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Governor's Newsletter, March 2001

Eldon V. Gibson, MD, FACP
Governor

2001 Oklahoma Chapter Meeting...
will focus on Cardiology, Infectious Disease and Pulmonary Medicine

The 2001 meeting will be held in downtown Oklahoma City at the Renaissance Hotel.  The meetings will be in the newly renovated Civic Center.  Plan now to attend.

C. A. Sivaram, MD, Chair of the 2001 ACP-ASIM, Oklahoma Chapter meeting has confirmed the following speakers:

• Michael Bronze, MD, Chairman of Dept of Medicine, OUHSC
• Suman Rathbun,MD from Vascular Medicine
• Saihari Sadanandan, MD from Cardiovascular Diseases
• Paul Carlile, MD Chief of Medical Service at VA Medical Center

Topics that will be discussed include:

• Venous Thromboembolism,
• Newer Guidelines in Acute Coronary Syndromes and
• Updates in Pulmonary Medicine and Infectious Diseases

Cecil Wilson, MD, FACP, ACP-ASIM Regent from  Florida will participate in the   Oklahoma Chapter Annual Meeting

Dr. Wilson will serve as the Official College Representative at the October  Chapter Meeting, making his third official visit to Oklahoma.  Before the merger of ACP and ASIM, Dr. Wilson represented ASIM as Trustee at our Chapter Meeting.  “We are happy to welcome him back to our State and Chapter Meeting“, stated Dr. Gibson

Governor’s Column

By Eldon V. Gibson, MD, FACP

As we approach the time for the Annual Session of the ACP-ASIM I would like to briefly review some of the activities of our National Organization during the past year.

On January 4, 2001, HCFA released the first part of the long awaited Stark II final rule concerning self referral. The rule contains significant changes from the original proposed rule. Many of the changes present were vigorously advocated by ACP-ASIM.  The final provision appears to be much easier for physicians to comply with than the 1998 proposed regulations. You can review the final rules at the HCFA web site.

ACP-ASIM is continuing to be your advocate in evaluating and commenting on the new Privacy Rules, Use of Restraints for Hospitalized Patients as well as the Patient Safety issues. If you have any comments concerning the proposed rules, please forward those comments to me or directly to ACP-ASIM.

ACP-ASIM has available, at its acponline web site, papers concerning the above topics as well as many publications that you will find useful for your practice. Available publications include Practice Management, Office Laboratory, Patient Satisfaction Surveys, Effective Clinical Practice and Health Policy Issues to name just a few.  The Annals of Internal Medicine and the Observer are both available online for your use as well.

At the Annual Session in March certain Bylaws changes will be considered. Each member of ACP-ASIM is entitled to vote on the changes during the Annual Business Session of our Organization. One of  the most significant changes proposed will, if approved, permit Associate Members, after two years of membership, to have voting privileges. This proposed change comes after recognition of the value of Associate Members to our Organization.

Your Oklahoma Chapter of the ACP-ASIM also continues to be active in attempts to serve our membership.  Your Member Service Committee continues to meet monthly with representative of our state Medicare Carrier. We have been able to maintain an excellent line of communication with our Medicare Carrier and feel that we have gained a reputation of being a reliable and trustworthy adviser in Medicare concerns that relate to the practice of Internal Medicine. If you have concerns or problems concerning Medicare claims, etc., please advise us of those problems so that we may assist you in seeking a reasonable resolution.

Our Organization continues to seek ways to encourage our medical students to develop an interest in some area of Internal Medicine. We are supporting the Internal Medicine Society on the Oklahoma Campus and are continuing to seek volunteers, especially in the Oklahoma City area, to serve as a mentor for a few hours a month to the students in the first or second year. If you are interested in serving as a mentor please contact Dr. Dean Drooby.

As mentioned, our Annual Session will be Atlanta in March and I hope to see many of you there. I would like to extend an invitation to all those going to the Annual Session to attend our Oklahoma/Arkansas Reception. This is a good opportunity for a visit with friends in a smaller, quieter location. The time and location will be printed in the Program Guide for the meeting.

Eldon V. Gibson, MD
Governor Oklahoma Chapter

Report From 3rd Party Relations Committee

Oklahoma’s ACP-ASIM Third Party Relations Committee continues to meet monthly with Medicare Services to exchange information, clarify policy, and represent the interests of our members in problem solving, trouble shooting, and conflict resolution with our state’s Medicare carrier. 

as We Begin Another new year, here is some good news:

• As of 7/1/01, colonoscopy will be a covered screening procedure for colorectal cancer.  For high-risk individuals (history of inflammatory bowel disease, first degree relative with colon cancer, certain hereditary syndromes)it will be covered every two years.  For average-risk individuals over 50, it will be covered every 10 years.  (However, if you are an average-risk individual and have had a covered flexible sigmoidoscopy, you must wait 4 years to be eligible for Medicare coverage of a colonoscopy)  Flexible sigmoidoscoppy will still be covered every 4 years.
• Screening Pelvic examinations and PAP Smears will now be covered every two years, instead of every three years.

Medicare Services has announced that they are now doing internal training for transition to a different computer system.  In general, it is not anticipated that this will affect providers significantly.  However, as of 6/1/01, all claims filed with Medicare Services must display both the individual provider number as well as the provider number of the corporation, if applicable.

As of 2/1/01, Medicare providers are required to accept mandatory assignment on claims for drugs and biologicals. Please contact our committee if we can help you.

Legislative Update

Federal Legislation –  ACP-ASIM has adopted positions on the following issues:

• Regulatory Relief— urging Congress to enact legislation that contains regulatory relief to ensure that physicians are able to spend adequate time caring for their patients instead of filling out unnecessary paperwork and complying with redundant regulatory burdens.
• Patient Safety— urging Congress to institute voluntary reporting system for medical errors with strong confidentiality and peer review protections.
• Patients’ Bill of Rights— urging Congress to enact legislation that contains the necessary patient protections to ensure that patients receive high quality care.
• Prescription Drug Coverage— ACP-ASIM has adopted six key principles on proposed legislation on Medicare prescription drug benefits.
• Access to Health Care— urging Congress to provide refundable tax credits for low-wage workers to purchase health insurance.  The College also recommends expansion of Medicaid and the S-CHIP programs to include all low-income adults.

The following specific bills have been endorsed:

H.R. 436 Graduate Medical Education— To amend the Internal Revenue Code of 1986 to repeal the dollar limitation on the deduction for interest on education loans, to increase the income threshold for the phase out of such deduction, and to repeal the 60 month limitation on the amount of such interest that is allowable as a deduction.

Patient Protections.  H.R. 526 — Bipartisan Patient Protection Act of 2001 and S. 283 — Bipartisan Patient Protection Act of 2001.

ACP-ASIM Leadership Day on Capitol Hill

Tues., May 8 - Wed., May 9

Leadership Day 2001 should prove to be even more exciting, important, and informative than ever before since the political environment is unlike any ever seen in Washington — an equally split Senate that is dividing exactly down the middle committee memberships and resources; a divided House in which the Republicans hold the narrowest of majorities; new chairs for three of the four major health committees in Congress; a new President elected to office despite losing the popular vote; and new heads of the Dept. of Health and Human Services, the Health Care Financing  Administration, and other health agencies.

The agenda for the 107th Congress is taking shape and will include a number of issues that are high priorities for the College. It is an especially important time for legislators to hear the views of internists one-on-one with many members assigned to new positions on key committees and a large number of new members (11 freshman senators and 41 freshman representatives).

State Health Policy Networking Session

Plan to attend this annual policy forum during the Annual Session in Atlanta.  It will be held on Wednesday, March 28 from 2:30 to 4:30 p.m. at the Marriott Hotel in the Yukon meeting room.  The workshop provides the opportunity to share ideas on how to improve chapter effectiveness on the issues that come up predominantly at the state and local levels.

States are taking center stage on many of the health policy issues being addressed this year. On the problem of the uninsured, states have become the primary vehicles for expanding coverage.   HHS Secretary-designee, Governor Tommy Thompson, is expected to advocate for states to be given additional authority and leeway to expand coverage.

Among the topics to be discussed are: state expansion of health care coverage; state prescription drug coverage plans for low-income beneficiaries; state reporting of health care errors to improve patient safety; prompt payment by insurance companies; Internet prescribing; and all products clauses in managed care contracts.

March 6, 2001

Oklahoma City—Legislation that would have required indigent patients to fork over a $5 co-payment for each visit to a medical provider was buried this week by the House, Rep. Kenneth Corn announced Tues.

House Bill 1112 would have imposed the co-payment provision across-the-board on all Medicaid patients in Oklahoma, the Howe Democrat said. This would have been an unbearable and unconscionable burden on citizens who can least afford it, he declared.

(HCFA) Policy on Physician Error Disclosure Still Unchanged, Contrary to New York Times ArticleCollege staff have quickly ascertained that existing HCFA policy requiring a physician's consent to release physician-specific data resulting from Peer Review Organization(PRO) investigation of a Medicare beneficiary's complaint, has NOT changed, contrary to an article appearing in the 1/2/01 issue of the New York Times.  Jencks, MD, who is in charge of HCFA's PRO program, was unequivocal in affirming that HCFA's policy remains unchanged.

National Quality Improvement Projects Continue

The Medicare National Quality Improvement Projects are still in progress and the Health Care Financing Administration (HCFA) has indicated that these projects will continue.  Because of the importance of the Quality Indicators (QIs) on the processes of patient care, HCFA will evaluate for improvements.  The QIs apply to “ideal patients” which have no documented exclusions.  The goal for “ideal patients” is 100% compliance with the QIs.

The baseline data on the National Projects was released on October 4, 2000, in JAMA.  The article compared the 50 states, Washington DC, and Puerto Rico.  Oklahoma ranked 42^nd overall.  The United Health Group data comparing the 50 states also had Oklahoma ranked 42^nd for years 1999 and 2000.

The 2001 Oklahoma State of the State’s Health Report notes that the leading causes of overall Oklahoma deaths are:

• Chronic Ischemic Heart Disease
• Heart Attacks
• Stroke
• Cancer: Larynx, Tracheal, Bronchial, Lung
• Other Chronic Obstructive Pulmonary Diseases
• Heart Failure
• Other Acute Ischemic Heart Diseases (not Heart Attack)
• Influenza and Pneumonia
• Diabetes
• Cancer: Breast

The Medicare National Projects include 6 of the 14 leading causes of Oklahoma deaths.  The Oklahoma Foundation for Medical Quality (OFMQ) has been working with many of the hospitals and physicians in Oklahoma on these National Projects.  The interim data available at this time has indicated some improvement since the HCFA baseline.

The Clinical Data Abstraction Centers have begun the HCFA remeasurement on the QIs.  The remeasurement periods for Oklahoma are:

HCFA plans to publish the remeasurement data and compare the states and territories.

The results of the OFMQ interim measurements, the HCFA Oklahoma baseline, and the HCFA Oklahoma ranking for each QI is noted in the following tables.

Pneumonnia

The second OFMQ interim measurement on Pneumonia has been completed and the data are being cleaned up and analyzed.  The raw data did not appear to show any additional improvement other that for pneumococcal evaluation and/or immunizations.

Acute Myocardial Infarction:

The statewide outpatient immunizations are being evaluated by the Centers for Disease Control Behavioral Risk Factor Surveillance System (BRFSS) Survey.  The Oklahoma baseline will be the 1999 BRFSS survey, but the state rankings for the Medicare beneficiaries has not been released.

Innunizations:

These National Projects allow Oklahoma physicians and patients to compare their care processes with a goal, as well as with physicians and patients in the other states and territories.

Page updated: 06-24-03

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