by Eric Speer, MBAHA, FACMPE, Chief Administrative Officer, Centeno-Schultz Clinic
Featured in the May-July 2021 Colorado Medicine Colorado Medicine.
When it comes to politics and medicine, there is an oft-quoted statement, “if you’re not at the table, you’re on the menu.” Fortunately, the Colorado Medical Society is always at the table shaping legislation and law creation for the benefit of physicians and practices of Colorado. It is no small feat averting the unintended consequences of what is usually … hopefully … well-intentioned legislation.
Good outcomes are achieved through the hard work of the Council on Legislation (COL) – which reviews legislation and recommends positions to the CMS Board of Directors, and CMS policy staff – who are the boots-on-the-ground educators of elected officials on how the health care system functions. Bigger picture, CMS has the unique position and ability to bring together component and specialty medical societies (the House of Medicine), practice staff and other stakeholders to form a united front.
I am the chief administrative officer for Centeno-Schultz Clinic, a board member of the Colorado Medical Group Management Association and a member of COL representing CMGMA. I truly believe that without the COL, we would have a different health care system in which physician-owned practices like mine would struggle to survive. I’ll give two examples of great legislation on which I collaborated with the Colorado Medical Society through my practice and CMGMA: Bills to simplify prior authorization and streamline credentialing.
The prior authorization bill, HB19-1211, was passed in 2019. I knew through my own experience and the experiences of my CMGMA colleagues that prior authorization was not only a hassle but hazardous to patients when they had to delay care unnecessarily waiting for prior authorizations. Bolstered by CMS survey data that echoed these concerns, we worked together on bill language and provided committee testimony to eventually see passage of a law that:
- reduces the response time for a non-urgent request from 15 days to five days,
- ensures that services that have been approved cannot be retrospectively denied, and
- ensures that an approved prior authorization request remains valid for at least 180 days and continues for the duration of the prescribed course of treatment.
CMGMA brought the credentialing bill to CMS in 2018. Since then, the CMS Government Relations team has placed their full advocacy muscle behind its success, and I am pleased to report it has a very good chance of passing this year as SB21-126. My practice – like many others – will benefit from timely credentialing by health insurers, especially now as doctors come into the state to provide care during the pandemic or are recruited to our practices and health systems.
One final example of how CMS works for Colorado physicians: Our practice brought our concerns to CMS in 2018 regarding bad actors in stem cell injection therapy who were misusing these therapies and misrepresenting outcomes. With the guidance of the policy team, one of our physician owners, Christopher Centeno, MD, proposed a policy on stem cells based on guidelines by the Federation of State Medical Boards. He submitted the policy through Central Line, CMS members weighed in, and it was passed by the CMS Board of Directors. Putting patient safety policies in place with stem cell injections will more easily allow CMS to take legislative action should need arise.