CMS president-elect advocates for top physician concerns at governor’s cabinet meeting

Wednesday, January 27, 2016 03:15 PM
Print this page E-mail this page

CMS President-elect Katie Lozano, MD, used an exclusive invitation-only meeting on Jan. 26 with members of Gov. John Hickenlooper’s cabinet to address the negative impact of administrative and regulatory burden on physicians, the damaging effects on patient care facing the state if proposed cuts in Medicaid E&M codes go through, and the extreme concern physicians have on the issues of network adequacy and the proposed health insurance industry mergers.

Lozano opened with physician wellness, burnout and the negative impacts of administrative and regulatory burden. The literature shows that physician professional workplace satisfaction peaks when doctors feel that they are providing good care to their patients; that there are too many barriers standing between physicians and their patients; and these barriers are imposed by health insurance companies, our state and federal government, and sometimes even by the physician’s employer.

“Here is the takeaway: We most respectfully urge the administration to adopt the philosophy of ‘standardize, streamline and make clinically relevant’ all that you do involving clinicians so there will be less red tape and more real-time care.”

She applauded the administration’s progress on encouraging increased coverage for Coloradans, and, particularly, the move to and success of the Medicaid Accountable Care Collaborative Program. CMS recognizes that Medicaid must transition into a high-performing delivery system and feels that ACC is the engine that can make this imperative a reality. However, data from an all-member CMS survey show detrimental effects on the primary care base if proposed payment cuts for primary care evaluation and management (E&M) services go through this year.

Most important, she encouraged careful attention to the issues of network adequacy and the proposed health insurance industry mergers. Four of the five largest commercial insurance companies are proposing to merge and, should they be approved, the four largest commercial carriers in Colorado would have almost 90 percent of the market. Though the recent CMS survey data has yet to be fully analyzed, preliminary results show that physicians across all practices sizes and specialties feel these mergers will not be helpful to patients or physicians.

She also commended the administration on the comprehensive statewide approach to addressing the opioid misuse and abuse crisis and the effort to integrate physical and behavioral health through the SIM initiative.

This event was one of a series the administration is hosting with health care stakeholders to reflect on Colorado’s progress towards implementing the Affordable Care Act and discuss the next few years’ health transformation efforts. The itinerary centered on opportunities and challenges within the governor’s four strategic focus areas, listed below, from the governor’s healthiest state plan that CMS voted to support in 2013 and has continued to support throughout its implementation.

  • Promoting prevention and wellness
  • Expanding coverage, access and capacity
  • Improving health system integration and quality/li>
  • Enhancing value and strengthening sustainability

Other physicians in attendance represented the Colorado Academy of Family Physicians and the Colorado Chapter of the American Academy of Pediatrics, among others.

Posted in: ASAP | Practice Evolution | Payment Reform | Interacting With Payers | Health System Reform | Medicaid Reform | Initiatives | Advocacy


Please sign in to view or post comments.