Board of Directors: Board work plan

Wednesday, January 01, 2014 11:20 AM

Board sets aggressive agenda for 2014

Kate Alfano, CMS contributing writer

The CMS Board of Directors finalized the 2013-2014 work plan at its Nov. 8 meeting. The comprehensive document encompasses directives enacted or referred from the 2011 through 2013 annual meetings, as well as other strategic and organizational issues. Board members representing regions across the state split into breakout groups to review each topic, action plan and timeline, and made changes to ensure the initiatives would meet the needs of the society over the next year.

The recommendations outlined in the plan will guide the efforts of CMS staff and committees this year, with many items requiring reports back to the HOD at the 2014 annual meeting.

At the top of the agenda is a directive to implement the Medicaid Reform report as a high priority, giving special emphasis to the urgent need to increase access to specialty care while lobbying the congressional delegation to maintain Medicare parity for primary care payments. CEO Alfred Gilchrist will make routine progress reports to the board. A goal of CMS President John L. Bender, MD, FAAFP is to increase Medicaid payments to specialists, and thereby access to specialty care.

The next phase of health care is the medical neighborhood, which is an extension of the patient-centered medical home (PCMH) and a necessary architecture to a functional accountable care organization (ACO).

“Specialty care is ready to contract with the Regional Care Collaborative Organizations (RCCOs) and deliver care that is integrated and higher quality,” Bender says. “By ensuring strong payment reform to specialists, Colorado can help ensure that Medicaid beneficiaries will have access to specialty care, and although payments to specialists will go up, just as we saw in the PCMH pilot, overall global costs will go down. The beneficiaries want access, taxpayers want lower costs, specialists want to see Medicaid patients with fair payment rules, and we all want to see less wasteful care being delivered solely through high-cost centers like hospitals.”

The board’s work will include a multimedia education and communications campaign for physicians about the continued progression of the Accountable Care Collaborative (ACC) and physician needs regarding new payment and delivery models in Medicaid. Additionally, CMS will collaborate with specialty societies and RCCO medical directors to enhance specialty care participation in the ACC through payment reforms. Bender sent a letter requesting feedback to these parties in early December.

The Committee on Physician Practice Evolution (CPPE) will continue to execute a multimedia information and education campaign regarding new payment models, delivery system changes and transparency initiatives to help physicians prepare for and adapt to new systems of care. CPPE will also assess the feasibility of mandating through state law the standardized use of performance measures across entities that rate or report physician performance in Colorado.

In advocacy, the Council on Legislation (COL) and government relations staff will continue to aggressively lobby the Colorado congressional delegation to repeal and replace the SGR and assist the AMA in these efforts. The COL will also work to protect the liability climate and the confidentiality of professional review in the Legislature and in the courts, placing immediate emphasis on Colorado Medical Board vs. Office of Administrative Courts pursuant to the Sept. 20, 2013 BOD action.

The Workers’ Compensation and Personal Injury Committee (WCPIC) will prepare members for the release of revised care guidelines and reimbursement reforms to be proposed by the Colorado Department of Workers’ Compensation. CMS hopes to recruit new members among physicians who care for injured workers.

Kathryn Mueller, MD, a CMS member, medical director for the Division of Workers’ Compensation and a professor in the Department of Psychiatry and the School of Public Health, said one of the purposes of the guidelines is to expedite quality care and prompt payment for providers. “This year we will continue to focus on ways to assure that providers are promptly reimbursed for their services within guidelines and that administrative burdens for physicians who are operating within guidelines are minimal,” she said. “We are extremely appreciative of all of the time and effort CMS members and WCPIC continue to devote to assisting us in these areas.”

The Committee on Employed Physicians (CEP) will implement CMS policy on anti-competitive conduct and report to the board on progress. The committee will complete model staff bylaws that will be forwarded to all hospital CEOs and they will perform the first of two surveys of hospital CEOs. CEP will also implement policy on non-compete/liquidated damages clauses in physician employment contracts, communicating a request to hospitals to remove these provisions and assessing the need for legislation based on their response.

“Our CMS stances on anti-competitive conduct and employed physician termination issues are of great interest to many of us as the ranks of employed physicians grow,” said CEP Chairman Edward Norman, MD, FACP, FHM. “Regarding the former, physicians are becoming more worried that as health systems expand, there may be economic and strategic decisions made in communities that greatly impact the previously more free-flowing relationship between the patients and their physician. CMS is planning to work with the Colorado Hospital Association on a mutually acceptable grievance process, should a physician feel that he is being clinically restricted for economic reasons in his relationship with the local health system.”

“The second concern, while it is not a widespread problem as of yet, is that as physician employment increases, physicians may be treated as simple pieces in a puzzle as opposed to valuable community assets,” he continued. “The possibility that physicians could be forced to relocate away from their own patients without an explicit cause for termination of their employment has raised numerous issues. The committee has met previously and has heard a number of valid, and opposing, arguments, but they all have focused on the value of maintaining a successful practice for providers and the patients in the communities they serve.”

Bender said that overall, the CMS work plan represents great advancements guided by strategies derived from the 2013 House of Delegates. “We will continue to lead the nation in health and wellness, Colorado style.”