ADEMS Past-President and CMS President-Elect Dr. Katie Lozano joined CMS President Dr. Michael Volz and physician leaders from Denver, Mesa, Northern Colorado, and Aurora-Adams Medical Societies on Capitol Hill in Washington, DC, late February, to advocate for physicians and patients. The delegation focused on educating the Colorado congressional delegation on four main issues:
Opioid abuse and misuse has reached a national public policy level and both the administration and the federal legislative branch are now involved in developing solutions. With concern that physicians could easily be put in the crosshairs of a solution, the Colorado NAC delegation discussed what Colorado physicians are already doing to address the issue. They shared that recently the CMS board of directors voted to make the abuse and misuse crisis a priority in 2012 actively participates in the Colorado Consortium to Prevent Prescription Drug Abuse. And CMS is partnering with multiple organizations to provide educational modules for physicians.
The proposed mergers of Aetna-Humana and Anthem-CIGNA are controversial; both chambers of Congress held hearings last year. State insurance commissioners and the U.S. Department of Justice are largely the deciders on whether the mergers are approved, denied or modified and the insurance companies have invested tremendous resources into pushing the mergers through. CMS is taking these mergers and their potential impact on physicians and patients very seriously and discussed our concerns.
The Hill visits were part of the American Medical Association’s National Advocacy Conference, which brought together over 30 state medical associations to hear the latest on national health policy and the politics of the 2016 election cycle. This was the first trip in well over a decade that physicians did not have to lobby for a fix to the sustainable growth rate (SGR).
(Photo/Content Credit: CMS ASAP March 1)
ADEMS joins CMS' opposition of SB 152,
"Notifications of Health Care Billing Charges for Covered Persons" - Killed in Committee.
Senate Bill 152, "Notifications of Health Care Billing Charges for Covered Persons," was voted down in committee Wednesday, March 16. The Arapahoe Douglas Elbert Medical Societiy along with other specialty and component societies supported the Colorado Medical Society in opposing the bill. Physicians from ADEMS and societies in key senate districts were called upon to reach out to their senators to express their concern.
CMS President Michael Volz, MD, testified against the bill. He explained that CMS and the Colorado Association of Health Plans entered into a professionally supervised mediation from September to January in an effort to find mutually beneficial solution to issues arising from out-of-network services and charges and other matters relating to network adequacy, but that the health plans decided to end the mediation without resolution.
"We understand that Sen. Aguilar [the bill sponsor] wants resolution to this issue as badly as we do, but her SB 152 is not the answer. It is punitive, unfair, unworkable and will give health insurance companies even more market power than they have today - and they have plenty."
Analysis showed SB 152 would pose problems for Colorado physicians because it had the potential to:
- Create ambiguity as to the carrier's existing responsibility to pay the out-of-network (OON) physician's bill.
- Make it difficult for physicians to get paid.
- Expand the value of a lawsuit by creating a private cause of action for plaintiffs against physicians for deceptive trade practices exposing physicians to three times the amount of actual damages (treble damages)
CMS thanked the Republican leadership and senators who voted to oppose the bill and also physicians who testified against the bill and contacted their senators. CMS will continue to work with legislators and healthplans to reach an agreement that addresses these complex issues.
(Content Credit: CMS ASAP 3/18)