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Chapter Newsletter, Summer 1999

From the Governor's Desk

The annual meeting of the Rhode Island Chapter of ACP-ASIM was held on April 6 & 7 at the Radisson Airport Hotel in Warwick.

Tuesday evening, April 6th, found resident physicians from the Internal Medicine training pograms at Rhode Island's hospitals assembling, displaying and discussing their posters. Dr. Harold Sox and his wife, Carol, joined us to review the posters and made new and met old friends and colleagues.

The next morning's events began with oral presentations of research and clinical vignettes by our associates:

  • Ombosola Akinsete, MD (Memorial Hospital of RI): "Diabetes mellitus in HIV/AIDS patients receiving protease inhibitors"
  • Moses Aboagye-Kumi, MD (Miriam Hospital): "A novel method assessing severity of illness in CCU compared to APACHE score"
  • Laura Obbard, MD (Rhode Island Hospital): "Communication during NRMP match: Insight from internal medicine program directors"
  • Tanya Ali, MD (Roger Williams Medical Center): "Unusual presentation of enteropathic arthritis"
  • Jonathan Doris, MD (Miriam Hospital): "Presentation of a patient with presumed Listeria rhomboencephalitis"
  • Dilshad Blackinton, MD (Roger Williams Medical Center): "Ceramide provides an apoptotic 'death signal' which potentiates the anti-tumor effect of Taxol"

This was followed by a business meeting conducted by me and a College update provided by Dr. Sox.

A panel discussion moderated by Dr. Sox and me discussed quality and outcome in the clinical practice of medicine. Dr. Edward Westrick explained how RI Quality Partners was involved in the quality and outcome effort. Dr. Peter Hoffman, Deputy Medical Director of Harvard Pilgrim Health Care of New England; Dr. Anthony Kazlauskas, Senior Medical Director of UnitedHealthCare of New England; Dr. Patricia Nolan, Director of the Rhode Island Department of Health; and Dr. Peter Hollmann, Medical Director of BlueCHiP, discussed how their respective organizations were involved with quality and outcome.

I had the honor and pleasure of presenting the 1999 Chapter Laureate Irving Addison Beck Memorial Award to Dr. Charles Kahn.

"Meet the Professor" sessions were held during lunch, led by Dr. Charles Kahn (Diabetes), Dr. Timothy Flanigan (HIV), Dr. Lance Dworkin (Nephrology and Hypertension), Dr. Marilyn Weigner (Cardiology), and Ms. Elaine Narducci (Coding and Reimbursement). Problem cases were discussed, and, as usual, I was impressed with the diversity and liveliness of the interactions among all members of the "Meet the Professor" groups.

Dr. Joseph Sweeney and Dr. Anthony Mega then presented cases and discussion on the newer anticoagulants. This was followed by the afternoon session of oral presentations by associates:

  • Gintaras Liaugaudas, MD (Memorial Hospital of RI): "Serum ystatin C is a major independent determinant of fasting plasma total homocysteine levels in coronary artery disease patients with normal serum creatinine"
  • Pragna Patel, MD (Miriam Hospital): "Human granulocytic ehrlichiosis"
  • Alice Fan, MD (VA Medical Center): "Two cases of hepatic hydrothorax without ascites"
  • Carolyn O'Connor, MD (Rhode Island Hospital): "Outcome predictors of abnormal thyroid function and morphology in a community screening program"
  • Emilio Rodriguez-Peris, MD (Roger Williams Medical Center): "Evaluation of a women's preventive medicine program in residents' clinic"
  • Sharon Rawlings, MD (Miriam Hospital): "Localized amyloidosis presenting as pelvic pathology"
  • John Straus, MD (Roger Williams Medical Center): "Lactate dehydrogenase and isoenzymes in myocardial infarction"

Dr. Sox was impressed with our Chapter's breadth and depth of expertise in all areas and we look forward to continuing successful gatherings.

Please note the topic and date of our Fall meeting "Update in Internal Medicine," which will take place at the Doubletree Hotel in Newport on October 7th.

With kindest personal regards,

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

From The Board of Governors' Meeting: The College's 1999-2000 "Hot Topics"

Yul D. Ejnes, MD, FACP

The ACP-ASIM Board of Governors met prior to the Annual Meeting in New Orleans. The Board considered twenty resolutions submitted by chapters and discussed several issues that will occupy much of the College's attention this year. "Hot" issues include:

PAC - Board of Regents Chairman Robert Copeland, MD, MACP, explained to the Board of Governors the Regents' reason for delaying a final decision on whether the College should establish a political action committee. This issue is discussed elsewhere in this newsletter. Over the next year it will be important for members to learn more about the role of political action committees and the implications of the College's having or not having a PAC.

Collective Bargaining - Physicians are organizing into groups in order to negotiate with insurers and other third parties. These groups have taken various forms ranging from large medical practices, to IPA's and PHO's, to labor unions. It is the unionization of physicians that has taken center stage in recent months. For many years house officers in some large cities have been unionized, but now practicing physicians are joining unions. The dilemma is how to balance the need for physicians to get some relief from the very restrictive antitrust laws that prohibit most forms of collective activity by physicians with the need to avoid any actions, such as strikes, that would interfere with patient care and jeopardize our status as professionals. Representative Campbell of California has introduced a bill that would permit physicians to negotiate collectively. The College is looking at this bill as a possible solution to the dilemma. In an informal breakfast discussion attended by thirty Governors and Regents there was considerable support for a position proposed by the Board of Regents that would allow collective bargaining, provided that there were no job actions or other activities that would impede the delivery of care. Expect to hear more about collective bargaining over the next several months.

Workforce reductions - An often-discussed concern was the projected growth in the number of health care providers. "Providers" includes osteopathic physicians, nurse practitioners, and physician assistants. ACP-ASIM Past President Harold Sox, MD, MACP, discussed this during his remarks at the Rhode Island Chapter meeting. Efforts to achieve some form of workforce reduction on a voluntary basis have not been successful. There are competing economic and political agendas that are responsible for that failure. The College supports legislative action that would restrict the number of residency spots to 110% of the number of US graduates.

Access to Health Care - ACP-ASIM President Whitney Addington, MD, FACP, whose term began at the Annual Meeting, announced that universal access to health care is his major project for his presidency. He and other College officials noted that the number of uninsured Americans continues to grow in spite of a robust economy. The College has proposed some measures that will rapidly reduce the number of uninsured Americans from the current 43 million to less than half of that. The College's plan calls for a tax credit for the least affluent Americans that would allow them to purchase health insurance and expansion of Medicaid eligibility to include more of the uninsured. Given the budget surplus that exists, these reforms are realistic and can be implemented relatively quickly. For this to happen, however, all members of the College, not just its leaders, must participate by contacting members of Congress, as well as state legislators.

Improving the Quality of Health Care - At the Annual Meeting, the College unveiled its first clinical theme, designed to improve the quality of care provided by physicians. This year's clinical theme is reducing unnecessary use of antibiotics. It has been observed that while there is a growing database of "best practices" and evidence-based guidelines, many of these recommendations are not being followed. Examples include the low rate of utilization of beta blockers after MI or the underuse of ACE inhibitors in CHF. The College hopes to achieve a measurable improvement in the quality of care through the promotion of the clinical theme in various settings, including state chapter meetings, College publications, and public advertising campaigns.

These are but a few of the issues that we discussed in New Orleans. Common to all of them is the need for active member participation, ranging from feedback to the Governor and Council about the PAC and collective bargaining, to phone calls and letters to Congress to promote universal access to health care, to changes in the way that we take care of patients for the clinical theme. In the back of this newsletter is our Member Response Form that asks for specific comments on the above issues. Please let us know how you feel about these important topics. If you prefer e-mail to other forms of communication, the Chapter now has a new e-mail address, RIACPASIM@worldnet.att.net. Fred and I look forward to hearing from you.

HCFA's Sixth Scope of Work

Edward Westrick, MD, MS

Rhode Island Quality Partners (RIQP) and other Peer Review Organizations (PRO) work under contract with the Health Care Financing Administration (HCFA) in three year cycles called Scopes of Work. We are coming to a close in the 5th Scope of Work and will be kicking off the 6th Scope of Work at the end of this year. We will continue to work primarily on quality improvement projects.

There will be six national topic areas and at least two local projects. The national topic areas include: acute myocardial infarction, heart failure, pneumonia/adult immunization, stroke/TIA/atrial fibrillation, diabetes mellitus, and breast cancer screening. All PROs in all states and territories will be doing projects to improve quality in these clinical topic areas using the same indicators of performance. HCFA will be able to show the national impact when the scope of work is complete. In previous scopes of work, the vast majority of projects were designed and implemented locally, without common measures and without common interventions.

Local projects will continue as part of the second task but will receive less emphasis than the national projects. One local project will focus on reducing the disparity of care received by a disadvantaged group and another will focus on a setting of care other than the hospital.

The quality indicators for the hospital setting attend primarily to medication use. Examples include aspirin, beta-blocker, ACE inhibitor, and reperfusion use in myocardial infarction; ACE inhibitor use in heart failure; antibiotic use in pneumonia and immunization for the prevention of pneumonia; and aspirin and other anti-platelets for TIA and stroke, warfarin for atrial fibrillation, and avoidance of sublingual nifedipine.

Dr. Westrick is Principal Clinical Coordinator of Rhode Island Quality Partners.

Contact information:

Edward Westrick, MD, MS
Principal Clinical Coordinator
Rhode Island Quality Partners
9 Hayes Street
Providence, RI 02908
ripro.ewestric@sdps.org
528-3250 voice
528-3210 fax

Committee Spotlight: Associates Committee

Andrea Tom

It's exciting to report that the Internal Medicine Interest Group took off with a great start! The support and enthusiasm of the group's initial meeting was overwhelming. Fifty-eight people signed up to join, a significant increase over the response of previous years.

A meeting is planned with fourth year medical students who matched into Medicine and Med/Peds residencies this year. A shadowing program was proposed for first and second year students to spend an afternoon with a physician to better understand particular fields of endeavor. We hope to identify preceptors through ACP-ASIM.

Other activities of student interest which are in the planning stages include:

  1. a meeting on opportunities in public health/international health/social medicine;
  2. meeting with residency directors to find out what they are looking for in applicants desiring to enter Internal Medicine programs. We hope to plan a meeting with the Brown Internal Medicine site directors to describe the different sites and give people information about the clerkship; and
  3. a meeting with third/fourth year students with tips for rising third years about scheduling clerkships.

If anyone would like to participate in the above activities please contact Andrea_Tom@brown.edu. Your experience and knowledge will be greatly appreciated.

Andrea Tom is a member of the Brown University School of Medicine Class of 2000.

Y2K Bug: Terminal Illness for Elderly Software?

For the past few months, Y2K articles have dominated the headlines. But according to the recent findings of the U.S. Senate Special Committee on the Year 2000 Technology Problems, health care professionals are the least prepared for dealing with the Y2K problems. In fact, the Committee found that most physicians' offices are unaware of the crippling affect that the Y2K bug can have on their practices.

Practice management software is a particular risk because its failure could disrupt practice operations, and vendors are not supplying Y2K retrofits for some older practice management software products. Practices owning such products are left with little choice but to purchase replacement systems, and the time remaining in which to accomplish such a complex selection and installation, is growing desperately short. Experts predict that by mid-year, vendor backlogs could develop that would push new installations into the year 2000.

As a result of these disturbing reports, the ACP-ASIM has stepped up its efforts to educate its members on how they can make their practices Y2K compliant before its too late. The College has developed a comprehensive web site, which can be accessed from ACP-ASIM Online. This site includes staff-written articles on how to cope with the Y2K problem; guides, checklists, and educational opportunities to help evaluate, compare and select Y2K compliant software; and links to major outside web sites.

The College's Center for a Competitive Advantage (CAA) has two, free informational packets available to members through Customer Service, Selecting a Software System and Electronic Medical Records. Call Customer Service at (800) 523-1546, ext. 2600 or (215) 351-2600. Members can also call CCA at (800) 338-2746, ext. 4553, or the College's Medical Informatics Department (800) 523-1546, ext. 2572, for more information about Y2K compliance issues.

Other informative medical Y2K web sites include:

http://irm.cit.nih.gov/y2000/ - the National Institutes of Health's (NIH) web site for medical schools and teaching hospitals; and

http://www.ama-assn.org/not-mo/y2k/help.htm - the AMA's web site.

This article was prepared by the ACP-ASIM Center for a Competitive Advantage staff.

RI Medical Society Membership - Strengthening RI ACP-ASIM's Voice

Several years ago the Rhode Island Medical Society (RIMS) took the revolutionary step of reorganizing its leadership structure to give the subspecialty societies a greater voice in the governance of the organization. The RIMS Council was reconfigured in a way that gave each subspecialty society a voting seat. The then "new" Council was such a success that RIMS eventually dissolved its House of Delegates, leaving the Council as the major policy-making body of the Society.

As a condition of participation on the RIMS Council, member specialty societies must have over 50% of its members also be members of the Rhode Island Medical Society. We're pleased to report that the RI ACP-ASIM Chapter has fulfilled that requirement. However, our participation in RIMS can always be improved. We strongly encourage all ACP-ASIM members to join the Medical Society in order to ensure our fullest participation in RIMS. For applications, call the Medical Society at 401-331-3207.

ACP-ASIM Services Political Action Committee: The Pros and Cons

Yul D. Ejnes, MD, FACP

At its January meeting, the Board of Regents decided to delay for one year a decision on the formation of a political action committee (PAC) by the College. The formation of a PAC was called for in Board of Governors Resolution 144, approved in September 1998. In delaying the final decision for a year, the Regents hoped to gather further information necessary for the decision, including opinions from the Internal Revenue Service and feedback from members.

The following "talking points" were produced by the College for discussion of the PAC. Rather than paraphrase them, I present them to you as written for your consideration. One technical note: because of the tax-exempt status of the College, the PAC would actually be housed in what is known as ACP-ASIM Services, a sister corporation to ACP-ASIM, hence the name "ACP-ASIM Services PAC."

Pros: The creation of an ACP-ASIM Services PAC might serve to further the agenda of the medical profession, and more specifically of internal medicine, by:

  • providing an effective avenue for members to be politically active;
  • enhancing access to members of Congress;
  • strengthening the association's grassroots program; and
  • raising visibility of the association and its issues.

Cons: Several concerns about the potential risks of establishing a PAC include:

  • the public may have an unfavorable perception of PACs, and establishing an ACP-ASIM Services PAC might tarnish the reputation of the College;
  • conflicts of interest might arise in supporting political candidates who may advocate policy issues not in line with those of the College; and
  • although a PAC bears the name of the organization, the number of members who contribute to the PAC may comprise only a small percentage of that organization.
  • contributions are voluntary; dues are not used as contributions.

The ACP-ASIM Health and Public Policy Committee developed a mission and operating rules for an ACP-ASIM PAC that has not been formally approved by the Board of Governors. It is available on the web site, or I can provide a copy upon request. Whether the mission and rules will be acceptable to the Governors is one of several questions that the College hopes to have answered by early 2000, when a final decision on the PAC will be made. Others include the impact of a PAC on the College's tax-exempt status and the potential effect on membership. Finally, while the Board of Governors has spoken quite clearly on this issue, the Regents would like to hear from members, either directly or through the Governor.

You can contact Fred Schiffman at fschiffman@lifespan.org or me at Yul_Ejnes@brown.edu or the chapter at RIACPASIM@worldnet.att.net.

Associate Wins National Poster Competition

Congratulations to Rebecca Ballard, MD, ACP-ASIM Associate, who was one of the winners of the Clinical Vignette Poster Competition held at the ACP-ASIM Annual Session in New Orleans in April. Dr. Ballard is an internal medicine resident at Rhode Island Hospital. Her Poster was entitled "Recurrent Pulmonary Embolisms As A Manifestation of Munchausen's Syndrome."

New Fellows March at ACP-ASIM Annual Session in New Orleans

Yul D. Ejnes, MD, FACP

One of the highlights of the Annual Session is the Convocation, held on the first evening of the meeting. At the Convocation, the College presents awards to distinguished physicians and honorary fellowships to international dignitaries. But the highlight of the evening is the official induction of the new Fellows and Masters of the College. The ceremony is replete with tradition, from the mace carried by the Marshall of the Convocation to the academic regalia worn by the participants.

This year two members of the Rhode Island Chapter participated in the convocation. Vincent A. Armenio, MD, an internist/hematologist from East Providence, and R. Bruce Gillie, MD, an nternist/endocrinologist from Westerly officially became Fellows of the American College of Physicians-American Society of Internal Medicine when they and several hundred other new Fellows from all over the world took the ACP-ASIM Pledge. Congratulations to Drs. Armenio and Gillie.

There are several pathways for members to advance to fellowship. While the June deadline for the current cycle of applications will have passed by the time you receive this newsletter, it isn't too late to begin the process for the next cycle in the fall. Applications for advancement to fellowship are available at the ACP-ASIM headquarters at 800-523-1546 or they may be requested at the web site at www.acponline.org/college/membership/formreq.htm.

Chapter Delegation Visits DC

Yul D. Ejnes, MD, FACP

On May 25 and 26, Scott Hanson and I participated in ACP-ASIM's seventh annual Leadership Day. The program consisted of a day of briefings on issues of interest to internists and their patients and sessions on how to be an effective advocate with members of Congress. This was followed by a day of visits to Capitol Hill. Scott and I met with Senator Jack Reed, Representatives Robert Weygand and Patrick Kennedy (see photo), and Senator Chafee's health policy aide Lisa Layman. We spoke in favor of the passage of patient protection legislation and introduced the College's proposal to reduce the number of uninsured through tax credits and increasing Medicaid eligibility.

Follow-up contact by ACP-ASIM members will reinforce our message. For details on the College's legislative agenda, visit the web site at www.acponline.org/hpp/hppmenu.htm. You'll also find information on how to contact members of Congress. Or you can call the College's toll free hotline at 1-888-218-7770 and be connected to your congressperson. Have your College ID number handy (it's on your Annals mailing label).

Rhode Island Chapter of ACP-ASIM Executive Council

Fred J. Schiffman, MD, FACP - Governor (1998-2002) (401-793-4035)

Yul D. Ejnes, MD, FACP - Transitional Governor (1998-2000); Chair, Communications Subcommittee (401-275-1991)

Michele G. Cyr, MD, FACP - Immediate Past Governor (401-444-4765)

Mitchell A. Pressman, MD, Member - Treasurer (401-435-5533)

John R. Audett III, MD, Member

Munawar Azam, MD, Member - Chair, IMG Subcommittee (401-456-3000)

James Burrill, MD, FACP

J. Russell Corcoran, MD, FACP K.

Robert S. Crausman, MD, Member

Frederick S. Crisafulli, MD, FACP - Chair, Health and Public Policy Subcommittee (401-331-8555)

Mark Fagan, MD, Member - Chair, Associates Subcommittee (401-444-5344)

Edward Feller, MD, Member

Neal Galinko, MD, FACP

Reginald Y. Gohh, MD, Member

R. Scott Hanson, MD, Member

Pamela Harrop, MD, Member - Co-Chair, Membership Subcommittee (401-253-8900)

James V. Hennessey, MD, FACP - Chair, Education Subcommittee

Harold M. Horwitz, MD, Member

Sewell I. Kahn, MD, FACP

Janice Kizirian, MD, FACP

Dennis S. Krauss, MD, FACP

Edward Lally, MD, FACP

Paul F. McKenney, MD, Member

Anthony Mega, MD, Member

Harold Sanders, MD, FACP

Diane Siedlicki, MD, Member

Karen Stevenson, MD, Member

Dominick Tammaro, MD, FACP

Alan Weitberg, MD, FACP

Administrative Assistant

Nancy Baker-Hobin
Division of General Internal Medicine
Rhode Island Hospital
593 Eddy St.
Providence, RI 02903
401-444-8537 (voice)
401-444-4730 (fax)
NBaker-Hobin@lifespan.org

Yul D. Ejnes, MD, FACP
Transitional Governor (RI), ACP-ASIM
Yul_Ejnes@brown.edu
(401)946-6200

Chapter e-mail address - RIACPASIM@worldnet.att.net