Indiana Chapter

Governor's Newsletter, Summer 2000

GOVERNOR'S COLUMN

I have just attended the Board of Governors' Meeting and Annual Scientific Meeting of the ACP-ASIM in Philadelphia, and wish to share some thoughts with you.

The Board of Governors provides an excellent means for grassroots input to the College. Several resolutions from State chapters were debated and passed for implementation to the Board of Regents (see Rich Kohler's notes about these on pages 6-8.)

I am impressed that the merger of ACP and ASIM has been accomplished with little rancor, and that the new organization is advocating well for the practicing internist, as well as for academia and the public health.

The Decision 2000 initiatives to address the plight of those without health insurance is well underway and is expected to be influential in this year's elections and subsequent legislation. This deserves the support of us all.

The College's Washington Staff continues to address the hassle factors and medical record documentation and coding. (See Bob Doherty's article in the May ACP-ASIM Observer.)

If you encounter hassle factors in your local practice environment with which you need help, let us know. If we cannot help through the State chapter, National ACP-ASIM has resources that can be utilized easily. Call, write, fax, or e-mail me at Ray Dunkin, 3266 North Meridian Street, Indianapolis, IN 46208; Phone: (317) 924-8315; Fax: (317) 924-8324; and e-mail: r_dunkin@pahsvr.com.

As a subspecialist, I found the scientific program provided excellent evidence-based updates in all areas of Internal Medicine and several hands-on skills workshops.

Eight Indiana members were advanced to Fellowship at the impressive Convocation ceremony. They are Scott Saxman now of Silver Springs, MD; Douglas Gillespie of Terre Haute; Michael Econs of Indianapolis; Baikadi A. Ravindra of Kokomo; Jim Heger of Fort Wayne; William Espar of Michigan City; and Mohamed El Mouelhi of Granger.

The Indiana Member and Alumni Reception was well attended by several old friends and many new members and associates.

I encourage all member subspecialists, as well as generalists, to attend our fall Chapter Meeting, October 13-14, 2000 and National Annual Session whenever possible.

Ramon S. Dunkin, MD
Governor, Indiana Chapter

 

VOLUNTEERISM IN PROFESSIONALISM
By Ramon S. Dunkin, MD

As events occur that tend to tarnish physicians' images as professionals, we should recall that part of the definition of a professional is "willingness to provide service without regard to financial reward." ACP-ASIM is placing increasing emphasis on volunteerism in our communities, whether providing medical service or time and effort to other community activities. Volunteer activity enhances the quality of life of our fellow humans, raises our self-esteem and polishes the image of our professions.

 

AWARDS COMMITTEE
By Ramon S. Dunkin, MD

The State Chapter Awards Committee chaired by Cloyd Dye of New Castle, is seeking nominations for the Laureate Award. If you know Fellows of the College who have provided distinguished service to their community, medical education and the College, please let Cloyd know.

 

COMPUTER CORNER
By Cheryle Southern, MD

Hopefully soon (or as soon as I can assimilate a 120 page manual,) the officers will be able to contact you by e-mail to inform you of important legislative issues, chapter and national news. You will be able to subscribe or de-subscribe to our Chapter electronic mail list. An example of information we could provide to you is that in February and March, 2000, ACP-ASIM had a free software download of their lab evaluation software and its manual. We will also be informing you of important elections and committee news and will be asking you to volunteer for various committees. If we don't have your e-mail address, please e-mail it to csouthern@pol.net.

The Indiana Chapter is a beta test unit for our maillist use and hopefully will make this a model for other chapters. Also, hopefully we can use this column to help us all with computer issues with healthcare in Indiana.

 

NEW PRODUCTS FOR YOUNG PHYSICIANS

The Young Physicians Subcommittee (YPS) of the ACP-ASIM was formed just over a year ago to meet the needs of young physicians under the age of 40 and to facilitate their passage from Associateship to Membership. The YPS has developed two new products for young physician - the Young Physician Practice Management Survival Packet and the Evaluation and Management Coding Card.

Aimed at the young physician, who is beginning his/her practice, the Young Physician Practice Management Survival Packet provides information about the resources that the College has to offer the young physician in the early stage of his/her career. In addition, the booklet contains information from a variety of sources that can help you successfully launch a career. The information provided contains references to Internet sites and telephone numbers. It also contains a checklist for getting started.

The Evaluation and Management Coding Card is a laminated, pocket sized sheet designed to help the young physician select appropriate levels of service for history, exam and medical decision making. It presents a great deal of information from a variety of sources in one easy to read card.

If you would like copies of the survival packet and/or coding card, please contact Jean Elliott, Staff Liaison, Young Physicians Subcommittee, at (800) 523-1546, ext. 2692.

 

INDIANA CHAPTER

1999 Indiana Council Member Roster

HEALTH AND PUBLIC POLICY COMMITTEE
 By Caitilin Kelly

The Health and Public Policy committee met about six times last year.

We presented a resolution to the ISMA requesting voting privileges for specialty groups. The ISMA Board of Trustees has referred the resolution to the ISMA Constitution and Bylaws Committee for further research. It will then be re-discussed at the next General Assembly.

We met with Senator Vi Simpson, Representative Mark Kruzan and Representative Peggy Welch to discuss health-related political issues including the tobacco money, access to care and various Medicare and Medicaid rules and regulations - including the recently passed Medicaid disability law.

We have representatives from both the Medicare Advisory Committee and the Medicaid Committee on our HPPC.

We are working to establish a Key Contact Program, a core of physicians who will contact legislators on a timely basis in regard to health care measures being considered by the legislatures at both the state and the national level.

Many paid lobbyists, with lots of money and many ulterior motives, are at work trying to influence these legislators on behalf of the various groups whose interest cannot be assumed to be consistently those of either physicians or patients. Only a few legislators have a strong interest in health-care legislation and are reasonably well informed about such matters, and even these cannot be expected to have the extensive medical knowledge necessary to judge accurately the full nature and impact of all medical legislation.

It is important, therefore, that physicians communicate their own informed opinions to the legislators and supply them with objective, scientific explanations of all the relevant medical facts. We have a professional and moral obligation to do this because the laws now being passed will go far to determine the way medicine will be practiced in the future. We are looking for volunteers for this program, if possible among those physicians who know individual legislators or have special knowledge and/or expertise in legislative matters, but obviously we will welcome anyone who is interested and willing. The more the better, even if some of you infrequently find occasion actually to contact legislators. Whenever relevant medical legislation is being considered you will be notified by e-mail and given all available relevant information.

If you are willing to volunteer for this important work, please notify Carolyn Downing, our Chapter Executive at (317) 261-2060, e-mail: cdowning@ismanet.org, or the National Office.

 

SUMMARY OF SPRING 2000 RESOLUTIONS
On April 12, 2000, the Board of Governors voted on 17 resolutions. Resolutions adopted as presented or amended were:

  • From the Latin American Governors, that the Board of Regents create a working group composed of representatives from the Latin American Governors; the Education Committee and the International Subcommittee to assess the feasibility of developing a mechanism to coordinate a fellowship exchange program between latin American and North American internal medicine physicians; and that the working group report its finding and recommendations to the Board of Governors within a year.
  • From the South Dakota Chapter, that the Board of Regents allocate funds to support attendance at Leadership Day for Chapters demonstrating financial need.

Comment: Leadership Day is an annual activity during which most Chapters send one or more members to Washington, D.C., to visit members of their state's congressional delegation. These members first attend sessions sponsored by the College to prepare them for their role as advocates. The following day, they visit their representatives and senators. Clay Molstad, Frank Byrne, and Eric Milbrandt have represented our Chapter in recent years. The travel, room, and boarding expenses are paid out of Chapter funds. This resolution asks the Board of Regents to instruct the College to pay these expenses for certain needy chapters. Those in most need are the smallest chapters, which typically have the smallest revenues but can also be very effective advocates, especially with their US Senators.

  • From the New Mexico Chapter, that the Board of Regents initiate discussions with the American Board of Internal Medicine to determine if there is a mechanism by which those individuals that complete the MKSAP for two consecutive editions be granted "recertification" by the ABIM.
  • From the Idaho Chapter, that the Board of Regents work with the ABIM to simplify the recertification exam process in internal medicine.
  • From the New Mexico Chapter, that the Board of Regents encourage that all members of the ACP-ASIM make certain that their employees have health insurance coverage. Additional language was added to this resolution asking the College to explore the possibility of developing a health insurance product for members' employees.
  • From the Council of Associates, the internal medicine residents' governing body, that the Board of Regents identifies ways to increase the number of research mentors and increase the amount of protected time for meaningful research for residents and fellows.
  • From the Pennsylvania Chapter, that the Board of Regents condemn the practice of "Big Tobacco" using economic power derived from the ownership of firms and other industries to promote tobacco sales.
  • From the Connecticut Chapter, that the ACP-ASIM update the 1997 policy paper entitled "Reinventing Managed Care: Formularies and Pharmacy Benefit Management" to include policy on limiting bureaucratic hurdles faced by physicians regarding formularies, physician profiling on the basis of prescriptive practices and financial penalties for patients and physicians for noncompliance wit the drug formulary. The resolution further resolves that the Board of Regents continues to exert pressure through public pressure through public education and political consensus to advocate the positions stated in the updated policy paper.
  • From the Connecticut Chapter, that the Board of Regents works with HCFA and Congress to develop legislation that would enable all Medicare patients to receive an annual health maintenance review. The Board of Governors passed this resolution against the advice of
    the Reference Committee.
  • From the Colorado Chapter, that the Board of Regents use its health policy resources to develop (1) a report on the manner and extent that the current health care environment impedes the delivery of quality health care, and (2) a strategic plan to remove those impediments. This resolution was also passed against the advice of the Reference Committee.
  • From the Rhode Island Chapter, that the Board of Regents study alternatives to employer-based insurance as the basis of our health care system, including individual ownership of health insurance.
  • From the North Carolina Chapter, that the Board of Regents reaffirm current ACP-ASIM policy to support one standard credentialing and recredentialing form to be involved in the development of the form.
  • From the Florida Chapter, that the Board of Regents support the development of federal legislation to require that insurance companies allow physicians to selectively choose the specific products in which they will participate without participation in all products. This resolution was introduced to defend physicians against the practice of some insurers that require physicians to participate in inferior insurance product plans in order to participate in the high quality products.
  • From the New York Chapter, that the Board of Regents condemns the practice of requiring submission of medical record documentation for all Level 4 or level 5 Evaluation and Management (E/M) codes. Further, the resolution instructs the Board of Regents to communicate with CIGNA and any other insurer who require submission of medical record documentation for all Level 4 or Level 5 E/M codes that this practice is unacceptable and should be rescinded immediately and to seek, if necessary, governmental intervention to prevent any organization from requiring submission of medical record documentation for all Level 4 or Level 5 E/M codes at the time of submission.

The Board of Governors rejected two resolutions. One, co-sponsored by the New Hampshire and Wisconsin chapters, asked the BOR to request a comprehensive and objective evaluation by the Washington, D.C. staff to measure the effectiveness of Leadership Day (see the second resolution above) in Washington with a report due back to the Board of Governors and the Board of Regents. A majority of the Governors felt that this activity is, in fact, very likely to be effective and that the time and effort needed to conduct the evaluation were not warranted. The second rejected resolution, offered by the Pennsylvania Chapter, and asked the BOR to change the name of ACP-ASIM to the American College of Internal Medicine.

The Board of Governors is an advisory board. Passage of these resolutions does not insure implementation. The Board of Regents must review resolutions adopted by the Board of Governors and decide whether to accept or reject them. In the past, the BOR has accepted over 90% of resolutions adopted by the BOG.

Members and Fellows of the College who wish to review the status of these and previously passed resolutions may do so at www.acponline.org/private/resolutions/, a members-only section of ACP-ASIM Online.

ASSOCIATES COUNCIL
 By Michael Sha

The Indiana Associates Council has been working on several projects for the benefit of our Associate members. The importance of our Physician Volunteer Initiative is demonstrated by our appointment of Grant McDougal as Volunteer Services Chair. Given the success of the September 1999 project, we have renewed the collaboration between ACP-ASIM and Habitat for Humanity. Everyone is welcome to participate.

The Council has also been busy at work on our 2000 Associates Meeting. The program looks exciting. Given last year's terrific response, there will be a repeat appearance by Dr. Morton Tavel and his Heart Sounds Workshop. This year's meeting will also see the launching of the Associate Plenary Session for which we are bring nationally renowned figures from the AMA and the ACP-ASIM. Other aspects of the program include an Update in Infectious Disease, the Business Aspect of Medicine, and an Ophthalmology Workshop. More details to come!

The Associates Council is pushing forward with a Mentorship Program for Medical Students. We are still mid-way through the planning stages with some logistical issues to surmount, but the prospects excite us. We hope to create a Mentorship Program that will benefit our profession, medical students, mentors and the School of Medicine.

Finally, I wish to welcome our new Chair-Elect Christina ("Chris") Ahmadian, a fellow resident at Indiana University. Her enthusiasm and ideas make her well suited to assume the Associate Council Chair position in July. As for me, I will continue serving our Associate members as the Midwest Representative to the National Council of Associates. I hope to use this position to the benefit of all our Associates.

You can contact the Council through the Associate representatives in each of the internal medicine residency programs, or me at mcsha@iupui.edu. As always, we welcome your input.

FROM THE MEMBERSHIP COMMITTEE
By Clay L Molstad, MD, FACP

Some 800 boarded Indiana internists have been sent membership applications by the ACP-ASIM Philadelphia office recently. I ask each current member to do whatever possible to encourage these physicians to complete and send in these forms. Each application requires both a letter of proposal and a letter of secondary support from current members. We will be a much stronger chapter with the inclusion of as many of these physicians who choose to join.

The second item that needs discussion is that there are many Indiana internists who have been members for more than two years, who have been a credit to internal medicine in their professional life and who should be advanced to Fellowship rank. Again, letters of proposal and support are required. There are several criteria for this advancement, but the advancement is usually granted based not upon fulfilling all of the criteria, but by fulfilling some criteria in each category. More information is easily obtained by calling ACP-ASIM at (800) 523-1546 and asking for Membership Services. Internal medicine, because of both the breadth and depth of knowledge required, is one of the most difficult specialties to practice. Several of our members have given far more to their communities and to patients than any reimbursement could recognize. It is time that these physicians are accorded the professional acclaim they deserve as examples for newer members to emulate.

If I can be of help in either of these two endeavors, please e-mail me at clmolstad@aol.com.

 

TIPS FOR PRECEPTORS:
HOW TO ORGANIZE THE AMBULATORY VISIT
By Patrick C. Alguire, MD, FACP, Director, Education and Career Development

Learners, and students in particular, often have trouble deciding how to organize the process of collecting and then presenting patient data. As compared to the hospital environment where time is not a factor, the ambulatory setting presents unique challenges of addressing patient concerns and collecting information in a limited amount of time and solving problems with limited use of technology. Linda Pinsky, MD, has created a useful organizational scheme that is used at the University of Washington. The learner is asked to organize the outpatient visit using the following framework:

What?
Elicit the patients agenda: "What should we talk about today?"

Why?
Elicit the patient's attribution or understanding of the problem: "What do you think is causing
this? What do you think should be done?"

Why?
Identify the most likely hypothesis and supporting data. Be able to answer the probing question,
"What is the supporting evidence?"

What else?
Create a prioritized and weighted differential diagnosis. Be able to answer the probing question
"What is the supporting evidence?" for each of the diagnoses.

What now?
Determine the immediate next steps: "What history, parts of the focused examination, and
test need to be done? What are the treatment options?"

This organizational framework, formatted as a set of instructions and a series of tables for student use, is available in the CBT Clearinghouse, or can be obtained by calling (800) 523-1546, ext 2614. These materials can help a student or first year resident organize an efficient and effective visit wit the patient and construct a concise follow up presentation to the preceptor. We recommend that they be copied and given to the student during the office orientation on the first day of the rotation.

 

ACP-ASIM TEACHING IN THE AMBULATORY SETTING
By Patrick C. Alguire, MD, FACP, Director, Education and Career Development

The College's Community-Based Teaching Program has just released ACP-ASIM Teaching in the Ambulatory Setting. This 20-minute videotape is intended to help office-based physicians responsible for precepting medical students and residents improve their teaching skills. The videotape presents nine different teaching scenes, each illustrating a different teaching strategy or problem. Illustrated in the precepting "microskills," priming and focusing, and providing feedback, as well as examples of common teaching errors. The videotape is accompanied by an 8-page companion text that briefly describes the teaching skill or error being demonstrated.

The videotape was produced by Gary S. Ferenchick, MD, a general internist, who has authored many articles on teaching and teaching improvement, and has designed and directed faculty development workshops for ambulatory-based teachers. Dr. Ferenchick is currently an Associate Professor of Medicine at Michigan State University, the Internal Medicine Clerkship Director, and a faculty member in the Michigan State University Primary Care Faculty Development Fellowship Program.

This videotape program can be used by individual physicians or as part of a faculty development program. To order, call Customer Service at (800) 523-1546 and ask for product number 190400100 (the cost is $24.95 plus shipping and handling.)

MKSAP FOR STUDENTS
By Patrick C. Alguire, MD, FACP
Director, Education and Career Development

The Education and Career Development Department is pleased to announce the release of MKSAP for Students. In creating this product, the College has partnered with the Clerkship Directors in Internal Medicine to create a useful educational tool for 3rd and 4th year medical students. We have chosen to model it after the highly successful Medical Knowledge Self-Assessment Program (MKSAP) for internal medicine physicians. MKSAP for Students consists of a printed collection of nearly 400 patient-centered, self-assessment questions and their answers. The questions begin with a clinical vignette, and the vignettes are organized into 28 different categories that correspond to the Core Medicine Clerkship Curriculum Guide "Training Problems."

The retail price for MKSAP for Students is $32.50, making the publication very competitive against other, lower quality books of this type. It can be purchased at medical school bookstores, or by ordering through the ACP-ASIM Customer Service at (800) 523-1546, ext. 2600.

CONTACT YOUR LEGISLATORS THROUGH THE LEGISLATIVE ACTION CENTER

To make participation in grassroots advocacy easier for its members, ACP-ASIM Established a Legislative Action Center (LAC), which may be accessed from ACP-ASIM Online. The LAC allows you as an ACP-ASIM member 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 ACP-ASIM, Congress' schedule, and tips on communicating with your legislators. ACP-ASIM encourages you to try the LAC by sending an e-mail to your members of Congress in response to the current Legislative Alert posted on the LAC.

You can access the Legislative Action Center through the "Where We Stand" section of ACP-ASIM Online, or by going straight to the LAC. To send a message to Congress, you are prompted for your zipcode and are zip-matched to your federal legislators. You will then be asked for you name and address (so that congressional offices can identify you as a constituent). ACP-ASIM encourages you to send a message based on the sample message posted for you, with your own personal anecdotes added. If you have any questions about the LAC or ACP-ASIM's Key Contact Program, please contact Jenn Jenkins, Associate for Grassroots Advocacy, at jjenkins@acponline.org, or at (800) 338-2746, ext. 4536.

What's New

Contact Information

Indiana Chapter Governor:
Michael C. Sha, MD, FACP

Shelly Symmes
Chapter Administrator
Ph: 317-261-2060
Email: ssymmes@ismanet.org