Governor's Newsletter, Winter 1999-2000

Council Members

Richard Kohler, Governor
1001 W. 10th St.
Indianapolis, IN 46202
317-630-6262
Fax 317-630-7522
rkohler@iupui.edu

Ramon Dunkin, Governor-Elect
Indianapolis
At-Large

Robert Rudesill, Treasurer
Indianapolis
At-Large

Frank Byrne, III
Fort Wayne
Northern Indiana

Mary Ciccarelli
Indianapolis
IUSM

Caitilin Kelly
Bloomington
Southern Indiana

Robert Lubitz
Indianapolis
Indianapolis Metro

Eric Milbrandt
Indianapolis
Associate Council

Charles Routh
Muncie
Central Indiana

Cheryle Southern
Indianapolis
At-Large

Message from the Governor

Dear Colleagues,

Today, as I write this note, is the day after our Annual Indiana ACP-ASIM Chapter Meeting. A record number of you attended this year's meeting. By our best reckoning, 136 Chapter members and Fellows and 120 residents attended on Thursday, Friday and/or Saturday. I don't have the feedback for the Saturday sessions, but the attendance for the Friday sessions, was the most positive I have ever seen.

The awards lunch hall was packed to capacity. You honored Cloyd Dye and Dick Schnute with this year's Laureate Awards. Both made acceptance remarks that I found to be heartwarming and rejuvenating; they reminded us once again by word and example that we entered medicine to "do good" and that the honor of doing so is our most precious reward.

About 80 of you attended our Friday evening dinner and social event at the IMAX Theater, many bringing your spouses and children. I greatly enjoyed meeting many of you at the meeting or dinner. I was pleased with the socializing that occurred at the dinner - you were having a good time meeting your fellow internists from other parts of the state. Not everyone stayed for the Saturday morning sessions, but many of you did - about 65 of you by our best count. That too, represents significant growth compared to last year when we reintroduced the Saturday morning component of the meeting. The growth in attendance of our Annual Chapter meetings gives me deep satisfaction, as I presided over the last one during my tenure as Governor. Our Education Committee, chaired by Brad Sutter (Indianapolis), deserves enormous credit for a job well done. His helpers included Bob Lubitz (Indianapolis), who coordinated fund raising and Cheryle Southern (Indianapolis), who coordinated the social events, as well as Ray Knight (Jeffersonville), Jean Rowe (Fort Wayne), and Don Kaye (Goshen), all of whom contributed their ideas and suggestions.

Next year's meeting will be held on October 12 (Associates), 13 and 14, 2000.

We will move the meeting from the Hyatt in downtown Indianapolis to the Marriott on the north side of Indianapolis. We have found working with the Hyatt to be frustrating for the past few years, and some of you have found parking to be a problem. The Education Committee believes that moving the meeting to the city's north side affords some new opportunities. We will give it a try. At any rate, mark October 12-14, 2000 on your calendars as dates to hold open for next year's meeting.

In this issue of the newsletter, I provide you with the results of our state survey on whether the ACP-ASIM should establish a Political Action Committee (PAC), while your Committee chairs update you on their varied activities. Have a warm and toasty winter.

Sincerely,

Richard B. Kohler, MD, FACP

Message from Your Governor-Elect

I am highly honored to have been elected to be your next Governor. I will make every effort to meet your needs and represent you at the national level. Rich Kohler and Cheryle Southern have done an excellent job leading us through the challenging task of merging our Chapter of the ACP and the ISIM. This new organization will have greater resources and opportunities to enhance the education and environment of care for our members and our patients.

In order to accomplish our goals, there will be a greater need for participation by our members. I hope all of you will be willing to volunteer some time to help. If so, please let us know by completing and mailing or faxing the attached form.

Again, thank you for honoring me.

Ray Dunkin, MD, FACP

Indiana PAC Survey Results

Put on your reading glasses and review the results of the survey conducted in the last Indiana Governor's Newsletter. Each choice is shown along with the number of responses and the comments of those who made the choice. A few of you sent responses very late and your input may not have made it into this summary. I have forwarded the survey results to the Board of Regents. The 68 responses represent a small portion of our Chapter members and would not pass the muster for a scientific survey. Nonetheless, it is one more set of data for the Regents to use in their deliberations.

I favor the formation of an ACP-ASIM PAC and would leave the organization if one is not formed - 2/68 [3%].

  • "If we do not have a voice, we will not exist!"
  • "I only endorse a PAC if the $ is not used for campaign contributions. PAC $ should be used for Legislative education, partnerships with patient advocates, not industry."

I favor the formation of an ACP-ASIM PAC, but would not leave the organization if one is not formed - 28/68 [41%].

  • No Comments - 20
  • "PAC's seem to be a necessary evil of present day politics. They aid access to legislators. I understand that almost all other medical organizations have PAC's. I respect Alan Nelson and Bob Dougherty's opinion re/value of PAC's. I have contributed little to PAC's."
  • "ACP-ASIM must maintain the high road of patient advocacy or risk losing credibility with legislators and the public. A PAC focused on patient advocacy above self-interest (economic or otherwise) could enhance our ability to advocate for those we serve."
  • "It's one more way to have an influence. Without it, we leave the influence to others." l "You pretty much have to have a PAC nowadays, if you want to have any measure of success in the political arena. If physicians themselves, do not want to get into the 'dirty' political ring, they should at least pay for a PAC to do it for them."
  • "I think a PAC is mandatory for this organization to adequately address the problems/ challenges facing internal medicine. We need such an organization to deal with managed care and Medicare issues. ASIM had a PAC. Let's not drop the ball!"
  • "A PAC would be of extreme value to the ACP-ASIM. Political involvement is mandatory for today's medical organizations."
  • "I don't like PAC's, but they are a fact of life in the current political scene in Washington. ASIM has had an effective PAC or lobbying effort and needs to be replaced or continued to get ideas of IM across on same level as other groups and to serve as an advocate for patients and physicians alike. Don't muffle or muzzle IM who has always championed quality medicine and patient care and allow other groups less qualified to have their say to legislatures."
  • "All the enemies of the internist have PAC's - insurance, hospital, surgeons, chiro-practors. The ACP has always had the arrogant attitude they were above politics, but the reality is that PAC's are important to the current political process - like it or not. I have been a member of ASIM and ACP for years. ACP has to have a PAC if it is to serve my best professional interests."

I do not favor the formation of an ACP-ASIM PAC and would leave the organization if one is formed - 0/68.

I do not favor the formation of an ACP-ASIM PAC, but would not leave the organization if one is formed - 23/68 [34%].

  • No comments - 18.
  • "Efforts are better utilized by lobbying and personal contact at the state level."
  • "I don't believe they represent the most professional and expeditious method of presenting our opinions."
  • "I am generally opposed to PAC's."
  • "PAC - a useless waste of time and energy. The ACP-ASIM has better things to do."
  • "I find it hard to pay a politician to listen to me and learn how to do things right. I believe I can justify what I say by the benefits to the patient, not to myself. In a pissing contest, internal medicine does not have the excess cash to throw around like a few other specialties, even with our enormous numbers. I do feel that my opinion is not the only one a reasonable person can hold, and I will certainly understand if the decision is different from my preference."

I do not have a strong enough opinion on whether the ACP-ASIM should form a PAC to choose any of the above options - 13/68 [19%].

  • No comments - 10
  • "I have seen IMPAC repeatedly back losing candidates despite my input."
  • "I lean towards favoring it."
  • "How does a PAC specifically help internal medicine MD's apart from the others? What about subspecialists? (rest of comment illegible.)"

None of the statements above suitably describe my opinion. It is stated below - 2/68 [3%].

  • "I would like control (or at least some say) over the activities and agenda of any PAC representing any organization of which I am a member. Without this clearly spelled out, I advocate against it."
  • "ASIM was primarily a financial/political/reimbursement advocate group. ACP was primarily med/scientific/academic based. If we honor both agendas, we probably need to do this, but I do not hugely favor it."

Summary of Committee Activities

Education Committee
Submitted by Brad Sutter, MD, FACP, Chair, Chapter Education Committee

The Y2K Annual Scientific Meeting will be held October 12-14, 2000 (Thursday-Saturday), at the dazzling new Indianapolis Marriott North in the Keystone-at-the-Crossing complex. Given the positive feedback at this year's meeting, the format will likely be similar to this year's very successful meeting. We will consider sponsoring a one-day ACLS recertification program either on Thursday or Saturday; we would like members' feedback on this. The Education Committee will keep you posted of the meeting agenda as we develop it over the next several months. But mark the dates on your calendar.

Health and Public Policy Committee
Submitted by Caitilin Kelly, Chair, Chapter Health and Public Policy Committee

As chair of the Chapter Health and Public Policy Committee, my primary goals are to make the Committee be politically active and to represent the interest of internists and their patients to Medicare, Medicaid, insurance companies and legislators. We want to help get legislation passed that enhances our ability to continue to practice medicine of the highest quality.

We have begun to establish lines of communication with our legislators. In November we met with state representative Peggy Welch and in January, we will meet with Senator Vi Simpson. We can give these people our opinions, which is useful, but what we really want to do is give them your opinions.

We are exploring how we can best work with the Indiana State Medical Association. This fall we introduced a resolution to the ISMA House of Delegates requesting voting privileges for medical specialty organizations. The resolution was generally well received but was referred to the trustees for further discussion. Two points, in particular, needed further clarification. Which organizations should have voting privileges and how many votes should each organization have. These points will be clarified, and the resolution will be submitted again next year.

We will be very happy to discuss any issues or problems you want to bring to the Committee, problems you are having in your practice - with Medicare or Medicaid, for example - or more general concerns in regard to your community or the country at large. The ACP-ASIM maintains a national Health and Public Policy Network where we can post questions for every Health and Public Policy Committee member in the country. It may be that a problem we are experiencing in Indiana today was a problem in New York or Arkansas last year, and so someone from one of those states can help us work out a solution.

Please contact me with your concerns. You can reach me at (812) 333-2800 or e-mail me at cakelly@indiana.edu.

Medicare Carrier Advisory Committee
Submitted by Linda Abels, MD, Chair, Medical Services Subcommittee

The Carrier Advisory Committee (CAC) was established in 1992 in an effort to enhance trust in the relationship between physicians and the Medicare carriers. Initially called the "Gary Committee," it evolved from the Advisory Committee on Medicare-Physician Relationships. It was formed to foster greater physician involvement in generating Medicare policies at the central office and carrier level. Its goal is for physicians, carriers and peer review organizations to work together for the best interest of the beneficiaries. The Gary Committee suggested that the Advisory Committee be comprised of members appointed by the carrier and state medical associations and include medical specialties and other professional medical associations. It was to meet quarterly to review newly proposed Medicare policies and policy changes as required by the Health Care Financing Administration (HCFA). Similar recommendations were made by ASIM in 1990 in a paper, "The Hassle Factor: America's Health Care System Strangling in Red Tape." This was adopted by HCFA and resulted in the Carrier Advisory Committee.

The Committee provides a formal mechanism for physicians to be informed of and participate in the development of local medical review policies in an advisory capacity. It is also supposed to provide a mechanism to discuss and improve administrative policies. Currently the CAC is composed of MD's, DO's, dentists, chiropractors, podiatrists and optometrists.

You may want to become involved with peer review of Medicare claims - volunteers are needed. See page 11 of this newsletter.

Membership Committee
Submitted by Clay Molstad, MD, FACP, Chair, Chapter Membership Committee

We need your help. The Chapter has not reached some 800 Indiana internists, and we would like your help in identifying these people, so that we can talk to them about the value of becoming members. I would like briefly to reinforce your decision to remain a member of the ACP-ASIM and to give you some information to share with non-member colleagues.

Since the merger of the ACP and the ASIM, Internal Medicine now speaks with one voice. Our membership is approximately half subspecialists and half general internists. Some potential members might feel they are better represented by subspecialty organizations. In some instances that feeling is correct. However, the ACP-ASIM works very closely with subspecialty societies; and the resources for educational effort, advocacy and coordination among internal medicine concerns simply cannot be duplicated by any other organization. Our national membership is now surpassed only by the AMA itself. I advocate membership in as many of these professional societies as is possible, but remain convinced that the value of membership in ACP-ASIM is unequaled in the profession.

Strenuous efforts are expended nationally and locally to represent the concerns of general and subspecialty internists with Congress, executive agencies, patient organizations, insurers and other professional groups. There have been extensive ongoing efforts to improve documentation guidelines, national Medicare payment policies and state Medicare carrier decisions. The Chapter leadership is aided by Committees that need your expertise and time. We must continue to identify those in the Chapter with talents for teaching, managing and advocating to fill positions within these Committees. These people should come from all over the state, to assure continuing balance and fair consideration of regional concerns.

Last week's Chapter meeting, the MKSAP series and the yearly Annual Session are examples of the unrivaled talent of both state and national ACP-ASIM in continuing medical education. Our organization is very much the richer for membership of world-famous educators on both national and state levels.

Many internists are too busy with family, community, religion and other activities to become active in the ACP-ASIM at this time. As their lives change, they may develop interests in Chapter or national activities. In the mean time, the membership and support of those acting in their interests is absolutely critical.

My e-mail is clmolstad@aol.com. Please let me know how I can help you in these discussions with colleagues who ought to be, but are not, ACP-ASIM members.

Chapter Web Site
Submitted by Cheryle Southern, MD, Immediate Past President, ISIM

In order to serve your professional needs better, we have updated our Web page. You can now send e-mails from the Web page to Chapter officers and committee chairs to let us know what you are thinking on various issues. To get to the Chapter Web site, go to ACP-ASIM Online. When you arrive, look on the left side of the screen and click on "About ACP-ASIM." At that site, find "Chapter Web Pages," then "Indiana." If you want to send an e-mail to a council member or committee chair, select the appropriate listing, then click on the e-mail address of the individual with whom you wish to correspond. A blank e-mail screen will pop up, and you can enter and send your message.

You can also find information regarding state legislative activity. Back on the Indiana Chapter home page, click on "The Indiana General Assembly." On that page, select "Session Information," then "Bills" (not "Bill Watch"). Two useful choices on that page are "Complete Information on Bills" or "List of 'Live' Information for Bills." For example, at the time I write this article, there are 52 bills listed for the House and 150 for the Senate. The Senate bills include:

  • SB001 - Blood and Breath Alcohol Concentration Tests
  • SB0013 - Family and Social Services
  • SB0032 - Insurer Practice and Victims of Abuse
  • SB0037 - Firearms and Weapons in Schools
  • SB0045 - Legal Actions Involving Firearms
  • SB0079 - Medicaid Definition of Disabilities
  • SB00108 - Distribution of Tobacco Settlement Funds

Our Chapter Web page also includes a link to the page of the Indiana State Medical Association. There, for example, you can read ISMA Medicare/Medicaid Committee reports.

If there are other enhancement ideas you have to suggest for our Web site, please do so. You can find my e-mail address there if you would like to share your ideas with me.

Summary of Resolutions Passed at the Fall, 1999, Board of Governors Meeting

The Board of Governor's recommended to the Board of Regents that three resolutions be implemented and a fourth be referred for further study.

Resolution 3-F99 resolved that the ACP-ASIM solicit reports from the various states on the effectiveness of their efforts to address tort reform and that the College should periodically prepare a report making this information available to Chapters and Regions. The Board of Regents approved the resolution and forwarded it to the Health and Public Policy Committee for implementation.

Resolution 4-F99 recommended changes in the ACP-ASIM's CME Chapter meeting accreditation process and this will not affect our Chapter.

Resolution 6-F99 resolved that the ACP-ASIM advocate that a direct physician patient relationship remains inviolate and that the use of the Internet for prescribing should facilitate, not circumvent that relationship. The resolution further charges the ACP-ASIM to advocate that Internet prescribing should be used only in the context of an established physician-patient relationship. The Board of Regents also approved this resolution and forwarded it to the Health and Public Policy for implementation.

Resolution 1-F99 dealt with recertification. The focus of the resolution was that failure to seek or achieve recertification should not jeopardize a physician's present or future employment. The resolution was not approved as proposed, but the Board of Governors felt the issue raised was important and recommended that it be studied by the Education Committee. The Board of Regents concurred.

A resolution recommending that the ACP-ASIM advocate for campaign finance reform was not adopted. The sponsor withdrew another resolution dealing with Chapter dues because an appropriate Committee was already addressing the issue.

Indiana Associates' Activities

Submitted by Michael Sha, Chair, Chapter Associates Council

The Indiana Associates Council has been working hard on the behalf of our ACP-ASIM Associate members. One of the important duties of the Council is the Annual Associates' Scientific Meeting, held this past November 18th. The meeting was a great success and built on the achievements of our past conferences. We are grateful to have had the participation of the likes of Drs. Morton Tavel, Larry Einhorn, Mahendr Kochar, Ed Fry, Dave Harsha, Alan Berkovitz, Tony Chang, Deborah Armstrong and Steve Wolverton. The Council looks forward to making the 2000 Associates' Meeting even more interesting and exciting.

The Council is also pursuing other projects. The Physician Volunteer Initiative seeks to encourage physicians at all levels of training to participate in their community. September 1999 marked a collaborative project between the Indiana ACP-ASIM Chapter and Habitat for Humanity. The project generated so much interest that we're planning another project in Spring 2000. The Council is also promoting the support of the free medical clinics around the state. Another important initiative concerns medical students. Both the Chapter and the Associates Council are working to establish a working relationship with the Internal Medicine Student Interest Group (IMSIG). By encouraging medical student membership and improving medical skills and knowledge, we hope to help in the development of the next generation of skilled internists.

We welcome your inquiries and can be contacted through the representatives in each of the internal medicine residency programs. The next meeting of the Associates Council is Thursday, January 13, 2000, at 6 p.m.

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