by Susan Koontz, JD, CMS General Counsel
Featured in the January/February 2019 Colorado Medicine.
Physicians face extraordinary challenges and opportunities in 2019 through legislation, regulation, and other marketplace and community initiatives. The sheer volume of exam-room relevant issues is breathtaking in its scope and complexity. The Colorado Medical Society Board of Directors suspended the 2019 Annual Meeting to supplement funding for 2019 physician-patient advocacy efforts during this critical time. The following issues will be high priorities in the 72nd Regular Session of the Colorado General Assembly from its convening on Jan. 4 until sine die May 3, and beyond.
Colorado’s medical professional liability climate, professional review and the Medical Practice Act
The risk of getting sued and the value of that lawsuit are both at serious risk of exploding in the 2019 General Assembly. Lawyers that sue physicians and hospitals will attack through votes to make professional review records discoverable in civil litigation and to raise the value of Colorado’s non-economic damage cap. If these efforts are successful, they will likely mean more lawsuits and higher liability premiums for all Colorado physicians. Taken together or separately, disturbances to the stability and continuity of these highly sensitive processes can compromise proven patient safety measures, spike health care costs, and subsequently restrict the supply and distribution of physicians in high-risk practices, exacerbating provider shortage areas of our state.
CMS advocacy in this area aims to reenact the Medical Practice Act and Professional Review Act to promote the safety of patients while maintaining or improving the professional liability climate, led by the work of the CMS Work Group on Professional Review-Medical Practice Act Sunset.
“As we face the myriad of medical issues the legislature deals with every year it will be incredibly important for physicians to be a part of the process,” said representative-elect Yadira Caraveo, MD (D-Thornton). “As an example, physicians understand the importance of the peer review process to the development of physicians and the safety of the patients they treat in ways that legislators who have not practiced medicine may not. I look forward to providing the perspective of my profession as I serve in the State House so that my fellow legislators understand how the decisions they make affect the day-to-day practice of medicine.”
“The quality, availability and affordability of health care are at stake in the upcoming legislative session,” said Sen. Bob Gardner (R-Colorado Springs). “The protection of the confidentiality of peer review records is absolutely critical for the promotion of quality patient care and if the cap on non-economic damages is removed, professional liability rates will soar, causing higher costs and providers to once again consider leaving the state or retire sooner.”
Despite all of the work in Colorado and across the country over the past six years to reverse the public health crisis caused by opioid abuse and misuse, there is still a great deal of work that remains. Experts predict that the epidemic of addiction and death will continue to increase for the next seven years before beginning to decline.
The 2018 House-Senate Opioid and Other Substance Use Disorders Interim Study Committee has met throughout the late summer and fall to continue their work to address the opioid epidemic in Colorado. Donald Stader, MD, has testified before the committee on behalf of the Colorado Medical Society. At least two bills have been proposed by the committee, one to provide housing assistance to those recovering from opioid addiction and another to make changes in treatment for substance use disorder in the criminal justice system.
Health care coverage and access, costs and transparency
The discussion surrounding coverage, access, cost and value are inextricably linked. Colorado has consistently shrunk the pool of uninsured individuals living in the state, which are otherwise a significant burden to safety net providers, local tax bases, and even private sector premiums. Several factors have contributed to this decrease: The adoption and implementation of Medicaid expansion, the regionalization of Medicaid services through the Accountable Care Collaborative program, and a state-run insurance exchange.
All of these measures have been sustained while further federal reform efforts have stalled. CMS will focus efforts regarding Medicaid on maintaining current coverage gains and protections like essential benefits and bans against pre-existing condition exclusions, while working to expand coverage to those still uninsured where possible.
Evidence continues to mount that Colorado has reached the tipping point on rising health care costs. In addition to increased media coverage and the concerns physicians hear daily from patients, frustration within the business community has spurred the Denver Metro Chamber of Commerce to convene a multi-stakeholder group, including CMS, to devise a comprehensive package of cost, transparency and accountability reforms achieved through voluntary efforts, regulation and legislation. CMS’s goal is to influence reductions in the cost of care while ensuring quality, under the guidance of the CMS Work Group on Health Care Costs and Quality.
Within the category of health care costs falls out-of-network (OON) “surprise” medical bills. CMS has been working on OON solutions for the past five years, and in November the CMS Board of Directors reviewed an OON proposal developed by the CMS Work Group on Health Care Costs and Quality. The proposal will continue to be fine-tuned by the work group through the session.
“Curbing the rising cost of health care is a bipartisan issue and one I and my colleagues in the legislature take very seriously,” said Sen. Jack Tate (R-Denver). “Like physicians, I often hear of my constituents’ frustrations with insurance premiums and coverage, ‘surprise’ medical bills and shrinking physician networks. I remain committed to easing the burden of health care costs and empowering patients to make smart decisions about health care.”
Scope of practice
Each year, in nearly every state including Colorado, non-physician health care professionals lobby state legislatures and regulatory boards to expand their scope of practice. While some scope expansions may be appropriate, others are not. It is necessary to assess each proposed expansion of scope of practice on a case-by-case basis, led by the physician experts on the Council on Legislation SOP Subcommittee and collaboration with specialty societies.
What to expect this session
Advocacy and communications are consistently ranked highest among CMS-member priorities. While CMS staff, lobbyists and leaders will continue to work on behalf of members and the medical community, member involvement is encouraged and necessary. Engage in policy development through CMS’s Central Line platform, cultivate relationships with elected officials through face-to-face interaction, and consider serving on a CMS committee, commission or work group. See other articles in this issue of Colorado Medicine or contact email@example.com for more information on getting involved, and watch for continued coverage of the 2019 Colorado General Assembly in all CMS publications.