2016 public policy priorities

Friday, January 01, 2016 12:12 PM

The involvement of all members is critical

by CMS staff report

The reinvention of how the Colorado Medical Society governs, establishes and acts on policy does not alter the society’s scope of work in terms of identifying and addressing emergent member priorities like network adequacy, the impending consolidation of two major health plans doing considerable business in Colorado, and a budget fight in the 2016 legislature to preserve Medicaid primary care code parity with Medicare. CMS’ primary function is now and will continue to be an advocacy organization that stands up for doctors and engages them in the legislative and regulatory process.

At the annual meeting in September, both the CMS Board of Directors and the House of Delegates analyzed and ranked eight areas of exam-room-relevant, politically-viable public policy priorities, directing staff on resource allocation. These issues and why they’re important to physicians are outlined below. Members will play an even greater role in CMS’ advocacy efforts under The New CMS. The society encourages all members to get involved in these most basic and important issues by visiting www.cms.org/the-new-cms or emailing president@cms.org.

Repeal of Medicaid E&M code parity with Medicare
Limits from the Taxpayer Bill of Rights (TABOR) are once again threatening the ability of the state General Assembly to fund Colorado infrastructure including health care. As such, the repeal of Medicaid evaluation and management (E&M) code parity with Medicare is a 2016 state budget issue and widely regarded to be an “at-risk” item. Colorado is one of few states that extended parity once the federal Affordable Care Act funds expired. There are three significant consequences to a proposed 20-percent-or-more rollback of these codes:

1. Decreased timely access to care for patients.
2. Reduced resources for care coordination within primary care and other practices.
3. A negative backlash on the state’s highly successful Regional Care Collaborative Organization (RCCO) program, leaving the initiative vulnerable to national managed care contracts when the bidding process resumes in 2017.

What this issue means to physicians:

• After years of stability, now there is resurgent uncertainty about fair rates that could potentially increase unwillingness to participate in the state’s largest health insurance plan.
• There will be increased calls to do more care coordination services with less for this important, frequently complex patient population.
• There will be pressure to reduce the number of Medicaid patients or stop taking Medicaid altogether.

Colorado has made great gains in the reform of its Medicaid program, namely through the Accountable Care Collaborative (ACC). For three years in a row, the ACC has produced savings and increased patient satisfaction. The program relies on a solid primary care base using the patient-centered medical home (PCMH) model, along with practice analytics and support. The enhanced fees through E&M code parity with Medicare helped strengthen PCMHs, save taxpayer dollars and improve care. Repeal of the enhanced fees threatens these gains.

Members can go to www.cms.org to access a legislative alert on Medicaid payment and send a communication to their state legislators.

Network adequacy policy overhaul: protecting consumers from excessive charges and surprise medical bills
In 2015, following failed legislation on excessive charges and surprise medical bills in situations where care is rendered by an out-of-network provider in an in-network facility or in an emergency situation, CMS physicians voted to prioritize commercial payer issues for the remainder of the decade. The focus in 2016 is new state policy on network adequacy with a rich mix of exam-room-relevant issues. As a first step, CMS and the Colorado Association of Health Plans are already deep into the process of mediation to develop state policy on out-of-network charges and surprise bills, with input from other stakeholders including consumer groups and hospitals.

What this issue means to physicians:

• Efforts are heating up to ensure that out-of-network physicians are paid fairly for their services and that their patients are protected.
• The viability of physician practices will continue to be threatened, including how doctors are paid and how much negotiating power they have in the marketplace.
• There will be increased efforts to enhance the transparency of health plan physician network development, including the methods and standards used to narrow their networks.
• Health plans can expect increased scrutiny to ensure that their provider directories are accurate, timely and contain the information patients need to make decisions about their care. Physician practices can in turn expect increased demands for up-to-date information from plans.

Aetna-Humana and Anthem-CIGNA proposed mergers (see related article)
Colorado Medical Society joined the American Medical Association and the American Hospital Association in urging the United States Department of Justice to thoroughly investigate the proposed mergers of Aetna Inc. and Humana Inc., and Anthem Inc. and CIGNA Corporation. The AMA opposes the mergers, as does the Physician Advocacy Institute. Colorado Medical Society has also asked the state insurance commissioner to investigate both mergers. The effect of these mergers on physician practices and their patients across the state of Colorado is currently being assessed, but CMS experts project the mergers will substantially lessen the competition among insurers by increasing health insurer concentration in the state or by moving toward a monopoly.

What this issue means to physicians:

• Decreasing competition in Colorado could increase insurer market power, resulting in harm to access and quality care.
• Physicians’ ability to negotiate fair and reasonable contracts with insurers may be further threatened.
• Physician practices may experience increased pressure to become employed or consolidate with other groups.
• Provider networks will increasingly narrow in health plan efforts to decrease costs, and opportunities for physicians to participate in these networks will also shrink.

Members can join CMS deliberations that will guide the board of directors on the CMS position before state and federal regulators, or share their stories with CMS on the potential impact of the mergers for submission to the U.S. Department of Justice and state Department of Insurance by emailing them to president@cms.org or by completing our all-member survey currently in the field (see an email from president@cms.org in your inbox regarding the health plan merger survey).

Colorado end-of-life options
Rep. Joann Ginal (D-Fort Collins) and Rep. Lois Court (D-Denver) have already made known plans to bring the issue of physician-assisted suicide to the 2016 Colorado General Assembly following a failed attempt in 2015. According to some public opinion polls, patients favor expanded options when it comes to end-of-life care. The last CMS policy on physician-assisted suicide was approved in 2000 and confirmed with limited debate in 2014 during a sunset review of the CMS policy manual. CMS policy is being re-evaluated through a series of focus groups on the topic, an all-member survey and in-person deliberations.

What this issue means to physicians:

• There is a range of passionate views by Colorado physicians on both sides of the physician-assisted suicide issue. CMS has already held focus groups to gain insight into these opinions and will continue to solicit member feedback as the issue and the legislation evolves.
• There is a great opportunity to expand the conversation with policymakers to the palliative care needs of patients in Colorado communities.

Members can participate by:

1. Completing an online survey to be launched in mid-January.
2. Emailing views to president@cms.org that will be shared with the Council on Ethical and Judicial Affairs (CEJA) responsible for re-evaluating the CMS policy.
3. Joining an online discussion hosted by University of Denver Law School Dean Emeritus Ed Dauer, LLB, MPH, that will be launched simultaneously with the all-member survey.

ColoradoCare ballot initiative
ColoradoCare is a universal health care proposal that the Secretary of State certified in November 2015 for the November 2016 general election ballot. It will be listed on the ballot as amendment 69 and would create a single-payer government-run health care plan through a new $25 billion annual tax taken out of paychecks, similar to how Medicare is funded. Funds would go to an elected board of trustees, which would act as an insurance company and reimburse doctors. Medicare and Tricare would remain intact but co-payments and deductibles would go away. Colorado Care proponents are organizing an aggressive ground game and the Denver Metro Chamber has announced a full-on effort to defeat the measure.

What this issue means to physicians:

• This ballot proposal ups the game in the ongoing debate on how to expand health care coverage. The question of coverage always turns on three points: how to pay for it, how to assure that it is affordable, and how to assure that care is accessible and delivered at the right time, place and value.
• Whether the proposal can pass or not, this will be a healthy debate because it will raise the awareness of Colorado leaders and voters on health care choices. Colorado will have a larger pool of informed and engaged patients who are willing to make those choices.

CMS will appoint a special select advisory committee to advise the board of directors, selected from a presidential call for volunteers. Members selected to serve will need, at a minimum, experience in public policy, health economics and nonprofit board governance.

The second regular session of the 70th General Assembly convened on Jan. 13, 2016. Watch for more on these issues and ways to stay involved with CMS during the session and beyond.