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Doris C. Gundersen MD Medical Director CPHP FSPHP 2011 Annual Meeting April 28, 2011 © Colorado Physician Health Program 2011 All Rights Reserved Please.

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Presentation on theme: "Doris C. Gundersen MD Medical Director CPHP FSPHP 2011 Annual Meeting April 28, 2011 © Colorado Physician Health Program 2011 All Rights Reserved Please."— Presentation transcript:

1 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

2 NOTHING TO DISCLOSE  © Colorado Physician Health Program 2011 All Rights Reserved  Please do not reproduce or use without written permission of CPHP

3  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

4 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” © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

5 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

6 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

7 * = BME License Renewal Years © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

8 Voluntary (64%) Mandatory (36%) © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP N=271

9 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP N=185

10 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) © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

11  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

12 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

13 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

14  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) © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

15 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

16  Peer Assistance fund grew excessively without equivalent provision to CPHP  CPHP would request increases in funding as needed © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

17 DATE ACTUAL ALLOTMENTS NOT TO EXCEED 2000 to 2001 $696, $696, to 2002 $774, $775, to 2003 $840, to 2004 $840, $900, to 2005 $900, to 2006 $1,020, $1,100, to 2007 $1,200, $1,500, to 2008 $1,200, $1,500, to 2009 $1,200, $1,500, to 2010 $1,200, $1,500, to 2011 $1,200, $1,500,000.00

18 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

19  Sunset process – MPA is open for revision by legislation  Last sunset process was 1995  2010 sunset occurred with new CPHP leadership (MD and ED) © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

20  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

21  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

22  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

23 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

24 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

25 *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! © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

26  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

27  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

28  *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  © Colorado Physician Health Program 2011 All Rights Reserved  Please do not reproduce or use without written permission of CPHP

29  CPHP Board Director attended legislative proceedings.  No comments on the peer assistance program revisions.  Passed without incident in June 2010! © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

30  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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

31  Per statute revisions, CPHP created a report summarizing:  CPHP Growth  Projected Growth (and need for increased funding)  Budget proposal © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

32  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

33  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”

34 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

35  Preparation time – one year in advance  Maintain awareness of political climate  Maintain Community Relationships © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

36  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

37  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

38 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) © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

39 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 © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP

40  Physician Health Programs are dynamic – not static  Consider “flux” the status quo  Maintain Vigilance

41 Phone or Office Hours: 8:30 a.m.- 4:30 p.m. Monday – Friday After Hours Clinical Emergencies: Pager: For additional information visit the CPHP website: © Colorado Physician Health Program 2011 All Rights Reserved Please do not reproduce or use without written permission of CPHP


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