DMS October Bulletin
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Official Publication of The Denver Medical Society

October 2019
What Doctors Must Know About the Vaping Crisis

New research shows that 40.5% of high-school seniors have tried nicotine vaping, adding urgency to President Trump’s announcement that the Food and Drug Administration (FDA) will take action to ban the e-cigarette flavorings that have proved so attractive to teens and young adults. Meanwhile, federal health agencies are encouraging physicians to report detailed information on cases of vaping-associated lung illnesses. Here’s what doctors need to know.

Vaping is taking off among kids. A national survey of 42,531 eighth–12th graders finds that 25.4% of high-school seniors have vaped nicotine in the last month, while 20.2% of 10th graders and 9% of eighth-graders have done so.

And while about 40% of 12th-graders have ever used a nicotine e-cigarette, 36.4% of 10th graders have vaped and 20.7% of eighth-graders have used an e-cigarette, says the survey, “Trends in Adolescent Vaping, 2017–2019,” published in The New England Journal of Medicine.

All of these figures have grown dramatically since 2017, the survey found, with past-month nicotine vaping skyrocketing 131% among 12th-graders in just two years.

It’s way past time to eliminate e-cigarette flavorings. The medical community has long called on the FDA to regulate e-cigarettes, especially the marketing practices that enhance the appeal of e-cigarette products to youth. 

“With soaring numbers of America’s youth using e-cigarette products, we are hopeful that the administration will now speed up e-cigarette regulations and remove all unregulated and unapproved products from the market,” AMA president Dr. Patrice A. Harris, MD recently said in a statement.

The AMA House of Delegates has declared the skyrocketing use of e-cigarettes to be an “urgent public health epidemic” and urged the FDA to take action to address it. 

Vaping-related lung illnesses have struck hundreds, killing seven. The Centers for Disease Control and Prevention (CDC) has reported 805 cases of lung injury in 46 states and one U.S. territory. The CDC has confirmed twelve deaths in ten states.

Colorado health officials reported on September 25, that the number of people in the state with a severe vaping-related illness had reached six, with four of the individuals hospitalized.

“As our outbreak report shows, this illness is affecting mostly young Coloradans who reported vaping either marijuana, nicotine or both,” Dr. Daniel Shodell, deputy director of disease control and environmental epidemiology at the state health department, said in a statement.

“Our advice has not changed: We want people to quit vaping until we have a clear understanding of what is causing this illness,” Shodell said.

While most of the patients affected used e-cigarette products with tetrahydrocannabinol (THC), some of the patients reported vaping only nicotine. The CDC is regularly providing updates on the outbreak.

Read the full article here.

It’s 2020 Dues Time
Don’t Forget to Include Your Voluntary Gift to the Denver Medical Society Foundation with your annual dues payment! It’s your chance to support the future of your profession!
Regional Hospital Price Information as a Percent of Medicare now Available from CIVHC
Across counties in Colorado, hospital payments range from just above Medicare rates (115%) to nearly six times Medicare payments (576%). New data unlocks another important aspect of cost transparency that can be used to inform decisions and improve the lives of Coloradans, and is the first in a series of new analyses that will be released over the next year by CIVHC, the Center for Improving Value in Healthcare.
The new interactive report and downloadable data show regional payments for inpatient and outpatient services as a percent of Medicare, along with patient experience and an overall quality rating at the individual hospital level. 
The data is based on a RAND Corporation hospital-specific analysis that was recently released using 2015-2017 paid claims in the Colorado All Payer Claims Database (CO APCD). Some highlights of the county-level data include:
  • The highest county is being paid almost six times Medicare rates (Morgan – 576%) for inpatient and outpatient services combined, whereas the lowest paid county is getting paid just above Medicare rates (Pitkin - 115%).
  • Rural areas are on both the low as well as the high end of the spectrum of counties for combined inpatient and outpatient payments, with no apparent correlation to resort or non-resort areas.
  • Volume of services also does not appear to be a direct driver of payments. For example, Lincoln County has very low inpatient and outpatient volume, yet is being paid second lowest across all 47 counties evaluated, whereas higher volume areas like Denver and El Paso are being paid at least twice Medicare rates.

Evaluation of the Division of Insurance rate setting regions shows similar variation. Groups like Peak Health Alliance in Summit County and others across the state are using data like this from the CO APCD to inform their work to drive down health care costs for employers and community members. 

CIVHC is in the process of working with the authors of the RAND Corporation study to conduct a similar percent of Medicare analysis for all claims in the CO APCD, regardless of the health care setting. This includes care provided in other settings such as Ambulatory Surgery Centers, doctor’s offices, Skilled Nursing Facilities, Long Term Care Facilities and Home Health Agencies. CIVHC anticipates having initial views of the expanded analysis in early 2020.

For more info regarding this report or other reports available, please contact us at

Physicians Enjoy Night Out at CMS Gala
DMS Treasurer Dr. Michael Moore and Donnis Moore
CMS Leaders: Drs. Robert Yakely, Past President, David S. Markenson, 2019-2020 President, and Debra Parsons,
2018-2019 President
Newly Elected CMS President-Elect
Dr. Sami Diab and Dr. Liliane Diab
Advanced Practice Provider Closed Claims: What Can We Learn?

The Doctors Company analyzed 649 claims against two types of advanced practice providers (APPs): physician assistants (PAs) and nurse practitioners (NPs). 

The analysis revealed that the most common patient allegations in both PA and NP claims were related to diagnosis. 

Case Example: PA

A 59-year-old female underwent redo quadruple coronary bypass grafting surgery. Her WBC was 13.9 prior to discharge.

When the patient was next seen, the sternal wound was healing well. 

The patient’s spouse subsequently testified that his wife complained of neck and shoulder pain during the visit. He called the physician’s office two days later and spoke with a PA, who advised him to increase the patient’s pain medication.

The spouse reported contacting the physician three days later and was again directed to the PA. He reported a continued complaint of pain.

The following day, the patient was experiencing chest pain with movement and deep breathing. She was instructed to report to the ER. An EKG was unremarkable. Her WBC was 14.8. The patient was discharged with a diagnosis of “chest wall pain.” 

The following day, the patient again phoned the physician. She was instructed to continue taking the pain medication. The patient sought care from a chiropractor, who noted a reddened, swollen area at the incision site.

That evening, the patient called the physician and was directed to a PA. She was given instructions to continue the pain medications. The patient’s spouse testified that he called the physician five times the following day, demanding that the patient be seen. The physician admitted the patient, and she underwent surgery for a ventral epidural abscess. The patient was rendered an incomplete C6 quadriplegic.

Continue reading the article here.

*UPDATE* Dr. Barbara Morris, recently terminated by Centura for helping in a patient's effort to utilize Colorado's end of life law, will share her story.

Colorado’s End of Life Statute:
Aid in Dying-A Physician’s Perspective

Cory Carroll, MD is a practicing family medicine physician in Fort Collins who has helped patients through the process.

He will share his experience and what physicians need to know to respond to patient questions and concerns.

Dinner provided.

  Register Here 

Sponsored by:

Considering  Venture Capital and Private Equity as Options for Your Practice?


 Key insights and considerations Offered in New Resources

Venture capital (VC) and private equity (PE) firms represent ready cash for physicians open to selling a practice or seeking outside investors. At a high level, private equity firms are more likely to buy and build value in hopes of profiting from a relatively quick sale, and venture capital firms are more likely to invest for a longer time horizon.

The AMA's guide, "Venture capital and private equity investments: How to evaluate contractual agreements," highlights key insights and considerations into the functioning of a VC or PE firm. Among the points raised in the resource, three particularly stand out in terms of assessing a deal—change in physician income, day-to-day practice management, and retaining professional independence. 

A two-page snapshot from the AMA provides a basic orientation for physicians unfamiliar with VC and PE investment. The AMA has also created a three-page model checklist that takes a point-by-point look at key topics, such as terms of sale for the practice, standardization techniques and economies of scale.

Mark Your Calendar!
Aid in Dying: A Physician’s Perspective
Cory Carroll, MD is a practicing family medicine physician in Fort Collins who has helped patients through the process.
6:00 PM at the Denver Medical Society
1850 N. Williams Street, Denver
Dinner provided.
RSVP here

Denver Medical Society Annual  Member Social
Curtis Ballroom at Landmark,  5345 Landmark Pl, Greenwood Village, CO
Join colleagues for a fun complimentary evening of cocktails, buffet dinner and live music
6:00 PM


Denver Medical Bulletin: Elizabeth L. Lowdermilk, MD, DMS President and Publisher / Usha Varma, MD, Chair of the Board / Alan E Kimura, MD, President Elect / MIchael L. Moore, MD, Treasurer / Kathy Lindquist-Kleissler, Executive Director. The Bulletin is the official publication of the Denver Medical Society, established April 11, 1871, as the first medical society in the Rocky Mountain West. Published articles represent the opinions of the authors and do not necessarily represent the official policy of the Denver Medical Society. All correspondence concerning editorial content, news items, advertising and subscriptions should be sent to: The Editor, Denver Medical Bulletin, 1850 Williams Street, Denver, CO 80218.
Phone (303) 377-1850.
Copyright © *2019* *Denver Medical Society*, All rights reserved.

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