Colorado payment reform: Specialty physician perspective Chet Seward, Senior Director, Health Care Policy Alan Synn, MD, is a part of a Denverbased five-person, vascular surgery group, which is the largest in the state. Colorado Medicine shared the health plan payment reform grid from pages 20-23 and asked him to respond to the following questions: Q. As a specialist, what do you think of the payer payment reform initiatives? A. I have approached health plans in the past and have been told that my subspecialty is below the radar as vascular surgery is too small in comparison to the other fiscally costly specialties such as cardiology, orthopedics and oncology. I think specialist physicians have a lot of worries about these initiatives because they don’t have a clear understanding about how these programs work or how physician performance is going to be evaluated. Negotiating payment reforms with payers requires an intense amount of time, resources and financial expertise – more than what most practices have or will ever have.

intimidated in terms of the business expertise required to negotiate one of these deals. Another big problem is interoperability of information systems. While we are on an electronic health record (EHR), it is not connected to the hospital and if we’re going to do this successfully we know we are going to need good data. Q. What is your perception of your colleagues’ ability to do this now? A. As I think about specialists, the way to improve consistent measurable quality is to either narrow the distribution on quality or exclude outliers. If you avoid providing the care to those that are high risk, in other words the complex patients who tend to need these services the most, you haven’t helped the access problem. When my colleagues and I were in training, we always wanted to be

the best surgeon who took on the most difficult cases. I worry that if we are not thoughtful with this [new approach], then the paradigm might shift to shying away from tackling complex cases. The motivation shifts to being “just good enough.” We need to be careful and patient-centered. We need to speak about measurable quality – in other words, measurable matrices that reflect quality care, in ways that include a patient’s quality of life. We cannot limit accessible care for high-risk complex patients. Q. What advice would you give to physicians in terms of what they can do? A. This is a topic of our time. Start engaging and learning more about these programs. Unless you’re 64 right now, you had better start paying attention because this is going to affect your practice life in major ways. n

Q. Are you currently participating in any of these programs? A. My practice is not currently participating. Q. What will it take for you to successfully participate in these programs? A. There are a number of barriers that currently challenge our ability to participate in these initiatives. Like many of my specialist colleagues, I feel pretty

Colorado Medicine for March/April 2012

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Colorado Medicine for March/April 2012

Features

Alan Aboaf, MD

Colorado payment reform: Primary care physician’s perspective Marilyn Rissmiller, Senior Director, Health Care Financing Alan Aboaf, MD, is a primary care internist practicing in a three-physician and one-physician assistant group in Aurora and Parker. Colorado Medicine shared the health plan payment reform grid from pages 20-23 and asked him to respond to the following questions: Q. What do you think of the payer payment reform initiatives? A. I’m always cautious about what exactly is involved and what those implications are for my practice. I’m suspicious sometimes because these programs are frequently geared toward costs, and not necessarily toward the quality care the patient needs. The physician can’t act on some of the things being measured as they are developed based solely on claims data and not the actual care delivered to the patient. Payers don’t come to your office to verify what you actually did, but rather base their decision on only the claims data they received. Even if you have the data in the chart, you may not get credit if the reviewer can’t find it. Many of these programs don’t even allow an appeal process if you disagree or have proof that the information you receive was inaccurate. Q. Are you currently participating in one of these programs? A. I am currently participating in Anthem’s AQI program, which is geared to large groups. It may be difficult for smaller groups or individual physicians to have the incentives apply since they just don’t have the numbers. For other primary care physicians (PCPs), they may not participate because they don’t know about the program or they ignored the mailings. The insurance comColorado Medicine for March/April 2012

panies should set the bars at achievable levels and make it easy to enroll. Q. What will it take for you to successfully participate in these programs? A. These initiatives use the typical measures that PCPs are familiar with to evaluate performance. These performance measures are not a barrier for us and are really the right thing to deliver quality patient care. The programs need to be better tailored for small practices. The initiatives are really for large multi-specialty groups, not for individuals. In addition, the incentives need to be substantial to justify the efforts and additional work required. Q. What is your perception of your colleagues’ ability to do this now? A. I think docs in general have the right skills to do this and they want to do it because it’s the right thing for patients. The incentives are not geared to small groups.

ernment incentives in the Affordable Care Act are helpful, but the cash outlay upfront is the sole responsibility of the physician. Q. What advice would you give to physicians in terms of what they can do? A. There is a significant variance on what/ how docs do things. Part of the problem is that the payment system doesn’t encourage change. The current fee-for-service system is a “churning system.” It has to change and become a value-based system. The younger docs are going to drive the way things get done. It’s easy if you’re older to stay on the sidelines and pretend it doesn’t exist since you’ll likely retire in the very near future. But if you’re not or can’t, then you need to understand how these systems are going to affect your practice and how you will adapt to them. You can pretend it is going to go away, but the earlier you get on board and adapt, the better off you will be in the future.

The biggest barrier is the infrastructure; specifically, health information systems – and many folks just don’t have that. The electronic health record (EHR) helps with improving the infrastructure. It would be helpful if the insurance company would provide you with an accurate list of individuals who haven’t had tests performed and if they have sent them reminders.

Small changes are easy to make, such as electronic prescribing via free software and the Physican Quality Reporting System (PQRS) reporting on Medicare patients through your billing systems. By doing these you get incentives and avoid penalties. The next step is evaluating and identifying EHR products that will work for your particular type of practice. After that is the big plunge into an EHR and learning to use it. That takes months.

EHRs would make this easier to achieve, as you would be able to generate your own reports/lists of measures that certain patients haven’t had and be able to contact them easily. The paper record is not conducive to doing this. There are significant upfront costs that self-employed physicians have to pony up to make EHRs a reality. The gov-

It is also important to work and collaborate with other providers and affiliate with other PCPs or specialists such as IPAs and/ or physician/hospital organizations. Remaining completely solo and unaffiliated is unlikely to be beneficial in the long run. n

Features

Alan Kimura, MD

Driving physician engagement on the road to system change As someone who appreciates racing cars and metaphors, I find myself bewildered by physicians’ lack of desire to jump behind the wheel and drive payment reform down the road to better health care. Physicians already understand the value of a good team in their practice and should also know that their contribution to the bigger health care team is not only desired, but critical. Yet these days all too often I find myself the only physician voice at critical meetings where payment reform and delivery system redesign strategies are being executed that will reshape Colorado health care. It’s at these times that an old saying keeps rumbling through my mind: “Sometimes you’re the windshield and sometimes you’re the bug.” Many of my peers may think that being a virtual spectator connected only through news stories and magazine articles is enough. It is not. To lead the team that is building the figurative car that is the health care system, you must become engaged, rev your curiosity and professional commitment, and accelerate your thinking on the road ahead by

finding out what payment reform means for you, your practice and your patients. The race is on Let me be clear. Payment reform is very much a reality in Colorado thanks in part to the work of the Center for Value in Health Care (CIVHC). CIVHC’s efforts to achieve the Triple Aim are focused on transforming Colorado health care by 2018 into integrated delivery systems that utilize global payments. The 2015 “midway milepost” to this larger plan centers on a blended approach to payment reform that includes: • Severity-adjusted bundled payments for specified chronic conditions and procedures; • Care management payments to primary care practices for care outside bundled arrangements (some fee-for service still); • Fee-for-service payments to specialists for care outside bundled arrangements and • Some “virtually integrated” systems in urban areas. Perhaps you’re thinking, “What can

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I really do? The system is too big and complex, maybe I can just ride this out.” I’m here to tell you that physicians cannot and should not take their eyes off this road. We don’t have to look very far to see that we cannot afford “this” anymore. The evidence is right in front of our faces–from the failure of a permanent fix for Medicare funding (also known as the Sustainable Growth Rate, or SGR), to the federal deficit debate, to state budget holes, to an increasingly bellicose business community demanding lower costs. Our resources are finite and the pay-for-volume system is running out of gas. The bottom line is the bottom line, and efforts are accelerating to find the brakes for these runaway costs. Shift from fee-for-service to bundling I believe that physicians are at the apex of the health care delivery system. Either we step up and engage or we risk being bystanders in the process that will radically transform the practice of medicine. That’s why I represent the Colorado Medical Society on the CIVHC Payment Reform Implementation Work Group. This group of hospital administrators, physicians, advanced practice nurses, health plans and patient advocates identified a list of conditions and procedures that can be bundled into one payment that includes all work associated with the respective condition or procedure. These conditions/procedures include asthma, coronary artery disease, coronary artery bypass graft, hip replacement, total knee replacement and lumbar fusion unrelated to scoliosis. The work group will soon disseminate a toolkit of resources to help providers and plans to develop those bundles. The Colorado Medicine for March/April 2012

Features group is also working on care coordination/management fees for primary care patient-centered medical homes. We need more physician engagement and participation in this work. CIVHC is using a deliberate approach that seeks broad participation and feedback on bundling and care coordination payments, as they are “way stations” toward global payments. CIVHC is also using the latest literature and data, and once it gets the All Payer Claims Database up and running later this year there will be even better information to drive change. Commercial health plans are already rolling out alternative payment models and through this work CIVHC is attempting to focus attention and drive consistency across payers. For example, by 2013 CIVHC intends to secure agreements from major payers representing 50 percent of covered lives in Colorado to implement specified bundled payments or limited global payments. These new approaches are exciting because they can advance health care quality, shared decision-making, integration of evidence-based practices, prevention initiatives and care coordination. However, care must be taken so that quality of care is not sacrificed in the drive to cut costs. The metrics of quality must be relevant and actionable (non-intrusive to clinical workflow). Again, a lack of physician engagement creates a void when a strong and deft hand is required on the wheel. Get into gear This is the time to get it into gear. Payment reform is not going away and now is your chance to exert your professional muscle and be part of the change. Check out the details of CIVHC’s work at www.civhc.org, meet with your colleagues, your component and/or specialty society and CMS to vet these proposals and help build a high-performance health care system. It is our responsibility to be good stewards of our patients’ health and our society’s fiscal health. n

All Medical Answering Service Owned and operated by the Arapahoe-Douglas-Elbert Medical Society (ADEMS) and backed by an all-physician Board of Directors, MTC is uniquely focused on the needs of its clients. Serving medical professionals is all we do. MTC’s management team has over 50 years of experience in medical answering services. Our operators are professional, friendly and expertly trained to handle any client situation. We offer a full range of customizable services to ensure your patients enjoy personal, timely communication while you stay on top of your busy schedule. MTC proudly received the prestigious 2009 Award of Excellence for the fourth year from ATSI (Association of TeleServices, Intl.), a service-quality award based on test calls placed over a six-month period. MTC is a member of the Denver/Boulder Better Business Bureau, ATSI and Telescan Users Network (TUNe). MTC participates in the Colorado Medical Society’s Disaster Preparedness Program by contacting volunteer providers in the event of a large scale disaster. In addition we collaborate with CMS every six months in testing the response time of the volunteer providers.

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Colorado Medicine for March/April 2012

CMS Corporate Supporters and Member Benefit Partners While CMS analyzes the quality and viability of our member benefit partners and their offerings, we do not guarantee any product or service will be right for you. Before you make a purchase, we recommend you perform your own due diligence. AUTOMOBILE PURCHASE/LEASE Rocky Mountain Fleet Associates 303-753-0440 or visit www.rmfainc.com * CMS Member Benefit Partner FINANCIAL SERVICES BBVA Compass 303-478-9054 or visit www.bbvacompass.com *CMS Member Benefit Partner COPIC Financial Service Group 720-858-6280 or visit www.copicfsg.com * CMS Member Benefit Partner Sharkey, Howes & Javer 303-639-5100 or visit www.shwj.com. * CMS Member Benefit Partner Wells Fargo 303-863-6014 or visit www.wellsfargo.com INSURANCE PROGRAMS COPIC Insurance Company 720-858-6000 or visit www.callcopic.com *CMS Member Benefit Partner UnitedHealthcare 877-842-3210 or visit www.UnitedhealthcareOnline.com MEDICAL PRACTICE SUPPLIES AND RESOURCES CO-POWER 720-858-6179 or www.groupsourceinc.com *CMS Member Benefit Partner National Jewish Health 800-844-2305 or visit www.njhealth.org/proed PRACTICE VIABILITY ALN Medical Management 866-611-5132 or visit www.alnmm.com athenahealth 888-402-6942 or visit www.athenahealth.com/cms. *CMS Member Benefit Partner ALLSCRIPTS 972-475-4159 or visit www.allscripts.com *CMS Member Benefit Partner

PRACTICE VIABILITY (cont.) CMSCodingToday.com (by PRS Network) 800-972-9298 Colorado Physicians Consulting 303-797-2222 or visit www.copracticevaluations.com CPS Healthcare Solutions 970-495-0300 Diagonal Medical Billing 303-551-7944 or visit www.diagonalmedicalbilling.com GL Advisor 877-552-9907 or visit www.gladvisor.com/cms Healthcare Management 866-986-3587 or visit www.hcmcolorado.com HealthTeamWorks 866-401-2092 or visit www.healthteamworks.com *CMS Member Benefit Partner KKB, P.C. 303-815-1100 or visit www.kkb-cpa.com Physiciansâ&#x20AC;&#x2122; Billing 720-236-1280 or visit www.physicians-billing.com Medical Telecommunications 866-345-0251 or 303-761-6594 or visit www.medteleco.com * CMS Member Benefit Partner Pinnacle III 970-685-1713 or visit www.pinnacleiii.com QSE Technologies, Inc. 303-283-8400 or visit www.qsetech.com *CMS Member Benefit Partner Solveras: A Division of TransFirst 800-613-0148 or visit www.solveras.com *CMS Member Benefit Partner TMS Center of Colorado 303-884-3867 or www.tmscenterofcolorado.com Transcription Outsourcing 303-638-9309 or visit www.medicaltranscriptionoutsourcing.net Transworld Systems 800-873-8005 or visit www.web.transworldsystems.com/npeters * CMS Member Benefit Partner Colorado Medicine for March/April 2012

Features

First phase of new Medicaid expansion begins Aubrey Hill, Colorado Coalition for the Medically Underserved Adults without dependent children (AwDC) have traditionally not been eligible for Medicaid. However, with some funding dollars from 2009 legislation known as the Colorado Health Care Affordability Act (House Bill 09-1293), Colorado is gradually expanding eligibility for these individuals, starting this April. While this expansion is still pending federal review, approval is expected. This spring, Colorado also will begin offering full Medicaid benefits to 10,000 individuals with incomes below 10 percent of the federal poverty level (or annual income of about $1,089 for a single adult). The 10,000 AwDC will be chosen by random selection from a pool of qualified applicants, and the remainder will be put on a wait list for future monthly selections, provided spots become available.

will only apply for the first round of random selections. Any random selections thereafter will be statewide. Become a Medicaid provider Care will be delivered via the ACC program, which will connect patients with a primary care provider as well as with care coordination and case management. Providing continuity of care is critical for this population; physicians whose patients become newly covered on this Medicaid expansion should register as a Medicaid pro-

vider and/or as a participant in the ACC if they have not already. If interested, please contact Jeffrey Konrade-Helm at the Colorado Medicaid agency via e-mail (jeffrey. konrade-helm@state.co.us) or phone (303866-2267). More information on the history of this expansion can be found online at the Connect Campaign website (connectcampaign.wordpress.com) or you may contact Aubrey Hill via e-mail (aubrey.hill@ ccmu.org) or phone (504-615-3085). n

Eligibility and wait list Individuals who remain on the wait list, as well as those otherwise ineligible for Medicaid, will be able to apply for the Colorado Indigent Care Program (CICP). CICP allows access to some health services until more adults without dependent children are able to be covered by Medicaid. As more funding becomes available for this expansion, the state may choose to either open up additional enrollment spots or raise the income limit. To ensure statewide availability for new enrollees, the first 10,000 spots have been pre-assigned to each of the stateâ&#x20AC;&#x2122;s seven regions in the Accountable Care Collaborative (ACC) program. These regional numbers can be found on the Colorado Department of Health Care Policy and Financing website (Colorado.gov/hcpf) and Colorado Medicine for March/April 2012

Inside CMS

Who takes care of the doctor? Susan Burke, Director, Communications

Expert panel on wellness convenes inaugural meeting Who takes care of the doctor? That was the question addressed by the Colorado Medical Society’s Expert Panel on Wellness during the panel’s inaugural meeting in March.

tion that places real importance on our professional and personal success – so much so that it is one of the pillars of strength in the CMS strategic plan.”

The Expert Panel on Wellness was formed in response to a survey CMS conducted last year that revealed the majority of physicians felt they are generally unable to have work-life balance. In addition, only half of respondents said they were able to live a healthy lifestyle (exercise, diet); fewer reported being able to find time to relax through yoga, reading or other pastimes.

Comprised of experts in the field of physician health and dedicated to ensuring that physicians thrive personally and professionally throughout their careers in an evolving health care system, the CMS Expert Panel on Wellness will endeavor to better understand the concerns and needs of Colorado physicians, explore quality of life enrichment programs and innovate new ideas to help physicians.

“Now, more than ever, it is critical that we develop a pathway for physicians to integrate new healthy practices to achieve a work-life balance,” CMS President F. Brent Keeler, MD, said. “Fortunately we are supported by an organiza-

Wellness Panel Chair Doris Gundersen, MD, a psychiatrist in private practice who also serves as medical director for the Colorado Physician Health Program, emphasizes the importance of physician wellness. “In a recent survey conducted by the American Medical Association, nearly nine out of 10 physicians reported significant stress,” Gunderson said. Of concern, two-thirds of those physicians described their stress as having increased “moderately to dramatically” over the past three years. The rate of physician suicide is two to four times that of the general population.

Expert Panel on Wellness members (left to right) Nick Ghiselli (in for Mark A. Fogg), Dianne McCallister, Brent Keeler, Doris Gundersen, Gerard Guillory, James Duke, Jeanette Guerrasio, Ruby Kadota, and Debra Parsons. 32

“Reports like these have inspired me to be more involved in the physician community and find ways to implement primary prevention strategies for physicians,” Gunderson said.

Resurrecting the “physician lounge” experience from years past, Porter Adventist Hospital’s Dianne McCallister, MD, chief medical officer, has successfully implemented and cultivated Porter’s wellness program. “My heart was breaking for my colleagues,” said McCallister, who is also a panel member. “The collegiality formed by physicians sharing their thoughts and frustrations in the safe environment of the physician lounge had gone away, and there hasn’t been a mechanism to replace it.” Porter Colleagues, as the program is called, relies on the financial backing of the administration as well as a culture that integrates physicians into the hospital’s strategy and decision-making process. More than 100 physicians participate in the program at some time during the year and enjoy peer-to-peer camaraderie in activities ranging from monthly 30-minute meetings facilitated by Lumunos, an organization that specializes in creating meaningful conversations, to dinners and outings centered around a fun topic. “The Porter Colleagues program is about getting to knowing and supporting one other. It’s not therapy; it’s physicians listening to other physicians,” McCallister said. “We don’t try to fix anything. The physicians simply listen to one another – and with the same confidentiality that a caring friend would give.” As we look to the future of health care, it is all about working together while keeping the patient at the center. It only Colorado Medicine for March/April 2012

Inside CMS makes sense to support your colleagues professionally as well as personally, as that leads to increased job satisfaction and overall improved performance, which is in everybody’s best interest. As any physician on the panel will tell you, it’s great to be able to treat a disease, but it’s better to prevent the disease – and nowhere is prevention more applicable than with physician wellness. “CMS is lucky to have leadership pro-

moting physician well being with a willingness to organize a panel of concerned physicians who are willing to work together to support our colleagues through tumultuous times,” Gunderson added. The goals of the CMS Expert Panel on Wellness are to raise awareness for the needs of physicians and to develop ways for them to achieve a better work-life balance while increasing their level of satisfaction for their chosen profession.

“The wellness panel is not only unique but, given our survey data, is also long overdue,” said CMS CEO Alfred Gilchrist. “Developing a wellness program is new to most state medical associations and represents a break from the traditional lines of business.” The panel will explore what challenges physicians face in different settings across the state and share ideas in future issues of Colorado Medicine. n

Expert Panel on Wellness Doris C. Gundersen, MD, (Psychiatry) Chair, Expert Panel on Wellness Medical Director, Colorado Physician Health Program

Jeanette Guerrasio, MD (Internal Medicine) IM Residency, Assistant Director for Physical Exam University of Colorado School of Medicine

James Duke, MD (Anesthesiology) President-elect Medical Staff at Denver Health

Gerard Guillory, MD (Internal Medicine) The Care Group, PC

Debra J. Parsons, MD. FACP (Internal Medicine/Geriatrics) Post-acute and LTC Medical Director RICCO East Metro

Mark A. Fogg, JD, COPIC General Counsel

Ruby L. Kadota, MD (Pediatrics) Kaiser Permanente

Brent Keeler, MD (OB/GYN) CMS President

Colorado Medicine for March/April 2012

Dianne McCallister, MD, MBA Chief Medical Officer Porter Adventist Hospital

Inside CMS

Reflections Reflective writing is now a regular portion 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 Henry N. Claman, MD and Steven R. Lowenstein, MD, MPH, from the new Medical Humanities Program

Procurement

Jenelle Holst Jenelle Holst is a fourth-year medical student at the University of Colorado. She grew up in rural Colorado near Hygiene and studied biochemistry and molecular biology at Franklin and Marshall College in Pennsylvania. She is planning a career in emergency medicine with a special interest in critical care and translational research. She lives for adventures in the Rocky Mountains with her friends, family and fiancé, Alex Badulak.

I didn’t sleep easy that night. I was so excited. I had a feeling that I would get a call and I did. It was about 10 p.m. and I practically shot out of bed, threw on my scrubs, washed my face and bolted out the door. As I got into my car, my head was swimming with thoughts, fears, images and anticipation. This would be my first organ procurement. It was strange to be driving to work on a warm July night, when the rest of the world was spilling onto the streets looking for fun. I couldn’t imagine anywhere else that I would rather be headed. I remember the green tile that lined the hallways, the dim lighting and the vacant OR. The only surgery in the entire suite was ours. I had arrived early so I

decided to explore the hallways a bit. As time went by my anticipation for what was to come heightened. I heard some noise in the main hallway. The double doors flew open and six people were quickly wheeling a patient in. My stomach churned and my palms started to sweat as I took in the scene. His eyes were taped closed, every orifice had been cannulated and a neurosurgical bolt sprang out from his head. This must be the donor. As we got him prepped for surgery I started to wonder who he was, what had happened to him, where his family was and how they were feeling. He could not have been older than 35; his legs were thick and strong, probably an athlete. His skin was pale but otherwise pristine. He almost looked healthy. I would later learn that he was in a bike race in the mountains and had a head-on collision with a truck, suffered a closed head injury and was rendered brain dead. He was survived by his wife and three young children. I couldn’t imagine a more tragic situation. Three surgeons and I started to work. We made an incision from sternal notch to pubic bone. The stimulation was overwhelming; I couldn’t decide whether to look to my left or right. Two surgeons were exposing the liver, kidneys and pancreas and the other was starting on the chest. Then I heard, “Have you ever opened a chest?” and one surgeon handed me a saw. I couldn’t believe it.

Colorado Medicine for March/April 2012

Inside CMS The next thing I knew I was asking anesthesia to lower the lungs and then pulled the trigger to launch the deafening power tool. I didn’t think I would be able to do it. I was simultaneously exhilarated and terrified but somehow managed to open the chest as if I had done it a thousand times before. At that time I was flying higher than ever. One of the surgeons caught a glimpse of my wide eyes and chuckled to himself. I couldn’t wipe the smile off my face if I tried. The patient was splayed open from top to bottom with every vital organ exposed. I had to step back to appreciate the gravity and beauty of what was in front of me. The beating heart was churning and twisting within the pericardium, the aorta surging with each beat, the glistening intestines and slick surface of the liver all laid out in textbook fashion. Then came the part that would change me. One minute the room was buzzing with tidbits of casual conversation and the next the abdomen was filling up with blood. Things were happening so fast I somehow didn’t see the surgeon cut the aorta to exsanguinate the patient. The blood was spilling over the edges of the abdominal wall, suction unable to keep up, continuing over the bed and onto my shoes. I found myself staring at the heart. It was valiantly struggling to pump, becoming smaller and less powerful with each futile squeeze. It began to quiver and then stopped. Panic overwhelmed me. The man was brain dead, so we didn’t kill him, right? Was he a man if he was already declared to be dead? Is brain death really death? His body was warm, his heart was beating, the air coming out of his lungs was moist, he had a family. Now we were shoveling ice into his open body and he started to turn grey-blue and cold. My vision started to close in and the panic accelerated. I felt like I was watching the scene from above. This was simultaneously the most tragic and rewarding situation I had ever been in. We exsanguinated one man to save another who was probably getting a phone call at that very moment that his number was up and he was getting the liver he had been waiting for. I wondered to whom Colorado Medicine for March/April 2012

the organs would go. I wondered if they thought about the donor. Did they feel the way I did? Did they feel conflict, guilt, confusion? So many questions flooded my mind. I struggled for clarity and tried to focus on one thing – not passing out. Eventually, the wave of emotion that had almost overtaken me began to wane and I was able to allow my mind to return to the surgery. After a while I found myself staring at emptiness. All of the vital organs were gone, anesthesia had already left, it was deafeningly quiet with only four people left in the entire room that was once uncomfortably crowded. Someone handed me a giant stitch and needle driver and I began to sew. I sewed for three whole feet in silence until I was completely alone. It hit me as I walked down the greentiled hallway. I started to cry. I didn’t know I was crying until I felt the tears on my cheeks. I don’t remember the drive home. I felt numb. I crawled into bed around 2 a.m., set my alarm for 4:15 a.m. and fell asleep as soon as my head hit the pillow. The next morning I realized that things had changed for me. I would always look at the world in a slightly different way. What I had experienced was life altering, a privilege that few other people in the world would come to know. I felt alone knowing that those close to me could never begin to sympathize. It took weeks for me to process all of the thoughts and emotions that were stirred up that night. As I sit here and write, I realize I still have many more. Being a doctor is unlike any other profession. We perform life-giving and sometimes life-taking tasks. We endure a rollercoaster of human emotion while wearing a mask of professionalism. We lose ourselves in a selfless culture. As I ponder my life ahead, I realize that I will evolve and regress; I don’t have to have all the answers. Some experiences are so much bigger than me that I have to let them wash over me and welcome my new self with acceptance and patient understanding. n

Inside CMS

2012 CMS Spring Conference Gold level sponsors:

COPIC Financial Wells Fargo

2012 Spring Conference May 4 through May 6, 2012 Sonnenalp Resort, Vail

Colorado Medicine for March/April 2012

Inside CMS

2012 CMS Spring Conference Agenda Conference attendees, through a series of interactive, expert-led discussions and case studies, will understand the importance of local engagement with public officials – why politicians still listen to their local medical community, why patients still listen to their doctor, and the significance of collective engagement. There is more that unites physicians than can divide their beliefs and duty to their patients that makes medicine still a community no matter where physicians work.

Learn the rules and relevance of physician engagement • • •

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

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

Constitutionality of the individual mandate; Preparing for 2012 election engagement; Colorado Health Insurance Exchange; Reimbursement realignment; Employed physicians and advocacy; Online reputation management and social media; Advertising & marketing laws for physicians

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

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

Saturday Morning, May 5 08:00 AM - 08:15 AM: 08:15 AM - 09:30 AM:

09:30 AM - 10:00 AM: 10:00 AM - 10:30 AM: 10:30 AM - 11:15 AM:

11:15 AM - 12:15 PM:

Why we are here: Jan Kief, MD, CMS President-elect The rules and realities of physician engagement: An interactive session led by political trainer Joe Gagen JD The value of relationships: Case studies and experiences – their relevance, and consequences: A discussion led by veteran journalist Time Magazine Michael Weisskopf Wellness break: Doris Gunderson MD Breaking through breakouts: Prepping for local engagement in the 2012 election cycle: A highly localized set of structured work sessions to prepare local physicians to engage their peers, communities and the candidate of their choice New patient relationships: The progress and probabilities of the roll out of the Colorado Health Insurance Exchange: A focus group discussion led by Health Insurance Exchange Chair Gretchen HAMmer

Saturday Evening, May 5 07:00 PM - 09:30 PM:

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

Sunday Morning, May 6 08:00 AM - 08:10 AM: 08:10 AM - 09:15 AM:

09:15 AM - 10:15 AM: 10:15 AM - 10:45 AM: 10:45 AM - 11:15 AM:

11:15 AM - Noon:

Noon:

Setting up the morning discussions: Jan Kief, MD Been there, still there – Doing, undoing, redoing physician advocacy in the brave new world of medical disruption: A discussion led by CMS former President Rick May, MD with Brent Mulgrew JD, CEO Ohio State Medical Association and Gordon Smith, JD, CEO of Maine Medical Association Defending your online reputation in the age of transparency: Learn the importance of knowing and managing what is being said about you on the Internet. Break and wellness break: Doris Gunderson, MD Cleaning up our advertising act(s): A discussion led by COPIC General Counsel Mark Fogg, JD on the current and prospective laws governing marketing and advertising in Colorado, and physician do’s and don’ts Reimbursement realignments – An updated prognosis: A focus group discussion led by Center for Improving the Value in Health Care (CIVHC) on the march toward a world without or at least less fee-forservice and what we and you can do to adapt Wrap up and next steps: Dr. Kief

Colorado Medicine for March/April 2012

Inside CMS

Colorado Medical Society

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

❏

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

❏ Friday May 4th

❏ Saturday May 5th

❏

My spouse/guest will attend the Conference.

❏

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

________________________________________________________ Name

_____________________________ Component Society

________________________________________________________ Name of Spouse/Guest (if attending)

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

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

Arrival Date: _________________ Departure Date: ____________________

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

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

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

❏ King Bed

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

❏ 2 Double Beds

Sonnenalp Resort of Vail suites all contain gas-log fireplace, large baths with soaking tub big enough for two, separate shower, heated tile floor, walk-in closet, TV, TV Internet access, hand-carved pine Bavarian furniture, and down comforters on all of our beds. There will be an additional charge of $25.00 per night for each person over 12 years of age exceeding Double occupancy. (Note: most suite types cannot accommodate more than 3 adults.)

Reservations received after April 4, 2012, will be taken on a space available basis only.

Cancellation Policy: In the event of cancellation 14 or more days prior to arrival, you will receive a full refund. If you cancel less than 14 days prior to arrival, you will forfeit the deposit of one night room and tax. As of day of arrival, early departures will be charged a $50.00 change fee.

Reservations will be taken with this form or call our Reservations Department at (800) 654-8312. Register Online at www.sonnenalp.com 1) Go to www.sonnenalp.com 2) Click top right tab “Reservations” 3) Enter group Code – 37J9FV 4) Enter your dates 5) Press continue at bottom of page 6) Review & ensure information is correct then press continue at bottom 7) Complete page noting your contact information, special requests & payment information 8) Bottom of page click book reservation 38

Please mail this form to: Colorado Medicine Sonnenalp Resort of Vail, Attn: Group Reservations, 20 Vail Road, Vail, CO 81657for March/April 2012

Colorado Medicine for March/April 2012

Inside CMS

Save the Date 2012 CMS Annual Meeting Keystone Resort and Conference Center September 6-9, 2012

Physicians! Enter to Win a $150 Gift Certificate to Your Favorite Restaurant! Simply complete a very brief survey about your continuing medical education needs and we will enter your name into a drawing for a $150 gift certificate to a restaurant of your choice. Let us help you achieve your continuing professional development goals and requirements through accredited CME. Survey link found at: www.surveymonkey.com/s/CMENeeds2012 Or, go to www.cms.org home page and click on Take a CME survey link under News Room. 40

Colorado Medicine for March/April 2012

Inside CMS

2012 Annual Meeting

Accommodations Reservation Form Keystone Resort (September 6-9, 2012)

ACCOMMODATIONS: Please indicate your first (1), second (2) and third (3) choices: (please use this form for one room only) ROOM TYPE Keystone Lodge & Spa Conference Village Studio Condo Conference Village One Bedroom Condo Conference Village Two Bedroom Condo

ROOM RATE $150 $120 $150 $210

CHOICE

OCCUPANCY MAXIMUM 4 people 2 people 4 people 6 people

The above rates do not include 12.02% tax. Check-in time is 4:00 PM and check-out time is 11:00 AM. Children under 18 stay for free in parent’s room with existing bedding. Extra adult charge is $20 per night. Rollaway charge is $25 per night. No pets allowed. Per room/per night resort fee at Keystone Lodge and Spa $20, Inn at Keystone Resort $10 NOTE: RESERVATIONS MUST BE RECEIVED BY MONDAY AUGUST 6, 2012 TO BE GUARANTEED SPECIAL COLORADO MEDICAL SOCIETY RATES. REGISTRATION INFORMATION Arrival Date_______________________ Departure Date________________________ Name(s) _________________________________________________________________________ Address__________________________________________________________________________ City_____________________________ State_________ Zip______________ Phone_____________________ Any Special Needs/Requests?___________________________________________________________________ E-mail Address:____________________________________ DEPOSIT AND CANCELLATION INFORMATION

If using individual request forms, a deposit in the form of a credit card equal to one night’s lodging is due together with the room request form. Reservations made by telephone require one night’s deposit in the form of a credit card when the reservation is made. If a reservation is made within 30 days of arrival, full payment is due at such time. After a deposit is received, a confirmation will be sent. Keystone will offer transportation packages to attendees making individual reservations. Individual cancellations within 30 days of arrival are subject to forfeiture of full deposit amount. Individual cancellations outside of 30 days of arrival will result in return of deposit less a $30.00 processing fee. No shows, late arrivals and early departures will be charged the room rate for the entire reserved stay.

Card Type___________________ Card #____________________________________ Expiration___________ Name of Cardholder__________________________________________________________________________ I authorize Keystone Resort to charge my credit card for the deposit for accommodations listed above. ________________________________________________________

________________________________

Signature

Date

RESERVATIONS PHONE 800-258-0437 Must refer to group code CK2MED FAX: 970-496-4343 Colorado Medicine for March/April 2012

Inside CMS

Annual Meeting Registration Annual Meeting of the Colorado Medical Society/Connection Keystone Resort & Conference Center • September 6-9, 2012

Name (please print) _____________________________________________________________________________ Component Society ___________________________________________________________________________ Name of Spouse/Guest(s)___________________________________________ CMS Connection Member q Yes q No q My physician spouse will not attend, please send handbook to my attention

If you are not a member of CMS, please provide the following information and $125 for registration fees:

Company/Organization _________________________________________ Title _________________________ Registration deadline is August 23, 2012. Registrations accepted on a first-come, first-served basis (may be limited for some

programs). 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.

Complimentary Events for CMS or Connection Member & Spouse/Guest Except for the COMPAC Luncheon, you and one guest are entitled to attend all events at no charge. To confirm your reservation, use the boxes below for yourself and one guest and the shaded area for additional guests.

Thursday, September 6

member

spouse/guest

7:30 pm

Friday, September 7

member

spouse/guest

12:00 pm

Welcome Reception AMA Forum Lunch

Meat q Vegetarian q Vegan q Gluten Free q 6:00 pm

Exhibitor Reception

Saturday, September 8 (Complimentary for member & one guest only)

CHARGES FOR ADDITIONAL GUESTS

7:00 am 8:00 am 5:30 pm 6:00 pm

Breakfast Buffett Education Program Candidate Reception Inaugural Gala Meat Dinner Vegetarian Dinner Vegan Dinner Gluten Free Dinner

Non-complimentary events Saturday, September 8

q q q

#_______ @ $35/each_________

q q q q

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

12:00 pm COMPAC Luncheon* Meat q Vegetarian q

Vegan q Gluten Free q

* CHARGE PER PERSON FOR ALL MEMBERS AND GUESTS

#________@ $45/each

TOTAL amount enclosed for non-members, additional guests and COMPAC Luncheon. $ Please make check payable to: Colorado Medical Society and mail this form, or charge ❑ Visa ❑ Mastercard ❑ Am. Express #______________________________________ exp. date____________ Signature _____________________________________________________________________________________ Please mail this form to us at PO Box 17550, Denver, CO 80217-0550 phone it to us at 720-859-1001 or 1-800-654-5653 or fax it to us at 720-859-7509

Hotel Reservation deadline is August 6, 2012. After that date on space available basis. 42

Colorado Medicine for March/April 2012

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

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

For more information and an application to join, call Genni Pearman 720-858-6308 or e-mail geneva_pearman@cms.org

CMS Education Foundation Help send a student through school

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

Call 720-858-6312 for more information and to donate 44

Colorado Medicine for March/April 2012

Inside CMS

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

Board declares $12 million Colorado physician distribution Distribution to offset COPIC insureds’ 2012 premium Great news! Because of the efforts our insureds have made to reduce risk and increase patient safety, COPIC’s Board of Directors declared a $12 million distribution for COPICinsured Colorado physicians. What does this mean for our insureds? Eligible physicians will receive an approximate 16 % credit on their 2012 premium. The board declares a distribution when COPIC’s financial position is strong and when we experience favorable loss development – meaning we did not pay out as much in claims as we anticipated. How do we explain this development? We believe there are

Colorado Medicine for March/April 2012

many factors that contributed, including our insureds’ active participation in our Patient Safety and Risk Management programs. For example, our insureds continue to make system improvements in response to our Practice Quality reviews. Also, many of our insureds avoid costly claims by participating in our 3Rs early intervention program (Recognize, Respond and Resolve unanticipated medical outcomes). All told, COPIC has declared more than $167 million in Colorado physician distributions since 1990. Keep up the good work, Colorado. Patient safety and risk management contribute to continued affordability of medical liability insurance, keeping health care more affordable for us all. n

Departments

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Colorado Medicine for March/April 2012

Departments

medical news Dikeou honored for work in physician education and patient safety The Center for Personalized Education for Physicians (CPEP) recently recognized veteran Colorado health care attorney George Dikeou as the first recipient of an award created in his honor to acknowledge the contributions of leaders in physician education, patient safety and health care quality improvement. More than 85 people, including top Colorado medical and legal professionals and hospital administrators, attended an award dinner to recognize Dikeou and his contributions in these areas. Throughout his distinguished career, Dikeou has served as an innovator and leader in the betterment of health care. Dikeou was in-house counsel and executive vice president of COPIC, a leading medical liability insurance provider and advocate for patient safety in Colorado and Nebraska, and served on its board until his retirement. Dikeou has served on the boards of more than 30 different organizations. He was a motivating force behind much of what are now considered Colorado health care fixtures, including CPEP, the COPIC 3Rs Program (which encourages providers to Recognize, Respond to and Resolve unanticipated outcomes) and key legislative efforts such as the 1988 Health Care Availability Act. Dikeou joined CPEP’s board in 1990, its inaugural year, and served for 15 years. He helped conceive of CPEP’s mission: to help doctors become better doctors.

Elizabeth J. Korinek, M.P.H., CPEP executive director. “Our services are confidential, objective and unbiased. Our policies allow us to fairly serve participants while being responsive to needs of the referring organizations. These principles have not changed and continue to guide us today.” The award is presented on behalf of CPEP’s staff and board of directors, as well as the more than 2,000 physicians throughout Colorado and the United States who have participated in CPEP’s services and the patients who have ultimately benefited from improved quality of care.

The event was sponsored by COPIC and held at the Denver Country Club. Event speakers who recognized Dikeou’s contributions to the profession included Korinek; Steven Rubin, president and chief operating officer, COPIC; and Edward Dauer, dean emeritus and professor of law, University of Denver Law School. Video testimonials were offered by Arja Adair, Jr., president and chief executive officer, Colorado Foundation for Medical Care; Patty Skolnik, executive director, Citizens for Patient Safety and Ned Calonge, MD, president, The Colorado Trust. n

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For more information: For more information: Ted Wirecki, MD, Medical Director Ted Wirecki, MD, Medical Director 4770 E. Iliff Ave 4770 E. Iliff Ave Suite Suite 224 224 Denver, Denver, Co. Co. 80222 80222 Telephone: Telephone: 303-884-3867 303-884-3867 www.tmscenterofcolorado.com

“George helped CPEP establish its central values and principles,” said Colorado Medicine for March/April 2012

Departments

medical news CPEP hosts Coalition for Physician Enhancement meeting in June The Center for Personalized Education for Physicians (CPEP) will host the conference “Advances in Simulation Technology for Use in Physician Assessment” at the Coalition for Physician Enhancement (CPE) Spring 2012 Meeting in Denver June 7-8.

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

This conference is designed for those interested in physician clinical competence and those involved in the evaluation and education of physicians who are currently practicing or returning to practice. Professionals working at universities and training programs, as well as hospitals with simulation centers and regional trauma centers, will gain valuable insights from the conference. Nationally recognized speakers will examine the rapidly advancing field of simulation technology and its applications in evaluating the clinical skills of physicians. Hands-on, small group sessions will allow participants to experience the use of emerging simulator technology. The conference will also provide a forum to speak with national experts and explore this important and timely issue. Registrations are now being accepted to join CPEP and CPE for this important event. For more information, or to register for the CPE 2012 Spring Meeting,

please visit www.cpepdoc.org or contact www.physicianenhancement.org. CPE is a consortium of professionals with expertise in health care quality, medical education and the assessment, licensing and accreditation of referred physicians seeking higher levels of performance in patient care. CPE conferences draw top national and international medical leaders and experts who have an interest in physician competence assessment and education. CPEP was created in 1990 with a single, clear purpose: to provide the in-depth information and educational solutions needed to address physician performance concerns. As an independent not-for-profit organization, CPEP is uniquely positioned to provide comprehensive assessments in an objective, neutral environment. More than 2,000 health care professionals in 61 medical and surgical specialties have participated in CPEP’s various programs. n

Providing Medical Practice Valuation Services Since 1991 • Valuations for Hospital or Private Practice Buy-in/Buy-out • Physician Compensation and New Tax Laws • Senior Physicians Retirement and Compensation Planning • MGMA Benchmarks to Industry Standards • Disaster Planning – Death, Disability, Departure or Divorce • New Practice Start-up Business Plans

Leon Harrison - CLU Craig Ciarlelli - CLU 303.797.2222 • info@copracticevaluations.com • www.copracticevaluations.com 48

Colorado Medicine for March/April 2012

Departments

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

➤ PROFESSIONAL OPPORTUNITIES ➤ PROFESSIONAL OPPORTUNITIES ➤ SPACE TO BUY OR LEASE EXECUTIVE DIRECTOR, HEALTH & COUNSELING CENTER, UNIVERSITY OF DENVER – The University of Denver Executive Director (ED) - Health and Counseling Center is a senior–level administrator responsible for the comprehensive leadership, vision and management of the HCC Cluster team and the integration of these areas (medical services, counseling services, health promotion and administration) for the optimal benefit of students, faculty and staff at the University of Denver. The ED is also the liaison to the medical and mental health community in Denver and local and state health department. The ED oversees the selection, training, supervision, evaluation, recognition/ appreciation, and management of the HCC department (a team of 34-36 professional and graduate staff). Application are made exclusively on-line at - www.du.edu/hr/employment/jobs.html MEDICAL DIRECTOR – Wardenburg Health Center at CU-Boulder WHC is a multi-disciplinary health care service for CU students with 150 staff that provides care for 70,000 patient visits annually. This position provides direct patient care and clinical oversight. Open until filled; preferred start date 7/1/12. For more information and to apply visit tinyurl.com/ cumeddir FAMILY PHYSICIAN – FORT COLLINS Established practice seeks family physician for immediate opening. Employment/Partnership Track. No OB/Inpatient. Fax CV to (970) 295-0036 or email to officemgr@ftcollinsfp.com. SEEKING MD OR DO GENERAL PRACTITIONER – to treat patients in a multidisciplinary medical facility located in Aurora. A minimum of 2 days per week will be available to start. Patient base is personal injury, soft tissue. For more information contact: Max Guzman 303-5779780 or email: injury.rehab.specialists@ gmail.com Colorado Medicine for March/April 2012

PHYSICIAN ASSISTANT – Job Description: Full-time position / Physician Assistant for busy family practice clinic with multiple locations. Looking for experienced applicant to provide healthcare services including assessment, diagnosis, treatment, and planning under the supervision of a physician. Coordinates orders for lab, x-ray, tests, referral to specialists, etc. Requirements: State certification/licensure. Certification by the National Commissions for the Certification of Physician Assistants. Unrestricted DEA licensure. Eligible to maintain status with Medicare and Medicaid. Two years’ experience in a Family Practice setting preferred. Family Physicians of Greeley, Professional LLP, 6801 W 12th Street, Suite 101, Greeley, CO 80634. Email trishcfp@viawest.net or call (970)378-8004. JOIN OUR GROWING HOSPITALIST TEAM! – Large primary care medical group seeking hospitalists to join our in-patient team at local Denvermetro hospitals. Competitive salary and benefits with incentive plan. E-mail CV and references to human.resources@nwphysicians.com

SUNNY, SPACIOUS OFFICE – to share with family physician. F/T or P/T. Primary care or specialty. Ample parking. 1370 So Wadsworth, Lakewood. 303.985.8773. OFFICE SPACE TO CO-LEASE SKY RIDGE CAMPUS – 2 exam rooms available Monday-Friday. Per Diem leasing possible. Contact Marie (303) 708-9273. MEDICAL OFFICE SPACE FOR LEASE – 4,348 RSF Medical Office Space Available Near I-25 & Orchard Rd. in DTC area. Entire First Floor with Private Entrances, 11 Exam Rooms w/Sinks, 4 Offices, Large Reception Area, Private Bathrooms, Lab Area, Conf Room, Break Room, Convenient Parking, $14.90/RSF Modified Gross. Jeff @ Pegasus Realty 303-721-1818 x2. OFFICE BUILDINGS FOR SALE – Office buildings/condos for sale on Arapahoe Road at Colorado Blvd. in Centennial (One mile east of Streets at Southglenn). Sizes from 2,700 SF to 6,000 SF with prices from $75/SF. Great deal for medical owner/user to occupy some or all of the buildings. Jeff @ Pegasus Realty 303-721-1818 x2.

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Features

the final word State Rep. Bob Gardner, R-Colorado Springs CMS Member and Physician State Sen. Irene Aguilar, D-Denver

Commitment to patient safety and quality care brings legislators and physicians together to strengthen professional peer review On paper, we could hardly seem more different. One of us is a physician and a Democrat who hails from her party’s stronghold of Denver. The other is an attorney and a Republican from western El Paso County, one of the most conservative areas of our state. Yet when each of us was approached by the Colorado Medical Society and other organizations to sponsor a bill to reform Colorado’s system for professional review (also known as peer review), we enthusiastically agreed. The reason is simple: Professional review, as it would function if this legislation becomes law, would ensure that Coloradans receive safer, higher-quality and more affordable health care. And that is something that people on both sides of the aisle, across professions, and from all corners of the state should get behind. As the story on page 9 explains in more detail, House Bill 12-1300 would maintain the confidentiality, privileges and immunities associated with professional review activities for seven years. It would specify sharing of professional review information with entities such as the state Medical and Nursing Boards, the Colorado Department of Public Health

and Environment and the Centers for Medicare and Medicaid Services, and it would authorize professional review of physician assistants and advanced practice nurses. By including all these professions, and ensuring these protections, the bill encourages thorough analysis of health care professionals’ performance as well as timely intervention. In other words, it allows you and your colleagues to shine a light on medical errors – not for the purpose of assigning blame, but so that you may learn from what has occurred, improve systems and minimize the likelihood of those errors happening again. It also would encourage physicians to participate as reviewers without worrying about getting tangled up in a lawsuit or hauled into court. The fact of the matter is, no one is perfect, and systems always stand to be improved. We ask the unconvinced to consider this scenario: An error occurs during a medical procedure at your local hospital. You are scheduled to undergo the same procedure at the same facility six months or a year down the road. Would you rather Colorado have a professional review system that discourages physi-

Join COMPAC Now! Colorado Medical Political Action Committee Call 720-859-1001 or 800-654-5653, ext. 6317 50

cians and other providers from exploring what happened and why? Or would you prefer those involved acknowledge the mistake, scrutinize what happened and figure out ways to reduce the odds it will occur again – before it’s your turn? We think the choice is obvious and overwhelming, and we are not alone. The bill has the support of more than two dozen professional organizations, from COPIC to Rocky Mountain Health Plan, the Colorado Nurses Association, Colorado Hospital Association, the Colorado Society of Advanced Practice Nurses and multiple physician societies. That support is particularly meaningful to lawmakers when they are considering any legislation that would protect information, because it indicates that a broad group of people have looked at the issue from different perspectives and concluded that the information is important enough that the protection is necessary. We commend the Colorado Medical Society for its years-long efforts to improve patient safety, for once again being a convener of key stakeholders, and for taking the initiative and raising this issue in 2012 – well before it was scheduled for review by the General Assembly. We encourage you to contact your lawmakers and urge them to support it. Every physician, in fact every Coloradan, owes a debt of gratitude to CMS for its work in bringing this legislation to fruition. This is a well-thought-out piece of legislation that enhances the patient safety – on paper, as well as in practice. n Colorado Medicine for March/April 2012

Colorado Medicine for March/April 2012