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Governor's Newsletter, Fall 2001

Message From The Governor
Kelly O'Brien-Falls, MD, FACP, Governor, Colorado Chapter

I had hoped to have for you a report from our Fall Board of Governors meeting, keeping you up to date on the workings of the College and the discussion and votes on the resolutions. As you may have surmised, the meeting, September 13-16th, was canceled. The reports and resolutions will be generated or discussed another day. In light of the events of September 11, many aspects of the meeting seem trivial. Dinners out with colleagues, a beautiful setting in the desert of Tucson-these are luxuries we would enjoy but can do without. Board recertification, physicians and the pharmaceutical industry-these can be temporarily set aside though they must be addressed shortly. We did lose something when we had our meeting canceled-the opportunity for fellowship and sharing, for exploring dreams for our chapters and strategies to make them real, and the furthering of relationships with others in similar circumstances. Overall, however, these losses are too small to be mentioned further. The College is developing an on-line strategy to allow us to complete some of the College business from our homes and offices.

What we all continue to work with is the repercussions of the attack. Effects are more far-reaching than initially imagined. We have patients in the airline industry or tourism business who suddenly have no jobs. We have patients who work downtown in high-rise buildings, having somatic symptoms we know are anxiety. Muslim patients are living in fear of retaliation. Patients are asking for antibiotics to keep at home in case of a bio-terrorist attack. The country is in need of healing. What group of professionals is better suited to start this healing process with individual people? Most of us will not contribute much to national policy nor is the President calling to get our opinions (a circumstance I've always found peculiar since I have so many of them) yet every day we work with patients who are hurting, in many different ways.

Early on, you no doubt realized that not often did you cure. Experience has shown you, though, that often you can heal. The mending process of the body and the soul can start with a visit to a concerned, thoughtful caregiver. Our education and training gives us certain responsibilities as well as certain privileges. We must continue the examples of giving blood, volunteering, assisting with community preparedness plans and welcoming our patients of all backgrounds. A national crisis is a time for each of us to participate in the healing process, one patient at a time. In the months ahead, I hope you find, and give, peace.

A Few Important Resolutions:
Jim Regan, MD, President of the Denver Medical Society

  • A resolution approved which will address problems with retroactive denials, especially when issues such as eligibility and preauthorization had been properly handled before hand. An appeals process is called for, as are time limits. Finally, the resolution charges the CMS delegation to the AMA with initiating a similar resolution at the "big house". At that time federal legislation will be sought to extend the principals of the resolution to the Employee Retirement Income Security Act (ERISA).

  • A resolution passed mandating that prior to enrolling in a Medicare HMO plan, patients be given a simply-stated document along with an adequate verbal explanation of their health care benefits and access thereto, as well as the limitations of their plan, including what may be diminished or eliminated compared to fee-for-service plans. Furthermore, upon enrollment the enrollee acknowledge understanding of these facts with particular attention given to the possible loss of their primary care physician. It was further resolved that CMS advocate that a patient enrolling in such a plan be given a current list of providers, and that Medicare HMO plans establish a timely and efficient mechanism such as a dedicated "hot line" to solve emergent access problems as they arise.

  • A resolution passed which seeks legislative relief whereby patients can tax deduct basic health care related costs such as premiums, co-pays, deductibles, and prescription costs.

  • Certainly the most important resolution was one calling for CMS to join the Connecticut and New York state medical societies in their class action lawsuits against the biggest private insurers in their states. In Colorado this would likely include Anthem BCBS, United, Cigna, Aetna, perhaps Prudential, and one of the larger insurers we have out here in the West. This would contend illegal business practices such as the mismanagement of appropriate claims, etc. The litigation would transpire in state courts, and the funding would derive from the Manhattan firm, which has initiated the action on behalf of the two societies. The firm is one of the integral players in the tobacco settlement, as well as securing compensation in the Holocaust proceedings. This was very lively debated. It was finally agreed upon that resolution would be sent to the CMS Board of Directors to, with the aid of their legal counsel, ascertain the validity of this litigation in light of Colorado State Law, whether this class action suit in state court is the best approach (as opposed to federal racketeering charges), and whether a contingency fee arrangement with a law firm is what the medical society should do. The board will report to the house every thirty days, with a final decision to come within a few months. It was generally agreed that this is an urgent issue.

There it is "that's all folks" at least internal medicine-wise. - Jim

What Can The Practice Management Center Do For You?

The Practice Management Center (PMC), located in the Washington office, is a valuable benefit of College membership. It supplies free assistance to members on how to handle the business issues associated with running or working in a practice. Internists are provided with timely information to succeed in today's health care environment through three different means.

First, PMC offers over forty practical written guides on various. These publications can be downloaded via PMC's web page, or ordered through the College's customer service desk. The first copy of each publication is complimentary as a part of your College membership. These guides cover everything from starting a practice to negotiating an employment contract and complying with Medicare regulations. Laminated pocket reference sheets on coding, documentation, and preventive services are some of the most popular items.

Second, PMC's management and regulatory experts respond to individual member inquiries via e-mail and telephone calls within 24 to 48 hours. If PMC experts cannot answer your question, then they may research the question, refer to another source, or, as needed, offer a list of qualified consultants. It is important to note that Center specialists do not address clinical questions nor do they provide legal advice.

And finally, PMC offers management tools for members to use in assessing and improving their practices "Check Ups." The Patient Satisfaction Check Up (PSCU) provides a survey instrument developed by internists for internists. After you survey your patients, PMC supplies customized comparison patient satisfaction assessment reports. The Office Laboratory Check Up (OLCU) is a spreadsheet program enabling you to evaluate and optimize the profitability of your office laboratory. The Practice Management Check Up (PMCU) is a benchmarking tool for conducting an overall assessment of the practice and identifying opportunities for improvement. Each of the three "Check Up" tools comes with a guide to help improve the practice and can be downloaded free of charge from the PMC web page.

Under the umbrella of the Practice Management Center, members receive one-stop service from two organizations. PMC's own professional staff has years of experience managing medical practices and this expertise is augmented by that of the Managed Care and Regulatory Affairs Department, whose staff write guides and respond to inquiries in their respective fields. This expertise combination enables PMC to offer a remarkable range and depth of knowledge to assist College members.

In addition, PMC supports the Young Physicians Subcommittee (YPS) in developing products and educational programs of interest to young physicians. Together, YPS and PMC have begun to assist chapters interested in developing their own practice management programming and young physician committees.

What is the best way to access the Center's services and resources? Go to the PMC web page where everything is right at your fingertips - downloads, e-mail questions, links, tools, and a host of other resources. The PMC web page offers members access to the various guides for the topic of concern to them. If still more specific information is needed, the next step is to e-mail a question directly from the web page to the PMC specialist in that field.

With all of its services instantly available on the web page, PMC represents a rich and valuable resource for College members. Visit www.acponline.org/pmc/ to explore it yourself. For more information, please contact Margo Williams at mwilliams@acponline.org.

Chapter Leadership Profile

James F. Bush, MD, FACP, Vice President, Colorado Chapter
Medical Background: Undergraduate at University of Texas, Graduated Phi Beta Kappa 1976.
Medical School: Southwestern in Dallas 1980
Residency: University of Texas, San Antonio 1980-83
Board Certified in Internal Medicine: 1983
Elected Fellow ACP 1988
President Colorado Society of Internal Medicine: 1990-1992
President Fort Collins IPA: 1998 to present
Vice President Colorado ACP-ASIM: 2000 to present
Chief of Staff: Poudre Valley Hospital 1991-1992
Clinical Instructor: University of Colorado, School of Medicine since 1984

Business Background: I established a solo practice of Medicine in 1983, and even then I was told that was foolish and anachronistic and I would be out of business in 1 or 2 years. I didn't even buy a practice but started with no patients and the only person I knew in town was my sister who had attended CSU. One of the things I learned early was to keep overhead low and track billings and A/R closely and document the "bejeebers" out of everything. I am gratified to report that the last payment on my office will be made this November! I also in 2000 became a 1/3 owner in a SNF (nursing home) here in Fort Collins which I call Blue Grouse Health Care and which has 100 Medicare certified beds. As President of the Fort Collins IPA I am responsible for contracting both Risk and FFS contracts. This has also made me aware of all the issues regarding coding and timely payments.

Personal background: My Father is still my greatest role model, he is a retired physician who started medicine before Penicillin, was a Flight surgeon during WW II and then did first a general practice in Texas before becoming one of the first Anesthesiologists in Texas. (He was the first in Dallas). My wife and companion of 27 years is Kay who gives me all the strength and support I need and 2 wonderful children, Ian and Kathy. My Hobbies include woodworking, hunting and bagpipes.

What ACP-ASIM needs to focus on: First we must remain focused on the needs of the patient, with their support anything is possible, but if they feel we are only serving our interest we will be consigned to trade status. But we must be careful of what we ask for. I hear many of us calling for a single payer system as if that would fix everything with the medically uninsured. If your practice was 100% Medicaid you would have no insured, and no living either. We have to recognize that the ability to fund our Health care system does vary from patient to patient, and we cannot afford "Cadillacs" for all, but some people will still want and be able to pay for everything.

The Rising costs of Insurance affect us all, as we still have to buy insurance for our families and employees. The Cost is due to the fact that insurance's have been mandated as to what they must cover, and a few catastrophic cases raise premiums significantly. The Risk contracting experiences of the last few years has shown us that if people feel like they are promised "complete" coverage then they will sue to get even experimental protocols but resist the price. I feel rather than create a brand new revolutionary system we should expand on our current programs such as Medicare and Medicaid to establish the basic level of service and which could cover the indigent, and require all other citizens to buy a supplemental insurance depending upon what they can afford which spreads the risk and cost in the middle and then again at the top have the Government provide a Catastrophic coverage as a ceiling, so that premiums can be minimized. The College needs to continue to focus on improved Medicine and education, but must remain vigilant in the political arena and monitor both State and National sessions of Congress and keep the legislature from trying to practice Medicine.

We need to minimize non-medical distractions that divide our group and diffuse our energies. For example land mine are a terrible, non discriminate weapon that people have strong feelings about, but it is not the business of this College, there are other forums to address that issue.

We need to work hard to preserve collegiality both among general internists and our subspecialists. Rather than fighting for turf and a shrinking slice of the pie we need to see how to expand the amount of dollars while providing more care to more patients. We cannot lose sight of what we do well, with rising life expectancies and falling rates of morbidity and mortality. Our system of health care is great, we need to make it more efficient.

Finally, we must learn to take better care of ourselves. I hear of many doctors who are "burned out". Hassle Factors, loss of autonomy, and long hours lead to Internists having one of the lowest rates of personal and professional satisfaction in Medicine. The single conversion factor and RBRVS are finally achieving some of its potential, now I'd like to see simplified coding, billing and documentation guidelines without fear of punitive government agents who can destroy a practice. Electronic documentation, if it can be made reliable, and inexpensive and efficient enough could help reduce hassles and payroll.

I welcome all input and feedback, I can be reached at (970-484-6406) or e-mail at jimbush@frii.com.

America's Internists: Helping in the Aftermath of National Tragedy

The following message was posted on ACP-ASIM Online in response to the terrorist attacks of Sept. 11.

The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) extends its condolences to the families and friends of those affected by the national tragedies of September 11 and pledges its commitment to helping America through this difficult time. Our 115,000 members grieve for those who lost their lives in New York, Washington, D.C. and Pennsylvania.

As primary care physicians and specialists, internists are prepared to help patients with the health consequences associated with the aftermath of these traumatic events. Even those who did not experience direct personal loss from the events in New York, Washington, D.C. and Pennsylvania will be affected emotionally. We are asking our members to talk with their patients about the recent events during office visits. The American Red Cross (http://www.redcross.org/) has regional chapters nationwide that can help with grief counseling and other services, and has downloadable information available to help patients cope with feelings of loss, fear and anxiety. Other resources include:

  • The American Psychiatric Association is providing a disaster psychiatry page, which gives information useful to physicians in preparing for and responding to disasters and other traumatic events. It also features several publications on disaster psychiatry and information for patients on how to cope with the tragedy

  • The American Academy of Pediatrics is offering advice on how to communicate with children and adolescents during times of crisis

  • The Centers for Disease Control and Prevention have released respiratory disease fact sheets for physicians and the general public

  • The Federal Emergency Management Agency (FEMA). Includes comprehensive health resources and information on how to help victims

Although biologic or chemical agents were not employed in the recent attacks, the College recognizes that there is a heightened sense of concern about such agents. ACP-ASIM's Bioterrorism Center (http://www.acponline.org/bioterro/) provides information vital for all practicing internists regarding biological terrorism. Visit (http://www.nbc-med.org/) for information about biological warfare, on-line courses, medical references, publications, and other related sites.

Recent events have touched all Americans, and resonated throughout the world. Internists worldwide have sent messages of support about the tragic events. ACP-ASIM joins with internists around the world in expressing our hope and commitment toward recovery, healing, justice, and peace in these difficult times.

Attacks Force Changing Legislative Priorities

While national defense now occupies center stage in Washington, DC, ACP-ASIM continues to advocate on behalf of its members. With this shift, a higher priority will be placed on bioterrorism in our advocacy and public policy activities. The College is also examining the potential impact of proposed anti-terrorism legislation on the confidentiality of personal health information.

The College is monitoring discriminatory policies that may affect current and future International Medical Graduates (IMGs). IMG's already in the United States may face additional requirements and surveillance, as well as other forms of discrimination. Policies aimed at restricting visas from "higher risk" countries may make it difficult for IMG's to accept residency positions in the United States.

Access to affordable health insurance will remain a top priority, particularly as the economic fallout from the terrorist attacks of September 11th places an even greater number of Americans at risk of losing their health insurance. The College supports legislation to specifically propose federal subsidies for individuals to maintain COBRA coverage during the time they are unemployed. We will continue to press for expansion of Medicaid, S-CHIP, and for tax credits for low-income uninsured Americans.

Other priorities, such as the patient bill of rights, Medicare reform and restoring cuts in payments to teaching hospitals, face steeper hurdles. Congress' focus on national security affects the time and money spent on these issues. Issues that will trigger partisan disagreements are even less likely to receive favorable consideration.

The College will expand its advocacy efforts on priority issues, although some actions are likely to be postponed until next year. We are seeking bipartisan compromises on Medicare regulatory relief and expansion of health insurance coverage in the hope of bringing final action on these issues before Congress adjourns for the year.

Mark Your Calendar

January 31 - February 2, 2002
Colorado Chapter Annual Scientific Meeting, Broadmoor Hotel, Colorado Springs, CO

For information, contact Christine Westbrook, (303-716-5722) or email her at madussa@msn.com.