ASAP e-newsletter: Dec. 19, 2018
Happy holidays from CMS and warm wishes for a prosperous New Year 
This holiday season and all year long the Colorado Medical Society is grateful for the opportunity to serve Colorado physicians by bringing you the latest information and resources to make your job a little easier, advocating for you in the public policy arena, and connecting you to your peers from around the state. Thank you for all that you do to improve the health of Coloradans. We wish you a wonderful holiday season and a prosperous 2019, and we look forward to working with you in the coming year. Don't hesitate to reach out to any member of our staff or CMS President Deb Parsons, MD, with questions, comments or concerns.
Division of Insurance: Judge's ruling won't change protections for pre-existing conditions in Colorado
On Friday, Dec. 14, a federal district judge in Texas issued a ruling stating that the Affordable Care Act (ACA) is unconstitutional. This was a ruling in the case Texas v. the United States, where 20 state attorneys general filed a lawsuit against the ACA, saying that since Congress ended the law's mandate to have health insurance, the entire ACA is unconstitutional.

"Even with this ruling, the ACA isn't going away," the Colorado Division of Insurance stated in a news release. "This decision will now be part of a long, drawn-out legal process, as it will be appealed and likely work its way to the U.S. Supreme Court. And the Trump administration is assuring the country that the ACA will remain in force during the appeals process."

This case has caused the most concern around the ACA's protections for people with pre-existing conditions, especially as the Trump administration said it would not defend that part of the law.

"I said it in June when this case first bubbled up, and I'll say it again: Guaranteed health insurance coverage for people with pre-existing conditions is enshrined in Colorado law," Interim Insurance Commissioner Michael Conway said in the release. "The Division of Insurance will continue to enforce Colorado law and maintain this important protection for our citizens."
Division of Insurance releases 2017 Health Insurance Cost Report
The Colorado Division of Insurance has released its annual Health Insurance Cost Report. It details the health insurance market in Colorado, including trends in the individual and group markets, the factors that drive premiums and the financial status of health insurers.

"It's crucial that we are able to look at the entire health insurance market in Colorado and compare it to national data, as well as look over the year-to-year comparisons," said Interim Colorado Insurance Commissioner Michael Conway in a news release. "This is the sort of big-picture data that can highlight patterns across the many parts of Colorado's market."

Highlights from the 2017 report include the following.
  • Average monthly premiums in Colorado across individual, small group and large group health plans  ranged from $331 to $428.
  • The average health insurance deductible in Colorado was $1,951 for single coverage and $3,721 for family coverage.
  • More than half of all Coloradans received their health insurance from an employer. For this group, those with family coverage paid 27 percent of the total premium, while those just covering themselves paid 21 percent of the premium (employers paid the remaining portion of the premium).
  • Approximately 44 percent of private-sector employers in Colorado offered health insurance to their employees.
  • As was the case in 2016, 86 percent of the premiums collected for health insurance in Colorado went directly to the cost of paying for health care services.
  • Of the 425 health insurers in Colorado, the top 10 largest insurers accounted for 75 percent of the market.
The report can be found on the DOI's page for " Insurance Brochures, Fact Sheets and Reports." Click on "Health Insurance Reports" under "Reports by DOI," and on the next page, click "Health Insurance Cost Reports."
CIVHC releases Colorado scorecards on payment reform
In 2016, over half of the payments to Colorado doctors and hospitals by commercial health insurance payers contained incentives to improve the quality of care that patients receive, according to the Center for Improving Value in Health Care (CIVHC). Surpassing national trends, 54% percent of payments in Colorado's Medicaid market were also tied to value in that same year. These are among the findings of  The Colorado Scorecards on Payment Reform  released by  CIVHC and  Catalyst for Payment Reform  (CPR) .

The most common form of value-oriented payment in the commercial market was shared savings (26.5%), which typically creates, on top of traditional fee-for-service payment, an upside-only financial incentive for providers to reduce unnecessary health care spending for a defined population of patients, or for an episode of care, by offering providers a percentage of any realized net savings, if first they meet certain quality standards. In the Medicaid market, pay-for-performance, which is typically traditional fee-for-service payment with a bonus for meeting quality or efficiency goals, along with payments for non-visit functions like care coordination, case management or health IT infrastructure, were the most common forms of value-oriented payment, each representing 16.4% of total payments.

Registration open for CHA's 2019 Colorado Opioid Safety Summit
The Colorado Hospital Association, in partnership with the Colorado Office of Behavioral Health (OBH), will host the 2019 Colorado Opioid Safety Summit from 8 a.m. to 4 p.m. on Jan. 24, 2019. The summit will feature experts discussing the current status of Colorado's opioid crisis and progress in opioid use disorder prevention, treatment, recovery, and harm reduction. Some of the sessions will include:
  • Pain, Suffering, and Addiction - Corey Waller, MD will discuss the neurobiology of addiction and the psychosocial aspects of pain.
  • Making Changes and Changing Lives - Cristen Bates from OBH will highlight best practices and lessons learned from the previous STR grant year and opportunities to participate in the new SOR grant.
  • Policy to Practice - Joshua Ewing, CHA associate vice president of legislative affairs, will discuss current and potential legislation relating to opioids that will affect hospitals.
  • Changing Attitudes: Psychology, Medicine, and Addiction - Brent Van Dorsten, PhD, will discuss pain management in the hospital setting, including appropriate treatments for patients already on MAT or who suffer from chronic pain.
Click here to learn more about the summit and to register. Registration is $30 and available until Thursday, Jan. 17, 2019.
Federal CMS agrees to improvements in E/M documentation, delays "collapse" of levels to 2021
In the 2019 proposed rule on the Medicare Physician Fee Schedule (PFS), the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the E/M documentation guidelines intended to reduce administrative burden on physicians. In addition, the federal CMS proposed coding and payment changes to new and established office visit services. The AMA led the development of a joint comment letter from 170 physician and other health professional organizations calling for the agency to finalize several proposed changes to E/M documentation guidelines for CY2019.

"The AMA is pleased to report that the federal CMS is implementing the documentation policies, which will significantly reduce administrative burden and allow all physicians to spend more time with their patients," the AMA stated.

The agency has also acknowledged the work of the AMA's CPT/RUC Workgroup on E/M and has postponed any coding and payment-related changes for E/M office visit services until CY2021. This delay in implementation will allow the CPT Editorial Panel to consider the workgroup's proposal in February 2019 prior to prompt consideration by the AMA/Specialty Society RVS Update Committee (RUC).

On page 584 of the rule, the federal CMS states:

"We recognize that many commenters, including the AMA, the RUC, and specialties that participate as members in those committees, have stated intentions of the AMA and the CPT Editorial Panel to revisit coding for E/M office/outpatient services in the immediate future. We note that the two-year delay in implementation will provide the opportunity for us to respond to the work done by the AMA and the CPT Editorial Panel, as well as other stakeholders. We will consider any changes that are made to CPT coding for E/M services, and recommendations regarding appropriate valuation of new or revised codes."

Click here for a summary of the rule from the AMA. The Colorado Medical Society continues to coordinate with the AMA.
AMA releases online education module to help physicians promote firearm safety among patients
With more than 38,000 Americans dying from firearm-related injuries each year and an estimated 85,000 people surviving non-fatal firearm injuries, the American Medical Association released a new online continuing medical education module to help prepare physicians to counsel their patients on firearm safety. The module is designed to assist physicians, particularly those who specialize in primary care and emergency medicine, in recognizing risk factors that increase the potential for firearm injury and death, identifying barriers to communicating with patients about firearm safety, and effectively communicating with patients to reduce the risk of firearm injury and death.

The module presents three scenarios to help physicians determine the best approach for handling patient interactions. Specifically, physicians will learn how to counsel patients at high-risk of firearm injuries, including a patient at risk of suicide, a patient dealing with domestic violence, and parents in a pediatric setting. The module is available for free on the AMA EdHub and qualifies for AMA PRA Category 1 credit. Click here to access the module.
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