Governor's Newsletter, Summer 2001

Joseph W. Stubbs, MD, FACP
Governor, Georgia Chapter

From the Governor's Corner

Perhaps no one issue has been more controversial or provoked more criticism from internists in the last couple of years than the American Board of Internal Medicin''s new recertification program, Continuous Professional Development. The American Board of Internal Medicine has traditionally had a close working relationship with the ACP-ASIM, but the two organizations are in fact two distinctly separate and different organizations. The American Board of Internal Medicine has sought the College's formal approval of this new recertification plan. Rather than simply endorsing the program, the College has used this opportunity to initiate serious discussions with representatives of the ABIM regarding internists' concerns about CPB. Most of the criticisms voiced by internists relate to the burden that the recertification process will require of internists above and beyond their already burdensome workload and the relevancy of the recertification process to the quality of their individual practices. What follows is an update by Dr. Herbert Waxman, one of the lead members of the College's taskforce dealing with recertification, regarding the College's position expressed to the American Board of Internal Medicine and their response to date. I believe that the College's response reflects the views of most internists and is supportive of such views.

Recertification: The Dialogue with the ABIM

Herbert S. Waxman, MD, FACP,
Senior Vice President, Education, ACP-ASIM

It's about a year since there began a serious dialogue between the College and the American Board of Internal Medicine (ABIM) about the many concerns the College had with the ABIM's plan to implement the proposed Continuous Professional Development (CPD) process for recertification. The core concerns of the College are as follows:

  • The process of recertification should be clinically relevant, not excessively burdensome, and not redundant of things that are already being done in physicians' practice environments (e.g. patient and peer evaluation, practice performance measures and improvement plans.) College members have expressed very strong feelings about this!
  • There should be a clear delineation of the responsibility for high stakes evaluation (ABIM) and education, including self- assessment (ACP-ASIM and other professional societies.)
  • There should be a clear articulation of the fact that maintenance of competence requires more than just evaluation periodically. It should also encompass relevant continuing education, taking into account learning preferences of the individual physician.

A Joint ABIM-College Committee on Recertification was set up, with three high-level governance members and a staff person representing each party. The College sought resolution of the above concerns; the ABIM sought endorsement by the College of the proposed CPD recertification process.

Thus far, the dialogue has resulted in agreement in principle by the ABIM of the need to resolve the College's concerns. However, the devil is in the details, and there haven't yet been proposed details that have been perceived to satisfy the needs of the College and its members.

At the meeting of the Board of Regents at the Annual Session in Atlanta, five resolutions pertaining to recertification were communicated to the ABIM, addressing the need to respond to the College's concerns and including a deadline for meaningful progress to have taken place. The Board has instructed its members of the Joint Committee to recommend in July whether the College should endorse CPD or refuse to endorse the process.

In response, the ABIM requested detailed information about what we want specifically. In a letter from Drs. Bernard Rosof and William Hall (our Board of Regents chair and our President, respectively) to the ABIM leadership, we presented our requirements. In short, we are insisting that a physician's participation in a self-assessment program (such as MKSAP) or in patient or peer evaluations or in practice performance measures in his or her own hospital or health system be allowed to satisfy the corresponding requirements of the self-evaluation modules of the recertification process. Recertification should not impose on the physician requirements of what is already being done well in many physicians' practices.

ACP-ASIM has not taken a position opposing the formal examination of medical knowledge. The College believes that such an evaluation is appropriate for documentation of maintenance of certification and is something the ABIM is skilled and experienced in doing.

Meanwhile, our Research Center has carried out a telephone survey of over 600 College members, most with time-limited certificates. The results confirm what we have been hearing as strongly expressed individual opinions: the concept of recertification is supported, but the support for CPD is much weaker. Of the self-evaluation components of CPD, the patient and peer evaluation module is viewed most negatively, the knowledge module least negatively. There is a clear sense that the costs of recertification and of the educational programs to prepare for recertification are much greater than the perceived benefit.

Supporting anecdotal reports, a high proportion of respondents are carrying out in their practice environments most of the functions embodied in CPD. For these physicians, the CPD modules would be redundant and therefore represent an excessive burden.

We're now waiting to hear how the ABIM responds to the demands outlined in our letter. Based on that response, there will be a final decision made by the College on whether or not to support the ABIM's proposed CPD process. Of paramount importance to the College is that, one way or another, the strongly felt and legitimate concerns of our members be satisfactorily responded to. Stay tuned!

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 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://capwiz.com/acp/home/ (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 jjenkins@acponline.org. Thank you for your help.

2001 Georgia Chapter Scientific Meeting: Technology in the Future of Internal Medicine

David Haburchak, MD, FACP, and his Scientific Program Planning Committee presented an outstanding scientific meeting for the Georgia ACP-ASIM membership. An outstanding faculty gave a variety of updates on new and cutting edge information about many different areas of internal medicine. The information was presented in a variety of formats that kept everyone's interest and attention.

One of the true highlights of the meeting was the privilege of having as our Official College Representative Dr. Cecil Wilson, who is Chair-Elect of the Board of Regents. Dr. Wilson gave an excellent update on the College's activities in areas of education, health policy, and physician patient advocacy. Everyone attending felt a renewed sense of confidence in the action and vision of the College.

We are planning to have our next annual Scientific Meeting May 3-5, 2002 at the Wyndham Peachtree Conference Center in Peachtree City. Please mark your calendars now and make plans to attend next year's meeting. It promises to be a great social gathering as well educational program.

Associate Competition

This year, the Associate competition featured some of the best quality oral and poster presentations ever. Miriam Parker, MD, Louis Lovett, MD, and Clark Hill, MD, did an absolutely fantastic job of organizing and orchestrating the program. Great credit goes to their perseverance and effort at overcoming every obstacle, including some thorny last minute technological glitches. Winners of the Associates' competition are as follows:

Research Competition Winners
1st Place: Laurie Sweeney, MD, Eisenhower Army Medical Center; Pulmonary Microvascular Nitric Oxide Down Regulates IL-8 Expression
2nd Place: Fadi Alamaddine, MD, Emory University; Osteopontin Regulation by Mechanical Deformation in Vascular Smooth Muscle Cells: Role for sre and MAPK Pathways
3rd Place: Kevin Chung, MD, Eisenhower Army Medical Center; Utilization Review of Unfractionated Heparin in the Treatment of Venous Thromboembolic Disease

Oral Presentation Winners
1st Place: Mohammad Wehbi, MD, Atlanta Medical Center; Diffuse Coronary Arterioluminal Fistulas Draining Into the Left Ventricle
2nd Place: David Gose, MD, Memorial Health University Medical Center; Hacek Endocarditis and Tongue Piercing
3rd Place: Matthew Pantsari, MD, Eisenhower Army Medical Center; Hypobetalipoproteinemia

Poster Presentation Winners
1st Place Tie: Darren Swenson, MD, Memorial Health University Medical Center; Is It All In Her Head? An Atypical Presentation of Bacterial Endocarditis
2nd Place: David Gose, MD, Memorial Health University Medical Center; An Atypical Presentation of Renal Cell Carcinoma Presenting as Heel Pain
3rd Place: Jason Berner, MD, Emory University; Acute Respiratory Failure Secondary to Massive Thymolipoma

Chapter Awards

Community Service Award - Dr. Bernard T. Scoggins, MD, FACP, was the first Georgia Chapter ACP-ASIM recipient of the Community Service Award. Dr. Scoggins, who is currently in private practice in general internal medicine in Albany, Georgia, received this award for his work regarding end-of-life care and his volunteer work in underdeveloped nations.

J. W. Willis Hurst Teacher Award - Dr. Thomas Andrew Albritton, MD, FACP, was the recipient of the award this year. Dr. Albritton is currently Associate Dean for Curriculum and Associate Professor of Medicine at the Medical College of Georgia. He received this award for his dedication to medical education, especially with medical students, and for his groundbreaking work in developing community-based medical teaching.

Laureate Award - This year's ACP-ASIM Georgia Chapter Laureate Award winner is Joel D. Todino, MD, FACP. Dr. Todino graduated in 1964 from the New Jersey College of Medicine at Newark. He then proceeded to complete his internship at the Naval Hospital in Great Lakes, Illinois, followed by his residency and chief residency at the Naval Hospital in Boston from 1965 to1968. He served as a staff internist in the Navy from 1968 to1972. He then entered private practice in general internal medicine in Rome, Georgia, and practiced from 1972 to1989. Dr. Todino became Coordinator and Chief of Internal Medicine in the Family Practice Residency Training Program at Floyd Medical Center in Rome, and continues in that position.

While practicing in Rome, Dr. Todino has played numerous leadership roles, not only within the medical community, but also in the Rome community at large. He has served as Chief of Medicine and Director of Medical Education at both of the Rome hospitals. He has been President of the medical staff and Chair of the Board of Trustees at Redmond Park Hospital. He has served on the Board of the Georgia affiliate of the National Kidney Foundation, American Cancer Society, and the Rome Chapter of the American Red Cross. He has also served as President of the Floyd/Polk/Chattooga Medical Society. From 1984 to1985, he served as President of the Georgia Medical Directors Association and was on the Board of Directors for the Medical Association of Georgia from 1986 to1994. He was elected Fellow of the American College of Physicians in 1993. Dr. Todino has been a vitally active member of the Georgia Chapter serving on the Governor's Council from 1980 to1984, and again from 1992 to the present. He has also served on the Chapter's Health and Public Policy committee and organized the judging of the Georgia Chapter's Internal Medicine Club patient brochure competition at the May, 2000 annual meeting.

In addition to his active participation in numerous community organizations relating to the medical field, Dr. Todino has been extremely active in other community affairs. He served on the Board of Directors of the Boy Scouts of America from 1976 to 1980. He was Chair of the Music Selection Committee for the Rome symphony orchestra from 1982 to1990, and even served as guest conductor of the Rome symphony orchestra in 1991. Dr. Todino married Lynn H. Captain in 1964 and they have two children. In addition to all his leadership and service activities, Dr. Todino makes time for classical music, literature, roses, and tae kwon do karate.

For his tremendous personal contributions to the medical, social, and cultural spheres of his Rome community, his leadership role in our state chapter and other state medical organizations, and for the profound sense of professionalism which he displays every moment of every day, we salute Joel D. Todino, MD, FACP, as the 2001 Georgia Chapter ACP-ASIM Laureate Award winner.

New Governor's Council

At our last annual Georgia Chapter Scientific Meeting, a new slate of officers and Governor's Council members were elected by the members in attendance.

Vice President
Jacqueline W. Fincher, MD, FACP, Thomason, GA
Phone: 706-595-1461, E-Mail: 102100.320@compuserve.com

Secretary
Hina Trivedi, MBBch, FACP, Kennesaw, GA
Phone: 770-427-4274, E-Mail: hariom@bellsouth.net

Treasurer
Jeffrey L. Bell, MD, FACP, Albany, GA
Phone: 229-888-3970, E-Mail: jeffrey.bell@albany.dciinc.org

Council Members
LTC William T. Browne, MD, FACP, Fort Gordon, GA
Phone: 706-787-6124, E-Mail: wtbmd@aol.com

Glenn Carter, MD, FACP, Hinesville, GA
Phone: 912-368-4885, E-Mail: rgcarter@ipninet.com

Ruth-Marie E. Fincher, MD, FACP, Augusta, GA
Phone: 706-721-3217, E-Mail: rfincher@mail.mcg.edu

Vince Nicolais, MD, FACP, Columbus, GA
Phone: 706-571-1454, E-Mail: nicolais.v@gain.mercer.edu

The full new Governor's Advisory Board includes the following:

Educational Program Chair
David Haburchak, MD, FACP, Augusta, GA
Phone: 706-721-2423, E-Mail: dhaburch@mail.mcg.edu

Associates' Chair
Miriam Parker, MD, FACP, Atlanta, GA 30312
Phone: 404-265-4919, E-Mail: miriam.parker@tenethealth.com

Membership Chair
Henry M. Patton, MD, FACP, Covington, GA 30014
Phone: 770-787-6900, E-Mail: henrypatton@hotmail.com

Health and Public Policy Co-Chair
Willette Davis, MD, Atlanta, GA 30339
Phone: 678-305-0760, E-Mail: wdavisw@hotmail.com

Health and Public Policy Co-Chair
Richard N. Fullerton, MD, FACP, Atlanta, GA
Phone: 404-367-3000, E-Mail: Fullerton_richard@promina.org

Literary Retreat Chair
Evan Weisman, MD, FACP, Marietta, GA
Phone: 770-427-1307, E-Mail: nweisman@mindspring.com

Awards Chair
Benjamin Okel, MD, FACP, Decatur, GA
Phone - 404-325-7059 E-Mail: okel@atl.mindspring.com

Diversity Committee Chair
Otto Goyco, MD, FACP, Winder, GA
Phone: 770-307-5944, E-Mail: ocgoyco@pol.net

Women Physicians Chair
Stacy M. Higgins, MD, Stone Mountain, GA
Phone: 404-616-0250, E-Mail: smhiggi@emory.edu

Public Relations Committee
Jacqueline W. Fincher, MD, FACP, Thomson, GA 30824
Phone: 706-595-1461, E-Mail: 102100.320@compuserve.com

Mentoring Committee
Joel D. Todino, MD, FACP, Rome, GA
Phone: 706-802-2787, E-Mail: todijo@aol.com

Primary Care Coalition
Kelly J. Ahn, MD, FACP, Atlanta, GA
Phone: 404-256-9544, E-Mail: ahnkelly@hotmail.com

Advisory Board Member
Michael B. Heisler, MD, Atlanta, GA
Phone: 404-756-1320, E-Mail: heislem@msm.edu

Associates' Committee
Mohammed Wehbi, MD, Chief Resident, Atlanta, GA 30312
Phone: 404-265-4919, E-Mail: mwchbi@medscape.com

Internal Medicine Clubs Faculty Coordinators
April Barbour, MD, FACP, Atlanta, GA
Phone: 404-778-2940, E-Mail: April_barbour@emory.org

Walter Moore, MD, Augusta, GA
Phone: 706-721-2055, E-Mail: wmoore@mail.mcg.edu

Jeffrey Stephens, MD, FACP, Macon, GA
Ph : 912-301-5850, E-Mail: stephens_j@mercer.edu

Mary Jackson, MD, Atlanta, GA
Phone: 404-756-1358, E-Mail: jumpinmej@aol.com

Leadership Day

Willette Davis, MD,
Health and Public Policy Co-Chair

Leadership Day is an opportunity to meet with members of Congress to advocate for priority health issues that impact the practice of medicine and patients. This was the ninth year that the ACP-ASIM sponsored the event and as in past years, it was very informative and practical. This two-day event began with a general session to give us a bird's eye view of how legislation is channeled through the system and the importance of lobbying to educate members of Congress. We were addressed by Bob Doherty, our Washington D.C. liaison, who described the current political climate. He briefed us on the key issues most likely to be before Congress this session. These included MERFA, a bill to reduce Medicare hassles; REACH Act, an effort to reduce the number of the uninsured via tax credits, expansions of Medicaid and S-CHIP; as well as the Patient's Bill of Rights.

We also attended workshops on working with the media and how to be an effective advocate on a year round basis. The second day we went to Congress to meet representatives from our state.

As physicians, our voice speaks to the concerns of our community - patients, family, staff and colleagues. We have a unique chance to personalize issues - to put a "face on it", so to speak. For these reasons, you can understand the value of Leadership Day. It was very practical, but it was also a lot of fun. We had the chance to meet and exchange ideas with other members of ACP-ASIM.

Update on Vaccine Supply Issues

Melinda Wharton, MD, FACP

On July 13, 2001, CDCs Advisory Committee on Immunization Practices issued supplemental recommendations for the 2001-2002 season. As of July 10, 2001, manufacturers estimated total production of 77.1 million doses during the season. This is more vaccine than was available in the 2000-2001 season and is comparable to production in 1999-2000. However, only 49.8 million doses are expected to be available for delivery by the end of October 2001, which is substantially less than what was available by the end of October 1999 (75.8 million doses) but more than was available by the end of October 2000. Thus, delays in delivery of vaccine should not be as great as last year, and the overall supply of vaccine should be adequate by November-December, 2001. However, because different manufacturers may ship vaccine at different times, some providers may not receive vaccine until November-December, depending on what manufacturer's vaccine was ordered.

ACIP recommends that providers target vaccine available in September and October to persons at increased risk for influenza complications and to healthcare workers. Beginning in November, providers should offer vaccine to contacts of high-risk persons, healthy persons aged 50-64 years, and other persons wanting to reduce their risk of influenza. Providers should continue vaccinating patients, especially those at high risk, in December and should continue as long as there is influenza activity and vaccine is available.

In order to assure that all providers have some vaccine available for early vaccination of persons at high risk of complications or death due to influenza, ACIP is recommending that manufacturers and distributors provide partial shipments early in the season to all providers who have placed orders, and that shipments for workplace vaccination programs be delayed until November.

These supplemental recommendations of the ACIP were in Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/ on July 13, 2001. Additional information on influenza vaccine can be obtained from the CDC website http://www.cdc.gov/nip/flu/.

Adult formulation tetanus and diphtheria toxoids (Td) continues to be in short supply, and the shortage is expected to continue until early 2002. On May 25, 2001, CDC recommended that routine booster doses of Td for adolescents and adults be deferred until 2002. Td use should follow existing recommendations for all other indications, which include, 1) persons traveling to a country where the risk for diphtheria is high; 2) persons requiring tetanus vaccination for prophylaxis in wound management; 3) persons who have received <3 doses of any vaccine containing tetanus and diphtheria toxoids; and 4) pregnant women who have not been vaccinated with Td during the preceding 10 years (MMWR 2001;50:418, 427). CDC recommends that healthcare providers record the names of patients whose booster dose is delayed during the shortage. When Td supplies are restored, these patients should be notified to return to their healthcare provider for vaccination.

Milestone

It was with great sorrow that we learned of the death of Louis H. Felder, MD, FACP, on Friday, April 27. Dr. Felder was dedicated to the medical profession, having served on numerous boards, and was an active member in many local, state and national medical associations. Dr. Felder was the recipient of the Laureate Award in 1994, and was active in the Georgia Chapter.

We join with Dr. Felder's many friends and colleagues in expressing our deepest sympathy to his wife, Joann, and his entire family.

What's New

Contact Information

Vincent Nicolais, MD, FACP,
Governor, Georgia Chapter

Karen Townsend
Executive Director
Ph: 770-693-9973
Georgia Chapter

Michelle Dietz
Administrative Assistant
Ph: 770-920-6995