April 28, 2017
Medicine claims another victory in insurance mega-mergers
Landmark ruling upheld, protects U.S. patients and physicians
Today Anthem suffered another setback in its determined push to overcome a district court ruling and a break-up lawsuit by its future-ex-acquisition, Cigna, when the U.S. Court of Appeals for the District of Columbia upheld a lower court's tough-worded ruling against Anthem that blocked their proposed $54 billion mega insurance merger.

The opinion aligned closely with the federal district court's finding that the merger acquisition was anti-competitive and agreed with the Department of Justice's argument -- supported by the American Medical Association, Colorado Medical Society and 16 other state medical associations where these mergers would have been most harmful, as well as Colorado Attorney General Cynthia Coffman and several other state attorneys general -- that the acquisition would, like its predecessors, suppress the clinical authority of physicians; raise, not lower, premiums; and grant impermissible market concentrations that would invite abuse and unaccountability. In short, Anthem would have both monopolistic and monopsonistic powers over those markets, physicians, their patients, and other caregivers and institutions.

It is not yet known if Anthem will persist and petition the U.S. Supreme Court, but Anthem to date has vigorously fought Cigna's lawsuit to bail out of the merger-acquisition and has moved to flank the courts politically, giving generously to the presidential inaugural activities, publicly endorsing a number of aspects of the White House-backed "repeal and replace" of the Affordable Care Act, and has seen one of their top antitrust lawyers moved to head the Antitrust Division of the Department of Justice.

"We must remain steadfast in our resolve to block Anthem's power play," said CMS President Katie Lozano, MD, FACR. "We are deeply grateful for the talent and resources brought to bear in this legal challenge by the AMA's expert team, our very own Attorney General Coffman, and our colleagues in the most affected states."

Click here to read more from the AMA.
AMA Action Alert: American Health Care Act

Last month U.S. House of Representatives leadership pulled the flawed American Health Care Act (AHCA) from consideration before heading home for a two-week work period. The American Medical Association and many other organizations opposed the AHCA.

Congress is back with a set of proposed changes that further weakens health insurance protections by allowing states to roll back the essential health benefits guaranteed under the ACA. The AMA says this would undermine the ability of insurance plans to medically underwrite individuals who have been without coverage for a period of time, in essence pricing them out of the market. It would also remove the ban on charging sick people higher premiums in high risk pools.

With these changes, this legislation could lead to millions of Americans being at risk of losing their health care coverage or being priced out of the market by skyrocketing premiums.

Click here to contact your legislators today and urge them to only support health system reform proposals that safeguard these important pieces of our health care system.
Coming soon to your mailbox: MIPS participation status letters

The Centers for Medicare and Medicaid Services is reviewing claims and letting practices know which clinicians need to take part in the  Merit-based Incentive Payment System (MIPS), part of the new Quality Payment Program (QPP), or if they are exempt. In late April through May, Novitas Solutions will send practices a letter providing the participation status of each MIPS clinician associated with your Taxpayer Identification Number (TIN).

Clinicians are exempted from participating in MIPS in the 2017 transition year if they:
  • Bill less than $30,000 in Medicare Part B allowed charges a year,
  • Provide care for less than 100 Part B-enrolled Medicare beneficiaries a year, or
  • Are new to Medicare or not among the types of providers required to report. 
QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate formula and streamlines the "legacy programs" -- Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

Get the help you need to prepare for these changes through the Colorado QPP Coalition. Click here to visit the coalition website for resources.
April 29 is National Prescription Drug Take-Back Day
From 10 a.m. to 2 p.m. tomorrow, April 29, 2017, consumers can safely dispose of unwanted medications at thousands of collection sites coordinated by the Drug Enforcement Administration (DEA), law enforcement agencies and community organizations. Click here to find a location near you, or click here to see permanent disposal locations.  

Events held on National Prescription Drug Take-Back Day give consumers an opportunity to safely and legally dispose of unneeded medications, including pain medications and other controlled substances.  The National Prescription Drug Take-Back Day is free and anonymous. Sites will accept tablets, capsules, and all other solid forms of unwanted medication. Personal information should be blacked out on prescription bottles, or medications may be emptied from the bottles into the bins provided at the events. The DEA and its partners have collected over 7.1 million pounds (more than 3,500 tons) of pills during its previous 12 Take-Back events.
Become a CMS leader
Nomination period closes April 30 for AMA delegates and alternate delegates
Time is running out to self-nominate for one of CMS's leadership positions of AMA Delegate and Alternate Delegate. The nomination period closes April 30, 2017. Overall, there will be four Delegate and four Alternate Delegate positions elected in an all-member election this August. The term of the positions will begin Jan. 1, 2018 and continue for two years through Dec. 31, 2019.

Read more about these positions in the the election guide, available here. Questions? Contact dean_holzkamp@cms.org.
Alert: Acquisition of Colorado Choice Health Plans by Melody Health Insurance, Inc.
Share your concerns in advance of May 12 hearing

Melody Health Insurance, Inc., is moving forward in its acquisition of Colorado Choice Health Plans. The Colorado Division of Insurance (DOI) will hold a hearing on Friday, May 12, to allow for testimony from affected parties and determine whether to approve the merger.

The Colorado Medical Society is continually monitoring mergers and acquisitions for anti-competitive affects that would harm physicians and patients, and will analyze the effects of this merger. We ask any physicians with thoughts and/or concerns with this merger to email chet_seward@cms.org.
You're invited: Prime Health Innovation Summit - May 4
The Governor's Office of eHealth Innovation, the eHealth Commission and Prime Health invite you to join other statewide health care thought leaders at the Prime Health Summit on May 4. Register here.

At this event, you'll discuss and define Colorado's greatest health innovation needs and best practices in integrating innovation into care models, patient satisfaction/engagement, enhancing value and interoperability. Attendees will help align key innovations and initiatives with the state's overall strategy and plans, identify unique entrepreneurial opportunities, help curate and advance digital health innovations across the state, and leverage the digital health innovation community in meeting statewide goals and objectives.

It will consist of facilitated breakout discussions resulting in an assessment of the state's strengths, weaknesses, opportunities and threats in the following areas:
  • Behavioral Health & Substance Use Disorder and Integration
  • Chronic Disease Management
  • Social Determinants of Health
  • Transition from Fee-For-Service to Value-Based Care
  • Information and Sharing - Breaking Down Silos
May 4 provider education event: Tools for safe and effective opioid prescribing
Thursday, May 4, 2017, 5:30 - 8:30 p.m.

Community College of Aurora
The Forum, Fine Arts Building
15990 E. Centretech Parkway
Aurora, CO 80011

$30 pre-registered, dinner included
More information and registration: https://tcopp.eventbrite.com
CME credit and COPIC Point may be provided.
CPEP to present programs on prescribing controlled drugs and pain management
Prescribing Controlled Drugs: Critical Issues and Common Pitfalls©
May 16-18, 2017, Denver, CO
CPEP, in collaboration with the Vanderbilt Center for Professional Health, is offering Vanderbilt's highly regarded Prescribing Controlled Drugs: Critical Issues and Common Pitfalls© course. This three-day course is designed to teach appropriate prescribing practices, facilitate understanding of personal motivations in the patient encounter as understood within the framework of family systems theory, discuss personal responsibilities with patients, and cultivate new skills in substance abuse identification. Course fee is $2,525. Up to 22.75 AMA PRA Category 1 Credits available. Download a program flyer here.
Enhance your Knowledge - Improve your Care
May 19, 2017, Denver, CO

CPEP's new course, Basics of Chronic Pain Management, is a one-day seminar that will help you treat a growing population of chronic pain patients with safety and confidence. This course is designed for clinicians who manage or encounter patients with chronic pain. It is not intended for pain management specialists. Course fee is $550, with a discount for those enrolled in "Prescribing Controlled Drugs." CME credits pending. Download a program flyer here.
Get covered with COPIC

COPIC Insurance Company is Colorado's leading medical liability insurance provider. Three out of four physicians choose COPIC for this critically important coverage. CMS members receive a 10 percent premium discount from COPIC.

For more information, call (720) 858-6000 or visit www.callcopic.com.

Is your lease expiring within 18-months? If so, we can help. Carr Healthcare Realty is the nation's leading provider of commercial real estate services for healthcare tenants and buyers. Visit: www.carrhr.com 

The average physician can save $38,000 by refinancing their student loans with LendKey! CMS members get a $400 cash bonus when refinancing through this partnership.

Rates as low as 2.14% variable and 3.25% fixed. Visit www.LKrefi.com/co-med. Phone: 888-549-9050 Email: customer.care@lendkey.com

You are unique.

More than 50% of physicians feel they have more complicated financial needs than other professions. Our firm works with physicians and their families to tackle these unique challenges. Call (720)-887-1299 or visit www.goldmedalwaters.com.

Transcription Outsourcing, LLC is the leading U.S. provider of medical transcription services. We provide physicians with the ability to be more productive and more profitable. To learn more, call 720-287-3710, visit www.transcriptionoutsourcing.net or email bwalker@transcription

Physician Program offers you Exclusive Benefits!
Full suite of consumer, commercial, and mortgage products in the Denver and Colorado Springs markets. Visit www.academybank.com/swatts or call 303-531-1190 (Office); 303-408-4648 (Cell); and email swatts@academybank.com

CO Drug Card
Compliments of CMS: Reduce patient callbacks, HIPAA compliant, RX Savings up to 75%, click for free customization COLORADO DRUG CARD.

Our cloud-based compliance solution is discounted for all CMS members. Please contact us today for a demo! Call 888-54-FIRST or email info@1sthcc.com. Visit www.1sthcc.com/cms. White Papers - download the latest white papers; webinars - register for our complimentary webinar and receive CEU.

Time is money! FREE banking services designed for medical professionals. Call 303-840-8484 today to schedule your appointment with a Relationship Banker.
GreenLight is the national leader in web-enabled behavioral health testing with over half a million assessments in 35 states. GreenLight is designed to help physicians enhance patient care, improve population health and add incremental revenue to the practice. Visit www.Greenlight.md or call 866-602-1778.

Improve patient care with our health information exchange services - query patient records via secure web portal, receive real-time encounter notifications, and exchange clinical documents securely.

Register to attend Centura Health's Future of Medicine Conference on 5/11-12 in Denver, featuring Eric Topol, Daniel Kraft and others. Visit www.centura.org/future-of-medicine

Email: FutureMedicine@Centura.org and Phone: 303-290-6500

To comment on something you read in ASAP or to update your contact information, send an e-mail to enews_editor@cms.org. Visit us online at www.cms.org.
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