Tanya L. Repka, MD, FACP
Governor, Minnesota Chapter
I am finally settled into my new position and home in the northland. As many of you already know, I moved to Duluth this spring. In March, I began working at St. Luke's Hospital practicing Hematology and Oncology. I grew up in Duluth and attended UMD medical school for my pre-clinical years, so coming back home was very appealing. However, I do miss the grocery stores in the Twin Cities!
The College has been involved in a number of very important advocacy issues this year, from ABIM Recertification (CPD) to health care for the uninsured. Unfortunately, Health care has taken a back seat in the legislature after September 11th, but with elections coming up; expect it to become more of a priority in the next few months. If you are not a "key contact" for the College, please consider becoming one, contacting your legislators before important votes can make a huge difference in the outcome. Go to Advocacy and click on Legislative Action Center.
If you have not visited the College's or our State's website recently you have many pleasant surprises in store for you, as there are pictures from our meetings (MN website) and the College has some very interesting areas. The PIER (Physicians' Information and Education Resource) project is up and running. This is a Web-based decision-support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for clinicians. Information in PIER is presented in a "drill down" formate, in which the user clicks from an opening guidance statement through to more specific information. PIER is a collection of modules divided into five topic areas: Diseases, Screening and Prevention, Complementary and Alternative Medicine, Ethical and Legal Issues and Procedures.
In other State news, David Williams is the Governor-Elect for Minnesota and will take over after Annual Session next year. David will spend this year learning the ropes, but has already taken over many responsibilities and is doing a wonderful job. Also, I expect to see every Deer Hunter who has complained to me in the past about the timing of our fall meeting, at this years meeting in October!
Women's Chapter Update 2002
Lorre Ochs, MD, FACP
The 2002 ACP Women's Group retreat was held 2/9/02 at The Spa at The Marsh. Thirteen women attended the event. In addition to enjoying a day of pampering, everyone appreciated seeing old friends and making new acquaintances. During the lunch meeting several topics were addressed, including encouraging all those who are not fellows to complete their applications for advancement to fellowship. Those in attendance who are fellows offered to write letters of support for those applying. Everyone was encouraged to attend the fall meeting and the women's breakfast, and bring a friend or colleague with. We considered possible names for our group, electing to keep the name American College of Physicians Women (ACPW). A new leader for the women's group will be required beginning next spring, when Dr. Williams takes over as Governor. Volunteers were sought, and Dr. Cynthia Schlick has accepted the position. During the retreat Dr. Schlick also gave a talk on skin care. Our next ACPW event will be the women's breakfast at the fall meeting - all are invited and encouraged to attend.
A Disappointing Year in Health Policy: 2001-2002
Mark Liebow, MD, FACP
Since my last article in the chapter newsletter, there has been more bad news than good in health policy. Little progress has been made on several important issues, Medicare has cut what it pays doctors, and more cuts may happen.
Last year both the House and the Senate passed versions of a patient bill of rights, but there was a crucial difference in the HMO liability provisions between the two bills, so a conference committee needs to reconcile the two bills. Conferees for that committee have not yet been appointed because House and Senate leaders have insisted on sticking to the provision originally passed in each House. If no conference committee is formed the bills will die at the end of the 2002 session.
The events of September 11 distracted lawmakers and administration officials from health policy issues for months. A Medicare regulatory reform bill passed the House unanimously in December, but hasn't yet been considered in the Senate. This bill has been watered down considerably from what was originally proposed (and vigorously supported by the College) but still would be an improvement if passed. The Senate may well approve the House bill or something close to it if the bill ever gets to the Senate floor.
The huge Federal tax cut along with the economic downturn has made anything that requires money from the Federal government hard to get. This has implications for physicians, patients, researchers, and teachers, whether it involves creating new programs, maintaining old programs, or restoring cutbacks. As an example, despite College efforts, there has been no movement on increasing coverage of the uninsured, even as the number of uninsured people begins to rise again.
The biggest hit to physician income happened at the beginning of 2002, when the formula for calculating the Medicare conversion factor that had been good to us when the economy was booming came back to hurt us. The conversion factor is a dollar figure that when multiplied by the relative value for a CPT code gives the amount that will be paid for the service with that CPT code. The formula for calculating the conversion factor is designed to connect the growth in spending for Medicare Part B with overall economic growth. When the economy is going well, the conversion factor can go up faster than inflation, but when the economy isn't good, the conversion factor may go down. This year it went down 5.4%. Attempts to avoid this started last November but didn't go anywhere. It's now very unlikely that anything will be done for 2002, but efforts to fix this problem at least for the next three years are in a bill, which just passed the House. This would be helpful since the conversion factor is predicted to go down for each of the next three years. If this problem is not fixed, it may lead to physicians refusing to see some Medicare patients, since the conversion factor will drop by 28% adjusted for inflation and Medicare fees were already well below private insurance fees, so that physicians may lose money by seeing Medicare patients. Annual updates for other parts of the health care system (e.g. hospitals) are tied to inflation, not the overall performance of the economy.
Teaching hospitals will also take a hit starting in October. A provision in the Balanced Budget Act of 1997 was to cut the indirect medical education adjustment (the amount added to each DRG for a hospitalization of a Medicare beneficiary) by 29% over four years. After half the cut took effect, Congress postponed the rest of the cut for three years, but the other half of the cut is due to take effect in Fiscal Year 2003, which starts October 1. This will cost large teaching hospitals ten to twenty million dollars a year. There are also efforts to avert this cut, but they don't seem promising.
This year has seen a revival of attempts to add a prescription drug benefit to Medicare, as the 2002 elections approach. The House passed a bill, almost exclusively with Republican votes, which would create such a benefit, but most impartial observers feel the mechanism to administer the benefit proposed in the bill is unworkable. Senate Democrats have a different, more generous proposal to be administered by the Centers for Medicare and Medicaid Services (CMS), the new name for HCFA. It's not clear whether the Senate can pass a drug benefit bill or how the bills from the two Houses can be reconciled.
A tight budget means that programs that require annual appropriations from the Federal government may get less than before. The National Institutes of Health will get more money, to complete the promise of doubling the budget over five years. The Veterans' Affairs hospitals' clinical and research programs are getting modest increases, consistent with inflation. However, the Agency for Healthcare Research and Quality (AHRQ) and the Title VII programs for health professional education were cut in the President's budget. President Bush has finally nominated a director for the National Institutes of Health, though directorships for several of the individual institutes remain vacant. He also nominated a Surgeon General to replace David Satcher, MD, whose term expired February 13. However, he still has not nominated a director for the Food and Drug Administration nor for AHRQ, where the directorship became vacant with the untimely death of John Eisenberg, MD, MACP from a brain tumor in March.
The weakening economy doomed any attempt to repeal the "sick tax" in the Minnesota legislature. The 2002 session of the Legislature did not pass much health-related legislation. Governor Ventura vetoed some of the money the Legislature had appropriated for the University of Minnesota medical school in the bonding bill, though he left some projects intact.
While I don't expect the economy to improve dramatically real soon, a number of 2002 elections will be quite close and there may be a way to get those running for office to adopt our points of view on health policy in an attempt to get votes and contributions.
Medical Student Committee Chair Report
Karyn Baum, MD
The Internal Medicine Interest Group (IMIG) at the University had a wonderful year, concluding with a bowling party for medical students, residents, and faculty. It was a good way to relax and spend some time together, and we plan on turning the party into a biennial event. With the completion of the academic year, the reigns of power passed to two new second year medical students, Dave Durnik and David Fermin. Plans are already underway for activities, beginning with the September 6th Activities Fair for first year medical students. At that event, all students who sign up for both the IMIG and ACP will be entered in a raffle for a PDA. Dr. Jonathan Ravdin, the chairman of the Department of Medicine, will choose the winner at random. Also new this year is an effort to join with two other primary care interest groups, the family practice interest group and pediatric interest group, for occasional events. As in the past, we will continue with journal clubs with guest faculty, a research conference for those students interested in working with faculty during the school year, and the Fall golf outing. An exciting year is being planned, thanks to enthusiastic students! (The Next Newsletter will have Mayo Student Activity Update) Winners of Associate Competition Minnesota Chapter ACP Fall 2001 Meeting:
Resident Clinical Vignette Competition
First Prize - Raj Shah, MD, Hennepin County Medical Center
Second Prize - S. Moualla, MD, Mayo Clinic
Third Prize - Salima Mithani, MD, University of Minnesota
Resident Research Competition
First Prize - Ondrej Lisy, MD, Mayo Clinic
Second Prize - Juris Lazovskis, MD, University of Minnesota
Third Prize - Aimee Koralesky, MD, Hennepin County Medical Center
Medical Student Clinical Vignette Competition
Second Prize - Michael Galle, Regions Hospital
Third Prize - Cynthia Brenden, University of Minnesota
Associate (resident) research has been an important part of our Chapter meeting and several of the States Internal Medicine Program Directors attend the Associate component of the State Meeting.
Annual Session- Philadelphia 2002 News
The ACP Annual Session was held in Philadelphia from April 11-14, 2002. The Annual MN Chapter and Mayo Alumni Reception was held on April 12th The North Dakota Chapter was again included as many of the physicians trained in MN and/or have close ties. Hosting the reception were MN Past Governors, Scott Litin, MD, MACP and Edward Rosenow, MD, FACP; the Governor of the North Dakota Chapter, Rolf Paulson, MD, FACP; and myself. Chapter members and Mayo alumni stopped by to renew old acquaintances and make new ones.
Associate activities at the annual meeting were an exciting component of the meeting. Winning abstracts were presented in both the clinical vignette and research categories; all four teaching hospitals had winning associates finalists present.
Oral Presentations of Winning Abstracts:
H. Madueme, Mayo Clinic
Research Poster Finalists:
Cristina Baker, Hennepin County Medical Center
Debra Burgy, Abbott Northwestern Hospital
Ahmad Elesber, Mayo Clinic
J. Hunt, Hennepin County Medical Center
Ondrej Lisy, Mayo Clinic (2 poster presentations)
Blaithnead Murtagh, Mayo Clinic
Amy Oxentenko, Mayo Clinic
Daniel Satran, Hennepin County Medical Center
Clinical Vignette Poster Finalists:
Cara Bondly, Mayo Clinic
TJ Bunch, Mayo Clinic
Michelle Johnson, Hennepin County Medical Center
Grace Dy, Mayo Clinic
Soundos Moualla, Mayo Clinic
Timothy Niewold, Mayo Clinic
Guilherme H. M. Oliveira, Mayo Clnic
Daniel Persky, Mayo Clinic
Raj Shah, Hennepin County Medical Center
Pierre Theuma, Mayo Clinic
This year we also had a Medical Student present a poster at the student competition:
Clinical Vignette - Chitra Kandaswamy, MD, University of Minnesota
Research - Elizabeth McDonald, MD, Mayo Medical School
Each resident winner receives a framed certificate and $750. The student winners had a choice of $300 or books and/or publications from the College, e.g. MKSAP.
Last year, we had 106 clinical vignettes and research posters submitted at the Annual Meeting. Compared to other states with the same amount of resident/student members, the state of Minnesota has the most resident/student abstracts submitted at Annual Meetings by a substantial margin! Congratulations to all of the Program Directors and Colleagues that have worked very hard in encouraging our residents and students to participate.
Convocation - Congratulations to the Fellows from the Minnesota Chapter that marched in the Convocation ceremony and took the pledge administered William J. Hall, MD, FACP, President of the ACP:
Casey R. Caldwell, MD, FACP
Mark G. Costopoulos, MD, FACP
Roger J. Cornetto, MD, FACP
Stephen B. Erickson, MD, FACP
Amit K. Ghosh, MD, FACP
Lorre A. Ochs, MD, FACP
Laxmana M. Godishala, MBBS, FACP
Joel S. Greenwald, MD, FACP
Douglas R. Osmon, MD, FACP
M. Kathryn McCulloch, MD, FACP
Guillermo Pons, MD, FACP
Jay H. Ryu, MD, FACP
Santhi Swaroop Vege, MBBS, FACP
Jo-Anne H. Van Burik, MD, FACP
Robert D. Tiegs, MD, FACP
Peter F. Weissmann, MD, FACP
Masterships Awarded - Masters comprise a small group of highly distinguished physicians, selected from Fellows, who have achieved recognition in medicine by exhibiting pre-eminence in practice or medical research, holding positions of high honor, or making significant contributions to medical science or the art of medicine. Mastership is considered a special class of membership. Currently the College has 412 Masters. This year our immediate Past Governor, Scott Litin, MD, MACP (Mayo Clinic) was awarded a Mastership at the annual meeting.
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! Please mark the dates of October 25th and 26th on your calendars now, to ensure that you remember to plan to come to the meeting and arrange coverage if needed.
Prescription for Safety
(NOTE: There will be a talk given by Heather Thompson on Patient Safety at our Fall Chapter Meeting)
Physicians' handwriting is a source of endless jokes, but illegible orders are no laughing matter. Illegible handwriting on prescriptions takes extra time to interpret, and pharmacist callbacks result in lost time to the practitioner. Tragically, illegible handwriting is a common cause of medical error and has led to patient injury and death. According to a 1997 American Medical Association report, errors related to misread prescriptions were the second most common and expensive malpractice claim over a seven-year period.
To prevent errors, prescriptions should:
- Be legible
- Use the metric system
- Avoid abbreviations and decimals
- Include the medicine's purpose
ACP promotes patient safety through its three-year initiative, Patient Safety: the Other Side of the Quality Equation, supported by a grant from the Agency for Healthcare Research and Quality. To find out more about the College's patient safety program, visit ACP Online, or call Kyle Bartlett, PhD, at 215-351 2838.
New Member Benefit: Online CME Transcripts
The College is pleased to announce a new member benefit: online CME transcripts. ACP members may view and point a transcript of their CME credit earned for participation in activities sponsored by the College. The transcript provides a six year listing and includes credit earned for:
- Annual Session
- Postgraduate Courses
- Chapter/Regional Meetings Accredited by the College (starting November 1999)
- MKSAP and Related MKSAP Enhancements
- MKSAP Audio Companion
- Clinical Problem Solving Cases
- Audio and Video Products
Work is underway to include credit earned for The Medical Laboratory Evaluation Program and the educational component of the ABIM recertification program.
Members can also print documentation of their participation in sessions related to state specific CME requirements. If you have any questions, please contact ACP's Customer Service Department: (800-523-1546 ext. 2600).