This week, legislation concerning prior authorization requests was introduced in the state House of Representatives. The goal of House Bill 19-1211 is to streamline the overall process of prior authorization and promote safe and timely access to evidence-based care for patients by increasing transparency and reducing the variations among payers and utilization management organizations. The Colorado Medical Society strongly supports prior authorization streamlining as outlined in the bill. According to a 2018 CMS membership survey nearly one-half of Colorado physicians (48%) say prior authorization has become harder over the past few years, including 28% who say it has become much harder and 20% who say it has become a bit harder. Read more on CMS.org.

The Colorado Medical Society joined the American Medical Association and more than 100 state and national physician organizations to express concern about the impact of unanticipated, or “surprise,” medical bills on patient out-of-pocket costs and patient-physician relationships, and to urge Congress to pass policies to address this issue. The organizations stated in the letter that health insurance plans are increasingly relying on narrow and often inadequate networks as one mechanism for controlling costs, often leaving even the most diligent patients seeking care from in-network physicians and hospitals with unanticipated out-of-network bills. “Physicians and other providers are limited in their ability to help patients avoid these unanticipated costs because they, too, may not know in advance who will be involved in an episode of care, let alone other providers’ contract status with all the insurance plans in their communities.” Read the full letter here.

New policies for opioid over-utilization management in the Medicare Part D prescription drug program will affect physician practices in 2019. There are three key elements of the new policies: opioid-naïve patients will be limited to an initial seven-day supply; pharmacies will be alerted when they receive a prescription for a patient’s cumulative daily morphine milligram equivalent dose reaching 90 MME or more and may consult with the prescriber; and Medicare Part D plans may implement management programs for patients determined to be at risk of opioid over-utilization. Read more in this MLN Matters article or in this article from the AMA.

The Colorado Hospital Association invites emergency departments to participate in the next iteration of the Colorado ALTO Project training: the ECHO ALTO Series. CHA, in partnership with ECHO Colorado, is providing EDs the opportunity to obtain the valuable information that was provided during the Colorado ALTO Project in-person trainings via a convenient virtual training platform. This four-part training series will begin on March 13, 2019 and will be continued on consecutive Wednesdays from 12-1 p.m. Click here to register and to learn more about the ECHO ALTO Series. Space is limited to 30 participants and admittance is on a first-come basis. For questions, or more information contact Diane Rossi MacKay at Diane.RossiMacKay@cha.com.

The “Continuing Board Certification: Vision for the Future” Commission submitted its final report to the American Board of Medical Specialties Board of Directors on Feb. 13, 2019, thereby concluding their work to review the framework and purpose of the continuing certification of physicians. Their final report details a set of recommendations to overhaul the current certification process and create the principles, frameworks and program models of a new continuing board certification system. Read more on CMS.org.

Patients searching for health care prices now have access to more procedures than ever before through an online shopping tool based on information in the Colorado All Payer Claims Database (CO APCD). CIVHC has launched the “Shop for Care” tool to help consumers across the state locate facilities with the lowest price and best patient experience ratings, and to aid the effort to reduce health care spending. The information includes prices for new X-ray imaging services and updates to currently available services like CT scans and MRIs. It also provides new “episode” prices for hospital and outpatient procedures including knee and hip replacement, births, cataract surgery and colonoscopies. Read more on CMS.org.

A website specifically designed to facilitate the illegal sale of firearms cannot escape liability for the harm that results from those transactions, according to an amicus brief filed in the Wisconsin Supreme Court by the AMA and the Wisconsin Medical Society. The brief, prepared by the Litigation Center of the AMA and State Medical Societies, cites AMA policy that declares firearm violence is a public health issue, advocates waiting periods and background checks for gun buyers, and highlights the need to bar high-risk individuals under domestic-violence restraining orders from possessing or purchasing a firearm. Read more from the AMA.

The Physician Practice Quality Improvement Award Program online application is live! Physician practices continue to make great strides in providing reliable preventive services and implementing effective care management methods. TMF Health Quality Institute sponsors the Physician Practice Quality Improvement Award Program with several state medical associations to recognize practices working hard to provide high-quality patient care and improve outcomes. The deadline to apply is May 31, 2019. Read more about the award criteria here.