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Governor's Newsletter, Spring/Summer 2000

From the Governor's Corner

Reminder

Mark your calendar for the upcoming Chapter Scientific Meeting, to be held in Traverse City, September 21-24, 2000, and chaired by Drs. Kenneth Fisher and Eric Scher. Our goal once again is to make this year the biggest and best ever. As you read this newsletter, you should have received a copy of the preliminary program, including the hotel and registration form. Our meeting this year will begin earlier at 3:00 p.m. and will include: Hands-on experience in EKG's, Chest x-rays, Joints and Skin Biopsies The session on Skin Biopsies will have three continuous sessions with each session accommodating twenty (20) participants. I am sure you will not want to miss the opportunity to attend one or all of these sessions, so work with your Program Director/Chairman to insure that you have the ability to arrive at the resort earlier this year. You won't be disappointed! Other areas of interest will include updates in Hepatitis C, Nephrology, Acute Coronary Syndromes, Type II Diabetes, Depression/Anxiety and Treatment of CHF. Another excellent Medical Student Program is underway. The Chapter received over 375 abstracts for consideration for presentation via the Chapter's web site. I do hope you found the method of submitting your abstract much easier than previous years.

If you have any questions regarding hotel/registration information, please call the Chapter Office at (800) 247-2485 (Michigan Only), or (313) 916-1403.

Annual Session

As a member of the Program Committee for the National Meeting in Philadelphia in April 2000, I can proudly inform you that the meeting was the best to date organized by the College. Attendance-wise, there were plenty of opportunities for learning, teaching and social interaction. I returned from a very busy schedule there and felt again that the College and its leadership are in good hands. Hats off to Philadelphia in not only providing a superb conference, but also showcasing Philadelphia as an excellent convention city!

Since my term as the Governor for the Chapter well expire at the conclusion of the Annual Business Meeting in 2002, it is necessary that a Governor-Elect be elected in 2001. This person will then automatically succeed me in the office of Governor of 2002. I urgently request that you assist our local Nominations Committee, chaired by Dr. Park Willis, in consideration of candidates for another Governor-Elect for our region. Please list your suggestions (each must be a Fellow or Master) and mail directly to Park W. Willis, III, MD, MACP, Div. of Cardiology, Dept. of Medicine, Michigan State University, 1016 Martin Place, Ann Arbor, MI 48104. Letters of recommendation should accompany your submissions. We extended the deadline to July 19. Your reply will be kept confidential.

The following is Article X, Section IV of the ACP-ASIM Bylaws:

Nominations and Election of Governors

"In each region, except the Government Regions, the Governor shall appoint a local nominations committee from among the Masters and Fellows within such Region, which committee shall, prior to any election of a Governor-Elect for such Region, nominate, from among the Masters or Fellows within the Region, two candidates who have agreed to serve if elected, for the position to be filled. The names of such candidates shall be forwarded to the Governors' Subcommittee on Nominations together with such other information as the Governors' Subcommittee on Nominations shall request. The Governors' Subcommittee on Nominations shall be responsible for the technical review and approval of the two can-didates for Governor-Elect of individual Regions, as submitted by the nominations committees of the respective Regions. Notice of the forthcoming election, including the names and pertinent information with respect to the two candidates, shall then be given to the members entitled to vote in the Region by mail or by publication in an official publication of the ACP-ASIM mailed to all members in the Region. Such notice shall include notice of the time within which additional nominations may be made by the members in such Region and the approximate date on which ballots will be mailed to members entitled to vote in the Region.

Additional candidates may be nominated by written petition signed by ten percent of the members from the Region entitled to vote in such election. Such petitions shall be delivered to the Executive Vice-President of the ACP-ASIM within the time set forth in the notice of the election. The election shall then be conducted by mail ballot and all Masters, Fellows and Members in the Region shall be entitled to vote. The candidate receiving a plurality of the votes shall be elected."

Newly Elected Fellows - January 2000

By the confirming of Fellowship, you have been recognized by your peers for your outstanding accomplishments, achievements and expertise in medicine and most importantly, for your contributions to your patients, communities, the College and to those students and physicians who have benefited from your teaching. Fellowship of course does not delineate an end, but is a beginning of a new period of your professional life and offers an opportunity for you to become involved in the leadership of the College, both on the chapter and national level.

Congratulations again and I am sure a number of you will go on to serve on regional-national ACP-ASIM committees and attain leadership positions including Governor for your region.

In my personal contact with many of you, I do know and believe that many of you qualify for advancement to Fellowship and therefore, to refresh your memory and give you some guidelines, the four pathways for advancement are listed on the following page. Please make it a point to join us on Saturday, September 23, at our Chapter Scientific Meeting, as we will have a roundtable discussion regarding advancement to Fellowship.

Pathways to Fellowship

The College has established four Pathways that serve as guidelines to qualify for Fellowship. For each of the following pathways, the candidates must meet the basic requirements listed above.

Pathway 1 - Members must have demonstrated skill in written medical communication.

Pathway 2 - Members must have significant and continuing certification activities and/or teaching (both institutional and community-based), and/or community activities that indicate professional achievement and scholarship; they must have undergone recertification, or they must have participated in the Medical Knowledge Self-Assessment Program (MKSAP) with a passing score. In addition, subspecialty certification or certificates of special competence in adolescent medicine, critical care medicine, clinical cardiac electrophysiology, geriatrics, or sports medicine can qualify a candidate for this pathway, but are not adequate by themselves.

Pathway 3 - Members must have been active members in ACP or ASIM for at least 10 years, with substantial participation in programs and activities, as well as demonstration of other professional accomplishments.

Note: Outstanding candidates who have been active Members for fewer than 10 years may qualify by combining Pathways 1 and/or 2 with Pathway 3.

Pathway 4 - Members must have distinguished professional activity in teaching, patient care or professional service over many years.

Candidates must document each pathway; however, a candidate may be accepted without fulfilling one pathway if his/her work in other pathways is deemed outstanding by the Credentials Committee. For a complete copy of the "Requirements for Advancement from Membership to Fellowship" and/or an advancement proposal, contact your local College Governor, or call ACP-ASIM Customer Service at (800)523-1546, ext. 2600. The requirements can also be found on the College's Web site at www.acponline.org/college/membership/required.htm.

Some Thoughts of Our Members Worthy of Publication

The following letter was addressed to Dr. William J. Hall, FACP, who was the Chair of the National Membership Committee of the ACP-ASIM in July 1999. Dr. John Papp was a member of that Committee. Dr. Hall asked all Committee members to put into writing their thoughts about the Membership Committee's main concern for the following year. The following is Dr. Papp's response in a letter dated July 18, 1999, which is worthy of reprint:

Dear Bill:

As you requested of me at the Membership Committee this past June, I have put what I perceive as the Membership Committee's main concern and perhaps the main concern of the ACP-ASIM, as follows:

• With the doubling of chiropractors by the year 2010;
• With the quadrupling of nurse practitioners and physician assistants in the near future, who are perceived as less costly;
• With the doubling of osteopathic physicians, who are perceived as more cost-effective than conventional doctors;
• With the increasing involvement of pharmacists in clinical care in integrated health systems;
• With the declining number of admissions to hospitals by internists;
• With the declining number of consultations in hospitals by internists because of hospi- talists and in-house physicians;
• Because hospitalists are increasingly caring for patients in Intensive Care Units, the internist is becoming an outpatient physician;
• Because HMO's perceive that physician assistants and nurse practitioners are less costly and seem to be able to address most medical problems effectively;
• Because society seems to see no difference in family practitioners and the internists, the internist is facing an identity crisis as a specialist in adult medicine, and he/she faces significant competition to economically survive.

I believe we need to address how the internist of the year 2000 and beyond will survive with this new competition and change in practice environment. If we fail to meet this challenge, we will have lost significant membership and our reason for being.

I hope that these thoughts are given serious consideration. I am deeply concerned about the internists of the future and our role as the ACP-ASIM in helping the internists survive.

John P. Papp, MD, FACP, MACG

Associates Day Summary

By Michael Zaroukian, MD, PhD, FACP

The 22^nd Annual ACP-ASIM Michigan Associates' Scientific Meeting was held on May 12, 2000, adjacent to the Michigan State University campus, in East Lansing. The meeting was hosted by the MSU Department of Medicine. Michael Zaroukian, MD, PhD, FACP, served as Program Chair and Rose Langhart graciously came out of retirement to use her 23 years of Program Administrator expertise to organize and ensure a successful meeting (thanks, Rose!) A local planning committee of faculty and chief residents assisted in organizing the meeting and providing support during the meeting, making for a very successful day.

The theme of this year's meeting was "Is Teaching Enough? Competency-based Evaluation of Learning," and was highlighted by an inspiring luncheon keynote presentation by Ruth B. Hoppe, MD, FACP, Senior Associate Dean of the MSU College of Human Medicine entitled, "How Can Teaching and Learning Be More Competency-Based?" Dr. Hoppe's presentation was followed by 3 concurrent workshops:

• Evidence-Based Medicine: Assessing Competency in Applying Evidence at the Point of Care (Gary S. Ferenchick, MD, FACP)
• Competency-Based Assessment of History and Physical Examination Skills (Ammar Hatahet, MD, Susan Eggly, PhD)
• Assessing Competency in Presentation Skills (Kenneth Fisher, MD, FACP)

As usual, the morning was filled with outstanding oral paper presentations and poster presentations in research and case report formats. A panel of judges had the difficult task of determining from these excellent pieces of work the top two presentations in each category. The award winners were as follows:

Paper Presentations

First Place (Research) - Lisa J. Kinsey-Callaway, MD

Second Place (Research) - Harriet Young, MD

First Place (Case Report) - Savitha Balaraman, MD

Second Place (Case Report) - Ovidu Niculescu, MD

Poster Presentations

First Place (Research) - Shaheen Islam, MD

First Place (Case Report) - Samuel A. Allen, DO

Second Place (Case Report) - Anitha Rajasekhariaiah, MD

Thanks to all of you who helped make this day a success. We look forward to seeing you again next year and will be hosted by McLaren Hospital in May. Watch for details.

Leadership Day on Capital Hill

By John P. Papp, MD, FACP, MACG

On May 16 and 17, 2000, Drs. Howard Goldberg, Joseph Weiss, Jan Rival and myself attended the ACP-ASIM Leadership Day Conference in Washington, DC. On the afternoon of May 16, we had in-depth briefings on patient safety, the IOM report on Medicare reform and a new prescription drug benefit, and "The Washington Landscape and ACP-ASIM Issues." One-hour workshops on advocacy and working with the media concluded the afternoon session. A very informative and interesting talk by Mr. Charles Cook discussing the Washington climate highlighted the evening dinner for all of us.

On Wednesday morning, May 17, a briefing from Senator James Jeffords (R-VT) occurred. We subsequently all met with Senator Carl Levin's legislative assistant, Laura Stuber. We also met with Senator Abraham and his senior legislative assistant, Robert Carey, Jr. In addition to being most cordial, Senator Abraham was well informed about ACP-ASIM concerns and enthusiastic to have a dialogue with us. Joseph Weiss visited with Representative Lynn Rivers' assistant, Alexander Demots, as well as Representative Sander Levin's assistant, Morna Miller. John Papp visited with Congressman Vernon Ehlers and his assistant, Jodi DeWits, while Howard Goldberg and Joseph Weiss visited with Representative Joe Knollenberg and his legislative assistant Jeffrey Onizuk. We focused our discussions on access to care of the uninsured, patient safety, Medicare drug prescription benefit and the Patient's Bill of Rights.

We all enjoyed our experience on "The Hill" and felt we were able to present the ACP-ASIM position on the above priority issues for the 106^th Congress.

Documentation and Billing When Teaching in the Office Setting

Patrick C. Alguire, MD, FACP, Director, Education and Career Development

Many internists teach students and residents in their office setting. Frequently, these preceptors have questions regarding proper documentation for Medicare billing when a learner is present. Here are some useful guidelines.

Documentation Requirements for a Resident

Current Medicare rules permit a teaching physician (preceptor) to substantiate a bill based on the combination of the resident's and the teaching physician's documentation of a specific service. The teaching physician must clearly convey that he/she saw the patient and participated personally in the patient's care up to the level of the EM services billed. The teaching physician can confirm that he or she verified the findings in the resident's note and agree with findings as documented by the resident. The teaching physician can also indicate that he or she agrees with the diagnosis and plan as written by the resident. These requirements, for the most part, permit a certain amount of time saving by using the resident's documentation as part of your own notes. This will somewhat decrease the overall work associated with teaching by allowing you to receive some "service" for your educational endeavors.

Documentation Requirements for a Student

The only documentation by medical students that may be used by the teaching physician is their review of systems (ROS) and past history, family history, and social history (PFSH). Currently, the teaching physician may not refer to a medical student's documentation of physical examination findings or medical decision making in his or her note. These restrictions will obviously have an impact on office efficiency. However, there are certain strategies that can be used to maximize efficiency in spite of these regulatory requirements. The use of the "wave scheduling" collaborative examinations and presenting in the room are other methods to help manage documentation requirements when a student is present.

For more information regarding these techniques, contact the ACP-ASIM Community-Based Teaching Program at (800) 523-1546, ext. 2845, or e-mail palguire@acponline.org.

ACP-ASIM PAC Decision

BOG Resolution #144 (Nevada, North Carolina and Pennsylvania chapters) called for the establishment of an ACP-ASIM political action committee (PAC). The resolution was approved by the Board of Governors in October 1998 and was subsequently referred to the College's Health and Public Policy Committee and the Ethics and Human Rights Committee. The reports of the two committees were reviewed and discussed by the Board of Regents of ACP-ASIM on February 6, 1999. The Board of Regents, after considering all the information that it received from committees, and after a lengthy discussion, voted to defer making a recommendation to ACP-ASIM Services, Inc. on establishing an ACP-ASIM Services, Inc. PAC for one year. Throughout 1999, the College gathered information from ACP-ASIM members to consider when making a decision about establishing a PAC. Membership feedback was encouraged through Governors' newsletters, Chapter and Regional meetings, and formal discussion by College leadership.

After careful evaluation of member feedback, on January 21, 2000, the Board of Regents of ACP-ASIM voted not to recommend to establish an ACP-ASIM Services, Inc. PAC. The Board of Regents' decision was based on the following reasoning:

• Membership feedback seemed to be mixed. With no apparent membership majority in favor of, or opposed to creating a PAC, it was decided not to establish a PAC at this time.
• The Board recognized the value of the views expressed by those who believe that a PAC could provide greater access to legislators. It concluded, however, that the ACP-ASIM could continue to be effective without a PAC since the College already enjoys ready access to many of the decision-makers on Capitol Hill and is a respected voice in the public policy arena. ACP-ASIM public policy staff is well established in Washington and is active in advising national committees and institutes on matters of public health and policy of importance to internists and their patients.
• The College is aggressively continuing its public policy initiatives. We will continue to fight for legislation that is friendly not only to those of us in the practice of medicine, but to our patients as well.
• The College strongly encourages all members to understand health-related issues on both a state and national level and to get involved with the legislative process. An excellent resource for those who wish to become more active can be found on the College's Web site under "Where We Stand."
• Individual College members are free to donate money directly to candidates who espouse agendas in support of public health.

How the "Doctors For Adults" Campaign Can Work for You

ACP-ASIM's national public relations and ad campaign is reaching literally millions of Americans, telling them an internist is a "Doctor for Adults" Does your community know you are a "Doctor for Adults?" Here are five easy ways to put the campaign to work for you.

1. Introduce Yourself as an Internist

Whether you're a generalist or a subspecialist, take a minute to tell your patients you are an internist and ask them if they know what that means. You might be surprised at their answers, but it's a quick and relaxed way to let patients know who you are - a "Doctor for Adults." One easy way to clear up confusion is to distinguish yourself from general practitioners or family physicians, whose practices may include surgery, obstetrics and pediatrics, and whose training is not solely concentrated on adults.

If you subspecialize, you'll want to explain that you chose additional training to specialize in one of the complex medical areas of interest that come under the internal medicine umbrella. When speaking publicly, publishing or responding to questions from the media, be sure to identify yourself as an internist.

2. Hand Patients a Brochure

Order your free sample copy of the College's "Doctors for Adults" patient brochures. One such brochure, Where We Fit in Today's Primary Care Picture, distinguishes internists from other primary care physicians and tells how we care for the whole patient.

A new brochure, 100 Million Adult Americans Are Overweight and at Risk of Serious Disease, supports the College's 1998-99 national campaign to alert Americans to the risk of overweight/obesity and explains the role of internal medicine. There's space on the back to stamp your name and address - in case your patients' friends or relatives want to see you.

3. Wear Your Badge and Patches

For as little as $2 you can outfit yourself with a badge and 10 iron-on white-coat patches. They will instantly identify you with the national "Doctors for Adults" program, showing your patients - at a glance - who you are. And they might open the door to a quick chat with your patients about what an internist is and does.

Many members are also outfitting their staffs with Campaign Polos or T-shirts to wear on office "casual days." Check out the growing line of "Doctors for Adults" merchandise and educational materials in the ACP-ASIM Observer, or in the 1999 College catalog, Resources for Internists.

4. Enlist Your Staff

Does your office staff know the short answer to the question, "What is an internist?" Tell them about the "Doctors for Adults" campaign and take them through the Where We Fit brochure, so they can easily and accurately engage patients, explaining what distinguishes an internist from the other primary care physicians.

5. Use the Campaign Logo

The "Doctors for Adults" logo is being registered in the name of the College for the exclusive use by members and associate members. The more you utilize it, the more closely you will be linked with our national public education campaign, which is telling literally millions of Americans, "We're Doctors for Adults."

For additional information on the College's "Doctors for Adults" campaign, log on to www.doctorsforadults.com.

Connect with Members Through ACP-ASIM's New Online Directory

Do you want to correspond with a member of the College, but find that you don't have his/her current mailing address? Use Member Connection, the College's new online membership directory, which is accessible to members-only via ACP-ASIM Online.

Updated daily, the information in Member Connection is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty.

Members who wish to be excluded from Member Connection must notify the College in writing. Members can obtain a Directory Exclusion Form on ACP-ASIM Online, or by calling Customer Service at (800) 523-1546, ext. 2600, or (215) 351-2600 (9 a.m. to 5 p.m. EST.)

Kudos to ACP-ASIM's Michigan Chapter for Another Successful Year

A round of applause to the Michigan Chapter for another successful Regional Scientific Meeting during the last fiscal year. Information obtained from the National Office for the 1998-99 Chapter/Regional Scientific Meetings, based on registration data from 54 chapters, reflected that Michigan and New York Downstate each attracted more than 400 attendees - more than any other state. Also, Michigan and New York each attracted over 100 Associates to their meetings.

I am most proud of the Michigan Chapter with the demonstrated active participation by our members and may we continue to grow not only in numbers, but also in our dedication and commitment to our patients of whom we serve. Again, thank you.

I wish you a healthy and peaceful summer season; an abundance of enjoyment for your family and yourself.

See You All In September

2000 Chapter Scientific Meeting

Thursday, September 21 to Sunday, September 24, 2000
Grand Traverse Resort
Traverse City, Michigan

New Fellows Inducted at Annual Session 2000

Congratulations to You All!

New Masters

Edward L. Quinn, MD
Ananda S. Prasad, MD

Let us not forget to include Raymond H. Murray, MD, former Governor, Michigan Chapter (1994-98), who now resides in Indiana. Out of sight, but not out of mind.

Congratulations on this most distinguished honor!

Ways to Contact Your Governor

Write:

Michigan Chapter ACP-ASIM
c/o Henry Ford Hospital
2799 West Grand Blvd.
Detroit, MI 48202

Call:

(800) 247-2485 (MI residents only)
or (313) 876-1403
Fax: (313) 916-1409
E-mail: Jrival1@hfhs.org

Remember, it is very easy to get in touch with us. If you would like to include any of your thoughts in a future Governors newsletter, give us your fax/e-mail address. Also, 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.

Jan Rival, MD, FACP
Governor, Michigan Chapter

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