Idaho Chapter Governor's Newsletter
This is my final newsletter for the ACP-ASIM for the state of Idaho. Now that Dr. Scott Smith has been appointment the new Governor, this responsibility will fall to him. I am confident that he will be the best Governor yet that this state has produced.
I wanted to share with all of the members what a marvelous experience the past 4 years have been for me. The leadership abilities of the ACP-ASIM are very impressive. Some of the highest quality people I have ever met in medicine are those that are involved in the ACP-ASIM. I think that you all can feel good knowing that these are the people that are part of this organization.
During the most resent ACP-ASIM meeting in Philadelphia, we introduced a resolution that stemmed from our Annual Idaho Chapter Meeting in Sun Valley. We submitted a resolution to simplify the recertification exam in Internal Medicine. A similar resolution had been presented about a year ago and our resolution was well received and combined with the earlier one. There was considerable support for simplifying the complex process of recertification and discussions between ACP-ASIM and American Board of Internal Medicine, we hope will accomplish that.
ACP-ASIM'S DECISION 2000 CAMPAIGN SEEKS MEMBER INVOLVEMENT
This summer, ACP-ASIM launched a new initiative, the Decision 2000 Campaign, to elevate the problem of the uninsured on the national agenda. Through Decision 2000, the College is working to secure commitments by presidential and congressional candidates to address the issue of the uninsured and to educate decision-makers about the impact of health insurance on health status.
To date, the College has placed advertisements in the Washington Post and other publications highlighting the evidence that the uninsured have worse health outcomes. Each ad featured the tag line "No Health Insurance? It's Enough to Make You Sick." In late October, ACP-ASIM sponsored a briefing for Capitol Hill staff on universal access with House Majority Leader Dick Armey (R-26-TX). In November, the College held a press conference to release a new white paper that demonstrates the link between a lack of health insurance and poor health. The white paper, "No Health Insurance? It's Enough to Make You Sick Scientific Research Linking the Lack of Health Coverage to Poor Health," summarizes available literature published within the last ten years that confirms the health hazards faced by the uninsured.
The College has also partnered with the Catholic Health Association (CHA) in a petition drive to highlight the need to make accessible and affordable healthcare a national priority. CHA and ACP-ASIM are working to get citizens across the country to sign these petitions, and will be submitting them to presidential and congressional candidates as a mandate on healthcare. A brochure featuring this petition is included in the November issue of the Observer. To request single or bulk copies of the brochure, contact ACP-ASIM Customer Service at 1-800-523-1546, ext. 2600 and ask for product number 510100190. ACP-ASIM encourages all physicians to sign the petition and make it available to their patients, civic groups, hospitals and any other organizations that are concerned about the uninsured.
As the state presidential primaries are held early next year, ACP-ASIM will work to elevate the issue of universal coverage with candidates and voters. The College will call on its leadership and members to write op-eds and letters-to-the-editor, and to attend candidate forums in support of accessible and affordable healthcare for all Americans. ACP-ASIM members will be asked to participate in similar activities during the congressional primaries later next year.
The success of ACP-ASIM's Decision 2000 campaign depends on the participation of Governors and chapter members. Chapter involvement will be especially important during the 2000 congressional elections. Washington staff will be contacting chapters and asking them to participate in grassroots activities throughout the primary season. For more information on the campaign or what you can do to help, contact Jenn Jenkins, Associate for Grassroots Advocacy, in the Washington Office at 800-338-2746, ext. 4536.
ACP-ASIM PAC DECISION
BOG Resolution #144 (Nevada, North Carolina and Pennsylvania chapters) called for the establishment of an ACP-ASIM political action committee (PAC). The resolution was approved by the Board of Governors in October 1998 and was subsequently referred to the College's Health and Public Policy Committee and the Ethics and Human Rights Committee.
The reports of the two committees were reviewed and discussed by the Board of Regents of ACP-ASIM on February 6, 1999. The Board of Regents, after considering all the information that it received from committees, and after a lengthy discussion, voted to defer making a recommendation to ACP-ASIM Services, Inc. on establishing an ACP-ASIM Services, Inc. PAC for one year. Throughout 1999 the College gathered information from ACP-ASIM members to consider when making a decision about establishing a PAC. Membership feedback was encouraged through Governors' newsletters, Chapter and regional meetings and formal discussion by College leadership.
After careful evaluation of member feedback, on January 21, 2000 the Board of Regents of ACP-ASIM voted not to recommend to establish an ACP-ASIM Services, Inc. PAC. The Board of Regents' decision was based on the following reasoning:
- Membership feedback seemed to be mixed. With no apparent membership majority in
favor of, or opposed to, creating a PAC, it was decided not to establish a PAC at this time.
- The Board recognized the value of the views expressed by those who believe that a PAC
could provide greater access to legislators. It concluded, however, that the College could
continue to be effective without a PAC.
- The College already enjoys ready access to many of the decision-makers on Capitol Hill
and is a respected voice in the public policy arena. ACP-ASIM public policy staff is well
established in Washington and is active in advising national committees and institutes on
matters of public health and policy of importance to internists and their patients.
- The College is aggressively continuing its public policy initiatives. We will continue to
fight for legislation that is friendly not only to those of us in the practice of medicine,
but to our patients as well.
- The College strongly encourages all members to understand health-related issues on
both a state and national level and to get involved with the legislative process. An excellent
resource for those who wish to become more active can be found on the College's Web
site, under "Where We Stand."
- Individual College members are free to donate money directly to candidates who
espouse agendas in support of public health.
ACP-ASIM STRIVES TO ENHANCE
ACP-ASIM has joined forces with the American Geriatrics Society in supporting a training initiative designed to enhance the quality of geriatric care provided by community-based primary care internists. Traditional continuing medical education, which typically awards credit for "seat time," regardless of what physicians learn, is unlikely to lead to changes in medical practice. Enhancing Geriatric Care Through Practicing Physician Education, a four-year project funded by the John A. Hartford Foundation of New York, uses an innovative peer-leadership approach to educate practicing physicians. The program provides small-group, case-based interactive learning sessions, with relevance to day-to-day practice, conducted by Physician Leaders, in order to encourage physicians to make positive changes in their care of older patients.
The first Physician Leader training was conducted at the 1999 Annual Session in New Orleans. Following the one and one-half day of training, the eight participating physicians returned to their communities to conduct small-group, CME-credited sessions based on materials in Memory Loss: Evaluation in Primary Practice, the first of ten "tool kits" on common geriatric problems developed by the project. Physicians who have participated in community sessions will be followed at six months and one year to determine the impact of the interventions on behavior change. Response by ACP-ASIM members to an invitation placed on the ACP-ASIM Web site was very positive. Over seventy-five members requested additional information on the application process; twelve physicians were ultimately selected to participate in this year's training, which focuses on Urinary Incontinence: Management in Primary Practice.
HOW THE "DOCTORS FOR ADULTS"
CAMPAIGN CAN WORK FOR YOU
ACP-ASIM's national public relations and ad campaign is reaching literally millions of Americans, telling them an internist is a "Doctor for Adults" Does your community know you are a "Doctor for Adults?" Here are five easy ways to put the campaign to work for you.
1. Introduce Yourself as an Internist Whether you're a generalist or a subspecialist, take a minute to tell your patients you are an internist and ask them if they know what that means. You might be surprised at their answers, but it's a quick and relaxed way to let patients know who you are a "Doctor for Adults." One easy way to clear up confusion is to distinguish yourself from general practitioners or family physicians, whose practices may include surgery, obstetrics and pediatrics, and whose training is not solely concentrated on adults. If you subspecialize, you'll want to explain that you chose additional training to specialize in one of the complex medical areas of interest that come under the internal medicine umbrella. When speaking publicly, publishing or responding to questions from the media, be sure to identify yourself as an internist.
2. Hand Patients a Brochure Order your free sample copy of the College's "Doctors for Adults" patient brochures. One such brochure, Where We Fit in Today's Primary Care Picture, distinguishes internists from other primary care physicians and tells how we care for the whole patient. A new brochure, 100 Million Adult Americans Are Overweight and at Risk of Serious Disease, supports the College's 1998-99 national campaign to alert Americans to the risk of overweight/obesity and explains the role of internal medicine. There's space on the back to stamp your name and address in case your patients' friends or relatives want to see you.
3. Wear Your Badge and Patches For as little as $2 you can outfit yourself with a badge and 10 iron-on white-coat patches. They will instantly identify you with the national "Doctors for Adults" program, showing your patients at a glance who you are. And they might open the door to a quick chat with your patients about what an internist is and does. Many members are also outfitting their staffs with Campaign Polos or T-shirts to wear on office "casual days." Check out the growing line of "Doctors for Adults" merchandise and educational materials in the ACP-ASIM Observer, or in the 1999 College catalog, Resources for Internists.
4. Enlist Your Staff Does your office staff know the short answer to the question, "What is an internist?" Tell them about the "Doctors for Adults" campaign and take them through the Where We Fit brochure, so they can easily and accurately engage patients, explaining what distinguishes an internist from the other primary care physicians.
5. Use the Campaign Logo The "Doctors for Adults" logo is being registered in the name of the College for the exclusive use by members and associate members. The more you utilize it, the more closely you will be linked with our national public education campaign, which is telling literally millions of Americans, "We're Doctors for Adults." For additional information on the College's "Doctors for Adults" campaign, log on to doctorsforadults.com.
DOCUMENTATION AND BILLING WHEN TEACHING IN THE OFFICE SETTING
Patrick C. Alguire, MD, FACP Director, Education and Career Development Many internists teach students and residents in their office setting. Frequently, these preceptors have questions regarding proper documentation for Medicare billing when a learner is present. Here are some useful guidelines.
Documentation Requirements for a Resident Current Medicare rules permit a teaching physician (preceptor) to substantiate a bill based on the combination of the resident's and the teaching physician's documentation of a specific service. The teaching physician must clearly convey that he/she saw the patient and participated personally in the patient's care up to the level of the EM services billed. The teaching physician can confirm that he or she verified the findings in the resident's note and agree with findings as documented by the resident. The teaching physician can also indicate that he or she agrees with the diagnosis and plan as written by the resident. These requirements, for the most part, permit a certain amount of time saving by using the resident's documentation as part of your own note. This will somewhat decrease the overall work associated with teaching by allowing you receive some "service" for your educational endeavors.
Documentation Requirements for a Student The only documentation by medical students that may be used by the teaching physician is their review of systems (ROS) and past history, family history, and social history (PFSH). Currently, the teaching physician may not refer to a medical student's documentation of physical examination findings or medical decision making in his or her note. These restrictions will obviously have an impact on office efficiency. However, there are certain strategies that can be used to maximize efficiency in spite of these regulatory requirements. The use of the "wave scheduling" collaborative examinations, and presenting in the room are other methods to help manage documentation requirements when a student is present. For more information regarding these techniques, contact the ACP-ASIM Community-Based Teaching Program at 800-523-1546, ext. 2845, or e-mail email@example.com.
HOW TO REACH US
Norman Zuckerman, MD, FACP
Immediate Past Governor
Mountain States Tumor Institute
100 East Idaho
Boise, ID 83712
Phone: (208) 381-2711
Fax: (208) 381-2974
C. Scott Smith, MD, FACP
VA Medical Center 5
00 W. Fort Street
Boise, ID 83702
Phone: (208) 336-5100
Fax: (208) 338-7219