Governor's Newsletter, Spring 2002
Chester Choi FACP Governor
Southern California Region 1
From the Desk of the Governor
Greetings and welcome to this update of the activities of our Southern California Region 1 Chapter. Much has happened since our last newsletter, and our activities have been important ones in furthering the goals of our organization. For those who have not seen them before, they include:
Goals and Objectives
Mission - to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.
- To establish and promote the highest clinical standards and ethical ideals
- To be the foremost comprehensive education and information resource for all internists
- To advocate responsible positions on individual health and on public policy relating to health care for the benefit of the public, our patients, the medical profession, and our members
- To serve the professional needs of the membership and advance internal medicine as a career
- To promote and conduct research to enhance the quality of practice, the education and continuing education of internists, and the attractiveness of internal medicine to physicians and the public
- To recognize individual excellence and distinguished contributions to internal medicine
Health & Public Policy News
Among our most important activities have been those related to health and public policies issues. Susan Sprau MD FACP has been a leader in this area, both for our Chapter as well as for the California Chapter. We were well represented at both the Sacramento and Washington DC Leadership Days in which some of our members took valuable time from their practices and academic roles to spend some invaluable time educating our legislators about our concerns and issues.
In Washington DC this past May 2001, Phyllis Guze MD FACP, Kouichi Tanaka MD MACP, Jose Perez MD FACP, and I visited our key Congressional officials as part of a large contingent of ACP-ASIM "visitors" from our state Chapter. There, our agenda included encouraging support of MERFA (the MediCare Education Reform and Finance Act), support of the Bipartisan Patient Protection legislation (McCain-Edwards), support for patient safety legislation and regulations that would truly foster the development of best safety practices. It was also at that meeting that the ACP-ASIM honored Dr. Tanaka as one of its key legislative contacts for his work educating our Congressional representatives on the ACP-ASIM's important issues.
In February of this year, members from the California chapters again visited Sacramento to educate our legislators on health care issues affecting patients and their doctors. Our Chapter was wellrepresented by Drs. Tanaka, Sprau, Glenn Littenberg MD FACP, Arthur Lurvey MD FACP and me. Our Chapter owes special thanks to Drs. Sprau and Littenberg for their leadership and tireless efforts to improve the climate of healthcare in our state in the areas of Health and Public Policy and Medical Services respectively. At this visit to Sacramento, the California Chapter announced a press conference and released the enclosed legislative report card to draw attention to our issues. As you can see, the overall grade point average for the legislators and our governor (Davis, not me) should not be a point of pride, and while many would say that little can be accomplished due to the fiscal straits of our state, we tried to point out that some of the issues are not related to the $17.5 billion state budget deficit and others may have an even greater fiscal impact if not acted upon now. Deficit or surplus, our legislators could definitely do more in regard to certain regulatory and managed care issues that inhibit good patient care.
2001 Regional Meeting
Our Regional Scientific Meeting last February 2001 emphasized differences in outcomes for certain racial and ethnic groups with common medical illnesses. This predated the March 2002 Institute of Medicine report citing evidence of the differences in care and outcomes, even for individuals with the same medical insurance coverage, so ours was a timely and topical meeting. Dr. Keith Norris, with the assistance of Dr. Thomas Yoshikawa FACP (both of the King Drew Medical Center), organized this event with participation by excellent faculty members from UCLA, USC, Drew University, and the Los Angeles County Department of Health and Human Services. Regent Charles Francis MD FACP, Dean of the Charles R. Drew University School of Medicine and Science, was our College representative.
Special thanks and congratulations go to Susan Sprau MD FACP and James Louie MD FACP who were honored as Chapter Laureate Award winners for 2001. These awards are given to those individuals who have made particularly important contributions to the Chapter over an extended period of time. Our Chapter was also pleased to recognize the Mastership awarded to J. Michael Criley MD MACP.
The Associates' Poster Competition was won by Brennan Spiegel MD and Hilarlal Maheshwari (both from the Cedars Sinai Program) for their posters entitled "Dyspepsia Management in Primary Care: An Appraisal of Competing Strategies" and "Familial Short Stature Caused by an Isolated Growth Hormone Deficiency," respectively. The runner-up award went to Junli Zha MD from King-Drew Medical Center for "Ethanol Induced T-Cell Activation and Increased HIV-1 Entry into Quiescent Peripheral Blood Lymphocytes (PBL's)."
Recertification and the ABIM
The discussions with the American Board of Internal Medicine are ongoing over 3 main issues of recertification. As many of you know, the ABIM was formed at the recommendation of the ACP some years ago to establish an independent accrediting body for Internal Medicine. Now, many of our members have voiced concern over the ABIM's recertification process, including the requirement for patient and peer evaluation (considered redundant and in many cases irrelevant), the relevance of questions in the self-study examinations, and the role of the ABIM in conducting continuing medical education, a role which accrediting organizations should not assume. These discussions continue at the national level, spearheaded by a committee that includes governors and regents of our organization. I will keep you posted as to the outcome of the recertification issue.
A Special Award
At the Convocation at Annual Session 2002, David H. Solomon MD MACP will be honored with the John Phillips Memorial Award for Outstanding Work in Clinical Medicine. A well-deserved congratulations to Dr. Solomon, the former Chair of Medicine at Harbor-UCLA Medical Center and subsequently at the UCLA School of Medicine, for this distinctive honor, one which has been awarded to only a very select group of outstanding clinicians, teachers, mentors, and clinical researchers.
A number of members from our region advanced to Fellowship in 2001 and some were able to be inducted at Convocation Ceremonies at Annual Session in Atlanta. Congratulations to:
Erlinda U. Concepcion-Claremont
David A. Goodkin-Thousand Oaks
Esmail David Hessami-Burbank
Hashim R. Kazmi-Bakersfield
Payman Khorrami-Los Angeles
Keith I. Mootoo-Cudahy
Carol Y. Nishikubo-Santa Monica
Ronald J. Oudiz-Long Beach
Pragnesh C. Patel-Los Angeles
Kalust Ucar-La Canada
Reed S. Wilson-Beverly Hills
Zelman G.Weingarten-Sherman Oaks
Arie L.M. Widerhorn-Long Beach
Bret A.Witter-Long Beach
Edward T. Wong-Lancaster
Arturo Z. Abalos-Delano
William E. Gilli-Bakersfield
Steven L. Hersch-Sherman Oaks
Burton A. Liebross-Van Nuys
Robert W. Tallon-Stevenson Ranch
Samer Alaiti-Los Angeles
Benjamin J. Ansell-Los Angeles
Luis L. Dimen-Pasadena
Peter C. Galier-Santa Monica
Charles M. Lim-Lancaster
Harold E. Quan-Valencia
Wael A. Salameh-Torrance
Susan E. Sprau-North Hills
Shane H. Tu-Bakersfield
Stephen T. Sigmund-Templeton
Lisa T. Vasak-El Segundo
Michael G. Bloom-Van Nuys
Ibrahim I. Hanna-Pasadena
Richard L. Hoffman-Beverly Hills
Irawan Susanto-Los Angeles
Jofel M. Yan-Long Beach
Janet P. Au-Arcadia
David M. Bloom-Redondo Beach
Paul E. Lizotte-Fresno
Sushil K. Ojha-Rancho Palos Verdes
Student Internist Awards
At the June graduation ceremonies for medical students from the UCLA and USC Schools of Medicine, our ACP-ASIM chapter presented the Student Internist Awards to Amanda Tracy Goldman at USC and Amandeep K. Shergill at UCLA. Dr. Goldman has begun her residency at Cedars-Sinai Medical Center and Dr. Shergill is training at UC San Francisco. Traditionally, we provide the awards in the name of a prominent ACP-ASIM member on the faculty at each school; this year the awards were given in the names of Peter Barrett MD FACP at UCLA and Jorge Mestman MD FACP at USC.
The February 2002 Associates' Meeting focused on the topic of Practice Management. Arthur Lurvey MD FACP, a practicing endocrinologist and a medical director for the Medicare carrier National Health Insurance Corporation (NHIC), Glenn Littenberg MD FACP, a practicing gastroenterologist and Medical Services coordinator for our chapter, and Carl Cunningham MBA, the Director of the Practice Management Center for the ACP-ASIM presented key information for our younger members embarking on or restructuring their practice careers. For any of our members, the Practice Management Center offers valuable resources and practical advice, most easily accessed through their link on the ACP-ASIM website. The handouts from the Associates' Meeting are posted to the Chapter's website. To assist our Associate members and stimulate additional Chapter activities, Soma Wali MD, the Associate Program Director at Olive View Medical Center, and Ronald Oudiz MD FACP from St. Mary and Harbor-UCLA Medical Centers have agreed to be Co-Coordinators of Associate Activities.
- Specific CME requirements for most physicians for education in geriatrics and pain management have been mandated. For those whose practices have >25% of patients in the 65 years or older age group, at least 20% of the mandatory CME hours (about 5 hours per year) must be in geriatric medicine. Most practicing internists will also need to obtain 12 Category 1 CME credits in pain management or end-of-life care within a 4-year period. Have you had your CME today? (Come to the Regional Meeting in August to meet some of these requirements)
- There have been issues regarding reimbursement for home health plan reviews and authorizations. Despite using the proper codes, some physicians have had claims denied for these services. Let us know if you're having problems.
- There continue to be intermittent and long-term shortages of a variety of drugs and vaccines (tetanus vaccine, hepatitis A and B vaccines, antibiotics, anesthetic agents, etc.). The explanations vary from manufacturing difficulties to regulatory constraints. It is clear that there is little foresight, planning, or government oversight in this area (this is one area where regulation could be helpful to patient care).
- MediCal rates (yes, the ones that were just increased after much lobbying) are in jeopardy of being reduced to the previous level (returning our rates to #42 or so of the 50 states), due to the California fiscal crisis. The Legislative Analyst recommends against the reduction and also against any implementation of a co-pay for MediCal patients.
- A recent report in JAMA questions the validity of some of the hospital report cards that are cited in the media and on the Internet. Seems that the data is not verified and may have methodology-related limitations. The authors warn that the public may lose confidence in local hospitals unnecessarily.
- Some members are concerned about the penalties that may be incurred for elder mistreatment ("abuse"). There can be significant penalties for failure to report suspected or patient-reported mistreatment. Clearly, protection of older adults is very important and physicians should report mistreatment, but there have been concerns voiced that this law may be used by some to circumvent MICRA or might put physicians in unwarranted legal jeopardy in some situations. If you have been impacted by the law and would like to share your experiences or concerns, please contact me. The California HPPC is examining this issue, and would like to know if it is a significant problem for practicing internists.
- Medicare rates have been reduced by 5.4% due to a flawed formula based on the "sustainable growth rate." It penalizes physicians for economic downturns and Medicare program errors that have nothing to do with the costs of providing patient care. Legislation has been proposed to reinstate the previous rates, and letters to your representatives and congressmen would be appropriate, supporting HR 3882 and HR 3351/S1707 that address this problem. More information on this is available on the ACP-ASIM website.
- Medicare patients can receive a discount on their medications by presenting their Medicare card at a pharmacy that accepts MediCal (state law SB393 which is set to expire this year). They would pay the MediCal rate plus a small processing fee. A recent survey indicates that only a few Medicare patients are taking advantage of this, in part because the discount is not advertised or posted. It often requires that the patient ask specifically for the discount. Please let your patients know of this benefit; for patients on 3 common drugs (Vioxx, Zoloft, and Lipitor) it made a 20% difference in the bill.
- ACP-ASIM Physician Charter: Medical Professionalism in the New Millenium has been published in a recent Annals of Internal Medicine. It addresses some key contemporary issues of ethical conduct. It's a good read.
- For those who have not seen this information previously, the NHIC (Medicare Carrier) local phone number for claims submission is (213) 593-5943; the Chico number is (530) 879-1774 and the EDI Tech support number is (213) 593-6950.
- Violence in the healthcare workplace seems to be an increasing problem, and nurses and psychiatrists seem to face the greatest dangers. A local hospital recently had an unfortunate incident with a psychiatric patient. Be careful and be safe.
- The just completed residency match saw a slight decrease in the number of US medical students entering Internal Medicine (there were even greater declines in family medicine, pediatrics, and general surgery). I'm sure that perceived problems with reimbursement and with the "hassles" of providing good patient care are key considerations. As someone who is happy overall with his choice of career, I would encourage those of a like mind to convey the positive aspects of our profession to our students and residents. We need to be the best role models while we work on the "hassles" and other negatives. Once again this year, our Chapter will be sponsoring a summer student internship program for 2nd year medical students to spend 2 weeks with an internist to learn a bit more about our profession. If you'd like to participate, please let me know at (firstname.lastname@example.org).
State of the Union's Health Care Reviewed
In a January 15, 2002 press briefing in Washington, DC, William Hall MD FACP, President of ACP-ASIM presented the College's legislative agenda for 2002. He urged President Bush and Congress to:
- Expand access to affordable health insurance
- Modernize Medicare benefits to include prescription drug coverage, preventive and screening services
- Provide adequate funding for health care professionals, hospitals, and public health departments who are poorly equipped to face bio- or chemical terrorism
- Ensure adequate funding of Medicare safety net providers and teaching institutions, and physician reimbursements that reflect the rising costs of delivering health care
- Pass Medicare regulatory reform legislation and a strong patient bill of rights to alleviate the complex and overlapping regulations imposed on physicians and patients by payers
- Develop a uniform, voluntary reporting requirement for medical errors
- Develop comprehensive final rules for HIPAA, with a single deadline for implementation and clear directives to safeguard privacy.
The complete report can be viewed online.
Lend a Hand to Tobacco Prevention
Tobacco use, primarily smoking, causes heart disease, lung disease and many cancers. More than 400,000 deaths in the United States every year are a direct result of tobacco use. According to the American Lung Association, 100 billion dollars a year are spent in health care costs and lost productivity due to tobacco use. Tobacco use and addiction is the leading preventable cause of death and disease in the United States.
The amount of CME time devoted to educating physicians and medical students about the health effects of tobacco use and the treatment of tobacco addiction is extremely small in proportion to the health importance of tobacco use and addiction. As a result, the College encourages members to join local anti-smoking campaigns and discourage the use of tobacco, particularly by young people.
Get involved in the campaign to limit tobacco. Help educate the public on the prevention of tobacco use and cessation of smoking. The following organizations maintain websites that will help get you started in the fight against tobacco:
Center for Disease Control (CDC) - The CDC hosts a "tip" page that contains specific information on smoking cessation.
Campaign for Tobacco Free Kids - An organization dedicated to protecting kids and adolescents from tobacco exposure. The website features tobacco initiatives on the state, federal and global levels.
American Lung Association - Articles, data and statistics educating on the use and effects of tobacco products.
The Truth.com - A site funded by the American Legacy Foundation, established in November 1998 after the Master Settlement Agreement (MSA) between 46 states, 5 US territories and the tobacco industry. Exposes the truth about tobacco and the companies that sell it.
ACP-ASIM Region 1 Annual Meeting
Save the date!! August 10-11, 2002, Saturday and Sunday in Long Beach, Updates, Patient Safety, Bioterrorism, Pain Management, and more (In conjunction with Region 2).
Health Care Issues 2002
Annual California Legislative Report Card - 2001
Presented by the California Chapter, ACP-ASIM