Chapter Newsletter - Summer 1998
From the Northern Illinois Governor . . .
The regional meeting will be on October 23rd and 24th in Springfield. Dave Steward has planned an exciting program for us. Attendance at the regional meeting is a great thing to have on the Advancement to Fellowship application. Dr. Sara E. Walker, MACP, will be the College Representative and Dave Steward, John Schneider, Sarah Walker, President-elect Whitney W. Addington and I look forward to seeing you in Springfield.
The Nominations Committee has selected Serafino Garella, MD, FACP and Patrick Fahey, MD, FACP as candidates for Governor-elect for Northern Illinois. Ballots will be out this fall. Please vote.
Each day is so important and sometimes it is good to reflect upon what we do. This morning I met Arturo's father for the first time. Arturo has been my patient for three years and, before he married and had his son and for reasons that are unimportant now, Arturo contracted HIV and Hepatitis C and Arturo has progressed to AIDS and decompensated cirrhosis and I was with his priest and his wife when we told him his prognosis and when we put him in hospice and I visited him in his father's home where Arturo, his wife and son had the ground level apartment and today Arturo's death is so near and we have made him as comfortable as possible and what a privilege to have shared this life and tried to help. In the ICU I saw a 32 year old woman and agreed Imipenem and Azithromycin would cover her pneumonia and she looked at me through wide rimmed glasses, bald from chemotherapy with metastatic breast cancer in multiple sites but not yet ready to quit and she is younger than my own daughter and it makes me feel so sad and so helpless.
And, the same day I heard from Walt McDonald that Oz had died. Oz is Oscar Edwards, a Regent of the College from Norfolk, VA and one of the people who always made me feel an important part of the college. Because he asked me to, and made me feel I was the only person who could do it, I went to the Tenth National Managed Care Congress in Atlanta to represent the primary care physician in a panel debate on the hospitalist. Oz Edwards was what the ACP ASIM is, well motivated physicians interested in making medicine better for our patients and promoting the camaraderie that goes with being in a profession. Oz died suddenly and many pray for a similar ending. Roger Bone knew his death was coming and in his Taste of Lemonade Trilogy and the Maumee, My Walden Pond, he gave us the wisdom of his suffering as to what things are important . . . taste the lemonade, family and friends and love of God. And Joseph Bernardin in dying told us that after we had fought the fight and done all we could, then to accept death as a friend. We have a profession that lets us into so many lives and lets us share triumphs and sorrows and it is in the discovery and treatment, it is in caring and being a part of lives, it is in study and striving to be as good as we can be and in collegiality and respect that we are a profession and there can still be joy and sorrow and fulfillment in the practice of medicine.
Mark Your Calendar:
April 2-5, 1998 San Diego, ACP-ASIM Annual Session
From our Transitional Governor
Update on National and State Legislation
Patient Protection Legislation
On July 24, 1998, the United States House of Representatives adopted House H.R. 4250. This is in spite of action by ACP-ASIM and your responses to your Congresspersons. The ACP-ASIM, ISMS, AMA supported H.R. 3605 which would have gone further than H.R. 4250 to include:
- All health plans including those who are exempt from state regulation under ERISA be held accountable for decisions that result in death or harm to a patient;
- Provide access to specialty care within a health plan's network of physicians and other health professionals;
- Provide more extensive internal quality improve- ments, and
- Be less restrictive in its requirements relating to the appeal of health plan denials to physicians who are not associated with the health plan.
At the time of my writing this report, it is unknown if Senate may reintroduce these items. The presumption is that the Senate will concur with the legislation passed in the House. At the present time it is assumed that President Clinton will likely veto the bill if passed.
The Illinois legislature, just before agreement, passed amended House Bill 974 reflecting Senate input. However, the Senate could not take action before the end of the session. It is unknown if further action will occur during the November veto session. House Bill 974 includes many of the items passed by the United States House of Representatives as well as items we supported that were not passed. Of particular interest is that there is emphasis on the patients having the right to choose a primary physician who coordinates the care but also allowing patients with chronic conditions access to specialists without continually returning to the primary physicians for approval.
Other action included passage of licensure of Advanced Practice Nurses. This was Senate Bill 1585 and will include nurse practitioners, nurse midwives, and clinical nurse specialists. Absent from the bill is licensure of nurse anesthetists who could not reach agreement with ISMS and the Illinois Society of Anesthesiologists regarding licensure and practice requirements. As has been mentioned before, the key provisions of the bill include that APNs have a masters degree, a collaborative agreement with the physician, and may only provide those services generally provided by the collaborating physician. The collaborating physician may delegate authority to an APN for non-controlled substances and schedule 3, 4, and 5 controlled substances but not schedule 2. Medical direction will be required and a new advanced nursing board of four nurses, three physicians, and two public members will license and discipline APNs.
The final item was the Children's Health Insurance Program that was created by House Bill 705. The Governor has not yet signed this but is anticipated to do so sometime in August. This program expands the coverage of insurance to children under the age of 19 whose household income is more than 133 percent above the federal poverty level up to 185 percent of the federal poverty level. The benefits will be essentially the same as provided under IDPA Medical Assistance Program. Depending upon the income level there will be premiums and co-pays with a limit on co-pays of $100 per family per year. It is clear that the program will require fairly aggressive marketing because the children that would be covered are not otherwise eligible for Public Aid. It is hoped that the Program will thus expand coverage to children who are at the present time otherwise uncovered. There is a component in the plan to subsidize the cost of employer sponsored health insurance when available. These were the major items that were passed by the Illinois legislature this past session.
John F. Schneider, MD, FACP
Health Care Leadership Summit
October 10, 1998
Sponsored by the Illinois Ad Hoc Committee to Defend Health Care
Dr. Arnold Relman, Keynote Speaker
Petition by the People of the State of Illinois
- We believe, as in the words of the late Cardinal Bernardin, that "health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right." We demand that legislation be enacted to make this a reality. We support the "Bernardin Amendment" (Illinois House Bill HJR17) which states that "on or before May 31, 2002, the general assembly by law shall enact a plan for universal health care coverage that permits everyone in Illinois to obtain decent health care on a regular basis.
- We decry the current trend of the bottom line mentality in health care which puts profits ahead of patients' needs. We call for our elected leaders to provide:
- An immediate moratorium on for-profit takeovers of hospitals, insurance plans, HMO's, physician practices, and other health care institutions in Illinois.
- Open broad-based ongoing dialogue on health care reform, not to return to the past, but to invent the new health care delivery system for the future which will emphasize traditional American values of fairness, stewardship, caring, and efficiency.
25th Annual Illinois ACP-ASIM Associates Meeting & Clinical Vignette Competition
Wednesday, October 14, 1998
Alternative Medicine and its interplay with traditional medical care is the theme of this year's scientific meeting. The topic is timely as academic medical centers throughout this country have begun sections devoted to the study of nontraditional forms of health care.
The Annals, as well as the ACP-ASIM Observer have recently published editorials and articles discussing this topic. The goal is to present the evidence so that we can give better counsel to patients . In celebration of our 25th year please join us for a day of outstanding activities including the 25th annual clinical vignette competition. The associates meeting will be capped off by an early evening cocktail reception and private viewing of the Chicago Historical Society museums .
Illinois Chapter on the Internet
The Illinois chapter web site has been operational since March, 1998.
If you have bookmarked the ACP's web site at www.acponline.org, then you can find us through the directory of state chapters. Besides finding announcements about the upcoming annual scientific meeting on October 23 and 24, and the annual associates meeting October 14, you can also refer to previous chapter newsletters.
The web page provides links to Illinois and congressional leaders. We plan to streamline the site, making it more interactive. We want your comments, criticisms, and assistance in creating a web site to serve you, and all ACP members. Send your suggestions, or volunteer your help to Carlotta Rinke, MD at firstname.lastname@example.org.
Join us for a buffet dinner in November
We need you as members and we need to discuss advancement to fellowship. We want to hear your views and be an advocate for your needs. Please send in your name, address and phone for a dinner meeting on Friday, November 6.
Warren W. Furey, MD
2525 South Michigan Avenue
Chicago, IL 60616
Illinois Chapter ACP-ASIM Proposed Resolutions
Presented and discussed at the September 24-26, 1998 Board of Governors Meeting
Returning Universal Health Insurance to the National Agenda
WHEREAS, there are 48 million Americans without health insurance;
WHEREAS, those without insurance have limited access to health care and almost no access to primary, preventive or even secondary care;
WHEREAS, funding for health care for the poor through educational institutions is being restricted and ultimately eliminated; and such institutions are increasingly utilizing their resources for insured patients with decreasing ability to cost shift to pay for the uninsured;
WHEREAS, medical care is being shifted to the outpatient area and there are fewer and fewer facilities willing or able to care for the uninsured;
WHEREAS, even if seen in an outpatient facility, the uninsured find it almost impossible to afford tests or medication;
WHEREAS, an enduring theme of the College has been advocacy for a restructured health system that achieves universal coverage, enhances quality, promotes ethical behavior and restrains cost growth; and
WHEREAS, the Board of Governors have forwarded resolutions virtually annually that call for such advocacy; and
WHEREAS, the College has published compelling position papers on the ill health effects of being uninsured; and
WHEREAS the "Incremental" strategies of the past few years have failed; indeed, the number of uninsured have increased despite a robust economy; therefore,
BE IT RESOLVED that the College marshal its resources to return Universal Health Care to the National Agenda.
Underrepresented Groups in the Medical Field
WHEREAS, African Americans, Hispanic Americans, and Native Americans are underrepresented in the medical profession; and
WHEREAS, diversity within the medical profession contributes to the proper delivery of health care; and
WHEREAS, there are many contributing factors to this underrepresentation, including problems in primary and secondary education and lack of role models and lack of understanding of the great need for their presence; therefore,
BE IT RESOLVED that the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) assume an advocacy positino for improving the underrepre-sentation of African Americans, Hispanic Americans, and Native Americans in the medical profession; and,
BE IT FURTHER RESOLVED that the ACP-ASIM address the many contributing factors, including problems in primary and secondary education and lack of understanding of the great need for these underrepresented groups in the medical profession; and,
BE IT FURTHER RESOLVED that the ACP-ASIM work to increase opportunities for minority groups to enter the medical profession.
Programs to Reduce Morbidity and Mortality Caused by Violence
WHEREAS, the morbidity and mortality from preventable epidemic disorders such as domestic violence and gun violence are major public health issues; and
WHEREAS, prevention is a well established, recognized, effective strategy to improve health; and,
WHEREAS, many physicians in the U.S. wish to be more effective in helping their patients to take advantage of preventive strategies involving these scourges, but do not have current materials, information or training to assist them in carrying out their unique and important duties and responsibilities; therefore,
BE IT RESOLVED that the American College of Physicians-American Society of Internal Medicine use its prestige and experience to lead ongoing programs to assist its membership and the country at large in reducing the toll that these problems of violence extract, by such initiatives as:
- Networking with other organizations to build efficient consortia which can broadly access needs assessment data, as well as educational materials for physicians and the public to use to reduce such events by improving recognition and management;
- Providing educational skills opportunities for our mem- bers so they can better apply strategies that help patients and their communities to deal with these problems;
- Obtaining extramural grants to develop and disseminate programs and methods to prevent and treat these events, and study outcomes of such programs to improve their effectiveness;
- Developing patient materials for dissemination at clinical sites. These should be self-guiding to support physician practices and reduce the time constraints on physicians;
- Proposing data-based educational offerings on these topics for venues such as The Observer, Annals, net sites and governors' newsletters, as well as lay publications;
- Maintaining a roster of speakers on these issues appro- priate for making presentations at medical meetings, on television and radio, and to non-medical groups; and,
- Preparing updates for public policy presentations to local and national legislatures and for other government agencies.
Medical Students: Medical students do not pay membership dues or fees for the annual/local meetings.
Associates: Associates are residents in internal medicine programs. Associates have all the benefits of members except for the right to vote and hold office.
Members: Members are board eligible and board certified internists. Members have the right to vote but do not hold office.
Fellows: Fellows are board certified and may hold office.
There are many ACP members in Illinois who are eligible for advancement or qualify for direct fellowship appointment. A candidate may apply under one or a combination of four pathways.
Basic College Requirements: The candidate must:
- be certified by the American Board of Internal Medicine, College of Physicians and Surgeons of Canada, or the American Osteopathic Board of Internal Medicine;
- have been a member in practice or in an academic position for 2 years;
- have an active medical license if in clinical practice;
- have confined professional activity to internal medicine or subspecialty;
- be proposed and seconded by two Fellows/Masters with reference to character, ethics, and medical activities;
- the proposer and seconder must write detailed letters of support;
- be endorsed by the appropriate College Governor.
Pathway 1: Skill in written medical communication
The Subcommittee considers the following: articles, editorials and abstracts of scientific work published in peer review journals and medical books; published or unpublished case reports or expanded consultations with bibliographic references; letters to the editor; short review articles, written patient educational materials; health care paper presentations and lectures to organizations other than professional and academic societies; quality assurance evaluations; community epidemiologic surveys and reports; and written materials concerning the planning and evaluation of training programs.
Pathway 2: Continuing certification and/or teaching
Recertification, participation in MKSAP with a passing score, certificates of special competence, or subspecialty certification are usually required for this Pathway but by themselves are not adequate. Exceptional candidates with outstanding scholarly and/or teaching and/or community and American College of Physicians activities may qualify even without fulfilling the MKSAP or subspecialty certification or recertification requirement.
Pathway 3: Active membership in the College for at least ten years
Participation in College programs, demonstrated by attendance at the College's Annual Sessions, scientific meetings, postgraduate courses and other meetings sponsored by the College or by universities, medical societies, and other medical organizations. Outstanding candidates who have been Members for less than ten years may qualify by combining Pathways 1 and/or 2 with 3.
Pathway 4: Distinguished professional activity in teaching, patient care, or professional service over many years
This category is designed for senior practitioners. The Subcommittee will give weight to substantial contributions to the professional education of other physicians, medical students, or allied health professionals through teaching, both institutional and community based, scientific presentations, or the organization of scientific or clinical training programs on a continuing basis.
Northern Illinois Advisory Committees July 1998-July 2000
Health and Public Policy
Chair: Serafino Garella, MD
Chair: Lee Francis, MD
Carole Warshaw, MD
James Webster, MD
Health Care Reform/Professionalism
Chair: James Webster, MD
Chair: John Schneider, MD
Chair: Kathy Johnson Neely, MD
Chair: Carlotta Rinke, MD
Chair: Vesna Skul, MD
Wayne Williamson, MD
Thelma Evans, MD
Evelyn Diaz, MD
Ashutosh Gupta, MD
Mark Valliere, MD
Vesna Skul, MD
Chair: Steven Potts, DO
Chief Resident Training Course
Michael Greenberg, MD
Michael Silver, MD
Chair: Ray Curry, MD
Chair: Carlotta Rinke, MD
Carlotta Rinke, MD
Nancy Furey, MD
Chair: Joan Mullan, MD
Chair: Rolf Gunnar, MD
We want your comments, criticisms, and assistance in creating and maintaining this web site to serve you, and all ACP-ASIM members. Send your suggestions, or volunteer your help to Carlotta Rinke, MD at email@example.com.