Governor's Newsletter, Winter 2001-2002
Joe C. Files, MD, FACP
Governor, Mississippi Chapter
The tragic events of September 11th have defined a new mark in the history of our country, not unlike the bombing of Pearl Harbor to initiate our involvement in World War II. This new war will be a defining period in our country's history and will test our resolve. There are numerous articles available to review biological weapons and their potential use by terrorists. Physicians of the ACP-ASIM must be at the forefront in knowledge to combat these potential acts of terrorism against the citizens of our country. Knowledge to reassure our patients, provide early appropriate diagnosis, and implementation of treatment must be our mission. We should all strive for the best possible knowledge to help in this effort.
The Fall Meeting of the Board of Governors and Regents was canceled due to the attack. There are issues that will require full participation during the Annual Meeting in the spring. Recertification continues to be a major focus of the Board of Governors. The following is an up to date summary of the discussions on recertification to this point. I hope you will all appreciate that we are continuing to work diligently on this.
The Recertification Dialogue Between the ABIM & the ACP-ASIM - Review and Update
Herbert S. Waxman, MD, FACP
Senior Vice President, Education, ACP-ASIM
In the fall of 2000, ACP-ASIM began a dialogue about Continuous Professional Development (CPD), the ABIM's planned new recertification program, to be implemented in 2004. The ABIM sought College support of the program. The College sought fundamental changes in the proposed new self-evaluation modules.
Both organizations agreed to the establishment of a Joint Committee on Recertification, with ACP-ASIM represented by Drs. Bernard Rosof (Chair-elect of the Board of Regents), Barbara Schuster (Regent) and Barbara McGuire Governor). Representing the ABIM were Drs. David Dansker (2000-2001 ABIM Chair), Douglas Zipes (2002-03 ABIM Chair) and Ronald Loge (ABIM member). The staff members were Drs. Daniel Duffy (ABIM) and Herbert Waxman (ACP-ASIM).
The College has three concerns: (1) the burdensome, redundant nature of some of the self-evaluation modules, (2) the expansion in CPD of the ABIM's role from evaluation to education, which the College considers the purview of the professional societies, not the certifying boards, and (3) the absence of any requirement for ongoing education as an element of recertification. For its part, the ABIM seeks support by the College (and other professional societies) of CPD.
A survey of an ACP-ASIM membership sample showed that the concerns are highest about the proposed peer and patient evaluation module and the practice improvement modules. It was also ascertained that many members are already carrying out these activities in local or other programs and that the ABIM's specific requirements would therefore be redundant and of little value in enhancing the quality of practice.
However, the College is supportive of the concept of recertification. Importantly, the College also supports the four components of maintenance of certification, as agreed to by the American Board of Medical Specialties (evidence of professional standing, evidence of a commitment to lifelong learning and periodic self-assessment, evidence of cognitive expertise, and evidence of performance evaluation in practice.)
ACP-ASIM also accepts the appropriateness of a secure examination of medical knowledge and the additional self-evaluation of clinical skills. Further, there is support for the concept of self-evaluation of knowledge, but the College feels that high quality self-assessment programs (such as ACP-ASIM's MKSAP and self-assessment programs of specialty societies) should be acceptable alternatives to the ABIM's knowledge modules.
Over the course of the next six months, the discussions produced agreement in principle with the need to respond to the ACP-ASIM concerns but not agreement by the ABIM about the specific changes that would have to be made to satisfy the College's concerns.
At its March meeting, the Board of Regents (BOR) rejected a Joint Committee draft document, primarily because of the absence of sufficient detail to ensure that the ABIM's general accommodation would be translated into satisfactory specific modification of CPD. A further exchange of communications led to the articulation by the College, in a May letter to the ABIM, of what the College would consider a successful outcome of the negotiations. This letter was not responded to by the ABIM, which was also unwilling to see a resumption of negotiations at the level of the Joint Committee.
In July 2001, the BOR again articulated its support of a recertification process and a secure examination of medical knowledge. The BOR also sought to have the CPD peer and patient evaluation module made optional rather than mandatory and sought to allow other practice performance measures and quality improvement initiatives being carried out in the physician's practice to be substituted for the CPD practice improvement modules.
There was also that month a meeting of the leadership of the College, the subspecialty societies, and the member organizations of the Alliance for Academic Internal Medicine to discuss CPD and the various organizations' views and actions. A strong consensus emerged that was consistent with the major points the ACP-ASIM had raised with the ABIM. Indeed, several subspecialty societies had directly and independently communicated to the ABIM their proposals for changes in the CPD process, similar to those that were being asked for by the ACP-ASIM.
During the next two months, a dialogue continued, now involving Drs. Rosof and William Hall (ACP-ASIM President) from the College and Drs. Paul Ramsey (2001-02 ABIM Chair and James Naughton (ABIM Secretary-Treasurer) from the ABIM. After several reiterations, a draft letter of agreement was signed by these four negotiators and sent to the ABIM and ACP-ASIM for action. We have heard that the ABIM has endorsed this letter. However, the BOR, at its October meeting, deferred action pending review of the letter by and receipt of input from the Board of Governors. This had been expected to take place in September, but the tragic events of September 11 caused cancellation of the September meeting of the Board of Governors, which will next convene in April 2002. The Board of Regents was encouraged by the changing tone of the ongoing discussions with the ABIM, although there remain issues to be resolved.
The ACP-ASIM is willing to continue negotiations with the ABIM but will take no action on any proposal from the negotiators until the Board of Governors has had an opportunity to provide input. Thus, until the spring of 2002, the College believes there exists a window of opportunity to move towards resolution responsive to the fundamental goals of both the ABIM and the ACP-ASIM.
Free College Help with HIPAA - Coming Soon!
In the long run HIPAA should yield huge savings for the US healthcare system, but in the coming months HIPAA will pose a major administrative challenge for providers, payers, and vendors. The Administrative Simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will require practices to protect patients' identifiable health information in any form - written, oral or electronic. The specific HIPAA regulations now being promulgated are divided into three basic Rules-Electronic Data Transactions, Privacy and Security. Physician practices will need to do substantial advance preparation to meet the following legally enforceable compliance deadlines:
|Electronic Transactions||October 16, 2002|
|Privacy||April 14, 2003|
|Security||26 months from release of final rule (expected late 2001)|
The Transactions Rule is designed to simplify the administrative processing of electronic claim and remittance forms and other patient encounter information through standardized electronic formatting. While the ultimate outcome could simplify various aspects of practice management and yield enormous savings by transforming information exchange between healthcare organizations, it will be no easy task getting to that point. Computer software programs as well as office procedures will need to be rewritten to accommodate the new requirements. For the most part, practices will depend on their computer vendors and payers to make these technical changes. However, if any one of the practice's business partners is not ready on time, transactions and therefore practice reimbursement and cash flow will be disrupted. Thus, it is critical that practices understand what needs to be done, make sure that their vendors and other business partners are supporting the practice appropriately, and know what to do if they are not.
The Privacy Rule mandates how providers, health plans, and clearinghouses may use and transmit personal health information. As a result of media and consultant attention, many physicians are generally aware of the potential impact that the privacy rule can have on their practices. While many practices probably already do some of the things required by the Privacy Rule, compliance with its specific legal provisions will require significant effort, including implementation of new forms, policies and procedures, staff training, and patient education.
The Security Rule, which is still only in proposed form, has to do with the physical and electronic security of the information that is stored, maintained, used or transmitted. In other words, technological controls on computer systems and the security of data transmissions will be required for compliance. The "proposed" rule is generally intended to be scalable to small practices and technologically neutral. As of this date, however, it is still unknown what changes the "final" Rule may bring, especially with regard to oral and printed communications (such non-electronic information was not addressed in the original proposed security rule but has since been added to HIPAA's purview). It may be prudent to put in place a risk management process now that can be revised and updated later, recognizing that the final security rule, when published, could require significant adjustments in the practice's security planning and operations.
Medication Samples and Safety-
Medication samples are an everyday part of ambulatory medicine. They can insure that low-income patients get the medications they need, and they help patients get started on their medication as quickly as possible. However, samples bring with them risks that can lead to accidents. To use samples safely, consider the following tips:
- Keep a sample distribution log of what medications patients were given, and how much.
- Use stickers or otherwise mark or separate look-alike and sound-alike items.
- Make sure the sample storage area is well lit and secure.
- Provide explicit written directions on how to use the medication.
- Involve patients in the safety check: ask them to repeat back to you how they should take the medicine.
- Provide empty childproof bottles to store the samples in to patients living with children.
Experience Annual Session - Philadelphia Style
Join the College April 11-14, 2002 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. Be Sure Not to Miss...
Clinical Pearls -
Remember those words of wisdom from your most respected clinical teachers? Those Pearls were based on an experience of depth and knowledge of medical literature of remarkable scope. Pearls are noteworthy for their clarity, timelessness, and clinical applicability.
Introduced at the 2001 Annual Session and an instant hit, Clinical Pearls rekindles the joy of bedside learning, using a highly engaging, case-based format. With the audience-response keypad-system, you'll have a chance to test the depth of your clinical acumen. You'll leave each session with a rich collection of Pearls, ready to be applied directly to the patients.
Multiple Small Feedings of the Mind -
Rated by many as the best of Annual Session, Multiple Small Feedings of the Mind uses a creative format to address some of the most common, yet challenging or controversial, patient-management issues. In these highly focused, fast-paced sessions, faculty offers answers to some of the most frequently faced dilemmas in patient care.
The Learning Center -
Experience the excitement of the Learning Center. Refine your techniques in a variety of office-based examination and procedural skills. Take advantage of small group or individual tutorials with experts in the field. The Learning Center is unique to Annual Session and offers a wide range of opportunities for closely supervised, hands-on practice. Become familiar with procedures and examinations you don't perform on a routine basis. Try out the latest software for clinical information management and patient care. The Learning Center is a dynamic collection of hands-on activities, which you can immediately apply to your clinical practice.
Keep up to date on the year's most important published papers in the subspecialty areas. Learn significant findings and their impact on patient care. Nationally recognized faculty reviews the literature and presents the year's highlights.
Experience Annual Session...
ACP-ASIM Annual Session 2002,
April 11 - 14, 2002, Philadelphia, PA
Registration and other meeting information is available online at (http://www.acponline.org/cme/as/2002/index.html), or contact Customer Service at 800-523-1546, extension 2600. Early sign-up is encouraged for the best selection of workshops and seating at breakfast/lunch sessions.
Eighth Annual Mississippi ACP-ASIM Associate's Meeting
Shirley D. Schlessinger, MD, FACP
The Eighth Annual Mississippi ACP-ASIM Associate's Meeting was held November 15, 2001, on the campus of the University of Mississippi Medical Center in the Norman C. Nelson Student Union Conference Center. As per tradition, residents and fellows from Keesler Medical Center Internal Medicine training program and the University of Mississippi Medical Center's Department of Medicine residency program presented "clinical vignettes" highlighting interesting cases seen in recent months. Fascinating cases reviewed included endocarditis from tongue piercing, ANCA and granuloma negative Wegener's Granulomatosis, Henoch-Schonlein Purpura in an elderly woman, and steroid-induced exophthalmos, among others. Trainees presented in either oral or poster formats and were judged in presentation skills, content, and response to questions. Winners received cash prizes and will represent Mississippi Associates at the regional Annual Louisiana-Mississippi ACP-ASIM meeting to be held March 7-9, 2002 in Biloxi, Mississippi. The first place oral winner also represents Mississippi at the National ACP meeting in the spring of 2002. We are pleased to announce the following ASP-ASIM Associate winners:
First Place: "Lewy Body Dementia," Captain Sharolyn Hoover Baldwin, MD, Keesler Airforce Base
Second Place: "Granular Cell Tumors of the Esophagus and Colon," Mary Beth Thornton, MD, University of Mississippi Medical Center
Third Place: "Intravenous Immune Globulin (IVIG) Precipitating Acute Myocardial Infarction," Major Erika J. Struble, Keesler Airforce Base
First Place: "Levaquin Induced Acute Tubulointerstitial Nephritis-Two Case Reports," Michael L. Wood, MD, University of Mississippi Medical Center
Second Place: "Brodifacoum Toxicity," Justin Baker MD, and Charel Graverson, MD, University of Mississippi Medical Center
SIMS at the University of Mississippi Medical Center
Jason G. Murphy, M3 , President, SIMS
On November 13, 2001, the Third Student Internal Medicine Society Meeting for the 2001/2002 year was held. The speaker was Robert McMurray, MD, a rheumatologist at the VA Medical Center in Jackson who spoke on "A Day in the Life of a Rheumatologist". His witty talk detailed all the angles of a day in his life from time spent with his family to time spent at work. It was quite interesting to see the breakdown of the number of hours he had for each facet of his daily life. In his power point slide show, he revealed what he saw as both the positive (which were many) and the negative (which were few) aspects of his life as a rheumatologist. The meeting provided fellowship and pizza for those students present!