Print Page   |   Sign In   |   Join
SlitLamp E-News
Blog Home All Blogs
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.


Search all posts for:   


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 

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 

Share |
PermalinkComments (0)

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 

Share |
PermalinkComments (0)

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 

Share |
PermalinkComments (0)