By Brad Roberts, MD, PCMS representative on the CMS Board of Directors
There are lots of important things currently being considered by CMS (the new Colorado public health insurance option, the continued opiate epidemic, the new and ever-increasing cannabis epidemic, managing cost of care discussions, evaluating and advocating in the current liability climate for physicians, scope of practice discussions, physician professional satisfaction… and the list could go on extensively).
That being said, this time of year is always a wonderful opportunity for me to pause and consider whether I am focusing on what is truly most important; to reevaluate goals and look forward to the future with plans to do better. I appreciate that this time of reflection also comes during a holiday season in which society focuses on giving and thinking of others. I hope you will allow me to pause to reflect for a moment with my article for the newsletter as well.
In true medical fashion, I went to the peer reviewed literature to find out if there were any studies done on the physiologic benefits of kindness (I had also just watched the Mr. Rogers movie, A beautiful day in the neighborhood, with Tom Hanks). Sure enough, I quickly found a paper titled ‘it’s good to be good: 2014 Biennial Scientific Report on health, happiness, and helping others by Stephen G. Post. In case it needs to be found on PubMed, the citation it came from is Int J Behav Med. 2005;12(2):66-77.
In the study, Post notes that volunteers have less trouble sleeping, less anxiety, less helplessness and hopelessness, better friendships and social networks, and a sense of control over chronic conditions. He then reviews a number of studies demonstrating improvements with serving others in a wide range of markers including improvements in cholesterol, lower BMI, decreased rates of HTN, and improvements in alcohol addiction treatment outcomes. There were improvements in chronic pain patients including decreased pain intensity levels, decreased degree of disability, and decreased depression when they began to serve as peer volunteers for others suffering from chronic pain.
He also cites changes seen on fMRI studies in the mesolimbic pathway and ventral striatum, the brain’s satisfaction and reward center, which is responsible for dopamine mediated euphoria, with giving. Interestingly, he cites a cross sectional study of 2,682 medical students attending medical school in seven U.S. medical schools in 2009 that found that students experiencing burnout had considerably reduced altruistic attitudes about physician responsibility to society, including less desire to provide care for the medically underserved. A separate study found that health professionals who volunteered to go on medical mission trips scored lower on burnout scales following their return and continued to improve at a six-month follow up.
It may be crucial to solving the problems above for us to step back, pause and serve others. It is in serving that we develop the relationships needed to understand one another; it is there we gain ideas to look outside of the constant drum of our practices and gain new insight; and it is through service that we can regain the altruism that drove us to medicine. And, apparently, as a biproduct, it helps us become healthier and happier as well. With that, I wish you all happy holidays!
For Immediate Release: Oct. 2, 2019
Contact: Chery Law, Chief Executive Officer
[email protected] | 719-281-6073
Pueblo, CO – Oct. 2, 2019 - The Pueblo County Medical Society Board of Directors announced today they have named Dr. Marcel Junqueira, MD, as the Society’s interim president. Dr. Thomas Greidanus, MD, who has served as PCMS president since 2017, recently began a needed leave of absence due to health issues. Dr. Junqueira, who has served as PCMS secretary, will undertake Dr. Greidanus’ official executive duties during his leave.
The Board of Directors unanimously recommended that Dr. Junqueira become the interim president immediately until elections take place at the society’s annual meeting on Nov. 13.
“Dr. Junqueira will be an influential thought leader for this medical Society,” Cheryl Law, CEO, said. "He is an individual of great integrity, vision and commitment to his colleagues in the medical profession who has, on more than one occasion, stated he would serve Society members even if he had no professional title associated with his name. He is the perfect choice to advance our mission to create a medical Society that serves as a venue for collaboration for the betterment of health care in Pueblo County. The Board expects a very smooth and successful transition period under his guidance.”
Dr. Greidanus was president of PCMS from 2017 to 2019 and has been an exceptional president and leader of the Society. He will remain an officer of the Society during the interim period. The Board and executive staff wish Dr. Greidanus a swift and full recovery and look forward to his return.
During his tenure Dr. Greidanus renewed the Society’s legacy of serving members, collaboration, and providing community support that has served the organization well. Under his leadership he set the momentum for PCMS to plan our third annual symposium on primary care updates, and to host continuous education and social events throughout next year for physician members and guests. His vision for an enhanced, complementary relationship with the city and county of Pueblo has led to the society spending time and resources in collaboration with the medical community and other community organizations to improve the practice of medicine and life of medical professionals, locally and throughout southern Colorado.
Due to Dr. Greidanus’ strong leadership ability, PCMS now has a greater focus on promoting sustainability through igniting change and elevating relevance in the lives of our membership and local community. Thank you, Dr. Greidanus and Dr. Junqueira!
The Pueblo County Medical Society is a membership association comprising 300 physicians in the city and county of Pueblo. Learn more at www.pueblocms.org.
PCMS was proud to partner with the Pueblo Department of Public Health and Environment (PDPHE) to present the Cannabis Community Forum on Aug. 8. Speakers included two emergency room doctors – our PCMS representative to the CMS Brad Roberts, MD, and Karen Randall – and an addiction psychiatrist, Libby Stuyt, MD. All from Pueblo, the speakers shared their considerable education, experience and knowledge. As PDPHE said in their post-event report, the story they told is indeed a local one, but like the opioid story, there is a cautionary message for us all.
If you missed it, you can view the archived Facebook video live stream here. And here is a link to a peer-reviewed article written by Brad Roberts, “Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects.”
PCMS will soon send a letter to Pueblo Mayor Nick Gradisar requesting a meeting with him and the city council about this issue.
Thanks to all of the physicians who attended the forum and continue to make an impact for patients in Pueblo.
Top: Karen Randall presents "Myths and Realities of Cannabis
Middle: Brad Roberts presents "Legalized Cannabis in Colorado Emergency Departments"
Bottom: Physician speakers from left: Libby Stuyt, Randall, Roberts and myself (Greidanus)
By Brad A. Roberts, MD, PCMS representative on the CMS Board of Directors
At the July 12 Colorado Medical Society Board of Directors meeting, board members heard from Paul Presken with the Colorado Health Institute on nine emerging themes in health care. Paul’s environmental scan analyzed trends in the Colorado health care system and national trends that will impact the state. Nearly all of them were related to health care costs. His report preceded a board discussion on what should be included in the 2020 CMS operational plan.
Here are the emerging trends he identified:
- Health care costs for consumers have reached a tipping point. The most obvious example of increased attention on health care costs is Gov. Jared Polis’s Office of Saving People Money on Healthcare, headed by Lt. Gov. Dianna Primavera.
- Prescription drug costs are increasing and legislators are crafting bills to control them. Prescription drug costs continue to outpace inflation at a rate of two to nine times for brand-name oral drugs and generic oral drugs, respectively. Bills were passed in 2019 to address costs and more are coming in 2020.
- Hospital costs are in the crosshairs. Bills to add transparency and control of hospital costs were also passed in 2019 as hospitals are subject to increased scrutiny for profit margins.
- Payment reform is affecting physician payment. Health plans are increasingly moving from up-side risk only to up-side and down-side risk arrangements and government programs like the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) are starting to have an impact.
- The physician workforce is shifting. 2018 marks the first time there were fewer physician owners than employees in the United States: 45.9 percent vs. 47.4 percent, respectively. This has been slowly changing over time and it looks like the trend will continue.
- Colorado has expanded substance use and regulation and is seeing the effects. Colorado continues to “experiment” with legalization. Colorado now has some of the highest rates of substance use in the country, with the third-highest rate of illicit drug use in the country, the nation’s highest rate of youth vaping, and a three-fold increase in cannabis-related ER visits, according to a UCHealth study. Overdose deaths from opioids have declined significantly in the past year but deaths from cocaine and methamphetamine have risen.
- Investment in technology and disruption of current models are growing. Venture capital firms invested record amounts in health care technology in 2018, and investment focused on “disruptive” technologies that hold significant promise.
- The business community is and will continue to be engaged. Pressure from the business community is increasing and specific to Colorado. Locally, employers in Summit County “finally had enough,” and formed Peak Health Alliance to negotiate lower insurance premiums directly with providers. This will increase thanks to a new law allowing for health care cooperatives in Colorado.
- The government has an increasing role as a payer. The 2019 Colorado legislature passed laws exploring options for increasing the state’s role in providing coverage, including a current effort to develop a proposal for an option for a state-sponsored health care plan.
Watch for more on these trends in 2020.
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