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Governor's Newsletter, February 2000

Joel S. Levine, MD, FACP
Governor, Colorado Chapter

Governor's Corner

I have just returned from the Annual Scientific Session and Business Meeting at the Broadmoor Resort; again reminded by the breadth, content, collegiality, and overall value of our meeting. The Program Committee chaired by Robert Swaney, MD again provided an excellent sequence of talks with topics ranging from the management of heart failure and arthritis to making end of life decisions. We were honored by the visit of Whitney Addington, MD, MACP the President of the College and his wife Ada. Dr. Addington spoke movingly about the medical consequences of being uninsured in the United States, and the College's initiatives to bring the construct of universal health insurance back to the forefront of this country's political agenda in 2000 (more later on this Chapter's participation). Our banquet speaker, Professor Steven Epstein of the History Department at the University of Colorado, gave an outstanding talk on 'Renaissance Astrology' that all the attendees enjoyed. Indeed, enough of consequence occurred at the meeting that I am turning over the remainder of this newsletter to informing the entire membership of the highlights.

  1. Announcement Of Our New Governor-Elect Designee
    It was a pleasure to inform the membership that KELLY O'BRIEN-FALLS, MD FACP was chosen as their next governor-elect (she will assume this role after the College's Annual Meeting in Philadelphia in April). Kelly has been a stalwart within the Chapter's leadership for almost a decade and is well prepared for her new responsibilities. JAMES BUSH, MD, FACP, the runner-up in the election has agreed to accept a continuing leadership role as Vice President-elect (see by-laws changes below).
  2. By-Laws Change—Creation of the Office of Vice-President
    The following section was unanimously approved by the Governor's Council and at the Annual Business Meeting:

    Section 7.10. The vice-president shall be a Fellow or Master of the College who is the runner-up (second place) in the election for Governor-Elect. The vice-president's tenure of office shall start at the same time as the new Governor's, and continue until the next scheduled election of the Governor-Elect. The vice-president shall be a voting member of the Governor's Council. In the absence of a Governor-elect the Vice President shall temporarily assume the title of 'acting-Governor' in the event of the inability of the Governor to perform his/her duties until the next new Governor is selected pursuant to the Bylaws of the ACP-ASIM. The Vice-president shall perform such important leadership duties as mutually agreed upon with the Governor-Elect and Governor. Being Vice-President does not obligate, or preclude, this member from running for Governor-Elect during the next election cycle.

    The only concerns raised were what would happen if a candidate for Governor-Elect did not want to share leadership responsibility as is intended by the new position. The membership were assured that Drs. O'Brien-Falls and Bush fully supported the intent of the amended by-laws, because they recognized the increasing challenge of serving the Chapter while attending to their 'regular' jobs. I suggested if a future candidate(s) did not appreciate the increasing local and national responsibilities of the Governor, then either they had way to much time on their hands or hadn't been adequately informed of the evolving job description. Since the by-laws are an evolving document it can be modified in the future if deemed necessary by the membership.

  3. Annual Election
    The following slate was presented by the Nominations Committee and approved unanimously by the membership at the Annual Business Meeting:

    Secretary: Mark Levine, MD FACP
    Treasurer: Mark Levine, MD FACP
    Governor's Advisory Council: Mark Earnest MD
    Frederick Walker, III, MD FACP

  4. Presentation Of Laureate Award To Joseph Matthews MD FACP
    It was my pleasure to award the Chapter's Laureate Award for 2000 to Joe Matthews. Joe has been Treasurer of the Chapter since 1994 and recently made a decision to move to Pennsylvania to resume his career as a Pulmonary Critical Care Specialist at the Guthrie Clinic. His career in Colorado had been characterized by excellence in clinical care, education, and administration. We will miss him.

    The Laureate Award is awarded to a member of the Chapter who has been a Fellow for at least 10 years and has demonstrated continuing excellence in patient care, education, and/or research. I ask that deserving members of the Chapter who fit this description be brought to the attention of the nominating committee by submitting the response form appended to this newsletter.

  5. Presentation of the First Annual Volunteerism and Community Service Award to Mary Chri Gray, MD.

    This meeting marked the presentation of the Chapter's first Volunteerism and Community Service Award. Our Nomination Committee could not have picked a more fitting first awardee in Chri Gray. Chri has provided the physician leadership that, in concert with students from the Medical School and Nursing School, created the Globeville Clinic at the Salvation Army Rehabilitation Shelter. This clinic provides important preventive health care services to this underserved population. Her continuing commitment of personal time to the development, maintenance, and success of the Globeville Clinic demonstrates the best of our profession.

    Eligibility requirements for this award have been developed by the College. Awardees must be members of the College who have distinguished themselves in voluntary service in the area of medicine. The service must have been performed on a voluntary basis and not required for the completion of teaching, training, or position requirements. Volunteer work must have been done as a physician and be medically related. I ask that deserving members of the Chapter who fit this description be brought to the attention of the nominating committee by submitting the response form appended to this newsletter. Self-nomination is not allowed.

  6. Establishment of the Task Force On the Medically Uninsured
    In response to the College's national initiative to bring the concept of universal health insurance back on the national agenda, the Governor's Council has created an ad hoc Task Force on the Medically Uninsured to advance this agenda in our state. Our initial approaches will be to collectively find ways to make the electorate and politicians aware of the public health risks and costs of being uninsured. Mark Earnest, MD our newest member of the Governor's Council has agreed to chair the Task Force. Mark is interested in as many members/associates/students as possible from around the state participating in our initiatives.

    If you are interested (or just want to know more) please fill out the appended sheet.

  7. Report on Fate of Chapter Resolutions
    • Resources for Grassroots Activities—Starting to see a better recognition of needs. A slow process. Our Chapter is the gadfly on this issue. *
    • Limiting the Sale of Products for Profit in the Office —Sent to Ethics Committee. Result was policy publication in recent Annals. *
    • Concerns about PRO-HCFA 6th Scope of Work —Unanimously approved by BOG and referred to Medical Services Committee for action. Within 3 months the 'bounty' provisions had been removed by HCFA. Great story of successful grassroots identification of problem leading to successful resolution at the appropriate national venue.
  8. New Resolution that is Outcome of Town Hall Meeting
    During the town hall meeting multiple concerns were raised that in the pursuit of defining financing for the uninsured the College would not pay due attention to the delivery system(s) which seem to be crumbling around us. As a consequence a resolution was created and will be presented to the Board of Governors at the upcoming Annual Meeting in Philadelphia.

    TITLE: TO DIRECT THE ACP-ASIM TO FORMALIZE A STRATEGIC PLAN THAT ENUNCIATES THE ESSENTIAL COMPONENTS OF A HEALTH CARE DELIVERY SYSTEM THAT THE COLLEGE WOULD ADVOCATE FOR IN THE COMING YEARS.

    WHEREAS: The College has developed into a large organization representing the educational, professional, and public policy aims of a diverse group of over 110,000 students, trainees, general internists and sub-specialists, both in practice and in academia, and ...

    WHEREAS: The College has demonstrated an increasing interest, effectiveness, and capacity to understand and represent the needs of our patients, our specialty, and our profession at the national level, and ...

    WHEREAS: The College has been at the forefront of the fight to provide health insurance to all Americans, and ...

    WHEREAS: Patients having health insurance does not guarantee access to a health care delivery system that provides patient centered care of high quality that respects the patient physician relationship, and ...

    WHEREAS: Patients having health insurance has been associated with onerous rules and regulations that serve accounting as opposed to patient care functions, and ...

    WHEREAS: Patients having health insurance does not guarantee equitable payment for appropriate provider services, and ...

    WHEREAS: The College published a position paper on "Access to Health Care" (Ann Int Med May 1, 1990) that has not been reevaluated or tested against the physician experiences with managed care and HCFA, or the changes in delivery systems over the past decade,

    THEREFORE, let it be resolved,

    That the COLLEGE shall use its health policy resources to develop a strategic plan that defines the core professional values, and specific tenets of the optimal system(s) for the delivery of quality health services to our patients.

    I will give you an update on the BOG discussion in May.

  9. Committee Minutes

    Program Committee - The Annual Scientific Session - Rob Swaney, MD, Chair.

    • Recognized the program Committee that put together this excellent scientific session: Drs. Sam Ferszt, Andy Fine, Laura Lasater, Deb Parsons, Jeanne Seibert, Hal Spritzer, Chris Unrein, and Sterling West.
    • Anyone interested in next year's Committee FILL OUT APPENDED FORM

    Medical Student Committee - Debra Parsons, MD, FACP, Chair.

    • Recognized hard work of the Committee. Major functions include finding funding for summer preceptorships (24 last year), identifying Internists interested in the School of Medicine's teaching programs, and helping the Internal Medicine Club at the School.
    • Recognized the Chapter's Outstanding Student Awardee for 1999, Lisa Schatena, MD, currently an intern at the SOM program. Lisa was given a $250 financial award as well as a free weekend at the Broadmoor.
    • Identified the contributions of Eric Hester, MSIII, to the College and this Chapter in his role on the National Medical Student Council of the ACP-ASIM.
    • Announced the contribution of a $1500 grant in aid from this Chapter to the Globeville Health Project.

    Associates Committee - Mark Reid, MD, Associate. Chair

    • Drs. Ben Shukert, Tracy Lippard, Jen Kapo, Frank Dumont, Henry Fischer, Alison Hirsh, and Kimberly Schleman entered abstracts that were selected for presentation at the Annual Meeting in Philadelphia
    • Described the new Associates Council structure that encourages the Associates to define their own issues, apply for resources to accomplish those goals, and participate more fully in this Chapter's activities.

    Membership Committee - David Abbey, MD, FACP, Chair.

    • Nine members were advanced to Fellowship this year.
      Bahri M. Bilir, MD, Gregory T. Everson, MD, William H. Farrar Jr. MD, Monica Kraft, MD, Robert A. Linden, MD, Michael D. Schwartz, MD, Kevin T. Tong, MD, Edward D. Chan, MD, Donald E. Maier, MD

    Health and Public Policy Committee - Christopher Unrein, DO, FACP, Chair. Gave a brief overview of current issues:

    Federal
    The sustained growth rate is a calculation used by the office of management and budget to forecast Medicare payments. Because of poor predictions and assumptions, the forecast was grossly mistaken. Two errors were made. First, the number of Medicare participants that were supposed to move to a managed care product was overestimated, and the continued growth of the economy was underestimated. This has led to a $3 billion underpayment to physicians since 1997. Last fall, the government did correct the flaws, but it has no plans of returning the 3 billion-dollar short fall. The ACP-ASIM is joining the AMA in filing suit against the federal government.

    The Norwood-Dingle bill, "the Patient's Bill of Rights," is in conference committee. Thanks to the efforts of ACP-ASIM, health care has become a front line policy issue and there is a fair chance that this bill could get out of the congress this year. In its current form President Clinton is likely to sign it. Encourage your U.S. Senators to vote in favor of this piece of legislation.

    The Campbell bill that would have allowed collective bargaining and relief of anti-trust burdens on physicians is having difficulty and is probably a lost cause for now.

    Colorado
    Scope of Practice: Scope of practice is an issue that comes back every year. This year pharmacists, optometrists, and EMTs are crafting pieces of legislation that could potentially expand their scopes of practice in Colorado. The optometrist are seeking legislation that allows for direct access to eye care without a referral. Pharmacists seek collaborative drug management in nursing homes. This bill is very broad. It makes the physician into an accrediting body, does not limit the scope of therapeutic substitution and perhaps masks broader agenda. Lastly on the western slope EMT's seek to act as primary care providers. EMT and paramedic education is much less than extensive than other health care workers and the idea that they want to be primary care triage officers/providers is not tenable.

    Insurance laws: Senator John Evans lost his primary care physician to a no-compete clause in a contract. As a result, he crafted a bill that would make such clauses illegal. This bill has a broad title and includes language that would make it illegal to contract with physicians on the basis of financial incentives. This has the potential of undermining managed care as we currently experience it. Needless to say, these provisions will be difficult to pass. Also, HMOs are traditionally under federal jurisdiction and therefore, any state regulation is preempted by the federal statues, and is probably not enforceable.

    Public Safety: There have been several public safety initiatives. They include primary stop laws to enforce seat belt use. Currently, the only time a driver can be cited for not wearing his seat belt is in conjunction with another violation. This bill would change that. There was also a bill to outlaw the uses of cell phones while driving unless it is a hands-free system; this initiative failed. There was also a bill presented to lower the legal intoxication limit for alcohol to 0.08. This bill was defeated.

    Then there are the gun safety issues. We need to remember that prior to the Columbine tragedy, Colorado was headed toward a concealed weapons permit law. The problem with passing gun control is the Second Amendment. In reality, it is a public safety issue. Policy makers need to change the debate from one of a right to bear arms to a discussion of how to do so safely. We need to instill moral responsibility and legal duty to the citizens our state and country. Gun ownership should be taken seriously, and irresponsible owners should suffer the consequences. ACP-ASIM has policy on this matter. You should be able to research in through the College's web page.

    Tobacco settlement: There are three proposals on how to use the money awarded the state by the tobacco settlements. In the first and most likely version to pass, 37% would go to health care, 43% would go to the governor's reading program, and 20% would go to a trust to keep these programs self-funded. The second proposal would give 60% to health care spending, 20% to the governor's reading program, and 20% to the trust. The third version would entrust all the settlement money and not allow it to be used for 20 years. It would be ideal to have as much money as possible go to the health care of our patients, but if we are not careful this money could be locked up for a long time. Please contact you legislator and let them know how you feel about health care funding from the tobacco settlement.

    Term limits: The 1998 election year saw the first installment of the effect of term limits. The governor, speaker of the house, and the president of the Senate in Colorado all stepped aside as the result of term limits. We had some 20 freshman legislators that year. The 2000 election cycle will bring even more. The result of this turnover is the loss of institutional memory. Battles fought and won must be fought again. The difference now is that the party controlling the government in this state is the one that traditionally hates the idea of government and regulation. Thus, the potential to loosen or remove the public safety aspects of the various practice acts exists on an ongoing basis. Physicians must be involved with their local legislators as both as advisors and financial contributors.

As you can see much is happening within the chapter and at the chapter meeting. Your involvement with any of the myriad of issues that the chapter is dealing with can be very fulfilling. Please look at the questionaire and fax or mail back a response.

THANK YOU

JOEL LEVINE MD FACP
GOVERNOR, COLORADO CHAPTER

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