William E. Dismukes, MD, MACP
Governor, Alabama Chapter
Dear Colleague, I invite you to join me and your colleagues in internal medicine at the next scientific meeting of the Alabama Chapter of the American College of Physicians- American Society of Internal Medicine, being held June 1-3, 2000, at the Perdido Beach Resort.
This meeting is not just for ACP-ASIM members. I particularly want to invite non-members to join us for this important clinical update and to learn about the benefits of membership at the same time.
In addition to earning 6 CME credits, by attending this meeting you will:
- Gain insight into recent medical advances.
- Discuss local and national issues affecting the practice and teaching of internal medicine.
- Greet old friends, meet new friends, and develop a network of colleagues in your area.
- Take some time for yourself or with your family to relax and enjoy the sights around the Gulf Coast.
To ensure your place at this invaluable meeting, complete the registration form on page 11 of this newsletter and send it in today. The opportunities available at this meeting will help you not only meet your needs as a physician, but also the needs of the patients you serve.
I look forward to seeing you.
THURSDAY, JUNE 1, 2000
3:00 p.m. Alabama ACP-ASIM Chapter Council Meeting
6:30 p.m. Welcome Reception
FRIDAY, JUNE 2, 2000
7:00 a.m. Registration and Continental Breakfast
7:55 Welcome William E. Dismukes, MD, MACP Governor, Alabama Chapter
8:00 Update in Thyroid Diseases Elizabeth D. Ennis, MD, FACP
8:40 Antibiotic Resistance—Emerging Problem, Corrective Approaches Craig J. Hoesley, MD, Member
9:20 News from the ACP-ASIM Rep Robert B. Copeland, MD, MACP
9:50 Coffee Break 10:20 Clinical Vignettes Presented by Associate Members, Part I
11:05 Obstructive Lung Diseases: New Insights and Management Dick D. Briggs, Jr., MD, MACP
11:45 Business Meeting ACP-ASIM Alabama Chapter 12:15 p.m. Adjourn 6:30 Laureate Award Cocktail Party
SATURDAY, JUNE 3, 2000
7:00 a.m. Continental Breakfast
7:55 Presiding: Richard H. Esham, MD, FACP, President, Alabama Chapter ACP-ASIM Health Services
8:00 Update in Management of Arrhythmias John S. Strobel, MD, Member
8:40 New Approaches to Treatment of Parkinson's Disease Barton L. Guthrie, MD, FACP
9:20 Issues Affecting Internists: News from Washington Debra Cohn
9:50 Coffee Break
10:20 Clinical Vignettes by Associate Members, Part II
11:05 Hepatitis C and Its Sequelae: Diagnosis and Management Michael B. Fallon, MD, Member
11:45 Town Meeting
12:30 p.m. Adjourn ACP-ASIM Clinical Skills Module: Office Dermatology is offered to participants. It is necessary to pre-register for the 2 hour session in the afternoon of June 2 or June 3. There is a limit to ten attendees per session. Space is on a first-come, first-served basis.
LITERATURE AND MEDICINE RETREAT
By: Robert Lokey, MD, FACP
The ninth annual Literature and Medicine Retreat of the Alabama Chapter of ACP-ASIM met January 29-30, 2000, at the Embassy Suites, in Montgomery, Alabama. This year's program included A Confederacy of Dunces, the Pulitzer-Prize winning novel by John Kennedy Toole, the short stories of Anton Chekhov, the poetry of W. B. Yeats and Tom Stoppard's play, Arcadia. A severe ice storm raged across the central portion of the state that weekend and had some influence on attendance. Nevertheless, a goodly crowd made up principally of long-time attendees, along with some new participants, came together in a lively discussion of these works, led once again by the superb skill of Dr. Randy Davis, English Faculty of Jacksonville State University. It was the general consensus of the participants that this was the best yet of the series of invigorating literary retreats. Program plans are already underway for 2001 and further announcements will be forthcoming in the fall.
ALABAMA QUALITY ASSURANCE FOUNDATION
By: Richard M. Allman, MD, Principal Clinical Coordinator
Alabama Quality Assurance Foundation (AQAF) shares and supports the goal of Alabama's health care providers and practitioners to improve the quality of care for Medicare beneficiaries. Physicians from throughout the state and groups such as the AL ACP-ASIM are collaborating with AQAF to make this happen. The Health Care Quality Improvement Program (HCQIP) is a national effort by the Health Care Financing Administration (HCFA) to achieve measurable improvement in the processes of care in some of the most prevalent diseases and conditions faced by the Medicare population. AQAF is funded to conduct a statewide program to achieve specific goals through the use of quality improvement projects and other activities with physicians, Medicare providers, other health care practitioners and professionals, managed care plans and beneficiaries. In Alabama, as well as on a national basis, the program focuses on six clinical areas:
- Breast Cancer
- Heart Failure
- Acute Myocardial Infarction
AQAF will be continuing a project designed to improve care for bypass graft patients, and another designed to prevent falls among nursing home residents. As part of the focus on breast cancer, AQAF will be specifically working to decrease the disparity in the proportion of African-American women receiving mammograms compared with other women in the state. HCFA has designed the program to make certain that HCQIP efforts will truly improve the health and health care of beneficiaries. l Quality indicators selected for these conditions are firmly based in science.
- Attainable improvement goals have been set.
- A large number of individuals will benefit from the work.
Hospital record reviews and Medicare Claims Data are being used to define baseline performance for the states. HCFA then sets an improvement goal based on baseline performance. Regular updates and other activities chart the progress for the project. AQAF is the conduit through which performed goals can be achieved. Although the data used and compiled by AQAF is strictly confidential, facilities, groups and individuals working with AQAF regularly receive data showing how close they are to reaching performance goals and/or how they compare to other facilities and groups or to state and national averages. AQAF staff will periodically visit hospital sites to provide data, progress reports on statewide and hospital specific goals and to offer other assistance, information and materials. AQAF will hold group meetings throughout the state to work with individuals physician practices and other groups, and a member of the AQAF staff who works with the project, is available at any time by phone during regular business hours for questions or to provide any other assistance. Pre-testing materials for patients or staff as well as other tools, are offered at no charge to physician offices. Call (800) 760-4550, extension 3124 or visit for additional information concerning:
- AQAF; l Quality Improvement Projects;
- How to become a part of these important projects; and
- l Other services and products AQAF can provide.
Examples of ongoing quality improvement projects & quality indicators:
- Stroke/TIA/Atrial Fibrillation m Warfarin for atrial fibrillation m Avoidance of nifedipine m Aspirin/antiplatelet for stroke and TIA
- Acute Myocardial Infarction m Early administration of aspirin m Early administration of beta blockers m Aspirin at discharge m Beta blockers at discharge m ACE inhibitor for low LVEF m Documentation of smoking cessation counseling
- Diabetes Mellitus m Dilated retinal eye exam, annually m Glycosylated hemoglobin (HbA1c) testing, quarterly, if treatment changes or not meeting goals. Every six months, if stable. m Lipid profiles, annually
ALABAMA ACP-ASIM HEALTH SERVICES
By: Richard H. Esham, MD, FACP, President, AL ACP-ASIM HS
In June of 1998, the American College of Physicians and the American Society of Internal Medicine merged into one organization forming the American College of Physicians-American Society of Internal Medicine (ACP-ASIM.) During the ensuing year, Alabama Internal Medicine and its leaders studied merger options for this state. At the annual meeting of the two state organizations in June 1999, Alabama internists elected to form one organization with two components. The parent, Alabama Chapter of American College of Physicians-American Society of Internal Medicine (AL ACP-ASIM), took the structure of a 501c(3) corporation, while the subsidiary, Alabama American College of Physicians-American Society of Internal Medicine Health Services (AL ACP-ASIM HS), became a 501c(6) entity. Both corporations are nonprofit. This plan gives Alabama internists the greatest flexibility in advocating for Internal Medicine in governmental, regulatory, and especially legislative arenas.
The Alabama Chapter of the American Society of Internal Medicine was officially terminated on December 31, 1999 and its assets transferred to AL ACP-ASIM HS. On January 23, 2000, AL ACP-ASIM HS held its organizational meeting in Montgomery, at which time a governance structure was constructed to maximize member input and involvement. Oversight for this organizational configuration will be performed by the AL ACP-ASIM HS STEERING COMMITTEE, which will be composed of five statewide members and includes: the AL ACP-ASIM HS President (who is also the Vice-President of AL ACP-ASIM), the Governor, the past Governor (or Governor Elect), the Treasurer (also the treasurer of AL ACP-ASIM), and a member-at-large. Further, seven additional members will be selected—one representative from each of Alabama's seven congressional districts. The Steering Committee plans to meet at least quarterly with additional called meetings to be held when important issues develop. A regularly scheduled meeting will occur at the time of the Annual Session in the summer and at the mid-winter meeting of the AL ACP-ASIM Board of Directors. Meetings in the spring and fall will occur either in person, or by conference call. The Steering Committee is now composed of the following members:
- Richard H. Esham, MD, FACP President
- William E. Dismukes, MD, MACP Governor
- John B. Bass, MD, FACP Past Governor
- Billy W. Boyd, MD, FACP Treasurer
- MaryElla D. Sirmon, MD, FACP Member-at-Large
- Stephen A. Davis, MD, FACP First Congressional District
- David N. Rhyne, MD, Member Second Congressional District
- Jimmy W. Davis, MD, FACP Third Congressional District
- William F. Peinhardt, MD, FACP Fourth Congressional District
- Don A. Evans, MD, Member Fifth Congressional District
- Peter W. Morris, MD, FACP Sixth Congressional District
- Randall D. Ayers, MD, FACP Seventh Congressional District AL
ACP-ASIM HS will address those issues typically examined by a medical services committee, but will also function as the Health and Public Policy Committee for the Alabama Chapter of American College of Physicians-American Society of Internal Medicine. At the January 23rd organizational meeting the following three areas were identified, which merit creation of Subcommittees: 1. Public Policy; 2. Reimbursement; and 3. Government Affairs. Germane matters will be referred to each subcommittee for study, and following evaluation, a report with recommendations will be forwarded to the Steering Committee for appropriate action. Members or Fellows of AL ACP-ASIM interested in serving on one or more of these subcommittees are encouraged to contact their AL ACP-ASIM HS congressional district representative, or any member of the Steering Committee.
Finally, AL ACP-ASIM HS strongly believes it is important to maintain a central office as a point of contact for members. Mrs. Teri Dingler, formerly Executive Director for Alabama ASIM, has agreed to continue as the Executive Director of AL ACP-ASIM HS. She will remain in the office rented from the Medical Association of the State of Alabama at 17 South Jackson Street, in Montgomery, Alabama. Please contact her at any time regarding matters of interest to Internal Medicine at (800) 239-6441, or by e-mail at: email@example.com.
AL ACP-ASIM MEETS CONGRESSMEN WITH MASA
By: Richard H. Esham, MD, FACP, President, AL ACP-ASIM HS
Representatives of Alabama Chapter of the American College of Physicians-American Society of Internal Medicine met with Alabama's Congressional Delegation during the Medical Association of the State of Alabama's (MASA) Annual Government Affairs Conference, February 26-29, in Washington, DC. Alabama's physician group is described by Mark Jackson, Director of Legislative Affairs at MASA, as the largest state delegation of physicians in the country to gather each year in Washington. Dickey Whitaker, Director of Government Affairs for MASA, has led this successful meeting for 23 years. He notes, that because of the numbers of physicians attending and their interest in federal regulatory and government activities, the members of Alabama's Congressional Delegation are all interested in visiting with this assemblage. This year's meeting, as in years past, was held at the historic Willard Hotel, one block from the White House. Perhaps the most important health care matter before this session of Congress is the passage of strong Patients' Bill of Rights legislation. This effort is to ensure that medical necessity of patient care is based on generally accepted standards of medical practice rather than definitions from managed care health plans based solely on cost. Richard Deem from the American Medical Association (AMA) Washington office provided extensive background and Medicine's perspective on this and other pending legislation. Key to a strong Patients' Bill of Rights law is to hold health plans accountable for negligent decisions in denial of covered services and to establish a medically-based independent external appeals procedure for patients and physicians.
Following a videotape presentation of U.S. Representative Tom Campbell's (R. Calif.) address to the December 1999 interim session of the AMA House of Delegates, the congressman's legislative assistant, Lori Kinder, provided details of HB 1304, the Quality Health Care Coalition Act of 1999. This legislation would modify antitrust laws by allowing health care professionals to jointly negotiate the terms of their contracts with health plans. HB 1304 would move to restore balance in the health care insurance market and permit patients and their physicians, not insurers, to make informed decisions about the patient's health care needs. Within Alabama's Congressional Delegation, six of our seven Representatives are co-sponsors of HB 1304. Mark Jackson attributes this in large part to the efforts of the MASA Washington meeting attendees.
Dr. Claude Earl Fox, former Alabama State Health Officer, presented an overview of the activities of the Health Resources and Services Administration (HRSA), for which he is the Administrator. HRSA, frequently referred to as the access agency, with a $4.6 billion budget for Fiscal Year 2000, leads the nation's efforts to provide care to the poor, uninsured, and isolated Americans through an array of grants to state and local governments and health care providers. Of particular interest to attendees was Dr. Fox's offer to assist with Alabama's under funded Medicaid program. Ken Rubin, political columnist and analyst for National Public Radio, provided an overview of the 2000 political contests and the impact changes in the current composition of Congress might have on important legislation. He commented on the House, Senate, and gubernatorial campaigns which have been his area of interest and expertise. In response to questions, he assessed the current status of the presidential races as well. The highlight of the conference was the dinner meeting with the entire Alabama legislative delegation and many of their important staff members. Following dinner, each delegation member made brief remarks about issues important to their individual constituents, the state of Alabama, and the nation as a whole. The following morning physician attendees visited the offices of our Congressmen and Senators to discuss with individual legislators their views and concerns about specific health care legislation. Generally, physicians attending the conference were impressed with the openness and availability of our legislators and their receptiveness to physician's comments on matters vital to the health of the nation.
AL ACP-ASIM SUPPORTS MASA BYLAWS CHANGES
By: Richard H. Esham, MD, FACP, President, AL ACP-ASIM HS
Proposed changes to the Bylaws of the Medical Association of the State of Alabama (MASA) were unveiled at the MASA Interspecialty Council Meeting at the Willard InterContinental Hotel in Washington, DC, on February 27, 2000, during the annual MASA Government Affairs Leadership gathering. The changes will be introduced as a resolution by the Clark County Medical Society at the MASA annual business meeting scheduled for June 17, 2000, at San Destin, Florida.
The Bylaw change is intended to increase specialty society representation and participation in MASA's College of Councilors and House of Delegates. The present Bylaws provide for delegate representation only when 80 percent or greater of a society's members are also MASA members. The proposed change would provide a delegate and alternate when a society has 25 MASA members; a second delegate and alternate when a society has 200 MASA members; a third for 500 members; and a fourth for 1000 members or more.
Members of the AL ACP-ASIM worked closely with the Academy to draft the proposed changes, which were approved at the winter board meeting of AL ACP-ASIM held in Montgomery, on January 23, 2000. The proposed Bylaw changes will be presented and discussed at the MASA congressional district caucus meeting prior to the MASA annual session. Members of AL ACP-ASIM attending these caucus meetings are urged to support the changes as proposed.