Governor's Newsletter, Summer 2001
Kelly O'Brien-Falls, MD, FACP
Governor, Colorado Chapter
Notes from the Governor
I hope July finds you enjoying summer, barbeques, bugs, your families and your patients. July is a busy time for the College, both on a national and local level.
Nationally, the search continues for an Executive Vice President — someone to direct the College with the same care and skill that Dr. McDonald has shown in the last seven years. Locally, the Program Committee, chaired by Dr. Deb Parsons, is well under way for our state meeting to be held January 31-February 2 (put that date down now!) Getting high quality speakers and appropriate CME accreditation takes a lot of lead time. Personally, I've been watching swim meets and going to jail (to work, that is.)
Our Council met recently to discuss several issues of "great social and political importance," including ways to improve our involvement in local legislative issues by using the resources already developed by the Colorado Medical Society. The names of the Council members are listed on page 6. Please feel free to contact one of them you know, or if you're more comfortable, one of them you don't know, with suggestions or input.
Our next national Board of Governors meeting is in September. Before that meeting, you will find the resolutions and issues that we'll be discussing posted on the ACP-ASIM web site. Look through these and let me know your feelings and recommendations. Just so you know, I am a liberal Democrat who's always been employed by a non-profit organization. If you think you have a different perspective, be sure to let me know before I go to vote!
Keep on the sun-screen!
Phone: (303) 986-5772
New Chapter Structure
Our Colorado Chapter is embarking on a new path this year. Previous Governors, here and in other states, have often used a secretary or receptionist (occasionally a wife) as the administrative assistant for the chapter, reimbursing her (generally) at an hourly rate. As the work load has grown, it is often difficult for this person to combine both positions. I now come to this office of Governor with no secretary or receptionist (nor a wife). To provide adequate support for our committees and other chapter activities, we are now paying a 0.5 FTE to be the Colorado chapter administrative assistant — Christine Westbrook. We are not in the same office, as is true in many chapters around the states. Ms. Westbrook works out of her home, and we make extensive use of e-mail and the phone. As our children attend the same school, we may be the only chapter operating with third grade couriers (who, by the way, are not financially subsidized by the chapter.) An advantage of this system is that should Ms. Westbrook still be in this position at the end of my tenure, she has the experience and knowledge to immediately assist the new Governor. This also means that we shouldn't lose any good candidates to the fear that their office staff will not be able to manage their office and the chapter business. Any qualified candidate can consider being Governor, even if his or her office/secretarial staff are limited. Finally, as I mentioned, many Governors are not in the same towns as their administrative assistants. With so many e-offices running
successfully, a Governor could easily live outside of the Denver area.
If you need help with any aspect of chapter business — you want a name or number, your CME is missing, you lost your registration form, you want to schedule a committee meeting, etc. — please feel free to contact Ms. Westbrook. I'm sure you will find her helpful and efficient.
Greetings From the New AA
Hello, my name is Christine Westbrook and I am the new Administrative Secretary for the Colorado Chapter of ACP-ASIM. I have an Associate Degree in Accounting and Business Management. I worked for Kaiser for five years and have been doing accounting out of my home for the last five years. I will continue to be working out of my home. I am available during the daytime if you need assistance. I have five children and have been married for 13 years. I am looking forward to working with you.
You can contact me at:
phone: (303) 716-5722;
fax: (303) 374-1488; and/or
Look forward to meeting you at the February meeting!
Annual Associates Meeting a Success
Over seventy people gathered to hear the case presentations and view the posters of over 26 of our state's internal medicine residents as they competed in the Annual ACP-ASIM Associates' Scientific Meeting on Tuesday, June 5. After hearing the cases and reviewing the posters, we joined for dinner and awarded the prize money. Each participant received $50 from the chapter, with winners receiving up to $300. As a minimally competent computer operator, I was impressed that each presentation was on Power Point and presented with the aid of a single laptop computer. It is clear that bulky carousels and lost slides will be a thing of the past, and it was great to see each Associate use this presentation format.
We want to thank our judges, who took the time to attend and the effort to meet and rank the presentations and posters. This was not an easy task because many were of excellent quality and were very interesting. Our judges were:
Kristen Hohmann, MD — Assistant Director of
Medicine, HealthOne (Presbyterian/St. Luke's)
Kevin Lutz, MD, FACP — Private Practice
Jeanne Seibert, MD, FACP — Private Practice
Leland Shapiro, MD — Assistant Professor of Medicine, Division of Infectious Disease, UCHSC
We also want to thank the Chief Residents of each program who participated in the initial selection of the cases — Drs. Ken Gotaas and Kevine Deane. Dr. Deane did a great job of soliciting educational grants from several pharmaceutical companies allowing us to offer this type of competition. These meetings introduce us to new therapies and theories, and remind us of potential problems we can easily overlook in a busy practice. Please join me in congratulating the winners:
1st Successful Treatment of Post-Transplant Lymphoproliferative Disorder with Foscarnet
Alison Hirsh, MD (Associate),
Raymond Blum, MD
2nd Spontaneous Regression of a Lymphoproliferative Disorder Resembling Hodgkin's Disease Following Discontinuation of Methotrexate Therapy
Tania Pauls, MD (Associate),
Martha Lynch, MD (Member)
(Finally — two ways to treat lymphoproliferative disorder.)
3rd Statin-Induced Life-Threatening Rhabdomyolysis in a 79-Year-Old Female: No Risk Factors and No Grapefruits
Marianne Novelli, MD (Associate),
Lorena Letkomiller, MD (Associate)
(Another reminder that no medicine is totally safe.)
4th A Case of Brucellosis
Rocio I. Gianani, MD (Associate)
(A good reminder that the old diseases are still around.)
1st Cytomegalovirus Colitis in an Elderly Woman
Peter Robinson, MD (Associate)
(She only got a bit of steroids at the office, and now she's a case presentation.)
2nd Non-Streptococcal Pharyngitis in an 18-Year-Old: Benign Course of Life-Threatening Illness?
Jennifer Guggeneheim, MSIII,
Marianne Novelli, MD (Associate),
Maureen Boehm, MD(Associate),
Anthony Leo, MD (Associate),
Nicky Hjort, MD
(Do we have to worry about this in every sore throat? These are the cases that keep you on your toes.)
3rd Accelerated Atherosclerosis in an HIV-Positive Man with Broca's Aphasia
Michael Robertson, MD (Associate)
(Especially interesting as the patient was not on therapy for his HIV.)
4th I Can See I'm Blind
Joshua Klopper, MD (Associate)
(A good neuro review.)
See the Colorado Chapter Web site for a complete listing of all the participants — http://www.acponline.org/chapters/co/.
Next June we will have another meeting with more stimulating and educational presentations. We hope to see you there!
Thanks to the following pharmaceutical companies for their support of the Annual Associates Meeting:
- Abbott Laboratories Inc. — Pharmaceutical Products Division
- AstraZeneca Pharmaceuticals LP
- Boehringer Ingelheim Pharmaceuticals, Inc.
- Glaxo Wellcome Inc.
- Janssen Pharmaceutical Inc.
- Merck & Co., Inc.
- Parke-Davis/Pfizer Inc.
Death Of a Former Governor
Kelly O'Brien-Falls, MD, FACP
Governor, Colorado Chapter
Members of the Colorado Chapter were saddened to learn of the sudden death of a former Governor, Dr. John "Jack" Frederick Mueller, in May of this year. Dr. Mueller was born in Goshen, Indiana in 1922. He married Elizabeth Tobin in 1945. He did much of his training in Cincinnati specializing in Hematology and Nutrition. He came to Fitzsimons Army Medical Center in the 1950s, doing some of the early research in IV lipids. He returned with his family to Cincinnati to be on the teaching staff at the University of Cincinnati Medical School. He was active in many medial societies including Young Turks and the American College of Physicians. In the early 1960s, he was the leader of a group of health care professionals invited to do nutritional research in the country of Burma. After an initial four month project there, he returned annually for many years to follow the results of the group's work and recommendations.
In the early 1970s, Dr. Mueller and his family moved to Denver, where he became Director of the Internal Medicine Residency Program and Chief of Medicine at St. Luke's Hospital. He then became Director of Medical Affairs at Presbyterian/St. Luke's Hospital after the merger of the hospitals and their staffs. He had a consultative practice, and after retirement had a small private practice. He continued to be active at the University of Colorado Health Sciences Center, interviewing prospective medical students, even recently.
In 1985, Dr. Mueller became Governor of the Colorado Chapter. His wife, Elizabeth, reports that he very much enjoyed his term as Governor, just as she enjoyed traveling and attending the Board of Governors meetings with him. As he had done so often before, he remained active in the College, attending meetings and serving on committees and the Governor's Council. We will miss his involvement and experience.
He is survived by his wife, Elizabeth, his sons, John and Tim, and his daughters, Rebecca and Judith. He is also survived by 13 grandchildren and 4 great-grandchildren. He was preceded in death by one grandchild.
Report From Our Representative to the CCMU
Mark Earnest, MD
The Colorado Coalition for the Medically Underserved met May 9. After a series of 20 town meetings across the state to assess needs and gather opinions, the group is now in the process of developing a policy proposal that will extend healthcare coverage to every Coloradan. The agenda of the meeting was to critique various policy proposals in terms of how well they met the opinions gathered in the townhall meetings, their efficacy in providing coverage, and political feasibility. The goal is to have a concrete policy proposal by autumn. This plan would then go back to the communities for discussion and fine tuning with the hopes of introducing legislation in next year's session.
As for my role: I have been attending the meetings regularly and participating in the process of critiquing the
policy proposals as they are developed.
Colorado Medical Society Legislative Council
The following excerpt is from "Colorado Medicine," the journal of the Colorado Medical Society. The author, Dr. Unrein, a member of our ACP-ASIM Chapter, is the chair of the CMS Legislative Council. Chris has spoken to us at the annual meetings in Colorado Springs, and this seemed a good way to share more of his work with the legislature. This is being shared with us with the permission of the CMS.
At the end of this session of the Colorado Legislature, I am struck by the oddity that most of the issues we dealt with were related to insurance benefits. CMS staff worked against legislation that threatened to reduce basic benefit requirement for health plans, reimbursement issues from auto insurers as they pertain to medical benefits, and the possible reduction or elimination of network adequacy for rural plans, just to name a few. The cause of these issues is obvious: the corporate bottom line. Apparently, physicians have been squeezed so hard that alternative profit protection methods must be sought by the insurance industry.
Heightened emphasis on health insurance financing became even more apparent to me as I listened to speakers at the recent CMS leadership conference. We had an administrator from a local university address us from the perspective of a health-insurance consumer. I was disappointed in her conflicted priority system. She related that when she, as an employee, receives an open enrollment form, she looks at what health insurance cost her last year, what it will cost her this year, and then she decides if she is willing to pay the increased cost or will reduce her coverage. Paradoxically, she went on to describe several wonderful relationships that she has had with physicians, as a patient, in the past. She apparently does not realize that if she ratchets down the cost of her health insurance, the reimbursement that ultimately makes its way to her physician may compromise her future positive experiences.
A recent event also colors this health insurance theme. By now, most CMS members realize that Dr. Joel Karlin, former CMS president and AMA delegate, suffered a life-altering illness. Joel was a true champion for medicine in dealing with the health insurance conglomerate. He created an open relationship to work with the insurance/HMO industry, but was able to only get so far. The leaders of that industry were faced with an advocate who believed that doctors work hard and care for their patients a great deal. It was Joel's nature to fight for patients to receive the benefits for which they had contracted, and also for physicians to get reimbursed a reasonable fee. When insurance industry leaders saw these qualities in Dr. Karlin, the cooperation stalled.
We have now lost Dr. Karlin's tenacity in this battle. We have lost the for-profit insurance industry; I'm not sure if they were ever truly on our side. And now, we may have lost the patients. My story about the university administrator is related to a book I recently finished by former Secretary of Labor under the Clinton administration, Robert Reich, The Future of Success. Reich relates that the Internet society we are just developing will magnify the issues created by our vigil of the quarterly bottom line, and how the search for the "better deal" will test our entire value system. The global economy is making it even easier for us to find someone who will do it for less. Those who are pushing for more returns on investments and expecting more service for less money complicates the issue; we all contribute to the problem. The Internet can drive this faster and farther than ever before, and might tear up the very basis of our social fabric. Will the necessary safeguards be in place for those who are less fortunate? Reich concludes that with the right public policy, we can maintain our collective conscience and not leave the disadvantaged behind.
This concept is fundamental to the work of the CMS Council of Legislation: to be an advocate for those patients who are vulnerable; to be a protector of the fragile physician-patient relationship. We do this by being the conscience of public policy makers. We need interested physicians to serve on the Council, to contact their legislators, and to contribute to political campaigns when appropriate. We can never replace Joel Karlin, but with enough collective effort, maybe we can get closer to Joel's idealism, with the advice of Mr. Reich. In the end, we need to find a balance between commerce and social responsibility.
I want to thank Suzanne Hamilton, Genni Pearman, Sandi Maloney, Robert Spencer, Dick Allen and Louise McDonald and the entire Legislative Council for another wonderful year. Last, I wish to thank you, the CMS members, for allowing me to serve you as chairman of this committee for the last five years. It has been rewarding and challenging and we are already looking forward to a lively 2002.
ACP-ASIM Works to Reduce Medicare Hassles
ACP-ASIM is pleased to announce its endorsement of the "Medicare Education and Regulatory Fairness Act" (MERFA), S. 452/ H.R. 868, which directly addresses internists' concerns with Medicare red tape and hassles.
Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, President-Elect of ACP-ASIM and a practicing geriatrician.
Dr. Hall represented the College and announced support for this important legislation at a March 7 press conference with the American Medical Association and the American College of Cardiology, as well as MERFA's Senate and House sponsors.
MERFA directly addresses the Medicare procedures and rules that are the source of much frustration with the program. Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.
Introduced in the Senate by Senators Frank Murkowski
(R-AK) and John Kerry (D-MA) and in the House by Representatives Shelley Berkley (D-1-NV) and Pat Toomey (R-15-PA), MERFA would allow physicians and their staff to spend more time treating patients, and less time handling needless paperwork. It would enact the following reforms:
Medicare rules and policies and answers to "frequently asked questions" would be made more accessible, and physicians would be given advance notice about changes in rules.
Medicare would be required to pay its claims, without demanding more paperwork, unless there is evidence that the bill is incorrect.
Medicare would be required to actually examine the records, rather than using a statistical sample, to determine that some claims were billed incorrectly.
Medicare's ability to investigate fraudulent claims would be preserved, while also educating physicians
on how to prevent inadvertent billing mistakes that result in overpayments.
Enactment of MERFA is one of the College's highest priorities. The College strongly encourages you to ask your Senators and Representative to cosponsor this important bill if they have not already. Illustrate for your legislators your experiences with the burden of complying with regulations, and how much time it takes you and your staff to deal with complex, confusing, duplicative and unfair Medicare requirements.
E-mail, fax or compose a letter to your legislators through the ACP-ASIM Legislative Action Center at http://www.acponline.org/lac (draft letter provided, please personalize), or call your Senators and Representative toll-free through the ACP-ASIM Grassroots Hotline at 1-888-218-7770. (The Hotline will prompt you for your 8-digit member number, which you can find on the mailing label of ACP-ASIM publications, such as Annals of Internal Medicine.) Report your contacts to Jenn Jenkins in the ACP-ASIM Washington Office at 800-338-2746, ext. 4536, or by blind copying e-mails to email@example.com. Thank you for your help.
Become an ACP-ASIM Key Congressional Contact
After hearing on the evening news about a proposed change to Medicare or a problem in the healthcare system, have you ever wanted to put your two cents in on the issues? Do you care how legislation coming through Congress affects your patients and the practice of internal medicine? Is one of your friends, family members, patients, church members or civic organization members a legislator?
If you answered "yes" to one of these questions, you would make a valuable addition to the ACP-ASIM Key Congressional Contact Program.
The College's success on Capitol Hill depends on grassroots advocacy by Key Contacts across the country who communicate with their members of Congress on issues of importance to internists and their patients. Key Contacts usually do not have established relationships with their members of Congress. ACP-ASIM gives them the tools necessary to develop and maintain relationships.
Key Contacts receive a periodic newsletter, the Capitol Key, updating them on important legislative issues. Then, as key issues approach the decision-making stage on Capitol Hill, the College sends Legislative Alerts to Key Contacts that include all the necessary information to make informative contacts with legislators. ACP-ASIM staff is always available to provide support and answer legislative questions. Key Contacts report their contacts back to staff in the Washington, DC, office of ACP-ASIM via fax, phone, e-mail or mail.
The College offers a Grassroots Hotline that Key Contacts can call to hear a legislative update and be matched-with and patched-through to their members of Congress at no cost. The Grassroots Hotline number is 1-888-218-7770. ACP-ASIM also offers the Legislative Action Center (LAC) website which allows ACP-ASIM members to view the most current ACP-ASIM Legislative Alerts, find out who their legislators are, and send an e-mail, compose a letter or a fax to their members of Congress. It provides the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with legislators. The Legislative Action Center can be accessed through the "Advocacy" section of ACP-ASIM Online, or at http://capwiz.com/acp/home/.
The College implemented a Key Contact Awards Program to recognize the hard work of members who go above and beyond the call of duty to contact their members of Congress. Each year, ACP-ASIM selects a Key Contact of the Year and a Top Ten Key Contact Special Recognition Winners based on the quality and quantity of responses to Legislative Alerts. The awards are presented each spring at Leadership Day in Washington, DC.
If you would like to be updated on the legislation affecting internists and their patients and are interested in corresponding with your legislators a few times a year on these issues, contact Jenn Jenkins at 800-338-2746, ext. 4536, and join the College's Key Contact Program.
What ACP-ASIM is Doing for You Today
"What have you done for me lately?" is a question that ACP-ASIM strives to answer before it is asked, by making membership needs an integral part of its strategic planning process.
As such, the following is a comprehensive list of products and services that ACP-ASIM offers to its members, which was compiled by the Board of Regents. Since the College leadership realizes the needs of it membership are ever-changing, they will continue to re-evaluate this list and add new products and services when appropriate. In addition, the College encourages you, the members, to submit your ideas for changes/additions to Dr. O'Brien-Falls at Flapneck@aol.com.
Advocacy and professionalism
For Associates and Medical Student Members
ACP-ASIM Colorado Chapter Governor's Council Members
|James Bush, MD||EX||Jimbush@
|970- 484-8826||303- 484-6406|
|Karla Demby, MD||1996||Kdemby@
|970- 565-5430||970- 564-8730|
|Mark Earnest, MD||2000||Mark.Earnest@
|303- 372-3102||303- 331-9269|
|Kelly O'Brien-Falls, MD||1998||Flapneck@
|303- 986-2334||303- 986-5772|
|Robert Gibbons, MD||EX||GibbonsR@
|303- 866-8044||303- 837-7836|
|Jean Greos||303- 837-7017||303- 488-9951|
|303- 691-5016||303- 866-8885|
|303- 393-4670||303- 393-2839|
|303- 776-4022||303- 776-3331|
|303- 745-9722||303- 337-2969|
|303- 315-5711||303- 315-7132|
|303- 695-2933||303- 657-6884|
|970- 243-4464||970- 243-3300|