Sept-Oct-13 by Colorado Medical Society

September/October 2013

Volume 110, Number 5

Covering Colorado

Connect for Health Colorado opens in October Colorado Medicine for September/October 2013

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Colorado Medicine for September/October 2013

cont n ent nt ns nt Sept/Oct 2013, Volume 110, Number 5

Features. . . 12

Alternative to traditional health insurance–HealthOP, Colorado's first statewide nonprofit health insurance cooperative, opens for business Oct. 1.

Driving innovation–Learn more about the Colorado Health Care Innovation Plan being developed from the State Innovation Models Initiative grant (SIM).

Prescription drug abuse–The House of Delegates will debate a new CMS platform on prescription drug abuse. Read more on what is being proposed.

An SGR fix at last?–Congress is closer than ever to repealing the Medicare Sustainable Growth Rate (SGR) formula and implementing significant payment reform.

Colorado is the sunshine state–Learn how the new federal Sunshine Act will mesh with Colorado's existing disclosure law, the Michael Skolnik Transparency Act.

Choosing Wisely Colorado–CMS partners with the Colorado Permanente Medical Group and several state specialty societies to launch this new statewide initiative.

CMS wins Ally Award–One Colorado has recognized CMS for efforts to improve health care access for LGBT Coloradans and to educate members on their needs.

Final Word–Brian G. Dwinnell, MD, FACP, discusses how physicians can partner with patients to enhance safety and quality through Think About It Colorado.

Cover story

Starting Oct. 1, consumers and small businesses will be able to shop for and purchase health insurance through the state’s new marketplace, Connect for Health Colorado. Experts hope this phase of health care reform will spur competition and make it easier to bridge the gap for uninsured populations. Coverage starts on page 8.

Inside CMS 5

President’s Letter

Executive Office Update

CMS Education Foundation

Annual Meeting

Reflections

COPIC Comment

Departments 40

New Members

Medical News

Classified Advertising

Colorado Medicine for September/October 2013

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

2012/2013 Officers Jan M. Kief, MD

President

John L. Bender, MD, FAAFP 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 F. Brent Keeler, MD Immediate Past President

Board of Directors Susan Bauer, MS Amy Beeson, MS Charles Breaux Jr., MD Joel Dickerman, DO Naomi Fieman, MD Carolyn Francavilla, MD T. Casey Gallagher, MD Jan Gillespie, MD Ripley Hollister, MD Johnny Johnson, MD Richard Lamb, MD Lucy Loomis, MD Randy Marsh, MD Gary Mohr, MD Christine Nevin-Woods, DO Edward Norman, MD Tamaan Osbourne-Roberts, MD Daniel Perlman, MD Bianca Pullen, MS Scott Replogle, MD Floyd Russak, MD Ranee Shenoi, MD Stephen Sherick, MD

Julia Tanguay, MS 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 J. Robinson, MD AMA Immediate Past President 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 Dianna Mellott-Yost, Director, Professional Services, Dianna_Mellott-Yost@cms.org Tom Wilson, Manager, Accounting, Tom_Wilson@cms.org

Division of Communications and Member Benefits

Division of Health Care Policy

Chet Seward, Senior Director, Chet_Seward@cms.org JoAnne Wojak, Director, Continuing Medical Education, JoAnne_Wojak@cms.org

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

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

Division of Government Relations

Division of Health Care Financing

Colorado Medical Society Foundation Colorado Medical Society Education Foundation

Marilyn Rissmiller, Senior Director, Marilyn_Rissmiller@cms.org

Susan Koontz, JD, General Counsel, Senior Director, Susan_Koontz@cms.org Chris McGowne, Program Manager, Chris_McGowne@cms.org

Mike Campo, Staff Support, Mike_Campo@cms.org

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

Alfred 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 September/October 2013

Inside CMS

president’s letter Jan Kief, President Colorado Medical Society

Moving forward with REV: Relationships, Evolution and Voice As my year as president comes to an end, I wish to thank all of the CMS staff, Board of Directors and CMS members for their incredible support, dedication and engagement with the vast number of issues facing health care. From the deliberations in meetings, to the outreach around the state and nation, it has been an enlightening journey for me. The more we understand about the various stakeholders, entities, points of view and economics at play, the better we can help craft and promote solutions to improve the health of our communities in the future. I truly understand that the more we listen to others, the more we will be listened to. This not only applies to interactions with our patients, but with our colleagues, legislators and others interested in health and sustainability of our communities and health delivery systems. My theme this year was REV and “Keep Moving Forward.” REV stood for the concepts of Relationships, Evolution and using our Voice. Little did I know how appropriate this would be as the year progressed. Relationships are the foundation of trust and that is how we get others to join us in making progress. We have stressed the importance of relationships with community, businesses, schools and especially our legislators. Being at the Capitol this year and testifying frequently in the health committees was such a rewarding experience. I urge you to have your legislators’ phone numbers on speed dial and keep up using the breakfast club concept to keep dialogue open. Evolution is the topic of the day in health care. We are scientists and must remember to seek evidence-based solutions to problems of the day instead of holding onto beliefs that may not be correct. Look

at your data, keep moving forward and don’t be afraid to try solutions that may require "out of the box" thinking. Foster team thinking and support each other’s creativity; you never know where the best ideas will come from. I challenge you to learn something new each year. I learned to use Facebook and Linkedin, completed more online CME, and found new ways to interact in my community. Simple things done by many can have a great impact. Please register with the PDMP and take the Opioid Prescribing CME on cms.org. Explore cms.org and the new opportunities. Join COMPAC and the AMA and volunteer for a committee at CMS! Never underestimate the power of your voice. You are highly educated and trusted. Now is the time to find that issue that you are passionate about and make your voice heard. Talk to your colleagues and patients. Find one place in your community where you can use your voice to address a health issue in that community. Reach out to other health professionals; we really are on the same team and take advantage of strength in numbers. There are plenty of people who need our help.

Finally, you cannot help others unless you are healthy yourself. TAKE CARE OF YOURSELF. Make definite plans for your own wellness and keep your goals front of mind. Your family and patients will appreciate seeing you at your best. Reach out to a colleague who may feel isolated or be having difficulty; mentor a student or resident.

“The more we understand . . . the better we can help craft and promote solutions to improve the health of our communities in the future.” Truly enjoy medicine, the best career in the world! Again, thank you so much for your support and kindness during my presidency, and know I will continue to be active and continue to strive for the best health possible in our state and nation. n

Join Now! Colorado Medical Political Action Committee

Colorado Medicine for September/October 2013

Call 720-858-6326 or 800-654-5653, ext. 6326 or e-mail chris_mcgowne@cms.org

Inaction vs IN ACTION We understand the difference The Litigation Center of the American Medical Association and the State Medical Societies fights to protect doctors and uphold the highest standards of patient care. In courtrooms across America, we are achieving legal victories that preserve the rights of physicians, promote public health and protect the integrity of the profession. Whether we are challenging managed care organizationsâ&#x20AC;&#x2122; payment practices or preserving the autonomy of the hospital medical staff, one thing remains constant: The Litigation Center is an active force fighting for physiciansâ&#x20AC;&#x2122; rights. Learn more on how The Litigation Center can help you.

ama-assn.org/go/litigationcenter

Membership in the American Medical Association and the Colorado Medical Society makes the work of The Litigation Center possible. Join or renew your memberships today by calling the CMS at (800) 654-5653.

The Litigation Center is proud to have Alfred Gilchrist, CEO of the Colorado Medical Society, serve on its executive committee.

ama-assn.org

cms.orgfor September/October 2013 Colorado Medicine

Inside CMS

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

Choosing Wisely Colorado In conjunction with the Colorado Permanente Medical Group and support from several state specialty societies, the Colorado Medical Society soon will launch our own homegrown version of the national “Choosing Wisely” campaign. Choosing Wisely is a patient outreach effort to reduce the frequency of marginal or unnecessary diagnostics and procedures. The national campaign was developed by nine national medical organizations, each coming up with its own respective lists of services that are prone to overuse. Participation continues to grow, and now more than 50 specialty societies have joined the campaign. Recent polling of our physician members shows overwhelming support for this movement. This same polling tells us this campaign is a formalization of common, everyday interactions with your patients while guiding them toward optimal care decisions by engaging them on the practical, economic and clinical aspects of their treatment regimen. The survey found: • Near universal belief among CMS members that it is “very important” physicians are aware of “specific, evidence-based recommendations for tests and procedures that display overuse, minimal benefit or potential for harm,” with 92% saying this is “very important” and 8% saying it is “somewhat” important.

cedures that display overuse, minimal benefit or potential for harm,” with 85% saying this is “very important” and 15% saying this is “somewhat important.” • CMS members already engaging their patients in efforts to discourage inefficient use of health care resources, with 34% saying they have conversations “discouraging medically unnecessary tests and procedures” on a “daily” basis, another 34% saying they have such conversations “a few times a week,” and 17% saying “a few times a month.” Only 8% say they have these conversations “rarely” and 6% responded, “does not apply to my specialty.” Colorado now has an evolving all-payer claims database and an abundance of peer-reviewed literature documenting patterns of over-utilization, technology reversals, and medical errors. At the same time, the rise of readily accessible, digitalized health care data and the scrutiny currently being enjoyed by hospitals and other facilities leaves physicians sitting in the wide-open cyberspace for all to see and scrutinize.

• Overwhelming agreement that physicians should have conversations with patients “about efficient use of health resources, including potentially discouraging them from tests and proColorado Medicine for September/October 2013

As clinical standards and a corollary of comparative effectiveness evolve, they can go stale or be replaced on a relatively short cycle, once or even twice a decade. The Choosing Wisely movement is critical to physician-to-physician and physician-to-patient communications and care management over time. Physicians and patients will make hundreds

“The Choosing Wisely movement is critical to physician-to-physician and physician-to-patient communications and care management over time.” of iterative choices only to determine at some later point that the conventional wisdom has been supplanted by new clinical evidence, which in itself will bear close scrutiny. Engaging patients in what works and what might not – or what works at twice the price – is the essence of shared decision making and helping patients “Choose Wisely.” n

Promoting health care decisions that are nonduplicative, evidencebased, free from harm and truly necessary Visit www.cms.org/choosingwisely

Cover Story

Covering Colorado

Connect for Health Colorado opens in October 8

Kate Alfano, CMS contributing writer Colorado Medicine for September/October 2013

Cover Story coverage ends in terms of income level. And those earning above the threshold for assistance can still shop for and purchase private health coverage through the marketplace without financial help. The countdown is on for the launch of Connect for Health Colorado, the state’s new health insurance marketplace. Starting Oct. 1, the nonprofit will offer a place for individuals, families and small businesses to shop, compare and purchase private health insurance with benefits starting Jan. 1, 2014 for those who sign up by Dec. 15. They’ll also provide assistance for Coloradans to find the best health plan for their needs through customer service center representatives, health coverage guides and licensed agents and brokers. As authorized by the Affordable Care Act, federal financial assistance will be available to individuals or families who need health insurance, who are not eligible for public health coverage through Medicaid or Medicare, and who do not have access to affordable coverage through a large employer. In general, this includes individuals earning between about $15,000 and $46,000 a year, couples earning between about $20,000 and $62,000 a year, and families of four earning between about $31,000 and $94,000 a year. Essentially, financial assistance begins where public health

Employers who have fewer than 25 employees and who pay average annual wages below $50,000 and provide health insurance may be eligible for a small business tax credit to offset the cost of premiums. Gretchen Hammer is the executive director for the Colorado Coalition for the Medically Underserved and chair of the 12-member board for Connect for Health Colorado. She spoke at CMS’ Spring Conference in May. “We believe that competition is a good thing. Customers will have the opportunity to shop for and compare health insurance products for the first time in an organized fashion. They’ll be able to be better informed and they’ll have the ability to really consider health insurance plans and pick the one that’s going to meet the needs of their small business or those of their family.” Open marketplace Connect for Health Colorado is an open marketplace model exchange, which means that health plans that make it

Physician’s guide to health insurance exchange Connect for Health Colorado, the state’s new online health insurance marketplace called for by the Affordable Care Act and approved by state law, will go live in October and may have a big impact on your practice. That’s why Colorado Medical Society has developed a new resource to help physician members understand and prepare for up to 240,000 newly insured patients that are projected in 2014 thanks to the exchange. Connect for Health Colorado: A Physician’s Guide to the State’s Health Insurance Exchange covers important topics including: • Participating health plans; • Patient churn between these new marketplace products and Medicaid; • 90-day grace period and how your practice may not be reimbursed for services delivered to patients that don’t pay premiums; and • Impacts of patient cost sharing. Learn about these issues and more by visiting www.cms.org and reviewing A Physician’s Guide to the State’s Health Insurance Exchange today. Colorado Medicine for September/October 2013

through the Division of Insurance regulatory process have the ability to sell their products through the exchange. “It is a much more competitive marketplace than perhaps some of the other models will be as they begin to crop up around the nation,” Hammer said. “This really will be a new way of purchasing health insurance,” she continued. “It will work in concert with the current marketplace. It does not replace the current marketplace but rather will be a new pathway to coverage.” States had the option to set up their own exchange or to let the federal government facilitate an exchange for them. The District of Columbia and 16 states, including Colorado, chose to establish a state-based exchange; seven are pursing a state partnership exchange; and 27 declined to set up an exchange and will default to have a federally-facilitated exchange. Hammer said Colorado should be proud of our approach. Five years have passed since the Blue Ribbon Commission for Health Care Reform, or 208 Commission, released recommendations to expand health care coverage and reduce health care costs for Coloradans. One of the recommendations was to create a “Connector” to help individuals and small employers understand and choose among insurance options. This concept recognized the high proportion of small businesses in the state and the struggle of individuals to find affordable coverage on the private market, Hammer said. Legislation authorizing the Colorado Health Benefit Exchange was passed by the General Assembly and signed by Gov. John Hickenlooper in 2011. The exchange re-branded itself as Connect for Health Colorado in May 2013. Because elected officials enabled the statebased exchange, Colorado stakeholders have had the opportunity to tailor the marketplace to meet the needs of the population. Hammer said this allows Connect for Health Colorado to focus on rural areas of the state, where a dis-

Cover Story (cont.) proportionate number of uninsured Coloradans live and where many small businesses are located. Additionally, Colorado’s exchange will offer more choices for small businesses than the federally-facilitated exchanges when they are launched. “The opportunity to have had this conversation for the last three years is perhaps something that we don’t necessarily recognize as a gift because the conversation has been long and at times difficult, but it really is a gift that we have been able to come together as a state, think about this, talk about it, recognize the needs of the current players in the marketplace, and recognize and understand the needs of our potential customers,” Hammer said. “I would argue that we would probably not feel as comfortable with that being handled at the federal level.” Lorez Meinhold, deputy executive di-

rector of the Colorado Department of Health Care Policy and Financing, who also spoke on the panel at Spring Conference, added that having a statebased exchange allows Colorado Medicaid to have a closer relationship with Connect for Health Colorado, particularly when it comes to the question of “churn,” when beneficiaries’ income level shifts their eligibility between public assistance and the private market. “We know that people’s incomes are going to change and they’re going to move between systems,” Meinhold said. “We can work very collaboratively to make that as seamless as possible so someone has a medical home and, regardless of the payer, that continuity of coverage continues. So the close working relationship we have both from an IT system and an appeals system is important, and we would lose that if we had a federally-run exchange.”

Connect for Health Colorado to offer 242 insurance plans from 13 carriers The Colorado Division of Insurance (DOI) has reviewed and approved a number of new health insurance plans for consumers and small businesses starting Jan. 1, 2014. Division of Insurance actuaries made sure that the new plans met the federally defined coverage levels: bronze (60% of costs paid by the plan), silver (70%), gold (80%) and platinum (90%). Of the 541 plans authorized by the DOI to do business in the state, Connect for Health Colorado will offer 242 plans from 13 carriers: • • • • • • • • • • • • •

All Savers Insurance Company: 9 individual plans Cigna Health and Life Insurance Company: 11 individual plans Colorado Choice Health Plans: 12 individual, 10 group plans Colorado Health Insurance Cooperative Inc.: 8 individual, 6 group plans Denver Health Medical Plan Inc.: 4 individual plans HMO Colorado Inc. (Anthem): 14 individual plans, 3 group plans Humana Health Plan Inc.: 7 individual plans Kaiser Foundation Health Plan of Colorado: 27 individual plans, 24 group plans New Health Ventures Inc.: 6 individual plans Rocky Mountain Hospital and Medical Service Inc. (Anthem): 2 group plans Rocky Mountain HMO: 52 individual plans, 30 group plans Rocky Mountain HealthCare Options Inc.: 14 group plans SeeChange Health Insurance Company Inc.: 3 group plans

Source: “Division of Insurance Approves Final 2014 Health Insurance Rates.” DORA press release, Aug. 16, 2013. 10

“In the IT system, we want people to have a common application that determines whether they’re eligible for Medicaid. If they’re not, we pass that information to Connect for Health Colorado, which determines their level of financial help and gets them enrolled,” she continued. “In the appeals system, we want to make sure people don’t get caught between an appeal, where we say they’re not eligible for Medicaid and Connect for Health says they’re not eligible for financial help. The melding of public and private insurance has never been done before to the level required by the Affordable Care Act so partnership and collaboration will continue to be key.” With less than two months remaining before Connect for Health Colorado opens for consumers to shop for and enroll in insurance plans, there are a few things stakeholders can do to help ease the transition. Of the 125,000 uninsured children in Colorado in 2011, 89,200 were eligible but not enrolled in Medicaid or the Child Health Plan Plus (CHP+), Hammer said. And there were 47,000 parents who were eligible to participate in Medicaid because they have a child who is enrolled in Medicaid, but who were not enrolled. “We could all put our shoulders to the boulder and try to get those enrolled who are currently eligible but not enrolled,” she said. “This would be helpful for a couple of reasons: It would help those patients and families immediately, it would help providers who are struggling to balance uninsured and patients with a payer source, and it would help the system to get moving a little bit so we don’t have as big of a rush in 2014.” Physicians will undoubtedly receive questions about the exchange from patients. Connect for Health Colorado encourages health professionals to refer patients to the organization’s website at www.ConnectforHealthCO.com, where they can get more information and an estimate of potential financial assistance to reduce the cost of insurance. Patients can also call the exchange’s toll-free number, 1-855-PLANS4YOU (855-752-6749), with general questions. n

Colorado Medicine for September/October 2013

Features

An alternative to the traditional Kate Alfano, CMS contributing writer

New insurance cooperative empowers patients for better health Leading up to Oct. 1, 2013, when Colorado’s new health insurance exchange opens for enrollment, Coloradans can expect to see an explosion in health insurance marketing and new plans coming online hoping to gain market share among the large number of patients newly eligible for health insurance and subsidies under the Affordable Care Act (ACA). Many of these plans will be offered through the ACA-authorized Connect for Health Colorado marketplace, but one new plan, also authorized by the ACA and opening for enrollment on Oct. 1, hopes to stand out in its effort to provide its members an alternative to traditional health insurance and a more engaged experience. Colorado HealthOP, Colorado’s first statewide nonprofit health insurance cooperative, is an independent health insurance plan governed and operated by members. Under the CO-OP structure, members have a voice in operations including deciding what is covered under benefit plans. Members can be elected to the CO-OP’s board of directors and, according to Colorado

HealthOP CEO Julia Hutchins, when revenues exceed costs, the surplus will go back to members through lower premiums, expanded benefits and quality improvements. “Colorado HealthOP offers a radically different solution and business model for improving access to high-quality, affordable health care,” Hutchins said. “As a CO-OP, we are committed to working with consumers, providers and employers to support local solutions to local health care problems. We are a new collaborative vehicle for payment and clinical reform in Colorado. The potential for innovative disruption is significant.” HealthOP was formed in March 2012 and approved for federal funding in July 2012. But while the insurer was born under the ACA, this is not a federal or state program; HealthOP will pay back the Health and Human Services loan it received for startup within five years and its solvency loan within 15 years. Jack Westfall, MD, MPH, is a family physician and Colorado HealthOP’s chief medical officer. He is leading

the efforts to support member health needs by building a robust statewide network of primary care, developing an integrated care model and population health programs, and optimizing the CO-OP’s clinical effectiveness. He previously spent 21 years with the University of Colorado School of Medicine practicing family medicine, providing rural clinical care and leading rural programs – a great fit for a company that strives to focus on prevention, wellness and rural health care. Westfall said one factor that led to his career change was his frustration with implementing patient care programs that demonstrated improved outcomes, but that then had no mechanism for long-term sustainability beyond the life of the research grant. Westfall gave the example of providing home blood pressure monitors to patients with hypertension, which he studied extensively in both urban and rural Colorado through the primary care practice-based research networks at the university. He found this patient empowerment tool to be an effective way to manage and improve blood pressure, decreasing the risk of heart attack and stroke in the long term. But when funding ended, so did the program – there was no way to continue providing this service as no insurance company paid for home blood pressure management at the time. “One of the things that helped me make the decision to move over to HealthOP was the ability to take some of that scientifically proven, locallyrelevant programming and implement it as a member benefit,” Westfall said. “So instead of providing these benefits

Colorado Medicine for September/October 2013

Features on a programmatic standpoint for two or three years, we can make them part and parcel of how HealthOP provides care.” Good for patients Hutchins said patients should choose these insurance products because HealthOP is focused on people, not profits, and the insurer strives to encourage healthy behavior rather than simply paying for care when a member is sick or injured. For example, HealthOP designates a list of prescribed “health actions.” If members meet the requirements, they can qualify for an “enhanced benefit” – lower co-pays, lower coinsurance, lower deductibles and a health incentive account that they’ll be able to use to pay for medicine or visits. There are three health actions patients can meet in the first year: participating in a primary care wellness visit, having their biometrics recorded and completing a health risk assessment so providers can help identify areas of potential improvement or preventive measures to prevent illness. In future years, the company plans to add measures related to diabetes, asthma and other chronic diseases.

“The goal is to engage patients in taking some responsibly for their health and facilitate that relationship with their physician to make those prevention and health actions easier,” Westfall said. “Our goal is to help people, to make it easier for them to be healthy.” HealthOP expects to attract members who are interested in ways to improve their health and who are interested in health education and preventive measures that their primary care provider will suggest to them, Westfall said. And the company wants the yearly wellness visit to be one where the patient and provider develop a comprehensive health action plan for getting healthy and staying healthy. Even patients with other health care coverage can benefit from HealthOP through a free affiliate membership. Westfall said it’s for people who are committed to the values of HealthOP as a consumer-driven health plan and healthy living resource, but who don’t necessarily want to purchase the insurance. These members will have access to some of the resources members have, such as discounts with partner organizations and healthy living tips.

Good for physicians HealthOP also wants to interact differently with physicians and other providers, improving their experience by providing “common-sense customer service,” decreasing paperwork and administrative hassles, and encouraging strong communication between physician and patient. “Instead of an insurance company that denies claims, our goal is to partner with patients and providers,” Westfall said. “We want to engage them in conversations and we want to enhance the relationships between patients and their primary care providers because we think that if we’re really going to bend that cost curve, we have to promote the benefits of primary care that will save lives and costs downstream because of decreased ER visits, decreased hospitalizations and decreased poor outcomes from chronic disease.” HealthOP will experiment with alternative payments models such as claimsfree primary care, bundled payments and risk sharing, striving to implement systems that are fair, patient-centric

Colorado Medical Society is pleased to announce Hamilton Linen & Uniform as our newest Corporate Supporter. Hamilton Linen & Uniform is a 100-year-old familyowned commercial laundry. We offer a full line of medical linen and apparel rental for any size of business, and we also offer mat and restroom services. We service from Colorado Springs to Greeley. You can be confident that your linens are being cleaned according to JCAHO and OSHA guidelines. For more information, contact Suzan Fournier, Sales Manager, phone 800.628.0846 or email suzanf@hamiltonlinen.com. Also visit www.hamiltonlinen.com Colorado Medicine for September/October 2013

HealthOP (cont.) and that appropriately fund health maintenance and improvement.

it’s not a capability we necessarily need to or want to develop internally.”

From the start, providers will be eligible for financial incentives for keeping patients healthy. In the example of blood pressure management, the member will receive a home blood pressure monitor and the provider will receive a yearly fee to work to help keep the patient’s blood pressure under control, whether in person, over the phone or through protocols with a nurse.

While Colorado HealthOP is currently pursing direct contracts with physician and provider organizations that are delivering patient-centered, coordinated care or want to pursue innovative health care solutions in their communities, the majority of provider relationships in 2014 will be through existing, statewide commercial networks, Hutchins said. Providers who are part of these networks will be able to see Colorado HealthOP patients without having to establish a direct contracting arrangement.

“Making this move from the beginning can significantly reduce overhead costs for consumers and for providers who are committed to making practice changes to support a new, more flexible way of getting paid for patient care,” Hutchins said. “We want to work with providers who are committed to this vision and to making the transition over time. And, for those providers who want to get paid the traditional way, our rental networks are already experts at that, so

Building to the future There is still much work to be done leading up to Oct. 1 and then to Jan. 1, 2014, when benefits start. Westfall said the biggest challenge is getting the word out that there’s an opportunity for individuals and small groups to purchase a reasonably priced plan,

“whether it’s our plan or not.” He also stressed the importance of understanding how Colorado HealthOP differs from traditional health insurance and the value added by a cooperative model that’s making decisions based on the benefit to the individual member and provider. “At the end of the day, we really expect that the way HealthOP is managed, the recognition of the importance of primary care and the administrative simplicity of HealthOP will provide an opportunity for healthier, more engaged patients,” Westfall said. “Patients, because of their experience with HealthOP, will be more engaged in their own health and engaged in working with their primary care provider and that will improve their health. A nonprofit committed to bending the cost curve, this model is going to result in a healthier Colorado.” n

Colorado Medicine for September/October 2013

Features

Driving innovation Kate Alfano, CMS contributing writer

Crafting a strategic road map for health care payment and delivery Colorado has received federal funding to develop a proposal for transforming the state’s health care payment and delivery systems. The Colorado Health Care Innovation Plan, once completed, will be submitted to the federal Center for Medicare and Medicaid Innovation (CMMI) for full funding. The CMS Board of Directors was briefed on the initiative in July. Last year, CMMI placed a call for proposals for the State Innovation Models Initiative (SIM). States had roughly five weeks to develop and present a plan for state-based health care models that would achieve the “triple aim” of improving population health, improving quality of care and reducing health care costs. Six states received full approval and SIM grants to begin implementing their plans. Colorado and two other states received pre-testing awards, which allows more time and funds to strengthen their proposals. CMMI indicated that Colorado’s plan should impact a large percentage of the state’s population, reflect a clear vision for payment and delivery system reform, show a strong commitment to multi-payer participation – both public and private – and connect to public health in a meaningful way. Now, a group of Colorado health care experts – under the leadership of the Department of Health Care Policy and Financing (HCPF) and Gov. John Hickenlooper’s office – have been working with the six-month, $2 million award from CMMI to create a strategic 16

road map that will improve the care experience and population health, and control costs for at least 80 percent of Coloradans over the next five years. It will be submitted to CMMI by Oct. 30.

our model integrating behavioral care more broadly into the primary care setting.” Sonn is serving on the state’s management team responsible for the project.

The key components of the plan include integrating primary care and behavioral health, enhancing coordination, aligning approaches between Medicaid and the commercial payers, and transitioning away from traditional fee-for-service to bundled and global payments for outcomes-based payment.

The rationale As stated in public SIM overview materials, health care in Colorado is fragmented: delivery systems are not coordinated, individuals are treated in parts rather than holistically and feefor-service payment does not support integrated care approaches.

“A critical piece of our plan will be ensuring the payers and – more importantly – the providers have the glide path to those new models of payment since most physician groups and most hospitals in this state are not yet ready to accept prospective payments and most of our commercial payers are not in a place to begin processing those types of payments,” explained Edie Sonn, vice president of strategic initiatives for the Center for Improving Value in Health Care (CIVHC). “We’re putting together a multi-year plan that is going to transform both delivery and payment.”

“I don’t need to tell any of you the importance of behavioral health and mental health in primary care because I’m sure you all know this better than I,” explained Benjamin Miller, PsyD, assistant professor at the University of Colorado at Denver School of Medicine and director of the Office of Integrated Healthcare Research and Policy (addressing the CMS Board of Directors). “Part of the reason the state decided to pursue this line of clinical inquiry is because of the ridiculous fragmentation that exists between physical and mental health care.”

She stressed that this is about making changes to Medicaid and in the commercial arena, and that the stakeholders involved in forming the plan are working on models for delivery and payment to align public and private payers. “That’s really crucial for fundamental system transformation. Colorado’s plan is founded on the principle of integrated care, specifically in terms of

He explained that, in any given year, roughly 25 percent of patients present with mental health problems. Between 15 and 18 percent of those patients present only to the primary care sector and between 40 and 60 percent of those who are identified and referred to the mental health sector don’t seek treatment. In those terms, he said, primary care is “almost the de facto mental health system,” which leads to the

Colorado Medicine for September/October 2013

Features desire to integrate behavioral and mental health with the largest platform of health care delivery, primary care. The basic concept is to co-locate a mental health provider in a primary care practice to allow the physician and mental health provider to work collaboratively on a shared treatment plan and improve outcomes. “What’s new here is we have a multisystem approach,” Miller said. Instead of just focusing on the clinical model, which many are currently pursuing, the SIM leaders are focused on building the financial model for long-term sustainability. Miller cited a recent survey that showed that 77 percent of primary care practices that have chosen to integrate care were primarily funding the effort with grants. Other practices have found “creative ways” to be paid for integrating these services that don’t necessarily translate to the majority of health settings. “That’s a problem,” Miller said. “What we want to do is free up practices to actually pursue these models, irrespective of what the payment barriers are, and give them a fighting chance to continue to do what’s best for their communities.” Crafting the plan Refining the proposal requires the work of many health care leaders from around the state in various levels of involvement. It begins with the smallest and most involved group, the SIM management team, which includes core staff from HCPF, the Colorado Health Institute, the University of Colorado School of Medicine Department of Family Medicine and CIVHC. They will conduct research, oversee all stakeholder input and draft the innovation plan.

mary care physicians, and representatives from local and state public health agencies and consumer groups who are considering models of community-driven systems of care and how to link them around common preventive health goals. A payer group comprising commercial payers and Medicaid are guiding the development of payment models. And the specific populations workgroup considers targeted areas of focus – K-12, homeless and Indian tribes – who will make recommendations based on the needs of their populations. Moving up another layer is the steering committee, a group of roughly 20 people from the business and health care sectors who will closely examine the work of the workgroup. And finally, the advisory group – a large group of stakeholders that will meet three times over the award period to give big-picture direction as the plan takes shape. The advisory group will approve the final plan. CMS CEO Alfred Gilchrist serves on the steering committee and

CMS President Jan Kief, MD, serves on the advisory group. “There are plenty of opportunities for public input and public comment,” Sonn said. She encourages all to visit the website, www.ColoradoSIM.org, for more information and to view draft versions of the plan as they are available. Stakeholders hope CMMI will approve the new Colorado Health Care Innovation Plan, and award full federal funding to implement it. However, receiving funding is not paramount. “We need to fundamentally transform the way we deliver and pay for health care in this state. We need to eliminate the fragmentation; we need to move toward more coordination and integration of care,” Sonn said. “We’re creating enough momentum over the course of these six months with these stakeholder meetings that we will sustain the momentum and keep us moving down this path.” n

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One level up are the workgroups. The provider workgroup includes primary care physicians, behavioral health specialists and hospital representatives who represent practice needs and clarify workforce implications. The public health workgroup includes pri-

Colorado Medicine for September/October 2013

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Colorado Medicine for September/October 2013

Features

Prescription drug abuse Susan Koontz, JD, CMS General Counsel

CMS releases draft recommendations The momentum is building in Colorado to set and implement policies to curb the abuse and diversion of prescription drugs. The Colorado Medical Society has been actively engaged on this issue over the past year and recently released a draft platform titled, “The Public Health and Safety Challenges of Treating Chronic Pain: The Medical Perspective.” This platform developed by the CMS Workers’ Compensation and Personal Injury Committee (WCPIC) and special advisors to WCPIC, recommends setting guidelines for state agencies and regulatory boards and supports the development of a CMS educational platform.

of a monitoring and tracking system for intervention strategies that allows expert evaluation and adjustments to interventions. The platform dives into the specifics, focusing on five platform planks: the Prescription Drug Monitoring Program (PDMP), licensing boards standardization, physician education, law enforcement, and prescription drug abuse as a public health issue. The platform will be presented to the House of Delegates in September.

The recommendations set forth in the platform are based on the medical society’s long-term goal and strategies approved by the CMS Board of Directors in May: to assure access to compassionate, evidence-based care for patients who suffer from acute and chronic pain while implementing a multi-pronged, coordinated strategy to significantly reduce the potential for medically inappropriate use and diversion of prescribed medications.

Prescription Drug Monitoring Program The largest piece of the platform addresses the Prescription Drug Monitoring Program (PDMP). Colorado’s Electronic Prescription Drug Monitoring Program was originally authorized by law in 2005 and was reauthorized in 2011. The program provides a secure database of controlled substance prescriptions that have been dispensed by registered Colorado pharmacies, and allows prescribers and pharmacists to gather information about the patients they serve to ensure their prescribing and dispensing is appropriate under the circumstances.

CMS will meet this goal by reviewing current evidence, developing and promoting new tools and existing resources and education, developing an educational campaign for physicians, promoting screening and access to treatment programs, working collaboratively with all stakeholders and elected officials, and urging the establishment

The information collected on patients is only available online to health care practitioners licensed by the state for the patient under review, is considered to be a medical record, and is highly protected. Licensees cannot share their login information or allow office staff to access or utilize the PDMP on their behalf, at the risk of being fined.

Colorado Medicine for September/October 2013

Funding is one major barrier to the PDMP’s long-term success. The Colorado Department of Regulatory Agencies (DORA) is in the process of rate setting to determine an annual fee for prescribers of not more than $20. The proposed platform before the House of Delegates asks CMS to support appropriate funding for the Colorado PDMP and begin the process of exploring funding alternatives. Time is another barrier to the PDMP’s effectiveness. The proposed platform supports real-time access to the information to ease the demand on the prescriber’s workflow. Currently, dispensing pharmacies report to the Colorado PDMP twice monthly and a delay can exist from about 25 days from date dispensed to when the data is available in the PDMP. The state of Oklahoma has implemented real-time data collection for its PDMP. Additionally, CMS supports the concept of delegated access: a specific individual designated by a prescriber could be accredited to access the PDMP under specific conditions and, perhaps, a different level of access. The proposed platform supports integration with other systems across state lines and to all patient populations, maintaining voluntary use of the PDMP, capturing outcomes data on whether use of the PDMP reduces the abuse and diversion of prescription drugs, and the exploration of the use of unsolicited reports.

Rx drug abuse (cont.) Licensing boards called upon to set same standards The platform calls on all prescribing boards to agree upon and set the same minimal standards for opioid prescribing, with all prescribers â&#x20AC;&#x201C; including nurse practitioners and dentists â&#x20AC;&#x201C; held to these standards. All prescribers, pharmacists and members of the continuum of care should work together to ensure appropriate access to necessary medications for patients with legitimate medical needs. This will not only improve management of patients but will also allow appropriate conversations between pharmacists attempting to decrease inappropriate prescriptions and providers who can explain how they are following the standards.

The Colorado Board of Medicine is currently seeking feedback to update its policy on the use of controlled substances for the treatment of chronic, non-cancer pain. Physician education The proposed platform supports continuing, voluntary medical education to assure safe prescribing and effective relief of moderate to severe pain. All physician education should be peer-reviewed and easily available to physicians; help physicians identify at-risk prescribing practices and implement strategies to minimize the potential consequences of opioid prescribing; be tailored to meet a physicianâ&#x20AC;&#x2122;s practice and population needs; be consistent in message; promote collaboration of members of the health care team; encourage the use of

validated screening tools; and be evaluated for effectiveness and outcomes. Physicians can access opioid prescribing and patient management CME at www. cms.org or visit the AMA website at www.ama-assn.org/go/stopdrugabuse. Law enforcement The proposed platform recognizes that law enforcement plays a role in supporting efforts to prevent abuse and diversion. However, this crisis requires a public health focus rather than a strictly law enforcement focus to emphasize the treatment and recovery needs of addicted patients. CMS supports enforcement to stop criminal activities related to the prescribing and distribution of medically unindicated pain medications. The proposed platform does not support unfettered access by law enforcement to PDMP data. Rather, CMS recommends making training available to district attorneys and law enforcement about the PDMP, providing options for law enforcement access that protects the confidentiality of patient-sensitive information, and placing strict prohibitions for releasing information from the PDMP while allowing for study of the standards for a probable cause-search warrant. Prescription drug abuse as a public health issue If we aim to maintain awareness and address prescription drug abuse as a public health issue we must implement public health programs that provide access to training in the use of opioid antagonists that can save lives, increase education and funding for take-back events and disposal programs, and develop more resources for prevention and addiction treatment and support for non-medical measures to treat pain. Collaboration among all public health stakeholders is necessary to raise public awareness and address the role of opioids, safety, and education on the issues of safe storage and the diversion of medications. n CMS would like to thank Daniel BlaneyKoen, JD, AMA Senior Legislative Attorney, for his help with the development of this proposed platform.

Colorado Medicine for September/October 2013

Features

A fix at last? Kate Alfano, CMS contributing writer

SGR repeal bill advances in Congress Congress is getting closer to repealing the highly criticized Medicare sustainable growth rate formula (SGR) that places a global cap on Medicare spending on provider services and has subjected physicians to an annual guessing game as to whether their payments would be cut by an ever-growing margin. HR 2810, the “Medicare Patient Access and Quality Improvement Act,”

would replace the SGR with a fair and stable system of payments starting in 2014. The legislation is sponsored by U.S. Rep. Michael Burgess, MD, of Texas, a physician specializing in obstetrics-gynecology.

of 0.5 percent for the next five years. Starting in 2019, physicians practicing under fee-for-service would receive an additional adjustment based on quality performance under a new Quality Update Incentive Program (QUIP).

The draft legislation was released in July. Instead of facing annual cuts, physicians would receive an annual update

Performance under QUIP would be assessed based on quality measures and clinical practice improvement activities, and physicians would be assessed based on their performance among peers who provide like services. High-performColorado physicians can help move HR 2810 along by urging your ing physicians would senators and representatives to stay committed to repealing the have an opportunity Medicare SGR formula and passing legislation to enact Medicare to earn a 1 percent bonus based on previous physician payment reform. The American Medical Association performance, while provides many resources and tools for physicians to stay up to low-performing physidate on the issue and reach out to your elected officials. cians would receive a 1 percent reduction in payments. SchedGo to the AMA’s Grassroots Advocacy web page, http://ow.ly/ uled penalties under ogVsW, to view tools and guides you can use including the current law would recongressional recess “Action Kit,” a new grassroots smartphone main in effect, such as app, the AMA Guide to Communicating with Congress, and those specified under more. the Physician Quality Reporting System and Electronic Health Go to the AMA Legislative Action Center web page, http://ow.ly/ Record Incentive ProogVDV, to send an e-mail or printed letter with the click of your gram.

How you can help repeal the SGR

mouse, or call the AMA’s Physicians Grassroots Network hotline at (800) 833-6354.

Congress must finally act this year to repeal the SGR and physicians must have the opportunity to lead in the development of quality metrics and alternative payment and delivery models. Get involved today.

The legislation also includes transparency and collaboration requirements to solicit input from medical organizations and other groups on the development and selection of quality measures,

Colorado Medicine for September/October 2013

Features and provides additional avenues for the development of new payment and care delivery models. HR 2810 was considered and approved by the Health Subcommittee of the U.S. House Energy and Commerce Committee, then considered and approved by the full Energy and Commerce Committee just before the five-week congressional recess began on Aug. 1. However, because the committee did not propose a solution for paying for the SGR repeal, the legislation will not be sent to the full House for consideration until lawmakers find the necessary offsets in the budget. The Congressional Budget Office estimates the cost of the SGR repeal to be around $200 billion. Ardis Hoven, MD, president of the American Medical Association, praised congressional leaders for their work to fix the Medicare physician payment system this year but also said that there is still work to be done to ensure a strong future for Medicare. “When crafting new payment systems, lawmakers must ensure that funding for Medicare’s payments to physicians is sufficient to allow for sustainable practice environments that give physicians the ability to invest in new ways of improving care for patients.

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“This includes maintaining budget neutrality related to adjustments to correct misvalued codes as part of that ongoing process. Changes to quality reporting requirements should build on the existing system rather than attempting to implement a new regimen that adds administrative burdens and could distract from more effective efforts to improve patient care.” Congress has acted many times – sometimes multiple times in a year – over the past decade to stop steep reductions from taking place under the SGR. Should they fail to act this year, a nearly 25 percent reduction in Medicare physician payments would take effect Jan. 1, 2014. n

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Colorado Medicine for September/October 2013

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Colorado is the sunshine state Kate Alfano, CMS contributing writer

New federal law requires manufacturers to report payments to physicians Colorado physicians will soon need to be prepared to review financial information posted about them online by the federal government. Under the Physician Payments Sunshine Act, manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs must report certain payments and items of value given to physicians and teaching hospitals. But physicians in Colorado already selfreport a large amount of information under the Michael Skolnik Medical Transparency Act. Let’s take a closer look at the two programs to understand their differences. Michael Skolnik Medical Transparency Act The Colorado Medical Society has been a longtime supporter of Patty Skolnik and her work to enhance and improve patient safety systems. The Skolnik Act took effect on Jan. 1, 2008, and its mission is to provide Colorado consumers access to information about their physicians so they can make more informed health care decisions. All new licensees and physicians reactivating or reinstating a license must maintain an online profile available to the public through the Department of Regulatory Agencies. The Act requires basic information to be disclosed: full name, current address and phone number, any medical license held, current board certifications and specialties, and current facility affiliations. It also requires disciplinary information to be disclosed: criminal con-

victions, malpractice settlements, any action to suspend or revoke a license, actions against medical staff membership, or refusal by an insurance carrier to issue medical liability insurance. Most similar to the Sunshine Act requirements are the financial disclosures. Under the Skolnik Act, physicians must disclose existing direct business ownership interests related to the provision of health care services or products, and existing health care-related employment contracts or contracts establishing an independent contractor relationship between the physician and an entity if the annual value of the contract exceeds $5,000. Jason Sunstrom, director of the Office of Healthcare Professions Profiling and Systems Support, which oversees compliance with the Act, said they built the profile directly off the statute. The financial disclosures are relatively general, he said, and pertain to any business whose mission relates to health care services or products, “which could be a wide variety of things.” The Sunshine Act Starting Aug. 1, 2013, manufacturers are required to collect and track payment, transfer and ownership information. They will then submit annual reports to the Centers for Medicare and Medicaid Services for any direct payments or transfers of value to physicians and/or teaching hospitals of $10 or more. Product samples and educational materials that directly benefit patients are excluded, among others. In addition, manufacturers and group

Colorado Medicine for September/October 2013

purchasing organizations (GPOs) must report certain ownership interests held by physicians and their immediate family members. On Jan. 1, 2014, the federal CMS is expected to launch an online portal for physicians to sign up to receive notice when their financial disclosures are available for review and correction. On March 31, 2014, manufacturers and GPOs will report the data for 2013 to CMS. Officials estimate CMS will provide physicians access to their consolidated financial disclosures for 2013 sometime between April 2014 and August 2014. Sept. 30, 2014, is the target for CMS to make the majority of this information available on a public, searchable website. Physicians will have 45 days to review their own consolidated transparency report and make corrections before the report is made public. They have two years to challenge reports that they feel are false, inaccurate or misleading. Any item under dispute is marked as such in the public database. Tips for compliance Colorado physicians are already familiar with reporting under the Skolnik law and Sunstrom said that things are going well. “We haven’t initiated any fines until recently and so far no fines have been levied against physicians; they’ve been levied against other license types.” “We get quite a few profile searches as the word gets out to consumers,” Sun-

Sunshine Act (cont.) strom said. “It’s obviously good to have the correct information out there. We remind [physicians] that it’s a living, breathing document. Anytime there’s anything that could be considered to be a change to a profile question, they need to go update their profile.” Physicians needing assistance with Skolnik Act reporting can go online to the HPPP website, www.dora.colorado. gov/professions/hppp, or contact HPPP staff John Scott or Phillip Deeds directly at 303-894-5942 for technical questions. While physicians don’t have the responsibility of reporting under the Sunshine Act and the information won’t be made public until 2014, the AMA advises physicians to be vigilant in preparing for its effects and recommends the following. 1. Ensure that all financial disclosures and conflict of interest disclosures are current and updated regularly. 2. If you have a National Provider Identifier (NPI), ensure all infor-

J. Bryan Sexton, PhD, MA Johns Hopkins University School of Medicine

Robert M. Wachter, MD University of California, San Francisco

mation in the NPI enumerator database is current and regularly updated as needed. 3. Ask all manufacturer and GPO representatives with whom you interact to provide you with notice and opportunity to review and correct all information they intend to report to the federal government before it is officially submitted.

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4. Download and use the federal CMS’ free OPEN PAYMENTS Mobile for Physicians app to control and track transfers.

Your bridge to quality improvement in health care

5. Visit the AMA Sunshine Act webpage at www.ama-assn.org/go/ sunshine, frequently for updates. The general intent of both the Skolnik Act and the Sunshine Act is to increase transparency, to engage consumers and improve health care as a whole. Physicians must be active in reviewing information published about them online and submitting updates and corrections, and those who are will feel more at ease with the new requirements. n

Accredited CME is education that matters to patient care. For more information contact the Colorado Medical Society CME office at 720.858.6309

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Colorado Medicine for September/October 2013

Features

Conversation starter Gina Claxton, CMS contributing writer

Colorado physicians encourage wise health care decisions Physicians have the power to ensure that Coloradans receive the very best care possible. As health care experts, patients rely on you to help make good care decisions. Sometimes those decisions are straightforward. Sometimes they are much more complicated and can lead to medically unnecessary tests and procedures. Sometimes this medically unnecessary care puts patients in harm’s way, and it certainly drives inefficiency. In fact, the Institute of Medicine has found that 30% of health care is unwarranted or duplicative.

are getting the right care–no less and no more,” said CMS president-elect John Bender, MD.

Having candid conversations about evidence-based best practices can improve care and enhance physician-patient relationships. “That’s why the Colorado Medical Society (CMS) has launched the statewide Choosing Wisely Colorado campaign to help us strengthen the bonds we have with our patients and at the same time ensure that they

More proof that Colorado is unique recently surfaced through a CMS physician survey. Survey results (see figure 1) show that as compared to some national data Colorado physicians are taking keen interest in and responsibility for reducing medically unnecessary care. A July 2013 edition of JAMA featured results of a national physician poll that

Physician leadership Colorado physicians regularly step up to important leadership responsibilities and so it wasn’t too surprising in the fall of 2012 that CMS became the first state medical society to endorse the national Choosing Wisely campaign aimed at encouraging conversations between patients and physicians and promoting evidence-based care decision making.

Figure 1

Physicians and Rising Health Care Costs

shows that only 36% of the 2,556 physician respondents thought they had a “major responsibility for reducing health care costs.” The article has received a great deal of media attention by spinning an it’snot-my-fault physician perspective and pinning the responsibility of escalating health care cost on trial lawyers, health insurance companies, hospitals and health systems, pharmaceutical and device manufacturers, and patients. Contrast those results with Colorado physician views that show that a strong majority (63%) believe that they “have a major responsibility to take the lead in Choosing Wisely conversations.” These conversations serve as the physician-operated vehicles to improve quality and drive down the cost of health care. Other encouraging results indicate that overriding majorities of Colorado physicians (85%) believe that having conversations to educate patients about efficient use of health resources is “very important,” and almost all (92%) think it is very important for physicians to be aware of evidence-based recommendations for tests and procedures that display overuse, minimal benefit or potential harm. These results demonstrate that Colorado physicians are ready to take on the challenging task of reducing medically unnecessary care, and Choosing Wisely Colorado from CMS is here to help. Saying no and doing the right thing As Colorado physicians show their

Colorado Medicine for September/October 2013

Features readiness to the lead in this effort, it is important to highlight tools that are available for your use. Let’s face it. Saying no can be hard, but when it comes to health care doing the right thing shouldn’t be. Support for physician-patient conversations promoting optimal health care decisions was first initiated on a national level by the American Board of Internal Medicine Foundation (ABIMF) with the Choosing Wisely campaign. ABIMF has partnered with Consumer Reports and several specialty societies to produce lists of “Five Things Physicians and Patients Should Question.” These lists help physicians focus their efforts and provide a starting point for dialogue. The end goal of these discussions is to promote health care decisions that are supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. Choosing Wisely has

Colorado website to see the list of tests and procedures we are targeting.

our physician toolbox at www.cms.org/ choosing-wisely. n

Sometimes it’s not just what you say, but how you say it. We urge you to use the Colorado-physician-developed and vetted tools to help with these important patient conversations. Think about using the simple scripts from CMS the next time you and your patient are trying to choose wisely! Find

Sources: Tilburt, Jon C. et al. Views of US Physicians about Controlling Health Care, JAMA, July 24/31, 2013, Vol 310, No. 4. Colorado Medical Society Physician Member Poll, Choosing Wisely Colorado, June 2013.

a wide range of resources created with the support of dozens of specialty societies and physicians that can be found at www.choosingwisely.org. Choosing Wisely Colorado puts a twist on the national campaign and is designed to support you. We have partnered with the Colorado Permanente Medical Group and a number of state specialty societies to concentrate on a subset of tests and procedures from the national list. Choosing Wisely Colorado concentrates on the physician side of these conversations by sharing tips, tricks and tools used by some of Colorado’s best physicians that are exceptionally gifted at having these often challenging conversations. Visit the Choosing Wisely Colorado Medicine for September/October 2013

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Features

One Colorado Education Fund Kate Alfano, CMS contributing writer

LGBT advocacy group honors CMS with 2013 Ally Award The One Colorado Education Fund – the leading statewide advocacy organization for lesbian, gay, bisexual and transgender Coloradans – has named the Colorado Medical Society one of two recipients of their 2013 Ally Award. “Since first being presented with ‘Invisible,’ One Colorado’s report on the health care needs and disparities facing the state’s LGBT community, the Colorado Medical Society has worked tirelessly to improve access, seek out new funding and create new opportunities to educate its membership on issues of LGBT health,” the organization said in a news release about the award. CMS board member Tamaan Osbourne-Roberts, MD, a Denver family physician, accepted the award on CMS’ behalf at an event on Aug. 17 that drew 400 attendees. “Despite the ability to cure things we once thought incurable, despite treatments to extend life and restore function in ways that once would have been thought miraculous, the benefits of such advances still do not accrue

equally to all members of society,” Osbourne-Roberts told attendees. “It has long been recognized that the gay, lesbian, bisexual and transgendered community, in Colorado and everywhere, suffer from worse health outcomes and often feel alienated from a system that should be helping them,” Osbourne-Roberts continued. “Physicians, voluntarily or involuntarily, have often been party to this process. We hope our recent, and continuing, efforts help to send a message that physician participation in any such exclusion, through either commission or omission, is a thing of the past.” The University of Denver men’s hockey team also received the 2013 Ally Award, in recognition of their participation in the You Can Play Project, an organization dedicated to promoting respect for all athletes and addressing homophobia in sports. “The 2013 Ally Award winners truly embody what it means to be an ally to

Join Now!

Colorado Medical Political Action Committee Call 720-858-6326 or 800-654-5653, ext. 6326 or e-mail chris_mcgowne@cms.org 30

From left to right, Rita Lee, MD, of Denver; and CMS Board member Tamaan Osbourne-Roberts, MD, of Denver after accepting award on behalf of CMS. Photo credit: Stevie Crecelius

the LGBT community,” said Brad Clark, executive director of One Colorado Education Fund, in the release. “Because of their courage and commitment to standing up for our community – along with so many incredible allies across our state – we can say without hesitation that Colorado is a fairer and more just place for LGBT Coloradans and their families.” Also recognized at the event were the honorary co-chairs: Denver County Clerk and Recorder Debra Johnson, state Senators John Morse, Angela Giron and Irene Aguilar, MD, and former state Representative BJ Nikkel. One Colorado honored Tim Sweeney, the outgoing president and CEO of the Gill Foundation, with a special tribute, recognizing him as a longtime champion for LGBT equality. n

Colorado Medicine for September/October 2013

Features

CMS Education Foundation Age Healthier. Live Happier.

Help send a student through school About the CMS Education Foundation Founded in 1982, the Colorado Medical Society Education Foundation (CMS EF) is a non-profit, tax-exempt charitable foundation established primarily to support educational and charitable programs in Colorado.

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Since 1993 the Foundation has dedicated itself almost exclusively to the funding of scholarships to incoming first-year 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 720-858-6310 for more information and to donate Colorado Medicine for September/October 2013

Inside CMS

Medical school scholarship recipients

CMS Education Foundation

Michael J. Campo, PhD, CMS Director, Business Development & Member Benefits

Education Foundation awards two $10,000 scholarships During the month of June, freshman students at the University of Colorado School of Medicine, Arezoo Bahramirad and Kenny Rodriguez, were each awarded $10,000 scholarships from the Colorado Medical Society Education Foundation (CMS EF). The mission of CMS EF, a 501(c)(3) private foundation, is to render financial support to select first-year medical students at the University of Colorado School of Medicine based on criteria

Arezoo Bahramirad received a $10,000 scholarship from the Colorado Medical Society Education Foundation. such as the student’s financial status, academic achievement, and desire to practice in rural or underserved areas upon graduation. Since 2003, CMS EF has provided $319,500 in scholarships. CMS EF also supports education programs such as the Colorado State Science and Engineering Fair and the Education Program at the CMS annual meeting. As W. Gerald Rainer, MD, CMS EF, Board Chair, explains, “The CMS EF 32

Board appreciates the generous donations and support from CMS members who make our scholarships possible.” Dr. Rainer is a Distinguished Clinical Professor of Surgery at the University of Colorado Anschutz Medical Campus. Arezoo Bahramirad “I completed my undergraduate degree in Amsterdam, the Netherlands, and then I moved to Charlotte, N.C., and got a Master’s degree in general Mathematics. After one year of Biostatistics training at Anschutz Medical Campus and two years of volunteering at The Medical Center of Aurora I got accepted to University of Colorado School of Medicine where I plan to grow into a knowledgeable and compassionate doctor. My goal is not only to serve the people in my community, but also contribute to the science and practice of medicine through innovative ideas and research.” Kenny Rodriguez “I was born in Caracas, Venezuela, where my family lived until we immigrated to Colorado in 1995. Since that time I have lived in Aurora, in the shadow of the now Anschutz Medical Center. In fact I graduated from Aurora Central High School just blocks from the campus. I currently still live in Aurora along with my wife, our son, and newborn daughter. I am deeply grateful for the opportunity to begin medical school this year as it did not seem a possibility for me as an immigrant to the U.S. I developed my passion for the medical field while working as a volunteer for two years following high school in Long Beach Calif. with underprivi-

leged families. Although I had lived with very limited access to medical care in my youth, it was during this time that I learned that I could really help others that were in need. This led me to the unorthodox path I followed to medical school. I attended Brigham Young University-Idaho where I graduated cum laude two years later with an Associates of Science in Nursing and later received a Bachelor of Science along with completing prerequisites for medical school. After becoming a registered nurse I was

Kenny Rodriguez received a $10,000 scholarship from the Colorado Medical Society Education Foundation. able to return to Colorado and work on my goal to help the underserved communities. I have been working at Rocky Mountain Youth Clinic as a pediatric nurse throughout the Denver Metro area where we focus on providing care to families with Medicaid or no insurance. I hope to continue on this course through medical school and continue to focus on the underserved pediatric community.” n

Colorado Medicine for September/October 2013

Inside CMS

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 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 * CMS Member Benefit Partner 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 BioTE Medical 877-992-4683 or visit biotemedical.com

athenahealth 888-402-6942 or visit www.athenahealth.com/cms. *CMS Member Benefit Partner Diagonal Medical Billing: 303-551-7944 or visit www.diagonalmedicalbilling.com PRACTICE VIABILITY (cont.) GL Advisor 877-552-9907 or visit www.gladvisor.com/cms * CMS Member Benefit Partner HealthTeamWorks 866-401-2092 or visit www.healthteamworks.com *CMS Member Benefit Partner IC System www.icmemberbenefits.com Line Pressure 303-742-0202 Massive Networks 303-800-1300 or visit www.massivenetworks.net Medical Telecommunications 866-345-0251 or 303-761-6594 or visit www.medteleco.com * CMS Member Benefit Partner Solve IT 303-800-9300 or visit www.solveit.us *CMS Member Benefit Partner

CO-POWER 720-858-6179 or www.groupsourceinc.com *CMS Member Benefit Partner

TransFirst 800-613-0148 or visit www.transfirstassociation.com/cms *CMS Member Benefit Partner

Hamilton Linen & Uniform 800-628-0846 or visit www.hamiltonlinen.com

TMS Center of Colorado 303-884-3867 or www.tmscenterofcolorado.com

PRACTICE VIABILITY ALN Medical Management 866-611-5132 or visit www.alnmm.com

Transcription Outsourcing 720-287-3710 or visit www.transcriptionoutsourcing.net

Alphapage 303-698-1111 or visit www.aplha-mail.com

Colorado Medicine for September/October 2013

Transworld Systems 800-873-8005 or visit www.web.transworldsystems.com/npeters * CMS Member Benefit Partner

Inside CMS

Good friends, good food & good music Jan Kief, MD, CMS President

CMS is bringing the best of Mardi Gras to the mountains Make plans to attend the Annual Meeting in Vail this September The 143rd Colorado Medical Society Annual Meeting and convening of the CMS House of Delegates takes place Sept. 20-22 at the Vail Marriott Mountain Resort. The weekend event will be injected with a touch of Cajun spice, humor and joie de vivre. “Mardi Gras in the Mountains” will feature fun, friends and interactive programming on issues important to physicians and patients. The House of Delegates will conduct business integral to the continuing success of CMS, electing a new slate of officers and establishing CMS policies. New this year, the main events of the Annual Meeting will span two days instead of three. Schedule streamlining mostly affects the business portions of the meeting. All proposed resolutions for the House of Delegates must be submitted by Aug. 11, which will allow the reference committee to hold two meetings and submit their report to be posted online prior to the annual meeting. The report will be distributed to delegates upon arrival Friday evening or Saturday morning. Registration opens Friday at 3 p.m. 34

All Annual Meeting registrants and their families are encouraged to attend the Welcome Reception Friday evening to socialize and enjoy giveaways, live music and a photo booth. The HOD convenes Saturday at 8:30 a.m. Caucus meetings will be held between 7 and 8:30 a.m. During the morning session, delegates will hear speeches from the officer candidates and consider items on the consent calendar. Saturday’s AMA-COMPAC luncheon features top elected officials who will participate in an interactive discussion on health care, the state-federal working relationship, and other issues important to physicians. During Saturday afternoon’s interactive programming, attendees will explore the topics of opioid abuse and maintenance of licensure, as well as hear a presentation from CMS-member medical students. That evening, attendees have the opportunity to meet the candidates for CMS President at a reception before heading to the presidential gala to celebrate the installation of 2013-2014 CMS President John Bender, MD, of Fort Collins.

The House of Delegates reconvenes Sunday morning to elect officers and all attendees can participate in additional programming: COPIC educational sessions and lectures on the liability climate, Medicaid expansion, the All Payer Claims Database, Choosing Wisely, ICD10 and the 2014 legislative session. Throughout the Annual Meeting representatives from various industries will be on hand to speak with attendees about the latest medical products and services. Don’t forget to visit with the 2013 sponsors and exhibitors to thank them for their involvement, which keeps attendee event fees low. The exhibitor area will be located outside of the meeting rooms. We hope to see you, the Colorado Medical Society krewe, in Vail this September. Register by visiting www.cms.org. Reserve your room by calling (877) 622-3140 or online at https://resweb.passkey.com/go/ comedical. Ca c’est bon. Laissez les bons temps rouler! n

Colorado Medicine for September/October 2013

Inside CMS

2013 Agenda Friday, September 20 12:00 p.m. – 1:00 p.m. – 3:00 p.m. – 3:00 p.m. – 6:00 p.m. –

12:45 p.m. 5:00 p.m. 3:30 p.m.

Finance Committee Board of Directors BOD Exhibitor Break and refreshments Registration opens Exhibitor Reception, including heavy appetizers and open bar

8:00 p.m.

Saturday, September 21

6:45 a.m. 7:00 a.m. 8:30 a.m. 9:30 a.m. 10:15 a.m. 12:15 p.m. 1:45 p.m. 2:45 p.m. 3:00 p.m. 3:30 p.m. 4:30 p.m. 5:30 p.m. 6:00 p.m.

– – – – – – – – – – – – –

8:15 a.m. 8:30 a.m. 9:30 a.m. 10:15 a.m. 12:15 p.m. 1:45 p.m. 2:45 p.m. 3:00 p.m. 3:15 p.m. 4:30 p.m. 5:30 p.m. 6:00 p.m. 11:00 p.m.

Breakfast Registration and caucus meetings HOD Opening Session • National Anthem • Statement of inspiration • Candidate speeches, announcements and housekeeping Exhibitor Break House of Delegates • The consent calendar • Adjournment until after lunch or Sunday depending on consent calendar progress COMPAC and AMA luncheon • AMA Lobbyist Todd Askew • Colorado U.S. Representative Cory Gardner, (R) Where does it hurt? Prescription drug abuse in Colorado Medical students presentation Why Maintenance of Licensure makes sense for Colorado Exhibitor break with giveaway drawings Open time Meet the candidates reception Presidential Gala • COPIC Dessert Buffet

Sunday, September 22

6:45 a.m. – 8:15 a.m. 7:00 a.m. – 9:00 a.m. 7:00 a.m. – 9:00 a.m. 9:00 a.m. – 9:30 a.m. 9:30 a.m. – 12:00 p.m. 9:30 a.m. – 10:30 a.m. 10:30 a.m. – 10:45 a.m. – 11:15 a.m. – 11:30 a.m. – 11:45 a.m. –

10:45 a.m. 11:00 a.m. 11:30 a.m. 11:45 a.m. 12:00 p.m.

Breakfast COPIC educational session: Our careers in medicine – who we are and how it shapes our journey Medical student breakout: underserved specialty care access study House of Delegates • Election of officers • Dr. Ted Clarke COPIC presentation • Science Fair winners award presentation Programming The liability climate: Are policy options on or off the table? • Oregon Medical Society General Counsel, Gwen Dayton JD • Panel discussion on the importance of preserving Colorado's stable tort environment: Sen. Ellen Roberts, (R), Rep. Clarice Navarro, (R), Rep. Joann Ginal, (D) and Rep. Mike Foote, (D) Medicaid expansion and reform: next steps The All Payer Claims Database Choosing Wisely Colorado The ICD-10 Coalition: ready or not Prioritizing emerging 2014 legislative issues

Colorado Medicine for September/October 2013

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

John Biebelhausen

John Biebelhausen, MD, MBA is a third year resident in the Hospitalist Training Program within the Internal Medicine Residency Training Program at the University of Colorado Denver. He obtained a bachelor’s degree in psychology from the University of Arizona and completed a dual MD/MBA in health care management at Tufts University School of Medicine. Upon completion of residency, Dr. Biebelhausen will pursue a career in hospital medicine, where he hopes to provide high quality patient care and affect change in the health care system that will lead to reduced costs, improved quality and value-based care.

Today Today I lost my first patient It was your mother, you see. She was very sick, you knew But there was nothing my hands could do. No words of mine can ease your pain, No words of mine can ever make it the same. I lost my first patient, you see. I sat down father, son and daughter To explain to them what had to be. Lost to me were their wife, mother, and grandmother to be. She died in my hands, my first patient did she. I put up the greatest fight, but to no avail. Please believe me when I tell you this. In your eyes, I see it was not enough

And in mine it will never be. I am only human though, you see. Because today I lost my first patient And I received no training for this, on how to care for me. Now, I am torn inside, crying silently. I was not supposed to get attached, But this patient, she was a life to me. A living, breathing, loving life was she. I can’t detach from that; I don’t care to know how Because today this patient of mine, she died did she. And her life, It was important to me. n

Colorado Medicine for September/October 2013

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 Tim Yanetta

720-858-6306 or e-mail tim_yanetta@cms.org

Colorado Medicine for September/October 2013

Inside CMS

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

Focus on patient safety COPIC continues to invest in ways that benefit Colorado insureds and health care When I describe COPIC, my conversation often veers toward the topic of patient safety. I believe the ideals of patient safety connect with the heart of our mission and support our common goal to deliver the best patient care possible. This requires an investment in staying connected to the ideas at the forefront of patient safety. More importantly, it requires involvement. Since COPIC’s inception, we have identified opportunities to be part of the national discussion on this topic. It enables us to understand best practices from the leaders and organizations who are defining what patient safety means to health care and how it can lead us to better results. The knowledge we gain from our focus on patient safety is passed along to our insureds through the programs and materials we provide them. It can be found in the medical resources and tools we post on our website, the speakers who present at our conferences, and the educational courses we develop to address current trends. COPIC’s emphasis on patient safety is also defined through our interactions with insureds. Listening to the specific challenges faced by our insureds gives us information to determine how we can work together to come up with the best solutions. Examples of our involvement in patient safety initiatives include: • Our physician risk managers are at the center of discussions at nationally-recognized events. The Telluride Patient Safety Roundtable is regarded as one of the top forums that bring together health care leaders and patient safety advocates to connect with medical residents and students. Alan Lembitz, MD, COPIC’s chief medical officer, and Jeffrey Varnell, MD, medical director for COPIC’s 3Rs Program, were among the faculty who facilitated interactive discussions at this year’s event. Not only does this event provide us access to the latest strategies to reduce patient harm, but it also connects us with young physicians and their ideas for the role of patient safety in health care. • We support partnerships designed to foster a cultural shift.

In 2012, COPIC formed a partnership with the University of Colorado Health-Poudre Valley Health System to launch a pilot program known as Seven Pillars. Its comprehensive approach reinforces key principles of patient safety among members of health care teams and was developed by recognized medical leaders at the University of Illinois Medical Center at Chicago. During the last year, the project team trained physicians, administrators and staff in the Seven Pillars concepts. We will continue to follow results from this program as it reinforces patient safety among medical teams. • Our data offers valuable insight that can be used to improve patient care. The information that COPIC tracks tells a rich and detailed story about how and why medical liability issues arise. We are working with the Rand Corporation to analyze this data and determine links between patient safety and our efforts to reduce claims through education programs and resources. The results of this study will further help us support insureds and provide insight that will benefit the broader health care community. • Our involvement with medical organizations offers new ways to contribute. COPIC Medical Foundation recently approved a grant for the American Congress of Obstetricians and Gynecologists to support its Council on Patient Safety in Women’s Health Care. COPIC will be one of the inaugural members of this council, which strives to improve patient safety through multidisciplinary collaboration that focuses on understanding the causes of patient harm, pursuing programs and tools to implement safety initiatives, and disseminating valuable patient safety information. And our involvement at the state level continues to build strong partnerships. For example, the work we do with the Colorado Medical Society supports a stable medical liability environment that fosters improvements in patient safety. All of these efforts support the ways in which we provide actionable ideas and trusted advice to our insureds. And being a partner for better medicine is what inspires us at COPIC – our commitment to patient safety is stronger than ever and continues to be an investment that yields positive results. n

Colorado Medicine for September/October 2013

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Colorado Medicine for September/October 2013

Departments

New Members Arapahoe-DouglasElbert Medical Society Russell E Bartt, MD Trista A Bowyer, MD Michael J Brazelton, MD, FAAP James O Chang, MD Jessica J Evans-Swanson, MD Troy W Finlayson, MD Lauren E Finney, MD Jeffrey D Foster, MD Desiree S Gleason, DO Heidi B Green, MD Locke P Keney, MD Scott A Klein, MD Erika M Lee, MD Michael J Makley, MD David J Mohlman, DO George M Pachello, MD Jeffrey L Schmidt, MD Lisa S Schwebach, MD Justin K Smith, MD Jennifer N Tiehen, MD Stephen M Weber, MD, PhD Anita M Zachariah, MD Aurora-Adams County Medical Society Elizabeth A Banwart, DO John M Froelich, MD Herman E Hasselkus, MD Anne M Jobman, MD Kimberly L Maino, MD Juanita R Redfield, MD Eric P Richards, MD Stephen S Rotholz, MD Boulder County Medical Society Christine H Abair, MD Kristina A Anton-Schnell, MD Charles B Armstrong, MD Leslie L Armstrong, MD Sherrie L BallantineTalmadge, DO

Eileen G Bickford, MD C Brian Blackwood, MD Eric T Christiansen, MD Cristina F Conklin, MD Murry Drescher, MD Darlene L Eyster, MD R Kevin Flynn, MD Lisabeth C Hall, MD Matthew T Hawkins, MD Eric J Hernandez, MD John S Kang, MD Sami Lababidi, DO Geeta A LalchandaniLalwani, MD Andrea M Mertz, MD Allison E Morrison, MD Ricardo Pena, MD Jennifer R Pulliam, MD Ethan M Ross, DO Sallie B Smith, MD Angela C Taylor, MD Susan L Taylor, MD John A Updike, MD Diane M Winters, MD Chaffee County Medical Society Randal E Villalovas, MD Clear Creek Valley Medical Society Theodore R Buttrick, MD Jayna K Doshi, MD Steven Fabian, MD Christopher A Gutierrez, MD James T Hardee, MD Lawrence S Janowski, MD Sameer J Lodha, MD Monica T Morris, DO Marc A Passo, MD Marci L Peralto, MD Michelle P Rhodes, MD David A Richmond, MD David W VanKooten, MD

Kurt S Walters, MD Wojciech Zolcik, MD CMS Direct Megan Eve Gorzalski, DO Rebecca J Kreutzjans, MD Stephanie M Oliva, MD Anna M Pazurek, MD Brooke E Rogers, MD Lisa R Rothlein-Naron, MD Zachary L Singer, DO Curecanti Medical Society Robert G Kilbourn, MD Simon Kotlyar, MD, MSC Denver Medical Society Andrew W Ambler, DO Michael C Bateman, MD Gregory W Berman, MD Justin C Chang, MD Anne K Cosgriff, MD David A Costantino, MD Martin M Dinges, MD Stephen M Dodge, MD Ake S Evans, MD Stacey N Folk, MD Jason M Friedrich, MD Mehul V Gandhi, MD Joy J S Guth, MD Romana M Haas, MD Rachel K Herlihy, MD, MPH Peter M Hession, MD Farah A Husain, MD Paul C Johnston, MD Elizabeth A Kelts, MD Lois E Kinney, MD Adam E Kowalski, MD Danica J Larson, MD Megan E Lederer, MD William R Marsh, MD D Mark Melton, MD Alexander R Menter, MD

Sheetal P Meshram, MD Eric J Mogyoros, DO Mark C Mollinet, MD Thomas J Moran, MD Aaron S Nadon, MD Lee S Newman, MD Brian D Nordstrom Lane, MD Riana M North, MD Mark E Patron, MD Amy A Pierce, MD Hanah N Polotsky, MD Jean K Rex, MD Jeffrey W Rickard, DO Patrick W Russell, MD Robert C Ryan, MD Michael A Sarche, MD Richard D Schulick, MD Nancy A Seibolt, MD Britt K Severson, MD, MPH Shibana Shafi, MD Emily A Speer, MD Alwin F Steinmann, MD Dominic J Titone, MD John P Wilkins, MD Stephanie Wilson, MD El Paso County Medical Society Pamela W Casson, MD Michelle D DeWing, MD Barbara Divish, MD Paul T Dube, MD Jamie D Glover, MD Thomas Henderson, MD Ronald F Hollis Jr, MD Deepak Honaganahalli, MD Peter A Liehr, MD Lisa R Ramey, DO Paul E Reckard, MD Roy D Rosenthal, MD Amir A Salek, MD Svetlana Tsirkin, MD Alifiya A Tyabji, MD Brenda Walker-Conner, MD

Colorado Medicine for September/October 2013

Departments Jeffry T Watson, MD Luke M Webb, MD

La Plata County Medical Society Joseph C Gambone, DO

Noah T Kaufman, MD Ryan J Keller, DO Keasha N Kuhnen, DO Kevin J Limbaugh, MD Mellyna A McGlothlin, DO Christopher D Mitchell, MD Alexander N Myers, MD Karl E Olsen, MD Catherine C Pizzi, MD Pauline E Powers-Peprah, DO Richard J Russell, MD Steven R Schuster, MD Randall W Smith, MD William B Taylor, MD Angela S Walter, MD

Larimer County Medical Society Ross Barner, MD Kent R Crews, MD Bethany A Davis, MD Hector E DeLeon, MD Gary JL Foster, MD Thomas J Fralich, MD Daniel W Giles, MD Stephanie D Goshorn, MD Aaron D Jarrett, MD Stacie L Johns, MD Neil D Jones, MD

Mesa County Medical Society Jessica I Cornett Allen, MD Heather R Harms, MD Nathan A Harms, MD Joshua M Hulst, MD Ryan K Jackman, MD David R Johansen, MD Braeden D Johnson, MD Katie J Mang-Smith, MD Shiela M Stegora, MD Katherine C Strack, MD Lori M Wittman, MD

Huerfano County Medical Society Steven E Boynton, MD Intermountain Medical Society Robert F La Prade, MD William I Sterett, MD

Mt. Sopris Medical Society Kelli J Konst-Skwiot, MD Northwestern Colorado Medical Society Jeanne C Fitzsimmons, MD Pamela R Kinder, MD Pueblo County Medical Society Jennifer A Ayars, DO Laurence A Berarducci, MD Eric M Bluml, DO Muath Dawod, MD Justin V Diegel, DO Karen Garcia, DO Edward A Malcolm, DO Debra McCormack, MD Mark D Porter, MD

Karen A Randall, DO Derek G Rodeback, DO Richard Salazar, MD Noah N Settergren, DO Ann A Turner, DO Jessica L Walsh, DO Kayleigh A Zerr, DO Lexie L Zuver, DO San Luis Valley Medical Society Mikaila H Pence, MD Southeastern Colorado Medical Society Gino F Figlio, MD, FAAP Weld County Medical Society Giovanna M Garcia, MD

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

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Colorado Medicine for September/October 2013

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medical news Register for CORHIO meaningful use boot camp CORHIO, the Colorado Regional Health Information Organization, is offering a one-day seminar on Meaningful Use on Friday, Sept. 27, 10:30 a.m. - 4:30 p.m. Physicians are encouraged to register to attend the Meaningful Use Boot Camp to learn how the elec-

tronic health record incentive program from the federal Centers for Medicare and Medicaid Services has changed how physicians use electronic health records (EHRs) and how the program will continue to shape future practice as it evolves over time.

Montrose Fall Clinics Montrose, Colorado Friday, September 27, 2013 42nd Annual Fall Clinics Speakers:

Martin Abrahamson, M.D., Senior Vice President for Medical Affairs, Associate Professor of Medicine, Harvard Medical School, Boston, MA • Managing type 2 diabetes in 2013: Challenges and Opportunities • Metabolic Syndrome: What is it? What can we do about it? Michael Dansinger, M.D., Assistant Professor, Tufts University School of Medicine, Boston, MA, Director, Tufts Medical Center Diabetes Reversal Program, Weight Loss and Nutrition Consultant for NBC’s “The Biggest Loser” and WebMD • What NOT to eat: Insights from a Hollywood Nutrition Doctor • Intensive Lifestyle Coaching for Type 2 Diabetes Reversal Keith Raziano, M.D., Associate Clinical Professor, Department of Physical Medicine and Rehabilitation, Emory University Hospital, Atlanta, Georgia • Pain Management: Emerging Trends • Pain Management: Safe Narcotic Protocols Jonathan Schoen, M.D., Associate Professor, Surgery-GI Tumor & Endocrine Surgery, University of Colorado Hospital, Denver, CO • Bariatric Surgery for the Treatment of Obesity • The Big Fat Debate: Surgical vs. Medical Management of Obesity – panel discussion Register on line at www.montrosehospital.com or call 970-240-7394 Fees: $150 for physicians and $75 for other healthcare providers Montrose Memorial Hospital designates this live activity for a maximum of 8 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The boot camp will be held at the Hilton Garden Inn Tech Center in Denver. Attendees will learn how to get the most out of their EHRs in Stage 1 and Stage 2 of Meaningful Use and how to attest for the Medicaid EHR Incentive Program, plus they’ll explore current HIT initiatives in Colorado, the health information exchange, cyber liability and key requirements from the HIPAA Final Rule. There is still plenty of time to take part in the EHR incentive programs and any eligible providers or hospitals that are committed to achieving Meaningful Use through the utilization of a certified EHR system can participate in the seminar. Attend the final boot camp in the series to discover how you can be a meaningful user of EHR technology to deliver better care and improved patient outcomes. For more information and to register, go to www.corhio.org and click on “Events.” n

CORHIO Meaningful Use Boot Camp Agenda "Meaningful Use 101" (1:00 p.m. to 2:45 p.m.) Concurrent sessions (3:00 p.m. - please choose one): "Completing Your HIPAA Security Risk Analysis" presented by David Ginsberg, Colorado state's leading authority on HIPAA Privacy & Security Compliance "Selecting an EHR Vendor" presented by Tracy Rue, Health IT Transformation Consultant EHR vendor showcase & demos (4:30 p.m. - 7:00 p.m.)

Colorado Medicine for September/October 2013

Departments

medical news Marguerite Salazar named Colorado commissioner of insurance Marguerite Salazar, who most recently served as the Denver-based region VIII director of the U.S. Department of Health and Human Services, has been appointed Colorado’s new commissioner of insurance. The announcement was made through a news release from Gov. John Hickenlooper’s office. Salazar assumed the post Aug. 19, replacing Jim Riesberg. “Marguerite Salazar’s deep roots in Colorado and small-business acumen

Online CME available: SBIRT mentor training

will serve her well in this new role,” Hickenlooper said in the release. “She is a savvy executive, understands regulatory reform and already knows her way around the insurance industry.” The division of insurance falls under the Colorado Department of Regulatory Agencies. The commissioner oversees the regulation of the insurance industry in Colorado, which includes responsibilities concerning wildfires and the next phases of the Affordable Care Act. As regional director of HHS, Salazar was responsible for the implementation of the ACA throughout the sixstate Rocky Mountain region, working

The concepts of disease prevention and the reduction of harm related to substance use are critical elements in the successful delivery of health care, including screening, brief intervention, and referral to treatment (SBIRT). Learn more through an online CME program, “The Substance Use SBIRT Mentor.”

Colorado Medicine for September/October 2013

In her new role she will also serve as a nonvoting member of the board of the state health insurance exchange, Connect for Health Colorado, which will offer consumers a place to shop for, compare and purchase health insurance products starting Oct. 1. As an open marketplace model exchange, health insurers are required to submit their plans to the Division of Insurance for approval to be eligible to sell their products through the exchange. n

Care For Your Financial Future. Lawrence Howes, MBA, AIF®, CFP®, has been recognized for eleven consecutive years by Medical Economics as one of the “Top 150 Financial Advisors for Doctors”. He’s ready to help you.

Participants will learn how to help improve patient outcomes by identifying substance use behaviors and determining a patient’s level of risk related to alcohol and other drug use. They will also learn to provide brief motivational interviewing about the health impact of substance use - and how to effectively refer a patient to treatment when appropriate. The cost of the program is $99, though Colorado Medical Society members who register by Aug. 1, 2013 can receive 20 percent off by entering coupon code SBIRTCMS20%. Participants will receive a certificate for three contact hours after successful completion of the training and post-test. For more information and to register, go to www.CMEcorner. com/SBIRT. n

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Departments

medical news California ballot measure would raise medical malpractice cap A California coalition that includes an organization representing trial lawyers is advocating to raise the state’s $250,000 medical malpractice cap. The Consumer Attorneys of California argues that the current ceiling on pain and suffering damages in malpractice cases, enacted in 1975, is “outdated and insufficient to cover the prolonged effects of doctor negligence or a botched medical procedure,” reported the Sacramento Bee. If passed, the measure would go before the voters as a ballot measure in 2014. It would raise the ceiling for pain and suffering damages payments to about $1.1 million and allow the ceiling to continue rising with inflation. The measure would also mandate random drug and alcohol testing for physicians who practice in hospitals and surgery centers and would mandate use of a prescription drug-monitoring database. The face of this legislation, titled “The

Troy and Alana Pack Patient Safety Act of 2014,” is Robert Pack, a father whose children were killed in 2003 by a hit-and-run by a driver under the influence of prescription pills and alcohol. The driver, who was not in a medical profession, received a sentence of 30 years in prison. The Packs are suing the prescribing physicians for irresponsible prescribing. The California Medical Association, the California Hospital Association and the Civil Justice Association of California oppose changes to the Medical Injury Compensation Reform Act, or MICRA. The first five of 10 findings in the legislation discuss doctors who suffer from addiction or practice while impaired by drugs or alcohol, CMA reported. The sixth discusses doctors overprescribing prescription drugs and the seventh states that patients harmed by impaired doctors deserve compensation. Finding

eight states that doctors can’t police themselves, finding nine states that the cap has never been adjusted for inflation and finding 10 states that research shows that “fair and adequate compensation” serves as a deterrent to future negligent acts. “The trial lawyer-sponsored changes to MICRA are going to make it easier for them to file meritless lawsuits to augment their fees, which will raise health care costs without doing anything to increase quality,” said Paul Phinney, president of CMA, in the Sacramento Bee article. He added that the provisions mandating drug testing and use of the prescription drug database are designed to distract voters from the measure’s main purpose. Colorado physician and patient advocates continue to monitor the landscape in Colorado. n

Colorado Medicine for September/October 2013

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.

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Montrose, Colorado

Family Medicine Physician needed for Beautiful Southwestern Colorado Practice An exciting opportunity exists for a BC/BE Family Medicine physician in Southwestern Colorado. Montrose is near the San Juan Mountains and we have a golden opportunity for a physician interested in a practice in a growing community. • Exceptional 90-member medical staff representing 19 medical specialties • 75-bed general acute care hospital that underwent a major expansion within the last 5 years which included a new inpatient tower, a new ICU and telemetry unit, and a new emergency department staffed by board certified emergency medicine physicians • On-site emergency helicopter adds to our capability as a Trauma III medical center • The hospital is a joint venture partner in a cancer treatment center and an outpatient surgery center • Diagnostic and interventional cardiac services in our cath lab • Unassigned emergency room call is covered by an on-site hospitalist program • Highly respected accredited CME program with weekly case presentation conferences and guest lecturers Life in Montrose is made more inviting with easy access to skiing, fishing, biking, hiking, hunting and the majestic San Juan mountain range just to our south. We have family medicine opportunities for group practice or independent practitioner.

Contact Mary Snyder at (970) 240-7398 or email CV to msnyder@montrosehospital.com.See our website under Physician Services, Physician Recruitment at www.montrosehospital.com

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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.projectcureorg, call 303-792-0729, fax 303-792-0744, or e-mail projectcureinfo@projectcure.org. 45

Features

the final word Brian G. Dwinnell, MD, FACP

Where is the patient's voice in patient safety? There has never been a time when we have experienced more change in our profession than we are experiencing today. Some have chosen to welcome this change; others would prefer to have all their teeth removed devoid of anesthesia. However, even the majority of those who see the changing landscape as ripe with possibilities have failed to seize the opportunity to collaborate with those experiencing the health care we deliver, breaking down the proprietary walls that inhibit our progress in safety and quality. Certainly other industries have learned to partner with their customers. I resist referring to our patients as consumers because it diminishes the inherent altruism associated with the delivery of care, which is a value we should never relinquish. But is it not the ultimate irony that we fail to value the contributions of the individuals for whom we strive to help? We seem to emphasize patient-centered care, yet we continually marginalize what patients can contribute to the care they receive. One could offer many theories regarding our lack of efforts at partnering

with patients. Fear is certainly a barrier, whether it is related to liability or perhaps the perceived potential loss of autonomy. Some of the fear may be rational, as there are examples of activated patients or advocacy groups that may convey a tone of accusation. However the mounting evidence of the effectiveness of the concept of full disclosure should provide adequate rebuttal. True patient safety efforts focus on system improvements rather than identifying a guilty party. Process improvement in complex systems requires the participation of each key stakeholder. Improving the culture of patient safety is certainly no exception, but we have failed to capture the voice of perhaps the most crucial stakeholder. We must overcome the perceived lack of alignment of key stakeholders and look for opportunities to collaborate. It is reasonable to expect that major delivery systems, insurers, providers, and the patients we serve may have incongruent goals at times. Surely we can all align around the desire for good outcomes for patients. Even the most cyni-

Have an idea you want to share? Do you like something CMS is doing? Are we heading on the right or wrong track with our strategic plan?

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cal argument cannot convince me that this is a value we don’t all share. Think About It Colorado (TAIC) is a coalition of knowledgeable leaders from health care, patient advocacy and business communities dedicated to promoting statewide awareness of the needs and opportunities for safer health care. TAIC also serves as the bridge across diverse health care organizations by bringing all partners together to enhance a culture of safety. A strong, genuine partnership between patients and providers can be a significant step toward better health care safety. We talk about transparency, but now is the time to walk the walk. Think About It Colorado includes tools and resources to help physicians engage patients in safer care. We need to share our shortcomings with our patients and work collaboratively to prevent errors, or at least address the systems that led to the errors they experienced. Let’s invite our patients to participate in longitudinal quality and safety improvement. Go to ThinkAboutItColorado.org to learn more. If we are going to redevelop systems and processes, isn’t it logical for those experiencing these processes to be involved in their development? n Brian Dwinnell, MD, FACP is the Director of Graduate Medical Education and Medical Staff President-Elect with Presbyterian-St. Luke’s Medical Center in Denver and is an Associate Professor of Medicine at the University of Colorado. He is also a member of the Think About It Colorado Board of Advisors and a member of the Colorado Medical Society.

Colorado Medicine for September/October 2013

Areas of service include: •Workers’ compensation •Property and casualty •Health and dental •Disability, life and long-term care •Cyber Liability •Personal lines: auto and home

While you’re taking care of patients, we’ll be taking care of you.

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Colorado Medicine for September/October 2013