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June 2011 Dennis W. Cope, MD, FACP


Dr. Cope

Letter from the Governor

Welcome to summer breezes and news about ACP Southern California Region I. As usual our chapter continues to be busy and is expanding with young enthusiastic members. Dr. Mark Richman, pictured below, is one of the ACP Key Contacts. He was recognized for such at an awards dinner in Washington, D.C. in May 2011.

Dr. Richman

Mark Richman, MD, being recognized as an ACP Key Contact in Washington, D.C.

Again, ACP recognized the best students going into Internal Medicine at the Keck School of Medicine at USC and at the David Geffen School of Medicine at UCLA. Pictured here is Nicholas Arger, MD with Dr. Dennis Cope and Dean Carmen Paliafito, MD from the Keck School of Medicine. Dr. Arger will do his residency training in Internal Medicine at the Yale-New Haven Hospital in Connecticut.

Receiving Student Award

Nicholas Arger, MD (Center) receiving the ACP Student Award from Dennis W. Cope, MD, (right) and Dean Carmen Paliafito, MD (left) from the Keck School of Medicine.

Dr. Soma Wali was recently elected as the next Governor for Region I of the Southern California ACP and has begun her duties this coming year as the Governor-Elect. She substituted for Dr. Cope and presented the UCLA ACP Student Award to Vatche Tchekmedyian, MD. He will be doing his residency training at Brigham and Women's Hospital in Boston, Massachusetts.

Dr. Tchekmedyian

Vatche Tchekmedyian, MD (left) receiving the ACP Student Award from Dr. Soma Wali.

Dr. Wali will be continuing to serve the chapter as Governor-Elect while Dr. Cope finishes his last year. She will become Governor after the annual ACP meeting in 2012. Finally, I would like to invite you to join us as this year’s ACP Southern California Regions 1 & 3 Regional Meeting on October 29, 2012 in Huntington Beach, California. I hope to see you there!

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ACP Pearls for the Boards Summary

By Kate Doolittle

As a member of the ACP Southern California Chapter Council of Student Members, I am delighted to report that our first event, ACP Pearls for the Boards, was a tremendous success. Student leaders from KECK-USC and UCLA medical schools joined forces through our local ACP chapter to organize the event. ACP Pearls for the Boards featured some of the most celebrated instructors from the two medical schools, including neurologist, Dr. Carolyn Houser, endocrinologist, Dr. Jonathan LoPresti, hematologist, Dr. Casey O’Connell, and pulmonologist, Dr. Nader Kamangar. The speakers highlighted important topics from their respective fields and used mini-cases to solidify the concepts. With over 120 medical students in attendance, the event drew in a large crowd. We asked the students to fill out evaluation forms at the conclusion of the event, and the critiques were excellent. Students greatly enjoyed Pearls for the Boards, and felt that it was an effective way to review high yield topics. In fact, two students in attendance from UCSD medical school asked if we could include their school in future events.

The success of our first event proves the incredible power of collaboration and teamwork. We were able to share ideas and support one another as we developed this event, and it was extremely rewarding to see our vision come to fruition. The ACP Southern California Chapter Council of Student Members has been effectively established in our region. As a current leader of this group, I am honored to have been able to represent the values and level of excellence of the American College of Physicians, and I look forward to the continued success of this new student chapter.

conference room with screen conference room

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ACP Advocacy Update

Authors: Natalie Kaczur, Executive Director, CA ACP and Susan Sprau, MD, FACP, Member CA ACP Health and Public Policy Committee

This spring members of our Southern California Region 1 ACP Chapter have been active promoting, with our elected officials in Sacramento, CA and Washington, D.C., ACP’s legislative issues.

Sacramento Leadership Day:

Sacramento Leadership Day took place on March 8-9, 2011, and was organized by our CA ACP (a C6 nonprofit corporation, California Chapter ACP Services, which is able to focus on advocacy issues more than our C3 chapter is allowed.) Chester Choi, MACP, was the chair of the subcommittee that developed the legislative priorities which were shared with State legislators by Chester, Dennis Cope, So.Calif. Region 1 ACP Governor, Daniel Kang, ACP Member, Roxanne Stallworth, Associate, and Med Student Benjamin Waterman.

Dr. Choi

Chester Choi, MACP, at Sacramento Leadership Day.

Dr. Choi

CA ACP members meeting with Jodi Hicks, CMA's Vice President of Legislative Affairs.

The key issues presented to our State lawmakers were:

MediCal Patients’ Access to Care and Services – CA ACP opposes the Governor’s proposed 10% reduction in payments for MediCal services as it would reduce access to care for the State’s most vulnerable populations.

MICRA – CA supports the continuation of the current MICRA legislation, as any erosion would increase the cost of healthcare and likely erode patients’ access to primary care as well as high risk specialties such as OB and Neurosurgery.

Support for Public Protection and Physician Health in California – California has been without a Diversion Program for impaired physicians since 2007. Impaired physicians have nowhere to turn for assistance and continue to treat patients, exposing those patients to risk or harm. CA ACP supports legislation which will allow development of a statewide physician health program with appropriate monitoring to assure safe patient care.

Volunteer Physician and Malpractice Coverage –Given the increasing number of uninsured patients and the decreasing number of primary care physicians, CA ACP supports legislation to seek funding of malpractise coverage for retired physicians who provide volunteer care to the underserved.

Washington Leadership Day:

Washington Leadership Day was held May 23-24, 2011. Our chapter was represented by: Dennis Cope, FACP and Governor, Chester Choi, MACP, Soma Wali, FACP and Governor-Elect, Phyllis Guze, FACP and Chair-Elect of the ACP Board of Regents, Mark Richman, FACP, Susan Sprau, FACP, Associates: Laura Heringer, Shireen Ghorbani, Laleh Boroujerdi-Rad, Richard Tennant, Bryant Sheh, Wendy White, Brian Van den Berg, Daniel Kang and Med Student Benjamin Waterman. In addition to the national ACP issues (including the need to fix the SGR problem), our CA ACP participants delivered a California-specific message which included the following issues:

Health Care Reform – CA ACP continues to support efforts to expand affordable health care coverage to California’s seven million uninsured; expand access to primary care physicians; and to stop insurance industry abuses, such as denying coverage for pre-existing conditions, rescinding coverage when a patient becomes ill or spending less than 85% of revenues on patient care.

Medi-Cal Reimbursement –Cal-ACP requested that Congress ask CMS (Center for Medicare Services) to not approve the waiver needed to allow Governor Brown’s cuts to the MediCal program take place.

Update the Medicare Geographic Payment Regions (GPCI) – CA ACP urged Congress to update the Medicare physician overhead formula which has not been updated in more than a decade and to allow many areas with increasing costs to be treated fairly. Because of the current classifications, physicians in 14 California counties are underpaid, according to Medicare, by up to 13%. These outdated designations are exacerbating the access to care problems.

Increase Funding for Graduate Medical Education to Train More Physicians - CA ACP supports increased funding for Graduate Medical Education from Medicare and private sources to expand the number of residency positions. California has fewer residency training slots than some Eastern States despite its larger population. The formula for allocating funding for residency training positions needs to be corrected to emphasize primary care and underserved areas. California’s diverse population and retiring baby boomers are outpacing California’s aging physician workforce and will soon be woefully insufficient to meet the State’s health care needs. Geographic Variation in Spending Must be Cost and Risk-Adjusted - CA ACP urged Congress to resist efforts to reduce payments to California physicians based on the incomplete Dartmouth Atlas studies that show wide geographic variation in Medicare spending. Costs and spending alone are not accurate measures of efficiency and quality. Dartmouth data did not include crucial factors such as patients’ insurance status, income, ethnicity and health histories. Once these risk and cost factors are assessed, Medicare spending does not differ as much from region to region. Failure to make these adjustments would harm access to care for California’s most vulnerable Medicare patients.

Unintended Consequences of Current CMS Fraud and Abuse Policies - CMS has recently mandated a prospective payment audit in California for all internists, family physicians and cardiologists for CPT code 99214. This code is for office follow-up evaluation and management services; the reimbursement amount was recently increased by CMS in an effort to improve primary care reimbursements. But because CMS has identified California as an “over-utilizer” of this code, compared to the rest of the country, an audit has been instituted. Something as simple as an illegible signature or a signature that does not include first initial, last name and “M.D.,” will be considered fraudulent. We have been advised that this error will likely account for up to half of the denied claims.

By auditing this code, it effectively deters primary care doctors from using this code and thereby decreases payments to them. CMS is not paying extra to the physicians who are audited for providing the records, even if they are acceptable, although it is a significant cost to provide records and have payments held until the requested records are reviewed. They have not been clear regarding whether payment withholds will then be extrapolated based on the percentage of “fraudulent” claims. CA ACP urged Congress to work with CMS to develop more sophisticated monitoring of true fraud and abuse (not just simple correctable documentation errors), so that it does not negatively impact the majority of physicians - especially primary care - who are trying to provide the best care for their patients.

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Become Involved:

Both Sacramento Leadership Day and Washington Leadership Day are open to all members/associates/medical students. If you are interested in participating in either of these events in 2012, or meeting with your State or Federal officials in their district offices to discuss ACP’s issues this fall, please contact me at: sesacp@aol.com. For those of you who may not have time to meet in person with your elected officials, please join the ACP Key Contact program.

We are now planning our fall advocacy agenda, including participation in the CMA (California Medical Association) House of Delegates. If you are a young physician, resident/fellow or medical student who is a member of CMA and would like to represent ACP at this event, please contact Natalie Kaczur at califacp@aol.com or myself at sesacp@aol.com.

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