The final word: CMS Special Advisory Committee physicians analyze ColoradoCare, current delivery sys

Friday, July 15, 2016 08:43 AM
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Katie Lozano, MD, FACR, CMS President-elect

In November, Colorado voters will be deciding the fate of ColoradoCare/Amendment 69, a universal health care coverage proposal for all Coloradans. In September 2015, the CMS House of Delegates approved policy asking CMS to perform an in-depth review of the pros and cons of ColoradoCare compared to Colorado’s current public-private multi-payer coverage system. Based on this policy, the CMS board of directors created a Special Advisory Committee on ColoradoCare/Amendment 69. This 37-member group of your colleagues was carefully selected from 85 volunteer physicians to ensure a broad range of viewpoints and experience, including multiple practice types, specialties, ages, geographic areas of Colorado, and delivery system philosophies. Over three months, with a total of at least 320 hours of volunteer physician time, the advisory committee carefully and extensively debated the pros and cons of both systems, and prepared an evaluation of ColoradoCare’s relative strengths and weaknesses as well as an evaluation of the relative strengths and weaknesses of the current multi-payer system. See those documents starting on page 26.

Our experienced CMS pollster is now working with committee members, including information from the analysis they created as well as a broad representation of opinions, to draft a survey of CMS members that will be administered in August to measure the magnitude and intensity of medicine’s views and concerns on Amendment 69 and their views of the current system. Then, to kick off the annual meeting in Keystone on Sept. 16, 2016, CMS will convene the top experts and advocates from both sides of the debate for a Friday evening plenary session. Earlier in the day, the CMS board of directors will likely make a final determination to support, oppose or stay neutral on the amendment based on the all-member survey results as well as other information such as the position of component and specialty medical societies. We will also have real-time polling during the discussion at the annual meeting.

Many organizations have already chosen sides. However, as a grassroots physician organization, the board felt strongly that, given the passionate member views both for and against the amendment, a full hearing and a methodical vetting of the amendment and the current system of care was in order. CMS has consistently and persistently advocated for optimal coverage expansion as a matter of practical economic and moral consideration, but until now had not formally engaged on the question of a unilateral shift away from the current mixed system of public and private sector delivery and financing models.

The two documents produced by the advisory committee reflect just how potentially divisive this idea is from the exam-room level, and committee members managed to filter out most of the doctrine and emotion that physicians will endure soon in the impending media storm.
The advisory committee’s analysis, our all-member survey, the Friday night plenary session, and our open invitation to members to share their views will assure a fully considered evaluation and optimal medical society participation in testing Amendment 69 and how physicians think about the delivery system for health care in our state, a deliberative process similar to the methodical approach doctors take before making a diagnosis and evaluating treatment options.

Regardless of the outcome of the vote of Coloradans on Amendment 69 in November, this initiative raises the debate over health care coverage, value and fairness in the complex world of health care delivery and finance to all Coloradans, and raises significant questions as to the role of state and local governments and commercial markets in the pricing, allocation and value of health care within the boundaries of cost, medical need and priority. In its simplest reduction, voters – including the medical profession – will decide whether the health care delivery system is mostly a commercial commodity or a public utility in our state. Through this process, we will have a more comprehensive understanding of the views of our members and what action should be taken on Amendment 69, as well as what action should be taken after the votes have been counted.



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