November-December 2020 Colorado Medicine

VO LU M E 1 1 7 N O . 6 N OV - D E C 2 0 2 0

COLORADO MEDICINE ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE

FINDING JOY IN OUR PROFESSIONAL AND PERSONAL LIVES SAMI DIAB, MD 2020 -2021 CMS PRESIDENT

C O N T E N T S

Finding joy Newly inducted CMS President Sami Diab, MD, reflects on his path to finding joy in his personal and professional life in the framework of four circuits identified in a popular book. His vision for his presidential year is to engage Colorado physicians in the Colorado Medical Society and ensure CMS brings joy to Colorado physicians.

PAGE 4 ⊲

F E A T U R E S

D E P A R T M E N T S

10 COLORADO’S COVID-19 VACCINATION PLAN

16 Reflections

The Colorado Department of Public Health and Environment outlines a proposed distribution plan for a potential COVID-19 vaccine that was presented to the federal Centers for Medicare and Medicaid Services, and speaks to how Colorado physicians can aid the effort.

12 PHYSICIAN PEER ASSISTANCE The Colorado Medical Society and other partners in the House of Medicine have been advocating for months to urge the state to continue the confidentiality and integrity of the physician peer assistance program. Read the latest progress.

17 Medical news • CDPHE-facilitated committee reviewing ketamine waiver program • Southwest Health Alliance and Peak Health Alliance demonstrate substantial premium savings for patients 18 COPIC Comment 20 Introspections 22 Advantage Partner Spotlight: Abyde decodes HIPAA

14 THE EPIDEMIC NOBODY IS TALKING ABOUT Marijuana use has a tremendous impact on adolescents and young adults and the negative effects should be seriously considered, particularly as vaping increases.

24 FINAL WORD: REFLECTING ON MY

Wow

FIRST YEAR AS YOUR CEO Bryan Campbell was announced as the new CMS CEO just one year ago, and what a year it has been! He reflects on the “deluge of dramatic worldwide changes” that have affected Colorado physicians and how our medical society can best serve you now and in the future.

I N S I D E

C M S

22 Call for nominations: 2021 president-elect, AMA delegation 23 Virtual CMS Annual Meeting brings physicians together 23 Staff spotlight: Gene Richer directs the CMS CME program

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

OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF 2020-2021 OFFICERS

BOARD OF DIRECTORS

AMA DELEGATES

Sami Diab, MD President

Brittany Carver, DO Danielle Coleman, MS Chris Linares, MD Evan Manning, MD Michael Moore, MD Edward Norman, MD Lynn Parry, MD Patrick Pevoto, MD, RPh, MBA Leto Quarles, MD Brandi Ring, MD Kim Warner, MD Hap Young, MD

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

Mark B. Johnson, MD, MPH President-elect Patrick Pevoto, MD, RPh, MBA Treasurer Bryan Campbell, FAAMSE Chief Executive Officer David Markenson, MD, MBA Immediate Past President

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

AMA PAST PRESIDENT Jeremy Lazarus, MD

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

Emily Bishop Director of Government Affairs Emily_Bishop@cms.org

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

Kate Alfano Communications Coordinator Kate_Alfano@cms.org

Dianna Fetter Senior Director of Business Development Dianna_Fetter@cms.org

Chet Seward Chief Strategy Officer Chet_Seward@cms.org

Susanna Barnett Membership Coordinator Susanna_Barnett@cms.org

Dean Holzkamp Chief Operating Officer Dean_Holzkamp@cms.org

Tom Wilson Manager of Accounting Tom_Wilson@cms.org

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

Krystle Medford Senior Director of Membership Krystle_Medford@cms.org

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

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

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

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

Does your wealth manager measure up?

A CFA CHARTERHOLDER HAS THE INVESTMENT EXPERTISE YOU NEED. ®

CFA CHARTERHOLDERS are the premier choice to manage your wealth because they put their investment expertise at the epicenter of wealth management to unlock opportunities other advisers might not see.

Learn more about CFA CHARTERHOLDERS at cfacolorado.org

© 2020 CFA Institute. All rights reserved.

C OV E R P R E S I D E NT ’ S

LE T TE R

FINDING JOY

IN OUR PROFESSIONAL AND PERSONAL LIVES ADAPTED FROM THE INAUGURAL ADDRESS OF THE 150TH COLORADO MEDICAL SOCIETY ANNUAL MEETING Sami Diab, MD, President, Colorado Medical Society

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

In deciding what to share in my inaugural remarks, I found myself turning to a book by two uplifting and inspiring individuals: “The Book of Joy: Lasting Happiness in a Changing World,” by His Holiness the Dalai Lama and the Reverend Archbishop Desmond Tutu. During this challenging time, especially with the COVID pandemic, it is essential to try to find joy in our professional and personal lives.

Specifically, I would like to examine how certain aspects of practicing medicine can activate the four neuronal pathways that are responsible for the state of well-being and joy.

The first circuit I will explore, although it is fourth in the book, is “our ability to be generous.” Yes, we have an entire brain circuit that is activated by generosity and the positive feelings that result when we engage in acts of giving, receiving or even witnessing acts of generosity. The second pathway of joy is triggered by a positive mind state. These two great spiritual leaders emphasized that the fastest way to a positive mind state is acts of compassion. The third circuit is, “our ability to recover from negative states.” And the fourth, which I will not discuss in detail but find is worth mentioning, is the ability to prevent mind-wandering and practice mindfulness through meditation, exercise, painting and other activities.

I’d like to share some stories that explain the role of joy in my life and how I came to be a doctor, an oncologist and member of the Colorado Medical Society.

CIRCUIT

1

The first story I’d like to share with you takes place on Christmas Eve in Damascus when I was a child of seven or eight years of age.

We were driving to my grandmother’s house to celebrate Christmas, as was our family tradition. It was a cold winter’s night in Damascus; it was actually snowing. It typically only snows once or twice a year in Damascus so this white Christmas was very special to me – I still remember it vividly! I was very happy and excited at the evening’s prospects: after all, I was going to receive gifts and play with other children. As we drove, we stopped at a red light outside my uncle’s ENT clinic.

Knowing the location well, I glanced towards the clinic and saw a mother and child, standing shivering in the cold, begging for food and money. At that moment I wanted to bundle these two unfortunate souls into our warm car and take them with us to dinner.

St. Paul was inspired on the road to Damascus and I, in my own small way, was inspired on a road in Damascus. I felt a deep need to help others and that need led me to become a physician. So, in many ways, I became a doctor because of that experience which activated my circuit – a circuit we all have – to be generous.

I think many of us become doctors out of a sincere desire to help others and thereby experience the repeated feelings of joy that come from helping our fellow human beings. I can truly say that being a doctor has brought me – along with a lot of other feelings – a great amount of joy.

Joining and being active in the Colorado Medical Society has also brought me joy.

I joined the CMS Committee on Physician Wellbeing and we explored at length the notion and importance of helping each other as doctors. And, once again, being involved in helping others brought joy to my professional life. Yes, CMS does not have to be, nor should it be, another boring professional organization. CMS membership can, and should be, both an act of and source of joy.

About Dr. Diab Sami Diab, MD, is a medical oncologist with Rocky Mountain Cancer Centers in Centennial and Aurora.

He completed medical school at Damascus University in Damascus, Syria, and his residency at Wayne State University in Detroit, Mich. He completed a fellowship in Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston and the University of Texas at San Antonio where he stayed on faculty for four years before moving to Colorado in 1999.

He also did a fellowship in Integrative Medicine at the University of Arizona in Tucson. He is board certified in medical oncology and hospice and palliative care. He enjoys playing tennis, skiing and painting. He is deeply thankful to his family: parent s George and Mary; wife, Liliane; children Nicholas and Christopher; and brother, Joseph. ■

C O LO R A D O M E D I C I N E 5

The 1891 painting, “The Doctor” by Sir Luke Fildes, reminds Diab that the patient-physician relationship is at the heart of the practice of medicine and is crucial to deriving joy from his professional life.

CIRCUIT

2

The second story I’d like to share with you is about what led me to become an oncologist.

It was January 1991 and I was assigned to work at the VA hospital. My optimism was muted as everybody told me this was going to be a depressing rotation. I was assigned Mr. Bradly, an oncology patient. I went into the room to find a veteran screaming in pain from a hip fracture resulting from the spread of advanced metastatic lung cancer. I still remember sitting down and, having already taken steps to obtain appropriate pain medication, simply holding his hand and trying to reassure him, getting to know the man behind the cancer. He was very kind and a strong bond formed between the two of us.

I went home feeling grateful and good about myself simply because I had taken the extra time to sit with my suffering patient during a very busy day and that too was a manifestation of joy. The circuit of positive mind states was activated by an act of compassion between a patient and a physician. A compassionate and positive patient-physician relationship triggers joy; that feeling we all have when we leave the bedside and feel like we did a good job and are immersed with the joy of practicing medicine.

For me this brings to my mind the 1891 painting, “The Doctor” by Sir Luke Fildes, part of The Tate Collection. The painting depicts the deep concern of a doctor seated anxiously at the bedside of his patient – a young child who is dying. For me, this painting serves as an evocative reminder of the patient-physician rela-

tionship that is at the heart of the practice of medicine and is so crucial to deriving satisfaction and joy from the practice of medicine.

I think a lot of us in medicine are dissatisfied because we feel that we are dealing on a daily basis with many forces that interfere with the sanctity of the patient-physician relationship: Less time with our patients, pressure from insurance companies, pressure from administrators to generate more revenue, more time on the EMR, and other factors that take away from the joy of this connection with our patients.

So, as it relates to CMS, I joined the Committee on Value in Health Care and in that committee, we talked the doctor language about how we can deliver better quality care. How can we improve the quality of care while reducing the financial toxicity on patients? It was all about patient care and doing the right thing for our patients; no hidden agenda, no other motivations. These discussions put me in a positive mental state that gives me joyfulness.

A compassionate and positive patient-physician relationship triggers joy; that feeling we all have when we leave the bedside and feel like we did a good job and are immersed with the joy of practicing medicine.

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

CIRCUIT

3

In case you think this is all one big joyride, my third story is sad and pertains to the third circuit, “our ability to recover from negative states.”

One day, as stories so often begin, I was sitting in my office in Parker and I got a call from our nurse in Aurora informing me that one of our patients had a terrible outcome and had died from a complication of treatment. That was a very difficult day in my life and really took a lot of the joy out of medicine.

Recovering from this emotional blow – this negative state – was crucial to me to regaining joy in medicine. I leaned on physicians and physicians’ organizations who were very helpful in enabling me to recover from that negative mind state to allow me to find renewed joy in medicine. To name just a few, Dr. Mike Seiden, physician and CEO of McKesson Specialty Health, was crucial in allowing me to express myself, listen carefully and take actions to bring big solutions. Dr. Seiden introduced Mr. Kirk Milhone to our organization, Rocky Mountain Cancer Centers; he is a wonderful coach of effective organizational culture and a very important person in my life.

I also recognize Dr. Rebecca Resnik, a palliative care doctor who helped me greatly, for being a good and special friend. COPIC provided valuable peer support. Dr. Jason Kelly, Dr. Lisa Corbin and Dr. Joanne Hilden deserve thanks. And, finally, my own organization RMCC was amazing in terms of root cause analysis, hiring pharmacists and revisiting many of our processes to improve quality. Upon reflection, it took a whole team and many organizations to help recover from this negative experience.

As part of my mission as president of Colorado Medical Society, I want the Colorado Medical Society to be a home and a resource for any physician who is experiencing a negative mind state.

CMS should be a place to start recovery from any negative situation. I would like CMS to have the resources, programs and the mechanisms to help any doctor in need to deal with the toll of a negative mindset. Unfortunately, we’re all in negative mindsets because of COVID and a host of other issues. Our ability to recover is going to bring us a lot of joy in medicine!

PAGE 8 ⊲

As part of my mission as president of Colorado Medical Society, I want the Colorado Medical Society to be a home and a resource for any physician who is experiencing a negative mind state.

Our Health Law Practice: Health Care Regulations

Health Care General Counsel

Licensing Board Disputes

Certification Board Disputes

Peer Review Proceedings

Medical Device Patents

Telehealth

Health Care Employment Agreements

1250 Connecticut Ave., NW Suite 700 Washington, DC 20036

1630 30th St Suite A Boulder, CO 80303

Reza Ghafoorian, MD, JD (202) 656 8387 rghafoorian@g2zlaw.com

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

CIRCUIT

4

Finally, I would like to take this opportunity to address prejudice because prejudice, as mentioned in “The Book of Joy,” is the product of a negative mind state.

In summary, I would like to say that CMS, and my involvement with CMS, has brought joy to my professional life. I think you can all find joy through involvement in CMS, and through involvement we can all activate our joy networks. I want CMS to be part of bringing joy to all physicians in Colorado.

As the authors state when discussing the work of John Bargh and notion of the unconscious prime – part of innate, and often unconscious goals: “Perhaps more sobering, it has also hardwired us to cooperate with and be kind to those who look like our caregivers, who presumably kept us safe. We are more wary of others who look different: these are the unconscious roots of prejudice. Our empathy does not seem to extend to those who are outside our ‘group,’ which is perhaps why the Archbishop and the Dalai Lama are constantly reminding us that we are, in fact, one group – humanity.”

Participation and involvement also bring responsibility, and I would like each of you to ask not only, “What can CMS do for me?” but “What can I do for CMS? What can I do to help CMS accomplish the goal of bringing joy to medicine?”

As physicians our group is humanity. We take care of sick people: Black, white, Latinx and others. We take care of the poor and rich. We are trained to look at our group as any human being who is suffering from illness. Our group is unqualified humanity regardless of race, regardless of color, regardless of socio-economic status. So, one of my goals as the president of CMS is to make sure that CMS is involved in tackling prejudice – to put action to our words by addressing discrimination and increasing diverse representation in our leadership.

Become a member, be involved, be generous, be positive in your involvement in the experience, and be united to bring a positive mental state to CMS. Please don’t withdraw when you disagree with the organization because, yes, we are all going to disagree from time to time. But, please, let’s stay united so that the house of medicine can be stronger.

Thank you so much for allowing me to be your president. ■

We are, in fact, one group – humanity.

THE JANE NUGENT COCHEMS TRUST

Application deadline Dec. 1, 2020

FINANCIAL HELP FOR PHYSICIANS IN NEED

The Colorado Medical Society administers grants from the Jane Nugent Cochems Charitable Trust to offer short-term financial help to physicians in need. The average grant to approved applicants ranges from $5,000 to $10,000, although larger amounts can be approved.

THE APPLICATION PROCESS IS SIMPLE AND THE REVIEW PROCESS IS COMPLETELY CONFIDENTIAL.

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

To download an application form, go to cms.org/about/cochems-trust For more information, contact Tom Wilson at the Colorado Medical Society 720.858.6316 or tom_wilson@cms.org

F E A T U R E

Colorado’s COVID-19 vaccination plan WHILE A COVID-19 VACCINE IS NOT AVAILABLE YET, COLORADO IS PREPARED FOR ITS ARRIVAL Eric France, MD, Chief Medical Officer Colorado Department of Public Health and Environment The Colorado Department of Public Health and Environment (CDPHE) submitted its COVID-19 Vaccination Plan to the Centers for Disease Control and Prevention (CDC) for review and feedback on Oct. 16, 2020. We appreciate the input that Colorado physicians and the Colorado Medical Society made to this plan. This initial plan is purposefully designed to evolve as more information about the vaccine becomes available and work with stakeholders continues. A number of points within the plan stand out.

Slowing the spread cannot wait for the vaccine.

First and foremost, any prospect of a COVID-19 vaccination in the future must not replace continued actions in the present to slow the spread of COVID-19. We need to remain vigilant now, and throughout the distribution of a COVID-19 vaccine.

We encourage you to continue to talk with your patients about appropriate prevention methods including wearing a mask in public, maintaining at least six feet of physical distance from others not in their household, avoiding large crowds, washing their hands often, and staying home when they are sick or have been exposed to COVID-19.

Vaccine approval must be driven by science.

Much like the medicine you practice every day, we believe that rigorous science must be the guiding principle in the vaccine approval process.

Independent advisory committees to the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) review vaccine safety and effectiveness data before any vaccine is approved or allowed for distribution, whether that is through normal regulatory approvals or under an Emergency Use Authorization.

Colorado will continue to rely on the clinical and public health expertise of the CDC’s Advisory Committee on Immunization Practice (ACIP) to provide guidance on distribution and use of a potential COVID-19 vaccine.

Using multiple scenarios to plan for distribution of a COVID19 vaccine.

There is still much we do not know about the COVID-19 vaccine. We don’t yet know which vaccines will be available and when, how many vaccines will be available, which vaccines will come to Colorado, or what the vaccine’s handling and storage requirements will be. We are still waiting to learn what the safety profile and level of effectiveness of those vaccines is, how long the vaccine may provide protection, or

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

if there is a certain percentage of the population that needs to be vaccinated to achieve protective levels. In light of these unknowns, the state is doing everything possible to prepare for various scenarios.

Colorado plans to implement a phased approach to distributing an FDA-approved COVID-19 vaccine.

Because the initial supply of vaccine is expected to be very limited, it will be distributed first to people most at risk for COVID-19, such as health care workers, first responders, and staff/residents of long-term care facilities and nursing homes.

The next stage will be people living in congregate settings, essential workers with direct interaction with the public or in high-density settings, and at-risk populations more broadly.

After that, the next phase is the general population. The state will continue to provide information about how it is making decisions on how to prioritize distribution before a vaccine becomes widely available.

Distributing a COVID vaccine to the entire state will take time.

While we are planning to act swiftly, we expect the process could take several months, or potentially more than a year, to distribute a vaccine to everyone who wants one. We will work closely with local public health agencies, health care providers, and other partners to distribute the vaccine as equitably and efficiently as possible. We have not yet initiated provider enrollment in the COVID-19 Vaccination Program, but you can express interest by submitting a COVID Vaccine Provider Interest Survey through the end of October or possibly later.

Review the entire Colorado COVID-19 Vaccination Plan that was submitted to the CDC at covid19.colorado.gov. Future actions will include expanding outreach to stakeholders and conducting exercises of this plan to test its effectiveness and make improvements before actual COVID-19 vaccinations arrive. ■

Phase categories and corresponding members with state estimates Phase

Category

Members

Estimated number of people

1A

Critical workforce

Inpatient health care workers, including those at assisted living facilitiesB Outpatient health care workers, including home health workers and outpatient pharmacistsC

186,760

1B

Critical workforce

EMS, firefighters, police, public health personnel and correctional workersD

116,532

1C

Highest risk individuals

Residents/patients of assisted living, long-term care, and nursing home facilitiesE

46,941

2A

Congregate housingF Essential workers

Congregate Housing: • Adults experiencing homelessness living in congregate shelters • Incarcerated adults • Adults living in group homes • Workers living in congregate settings (e.g., ski industry, some agricultural workers, etc.)

• Students living in college dorms or other congregate housing

874,655

Essential workers:G • With direct interaction with the public (e.g., grocery store workers, teachers, childcare, etc.)

• Working in high-density settings (e.g., agricultural, meat-packing workers, etc.)

• Serving persons that live in high-density settings (e.g., homeless shelter or group home workers) 2B

Higher risk individuals

Adults 65 or older Adults with obesity, diabetes, chronic lung disease,H significant heart diseaseI, chronic kidney disease requiring dialysis, active cancers, and/or immunocompromised status

1,459,825

3

General public

Adults 18-64 without high-risk conditions

1,937,711

Note: There are certain key populations that are not yet part of the system outlined above, including Native Tribal members, military personnel, children, and pregnant women. We anticipate that military personnel will work directly with the federal government.

Consultation with Tribes and conferencing with our Urban Indian Health Program regarding their preferred methods of vaccine allocation and distribution are ongoing. Children and pregnant women are not included in this preliminary phased approach as the current vaccine trials exclude children and pregnant women. We anticipate some guidance from the federal government about the safety and efficacy in these important populations at the time of an emergency use authorization or full approval and plan to incorporate children and pregnant women, if appropriate, at the time of actual implementation.

A The classification of high-risk conditions is constantly evolving and modifications to the list of potential high-risk conditions will be updated over time.

B Inpatient health care workers would include individuals working at nursing and residential facilities. Inpatient health care workers specifically refers to those with direct patient care responsibilities (physicians, nurses, pharmacists, respiratory therapists, physical therapists, etc.), patient support responsibilities (e.g., social workers, case managers, chaplains, etc.), those involved in processing patient samples (e.g., phlebotomists, laboratory technicians, etc.), and hospital support personnel with contact with patient care areas (e.g., environmental services staff). See Appendix B in the full plan for a definition of health care workers.

C Outpatient health care workers would include similar categories as inpatient health care workers as well as home health workers, outpatient pharmacists, and primary vaccine providers. See Appendix B for a definition of health care workers.

D Public health personnel may include vaccine providers and contact tracers if their position results in increased risk of exposure.

E Not including patients in a dedicated hospice facility. Patients in hospice facilities would be vaccinated with the general public.

F People living in high-density housing who may have challenges with social distancing. This includes homeless shelters, group homes, correctional facilities, college dorms and other congregate student housing, and congregate housing typically used for some workers (e.g. agricultural and migrant workers, meatpacking workers and ski industry workers).

G Front-facing essential workers are those who have direct interaction with the public (e.g., grocery store workers, teachers and childcare workers, transportation personnel, public-facing staff at essential business, etc.), those who work in high-density areas with high risk of transmission (e.g., food service industry workers, meatpacking workers, migrant farm workers, agricultural workers, postal workers, workers that manufacture a COVID-19 vaccine, etc.) and those who serve persons living in congregate housing (e.g. homeless shelter workers).

H Chronic obstructive pulmonary disease (COPD), chronic hypoxic respiratory failure, and other severe lung diseases.

I Significant hear t disease includes hear t failure, coronar y ar ter y disease, moderate to severe pulmonar y hyper tension, and other cardiomyopathies.

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

F E A T U R E

Physician peer assistance ENSURING THE CONTINUATION OF CONFIDENTIAL, PEER SUPPORT Chet Seward, CMS Chief Strategy Officer

Advocacy efforts to ensure the confidentiality and integrity of the physician peer assistance program have intensified over the past few months.

Proposed changes by the Department of Regulatory Agencies (DORA) threaten protections that for years have helped physicians and physician assistants get the mental and behavioral health care they need without fear of discovery by the Colorado Medical Board (CMB). Countless physicians have joined calls by Colorado Medical Society, the House of Medicine, COPIC, Colorado Hospital Association and others to fix these proposed changes.

Earlier this year, the Depar tment of Regulatory Agencies (DORA) announced its intention to award the state peer assistance contract to Peer Assistance Services (PAS) rather than the Colorado Physician Health Program (CPHP) that has expertly run the contract for more than three decades. The award is being appealed. CMS has opposed critical changes in this process that were made

by DORA that will require all physicians accessing the program, both mandated and voluntary participants, to sign a waiver allowing PAS to share their medical information with the CMB.

1 2 C O LO R A D O M E D I C I N E

Until now, physicians who voluntarily seek services are not reported to the medical board as long as they adhere to treatment plans. “Prevention and early treatment of physician mental/behavioral health issues are essential, and we worry that by awarding this contract in its current form there will be a chilling effect resulting in physicians ignoring or minimizing their response to difficult and traumatic events,” wrote then-CMS President David Markenson, MD, MBA, in a letter to Gov. Jared Polis in July. Concerns were also raised about the longstanding, peer-to-peer nature of the services to be provided because PAS does not have physicians on staff. What’s more, DORA made these changes and selected a final vendor without consulting CMB members who by law are required to choose the program provider. During the Aug. 20, 2020, CMB public meeting, members of the board were effectively gagged by DORA and Colorado Attorney General staff from questioning or even discussing the issue under threat of lawsuits.

Swift, unified opposition These changes have prompted a swift, unified and negative response from across the physician and health care community.

In several letters to state leaders, the Colorado Medical Society and others expressed extreme concern about harmful consequences to patient safety, physician well-being and the inability to maintain an adequate physician workforce in Colorado should the decision be upheld.

There is substantial evidence that lack of access to confidential care increases physician stress, burnout and depression, and is a leading cause of physicians leaving practice before retirement age. Research also shows that without confidentiality (safe haven) protections, many physicians will not voluntarily seek services because of concerns about repercussions to their medical licensure. There are clearly circumstances in which a physician peer assistance program must disclose a participant’s identity and involvement to the CMB, which CMS supports.

Colorado must ensure the confidentiality of physician mental health treatment and not discourage voluntary self-referral by the implied threat to one’s license/job and the loss of professional esteem.

Looking ahead On Oct. 7, CMS, COPIC, Colorado Hospital Association and the Colorado Association of Health Plans wrote to DORA requesting an emergency meeting of the Colorado Medical Board to formalize needed confidentiality protections, especially in light of continuity of care issues that the approximately 500 physicians, physician assistants and anesthesiology assistants who are currently being treated

by CPHP now face given the looming switch to PAS. About one week later CPHP was notified that their contract was being extended until Jan. 31, 2021, and their appeal was being transferred to the Office of Administrative Courts. At press time no official response from DORA to the Oct. 7 letter has been received, but the board meets on Nov. 19 for their regularly scheduled quarterly meeting.

The increasing intensity of advocacy efforts reflects the importance of this issue to the physician communit y.

CMS and partners have methodically and persistently advocated to DORA, the governor, legislative leaders and members of the CMB that these changes must be averted. The message is simple.

This uncertainty must end. Colorado must ensure the confidentiality of physician mental health treatment and not discourage voluntary self-referral by the implied threat to one’s license/ job and the loss of professional esteem.

The current focus continues to be on reversing these proposed regulatory changes through DORA, but CMS and partners are resolved and ready to fix this legislatively during the upcoming session if necessary. ■ C O LO R A D O M E D I C I N E 1 3

F E A T U R E

The epidemic nobody is talking about

By Evan Manning, MD, and Ken Finn, MD

Colorado has played a prominent role in the transformation of cannabis in the national discourse starting with medicinal legalization in the year 2000 and more significantly with recreational legalization in 2012.

Because we are medical professionals interested in the safe use of all substances, the impact of cannabis on our patients cannot be overlooked.

The most comprehensive data on cannabis use and correlated outcomes features adolescents and young adults. Data is collected nationally through the Youth Risk Behavior Surveillance System (YRBSS) and Monitoring the Future survey and locally by the Healthy Kids Colorado Survey.1,2,3 Recent data from Monitoring the Future 2019 show that cannabis use among the 19- to 22-year-old age group is at or near its highest level in 40 years, in large effect due to the current vaping epidemic, with annual prevalence reaching 43 percent and 1 in 7 young adults using cannabis on a daily or near-daily basis.2 This trend of cannabis is particularly concerning when considering the health care implications of frequent use.

Marijuana - related emergency ser vice utilization

by Colorado adolescents

increased from 1.8 visits per 1,000 in 2009 to 4.9 in 2015 following the legalization of recreational cannabis.4 Mounting national and international data also show strong statistical associations between cannabis use and the development of schizophrenia and other psychoses. A recent meta-analysis reports a pooled odds ratio of 3.90 and dose-dependent association for psychoses among cannabis users compared to non-users.5 Furthermore, adolescents who use cannabis regularly are more likely to develop additional substance use disorders and, according to the most recent YRBSS data, “having ever used cannabis” is the greatest risk factor for future opioid misuse in this age group.1,6 Finally, the growing evidence correlating cannabis use and reduced cognitive function has prompted the surgeon general to formally state that heavy marijuana use can be detrimental to cognitive function and to mental health.7 Cannabis use in adolescence has been correlated with lower educational obtainment, lower employment rates, and lower income in both international and state-level studies; however, these associations must be interpreted carefully despite adjustment for many social, domestic and personal variables.8 More granularly, cannabis use has been correlated to several deadly outcomes for adolescents. In 2019, over 30 percent of Colorado’s adolescent marijuana users operated motor vehicles under the influence of cannabis and since 2013 marijuana-related traffic fatalities have increased from 15 percent to 25 percent of all traffic fatalities within the state. 3,9 Cannabis use is also associated with increased suicidal ideation, suicide attempts, and likelihood of suicide completion among adolescents and was the most common drug identified in completed adolescent suicides in the state of Colorado in 2016 at nearly 33 percent.10,11 The established effect of marijuana on our adolescent population deserves our close attention especially as vaping increases and adolescents reach for more potent THC formulations. With COVID-19 at the forefront of societal discourse, the public outcry for science and evidence to inform public policy has never been more apparent. Considering the broad and potentially lethal impact of cannabis on our youth, the health community should be just as ardent on the necessity of evidence to guide our approach to the marijuana epidemic. ■

Mounting national and international data also show strong statistical associations between cannabis use and the development of schizophrenia and other psychoses.

1 4 C O LO R A D O M E D I C I N E

1 in 7 young adults report using cannabis on a daily or near-daily basis

Mary Jo Heins is a former medical practice manager and past president of Colo MGMA. As an independent Medicare insurance agent, she now helps people with all facets of Medicare – objectively and fee free.

Marijuana-related emergency service utilization by Colorado adolescents

1.8 visits per 1,000 in 2009 4.9 in 2015 Since 2013 marijuana-related traffic fatalities have increased from

15%

TO

of all traffic fatalities within the state

25%

1. Centers for Disease Control and Prevention (2019). Youth risk behavior survey (YRBS).

2. Schulenberg, J.E., Johnston, L.D., O’Malley, P.M, Bachman, J.G., Miech, R.A., & Patrick, M.E. (2020). Monitoring the Future national survey results on drug use, 1975-2019: Volume 2, College students and adults ages 19-60. Ann Arbor: Institute for Social Research, The University of Michigan, 476 pp.

3. Colorado Department of Public Health and Environment (2019). Healthy Kids Colorado Survey (HKCS).

4. Wang, G. S., Davies, S. D., Halmo, L. S., Sass, A., & Mistry, R. D. (2018). Impact of marijuana legalization in Colorado on adolescent emergency and urgent care visits. Journal of Adolescent Health, 63(2), 239-241.

5. Sideli, L., Trotta, G., Spinazzola, E., La Cascia, C., & Di Forti, M. (2020). Adverse effects of heavy cannabis use: even plants can harm the brain. Pain.

6. National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press.

7. United States Department of Health and Human Services (2019). Marijuana Use During Adolescence. US Surgeon General’s Advisory.

8. Levine, A., Clemenza, K., Rynn, M., & Lieberman, J. (2017). Evidence for the risks and consequences of adolescent cannabis exposure. Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 214-225.

9. The Legalization of Marijuana in Colorado: The Impact (2020) Rocky Mountain High Intensity Drug Trafficking Area, volume 7.

10. Roberts, B. A. (2019). Legalized cannabis in Colorado emergency departments: a cautionary review of negative health and safety effects. Western journal of emergency medicine, 20(4), 557.

11. Colorado Department of Public Health and Environment (2017). Suicides in Colorado: Circumstances, Toxicology, and Injury Location. Colorado Violent Death Reporting System.

“Over the years I watched my patients struggle with what type of Medicare plans to select for their particular needs. As I approached going on Medicare, I did not relish wading through the choices. My burden was lifted when I started working with Mary Jo Heins.

Working with Mary Jo has been the most pleasant experience I have ever had in selecting an insurance program for me or my practice group. I trust her knowledge and advice so much that I have referred my patients, colleagues, friends and neighbors to her. My office manager was right – she is ‘the best.’”

– Michele A. Velkoff, MD • Enrollment in Medicare Parts A & B • Supplement v. Medicare Advantage • Rx plans – mapping medication regiments to the best formulary • Dental/hearing/vision plans • Education sessions via Zoom 303-916-6992 www.medicareinsurancedenver.com

C O LO R A D O M E D I C I N E 1 5

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

Humanity in medicine Amelia Davis Reflective writing is an important component of the CU School of Medicine curriculum. Beginning in the first semester, medical students write essays, stories or poetry that reflect what they have seen, heard and felt.

Reflections is edited by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is dedicated to the memory of Henry Claman, MD, Distinguished Professor of the University of Colorado, founder of the Arts and Humanities in Healthcare Program, and original co-editor of this column.

Amelia J. Davis is an MD/MPH student at the University of Colorado School of Medicine and Colorado School of Public Health. She cares deeply about health equity and, in a nod to her undergraduate studies in English literature and biology at the University of Denver, she often contemplates the intersection of medicine, humanities and ethics, especially as a way to connect with patients and hear their stories.

She hopes to serve communities with a career in either primary care or infectious disease.

It was 11 minutes into a trauma activation in the emergency department when I belatedly remembered that I had never seen someone die.

“I don’t know,” was my honest response. But immediately after, I walked into the bathroom in the resident lounge and just cried.

I cried again in the car on the way home. No one knew his name. He had no identification on hand, so he was given a At the moment I remembered, the man had already been rolled letter-number combo to identify him in the medical record. No into the emergency department, chest compressions pumping, one knew how he got stabbed. I didn’t know this person who and the chief resident asked, “How long have we been resusci- died at all, but that didn’t keep me from wondering about his tating?” After a beat to subtract the start time from the current life and what he did with his days. I wondered if his family and time, a nurse replied, “11 minutes.” friends had any idea what was happening or if they hadn’t been made aware yet. I pondered his name.

He came in without a pulse, but I was unconsciously confident that his heart would beat again, thanks to this team of what Since no one else seemed visibly affected in the aftermath, I felt seemed like 40 people in the room, at least 10 of whom had their confused that I was affected so deeply. I wondered if I am too hands moving quickly on him, working around him. His rib cage sensitive for this field. After some time, I thought that perhaps was completely open, and the trauma surgeon massaged his that was my way of honoring this person. And maybe the trauma heart, trying to coax it back to life. He received so much blood. surgeon went into the bathroom afterwards to cry like I did. In But he also lost a lot of blood. People were moving everywhere, the days and weeks that followed, mentors and classmates but many were watching and waiting. I couldn’t move from my who weren’t in the room that day shared their experiences with corner – ready to jump in if asked but also frozen on the spot. witnessing trauma and their coping mechanisms, and by opening up, my soul, though sorrowed, felt more whole.

“Time of death: 4:39 p.m.,” announced the at tending trauma surgeon.

But I wish there had been a moment – even if it was 15 seconds – when a leader that day asked the room to take a pause, check in, The immediate and sudden exodus of two-thirds of the room and show vulnerability and compassion openly to acknowledge was disorienting. It took me a few seconds to realize that I, as a the difficulty of the moment. learner, should be over by the gurney where the attending had moved right into his teaching.

There are many fears I’ve had throughout my medical education: fear of failing patients, fear of failing my team, fear of failing The attending matter-of-factly and clinically explained what he exams. But the most pervasive is the fear that medical educadid. Where to cut, where to clamp, where the knife stabbed this tion will make me cold, indifferent, and less humanistic in my man through his neck and superior chest. He gave a half-frown, ever-constant desire to learn and improve. half-shrug at the end and said, “Sorry, guys.”

“Medicine encounters humanity at its most vulnerable.” When I During this clinical explanation, my eyes kept straying to this first wrote those words in my personal statement for admission man’s eyes. Open, glassy, unmoving. To his hand, bloody and to medical school, I had yet to fully appreciate that medicine limp, hanging over the edge. touches its practitioners as deeply as it touches its patients.

It has been an immense privilege and honor to learn to share And the team, engrossed in their checklist and their own worries, my vulnerabilities with my colleagues and even my patients moved right along. Lost and in shock, I wandered out of the throughout my third year of medical school because it has room, and only a fellow third-year medical student came up next nurtured meaningful connections and the quiet voice of courto me and asked, “How are you?” age that will speak up even in face of the fear. ■ 1 6 C O LO R A D O M E D I C I N E

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

N E W S

CDPHE-facilitated committee reviewing ketamine waiver program The Colorado Depar tment of Public Health and Environment (CDPHE) is reviewing the state’s ketamine waiver program after public outcry related to the use of the drug in the 2019 death of Elijah McCain in Aurora. The review is being conducted by a committee comprised of EMS providers, pharmacists, physician specialists in emergency medicine and anesthesiology, and others. CDPHE Chief Medical Officer Eric France, MD, MPH, is facilitating the committee. The Colorado Medical Society is actively monitoring the review process as the committee

examines the safety of ketamine administration in emergency medical service (EMS) settings.

CDPHE regulates the scope of practice for EMS providers and allows EMS medical directors to obtain permission through a waiver system to expand the standard scope of practice and allow paramedics to administer ketamine outside of the hospital setting, the department stated in a news release. CDPHE allows waivers for ketamine administration for excited delirium and/or extreme or profound

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

agitation and pain management. Under the waiver program CDPHE requires medical directors to report every time ketamine is used under this waiver program. In the past three years, the drug has been administered 902 times for excited delirium and/or extreme or profound agitation, CDPHE said.

The ketamine review began in August and is expected to last a minimum of 12 weeks. CDPHE will release a final report when the review is complete. ■

N E W S

Southwest Health Alliance and Peak Health Alliance demonstrate substantial premium savings for patients Southwest Health Alliance, a purchasing alliance based in Durango, Colo., announced preliminary rates for health insurance products in 2021 that are expected to save patients 35 percent compared to other plans in La Plata, Dolores, Montezuma and San Juan counties. The insurance products are carried

by Bright Health Plan and SWA partners directly with local doctors and hospitals to negotiate rates.

SWA par tner Peak Health Alliance, based in Keystone, Colo., has helped lower rates substantially in Summit, Grand and Lake counties – consistently the most expensive region of Colorado

to buy health insurance. Peak recently announced that their individual market plans, also carried by Bright Health, will be the lowest priced in each of the seven counties they operate. ■

Monique DiGiorgio, executive director of the Local First Foundation, a community nonprofit that created SWA, wrote in the September- October 2020 Colorado Medicine about the importance of bringing price relief and accountability to health care in the region.

“In Durango, we spent over a year listening to locals tell us they could not afford health insurance and, if they could, it was only for catastrophe coverage,” DiGiorgio said in a news release about the 2021 rates. “Partnering with local doctors and our two hospitals helped us not only provide lower prices, but more access to things our residents care about — mental health and preventive care,” DiGiorgio said.

C O LO R A D O M E D I C I N E 1 7

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

And now for some

good news

Gerald Zarlengo, MD, Chairman & CEO, COPIC Insurance Company

For my last article of the year, I put two rules in place. First, I would not use the following words: crisis, pandemic, challenging, uncertain, ever-changing, overwhelmed, unprecedented, surreal or troublesome. And second, I would focus on the positive and highlight some good news.

Our medical liability insurance rates will not increase in 2021 It was a straight-forward decision to keep our rates unchanged and continue to provide the high level of support that our insureds want and deserve.

We will be crediting COPIC points in appreciation of our insureds’ efforts with COVID-19 COPIC recognizes the added steps that were taken this year to protect patients and staff while still delivering quality care.

To acknowledge this, we are awarding each eligible physician and advanced practice provider 3 COPIC points. In addition, we are awarding each of our eligible insured medical facilities the Tier 1 (3 percent) discount to recognize their efforts. Eligible facilities can still earn points to reach higher tiers of discount (7 percent and 10 percent) through participation in designated activities.

We also enhanced the benefits of our Facility Profit Sharing Program COPIC is increasing the percentage of premium credit under this program for the 2021 renewal term for insured medical facilities that have met the eligibility requirements. It is an opportunity to recognize facilities that have focused on reducing claims losses and shown a commitment to increasing patient safety while managing the impact of COVID-19.

1 8 C O LO R A D O M E D I C I N E

Th e CO P I C M e d i c a l F o u n d a t i o n will be accepting new proposals for grant funding Our Foundation kicks off its new strategic responsive grant making approach in November as the next chapter in our history of providing more than $9 million in grants over the years. Those interested in obtaining a grant can fill out a Request for Proposal (RFP) that is due Jan. 15, 2021. To be considered for funding, organizations must meet established criteria, which includes:

Our Resident Rotation was attended by more than 175 participants Despite having to pause this program for several months, we were able to shift to a virtual format and continue to offer this unique learning environment for medical residents. The most detailed program of its type in the nation, COPIC’s Resident Rotation has been recognized as a benchmark in training medical residents through an active, case-based experience that focuses on key patient safety and medical-legal issues.

•

Approach or program has demonstrated potential for uptake or replication by the health care community

•

Organization is designated as a 501(c) (3) organization or has an identified fiduciary

COPIC’s advocacy efforts highlighted a broader commitment to health care A key aspect of our legislative advocacy is meeting with state-level candidates to discuss COPIC’s priorities of improving medicine and practice quality so that patients have access to safe, quality care.

Our team has met with many candidates over the last year to talk about these priorities. A substantial majority of the candidates who share our priorities were selected by their constituents, through primary elections, to represent their districts as candidates in the November elections. To us, this shows a positive alignment with future legislative leaders on issues related to access to care, ensuring safe care when accessed, maintaining liability costs, eliminating barriers to learning within health care delivery, and protecting medical judgment and the patient-physician relationship.

To learn more and to download an RFP form, please visit callcopic.com/ about-copic/copic-medical-foundation.

PR/communication support COPIC wants to help our insureds navigate communication challenges such as responding to media inquiries or participating in discussion forums. We have a contract in place with a well-respected public relations/media consultant who can provide one-on-support for our insureds who find themselves in uncharted waters. Call our Patient Safety and Risk Management department at (720) 858-6396 during business hours for more information.

Everyone at COPIC is grateful for the dedication displayed by medical providers and professionals during the past year. As we prepare for 2021, COPIC’s commitment to health care in Colorado will continue to guide our efforts to suppor t improved care and patient safety. We look forward to serving as a trusted partner and being there when you need us. ■

THE COLORADO MEDICAL SOCIETY IS PLEASED TO PROVIDE

A GREAT MEMBER BENEFIT CUSTOMIZED PLANS FOR CMS MEMBERS

+ GROUP DENTAL INSURANCE PLANS THROUGH DELTA DENTAL, THE STATE’S LEADING DENTAL BENEFITS PROVIDER. A new collaboration between Delta Dental of Colorado, Colorado Medical Society and COPIC Financial Service Group.

H I G H LI G HT S

O F

TH E

P L A N

I N C LU D E :

Available with effective dates starting Jan. 1, 2020

Competitive rate guarantee until Jan. 1, 2022, regardless of start date

Intended for groups of two people or more

Choice of two benefit plan tiers

The Delta Dental plan is available through your current agent or contact John Kaufman at COPIC Financial Service Group: jkaufman@copic.com or 720.858.6287

COPIC Financial Service Group, Ltd www.copicfsg.com

COPIC Financial Service Group is an independent insurance brokerage and consulting fi rm that works with physicians, dentists, members of the health care community, and other professionals. We provide customized planning to make sure you are adequately insured, allowing your professional career and personal life to fl ourish.

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

Black patients matter: The impact of the current racial climate on medicine through the eyes of a third-year medical student Mercedes A. Harvey, OMS-III Critical reflective writing holds a prominent place in the Medical Humanities curriculum at Rocky Vista University, College of Osteopathic Medicine.

Beginning in the first semester of Medical Ethics, students engage in critical reflection to explore their own assumptions and biases and how their values impact their practice. This submission is selected and edited by Nicole Michels, PhD, chair of the Department of Medical Humanities, and Alexis Horst, MA, writing center instructor.

Mercedes A. Harvey is a third-year medical student at Rocky Vista University College of Osteopathic Medicine, working towards pursuing a career in surgery. She completed her undergraduate education in Dallas, Texas, at the University of Dallas where she received her Bachelor of Science degree in Biology and graduated cum laude. In her free time, she loves cooking with her boyfriend, taking her fur-baby Oreo on long walks, and weightlifting.

I will never forget the first day of medical school orientation when I walked into the auditorium and immediately realized that I was the only Black female student in my entire incoming class. For those in the ethnic majority, the biggest fears on the first day of school most likely are along the lines of finding a friendly person to sit next to or navigating the syllabus.

For those whose ethnicity is solitary, like me, this moment comes with increased responsibility. Not only is it incredibly isolating to immediately recognize that you are different from your peers, but there is no community for you to share the burden of fighting against racial bias with, or one to be comforted by when you feel its sting. You assume the position of becoming both the designated educator of racial injustice and casualty of the inequity. Although I should not have to act as an example for all persons of color (POC), when I am the only Black student in my class, it becomes my responsibility to ensure that my classmates’ view and treatment of POC is without bias. If there is a racist comment brought up in class or stereotypical teaching in the curriculum, it becomes my responsibility to confront it,

2 0 C O LO R A D O M E D I C I N E

while at the same time working to prevent being labeled as the “angry Black woman.”

I realized from day one that in addition to coursework, I had to also actively work on improving the racial climate of my campus and ensure the Black narrative was being both acknowledged and included.

Soon I noticed that more than 90 percent of our dermatological cases were shown on white patients’ skin, and that the hair inspection element of physical exams never once highlighted how to examine a Black patient with a weave or braids, or gave tools on how to approach that conversation. I questioned why the Black experience was being omitted and how this was damaging the relationship between Black patients and health care workers. If we as future physicians are expected to be equipped from our education with knowledge to treat all patients equally, no matter their race, we need opportunities to study racial diversity and experience it within our class. If I have only ever been taught in lecture to notice the characteristic presentation of squamous cell carcinoma or Lyme Disease on white patients, how long would it take me

to recognize its presentation on a Black patient? And by that same rationale, how much time will be wasted for that patient to receive a correct diagnosis, be treated appropriately, or be treated at all?

It has been well-established that POC experience shorter life expectancies, increased infant mortality, and worse health outcomes than white people in this country, suggesting that different groups of patients are getting different care by the same health care professionals (CDC 2015). In an article from Harvard Medical School, “Racism and Discrimination in Health Care,” Monique Tello, MD, MPH, shares the experience of a Black patient whose emergency room doctor disregarded her pain as being medication seeking and refused to treat her. This patient had to leave and see another doctor just to receive a proper diagnosis and appropriate treatment, because her initial medical care was insufficient.

This biased treatment by physicians has devastating health implications, as it is imperative to have trust between patient and physician to ensure good health outcomes. If persons of color don’t feel

like they are being taken seriously by their doctor, they won’t trust the care provided or be compliant with the plan created. In fact, this is one of the strongest implications for why we need more Black doctors. Even if a Black patient has been treated with racial bias by a physician in the past, they may still trust a Black physician in the future.

As a third-year medical student, I have had a front-row view of the disparity in my education regarding diversity, pathology and clinical skills pertaining to POC. The next generation of physicians can’t change what has been done by those before us, but we can work to ensure that the same mistakes aren’t repeated and the gaps in care for POC are filled. In 2008, the Association of American Medical Colleges (AAMC) published a report that only 5 percent of physicians in this country are Black, and the implications of having so few Black doctors are obvious – just look at our health outcomes. Black patients should be able to expect that their physicians have equal experience in recognizing and diagnosing their chief complaints, just as they do with their white patients. How can we as future physicians truly swear to “do no harm” when our unfamiliarity towards the medical care of a large percentage of our patients can and will do harm?

As future physicians we will swear to treat all patients equally, without injustice, and to do no harm. To us, all lives do matter.

However, just as Black Lives Matter is confronting civil issues, I believe it equally transcends into medicine. Black patients matter. Acknowledgment about the differences in their experiences matter. Focus is not the same thing as exclusion, and by shifting more focus onto Black patients in medicine we are not excluding the lives of other patients but rather upholding our oaths as physicians to treat all human lives equally and skillfully. If we expect the next generation of physicians to treat all patients equally then we need to be educated about all patients equally. ■

All Medical Answering Service

Owned and operated by the Colorado Medical Society, and backed by history of physician ownership, 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 combined 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 is committed to providing the highest level of customer service.

MTC is a member of the Association of TeleServices Int’l (ASTI) and a proud recipient of the prestigious ASTI Award of Excellence for service quality. MTC continually upgrades its technology and our servers and your data are kept in a secured state-of-the art data center with redundant internet and power supply.

Serving Medical Professionals for Over 40 Years

• • • •

Secure Messaging Application Voice Logger and Voicemail Appointment Confirmations/Reminders Custom Applications

CMS MEMBERS:

Contact us today for your FREE two-month trial and monthly discount call 303.761.6594 or 1.866.345.0251 www.medteleco.com email info@medteleco.com Member Benefit Partner MTC is the Only Answering Service Endorsed by CMS

C O LO R A D O M E D I C I N E 2 1

D E PA R TM E NT S A DVA NTAG E

PA R TN E R

S P OTLI G HT

2020 HIPAA enforcement activity highlights and takeaways Abyde HIPAA Compliance

Do you have a complete HIPAA program in place? If not, your practice may not be protected from HIPAA fines like the ones making the news left and right. Read what these practices did wrong and what to do to protect yourself instead.

When an uncontrollable incident like a data breach or a patient complaint sparks a HIPAA audit, if your practice doesn’t have the right documentation ready the Office for Civil Rights (OCR) could bring down the hammer in fines and corrective action plans – which is exactly what happened to the many practices that made the news for HIPAA violations this past quarter.

In the last two weeks of September alone, the OCR levied eight HIPAA settlements totaling $10,786,500 in fines. The OCR followed with another $260,000 in fines in the first few days of October, driving home their emphasis on practices keeping HIPAA at the top of their priority list.

All of the practices fined either: 1. improperly provided patient access to records, or 2. suffered from a data breach as a result of “systemic lack of [HIPAA] compliance” (as the OCR put it).

I N S I D E

The fines relating to patient right of access ranged from $3,500 (the smallest HIPAA fine to date) to $160,000, and totaled almost $400,000.

Each practice affected failed to provide patients or their authorized personal representatives with access to requested medical records within the HIPAA-mandated time frame. In fact, two of the five instances were only resolved after the individuals involved complained a second time to the OCR, and one of the covered entities didn’t provide the requested records until almost three years after the initial request was submitted. To put that in perspective, Colorado state law and federal regulations require records to be provided within 30 days of the patient request.

The other three fines all centered around practices who failed to prevent a cyberattack. When the OCR investigated, all three audits revealed that none of the entities had completed even a basic Security Risk Analysis, had none of the proper technical safeguards in place, and had no proper incident response.

Each cyberattack occurred a little differently but all three practices did not halt hacker access right away, even after being notified. This lack of compliance and proper procedures is a large part of the fines the OCR levied, including the second largest HIPAA fine to date of $6.85 million. Together, all three incidents resulted in the breach and improper access of more than 16.7 million records.

As a covered entity, you always run the risk of falling victim to a data breach. While the catalysts of these violations were out of anyone’s control, the long-standing noncompliance discovered was what ultimately led to each settlement.

Protect your practice and get a complete HIPAA program in place, before an incident occurs and before missing annual HIPAA requirement deadlines (Dec. 31).

Concerned you might be missing annual security risk analysis and training requirements? Register for an exclusive CMS webinar at abyde.com/webinar to learn where your practice stands! ■

C M S

Call for nominations: 2021 PRESIDENT-ELECT, AMA DELEGATION The nomination period for the 2021 Colorado Medical Society all-member election is open through Jan. 31, 2021.

The Colorado Medical Society encourages all members to consider nominating a colleague or self-nominating for a leadership position. One member will be elected president-elect and eight members will be elected or re-elected to the AMA Delegation.

2 2 C O LO R A D O M E D I C I N E

The election manual is available at: cms.org/uploads/2021_Election_Manual.pdf This manual provides all the information a potential candidate needs about the duties, eligibility, terms of office and honorarium for each open position, as well as candidate requirements, campaign guidelines and the election process. The position descriptions and qualifications for office are available starting on page three of the election manual and the candidate requirements on page five of the election manual.

Questions? Email president@cms.org.

I N S I D E

C M S

Virtual CMS Annual Meeting brings physicians together OVERALL MESSAGE IS TO PERSIST IN DIFFICULT TIMES AND FIND JOY IN MEDICINE The Colorado Medical Society brought physician members and friends of CMS together for the 150th Annual Meeting on Friday, Sept. 25, engaging attendees in the virtual event through addresses by keynote Susan Bailey, MD, AMA president; David Markenson, MD, MBA, outgoing CMS president; and Sami Diab, MD, incoming CMS president. Participants were also treated to a special video compilation of thank-you messages from prominent Coloradans: from Gov. Jared Polis to University of Colorado football coach Karl Dorell and many other elected officials, nonprofit leaders and more.

I N S I D E

Watch the video on CMS’s YouTube channel at youtu.be/PiHhQsRPWBE. A highlight of the annual meeting was the swearing in of Dr. Diab and his inaugural address, printed in full in the cover story of this issue; he encouraged all physicians to find joy in medicine, and promised to work through his presidential term to help CMS bring joy to Colorado physicians. Following Dr. Diab’s address, attendees competed in trivia.

We hope to hold an in-person event in 2021, when it is again safe to gather as a full medical society. Thank you for your membership. ■

The following day, Saturday, Sept. 26, the Colorado Medical Society Board of Directors held a facilitated virtual strategic planning retreat that included CMS staff and physician members of the CMS Strategic Planning Committee. A full report will be given to the board at the Nov. 6 meeting and more information will be published in the next Colorado Medicine.

C M S

Colorado Medical Society CME program SPOTLIGHT ON MS. GENE RICHER, DIRECTOR OF CONTINUING MEDICAL EDUCATION M s . G e n e R i c h e r, M Ed, CHCP ™ has served the Colorado Medical Society as director of continuing medical education since 2017. In this capacity, she coordinates the entire CMS CME program, which comprises two parts in its goal to increase physician access to and utilization of high-quality CME that promotes lifelong learning:

•

CMS is an ACCME (Accreditation Council for Continuing Medical Education) Accredited Provider that provides accredited CME activities to support physicians in improving health care.

•

CMS is an ACCME recognized Accreditor of CME providers, providing accreditation to 17 public and private organizations in accordance with ACCME standards to enable them to produce accredited CME programs to support physician learning.

Richer successfully directed CMS through the re-accreditation process at the end of 2019 to extend CMS Accreditation as a provider of CME for physicians and providing AMA PRA Category 1 Credit™ through 2023. In addition to AMA PRA Category 1 Credit™ several CME activities have offered MOC Part 2 ABIM, ABP points, and/or COPIC points, all of which brings added value to CME membership.

The COVID-19 pandemic offered a unique opportunity to respond to the needs of CMS physician members by offering certified CME activities addressing the

most pressing need for accurate information. Nine topics with a total of 11 AMA PRA Category 1 Credits™ and 7 COPIC points were presented to 1,219 physicians and 170 other learners between April 3 and July 29, 2020, all provided at no cost and virtually.

Under Richer’s leadership, the CMS CME program has presented a total of 110 activities offering 344.75 AMA PRA Category 1 Credits™ to 3,299 physician and 839 non-physician attendees in 2020, with much more planned for 2021. ■

C O LO R A D O M E D I C I N E 2 3

F E ATU R E F I N A L

WO R D

Reflecting on my first year as your CEO

Wow

Bryan Campbell, CMS Chief Executive Officer

Wow.

I tried to come up with a pithy comment that would summarize my experience in my first year serving as your CEO for the Colorado Medical Society. “Wow” is the best I could come up with.

When I started in January 2020, who would have predicted the deluge of dramatic worldwide changes that would affect how you practice medicine every day? Now, after spending nearly an entire year working from home, trying to help the physicians of Colorado navigate this deadly pandemic, I have some thoughts on 2020, and how it will propel CMS and its members to new heights in the coming years.

Start with why

Back in February, the CMS staff participated in a retreat focused on making sure that we are providing the best service to our members. We focused our analysis on the concept of “start with why.” This principle was introduced by the author Simon Sinek in his book, “Start with Why: How Great Leaders Inspire Everyone to Take Action.” The concept is that most organizations focus on the thing that they do well and promote that thing. More successful organizations start with understanding what motivates people to buy something or join a specific organization.

COVID-19

This insight was critical just weeks later as the COVID-19 pandemic shuttered offices, stopped elective procedures, and put the lives and livelihood of you and your families at risk. Your physician leadership and CMS staff immediately began working to tackle the issues that were important for you. From weekly Town Halls to up-to-the-minute Virtual Grand Rounds, we worked to ensure that you had the information and resources needed to continue to practice medicine.

Speaking of resources, we heard your call for better access to PPE, so we worked with vendors across the globe to provide access to PPE for practices around the state, and have entered into a partnership with ActionPPE that provides on-demand PPE for your practice every day.

When you told us that maintaining access to telehealth services and appropriate reimbursement was a priority, we worked 2 4 C O LO R A D O M E D I C I N E

to get that bill passed in the Colorado General Assembly. Additionally, we worked to ensure that in the difficult pandemic budget, a plan was in place to ensure that the hundreds of thousands of Coloradans left without health insurance due to the pandemic would have access to coverage.

Pressing forward

While we were all adapting to the new normal, the world was devastated by the death of George Floyd. CMS was quick to condemn systemic racism, especially its impacts on health equity. Thanks to the voices of many of you who have called for CMS to take a more impactful role of leadership in this area, CMS will be embarking on the creation of a diversity, equity and inclusion strategic plan. This effort will help CMS be a model society where all members feel welcome and included, regardless of background. As a result, we will be in a position to have real impact on how these iniquities affect health care outcomes.

Now?

Like many of you, I was stunned that now, in the middle of a pandemic, the state would make a dramatic change in the very successful Colorado Physician Health Program. This program has been providing physicians access to confidential counseling for more than 30 years, but a stunning revelation this summer informed all of us that this protection would be going away when the state awards the contract to a new provider in early 2021.

CMS has rallied together the entire House of Medicine to fight this short-sighted decision. While the issue plays out today in the court system, we are prepared to take the issue to the legislature to ensure that you do not lose this critical resource.

What’s next?

As we continue to inch back toward life as we once knew it, the realities of your profession remain unchanged. The demand for your services will not change, even if the settings, reimbursement models, and regulations continue to shift.

The more we adapt to the “new normal,” the more we will be able to focus on those things that matter to you. Your why.

In 2021, I look forward to engaging with even more of you. I want to know more about what drives you and how CMS can help to fulfill your needs. I am excited by the energy of new CMS President Sami Diab, MD. He and I are planning to visit communities across the state just to hear from you. And with your selection of Mark Johnson, MD, MPH, as your president-elect, I know that the string of great CMS leaders is preserved.

Thank you for your dedication to the art and science of medicine, for taking care of your patients in the most turbulent moment of our lifetimes, and for belonging to the greatest membership organization in Colorado, the Colorado Medical Society. ■

CALLCOPIC.COM | 800.421.1834

Why COPIC FSG

COPIC Financial Service Group’s team of specialists offer insurance and financial solutions to keep your business (and life) running smoothly.

Objective recommendations and specialized industry knowledge.

That’s why.

ONLY OUR CMS MEMBERS CAN DO THIS

Advantage Partner

LET USFA HELP YOU GET INTO A NEW CAR

By special arrangement with commercial fleet purchasing requirements in Colorado, individual members are allowed to buy or lease a new car under this program.

• NO CAR SALES PERSON • OVER THE PHONE • TYPICAL SAVINGS $1,000-$7,100

Visit USFACORP.COM to find out more.

Or call 303.753.0440

33 YEARS IN BUSINESS • 10,000 MEMBERS SERVED SINCE 1989 • LICENSED & BONDED