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Colorado Physician Health Program Annual Report July 2002 – June 2003

Colorado Physician Health Program Annual Report July 2002 – June 2003. Executive Director: Sarah R. Early, Psy.D. Medical Director: Michael H. Gendel, MD. Table of Contents. New Referral Case Summary Page 3 Number of New Referrals - Program History Page 4

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Colorado Physician Health Program Annual Report July 2002 – June 2003

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  1. Colorado Physician Health ProgramAnnual Report July 2002 – June 2003 Executive Director: Sarah R. Early, Psy.D. Medical Director: Michael H. Gendel, MD

  2. Table of Contents • New Referral Case Summary Page 3 • Number of New Referrals - Program History Page 4 • Source of New Referrals - Year-to-Date Page 5 • Primary Presenting Problem -Year-to-Date Page 6 • Specialty of New Referrals - Year-to-Date Pages 7-9 • License Status of New Referrals – Year-to-Date Page 10 • New Referrals – Geographical Area – Year-to-Date Page 11 • Referrals & Reactivations 1993 – 2003 Page 12 • Reactivations – Year-to-Date Page 13 • Inactivations (Reasons/Outcome) - Year-to-Date Page 14 • Program Highlights Pages 15-16 • Community Outreach Page 17 • Services Provided by CPHP Page 18 • CPHP Board of Directors and Staff Page 19 APPENDIX • Definition of Terms Page 21

  3. Annual New Referral Growth Reaches All-Time High for License Non-Renewal Year! REFERRAL SUMMARY • New Referrals: Fiscal Year 2002-03 represents the highest number of New Referrals for a medical license Non-Renewal Year! When compared to Fiscal Year 2000-01, the last fiscal year that was not a BME license renewal year, CPHP experienced an actual growth of 40 cases which is an increase of 17%. CPHP is pleased with the continued growth of New Referrals throughout our program history. CPHP encountered an expected slight decrease in New Referrals of 12% when compared to Fiscal Year 2001-02. This was likely due to the fact 2002 was not a Colorado Board of Medical Examiners (BME) license renewal year. Fiscal year 2002-03 represents the second highest number of New Referrals in CPHP history! The average active caseload at any given period during Fiscal Year 2002-03 was 356 clients. This represents an increase of 5% compared to Fiscal Year 2001-02 (340 active client caseload). • Primary Presenting Problem of New Referrals: A primary presenting problem area which best represents the participant is identified by a CPHP clinician following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary problem is identified for reporting purposes. During Fiscal Year 2002-03, the three most common primary presenting problems among the 204 New Referrals were: Psychiatric (23%), Behavioral (20%) and Substance Abuse (12%). • Specialty of New Referrals: During Fiscal Year 2002-03, the specialty most frequently seen at CPHP was Family Practice (19%), followed by Internal Medicine (10%). In an effort to better understand the specialty of CPHP New Referrals, CPHP located a comparison data set that represents physicians of Colorado. See pages 7-9. Overall, CPHP has relatively similar New Referral Client Specialty percentages when compared to Colorado Physicians, with the exception of slightly more prevalent CPHP clients with the specialties of Family Practice and Surgery. • Overview of New Referrals: Of the 204 New Referrals, 49% were voluntary and 51% were mandatory. Of the total New Referrals this year, 67% had active Colorado licenses, 11% were applicants, 10% had Colorado Training Licenses, 3% were under investigation or probation, and 2% had lapsed or inactive licenses. The remaining 7% of New Referrals did not have licenses, which included medical students and physician assistant students. CPHP served New Referrals from 23 counties of residence throughout Colorado with the most frequent county of residence among New Referrals being Denver County (24.5%). • Outcome: Year-to-date, CPHP “inactivated” (closed) a total of 212 cases. Of the 181 evaluated, 168 (93%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with the continued high satisfaction outcomes. • Total Referrals in CPHP History: Since the inception of the program in 1986, CPHP has received 2,215 referrals and has served 1,898 participants. Of 2,215 referrals, approximately 14% were referred more than once.

  4. Annual Number of New Referrals Program History 1986 - Present This graph shows the steady growth of numbers of New Referrals in the history of the program. Fiscal Year 2002-03 represents the highest number of New Referrals for a medical license Non-Renewal Year! When compared to Fiscal Year 2000-01, the last fiscal year that was not a BME license renewal year, CPHP experienced an actual growth of 40 cases which is an increase of 17%. CPHP is pleased with the continued growth of New Referrals throughout our program history. CPHP encountered an expected slight decrease in New Referrals of 12% when compared to Fiscal Year 2001-02. This was likely due to the fact 2002 was not a Colorado Board of Medical Examiners (BME) license renewal year. Fiscal Year 2002-03 represents the second highest number of New Referrals in CPHP history! * = BME License Renewal Years

  5. Source of New Referrals July 2002 – June 2003 Continued High Self & Voluntary Referrals Client Medical Profession Other =Ph.D., DPM N=204 Other = Family, Physician Health Programs, Medical School, Physician Assistant Program, CPEP • During Fiscal Year 2002-03, the highest single source of New Referrals was Self referrals, representing 33% of New Referrals. This is a slight increase when compared to last year (30%). CPHP continues to be proud of the amount of Self referrals to the program which demonstrates trust and confidence in CPHP. • Significantly, 49% of New Referrals came to CPHP voluntarily. 51% were mandatory referrals. Once again, CPHP is proud of the high percentage of referrals that are voluntary, as this reflects the respect for the program among physicians in the state and medical community. CPHP attributes this high level of voluntary referrals to the relationship building efforts made in the community, the positive and caring approach of CPHP’s staff and provision of educational materials that normalizes physician experiences and illness. • The second highest single source of New Referrals was the Colorado Board of Medical Examiners (BME) (22%), and Hospital (15%) was the third highest category of referral source. • For definitions of referral source categories, see page 21. • The pie chart on the right reflects clients medical profession. The majority of clients are physicians without a resident status (69%). Residents (15%) comprise the second largest group served and physician assistants (PA) (5%) comprise the third largest group.

  6. Primary Presenting Problem of New Referrals July 2002 – June 2003 N=204 • A primary presenting problem area which best represents the participant is identified by the clinical team following the completion of the initial intake interview. This does not mean that other problem areas are not present or being addressed with the participant at CPHP. Rather, the primary presenting problem is identified for data collection and reporting purposes. • The three most common primary presenting problems among the 204 New Referrals were: Psychiatric (23%), Behavioral (20%) and Substance Abuse (12%). This representation is similar to Fiscal Year 2001-02 with the same top three categories of Psychiatric (21%), Behavioral (16%) and Substance Abuse (13%).

  7. CPHP 2002-2003 Annual ReportSpecialty of New Referrals • In an effort to better understand the data about CPHP New Referrals, CPHP created a data table (see following page) comparing the data of Fiscal Year 2002-03 CPHP New Referral Client Specialties with data from the 2001 Colorado Physician Survey Results. • The 2001 Colorado Physician Survey was developed by the University of Colorado Health Sciences/Colorado Area Health Education Centers (AHEC) and the Colorado Board of Medical Examiners (BME) as a collaborative effort to be able to track the demographics of the physician population in Colorado. The statistics from the 2001 Colorado Physician Survey were calculated from a one-time voluntary survey distributed to physicians with their licensing materials by the Colorado Board of Medical Examiners. The following statistics were computed from a sub-sample of the data collected in 2001. The data set for this analysis includes only physicians whose primary practice site is in Colorado and does not include any physicians identifying themselves as residents or fellows. The total sample size for this analysis was 6,352 individuals. • CPHP notes caution in interpretation of this data for several reasons. First, the CPHP data set includes all clients referred during Fiscal Year 2002-03 (residents, medical students, physician assistant students, out-of-state clients, etc.) while the 2001 Colorado Physician Survey data set contains strictly Colorado physicians. Second, the data sets were collected from different years. Lastly, while the 2001 Colorado Physician Survey data set is not all inclusive of the total number of Colorado physicians, CPHP is utilizing this data to assist in hypothesizing about CPHP clients as compared to the general Colorado physician population. To date, CPHP has been unable to locate a source that collects complete state-wide statistics regarding specialties of licensed or practicing physicians within Colorado. • The 2001 Colorado Physician Survey is the most complete data set found. CPHP appreciates the donation of this data to CPHP in an effort to better understand CPHP New Referral Client Specialty demographics.

  8. CPHP 2002-2003 Annual ReportSpecialty of New Referrals Data Table

  9. CPHP 2002-2003 Annual ReportSpecialty of New Referrals • In analyzing the data table (previous page) comparing the data of Fiscal Year 2002-03 CPHP New Referral Client Specialties with data from the 2001 Colorado Physician Survey Results, some interesting information is gleaned. • When examining the percent of clients seen at CPHP during Fiscal Year 2002-03, the specialty most frequently seen at CPHP is Family Practice (19%). Clients with the specialty of Internal Medicine followed at 10%. Twenty-one percent remained in progress, which means a specialty had not yet been identified at the time of this report. • When examining the valid percent of the specialties represented, the majority of specialties from the CPHP New Referrals are represented to a corresponding percentage when compared to the 2001 Colorado Physician Survey Results. All of the CPHP New Referral specialties are represented within 5 percent of the 2001 Colorado Physician Survey Results except for 2 specialties. Overall, CPHP has relatively similar New Referral Client Specialty percentages when compared to the physicians of Colorado (as represented in the Colorado Physician Survey Results). • The CPHP New Referral specialties of Family Practice and Surgery are slightly more prevalent when compared to Colorado Physician Survey Results. Specifically, Family Practice represents 25.4% of CPHP New Referrals and 16.8% of the Colorado Physician Survey data set. This is a difference of 8.6%. Surgery represents 10.0% of CPHP New Referrals and 3.9% of the Colorado Physician Survey data set. This is a difference of 6.1%. • CPHP is unsure why this elevation is seen in New Referrals with the specialties of Family Practice and Surgery, however, the actual difference in percent is slight. CPHP is cautious in hypothesizing about the relevance of this data due to the fact that the difference is less than 10% in both specialties. CPHP will continue to assess the CPHP data on a yearly basis to determine if larger differences will occur over time. • Unfortunately, the University of Colorado Health Sciences/Colorado Area Health Education Centers (AHEC) and the Colorado Board of Medical Examiners (BME) presently do not plan to continue to gather this information so the 2001 Colorado Physician Survey will become quickly dated. CPHP will continue to research sources that may gather this information.

  10. License Status of New Referrals July 2002 – June 2003 N=204 • This pie chart shows the medical license status of each New Referral to CPHP at the time of referral. • Of the total New Referrals this year, 67% had active Colorado licenses, 11% were applicants, 10% had Colorado Training Licenses, 3% were under investigation or probation, and 2% had lapsed or inactive licenses. The remaining 7% of New Referrals did not have licenses, which included medical students and physician assistant students.

  11. Colorado Counties Served by CPHP July 2002 - June 2003 ^ ^ * * * ^ * N * ^ * * * * * ^ * * * ^ * ^ * * * * ^ ^ ^ ^ * ^ ^ ^ * * ^ * * ^ ^ ^ = Other Other includes counties that contain less than 10 physicians, based on 2001-02 BME listing of Colorado licensed physicians. These counties are grouped into one category (Other) to protect the confidentiality of clients residing in those counties. Counties in this category include: Archuleta, Baca, Cheyenne, Conejos, Crowley, Custer, Dolores, Hinsdale, Jackson, Kiowa, Lake, Mineral, Park, Phillips, Rio Blanco, Saguache, San Juan and Sedgwick. ^ = County Served * + = Broomfield County is not indicated on this map due to recent designation as a county. • CPHP served New Referral clients from 23 counties of residence throughout Colorado during Fiscal Year 2002-03. CPHP is pleased with the efforts to assist clients throughout the state. These results demonstrate the effective promotion and utilization of CPHP services state-wide. • The most frequent county of residence among New Referrals was Denver County at 24.5%, followed by Jefferson County at 9.3% and Arapahoe County at 7.4%.

  12. Referrals & Reactivations1993 - 2003 • Fiscal Year 2002-03 represents the highest number of New Referrals for a Non-Renewal Year! When compared to Fiscal Year 2000-01, the last fiscal year that was not a BME license renewal year, CPHP experienced an actual growth of 40 cases which is an increase of 17%. CPHP is pleased with the continued growth of New Referrals throughout our program history. CPHP encountered an expected slight decrease in New Referrals of 12% when compared to Fiscal Year 2001-02. This was likely due to the fact 2002 was not a Colorado Board of Medical Examiners (BME) license renewal year. Fiscal Year 2002-03 represents the second highest number of New Referrals in CPHP history. • CPHP experienced the impact of license renewal years in: 93-94, 95-96, 97-98, 99-00 and 01-02. Of the 204 New Referrals, 29 were reactivations. This represents 14% of the total New Referrals. This percentage is a slight decrease when compared to Fiscal Year 2001-02 (19%). CPHP expects to again realize an increase in New Referrals in the upcoming Fiscal Year.

  13. Reactivations:35% Self-Referred/41% VoluntarilyJuly 2002 – June 2003 Referral Source Primary Presenting Problem N=29 • “Reactivation” refers to when a participant returns to CPHP after having been inactivated. • Referral sources of reactivated clients are depicted on the left pie chart. Of 29 participants who were reactivated, 35% Self referred. This is similar to Fiscal Year 2001-02 when 39% Self referred. • 41% of reactivations came voluntarily to CPHP during Fiscal Year 2002-03. Voluntary referrals of reactivations have decreased when compared to Fiscal Year 2001-02 which had 56% voluntary reactivation. CPHP attributes the increase in mandatory referrals of reactivations due to improved workplace satisfaction. Namely, workplaces have been pleased with previous CPHP guidance on cases. If issues such as behavior problems reoccur, workplaces readily re-refer to CPHP. • Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that reactivations most commonly present with problems with Behavior (28%), followed by Substance Abuse (21%) and Psychiatric (17%). The distribution of primary presenting problem areas was proportionately higher in the category of Behavior at 28% when compared to percentages of total New Referrals for the 2002-03 Fiscal Year (20%). Substance Abuse was also significantly higher in reactivations (21%) when compared to Annual New Referrals (12%). The New Referrals with a primary presenting problem of Psychiatric were proportionately lower for reactivations (17%) when compared to percentages of total New Referrals for this Fiscal Year (23%).

  14. 176 Participants Inactivated (Reasons/Outcome)July 2002 – June 2003 Length of Active Status at CPHP N=212 License Status = License has been inactivated/ surrendered Other = Admin. complete, client request, deceased, non-compliant, referred in error • “Inactivation” refers to when a case is closed at CPHP. Definitions of inactivation reasons are on page 21. • For Fiscal Year 2002-03, CPHP inactivated 212 participants and opened 204 new cases, resulting in a net loss of 8 cases. The client load of CPHP has virtually remained consistent from Fiscal Year 2001-02 to Fiscal Year 2002-03. • Of 212 inactivations, 31 (15%) declined evaluation; therefore, 181 clients were evaluated. Of the 181 evaluated, 168 (93%) were inactivated with an outcome considered successful and/or satisfactory. CPHP maintained its high success rate when compared to Fiscal Year 2001-02, which also was 93%. CPHP is pleased with our continued high rate of satisfied outcomes! • Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (65%) completed the necessary treatment in one year or less.

  15. Program Highlights • CPHP Team Grows! : • Sarah R. Early, Psy.D., began her new position as Executive Director on July 1, 2003. Dr. Early brings a professional history of direct care, administration and EAP experience. • CPHP welcomed new Board Directors: George Dikeou, Esq., Maureen Garrity, Ph.D., and Sandy Maloney! • CPHP hired a new Associate Medical Director, David A. Iverson, MD! • CPHP expanded to include a position of Development Specialist to assist CPHP in the management and growth of the Spirit of Medicine fundraising campaign. CPHP welcomed Susan Swern to this newly created position. • CPHP Completes Office Expansion: CPHP completed an office expansion to achieve our newly renovated addition of 1,138 square feet for an office suite total of approximately 5,000 square feet. This new space has been utilized to better serve our clients, accommodate our expanding staff and to allow for future growth. • Availability of Services: In addition to CPHP providing services to Colorado licensed physicians and physician assistants, contracts exist to provide services for University of Colorado Health Sciences Center (UCHSC) Residency Program, Medical School, and Physician Assistant Program and Red Rocks Community College Physician Assistant Program. CPHP was pleased to also begin providing services to St. Joseph’s Residency Training Program. • Spirit of Medicine Campaign:CPHP completed the annual Spirit of Medicine fundraising campaign with successful results that exceeded last year’s campaign! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors as well as CPHP staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. We are pleased with the show of support for CPHP and we are planning to utilize the funds raised for projects to continue improvement of client services. • HIPPA: Through an extensive educational process and consultation from numerous sources, it was determined that CPHP has met the appropriate standards to be in compliance with the Health Insurance Portability and Accountability Act (HIPPA).

  16. Program Highlights continued • Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2002-03. • CPHP Medical Director, Michael Gendel, MD, was elected President of FSPHP in May, 2003. He will serve a two year term. CPHP is proud to have Colorado representative, Michael Gendel, MD, provide his leadership and expertise as President to this national organization. • CPHP representatives Michael Gendel, MD, Sarah Early, Psy.D, Stephen Dilts, MD, Doris Gundersen, MD, and Scott McClure, MD, attended the FSPHP Annual Meeting in Chicago, IL in May, 2003. Presentation topics addressed at this meeting included toxicology and methodology of random testing, diversity of state programs, pain management for professionals, boundaries: prescribing and professional relationships, workplace behavioral monitoring and spirituality and mindfulness. CPHP representatives welcomed the opportunity to network with colleagues from other Physician Health Programs and gain valuable information about physician health related issues. • In October 2002, CPHP hosted the Annual Conference and Meeting of the Western Region of the FSPHP in Vancouver, British Columbia, Canada. The theme of this conference was ‘Cultivating Effective Relationships’. In addition to many presentations, a panel presentation and discussion on Strengthening Relationships Between Regulatory Boards and Physician Health Programs was initiated by representatives from Colorado, New Mexico and British Columbia. Colorado was represented by Susan Miller, Program Administrator of the Colorado Board of Medical Examiners and Michael Gendel, MD, Medical Director of the Colorado Physician Health Program. CPHP was pleased to host this informative and collaborative conference. • CPHP Establishes New Policy for Credentialing and Status Reports: Due to increasing demand on CPHP to provide the “indirect” service of assisting medical entities and organizations in the credentialing process through the provision of credentialing and status reports, CPHP has established a new policy that will charge a $35 fee per ongoing report of this nature, effective July 2003. Thus far feedback has been accepting, as charging for these types of reports tend to be standard practice. • Finance and Peer Assistance Budget: CPHP finished Fiscal Year ending June 30, 2003, with a Program Operations Year-to-Date Net Loss of $33,150.12. This can be attributed to increased Corporate insurance expense, costs associated with office expansion and increased computer service expense. This Net Loss was supplemented with cash reserves from the annual Spirit of Medicine Campaign.

  17. Community Outreach Highlights • Executive Director Community Outreach: Sarah Early, Psy.D., made a concentrated effort to meet the medical community of Denver and Colorado. • An Open House was held on August 23, 2002 for CPHP treatment providers and various community members. • Individual and group meetings were held for the Colorado Board of Medical Examiners staff, Attorneys General, hospital administrators and medical office staff, medical and physician assistant training programs and various other medical organizations. Annual reports were prepared and presented to appropriate agencies. • Additional meetings were conducted with COPIC, Colorado Medical Society, Colorado Society of Osteopathic Medicine, Center for Personalized Education for Physicians (CPEP) and other professional peer assistance programs for other licensing agencies, Employee Assistance Professionals Association, and treatment facilities. • Physician Stress and Stress Management Seminars: CPHP and COPIC have continued to partner to provide the second series of Physician Stress and Stress Management Seminars to educate physicians about the importance of stress management to attain good health. The first series of presentation were completed in Aurora, Colorado Springs, Denver, Fort Collins, Grand Junction, Greeley, Longmont, Thornton, Trinidad, and Wheat Ridge. The second series of presentation have, thus far, have been presented in La Junta, Loveland, Metro Denver and Sterling. The second series will be completed in Steamboat Springs, Louisville, and Boulder. • Additional Community Presentations: In addition to the presentations on Physician Stress,CPHP conducted presentations and exhibits about CPHP and related physician health topics. Audiences included Residency Programs, Medical and Physician Assistant Programs, Medical Societies, Medical Staff Offices and Group Practices. • Community Meetings: Referral source meetings were held with community entities including hospital administration and medical staff offices; medical and physician assistant training programs; residency programs; and affiliate organizations. Issues addressed included, how CPHP and the organization may work best together, building relationships with referral sources and improving CPHP services. Workplace consultation continues to be an important element of CPHP services. CPHP participants’ or participants’ potential workplaces seek assistance from CPHP on identifying problems, interventions strategies, how to make referrals, and documentation. Lastly, CPHP made participant monitoring visits to various areas in the state outside of Metro Denver including Boulder, Colorado Springs, Durango, Fort Collins, Grand Junction and Pagosa Springs.

  18. Services Provided by CPHP • Client Services: • Assessment • Treatment referral • Monitoring and support • Family support • Documentation • Workplace and Referral Source Services: • Consultation on identifying physicians who need assistance • Consultation on making referrals • Workplace consultations • Educational presentations • Medical Community Services: • Promote physician health awareness • Educational presentations • Partnership with organizations to meet special needs • Develop meaningful research on physician health • Presentation Topics: • Colorado Physician Health Program services • Work stress • Substance abuse, addiction • Professional boundaries • Self-care and physician health issues • Disruptive physician management

  19. CPHP Board of Directors and Staff

  20. APPENDIX

  21. Definition of Terms REFERRAL SOURCES: For the purpose of this report, the following definitions are applied: Self: Voluntary referrals who request services on their own and there are not consequences with other entities or organizations if they do not follow through. Board of Medical Examiners (BME): Any written referral made by the BME or required evaluations as part of the application or renewal process to Colorado Administrative (Admin): Dept. Heads, Directors, Partners, Presidents, CEO’s (which are not part of a hospital system). For example, Vail Clinic, CFO of a Radiology group, managed care such as Kaiser Permanente Hospital: MEC, Medical Staff Offices, Quality Management, Chief of Staff, Credentialing Committees Resident Program (Res Prog) : Any referrals made by Residency Directors and personnel Peer: Any MD, DO, or PA that does not fit into another category Treatment Provider (Tx Prov): Professionals in community that provide treatment to CPHP participants Malpractice: A malpractice company Attorney: Referrals made by a physician’s attorney Medical School: Any referrals made by the Medical School Faculty, administration and personnel Physician Assistant Program: Any referrals made by a Physician Assistant School Faculty, administration and personnel REASONS FOR INACTIVATION: Treatment Completed (Tx Comp): Client has completed the CPHP recommended treatment and/or monitoring Evaluation Completed (Eval Comp): Client referred for evaluation, no treatment or monitoring recommended. Used for most out of state referrals Evaluation Declined (Eval Declined): Client referred for evaluation and refused or declined to have evaluation. Client self-referred and did not follow through with evaluation and/or cannot be located Relocated: Client relocated, typically out of state Client Request (Client Req): Client is self-referred or voluntarily referred for evaluation. Client does not follow through with treatment because the circumstances have changed and the client does not feel services are necessary Declined Treatment (Declined Tx): Client declined the treatment recommendations. Typically used for self referrals who have an evaluation, treatment is recommended however client does not follow through Other: Any reason that does not fit another category License Denied: Client was involved with CPHP as license applicant and license was denied Non-Compliance: Client inactivated by CPHP because client did not comply with CPHP treatment and/or monitoring recommendations. Typically used for voluntary referral with no concern for patient safety issues. Admin Completed: Used historically for reactivations who are opened for documentation requests

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