Adapted from the inaugural address of the 2023 Colorado Medical Society Annual Meeting

by Omar Mubarak, MD, MBA

I just want to tell you a little bit about me, why I think the organization is important, and why I think CMS is going to be a huge change agent for all of us now and in the future.

So, about me. I was born and raised here in Colorado; I went to Colorado Academy from kindergarten through 12th grade. And I was born at St. Joseph’s Hospital where I now practice. I went to the University of Colorado for undergraduate and I got a degree in molecular, cellular and developmental biology. I love Colorado; I didn’t want to leave, so I went to medical school here. And then when I was thinking about what I wanted to do in life, I knew that I wanted to become a vascular surgeon from a young age, because my father was a thoracic and general surgeon. Then I knew I would have to leave the state because there wasn’t a vascular surgery fellowship at the University of Colorado at the time. I went to Michigan State and Henry Ford Hospital, which I’m very fortunate I did, because that is where I met my wife. She takes care of me in every endeavor of my life.

My family has a very strong history in medicine in Colorado. As I mentioned, my father was a general and thoracic surgeon who practiced at Lutheran Medical Center. My wife, Leslie, is a rheumatologist. My sister, Hanan, is a PhD in pharmacology, who spent most of her career here. So we have a lot at stake in Colorado in the medical field. And we want to see the medical field improve. We know the strains of medicine; we talked about them all day at the CMS Annual Meeting – occupational stress, scope of practice, dealing with insurance companies and prior authorization, and dealing with health care systems. These are just some of the challenges doctors are experiencing, and that I experience as a private practitioner.

To understand why I’m here today, you have to understand the evolution of my career since I came back from Henry Ford Hospital in 2006. I told myself that if you work hard as a physician, and you know what you’re doing, and you practice good medicine, you’re going to be fine. That was my belief. And over the next decade of my career, I realized that is not true. You could be an amazing doctor, and you could work yourself to death, and the system itself could bring you down. Arguing with insurers, arguing with health care systems, you could go crazy.

Right around that time, an article came out from Forbes about why private practice is dying. That led me to go back and get an MBA at the University of Colorado, because I just couldn’t believe how things had changed from my father’s generation to my generation. Even while I was going though the MBA program, we started making major changes in my practice; we started creating office-based labs, and even bought our own building and created a space that functions as an office-based lab on some days and an ambulatory surgery center (ASC) on other days, allowing us to drive down health care costs for patients and help our business thrive.

Things were getting much better and we were doing well, but a certain event in my life led me to recognize that there was something just wrong. It was when we started to partner with a group called Western Slope Cardiology in Grand Junction, which technically is still an underserved area. This group of cardiologists wanted to work with us to create their own office-based lab. But a hospital system literally decided to destroy the group by removing their privileges. The hospital administration must have thought that once this group is gone – the largest group of cardiologists serving an underserved area – that the hospital would get some of them and the ones that they didn’t get or didn’t want will just move on.

The hospital created a closed system, initially only for cardiology but now they’re a completely closed system, so only physicians employed by the hospital could have privileges and all others were excluded. I contacted Sami Diab, who was the president of CMS at the time, and talked to one of my local representatives, Iman Jodeh. I told them I couldn’t even believe this was legal. I had 10 years of experience on med exec for Presbyterian St. Luke’s and the only way I thought you could remove somebody’s privileges was if they did something very wrong. But Sami did some research for me and I learned that it is legal to take away physicians’ privileges that simply. I thought, you’ve got to be kidding me. Then Sami said, if you don’t like it, get involved. That’s what you’ve got to do as a doctor. Know that this is coming from California and they’re doing it in other places, just wiping out private practices.

I thought back to a statement that I learned in Latin, which is vive ut vivas, which translates to “live so that you may live.” What it really means is live your life every day to the fullest extent to get the most out of life, almost unapologetically. And I thought you’ve got to get involved. That’s all there is to it. So I got more and more involved with Sami and I worked on the Independent Physician Task Force for two years. And that’s how I got here, standing in front of you as CMS president.

My vision of CMS is that it is already an essential organization. If people don’t realize that, they’re kidding themselves. It’s an essential organization for doctors in the state of Colorado to have a voice and to function. But it is going to become, I believe, with people like myself, with President-elect Dr. Kim Warner, the biggest change agent we have. So I encourage everyone to try to tell every doctor that they know to join. Today’s medicine is difficult. We heard about it all day long [in the Annual Meeting educational sessions]. There are administrative burdens, burnout, battles with payers, corporatization of medicine, scope creep. That’s just some of it. AMA President-elect Dr. Bruce Scott very eloquently summarized the issues AMA is addressing for physicians on a federal level.

You have to become involved to protect our profession because medicine is so incredibly rewarding. Every single time I’m just about to throw up my hands because I have had it, there’s some patient who yanks me back and makes me remember why it’s worth it. One particular gentleman went to a hospital in Grand Junction with a ruptured thoracic aneurysm, which is essentially fatal. You can rupture an abdominal aortic aneurysm and the retroperitoneum will contain it so you have several hours. But a thoracic aneurysm bursts in your chest and there’s nothing to hold that back. The patient showed up to the hospital and the thoracic surgeon and vascular surgeon which they replaced us with after they became a closed system did not want to care for the patient. So they airlifted him from Grand Junction all the way to St. Joseph’s Hospital where I placed a thoracic endograft percutaneously with just two access points; one in the common femoral artery on each side. He’s the main provider for his family. He has three kids. I reflected on that experience with gratitude and wonder: What job gives you that kind of reward? There simply isn’t any comparison. The height of technology is ridiculous. The things you can accomplish with that technology is unbelievable. And then the effect you can have on an entire family is amazing. That’s what medicine is – just incredible.

We have to advocate, belong, educate, engage. You’re going to hear that mantra over and over from CMS. Because CMS as an organization is moving us, Colorado physicians, forward. In just 2023, CMS affected through advocacy, your patients, your practice and the profession. In terms of patients, CMS reduced the prescription administrative burden requirements for serious mental health. And we ensured care for chronic pain. For your practice, we drove an audit on the Medicaid RAC audit program, which I personally felt the pain of and so did many of the people at PSL that I worked with who are in private practice. We prohibited unnecessary processing fees when being reimbursed for billed claims. And in terms of our profession, we defeated trial lawyers’ efforts to increase rates, number of settlements and physician exposure to personal liability. We also achieved important guardrails around psychologists’ prescriptive authority and physician assistants; I personally helped with that one.

But we have big plans and there are big problems, and it’s not going to stop. I wish I had a silver bullet to make it all better but it’s not going to stop. That’s why we need CMS, because every year is going to be a different fight. And if you love medicine, and you want to make it good for your kids, to possibly pave the way for them to become doctors, you have to get involved.

The key advocacy fights that we face are credible threats on non-economic damage caps and passing our prior authorization reforms to make it so that we don’t have to take time away from patients to complete the same stupid pre-auth all the time. These efforts by CMS mimic everything Dr. Scott, the president-elect of the AMA, was talking about and all the pressures we feel. CMS is also going to have a membership forum and take a comprehensive review of our value proposition and market demands to analyze what doctors need in Colorado and what we can do to help them. I would also encourage every member to talk to the physicians that you know who aren’t involved, and convince them. Advocate, belong, engage, educate; let’s do this. We can make it better. Thank you very much.

Categories: Communications, Colorado Medicine, Cover Story