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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 

Ready for MACRA and value-based payment? TCPi can help

Posted By Chet Seward, Tuesday, December 6, 2016

Without some help doing two things at once is often a prescription for failure. With the looming implementation of Medicare’s Quality Payment Program and accelerating efforts by commercial health plans to pay for your care in different ways, you may be wondering how you can keep your practice running in the so called “old way” while simultaneously enhancing your systems and practices in pursuit of “new” value-based payment models.  This is hard work. 

Luckily as a practicing ophthalmologist in Colorado you have access to free quality improvement and practice transformation coaching and other resources through the Transforming Clinical Practices Initiative(TCPi) funded by the federal government. The initiative offers:

  • Business process development for new models of payment;
  • Change management and skills development for practice champions;
  • Efficient and effective referral processes – right patient in the chair with the right information;
  • Reporting and using data to drive improvements and to demonstrate the value of care;
  • Tools and training to develop effective care coordination and manage transitions in care; and
  • CME and credit for part IV of Maintenance of Certification.

With TCPI you can do two things at once. Get the help you need to make the necessary practice changes to thrive under new payment models, while surviving in current models as the system transformation occurs over time. Limited slots are left. Read more about TCPi here and sign up today. 

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Health plan pain points: eyeMDs identify top priorities

Posted By Chet Seward, Tuesday, December 6, 2016

Almost 30 Colorado ophthalmologists and their staff met on August 24, 2016, in Denver to discuss the challenges that they are facing in doing business with commercial health plans. CSEPS called the meeting in order to understand what some of the current, pressing issues that ophthalmology practices are struggling with so that CSEPS can devise appropriate advocacy strategies to address them.

It didn’t take long for the group to warm up and soon the room was bursting with stories demonstrating the growing frustration with increased bureaucracy and inefficient systems that are increasing costs. Cataloguing these concerns comes at a pivotal time as CSEPS opposes the Anthem-Cigna and Aetna-Humana mega mergers, and as the Colorado Division of Insurance is in the process of crafting new regulations on health plan network adequacy along with convening a new Physician Advisory Group. Key pain points identified include ineffective provider representatives, too many audits resulting in withheld or inappropriate payments, no access to renegotiate contracts and faulty designation formulas and programs. Review the full report here. The CSEPS board will take up these identified priorities during their November board meeting in advance of making an operational plan for the upcoming year. Members are encouraged to review the report and share what currently “hurts most” for them with commercial health plans.

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(i)mmersion Day: Rep. Ginal

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

Rep. Joann Ginal, PhD, (D- Fort Collins) is no stranger to health care given her deep background in bioscience and pharmaceuticals, and as member of both the Colorado House of Representatives Health, Insurance and Environment Committee and the House Public Health and Human Services Committees. She’s also no stranger to ophthalmology as she worked with her ex-husband for years in his ophthalmology practice. Even with all of that experience, Rep. Ginal learned something new during a visit in July to the Eye Center of Northern Colorado to see CSEPS board of directors member Kent Bashford, DO, perform a cataract surgery. She remarked that surgery has become more sophisticated and intense over the years since she had last seen one.


Kent Bashford, DO, (right) explains details of a surgery with Rep. Ginal (front left).

The visit was part of the CSEPS (i)mmersion Day project that connects legislators with local ophthalmologists to witness a surgery, get a first hand look at what it takes to run a practice and importantly build some lasting relationships. Are you interested in hosting a legislator at your practice? CSEPS is setting up more meetings for the fall so if you’re willing then please contact Chet Seward in the CSEPS offices.

CSEPS is grateful to Rep. Ginal for her time and leadership. A big thanks also goes out to Dr. Bashford and his great team at the Eye Center of Northern Colorado. “I am so proud of ophthalmology and the way this profession does wonderful things for people,” concluded Rep. Ginal.

Tags:  advocacy  legislator 

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DOJ sues to block health plan mega mergers

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

In July the U.S. Department of Justice (DOJ) issued lawsuits to block the proposed mega-mergers between Anthem and Cigna and Aetna and Humana. The Colorado Society of Eye Physicians & Surgeons joined numerous other physician-driven organizations in efforts to oppose these planned mergers. CSEPS opposition hinged upon the adverse effects that such mergers would have on care quality, patient access and insurance premiums given the mergers’ anti-competitive nature. Aetna and Anthem are opposing the DOJ suit. The DOJ action represents an important step and CSEPS will continue our vigorous advocacy on your behalf to ensure that your patients can get the eye care they need and that your practice can remain viable in a competitive marketplace.

Tags:  health plans  mergers 

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CSEPS positions on November ballot initiatives: ColoradoCare and tobacco tax

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

Coloradans will vote on a number of important constitutional amendments in this fall’s general election. CSEPS has taken official positions on two of these proposed changes including ColoradoCare and the tobacco tax increase.

CSEPS is opposed to ColoradoCare (Amendment 69). The initiative would create a universal health care coverage program for Colorado, essentially replacing all commercial coverage but not Medicare and Veterans coverage, paid for by 10% tax on all payroll and non-payroll income along with existing government funding. A 21-member board would be empowered to set provider rates, administer the benefits package and determine how other parts of the unprecedented program would work. Much about the program is unknown as the yet to be elected board has not decided many, important details. You can learn more about the program here (proponents), here (opponents) and here (non-partisan analysis). CSEPS opposition focuses on the sweeping, expensive and yet to be determined nature of the initiative that will be effectively locked into the state constitution should it pass. The current health care system is plagued with many problems but ColoradoCare is not the solution.

CSEPS supports the proposed tobacco tax increase that would raise about $315 million a year by increasing the existing tax on cigarettes by $1.75 and increasing the tax on other tobacco products by 22%.  Proceeds from the tax would be used to fund research on cancer treatment, lung disease and mental health, provide physical and behavioral health for 500,000 Colorado veterans, increase funding for prevention, education and tobacco cessation programs, and decreasing student debt for medical professionals in rural and underserved areas of the state. Learn more about the initiative that, as of press time, has yet to be certified for the November ballot here

 

Tags:  advocacy 

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CSEPS events: Staying local and going lean

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



From left, Drs. Ryan Rich, John Burroughs and Ron Pelton.
CSEPS regularly sponsors cutting edge educational programming and the past few months highlighted some outstanding local and national expertise. 

In May Drs. John Burroughs, Ryan Rich and Ron Pelton presented to Colorado Springs colleagues. While the presentations on blethroplasty, AMD anti-veg drugs and informed consent were great, some attendees thought the location at Johnny Martin’s Car Club was amazing. Check out pictures of some of the beautiful automobiles on display here

Not to be outdone, AAO Senior Secretary for Ophthalmic Practice Robert Wiggins, MD, MHA, came to Denver in July with a keen focus on helping to optimize Colorado ophthalmology practices through Lean Management. The essence of Lean thinking is to eliminate waste through understanding the value to the patient, using a value stream to deliver that value, creating an efficient and waste-free continuous flow system built on a pull approach, and continually pursuing perfection. Using stories from his practice in North Carolina, Dr. Wiggins both demonstrated and coached attendees on how eyeMDs and their team can excel in tomorrow’s health care system. Review pictures of the event here.

Tags:  CSEPS Connect  member meeting 

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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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