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Governor's Newsletter, Spring 2002

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

Governor's Corner

Well, it has been several months since our State Meeting, and already we're starting the planning process again. I appreciate each of you who took time to write comments in the evaluation forms, especially those suggesting future program ideas. As the Program Committee is formed, we'll use those to guide the planning. If you have further ideas, or an interest in being a part of the Program Committee for 2003, please call me at (303-986-5772) or send me an e-mail at (kobrien@idcomm.com). We'd love to have you!

Many of you received a test e-mail from the Governor's office in April. The National ACP-ASIM office is looking at improving our e-communications. If you did not get such an e-mail, please send me a message at (kobrien@idcomm.com), so you can be put into the data base. Chapters with a large accurate e-mail data base have quicker, and cheaper, communications capabilities. If you're not doing e-mail regularly yet, it's time to get on board. Congratulations to our long standing member, Dr. Louis Barbato, for his use of e-mail. (If he can do it, really, no one has any excuses.) Congratulations, also, to the UCHSC and Exempla St. Joseph Hospital faculty for their use of e-mail. I got many quick responses from them.

The National Meeting, held in Philadelphia in April, was again an excellent educational and social session. It is exciting to see that many internists from all over the country, and the world, coming together for some very high quality programs. Next year's meeting is in San Diego (a far more reasonable time-zone change). Prepare now to attend this well-planned meeting in a great family town. For those of you applying for Fellowship, San Diego would be a wonderful city in which to be inducted. Your family could attend the colorful ceremony, and join us at the reception following.

Negotiations with the American Board of Internal Medicine (ABIM) have entered a new and hopeful phase. The College recognizes the variations in our practices and the traits of adult learners. We are suggesting multiple, flexible tracts to recertification. Like all of you, the College recognizes the value of accredited continuing education in the rapidly changing world of patient care. It is important that hospital boards, third-party payers and our patients, understand that internists in no way wish to avoid the responsibility of ongoing, meaningful education. In fact, the key word there is meaningful and much of what had been proposed to this point was "busy work" rather than meaningful physician evaluation that would improve patient care. The ABIM is now willing to explore some other paths and ideas with the College. This is an excellent time for your input—those of you recertifying, those of you in adult or continuing education: We want to hear ideas and recommendations from you about this important process.

You'll find in this newsletter an article from medical student Jennifer Guggenheim, who was selected to go back to Philadelphia and present her work. Her trip was supported by our Colorado Chapter. Jennifer is going into OB-GYN, and we hope this meeting increased her appreciation of internists. It's always nice to have interested colleagues in other fields. You'll also find a column from Dr. Dave Abbey of Fort Collins, sharing a bit of his hobby—studying the life and work of Thomas Jefferson. At our state meeting, we learned of many interesting and unusual hobbies that I think are fun to share with each other. We'll look forward to more articles on your hobbies, interests and passions.

As you read this, I hope your summer is looking good, and that too much of the state isn't on fire. Get down the important upcoming meeting dates now—it'd be great to see you all there!

Important Dates For My Daytimer Or PDA:

State ACP-ASIM Meeting
Colorado Springs
January 30th (Thurs.) - February 1st (Sat.)

National ACP-ASIM Meeting
San Diego, California
April 3rd (Thurs.) - 6th (Sun.)

To Do List:

  • Be sure the Colorado Chapter has my current e-mail address.
  • Get my Fellowship application turned in (call the Governor's office if I need a Fellow to "second" my application.)

Free College Help with HIPAA - Coming Soon!

In the long run HIPAA should yield huge savings for the US healthcare system, but in the coming months HIPAA will pose a major administrative challenge for providers, payors, and vendors. The Administrative Simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will require practices to protect patients' identifiable health information in any form - written, oral or electronic. The specific HIPAA regulations now being promulgated are divided into three basic Rules-Electronic Data Transactions, Privacy and Security. Physician practices will need to do substantial advance preparation to meet the following legally enforceable compliance deadlines:

Rule Compliance Deadline
Electronic Transactions October 16, 2002 (an extension to October 2003 may be requested)
Privacy April 14, 2003
Security 26 months from release of final rule (expected early 2002)


HIPAA Components: The Transactions Rule—Is designed to simplify the administrative processing of electronic claim and remittance forms and other patient encounter information through standardized electronic formatting. While the ultimate outcome could simplify various aspects of practice management and yield enormous savings by transforming information exchange between healthcare organizations, it will be no easy task getting to that point. Computer software programs as well as office procedures will need to be rewritten to accommodate the new requirements. For the most part, practices will depend on their computer vendors and payers to make these technical changes. However, if any one of the practice's business partners is not ready on time, transactions and therefore practice reimbursement and cash flow will be disrupted. Thus, it is critical that practices understand what needs to be done, make sure that their vendors and other business partners are supporting the practice appropriately, and will be able to meet the compliance deadline. If not, new legislation enables the practices to obtain an extension to April 2003 for testing its systems and October 2003 for final compliance.

The Privacy Rule—Mandates how providers, health plans, and clearinghouses may use and transmit personal health information. As a result of media and consultant attention, many physicians are generally aware of the potential impact that the privacy rule can have on their practices. While many practices probably already do some of the things required by the Privacy Rule, compliance with its specific legal provisions will require significant effort, including implementation of new forms, policies and procedures, staff training, and patient education.

The Security Rule—Which is still only in proposed form, has to do with the physical and electronic security of the information that is stored, maintained, used or transmitted. In other words, technological controls on computer systems and the security of data transmissions will be required for compliance. The "proposed" rule is generally intended to be scalable to small practices and technologically neutral. As of this date, however, it is still unknown what changes the "final" Rule may bring, especially with regard to oral and printed communications (such non-electronic information was not addressed in the original proposed security rule but has since been added to HIPAA's purview). It may be prudent to put in place a risk management process now that can be revised and updated later, recognizing that the final security rule, when published, could require significant adjustments in the practice's security planning and operations.

Practice Management Center Assistance to Members: Few physicians truly understand the potential impact HIPAA will have on their practices. Although the HIPAA rules are still in various stages of finalization, a host of consultants have already begun marketing manuals, seminars, and advice to physicians. Before sifting through such often-costly options, college members should be aware that ACP-ASIM's Practice Management Center (PMC) is developing sound, practical tools to be offered as free member benefits.

The "HIPAA Overview" is already posted on PMC's web page (under Regulatory Requirements) for members needing a basic explanation of these complex regulations. Very soon PMC will also begin releasing three separate manuals, each covering one of the HIPAA rules. These valuable tools will provide practical guidance, sample templates, forms, job descriptions, contracts, checklists, and other resources that members will need to comply with the new HIPAA rules. They are being developed with special emphasis on the compliance needs of small practices.

The requirements of the electronic data transactions rule are the most rigid and the least well understood of the three rules with which practices must comply. PMC therefore believes that transactions should be the initial focus of HIPAA compliance efforts by College members. PMC's Electronic Transactions Manual will be available in early 2002. ACP-ASIM and the American Academy of Pediatrics have contracted with one of the most recognized experts in this field, Margret\A Consulting, LLC, to develop a transactions toolset that will provide our members what they need to prepare for compliance with the electronic transactions regulations. The toolset is expected to be available on PMC's web page in early 2002. Members should check the web page's "What's New" listing for announcement of this and other manuals.

ACP-ASIM is also one of ten medical specialty societies, representing over 400,000 physicians that have contracted with a leading consulting firm, Gates, Moore & Company, to develop Privacy and Security Manuals for members. The Privacy Manual will be available in early 2002 and the Security Manual will be produced shortly after the final Security Rule is eventually published. The Privacy and Security Manuals will also be available in Spanish.

Free to Members Online: College members will be able to download all of these manuals free of charge from the PMC web page. Members who do not have good Internet access will be offered CD-ROM or other versions (shipping and handling charges apply). Keep your eye on the PMC web site for release of the latest HIPAA compliance tools. They will be valuable benefits of your College membership.

College Mounts Public Affairs Effort on Excessive Medicare Cuts

The College's Public Affairs office has mounted a campaign to educate the public about the recent cuts in Medicare and what they will mean to the future quality of care in the United States. In mid-March ACP-ASIM released a video news release featuring College President William Hall, MD, FACP, which dramatized the impact of excessive Medicare cuts on patient care. The release, titled "Medicare Cuts May Mean Trouble Ahead for Patients and the Physicians Who Treat Them," noted that Medicare patients may soon be faced with a serious reduction in available physicians and services if Congress doesn't act soon. A nearly 30 percent decrease in physician reimbursement over four years is forcing physicians to cut practice expenses and reconsider their participation in the Medicare program. In Dr. Hall's geriatric practice in New York State a five percent cut in funding has already led to the reduction of two staff positions. The College is working with Congress to avoid additional cuts that will force further reductions in services for Medicare patients between now and 2005.

In addition to the video news release, Public Affairs is working with members around the country to write and place op-ed letters in local newspapers. Op-ed pieces are an excellent tool to reach a broad audience with a targeted message. Physicians who are interested in lending their name and support to an op-ed piece may contact Carolyn Albert in the Public Affairs office at (800-338-2746).

Thomas Jefferson: A Man For Our Times

Dave Abbey, MD

The purpose of the Jefferson Legacy Foundation is to encourage people to learn about and from Thomas Jefferson's life, times and ideas; and from this inspire participation in public affairs. For as Lincoln said, "The principles of Jefferson are the definitions and axioms of free society." From this we hope a civil discourse addressing important political and social issues will follow. Let me give one brief medical example which pairs public health with political leadership.

The threat of smallpox from a terrorist act or reemergence from frozen human cadavers in the artic are real possibilities. Bioterrorism with smallpox is not new to North America. It was used by the British during the French and Indian War and most likely during the American Revolution as well. Thomas Jefferson was very familiar with this scourge and took a personal interest in plans for its eradication. Long an advocate of inoculation (purposeful injection with the smallpox matter itself, not to be confused with vaccination which involves injection with cowpox matter) Jefferson was impressed with Jenner's cowpox vaccination experiments. When Benjamin Waterhouse MD first brought this new vaccination procedure to America, he was keenly aware that it was controversial, and political support would be important for its success. For this he cleverly solicited the help of Thomas Jefferson, President of the United States. After personally reviewing the data, Jefferson enthusiastically embraced the project. He became an expert technician on thesometimes fickle procedure, and from the White House directed the vaccination program in the South. According to Waterhouse, Jefferson was responsible for introducing vaccination into Virginia, the District of Columbia, Pennsylvania, Delaware, Maryland and North Carolina.

After receiving material from Waterhouse, Jefferson quickly arranged for physicians to begin vaccinations. When these early attempts failed, Jefferson hypothesized that heat destroyed the vaccination matter in transport, and suggested that future samples be insulated in a vat of water. This strategy proved successful. Jefferson became a legitimate vaccine expert and his support played an important role in the wide acceptance of the new procedure. A critic of existing medical theory, vaccination was a prime example of the scientific direction in which Jefferson believed medicine should move. This smallpox story is an early example that lofty public health goals should be backed with a sound political strategy.

Identifying political allies with leadership skills is fundamental when transforming scientific progress into successful public health policy. If this brief example peaks your interest refer to an article on Jefferson and smallpox in the newsletter section of our web page. For a fun break from your routine, try applying history to your thoughts about contemporary social issues. The study of Thomas Jefferson is a great place to start.

Student's Perspective

Jennifer Guggenheim, MS IV, University of Colorado Health Sciences Center

As a fourth year medical student, I was invited to present a clinical vignette poster at the April ACP-ASIM Annual Conference in Philadelphia. My trip was very exciting and I was happy to have the opportunity to attend some wonderful sessions offered at the conference. This was my first experience giving an oral presentation to judges, and a good career experience. The topic of my poster was Lemierre's Syndrome, a rare complication of oropharyngial infection with Fusobacterium necrophorum. I was surprised and pleased to be chosen as one of the five winners of this competition. I greatly appreciate the Colorado Chapter financial support for this trip and wish to thank all of you who contributed to this experience.

New E-Newsletter for Members

A new monthly electronic newsletter for College members will debut on May 1, 2002. The newsletter will cover new College programs, products and services, and will also keep members updated on ACP-ASIM's advocacy efforts on behalf of internists. The nearly 50,000 members who have provided the College with their e-mail addresses will receive the newsletter the first Wednesday of each month; recipients will have the opportunity to opt-out of receiving the publication at any time.

The newsletter will provide brief articles (two to three paragraphs) about College activities and services that directly affect members. Readers who wish to learn more about a particular topic will be referred to more information on the Web (when available). Members who do not have e-mail may also access the newsletter on ACP-ASIM Online. For more information please contact Allison Ewing at (800-523-1546, ext. 2649).

Bioterrorism Resource Web Site Updated

The College's bioterrorism Web site has been revised for easier navigation, and features new clinical information, images, and support tools. The site has received praise from the Centers for Disease Control and Prevention and other viewers for its comprehensiveness and content.

Recent additions include new support tools on cutaneous and inhalation anthrax, self-assessment questions on biological and chemical agents, and new information about biotoxins, nerve agents, and toxic gasses. Physicians are urged to visit the site to increase their knowledge of bioterrorism agents and to learn how to deal with a suspected bioterroristic attack.

Match Shows Decrease in Interest in Primary Care Careers

Results of the 2002 National Resident Matching Program residency match, released on March 21, 2002, suggest a continuing decline in interest in careers in primary care. Overall, internal medicine was the least negatively affected primary care specialty this year, according to Herbert Waxman, MD, FACP, ACP-ASIM senior vice president for education.

The three career-bound internal medicine program tracks—categorical, primary and medicine-pediatrics—matched 3,234 U.S. medical school seniors this year. Categorical, the track chosen by 85 percent of these seniors, declined the least—2.2 percent—since last year. Primary internal medicine residencies attracted 16 percent fewer U.S. seniors this year, and medicine-pediatrics residencies attracted 9 percent fewer residents than last year.

In contrast, there was a sharp increase in U.S. seniors matched to preliminary programs in internal medicine. These seniors will be entering other specialties such as ophthalmology and dermatology after first-year residency. The number of students matched to preliminary internal medicine programs was 1,398—the highest number since 1991.

According to Dr. Waxman, the match results do not reflect the large number of positions filled outside the match by international medical graduates and by doctors of osteopathic medicine. Dr. Waxman also noted that it is likely that more than 50 percent of U.S. medical school seniors entering categorical internal medicine programs will not end up in careers in general internal medicine, and that the NRMP figures don't reflect the full extent of declining interest in primary care careers.

New Requirements for Interpreters in Medical Facilities

The Office of Civil Rights (OCR) published a policy guidance on February 1, 2002, that would require all physicians who receive any federal financial assistance to hire, train, and assure the competency of clinical interpreters for all of their patients, even those not insured by Medicare or Medicaid. ACP-ASIM strenuously objected to the requirement that could result in interpreter expenses of $400 for a visit reimbursed by Medicaid an average of only $30 to $50. A physician could conceivably have to hire, train, and pay several interpreters if his/her patient population were ethnically diverse.

ACP-ASIM recognizes the conceptual basis for the requirement, but urged the OCR to rescind this policy until alternate approaches were discussed. While the OCR's intention was to increase access to care for non-English speaking patients, ACP-ASIM believes the unfunded expense of hiring interpreters would force physicians to abandon the Medicare and Medicaid programs in order to avoid these costs. The College's comments to the OCR are available on the College website.