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SlitLamp provides illuminating e-news for Colorado ophthalmologists. It keeps you in the know on the evolving Colorado health care scene by detailing the latest legislative and regulatory happenings. It also spotlights the information and resources you need for your practice.

 

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Executive Director's Update: Thanks, I Forgot

Posted By Chet Seward, Thursday, February 6, 2020

If you have kids, then perhaps this scenario sounds familiar. In the past as one of my children ambled out the door in the dead of winter (frequently in short sleeves), I would ask, “Did you grab a coat?” I would often get a gruff harrumph in retort, but sometimes I would get, “Thanks, I forgot.” While my kids are far too old now for nagging, I was reminded of that reply recently when talking with a CSEPS member who is glaucoma specialist about the eyedrop early refill bill that CSEPS helped to pass in 2016. Except in this instance the roles were reversed, as I was the one doing the thanking while muttering about my memory.

This law provides important protections for patients, especially those with chronic eye conditions like glaucoma that require regular eyedrops. If patients run out of drops because of unintentional wastage before the prescription is due, then they can get a refill within certain time frames. It sounds pretty commonsense, but it required some savvy CSEPS advocacy to pass the bill.

But here’s the thing – many patients and even some ophthalmologists don’t know about these protections for eye health. Whether they never knew or just had a memory lapse, it is important to educate and remind people about this law. Here is a one-page fact sheet for you to hand out to your patients and display in your waiting room. So if your patients are experiencing problems getting their eyedrops refilled by pharmacists or health plans then encourage them to use this resource so that they can get the medicine they need. Bottom line, when good work gets done, we want to ensure that your patients continue to reap the benefits. Who knows maybe you will even get a thanks – just don’t forget your coat. It’s cold out there.

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Coronavirus: Information to be prepared

Posted By Chet Seward, Thursday, February 6, 2020

While concerns about the new 2019-nCoV coronavirus are growing, authorities are emphasizing the need to be informed and prepared. Now is the time to ensure that you and your practice are prepared for an outbreak and there are good resources available from the state health department to bring you the latest news and provide you as a physician with the important resources including assessments, checklists and the latest clinical guidelines.

The American Academy of Ophthalmology has also shared important ophthalmology-specific information related to the new 2019-nCoV coronavirus.

CSEPS encourages you to review all of this information. 

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Call Congress: Fix prior auth headaches

Posted By Chet Seward, Thursday, February 6, 2020

Are you tired of paying staff extra to deal with Medicare Advantage prior authorizations or getting claims finalized? A bipartisan bill working its way through Congress, H.R. 3107 the Improving Seniors’ Timely Access to Care Act, may help solve some of these problems but grassroots pressure is needed to move it along. Use this link to learn more about the proposed act and to contact your member of the Colorado Congressional delegation to support federal HR 3107.

This is what it would do:

  • Establishing an electronic prior authorization (ePA) program for Medicare Advantage plans;
  • Prohibiting MA plans from requiring additional PA on any surgical or invasive procedure that was performed during an already-authorized procedure or a procedure that did not require PA;
  • Creating a process for “real-time decisions” for services for which PA requests are routinely approved;
  • Establishing beneficiary protections under MA plans; and
  • Developing transparency requirements for MA plans to abide by.

Feel free to share the link on other physician social media groups: http://www.votervoice.net/Shares/BAAAAAupACMTQAtlwwV7FAA

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Surprise bill legislation: Out-of-network data now available

Posted By Chet Seward, Thursday, February 6, 2020
One of the most highly contested bills (HB 19-1174) from the 2019 legislative session focused on how to protect patients from surprise bills for health care services from out-of-network providers. The legislation designated the Colorado All Payer Claims Database (CO APCD) as a data source for determining payment for out-of-network provider and emergency services. The CO APCD is specifically being used to calculate the 50th percentile paid (allowed) amounts for Emergency Department visits and 60th percentile paid amounts for Professional/Anesthesiology services by region and statewide. The bill went into effect on January 1, 2020, and the first datasets generated by CIVHC and other related resources are now available on the Division of Insurance (DOI) website. If you provide out of network services then be sure to review these resources. 

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CSEPS Election Results

Posted By Chet Seward, Thursday, February 6, 2020

Thanks to all CSEPS members that voted for new leadership during the 2019 membership wide elections. Congratulations to the following leaders for their elections to leadership positions within CSEPS:

  • Ron Pelton, MD, PhD, President-elect
  • Rebecca Braverman, MD, AAO Councillor,
  • Robert Fish, MD, Treasurer,
  • Matt Asano, MD, and Roman Krivochenitser, MD at-large members of the board of directors.

Thank you in advance for your time and your leadership.

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Executive director's update: Tectonics

Posted By Chet Seward, Friday, November 22, 2019

Chet Seward,
Executive Director
Maybe it is because the end of the year is approaching faster than my to-do list would like, but these days it seems like there are a ton of important things in motion. Health reform changes that are underway and planned in Colorado have caught the attention of the nation. Indeed, at a recent conference I heard Colorado referred to as the hot bed of health policy changes. Last year’s Democrat sweep of every state office continues to be felt as Governor Polis and legislative leaders have embraced activist roles and demonstrated a willingness to shake things up. Given the continuing impact of recently passed legislation all signs point to another very interesting legislative session in 2020 where ophthalmology will need to be both thoughtfully prepared and actively engaged.

Consider just a few of the bills that rocked the Colorado health policy world last year including the creation of a state reinsurance for the individual insurance market that has decreased premiums up to 20%, capping physician out of network fees associated with surprise bills, directing the creation of a public option plan (see Capitol View story above), and a string of skunk-works mission bills to uncover more hospital and pharmaceutical pricing and cost data that can be used to drive other seismic bills in the future. While decreasing the cost of care is a priority in Colorado, it’s critical to note the continued push throughout the states, including our immediate neighbors, by the optometric community to expand their scope of practice. The projections are that approximately 20 states in 2020 will see surgical scope expansion battles and Colorado ophthalmology must be on firm footing and ready to respond.

The CSEPS board grappled with the opportunities and challenges of these tectonic shifts during their October board meeting as they set aggressive plans for the coming year to protect and advance ophthalmology’s priorities. This is where you come in – by remaining a CSEPS member, staying informed about our work, and taking steps (small and large) to get engaged by meeting with your legislator or serving as a volunteer with CSEPS.

Even when the world moves unexpectedly there are ways to stay safe, to make sense of things and to move forward prosperously. When it comes to advocacy, information and professional connectivity I hope that CSEPS serves these foundational needs for you, your practice and your patients.

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Pueblo eyeMDs meet with Sen. Garcia

Posted By Chet Seward, Friday, November 22, 2019

From left Eric Blom, MD, Anak Shrestha, MD, Ron Pelton, MD, PhD, Sen. Leroy Garcia and James Luu, MD

One of the most impactful and important advocacy actions that ophthalmologists can take is to get to know their local legislator. Policymakers welcome these interactions and with a quick phone call you can create lasting strong relationships with the people that profoundly affect your practice. Leaders from the Pueblo area recently met with Colorado State Senate President Leroy Garcia. They learned about Sen. Garcia’s service as a marine and his work as a paramedic and an emergency medical services teacher at Pueblo Community College. The group discussed the importance of surgery being done by surgeons and other health care issues. If you need help setting up a meeting with your legislators just contact CSEPS.

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Urge Congress to support positive payment update for physicians

Posted By Chet Seward, Friday, November 22, 2019

CSEPS is engaged in fighting a scheduled six-year pay freeze that is set to go into effect on January 1, 2020. Please join us in urging Congress to support a positive payment update for physicians.

 

Urge Your Elected Representatives to Support a Positive Payment Update for Physicians

 

The Medicare Access and CHIP Reauthorization Act (MACRA) provided for modest payment increases for the first five years of the new law. But even with these increases, payment rates still have not kept up with inflation. The cost of running a medical practice increased 32 percent between 2001 and 2018, or 1.7 percent per year far outpacing the 0.4 percent on average increase in Medicare physician pay over the last decade and a half. By contrast, other Medicare providers such as hospitals and skilled nursing facilities have seen their pay increased by 50 percent or more over the same time period.

Under MACRA, physicians will receive zero percent payment updates for years 2020-2025. CSEPS, the American Academy of Ophthalmology, the American Medical Association and other physician organizations have launched a campaign to stop the six-year freeze on physicians' annual pay increase, which begins in January 2020. To stop this pay freeze, Congress must be convinced to act via changes to MACRA, a challenging process that could cost billions of dollars. If Congress doesn’t act, many physicians who see Medicare patients will be negatively affected. Use the American Academy of Ophthalmology’s online advocacy tool to tell your federal lawmaker to join the effort.

Contact Dash Delan, the American Academy of Ophthalmology’s grassroots coordinator, with questions or concerns.

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Save the date: CSEPS legislative reception – January 22, 2019

Posted By Chet Seward, Friday, November 22, 2019

Mark your calendar to the annual CSEPS legislative reception on January 22 from 7:30-8:45am at the University Club in Denver. This is your chance to make an impact on the future of ophthalmology. With a push of a button to vote on a bill, state legislators can radically change where and how you can practice ophthalmology. Look no further than the optometric scope of practice battles sweeping the nation, including recent pushes in Wyoming and Utah, and you will understand the importance of having strong relationships with legislators. 

 

Plan on starting your morning off strong that day by meeting legislators, learn more about how public policy is affecting your practice and your patients, and build lasting relationships with policymakers. Consider it an investment on behalf of your patients and your profession. Register now for this free event.

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New local guidance on billing for Avastin

Posted By Chet Seward, Friday, November 22, 2019

David Johnson, MD

Attention all CSEPS members who use Avastin (bevacizumab) for treatment of eye disease. Please read the following article on the CMS.gov website regarding changes in how to bill for Avastin (bevacizumab), using code J7999:

 

Article A53121 Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases.

 

Novitas representatives informed AAO staff and regional Contractor Advisory Committee (CAC) members, in a phone conference on 11/13/19, that they now request an invoice from the Avastin source/compounding pharmacy, along with billing the correct J code, in order to determine proper reimbursement. The AAO has suggested the benchmark of $97.00 per syringe, which is currently in place with contractor Noridian. Stay tuned for further developments!

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