Colorado Physician Health ProgramAnnual Report

July 2003 - June 2004

Executive Director: Sarah R. Early, PsyD

Medical Director: Michael H. Gendel, MD

Page 2

Table of ContentsAnnual Report

July 2003 – June 2004

• Referral 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 – 2004 Page 12• Reactivations – Year-to-Date Page 13• Inactivations (Reasons/Outcome) - Year-to-Date Page 14• Participants Documentation Requests Page 15• Program Highlights Pages 16-

17 Community Outreach Page 18• Services Provided by CPHP Page 19• CPHP Board of Directors and Staff Page 20

APPENDIX• Definition of Terms Page 22

Page 3

Referral Summary July 2003 - June 2004

• New Referrals: CPHP continued to receive steady New Referrals throughout Fiscal Year 2003-04 with 222 New Referrals. When compared to Fiscal Year 2002-03, CPHP experienced an actual growth of 18 cases which is an increase of 9%. The Colorado Board of Medical Examiners (BME) made modifications within the licensing application that CPHP suspects will effect New Referral growth projections. Specifically, the BME License application now contains wording that allows respondents to keep their medical and psychiatric histories confidential if they are known to CPHP. This language has been used on the BME licensing reapplication with success. CPHP predicts that growth of New Referrals will be a continued steady incline, instead of previous elevations and reductions that corresponded to the BME licensing renewal application cycle. CPHP is pleased with the overall continued growth of New Referrals throughout our program history.

• Case Load: The average active caseload at any given period during Fiscal Year 2003-04 was 365 clients. This represents an increase of 3% compared to Fiscal Year 2002-03 (356 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. The three most common primary presenting problems among the 222 New Referrals were: Psychiatric (14%), Behavioral (13%) and Substance Abuse (10%).

• Specialty of New Referrals: During Fiscal Year 2003-04, the specialty most frequently seen at CPHP was Internal Medicine (22.4%), followed by Family Practice (17.2%) and Anesthesiology (13.4%). 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 New Referral clients with the specialty of Anesthesiology.

• Overview: Of the 222 New Referrals, 53% were voluntary and 47% were mandatory. Of the total New Referrals this year, 65% had active Colorado licenses, 14% had Colorado Training Licenses, 12% were applicants, 3% had lapsed or inactive licenses, and 2% were under investigation or probation. The remaining 3% of New Referrals did not have licenses, which included medical students, physician assistant students and out-of-state clients. CPHP served New Referrals from 22 counties of residence throughout Colorado with the most frequent county of residence among New Referrals being Denver County (24.8%).

• Outcome: Year-to-date, CPHP “inactivated” (closed) a total of 228 cases. Of the 195 evaluated, 175 (90%) were inactivated with an outcome considered successful and/or satisfactory. CPHP is pleased with our continued high rate of satisfactory outcomes!

• Total Referrals in CPHP History: Since the inception of the program in 1986, CPHP has received 2,437 referrals and has served 2,082 participants. Of 2,437 referrals, approximately 15% were referred more than once.

Page 4

Annual Number of New Referrals Program History 1986 - Present

0

50

100

150

200

250

85*-86

86-87

87*-88

88-89

89*-90

90-91

91*-92

92-93

93*-94

94-95

95*-96

96-97

97*-98

98-99

99*-00

00-01

01*-02

02-03

03*-04

• This graph shows the continued overall growth of New Referrals in the history of the program. CPHP continued to receive steady New Referrals throughout Fiscal Year 2003-04 with 222 New Referrals. When compared to Fiscal Year 2002-03, CPHP experienced an actual growth of 18 cases which is an increase of 9%. The BME made modifications within the licensing application that CPHP suspects will effect New Referral growth projections. Specifically, the BME License application now contains wording that allows respondents to keep their medical and psychiatric histories confidential if they are known to CPHP. This language has been used on the BME licensing reapplication with success. CPHP predicts that growth of New Referrals will be a continued steady incline, instead of previous elevations and reductions that corresponded to the BME licensing renewal application cycle.

* = BME License Renewal Years

Page 5

Source of New Referrals July 2003 - June 2004

Continued High Self & Voluntary Referrals

Admin17%

Peer3%

Treatment Provider

2%

Other4%

Res Prog9%

Malprac3%

BME14%

Attorney1%

Self38%

Hospital9%

• During Fiscal Year 2003-04, the highest single source of New Referrals was Self referrals, representing 38% of New Referrals. This is a slight increase (5%) when compared to last year (33%). CPHP continues to be proud of the amount of Self referrals to the program which demonstrates trust and confidence in CPHP.

• Significantly, 53% of New Referrals came to CPHP voluntarily. 47% 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 Administration (17%), and the BME (14%) was the third highest category of referral source.

• For definitions of referral source categories, see page 22.

• The pie chart on the right reflects the medical profession of CPHP clients. The majority of clients are physicians without a resident status (69%). Residents (16%) comprise the second largest group served and osteopathic physicians (7%) comprise the third largest group.

Other = DEA, Physician Health Program, Medical School, Friend, CPEP, Out-of-State, BME, Anonymous

N=222

MD69%

Other1%

DO7%

Med Stud1%

Res16%

PA 6%

Client Medical Profession

Other = DPM, PA Student

Page 6

Primary Presenting Problem of New Referrals

July 2003 - June 2004

Behavioral13%

Career2%

Work Stress6%

Psychiatric14%

PhysMed5%

Sub Abuse10%

Psyc/Sub4%

Legal5%

Stress4%

Prof Bound2%

Family1%

Eval in Progress

16%Emotional

7%

Inactivated w/o Eval

11%

• 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 222 New Referrals were: Psychiatric (14%), Behavioral (13%) and Substance Abuse (10%). This representation is similar to Fiscal Year 2002-03 with the same top three categories of Psychiatric (23%), Behavioral (20%) and Substance Abuse (12%).

N=222

Page 7

Specialty of New ReferralsJuly 2003 - June 2004

In an effort to better understand the specialty data about CPHP New Referrals, CPHP created a data table comparing the statistics of Fiscal Year 2003-04 CPHP New Referral Client Specialties with statistics from from Peregrine Management Systems. CPHP appreciates the donation of this data to CPHP in an effort to better understand Colorado physician specialty demographics.

Peregrine Management Systems collected specialty data on 9,420 Colorado physicians. This data set is continually updated and it is current as of March 2004. The Peregrine data set includes only Colorado physicians and does not include any physicians identifying themselves as residents. To date, CPHP has been unable to locate a source that collects complete state-wide statistics regarding specialties of all licensed or practicing physicians within Colorado. This is the most complete and representative data set CPHP has found which collects specialty information on Colorado physicians.

In order to best compare the two data sets, CPHP modified to standardize specialty. Specifically, CPHP grouped specialty according to American Board of Medical Specialties. However, due to the overlapping of several subspecialties, CPHP identified the most frequent specialty for the particular subspecialty and assigned the subspecialty accordingly. The specialties utilized and their incorporated subspecialties are listed below.

• Allergy & Immunology (includes: Pediatric)• Anesthesiology (includes: Critical Care Medicine, Pediatric, Pain Management)• Colon & Rectal Surgery• Dermatology (includes: Dermatopathology, Pediatric)• Emergency Medicine (includes: Toxicology, Undersea & Hyperbaric Medicine, Urgent Care)• Family Practice (includes: General Practice)• Internal Medicine (includes: Cardiovascular Disease, Clinical & Laboratory Immunology, Diabetes,

Endocrinology, Gastroenterology, Geriatrics, Hematology, Hospitalist, Infectious Disease, Nephrology, Medical Oncology, Pulmonary Disease, Rheumatology)

• Medical Genetics• Neurological Surgery (includes: Pediatric, Spine)• Nuclear Medicine• Obstetrics & Gynecology (includes: Gynecological Oncology, Infertility, Maternal & Fetal Medicine, Women's

Health) • Ophthalmology (includes: Eye Surgery, Pediatrics, Retinal Surgery)• Orthopaedic Surgery (includes: Hand Surgery, Pediatrics, Sports Medicine, Total Joint)• Osteopathic Medicine (includes: Acupuncture, Alternative Care, Holistic Medicine, Manipulative Therapy)• Otolaryngology (includes: Pediatric, Otology)• Pathology (includes: Forensic, Pediatric, Clinical Pharmacology)• Pediatrics (includes: Adolescent Medicine, Cardiovascular Disease, Child Development, Critical Care Medicine,

Diabetes, Emergency Medicine, Endocrinology, Epidemiology, Gastroenterology, Hospitalist, Infectious Disease, Neonatal-Perinatal Medicine, Nephrology, Oncology/ Hematology, Pulmonary Disease, Rheumatology)

• Physical Medicine & Rehabilitation (includes: Physiatry, Worker's Comp)• Plastic Surgery (includes: Head & Neck, Maxillo-Facial, Oral, Otolaryngology, Pediatric, Reconstructive)• Preventive Medicine (includes: Aerospace Medicine, Bariatrics, Nutrition, Occupational Medicine, Research,

Wellness Medicine)• Psychiatry & Neurology (includes: Addiction Medicine, Neurology, Neurology: Pediatrics, Neurotology,

Psychoanalysis, Sleep Disorders)• Radiology (includes: Radiation Oncology, Body Imaging, Vascular & Interventional, Mammography,

Neuroradiology, Pediatric• Surgery (includes: Abdominal, Breast, Burn, Cardiovascular, Critical Care, General, Other, Pediatric, Transplant,

Traumatic, Upper Extremity, Urological, Vascular, Surgical Assists)• Thoracic Surgery• Urology (includes: Pediatric, Urogynecology)

Page 8

Specialty Peregrine Data

Percent CPHP Data

Percent

Administrative 52 0.6 0 0

Allergy/Immunology 83 0.9 0 0

Anesthesiology 604 6.4 21 13.4

Colon & Rectal Surgery 8 0.1 0 0

Dermatology 135 1.4 1 0.6

Emergency Medicine 611 6.5 8 5.1

Family Practice 1661 17.6 27 17.2

Internal Medicine 1898 20.2 35 22.4

Medical Genetics 9 0.1 0 0

Neurology Surgery 66 0.7 0 0

Nuclear Medicine 3 >.01 0 0

Obstetrics/Gynecology 539 5.7 5 3.2

Ophthalmology 250 2.7 3 1.9

Orthopaedic Surgery 417 4.4 5 3.2

Osteopathic Medicine 34 0.4 0 0

Otolaryngology 146 1.6 3 1.9

Pathology 175 1.9 6 3.8

Pediatrics 696 7.4 10 6.4

Physical Medicine & Rehabilitation

141 1.5 3 1.9

Plastic Surgery 124 1.3 1 0.6

Preventative Medicine 119 1.3 1 0.6

Psychiatry & Neurology 692 7.3 11 7

Radiology 454 4.8 6 3.8

Surgery 379 4.0 9 5.8

Thoracic Surgery 11 0.1 1 0.6

Urology 108 1.1 1 0.6

Subtotal 9415 100 157 100

Unknown/Not Applicapable 5 4

In Progress 61

Total 222

Specialty of New ReferralsJuly 2003 - June 2003

Data Table

Page 9

Specialty of New ReferralsJuly 2003 - June 2004

•Cautionary Notes:

CPHP notes caution in interpretation of this data for several reasons. First, the CPHP data set includes all clients referred during the fiscal year (residents, physician assistants, out-of-state clients, etc.) while the Peregrine data set contains strictly Colorado physicians. Secondly, the data sets were collected from different time frames. The Peregrine data set is current through March 2004 and the CPHP data set is from July 2003 through June 2004. Lastly, while the Peregrine data set is not all inclusive of the total number of all Colorado physicians, CPHP is utilizing this data to assist in hypothesizing about CPHP clients as compared to the general Colorado physician population. •Results:

In analyzing the specialty table (previous page) comparing the statistics of Fiscal Year 2003-04 CPHP New Referral Client Specialties with statistics from the Peregrine data set, some interesting information is gleaned.

When examining the percent of clients seen at CPHP during Fiscal Year 2003-04, the specialty most frequently seen at CPHP is Internal Medicine at 22.4%, followed by Family Practice at 17.2%, and Anesthesiology at 13.4%. This is similar to the physicians of Colorado (as represented in the Peregrine data set) with the largest specialty being Internal Medicine at 20.0%, followed by Family Practice at 17.6%. However the third largest specialty for Colorado physicians is Pediatrics at 7.4%. (Anesthesiology is the sixth largest specialty for Colorado at 6.4%.) Overall, CPHP has relatively similar New Referral Client Specialty percentages when compared to the Colorado physicians. All of the CPHP New Referral specialties are represented within 5 percent of the Peregrine data set specialties except for Anesthesiology.

The CPHP New Referral specialty of Anesthesiology is slightly more prevalent at 13.4% when compared to the Peregrine data set at 6.4%. This is a difference of 7.0%. It is hypothesized that more Anesthesiologists are seen at CPHP when compared to other Colorado physician specialties due to Anesthesiology being considered a high risk specialty for substance abuse. CPHP is pleased that Anesthesiologists are utilizing CPHP services and currently targets this specialty group for provision of educational information.

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License Status of New Referrals July 2003 - June 2004

Active65%

Applicant12%

None3%

Training14%

Inactive/ lapsed

3%

Investigation/ Probation

2%

Suspended1%

• 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, 65% had active Colorado licenses, 14% had Colorado Training Licenses, 12% were applicants, 3% had lapsed or inactive licenses, and 2% were under investigation or probation. The remaining 3% of New Referrals did not have licenses, which included medical students, physician assistant students and out-of-state clients.

N=222

Page 11

Region Number Percent

Adams 3 1.3

Alamosa 1 .5

Arapahoe 20 9.0

Boulder 7 3.1

Broomfield+ 1 .5

Denver 55 24.7

Douglas 9 4.0

Eagle 4 1.8

Colorado Counties Served by CPHP July 2003 - June 2004

• CPHP served New Referral clients from 22 counties of residence throughout Colorado during Fiscal Year 2003-04. 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 24.8%, followed by Arapahoe County at 9.0% and Jefferson County at 6.3%.

= County Served

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.

Region Number Percent

El Paso 10 4.5

Fremont 2 .9

Garfield 1 .5

Gunnison 1 .5

Jefferson 14 6.3

La Plata 1 .5

Larimer 4 1.8

Logan 2 .9

Region Number Percent

Mesa 2 .9

Prowers 2 .9

Other 1 .5

Pueblo 5 2.2

Routt 1 .5

Weld 5 2.2

Out-of-State 10 4.5

In Process 61 27.5

YR 2003-04 222 100+ = Broomfield County is not indicated on this map due to recent designation as a county.

Page 12

Referrals & Reactivations1993 - 2004

110137 143 119 130 112

153 132187 175 184

1821 24

22 1816

4732

293845

0

50

100

150

200

250

1993-1994

1994-1995

1995-1996

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

Referrals Reactivations

• CPHP continued to receive steady New Referrals throughout Fiscal Year 2003-04 with 222 New Referrals. When compared to Fiscal Year 2002-03, CPHP experienced an actual growth of 18 cases which is an increase of 9%. The BME made modifications within the licensing application that CPHP suspects will effect New Referral growth projections. Specifically, the BME License application now contains wording that allows respondents to keep their medical and psychiatric histories confidential if they are known to CPHP. This language has been used on the BME licensing reapplication with success. CPHP predicts that growth of New Referrals will be a continued steady incline, instead of previous elevations and reductions that corresponded to the BME licensing renewal application cycle. CPHP is pleased with the overall continued growth of New Referrals throughout our program history.

• Of the 222 New Referrals, 38 were reactivations. This represents 17% of the total New Referrals. This percentage is a slight increase when compared to Fiscal Year 2002-03 (14%).

Page 13

Reactivations July 2003 - June 2004

Admin18%

Mal Pract5%

Peer3%

BME16%

Hospital3%

Self42%

Attorney5%

Tx Prov5%

Res Prog3%

• “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 38 participants who were reactivated, 42% Self referred. This is an increase when compared to Fiscal Year 2002-03 when 35% Self referred.

• 55% of Reactivations came voluntarily to CPHP during Fiscal Year 2003-04. Voluntary referrals of Reactivations have increased when compared to Fiscal Year 2002-03 which had 41% voluntary reactivations. CPHP is pleased with the increase in voluntary referrals as this demonstrates trust and confidence in CPHP services.

• Primary presenting problems of reactivated clients are illustrated on the right pie chart. These statistics reflect that Reactivations most commonly present with problems of Substance Abuse (16%), followed by Legal (13%) and Psychiatric (11%) issues. This distribution varies from total CPHP New Referrals (three largest categories listed in descending order: Psychiatric, Behavioral and Substance Abuse). The distribution of primary presenting problem areas was proportionately higher for Reactivations in the category of Substance Abuse (16%) when compared to percentages of total New Referrals for the 2002-03 Fiscal Year (10%). Legal was also significantly higher in reactivations (13%) when compared to Annual New Referrals (5%). The percentage of Reactivations and New Referrals with the primary presenting problem of Psychiatric was similar at 11% and 14% respectively.

N=38

Behavior8%

Inactivated w/o Eval

17%

Legal13%

Career8%

Eval in Progress

11%

Sub Abuse16%

Psyc11%

Prof Bound3%

Stress8%

Emotional5%

Primary Presenting ProblemReferral Source

Page 14

228 Participants Inactivated (Reasons/Outcome)

July 2003 - June 2004

Eval Comp32%

Relocated3%

Tx Comp45%

Declined Tx1%

Client Req7%

Deceased1%

Eval Declined

11%

• “Inactivation” refers to when a case is closed at CPHP. Definitions of inactivation reasons are on page 22.

• For Fiscal Year 2003-04, CPHP inactivated 228 participants and opened 222 new cases, resulting in a net loss of 6 cases.

• Of 228 inactivations, 23 (11%) Declined Evaluation, 3 unfortunately were Deceased, and 7 Relocated; therefore, 195 clients were evaluated. Of the 195 evaluated, 175 (90%) were inactivated with an outcome considered successful and/or satisfactory. CPHP maintained its high success rate when compared to Fiscal Year 2002-03. CPHP is pleased with our continued high rate of satisfactory outcomes!

• Length of Active Status at CPHP is depicted on the right pie chart. The majority of participants (56%) completed the necessary involvement with CPHP in one year or less.

N=228

0-3 Mos12%

4-6 Mos23%

7-9 Mos13%10-12 Mos

8%

1-2 Yrs14%

2-5 Yrs19%

5+ Yrs11%

Length of Active Status at CPHP

Page 15

Participants Documentation Requests July 2003 – June 2004

BME Interim/ Addendum

6%

BME Qrtly27%

Standing Status

2%Credentialing

32%

One-Time Status

Request26%

BME Evaluation7%

•CPHP processed 933 requests for reports during Fiscal Year 2003-04.

N= 933

Page 16

Program Highlights

• Physician Peer Health Assistance Contract: CPHP successfully completed the Request for Proposals process and was awarded the five year Physician Peer Health Assistance Contract. CPHP is looking forward to continue to provide the peer assistance services to the physicians and physician assistants of Colorado.

• CPHP Medical Director and Associate Medical Directors:

– CPHP Medical Director Emeritus Retires: Stephen L. Dilts, MD, Medical Director Emeritus, retired from CPHP on May 1, 2004 after 18 years of service. A CPHP-sponsored luncheon was held on April 20th to recognize Dr. Dilts and the pivotal role he has played in helping to create one of the country’s premier physician health programs. Dr. Dilts plans to continue in his role as a Park Ranger at Roxborough State Park. CPHP wishes him the best in his future endeavors.

– CPHP hires new Associate Medical Director: CPHP is pleased to announce Elizabeth “Libby” Stuyt, MD, as the Associate Medical Director for the southern Colorado region. She received her Doctor of Medicine degree from Texas Tech University Health Sciences Center and is certified by the American Board of Psychiatry and Neurology with added qualifications in Addictions. Dr. Stuyt was a member of the Texas Medical Association state committee on Physician Health and Rehabilitation for ten years working with physicians in areas of education, intervention and monitoring. Dr. Stuyt is currently the medical director for the Circle Program, a 90-day inpatient dual-diagnosis treatment program at the Colorado Mental Health Institute at Pueblo. She is a senior instructor in the Department of Psychiatry at the University of Colorado Health Sciences Center. She is active in research and is very interested in the effects of all addictive drugs, including nicotine, on the addiction process, treatment and recovery. CPHP is welcomes Dr. Styut to CPHP.

– CPHP Medical Director and Medical Director Emeritus Honored: Colorado Psychiatric Society (CPS) bestowed distinguished awards to both CPHP Medical Director and Medical Director Emeritus at the CPS Spring Dinner Meeting on March 23, 2004. Michael H. Gendel, MD, CPHP Medical Director, received an Outstanding Achievement Award. Stephen L. Dilts, MD, Medical Director Emeritus received a Lifetime Achievement Award. CPHP applauds the professional accomplishments of Dr. Gendel and Dr. Dilts. Congratulations!

• CPHP’s Website Goes Live: CPHP was proud to announce our website to the medical community of Colorado in September 2003. The website has improved accessibility of information about CPHP services and procedures. Check out the CPHP website at www.CPHP.org.

• 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 Residency Program, Medical School, and Physician Assistant Program, St. Joseph’s Residency Training Program and Red Rocks Community College Physician Assistant Program. CPHP was excited to also begin providing services to St. Anthony’s Residency Training Program for the 2003-04 academic year. CPHP welcomed the opportunity to expand our services to serve this Denver-based training program.

Page 17

Program Highlights continued

• Spirit of Medicine Fundraising Campaign: CPHP completed the annual Spirit of Medicine fundraising campaign with successful results! CPHP utilizes fundraising efforts to supplement expenses that exceed the Peer Assistance Budget. CPHP Board of Directors along with the Development Specialist and Staff work together to cultivate and extend fundraising efforts throughout the Colorado medical community. This year CPHP expanded the campaign to highlight Women in Medicine. In addition the LivingWell Giving Society (which honors multiple year donors) and the Eternal Life Legacy Program (which honor donors who provide a bequest) were developed. CPHP hopes to continue the tradition of success for Fiscal Year 2004-05. We are thrilled with the show of support for CPHP and we are planning to utilize the funds raised for projects to continue improvement of client services and community outreach.

• Federation of State Physician Health Programs (FSPHP): CPHP continued active national involvement with the FSPHP during Fiscal Year 2003-04 with CPHP Medical Director, Michael H. Gendel, MD, serving as President of this organization.

– Annual Federation of State Physician Health Programs Annual Meeting: CPHP Medical Director, Executive Director and Associate Medical Directors attended the FSPHP Annual Meeting in Arlington, Virginia, April 26-28, 2004. Dr. Sarah R. Early presented on CPHP’s Fundraising History and Spirit of Medicine Campaign on a Panel to discuss various Physician Health Program fundraising efforts. Additional presentation topics addressed at this meeting included innovations in toxicology, boundary crossings and violations, challenges to re-entry for physicians and healthcare professionals, Federation of State Medical Board overview, and health of women and men physicians. CPHP representatives welcomed the opportunity to network with colleagues from other Physician Health Programs and gain valuable information about physician health related issues.

– Western Region of the Federation of State Physician Health Programs Annual Meeting: CPHP Medical Director, Executive Director and Associate Medical Directors attended the Western Region of the FSPHP Annual Meeting in Canon Beach, Oregon September 25-27, 2003. In addition, Michael Gendel, MD, CPHP Medical Director attended the Northeast Region of the FSPHP Annual Meeting in Cape Cod, Massachusetts on September 12, 2003. CPHP is pleased to have an active role with physician health colleagues.

• Finance and Peer Assistance Budget: CPHP finished the fiscal year ending June 30, 2004, with an actual Year-to Date Program Operations Net Loss of $21,171.58 versus an anticipated Year-to-Date budgeted Net Loss of $94,856.00. The substantial decrease in the net loss can be attributed to increased Fee-for-Service Revenue and a decrease in physician fees related to a temporary reduction in contracted physician hours.  The Net loss was supplemented with cash reserves from the annual Spirit of Medicine campaign.

Page 18

Community Outreach Highlights

• Physician Stress and Stress Management Seminars: CPHP and Copic successfully completed the second series of Physician Stress Seminar to educate physicians about the importance of stress management to attain good health. These seminars were met with overwhelming success throughout Colorado. Locations of the second series of presentations included: Pueblo, La Junta, Denver, Sterling, Loveland, Englewood, Boulder, Louisville and Steamboat Springs. Due the success of this educational venture, the third series of Physician Stress and Stress Management Seminars commenced this fiscal year.

• 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 and Professional 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, intervention strategies, how to make referrals, and documentation.

• Participant Monitoring Visits: CPHP Medical Director and Associate Medical Directors traveled to various areas in the state for client appointments outside of Metro Denver including Boulder, Colorado Springs, Durango, Fort Collins, Grand Junction and Pagosa Springs.

Page 19

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 Physician stress and stress management Substance abuse, addiction Professional boundaries Self-care and physician health issues Disruptive physician management

Page 20

CPHP Board of Directors and Staff

Board of Directors Board of Directors- continued Medical Director andAssociate Medical Directors

Officers: Board Directors:

ChairBruce Wilson, MD George Dikeou, Esq Michael H. Gendel, MDMedical Director Executive Vice President Medical DirectorRocky Mountain Health Plans Copic CompaniesGrand Junction Denver Doris C. Gundersen, MD

Associate Medical DirectorVice Chair John Drabing, DO Theodore (Ted) Zerwin, MSW Retired David A. Iverson, MDRetired, President Orthopedic Surgery Associate Medical DirectorArthritis Foundation, Rky Mtn Cptr Colorado SpringsWestminster Jay H. Shore, MD

Caroline Gellrick, MD Associate Medical DirectorSecretary Exempla Occupational MedicineMichael Michalek, MD Occupational Medicine Michael S. Stuges, MDMedical Director Wheat Ridge Associate Medical DirectorAddiction Recovery Unit Presbyterian/St. Luke’s Hospital Carol Goddard Elizabeth “Libby” B. Stuyt, MDDenver Owner and CEO Associate Medical Director

Goddard Associates Treasurer Englewood Professional and Administrative StaffJames Borgstede, MD Penrad Imaging Debbie Lazarus Sarah R. Early, PsyDRadiology President Executive DirectorColorado Springs Colorado Medical Society Alliance

Greenwood Village Cae Allison, LCSWDirector-at-Large ClinicianMaureen Garrity, PhD Sandra MaloneyAssociate Dean, Student Affairs Community Member Teresa Bajorek, CPCSUniv. of Colo Health Science Ctr Littleton Executive Assistant/Office AdministratorDenver

Judith Beshel, LCSWDirector-at-Large ClinicianLarry Schafer, MD Private Practice Karen Chipley, MBAOncology/Hematology Director of FinanceArvada

Brian EllisReceptionist/Program Assistant

Shari Lewinski, LPCClinician

D.Jo Lowell, MDivDirector of Clinical Services

Jill Sample, BSClinical Coordinator

Susan Swern, BSDevelopment Specialist

APPENDIX

Page 22

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