This page contains an index to all policies of the Colorado Medical Society. The title of each major section is a clickable link to the related policies.
This page contains an index to all policies of the Colorado Medical Society. The title of each major section is a clickable link to the related policies.
CMS supports policy measures to facilitate the integration of physical and behavioral health care, including:
CMS supports payment systems that integrate coverage of physical and behavioral health.
(RES 6-P, AM 2013; Reaffirmed, BOD-1, AM 2014)
Rapid health care system evolution continues to pressure physicians as they face a myriad of connected and often conflicting issues that affect their ability to care for patients and transform their practices. Some of the more important issues include payment reform, HIT/HIE and performance assessment data reporting programs by public and private payers. The Committee on Physician Practice Evolution (CPPE) has focused efforts over the last year on:
The following report of the Committee on Physician Practice Evolution (CPPE) reviews outcomes from work to date and makes the following recommendations for action:
Payers are increasingly utilizing physician designation programs to ascertain provider quality and efficiency. Programs are not always aligned, lack a high degree of transparency and are difficult for physicians and other stakeholders to interpret and take action. Moreover, health plans are using these programs to tier out their networks and/or experiment with alternative payment methodologies. Physicians are not well equipped to respond to these programs and position their practices for alternative and/or enhanced payments and new delivery models.
Continue to execute a broad-based, outreach and education campaign that emphasizes core competencies and capabilities necessary for physician practices to survive and thrive under new payment models, delivery systems, transparency initiatives and administrative simplification. Help doctors to understand what they can expect from the health care system in the future and provide practical tools and advice to concentrate their preparation and transformation efforts.
Aggressively advocate for transparency of payment and performance measure program methodologies and processes. Advocate for standardization of methodologies and measures across payer programs.
CMS recognizes the importance of providing performance information to physicians so that they can verify the accuracy of profiling results, especially given how the payers are utilizing this data. If there were greater standardization of the reporting format and increased transparency of the methodology used to create them, then reports could be valuable sources of information to support physicians in their decision-making.
Continue to work with CIVHC to ensure that the reports developed from the All Payer Claims Database (APCD) are methodologically sound, easy to understand and use, and are data-driven tools for quality and practice improvement. CMS should also continue to work with health plans and CIVHC to determine the feasibility of using the APCD to merge the claims history used by each of the payers and health plans into a single all-payer report, rather than the limited payer-specific data currently in use.
(CPPE-1, AM 2012; Revised, BOD-1, AM 2014)
Report by the Committee on Physician Practice Evolution (CPPE) - HOD 2011
Changing the way that care is reimbursed poses a number of challenges and opportunities that physicians are uniquely positioned to address. Over the last year Colorado physicians have been engaged in a broad strategy to understand, define and initiate meaningful payment and delivery system reform. While it is clear that at this time there is no one preferred payment reform by Colorado physicians, many other opportunities exist. The following report by the Committee on Physician Practice Evolution (CPPE) reviews outcomes from work to date makes the following recommendations for action:
Payment reform is a complex, extremely important issue that deserves thoughtful physician participation because it is predicated on finding savings within the system. Efforts to realign the system should be taken in stages beginning with things that physicians and their care teams can control and provide benefit to other stakeholders throughout the system.
Start first by focusing on payment reforms that present win/win opportunities for patients, physicians and payers.
Meaningful change will not occur if only one or a few payers adopt payment reforms. If payers adopt different reforms then the benefits will be lost as physicians spend their time, resources and talent on administration rather than care improvement.
Advocate for all-payer reforms that utilize consistent and transparent standards and methodologies to support revised payment systems.
Successfully realigning new systems requires time, resources and appropriate risk-adjustment.
Advocate for transitional approaches to payment reform in order to build skills and manage change. Ensure that there is appropriate risk adjustment for Colorado patient populations.
Colorado communities are not the same and there is no one right way to implement payment reform.
Seek out and support public and private pilot programs to test these system changes in multiple settings across Colorado. Encourage physicians to make necessary individual practice changes to participate in these pilots and engage with other stakeholders to build trust and affect broader payment and delivery system reforms.
Private initiatives and public policies will continue to shape the evolving health care system. Ongoing engagement and participation by physicians in these activities is essential.
Continue work to shape local, state and federal policies on payment and delivery system reform. Remain actively engaged in the work of the Center for Improving Value in Health Care to promote payment reform that appropriately aligns compensation with both individual and system performance.
Payment reform is necessary but not sufficient to affect the changes that must occur to the health care system. Other barriers and issues must also be addressed or else the success of potential reforms will be threatened.
Advocate for changes in other areas that support payment and delivery system reform, including:
(CPPE-1, AM 2011; Reaffirmed, BOD-1, AM 2014)
The Colorado Medical Society endorses the 2007 Joint Principles of the Patient-Centered Medical Home as noted below:
Joint Principles of the Patient-Centered Medical Home - March 2007
The Patient-Centered Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.
The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PC-MH.
Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
Physician directed medical practice - the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
Whole person orientation - the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
Quality and safety are hallmarks of the medical home:
Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.
Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following framework:
(RES-9, AM 2010; Reaffirmed, CPPE-1, AM 2011; Reaffirmed, BOD-1, AM 2014)
Colorado Medical Society supports the following as an outline of a basic, universal health plan that could provide medical, mental and dental care for all Coloradans that could be implemented in the event that other reform efforts fail to achieve CMS’ strategic objectives for health care reform. The proposed plan for Colorado would:
Establish a mechanism for all stakeholders to fund and participate in the development and usage of interoperable health information systems that facilitate the delivery of patients’ care.
Utilize non-tort based system that separates compensation for medical injury from a finding of medical negligence, thus facilitating system changes to enhance patient safety.
Place greater emphasis on primary care and training principles that highlight patient safety, comparative effectiveness, chronic care management, end of life care and outcomes improvement.
Align accountability with responsibility of all stakeholders and provide incentives for healthy behaviors.
Support the development of systems of care, specifically patient-centered medical homes, and encourage the development of organizations that are accountable to local communities for the continuum of patient care, including outcomes, quality, service and costs.
Utilize an independent governing board, appointed by the Governor and the legislature, to oversee all aspects of the universal health care plan including:
(CONG-1, AM 2009; Reaffirmed, BOD-1, AM 2014)
Colorado Medical Society supports the following integrated set of recommendations to improve health outcomes and value in health care. The recommendations also provide an opportunity to advance health system reform efforts already underway in Colorado and provide direction for long-term change.
Optimizing performance on these three dimensions requires sustained, strategic effort and movement beyond individual self interest because the current system is structured to meet perhaps one or possibly two of the aims, but not all three.
The Physicians’ Congress believes that the following list of system attributes…(is) a succinct, starting point to define success for a better performing the delivery system:
Sustainable health care reform must be anchored at every level in the delivery system. The Physicians’ Congress believes that physicians must focus their individual and collective leadership at the microsystem level to improve health outcomes and lower costs by driving better integration, coordination and organization. Reform at this level can be divided into three categories:
(CONG-1, AM 2009; Reaffirmed, LATE CPPE-1, AM 2011; Reaffirmed, BOD-1, AM 2014)
The Colorado Medical Society, through the Physicians’ Congress for Health Care Reform, shall explore and consider advocating for reform legislation using the Matrix as a template with one important addition which represents a compromise between the market based advocates and the single payer advocates – that the proposal be based on a private non-profit payer system.
(Late RES-23, 2008; Reaffirmed, BOD-1, AM 2014)
Principle I: Coverage - Health care coverage for Coloradans should be universal, continuous portable and mandatory.
Principle I Section A: Universal health care coverage
The new system will:
Principle I Section B: Continuous/portable coverage
The new system will provide coverage that continues without regard to circumstance, including but not limited to, employment, health status, age, family member coverage and marital status
Principle I Section C: Mandatory coverage
The new system will include a mechanism to ensure that all Colorado residents participate, with the option to obtain additional benefits
Principle II: Benefits: An essential benefits package should be uniform, with the option to obtain additional benefits.
Principle II Section A: Essential benefits
The new system will provide comprehensive, essential health care benefits, emphasizing wellness
Principle II Section B: Benefit design
The new system will utilize a benefit design process that is:
Principle II Section C: Administration of benefits
The new system will utilize a process to administer benefits that is:
Principle III: Delivery System – The system must ensure choice of physician and preserve patient/physician relationships. The system must focus on providing care that is safe, timely, efficient, effective, patient-centered and equitable.
Principle III Section A: Cost effectiveness
The new system will provide an accurate mechanism for physicians to measure their performance on:
The new system will utilize standards for performance measurement that promote continuous quality improvement
The new system will include interoperable data systems
The new system will utilize:
The new system will utilize a system for measurement and public access to accurate, meaningful and constructive measures of provider performance
The new system will specify that the systems for determining what will be measured and reported will be:
The new system will utilize active care management principles and clinical strategies to meet the needs of high risk/high cost populations
The new system will utilize a process to develop consensus decisions, based upon best scientific evidence, about clinically, ethically and culturally appropriate end of life care
The new system will utilize price transparency provisions that make pricing information meaningful and relevant to patients and purchasers, to enable more informed decision-making
Principle III Section B: Quality improvement
Principle III Section C: Patient safety
Principle III Section D: Regulatory oversight
Principle IV: Governance and Administration - The system must be simple, transparent, accountable, efficient and effective in order to reduce administrative costs and maximize funding for patient care. The system should be overseen by a governing body that includes regulatory agencies, payers, consumers, and caregivers and is accountable to the citizens.
Principle IV Section A: Administration
Principle IV Section B: Governance
Principle V: Financing – Health care coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency. It should emphasize personal responsibility as well as societal obligations, due to the limited nature and resources available for health care.
Principle V Section A: Financing
(CONG-1, AM 2007; Reaffirmed, BOD-1, AM 2014)
As was originally envisioned by the Colorado Medical Society (CMS) (see original concept paper approved September 1996), the CMS supports the following American Medical Association (AMA) policies on individual health insurance (AMA H-165.920, excerpted portions). The CMS supports the principle of the individual’s right to select his/her health insurance plan and actively supports the concept of individually selected and individually owned health insurance. The CMS supports individually selected and individually owned health insurance as the preferred method of people to obtain health insurance coverage. The CMS advocates a system where individually purchased and owned health expense coverage is the preferred option, but employer-provided coverage is still available to the extent the market demands it. The CMS supports the individual’s right to select his/her health insurance plan and to receive the same tax treatment for individually purchased coverage, for contributions toward employer-provided coverage, and for completely employer provided coverage; equal tax treatment for the costs of health insurance is necessary, whether that coverage is purchased fully by individuals, partially by employers or fully by employers. The CMS supports and promotes efforts to establish and use medical savings accounts (MSAs). The tax-free use of such accounts for health care expenses, including health and long-term care insurance premiums and other costs of long-term care, are an integral component of CMS efforts to achieve universal coverage and universal access. The CMS supports enactment of federal legislation to expand opportunities for employees and others to individually own health insurance through vehicles such as medical savings accounts.
Additional Information: Individually Selected and Individually Owned Health Insurance System
(Motion of the Board, September 1996 • Amended March 2004; Revised, BOD-1, AM 2014)
The Colorado Medical Society (CMS) believes that a universal health insurance proposal is needed that would provide coverage for all Coloradans. The goal of health system reform must be to allow Coloradans access to the most appropriate site of care. The CMS recognizes the complexity of developing and implementing such a proposal. It is imperative that the medical profession participates in the health system reform process as it evolves. The CMS views the following issues as the top priorities within health system reform:
The CMS supports the concepts of universal health insurance coverage and universal access. All Colorado residents must have health insurance coverage of their appropriate health care costs regardless of their health or employment status. Ensuring universal coverage advances the goal of universal access to affordable, quality health care for all Coloradans. The CMS believes that a universal coverage system should fairly spread risk across all populations. Any universal coverage system must necessarily define the term resident. Once a precise definition is created then coverage should be extended to all residents, regardless of whether they seek the benefit or not. The CMS supports policies regarding residency requirements that discourage people from moving to Colorado specifically to obtain health care coverage. A combination of public and private cost sharing should be used to cover people ineligible for coverage due to residency requirements.
The CMS supports portability of health insurance coverage as an individual’s life situation changes. Continuity of coverage enables continuity of care.
The CMS supports the elimination of pre-existing condition limitations. Individuals with chronic or other medical conditions must be able to secure and keep private coverage. The elimination of pre-existing limitations must be done cautiously to maintain the affordability of health insurance coverage.
The CMS supports the intent of community rating which is to spread the cost of illness or injury evenly over all subscribers to an insurance plan, rather than charging the sick or injured more than the healthy for insurance. The CMS opposes experience rating and rate banding.
The CMS believes that all Coloradans should have a basic health insurance benefit package. The CMS believes that a common set of mandated minimum health insurance benefits is necessary for all self-funded and fully insured plans. This basic benefit package requirement should be applied nationally in order to prevent the administrative inefficiencies that result from various state and federal mandated benefits. The CMS supports physician and citizen involvement in the development of a basic set of minimum benefits. Coverage for preventive medicine should be emphasized and included in a basic set of minimum benefits. Among other covered services, a basic benefit package should also include access to inpatient and outpatient care, emergency care and prescription drugs.
The CMS supports the concept of a multi-tier health insurance system. Such a system should provide for a basic benefit package for all Coloradans, with an option for individuals to purchase, with their own funds, additional benefits and health care services.
The CMS supports the individual patient’s freedom of choice to select his or her own physician and to pursue services that meet his or her health care needs. A patient’s freedom to choose their physician through their health plan should include the ability of patients to select both primary care and specialty physicians. If the physician is not in that specific health plan, access to that physician should be permitted through a point of service option. The CMS supports a physician’s ability to choose to apply to any managed care plan. The CMS recognizes a health plan’s right to set standards for entry into or continuation in their provider panels. Based on those standards, they are entitled to select with whom they will or will not contract. The CMS believes that these standards must be made public and available to physicians prior to applying for membership on a panel. Physicians who are denied access into a panel or terminated from it must have the right to an appeal process.
The CMS supports a pluralistic delivery system. Decision-making for type of health care delivery system and selection of personal physician must rest in the hands of the patient. Accordingly, the patient should be allowed to choose the financing arrangements for payment of health services, including levels of insurance beyond the basic benefit package, that best meet their personal needs. The CMS promotes competition within such a system and encourages government action to apply the same rules of competition to all competitors, including self insured and fully insured carriers.
The CMS supports a budgeting system for health care that promotes fiscal responsibility. The CMS supports research into health care expenditures to better define where money is spent, by whom and why. The CMS also believes that input from the medical profession is essential in the development of an adequate budget.
The CMS recognizes the finite nature of health care resources; adherence to a health care budget may require the limitation of certain kinds of health care. True cost effective care must be emphasized. The CMS supports dialogue amongst all segments of society regarding the complex and controversial bioethical and socioeconomic issue that must be addressed in any health system reform plan. The CMS believes that it is society’s role to make choices regarding the limitation of certain kinds of health care. The CMS encourages the prioritization of health care services. The CMS encourages physicians to continue to treat their patients as individuals and to use their best professional judgment in every case, and to practice in accordance with the highest ethical standards. The CMS believes that the primary role of an individual physician must be to advocate for the health and well being of his or her patients. In addition, physicians and physician groups must advocate for the public’s health and well being, while being conscientious stewards of health care resources.
The CMS believes that funding for a universal coverage plan should be provided through a public sector/private sector partnership that builds upon the strengths of the existing system. While the CMS supports moving away from an employment based health care system toward increased patient responsibility for the cost of health care services, the CMS also promotes compromise and flexibility to achieve universal coverage. The CMS supports the shared responsibility of employers, individuals and government in paying for health care coverage. Sufficient assistance must be provided to low-income or unemployed individuals and families to ensure a basic level of coverage. The CMS believes that it is necessary to conduct research on both the intended and unintended costs of a universal health insurance proposal in order to ensure adequate and appropriate funding. The CMS believes that evaluation of the taxes necessary to fund a universal coverage proposal must be conducted at the time the proposal is developed. Issues to consider when assessing the merits of a proposal include kind of tax, level of tax and implementation timelines for a tax. The CMS supports placing extra taxes on alcohol and tobacco to help offset the cost of a universal coverage program. The CMS opposes the use of provider taxes to fund a universal health insurance plan.
The CMS supports equitable and uniform resource-based relative value fee schedules for reimbursement by all payers. The CMS supports comprehensive health care reform that may include consideration of a multi-payer system, a single payer system and all other options.
The CMS supports proposals that make the health care system simpler, less costly and more efficient. The CMS maintains that it is imperative to maximize administrative cost efficiencies and to simplify administrative functions within any health system reform or universal coverage proposal in order to allow more time and resources to be devoted to patient care. The CMS believes that administrative costs must be made reasonable. The CMS supports the implementation of a universal claim form. The CMS supports the implementation of a single procedural coding system by all third-party payers. The CMS believes that utilization controls should be uniform and periodically evaluated for demonstrated effectiveness and disclosed to patients and physicians. The CMS encourages the purchase of optional, supplemental coverage from the same insurance company that the basic package (see section on basic benefits) was purchased from in order to increase administrative simplification.
The CMS believes that the assurance and improvement of health care quality are essential components of any potential health care system reform or universal coverage plan. The CMS supports quality medical care that is based upon the best evidence or clinical consensus at the time. The CMS believes that health care quality programs should be fair, objective and based upon the principles of continuous quality improvement and outcomes research. The CMS encourages the use of educational feedback as the primary motivating force driving the improvement process. This education should be directed to providers, consumers, health plans and policymakers as each will require access to objective data in order to improve performance and make wise decisions. The CMS encourages rigorous assessment of the accuracy and meaningfulness of data that is used to measure quality. Provider utilization and quality data must be properly interpreted so as not to present inaccurate or misleading information. The CMS maintains that quality programs should measure and compare the effectiveness and efficiency not only of physicians, but also of all providers of care and of health plans. The CMS supports the concept of health plans sharing information on physician performance with practitioners in order to enhance and modify practice patterns through education. The CMS believes that quality programs should have the direct involvement and guidance of practicing physicians in their communities and should not be controlled solely from a regional perspective. The CMS supports the use of clinical performance guidelines that are comprehensive, thoughtful and accepted by the practicing physician community to help guide the improvement process. The CMS believes that practicing physicians must be instrumental in their development. Guidelines must be strong enough to be evidence of appropriate practice in defense of threatened professional liability, yet flexible enough to allow for variations that are appropriate in caring for patients with individual needs.
The CMS supports and encourages the use of preventive care as a primary means of containing costs. The CMS believes that physician and patient education is an important component of cost containment. The CMS supports and encourages education of patients, providers and payers regarding appropriate and adequate health care cost containment strategies; individuals must become more sensitive to the actual cost of health care. The CMS believes that in order to contain costs it is essential to simplify the health care delivery system through reduction of paperwork and government regulation, and standardization of third party payer requirements, claims procedures, review practices and disclosure policies. The CMS believes that the costs of health care services should be made as transparent as possible in order to enable more informed decision-making. The CMS encourages both physicians and patients to make cost-conscious decisions. The CMS supports health care cost containment through free market competition and voluntary efforts. The CMS opposes the use of administrative delay or other inconvenience of the patient or physician as an appropriate cost containment technique. The CMS recognizes the impact that medical malpractice liability insurance has on the rising cost of health care. The CMS supports current Colorado malpractice tort laws. Furthermore, the CMS supports the prevention of costly, inappropriate defensive medicine by exploring other dispute resolution procedures in order to avoid the tort system. The CMS believes that appropriate incentives must be built into any health care system that encourage physicians to provide appropriate care and patients to seek appropriate care. The CMS believes that cost savings can be realized by educating physicians on appropriate choice of procedures, prescribing habits for pharmaceuticals, durable medical equipment and like issues. The CMS similarly believes that education of patients regarding healthy lifestyle choices can also generate savings. The CMS encourages health education of the public that includes information on the hazards of substances known to be harmful to public health. The CMS promotes programs to eliminate smoking, discourage alcohol and drug abuse, reduce cholesterol, encourage better adolescent health, and other similar programs that are all aimed at improving health and reducing costs of health care. The CMS encourages collaboration and cooperation among health care providers in order to contain costs by addressing excess capacity within the health care system.
(Motion of the Board, March 2004, Amended, AM 2005; Reaffirmed, BOD-1, AM 2014)
The Colorado Medical Society (CMS) acknowledges the important, active leadership role it must play in partnership with other public and private providers, employers, health insurers, community leaders and the residents of Colorado to meet the health needs of indigent Coloradans. The CMS believes that Colorado can reach its full potential only if the residents of the state are healthy. In seeking solutions to the problems of the underserved CMS is guided by the following core values:
The CMS supports both comprehensive and incremental efforts that will reduce the number of uninsured in Colorado and ultimately provide access to affordable, quality health care and preventive programs for all Coloradans. The following general principles guide CMS action:
(Motion of the Board, March 2004; Reaffirmed, BOD-1, AM 2014)