Nathan Davis Award

Sunday, March 01, 2015 11:20 AM

CMS physicians lobby Capitol Hill at National Advocacy Conference and celebrate Sen. Aguilar’s Nathan Davis Award

by Kate Alfano, CMS communications coordinator

Colorado Medical Society and component society leaders traveled to Washington, D.C., Feb. 23-25 for the AMA National Advocacy Conference (NAC). Colorado delegates celebrated the 2015 AMA Nathan Davis Award winner Sen. Irene Aguilar, MD, and met with members of the Colorado congressional delegation to discuss the top health policy issues facing doctors in the state and country.

Sen. Irene Aguilar wins Nathan Davis Award

For the second year in a row, a Colorado public servant was awarded an AMA Nathan Davis Award for Outstanding Government Service: Sen. Irene Aguilar, MD. See the sidebar for her acceptance speech. The 2014 Colorado award winner, also nominated by CMS, was Susan E. Birch, executive director of the Colorado Department of Health Care Policy and Financing, for work to reform Medicaid into seven regional accountable care collaborative organizations.

Nominated by the Colorado Delegation to the AMA, CMS touted Sen. Aguilar’s legislative advocacy and leadership during the last four years, most recently as chair of the Senate Health and Human Services Committee and assistant majority leader, as the single most important factor in assuring delivery system reforms that expanded coverage, reduced administrative burdens, improved patient safety, and addressed health care costs and quality. Specifically, Sen. Aguilar successfully passed legislation to modernize Colorado’s professional review, expand and reform Medicaid, standardize prior authorization of medications, and address health care costs and clean claims.

“What an honor it was to receive this national recognition for the work happening in Colorado,” Aguilar said. “I am just a part of our success, as working collaboratively with invested stakeholders like the CMS and others really helps propel Colorado to the front in the country on issues of health reform and working to achieve quality, accessible and affordable health care for everyone in our state.”

Advocating for Colorado physicians on the top issues

Led by CMS President Tamaan Osbourne-Roberts, MD, and President-elect Michael Volz, MD, the Colorado physician delegation urged the Colorado congressional delegation to act on three critical issues: the trend in health insurance toward “narrow networks,” Medicare physician payment reform, and the regulatory penalties tsunami.

“Having participated in this meeting annually for a number of years, I’m always struck by how much the physicians enjoy this grassroots opportunity to engage with their representatives and see how the system works,” said Kathy Lindquist-Kleissler, executive director of the Denver Medical Society.

Physicians first explained the issue of network adequacy, a concept with which the congressional delegation was least familiar. The current trend in the health insurance marketplace is for carriers to offer products with smaller networks for consumers purchasing coverage both on and off the insurance exchange. The result of this trend is that Colorado consumers may lose their providers as insurers sell narrow networks without notice. It is in the best interest of Colorado patients to have a clear understanding of which providers are participating in the various benefit plans.

“Everyone that we met with through the day voiced surprise at the depth of the problem when Dr. Osbourne-Roberts and I shared personal experiences,” said CMS NAC attendee Gina Martin, MD. Martin described the experience of an established patient who became pregnant and had to transfer her care to Grand Junction (Mesa County) because her insurance plan through her Delta County employer would not cover Delta County Memorial Hospital for the delivery.

Osbourne-Roberts shared that his family recently changed to a new insurance plan through the exchange, and while his son’s pediatric ENT was covered on the plan, the only hospital at which he had privileges was not.

CMS NAC attendee Genie Pritchett, MD, said there was “lots of learning” around narrow networks and that all Colorado legislators expressed their willingness to sign a letter in support of appropriate measures to address this issue.

Once again, physicians urged Congress to eliminate the flawed sustainable growth rate (SGR) formula; the current Medicare payment patch will expire on March 31. Bipartisan, bicameral legislation developed last year eliminates the SGR and supports innovative delivery and payment models. Physicians asked Congress to consider this legislation again.

The Colorado congressional delegation fully understands physicians’ frustration with the SGR but indicated that Congress will likely pass another short-term patch of six to 12 months before the March 31 deadline to “give time” to find funds in the budget and wait for a Supreme Court case to be reconciled. However, Volz said a longer-term fix is “indeed expected and should occur.”

Doctors asked legislators and policymakers to provide relief from the regulatory penalties tsunami that is burdening their practices and threatening their ability to provide care for Medicare beneficiaries. Peter Smith, MD, shared a personal story about the flood of mandates from the government that places “a clear burden on health information technology.”

Attendees asked for changes in meaningful use, the Physician Quality Reporting System and the value-based modifier, including simplifying and aligning requirements and reducing the threat of financial penalties. “There was agreement that there is too much regulation, but no real discussion on steps forward,” Pritchett said.

“The majority of elected officials seemed to have general support for decreasing the burden by trying to be sensitive to multiple reporting systems and limitations of the data without proven benefits to patients,” said CMS NAC attendee Gina Alkes, MD.

Thanks to all the physicians and component staff who attended NAC on behalf of the Colorado Medical Society. For more information on this conference, go to www.ama-assn.org.

Sen. Irene Aguilar’s acceptance speech for the 2015 Nathan Davis Award for Outstanding Government Service

Thank you, AMA, for having me, and thank you CMS for nominating me for this honor. I specifically want to thank my good friends Dr. Jan Kief and Dr. Genie Pritchett for hosting the only fundraiser in which doctors give money to politicians. I need to also acknowledge our CMS President Dr. Tamaan Osbourne-Roberts and our President-elect Dr. Michael Volz. And thank you for that wonderful dinner last night. I’m glad you are not registered lobbyists!

You know, people often ask me how I went from being a primary care doctor at a county hospital to a state senator, and I say a couple of things. The first thing I say is that unfortunately I found out how health care is financed in the United States and it really angered me. I am one of those idealistic doctors who thinks that access to basic health care is a human right and that it is shameful that the richest country in the world does not guarantee that access for its population.

At the end of the day, when people show up in our clinics, our hospital rooms and our ERs in need of care, we are thankfully a humane-enough society that we give it to them. Those of you in medicine know we are just shooting ourselves in the foot by not helping them access that care earlier when they are healthier and can continue to work and live healthy lives. 

I hope that you will help the legislators in your states design a waiver for the Affordable Care Act. You know it isn’t perfect. Getting 100 politicians in Colorado, getting 50 plus 1 to agree on anything is almost a miracle. I can’t imagine that we can get anything better in Congress.

Fortunately, they left us a section that says that if your state can figure out how to cover at least as many people with at least as rich of a benefit plan and not cost the federal government more money, you can apply for a federal waiver. I think that there is no better group of people to tell legislators how to do that than you as doctors. And so I look forward to seeing what we bring forward in the future where state by state we become a country that guarantees health care access for everyone in our country.

Thank you again for this honor.