Report from the CMS Board of Directors - Jan. 18, 2019
Dear Colleague,

Your board of directors just completed our first meeting of 2019 and I am happy to report on today’s outcomes. A reply to this email with your perspective will be greatly appreciated.

1. Public Policy: State-of-the-art advocacy will focus on member priorities to positively impact rewarding physician careers.

Your Council on Legislation is hard at work, having met in December and again on Jan 16. Our greatest challenge this year will be an aggressive move by lawyers that sue physicians to expand the value of a lawsuit by raising the non-economic damage cap. Among our top priorities is reenactment of the body of law governing professional review and the Medical Practices Act, both of which are subject to “sunset” and must be reenacted by the 2019 Colorado Legislature. Plaintiff attorneys will be using this as an opportunity to try to remove legal protections and immunity for the peer review process, making patient safety records open to discovery in civil litigation and threatening Colorado’s stable medical liability climate. Reversing the opioid crisis and addressing health care costs will also be high priorities. With this backdrop in mind, the board took the following actions on public policy:
   
a. Mandatory opioid e-prescribing with exemptions: The Board of Directors approved the recommendation of the Committee on Prescription Drug Abuse to support mandatory opioid e-prescribing legislation with appropriate exemptions. Although CMS spent significant political capital in the 2018 General Assembly successfully opposing mandatory e-prescribing of opioids, the U.S. Congress just passed a new federal mandate for physicians to electronically prescribe by January 2021 for Schedule II, III, IV, and V controlled substances covered under a Medicare Part D prescription drug plan or Medicare Advantage prescription drug plans.

Please click here to read the report of the Committee on Prescription Drug Abuse to better understand the board’s decision.

b. Prior authorization: Physician dissatisfaction with the unnecessarily burdensome prior authorization process led to a decision to “green light” a prior authorization bill. The goal of this legislation is to provide prior authorization relief to physicians while promoting safe, timely and affordable access to evidence-based care for patients. Additionally, enhancing efficiency, increasing transparency and reducing the variations among payers and utilization management organizations will streamline the overall prior authorization process.

Click here to read more about the bill specifications and be on the watch for future legislative alerts in support of the legislation once it is filed.

c. CMS-CIVHC (Center for Improving Value in Health Care) CPT Dashboard Pilot Project: With the cost of care at a tipping point, the board voted to approve a recommendation submitted by our Work Group on Health Care Costs and Quality to: 

  • Explore a small-scale CMS/CIVHC partnership to provide 15 physician-member practices with customized data reports to understand average and median payments for top CPT codes for specific specialties by payer and region as compared to the Medicare fee schedule; and,  
  • Carefully evaluate the project to assess report usability and value and priorities for report upgrades including other tools, costs, and business plan options. 

The board strongly agrees with the work group’s consensus that physician members need customized data to help enhance practice viability, improve quality of care, and drive down health care costs. This was also confirmed in a September 2018 CMS membership poll demonstrating that three-quarters (72%) of physician members would be interested (32% of whom would be very interested and 40% who would be somewhat interested), in a report that would highlight opportunities for practice improvement based on their data from an all-payer quality and cost database. 

Click here to read the full report of the Work Group on Health Care Cost and Quality

d. Out-of-network legislation: In November, I reported to you on the board’s approval of an approach to an out of network (OON) legislative solution that gets patients out of the middle of these situations. At the board’s direction our Work Group on Health Care Cost and Quality has continued to refine the proposal for legislative action during the current session, specifically a minimum benefit standard for OON services. The board was updated on the current OON actions in the General Assembly given the intense national and local media attention on this issue and the importance of the issue to many CMS members. The Speaker of the House, Rep. KC Becker, in her inaugural speech, noted that the OON issue will be addressed to protect consumers this year.

Click here to read the report provided to the board of directors.  

e. Professional Review Sunset-Medical Practices Act Sunset (PR-MPA Sunset): The stage is one step closer for legislative debate on reenactment of PR and MPA sunset. The Division of Regulatory Affairs released its sunset reports on both subjects on Oct. 15, 2018, and our Expert Panel on PR-MPA Sunset met in November to evaluate these reports. Both reports are were reviewed favorably by the expert panel and the board of directors adopted all of the expert panel’s recommendations. Please watch for legislative code blue alerts on reenactment of both PR and the MPA that will ask you to contact your legislator.

Click here to read the full report and recommendations of the Expert Panel on PR-MPA Sunset.

f. Firearm Safety: The board voted to combine existing CMS policy into one succinct, overarching policy statement as an alternative to a Central Line firearm safety proposal originally submitted in September. This new, overarching policy was reviewed by the board and will be placed on Central Line for membership review and final board vote at the March meeting.  

Click here to read to the overarching firearm policy statement that will be placed on Central Line for the March board meeting.

2. Organizational Excellence: Continued innovation of CMS will increase membership value and make CMS meaningful and relevant to a diverse physician population.

a. Board best practices: The board retained Charney and Associates to review current board governance practices and literature-based, best practices to determine consensus changes in how the board conducts its business. The goal of this project is to update and institute best practices for the CMS Board of Directors. The board heard a presentation from Tom Keyes, JD, a Charney principle assigned to work with the board on this project.

Click here to read our approach to upgrading board best practices. 

b. Consent calendar: A consent calendar that includes nominations and minutes from meetings since November 2, 2018, was approved by the board.

Click here to review the consent calendar

  • Finance Committee Report: Finance Committee Chair Patrick Pevoto, MD, reported on financial summaries and statements from October through November 2018. The Finance Committee report is available upon request. 
 
The next board meeting is scheduled for March 15, 2019, at CMS Headquarters in Denver. Any member is welcome to attend. Thank you very much for taking time to read this report and for sending me your comments in a reply to this email.

With gratitude,
Debra J. Parsons, MD, FACP
President, Colorado Medical Society