CMS physicians lobby Capitol Hill in Washington D.C.

Saturday, March 01, 2014 11:15 AM

Colorado congressional delegation supports SGR repeal, clean claims federalization

Alfred Gilchrist, CMS Chief Executive Officer

Colorado Medical Society (CMS) and component society leaders attending the AMA National Advocacy Conference (NAC) in Washington, D.C., took to Capitol Hill on March 5 for meetings with the nine-member Colorado congressional delegation. Led by CMS President John L. Bender, MD, and President-elect Tamaan Osbourne-Roberts, MD, the physician delegation had an assignment to press medicine’s case on two critical “asks”: Urge co-sponsorship for H.R. 4015/S. 2000, the SGR “fix,” and designate the Colorado Clean Claims Initiative by federal Health and Human Services (HHS) as a national pilot.

H.R. 4015 and S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, permanently repeals the flawed Sustainable Growth Rate Medicare physician payment formula, institutes a modest update for five years and includes incentives and a pathway for physicians to develop and participate in new models of care delivery and payment. The vast majority of national and state physician organizations have publicly stated support for the bill.

(from left to right) Thomas Mohr, DO, Rep. Mike Coffman (R), CMS President John L. Bender, MD, and CMS President-elect Tamaan Osbourne-Roberts, MD.

Colorado’s congressional delegation was already very familiar with the SGR issue. They had voted many times to stop scheduled SGR payment reductions and to provide modest fee schedule updates. CMS had been lobbying them on the SGR debacle literally since the first time Congress kicked the can down the road, well over a decade ago. Even so, the physicians did not fully know what to expect.

The Colorado Clean Claims Initiative is an effort by the state of Colorado, strongly supported by CMS, to standardize CPT claims edits across all private payers. It is estimated that standardization of claims edits (there are millions of them) would save $80 million to $100 million a year in Colorado alone. The physician delegation was advised by CMS lobbyists that the congressional delegation would be much less familiar and most likely unaware of the Colorado Clean Claims Initiative, and that more time may be needed to level them up to an understanding of our request to federalize the project.

Sen. Mark Udall, (D), and CMS President John L. Bender, MD, discuss SGR repeal.

In the first meeting of the morning with all of the Colorado physicians looking on, Dr. Bender made the pitch for co-sponsorship of H.R. 4015 to Congressman Mike Coffman (R-CO-6). Rep. Coffman replied that everything he’d heard about the bill was good and that he would be making a decision on it in the afternoon in a meeting with his staff. Next Dr. Bender teed up federalization of the Colorado Clean Claims initiative; Coffman not only stated his support for the initiative, but also offered to help draft a Colorado delegation letter to HHS.

In a harbinger of meetings ahead, AMA Immediate Past President Jeremy Lazarus, MD, of Denver, asked Coffman, “Can we circle back on the SGR discussion?” Coffman literally threw up his hands and exclaimed, “Look, I don’t want you to worry about it; I’m for it. It needs to be repealed; we are going to get this done this year.” The room spontaneously erupted with thunderous applause.

In the early afternoon meeting with Colorado’s two U.S. senators, Dr. Bender led with the SGR co-sponsorship. Sen. Mark Udall immediately responded, “I’m committed, what else have you got?” To the second pitch, federalization of the clean claims initiative, he told the group, “I’m for it. What will it take to move it?”

Sen. Michael Bennett, who had previously voted for S. 2000 as a member of the powerful Senate Finance Committee, expressed a similar sentiment. The two senators had worked together on an administrative simplification provision of the Affordable Care Act, the precise language that would allow the HHS secretary to designate Colorado’s Clean Claims Initiative as a federal pilot. 

First-time NAC attendee Gerald Kirshenbaum, MD, president of the Aurora-Adams Medical Society, said, “The AMA NAC was excellent – educational, entertaining and eye-opening. Of course I was aware of efforts to reverse the SGR but I learned of the in-depth approach the AMA took to encourage its repeal.”

(from left to right) Kathy Lindquist-Kleissler, Aaron Burrows, MD, Rep. Ed Perlmutter, (D), and CMS President-elect Tamaan Osbourne-Roberts, MD.

“The best part of the conference was going to the Hill,” he continued. “I have heard many times of the importance of contacting your representatives in Washington about issues of concern, but really didn’t understand until yesterday of the efficacy of these efforts. During one meeting we literally accomplished bringing one gentleman from on the fence to committing to vote for the SGR repeal bill. They all really did listen.”

Also during the conference, Sue Birch, BSN, RN, MBA, executive director of the Colorado Department of Health Care Policy and Financing, was awarded the AMA’s 2014 Nathan Davis Award for Outstanding Government Service. HCPF administers Colorado Medicaid and the Child Health Plan “Plus” Program. This award is one of the most prestigious honors extended to elected officials and government employees for outstanding endeavors that advance public health. She was one of four honorees chosen from among 400 applicants nationwide. Dr. Bender nominated Birch for the award.

“Sue Birch is among the country’s most accomplished leaders for implementing community-based, patient- and primary care-centered innovations that improve outcomes and reduce costs,” Dr. Bender said. “She is held in the highest regard as a trusted and skilled leader who has pulled together the fragmented and costly Medicaid program into a lean, viable, high-performing system.”

Dr. Osborne-Roberts said NAC delivered multiple victories for Colorado’s doctors, from garnering support for the SGR reform bill and obtaining unanimous support for the federalization of the Colorado Clean Claims Task Force, to Birch’s recognition. “Coupled with the rousing presentations from multiple nationally-recognized speakers, as well as the camaraderie enjoyed by all in attendance, the meeting was a through-and-through success for Colorado.”

Enno Heucsher, MD, from Mesa County Medical Society concurred, saying, “The NAC was very productive this year and we were excited to see the Nathan Davis award go to Sue Birch.”