Minutes – December 18, 2023

Northern Colorado Medical Society Meeting with Congresswoman Yadira Caraveo
Conversations on Healthy Equity

Held at 3400 West 16^th Street, Building 1S, Suite C, Greely, CO

2:00 p.m. – 3:00 p.m.

1. CALL TO ORDER – Sean Pauzauskie, MD, called the meeting to order at 2:00 p.m.

ATTENDANCE – Colorado Medical Society’s CEO Dean Holzkamp, UCHealth’s Associate CMO Dr. Christine Johnston, NCMS Executive Director Crystal Goodman, NCMS Advocacy Committee Chairperson Dr. Donna Sullivan, CMS DEI Committee member Dr. Lynn Parry, NCMS President Dr. Sean Pauzauskie, and Congresswoman Yadira Caraveo with staff members Esai Sanchez and Katie Wallace.

• Dr. Pauzauskie opened the meeting by sharing the definition of health equity as defined by the Centers for Medicare and Medicaid Services Strategic Plan.  He asked what the most successful initiatives have been.  Congresswoman Caraveo feels there’s a trifecta with reproductive healthcare, LGBTQ+ care, and eyecare.  She also supports efforts being made by the Colorado Latino Leadership, Advocacy, and Research Organization (CLLARO), and other advocacy groups including child advocacy groups.  Dr. Pauzauskie shared his background with underserved populations as he worked with Latinos in El Paso, TX which was part of a grant program. 

• Congresswoman Caraveo is focusing on STEM programs and asked if we have a relationship with the DO school at UNC (Dr. Beth Longnecker was invited to attend but unable to make it).  There are currently 8 residency programs in the state and the goal is for the residents to work in rural areas, so these areas have more well qualified and well-trained family physicians in their area.  There’s a need to address adequate staffing levels in rural hospitals.  They’re also seeing issues with nursing home staffing requirements because the workforce is just not there.  This delays the discharge of seniors who need long term care because facilities can’t accept new patients due to staffing shortages. Congresswoman Caraveo feels there’s bipartisan support for bills regarding rural medicine, but they need the right appropriations. She’s co-sponsoring the Resident Physician Shortage Reduction Act of 2023 (HR 2389—118^th Congress 2023-24) The bipartisan legislation would provide 2,000 new Medicare-supported graduate medical education (GME) positions per year over seven years, for a total of 14,000 new GME positions.  The bill stipulates that at least 10% of the slots must be distributed to hospitals that are within rural or noncontiguous areas, such as Alaska and Hawaii, training over their GME cap, located in states with new medical schools or branch campuses, and serve designated health-professional shortage areas, with priority given to hospitals affiliated with historically Black medical schools. (Reference: AMA website- https://www.ama-assn.org/practice-management/sustainability/bill-add-14000-new-gme-positions-picks-support)  When discussing transgender care, Dr. Sullivan mentioned there’s only one residency office in Fort Collins that provides transgender care.  There’s a concern we don’t have enough residency slots available in rural areas for all healthcare services.  They’ve also tried addressing the shortage with loan forgiveness programs in the past but they’re not as popular legislatively.  Congresswoman Caraveo met with middle school students that morning to encourage students to consider a career path in STEM.  The issues they see for medical students are the costs for medical school and the pressure of graduating. 

• Dr. Parry mentioned a bill that was recently passed for youth who no longer need a diagnosis to receive mental healthcare services.  She’s been working with the local sector on fundraising for local youth programs.  The other issue is those that need healthcare services don’t typically reach out because of language barriers, cultural barriers, and they’ve had bad experiences.   Another issue discussed was the need for more funding for gun violence victims. 

• Dr. Johnston feels legislation and mandates are what pushes large organizations to make changes and create urgency.  At UC Health they’ve implemented training and competency tests for staff and are auditing visits to make sure those with language barriers are being served effectively.  They have limited access to translators because there aren’t many available for hire.  This can create issues as they then must rely on family to assist.  They’ve used technology including I Pads to assist with translation.  According to Dr. Johnston, UC Health is currently #1 in Medicaid care, and they’ve partnered with rural hospitals to provide services but again the nursing and support staffing shortage is an issue.  They’ve created a patient care assistant program in which employees don’t need a CNA to start.  They work through a fully funded 6-week training program to receive their certification.  Another issue with Medicaid care is most patients don’t have transportation resources.  When addressing primary care physician shortages, Dr. Johnston mentioned we need reform for malpractice and TORT reform, which has been a topic of discussion for decades.  Dean informed us there’s a TORT ballot initiative this coming year.

• When addressing language barriers Dr. Sullivan explained a family member is currently a social worker in North Dakota and they’ve received a federal grant to work with immigrants and small businesses to address retention issues.  It was mentioned that at the JBS plant in Greeley there were over 100+ languages spoken.  Weld County would benefit from this type of program.

• Congresswoman Caraveo is serving on the Science Space and Technology Committee.  Dr. Pauzauskie talked about his current bill proposal regarding protecting the privacy of biological data.  She feels congress has a bipartisan interest in AI ethics. We’ve seen issues with face recognition and technological biases causing issues for minorities.  There’s a concern about the commercialization of data.  Congresswoman Caraveo mentioned a recent NIH trial in which they used published research data as a tool to sell testing kits.  Sen. Bernie Sanders has proposed the debate that if private companies are going to rely on federal testing for commercialization, then they may want to consider revoking the patent.  There’s also a bill about commercial airspace as NASA and national security organizations are concerned there are risks.

• Dr. Parry feels we need to address the eroding belief in medical practitioners.  Congresswoman Caraveo said the director of the CDC has been working on a PR campaign addressing this issue.  There’s concern because scientific agencies are under attack and COVID exacerbated this.

• Dr. Pauzauskie asked what are the most effective ways we can help on a grassroots level?  The issues that were brought to the table include:
  • The No Surprises Act has bipartisan support and has created unity.
  • Continued focus on workforce burnout.
  • The costs of medications affect healthcare needs on a large scale.
  • Patient care and equity. 
  • The perception of quotas and high volumes to meet the financial needs of the hospitals.
  • Addressing maternal mortality rates most specifically in African American populations.
    • Dr. Johnston feels it’s hard to collect the data in order to distribute the appropriate resources.
    • Implicit bias courses are necessary.
    • UC Health has opened two delivery rooms in Greeley because traveling to Denver or outlying areas is not easy or financially feasible for some families.
  • Funding for service lines (Pueblo cut their health affairs service line).
  • Continued focus on Medicare payment models and fees.
    • Dean mentioned HR 6833 will be a bill to watch as it addresses Medicare cuts:  TITLE I–MEDICARE AND MEDICAID

(Sec. 101) This section extends certain increased payment adjustments for low-volume hospitals under Medicare’s inpatient prospective payment system.

(Sec. 102) This section extends the Medicare-Dependent Hospital Program, which provides additional payments to certain small rural hospitals that have a high proportion of Medicare patients.

(Sec. 103) This section extends the increased Medicaid federal matching rate (also known as the Federal Medical Assistance Percentage) for U.S. territories.

(Sec. 104) This section decreases funding for the Medicare Improvement Fund.

(Reference: https://www.congress.gov/bill/117th-congress/house-bill/6833)

• Dr. Pauzauskie wrapped up the meeting by stating we’d like to continue our relationship as we focus on healthy equity in the coming year.  Congresswoman Caraveo was very pleased with the meeting and looks forward to staying in touch.

The meeting was adjourned at 3:00 p.m.