Colorado Physician Health Program Medical Practice Act Sunset

Doris C. Gundersen MD

Medical Director

CPHP

FSPHP 2011 Annual Meeting

April 28, 2011

© Colorado Physician Health Program 2011 All Rights Reserved

Please do not reproduce or use without written permission of CPHP

NOTHING TO DISCLOSE









Understand a Medical Practice Act (MPA) sunset process and the potential effects on one physician health program



Analyze the potential benefits and challenges that may arise during the involvement of a legislative process, including building an awareness of potential resources at a PHP’s disposal



Strategize for future physician health program development - succession planning



Learn ways to strengthen medical community and regulatory relationships



• Contractual Agent of the CMB

•

•

CPHP is an independent 501(c)3

CPHP does not have immunity

• CMB Makes Referrals to CPHP

• Applications for licensure

• Renewal applications

• Complaints

• CPHP Provides “Treatment Monitoring” for individuals with license stipulations

• Approximately 20% of CPHP cases are known to the CMB

• “Safe Haven ”



• Board of Directors

• Executive Director & Medical Director

• Clinical Team:

• 6 Associate Medical Directors – Psychiatrists with additional expertise in Addiction and/or Forensic Psychiatry. (Independent Contractors)

• Director of Clinical Services

• 4 Masters level Licensed Clinicians

• Compliance Coordinator

• Receptionist/Program Assistant

• Part-time Research Assistant

• Administrative Team:

• Finance Manager

• Development Specialist

• Executive Assistant

• Administrative Assistant



CPHP’s Mission is to Assist Physicians,

Residents, Medical Students, Physician

Assistants, and Physician Assistant Students,

Who May Have Health Problems That if Left

Untreated, Could Adversely Affect Their

Ability to Practice Medicine Safely

Serving the Medical Community Since 1986



350

300

250

200

150

100

50

0

85*-86 86-87 87*-88 88-89 89*-90 90-91 91*-92 92-93 93*-94 94-95 95*-96 96-97 97*-98 98-99 99*-00 00-01 01*-02 02-03 03*-04 04-05 05*-06 06-07 07*-08 08-09 09*-10



* = BME License Renewal

Years

•

Voluntary (64%)

•

Mandatory (36%)

N=271

Other

Treatment Provider

Peer

PA Program

Residency Program

Self

Medical School

Proactive

Hospital

Family

CMB

Administration



0

1%

1%

3%

1%

5.5%

2%

8.5%

2%

7%

17%

9%

50 100

43%

150

Other

Emotional

Career

Domestic Violence

Professional Boundaries

Psychiatric/Substance

Substance Abuse

Work Stress

Legal

Psychiatric

Physical/Medical

DUI/DWAI

Family

Behavioral

Stress

N=185

0

.5%

1%

2%

1%

4%

1.5%

2%

3%

10

7%

8%

8%

8.5%

20

13%

14.5%

30 40



26%

50 60

•

CPHP’s direct services (evaluation, treatment referral and monitoring) are free to Colorado licensed physicians and physician assistants.

•

Participants are responsible for costs of any additional evaluations and treatment if those services are necessary.

•

Peer Assistance Funds are not used for applicants or re-applicants.

•

CPHP has contracts to serve many Colorado residents, medical students and physician assistant students. (12 Training Programs Served)







Client Services:







Clinical Assessment

Treatment referral (CPHP does not provide treatment in house)

Monitoring and support





Family support

Documentation

Workplace and Referral Source Services:







Consultation on identifying physicians who need assistance

Consultation on making effective referrals

Workplace consultations







Consultation on back-to-work issues

Educational presentations

Critical Incident Debriefing



Education/Presentations



















CPHP Services (Orientation)

Physician Stress and Stress Management

Physicians in Relationships and Families

Women in Medicine

Substance Abuse and Addiction

Professional Boundaries

Self-care and Physician Health Issues

Disruptive Behavior Management

Medical Marijuana



Research

•Comparing CPHP success rates of monitoring substance use disorders to other Physician Health Programs

•Success of substance abuse recovery in relation to relapse rates and type of treatment

•Tobacco use by physicians

•Physician professional boundary issues

•Physician prescribing personal medical care

•Gender differences among physicians seen at CPHP

•Understanding clients who reactivate with CPHP

•Evaluating “Art of Medicine” ratings in healthy vs ill MDs

•Evaluating if there is a greater risk for malpractice in

CPHP clients











Developed in collaboration with Denver County

Medical Society/Colorado Medical Society

Inception: 1986

Peer assistance program created through statute -

Medical Practice Act (MPA)



Surcharge

 RFP (every 5 years)

Importance of separate holding of funds with 3 rd party (COPIC)



1999 to 2010:



Each applicant pays a surcharge not to exceed $50/yr



Amount adjusted by CMB annually to reflect changes in

US bureau of labor statistics, CPI, etc.



Fee shall be used to support designated providers selected by the CMB to provide peer assistance



Cost of living adjustments available to $50 surcharge





Peer Assistance fund grew excessively without equivalent provision to CPHP



CPHP would request increases in funding as needed



DATE

2000 to 2001

2001 to 2002

2002 to 2003

2003 to 2004

2004 to 2005

2005 to 2006

2006 to 2007

2007 to 2008

2008 to 2009

2009 to 2010

2010 to 2011

ACTUAL

ALLOTMENTS

$696,528.00

$774, 996.00

$840,000.00

$840,000.00

$900,000.00

$1,020,000.00

$1,200,000.00

$1,200,000.00

$1,200,000.00

$1,200,000.00

$1,200,000.00

NOT TO EXCEED

$696,530.00

$775,000.00

$840,000.00

$900,000.00

$900,000.00

$1,100,000.00

$1,500,000.00

$1,500,000.00

$1,500,000.00

$1,500,000.00

$1,500,000.00

•

•

•

•

•

•

CMB realized excess of peer assistance funds

CMB offered solution of various proposals to utilize excess funds.

CPHP requested and accepted one of the proposals

Problem! Calculations were not conducted for longer term and fund was depleted.

CPHP “covered” 3 months in 2009 which were paid back upon licensure renewal and replenishment of peer assistance fund

The fund will again be depleted approximately 1-2 months shy this cycle due to COLA increases implemented in 2009 which reduced some of this deficit





Sunset process – MPA is open for revision by legislation



Last sunset process was 1995



2010 sunset occurred with new CPHP leadership (MD and ED)





No current CPHP staff members previously participated in sunset process of 1999



CPHP Board Director versant in legislation advised use of

CPHP Advisory Committee which includes individuals with significant medical community connections and who were active in legislation



Long Term Planning Committee Established



Medical Director









Medical Director Emeritus

Executive Director

Board Directors

Advisory Committee





Preserve statute language to maintain a peer assistance program for Colorado





Surcharge amount not to exceed $61/year

Surcharge may be adjusted annually by CMB



Revise funding mechanism:







To accommodate for growth of program

To allow different surcharge for MD vs PA

Allow CMB to determine when surcharge changes are warranted

(to remove it from MPA sunset process)







Changes in US Bureau of Labor statistics and CPI

Overall utilization of the program and

Differences in program utilization by MDs vs PAs





Fee imposed shall be used to support designated providers selected by the board to provide assistance to physicians and PAs



Administering Entity:





All funds collected by the CMB are custodial funds NOT subject to appropriations by the General Assembly

The distribution of payments to the administering entity does not constitute state fiscal year spending for purposes of Section

20 of Article X of the state constitution



What CPHP wanted to avoid

- Unnecessary attention/negative PR

- Hostility with other medical community entities (ex. CPEP, CMB)

What CPHP wanted to gain

-

Maintain language allowing for a peer assistance program

Develop language to create a better funding stream



Meet with other medical community stakeholders

Identify supporters of our goals

Educate other stakeholders

Find medical community lobbyists to support CPHP:

CPHP limitations due to nonprofit status/limited budget

CMS and CPS have strong lobbyists

Awareness of DORA’s role in Sunset Process:

Policy Analyst reports to Legislative Committee

Legislative Committee traditionally accepts 80-90% of Analyst’s recommendations

Primary mission of DORA: Patient Safety



*Created Patient Safety Committee as CPHP BOD advisors

Patty Skolnick

Ed Dauer

Judy Ham

Legislative Strategy: Highlight and explain the connection between patient safety and CPHP’s work

* Some risk with this!









LTP Committee encouraged development of a presentation highlighting “Public Protection through

Physician Wellness”

Create list of individuals from Medical Community supportive of CPHP.

This info was available as a “supporter list” drafted as apart of our proposal in the RFP process for the Peer Assistance Contract every five years

Create a list of individuals who need to know about

CPHP





We did not identify local “enemies” of CPHP

Concern about national detractors of PHPs





CPHP did not hire a lobbyist:



Our nonprofit status









Budgetary limitations

Our strategy was to align with DORA/ CMS / CMB recommendations so their lobbyists could carry our revisions to sunset

CMS has a strong lobbyist presence

Dilemma:





CMB disallowed from directly having any position on legislative matters

CMB could not publically speak to the benefits of

CPHP





* DORA Analyst













Highly Competent

Thoughtful Analysis of the MPA

Several interviews/meetings with knowledgeable stakeholders

Initially was opposed to recommended changes in how peer assistance program would be funded



* CPHP’s Patient Safety Committee Member







DU Law School Professor (Ed Dauer)

DORA Analyst was previously his student

Convinced DORA Analyst to support CPHP’s funding recs





CPHP Board Director attended legislative proceedings.



No comments on the peer assistance program revisions.



Passed without incident in June 2010!





In CPHP’s favor:



Creation (continuance) of a peer assistance program

 An unanticipated Surprise:

Creation of “Confidential Agreements”



One disappointment:

• SUDs excluded from confidential agreements





Per statute revisions, CPHP created a report summarizing:







CPHP Growth

Projected Growth (and need for increased funding)

Budget proposal



 CPHP met with CMB in November 2010

 Previous deficit from peer assistance fund was included to vote upon with CPHP budget proposal

 Deficit was due to a CMB miscalculation (CPHP did not want to “out” the CMB for this mistake)



Both funding requests require the CMB to authorize a peer assistance surcharge increase under the statute language

“utilization of program”

 The funding request to account for the deficit was more than

CPHP budget proposal request

 Concern that the funding request to make up for the deficit would jeopardize overall CPHP budget request



CPHP provided organizational growth indices of:

New referrals

-Average active case load

-CMB referrals

-Safe haven cases (exceed CMB referrals)

-Cost per program participant

-Salary costs for staff/contract MDs

-Funds from other contracts (i.e. medical school)

-Reports generated

-Community outreach activities (education/crisis interventions, etc)



CMB members complained that they did not have enough information – they wanted more “metrics”

Difficulty:

Growth indices used could not be compared directly to program funding increases as CPHP previously made requests for budget increases on an as needed basis

Budget Proposal was approved:

8 CMB members approved our budget proposal

2 voted no (wanting additional data)

2 voted no (believed budget proposed was inadequate)

Budget requests will now correspond directly to license renewal cycle so that growth rate comparisons are more realistic



Preparation time – one year in advance



Maintain awareness of political climate



Maintain Community Relationships



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

















Regarding Statute

Know your states legislative process and key players

Importance of historical memory – requires succession planning

Develop program advocates active in the legislative process

Medical Boards

Important to know what data MB wants to review

Design budget proposals which correspond directly to license renewal cycles/program utilization so that growth rate comparisons are more realistic

Keep budget issues outside of statute for easier modifications

Medical Boards are political entities that change





Work to maintain relationships

Consider routine task force/liaison meetings

Protect funding with 3 rd party administrator



Requires constant identification and recruitment of skill:



Medical Director









Executive Director/Program Administrator

Board of Directors

 Cross Pollination with medical board ideal

Clinical Staff – diversity is good

Relationships with the community

Six Psychiatrists with Varying Expertise and Age

General Psychiatry

Forensic Psychiatry

Addiction Psychiatry

Psychoanalytic Psychiatry

Four Experienced Masters Level Clinicians

Executive Director

Executive Committee (Anonymously)



Clinical Staff Meetings

Weekly full team meetings

Review/discussion of new cases

Review/discussion of difficult cases

Determination of:

• Diagnostic clarity

• Additional Assessment Needs

• Treatment Plan Development/Modification

• Treatment Referral

AMD/Clinicians Weekly Meetings





Physician Health Programs are dynamic – not static



Consider “flux” the status quo



Maintain Vigilance

Phone

• 303-860-0122 or 800-927-0122

Office Hours:

• 8:30 a.m.- 4:30 p.m.

• Monday – Friday

After Hours Clinical Emergencies:

• Pager: 303-437-2138

For additional information visit the CPHP website:

• www.CPHP.org



Colorado Physician Health Program Medical Practice Act Sunset

NOTHING TO DISCLOSE

Research

Clinical Staff Meetings

Weekly full team meetings

AMD/Clinicians Weekly Meetings

Physician Health Programs are dynamic – not static

Consider “flux” the status quo

Maintain Vigilance

Related documents

Products

Support

Colorado Physician Health Program Medical Practice Act Sunset

NOTHING TO DISCLOSE

Research

Clinical Staff Meetings

Weekly full team meetings

AMD/Clinicians Weekly Meetings

Physician Health Programs are dynamic – not static

Consider “flux” the status quo

Maintain Vigilance

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