Idaho Chapter Governor's Newsletter
C. Scott Smith, MD, FACP
Governor, Idaho Chapter
From The Governor...
"The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies around the world. These challenges center on an increasing mismatch between the legitimate needs of patients, the available resources to meet those needs, an increasing dependence on market forces to transform healthcare systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patient interest. In order to maintain the fidelity of medicine's social contract during this challenging time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients, but also collective efforts to improve the health care system for the welfare of society." This is the summary from the draft Charter on Medical Professionalism. The charter represents an ongoing partnership between ACP-ASIM, the ABIM Foundation, and the European Federation of Internal Medicine.
I sometimes feel powerless against the broader forces operating outside my exam room. Then I go to Annual Session and get my "batteries recharged." As Governor, I have come to realize the importance of collective action by ACP-ASIM on behalf of our patients and members. The merger of ACP with ASIM, in my opinion, has produced a marriage of principals and pragmatic action that is working (see articles below.) However, the organization is only as strong as its members. We continue to need your support, your ideas, and your involvement.
Highlights From Annual Session
The keynote speaker at Annual Session was Ken Kizer from the Institute of Medicine. He spoke in some detail about the findings revealed in their "To Err is Human" report. He believes that most of the errors seen in medicine are system errors. He urged physicians to embrace things that have worked in other high-risk fields (e.g., aviation) including checklists, guidelines, and computer support systems, and to help to make them practical.
The quality of the Associate presentations and the Scientific Sessions was very high. I always learn a lot that I can bring right back and put into practice. We all met the new editor of Annals of Internal Medicine, Hal Sox, MD, MACP. There is lively discussion going on in ACP-ASIM about the appropriate role of the pharmaceutical industry in our Annual Session, and in Annals of Internal Medicine.
ABIM Recertification Reform Priority One!
Every chapter has heard from the "grass roots" that there are problems with the ABIM recertification process. Several resolutions have been proposed in the last three years to make the process simpler and more relevant, or replace it altogether. The leadership has heard our concerns, and has made this a strategic priority for the organization. We now have high-level discussions between ACP-ASIM and ABIM. The three goals of the College for this dialogue are:
The recertification process should be clinically relevant, cost and time-effective, and not redundant of existing quality measures.
ABIM should be limited to evaluation. Education should be handled by ACP-ASIM (and others) with a history of educational program development and delivery.
There should be requirements for CME to assure maintenance of competence. However, there must be flexibility in how this requirement can be met, recognizing that physicians, as adult learners, may have varying but equally effective learning styles and opportunities.
A joint committee is working out details of an acceptable process. A draft of seven principles was submitted to ABIM, and accepted in principle. So far, ACP-ASIM has withheld endorsement of ABIM's continuous professional development (CPD) process until we see the details of their response to these principles. If an acceptable process cannot be worked out, the leadership is prepared to actively campaign against CPD and provide/suggest alternatives. My own feelings about this process are as follows:
Continuing medical education and professional development are important professional standards. They also assure accountability in the public's eyes.
These are important for all internists (regardless of their year of board certification, current job situation, etc.)
The process needs to be convenient, flexible, and relevant.
The best solution is a negotiated one between ACP-ASIM and ABIM. If we leave ABIM, it makes it more difficult to avoid conflict of interest and provide acceptable accountability to the public.
As it stands, anyone who is unable/unwilling to complete the process is disenfranchised. This is the real "flunk" rate, and for many groups may be much greater than the stated "7%". The rural internist, already an endangered species, is particularly vulnerable for several reasons. I made this point to ABIM leadership during a Town Hall Meeting at Annual Session, and they seemed genuinely unaware and concerned.
It is easy to vilify ABIM and its individual members. However, many of them come from our own ranks (practicing internists, prior ACP-ASIM Governors and Reagents, etc.), and they are competent, responsive, and concerned.
This is a great example where we as individuals are powerless, but we as a collective have begun to make important changes. The negotiation is certainly not over. I believe we should give our leadership support, and time to complete these negotiations satisfactorily.
Send me an e-mail if you have further questions or comments Scott.Smith2@med.va.gov.
A few bullets about progress on political issues. As always, an easy way to make our elected representatives aware of your views in these areas is to go to www.acponline.org, hit the "Advocacy" button, then hit the "Key Contacts" button. You can sign prepared statements or create your own and easily forward them to your Congressional representatives.
Regulatory relief: The "Medicare Education and Regulatory Fairness Act," (MERFA) S. 452 is before Congress and would provide the following:
Give providers due process rights including an equitable right of appeal.
Provide meaningful options for appeal.
Curtail extrapolation (cannot extend findings to unexamined charts).
Target Medicare education dollars to provide needed outreach especially in rural areas on the complexities of Medicare billing.
Prohibit payment demands until appeals are heard.
Protect health professionals from unfunded man dates (requiring Medicare payment rates better reflect the costs of mandates imposed).
Our Washington office has been very effective in bringing this to the forefront. At one point, they literally brought in the 9-foot stack of documents a physician is expected to read to bill appropriately!!
Patients Bill of Rights: the Bipartisan Patient Protection Act of 2001 S.283 is being supported by ACP-ASIM. Some form of this is likely to pass this year. Key points are:
Creation of effective timely appeals for patients denied services.
Able to hold managed care plan accountable for harm.
Assurance that medical necessity will be based on professional standards derived from clinical evidence, not the health plan's own criteria.
Guaranteed choice of physician and access to specialty care.
Confidentiality of Medical Data (HIPPA) Response: The HIPPA plan, put forward late in the Clinton administration, has been held up for further study.
ACP-ASIM has been active in eliminating the "business associates" clause (e.g., where you can be held libel for leaks from a company you deal with that has access to records). We are probably going to be successful. Staffers are currently studying and responding to the impact HIPPA will have on transaction standards and security rules for physician practices.
ACP-ASIM Releases Four New Guidelines for Appropriate Antibiotic Use for Treatment of Upper Respiratory Tract Infections
The new guidelines were published in the March 20, 2001, issue of Annals of Internal Medicine. The guidelines were developed by the Clinical Efficacy Assessment Committee (CEAS) and approved by the Board of Regents on July 16, 2000. They are based on four background papers of principles for appropriate antibiotic use in upper respiratory tract infections developed by a Centers for Disease Control (CDC) panel with representatives from ACP-ASIM, the American Academy of Family Physicians (AAFP) and the Infectious Diseases Society of America (IDSA). The guidelines cover treatment for acute bronchitis, sinusitis, pharyngitis and non-specific upper respiratory tract infections. They say that antibiotics are not needed for most respiratory tract infections. Each guideline also outlines steps to establish a diagnosis, estimate the likelihood of a bacterial cause of the infection and determine whether, and in whom, antibiotic therapy is appropriate. The guidelines have also been posted on the Annals site (www.annals.org).
For more information, call Vincenza Snow, Senior Medical Associate at ACP-ASIM (1-800-523-1546, ext. 2417). If you are contacted by your local media about these guidelines, please call Susan Anderson in the ACP-ASIM Communications Department at 800-523-1546, ext. 2653.
Young Physicians Subcommittee
The Young Physicians Subcommittee (YPS) wants to hear from young physician members of the College about the practice environment today. Your frank comments will, through the Subcommittee, have a direct impact on you and your colleagues.
We'd like to know how you feel about recertification, establishing a practice, coping with stress, and time constraints. Would you like a copy of the YPS Practice Management Survival Booklet? An E/M coding card? A curbside consultation about and evaluating and improving a practice via the College's Center for a Competitive Advantage? If you answered "yes" to any of these questions, the web site can also be used to request this information. ALL e-mails will be answered.
If you have any questions, please contact Jean Elliott, YPS Staff Liaison at (800) 523-1546, ext. 2692.
The chapter meeting will again be held at the Elkhorn Lodge in Sun Valley. The dates are January 17-20, 2002. Set these dates aside, this year will be special. It is the 25th anniversary of the training program at the Boise VA, which co-sponsors the meeting. All the speakers will be graduates!
Congratulations to Melissa Hagman, MD. She is the first Associate representative on our council. We have established a joint representative program with the Washington Chapter. Each year, a promising young leader will be identified during their internship year at Seattle. When they come to Boise for their second year, they will participate on the Idaho council. When they return to Washington for their third year, they will participate on the Washington council.
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.
How to Contact the Idaho Chapter
C. Scott Smith, MD, FACP
Governor, Idaho Chapter
Medicine Service (111)
VA Medical Center
500 W. Fort Street
Boise, ID 83702
Phone: (208) 422-1325
Fax: (208) 422-1319