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Governor's Newsletter

Summer 1998

Edited by:
Scott C. Litin, M.D., F.A.C.P.
Governor, Minnesota Chapter ACP

Minnesota Highlights
American College of Physicians 79th Annual Session San Diego - 1998

Edward C. Rosenow, III, M.D., M.A.C.P. Receives Mastership

Congratulations go out to Ed Rosenow who deservingly received a mastership at the Spring San Diego ACP Meeting. Throughout his illustrious career, Ed has garnered essentially every significant honor and award that the Mayo Clinic has ever offered a clinician and educator. He served as former ACP Governor for the Minnesota Chapter where proportionally he advanced more candidates to fellowship than any other governor before or since. He has also been honored as a Laureate of the Minnesota ACP Chapter. Our good wishes go out to Ed for achieving this highest career honor that the ACP can bestow on one of its leaders.

The following posters of Minnesota Chapter Associates and Medical Students were displayed in San Diego.

Acute Pancreatitis: An Infrequently Considered Complication of Campylobacter Jejuni Enterocolitis. Harini Chakkera, M.D. (Associate); David Williams, M.D. (Fellow). HCMC, Minneapolis, MN.

Induction of Tissue Factor Procoagulant Activity in HL-60 Cells Inoculated by the Agent of Human Granulocytic Ehrlichiosis. R. Behl (Associate), M. B. Klein, L. A. Dandelet, R. R. Bach, J. L. Goodman, N. S. Key. University of Minnesota Medical School and VA Medical Center, Minneapolis, MN.

Physical Findings Rounds (PFR): A Preliminary Report of an Activity to Improve Clinical Skills in Internal Medicine (IM) Residents. V. M. Montori, M.D. (Associate), Mayo Foundation, Rochester, MN.

Transjugular Intrahepatic Portosystemic Shunts (TIPS) Do Not Result in Decreased Spleen Size or Increased Platelets in Long Term Survivors. Sul, J. (Associate); Fredstrom, S.; Rank, J.; Department of Medicine, University of Minnesota, Minneapolis, MN.

Diffuse Intrathoracic Lymphadenopathy Resulting in Pulmonary Artery Branch Compression Mimicking Pulmonary Embolism. K. Kimura, M.D. (Associate); P. B. Johnston, M.D., Ph.D.; and C. H. Rohren, M.D., Mayo Clinic and Foundation, Rochester, MN.

Orthodeoxia and Platypnea as the Presenting Symptoms of Carcinoid Heart Disease. V. J. Legner, M.D. (Associate); J. Stepanek, M.D., St. Marys Hospital and Mayo Medical Center, Rochester, MN

Sumatriptan Induced Mesenteric Ischemia. J. J. Liu, M.D. (Associate); D. J. Brandhagen, M.D. (Member), Mayo Clinic and Foundation, Rochester, MN.

Giant Cell Arteritis (GCA): A 74-Year-Old Woman with Intermittent Fever, Headache and Stroke. J. P. Rho, M.D. (Associate); V. M. Montori, M.D. (Associate); B. A. Bauer, M.D. (Member), Mayo Foundation, Rochester, MN.

Post Traumatic Cutaneous Cryptococcus Infection in a Nonimmunocompromised Man. R. Spiekhout (Associate), N. Vlahakis, Mayo Clinic, Rochester, MN.

Recurrent Confusion, Ataxia, and Dysarthria in a 50-Year-Old Female with Short Bowel. Adrian Vella, M.D. (Associate) and Gianrico Farrugia, M.D. (ACP Member); Mayo Clinic and Foundation, Rochester, MN.

Gender Ambiguity in an Elderly Male. V. R. Vigen,B.S. (Medical Student Member), J. M. Evans, M.D., C. Kuhle, D.O.; Mayo Medical School and Mayo Clinic, Rochester, MN.

Sapho Syndrome. Gita R. Rabbani (Medical Student Member), Robert D. Tiegs, M.D., Mayo Clinic, Rochester, MN.

Mark Your Calendars
Next State Chapter Meeting: November 6-7, 1998

Bob Lohr and the Scientific Program Committee met recently and came up with another super lineup for the next Minnesota Chapter ACP Annual Meeting for November 6-7, 1998. This year we will have a change of location and will host the meeting at the Minneapolis-St. Paul Airport Hilton Hotel. The Minneapolis-St. Paul Airport Hilton is located conveniently in the Bloomington area of the "Twin Cities". This full-service hotel offers many Deluxe Guest Rooms and Suites at a very reasonable price. Its location is only a couple of minutes away from the Mall of America. This hotel will also offer our attendees easy access to all major freeways and very importantly free and plentiful parking.

Highlights will once again include specialty updates from outstanding speakers representing infectious diseases, gastroenterology, endocrinology (diabetes), pulmonary, cardiology, women's health, neurology, rheumatology, and urology. One of the regents from the College will also update us about the national scene and we will get a representative from the newly reorganized ACP Washington office to give us a legislative update. We will also be having our traditional "town meeting". The Laureate Award Presentation will take place during the luncheon and business meeting. Last, but not least, we will be continuing our always fun "Jeopardy Game" between internal medicine residents from our various state programs-which will transition into the annual Associate Poster Competition Display and Reception.

You will soon be receiving in the mail a finalized schedule. We will also be putting this schedule and registration information on our Minnesota homepage web site.

Mark these dates in your calendar. More detailed information will follow as the date draws closer.

Last Chance To Send Laureate Nominations:

Once again, we are requesting your help in identifying internists that demonstrate by their example and conduct, an abiding commitment to service in their community and to the ACP. We want to recognize these internists with our state chapter's highest award, the Laureate Award at our 1998 State ACP Chapter Meeting. You can direct your nominations to me. Please send them to:

Scott C. Litin, M.D., F.A.C.P.
Mayo Clinic
200 First Street S.W.
Rochester, MN 55905

Advancement to Fellowship

I have recently looked through the membership roster of our Minnesota ACP Chapter and noticed that many of our group are still designated as "members". Many of your would qualify for advancement to fellowship. If you are such a person, I strongly encourage you to initiate the fellowship process.

"FACP" is a title that is respected worldwide. Fellowship in the American College of Physicians is an honor achieved only by those recognized by their peers for professional accomplishment, personal integrity, superior competence in internal medicine, and proven scholarship. One earns the title of "FACP" by demonstrating these qualities.

If you have questions regarding your qualifications, please either call my office (Ms. Vickie Ronnenberg, Administrative Assistant at (507) 284-8586) or the ACP Customer Service Center at (800) 523-1546, extension 2600. You may also obtain a fellowship application form from either source mentioned above.

I look forward to being notified of your completed application and being able to write a supportive governor's letter for you at that time.

Health and Public Policy Committee Update
By Dr. Mark Liebow

It's been a surprisingly big year in health policy so far with the promise of even more happening before Congress adjourns later this summer. While the Minnesota legislature adjourned without taking substantial actions affecting most ACP members, the Minnesota courts produced a lot more excitement. I see the settlement of the state's and Blue Cross/Blue Shield's suit against the tobacco companies as a huge defeat for the tobacco companies. Not only did the tobacco companies end up agreeing to pay more than the jury might have awarded, but they agreed to a number of non-financial conditions which might not have been included in a judgment. The companies also endured terrible publicity from documents that became public which I'm sure they would have preferred remain private. The tobacco companies are now more vulnerable to similar suits in other states unless federal legislation is passed. Our ACP chapter needs to think about what uses we might recommend to the legislature for the money arising out of the settlement. Increased efforts at smoking cessation, especially among the poor and lower-middle class where the prevalence of smoking is greatest, may be a politically and medically useful solution.

As rules come out of the Health Care Financing Administration (HCFA), we are beginning to see the implications of the Balanced Budget Act of 1997 on Medicare. It is still too early to have a full sense of what changes in medical practice will occur as a result of this, but it is clear how Medicare funds graduate medical education programs in the state will change over the next few years. This will be a topic the ACP Minnesota Chapter's Health and Public Policy Committee will follow for you.

As I write this, it is uncertain whether Congress will pass any tobacco control legislation, much less whether it can pass comprehensive legislation. Failure to pass legislation may mean that there will be no money to fund programs that are important to us as internists but may open the way for devastating litigation against the tobacco companies on a state-by-state basis. It is a close call as to whether the tobacco companies would rather accept a harsh bill from Washington or take their chances in the various states. The ACP has taken a commendably strong position on what it thinks is necessary in comprehensive tobacco control legislation but has run up against a mixed bag of forces complaining about the effects of higher tobacco prices on the poor and those who oppose raising taxes.

HCFA has delayed the implementation of the newest and rather dreadful Evaluation and Management coding guidelines. The delay is indefinite and the new guidelines may be substantially changed from before. I think this is very good for internists but does raise the public policy question about how much documentation is necessary for billing. Anyone interested in this somewhat arcane topic should let me know or let the College know because there may be some interest in developing a position paper on this topic. I believe that internists would be better off if medical decision making were the key component in coding given the increased complexity and severity of the patients we see.

There is another struggle in Washington now about whether to regulate managed care plans, especially ERISA plans, more tightly. Business forces, usually strong in the Republican Party, are vehemently against this but there may be strong political forces towards increasing regulation at least modestly to defuse quality in managed care as an election issue in November. This is another issue on which there may be some time to write to your congressman or senator if you feel strongly about the issue. The College's position is generally noncontroversial with the exception of the provision that ERISA plans should be vulnerable to malpractice suits. If you are interested in the College's position, please let me know and I will try to get something to you.

Finally, fraud and abuse enforcement has become a controversial issue. Many lay people and politicians assume that all of Medicare's problems could be fixed if "fraud and abuse" problems were resolved. HCFA has been sloppy about lumping billing errors, often due to inadequate documentation, together with fraudulent and abusive practices. Old legislation with draconian penalties has been resurrected as a potential club to be used against physicians. Many medical organizations, including the College, have worked to see that innocent mistakes are treated differently than patterns of fraud or abuse. There have been some promising signs that the Federal government is prepared to recognize this. Still, ongoing reminders to our patients and to enforcement officials as well as legislatures that the Medicare and Medicaid billing systems are extremely complex and that it is easy to come up with coding or billing with which an auditor does not agree but which is not fraud will be useful. The College plans to make a strong effort in this area. The chapter's Health and Public Policy committee will continue to monitor and report on this issue. If you have any questions or comments, please e-mail me mliebow@mayo.edu or write to me at:

Dr. Mark Liebow
Mayo Clinic
200 First Street, SW
Rochester, MN 55905

ACP Women Physician's Committee Update
By Dr. Tanya Repka

Highlights from the ACP Women's Meeting held April 19, 1998.
ACP Update: The path to fellowship was discussed and Lynne Shuster spoke of the convocation she and Tanya Repka had recently attended at the National ACP Meeting in San Diego. The different tracts to fellowship were discussed and the interested attendees will contact Tanya Repka about applications.

ACPW Leadership: A new leader for the group was discussed as Tanya Repka is now Governor-Elect. Lorre Ochs was nominated and seconded. The nomination and a call for other nominations will be discussed again and the issue voted on at the fall ACPW breakfast on Friday, November 6, 1998.

Alternative Medicine: RaeAnn Williams talked about the new herbal treatments that are being practiced. She names specific types which could provide alternative treatments for patients in all fields.

E-mail Addresses: Judy Walker expressed interest in having a list of all of the active member's e-mail addresses. It was felt by all attendees to be an excellent way of keeping in touch with each other. Beth Fredrickson is in the process of gathering this information.

Dates to Remember

1998: November 6-7: Minnesota State Chapter ACP Meeting, Minneapolis, MN

Annual Session National Meetings:

1999: April 22 - 25: New Orleans
2000: April 13-16: Philadelphia

Contact Information

Heather E Gantzer, MD FACP, Governor, Minnesota Chapter

Chapter Staff:
Katherine Cairns, Executive Director
1043 Grand Ave. #215
St. Paul, MN 55105
Fax: 651-699-7798