Governor's Newsletter, Winter 2001-02

Jan Rival, MD, FACP
Governor, Michigan Chapter

From the Governor's Corner...

Annual Scientific Meeting 2001—

The Michigan Chapter Year 2001 Annual Scientific Meeting held September 20-23 was again a huge success with special thanks to our Program Chair, Dr. Eric J. Scher. We are delighted that the total number of physicians, medical students (72), family members and exhibitors in attendance during a most difficult time in our country exceeded 950. I believe that our regional meeting continues the tradition of offering high quality and clinically relevant topics in internal medicine.

The Chapter was pleased to secure as our College Representative, Munsey Wheby, MD, FACP. Dr. Wheby was an active participant in our Town Hall Meeting on Physician Workforce issues entitled "Are there too many of us?", a luncheon panelist on issues addressing Recertification, an oral abstract judge and was very accessible throughout the conference to answer any questions. It certainly made it easy to direct anyone looking for Dr. Wheby as one only had to look for his bow tie. Our invitation and participation of Harold Sox, MD, MACP, the "new" Editor of the Annals of Internal Medicine added the luster and quality of the program with continued annual highlights of "Thieves Market" and "Professors in Action".

I am pleased once again to announce that the Michigan Chapter was recognized for its efforts for meeting the standards determined by the Chapter's Subcommittee in Philadelphia for excellence in chapter management and awarded the ACP-ASIM Chapter Excellence Award. Dr. Wheby presented this award during our Laureate and Recognition Awards Banquet on Saturday evening.

Abstract Submissions—

The Chapter received over 375 abstract submissions for either oral/poster presentation with 325 selected for poster and 24 for oral competition. The first place winners will be sent to Philadelphia by the Chapter in April 2002 and entered into competition. Resident Competition 1st place, $100 and a plaque, 2nd place, $75 and a plaque; 3rd place, $50 and a plaque for a total of 12 awards.

Poster Presentations

First Place Case: Preeti Chandra, William Beaumont
Second Place Case: Kseniya Filippova, Detroit Medical Center
Third Place Case: Hamid Sattar, Wayne State University

First Place Research: Samir Ataya, Henry Ford
Second Place Research: Naveed Aslam, Sinai/Grace
Third Place Research: Arti Bhan, St. John Hospital & Medical Center

Paper Presentations:

First Place Case: Shanthi Marur, Sinai/Grace
Second Place Case: Violeta Botea, Sinai/Grace
Third Place Case: Razuan Chirila, William Beaumont

First Place Research: Michael Donnino, Henry Ford
Second Place Research: Priya Vishnubhotla, Wayne State
Third Place Research: John Sallach, Henry Ford

Governor's Award—

For his tireless effort to help the Michigan Chapter of ACP-ASIM, his resourcefulness and ability to teach and share his knowledge, his proven ability to build a meaningful relationship with physicians, scientists, educators, administrators, and other members of the clinic and healthcare management community, the second recipient of the Governor's Award of the Michigan Chapter was given to Eric J. Scher, MD, FACP.

Laureate Awards

Gilbert B. Bluhm, MD, FACP,
Chair, Awards Committee

The Laureate Award honors those Fellows of the College who have demonstrated by their example and conduct an abiding, commitment excellence in medical care, education, research, and service to their community, their chapter and the American College of Physicians/American Society of Internal Medicine. There were five physicians honored as recipients of the 2001 Laureate Award during the Awards/Banquet on Saturday evening and were Daniel Takeharu Anbe, MD, Leo J. Bingley, MD, H. David Humes, MD, Carl B. Lauter, MD, Louis D. Saravolatz, MD. Congratulations on an honor well deserved.

The Michigan Chapter Awards Committee requests nominees for the 2002 Laureate Award. Nominations for consideration must be received in the Governor's office by February 28, 2002. To guide you in your nomination, the following is the Laureate Award criteria. For your convenience, the last page of this newsletter contains a nomination form for your use.

Criteria for Michigan Chapter ACP-ASIM Laureate Award—

The Laureate Award honors those Fellows of the College who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, research, and/or service to their community, their chapter and the American College of Physicians/American Society of Internal Medicine. It is recognized that all these qualities are not likely to be found in a single individual except rarely and that qualification for the award could be either on the basis of medical care, education or research. An emphasis is placed on the continued participation in College affairs at all levels including attendance at regional meetings, as well as annual meetings of the College. It is expected the awardees will be senior physicians, Fellows for at least 15 years, and will have a long history of professional excellence and peer approval.

Newly Elected Fellows - July 2001

Muhammad Ahsan, MBBS
Mohammed S. Al Ogaily, MBBch
Hoda A. Asmar, MD
Don G. Burke, MD
Nabil Khoury, MD
Changxin Li, MD
Basavaraj I. Mutnal, MD
Majeed A. Paduvana, MD
Devakinanda V. Pasupuleti, MBBS
Kenneth J. Pienta, MD
Ibtihaj Rajoulh, MD
Silverman, Larry J., MD
Stephen J. Smith, MD
Theresa E. Vettese, MD
Pankaj K. Vij, MBBS
Vernon E. Wendt, MD

Board Of Regents Actions

The ACP-ASIM Board of Regents met in Philadelphia October 26-28, 2001. At the fall meeting they took actions on the following items:

2002-2003 President- and Chair-elect Announced—

Mary T. Herald, MD, FACP, our guest and College Representative in 1998, was elected 2002-2003 Chair-elect of the Board of Regents. Dr. Herald is a general internist and endocrinologist in northern New Jersey, and has served on the Board of Regents since 1997. She was governor of the New Jersey Chapter from 1992-1996, and has chaired the College's Health and Public Policy Committee. She will assume office as Chair-elect at the close of the Annual Business Meeting in Philadelphia in 2002.

Munsey S. Wheby, MD, FACP, was nominated as President-elect for the 2002-2003 term. Dr. Wheby is a Professor of Medicine, Senior Associate Dean and Associate Dean for Graduate Medical Education at the University of Virginia School of Medicine in Charlottesville, Virginia. He currently chairs the College's Marketing and Communications Committee and is a member of the Bylaws Committee. He was chair of the Board of Governors from 1999-2000, and was Governor of the Virginia chapter from 1995-1999. He has been a Regent since 2001.

Regents to Seek Governors' Input on Recertification at Spring Meeting—

The Board of Regents carefully reviewed a proposed agreement with ABIM concerning the Continuous Professional Development (CPD) program, but delayed a formal motion until the Board of Governors has had an opportunity to discuss the issue at its spring 2002 meeting. The Governors were originally scheduled to discuss CPD at their fall 2001 meeting in September, which was cancelled due to the events of September 11. In its discussion, the Board of Regents noted that it was encouraged by the changing tone of ongoing discussions with the ABIM, although there remain issues to be resolved, and will continue to explore the situation.

Task Force on Bioterrorism Approved—

The Regents approved the formation of a Task Force on Biological and Chemical Weapons of Terrorism, which will report to the Executive Committee of the Board of Regents. The task force will consist of College Members and Headquarters Staff, with ad hoc consultants representing other organizations and areas of expertise. Patrick Alquire, MD, FACP, will chair the committee. It will be established initially for a one-year period (Nov. 2001-Nov. 2002), and may be extended at the request of the Executive Committee of the Board of Regents.

Other bioterrorism efforts from the College include the continually updated bioterrorism Web site on ACP-ASIM Online (http://www.acponline.org/bioterro/index.html).

Action Taken on Fall 2001 Board of Governor's Resolutions—

Resident Work Hours Position Approved

The Board of Regents approved a position statement on resident work hours developed by the ACP-ASIM Council of Associates (COA). The six-point position holds that:

  1. Safe working conditions for internal medicine residents and fellows is a top priority for the COA.
  2. The COA encourages the ACGME to improve its systems of monitoring and enforcing their current regulations.
  3. The COA believes the medical profession itself needs to be more responsible in monitoring and regulating the working conditions of internal medicine residents and fellows.
  4. The COA fully supports the efforts of other national organizations in addressing and reforming resident work hours.
  5. The COA feels that further systematic study of this issue is needed.
  6. The COA feels strongly that any change in resident and fellow working conditions will require the resident's own involvement at an individual program level in order to overcome current traditions.

Action Taken on Spring 2001 Board of Governor's Resolutions—

The Board of Regents took the following actions on resolutions from the spring 2001 Board of Governors meeting:

  1. "Physician Compensation for Limiting Patient Care is Unethical" (4-S01) resulted in current College policy being reaffirmed in lieu of the resolution (current College policy states, in part, that "All health plans must assume responsibility to assure that financial risk-sharing methods do not lead to compromised patient care…").
  2. A "Revision of HCFA's 'Claims, Filing, Jurisdiction and Development Procedures'" (12-S01) was adopted by the Board of Regents. The resolution calls for staff to meet with HCFA to "simply, revise and update" the noted procedures.
  3. Current College policy was amended to respond to 22-S01, "Orders for Procedures." Revised policy now reads: "ACP-ASIM believes that any effective patient protection legislation must require that physicians, rather than health plans make determinations regarding the medical necessity and appropriateness of tests, procedures, and treatments."
  4. "Reimbursement for Oncology Services" (35-S01) was adopted, with editorial changes. The adopted resolution reads: "…that the Board of Regents support efforts to secure appropriate reimbursement for oncology services."
  5. "Limitation of User Fees" (36-S01) was adopted with editorial changes, and now reads: "…that the Board of Regents oppose the practice of insurance companies charging physicians to participate in insurance panels (user fees) and consider actions, legislative or regulatory, to prohibit such practices."

Position Paper on Medicare Coverage of Prescription Drugs Approved—

The Board of Regents approved a position paper submitted by the HPPC concerning Medicare coverage of prescription drugs. The ten position points include recommendations that prescription drug benefits be provided for those most in need, provided that any benefit be financed in such a way that sustainable, predictable funding is assured and that the solvency of Medicare is not compromised and no other services or benefits are reduced. For more information contact the Public Affairs office at (800-338-2746, ext.4572).

ACP-ASIM Urges Government to Designate Physician Spokesperson

ACP-ASIM sent a letter to President George W. Bush urging him to designate a physician from within the Executive Branch of Government as the principal public spokesperson on bioterrorism. (At the time of this newsletter, the name has not been given).

Extended Implementation Requested for Electronic Transaction Standards - Comments on Medicare Fee Schedule for 2002

In a letter to Thomas A. Scully, Administrator of the Centers for Medicare and Medicaid Services (CMS), the College expressed concern that the Medicare formula for updating payments for physician's services does not fully account for increases in physician practice costs brought on by changes in the healthcare delivery environment and other external events. Improvements to both the Medicare Economic Index (MEI) and the sustainable growth rate (SGR) were requested. The College further recommended that CMS exclude 1999 American Medical Association (AMA) Socioeconomic Monitoring Survey (SMS) survey data from the calculations of Resource Based Practice Expenses (RBPE). The reduced number of surveys and respondents in certain medical subspecialties raises questions as to the validity of the data, as does public awareness during the survey process that the SMS data was used to calculate Medicare payment rates.

CMS was encouraged to continue its examination of physician time data, particularly relative to the number of postoperative hospital visits included in the global surgical period. Support was expressed for the CMS proposal to relax employment requirements for services billed "incident to" the services of physicians or nurse practitioners and physician assistants. ACP-ASIM agrees with the CMS proposal to allow physicians to list performance measure codes on their Medicare bills to facilitate tracking of these services, and the payment of emerging technology codes on a case-by-case basis. However, category III emerging technology codes should sometimes warrant CMS payment and should be assessed using the current CMS process for assessing new technology. CMS should refrain from categorically denying payment just because CPT chose a category III code. Overall, the College appreciates CMS's recognition of these new categories of CPT codes and encourages CMS to continue to actively utilize CPT codes and participate in the CPT process.

The Benefits Improvement and Protection Act (BIPA) 2000 made a substantial number of changes to policies applicable to the Medicare physician fee schedule, which ACP-ASIM supports. ACP-ASIM has specific comments on CMS's proposed implementation of screening colonoscopy coverage and payment, medical nutrition therapy, and telehealth services.

Other ACP-ASIM recommendations to CMS include: reduction of the productivity adjustment for physician services, such as compliance with increased regulatory burdens; refraining from categorically denying payment just because the service is a category III Current Procedural Terminology-Volume 5 (CPT-5) code; updating the clinical staff salary data used to price CPEP inputs for clinical staff time; identification of International Classification of Diseases volume nine codes acceptable for use with the screening flexible sigmoidoscopy G0121 code; and revision of the definition of renal disease as "either chronic renal insufficiency or post-transplant care provided after discharge from the hospital."

Excerpts from ACP-ASIM Environmental Assessment: 2002-2007

  • The shift of patient care from the in-patient to the out-patient setting will continue.
  • Patients will increasingly utilize technology, especially the Internet, to access medical information, communicate with their physician and participate in their medical care There will be concerns regarding the reliability of medical information and quality of medical products found on the Internet.
  • Physicians will need to increase competency in palliative care.
  • Physicians will need to keep abreast of developments in the emerging field of genetic medicine, including its implications for clinical care, public health and prevention, medical research, and the ethics of genetic testing.
  • Physicians will need to improve competency in managing patients with behavioral and psychosocial problems.
  • Physicians, in making clinical decisions, will need to strike a balance between principles of population-based care and maximizing benefit for the individual patient.
  • Complementary and alternative medicine will increasingly play an important role in U.S. health care. Payers will increasingly cover alternative providers and therapies. Physicians will be called on increasingly to know about and help patients manage alternative medicine in their overall health care practices.
  • MCO's will increasingly encourage physicians to use practice guidelines, despite barriers to guideline adherence.
  • In order to compete successfully, the internist will need to utilize management and business practices, possess managed care competencies* and medical information skills, and have an understanding of the population health perspective.
  • The continued expansion of medical knowledge and availability of electronic technologies will require that physicians' increase their awareness and skilled use of electronic technologies in support of patient care and in the management of their practices.
  • Continuing medical education will remain critically important. Traditional sources such as meetings and paper media will continue to be more popular than electronic sources. New program designs will focus on self-direction, interactive and practice-based learning, and the assessment of educational needs and outcomes.
  • Recertification requirements will increase internists' need for continuing professional development programs that support their efforts to recertify.
  • Subspecialists will provide an increasing amount off primary care and may assume more roles in research and chronic-disease management.
  • As members of the "Baby Boom" generation (born 1946-1964) age, the prevalence of chronic disease will increase. The increasing number of patients with one or more chronic diseases will have important implications for clinical management, long term care, education, research, and health care costs.
  • Behavior change programs and community level interventions will become more widely used for health promotion and disease prevention. As a result, the public's expectation that physicians provide patient education and counseling will increase.
  • Members will expect ACP-ASIM to make a leadership role in providing them with information and education about the practice environment.

*Managed care competencies include: communication skills; clinical decision making; clinical epidemiology; biostatistics; public health and community medicine; health promotion and disease prevention; quality assurance in medicine; risk management; medical care cost control; and cost effective medical practice (Association of American Medical Colleges. "Teaching managed care competencies: An initial look at the best practices". Contemporary Issues in Medical Education: December 1997).

Mark your calendar

  • Join the College and be a part of Annual Session 2002 in Philadelphia. Experience over 275 sessions covering the spectrum of internal medicine and the subspecialties. Upholding tradition, ACP-ASIM promises to offer a rich educational experience with an emphasis placed on content that is clinically relevant and practice oriented. Registration and other meeting information is available online. Visit the College website at (http://www.acponline.org) and look for the link to Annual Session.
  • Associates Meeting - The Host for the 2002 Associates Day Conference is the University of Michigan scheduled for Friday, May 17, 2002, Eagle Crest Conference Resort-Marriott, 1275 South Huron Street, Ypsilanti, MI. Please direct your questions to Ms. Sherry Reise, Program Administrator, University of Michigan at 734-936-4385. All Members/Associates/Students are invited however due to the cost of mailing, headquarters will only be mailing the program to Associates and Students.
  • Michigan Chapter Regional Meeting - September 12-15, Grand Traverse Resort, Acme, Michigan.

Just a reminder

It is very easy to get in touch with us. If you would like to include any of your thoughts in a future Governors letter, give us your fax/email address. We need to hear of your concerns/suggestions/proposals. Our door is open to all. If there is something special that you would like me to do, I would be pleased to hear from you. Ways to Contact Your Governor-

Write:
Michigan Chapter ACP/ASIM
C/0 Henry Ford Hospital
2799 West Grand Blvd.
Detroit, MI. 48202
ATT: Room B-1540, K-15

Call: 800-247-2485 (Michigan residents only) or (313) 916-1403
Fax: (313)-916-1409
Email: Jrival1@hfhs.org

Please let me know of your ideas, concerns, and criticisms!

Farewell

In that this will be my final newsletter as Governor of the Michigan Chapter, it is time to thank you. During my tenure, the American medical care has come under considerable criticism in the press, in books, on television and just about everywhere that people gather to talk. This is one of the many reasons to be organized - explain to the public the numerous problems bearing on patient care, on the climate in which we practice, teach and investigate. The College needs you to be organized - and you need the College. It represents a vital synergism bearing on the welfare of our patients.

It was my pleasure and privilege to represent you for the last four years. I did have a good time and made great friends. It was a great learning opportunity. Thanks, Thanks, Thanks.

Peace to All,
Jan Rival, MD, FACP,
Governor, Michigan Chapter ACP-ASIM

What's New

Contact Information

Ruth Hoppe
Governor, Michigan Chapter

Marty Muth
Michigan Chapter Staff
Phone: 517-353-9548
Fax: 517-353-9604