Tanya L. Repka, MD, FACP
Governor, Minnesota Chapter
The storms of April seem to be upon us. The creeks and rivers are flowing fast and hopefully this newsletter finds you all safe from flooding. The winter was long and hard, perhaps nature's way of telling us Minnesotans not to get too comfortable with mild winters. But with these spring storms come the promise of warmer weather and the ability to get out into the great Minnesota countryside.
The Scientific Program director of this year's Annual Meeting in Atlanta was none other than our Immediate Past Governor, Scott Litin, MD, FACP (Mayo Clinic, Rochester). The Annual Session was a huge success, kudos to Scott. More information on the Annual Session follows.
Our spring Chapter Council meeting will be held soon in Rochester, MN. If you are interested in serving on any of the Chapter's committees, please contact the Chair of that committee.
The College continues to work on behalf of you and your patients. The Washington Office along with College leadership is continuing to work for the enactment of a strong Patient Bill of Rights, prescription drug benefits, reducing the number of the uninsured, and reducing Medicare's red tape and hassles.
The College has also been working with the ABIM on recertification issues. The three broad goals of the College as it entered this dialogue were:
1. The recertification process should be clinically relevant, cost and time-effective, and not redundant of the quality measures that are already being done well in the practice environment of many physicians (such as patient and peer feedback and practice performance improvement).
2. The responsibility of the ABIM in recertification should be limited to evaluation; the education that is a necessary part of every physician's maintenance of competence should be left to those organizations that are skilled in educational program development and delivery.
3. There should be requirements for continuing medical education to assure maintenance of competence. However, there must be flexibility in how this requirement can be met, recognizing that physicians, as adult learners, may have varying but equally effective learning styles.
The revised Internal Medicine Recertification process, now called Continuous Professional Development (CPD) which will take effect in 2005, consists of five modules, a secure examination, and credential verification. The five modules are: 1) self-evaluation module focusing of new medical knowledge, 2) a clinical skills module that must be done on CD-ROM or the Internet, 3) a patient care satisfaction module requiring 10 peers and 25 patients to call a toll free number and answer questions about you, 4 & 5) two practice improvement modules (such as asthma) which consist of 10-15 clinical questions about the diagnosis, a chart review of your asthma patients, a patient questionnaire, and a asthma practice review.
One of the sessions at the Annual Meeting in Atlanta was on CPD. The panel consisted of Dr. Harry Kimball and ABIM Board Members Drs. Naughton and Heather Gantzer (Park Nicollet, Minneapolis). Many of the Governors and Regents of the College were in the audience. At the onset, we were told by Dr. Kimball that the reason we (and our members) were upset about CPD was because we didn't understand it! Drs. Naughton and Gantzer gave a nice review of the components, and at the end there was a "brief" time for questions; and the audience microphone was never empty. It was clear from Dr. Kimball's dismissive answers to the questions raised that there is indeed an understanding problem. However, I believe it lies with the ABIM. We were told that Internists must apply for CPD no later than five years before their certificate expires. If they apply less than five years, they will not be able to recertify on time. Dr. Kimball stated the reason for this is that the modules must be done over time, and not at the last minute, implying that we (Internists) can't manage our own time and that therefore, the ABIM must. There were also multiple questions and comments about the fact that all Internists and their practices are not the same. Some practice in small towns without 10 peers, some do not have primary patients (hospitalists, some academicians/administrators), and some have patients with no access to phones (i.e., prison doctors). Many Internists' practices do not include the types of patients covered in the current patient improvement modules.
The reason cited in a recent Annals for mandatory recertification is that very few Internists chose to do the voluntary recertification. It is interesting to note that none of the ABIM board voluntarily recertified either! The ABIM board members are now required to recertify (even those with non-expiring certificates). The College has formed a Committee that continues to work with ABIM on the above issues and is committed to representing College members' interests. If you have any comments on CPD or are currently completing modules and have comments, please e-mail me and I will forward them to the Committee.
Fall Scientific Meeting
The Annual Scientific meeting will be held at the Airport Marriott again this fall. This hotel is quite close to the Mall of America for all you shoppers! The program will have pertinent updates in subspecialties and will again contain the hands-on modules that were so popular last year.
Please mark the dates of November 3rd and 4th on your calendars now, to ensure that you remember to plan to come to the meeting and arrange coverage if needed.
This year the Council approved moving the date of the Fall Scientific meeting to ensure it did not coincide with opening of deer hunting. However, we were unsuccessful, as the hotel, which had served us admirably for last year's meeting, was already booked. We are currently trying to secure booking for 2002 that will not conflict with opening deer hunting. So attention Deer Hunters! The counsel has heard your comments and we expect to see all of you at the Fall 2002 meeting!
Annual ACP Meeting, Atlanta Style
The ACP Annual Session was held in Atlanta from March 29 through April 1, 2001.
The Annual MN Chapter and Mayo Alumni Reception was held on March 30. This year the North Dakota Chapter was also included as many of the physicians trained in MN and/or have close ties. Hosting the reception was MN Immediate Past Governor Scott Litin, North Dakota Chapter Governor Rolf Paulson, and myself. Chapter members and Mayo alumni stopped by to renew old acquaintances and make new ones.
Our Associate and Medical Student activities were a highlight of the Annual Meeting. Winning abstracts were presented in both the clinical vignette and research categories; all four teaching hospitals had winning Associates finalists present. Below are the Associates and students who are among a select group chosen to present personally at the Annual Meeting. There were 1,312 submissions at the Associate level, and 109 submissions at the student level, only a fraction was chosen to personally present at the Annual Session. The Minnesota Chapter had winners in every category!
Oral Presentations of Winning Abstracts
Kevin A. Bybee, Mayo Clinic
Chris Gibbs, Mayo Clinic
Medical Student Division:
Michael A. Thompson, Mayo Clinic
Associate Research Poster Finalists:
Kevin A. Bybee, Mayo Clinic
Rebecca Chapin, Abbott Northwestern**
Karen F. Mauck, Mayo Clinic
Associate Clinical Vignette Poster Finalists:
W. Houck, Mayo Clinic
Aimee E. Koralesky, Hennepin County Medical Center
Peter Melchert, U of MN**
A.S. Oxentenko, Mayo Clinic
Anne E. Rahman, Mayo Clinic
Medical Student Poster Finalists:
Elizabeth McDonald, Mayo Clinic (Research)**
Alex Cho, U of MN (Clinical Vignette)**
The Convocation of the American College of Physicians- American Society of Internal Medicine is a yearly ceremony whereby the College recognizes and applauds it's new Fellows and the recipients of various honors. It is a ceremony of tradition, transition, renewal and celebration. The first ACP convocation was held is 1916, the year after the College's founding. Convocation is conducted in full academic regalia, a ceremonial form that dates back to the twelfth century. According to current etiquette, only holders of a doctoral degree (MD, PhD, JD, etc.) may have velvet on their gowns and only doctors may wear a gold tassel on the cap. Moreover, the doctor's hood is longer than that of any other degree. Hoods for all degrees are lined with silk in the official colors of the institution conferring the degree. The velvet border on the outside of the hood is also significant; its color indicates the discipline to which the degree pertains. For example, royal purple signifies law. The deep green on medical doctors' hoods comes from the green of herbs - healers in humanity's earliest pharmacopoeia.
This year seven Fellows from the Minnesota Chapter marched in the Convocation ceremony and took the pledge administered by Stephen C. Beuttel, Chair of the Credentials Subcommittee:
Hani S. Al-Khatib, MBBS, FACP, Sartell
Robert O. Berkseth, MD, FACP, Minneapolis
Heather E. Gantzer, MD, FACP, Minneapolis
Lois M. Heaney, MD, FACP, Minnetonka
David E. Midthun, MD, FACP, Rochester
Ashokakumar M. Patel, MD, FACP, Rochester
Christopher J. Sullivan, MD, FACP, St. Paul
Spring Board of Governors Meeting
(held in conjunction with the Annual Meeting)
Recommendations to the Board of Regents
The College's Board of Governors (BOG) voted to recommend that the College re-examine its relationship with the American Board of Internal Medicine (ABIM) with the goal of resolving the current differences between the College and the ABIM. In the meeting's most impassioned debate, several Governors spoke about the College's support for the concept of recertification as long as the process is simplified or reconfigured. The comments of Faith Fitzgerald, MACP (Governor of the Northern California Chapter) echoed the opinions of the majority of Governors when she stated that, "It can't proceed by penalizing young physicians and removing them from time spent with patients." More on recertification and the College's efforts to work with the ABIM will be forthcoming in future newsletters.
A resolution asked that the Regents recommend that the Health and Public Policy Committee develop a position paper on chiropractic scope of practice that could serve as a basis for College advocacy efforts.
Another resolution called on the Regents to charge manufacturers and distributors of influenza vaccine, as well as government agencies, with ensuring that adequate vaccine supplies are available to health care providers prior to distribution to other parties. One Governor remarked, "It seemed like hairstyling boutiques and auto shops were using vaccines as marketing tools, while we couldn't get them for our high risk patients."
ACP Works to Reduce Medicare Hassles
ACP is pleased to announce its endorsement of the "Medicare Education and Regulatory Fairness Act" (MERFA), S. 452/ H.R. 868, which directly addresses internists' concerns with Medicare red tape and hassles.
Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, President-Elect of ACP and a practicing geriatrician.
Dr. Hall represented the College and announced support for this important legislation at a March 7 press conference with the American Medical Association and the American College of Cardiology, as well as MERFA's Senate and House sponsors.
MERFA directly addresses the Medicare procedures and rules that are the source of much frustration with the program. Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies.
Introduced in the Senate by Senators Frank Murkowski (R-AK) and John Kerry (D-MA) and in the House by Representatives Shelley Berkley (D-1-NV) and Pat Toomey (R-15-PA), MERFA would allow physicians and their staff to spend more time treating patients, and less time handling needless paperwork.
It would enact the following reforms:
- Medicare rules and policies and answers to "frequently asked questions" would be made more accessible, and physicians would be given advance notice about changes inrules.
- Medicare would be required to pay claims, without demanding more paperwork, unless there is evidence that the bill is incorrect.
- Medicare would be required to actually examine the records, rather than using a statistical sample, to determine that some claims were billed incorrectly.
- Medicare's ability to investigate fraudulent claims would be preserved, while also educating physicians on how to prevent inadvertent billing mistakes that result in overpayments.
Enactment of MERFA is one of the College's highest priorities. The College strongly encourages you to ask your Senators and Representative to co-sponsor this important bill if they have not already. Illustrate for your legislators your experiences with the burden of complying with regulations, and how much time it takes you and your staff to deal with complex, confusing, duplicative and unfair Medicare requirements.
E-mail, fax or compose a letter to your legislators through the ACP Legislative Action Center at (draft letter provided, please personalize) or call your Senators and Representative toll-free through the ACP Grassroots Hotline at 1-888-218-7770. (The Hotline will prompt you for your 8-digit member number, which you can find on the mailing label of ACP publications, such as Annals of Internal Medicine.) Report your contacts to Jenn Jenkins in the ACP Washington Office at 800-338-2746, ext. 4536, or by blind copying e-mails to firstname.lastname@example.org. Thank you for your help.
The University Needs Our Help
Living in this state, we are all affected by the vitality of the University of Minnesota. From research and inventions, to food safety and an educated workforce, the U impacts us all. This is particularly true for health industries.
The MN Chapter of the ACP recognizes the important role that the University's Academic Health Center plays in the success of our state. With the shortage of pharmacists, nurses, medical technologists, dentists, and even physicians, we rely on a healthy University to meet our future workforce needs. We rely on the Medical School to continue training physicians and specialists for our communities, as well as to translate their research discoveries to the bedside. The University is home to the leading-edge research and innovations that fuel medical technology companies, biotech industries, and pharmaceutical firms in Minnesota - and that's important for our future. In addition, I know each of us wants to maintain access to the unique health care services that the U provides.
If each of our members would contact the legislature and the Governor, we can help ensure the future vitality of the state. We've long been proud of the quality education and health care provided in Minnesota, and we believe Minnesotans want to maintain that quality.
The schools and colleges of the U's academic Health Center prepare nearly 70 percent of the state's health professional workforce. Those are the pharmacists, dentists, physicians, veterinarians, public health professionals and graduate level nurses who improve the health of our communities as well as discover and deliver new treatments and cures. Without a strong University, the Academic Health Center cannot successfully strengthen the vitality of our health industries.
Let your legislators and the Governor know - we want a strong University for the future of our state. For more information on the U's request or to identify your legislators, visit the University of Minnesota web site.
Candidates Elected to ACP Fellowship in January 2000
Congratulations to these very deserving new Fellows:
Thomas C. Gerber, MD, FACP
Lois M. Heaney, MD, FACP
Christopher J. Sullivan, MD, FACP
Jo-Anne van Burik, MD, FACP
Santhi Swaroop Vege, MD, FACP
Fellowship Proposals Due June 1, 2001
Look around you. You have colleagues, sometimes even mentors, who are deserving of the title of Fellow of the ACP who have likely been putting off completing the application. I would like each of you to seek out a member you feel is deserving of Fellowship and urge them to complete the application.
For all of you contemplating advancement to Fellowship, please complete your application, and if you need help with identifying Fellows to write your supporting letters, feel free to contact me or any of the Council members. I look forward to marching with you next year in the Convocation in Philadelphia at the Annual Meeting in April.
The current ACP guidelines acknowledge a range of professional activities that indicate continuing scholarship and professional achievement. You no longer have to publish to qualify for advancement.
If you would like information on advancement to Fellowship or a Fellowship packet, please call the ACP Customer Service Department at 800-523-1546, ext 2600 or 215-351-2600 (9 am to 5 pm EST) or go to www.acponline.org and request a Fellowship application.
Health Policy 2000 Roundup
Mark Liebow, MD, MPH, FACP
Chair, MN Health and Public Policy Committee
The year 2000 featured more talk than action about health policy at both the Federal and state level. While health policy issues were prominent in the presidential election campaign, specific proposals were few and not apparently the issues on which most people voted. At the end of the year, things were not much different than at the end of 1999.
The most controversial and well-publicized issues in 2000 all went unresolved. The Norwood-Dingell Patients' Bill of Rights, which passed the House late in 1999, went to a conference committee to be reconciled with a much weaker bill passed by the Senate and never re-emerged as the conferees could not agree.
This was viewed as a victory for House and Senate Republicans, most of who did not want to see any such bill. Al Gore tried to make a campaign issue out of this failure but was largely blunted by George Bush's assurance that he too was in favor of a Patients' Bill of Rights, though Bush never came out in favor of a specific proposal. The proposal to add a prescription drug benefit for Medicare recipients also foundered over fundamental disagreements about how it should be done. The Republicans took a position that the benefit should only be available to low-income elderly people while Democrats wanted to make it available to all those on Medicare. In addition, the House Republicans passed a bill that depended on subsidized private insurance policies for this benefit which was widely derided as unworkable, in some cases even by the insurance industry. The Senate was never able to pass a bill and so nothing even went to a conference committee. This too became a campaign issue though it was neutralized by both candidates coming out in favor in principle for a drug benefit. More generalized Medicare reform was talked about at length both in Congress and in the campaign, but while proposals were offered in Congress, little action ensued in either House, with most agreeing that this should be put over until after the election. A small glimmer of light at the end of the session was the passage of the Healthcare Fairness Act of 2000 that will help fund research on and efforts toward overcoming racial and ethnic disparities in health care as well as supporting the education of minority professionals.
On the other hand, programs that depended on annual appropriations did well. The National Institutes for Health got a large increase in appropriations as part of the overall goal of doubling its appropriations in a five-year period, while the Agency for Healthcare Research and Quality saw its budget go up to 300 million dollars. The VA saw both its clinical care and research budgets go up nicely even as the Undersecretary for Health in the Department of Veterans Affairs had to step down because he was unable to get the Senate to reconfirm him. Health professional training programs such as Title VII got their first significant increases in several years. Congress passed another bill at session's end giving back to hospitals a bit of the money taken away in the Balanced Budget Act of 1997. It kept the indirect medical education adjustment at 6.5% for the next two fiscal years instead of letting it fall to 5.5%, something which has a substantial impact on teaching hospitals, especially Mayo, the University and Hennepin with their large teaching programs. Also, hospitals are getting almost a full inflation-adjusted rise in the clinical portions of their DRG payments, which hadn't happened in years.
In Minnesota, there was much talk about repealing the "sick tax" but at the end of the session reducing income taxes and giving a broad-based tax rebate won out. A variety of smaller health issues were considered but most did not pass the legislature. Bills to rein in managed care somewhat and to require that managed care utilization decisions be made by physicians licensed in Minnesota failed even with the support of the Attorney General. Fortunately, bills that would have made malpractice litigation against physicians somewhat easier also failed. The University of Minnesota got only a modest increase in funding in the biennium, which set the stage for its request late in 2000 for a large increase to be presented in the current legislative session. Risk adjustment began to phase in into the Medicaid program, though only at 5% in 2000. This was the "short" session of the two-year cycle in Minnesota and the amount of legislation introduced was considered high, though, as usual, the legislature did not take definitive action on much of it. 2001 promises to be a more active session as the odd-year session is traditionally the more policy-oriented session.
We will report on the Minnesota legislative session later this year and review congressional action early in 2002 in this newsletter. If you want more information about Federal or state health policy issues or if you are interested in working with the Chapter's Health and Public Policy Committee, please e-mail me at email@example.com.
June 1, 2001 - Fellowship Applications Due at ACP
July 1, 2001 -Award and Mastership Proposals Due
August 21-22, 2001 - ABIM Cert. Exam in Internal Medicine
November 2-3, 2001 - Minnesota Chapter Scientific Meeting
November 7, 2001 - Subspecialty Recertification Exams
December 1, 2001 - Fellowship Applications Due at ACP
April 11-14, 2002 - ACP Annual Session, Philadelphia
April 3-6, 2003 - ACP Annual Session, San Diego
Minnesota Chapter of ACP Executive Council
Tanya Repka, MD, FACP
Gary Schwartz, MD, FACP
Scientific Program Committee Chair: TBA
Health and Public Policy Committee Chair:
Mark Liebow, MD, FACP
Membership Committee Chair:
Joel Greenwald, MD, FACP
Associate's Committee Chair:
Brad Benson, MD
Medical Student Committee Chair:
Karyn Baum, MD
Women Physician Committee Chair:
Lorre Ochs, MD, FACP
Chair Awards and Nominations Committee:
Scott Litin, MD, FACP
Past ACP Governor
Robert Lohr, MD, FACP
Peter Elkin, MD, FACP
Web Page Coordinator
Edward Rosenow, III, MD,MACP
Past ACP Governor
Bruce Money, MD
Donald Deye, MD
Tim Kleinschmidt, MD
Medical Student Representatives
Joseph Lin, MD
Chief, Resident/Associate Representative
Call for Laureate Award Nominations
At the annual Chapter meeting each year, the Chapter presents the Laureate Award. This award honors those Masters and Fellows of the ACP in Minnesota who have demonstrated, by their example and conduct, a commitment to excellence in medical care, education or research and service to their community and to the ACP.
If you would like to nominate someone please contact Scott Litin, Chair Awards and Nominations Committee or Tanya Repka (see contact info above).