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=^0T cwC'J’- „oT -ro [ lary, 1998 Volume 95, Number 1 N HEALTH SCIENCES LIBRARY UNIVERSITY OF MARYLAND AT BALTIMORE MAR 18 1998 STACKS the matter of )n HOT m cm. lanaged Care... we? Vhere are A physician's view from the other side of the looking glass: Leigh Truitt, MD, long-time CMS consultant on managed care oversight, now looks back the other way in his position with a major managed care player. Page 14. This Issue: But officer, I'm not a criminal by Gary D. VanderArk 5 MD Critical appraisals of outcomes studies by John F. Steiner, P^g^ Special Insert: Medicare payment, coverage and coding changes Public health concerns with use of antibiotics P^gc 28 You must not be insured by Copic. — n an environment of seemingly incessant Every day, our insureds are finding Ichange, it's natural to wonder can my themselves in new business relationships insurance carrier keep up? When you're with new insurance needs; that's why we insured with Copic, you can be certain the created our Medical Entity, Hospital, and answer is "Yes!" Provider Stop Loss policies. — — Credentialing is becoming increasingly - The legislature can play a tremendous role in important for our insureds; that's why we health care changes; that's why we focus so purchased a national credentials verification strongly on our advocacy and lobbying role. company and are developing methods to Copic...keeping up with the changes that affect streamline this often tedious process. Colorado health care. C>pic Copic Insurance Company Call our Underwriting and Policyholder Service Department at (303) 779-0044 or (800) 421-1834. 4 Colorado Medicine January, 1998 Volume 95, Number 1 r“ On the matter of Managed Care... Where are we? Cover Story 5 Physicians as criminals? The prevention of health care fraud and abuse is a governmental priority. The Manage care, wherearewe, issues should demand attention from everyone. MD where have we come from, Gary D. VanderArk, where are we going? President, Colorado Medical Society Thoughts from an expert on the other side of the fence 10 List of legislators - the 1998 Legislative Session has and notesfromthefrontline. begun. Here is your contact list for Colorado Senators and Representatives. See page 1 15 Feedback from the front lines - CMS members speak out about managed care. Departments 16 Critical appraisal of studies of health outcomes - a clinician/scientist reviews the key points of what makes and breaks a quality outcomes study, and provides pointers on how to properly interpret these important measuring tools. John F. Steiner, MD, MPH SPECIAL INSERT: Medicare payment, coverage and coding changes. 5 President's Letter 7 Executive Director's Update 9 The Lobby 26 1998 CMS Interim Meeting schedule and registration 13 Board Highlights 16 Accountability 28 Careful antibiotic use in Colorado - risks and 19 Copic Comment reasons. Part two of a series. 23 Archives Steven Lowenstein, MD, MPH 26 1998 CMS Interim Meeting Kenneth Gershman, MD, MPH 30 Colorado Physician Network 31 Classifieds 34 Ruminations Colorado Medicine, including Med Fax®, is printed entirely on recycled paper. i Colorado Medical Society http://www.cms.org 'N^f^ SEP'^ COLORADO MEDICAL SOCIETY OFFICERS, BOARD MEMBERS and AMA DELEGATES Board of Directors Board of Directors 1997/1998 Officers MD Joseph R. Tyburczy, Jr., MD MD Stephen G. Batuello, R. Douglas Yajko, Gary D. VanderArk, M.D. MD MD Jack L. Berry, Harold A. Yocum, President John V. Buglewicz, MD W. George Shanks, M.D. Roy E. Carlson, MD AMA Delegates MD President-Elect Alfred N. Carr, Robert L. Kruse, M.D. MDaorniallydn GG.iffEocrkdh,ofMf,DMD MRi.chRearyt EP.aiQnuteirn,n,Jr.,Jr.M, DMD Treasurer Rod R. Holland, MD Mark A. Levine, MD Louise L. McDonald, M.D. Mary Jo Jacobs, MD Joel M. Karlin, MD Speaker ofthe House Brian L. Johnson, MD Sherri Laubach, MD Karen Johnson, MS Alternate Delegates J. MD SandraVLi.cMea-slpoenaekyer ofthe House MPNaueurllysloBn.L.JoLnMaeomsz,aina,, MMDD JReorbeermty DL.azMacruCsa,rtMnDey, MD Secretary/Executive Director I. MD MD Alan D. Rapp, Barbara Reed, M. Ray Painter, jr., M.D. Barbara R. Reed, MD Steven J. Thorson, MD MD (Immediate Past President) Elaine N. Scholes, Susan A. Sherman, MD Robert R. Montgomery Legal Counsel COLORADO MEDICAL SOCIETY STAFF Executive Office Division of Professional Services Sandra L. Maloney, Executive Director [email protected] Sandra M. Einney, Director [email protected] Debra M. Jones, Executive Admin. Asst. [email protected] Don Rutt, Manager, SupportServices [email protected] Genni Pearman, Secretary [email protected] Mary LeeJohnston, ExecutiveAdmin. Asst. Emeritus Division of Health Care Policy Nancy L. Deter, Manager, Accounting [email protected] Ellen J. Stein, Director [email protected] Lorraine K. Heth, Program Manager [email protected] Western Slope Office Suzi Shevell, Program Manager [email protected] Dolores M. Bennett, Executive Secretary Division of Government Relations Division of Membership Information Services Lorraine L. Koehn, Director [email protected] Timothy H. Roberts, Director [email protected] K. Suzanne Eiamilton, Program Manager/Lobbyist Beth M. Crusha, Membership Coordinator [email protected] Suzanne_Hamilton@cms org . Division of Health Care Financing Division of Communications Edie K. Register, Director [email protected] William S. Pierson, Director B //[email protected] Marilyn Rissmiller, Program [email protected] Chet P. Seward, Communications Specialist [email protected] M5re4Eg5Da5Ir.CdiIOCnNugOtEs,tLihOdeP.eRedODAi.etDonBrOvioeaxlMrE1caDo7rneI5at5C,e0In,cNtalEDtleo(n1tIv-hSe8eSr0N,e0-d-0Ci16tOo59r49i-8a-50l7623a514n337d.)-0bPi5ues5srpi0iuon.bdelisAicsdasdlohrfseefdispcsomes.oatlnSaltugchbesolcrpyrariaiepsdstptiaohtoennEdsonefgafnrilcceeeiwaalorveaojlidoal,utaribnCnlagoelltofooorfrsaudt$bho3se,5crCaiponpeldtroiroaytnaesada,rod,daMidpetvaideioridntcaiailsnlimanSagdoivcolairinentcagyed,.dorf7fe8isc0se0sc.hE.aPnODgSoeTrs,MadAmoSaTnPuELs,Rc,rEinspgtelsne,dwooarodgddar,neisCzsaOtcih8oa0nn1agl1e1asn.tdToeolCtehOpeLhroOnnReewA(sD30iO3t)em7s79- 1995byCOthLeOCRolAoDraOdoMEMDedIiCcIaNlESomcaigeatyz.inAlelimsattheerioaflficsiuabljjeocutrtnoalthoifstchoepyCroilgohrtaadpopeMaerdiincgalinSCocOieLtyO,RaAnDdOasMsEuDcIhCiIsNalEsomaauythboeripzheodtotococpairerydgfeornetrhaelnaodnve-rctoimsimnegr.cCiaOlLpOuRrpAoDseOoMfEeDduIcCaItNioEniasncdopsycriiegnthitfeidc advancement.PublicationofanyadvertisementinCOLORADOMEDICINEdoesnotimplyanendorsementorsponsorshipbytheColoradoMedicalSocietyoftheproductorserviceadvertised. PublishedarticlesrepresenttheopinionsoftheauthorsanddonotnecessarilyreflecttheofficialpolicyoftheColoradoMedicalSocietyunlessclearlyspecified. SandraL.Maloney,ExecutiveEditor;WilliamS.Pierson,ManagingEditor;ChetSeward,CommunicationsSpecialist http://www.cms.org/ColoradoMedicine.html Member,ColoradoPressAssociation, Member,ColoradoBroadcastersAssociation 4 Colorado Medicine for January, 1998