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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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Top tags: advocacy  health plans  practice management  2014 legislative session  Avastin  MACRA  AAO  Coffman  compounding  CSEPS Connect  FDA  health advisory alert  HIPAA  IPAB  legislator  Medicaid  Medicare  member meeting  mergers  MIPs  pay issues  payer issues  payment reform  PDMP  QPP  reimbursement  repackaged drugs  US Congress 

Codequest brings strategies for practice viability

Posted By Administration, Tuesday, May 3, 2016

Anyone that’s willing to battle through the complexities of ophthalmology coding every day is tough. Codequest 2016 in Denver was a testament to this unfailing commitment as over 70 hearty physicians and practice staff battled through a spring snowstorm to attend. Elizabeth Cottle from the American Academy of Ophthalmology Executives once again provided an engaging presentation detailing how to code correctly, providing information on the latest ophthalmology coding trends, and practical strategies to reduce audit triggers and avoid costly penalties and denials. CSEPS is proud to partner with AAO to offer this premier ophthalmic coding course. Plans are already being made for next year’s course. Watch for details soon. 

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AAO Mid-Year Forum: Spring advocacy

Posted By Chet Seward, Tuesday, May 3, 2016

by AAO Councilor Alan Kimura, MD, MPH
 
CSEPS current and emerging leaders descended upon the nation’s capitol to champion ophthalmology’s priorities. We visited with Colorado’s Congressional Delegation, focusing on: large cuts to retina and glaucoma procedures, the need for continued funding of the National Eye Institute, and relief from EHR “meaningful use” penalties. Colorado sponsored two young ophthalmologist Advocacy Ambassadors - Drs. Cara Capitena and Gabriela Rodriguez-Colon. Both did a fantastic job representing Colorado and the profession.

From left, Drs. Gabriela Rodriguez-Colon and Cara Capitena.

Following our day of Congressional visits, the AAO Mid-Year Forum began. Presentations featured the rapidly expanding AAO IRIS clinical data registry, new value-based payment models under MACRA, how to survive in small practice, and public reporting of physician costs and quality. 

Next, state ophthalmology societies gathered in regional meetings to learn about local priorities and share best practices. Check out the CSEPS semi-annual report to AAO summarizing our activities on behalf of Colorado ophthalmologists.  Highlights include successful passage of the eye drop early refill bill, and many educational and social mixer programs. 

The AAO Council met as the final session of the Mid-Year Forum.  The Council’s role is to deliberate and advise the AAO Board of Trustees.  Council Advisory Recommendations (CARs) included a number of pressing policies: optometry co-management, relief from ABO’s maintenance of certification, and ways to strengthen state government advocacy.

If you have not attended an AAO Mid-Year Forum in the past, then I strongly recommend that you join us next year in Washington, DC April 26-29, 2017.  As the CSEPS Councilor to the AAO Council, I am always interested in hearing from you, to hear your perspectives and elevate your priorities to the national level.

Tags:  AAO 

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Opposing Medicare Part B payment model

Posted By Chet Seward, Tuesday, May 3, 2016

CSEPS joined almost 30 other Colorado organizations in a letter to the Colorado Congressional delegation urging them to intervene and request that the Centers for Medicare & Medicaid Services (CMS) withdraw their proposed rule that would implement a new Medicare Part B drug payment model. CMS is focused on implementing alternative payment strategies and how those efforts affect physician-prescribing patterns, especially for high priced provider-administered drugs. The proposed initiative would greatly impact retina specialists and others who do intravitreal injections. The proposed initiative would reduce the add-on to the average sales price below the current 6 percent that providers are paid to administer drugs. As proposed, CMS would pay this average sales price, plus 2.5 percent. In addition, there would be a flat $16.80 administrative fee. These numbers do not include the current sequestration adjustment, and therefore physicians would only receive a fraction of that add-on. There is a growing backlash as the issue heats up in Congress. Be sure to review more background information from the AAO on this ill-advised proposal,read the letter that CSEPS sent to the Colorado Congressional Delegation and consider writing a letter to CMS yourself (comments are due by May 9). CSEPS will continue to advocate in opposition to this proposed program.

Tags:  Medicare  payment reform 

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Take it or leave it: What it's really like to deal with health plans

Posted By Administration, Tuesday, May 3, 2016

CSEPS leadership recently participated in a listening session with the Colorado Division of Insurance (DOI) Commissioner Marguerite Salazar and her boss Division of Regulatory Affairs Director Joe Neguse. Convened by the Colorado Medical Society (CMS), the purpose of the meeting was to hear first hand from physicians what they experience dealing in working with health insurance plans. CSEPS board members Alan Kimura, MD, MPH, and Ron Pelton, MD, PhD, joined about 30 other physicians in a two and a half hour session focusing on issues ranging from delayed payment, prior authorization problems, to inability to negotiate fair contracts.

“As a solo practice physician I feel unimportant to insurance companies and powerless to fight against them. I was surprised to find that even big practices feel the same way,” said Dr. Pelton.


DORA Executive Director JoeNegus and DOI CommissionerMarguerite Salazar.

The listening session was particularly opportune as the DOI is in the middle of developing new regulations regarding network adequacy, along with considering whether or not to block the proposed merger of Anthem and Cigna. The session was also a powerful reminder about the importance of active advocacy. Commissioner Salazar has agreed to convene a separate group in an attempt to address some of these issues. CSEPS is grateful to CMS for the opportunity to participate in the listening session and welcomes the chance to continuing to work on these problems in the future. Paraphrasing Benjamin Franklin, Dr. Pelton concluded that we have to hang together on this or we will continue to hang separately.

 

Tags:  advocacy  health plans  pay issues 

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CSEPS joins fight against health plan mega-mergers

Posted By Administration, Tuesday, May 3, 2016

Four of the five largest health plans in the state have announced their intentions to merge and CSEPS is actively opposed. Last year Aetna announced that it intends to merge with Humana, and Anthem gave the nod to buy Cigna. The effect of these health plan mega-mergers will be profound on the Colorado marketplace. The CSEPS board of directors recently reviewed the proposed mergers and after deliberation unanimously voted to oppose the deals on the grounds of their anti-competitive nature and the adverse impacts that they would have on patient care and ophthalmology practices.

Regulators both locally and nationally are reviewing the mergers and have varying powers to block them. Nationally the Department of Justice is actively reviewing both deals. The Colorado Division of Insurance has already determined that the Aetna-Humana does not violate state anticompetitive standards. This ruling came without public hearings and raised concerns across the health care system. The DOI intends to hold hearings and conduct an independent analysis of the Anthem-Cigna merger. Once Anthem-Cigna submits formal paperwork a regulatory clock starts and it will be essential for ophthalmologists across the state, especially in already overly concentrated health insurance markets to share their stories about why this deal is bad for patients, eyeMDs and the state. It is unclear when exactly that filing will actually occur and the formal DOI process will start, so please be on the look out for a CSEPS member alert. Please send us a note about why you’re concerned about the mergers and how they may impact your care of patients and your practice. Staff will compile these stories for use during upcoming DOI public hearings. CSEPS joins a number of other state specialty societies, the Colorado Medical Society and consumer groups in opposition to the mergers

 

Tags:  advocacy  health plans  payer issues 

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(i)mmersion Day: Host a legislator

Posted By Administration, Tuesday, May 3, 2016

With a seemingly harmless, quick vote policy makers can dramatically change how and where you can practice ophthalmology in Colorado. That is why it is so important for legislators to understand what you and your practice team do every day with patients to preserve and promote vision. CSEPS is once again coordinating legislator site visits with local eyeMDs so that these policy makers can see an actual surgery and learn more about behind the scenes billing and practice management. (i)mmersion Day is a great chance to connect with local legislative leaders and build lasting relationships that can help you and your profession the next time a “quick vote” on eye care surfaces at the capitol. If you are interested in hosting a local legislator at your practice/ASC then please send a note to CSEPS staff here. Watch for more details.

Tags:  advocacy 

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CSEPS Day at the Capitol: Big success

Posted By Administration, Tuesday, May 3, 2016

Drs. Alan Kimura, David Johnson and Leonard Seibold take a break from advocacy activities with Rep. Beth McCann (center).

On March 18, 2016, Colorado ophthalmologists converged on the state Capitol for a morning of advocacy, education and relationship building. Attendees experienced a whirlwind of advocacy activities ranging from one-on-one meetings with their local legislators, to group presentations by legislative leaders to coveted visits to the actual floors of both the Senate and House chambers. Almost all of the residents and fellows from the department of ophthalmology at the University of Colorado attended thanks to the leadership of Leonard Seibold, MD, who envisioned the Day at the Capitol during his participation in the AAO Leadership Development Program.

Attendees did a great job of representing the profession by not only putting a face on medicine but also sharing a little about what life is like as a surgeon that works every day with patients on their vision needs. Legislators repeatedly thanked and encouraged greater participation by ophthalmologists in the legislative process. The group had broad participation by legislators from both parties and from both chambers including:

  • Sens. Larry Crowder, Randy Baumgardner, Mike Johnston, Linda Newell, Irene Aguilar, Beth Martinez Huminek, Jack Tate and Senate Minority Leader Lucia Guzman
  • Reps. Beth McCann, Su Rydell and Paul Rosenthal

Check out the complete photo gallery of the day’s events, including some of the intricate architectural details of the Capitol. 


Day at the Capitol attendees enjoy a rare moment on the floor of the Senate with Sen. Mike Johnson (c).

Did you miss your chance to attend the CSEPS Day at the Capitol? Plan on attending next year’s event and in the meantime consider hosting a legislator at your practice or surgery center so that they can see you in action. See details about (i)mmersion Day.

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Open Payments Program: Review Your Data Before it Becomes Available to the Public in June 2016

Posted By Chet Seward, Sunday, May 1, 2016

Ophthalmologists are encouraged to review and dispute any data within the federal Open Payments database before it is the 2015 data goes live on June 30, 2016. Updates to 2013 and 2014 data will also be published at that time. 

Since 2013, the Centers for Medicare & Medicaid Services’ (CMS) Open Payments program (also known as the Sunshine Act) has collected data from drug and device manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals. The program also collects information about ownership and investment interests of physicians and their immediate family members in drug and device manufacturers and GPOs. CMS publishes this data on its website, so it is important for physicians to check and confirm the accuracy of the financial transactions reported about them.

The review and dispute timeframe opened on Friday, April 1, 2016, and will end on May 15, 2016. In order for any disputes to be addressed before the June 30 publication, physicians must initiate their disputes during the 45-day review period, and industry must resolve the dispute before the publication deadline. Review and dispute is voluntary, but strongly encouraged. The opportunity for physicians to review and dispute the data submitted about them expires at the end of the year that the record is first published. 

If You Have Never Registered with Open Payments Before:

Make sure you have your National Provider Identifier (NPI) number, Drug Enforcement Agency (DEA) number, and State license number (SLN).  Initial registration is a two-step process and should only take 30 minutes:

  1. Register in the CMS Enterprise Identity Management System (EIDM);
  2. Register in the Open Payments system

For Users That Registered Last Year and Have Used Their Accounts in the Last 60 Days:

Physicians who registered last year do not need to reregister in the EIDM or the Open Payments system. If the account has been accessed within the last 60 days, go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.

For Users That Registered Last Year but Have Been Inactive for More than 60 Days:

The EIDM locks accounts if there is no activity for 60 days or more. To unlock an account, go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions; you’ll then be prompted to enter a new password. 

For Users That Registered Last Year but Have Been Inactive for More than 180 Days:

The EIDM deactivates accounts if there is no activity for 180 days or more. To reinstate an account that has been deactivated, contact the Open Payments Help Desk.

For more information about the registration process, visit the physician and teaching hospital registration page on the Open Payments website.

For assistance with the registration process, please call our live Help Desk at 1-855-326-8366, Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET), excluding Federal holidays. Questions can also be submitted to the Help Desk via email, at openpayments@cms.hhs.gov.

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Seibold Graduates from AAO Leadership Development Program

Posted By Kate Alfano, Monday, January 18, 2016

For many years the American Academy of Ophthalmology has conducted a leadership development program for national and international ophthalmology leaders. Denver glaucoma specialist and CSEPS board of directors member Leonard Seibold, MD, was one of just 18 physicians selected to participate in in the 2015 AAO Leadership Development Program. During the Society Presidents’ Recognition and Awards Session held in conjunction with AAO 2015 in Las Vegas, Dr. Seibold graduated from the program.

“My experience in the LDP program was very positive throughout,” said Seibold. “The program takes you through an intense course designed to develop leadership through inspiration, workshops and practical application. The program coordinators and educators were routinely excellent and took a vested interest in ensuring a meaningful experience for all. In addition to fostering leadership skills, the program included involvement at AAO council meetings as well as exposure to Academy leadership and the organization as a whole. Perhaps the greatest and most lasting impact of the LDP program will be the friendships made with my classmates and Academy staff and leadership involved with the program. I am grateful to CSEPS for their sponsorship and would highly encourage anyone with an interest in leadership or advocacy within our profession to consider the LDP program.” 

In January 2015, Dr. Seibold took part in a 2 ½ day interactive session in San Francisco covering a wide variety of leadership and association management topics. The meeting also included a visit to AAO headquarters to hear from the 2015 Academy President Russell Van Gelder, MD, PhD; CEO David Parke II, MD; and Academy vice presidents on key priorities for the Academy. Next was a trip in April 2015 to attend the AAO’s Mid-Year Forum in Washington D.C. where Seibold visited many members of Colorado’s Congressional delegation as part of Congressional Advocacy Day. During the final LDP XVII session in Las Vegas, LDP 2015 class members heard from leadership of the AAO and the Pan-American Association of Ophthalmology regarding global collaborative efforts and priority issues for organized ophthalmology.

CSEPS is proud of Leonard Seibold, MD, and looks forward to good things from him in the future!

 

Graduates of the AAO Leadership Development Program XVII, Class of 2015

  • Alabama Academy of Ophthalmology - Lindsay A. Rhodes, MD
  • American Academy of Pediatrics, Section on Ophthalmology / Pennsylvania Academy of Ophthalmology - David I. Silbert, MD
  • American Association for Pediatric Ophthalmology & Strabismus -Faruk H. Orge, MD
  • American Association of Ophthalmic Oncology and Pathology - Heather A. D. Potter, MD
  • Colorado Society of Eye Physicians and Surgeons - Leonard K. Seibold, MD
  • Indiana Academy of Ophthalmology - Yara P. Catoira-Boyle, MD
  • Iowa Academy of Ophthalmology - Michael H. Scott, MD
  • Lebanese Ophthalmological Society - Nadu S. Jabbur, MD
  • Louisiana Academy of Eye Physicians and Surgeons - Pamela E. Williams, MD
  • Missouri Society of Eye Physicians and Surgeons - David E. Vollman, MD, MBA
  • Montana Academy of Ophthalmology - Scott M. Guess, MD
  • National Medical Association - Ophthalmology Section - Atif B. D. Collins, MD
  • New York State Ophthalmological Society - Grace Sun, MD
  • Ophthalmic Mutual Insurance Company - Michael C. Tigani, MD
  • Society of Military Ophthalmologists - Rachel A. Lieberman, MD
  • Tennessee Academy of Ophthalmology - Janice C. Law, MD
  • Utah Ophthalmology Society - James G. Howard, MD
  • Virginia Society of Eye Physicians and Surgeons - Geoffrey G. Cooper, MD

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Capitol view – Your insider news from the Colorado Capitol

Posted By Administration, Monday, January 18, 2016

by Chris Howes 

The New Year has begun and the General Assembly has convened for the 2016 session. The state legislature is still split, with Democrats controlling the House and Republicans controlling the Senate, so we can expect many of the same battles from last year to again end in a stalemate and never make it to the desk of Gov. Hickenlooper. 2016 is an election year so we can also look for plenty of proposed bills and heated rhetoric designed to get political opponents officially on record on controversial issues. Because Colorado is so politically divided right down the middle we can expect tens of millions of dollars to be spent in our state on TV advertising for the presidential race, Michael Bennet's U.S. Senate seat and dozens of separate ballot measures. We can’t wait!

CSEPS is championing a bill concerning Health Insurance Coverage for Early Refills of Prescription Eye Drops. Many thanks to Rep. Beth McCann of Denver for agreeing to be our bill sponsor. We have already met with a number of members of the legislature who serve on the House and Senate health committees and we look forward to gaining even more support for this important bill as it moves through the legislative process. The bill is expected to be introduced and then heard in committee by the end of January. We need your help in two ways: 1) take the 3 minute eye drop online survey to help inform our advocacy and 2) consider coming to the Capitol to testify in support of the effort (contact me for details).

Be sure to mark your calendars for our upcoming Day at the Capitol on Friday, March 18. This will be a great chance to meet your legislators in person, help us gain support for the eye drop refill legislation and generally be a strong proponent for our profession. Click here for more information and to register.

The State Capitol is a very busy place from January to early May because the Colorado General Assembly only meets for 120 days each year. Some 700 bills will be introduced, debated in public and voted on. More than half of those bills will never pass. With such a fast pace and over a hundred lobbyists in the building trying to influence the process, it's hard to pass a bill. You can help us increase our chances of developing champions for the profession by contributing to our Political Action Committee (EYEPAC) and small donor committee. Thank you for your support and your participation. 

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