Cover: Physician voice, patient advocacy

Tuesday, September 01, 2015 12:00 PM

by Kate Alfano, CMS Communications Coordinator

The Colorado Medical Society is only as strong as its members. As a result of the investment of time, talents and resources of each of the 7,500 physicians and medical students across the state, 2015 will stand out as a banner year. As Colorado physicians prepare to gather in late September for another annual meeting, your society takes the opportunity to reflect on your accomplishments since the last annual meeting.

“As president-elect of the Colorado Medical Society, I’ve been able to see firsthand the real difference our members make as individuals and collectively,” said Michael Volz, MD. “I extend sincere thanks to each CMS member, no matter your level of involvement. Whether you actively participate in a committee, the board or the House of Delegates, or you make a phone call to advocate on an important issue, or you write a dues check every year, you are committed to Colorado medicine. As a united society of Colorado physicians, we accomplished significant achievements.”

Here are some highlights of your CMS member triumphs this year.

Preserving the liability climate and professional review
For the 11th legislative session in a row, CMS members led the fight to maintain Colorado’s stable liability climate in the 2015 General Assembly, thanks to involvement during the 2014 election cycle.

This past summer CMS members conducted more than 60 interviews of candidates and meetings with sitting members of the legislature to explain and answer questions about medicine’s top legislative priorities. COMPAC, CMS’s political action committee, met several times over the summer and voted on local recommendations for endorsements, selecting 71 candidates or friendly incumbents for the November 2015 general election. The COMPAC chair and local physicians signed letters of support for candidates and friendly incumbents that were mailed to all physician members in their respective districts.

CMS general counsel met with business and community leaders and Gov. John Hickenlooper to discuss the preferred qualifications for a candidate to be appointed to an open position on the Colorado Supreme Court. In June, CMS co-signed a letter to the governor with the Colorado Civil Justice League commenting on the three nominees for the Colorado Supreme Court Justice open position. The governor selected one of the CMS-recommended candidates. “This is a significant achievement and one that should benefit Colorado physicians as we look to continue our string of positive opinions over the past five years,” said Mark B. Johnson, MD, COMPAC chair.

In addition, CMS leaders helped persuade the Colorado Supreme Court to clarify the hearsay rule in favor of physicians defending malpractice cases.

Medicare SGR repeal and replace
Congress passed a bill in April to repeal the sustainable growth rate (SGR), the flawed payment formula that left the Medicare program unstable and threatened patients’ access to care. The law provides positive annual payment updates of 0.5 percent, starting July 1 and lasting through 2019.

CMS physician leaders held meetings with members of the Colorado congressional delegation during the American Medical Association interim meeting in November 2013 and again during the AMA National Advocacy Conference in March 2014. And in 2015, seeing the best opportunity in a decade, CMS members repeatedly took up the call to contact their member of Congress and Colorado’s two U.S. senators.

“The SGR repeal is a huge deal because we now have an opportunity to pursue real payment reform,” said Lynn Parry, MD, CMS delegate to the AMA. “The biggest barrier to changing the way we deliver health care to improve access for patients has been the way we pay doctors. I look at the SGR repeal as the beginning of real health care reform.”

Regulation of health plan networks/network adequacy
A debate in the 2015 Colorado legislature over out-of-network charges by health care providers uncovered a much broader discussion of the complexity of network adequacy and fierce competition within the health insurance industry in the state. A team of CMS members testified against the bill, expressing frustration that physicians are often left out of networks not by choice and that patients unknowingly buy insurance products that do not provide adequate coverage. The physicians pushed for and successfully achieved an interim study that has brought together CMS, health plans and consumer representatives to address matters related to network adequacy.

CMS members, specialty society and component society representatives formed a new work group, the CMS Working Group on Managed Care, to propose potential policy on excessive charges and usual and customary fees, as well as language that non-participating physicians can provide patients on their billing statements to make them aware of the potential protections they may be afforded under existing Colorado statute.

“Greatly assisting with our work to develop policy solutions on the major issues relating to out-of-network charges and billings are the results of an all-member survey on a broader array of pain points with managed care plans, including the impact of narrow networks and provider directories,” said Peter Ricci, MD, chair of the working group. “There is a great deal of work ahead of us but our chances of success are greater if medicine is unified from a policy perspective, we know our bottom line and we hang together.”

Commission on Affordable Health Care
Jeffrey Cain, MD, a decorated family physician leader, was chosen among a pool of highly qualified CMS members to represent physicians on the state’s Commission on Affordable Health Care. The commission has been working to identify systemic and other underlying causes of excessive and unnecessary health care costs and propose specific legislative, regulatory and market-based strategies to reduce costs and improve care value. To help inform the cost commission on physician priorities, many CMS members joined the new CMS Task Force on Health Care Costs and Quality. The task force is co-chaired by Laird Cagan, MD, and Alan Kimura, MD.

“CMS members must be proactive in helping the commission better understand cost and quality from a physician’s perspective to provide solutions that work for physicians and for patients,” Cain said. “The commission will receive input from other stakeholders – from insurance companies, from hospitals, from employers – and the cost commission needs to be able to hear how the solutions will impact our ability to care for patients.”

Physical and behavioral health integration – State Innovation Model (SIM)
Gov. Hickenlooper announced in December 2014 that Colorado was awarded $65 million to implement its State Innovation Model (SIM) plan. Glenn Madrid, MD, of Grand Junction, was appointed as the physician representative on the SIM Advisory Board and Chet Seward, CMS senior director of health care policy, was appointed to the policy workgroup. CMS is working with SIM leadership to explore options to provide CME and maintenance of certification credit for SIM training activities.

From the beginning CMS has actively participated in the plan’s development by submitting detailed written comments. The CMS board sees this as an opportunity to advance CMS payment and delivery system reform priorities. As it is implemented, SIM will accelerate public and private sector collaboration on multi-payer models and delivery system transformation and open unique opportunities for CMS to drive innovation and health plan standardization. CMS members and their patients stand to greatly benefit as SIM funds assist practices in integrating physical and behavioral health care.

ICD-10 transition
The Colorado delegation to the AMA led the way on one of the most important policies passed at the 2015 AMA Annual Meeting in June, which directed the AMA to seek a two-year grace period for ICD-10 to allow physicians to avoid financial disruptions following implementation. The AMA and Centers for Medicare and Medicaid Services announced on July 6 that for a one-year period starting Oct. 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes submitted, as long as the physician billed using an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.

To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if the federal CMS experiences difficulties in accurately calculating quality scores.

To help physicians and their staffs prepare for the switch to ICD-10, CMS worked with local physicians and component societies to host a series of ICD-10 documentation seminars at several locations along the Front Range in late August and early September. The speaker, James Taylor, MD, senior medical director of clinical analytics/performance improvement at Colorado Access, volunteered his time and expertise to help physicians gain a better understanding of the documentation differences between ICD-9 and ICD-10. Taylor will record a webinar presentation for those who cannot attend in person. CMS has also been an active leader of the Colorado ICD-10 coalition for the past two years, which has raised awareness for the requirements and provided resources to ease the transition.

Caring for injured workers
Over the past 18 months, members of the CMS Workers’ Compensation and Personal Injury Committee (WCPIC) have been working to upgrade the Colorado system of workers’ compensation to ensure physicians caring for injured workers can thrive in the system and physicians not currently participating will register and participate. WCPIC has been acting on five tactics they developed late last year that were approved by the CMS Board of Directors in January: regulatory relief, administrative simplification and practice efficiency, stakeholder collaboration and relationship building, physician education and resources, and membership recruitment.

WCPIC Chair Greg Smith, MD, testified before the Division on Workers’ Compensation at their rulemaking hearing on July 30, providing comments on the new fee schedule, reimbursement, physician reviewers and independent pre-authorization.

Thanks to WCPIC’s work, the DOWC is implementing a big change: Physicians who are reviewing prior authorizations or who are recommending services for denial have to be accredited. This goes a long way to resolve a complaint WCPIC raised on behalf of physicians caring for injured workers that physician reviewers located out of state were unfamiliar with Colorado Workers’ Compensation Treatment Guidelines and were incorrectly denying requests for services, which then adversely affected patient care as they waited with no alternative care plan. “This has been a major impediment to access to proper care, in our assessment, and a major cost driver for providers, as we need to spend large amounts of additional time addressing this problem,” Smith said in his testimony.

Telemedicine
The use of telemedicine is expected to grow throughout the state, with the goal to reduce health care costs, improve the efficiency and quality of care, improve access to care, and provide needed specialist consultations. Recognizing the promise of telemedicine, the Colorado Medical Society House of Delegates passed a resolution during the 2014 Annual Meeting that updated CMS policy on telemedicine and telehealth and directed CMS to push for legislation in the 2015 session. A bill was successfully passed and will take effect on Jan. 1, 2017. CMS Past President John L. Bender, MD, helped draft the bill and recruit its sponsors, and the CMS Council on Legislation voted to support it.

Physicians testified in front of the medical board in November 2014. As a result, DORA hosted a telehealth symposium on Feb. 23 that brought together all regulatory bodies so different practitioners and organizations could explain how telehealth might work in Colorado and the regulatory bodies could consider updates to their licensure.

In mid-August the Colorado Medical Board updated their policies to be in line with the CMS policy and legislation that is to take effect in 2017.  From the physicians’ perspective DORA’s outdated policies were one last hurdle to be removed to ensure the appropriate use and expansion of telehealth services in Colorado.

Patient safety
CMS members passionately support efforts to reverse the escalating trend of opioid abuse and misuse and its often tragic consequences in Colorado. The 2013 HOD approved a CMS platform on prescription drug abuse and the BOD appointed a special Committee on Prescription Drug Abuse in 2014. CMS members and staff actively participate in the Colorado Consortium to Reduce Prescription Drug Abuse and CMS has been educating members about the crisis over the past two years. CMS alerted members to a November deadline for mandatory PDMP registration and promoted the “Take Meds Seriously” campaign, which educates patients about safe use, safe storage and safe disposal. The campaign website provides handouts that can be customized to individual physician offices or pharmacies.

In response to the 2014 Ebola epidemic, the largest in history, the board of directors appointed an advisory committee headed by public health officials Christine Nevin-Wood, DO, and Mark B. Johnson, MD. They worked with state and local public health officials to monitor the situation and develop an educational CME webinar targeted to inform office-based physicians of proper safety procedures. CMS also maintained a comprehensive list of resources from around the country on a designated resource page to keep members up-to-date on the latest recommendations and resources.

Public health
Nevin-Wood and Johnson also took leadership of a CMS initiative to support a long-term public health initiative as part of its core work. They hosted a meeting in March at CMS headquarters that brought together more than 20 of the state’s top public health officials. Attendees included CMS President Tamaan Osbourne-Roberts, MD; CMS President-elect Mike Volz, MD; Colorado’s Chief Medical Officer Larry Wolk, MD, and several other leaders from the Colorado Department of Public Health and Environment; multiple representatives from local public health agencies around the state; and leaders from the University of Colorado School of Medicine and the Colorado School of Public Health.

Instead of focusing on just one public health initiative over the next decade, the invited guests recommended more formalized engagement for public health within the CMS structure by fostering partnerships, flexibility and relationships at multiple levels.

“Fortunately, public health has a long history of focusing on communities and CMS has a long history of focusing on physicians and their patients,” said Osbourne-Roberts. “A long-term commitment between CMS and public health leaders can help connect clinical physician practices and public health agencies to keep our patients and communities healthy. CMS helps provide the framework and coordination so desperately needed to be effective in this arena.”

The 2015 Annual Meeting: NextGen CMS
When physicians gather in Breckenridge for the 2015 Annual Meeting and convening of the House of Delegates, they will experience camaraderie and fellowship in a picturesque mountain setting, and will have a great opportunity to celebrate the achievements of the year. They will also combine their strengths and ideas to keep CMS on the cutting edge for the benefit of their patients and practices. Find more information on the meeting at www.cms.org/events/annual-meeting.