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Governor's Newsletter, Fall 2000

William E. Dismukes, MD, MACP
Governor, Alabama Chapter

ANNUAL SCIENTIFIC MEETING OF ALABAMA CHAPTER

Bill Dismukes, MD, MACP

Our June 1-3, 2000 meeting at Perdido Beach Resort, Orange Beach, Alabama, was another success. Over 95 members/associates and their spouses/families attended. We sponsored six Associate (Resident) members from the five different Internal Medicine Residency Training Programs in the state. These six presented clinical vignettes as a part of the program. For more details, see the Associate Activities article in this issue. Our faculty speakers did an excellent job. Speakers and their topics were as follows:

  • Update in Thyroid Diseases - Elizabeth D. Ennis, MD, FACP, Director, Internal Medicine Residency Training Program, Baptist Health Systems, Birmingham.
  • Antibiotic Resistance-Emerging Problem, Corrective Approaches - Craig J. Hoesley, MD, Member, Assistant Professor of Medicine, Division of Infectious Diseases, UAB School of Medicine.
  • Obstructive Lung Diseases: New Insights and Management - Dick D. Briggs, Jr., MD, MACP, Professor Emeritus of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, UAB School of Medicine.
  • Update in Management of Arrhythmias - John S. Strobel, MD, Member, Assistant Professor of Medicine, Division of Cardiovascular Diseases, UAB School of Medicine.
  • New Approaches to Treatment of Parkinson's Disease - Barton L. Guthrie, MD, Associate Professor of Surgery, Division of Neurosurgery, UAB School of Medicine.
  • Hepatitis C and Its Sequelae: Diagnosis and Management - Michael B. Fallon, MD, Member, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, UAB School of Medicine.
  • Issues Affecting Internists: News from Washington - Debra Cohn, Legislative Counsel, ACP-ASI Washington, DC.
  • News from the ACP-ASIM Representative - Robert B. Copeland, MD, MACP, Immediate Past Chair, Board of Regents; College Representative; President, Southern Cardiopulmonary Associates, LaGrange, Georgia.

Special activities included a welcome reception on Thursday evening; a Business Meeting; a Town Hall Meeting; a Dermatology skin biopsy workshop; and another reception on Friday evening to honor our Laureate Awardees (see article on Laureates on pages 3-4.)

Attendees were very positive about the program, speakers, facilities and special activities. If you did not attend, please plan to join us at our next Alabama Chapter meeting on May 31-June 2, 2001. We promise another good meeting!

NINTH ANNUAL LITERATURE
AND MEDICINE RETREAT

Robert Lokey, MD, FACP

The next Annual Literature and Medicine Retreat of our Alabama Chapter will be held on January 27-28, 2001, at the Embassy Suites Hotel in downtown Montgomery.

Works for reading and discussion include Anna Karenina by Tolstoy; Opened Ground: Selected Poems, 1966-1996 by Seamus Haney; Edward Albee's play, A Delicate Balance, and Collected Stories by Gabriel Garcia Marquez. The facilitator will again be Dr. Randy Davis, Associate Professor of Literature, Jacksonville State University.

Registration fees are $75/person and $150/couple.
Make check payable to Alabama Chapter ACP-ASIM.

Mail to: John Bass, Jr., MD
University of South Alabama Medical Center
2451 Fillingim Street
Mastin Building, Ste. 400A
Mobile, AL 36617

Make room reservations directly with Embassy Suites, Montgomery, at (334) 269-5055.

BECOME AN ACP-ASIM KEY LEGISLATIVE CONTACT

Bill Dismukes, MD, MACP

With over 110,000 members, the American College of Physicians-American Society of Internal Medicine is the largest medical specialty society in the U.S. Many of our members are the leaders in their communities. Many of our members are politically active.

Others need to become politically active to influence the direction of access to care, government-sponsored insurance programs, graduate medical education, medical research and the government regulation of our profession.

The Washington office of ACP-ASIM has over 50 people who keep their fingers on the pulse of what is happening in Washington. Often contacts to key legislators can swing a vote and influence legislation. If you are willing to be part of this process of American democracy, please volunteer as a KEY CONTACT.

If you know a legislator personally, if you know someone who works in your congressperson's or senator's office, if you provide medical care to a congressman or senator or their families, if you have supported the campaign of a legislator, or if you just want to become politically active, YOUR SERVICES ARE NEEDED.

As a KEY CONTACT, you will receive periodic congressional updates on legislation that affects you and your patients. When our Washington watchdogs believe that your contact can make a difference in national legislation, you will receive a fax guiding you through that contact. You will be asked to contact your congressman by letter, telephone, or e-mail. The easiest way is to use the ACP-ASIM interactive phone system. Dialing a toll-free phone number (888-218-7770) and entering your 8-digit member number and home zip code will put you in direct contact (or you may leave a recorded message) with your senator or representative. A FEW MINUTES OF YOUR TIME MAY HAVE AN IMMENSE IMPACT.

You may wish to attend Leadership Day in Washington, DC. This is a one and a half day session held on Capitol Hill; after a briefing by congressional staffers you are turned loose to call on our Alabama congressmen and senators. Several of your colleagues and I have been active in this program over the last six years. When we started, most congressmen did not know what an internist was. They now know us as ethical physicians who support access to care, medical education and fairness in medicine. The next ACP-ASIM Leadership Day on Capitol Hill will be held May 8-9,2001, when we can have the most influence on legislation.

If you would like to be a key contact, call the Washington office at 800-338-2746, or speak to Bill Dismukes
(205-934-5191) or Dick Esham (334-460-6667). If you wish to attend Leadership Day, contact Bill Dismukes or Dick Esham.

LAUREATE AWARDS

John Burrell Bass, MD, MACP

Dr. John Bass, a fourth generation Alabama physician, attended Auburn University and Tulane University, and earned his MD at the Tulane University School of Medicine. Following his residency in Internal Medicine at UAB, Dr. Bass continued his training at UAB, first as a Chief Medical Resident, and then as a Fellow in Pulmonary Medicine. Since 1974, Dr. Bass has been on the faculty, University of South Alabama School of Medicine. For 25 years, he served as Director, Division of Pulmonary and Critical Care; and since 1997, he has been Chairman, Department of Medicine.

Dr. Bass has been highly active in the ACP-ASIM, having presented many Meet-the-Professor sessions at annual national meetings, and served on two pulmonary/critical care MKSAP committees. From 1995 to 1999, Dr. Bass served with distinction as Governor, Alabama Chapter, ACP-ASIM.

Of all of his professional activities, Dr. Bass is most proud of his teaching. He has taught each of the more than 1600 students who have graduated from the USA School of Medicine, and has been selected as the Best Clinical Professor on six occasions. In addition, Dr. Bass has been given a Distinguished Faculty award each year since its inception in 1990. Recently, at the 2000 annual meeting of the ACP-ASIM, the College bestowed on Dr. Bass a coveted Mastership in recognition of his many contributions to internal medicine, especially his teaching of medical students, residents, fellows, and practicing physicians.

Dr. Bass and his wife, Becky, have two children.

Peter William Morris, MD, FACP

Dr. Peter Morris, a native and life-long Alabamian, did his undergraduate work at the University of Alabama, Tuscaloosa, and earned his MD from the Medical College of Alabama in 1956. Following completion of his residency in Internal Medicine at University Hospital (UAB), Dr. Morris served two years in the United States Navy, and then did a two-year fellowship in Hematology/Oncology at Duke. In 1963, Dr. Morris opened his office in Birmingham for the practice of internal medicine and hematology/oncology, and has continued his solo practice uninterrupted for the past 37 years.

During his long and distinguished career, Dr. Morris has been a highly involved leader and valuable contributor to numerous local, state and national medical organizations. He ascended the ladder from Secretary-Treasurer to President (1981) of the Jefferson County Medical Society. He also served two terms as President, Birmingham Society of Internists. Dr. Morris has held all of the major offices and served on the key boards of the Medical Association of the State of Alabama, serving as President of MASA, 1992-93, and as a member of the State Board of Medical Examiners, 1983-94. Dr. Morris is currently serving as one of the Alabama delegates to the American Medical Association, and as a member of the AMA Reference Committee for Constitution and By-Laws.

Dr. Morris's involvement in the American Society of Internal Medicine since 1964 culminated with his being named Internist of the Year, 1993, and President, 1995-96. Over the past two years, he has served on the Board of Directors, Alabama ACP-ASIM.

Dr. Morris and his wife, Diane, have two children.

ACP-ASIM'S EFFORTS TO REDUCE
THE HASSLE FACTOR

The ACP-ASIM continues to work diligently to reduce those factors which are outside of an individual internist's control and which make the daily practice of medicine much more difficult.

The ACP-ASIM's Department of Managed Care and Regulatory Affairs Department is involved with efforts to reduce the hassle factors faced by physicians. From meeting with the staff of the United States Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) to influencing pending legislation on physician-assisted suicide, the ACP-ASIM is dedicated to fighting the hassle factor battles for its members. The following is a sampling of the College's efforts.

Easing Evaluation and Management (E/M) Documentation Requirements:

  • Urged the Medicare Payment Advisory Commission (MedPAC) to recommend that physician E/M documentation requirements be made less burdensome.

Simplifying Claims Processing and Credentialling:

  • Reached agreement on a process that will allow ACP-ASIM leaders to meet regularly with policymaking representatives from the Blue Cross Blue Shield (BCBS) and the Health Insurance Association of America (HIAA). Both HIAA and BCBS have recently announced initiatives to reduce hassles affecting physicians. ACP-ASIM has been invited and agreed to participate in both efforts.

Simplifying Billing for Laboratory Tests:

  • Participated in the negotiated rulemaking committee to develop standard Medicare policies for 23 clinical laboratory tests with the goal of reducing the administrative burden physicians' face when ordering lab tests and to eliminating Medicare carrier policy variability.

Addressing Concerns about Fraud and Abuse:

  • Achieved revisions in OIG's "Who Pays, You Pay" campaign materials that are more physician friendly, and that direct patients to resolving billing issues with their physicians first, rather than calling the OIG Fraud Hotline. The revised materials note that most physicians are honest and want to work with patients to resolve questions about bills.

Improving CPT Codes for Care Plan Oversight Services:

  • The Current Procedural Terminology (CPT) Editorial Panel agreed to an ACP-ASIM proposal, submitted jointly with the American Academy of Family Physicians, that would allow physicians to bill for the time they spend communicating with family and other care decision-makers regarding coordination of care for home health and hospice services.

Reducing Other Hassles:

  • Made numerous recommendations aimed at promoting fairness in the way Medicare audits physicians and seeks recoupment of money paid to physicians based on those audits. ACP-ASIM's recommendations also 1) aim to eliminate the elements of the current process that coerce physicians into accepting settlements on Medicare's terms; 2) provid guidance to HCFA so the agency can ensure all of its Medicare carriers are not restricting patients' ability to be evaluated by an internist (or other physician) prior to surgery.

Empowering Physicians to Influence Third Party Payers:

  • Lobbied for comprehensive patient bill of rights legislation (Norwood-Dingell bill) that will provide physicians and patients with greater rights to influence and appeal inappropriate denial of payments. The bill would also prohibit gag clauses, assure that physicians - not MCOs define what is medically necessary, and allowing recourse to the courts when self-insured plans deny needed benefits.

Helping Internists Cope with Hassles:

  • Developed numerous educational resources to help internists cope with requirements from Medicare and private payers in the least burdensome manner possible. Resources include a guide on compliance with federal fraud programs and Medicare audits, a laminated list of ICD-9 codes typically used by internists, and a pocket guide to coding for E/M services.
  • ACP-ASIM maintains a toll-free hotline to enable internist-members to get personal assistance in resolving problems with Medicare and other payers.

ALABAMA CHAPTER ASSOCIATES ACTIVITIES

David Ennis, MD, FACP

Our ACP-ASIM Associates continue to be an active group. Their first project for the fall will consist of presentations/discussions to the Health Services Classes, Phillips High School, Birmingham, regarding careers in Medicine. The Associates Council for the academic year 2000-2001 has representatives from each of the Internal Medicine Training Programs in the state as shown below:

  • Baptist Health Systems - Kevin Napier and Phil Hemstreet
  • Carraway Methodist Medical Center - Rhonda Sivley and Robert Spiegel
  • UAB - Sumai Desai and Veronica Franco
  • UAB, Montgomery - Wenimar Salvador
  • University of South Alabama - Bryan Green and Takiko May

At the Annual Meeting of the Alabama Chapter in June 2000, at Orange Beach, six Associates presented interesting clinical vignettes to the attendees. Presenters and their topics included:

  • Brion Lock, MD (UAB) - HIV associated Kaposi's Sarcoma presenting as stridor
  • Lesa Proctor, MD (Carraway) - Brigada Syndrome: unmasking a preventable cause of death
  • Randy Panther, MD (UAB-M) - CML forme fruste mimicking essential thrombocytosis
  • Oto Prokop, MD (USA) - New onset seizures
  • Shawn Gregory, MD (UAB) - Infected cardiac myxoma
  • Bill Summers, MD (Baptist) - Man with a wide based gait

The winning vignette was presented by Bill Summers who will represent our Chapter at the upcoming national meeting in Atlanta in April 2001. We are proud of all of the presenters and the fine job they did. Our Chapter was also pleased to sponsor ten other Associates, two from each training program, to attend our Chapter meeting.

The Alabama Chapter is committed to expanding the number of Associate members. This category of membership is available to any resident in an accredited Internal Medicine Residency Training Program. Dues for Associates are $104/year.

CHAPTER PHOTO ALBUM
VOLUNTEERISM

Volunteerism, like commitment to continuing medical education, has long been an established tradition among internists and many other physicians. A study done by the American Medical Association (AMA) in 1994 found that two-thirds of all practicing physicians provided some free or reduced fee care, averaging 12% of their work time. Moreover, time spent in volunteer work had increased between 1900 and 1994.

ACP-ASIM encourages all physicians to get involved in volunteerism and community service. The cumulative effects of physician volunteerism brings access to health care a little closer to many underserved patients, and can make a real difference in the lives of people and communities. Volunteerism can also benefit the physicians by providing unique experiences not encountered in training or practice, feelings of satisfaction at making a difference over and above one's usual career accomplishments, and an opportunity to choose an area of interest unrelated to issues of compensation.

How To Get Started

1.Think about what you would like to do specifically:

  • Patient Populations
  • Teaching
  • Location- local or abroad?
  • Wellness or preventive services vs. treating the ill

2. Read the brochure "Interested in Volunteering as a Physician? A Guide for Getting Started," produced
by the ACP-ASIM Membership Division:

3. Investigate the pathways available:

  • Internet listings - www.diversionmag.com
  • Local/national agencies
  • County Health Departments
  • Religious/altruistic organizations

4. Learn the legal issues about volunteer work:

The ACP-ASIM supports local and national volunteerism by its membership and has established these activities as major criteria for advancement to Fellowship.

Upcoming Meetings

ACP-ASIM Annual Session
Atlanta, Georgia
March 29-April 1, 2001

Alabama Chapter Annual Meeting
Orange Beach Resort
May 31-June 2, 2001

GOVERNOR/CHAPTER CONTACT INFORMATION

William E. Dismukes, MD, MACP
University of Alabama at Birmingham
Division of Infectious Diseases
THT 229, 1530 3rd Avenue South
Birmingham, AL 35294-0006
Phone: (205) 934-5191
Fax: (205) 934-5155
E-mail: wdismukes@uabid.dom.uab.edu