Governor's Newsletter, Spring 2000
From the Governor
I never planned to be a Governor of the American College of Physicians, but I did always want to be a Fellow.
My dad died when I was a junior student at Northwestern University Medical School and I married Nancy Lee Schriver, one of the six women in our class. I was drafted into the Army and Nancy and my son, Warren, came with me. We had a second child at Fort Belvoir, Virginia and returned to Northwestern University to finish residency. Craig Borden, my Chair of Medicine at the VA Research Hospital in Chicago, inspired me to be the best physician I could be. He was a wondrous clinician and Chair of the Oral Board of Examiners of the American Board of Internal Medicine.
We had five children by the time Nancy finished her dermatology training, and she has an unbelievable dedication to her work, our family, medicine, my work, historic preservation, our old house, the Bernardin Amendment and our new grandchildren. She can never cut back to regular hours, so I don't think she will ever really retire, and I am so grateful for all she has done and for what I have been able to do because of her.
Dr. Armand Littman suggested that Nancy had enough publications to become a Fellow of the College, and I qualified with about as few publications as was possible in that era of only one pathway to Fellowship.
We always enjoyed the American College of Physicians meetings, and I have been to virtually every one since I received my Fellowship in Philadelphia in 1976. Later that summer the hotel that I stayed in was condemned because of Legionnaire's disease.
A few years ago, I was asked to chair the Awards Committee for the chapter, and if you want to win friends, giving awards is a good place to start. Soon I was a Governor candidate, and here I am. I was told I would love being Governor, but it took a year or two of asking "are we having fun yet?" before we realized we were. I saw four great locations in fall Governor meetings: Charleston, Toronto, Palm Springs and Asheville, North Carolina. I was privileged to host my Governor Classmates at our home in Hinsdale and to address the Governors' fall meeting in Chicago on "My City of Big Shoulders." I presented what Chicago meant to me and that meant the Daley family, Michael Jordan, Sammy Sosa, the Chicago River, Carl Sandberg and, of course, Joseph Cardinal Bernardin. I have met wonderful people during my Governorship including Dr. Ralph George, who died shortly after becoming Governor from California. I hope to remain close to our Governor Class of 2000 in years to come.
Rolf Gunnar, MACP, was a major help to me as an ex-Governor, ex-Chair of Medicine at Loyola, ex-Regent and ex-Treasurer of the College. He kept me focused. Jim Webster, MACP, also an ex-Governor, has been a leader in "To Defend Health Care" and the Bernardin Amendment in the State of Illinois, which have been the themes for my Governorship. Steve Potts ran the Associates Program, and I never had to worry about it. Whitney Addington, as President of the College, has been a wonderful leader and a great support, and his crusade for universal health care has been inspiring. Andy Hedberg was my predecessor as Governor and is now a Regent, and he and his wife Junia have been a presence I could count on. We had a great newsletter thanks again to Dr. Nancy Furey. John Schneider, Transitional Governor from Illinois, made the ACP-ASIM merger go smoothly and is a valuable source of know-how in the Illinois State Medical Society and the American Medical Association. Serafino Garella, our new Governor, has run with Public Policy, and the Chairs of Medicine at our seven medical school have been most receptive to ideas and needs. Thanks to Dr. Ann Dean and all the residents who formed our Illinois Associates Council. Thanks to Dr. Ray Curry and the medical students who have formed Internal Medicine Interest Groups at all the medical schools in the area. We have been privileged to accept a large number of wonderful physicians into Fellowship, and we have received seven national awards, elected three Regents and a President of the College. I want to thank all of my committee chairs and members, as well as anyone who came to a meeting, spoke at a meeting or offered a kind word or a word of constructive criticism. Dave Steward has been a good friend and a marvelous Downstate Governor of our Illinois Chapter. Nikki Keil, my executive assistant, has been everything I could ask and losing her to Dr. Garella will be as difficult as giving up the Governorship. It is a great organization. I am honored to have been able to serve as your Governor. Thank you for the opportunity, and God bless you, our patients and the profession of medicine.
Warren W. Furey, MD, FACP
Board Review Strategies
Patrick C. Alguire, MD, FACP, Director, Education and Career Development
|Whitney Addington, MD
John Brill, MD
Marion Brooks, MD
William Cannon, MD
Ray Curry, MD
Anne Dean, MD
Evelyn Diaz, MD
Thelma Evans, MD
James Foody, MD
Lee Francis, MD
Nancy Furey, MD
Serafino Garella, MD
Stephanie Gregory, MD
Rolf Gunnar, MD
Ashutosh Gupta, MD
C. Anderson Hedberg, MD
Holly Humphrey, MD
E. Stephen Kurtides, MD
David Liebovitz, MD
Armand Littman, MD
|Melvin Lopata, MD
Joan Mullan, MD
Kathy Neely, MD
Lisa Oreliind, MD
Steven Potts, MD
Brendan Reilly, MD
Janet Riddle, MD
Arthur Rossof, MD
John Schneider, MD
John Sheagren, MD
Lori Siegel, MD
Michael Silver, MD
Kevin Simpson, MD
James Sipkins, MD
John Skosey, MD
Vesna Skul, MD
James Webster, MD
Wayne Williamson, MD
Quentin Young, MD
The American Board of Internal Medicine certifying examination differs from most traditional examinations in that it tests overall knowledge and the application of that knowledge to solve problems, rather than simply recalling facts. To be successful, you may need to view the examination differently and prepare in new ways. The following suggestions were gleaned from the article "Taking the boards? Try these strategies for success," published in the May 1999 ACP-ASIM Observer by Christine Kelly, and the collected experiences of selected program directors.
The Format: Nearly 85% of the test questions are presented as clinical scenarios that take place in ambulatory settings. The test emphasizes general knowledge; if you haven't seen or heard about it during your residency training, chances are slim that it will be on the board exam. Don't worry about recent studies in medical literature. Examinations are created over a year in advance of their use, so recent material will not be tested. For a breakdown of what is covered on the examination, see the ABIM's web site.
Pace Yourself: Last minute cramming for the exam is not likely to help and may hurt your chances. Despite the difficulty in motivating yourself, most residents need to begin a study program at the beginning of their second year; starting at the beginning of the third year is cutting it pretty close, and halfway through the last year is too late. Most experts recommend reading about your own patients as the basis for your study plan. In general, the frequency that you encounter certain problems during the residency program will reflect the importance they receive on the examination.
Assess Yourself: Review courses and practice examinations can help you prepare by identifying your weak areas. One of the most popular and most accurate at predicting your performance on the board examination, is the in-training examination. Residents with scores falling below the 50th percentile on the in-training examination will have the greatest probability of failing the board examination. Remediation, usually in the form of changing reading habits, can improve the likelihood of passing the board exam. In fact, and not surprisingly, there is a direct correlation on the amount of time spent reading and the ability to pass the board examination; about 5 to 7 hours per week appears to be the bottom line for success.
Study Groups: Study groups are a good method to ensure compliance with your student program. Limit the number to three or four individuals, and meet consistently - weekly or every other week. The groups can be organized by problem, organ system, or chapters in the textbook. A tried and true strategy is to have each member prepare questions based on their reading and use them to test the group's knowledge. It's not unusual to accurately guess the content areas and types of questions that will appear on the board exam.
Review Sample Questions: Trying out sample questions can help you become a better test-taker by learning strategies to increase your odds of selecting the correct answer. About 80% of residents taking the board examination use the College's Medical Knowledge Self-Assessment Program (MKSAP) as a study tool. In addition to the questions, the accompanying syllabus presents key advances in the subspecialty and general internal medicine areas for the past three years.
Review Courses: Near the end of residency training, review courses can help solidify what you have learned during training. Do not deceive yourself into believing that a review course will make up for the lack of consistent and steady study habits, but rather they tend to "tie things together" and give a sense of confidence regarding preparedness for the examination. The College offers a number of board review courses and information about them is available online.
- When starting the exam, determine the number of questions and the amount of time available. Calculate how many should be answered by halfway through the allotted time. Typically, you will need to answer a question every one or two minutes.
- Read the stem (the clinical vignette) carefully. Pick out the pertinent parts of the stem that will help you select the correct diagnosis.
- Pick the obviously correct answer. There are no trick questions.
- Consider race, sex and age when selecting the answer.
- If you don't know the answer to a question, make your best guess and move on.
- Don't change the answers to questions unless you have made an obvious mistake; first impressions are generally the correct
ACP-ASIM's Decision 2000 Campaign
Last summer, the 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 (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 this 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 in the year.
The success of ACP-ASIM 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 and Ethics and Human Rights Committees.
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 establishing an ACP-ASIM Services, Inc. PAC. The Boards' 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.
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.
- 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.
- 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.
- 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 "causal 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.
- 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.
- 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 out national public education campaign, which is telling literally millions of Americans, "We're Doctors for Adults."
Documentation and Billing When Teaching in the Office Setting
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 to 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 examination, 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 firstname.lastname@example.org.
Tips for Office-Based Preceptors
What do students and residents want from a community-based teaching experience?
To students, preceptor characteristics are the most important factors defining a successful office-based experience. One of the most highly rated teaching characteristics is the preceptor's ability to promote student independence (1). This was accomplished by giving the student increasing patient care responsibility. Other highly favored characteristics is the willingness to allow students to practice technical and problem-solving skills, enthusiasm and interest in students, and the ability to actively involve the student in learning. The willingness of a preceptor to act as a mentor and advise the student is also highly valued (1-3).
Characteristics of the office are of secondary importance to the learner when compared to preceptor characteristics. Valued office characteristics include having a wide mix of different available preceptors, a wide variety of presenting patient problems, and a range of patient ages (1).
The areas providing the most difficulty for students are learning to work within the time constraints of the office setting, performing a focused examination, and learning to rely upon data gathering skills and problem-solving abilities, rather than imaging and laboratory tests (4). Other highly valued educational experiences include discussion of general management issues, diagnosis, and demonstration of physical examination skills (5). Residents value the opportunity to discuss differential diagnosis and management issues, ad appreciate the close supervision, feedback, and to practice and improve clinical and procedural skills (5).
The message from the learners is consistent and clear; they want the opportunity to practice basic data collection and management skills on a wide variety of patients typically seen in the office setting. They desire feedback on their performance and a role model to emulate.
- Biddle WB, Riesenberg LA, Dacy PA. Medical student's perceptions of desirable characteristics of primary care teaching sites. Fam Med 1996;28:629-33.
- Prislin MD, Feighny KM, Stearns JA, et al. What students say about learning and teaching in longitudinal ambulatory primary care clerkships: a multi-institutional study. Acad Med 1998;73:680-87.
- Epstein RM, Cole DR, Gawinski BA, Piotrowski-Lee S, Ruddy NB. How students learn from community-based preceptors. Arch Fam Med 1998;7:149-54.
- Feltovich J, Mast TA, Soler NG. Teaching medical students in ambulatory settings in departments of internal medicine. Acad Med 1989;64:36-41.
- O'Mallery PG, Kroenke K, Ritter J, Dy N, Pangaro L. What learners and teachers value most in ambulatory educational encounters: A prospective, qualitative study. Acad Med 1999;74:186-91.
Associates Council of Northern Illinois
With much enthusiasm, we are excited to introduce to the Illinois Chapter of ACP-ASIM the newly established Associates Council of Illinois. Although it may seem impossible to get any group of house staff to meet regularly while balancing hospital and call responsibilities, the Council has been vigorously organizing itself and establishing short and long-term goals. As you can see, the Council is composed of residents from various programs, from the community based to university sponsored, from the small to the large. This energetic and diverse group of young doctors is forging new and strong partnerships while implementing plans for a proactive and involved Council.
While much of the recent activity has surrounded establishing the necessities, like regular monthly meetings and electing an executive council, members are already involving themselves in ACP-ASIM activities. A contingent of members attended the national meeting in Philadelphia, and two members are applying for positions on the National Associates Council. Several members have also involved themselves in ACP-ASIM issues and talks ranging from national healthcare to physician unions. Plans are also under way concerning Associate member issues from around the state, like house staff representation in their hospitals and continuing medical education. The Council is looking forward to a productive and exciting future.
While the Associates have worked hard and committed themselves to establishing the Illinois ACP-ASIM Associates Council, the Council would not have been possible without your support. At this time the Associates would like to thank three physicians in particular, Dr. Warren Furey, Dr. Anne Dean and Dr. Steven Potts - for without their encouragement and leadership, Illinois would still be without an Associates Council. We look forward to our relationship with Northern Illinois and National ACP-ASIM, and please feel free to contact any of the members listed with questions, advice, opportunities or just introductions.
Dan Dilling, MD - President
Loyola University Medical Center
Laura Harrell, MD - Vice President
Rush-Presbyterian-St. Luke's Medical Center
Oyi Igbokidi, MD - Secretary/Treasurer
West Suburban Hospital and Medical Center
Sheikh Parviz, MD - Membership Enhancement Committee
Mt. Sinai Hospital (Chicago Medical School)
Azhar Majeed, MD
Mercy Hospital and Medical Center
Tom Bleasdale, MD - Liaison to Ad Hoc Committee to Defend Health Care
Rush-Presbyterian-St. Luke's Medical Center
Anne Dean, MD - Council Advisory
Loyola University Medical Center
Keith Burgard, MD
Loyola University Medical Center
Jen Coican, DO
Lutheran General Hospital
Greg Jun, MD
Lutheran General Hospital
Dan Milton, MD
Northwestern University Medical School
Peyman Pahlavan, MD
Christ Hospital and Medical Center
Ramona Pungan, MD
Chicago Medical School
Athe Tsibris, MD
Northwestern University Medical School
The Illinois Ad Hoc Committee to Defend Health Care
The Northern Illinois Chapter of the ACP-ASIM is continuing their support of universal coverage to health care by among other activities, working with the Illinois Ad Hoc Committee To Defend Health Care. It appears that opinion is finally beginning to shift back in favor of reestablishing the primacy of the patient, instead of the marketplace.
The committee is engaged in the following activities:
- Education of our legislators to get their assistance in helping pass the Bernardin Amendment to assure that all residents in Illinois have the right to health care regardless of age, health status, income, and status of employment - eliminating all discrimination.
- Encouragement of grass roots support of the Bernardin Amendment by working with other organizations, churches and synagogues that are committed to achieving the right of health care for all residents of the State of Illinois.
- A report card initiative for the national and local 2000 election candidates to force them to go public regarding their stand on universal health care and the right to health care.
- A questionnaire for Illinois physicians to solicit their thoughts about solutions to achieve universal medical coverage.
- Sponsorship of the Budetti and Waters research project to evaluate the cost of universal health care in the State of Illinois.
- The restatement and commitment of health care professionals to the primary tasks of relieving suffering, prevention and the treatment of illness and promotion of health;
- An understanding that the pursuit of corporate for-profit and personal fortune have no place in caregiving;
- The prohibition of potent financial incentives that reward overcare or undercare and weaken the doctor/patient and nurse/patient bonds;
- The prohibition of business arrangements that allow corporations and employers to control the care of patients;
- The assertion that the patient's right to chose his/her health care professional must not be curtailed or obstructed;
- The assertion that health care must be the right of all.
For more information or if you are interested in helping with this effort contact:
The State of Illinois: The Bernardin Amendment
Representative Mike Boland, East Moline, IL - Chief Sponsor
If approved by the Illinois Legislature and 60% of the voters in Illinois, the Illinois State Constitution would read:
Whereas thousands of working Illinois residents have inadequate or no health insurance, and the number is increasing each year, and the current medical insurance system is costly with too high of a proportion of premium dollars being spent on profits, administration, marketing, and complex claims processing procedures, instead of patient services, and patients increasingly lack choice, have delays in care and worry about the quality of their care, and limited incremental reforms have not changed our structurally flawed system,
Be it resolved that the Bernardin Amendment be adopted.
Such a health care plan should guarantee:
- Access to medical care regardless of age, health status, income, and status of employment - eliminating discrimination based on age, preexisting illness, income, and status of employment.
- Benefits based on medical necessity according to professional medical guidelines instead of a variety of insurance company plans and policies.
- Choice of physicians, allied health professionals and site of care even when changing jobs and plans.
- Delivery system managed by a Health Care Board, that would assure administrative simplicity, quality of care, cost containment and accountability to the patients served.
- Education and research support - essential to the long-term vitality of the United States health care system.
Does the proposed Amendment advocate one type of universal health care system? NO.
The Amendment does not state support for any certain type of universal health care plan. Such a plan could be a mix of public and private sector, some sort of single-payer plan or any other solution that is based on sound principles and meets the requirement of universal health coverage for all residents of the state.
How to help:
- Copy this form and give it to friends.
- If you belong to an organization that could support this Amendment, ask for a written endorsement.
- Contact your state legislators and ask them to support the Amendment. Ask them how they plan to vote when it comes before the Illinois House of Representatives and the Illinois Senate.
- Contact Representative Boland for more information and tell him that you support the Bernardin Amendment.
Representative Mike Boland
605 17th Ave. #2
East Moline, IL 61244
Phone: (309) 752-7171
Fax: (309) 752-7186
John Schneider MD, PhD, FACP
As of April 1, 2000, physicians are no longer required to use triplicate prescription forms when prescribing Schedule 2 controlled substances. Standard prescription forms can be used instead,. However all the information that was required to be entered on the triplicate form (the name and address of the patient and the name, address and DEA number of the practitioner), now must be entered on the standard prescription form. Physicians can still continue to use their old triplicate forms until their supply is exhausted or the expiration date is reached. In the future it will be even more important that physicians maintain tight security over their prescription pads and ideally, avoid having preprinted DEA numbers on them.
Timely Insurance Payments
Legislation, passed in Springfield on December 14, 1999, now requires insurance companies and HMOs pay claims in a timely fashion. Clean claims for health care services must be paid in 30 days. IPA claims would not initially be due for 60 days, but in the year 2001, IPA claims must also be paid in 30 days. In addition, HMOs must make timely capitation payments. Initial capitation payments to physicians must occur within 60 days of the patient's effective enrollment date and monthly then after. Interest is established at a rate of 9% on all late claims and these payments would be automatic. The physician would not need to bill the insurance company or HMO in order to collect. It is important for physicians to recognize that these same conditions should be incorporated in any written contracts they have with insurers, IPAs or HMOs in order to assure that compliance will occur.
Illinois Antitrust Legislation
The Illinois Antitrust legislation, designed to give physicians greater leverage in negotiating managed care contracts is supported by the Illinois State Medical Society. Unless physicians are organized so that they share risk as a group, they cannot negotiate with an HMO or insurer regarding any of the conditions of the contracts which they are being expected to sign when presented to them by the insurer. From the State Medical Society standpoint, this proposed legislation would allow physicians to assure better patient access to service, adequate drug formularies, more workable administrative procedures to aid patients in obtaining necessary and appropriate care and to gain access to needed specialty care. The counter argument from the business community and the insurers is that this proposal is simply a mechanism whereby physicians can increase their revenue. The legislation has received a hearing but is unlikely to proceed during this session. There will be continued efforts to permit physicians to negotiate under very specific conditions with managed care entities in the future.
The State Medical Society continues to work to convince the State to allocate the tobacco settlement funds for health related programs and to increase access to care for states uninsured and underinsured. At the present time much of the discussion in Springfield has to do with setting at least a greater part of the tobacco settlement funds aside as a rainy day fund. Of course, there is also an interest in some groups of attorneys in receiving a portion of the funds on the basis of what they view their contributions to accomplishing the initial settlement with the tobacco industry.
House Bill 4075, which would create and publicize Illinois physician profiles failed to move out of committee. The law, if passed, would require the Illinois Department of Professional Regulations to gather personal and professional background information including medical malpractice verdicts, settlements, arbitration awards, disciplinary records from Illinois and other states and descriptions of revocation or involuntary restriction of hospital privileges for reasons related to competence and character. The Illinois State Medical Society has objected because of concerns about errors, omissions and inaccuracies. There is also concern as to how necessary obtaining this information by the Illinois Department of Professional Regulations would be in meeting patient care needs. As we are all aware, physicians are credentialed by hospitals and by various managed care entities who collect the same information and go one step further in that they assess it in order to make a decision as to whether the physician should be included in their practice panel or on their hospital medical staff.
There a strong interest at a national level in improving coverage for some pharmaceuticals because it represents one of the fastest growing components of health care costs for the elderly. The major difference in proposals is whether to cover only the indigent elderly or provide similar coverage for all Medicare recipients. Interestingly a similar proposal has been made in the Illinois House of Representatives. This bill would require drug companies selling products in Illinois to participate in a program that would provide discounts to seniors. It would involve establishing another bureaucracy with individuals needing to track eligibility and make sure that the invoices were shuffled appropriately between the drug companies and the drug stores where other Medicare individuals would go to obtain their prescriptions. Again, it is unlikely that this bill would pass, however, as you can well imagine with the elections coming up this fall, it has a great deal of appeal to legislators when they go home to seek support from the usually much more likely to vote population, that is individuals over 65.
Universal Health Care Coverage
Unfortunately, at the present time there is not much discussion at the state level or at the national level about substantial changes that would result in the expansion of insurance coverage to the presently increasing population that is uninsured. Proposals were made early on by the various candidates competing for both the Republican and Democratic nominations but as the campaigning has proceeded, health care reform issues have been dropped from the ongoing discussions and debates. Hopefully, there will be more energy in this area between Gore and Bush once they achieve their respective parties' nominations. One would hope and one would certainly feel it appropriate for physicians to question and encourage both of these candidates if they have any interaction at all with them to consider substantial expansion of insurance coverage by whatever mechanism is economically feasible to cover a substantial portion of the presently uninsured population.
New Governor, Northern Illinois Region
Serafino Garella, MD, FACP
Chair, Department of Medicine
Lutheran General Hospital
Professor of Medicine
Chicago Medical School
President and Medical Director
Fellowship Deadline - June 1, 2000
For an Advancement to Fellowship kit, call (800) 523-1546, ext. 2600 or (215) 351-2600. Completed proposal form, curriculum vitae and two sponsors' letters must be in Philadelphia by June 1st.
For more information, contact Nikki Keil, (312) 567-2333, or read the Membership Information section of ACP-ASIM Online.
A Special Thank You
To The Advisory Committee for Northern Illinois ACP-ASIM
ACP-ASIM Legislative Action Center
The ACP-ASIM Legislative Action Center (LAC), may be accessed from ACP-ASIM Online. The LAC allows ACP-ASIM members to view the most current ACP-ASIM Legislative Alerts, find out who your federal legislators are, and send e-mails or faxes to your members of Congress. It also provides you with the status of key legislative issues of concern to the ACP-ASIM, Congress' schedule and tips on communicating with your legislators.
You can access the Legislative Action Center through the "Where We Stand" section of ACP-ASIM Online or by going to the LAC at http://congress.nw.dc.us/acp/. To send a message to Congress, you are prompted for your zip code and are zip-matched to your federal legislators. You will then be asked for your name and address so that congressional offices can identify you as a constituent.
Questions? Please contact Jenn Jenkins, Associates for Grassroots Advocacy at email@example.com.
Connect With Members Through ACP-ASIM'S New Online Directory
Do you need to correspond with a member of the College, but find that you don't have his/her current mailing address? Use Member Connection, the College's new online membership directory, which is accessible to members-only via ACP-ASIM Online. Updated daily, the information in Member Connection is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty.
The Adult Mini Medical Record
A wallet-sized brochure for your patients to keep track of their medical statistics is available. It includes space to record medications, dates of immunizations, test results as well as a listing of risk factors for particular illnesses (e.g. stroke, cancer, etc.)
If you want free copies for your patients, please call (312) 567-2333 and leave your name and address.
A Special Welcome to the New Illinois Council, Illinois ACP-ASIM
Warren Furey, MD, President
David Steward, MD, Vice President
Sara Rusch, MD, Secretary
John Schneider, MD, Treasurer
Serafino Garella, MD, Governor-Elect
Raymond Curry, MD
Gail Clifford-Mullen, MD
Patrick Fahey, MD
James Foody, MD
Stephen Goetter, MD
Ashutosh Gupta, MD
Lawrence Jennings, MD
Patricia Russell, MD
Michael Silver, MD
Sunil Sinha, MD
Vesna Skul, MD
Wayne Williamson, MD
Illinois Carrier Advisory Committee (CAC)
James Sipkins, MD
IL BlueCross BlueShield
End-of-Life Care Advisory Panel
Michael Preodor, MD
William Rhoades, DO