The New CMS

7 Reasons to Engage in Public Policy in 2016

As medical practice evolves (or dissolves) into a series of radical realignments, form will follow function in terms of public policy. Market adaptations will be either influenced or chased by shifts in state and federal policy – how services are authorized and paid for, and how networks include or exclude physicians, to mention a few. Those laws will be set by public officials who for the most part have little or no clinical training. That is where you and the Colorado Medical Society intervene. By engaging in those conversations in the public affairs arena, you bring exam-room-level relevance to the debate.

  1. If you aren’t talking to your legislators, someone else is.
    Your legislators should not be talking only among themselves or hearing from others who may have an adversarial point of view. They are eager to talk with you and they rely on their medical communities. They want evidence-based arguments and in the coming months will be overwhelmed with policy choices and contradictory information for which very few have professional or practical experience.
  2. Medicaid reimbursement rates affect access.
    Help us explain to your legislators and the governor the consequences of a 22 percent or more cut to Medicaid E&M codes and how it would affect you, your colleagues and your patients. The state budget has once again hit TABOR limits, prompting a range of freezes and cuts, including a proposed rollback in the governor’s proposed state budget of the E&M Medicaid parity payments with Medicare.
  3. Insurance networks matter.
    Explain to your legislators the practical result of narrowing provider networks. The Colorado General Assembly will debate how health plans develop, maintain and limit their networks.
  4. Out-of-network service issues must be managed.
    No patient should be blindsided with a bill that by any rational measure is excessive, nor should physicians find themselves at sea because an insurance company arbitrarily decides to include some magical number of specialists and primary care physicians while throwing the rest overboard. The General Assembly will either debate an agreement between CMS and health plans or take sides if the professional mediation between physicians and health plans currently underway doesn’t find a sweet spot.
  5. Two huge insurance company mergers are in the works.
    Just how big does a health plan have to be? The state and federal agencies with antitrust enforcement authority have begun the methodical and mind-numbingly complex task of determining whether the two proposed mega-mergers (Aetna Inc. with Humana Inc., and Anthem Inc. with CIGNA Corporation) are sufficiently anticompetitive to limit or block those deals. You can weigh in now by completing a CMS survey designed specifically to inform state and federal regulatory agencies and by telling us your own story.
  6. Colorado will discuss patients’ end-of-life decisions.
    Advocates for physician-assisted suicide have targeted Colorado. CMS is currently evaluating its 15-year-old position statement by engaging physicians and will soon poll its full membership.
  7. Relationships matter.
    There are few more valued relationships between a constituency and a legislator than those forged in the heat of a campaign. These homegrown, organic ties carry over into the halls of the capitols in both Denver and Washington and enhance the quality and credibility of those interactions in ways unachievable through a drive-by visit or blast-emails.

FOR MORE INFORMATION: Stay tuned this page and other CMS communications to learn more about these important changes, follow our progress and learn how you can get involved. We want to hear from you and are available to answer your questions. Please contact CMS President Katie Lozano, MD, FACR, at president@cms.org.