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Chapter Newsletter - Fall 2000

From the Governor's Desk…

There is much to report as we leave for the Fall Board of Governors' Conference in Seattle, Washington.

Offered there are interesting symposia and workshops which I will discuss more fully in my next column.

Planned locally is the up-and-coming November 15, 2000 meeting in Newport. This year we are especially excited to have extended the time of the meeting into the afternoon and co-sponsor it with the Department of Medicine at Brown University. We have scheduled many distinguished speakers. Updates by the following individuals in their respective areas are:

  • Dr. Charles C.J. Carpenter on HIV
  • Dr. Lance Dworkin on nephrology
  • Dr. Jack Wands on GI and liver disease
  • Drs. Richard Besdine and Robert Crausman on geriatrics
  • Dr. Robert Smith on diabetes
  • Dr. Rena Wing on obesity
  • Dr. Jane Carter on tuberculosis
  • Robert Doherty from the ACP-ASIM Washington D.C. office will talk about what internists can expect from our new United States President who will be elected by then.

Also at that meeting will be the presentation of the Milton W. Hamolsky Lifetime Achievement Award.

Please make certain to save the date. You will receive further details in a separate mailing.

The Governor's Executive Council Meeting was held on August 31, 2000 at the Gatehouse Restaurant. There was high attendance and great participation with a lively discussion in a number of areas, including review of the resolutions for the fall ACP-ASIM Board of Governors meeting and updates from the chapter subcommittees, including an description of upcoming events to be presented by our very active Medical Student Subcommittee.

I think you can be proud of your chapter which continues to be a vibrant and responsive resource for internists in Rhode Island. Please help us increase our membership by talking to your colleagues about the benefits of being in our wonderful organization.

We are already planning our Spring, 2001 Meeting. Please contact Jim Hennessey or me with your ideas.

Fred J. Schiffman, MD, FACP
Governor, RI Chapter ACP-ASIM

 

Exercise Your Right To Vote

Your vote counts! Exercise your right to vote and have your voice heard this fall when the ballots are mailed to elect the next Governor for the chapter. Candidates willing to serve your interests, represent your thoughts and positions on nationwide issues, and support local activities that will expand and enhance the chapter are running for office.

You are empowered to guide the College's leadership into the new century. It all starts with one little check mark. Ballots will arrive in November to all eligible voters (Masters, Fellows and Members), including brief biographical information on the candidates as well as vision statements from them. If you don't receive your ballot by the end of November, look in the Member Connection section of ACP-ASIM Online, located at http://www.acponline.org/private/mbrconn, to check that the mailing address listed for you is correct. If you did not receive a ballot, you can request that one be sent to you by contacting Joy Crist at 800-523-1546, ext. 2722.

Support the best your chapter has to offer and take a few moments to review the ballot. It's easy. When the ballot arrives, just check off one name and return it in the envelope provided. It's that simple. And you can make a difference.

 

Personal Statements of the Candidates for Governor-Elect

This winter, Members, Fellows, and Masters of the Rhode Island Chapter of ACP-ASIM will be asked to vote for the next Governor. This individual will serve from 2001-2002 as Governor-Elect and then succeed the current Governor of the chapter, Fred J. Schiffman, MD, FACP, in 2002 for a four-year term.

The Nominations Committee, chaired by Frederick S. Crisafulli, MD, FACP, has nominated two candidates for the office of Governor-Elect. They are Yul D. Ejnes, MD, FACP, and Robert E. Knisley, MD, FACP.

This fall, all members who are eligible to vote will receive a mailing from the College with a biographical sketch of each candidates as well as a brief mission statement written by the candidate. To supplement those materials, we asked each candidate to prepare a statement for this newsletter on a topic of his choice.

Robert E. Knisley, MD, FACP

After completing my undergraduate studies at Princeton I moved to the University of Pennsylvania for Medical School and Graduate training, including internship, residency, and fellowship. I intended to stay at Penn, but was sidetracked by the Vietnam Crisis and joined the Berry Plan and then spent the subsequent two years in the service at Fort Knox, Kentucky. While there I spent some of my free time at the University of Louisville teaching in their Hematology Program.

On leaving the service I settled in southern Rhode Island, but wished to continue to participate in a teaching setting and did this at Rhode Island Hospital and subsequently with the Brown University Medical Program.

In the early 70's when Hematology and Oncology first developed their specialty boards and rapidly expanded; along with another physician, we set up the first private practice in Hematology and Oncology in the Providence area and at Rhode Island Hospital as well in several community hospitals.

From my perspective Medicare was just starting when I began to practice. In the last twenty years the practice of Medicine has changed dramatically and all forms of third party payers and programs, including the HMO's and hospital administrators have proliferated.

For a period of time I was associated with the Ocean State Health Plan, an HMO which was started in this state and served on the Executive Board and as Treasurer.

I feel fortunate to have been in what I consider a rather unique position bridging academic medicine, as well as developing a private subspecialty practice and indeed being associated with practice management groups. Medicine is rapidly changing and I believe the ACP-ASIM and similar leaders are helping us to move in the appropriate direction. I could like to be part of that movement and utilize my energy and skills assisting the process.

Yul D. Ejnes, MD, FACP

A successful medical organization is one that is relevant to the professional lives of its members. We are "relevant" when every member, no matter where and how he or she practices, views ACP-ASIM as their "first stop" for professional needs. That does not mean that the chapter must solve every problem and meet every need, but even when it can't, the member should at least feel that they "got their money's worth" from the chapter.

In the two years since the merger, the Rhode Island Chapter has become more relevant than ever. More remains to be done, however. As Governor, I would further widen the spectrum of services that the chapter provides to members. Increasing our visibility with the local insurers, state government, and the public; further developing the chapter's ability to quickly communicate with members and vice versa through e-mail and fax; and creating a more robust system to deal with members' "hassles" of practice are just a few of the areas on which I would focus.

As a result of the merger, I am in a rather unusual position. Having served for over two years as a Transitional Governor alongside our elected Governor, Fred Schiffman, I've had the pleasure of sitting on the national Board of Governors as a full voting member. In addition, I'm honored to sit on two national committees of the College. This gives me a valuable perspective and understanding of ACP-ASIM and how it operates. It has also allowed me to form working relationships with other states' leaders and staff in the Philadelphia and Washington offices, as well as with members of our chapter's Executive Council. I am committed to using the experience and knowledge about our organization that I've gained to serve the Chapter in whatever capacity our members see fit.

 

ACP-ASIM's Efforts to Reduce the Hassle Factor

The ACP-ASIM's Department of Managed Care and Regulatory Affairs Department has compiled a comprehensive list, which outlines the College's efforts to reduce the hassle factors faced by physicians. From meeting with the staff of the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) to influencing pending legislation on physician-assisted suicide, the ACP-ASIM is dedicated to fighting the hassle factor battles for its members.

The following is a sampling of the College's efforts as prepared by its Department of Managed Care and Regulatory Affairs Department (March 2000). For the complete list, log on to ACP-ASIM Online at http://www.acponline.org/hpp/hassles.htm.

1. Easing Evaluation and Management (E/M) Documentation Requirements:

  • Urged the Medicare Payment Advisory Commission (MedPAC) to recommend that E/M documentation requirements be made less burdensome; ACP-ASIM's recommendations were included in their March 2000 report.

2. Simplifying Claims Processing and Credentialing:

  • Reached agreement on a process that will allow ACP-ASIM leaders to meet regularly with policymaking representatives from the BCBSA and the Health Insurance Association of America (HIAA). Both HIAA and BCBS have recently announced initiatives to reduce hassles affecting physicians. ACP-ASIM has been invited and agreed to participate in both efforts.

3. Opposing Imposition of Mandatory Hospitalist Programs:

  • Persuaded United Healthcare to withdraw its mandatory hospitalist plan in Rhode Island; influenced MCOs in Florida and Texas to withdraw their mandatory programs and make them voluntary.

4. Simplifying Billing for Laboratory Tests:

  • Participated in the negotiated rulemaking committee to develop standard Medicare policies for 23 clinical laboratory tests with the goal of reducing the administrative burden physicians' face when ordering lab tests and to eliminating Medicare carrier policy variability. New proposed rule has been published for comment that incorporates the rulemaking committee's recommendations, including most of ACP-ASIM's concerns.

5. Addressing Concerns about Fraud and Abuse:

  • Achieved revisions in OIG's "Who Pays, You Pay" campaign materials that are more physician friendly, and that direct patients to resolving billing issues with their physicians first, rather than calling the OIG Fraud Hotline. The revised materials note that most physicians are honest and want to work with patients to resolve questions about bills.

6. Improving CPT Codes for Care Plan Oversight Services:

  • The CPT Editorial Panel agreed to an ACP-ASIM proposal, submitted jointly with the American Academy of Family Physicians, that would allow physicians to bill for the time they spend communicating with family and other care decision-makers regarding coordination of care for home health and hospice services.

7. Reducing Other Hassles:

  • Made numerous recommendations aimed at promoting fairness in the way Medicare audits physicians and seeks recoupment of money paid to physicians based on those audits. Met with an independent auditor that prepared a report on ways to improve Medicare's review processes. ACP-ASIM's recommendations also aim to eliminate the elements of the current process that coerce physicians into accepting settlements on Medicare's terms.
  • Provided guidance to HCFA so the agency can ensure all of its Medicare carriers are not restricting patients' ability to be evaluated by an internist (or other physician) prior to surgery.

8. Empowering Physicians to Influence Third Party Payers:

  • Lobbying for comprehensive patient bill of rights legislation (Norwood-Dingell bill) that will provide physicians and patients with greater rights to influence and appeal inappropriate denial of payments. The bill would also prohibit gag clauses, assure that physicians-not MCOs-define what is medically necessary, and allowing recourse to the courts when self-insured plans deny needed benefits. Norwood-Dingell bill was passed by the House of Representatives last year. The College is currently influencing House-Senate conferees to report legislation based on Norwood-Dingell, rather than a weaker version passed by the Senate.

9. Helping Internists Cope with Hassles:

  • The College's Department of Managed Care and Regulatory Affairs and ACP-ASIM's Center for a Competitive Advantage have developed numerous educational resources to help internists cope with requirements from Medicare and private payers in the least burdensome manner possible. Resources include a guide on compliance with federal fraud programs and Medicare audits, a laminated list of ICD-9 codes typically used by internists, and a pocket guide to coding for E/M services.
  • The Department of Managed Care and Regulatory Affairs authors a monthly column in the Observer on coding, coverage and payment policies.
  • ACP-ASIM maintains a toll-free hotline to enable internist-members to get personal assistance in resolving problems with Medicare and other payers. The hotline number is 1-800-338-2746, ext. 4533.

 

Update on the Health Quality Performance Measurement and Reporting Program

Edward Westrick, MD, MS
Principal Clinical Coordinator
Rhode Island Quality Partners

Rhode Island is the first state to pass a law requiring mandatory public reporting of quality data on licensed health care facilities. The details of this program are currently being developed by the Department of Health under the advisement of a legislated Steering Committee.

Patient satisfaction with hospital care is the first subject to be addressed. A common vendor has been selected by the hospitals. The common survey is currently being tested. Public reporting will likely occur in 2001.

Clinical performance is the second subject to be addressed. In order to minimize data collection burden, measures will be selected to satisfy JCAHO and HCFA requirements in addition to the state legislation. Both JCAHO and HCFA are actively participating with us and hope to use RI as a model for the nation. The first clinical performance measures will likely involve care in pneumonia, heart failure, and myocardial infarction. Statewide performance on candidate measures has been published in Medicine & Health Rhode Island (Gifford DG and Maxim R. How Does RI Rank Nationally on Quality Indicators? Medicine & Health RI. 83: 225-6 (2000)). National performance on these measures will be published in a national journal this fall.

Other settings of care will be the subject of future planning: skilled nursing facilities, home health agencies, ambulatory surgery centers, and ambulatory clinics. Quality reporting on health plans is covered by another piece of state legislation, the Health Care Accessibility and Quality Assurance Act. There is no existing legislation to publicly report on the performance of private physician practices. You can find more information on these efforts at: www.health.state.ri.us

The author may be contacted at:

Rhode Island Quality Partners
9 Hayes Street
Providence, RI 02908
ripro.ewestric@sdps.org
401-528-3250 voice / 401-528-3210 fax

New ACP-ASIM Fellows Approved by Regents

The Rhode Island Chapter recognizes the following members who were elected to fellowship in ACP-ASIM in the July, 2000 by the Board of Regents:

Thomas A. Bledsoe - Providence
Edward J. Wing - Providence

 

Fellowship Advancement Made Easy (FAME)

Marc Shabot, MD, FACP
Texas Southern Governor

Prerequisites

  • ABIM, RCPSC, or AOBIM certified*
  • Licensed practitioner
  • Formal training completed, Member at least 2 years, in practice or teaching for at least 2 years
  • Proposed/seconded by 2 Masters/Fellows
  • Commitment to lifelong learning and professional development

*May be waived in extraordinary circumstances

Then, Qualify by 1 of the 4 Pathways*

Pathway 1- Academician

  • Holds academic appointment as teacher, researcher, administrator, writes scientific papers, scholarly reviews, book chapters, etc.

Pathway 2- The Scholar/Teacher/ Multiple Certification

  • Active in community as teacher in Continuing Education and Professional Development activities
  • Recertified or dual boarded, or MKSAP for score

Pathway 3- The Active ACP-ASIM Member

  • 10 years membership in the ACP-ASIM
  • Active in ACP-ASIM meetings and Committees at local and national level

Pathway 4- The Senior Physician

  • May have been a longstanding Member or have joined ACP-ASIM later in life
  • Has demonstrated longstanding professional activity in the community, in teaching, in patient care or in service; acts as a role model for other physicians and health professionals

Note: Community service, especially the voluntary provision of medical care, and ACP-ASIM activities significantly enhance the likelihood of advancement, under all four pathways.

*Pathways are not mutually exclusive, "combinations" are permissible

 

Wanted: Future Chapter Leaders

Are you interested in getting more involved with our chapter and sharpening your leadership skills? Do you aspire to hold an elected office in our chapter (Governor, member of a National Committee) and/or advance to Fellowship? If you answered yes to these questions, then we need you for our newly created Chapter Leader Network.

Designed to lighten the workload of the chapter Governor, make operations at the chapter level more efficient and increase member involvement, the Chapter Leader Network will be composed of local "point people," who will chair the activities/initiatives of various areas, including Associates/Medical Student Activities, Community-Based Teaching, Credentials, Clinical Skills Modules, etc.

The network members will exchange information with specific College staff and initiate local activity when needed. A Chapter Leader Web site will be developed to facilitate communication between network members and staff.

So, if you want to be instrumental in improving the effectiveness of our chapter, volunteer to be a member of this exciting new endeavor. For a complete listing of the network areas and responsibilities, please contact Governor Fred J. Schiffman, MD, FACP, at (401) 793-4035, or Administrative Assistant Nancy Baker-Hobin at Divison of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903; phone: (401) 444-8537; fax: (401) 444-4730.