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Governor's Newsletter, Winter 2002

Joseph G. Weigel, MD, FACP
Governor, Kentucky Chapter

It is hard to believe how quickly time passes. It seems like only yesterday to me that my term as governor of this chapter had begun. As we age, time seems to pass more quickly, and these last 4 years have passed quickly. I do believe that our chapter remains in good shape as David Bybee becomes your new governor, with active programs for associates ongoing, and ongoing efforts to broaden our relationships with medical students at both schools.

Dr. Bybee has been actively involved with this chapter for years. He has served as a long time member of the Governor's council, and as chapter treasurer for the last eight years. He is extremely well qualified to serve as Governor of the chapter, and I believe the chapter can only flourish under his leadership.

I would ask all of you to continue to support both this chapter and the national American College of Physicians-American Society of Internal Medicine. Only in the fashion can the professionalism necessary to internal medicine continue to have a national and local voice.

As you receive this newsletter, the annual Associates meeting in Shakertown is being planned for March 26& 27. Under the continuing leadership of former governor, Cap Hoskins, this informative 2-day session for 2nd year residents at both the University of Louisville and the University of Kentucky provides time for rest, relaxation, and learning. Later this year we hope to continue with the regional meeting held last year in Bowling Green and Pikeville.

Following are some articles that may be of interest to each of you:

Internal Medicine Report Released to Television Stations Nationwide:
The latest installment in the ACP-ASIM "Internal Medicine Report" was released tot he national television media on Tuesday, December 18. The "Internal Medicine Report" is a series of monthly medical and health-related video news stories for television news stations to air nationwide. Topics for the series are selected from issues of Annals of Internal Medicine, ACP-ASIM position papers, public policy and advocacy issues and clinical guidelines.

December's Internal Medicine Report covers findings on Hypertension published in the December 18, 2001, issue of Annals. In one article, new data from a major dietary study found a diet high in fresh fruits and vegetables and low in saturated fats lowered blood pressure, as did a diet low in sodium. The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is rich in fruits, vegetables and low-fat dairy foods and reduced total and saturated fats. The combination of the DASH diet and reduced sodium intake lowered blood pressure more than either alone.

An editorial found in Annals of Internal Medicine says that although therapies have clearer proven clinical benefits in lowering blood pressure than diet, people may benefit from and are unlikely to be harmed by the following advice: Eat fresh fruit and vegetables; don't add salt during cooking or at the table and avoid preprocessed prepared foods.

January's Internal Medicine Report will cover new recommendations by the Third U.S. Preventive Services Task Force (USPSTF) on the use of aspirin for the primary prevention of cardiovascular events. It was released on January 15, 2002.

The Internal Medicine Report is produced by the ACP-ASIM Communications Department and is part of the College's ongoing efforts to raise awareness about internal medicine, internists and ACP-ASIM, thereby enhancing the image, credibility and respectability of ACP-ASIM and Annals of Internal Medicine.

Medicare Regulatory Reform Move Forward in the House:
By unanimous vote, the House of Representatives passed the Medicare Regulatory and Contracting Reform Act of 2001 (H.R. 3391) on December 4, 2001. The College was pleased that the House acted to reform a system that has generated mere than 100,000 pages of regulations governing physicians' treatment of patients, and has urged the Senate to adopt the legislation.

Among its many provisions to ease the regulatory burden and promote fairness for physicians and other providers in dealings with Medicare, the House legislation would limit the use of extrapolation, allow physicians up to five years to return overpayments and require that pilot tests be conducted nationwide prior to implementation of any new evaluation and management documentation guidelines. The bill would also require that any new guidelines increase clinically pertinent documentation and decrease irrelevant paperwork.

The bill also incorporates amendments to the Emergency Medical Treatment and Active Labor Act (EMTALA) requested by ACP-ASIM and the medical associations. Specifically, the amendment would establish an EMTALA task force to review existing EMTALA regulations; require the Secretary to notify providers, physicians and hospitals when an EMTALA investigation is closed; and require peer review prior to terminating a provider from Medicare for an EMTALA violation.

Medicare regulatory reform legislation was also introduced in the Senate in November. Although the issue was not taken up on the Senate floor prior to adjournment, ACP-ASIM will continue to urge the Senate to pass meaningful Medicare regulatory relief legislation in 2002.

See the letter to the Senate Committee on Finance at http://www.acponline.org/hpp/marcia_letter.htm.

Medicare Reimbursements to Fall in 2002

Medicare beneficiaries and providers will soon feel the sting of a 5.4 percent cut in Medicare reimbursements scheduled to take effect on January 1, 2002. Congress failed to vote on the "Medicare Physician Payment fairness Act," legislation that would have reduced the Medicare payment cut, prior to its adjournment on Dec. 20, 2001. The legislation will not be considered until the new year.

Although nearly two-thirds of legislators in both the House and Senate support a fix of the fee schedule cut, the measure fell victim to Congress' unwillingness to provide any additional funding to the Medicare program at this time.

In its report accompanying the Fiscal Year 2002 appropriations bill for the Department of Health and Human Services, Congress expressed concern about the impact of the payment reduction and included language expressing it intent that the Medicare Payment Advisory Committee (MedPAC) study the sustainable growth rate (SGR) formula that ties physician reimbursement to the Gross Domestic Product. Conferees intend for medPAC to examine alternatives that more fully account for changes in the cost of providing physicians' services and report back to Congress by March 1, 2002.

While the 5.4 percent reduction will not be halted to taking effect January 1, 2002, ACP-ASIM will continue to work with Congress to obtain prompt relief from the cut early next year. In addition, the College and its allies will join together with MedPAC, the administration, and Congress to identify a suitable new formula that all agree is needed for future updates to the fee schedule.

Benefits for the Uninsured Considered in Economic Stimulus Packages

Congress and President Bush have acknowledged that the newly unemployed are likely to lose their health insurance in addition to losing their jobs. Multiple proposals are being considered to alleviate this problem. The president has supported grants to state, while member of the House and Senate are considering tax credits or subsidies to pay the cost of premiums to maintain employer-based coverage for the newly unemployed. Such proposals were included in the economic stimulus packages floated by Democrats and Republicans. Unfortunately, Congress adjourned before both sides were able to reach accord.

A new ACP-ASIM policy identities tax credits as a straightforward way to reduce the insurance premiums a person would have to pay, making coverage more affordable for low-income workers. The College cautions that unless the tax credit subsidy is nearly the full amount of the premium, low-income workers will still not be able to afford health insurance premiums.

The College has also recommended a publicly funded defined contribution plan, similar to the Federal Employee Health Benefits Program (FEHBP), for low-income individuals.

College Seeks to Make Drug Formularies More Uniform and Less Restrictive

ACP-ASIM has asked the National Association of Insurance Commissioners (NAIC) to support the establishment of uniform state laws which would ensure that members of health plans are not subjected to restricted drug formularies. There is ample evidence in the medical literature, as well as from physicians' personal experiences, that patients can be harmed, or at least less effectively treated, when drug choices are limited. The reasons for this are many: patients often differ in the response to drugs within a particular class (e.g., having an adverse reaction to one member of the class and not to other member(s) of the same class), one class of drug for treating a condition (when two or more classes exist but are excluded from a particular formulary) may be ineffectual or contraindicated due to a patient's history or potential for harmful interactions with other medications, and generic substitution may not always have the same bio-equivalency and therapeutic effect as brand name medications.

Restricted formularies also harm patients in other critical ways. Financially, patients may be forced to pay for drugs that are crucial to their health but are not covered by their health plans, and continuity of patient care be disrupted if patients are forced to change health plans solely in order to obtain medically necessary medicine not covered by the original health plan.

The letter to the NAIC can be viewed at: (http://www.acponline.org/hpp/uniform_drug.htm).

Governor's Farewell

It has been a privilege to serve as governor for this chapter over the last 4 years. I intend to remain active in, and continue to support the College. I hope you all will also.

—Joseph G. Weigel, MD, FACP