CMS board acts on issues that impact all physicians
Report from the July 11 meeting

The CMS Board of Directors met on Friday, July 11, to act on reports on telemedicine; CMS governance reform; CMS policy sunset; the 2014-15 CMS budget; and a HOD referral and policy. The Office of the Governor led a strategic discussion on the State Innovation Model (SIM) testing grant and recent Supreme Court decisions favorable to physicians were reviewed. Please review these items in more detail below.

We would very much appreciate delegates giving special attention to the board's recommendations on governance reform and letting us know if more information is needed, if you have questions, or want to provide us with any observations and suggestions. We are looking forward to seeing you at the annual meeting in September.


- CMS Speaker Robert Yakely, MD and Vice-Speaker Brigitta Robinson, MD
1. Board votes to send updated telemedicine policy to House of Delegates

The board passed a motion at the March 14 meeting directing the Committee on Physician Practice Evolution (CPPE) to continue efforts currently underway to review and update CMS policy, as appropriate, on telemedicine and electronic communications with an update to the board of directors in July and a report to the HOD in September. CPPE, headed by Peter Ricci, MD, worked diligently and in a timely manner to forward policy updates to the board. The use of telemedicine is expected to grow and not just in in rural areas. It is touted to reduce health care costs, improve the efficiency and quality of care, improve access to care, and provide needed specialist consultations. As new technologies come into the marketplace, it was clear to the board that CMS policy, now ten years old, needed to be reviewed and updated to give CMS members timely guidance, and to give the Council on Legislation direction as telemedicine is expected to be a public policy issue in the 2015 General Assembly and with the regulatory boards. 

Click here to review updated CMS policy on telemedicine that will be an action item at the House of Delegates in September.

2. Report of the board task force on governance

CMS governance reform began in earnest when the House of Delegates (HOD) approved a board report in 2012 that shortened the annual meeting from three days to two days; changed the order of business of the HOD, including the use of an on-line reference committee and elimination of the in-person reference committee; directed the board to focus HOD meetings on socialization and engagement on issues of critical importance to the profession; and directed the board to continue to pursue other improvements to streamline the annual meeting and functions of the HOD.

In January 2013, the board spent a weekend refreshing the CMS strategic plan and one of the eight outcomes of the retreat was a recommendation to study CMS governance reform, including the board of directors and the HOD. At the March board meeting, the board unanimously confirmed the eight retreat outcomes and decided to move forward on a governance study by appointing a board task force on the subject chaired by Immediate Past-president and former HOD Speaker, Jan Kief, MD. On May 30 and 31, the board's 10-member Task Force on Governance met in a weekend session professionally designed and facilitated by an expert on non-profit governance. The outcomes of the weekend session, including all background materials, were folded into a report and unanimously approved, with amendments, by the board on July 11. The recommendations in this report will be an action item at the HOD meeting in September and we respectfully request the delegates begin reviewing the report at this time and not wait for its posting in the on-line reference committee.


As you read and consider the report, we also ask you to be mindful of another important outcome of the board's January planning retreat directly related to the governance reform recommendations - a motion "directing the CEO to retain a qualified consultant to perform a communications audit assessing internal and external communication functions and to develop recommendations to upgrade these functions in a manner that increases the media exposure of CMS and substantially enhances physician engagement through an effective web presence." The point being that the board fully understands that enhanced physician engagement must be associated with any governance reforms.


Click here to read the board's recommendations on governance reform and click here to read background material including associated studies reviewed by the Task Force on Governance. Click here to read a communications audit RFP developed by our CEO. 

3. Policy sunset: Constitution and Bylaws Committee recommendations

CMS bylaws direct the Constitution and Bylaws Committee to periodically review the CMS policy manual to determine those policies that are no longer pertinent and to incorporate like policies into one policy; and that such changes will be brought to the BOD for action. The board decided in November 2013 to perform a sunset review of the CMS policy manual. Having served on the Constitution and Bylaws Committee and your House Speaker can attest that wading through the lengthy policy manual was both time-consuming and overdue. At the May board meeting, the first phase of the sunset review was presented and the board decided to delay a vote on the recommendations to give board members more time to review the recommendations. Subsequent to the May meeting, the Council on Constitution and Bylaws continued to meet to finalize their recommendations. On July 11, the board amended and approved the sunset policy recommendations. Click here to review the sunset policy recommendations that will be an action item for the HOD in September. 

4. Board approves proposed 2014-2015 CMS budget for House of Delegates approval

Every year in late June, a joint meeting of the Executive Committee and the Finance Committee convenes to review a recommended budget for the upcoming fiscal year. This balanced budget is developed by CMS staff based on expected revenues and expenses. The board voted unanimously to approve the proposed budget to send to the HOD for final approval.

Click here to read a summary review of next year's proposed budget followed by the proposed budget.

5. Colorado SIM Phase 2 Board strategic presentation

Colorado SIM stands for State Innovation Model and is a program to innovate in health care sponsored through federal Centers for Medicare and Medicaid Innovation, or CMMI. One year ago, Colorado's state's SIM management team made a presentation to the board and explained that Colorado was engaged in a path-breaking exercise to develop a plan for transforming health care for both Medicaid and commercially-insured Coloradans to achieve the goal of becoming the healthiest state in the country. They reported that with the help of a 6-month, $2 million award from CMMI, leaders from across Colorado were coalescing around a vision of coordinated systems of care that integrate physical and behavioral health, coordinate public health and clinical care, and transform health care payment. Our CMS was involved in this effort.

As a result, in November 2013 the board voted to "direct the CEO to advance CMS payment and delivery system reform priorities by coordinating input into the state's development of the Colorado Health Care Innovation Plan being prepared by the Office of the Governor through federal SIM." Later in November, our President, John L. Bender, MD signed a letter providing the SIM management team with an extensive set of recommendations on the Colorado Health Innovation Plan. We were pleased that many of the CMS recommendations were included in the final plan that was submitted to CMMI for the second round of funding.


In May, federal CMMI provided notice that Colorado qualifies for the second round of SIM funding -- making Colorado eligible for a funding range from $20-$100 million over 4 years. The SIM management team is currently drafting a proposal for this grant that will run from 1/1/2015-12/31/2018. Click here to review a letter from the CMS president to the SIM management team expressing qualified support for SIM Phase 2. The board believes that SIM phase 2 is extremely important to health care reform and to our profession. The board will continue to discuss CMS involvement with SIM Phase 2 at future board meetings.


Click here to read the broad overview of SIM Phase 2 and click here to read SIM Phase 2 goal statements.
6. Patient Safety: Colorado Supreme Court cases of interest to CMS members
  1. Defendant Physicians v. Haralampopoulos: June 16 Decision preserves medical hearsay rule
  2. Colorado Medical Board v. Office of Administrative Courts: June 23 decision protects confidentiality of peer review
  3. CMS-CSA v. Hickenlooper: Anesthesia Opt Out (Decision Pending)
  4. Defendant Physician v. Harner: Res Ipsa Loquipor (Decision Pending)

We are pleased to report that the voice of the physician is being heard at the Colorado Supreme Court by handing down two decisions in June that were highly favorable to physicians. These are cases where CMS had an interest either through Amicus or "friend of the court briefs." The first decision helps physicians defend themselves in medical malpractice cases and the second decision protects the confidentiality of professional review. Both are great news for physicians and for patient safety advocates. The board also discussed two remaining cases before the high court where CMS has an interest. Click here to read a summary of all four cases. 

7. Board acts on two gun safety proposals from 2013 House of Delegates meeting

The board referred the following two 2013 resolutions to the Council on Ethical Affairs and approved the Council's recommendations as outlined below. These board decisions will be action items at the HOD meeting in September.

1. RES-3-P Inclusion of Gun Safety Counseling in Patient Encounters

The resolution, passed by the 2013 HOD, directs Colorado Medical Society to encourage physicians to include inquiry of gun ownership and subsequent discussion of gun safety as an element of their practice, as appropriate, and to work with the specialty society community to support development of specialty-appropriate guidelines to encourage and support this activity.


CEJA determined that few national specialty societies have specific policies on gun safety and the major national societies that do have such policies are mostly primary care, such as the American Academy of Family Physicians and American Academy of Pediatrics, which have policy directed at protecting children. CEJA feels that discussion of gun ownership and gun safety is appropriate for all physicians as a matter of public health. Accordingly, the board approved the CEJA recommendation that primary care specialties lead the way in the development of appropriate policies for gun safety and/or that a new resolution be submitted to the HOD that considers current AMA policy.


2. RES-2-P Limited Role of Organized Medicine in Gun Control

This 2013 HOD action was referred to the BOD for report back to the HOD.The single resolve stated: "That CMS opposes legislation expanding mandatory disclosure of protected health information to databases linked with background checks concerning future firearm acquisition rights unless the patient meets civil commitment criteria."


CEJA explained to the board that they had difficulty completely understanding this resolution as the terms are very broad and potentially encompass an infinite number of situations, and that the resolution does not detail which databases are being discussed. They also cited no pending legislative effort to require mandatory reporting or mandatory disclosure of protected health information. While there has been a legislative proposal, HB 14-1272, this bill simply extends immunity and duty to warn from individuals to entities. CEJA also concluded that there are sufficient current protections, both in state and federal statute, for nondisclosure of protected health information. The board therefore approved the CEJA recommend that Resolution 2-P not be adopted.

8. Approval of minutes from May 16, 2014 meeting

Click here to read the approved May 16 meeting minutes.

9. Upcoming CMS meetings
The Sounding Block is a periodic electronic publication from the CMS Speaker and Vice-Speaker of the House to members of the House of Delegates to keep you informed of the society's business and concerns throughout the year.

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2014, Colorado Medical Society