Governor's Newsletter, Winter 2000

PCIM Holds Annual Meeting in Hershey, PA

Celebrating the Wealth and Diversity of Internal Medicine was the theme of the 1999 PCIM Annual Meeting held at the Hershey Lodge and Convention Center in Hershey, PA, on November 19-20. Over 200 Internists from across the state gathered to hear timely and topical discussions of the medical, economic, and political issues that internal medicine faces today, and in the future.

The exciting two-day program, sponsored by the PCIM, the Association of Program Directors in Internal Medicine (Pennsylvania Delaware Subgroup) and the Association of Professors of Medicine (Pennsylvania Chapter), was filled with educational program, social gatherings and fun for the entire family.

Internists had the opportunity to participate in scientific presentations from numerous industry professionals on topics including Preventive Medicine, Endocrinology, Medical Ethics, Behavioral Medicine, Neurology, and Oncology to name a few. Between scientific session, participants had the chance to visit the ACP-ASIM College display and numerous other product displays from the sponsors of the meeting. The PCIM would like to thank those companies who offered their generous support to our meeting including Genetech, Glaxo-Wellcome, Pharmacia& Upjohn, GD Searle & Co., PMSLIC, WB Saunders/Mosby, Parke-Davis, Roche Labs, Hoecht Marion Roussel, Merck & Co., Group Insurance Administrators.

The Annual Meeting also featured a residents' program which was held on Saturday, November 20. Over 130 abstracts were submitted for the competition. Residents from hospital across the state presented abstracts in various categories including: cardiology; allergy and immuniology; infectious disease; pulmonary; endocrinology, nephrology; hematology; and oncology. (see page 3 for 1999 winners).

In addition to the residents' program, a Medical Knowledge Challenge Tournament was held, sponsored by the PCIM and the Association of Program Directors of Internal Medicine. Joseph Joyce, MD, Michael Anshelevich, MD and Jeffrey Friedel, MD from Allegheny General Hospital and Steven McCullough, DO, Peyman Markazi, DO and Phillip Huffman, MD from Lehigh Valley Hospital competed for the state title after winning their local competitions. Each team answered a series of questions, with a format based upon the television game show, Jeopardy, from various categories during the competition and the residents from Allegheny General Hospital were successful in scoring the most points in the competition. They will move onto the National Competition to be held in April 2000.

The 1999 Awards reception held on November 20, recognized the 1999 Pennsylvania Laureates who have demonstrated, by their example and conduct, and abiding commitment to excellence in medical care, education, or research, and in service to the community, their Chapter, and the ACP-ASIM (see page 4 for 1999 recipients). Additional awards presented included the Robert S. Pressman Award for Outstanding Contributions to Internal Medicine given to George Ross Fisher, III, MD and the 1999 Clinical Practice Award was presented to Jay Jenkins, MD. Additionally, the winners of the Resident's Program and the Medical Knowledge Challenge Tournament were recognized at the banquet.

The Annual Meeting concluded on Sunday, November 21 with the Town Meeting in which members had an opportunity to voice their concerns about issues affecting the internal medicine environment as well as the Pennsylvania Chapter. Our College representative, David Gullen, Chair of the ACP-ASIM Board of Regents was present at the Town Meeting to hear the members concerns.

Plans are underway for the 2000 Annual Meeting to be held in Harrisburg, PA at the Hilton on October 27-29, 2000. Please join us!

PCIM Honors Residents at 1999 Annual Awards Banquet

PCIM honored the following residents for "Best Presentation" in the 1999 Abstract Competition at its Annual Banquet on November 20, 1999. Each resident was given an awards certificate and a $100 check for their winning abstract presentation.

Neville Alberto, MD
Easton Hospital, Easton, PA

Krishna Padiyar, MD
Geisinger Medical Center, Danville, PA

Neil Louwrens, MD
Albert Einstein Medical Center, Philadelphia, PA

Jayashree Rao, MD
Easton Hospital, Easton, PA

Vinko Bogdanic, MD
St. Francis Medical Center, Pittsburgh, PA

Steven Eric Silver, MD
Thomas Jefferson University Hospital, Philadelphia, PA

Jeffrey Sager, MD
Albert Einstein Medical Center, Philadelphia, PA

Felix Vergara, MD
Temple University, Philadelphia, PA

David Henner, MD
St. Luke's Hospital, Bethlehem, PA

Anuradha Ganesan, MD
Mercy Hospital, Pittsburgh, PA

Heidar Arjomand, MD
Easton Hospital, Easton, PA

Mourad Nessin, MD
St. Francis Medical Center, Pittsburgh, PA

David Sass, MD
Albert Einstein Medical Center, Philadelphia, PA

Mei Weng, MD
Abington Memorial Hospital, Abington, PA

Internists Lead PMS Young Physician Council

Young physician members of the Pennsylvania Medical Society have elected five internists, including the chair, vice chair and secretary, to serve on the 2000 Young Physicians Section (YPS) Governing Council.

The YPS works within the Pennsylvania Medical Society to address issues of importance to young physicians, promotes young physician membership, and encourages young physician involvement in public policy and organized medicine. Membership in the section is limited to practicing physician members ages 39 and under or in their first five years of practice.

Eric Gertner, MD, 33, of Allentown, was elected chair of the YPS. Dr. Gertner works for Lehigh Valley Health System in Allentown. He previously served as PMS-YPS vice-chair and has been a delegate to the American Medical Association's Young Physycians Section. He is a member of the Lehigh County Medical Society.

John Bulger, DO, 35, was elected vice chair. An internist at Geissinger's Knapper Clinic in Danville, Dr. Bulger was previously a member-at-large on the governing council. He is also active in the Pennsylvania Osteopathic Medical Association and the Montour County Medical Society.

Michael Heinle, MD, 37, from Beaver County was re-elected as secretary of the PMS-YPS. Also elected were: Patricia O'Halloran, MD, 32, Delaware County, Alternate Delegate; Kevin Zakrzewski, MD, 37, Montgomery County, Member-at-Large.

PCIM Testifies on Adult immunization legislation

By John Oh, MD, Assistant Clinical Coordinator, KePRO

On October 12, 1999, the Pennsylvania House Majority Policy Committee held a public hearing in the Capitol on adult immunizations in long-term care facilities. At issue was a proposed bill that would mandate long-term care facilities to assess their residents' pneumococcal and influenza vaccination status upon admission and then on an annual basis, and to offer recommended adult immunizations to all of their residents and staff.

I testified on behalf of PCIM in favor of this bill. Also testifying in favor were Dr. Wanda Filer, the former Physician General for Pennsylvania, and Dr. Christine Stabler, the president of the Pennsylvania Academy of Family Physicians. Representatives of the long-term care industry raised concerns about having to comply with an unfunded legislative mandate. They appeared ready to fight any legislative mandate on principal, no matter what the public health benefit. The current Physician-General, Dr. Robert Muscalus, also did not explicitly offer support for the bill, but called for greater awareness of the adult immunization problem in long-term care facilities.

Each year an estimated 40,000 Americans die from vaccine-preventable pneumococcal and influenza infections, yet only one-half and two-thirds of seniors have received pneumococcal and influenza vaccinations, respectively. Medicare pays the full cost for both vaccinations, and several studies have shown that these vaccinations more than pay for themselves through reduced hospitalizations. I referenced the case report in NEJM last year that described an outbreak of multidrug-resistant pneumococcal pneumonia in a nursing home where only 4% of the residents had undergone prior vaccination. I stated that the public health importance of this issue justified this legislation, and stated that internists are ready to work collaboratively with long-term care facilities to improve vaccination rates.

PCN-TV aired the hearing that night. Although it competed with the baseball playoffs, the hearing clearly demonstrated PCIM's commitment to public health and the safety of older Pennsylvanians. If you are interested in obtaining a copy of PCIM's testimony, please contact Natalie Slembarski at the PCIM office.

Keypro Study on Diabetes

By John Oh, MD, Assistant Clinical Coordinator, KePRO

As an Assistant Clinical Coordinator with KePRO, Pennsylvania's Medicare quality improvement organization, I have responsibility for collaborative quality improvement projects in diabetes, adult vaccinations, and cardiovascular disease. KePRO seeks partnership with physician professional organizations like PCIM to help improve the health of Pennsylvania's 2.1 million Medicare beneficiaries.

The active involvement of physicians, particularly internists, is critical in advancing the quality of health care. Many Americans are concerned about what is happening to health care under managed care; witness the widespread public support for patients' rights legislation. By visibly working to improve quality, internists can reaffirm the professionalism and trust that patients associate with our specialty.

KePRO is collaborating with PCIM and other physician professional organizations in an ambulatory diabetes quality improvement project for South Central Pennsylvania. Physicians who agree to participate can have an assessment of how well they are doing on quality measures from the Diabetes Quality Improvement Project (DQIP). DQIP is a standardized set of quality indicators that measure: HbA1c testing and control, lipid testing and control, eye exams, foot exams, assessment for nephropathy, and blood pressure control. They were developed collaboratively by ADA, NCQA, and HCFA, with input from physicians including ACP-ASIM.

Because KePRO's resources are limited, at this point it can only offer free, on-site chart abstraction for practices within Cumberland, Dauphin, Juniata, Lancaster, Lebanon, Perry, and York Counties. But KePRO can help practices outside of these counties who are interested in doing their own chart abstractions on patients with diabetes.

I should emphasize that practices' participation and the results of their DQIP chart audits are kept confidential. No data is released to outside parties. HCFA only receives aggregate information on the project. This project is neither a "report card" nor a "practice profile". This project is only about identifying how a practice can improve care for their patients with diabetes.

Anyone interested in learning more about this or other quality improvement projects is invited to contact me at (717) 564-8288 x2157 or joh@kepro.org.

CAPITAL COMMENTS.... From Capital Associates, Inc.

2000 A Key For Politicians and Internists

This year is a huge election year for Pennsylvania internists, as Pennsylvania voters will elect a U.S. Senator, the entire states Congressional delegation, all 203 members of the state House of Representatives and half of the 50-member state Senate.

The elections are key not only for control of those chambers, but for setting agendas for the coming years. In addition, every ten years following the national census, the General Assembly takes up reapportionment to establish the size and location of electoral districts for the state's legislative and congressional seats.

The state House will be a particularly serious battlefield, because it has been nearly 50-50 for several years. If the Republicans can maintain control of the Senate (currently 30-20) and the House (currently 102-100), they will work together to establish new legislative and congressional districts, which would yield control by the GOP for another ten years.

On the other hand, Democrats, who have never been more than three seats out of the majority in the past six years, see 2000 as the year they finally get control back in the House. Legal problems faced by Reps. Frank Serafini, Tracey Seyfert and Tom Druce have already knocked them out of the 2000 races.

Election-year politics often yield intense debate, and with the House this close, 2000 will likely result in bitter, partisan bickering. But election years also provide an opportunity for professional organizations to show their strength and help set the stage for successes in the years ahead. The House caucuses are each seeking to raise more than $3 million to support local election campaigns this year.

Chadwick Tells PCIM Council: "Get Involved"

State Representative Scot Chadwick, the author of the Medical Malpractice Reform Act of 1996, addressed the PCIM Governing Council at the annual meeting, explaining how physicians can interact with government, politics and third party payers. The key, Chadwick said, is direct personal involvement. He cited the visit to Harrisburg by thousands of physicians that put incredible pressure on members of the House and Senate to pass the bill as an example, but he noted that similar visits in the district could have a cumulative impact.

Chadwick, who is retiring from the legislature after 16 years in Harrisburg, urged physicians to "get involved" with elected and appointed officials in every way possible, starting at home. Your state senators and representatives can be influenced in a variety of ways, but never more so than in election years. Physicians can help their own cause by simply talking to their elected officials about how state government affects practice, by sending letters or making phone calls on important issues, and by "putting their money where their mouths are," with campaign contributions and personal involvement in election campaigns.

When you "sit it out," and fail to get personally involved, others will be happy to take the lead in providing information for critical decisions that affect you, your practice and your family, he said. With nearly 6,000 members, PCIM is the second largest physician organization in the state. To take advantage of these numbers, PCIM will be working to establish a member grassroots contact system throughout the state to carry messages to the General Assembly on key issues. This is your opportunity to "get involved." Call the PCIM headquarters at 1-800-846-7746 for more information.

Advanced Practice Nurses Seeking Independent Practice

Advanced Practice Nurses have been fighting a several year battle to change their scope of practice, seeking the ability to prescribe therapeutic drugs and to practice independently without regulation by the Board of Medicine. PCIM has opposed HB 50, which would accomplish that, and has actively lobbied against CRNP, CRNA and other Nurse Specialists' independent practice.

PCIM Services President Ralph Schmeltz, MD, FACP, testified in Pittsburgh to the House Professional Licensure Committee, citing concerns for educational requirements, and a need to maintain quality of care for all patients. PCIM has focused on the impact any such measure would have on the practice of primary care medicine and through Capital Associates, will take part in ongoing discussions as this legislation is considered.

The State House of Representatives has received a second draft of HB 50 from the advanced practice nurses who pushed for the legislation in 1999. Issues like nursing scope of practice legislation are extremely difficult for many elected officials to deal with, not only because they hear such conflicting stories from opposite sides, but also because, as elected officials, they prefer not to make enemies needlessly.

The nurses continue to say the legislation would give them prescribing privileges which were originally voted for them in 1985. Nurses have complained that they are the only profession governed by two separate boards, while physicians have supported the role of the Board of Medicine in oversight for the practice of medicine, rather than physicians/ physicians' assistants, or APNs.

One thing is certain. Passage of HB 50 would lead to fundamental changes in nurses' legal clinical abilities without oversight by the Board of Medicine. Given the fact that the Advanced Practice Nurses have been pushing this issue for more than a decade, you can be sure they will renew their efforts to get legislative support for HB 50. PCIM urges members to call your state representative or state senator's office and ask them to oppose HB 50.

Joint Negotiation Legislation

Sen. Richard Tilghman (R, Montgomery Co.) has introduced legislation that would allow independent physicians and health care providers to jointly negotiate the terms of provider contracts with insurers. The legislation is similar to laws already on the books in Washington and Texas, and is based on a "state-action" exemption to federal antitrust laws.

In late November, the National Labor Relations Board ruled that house staffs are employees eligible to take part in collective bargaining, adding additional fuel to the unionization fire. The PCIM has joined with dozens of other provider organizations and Sen. Tilghman to seek legislative hearings on the bill this spring. Among its provisions, the bill would allow joint negotiations with managed care plans under state supervision, on subjects like the definition of medical necessity, utilization review criteria and procedures, clinical practice guidelines, drug formularies, credentialing criteria, specialty referrals and dispute resolutions.

The bill would permit joint negotiations over fees and monetary matters if the insurer has substantial market power, either exceeding 15 percent of covered lives in the market, or 25,000 lives. Similar negotiations would be permitted when the Attorney General decides that the market power of the insurer significantly exceeds the countervailing market power of the providers acting individually. The Attorney General would have to approve joint negotiations and the jointly negotiated contract. PCIM has endorsed joint negotiation legislation, with a no strike clause, and a mandate for the Attorney General to act when insurers assert market powers.

For more information on SB 1052, physician representation and joint negotiations, contact the PCIM office.

Lawsuit Abuse Reform Moving

The Senate Judiciary Committee has held three hearings on SB 5, the Lawsuit Abuse Reform Act, and is also considering SB 1025, which would create additional responsibilities for physicians regarding tort law. PCIM has joined the PA Civil Justice Coalition and endorsed actions to seek court rules changes that would improve the playing field for internists, changing the rules of evidence and rules of procedure for the courts. PCIM encourages you to contact your state senator and ask them to support the changes sought in SB 5 and through the requests to the Supreme Court for rules changes.

Tobacco Settlement Spending Plan Announced

On January 26, Governor Ridge announced his plan to spend the $11.3 billion in expected funds from the national Master Settlement Agreement with the major tobacco companies. Ridge called for spending 40 percent of the funds for low cost health insurance for uninsured Pennsylvanians, 15 percent for home and community based care for older Pennsylvanians, 15 percent for tobacco prevention and cessation programs, 15 percent for health care research and venture capital development, 10 percent of the funds to reimburse hospitals and clinics for uncompensated care, and five percent of the funds for reserves, to continue programs if settlement funds decline or stop.

PCIM has testified to several House and Senate Committees and to the Governor's Office regarding the spending of these funds, and has pushed for spending at least 25 percent for tobacco prevention and cessation programs, creation of a reserve fund, and has opposed spending funds for capital improvements or construction, rather than for direct smoking/health related problems.

The General Assembly will be considering the Governor's plan at the same time it works on the state's 2000-2001 budget, and passage of the entire package is expected this spring. PCIM will continue to seek to maximize the funding for direct programs for smoking related health problems and for expansion of tobacco prevention and cessation programs.

1999 Laureate Recipients Honored

The Pennsylvania Chapter honored its 1999 Laureate Award recipients on Saturday, November 20, 1999 at the Hershey Lodge and Convention Center, Hershey, PA.

The Laureate Award honors those Fellows and Masters of the American College of Physicians, American Society of Internal Medicine who have demonstrated, by their example and conduct, and abiding commitment to excellance in medical care, education, or research, and in service to the community, their Chapter, and the ACP-ASIM.

The 1999 Pennsylvania Laureates are:

Herbert S. Diamond, MD, FACP

Herbert Diamond is the Chairman of the Department of Medicine the Western Pennsylvania Hospital and Program Director for its internal medicine residency program and also serves as Clinical Professor of Medicine at the University of Pittsburgh School of Medicine. Prior to assuming these positions in 1989, he was a member of the full-time faculty at SUNY-Brooklyn where he rose to the rank of Professor of Medicine, Chief of the Division of Rheumatology, and Director of the NIH Clinical Research Center. He then went on to become Chairman of the Department of Medicine at the Long Island Jewish Medical Center and Vice Chairman of the Department of Medicine at SUNY-Stonybrook.

Dr. Diamond has been active in many national and local media organizations, including the American College of Physicians. Locally he serves on the Board of the Pittsburgh Chapter of the Arthritis Foundations; chairs its Research Committee, and is a member of the Board of the Western Pennsylvania Advisory Group and chairs the ACP-ASIM's Research Committee. Nationally he is active in the APDIM where he chairs the International Medical Graduate Subcommittee and serves on multiple other committees.

Wesley P. Kozinn, MD, FACP

Wesley Kozinn joined the internal medicine residency training faculty of Easton Hospital, Easton, Pennsylvania, in 1978. At Easton Hospital, Dr. Kozinn has been responsible for directing the infection control, antibiotic utilization, travel medicine, and immunization programs. He maintains an active clinical teaching practice of infectious disease. He is Clinical Assistant Professor of Medicine at the Medical College of Pennsylvania/Hahnemann University.

Currently, Dr. Kozinn is Director of the Internal Medicine Education Programs and Coordinator of Clinical Research and directs the Pennsylvania Medical Society accredited continuing medical education program at Easton Hospital. His service to community organizations has included the Rotary Club of Easton, the Weller Center for Health Education, the Lehigh Valley Health Education Center, and the AIDS Services Center.

Paul M. Rike, MD, FACP

Paul Rike practiced internal medicine at Magee Womens Hospital and served as a consultant at the Western Psychiatric Institute and Clinic. He had a faculty appointment at the University of Pittsburgh School of Medicine as Clinical Assistant Professor of Medicine. During his career he was appointed as Director of the Falk Outpatient Cardiology Clinic and attending physician at Heart House in Venencia, Pennsylvania. This facility was devoted to the long-term care of children with rheumatic fever before the penicillin era.

Dr. Rike has been active in many professional societies, including the American College of Physicians, American Society of Internal Medicine, American College of Cardiology, American College of Angiology, and International Society of Internal Medicine. He was awarded a Fellowship in each of these organizations in recognition of his outstanding contribution to the practice of medicine.

Salvatore J. Scialla, MD, FACP

Salvatore Scialla is currently in an office practice in association with Hematology and Oncology Associates of Northeastern Pennsylvania. He serves as Director of Clinical Research at the Scranton-Temple Residency Program, Associates Clinical Professor at Temple Medical School and Director of the Special Hematology Laboratory at Moses Taylor Hospital.

Dr. Scialla was honorably discharged as a Lieutenant Colonel, Medical Corps, stationed at Walter Reed Army Medical Center in 1982.

Additionally, Dr. Scialla has been very active in many professional societies, including the American Medical Society, Pennsylvania Medical Society, Sigma Zi Honor Society, and America Society of clinical Oncology, to name a few. He has received awards including the American Cancer Society Vision of Hope and Humanitarian Award, the Rho Chi Award for Pharmaceutical Excellence, and the Roche Award for Excellence in Medicine.

Richard J. Simons, MD, FACP

Richard Simons is Professor of Medicine, Assistant Dean for Medical Education, and Director of the Internal Medicine Residency Training Program in the Department of Medicine at the Pennsylvania State University College of Medicine. Dr. Simons also served as President of the Clerkship Directors in Internal Medicine and has served on this organization's board for eight years. Additionally, during Operation Desert Storm, January to March 1991, he was called to active duty as an U.S. Navy Lieutenant Commander in the Medical Corps.

Since July 1996, Dr. Simons has served as a consultant and instructor to the Office of the Attorney General, Commonwealth of Pennsylvania, in a statewide training program focusing on elder abuse for state personnel, law enforcement officials, and health care providers. In August 1998, Dr. Simons was invited to become a member of the Office of the Attorney General of the Commonwealth of Pennsylvania, serving on a Medical/Legal Advisory Board of Elder Abuse and Neglect.

What's New

Contact Information

Eastern Region
Richard J. Simons, MD, FACP, Governor

Southeastern Region
Charles Cutler, MD, FACP, Governor

Western Region
Alejandro R. Gonzalez, MD, FACP

John Derrickson
Executive Director
Phone: 610-543-6880 or Toll-free: 800-846-7746
Fax: 610-543-6806
E-mail: pcim.hq@verizon.net