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The Florida Internist

Spring, 2002

We Are the Best
How the Florida Chapter ACP-ASIM Advocates For You

At the last Florida Chapter meeting at the Vinoy in St. Petersburg President of the ACP-ASIM William Hall said, "They are the best. Not one of the best, the best." Bill was referring to your Chapter's advocacy program. Through the years the internists of Florida have developed a formidable apparatus for influencing the legislature in Tallahassee. Because of your chapter's efforts "all products clauses" in HMO contracts are not legal, adverse determinations for patient care decisions by insurers must be made by physicians licensed to practice in the state of Florida and hospitalist care can not be mandated by managed care organizations.

Here are the six reasons we are the best.

N.H. (Bo) Tucker
Much of the credit for our advocacy lies with N.H. (Bo) Tucker. Bo is the chair of our Legislative Committee. Dr. Tucker has built on the efforts of the legislative chairs that have preceded him (People like Fred Carter, who is legendary in the halls of Tallahassee.) and has established your chapter as a powerful force in medical politics. Bo knows every issue. Bo knows every angle. Bo's timing and judgment are impeccable. Thanks Bo!

Legislative Agenda
The messages carried to legislators in Tallahassee are not random. The chapter's advocacy efforts are based on a document called the Legislative Agenda. This document, available for your review at www.acponline.org/chapters/fl/agenda.htm. , is a dynamic work that defines the chapter's advocacy interests. It has been carefully developed and is regularly reviewed by the chapter's council to assure its timeliness and pertinence.

Leveraging the FMA
The Florida Chapter ACP-ASIM is not the biggest fish is the sea in Tallahassee. In the world of medical politics that distinction belongs to the FMA. Via a carefully developed cooperative effort the FMA and the chapter work hand-in-hand to maximize clout. Because of the FMA, the chapter expends fewer resources than would be required if we had to go it alone. We are pleased with our relationship with the FMA and hope to grow in cooperation with that organization in the future.

Professional Lobbying
The chapter employs a professional lobbyist named Gene McGee who works for us in Tallahassee. Gene has the connections and the skill to use those connections to our advantage.

Tallahassee Visitation
Each year the chapter sends members to Tallahassee who are experienced in lobbying. These doctors personally visit key legislators and speak up for your interests. This year we thank Drs. Elias N. Amador, Fred S. Carter, Manning Hanline, Saeed A. Khan, Cornel J. Lupu, Kenneth R. Ratzan, N. H. Tucker III and Michael A. Zimmer. We appreciate each of you taking time off from your practice and doing such a good job.

Key Contact Network
Under the leadership of Ken Ratzan, the chapter developed a Key Contact network this year. This network consists of a number of doctors across the state who directed timely calls, letters and emails to their Tallahassee representatives. Many met their representatives or state senators in their home towns before the legislative season began. They took the time to develop personal relationships with their legislators and with time this sort of close relationship building will pay huge dividends for the internists of Florida. This year we will be expanding this element of our advocacy program. At the Regional Meeting at the PGA National Resort and Spa near West Palm Beach a special part of the program will be devoted to training selected individuals in how to maximize their effectiveness in carrying the message of internal medicine's interests to the people who make the laws in Florida's capital.

Working together we will make medicine better in Florida.

Frederick E. Turton, MD, FACP
Florida ACP-ASIM Governor
fturton@gate.net

From the President

This will be my last written message as President of the Florida Chapter of the American College of Physicians-American Society of Internal Medicine and in a sense my "State of the Chapter" report. Two years ago we completed the merger of the Florida Society of Internal Medicine and the Florida Chapter of the American College of Physicians. Our bylaws were an experiment and in a sense still are since the national ACP/ASIM is still uneasy with our organization. The two divisions we established, The Division of Advocacy and Member Benefits (C-6) and The Division of Education and Membership (C-3), have worked smoothly under the umbrella of one organization and the Florida Chapter remains the strongest of all the chapters of the ACP/ASIM. The reasons for our success originally stem from the leadership of men such as Cecil Wilson, Jim Borland, Phil Altus, Jamie Barkin, Fred Turton, Craig Kitchens, and the hard work of our council. Under the editorship of Norm Vickers we have the most successful Newsletter in the College. We have won the Chapter Excellence Award each year it has been given due to the direction of Alice Sutton, the Administrative Assistant of the C-3 and, during this past year, Dawn Moerings, the Administrative Assistant of the C-6. We won two Evergreen Awards, one for our Advocacy Program in Tallahassee and the second for our Practice Management Seminar which was an innovative program provided free of charge to office staff and members of our chapter. This year we have applied for an Evergreen Award for our Key Contact program whereby our members contact their legislators to urge them to vote for important issues involving our patients and our profession. We are close to passage of the Prompt Pay Bill which requires Managed Care and Insurance companies to reimburse us for our services in a timely manner, and 2 years ago we were instrumental in the passage of a bill which prohibits mandatory use of hospitalists.

There are many challenges ahead. The most immediate challenge for our organization is to resolve our conflict with the American Board of Internal Medicine over recertification. The overwhelming majority of our membership feels that the process of recertification is too lengthy, burdensome, expensive, intrusive, and arbitrary. The Board of Governors will be hotly debating this issue at our annual meeting in April. We hope to reach a consensus and negotiate a fair and equitable arrangement with the American Board of Internal Medicine. Politically we have equal challenges. We need Congress to restore the cuts in Medicare which it failed to reverse during its last session, reduce the burdens and hassles imposed upon physicians by Medicare by passing the Medicare Reform Act (MERFA), pass a Patient Bill of Rights which will hold HMOs accountable in a court of law if necessary for the medical decisions they make concerning our patients, and provide universal access to excellent healthcare for all Americans.

I have great confidence in the leadership of Fred Turton and Craig Kitchens, our Governors, and the leadership of our National Organization. It has been an excellent two years, and I thank all of you for your steadfast support.

A Place of Healing: The Lakeland Volunteers in Medicine Clinic

By Angelo P. Spoto, Jr., MD, FACP

A year ago, on Valentine's Day, February 14, 2001, Lakeland Volunteers in Medicine (LVIM) opened. The historic John Cox Grammar School (1928) was complete renovated into a modern, primary care/specialty care, medical clinic at a cost of over $2,500,000. The first floor contains 11 examining rooms, a procedure room, 2 counseling rooms, 3 in-take rooms, laboratory, x-ray, pharmacy, central supply, medical records, a 3-chair dental clinic, ENT clinic, eye clinic, volunteer and administrative offices, a large community room, and ample reception area.

How did we get there? A number of Lakeland physicians felt the need for a clinic for the working uninsured. Polk County had long had a history of indigent care through the old Polk County Hospital and Clinic, a facility begun in the 1940's. This was significantly pared back in the 1990's with the closing of the hospital.

A Saturday morning clinic at a local homeless shelter was begun in 1992; however, it was felt there was a need for a separate, centrally located, easily accessible medical clinic to serve other than the homeless. In seeking a solution, a community-wide inventory assessment of needs and service produced a plan for the LVIM Clinic. Physicians and community leaders felt it was very important for this clinic to be a community non-profit organization until it was proven to be self-sustaining and immunity from malpractice was to be provided by State statute. This was placed under the auspices of the Watson Clinic Foundation in 1999 but is being spun-off as a separate entity this year. The Watson Clinic Foundation is a 50(c)(3) charitable arm of the Watson LLP, a 180-physician, multi-specialty group located in central Florida. The Foundation has been in existence since 1960. Capitalizing on the experience of Dr. Jack McConnell, founder of the Volunteers in Medicine Clinic in Hilton Head, South Carolina, we began development.

A successful capital campaign was instituted in late 1999. In addition the Polk County School Board arranged for the provision of the historic school and the City of Lakeland provided adjacent land for parking. The Clinic was endorsed by the Polk County Medical, Polk County Dental, and Polk County Pharmacy Associations, numerous churches and non-profit organizations.

The need is immense. Since opening, the clinic has registered over 4,000 patients and 10,000 patient visits. Approximately 60 healthcare providers have volunteered their services, including eight physicians who have provided over 100 hours of medical care since the clinic opened. Retired physicians who volunteer once or twice a week have been a good resource. Physicians in active practice, especially primary care, find it very difficulty to volunteer over one-half day per quarter. Over 600 lay volunteers have provided approximately 40,000 hours of community service.

During the first year it is estimated that $1,300,000 in care has been rendered and this year the clinic will probably render about $1,750,000. Such an institution requires continued fund-raising.

Continuing problems include the continued recruitment of healthcare professionals and the escalating costs of supplies, personnel and pharmaceuticals. The rapidly escalating cost of medications will approach $140,000 this year. The clinic will probably give out approximately $200,000 worth of medications when you include donated pharmaceuticals and a very active pharmaceutical company indigent care program run by ten volunteers. In addition, there are administrative, insurance and utility costs.

The second floor houses Success by 6, a tenant organization that bring in outside community service to render to children medical and educational services to foster their proper development and to encourage good parenting. This dovetails with our pediatric care.

In 2001 the state legislature approved a grant, which includes seminars to encourage the development of similar facilities throughout the state. Upon the completion of a contract, we will be able to provide three informational seminars in Florida communities to assist in developing similar clinics throughout the state. This would include the development of staff, facility, administrative and development resources. LVIM would be happy to work with the Florida ACP-ASIM. We welcome inquiries and visits.

Contact: Angelo P. Spoto, Jr., MD, FACP, C.E.O. or Robert L Yates, C.A.O., Lakeland Volunteers in Medicine Clinic, 1021 Lakeland Hills Boulevard, Lakeland, FL 33805 (863-688-LVIM.

Florida Chapter Associates Meeting

By Farzanna S. Haffizulla M.D.
Cleveland Clinic Representative, Florida Council of Associates

The Florida Chapter ACP-ASIM meeting was held on March 9th and 10th 2002 in Orlando at the Sheraton World Resort. As usual the atmosphere was one of intellectual enthusiasm. I take this opportunity to congratulate all of our Associates who presented at this meeting. Your esteemed efforts are appreciated by all. There were three awardees in the oral presentation category.

Dr Maria Cannarozzi's presentation was entitled: " A Rare Presentation of an Unusual Medical Syndrome." Dr. Cannarozzi is a 2nd year Medicine-Pediatrics resident at the University of South Florida College of Medicine. She does have professional interests in Pulmonary medicine specifically asthma but intends to pursue a career in General medicine/Pediatrics. Dr Cannarozzi is also expecting her 3rd child. We all wish you the best of luck with your future endeavors.

Dr. Todd Heimowitz's presentation was entitled: " A precious Metal- A Rare Find." Dr Heimowitz is completing his residency training at Mount Sinai Medical Center and will continue at Mount Sinai as Chief Resident in 2003. He also plans on pursuing a Cardiology fellowship thereafter. Dr Heimowitz was also appointed as our new Chair of the Florida Council of Associates. Congratulations Dr Heimowitz, we all look forward to working with you!

Dr Raphael Azulay's presentation was entitled: " Affairs of the Heart." Dr Azulay is a 2nd year resident at Orlando Regional Medical Center. Dr Azulay was a colleague of mine from the University of Miami School of Medicine. Kudos to you for a job well done.

There were three awardees in the poster presentation category. Dr Gustavo Cardenas's poster was entitled: " A case of Intestinal Spirochetosis." Dr Cardenas is completing his residency training at the Cleveland Clinic Hospital and is also the current chief resident. He will embark on his Vascular Medicine Fellowship at the Cleveland Clinic Foundation this summer. Excellent work Dr Cardenas!

Dr Yoram Padeh's poster was entitled "Hemolytic Anemia Due to Cold Agglutin Disease in a Patient with Legionella Pneumophilia Pneumonia." Dr Padeh is completing his residency at Mount Sinai Medical Center and will serve as chief resident there this year. He will pursue a career in Allergy/Immunology at Albert Einstein Medical Center.

Dr Rodolfo Carrillo-Jimenez's poster was entitled " Brain Natriuretic Peptide And HIV Related Cardiomyopathy." Dr Carillo-Jimenez is a Cardiology research fellow at Mount Sinai Medical Center where he will continue as a Cardiology fellow this summer. We applaud your excellent work.

As always our Doctor's Dilemma competition was certainly invigorating. I congratulate all my co-participants for a job well done. There were three winning teams. UF Health Science Center-Jacksonville: Drs Eric Ibegbu, Samir Habashi and Keith Robinson. From Mount Sinai Medical Center: Drs Rafael Bravo-Vera, Antonio Cano and Jose Castillo and from the University of Miami: Drs Galo Garces, Gilberto Lopez and Andres Soriano. Congratulations for your outstanding performance. These three teams will compete in September at our next scientific meeting.

On a final note, on behalf of all members of the Florida Council of Associates, I offer a heartfelt thank-you to Dr Max Brito for his successful efforts as our Chairman these past 2 years. We enjoyed working with you and send our best wishes as you pursue your career in Infectious Disease. We invite all Associates to both attend and participate in our September meeting. This will be an excellent academic arena to have your endeavors recognized.

Legislative Report

March 26, 2002

The 2002 Legislative Session ended Friday, March 22. All of the major health care legislation pushed by the FMA and the Florida Chapter - prompt payment, adverse incidents/public records, patient choice, and tort reform - fell victim to power struggles between the Florida House and Senate. For 60 days the Republican led legislature debated a variety of contentious bills and finished without passing the CFO governmental reorganization bill, the education reform, the 2003 budget, or substantive healthcare legislation. Unfortunately, issues such as tax reform, redistricting, and the state's budget dominated the attention of the legislature during session leaving little time to deal with other important healthcare issues. During this year's session, 2,700 bills were introduced and only 137 substantive bills passed both chambers and were sent to the Governor. Nevertheless the Chapter and FMA were able to kill a number of legislative proposals that would significantly affect your ability to practice medicine. Below is a summary of the legislative proposals that were defeated and that passed the legislature during the 2002 regular session.

Issues Defeated

Scope of Practice
ARNPs - prescribing of controlled substances
ARNP's being able to admit patients to Pediatric Extended Care Facilities
Acupuncturists - expansion of scope and use of title "Physician"
Chiropractors and school services
Pharmacists second guessing physician Medicaid prescribing and receiving payments
Naturopaths scope of practice expansion
Physical therapists scope of practice expansion

Medical Malpractice
Prevented Wrongful Death Changes
Prevented Mandatory Medical Malpractice Insurance (protected ability to self insure)
Stopped an amendment that would have made it harder to hold out of state expert witnesses accountable

Insurance / Managed Care
Defeated a required study of all existing mandates in present law

Medical Regulation
Prevented a mandatory increase of licensure fees for physicians
Protected the 10% cap on increase of licensure fees
Prevented fee caps from automatically increasing year after year
Protected the mandatory 24 hour notice, peer review protections, and case mix requirement for Medicaid audits
Helped to prevent an additional biomedical waste fee

Issues Passed:

Workers Compensation Fee Study (SB 108) - studies the fee schedule and provides data regarding reimbursement levels.
Repayment of physician student loans (HB 1405) - requires repayment of federal student loans or your license can be suspended.
Bioterrorism Bill/ Good Samaritan (SB 1262) - allows healthcare providers to be covered under the Good Samaritan law when there is a declared public emergency.
Controlled Substance (SB 640) - allows criminal penalties for inappropriate writing of controlled substances.

Call For Nominations

Elections for regional representatives to the Governors' Advisory Council will be held this summer. There are seats available in all three regions for a three year term. If you would like to be considered for service on the Council or know of someone whose area of expertise would add another dimension to our board, please contact the Chapter office in the very near future to request a biosketch form. The Nominations Committee will conclude their selection process in June.

You will be notified soon by the College that the Florida Chapter will elect an individual to serve as Governor-elect from 2003-2004 and as ACP-ASIM Governor for a term that will end in 2008. You are invited to send a letter of nomination along with a c.v. of that individual to the Chapter offices in Clewiston. The Nominatioins Committee will select two candidates from those submitted and the College will conduct the election by mail ballot in the fall of this year.

The Awards Committee will also meet to select recipients of various awards for our upcoming regional meeting at the PGA National Resort and Spa in Palm Beach Gardens. Please review the awards and criteria outlined below and send your letter of nomination to our Clewiston office by June 1.

Laureate: Senior Florida Chapter physician who has demonstrated, by example and conduct, a commitment to excellence in medical care, education, or research and in service to the community and ACP-ASIM.

Internist of the Year: for outstanding leadership and dedication to the practice of internal medicine.

Outstanding Teacher of the Year: for outstanding leadership and dedication to medical education.

Community Based Teacher for contributions to the education of medical students, residents and fellows as an office based internist.