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Rhode Island Internist

Summer 1996

In this issue:

PRESIDENT'S MESSAGE - Mitchell Pressman, MD

This year has passed quickly and it's time to look back at the Rhode Island Society of Internal Medicine's (RISIM) accomplishments and to set goals for the year to come. RISIM council members were actively involved in meetings with United Health Plans, Blue Cross/Blue Shield and local Medicare carriers. We met with representatives of Harvard Community Health Plan, Pilgrim and Health Advantage to learn more about their merger and discuss how it will affect internal medicine. We presented a managed care forum for members to learn about the credentialing processes that Harvard, United and the Health Maintenance Organization of Rhode Island use and how RISIM might be affected. RISIM also was involved in joint discussions with the Rhode Island Medical Society (RIMS) and assisted them in working on the various managed care bills that went before state House committees during this current legislative session.

The Society also had some fun. Our joint winter meeting with the Rhode Island Chapter of the American College of Physicians was extremely successful. "Medicine On Stage"--presented by Trinity's Bob Colonna--entertained us with literature and art viewpoints on the practice of medicine. The RISIM Annual Meeting on May 23 topped off this successful year. You will find coverage of the meeting in this newsletter.


RISIM received "Honorable Mention" recognition for this newsletter last October at ASIM's 39th Annual Meeting in Washington, D.C. The thanks should go to Newsletter Editor Dennis Krauss, MD, for the hard work needed to put this all together, along with ASIM staff. RISIM also has received recognition in the "ASIM at the Grass Roots" section of both the March and May issues of The Internist: Health Policy in Practice. RISIM's World Wide Web page was featured in the March issue. The Web page not only provides the most up-to-date information on RISIM, but also provides useful links to other areas on the Web. The address is http://users.aol.com/yde/html/RISIM.html. Thanks should be given to Dr. Ejnes for maintaining this service.

I want to thank all the officers and members of the council for their support in making this a successful year. To continue this trend, RISIM needs your support and ideas in the upcoming year. RISIM has 101 active members, compared to 104 members the prior year, so we need to stay involved and encourage new membership. To help increase membership, the Society is teaming with ASIM to identify and recruit Rhode Island internists.


I need your help to make this coming year even more successful. I would like to be able to communicate as quickly and efficiently as possible with the entire membership without interrupting your office hours. On the back page of this newsletter, there is a mail-in/fax back form to provide fax numbers and E-mail addresses. These will be invaluable to me to provide you with timely information. If you do not have E-mail access, you can obtain it free through Physicians' Online (POL)--as well as gain the benefits of asim interact, ASIM's online forum. Call 800-332-0009 to get a free installation disk or download it from POL's home page on the Internet at http://www.po.com. I also am interested in what important topics you would like to see RISIM address in the upcoming year. My E-mail address is Mitchell_Pressman@brown.edu.

I hope you all have a safe and healthy summer.

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ASIM Trustee Cecil Wilson, MD, of Winter Park, Fla., addressed the RISIM Annual Meeting on May 23 at the Inn at the Crossing in Warwick. Dr. Wilson spoke about ASIM's accomplishments in the past year in both the public and private sectors.

In the public sector, ASIM has been involved in reinventing Medicare and Medicaid, and in health insurance reform. The Society has made progress in Medicare reform; e.g., in advocating for a single Medicare fee schedule conversion factor. Also, ASIM has addressed a single sustainable growth rate for fee schedules, as well as relief from antitrust regulatory relief and practice hassles. Successful wins in the past year include increased fees for hospital discharge days. Additionally, ASIM made progress on relief from the Clinical Laboratory Improvement Act in laboratory surveys for deficiency-free office labs.

In the private sector, the Society has pursued continued involvement in corporate health plan policies--repeatedly emphasizing physician input. ASIM published a series of policy papers in a number of areas including reinventing managed care, higher capitation rates for more complex patients, physician input into quality and deselection issues, and in finding alternative credentialing requirements besides board certification for plan participation.


ASIM also has been active at both the state and local level, and the Society continues to address objectionable parts of various managed care plans. As another example of this physician initiative, ASIM has sent physicians in both Houston and Orlando surveys that will provide the information for report cards on local managed care plans. ASIM also offered two national practice integration conferences, and has an active legal advocacy program available to all members. With asim interact, members are updated on policy initiatives, various events and general information--including a "Members Only" section. (RISIM was the first to have its newsletter included as part of the national Internet connection.)

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A recent Rhode Island Hospital (RIH) Department of Medicine staff meeting included a lively discussion of new Medicare rules specifying conditions under which teaching physicians may bill Medicare Part B. Effective July 1, the new rules state that, for teaching physicians to bill for evaluation and management services or procedures in which residents participate, the attending physician must be present for "key portions" of the service that is being billed. This caused great confusion at the meeting, and physicians raised questions about whether current billing practice would be allowed under the new rules.

Following the staff meeting, I posted an inquiry to ASIM about the rules via asim interact. Three days later, John DuMoulin, ASIM's director of managed care and regulatory affairs, replied by E-mail.

Using the information obtained from ASIM, l drafted a memo to the internists at RIH to reassure them that, under new rules, little would change since they usually see their own patients on the teaching service daily and bill only for the services that they perform themselves. A copy of the memo is available at the RISIM home page at http://users.aol.com/yde/html/RISIM.html, or call me at 946-6200.

The vast resources of ASIM are an indispensable source of expert information and assistance to all internists. Our support through membership in ASIM helps to maintain and further develop these helpful resources.

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For physicians, access to online computing is almost a necessity in 1996. Valuable information can now be accessed from your home or office desktop. This can be a time saver as well as a useful learning tool. Patients also are making use of this information, so it's important for physicians to be aware of what's out there.

To begin, you need computer hardware consisting of a processor or "brain" (either Mac or IBM-compatible); a color monitor; enough memory in the processor to run the necessary programs; a hard drive to store the information that you retrieve; and a modem that links your computer to your phone line. Most of you already have this equipment, since the PCs that United Health Plans placed in most offices are equipped with all of the above items. If you are buying from scratch, systems consisting of a Mac with a Power PC chip or an IBM-compatible with a Pentium chip, plus monitor and modem can be purchased for under $2,000.

Once you have the hardware, you need software and a way to access the Internet. For beginners, I suggest combining the two and enrolling in one of the major online services such as America Online, CompuServe or Prodigy. The software to join and use one of these is usually included with any new computer or modem.

For the more adventurous, there are Internet access-providers (IAP) that sell access to the Internet without the additional features of a full-fledged online service. Most will provide software to access the Internet. Some of them are ids, Log on America, Netcom and AT&T. Members of the Brown University faculty have the option of free access to the Internet through the University's facilities, although it can be overwhelming to a beginner. To obtain a Brown Net ID and the necessary software, go to the Center for Information Technology consultant's office on the corner of Waterman and Brook streets in Providence. ASIM also offers POL--which will soon provide Internet access.

The current focus of attention on the Internet is the World Wide Web. A user simply clicks on a word or picture--called a "link"-- highlighted in a different color from the rest of the text to go to another Web page or to transfer a file to their own computer. The attractions of the World Wide Web are its ease of use and its availability for users of all types of computers.

To retrieve information on the World Wide Web, you use a program called a Web browser. Whichever online service you sign up with likely will provide you with this software, but if you have a choice of browser, you should use either Netscape Navigator or Microsoft Internet Explorer. Once on the Web, you can request that the browser retrieve specific Web pages by typing the page's URL (Uniform Resource Locator), which is in the form http://nameofcomputer/directory/filename.html. Better yet, you can start at one Web page and move to another by clicking on a link that interests you, then click on a link on the new Web page, and so on. This is referred to as "surfing" the Web.

A good starting point for physicians is "The Doctors Home Page" (http://users.aol.com/gsnace/homepage/mypage.htm), which lists most of the useful medical resources on the Web. There is a link there to a comprehensive listing of patient information resources. The National Library of Medicine (NLM) (http://www.nlm.nih.gov) has links to resources on the National Institutes of Health computers and now includes Medline (http://igm.nim.nih.gov) searches among its offerings (you must have an account at NLM to use Medline). Computer programs called search engines allow you to enter a word or phrase and retrieve a list of Web pages that match your entry. A collection of search engines is located at http://www.search.com, and is worth a visit if don't know where to find something. I invite you to visit my home page (http://users.aol.com/yde/html/home.html), which contains a listing of my favorite medical and nonmedical Web pages, as well as some other "fun stuff."

I also suggest reading Adam Engst's "Internet Starter Kit for Macintosh," which also is available for Windows. In future issues of the The Rhode Island Internist, I'll point out Web sites of interest to internists. You can E-mail me with any comments or questions at Yul_Ejnes@brown.edu. See you in cyberspace!

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This has been a busy year for health care legislation--by some calculations, more than 140 bills dealing directly with health care were introduced this session. Most of the significant health care legislation is still alive, having moved from one chamber to the other.

The biggest item of interest is the "Zainyeh Bill," which is based on the American Medical Association's Patient Protection Act. After 15 months, this bill is on its way to Gov. Lincoln Almond's desk, having passed both chambers unanimously. This is the most comprehensive and significant health care legislation to ever pass in Rhode Island and it is sure to generate national interest. Included with the disclosure requirements are due process protections for providers from deselection by an insurer.

The "OB Express" bill (24-hour post-partum stay) seems to have lost some steam, yet it will pass. The 13-bill package submitted by House Majority Leader George Caruolo has been moved to the House Finance Committee and no further action has taken place to date. It will be interesting to watch the fate of this legislative package, since these bills have been derided as antimanaged care by the insurance industry.

Each chamber has passed its own version of assisted suicide legislation. The Senate bill is slightly more onerous, since it contains language on injunctive relief that was stripped from the House version. The Senate version has been reconciled with the House version and soon will be on its way back to the Senate. It is unclear how the "pride of authorship" will be resolved. However, based on the fervor of the issue's proponents, a bill criminalizing assisted suicide will be sent to the governor's desk.

RIMS insurance reform bills for removal of "gag," "hold harmless," and "contingency" language in provider contracts remain alive. The House and Senate are not engaged in a knock-down, drag-out fight over the budget--thanks in no small part to better than expected revenue projections--so the plan seems to be to adjourn the General Assembly in late July.

(Steven DeToy is a lobbyist for the Rhode Island Medical Society)

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David Fried, MD--Cranston
Anne Bauman, MD--Barrington
Suzanne Burns, MD--Bristol
R. Scott Hanson, MD--East Greenwich
Vincent Armenio, MD, East Providence



Mitchell Pressman, MD
Coastal Medical, Inc.
450 Veterans Memorial Pkwy, Building 6
East Providence, RI 02914
(401) 435-5533
E-mail: Mitchell_Pressman@brown.edu


Yul Ejnes, MD
Coastal Medical, Inc.
75 Sockanossett Cross Road
Cranston, RI 02920
(401) 946-6200
E-mail: Yul_Ejnes@brown.edu

Immediate Past President

Sewell Kahn, MD
250E Centerville Road
Warwick, RI 02886
(401) 739-7380
FAX: (401) 737-7558

Secretary-Treasurer/Membership Chair

Paul McKenney, MD
470 Tollgate Rd.
Warwick, RI 02886
(401) 738-6544

Newsletter Editor

Dennis Krauss, MD
49 Seekonk Street
Providence, RI 02906
(401) 351-7103
FAX:(401) 751-6179

Meeting-Program Coordinator

Harold H. Horwitz, MD
49 Seekonk Street
Providence, RI 02906
(401) 351-2280

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