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Governor's Newsletter, Spring 2001

Richard L. Neubauer, MD, FACP
Governor, Alaska Chapter

New Governor's Message

As newly installed Governor of the Alaska Chapter ACP, I congratulate our outgoing Governor, Steve Tucker MD, FACP, for a job well done. Under Steve's direction over the last four years, our chapter has flourished, largely because of his hard work and leadership abilities. Great work, Steve!

As I begin my term as Governor, this is a good time to look at where our chapter stands, where we have put our energies, where I think we need to go in the next four years, and how we might best get there.

The Card Project, initiated by Dr. Tucker four years ago is a great example of an innovation that remains underutilized. These are attractive multi-purpose cards (you can check out the appearance of these cards at our chapter website that I personally use routinely as sympathy cards upon the death of one of my patients. Proceeds go to a chapter scholarship fund that is held in a separate chapter account. These cards have been a great enhancement to my own practice (I almost always get a nice reply from families), and the funds are going toward a scholarship fund that we can proudly use in the future. I would like to see more of you use these cards. Contact Dr. Tucker: sbtucker@alaska.net with your order.

The annual Alaska Chapter ACP scientific meetings have continued to be a proud centerpiece of our chapter activities. This year our meeting will be held June 28-30 at Alaska Regional Hospital and will focus on Congestive Heart Failure, a clinical field that has dramatically changed in the last decade. We've put together a panel of experts from across the country to update you on these new advances. You should all have received a brochure for this meeting, but you can also download a registration form from our chapter web site.

I like planning in advance, so here is a sneak preview of what is planned for future chapter meetings:

  • June 2002
    History of Medicine,A Look Back and A Look Ahead
    Faculty to include: Lynn Loriaux, Faith Fitzgerald, Jock Murray

  • June 2003
    Women's Health
    Planned in conjunction with Sandy Fryhofer, Immediate Past President ACP

  • June 2004
    Geriatric Medicine Update
    Planned in conjunction with Patricia Blanchette, Governor Hawaii Chapter ACP

Our chapter meetings have continued to be a great source of fun for me personally, and a lucrative effort for our chapter. Your continued support via attendance is vital to keep these efforts on track. Send in your registration for the June 28-30, 2001 meeting today!

Our most recent chapter activity has been the Anchorage Internal Medicine Grand Rounds Program administered via our chapter CME Committee. This undertaking was originally conceived by Brian McMahon, MD, FACP under the direction of Burt Janis, MD, FACP, as committee chairman, the internal medicine grand rounds at Alaska Native Medical Center, Providence Alaska Medical Center, and Alaska Regional Hospital have been transformed and reinvigorated.

Using a curriculum based system and by pooling our efforts using the ACP chapter as an independent third party, we have been able to breathe new life into an institution that had become stagnant. While currently benefiting the Anchorage medical community, this chapter activity could easily be expanded to other Alaska communities. Anyone interested?

Another Anchorage based activity has been the chapter journal clubs. Our latest was a delightful January gathering at my house with Marvin Turck. Marv gave us a great update on the infectious diseases literature, and the attendance was the best we have had in a long time. With the terrific array of speakers we have coming for grand rounds, it is our plan to have journal clubs put on by selected visiting speakers on a regular basis. To make these more interesting, we'll be rotating locations, and Paul Steer, MD, FACP, has volunteered his house for the next journal club meeting.

One area that needs further attention is getting more chapter participation from internists in our state outside of Anchorage. In the last year, our chapter council was reorganized to do just that. At this time, our council has a large representation of internists from across the state. Please refer to our chapter web site, www.acponline.org/chapters/ak/ for a full listing of council members. We still need to do more in this area, and I am establishing a Rural Internists Committee which will be chaired by David Rudolf, MD, FACP, to explore ways that our chapter might enhance its activities outside of Anchorage.

There are other areas that challenge our chapter and our national organization. One is how to meet the special needs of women internists. In this regard, I have appointed Song Gan, MD, FACP, to chair a Women Internists Committee. Song works at the VA Clinic in Anchorage and is a newly elected Fellow of the College. I've given her the open-ended task of making our chapter more helpful to our women colleagues.

Another challenge to ACP is how to address the needs of both specialists and generalists. I've appointed Steve Compton, MD, to chair a Specialists Committee to explore the relationship of our chapter to sub-specialist internists. Steve is an Anchorage cardiologist and electrophysiologist, who has recently completed his application to advance to fellowship in the College.

Finally, as my generation of physicians ages, we need to look toward who will take the helm of the Alaska Chapter ACP in the future. I still remember (even though it was a long time ago!) when Tom Wood, MD, FACP, Rod Wilson, MD, MACP, Keith Brownsberger, MD, FACP, and Norm Wilder, MD, FACP, encouraged and inspired me to participate in chapter affairs. To provide a clearer pathway toward encouraging participation from young Alaska internists, I've asked Tim Bateman, MD, to chair a Young Internists Committee of our chapter. Hopefully his committee will be a wellspring of future chapter leadership.

These are complex and challenging times. While we advance our chapter activities, I will need to follow the illustrious example of prior Governors in also ensuring the financial stability of our chapter and the continued growth of our membership. I'll have the assistance of Dave Peach, MD, FACP, our new chapter treasurer. Because membership is so important to keeping our chapter strong, I have appointed Co-Chairs of the new membership committee, John Mues, MD, FACP, and Robert Bundtzen, MD, FACP. I'm excited by what the future holds for our chapter. I hope that you are too.


CME Grand Rounds Survey

For CME Grand Rounds at Alaska Native Medical Center, Alaska Regional Hospital, and Providence Hospital

This survey was conducted from 1/1/01 to 3/1/01, one year after initiation of the new grand rounds format administered in conjunction with the Alaska Chapter ACP. The survey was distributed to all members of the departments of medicine at the participating institutions and to attendees at grand rounds.

The purpose of the survey was to get an overview of how the new Internal Medicine grand rounds format is perceived by our audience, above and beyond the individual evaluations of each lecture that were conducted separately.

The total number of respondents was 61. We did not attempt to separate the responses by institution, since our aim was to evaluate the program as a whole.

  1. Compared to the Old Style, How Do You Rank Our Current Format
    chart

  2. Since the New Grand Rounds Format Began On 1/1/00 are You More or Less Likely to Attend?
    chart

  3. How Free of Commercial Bias are the New Style Grand Rounds Compared to the Old Style?
    chart

  4. How Well are the Current Grand Rounds Meeting Your Educational Expectations and Needs?
    chart

The survey also included a solicitation of suggestions for future grand rounds topics, and a space for general comments. It was particularly gratifying to receive quite a few suggestions for future programs. It has in the past been difficult to obtain suggestions from the audience for future programs.


Alaska Chapter Annual Meeting Makes A Difference

Heather Wilder, MLIS, (as shown below with her proud dad, Norman Wilder, MD, FACP) was finished with the first year of a two-year Master's program in Library and Information Science at the University of Washington when she attended the Alaska Chapter Annual Meeting on Medical Informatics. She was unsure about career paths when she attended the meeting. Norm invited her to come to the meeting because he felt "she would probably understand and appreciate the material better than he did." He was correct, but what he hadn't counted on was Heather's instant love of the material and her bonding with two of the guest speakers, Ted Shortliffe, MD, PhD (Head of the Medical Informatics program at Stanford University) and Anna Harbourt (from the National Library of Medicine). That was three years ago. Heather has completed her MLIS degree, an Associate Fellowship at the NLM, and is nearing the end of a second Fellowship year at McMaster University in Hamilton, Ontario where the ACP Journal Club is produced.

Brian Haynes, MD, PhD, Editor, and Ann McKibbon, MLS, Research Associate, have provided further mentoring for Heather who is now listed as a Research Associate for the ACP Journal Club. She'll be off to Oxford for a full-time job in Evidence-Based Medicine this fall if all goes as planned. She looks back to the Alaska Chapter Medical Informatics Meeting with fond memories and the realization that it made a huge difference in her career plans!


Spring ACP Governor's Meeting

Richard Neubauer, MD, FACP

What has the American College of Physicians-American Society of Internal Medicine done for you, the practicing internal medicine physician lately?

For me, as incoming Governor of our ACP chapter, this question was answered at the spring meeting of the Board of Governors. Here is a brief run down of some key items from the meeting.

The ACP political agenda was reviewed. This includes an emphasis on the following points:

  • Continued lobbying for expanded health care coverage
  • Cut Medicare red tape (support MERFA legislation)
  • Improve patient safety
  • Modernize medicine
  • Get changes in specific regulations including HIPAA

There was discussion of forming an ACP Political Action Committee (PAC), but the Board of Governors did not vote to support formation of a PAC. The general feeling was that our interests might be just as well served without a PAC.

The most discussed issue by far was ABIM's new recertification scheme based on their concept of CPD (Continuing Professional Development). While there was acknowledgment that some form of recertification is reasonable, the concept of CPD and ABIM's execution of what this entails has come under intense criticism from some quarters as being burdensome, intrusive, and of unproven value.

While ABIM is a completely separate organization from ACP, they have looked to the College for validation of their plans. The battle lines seem to be clearly drawn. The ACP leadership appears to be ready to advocate for its membership and is very committed to trying to change the way that ABIM envisions the recertification process. This may be a lengthy battle, but I was very impressed at how committed the leadership was toward this issue.

Finally, there was a discussion of how ACP relates to subspecialists in internal medicine. It is going to be increasingly important for ACP to represent generalists and specialists alike. There is also likely to be increasing potential for erosion of the membership as specialists look toward their specialty societies to represent them. There is certainly a commitment on the part of the College's leadership to find ways to represent us all. One thing that has remained constant as the College faces these challenges is their commitment to patients and educational values first.

I came away from this meeting with renewed enthusiasm for ACP. There are few organizations with such solid core values, and impressive leadership.


Message From Immediate Past Governor

Steven B. Tucker, MD, FACP

It has been both an honor and a privilege to have served the College nationally and our Chapter locally over these last 5 years—boy it went fast.

Nationally these last years have seen tremendous change and challenge for the College. The American College of Physicians merged successfully with the American Society of Internal Medicine, thus becoming the largest subspecialty organization in the world with some 115,000 members. The College remains active on its core issues of patient advocacy, professionalism, defense of the calling of medicine and education. The organization has grown not just in numbers but in diversity with Chapters in North and South America, as well as a rise in minority membership and leadership and recruitment of new Internists. This year was called the "year of the woman" with the President of the College, the next President-elect of the College, the current Chair and Chair-elect of the Board of Governors all being women.

Challenges remain of course with the College focused on Access to Health, 'hassle factor' reduction including the thorny issue of recertification, patient safety, professional growth and the "Internists-Doctors for Adults" project to name but a few of the key challenges ahead.

Locally our Chapter continues to thrive!! We have grown to record numbers with our total membership up almost 16%. We have a record number of Fellows—a 10% increase in total and a 200% increase in women Fellows. We have our first Master, Rod Wilson, and our fourth Laureate, Norm Wilder. We have grown financially experiencing a 275% increase in reserves and in stature nationally with our science meetings second to none. We've attracted the best and brightest speakers predominantly thanks to Rich, and have College Representatives fighting to get here— Presidents Bill Reynolds, Whitney Addington and Sandra Fryhofer and this year Chair of the Board of Regents, Bernie Rosof. Our annual meeting ranks second in the College for member support. Our local projects like the donation card Scholarship fund and the meeting enhancement projects (e.g. the hike, the bed and breakfast and the dinner) achieved national recognition winning College Evergreen awards. Our CME project is a likely winner for next year (we hope!!) and we have been a consistent winner of the Chapter management award (the last 5 years!!)

We now have our first elected Council, new Bylaws, a new Volunteer of the Year Award and full coffers with CD reserves, a full checking account, an expanding scholarship balance, and good funding for the CME project. As importantly, we have a superb incoming Governor with firm plans for excellent June meetings already outlined for the next 4 years.

Well enough said. It's been a life altering/enhancement experience for myself and my family. A life highlight I won't ever forget. To steal a line from Bob Hope — "thanks for the memories."

Steven B. Tucker, MD, FACP
Immediate Past Governor
Alaska Chapter ACP
3300 Providence Drive #304
Anchorage, AK 99508
sbtucker@alaska.net
907-261-4840 (phone)
907-261-4820 (fax)


ACP Works To Reduce Medicare Hassles

ACP is pleased to announce its endorsement of the "Medicare Education and Regulatory Fairness Act" (MERFA), S.452/ H.R. 868, which directly addresses internists' concerns with Medicare red tape and hassles.

Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, President- Elect of ACP and a practicing geriatrician.

Dr. Hall represented the College and announced support for this important legislation at a March 7 press conference with the American Medical Association and the American College of Cardiology, as well as MERFA's Senate and House sponsors.

MERFA directly addresses the Medicare procedures and rules that are the source of much frustration with the program. Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.

Introduced in the Senate by Senators Frank Murkowski (R-AK) and John Kerry (D-MA) and in the House by Representatives Shelley Berkley (D-1-NV) and Pat Toomey (R-15-PA), MERFA would allow physicians and their staff to spend more time treating patients, and less time handling needless paperwork. It would enact the following reforms:

  • Medicare rules and policies and answers to "frequently asked questions" would be made more accessible, and physicians would be given advance notice about changes in rules.

  • Medicare would be required to pay its claims, without demanding more paperwork, unless there is evidence that the bill is incorrect.

  • Medicare would be required to actually examine the records, rather than using a statistical sample, to determine that some claims were billed incorrectly.

  • Medicare's ability to investigate fraudulent claims would be preserved, while also educating physicians on how to prevent inadvertent billing mistakes that result in over payments.

Enactment of MERFA is one of the College's highest priorities. The College strongly encourages you to ask your Senators and Representative to co-sponsor this important bill if they have not already. Illustrate for your legislators your experiences with the burden of complying with regulations, and how much time it takes you and your staff to deal with complex, confusing, duplicative and unfair Medicare requirements.

E-mail, fax or compose a letter to your legislators through the ACP Legislative Action Center at http://capwiz.com/acp/home/ (draft letter provided, please personalize), or call your Senators and Representative toll-free through the ACP Grassroots Hotline at 1-888-218-7770. (The Hotline will prompt you for your 8-digit member number, which you can find on the mailing label of ACP publications, such as Annals of Internal Medicine.) Report your contacts to Jenn Jenkins in the ACP Washington Office at 800-338-2746, ext. 4536, or by blind copying e-mails to jjenkins@acponline.org. Thank you for your help.


Pitty Pats and Journal Clubs

Steve Tucker MD, FACP

Congratulations to Drs. Song-Qing Gan, Daryl McClendon, and Nelson Isada who were officially inducted as new Fellows at the Annual ACP Convocation in Atlanta, on Thursday March 29. Also honored was Dr Norman Wilder, our Chapter's fourth Laureate. These physicians accompanied Drs. Tucker and Neubauer "down the aisle at the convocation ceremony."

A chapter celebration dinner was held at Pitty Pat's Porch, a well-known eatery in Atlanta. Besides having great southern style food, they certainly have a catchy name that I couldn't help using in the headline for this narrative. In addition to the six marchers, Drs. Herndon, Brownsberger, and Rudolph also attended. Other guests included spouses Lindsay Tucker, Elle Neubauer-Ryan, Sally Brownsberger and Kathy Wilder. Norm's daughters Brenda and Heather, as well as Brenda's husband Kevin Sanders, MD, and the Tucker children Jacob and Alanna rounded out the affair. The food and ambience was terrific!!

Journal Club was held at Elle and Rich's lovely home on Thursday January 25th with a catered meal courtesy of SmithKline Beecham. Marvin Turck, MD, MACP, presented a snapshot of new breaking developments in Infectious Diseases. To tie in with some of the great speakers that our new Anchorage area grand rounds program has attracted, we plan further journal club events on a regular basis. To make it more interesting, we will be rotating where these are held. Paul Steer has volunteered that his house will be next.

In attendance at the January 25th journal club event were: Greg Gerboth, Buff Burtis, Paul Steer, Bob Bundtzen, Burt Janis, Veneeda Spencer, Hans Hagar, Mike Davidson, Brian McMahon, Madeleine Grant, Song Gan, Dave Rudolph, Rich Neubauer, Steve Tucker, John Clark, and Rebekah Miller, a UAA senior WAMI hopeful who has been doing a preceptorship with Rich Neubauer over the last year.


Cardiovascular Diseases: Congestive Heart Failure
Alaska Chapter Annual Meeting
June 28-30, 2001

Alaska Regional Hospital
Plaza Building Classrooms

Thursday, June 28, 2001

7:00 AM-7:50 AM: Breakfast and Registration

7:50 AM-8:00 AM: Introductory Remarks

8:00 AM-9:00 AM: Pathophysiology and Prevention of Congestive Heart Failure; Dr. Greenberg

9:00 AM-10:00 AM: Cytokines and Cytokine Antagonists in Congestive Heart Failure; Dr. Levy

10:00 AM-10:30 AM: Break and Refreshments

10:30 AM-11:30 AM: Advances in Prevention of Sudden Death; Dr. Compton

11:30 AM-12:30 PM: Monitoring Technologies in Heart Failure Patients; Dr. Abraham

12:30 PM-2:00 PM: Lunch (Provided)

2:00 PM-3:00 PM: Hypnosis: Its use in Cardiac Patients; Dr. Steve Pauker

3:00 PM-4:00 PM: Patient Safety; Dr. Rosof

Friday June 29, 2001

7:00 AM-8:00 AM: Breakfast

8:00 AM-9:00 AM: The Development and Role of Heart Failure Clinics; Robin Trupp RN

9:00 AM-10:00 AM: Biventricular Pacing in Heart Failure/Cardiac Resynchronization; Dr. Abraham

10:00 AM-10:30 AM: Break and Refreshments

10:30 AM-11:30 AM: ACP Update; Dr. Rosof

11:30 AM-12:30 PM: Genetics for the Primary Care Physician: Its Role in Patients with Heart Disease; Dr. Susan Pauker

12:30 PM-2:00 PM: Lunch (Provided)

2:00 PM-3:00 PM: Bottlenecks and Buffers: Thoughts on Throughput and Conflicts in Practice; Dr. Steve Pauker

3:00 PM-3:30 PM: Break and Refreshments

3:30 PM-4:30 PM: The Use of B-Blockers and ACE Inhibitors in Heart Failure; Dr. Greenberg

6:30 PM: Banquet - Native Heritage Center

Saturday June 30, 2001

8:00 AM-9:00 AM: Breakfast

9:00 AM-10:00 AM: Advances in Arrhythmia Management; Dr. Compton

10:00 AM-11:00 AM: Mechanical Heart Devices; Dr. Abraham

11:00 AM-11:30 AM: Break and Refreshments

11:30 AM-12:30 PM: Cardiac Aging and Effects of Exercise Training in Healthy Subjects; Dr. Levy

12:30 PM-2:00 PM: Lunch & Townhall Meeting

5:00 PM: Annual Flattop Climb

Faculty

William T. Abraham MD, FACP, FACC
Professor of Medicine
Chief, Division of Cardiovascular Medicine
Co-Director, Gill Heart Institute
University of Kentucky College of Medicine, Lexington, Kentucky

Robin Trupp MSN, RN, CS, ACNP, CCRN, CCRC Nurse Practitioner / HF Program Manager University of Kentucky Lexington, Kentucky

Steve Compton MD, FACC
Clinical Cardiac Electrophysiology
Alaska Heart Institute; Anchorage, Alaska

Barry Greenberg MD, FACC
Prof. of Medicine & Director, Heart Failure and Cardiac Transplant Program
University of California San Diego; San Diego, California

Wayne Levy MD, FACC
Associate Professor of Cardiology
End Stage Heart Failure/Cardiac Transplant Unit
University of Washington; Seattle, Washington

Susan P. Pauker, MD, FAAP, FACMG
Associate Professor in Pediatrics, Harvard Medical School
Chief, Genetics Department, Harvard Vanguard Medical Assoc.
Co-Director of the Genetics Clinic; Massachusetts General Hospital
Boston, Massachusetts

Steve Pauker MD, MACP
Vice Chairman, Department of Medicine
Sara Murray Jordan Professor of Medicine
Tufts New England Medical Center; Boston, Massachusetts

Bernard M. Rosof MD, FACP
Chair, Board of Regents ACP
Senior Vice President, Clinical Affairs/Quality
North Shore-Long Island Jewish Health System
Great Neck, N.Y.
Clinical Associate Professor of Medicine
State University of New York at StonyBrook
StonyBrook, N.Y.

Objectives

After many years of relative stagnation in the treatment of congestive heart failure, the last few years have seen a new understanding of the pathogenesis of this disorder, and with it, a whole new concept of treatment.

We have assembled a faculty of experts to explore some of these new concepts and treatments. Join us for a meeting that should be directly relevant to your practice in the treatment of congestive heart failure and other cardiovascular disorders.

While this meeting will be directed primarily toward internists and cardiologists, any practitioner who treats patients with congestive heart failure will benefit and is invited to attend.

StevenTucker MD, FACP
Nephrology
Anchorage, Alaska
Governor-Alaska Chapter ACP

Mark Selland MD, FACC
Cardiology
Anchorage, Alaska
Program Co-Chairman

Richard Neubauer MD, FACP
Internal Medicine
Director of Physician Education
Alaska Regional Hospital
Program Co-Chairman

For registration information, please go to the Chapter Web site and click on the "Alaska Chapter Scientific Meeting" link.