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Idaho Chapter Governor's Newsletter

Fall 2000

C. Scott Smith, MD, FACP
Governor, Idaho Chapter

From The Governor...

This is my inaugural newsletter for the Idaho chapter of ACP-ASIM, so I thought a few bullet points about me would be in order.

  • I was actually born in Idaho (Coeur d'Alene)!
  • I did my medical training in the WWAMI program. My first year was at WSU, and I had rotations in Boise, Pocatello, Pullman and Spokane.
  • I practice at the Boise VAMC. I also did my Internal Medicine rotation as a student, and my PGY2 year of residency here.
  • I met my wife, Cathy Sandstrom, during medical school. She is a Pediatrician here in Boise.
  • I am an Associate Professor of Medicine and Medical Education at the University of Washington. My academic interest is in medical, resident and continuing education.
  • I would love to hear from all of you, particularly if you want to volunteer for something!

Highlights From The Fall BOG Meeting

  1. Patient's Access To Health Care

    The decision 2000 campaign is having an effect. An ACP-ASIM paper covering the effects of the balanced budget act of 1997 (endangered access, especially for 'critical safety net' centers) and the health consequences of being uninsured will be coming out in the 10/25 issue of JAMA. It is considered definitive and is already being used by RWJ, AMA and others to guide policy. The paper reviewed 1000 references and 130 studies, and came to the conclusion that you live less well and less long when uninsured. Also, focus groups in the "beltway" have identified and dispelled several misconceptions that exist. For instance, 'these people could get a job and get insurance' (actually 80% of the uninsured are working.) The project will now be moving to other key markets to inform the public, and is adopting the slogan, "It's time to make the health care system work for working people."

  2. HCFA, Medicare, E&M Coding, "Fraud & Abuse"

    The ACP-ASIM national efforts have recently included the Office of Inspector General (OIG), where we were favorably received. We are making the case that the current printed information for Medicare recipients is unnecessarily adversarial (when investigated, the number of outright fraud cases is very low.) We are asking for changes to HCFA pamphlets that will make them less legalistic, shorter, more educational and fair.

    HCFA had a proposal to collapse E/M coding for established office visits (99211-5) from five to three categories. This would have benefited Nurse Practitioners and Family Medicine at the expense of Internists. It appears that ACP-ASIM has successfully lobbied to stop this proposal.

    ACP-ASIM continues to lobby for simpler E&M coding, ways to supervise senior residents without having to "redo" everything, and less aggressive "fraud and abuse" marketing from Medicare. It was noted at the meeting that there is a legal definition of fraud (and it is very rare in the case of Medicare claims), but there is no legal definition of abuse. HCFA's working definition includes mistakes! The plea was to quit using these terms, because we are only adding fuel to the fire.

  3. ABIM Recertification

    We heard a presentation by Harry Kimball, MD, Daniel Duffy, MD, and Ron Loge, MD of the ABIM about changes in the recertification process. There is some friction between the ACP-ASIM and the ABIM about this issue.

    Changes

    • The test is designed to require "outside help or printed literature" for about 50% of the questions. Most people are completing each module in < 30 hours.
    • If you take the test cold (without this help,) the first-attempt pass rate is about 72%. It is eventually about 95+%.
    • New modules will test physical exam skills (by CD ROM), communication skills (by CD ROM) and practice performance (a guided review of your practice patterns.)

    Challenges

    • This program is blurring the lines between evaluation (ABIM) and education (ACP-ASIM.)
    • Any recertification must be efficient.
    • Any recertification must have some value (hopefully to patients, providers and society.)
    • The recertification process should be evidence-based (result in improved outcomes), or be collecting the data to evaluate itself in this way.

If you have comments or concerns, let me know. There will be representatives from the ACP-ASIM Board of Regents, as well as the ABIM, at the chapter meeting in Sun Valley.


Chapter Meetings

This year's Idaho Chapter Meeting will be held at the Elkhorn Resort in Sun Valley, in conjunction with the VA's winter meeting. The meeting will be held from Thursday, January 11, 2001, at 5 p.m. through Sunday, January 14, 2001, at noon. You will be receiving a flier soon, but here's a sneak preview. Topics include practical, case-based updates on dementia, somatiform disorders, the difficult patient, rheumatoid arthritis, skin ulcers, disability evaluations, acute coronary syndromes, refractory/atypical pneumonia, and many more! The workshops will also be back by popular demand.

Two ideas have come up for future meetings. A fall 2001 meeting, in conjunction with the Washington chapter, to be held in the Spokane/Coeur d'Alene area. This is to try and reach members who have been geographically disenfranchised from both chapters' meetings in the past. And/or a regional meeting in 2002 at Lake Louise, B.C. This would be held with the Montana, Wyoming, North and South Dakota, and B.C. chapters. We would use this to replace the old "tri-state" meeting, which was held every three years, but was usually poorly attended. By creating this coalition at a destination resort, we believe that we could attract several national-level speakers. If you have any thoughts about these proposed meetings, please contact me. We will not proceed with the second unless several of you contact me showing some interest.


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. Recruiting new Key Contacts is an ongoing process, but it will be especially important when the elections are over and the new members of the 107th Congress are selected.

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, so ACP-ASIM gives them the tools necessary to develop and maintain these 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 "Where We Stand" section of ACP-ASIM Online, or at http://congress.nw.dc.us/acp/

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, x4536, and join the College's Key Contact Program.


Recertification, E/M Coding & Other "Hassles"

Did I get your attention? Great! These are some of the big issues that the ACP-ASIM is dealing with lately, and I'm happy to report that we are making some headway. We are the largest physician professional organization in the country, so we carry some clout in these discussions. However, a critical part of this process is getting accurate information from you, our members, to insure our credibility.

I know you're busy! I know you don't believe you can make a difference. But you can! As many of you as possible need to answer the following brief questions by sending me a message on e-mail at scott.smith2@med.va.gov, or faxing this form to (208) 422-1319.

  1. What is your age?

    • 20-29
    • 30-39
    • 40-49
    • 50-59
    • 60-69
    • 70
  2. Are you planning to be in the same type of practice in 5 years?

    • Yes
    • No
  3. Why (be specific)?









  4. When did you take the Internal Medicine boards?

    • Before 1989
    • After 1990
  5. Are you planning to be recertified?

    • Yes
    • No
  6. Why (be specific)?









Contact Information

Banu E. Symington, MD, FACP
Governor, Idaho Chapter
Twin Falls, Idaho
Phone:209-814-1600

Kelly Hess
Executive Director, ACP Idaho Chapter
Phone:208-490-3329