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President's update
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A bi-monthly blog detailing the latest news and perspectives from the president of the Colorado Society of Eye Physicians and Surgeons.

 

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President's update: Sept/Oct 2017

Posted By Chet Seward, Sunday, October 15, 2017
What to do with your practice amidst all the turbulence in health care coming from Washington, DC? Many others ask this question, as one-sixth of US economic activity flows through the health care ecosystem. Uncertainty in the fate of the individual insurance markets, and Medicaid cost sharing with the federal government, all create problems closer to home at the state-government level. Furthermore, MACRA and MIPS bonuses and penalties loom on the near horizon for physicians directly.

I invite you to imagine what is possible, and importantly, under our own control, when we shift the focus of health care reform and value-based care from externally imposed to internally driven improvements. By working upon your own practice, you begin to solve the challenges that characterize your practice’s unique combination of strengths and weaknesses. There is plenty to do to improve your practice for intrinsic reasons, but also to survive the transition from fee-for-service to value-based payments. Inefficiencies within your practice are a threat to your practice, like never before.

The foundation for physician-directed practice improvements rests upon three pillars: autonomy, mastery, and purpose. Much has been written lately about these elements relating to “physician engagement with work.” We need to find these three elements in our daily work, and over the course of our professional careers, to ultimately find fulfillment. Activities that do not feature these three principles, especially for high-achieving professionals like ophthalmologists, lead to frustration, and ultimately increase the risk of burnout.

When working hard to create your own solutions to problems, you find pleasure in the exercise of autonomy. As your practice becomes more proficient, the pleasure of mastery is manifest. A higher-performing practice allows the individual and organization to fulfill its purpose. Yes, it is possible to find joy in our work, rooted in these three supports.

What does this look like in practice? The choice of solo versus group practice boils down to how strongly one values autonomy. There are definite trade-offs to either choice. For some, achieving mastery is found by working alone, while for others, mastery is better enabled through the advantages of a group practice. Whether in solo or group practice, a lifetime of feeding one’s curiosity, and an ethos of continual learning and self-improvement eventually leads to mastery. At a minimum, one must continually evolve their clinical and surgical skills, as well as basic business skills – but at some point in one’s career, we grasp the importance of community and advocacy to achieve a higher purpose – service to others.

As president, I highlight that CSEPS is the cement of this foundation. CSEPS provides opportunities to create vital social bonds with like-minded professionals. CSEPS also provides forums to learn from outside experts, such as AAO Past-President Ruth Williams’ cutting-edge talk on private equity last month. Finally, CSEPS is the only purpose-built organization that exists to defend our professional autonomy, supporting our individual and collective efforts to achieve professional mastery, and ultimately fulfill our purpose as healers.

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President's Update: July/August 2017

Posted By Chet Seward, Wednesday, August 9, 2017

Changing our focus for this CSEPS President’s newsletter, instead of outward-looking federal and state advocacy, let’s look inward into our own ophthalmology practices. 

Our 11-physician practice is headed into our Annual Partners’ Retreat in August. This critical inward look at our practice is a yearly exercise – a vital task of any organization, no matter its size. Indeed, it may be even more important for a solo or small practice that may not frequently ask hard questions of it’s self. It is axiomatic that no organization looks to find fault in itself, or to force a foray into the unknown.

A common entry point into organizational, or personal, self-assessment is the SWOT Analysis. SWOT is an acronym for strengths, weaknesses, opportunities and threats. It is a simple framework for taking stock of the company and planning for its future. Examples of questions common to many businesses, including healthcare are included in the SWOT 2x2 matrix below. 


Source:http://www.cbpp.uaa.alaska.edu/afef/swot.h1.jpg.

Strengths and weaknesses are internal factors, whereas opportunities and threats are external to the practice. The easier work, or the fun part, is to list your practice’s strengths and opportunities. The more difficult, painful and therefore most likely to be ignored are your practice’s weaknesses and threats to its existence.

The stress for every organization doing the necessary, hard work of looking inward at its weaknesses is perilous for those leading this inquiry. There are strong inertial forces deeply invested in maintaining the status quo. Significant resistance and pushback is the expected default position, often making significant change an uphill climb. Sisyphus, the character from Greek mythology is forced to roll a massive boulder uphill, only to have it fall back upon him, in a never-ending cycle of labor and futility. So, why would anyone undertake such an endeavor?

An organization that either undergoes a process of internal, or external review, of itself will identify areas that diminish its performance. These internal weaknesses are barriers to achieving greater success, or risk their organization’s demise, if continually swept under the carpet.


Source:https://www.planplusonline.com/wp-content/uploads/2014/06/The-Simplicity-on-the-Far-Side-of-Complexity_blogheader1.png

It is a false economy to not invest the time and energy performing this vital self-assessment. It is less effort to coast, rather than actively steer the organization. However, the state of ease we all seek, entails first passing through a difficult period of disruption. This is called “simplicity on the far side of complexity”.

As for the external threats to your medical practice, I circle back to the reason for CSEPS existence -- CSEPS is the only purpose-built professional organization representing Colorado’s ophthalmologists. CSEPS dues support extremely hard-working staff and lobbying activity, directed by a voluntary board of directors (peer ophthalmologists). CSEPS is in a bi-directional exchange of information between the grassroots ophthalmologist and the national organization, the AAO, via the Council. CSEPS is also your voice at the critical state-level, where both legislation and regulation often create the greatest impact upon your practice. 

So, I hope I have stimulated your thinking on this vital topic. I encourage you to have this conversation within your practice. We all collectively benefit by having more robust and adaptive ophthalmology practices, acting in concert, to provide the best care for our patients. Thank you all for your hard work in the communities you serve.

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President's Update: May/June 2017

Posted By Chet Seward, Wednesday, May 24, 2017

Colorado sent its largest delegation of ophthalmologists to the nation’s capital April 2017 to attend the AAO Congressional Advocacy Day & Mid-Year Forum. This “fly-in” is the American Academy of Ophthalmology’s signature federal advocacy event. While emails to Congress are appreciated, there is nothing as powerful as when physicians give up a day of their practice to perform face-to-face advocacy. (See all of the photos from our trip here.) Physicians are the subject matter experts on medicine, but have greater impact upon legislation when we can tell our own stories of practicing medicine under the ACA, MACRA and MIPS.

Multiple generations of actively practicing ophthalmologists bore witness before our Congressional representatives. The more experienced doctors were delighted with how those attending for their first time learned the craft. The younger physicians spoke to their future careers in medicine caring for an ever-aging population with chronic eye diseases. Recognizing the need to develop the next generation of ophthalmology leaders to be effective leaders, a cohort called the Advocacy Ambassadors was brought to Washington, DC. Both CSEPS and the University of Colorado sponsored an ophthalmology resident to be part of the Colorado delegation. This program has been very successful on many levels and will continue to thrive.


Members of the Colorado MYF delegation. From top left back row: Drs. Leo Seibold, Prem Subramarian, Lacey Echalier, Ron Pelton, Niranjan Manoharan, Peter Hovland, Front row left: Drs. David Johnson, Rebecca Braverman, Robert Fante and me.

Not only were all the ophthalmic specialties represented, but also academic and private practices were present. The breadth and depth of clinical experience at the table were CSEPS’ strength. All our challenges with insurance networks, pre-authorization, timely drug access, EHR and reporting burdens, so well-known to us, are a small part of the discussion informing federal legislation – unless there is very strong representation by the grassroots ophthalmologists. Several hundred ophthalmologists descending upon The Hill on a single day provides great weight to assist AAO’s Washington team in leveraging ophthalmology’s position.

While not every Colorado ophthalmologist can sacrifice a day away from their practice to attend this annual event, there are ways to directly or indirectly support the effort to protect our field. The most important is to simply commit to being a dues-paying member of CSEPS every year. I also encourage you to contribute to EYEPAC and the CSEPS Small Donor Committee so that we have the necessary resources to make contributions to Colorado candidates that support our priorities. CSEPS defends ophthalmology interests at the state level, and simultaneously provides representation of Colorado at the national level in the AAO Council. Our Congressional members return to their districts throughout the year, and we would be happy to assist you with talking points when you meet with them.

In summary, the AAO Congressional Advocacy Day and Mid-Year Forum in 2017 was both very successful, and very enjoyable. Thank you, again, for your membership dues -- CSEPS will continue to support your practices and our patients’ interests at the state and federal level.

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President's Update: March/April 2017

Posted By Chet Seward, Friday, March 24, 2017

The raison d’etre for the existence of an organization over that of an individual is clear – to accomplish what a single person cannot by acting alone.

In the case of ophthalmology in Colorado, the Colorado Society of Eye Physicians and Surgeons (CSEPS) is the collective voice of Colorado’s ophthalmology community. But CSEPS is part of a larger ophthalmic community nationally.

The state ophthalmology societies rely upon each other to act collectively in a number of ways. Sometimes it is to develop model legislation useful in other state capitols. At other times it is to provide mutual protection of our interests and that of our patients.

Our colleague from Colorado Springs, Ron Pelton, MD, PhD, represents our interests in the AAO State Affairs section. His letter highlights the need for each of us to do our fair share in contributing to the mutual defense of our profession, our patients, and our practices.

Please join me, and all the members of the CSEPS Board, whom are contributing to the Surgical Scope Fund. While you’re at it don’t forget about supporting advocacy efforts here in Colorado by donating to the CSEPS EYEPAC and the CSEPS Small Donor Committee. All of these funds are critical to help protect you and ophthalmology’s priorities.

Thank you kindly for contributing to the Surgical Scope Fund now, and making a positive impact for our patients and our profession. 

Alan Kimura, MD, MPH

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President's update: Jan/Feb 2017

Posted By Chet Seward, Friday, February 17, 2017
Greetings, my fellow hard-working ophthalmologists in Colorado!

It is an honor and privilege to be the next President of the Colorado Society of Eye Physicians and Surgeons. CSEPS is the only purpose-built professional organization designed to represent our profession at the state level. In turn, CSEPS is a component in the larger American Academy of Ophthalmology’s Council, where our collective voice is expressed through our CSEPS Councilor Rebecca Braverman, MD.

At this time in history, we have a new President of the United States, a new Congress, and a newly confirmed Secretary of Health and Human Services. Dr. Tom Price, an orthopedic surgeon, has been a vocal critic of the Affordable Care Act, previously as a US Senator. Much uncertainty over repealing and replacing the ACA exists. But it is clear that the inherent complexity of our $3,200,000,000,000 healthcare spend is fragmented by different views of politics, economics and culture – making consensus difficult.

As the new contours of our political landscape emerge on the federal level, there is perhaps more impactful legislation to attend to at the state level. We have bulked up and are punching at a higher weight class for our size: we have a refreshed CSEPS Board with a great mix of experience and new ideas, an excellent lobbyist at the Colorado State Capitol (Chris Howes), a knowledgeable CSEPS Legislative Committee to take positions on healthcare bills, and above all a great Executive Director (Chet Seward).

I look forward to this next year, working with all of you talented, incredibly hard-working and dedicated physicians. But it is not enough to attend to our patients in clinic and the operating room. We exist as part of a larger healthcare ecosystem.
In the ensuing weeks, I’ll reveal this year’s ambitious agenda for CSEPS.

Thank you again.

Alan Kimura, MD, MPH

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President's update - Nov/Dec 2016

Posted By Chet Seward, Saturday, December 24, 2016

Over the past two years, we have sponsored our first piece of legislation in years, enjoyed many great educational programs, begun creation of an ophthalmic surgery charity network, and enhanced our relationships with other branches of medicine as well as with our colleagues in optometry. It has been a tremendous privilege to serve as CSEPS president over this time, not least because of the opportunity to interact with some of the best people in the world of ophthalmology. Our executive director, Chet Seward, is a wonderful man and a terrific asset, and our Board is filled with enormously talented and dedicated physicians, including our next president, Dr. Alan Kimura, whose national connections and experience will be invaluable for Colorado.

Among our current challenges is the new Medicare Quality Payment Program (QPP), which goes into effect next month, replacing meaningful use, PQRS and other programs. QPP uses a point system based on physician self-reporting and other data that will result in a negative, neutral, or positive payment adjustment for Medicare payments. Non-participation in QPP in 2017 will result in a 4% penalty in 2019, but fortunately this can be avoided by some basic participation (for example, one quality measure or one improvement activity for any point in 2017). If you do more then it can result in a bonus payment. For an overview of QPP, click here

There are currently four facets to QPP. 1) You can choose one or more quality measures (there are over 270 of them) and report chart audit covering at least 90 days. 2) You can attest that you have participated in four or more quality improvement activities for at least 90 days. 3) Your EHR might be able to qualify under the Advancing Care Information segment of QPP. 4) Finally, you can analyze your practice’s cost to Medicare per beneficiary to be compared against national norms. The first three appear to be much more manageable for most of us than the last one.

You don’t need to be daunted by QPP (as I was) because Medicare will pay for a consultant to come to your practice and help you get started. For Colorado, the contractor is Telligen, and the program specialist can be reached at 303-875-9131 or by email at Devin.Detwiler@area-D.hcqis.org.

This will be my last official communication as CSEPS President but I would welcome your thoughts and ideas anytime. Thanks so much for your support. 

Robert Fante, MD

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President's update - Sept/Oct 2016

Posted By Administration, Tuesday, December 6, 2016

“It was the best of times, it was the worst of times…”  Although life is undoubtedly better for us today than it was in the days of Charles Dickens (one of my favorites), there are certain parallels that come easily to mind.  Ophthalmology, like western society in general, has made such spectacular advances that they are difficult to grasp. DSEK, DSAEK, ICL, RLE, VEGF, MIGS, premium IOLs, and intraocular telescopes, are some of the futuristic techniques with which we are now able to save and enhance our patients’ sight.  On the other hand, the hassles of the Affordable Care Act, HIPAA, MACRA, meaningful use, etc., threaten to rob us of the satisfaction and joy we would otherwise feel from our work.  And of course, the ColoradoCare Amendment (#69), if passed, would potentially change our practices substantially in many unknown ways, and would certainly add to our tax burdens.  CSEPS is dedicated to celebrating and protecting ophthalmology’s achievements while working to help you to adapt to the hassles or to fight them whenever we can.

Please consider getting involved.  Getting involved could be as simple as talking to one of our CSEPS board members about issues you’d like to have us address, or even telling us about great things you’re doing at your office so that we can share them.   Our board includes: Ron Pelton and George Ulrich in Colorado Springs; Dave Johnson, Rob Fante, Alan Kimura, Bill Richheimer, Adrienne Ruth, Leo Seibold, and Jasleen Singh in Denver; and Kent Bashford in Fort Collins.  If you are more energetic, we would welcome your direct involvement in programs ranging from upcoming collegial evenings such as the Oktoberfest CSEPS/COA Social Mixer, or educational events such as the Medicare Physician Quality Payment Program, or with our nascent statewide charitable surgery referral network Vision4Coloradoor even hosting a state legislator as an observer for a day of surgery.  If you are on the western slope, we would especially welcome and encourage you to get involved.  Feel free to call (303-839-1616) or write me.

Thank you for everything you do to help our patients and our profession!

Robert Fante, MD

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CSEPS opposes ColoradoCare

Posted By Chet Seward, Monday, August 8, 2016
Updated: Sunday, August 7, 2016

This summer heat is making me think about the cool fall and the bushel full of issues we face with the upcoming November election. Instead of adding to the confusion of the presidential race, I want to focus on a proposed constitutional amendment that seeks drastic change to Colorado’s health care system. 

ColoradoCare, also known as Amendment 69, would create a new system where every resident has health care coverage financed by taxes instead of private insurance premiums. It would replace most other health insurance in the state except for Medicare and Veterans Administration coverage. The program would be funded by big tax increases and current state and federal government support for health care programs. When fully operational a 21-person board would have sweeping powers to determine details of the benefits package, set rates for care providers, hire managers and approve annual budgets estimated at $38 billion/annually (more than the total current state budget of $25.7 billion). ColoradoCare would not be subject to oversight by any executive or legislative branch agency, and board members could not be recalled. You can learn more about the proposed amendment here and here.

Your CSEPS board of directors discussed ColoradoCare during their July meeting and unanimously voted to oppose it. Putting something this big into the inflexible state constitution and having it run by a largely unaccountable board provokes serious concerns. Besides governance issues, other key questions include what health problems would be covered, how physicians would be paid, how care delivery would change, how the system would be administered, and how Colorado’s economy would be impacted. The bottom line is that we just won’t know the answers to those questions until after the amendment passes and the yet-to-be seated board acts. That unknown is too big of a risk to foist on ophthalmologists and the Colorado patients they serve.

Since we oppose ColoradoCare, does that mean that CSEPS therefore loves everything about the current system? The answer is an unequivocal NO. We are all confronted by a litany of daily issues in dealing with today’s commercial and government payers. Clearly there are a lot of problems with the current system, but ColoradoCare is not the solution given its deeply flawed and “to be determined” nature. I encourage you to study the proposed amendment and join CSEPS in opposition to it this fall. 

Robert G. Fante, MD

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Gratitude

Posted By Administration, Tuesday, May 3, 2016

Like all of you, most days I feel intensely grateful for the cool job and skills I have, for the wonderful patients sent to me, for the dedicated teams in my office and the ASCs, and for my good fortune to be working in America in the 21st century.  But I probably don’t say ‘”thank you” nearly enough, especially to the teams that make it possible for me to do what I love to do. Quite simply, they help me and my practice do great things.  And although it is not as everyday obvious, I consider CSEPS part of my team too. 

CSEPS helps to fight for what’s important to me, such as the recent passage of the eye drop early refill bill, while CSEPS events and educational programming keep me connected to my peers and in the know. Over the past few years, CSEPS board member Dr. Adrienne Ruth has put together a series of blockbuster social mixers and Case Club discussion series. Continuing education events such as the visits by Dr. Ruth Williams last year, or Dr. Bob Wiggins next month are also terrific.  And although you might think that as president I would be aware of everything happening in our state (I’m not), I am particularly thankful to our politically savvy ED Chet Seward, our lobbyist Chris Howes, and ophthalmologists around the state who point me toward issues that matter to us, such as the Colorado Care initiative, a misguided attempt to create the first single-payer state health care system in the US (find information here and here). CSEPS is even building a team that will help me give back in a concrete way - Vision4Colorado (stay tuned for more information soon). Ophthalmologists in Colorado improve and preserve vision for our patients, and we work very well as a team, both at the grassroots and organized levels. I am very thankful for the opportunity to be here in Colorado with all of you, and I’m looking forward to our progress together in the years to come.

Robert G. Fante, MD

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January/February 2016 - Welcome to 2016 - another new year full of promise

Posted By Administration, Monday, January 18, 2016

CSEPS has a long and proud history of advocacy for patients and physicians to improve quality, collegiality and justice in health care. Last year, CSEPS offered a variety of programs and initiatives to help physicians cope with the changes in coding and reimbursement. Although these will continue, this year’s focus will be to find more ways than ever to improve eye care for the people of Colorado. As a big start, Rep. Beth McCann of Denver will introduce a bill later this month that will guarantee early refills for our patients on sight-sustaining ophthalmic medications if they run out early. Once this becomes law, Coloradans with glaucoma and other conditions will benefit tremendously, and your CSEPS team will have helped to make it happen.

In 2016, CSEPS will also initiate a new program, VISION 4 COLORADO, to provide free surgery for the underserved in our state. I invite all of you to get involved. Our pilot program will start in Denver and Colorado Springs, and will rely primarily on the altruism of Colorado ophthalmologists, and the goodwill of the companies that support us year-round. This new initiative will dovetail with CSEPS’ existing involvement in Von’s Vision that provides exams and glasses to underprivileged children in Colorado. All of us see indigent or uninsured patients who need eye surgery, and this program will help us provide that surgery in an equitable and organized way. You can click here to sign up to join us in giving back to our community through this program, as part of the planning team and/or as one of our surgeons. Watch for more details!

Thank you for all that you do every day to enhance the health of the people of Colorado. Feel free to contact me with any ideas, questions, or comments.

Robert Fante, MD

 

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