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Governor's Newsletter, Winter 2000

James L. Bernene, MD, FACP
Governor, Connecticut Chapter

Governor's Column

It seems like such a short time ago that I was being welcomed as the new Governor-elect and now, four years later, I have the pleasure of announcing the new Governor-elect, David Podell. As you are all aware, we had two superb candidates to choose from. It was unfortunate that we could only elect one. I would like to thank Noel Robin for agreeing to run and for all of his contributions to the Chapter and to the College. As I pass the baton (since it is an Olympic year) to Dave Podell for the next year, we will try to make the transition as seamless as is possible.

Currently, we are in the process of putting final arrangements together for our Associates' meeting to be held at the Waterbury Sheraton, on May 17, 2000. I look forward to the same kind of outstanding participation that we have had in the past. Winners of the oral presentations competition will be asked to present at our Annual Meeting in the fall. I encourage you all to attend this wonderful demonstration of resident talent in the state of Connecticut.

With respect to the Annual Meeting, planning for this is also proceeding. The theme for this year's meeting will be the impact of the human genome project on medicine with particular reference to molecular biology and genetic engineering. The Planning Committee felt strongly that the issues discussed be a critical part of medicine in the future. We also are planning to have a presentation from a Connecticut legislator, a presentation of the Laureate Award winners, and, for the first time this year, a medical knowledge competition, conducted in a currently popular format. More details will follow over the next two or three months. Please mark October 20, 2000 on your calendars - Waterbury Sheraton Hotel.

The third meeting I would like to encourage you to register for is the Annual Session to be held from April 13-18, 2000, in Philadelphia. For the first time, the College has chosen a clinical them for special emphasis on its educational program. This year's theme is that of "Emerging Antibiotic Resistance," which is now a major threat to the health of people worldwide. Numerous sessions will provide up-to-date information on strategies designed to reduce this threat. In addition, the first set of time-limited internal medicine certificates are due to expire in 2000, and recertification will be the theme of a two-day pre-session course. The Connecticut and Rhode Island chapters will be hosting a reception on Saturday evening, April 15, and I will notify you all subsequently about the exact time and location.

Lastly, I would like to congratulate all of our new Fellows in the Chapter. A listing of their names is included in this issue of the newsletters. I would like to encourage those of you that have not applied for Fellowship to do so; eligibility criteria can be found on this web site.

As always, let me know if the Chapter or the Governor's office can be of some help to you and best wishes for a happy and healthy year.

James L. Bernene, MD
Governor, Connecticut Chapter

Health and Public Policy Committee Initiatives With HMO Medical Directors

By: Paul Dolinsky MD, FACP

The Health and Public Policy Committee met with medical directors of the State's HMO's in order to better coordinate disparate medical policies, formularies and the specialist referral process. With the assistance of Dr. Attilio Granata, Oxford Medical Director and ACP Health and Public Policy Committee member, a joint meeting was held in the fall, with almost all the State's Medical Directors in attendance. It was a very informative gathering, although sometimes frustrating, given the limitations in our ability to practice medicine without the restrictions imposed my managed care. Our Committee did learn a number of points:

  • HMO Medical Directors have been meeting independently, so that they might coordinate some projects. However, they are restricted by anti-trust regulations from discussing certain topics. Also, there may be proprietary information that cannot be shared, being that the HMO's compete in the marketplace.
  • HMO Medical Directors are developing a drug formulary comparison chart for physician use, that would be regularly updated. This could improve the efficiency of prescribing by the practitioner, by obviating the need to play guessing games with the pharmacist and the patient, as to the HMO "preferred" drug.
  • Not all HMO's are alike; those with a national presence (i.e. Aetna USHealthCare, Cigna, United, Anthem Blue Cross etc. ) must maintain medical policy uniformity across the United States. Hence, system changes, that would seem to be "common sense" to members of the H&PP Committee, may be difficult or impossible to implement locally, without a national corporate consensus.
  • HMO's do have an obligation to promote optimum health for their enrollees to maintain NCQA accreditation, using limited tools such as service claims data (and applying HEDIS criteria.)
  • Many of the HMO Medical Directors believe that they are in a position to improve public health and lower overall medical costs by developing population based disease management programs (such as asthma, congestive heart failure or diabetes.)

Future avenues for cooperation between Connecticut ACP and the HMO Medical Directors may include:

  • An initial step to review the draft of the formulary comparison chart, and possible co-sponsorship of its distribution.
  • Cooperation with the development of uniform disease management guidelines, acceptable to all the HMO's, coordinating efforts with Qualidigm (former CPRO.)
  • Promotion of a health initiative, such as pneumococcal vaccine administration.
  • Smoking cessation efforts.
  • Longer term electronic information systems that may aid in medical office interaction with HMO's for referrals, medical policies, prior authorizations, etc.

Future meetings are planned.

Supporting Your Chapter Through Chapter Dues

Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives.

When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

Resident Representative to Governor's Council

By: Matthew Voss, MD

"Life is short, the Art is long, opportunity fleeting, experience delusive, judgement difficult" (Aphorisms of Hippocrates, about 400BC.)

It was about one and a half years ago that I began my residency training in Primary Care at Yale. About the same time, the ACP and ASIM united, creating the largest society of internists in the world. With this union came restructuring and the Connecticut Chapter of the ACP desired more active resident input to the Governor's Council. Thus I was asked by the Council to be the Resident Representative. I am very honored and excited at the opportunity to represent such a distinguished group. As the Resident Representative, I wish to provide guidance to Connecticut Residents (Associates) on what the ACP offers to its members:

  • Education
  • Annals of Internal Medicine (Online January 2000)
  • ACP Journal Club
  • ACP Observer
  • MKSAP
  • Internet Resources
  • ACP Online
  • CT Chapter Site
  • Research and Scientific Meetings/Presentations
  • Annual Session Philadelphia, 2000 April 13-16
  • Connecticut Associates Meeting, May 17, 2000
  • Connecticut Annual Meeting, October 20, 2000
  • Community Projects
  • International Health
  • Fellowship Training
  • Job Opportunities
  • Promotion of Health
  • Medical Ethics and Professionalism

As we gear up for the new millennium, the Connecticut Chapter is eager to start new projects (Procedure Workshops/Community Health Promotion/Internet as a Medical Resource/Job Fair, etc.) to provide a strong foundation for the future. We must strive to continue excellence in education, research, and patient care.

Please feel free to e-mail me with any questions or suggestions.

Matthew Voss, MD
Resident Representative to the Governor's Council
Connecticut Chapter of ACP
E-mail: mvoss@javanet.com

Medical Student Report

By: Barry J. Wu, MD, FACP, Chair, Medical Student Committee

We are thankful for over 140 medical student members in Connecticut this year. Many of the students joined during the Yale Medical Student Activities Fair held on September 1999. Ellen Nestler, MD, from the University of Connecticut, has further increased our student membership through her involvement in the Scholar's in Medicine/General Medicine Interest Group at the University of Connecticut. We are grateful this year to have Jessica Mega, a third year Yale medical student, as the student representative on the Governor's Council. Medical students highlighted our Fall ACP activities. We were delighted to have third and fourth year students from both schools represented at the First Annual ACP Northeast Medical Schools' Jeopardy Tournament held at the Hospital of Saint Raphael, on September 25. This was followed by inspiring student presentations at our Connecticut Chapter Annual Meeting in October. Jersey Chen, a graduating Yale medical student, and Stacey Raczka and Jennifer Botte, third year University of Connecticut medical students, gave outstanding oral presentation of their research.

The "Meet the Professor" Rounds showcased Heather Yun, a third year Yale medical student, and Michael Greene, a senior University of Connecticut student, presenting two interesting patients as unknowns to our distinguished faculty, Dr. Henry Schneiderman and Dr. Leo Cooney.

We look forward this Spring to announcing the winners of the ACP Medical Student Award. This award is given to a graduating senior from Yale and the University of Connecticut for outstanding academic achievement and community service. The candidates will be selected from those who have matched to an internal medicine residency in program in Connecticut. A plaque with the winners names has been established in the Dean's Office at Yale and the University of Connecticut.

We are also beginning to prepare for the next medical student jeopardy tournament to be held in September 2000. If you are interested in serving on the Medical Student Committee, please contact me at bwu@srhs.org.

Student Representative to Governor's Council

By: Jessica Mega

After entering Douglas House, a shelter for homeless adolescents, I headed upstairs to the makeshift clinic. My first patient of the evening was Tammy, an energetic, talkative fifteen year old. When I finished asking about her medical history, I reached into my canvas bag and pulled out a stethoscope and a blood pressure cuff. Much to my surprise, Tammy exclaimed, "What are you going to do with those things?" At that moment, my fellow medical students and I realized that this young woman had not received a medical examination in years.

Tammy is not alone; over 41 million adults including 11 million children are currently uninsured and, therefore, not receiving the medical care they need. In fact, the number of Americans without adequate health insurance has grown by nearly 10 million over the last ten years, and this trend continues today. The question now arises, who is going to advocate for these underserved people. Although the default answer has been "policymakers," I would argue that medical students and physicians should play a role in instigating change. We are the ones who personally understand that people without insurance frequently do not receive timely medical care, such as regular check-ups and mammograms, and are, therefore, more likely to be hospitalized for preventable conditions. Even in my limited medical practice experience, I have seen this scenario emerge.

During the first week of my Internal Medicine rotation, I remember eagerly running down to the emergency department to meet and admit my first patient. I had been given only the patient's age, gender, and medical condition: type II diabetes. As I searched the florescent-lit Ed for a person that might match my patient's description, my eyes landed on a woman lying limp in a stretcher, surrounded by a mass of white coats. When I approached the group, I was told that the patient had stopped taking her insulin several weeks ago when she could no longer afford it. Now she was unconscious with uncontrolled diabetes threatening her life.

Situations like this one suggest that medical students and physicians are very familiar with the detrimental impact of underinsuring Americans; but, are we being trained to advocate for change? Out of curiosity, I conducted an informal survey of my third year medical school class. It quickly became clear that we are aware of the problem but are uncertain about how to proceed. What is our role in policy-making? Are we supposed to be learning to serve just medical science or are we aiming to serve the people as well?

If we choose the latter or a combination of the two, then it makes sense for us to become educated about legislative actions, such as those that would extend healthcare to more people. We could use our knowledge to generate public support, build consensus, and lobby our federal and state legislators. Perhaps then, legislators would feel compelled to support sound, medically beneficial initiatives. Maybe it is even time for some of us to become the legislators. Then medical decisions would be made by medical minds-people who intimately know the value of quality health care, the cost of medical services, and the price we pay for underinsuring Americans.

New Fellows - January 2000

Sudhir K. Bhatnagar, MBBS
Sharad Jaitly, MBBS
Uchenna H. Iloeje, MBBS
Kolawole A. Olofinboba, MBBS
Frederick A. Kayal, MD
Teresa K. Rutkowski, MD

Governors Debate Resolutions on Tort Reform, Online Prescribing

At its fall meeting in October, the College's Board of Governors debated six resolutions on issues ranging from online pharmacies to effective tort reform.

The Governors recommended that three resolutions be adopted by the Board of Regents. The three resolutions, all proposed by the College's New York Chapter, call on ACP to do the following:

  • Collect information from various state governments on the effectiveness of local efforts to address tort reform and periodically release a report making this information available to chapters and regions.
  • Develop a shortened application and accreditation process for CME programs offered by College chapters.
  • Work to make sure that the use of the Internet to prescribe drugs facilitates, not circumvents the doctor-patient relationship. The resolution also called on the College to work to ensure that Internet prescribing occurs only when there is an established relationship between the physician and patient.

The Governors also discussed the issue of board certification. A resolution from the Wisconsin Chapter called on the College to support the position that employment opportunities for physicians who do not seek recertification or who fail to become recertified should not be jeopardized. The BOG recommended that this resolution be forwarded to the Board of Regents for further study and report.

The Governors also voted against the adoption of two additional resolutions, one from the New Jersey Chapter calling for campaign funding reform and one from the Florida Chapter requesting that ACP amend its dues statement.

All resolutions adopted by the Governors are referred to the Board of Regents, which decides whether to make resolutions official ACP policy. Coverage of the next Board of Regents meeting will appear in a future issue of ACP Observer.

ACP Launches Legislative Action Center

To make participation in grassroots advocacy easier for its members, ACP launched in August the new Legislative Action Center (LAC), which may be accessed from ACP Online. The LAC allows you as an ACP member to view the most current ACP Legislative Alerts, find out who your federal legislators are, and send e-mails or faxes to your members of Congress. It also provides you with the status of key legislative issues of concern to ACP, Congress' schedule, and tips on communicating with your legislators. ACP encourages you to try LAC by sending an e-mail to your members of Congress in response to the current Legislative Alert posted on ACP Online.

You can access the Legislative Action Center through the "Where We Stand" section of ACP Online, or by going straight to the LAC at http://congress.nw.dc.us/acp/. To send a message to Congress, you are prompted for your zipcode and are zipmatched to your federal legislators. You will then be asked for your name and address (so that congressional offices can identify you as a constituent.) ACP encourages you to send a message based on the sample points posted for you, with your own personal anecdotes added. If you have any questions about the LAC or contacting your federal legislators, please contact Jenn Jenkins, Associate for Grassroots Advocacy, at jjenkins@acponline.org.

Connect With Members Through ACP's New Online Directory

Do you need to correspond with a member of the College, but find that you don't have his/her current mailing address? Use Member Connection, the College's new online membership directory, which is accessible to members-only via ACP Online.

Updated daily, the information in Member Connection is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty.

Members who wish to be excluded from Member Connection must notify the College in writing. Members can obtain a Directory Exclusion Form on ACP Online, or by calling Customer Service at (800)523-1546, ext. 2600, or (215)351-2600 (9 a.m. to 5 p.m. EST).

Report of the Health & Public Policy Committee

By: Robert McLean, MD, FACP (rmmclean@optonline.net)

The Chapter Health & Public Policy Committee leadership is again working closely with the legislative liaisons of the Connecticut State Medical Society (CSMS) during the current legislative session in Hartford.

The top priority on the CSMS legislative agenda for 2000 is an issue which directly impacts our practice of internal medicine: the State of Connecticut has drastically cut Medicaid funding for dual eligible Medicare/Medicaid patients by eliminating virtually all Medicaid payment of Medicare Part B crossover claims. The total cut is $54 million - $14 million of which is in physician services. This cut has serious implications to patient access - can you cover your overhead seeing patients for fees which will be 80% of Medicare's fee schedule? We internists need to effectively mount a grass roots effort to contact our State House and Senate representatives about this problem and explain that internal medicine practices as small businesses (we must acknowledge this reality) cannot financially take this hit. The dual eligible patient is frequently the nursing home patient, the renal dialysis patient, the mentally disabled patient, and the poor elderly patient - the very patients who need access to quality health care services.

We must highlight for our local and federal legislators that the 20% cut reduces a medical practice's ability to assume new (or even continue managing established) dual eligible patients, and, unlike hospitals and nursing homes, physicians have not had a Medicaid rate increase in over ten years. We need all internists to write letters with such information as soon as possible. The csms.org web site through "political grassroots" has a very easy way to look up your local legislator. Please write now or contact me for a letter outline I can provide.

At our Committee meeting in October, we met with Rep. Mary Eberle, Chair of the Public Health Committee, and came to a better understanding of the importance of our input and efforts when health-related legislation is raised in Hartford. In January, we were joined by Rep. Rosa DeLauro to discuss health legislation at the federal level. In honor of her years of advocacy for improving health access and for promoting important legislative measures, the Health & Public Policy Committee presented her with our "1999 Legislator of the Year Award." Details of both of these meetings can be found on our Chapter web site.

There promises to be much legislative activity at both the state and federal level this year which will warrant our concern and input. Please keep an eye out for "Call to Action" alerts on ACP Online and contact me if you are willing to help us with letter writing and other important contacts.

FYI

The Connecticut Down Syndrome Congress, a parent advocacy group (sponsored with other medical organizations), is holding a conference on May 3, 2000, at the Ramada Inn, Meriden, CT. Topics include Mental Health Issues in Down Syndrome. CME credits will be offered.

For more information, contact Robert Greenstein, MD, Medical Advisor, Division of Human Genetics, CT Children's Medical Center, 282 Washington Street, Hartford, CT; Telephone: 860-545-9580.

Save the Dates

ACP Connecticut Chapter
Spring Associates Meeting
Wednesday, May 17, 2000
Waterbury Sheraton Hotel
Waterbury, CT

ACP Connecticut Chapter
Educational Conference & Annual Meeting
Friday, October 20, 2000
Waterbury Sheraton Hotel
Waterbury, CT

Contact Information

Robert Nardino, MD, FACP
ACP Governor, Connecticut Chapter

Nancy Sullivan
30 Dwight Drive, Middlefield, CT 06455
Phone: (860) 349-8995
Fax: (860) 349-3004 or
E-mail: ctacp@comcast.net

Visit the CT Chapter Blog