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July 2011 Jim A. Yturri, MD, FACP, Governor

Governor's Corner

Dr. Yturri

I am sure that when the time comes to pay annual dues for ACP membership, one of the questions that should come up in our minds at least occasionally while we write the check is: "What is the ACP doing for me?" As your Governor over the past several years, it has been very easy to see the multitude of things that the ACP does for internists, especially in the realm of advocacy at the national level. In what follows in this column, I will convey a few examples of such recent efforts.

The ACP was recently asked for input by a bipartisan group of legislators on an Energy and Commerce Subcommittee on how to do something meaningful and sustainable while replacing the SGR method of calculating physician reimbursement. In response, the American College of Physicians submitted written testimony, outlining a two stage process for moving beyond the SGR.

According to the ACP plan, the first step would be to pass legislation eliminating the SGR as a factor in determining annual updates to the Medicare fee schedule. Instead, the ACP calls for guaranteeing that no physician services would be cut and ensuring that annual payment updates for evaluation and management services would be no less than 2 percent for years 2012 through 2016. Also during this time, physicians would voluntarily participate in payment initiatives demonstrated to improve efficiency and outcomes, such as patient-centered medical homes and accountable care organizations.

In the second stage of the ACP proposal, participation in such programs would be mandatory. This approach not only leads to doing away with the SGR, but also reforms the Medicare payment system in a way that recognizes the importance of primary care and improves care coordination, quality, appropriateness, and costs.

Another recent example of ACP's advocacy for internists is its influence on how Accountable Care Organizations (ACOs) take shape. Internists in small and medium practices could find it difficult to participate in ACOs, given the new regulations that have been proposed by CMS. Of top concern is that start-up costs and first year operating expenditures for each ACO have been estimated at $1.76 million, an investment that would be far out of the reach of most primary care doctors and their practices. ACP staff is currently doing a line-by-line review of the 127 page proposal of regulations for ACOs, and will submit comments to CMS, which are due June 6, 2011. These comments will almost certainly ask that the barriers to participation by smaller practices be eliminated, according to Neil Kirschner, ACP's senior associate for insurer and regulatory affairs.


Healthshare Montana

On May 12, 2011, I had the opportunity to participate in an informational webinar sponsored by HealthShare Montana, an organization selected by Governor Schweitzer in May 2009 to be the designated entity in charge of establishing a statewide health information exchange. One of the initial goals of this organization is the deployment of provider to provider secure messaging. The ability to transfer such electronic information will enable providers to achieve stage 1 meaningful use criteria. HealthShare Montana will be able to help providers incorporate this into their practices at no cost as early as summer 2011. Other online applications such as eRX and certified modular EHR will be available in June/July 2011, cost to be determined. I would encourage any members interested in these services to contact HealthShare Montana at 406-794-0170 or www.healthsharemontana.org


Leadership Day

Leadership Day Banner
Montana Chapter Members Lobby for the ACP in Washington, D.C. at Leadership Day 2011

Dr. Susan Effertz and I had the opportunity to attend the ACP Leadership Day on Capitol Hill on May 24th and 25th of this year. This was an opportunity for us, as physicians and College members from Montana, to speak directly with the offices of our elected congressional delegation from Montana about current legislative priorities for the ACP.

Neither of us had attended Leadership Day in the past, so I know this was a learning experience for us both. Clearly, this year, American priorities and the role of the federal government in health care are being debated at the highest levels of our government; we heard many times about the deep philosophical differences between the two major political parties regarding our government’s role in health care delivery in the future. We did our best to represent the ACP fairly to both sides of the aisle, emphasizing that the ACP is a nonpartisan organization.

In the few weeks prior to the event, we received background information from the Washington ACP offices clarifying the ACP’s legislative priorities for the 112th Congress. These can be broadly divided into several major categories. First, emphasis was made on the ACP’s perennial goal to achieve reform of Medicare payment systems through a repeal of the SGR formula. In the ACP’s suggested model for reform, physician payments would be held steady for five years, and then transitioned to new payment models, which would be pilot-tested during the initial five-year period. Additionally, the ACP voices support to continue the Primary Care Incentive Program, provided with funding through the Affordable Care Act, and Medicaid Comparability Programs to increase payment for primary care services, also begun under the Affordable Care Act.

We were provided information regarding numerous other specific pieces of legislation which the ACP supports. We would be happy to provide other members with specific names or more details about these, which include bills and programs to improve health outcomes while achieving cost savings, to reform health care delivery systems to recognize the value of primary and comprehensive care in internal medicine, to ensure broader access to affordable health care insurance, and to help develop a robust internal medicine physician workforce in the future. Some of the specific programs supported included the Public Health Services Corps (PHSC), support for innovations through a Center for Medicare and Medicaid Innovation (CMMI) and a Patient-Centered Outcomes Research Institute (PCORI), tort reforms including placing limits on noneconomic damages, and the use of health courts in medical liability cases.

At an awards dinner the evening before the day of the office visits, the ACP presented Senator Max Baucus the Joseph F. Boyle Award for Distinguished Public Service, recognizing his efforts on behalf of the Affordable Care Act. Our state delegation had the honor of presenting the award on behalf of the College.

On the day of the office visits, we were able to meet directly with Senators Baucus and Tester, and to meet with a senior staff member from Congressman Rehberg’s office. Although our time at each office was somewhat limited considering the scope of the ACP’s priorities and goals for this session, I think we had interesting and productive conversations at each of the offices. Unfortunately, budgetary and immediate financial concerns loom large this year, and it seems this may limit the concrete progress that may be ultimately achieved towards the ACP’s goals. Repeal and replacement of the SGR formula for Medicare was probably the most spoken-of goal of the ACP at the sessions before the office visits, and seemed a very high priority to the College; however, offices of all Congressional members were concerned with estimates that such action may cost in the neighborhood of $300 billion over the coming decade. Despite acknowledgement of the dysfunction of the current formula, enthusiasm for definitive change now seemed guarded. Of note, the American Medical Association and the American Academy of Family Practice are endorsing repeal of the current SGR formula with a five-year transition to new payment formulas in a fashion similar to ACP’s recommended plan.

Other discussions and recommendations seemed to be received with interest. Again, face-to-face time was limited on the day of the visits, but hopefully we helped to establish some points of contact for physician input into the legislative process, and we can continue to advance the ACP’s goals through contacts made.

Encouragement was given for physicians to increase their participation year-round through the ACP’s Political Action Committee (PAC), as well. This recommendation was strongly seconded by Mr. Alex Castellanos, our guest speaker at the awards dinner event, who served as the Presidential campaign manager for Mr. Mitt Romney in 2008 and has directed numerous campaigns for others in the Republican Party at the national and state levels. We were reminded that such participation as a College will strengthen our collective input into the legislative process that is central to so many aspects of our ability to perform our work.

I think we both found Leadership Day to be a fascinating experience, and were proud to represent our state and our chapter while advocating for ACP priorities in legislation.

Eric Saberhagen, MD, Department of Internal Medicine, Billings Clinic

Drs. Baucus and Effertz

Senator Max Baucus and Susan Effertz, MD, FACP at Leadership Day


New ACP Online Resource

There is a new ACO page on the ACP Web site at: www.acponline.org/running_practice/aco/. As ACOs evolve, I'm sure that this site will get more and more sophisticated and serve as a great resource for our members.


New Montana Chapter Committees

As listed below, our Chapter has developed two new Committees which I think will serve the membership well in the future. Please let me know if you have interest in serving on one of these Committees. Also, please contact a member of one of these Committees if you have a concern or idea with regard to ACP advocacy or membership.

Advocacy Committee

Ann M Bukacek, MD FACP (Chair) – Kalispell
Kirsten Krauss, MD – Great Falls
Susan J Effertz, MD FACP – Great Falls
Lisa J Milch, MD - Corvallis
Charlotte R Nelson, MD - Missoula
James E Loeffelholz, MD, FACP - Bozeman

Membership Committee

Jay L Larson, MD FACP - Helena
Bradford A Bergman, MD FACP – Great Falls
Erin N Reis, MD - Butte

The Membership Committee established a marketing plan to increase membership. A letter, along with a membership application was mailed to a list of eligible non-member physicians that was composed by Jay Larson, MD, FACP. The letter offered a dues discount on the first year of membership and the opportunity to attend the annual meeting without paying a registration fee. An e-mail was also sent to members asking them to participate in the “Recruit-a-Colleague” program.

New Members

Troy Fiddler, MD, PhD – Billings
Sharon Hecker, MD, FACC - Butte


The Montana Chapter would like to thank the following members for recruiting their colleagues as part of ACP's Recruit-a-Colleague program:

  • Lisa J Milch, MD
  • Anne M Murphy, MD
  • Erin N Reis, MD


Internal Medicine 2011, San Diego

One of the pleasures of being Governor is the opportunity to share the experience of the annual Convocation Ceremony with new Fellows. One of the many things that this ceremony does formally is review those values that we have as internist physicians and recognize those who have lived those values in an exemplary fashion. This year I had the honor of marching at the Convocation with Drs. Pam Hiebert of Bozeman and Doug Wadle of Livingston.

Drs. Yturri, Hiebert, and Wadle

Jim A Yturri, MD, FACP, Pam Hiebert, MD, FACP and Doug Wadle, MD, FACP

Internal Medicine Photo 1

Ben Yturri, Jim Yturri, MD, FACP, Doug Wadle, MD, FACP, Erin Ries, MD, Brett Kronenberger, MD, FACP and Kristin Wadle

Internal Medicine Photo 2

Jim Yturri, MD, FACP, Kathleen Blair, DO


Annual Chapter Meeting, Dillon


The upper Grasshopper Valley is one of the best kept secrets in Montana for scenic beauty and outdoor activities. The meeting is designed with activities for your entire family

July 21-23
Montana High Country Lodge, Polaris


  • Elkhorn and Jackson Hot Springs
  • Historic Bannack State Park, Montana’s first territorial capital
  • Crystal Park - open digging for quartz and amethyst crystals
  • Spectacular high mountain lakes in the Pioneer and Big Hole mountains
  • Nez Perce National Battlefield west of Wisdom
  • Wild flower hikes
  • Fishing – kids pond at the lodge. Nearby mountain streams and the fabled Big Hole and Beaverhead Rivers (If you want a fishing guide, contact Russ at the Lodge.)
  • Horseback rides - Short hourly rides or day trips to nearby alpine lakes

Friday night dinner speaker: Carl Davis, National Forest Service regional archeologist will enlighten us on 10,000 years of human occupation in Southwestern Montana – from Paleo-Indian cultures to Shoshone. With artifacts representing different eras, this will be of interest to kids of all ages.

Post-meeting Saturday afternoon expedition will be led by Montana FWP archeologist, Sarah Scott who will give and interpretive tour of important Native American rock art (pictograph) sites in the nearby valleys.

Saturday morning SEP post-course with ABIM modules. These are excellent educational tools to update the latest in internal medicine. If you need credit for ABIM’s maintenance of certification, register for this portion of the meeting. Since this is group learning and answer solving session, bring your laptop and internal medicine information resources.

Review the meeting brochure and register on-line


Program co-chairs: Sandra McIntyre, MD and Ron Loge MD MACP


Don't Forget ACP Summer Session, Chicago

Summer session

Don't miss this low-cost option to enjoy the excellence of ACP's CME programs. Includes 16 engaging sessions. For more information visit the Web site at http://www.acponline.org/meetings/summer_session/attendees/