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Governor's Newsletter, Fall 2000

From the Governor

Serafino Garella, MD, FACP

I would like to use the vehicle of the newsletter to list some of the recent activities of the Northern Region and of the Chapter. The last few months have been quite productive. In addition to forming the Council and the Executive Committee of the Council, we held a meeting of the Advisory Committee and have begun forming several additional Committees, which are listed together with their leadership on page 6. If you are interested in participating in the work of one of these committees, please contact the office at (312) 435-0484, or Email: nkeil@dellnet.com and we will put you in touch with the appropriate chair/co-chair.

The Northern Illinois Advisory Council has started planning for the 2001 Chapter Meeting. The Program Planning Committee for 2001 includes Drs. Fahey, Foody, Gall, Harrell and Potts as well as me. The thinking now is that we will hold that meeting in November, in order to avoid conflicts with the ACP-ASIM In-Service Training Examination for the residents and with many other events which are already scheduled for October 2001. The dates would be Friday and Saturday, November 9-10, 2001. We are strongly considering the option of having a joint meeting that will include the Associates as well as the Members. Combining the two events (Associates Day and the Regional Meeting) will make for a more stimulating and lively meeting for both. In addition, it will provide an opportunity for our young members and those of us from an older era to interact more directly. Please mark your calendars now. We will keep you informed of the location and details in future newsletters.

Other news: on Wednesday, August 2, 2000, I represented the ACP-ASIM before the Governor's Commission on the Death Penalty. As you know, the ACP-ASIM position is that it is unethical for physicians to participate in capital punishment. The request was submitted that the Legislature should end participation by health professionals in executions. There were more than 100 people present at this meeting. The largest majority was against continuing capital punishment in the State of Illinois.

By the time you have received this newsletter two additional ACP-ASIM events will have been held in Illinois. The first event Uninsured Latinos: Community at Risk, will be held Thursday, September 7, 2000 and will highlight the health risks of the uninsured Latino community and examine why Latinos are more likely to be uninsured than the general public. The conference will consist of a Forum and a Press Conference, and represents the follow-up of the white paper titled "No Health Insurance? It's Enough to Make You Sick: Latino Community at Great Risk" prepared by ACP-ASIM and released in March. Chicago is the first stop in a series of three of these conferences throughout the United States. The Forum will be held at the Hyatt at University Village at 625 S. Ashland Avenue. Dr. Whitney Addington will welcome the participants, and Dr. Sandra Adamson Fryhofer, President of the ACP-ASIM will serve as moderator. Other panelists will include Melinda Schriver, Health Policy Associate of ACP-ASIM, Elena V. Rios, President of the National Hispanic Medical Association, Sister Sheila Lyne, Commissioner, Chicago Department of Health, and myself. Following the Forum a Press Conference will be held at CommunityHealth, a volunteer-based free clinic located at 2611 West Chicago Avenue, which provides free care to a population with a high percentage of Latino patients.

On Saturday, September 9, 2000, the ACP-ASIM will sponsor a meeting on the Appropriate Use of Tobacco Settlement Monies. The meeting will be held at the Chicago Medical Society and will include representatives from a large number of health-related professional organizations. The State of Illinois achieved the dubious distinction of being the only State in the nation to earmark much of the first year's tobacco settlement money (approximately $350,000) for purposes that are not health related. Another State also used some of that money for non-health-related purposes, but it was a much smaller percentage of the total. It is hoped that this meeting will result in a unified statement by all health-related professions and in activities that will cause changes in this policy for the future. The proposed motto of that meeting is "All for Health."

As I mentioned earlier in this column, the Illinois Chapter is working on developing resolutions for submission to the College. About four months before each Board of Governors meeting (there are two a year; one at the Annual Session and one in the fall), resolutions may be initiated at any level of a chapter, including members, committees, councils, officers or Governors. Resolutions may address any topic of interest to the author, and they are to be presented first to the Governor and the Council of the chapter before being forwarded on to the College to be submitted to the Board of Governors and the Board of Regents. Eventually, the aggregate of the resolutions approved by the Board of Governors and the Board of Regents constitutes the framework of the principles that guide the College. Therefore submitting resolutions is one of the most effective ways of influencing College policies and actions. At this time, the Illinois Chapter is working on the resolutions that appear on the following page. They will be discussed and most likely modified at the October 20, 2000 Chapter Meeting, in Springfield, before being forwarded to the College. Even if you are not planning to be in Springfield on October 20 and 21 (and why should that be?) you can participate in crafting these resolutions, or add new ones, by telephoning Nikki Keil at (312)435-0484, or sending an Email: nkeil@dellnet.com.

On a final note, I want to remind everyone about the upcoming Regional Meeting at the Springfield Hilton Hotel on Friday, October 20 and Saturday, October 21, 2000. A detailed program for the meeting is included in this newsletter (see pages 4-5.) This should be an educational and very enjoyable get-together and I hope to see and speak with many of you there.

Thank you for taking the time to read this newsletter. Please let me know if there is anything you would like more information on, or would like to have discussed in future newsletters.


David Steward MD, FACP

Governor, Downstate Region

The Illinois ACP-ASIM State Scientific Meeting for the year 2000 will be held on Friday and Saturday, October 20 and 21, 2000, in Springfield at the Hilton Hotel, just one block from Lincoln's Home and two blocks from the historic Old State Capitol. As you can see from the program, we have an exceptional group of speakers and topics lined up. We are especially looking forward to hearing from our College Representative, Dr. Ted Shortliffe, MD, FACP, a Regent of the College and one of the world's leading authorities on the future of medicine in the age of the Internet. And, we have a memorable dinner planned for Friday night at the Old State Capitol Rotunda. Mark you calendar now for these dates, and watch your mail for the meeting brochure, which should arrive in mid-September. Registration fees will be $80 for members and fellows, $100 for non-members, and "fee waived" for students and associates, masters, and retired College members. If you need any further information, just call the office of the Downstate Governor at (217)782-2596 during normal weekday working hours.

We look forward to a great two days of meetings and a chance to see our colleagues in the ACP-ASIM again.


Proposed New Illinois Resolutions

Below are three draft resolutions that will be discussed at the Springfield Regional Meeting, October 20-21, 2000. If you have any comments or wish to suggest other resolutions, please contact Nikki Keil at (312) 435-0484, or Email: nkeil@dellnet.com.

  • Title: Physician compensation for limiting patient care is unethical.
    Whereas, Medicine is, at its center, a moral enterprise grounded in a covenant of trust; and
    Whereas, the medical profession has a primary obligation to the patient through our professional societies and organizations, but especially through personal behavior; and,
    Whereas, ACP-ASIM endorses the Patient-Physician Covenant which obliges physicians to use their competence in the patient's best interests; and
    Whereas, many third-party payers offer financial incentives to physicians who limit utilization of services by patients; and,
    Whereas, this practice constitutes an inherent conflict of interest between physicians' personal financial advantage and their obligation to act as advocates for patients in providing the best available care to them; therefore be it
    Resolved that ACP-ASIM will publicly and formally condemn as unethical the practice of offering financial bonuses or any other incentive resulting in personal advantage to physicians for limiting services to their patients; and be it further Resolved that ACP-ASIM will stimulate and support legislation to prohibit such practices.
  • Title: The proliferation of Certification Requirements should be opposed.
    Whereas, the Institute for Clinical Evaluation (I.C.E.) was created to accredit physicians' competence in certain specific areas of medical practice, procedures and specialized knowledge; and
    Whereas, the American Board of Internal Medicine is already certifying competence in General Internal Medicine and its Subspecialties, as do other Specialty Boards for practitioners in Medicine and other Disciplines; and
    Whereas, the implications of I.C.E. are that existing certification is inadequate to assure such competencies; and
    Whereas, such certification by I.C.E. also implies competence of non-physicians and non-internists to perform procedural and cognitive functions in which Internists are trained and already certified; and
    Whereas, there are financial and reimbursement issues which may require multiple certifications of competence above and beyond the current structures in place which have not been shown to be deficient; therefore, be it
    Resolved, that the ACP-ASIM oppose the formation and proliferation of certification requirements being developed by the Institute for Clinical Evaluation and recommend that these certifications be incorporated under the aegis of the American Board of Internal Medicine.
  • Title: Coverage of Appropriate Preventive Measures and/or Screening Tests.
    Whereas, the Medical Services Committee has recommended to the Health and Public Policy Committee the adoption of "RESOLVED, that the BOR work with HCFA and Congress to develop legislation that would enable all Medicare patients to receive an annual health maintenance review as a covered benefit;" and,
    Whereas, Medicare patients now receive preventive and early detection services such as bone density measurement, PSA testing, pap smears, mammography, and screening tests for colon cancer; and,
    Whereas, with increasing medical evidence, additional screening procedures are being established as cost effective, such as measurement of lipids in elderly patients; therefore be it
    Resolved that yearly addition of accepted effective screening and preventive testing be incorporated as a covered benefit as part of an annual health maintenance review.

Illinois Chapter Scientific Meeting 2000
Friday and Saturday, October 20 and 21, 2000
Hilton Springfield


ACP-ASIM Northern Illinois Chapter Advisory Council Members:

Whitney Addington, MD, MACP
David Ansell, MD, FACP
Christine Amstadt, DO
John Brill, MD
Laurie Broutman, MD, FACP
John Butter, MD, FACP
William Cannon, MD, FACP
May Chow, MD, FACP
Ray Curry, MD, FACP
Anne Dean, MD
Evelyn Diaz, MD
Dan Dilling, MD
Thelma Evans, MD, FACP
Patrick Fahey, MD, FACP
James Foody, MD, FACP
Nancy Furey, MD, FACP
Warren Furrey, MD, FACP
Eric Gall, MD, FACP
Serafino Garella, MD, FACP
Stephanie Gregory, MD, FACP
Rolf Gunnar, MD, FACP
Ashutosh Gupta, MD, FACP
Laura Harrell, MD
Trent Haywood, MD
C.A. Hedberg, MD, FACP
Holly Humphrey, MD
Nkem Iroegbu, MD, FACP
       Estefen Kurtides, MD, MACP
Linda Lesky, MD
Stuart Levin, MD, MACP
David Liebovitz, MD
Armand Littman, MD, MACP
Melvin Lopata, MD, FACP
Joan Mullan, MD, FACP
Kathy Neely, MD, FACP
Lisa Orelind, MD
Steven Potts, DO, FACP
John Quinn, MD, FACP
Janet Riddle, MD, FACP
Patricia Russell, MD
John Schneider, MD, FACP
Gordon, Schiff, MD
John Sheagren, MD, FACP
Lori Siegel, MD, FACP
Michael Silver, MD FACP
Kevin Simpson, MD, FACP
James Sipkins, MD
John Skosey, MD, FACP
Vesna Skul, MD, FACP
James Webster, MD, MACP
Arnold Widen, MD, FACP
Wayne Williamson, MD, FACP
Quentin Young, MD, MACP

Committees and Committee Chairs

Associates
Steven Potts, DO, FACP, Chair

Awards
Joan Mullan, MD, FACP, Co-Chair
Warren W. Furey, MD, FACP, Co-Chair

Communications/ Informatics/newsletter
Nancy Furey, MD, FACP, Co-Chair
John Brill, MD, Co-Chair

Community-based Teaching
Lisa Orelind, MD, Co-Chair
John Sheagren, MD, FACP, Co-Chair

Community Service
Nkem Iroegbu, MD, FACP, Co-Chair
William Cannon, MD, FACP, Co-Chair

Medical Students
Ray Curry, MD, FACP, Chair

Health And Public Policy
James Foody, MD, FACP, Co-Chair
Patrick Fahey, MD, FACP, Co-Chair

Health Care Reform
James Webster, MD, MACP, Co-Chair
Whitney Addington, MD, MACP, Co-Chair

Membership Diversity
Evelyn Diaz, MD, Co-Chair
Vesna Skul, MD, FACP, Co-Chair


Leadership Day
May 16-17, 2000

John Schneider, MD, FACP

Drs. Patricia Russell, Craig Backs and myself, along with over 100 representatives from most of the states, participated in the ACP-ASIM Leadership Day. May 16th we met and discussed with the leadership from both the Congress and from the ACP-ASIM, the major issues of the College this year. On May 17th we visited the offices of our Representatives and Senators.

The major issues discussed were as follows:

  1. The strategies for reducing the number of uninsured.

    The College has documented that the absence of health insurance causes illness and mortality for the poor and for the Latino community and has made a major commitment to the expeditious expansion of health insurance coverage.

    The College supports Senate Bill 2320, which has bipartisan support to help low income families purchase health insurance through refundable and targeted credits to low and moderate income individuals. These credits must be available at the beginning of the year to permit individuals to use that money toward purchasing their own health insurance. This will build on the present health care system rather than replace it.

    Research has shown that credits are effective in expanding coverage for lower income individuals if they cover a significant portion of the cost of the insurance premium. In addition the College supports expanding Medicaid to individuals at or below poverty and increasing funding for outreach so that more children are eligible for Medicaid and CHIP. Coverage should be expanded to parents of families with eligible children.

    The College supports working toward long term solutions to provide insurance coverage for all Americans. These viewpoints were well received by our Congress-persons. The major discussion is about the amount of the refundable tax credits that would be available.

  2. The second issue is the Patient Bill of Rights. Our College strongly supports the HR-2723,

    which passed the House last October. A Senate vote on patients' rights legislation is expected in September.

    The issues to be resolved include:

    • All insured Americans should be included, not just those in ERISA plans.
    • An external independent review should be made available to pass judgment on whether the services were medically necessary. The College recognizes that simply having a physician determine that services provided are medically necessary would not be acceptable. On the other hand, physicians object to plan administrators being able to make that decision. An independent group, using data based upon medical evidence of medical necessity, not just based on arbitrary rules of the plan, can best make the judgment about standard of care.
    • All plans should be held accountable in a court of law for medical decisions that harm patients. Managed care entities claim that such lawsuits will increase the cost of health care. However if medically necessary care is not denied, there should not be any large increase in claims.
    • Emergency services should be covered if a prudent lay- person would reasonably believe that an emergency exists.
    • Prohibition of gag clauses is essential.
  3. The third issue is prescription drug coverage.

    The rapid increase in prescription costs has served as a stimulus for development of some program that would provide for Medicare prescription coverage.

    There are a number of proposals before Congress. The position of the College is that there be sufficient revenues to support the cost of the program, both short and long term, without bringing about cuts in any present Medicare programs.

    The highest priority should go to those in most need. Pharmacy benefit managers should develop formularies so that approved medications reflect efficacy, safety and ease of administration rather than simply cost.

    Physicians should be able to prescribe drugs not on formulary through a tiered system where the co-pay for generic drugs is the lowest, with intermediate co-pay for drugs on formulary and a higher co-pay for drugs not on formulary.

    There are proposals to address the issue of pricing by the pharmaceutical companies. The pharmaceutical industry is the only component of health care that is not regulated.

    The industry now is being challenged to reduce or control costs just as has been true for physicians, hospitals, home health care providers and nursing homes. The pharmaceutical industry claims that this would affect their ability to continue to invest in research and development.

    However costs could be cut by eliminating, direct advertising to the public. This practice is supposed to educate, but is simply a marketing tool for a specific drug. Likewise, elimination or restriction of marketing activities directed at physicians, particularly residents further would reduce costs.

  4. Another issue has become patient safety, as a result of the Institute of Medicine's report "To Err is Human: Building a Safer Health System."

    There are plans for creation of a patient safety program within the Agency for Healthcare Research and Quality. The College supports the creation of this Center with appropriate funding.

    In principle, the College supports mandatory reporting of major preventable errors resulting in death or permanent disability, but with confidentiality protection and prohibition of disclosing names of practitioners and limits on "discoverability" in liability lawsuits. However there is no uniformity of opinion among all members of the College about this. There is support for the development of a voluntary system, which would permit distributing information about programs that could make changes in practice, which would prevent errors before they occur.

    Simply having errors reported without the development of programs to prevent errors would not meet the goal of the Institute of Medicine. Further examination of how best to report and analyze data should occur before either a mandatory or a voluntary reporting program is implemented.

  5. The College supports The Campbell Bill HR-1304,

    which would enable independently practicing physicians to collectively negotiate price and other terms of contracts with their payers. The bill passed the House in June; however, presently there are no sponsors for this legislation in the Senate. Some members in the House will not support the bill because of their concern about the ability of physicians to be able to negotiate price with payers and cause price fixing.

    Your Leadership Day representatives were impressed that this activity is a most valuable experience. It serves to educate the attendees on how the College positions are developed and how one can best advocate those positions. It also provides local members with information so that they can be involved at the state as well as the national level to better provide care of our patients. Please write, fax, or e-mail your Representatives and Senators.


27th Annual Illinois
Associates Meeting
Wednesday, October 4, 2000

Rush Medical College
1653 West Congress Parkway
Chicago, IL 60612

12:00 Noon     Registration and Box Lunch
    Medical Jeopardy Competition
    Unknowns in Clinical Medicine
5:00 p.m.     Awards Reception, Room 500, Rush Medical Center

Associates Corner:

The Illinois ACP-ASIM, Council Of Associates
With the help of Dr. Steve Potts and the host sponsors at Rush Medical College, we are hoping to make this year's Associates Meeting the most successful and memorable to date. A welcome addition to this year's meeting will be a "Doctor's Dilemma" (also called "Medical Jeopardy") competition which we hope will be a hit. The winning team will be assisted in getting to Atlanta for the national competition at the Annual Session.

Other projects we have in the works include programs on contract negotiating and interviewing. We hope to hold these in December and January.

We continue to look for participation on our council by all residency programs in the city. Ideally we want two members from each. Ask your program director or chief resident if your program is sending reps. We meet once a month and discuss issues relating to our residency programs and plan these projects. You can contact Daniel Dilling at Loyola,
Email: ddillin@luc.edu for information on the next meeting.

Don't forget to plan a trip to Atlanta March 29-April 1, 2001, for the ACP-ASIM Annual Session! We're hoping to have a record showing for Illinois associates.

Finding A Fellowship In Today's Competitive Market
Thanks to Dr. Azhar Majeed and the Associates Council for planning the first annual Fellowship Information Day. The event was held on Saturday, August 26th at Dave and Busters in downtown Chicago. Sixty plus residents attended the information question and answer program. Many thanks to Fellowship Directors Dr. Patrick Murray (University of Chicago) and Dr. Robert Balk (Rush Medical College) and the Fellows from Loyola and Rush who helped to make this event a great success.


Annals Of Internal Medicine:
Web Site Launched

Annals.org, the new Annals of Internal Medicine Web site, is up-and-running. The new site has its own URL address www.annals.org, and can also be reached through ACP-ASIM Online. The site features a new home page with an easy-to-navigate directory and a variety of new services, including:

  • Access to the full text of all articles and Adobe Acrobat PDF files for most articles that allow the article to be viewed exactly as it appears in the print version of the journal;
  • Enhanced search capabilities (by author, title, date, and by keywords such as medical condition or other MeSH terms);
  • Direct links from bibliographic references in Annals articles to abstracts in the National Library of Medicine's PubMed database. From there, readers can access all of PubMed's services;
  • "Summaries for Patients" non-technical explanations of Annals original research articles written for lay readers (formerly known as "non-technical summaries");
  • Interactive features that allow users to evaluate articles and to write comments and letters to the editor, which will provide feedback to the authors and will help editors choose future content; and
  • Personae a link that takes visitors to an online photograph gallery.

Accessing the full text articles and PDF files of Annals.org is restricted to ACP-ASIM members and Annals subscribers; however, the public will have access to each issue's table of contents, as well as all abstracts and Summaries for Patients. Full text articles and PDF files will be available to the public on a pay-per-view basis.


Bernardin Amendment Update

If approved by the Illinois Legislature and 60% of the voters in Illinois,the Illinois State Constitution would read:

"Health care is an essential safeguard of human life and dignity, and there is an obligation for the State of Illinois to ensure that every resident is able to realize this fundamental right. On or before May 31, 2002, the General Assembly by law shall enact a plan for universal health coverage that permits everyone in Illinois to obtain decent health care on a regular basis."

Illinois State Representative Mike Boland, from East Moline, was asked by his constituents to help them obtain health insurance. Many were working part time jobs with no insurance, others had pre-existing illnesses such as diabetes, and still others were being hassled by their managed care organizations and were increasingly unable to obtain the care they wanted without delays. Mr. Boland responded by introducing the Bernardin Amendment on February 3, 1998. In November 1998, a non-binding referendum asking for approval of the Bernardin Amendment was placed on the ballot in Cook County. It received 83% approval of the voters. In March 1999, the amendment was placed on the ballot of 16 other counties in Illinois and again won on the average over 70% approval.

The following representatives have sponsored the bill:

Chicago: Tom Dart, Mary Flowers, Ed Acevedo, Rich Bradley, Daniel Burke, Barbara Currie, Monique Davis, Willie Delgado, Sara Feigenholtz, John Fritchey, Calvin Giles, Connie Howard, Lou Jones, Howard Kenner, Joe Lyons, Howarf Kenner, Larry Mc Keon and Todd Stroger
Rockford: Doug Scott
Oak Lawm Jim Brosnahan
Oak Forest: Maggie Crotty
E. Alton: Steve Davis
Evanston:Julie Hamos
Orland Pk: Kevin McCarthy
Joliet:Jack McGuire
Sparta: Dan Reitz
Canton: Mike Smith
E. St Louis: Wyvetter Younge
Gillespie: Gary Hannig
Lake Bluff: Susan Garrett
Park Forest: George Scully
Harrisburg: Jim Fowler

In spite of the overwhelming support of the Bernardin Amendment in the Advisory Referendum around the state, Representative Boland did not introduce this bill to the House in the Spring 2000 Session, as was expected. The explanation given was that the amendment did not have bipartisan support in the legislature. Democratic support is strong, but not Republican, in spite of the fact that the majority of constituents from Republican counties supported the referendum.


Northern Illinois Chapter
Contact Information

Governor: Serafino Garella, MD, FACP

Administrative Assistant: Nikki Keil
Email: nkeil@dellnet.com

Phone:(312) 435-0484

Fax:(312) 435-0487

Mail: ACP-ASIM, 332 S. Michigan, #525, Chicago, IL 60604

Web site: www.acponline.org/chapters/il/northern



ACP-ASIM Membership
and Fellowship

Becoming a Member or advancing to Fellowship is easier than you think!

Simply request the appropriate application from the ACP-ASIM office:

E-mail: nkeil@dellnet.com
Phone:(312) 435-0484
Fax:(312) 435-0487

Mail: ACP-ASIM, 332 S. Michigan, #525, Chicago, IL 60604


Medical Students: Medical student members do not pay membership dues or fees for the annual or local meetings. Just fill out an application.

Associates: Associates are residents in internal medicine. They have all the benefits of members except for voting and holding office. Dues $104.

Members: Members are board eligible or board certified internists. Members vote, but do not hold office.
Dues: $200- more than 9 years post-graduate and over 65 years old; $328- less than 9 years. Benefits include the Annals Internal Medicine, many other publications, and insurance programs.

Fellows: There are many members who are eligible for advancement to Fellowship, or who qualify for direct Fellowship, but simply have not taken the time to apply for advancement. Dues are the same as for members. Basic Requirements:

  1. Certified by the ABIM, AOBIM, or RCPSC.
  2. Member for at least two years and in practice or in a teaching position for two years.
  3. Have a medical license to practice.
  4. Professional activity confined to internal medicine or a subspecialty.
  5. Be proposed/seconded by two Fellows or Masters and endorsed by the regional College Governor.
  • Pathway 1: Academic: The candidate should have skills in written medical communication, research and teaching. The applicant should hold an academic appointment and write scientific papers, reviews, book chapters, patient education materials, epidemiological surveys or reports and reports.
  • Pathway 2: Continuing certification and/or teaching. Recertification, participation in MKSAP with a passing score, certificates of special competence, or subspecialty certification is usually required. Exceptional candidates with outstanding scholarly and/or teaching and/or community and ACP-ASIM activities may qualify even without fulfilling the MKSAP, subspecialty certification or recertification requirement.
  • Pathway 3: Active ACP-ASIM member. The candidate should be a member of the College for at least 10 years and participate on committees and attend the College's national and local meetings and postgraduate courses. The candidate who is active in community service and the provision of medical care as a volunteer are additional attributes. Outstanding candidates who have been a member for less than 10 years may qualify by combining Pathways 1, 2, and 3.
  • Pathway 4: Senior Practitioner. Advancement through this pathway is for candidates who have shown distinguished professional activity in teaching, patient care, professional service over many years with substantial contributions to the professional education of other physicians, medical students, allied health professionals and the community.
Remember that Candidates may apply under one pathway or under a combination of pathways.