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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 

Repealing IPAB: The fight continues

Posted By Chet Seward, Wednesday, August 9, 2017

The ongoing existence of the Independent Payment Advisory Board (IPAB) provision of the Affordable Care Act has hung like a Sword of Damocles over the heads of ophthalmologists and other physicians for years. CSEPS has remained part of the fierce and focused fight to repeal IPAB, which is a panel of presidential appointees with the ability to arbitrarily enact payment cuts to physicians and other providers if Medicare's growth rate exceeds a statutory threshold.

The latest advocacy push was by a group of more than 700 organizations, including CSEPS and the American Academy of Ophthalmology, opposed to IPAB. Using a co-signed letter, the group pressed members of Congress to support existing, bi-partisan legislation to repeal IPAB.

While the Medicare Board of Trustees recently released a report that per capita Medicare spending did not exceed the statutory threshold that triggers IPAB provisions this year, the threat is very real next year

CSEPS will continue the fight to repeal IPAB in order to continue to ensure access to care for patients. Watch for action alerts in the future.

Tags:  advocacy  IPAB 

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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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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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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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Congressional advocacy

Posted By Chet Seward, Tuesday, July 15, 2014
As the federal election starts to heat up in preparation for November, CSEPS leaders are actively engaged in building relationships with the Congressional Delegation and sharing information about ophthalmology’s priorities. Drs. Richard Kelmenson and Alan Kimura met with Congressman Mike Coffman at the end of May. The conversation focused on the systemic woes within the VA system, transparency in health care marketing issues and electronic health records. Congressman Coffman is locked in a tight race for re-election to Colorado’s 6thCongressional District.

Caption: Drs. Richard Kelmenson (left) and Alan Kimura meet with Congressman Coffman (right).

Tags:  advocacy  Coffman  US Congress 

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Medicaid provider rate increases

Posted By Chet Seward, Tuesday, July 15, 2014

CSEPS joined a number of medical societies and other stakeholders to advocate for increased reimbursement rates for ophthalmologists within Medicaid during the last legislative session. (Read the letter CSEPS sent to the state here.) Access to much needed specialty care has been hampered for some time given low reimbursement rates that frequently do not cover an ophthalmologist’s costs associated with providing care.

The General Assembly and Governor Hickenlooper approved a 2% increase for most fee-for-service benefits including physician and clinic services and vision services.In addition, the legislature approved a series of targeted rate increases for specific providers, codes and specialties. According to a Department of Health Care Policy and Financing fact sheet, “These (targeted) increases are intended to address large inequities in rates and to demonstrate the Department’s priority to pay for services that provide high value for clients.” The objective was to raise codes from current levels to approximately 80% of Medicare rates. Be aware that the following eye codes were positively affected by these changes:

  • Code 92002 – Eye exam, new patient
  • Code 92004 – Eye exam, new patient
  • Code 92012 – Eye exam established patient
  • Code 92014 – Eye exam & treatment
  • Code 92018 – New eye exam & treatment
  • Code 92019 – Eye exam & treatment
  • Code 92020 – Special eye evaluation
  • Code 92060 – Special eye evaluation
The June 2014 Medicaid Provider Bulletin provides more details about both the across the board and targeted rate increases.

Tags:  2014 legislative session  advocacy  Medicaid  reimbursement 

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CSEPS presses for FDA changes on repackaged and compounded drug products

Posted By Chet Seward, Tuesday, July 15, 2014
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Legislative update - July/August 2014

Posted By Chet Seward, Tuesday, July 15, 2014
Dick Brown
by Dick Brown, CSEPS lobbyist

The 2014 Colorado legislative session is now officially on the books and CSEPS has the scoop on the bills that passed that can and will affect you and your practice. We have developed a compendium that identifies and summarizes key bills from the session that are important to ophthalmologists. This is a great resource for physicians and their office staff. The information is organized by subject area including topics like:

  • Criminal offenses;
  • Employer-employee relations;
  • Health care financing;
  • Insurance;
  • Liability and court procedures;
  • Pharmaceuticals;
  • Professions and licensing; and
  • Public health.

While the compiler is not an attorney, the compendium provides a summary and an explanation of each selected new law. Questions regarding a more technical legal question should be referred to an attorney. Access the compendium here.

Tags:  2014 legislative session  advocacy 

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