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Governor's Newsletter, Summer 2000

David W. Potts, MD, FACP
Governor, South Carolina Chapter

Letter from the Governor

Hello to All:

COME JOIN US for the September 22-24, 2000, South Carolina ACP-ASIM Chapter Meeting. This year's meeting looks especially interesting. Friday morning, September 22, will start with the Associates' presentations and posters. These have become highlights of the meeting with much original and excellent work and the opportunity for the "winners" to present at the national meeting. The general session will begin Friday afternoon at 2 p.m., with a lecture and group discussion on professionalism by Dr. Don Saunders. Don has become a national expert in this area and is now devoting his time fully to this intriguing topic. His lecture will be followed by a period of discussion for all of us to consider our role in this vital aspect of medical practice. During the next two days we will have numerous outstanding speakers, including our College Representative, Dr. Munsey Wheby, Regent, who will be talking about anemia, as well as informing us of the activities of the ACP-ASIM. Other speakers include Dr. Trey Dunaway, who will update us on coding; Dr. Wharton, who will give us a pharmacology update; and Dr. Stewart Sprague, who will talk with us about Physician Assisted Suicide. These are just some examples of the excellent speakers, who will also be joined by Drs. Thandroyen, Gallagher and Desmond Smith. This year's meeting will be held at the Frances Marion/Weston Hotel in Charleston. In addition to the excellent academics as noted above, there will be plenty of time for camaraderie, sightseeing, and of course, indulging in the excellent foods available to us in Charleston.

Fellowship in the ACP-ASIM is a true honor and should be sought by all members. Anyone interested in obtaining Fellowship should plan to attend the South Carolina ACP-ASIM Chapter Meeting in September. We will offer clerical services at this meeting to assist you in the process. If you will bring your CV, the Membership Committee headed by Dr. Robert Walker, will complete the paperwork during the course of the meeting.

For additional information, please contact me or any of the members of the Committee, which include Drs. Mike Hawkins, Barry Blackston, Theresa Gallagher, Dawn Clancy, Paula Woods, Mike Kunkel and Bill Robinson.

Dr. John Black, who so well represents us on both the Medicare Carrier Advisory Board and on the Specialty Board, reminds us to support the South Carolina Medical Association, which lobbies the South Carolina Legislature about medical issues. He also believes that AMA Membership is very important even though we may not agree with all of their specific positions. They are surely a strong force in good medical care and have been very important in moderating Medicare payments and CLIA regulations.

Dr. Bill Bouleware and I had the chance to attend Leadership Day in Washington to discuss issues important to all of us with the Legislative Delegation from South Carolina. Our hot topics this year included Patient's Bill of Rights, Universal Coverage, Medicare prescription benefits, and the Institute of Medicine's Report on patient's safety. Bill is organizing a fax information sheet with hot topic items concerning legislative as well as other issues, which will be faxed to all members for whom we have a fax number If you are interested in this fax information sheet, but do not receive one by the middle of July, please contact Bill and let him know of your interest.

The ACP-ASIM has put out a booklet called "Young Physicians Practice Management Survival Skills," which is available to you by calling Jean Elliott, Staff Liaison, Young Physicians Subcommittee, at (800) 523-1546, ext. 2692. Although designed for new physicians, I found it very helpful. Also included with this is an excellent summary of Evaluation and Management codes. Each of you may which to obtain a copy of these new products.

It is not too late to submit your suggestions for the next Governor. This year we will choose a Governor-Elect, who will become the Governor in April 2002. We will also elect council members at the September South Carolina Chapter Meeting. If you are interested in this exciting opportunity, please let Jim McFarland or me know.


Associates' Corner

Shawn Stinson

Feedback from last year's Associates' Competition has been excellent. We are optimistic that participation among the state's residents and fellows will be even greater this year. The Associates' presentations on clinical cases and research projects will again occur the morning of Friday, September 22, at the Annual South Carolina ACP-ASIM Chapter Meeting. Attendance by the general membership is strongly encouraged.

The South Carolina ACP-ASIM has been successful at encouraging the Internal Medicine resident trainees to join our organization. However, we would like to increase the membership, so that all of the trainees in the three residency training programs in South Carolina are Associate members. We have been minimally successful in recruiting membership among the medical students at our state's two medical schools; needless to say, we are very interested in improving this. Any individuals with suggestions, or who are interested in working to improve membership among our trainees, should contact Shawn Stinson, MD, at (803) 540-1000. Your help will be greatly appreciated.

How the "Doctors for Adults" Campaign Can Work for You

ACP-ASIM's national public relations and ad campaign is reaching literally millions of Americans, telling them an internist is a "Doctor for Adults." Does your community know you are a "Doctor for Adults?" Here are five easy ways to put the campaign to work for you.

1. Introduce Yourself as an Internist

Whether you're a generalist or a subspecialist, take a minute to tell your patients you are an internist and ask them if they know what that means. You might be surprised at their answers, but it's a quick and relaxed way to let patients know who you are - a "Doctor for Adults." One easy way to clear up confusion is to distinguish yourself from general practitioners or family physicians, whose practices may include surgery, obstetrics and pediatrics, and whose training is not solely concentrated on adults.

If you subspecialize, you'll want to explain that you chose additional training to specialize in one of the complex medical areas of interest that come under the internal medicine umbrella. When speaking publicly, publishing or responding to questions from the media, be sure to identify yourself as an internist.

2. Hand Patients a Brochure

Order your free sample copy of the College's "Doctors for Adults" patient brochures. One such brochure, Where We Fit in Today's Primary Care Picture, distinguishes internists from other primary care physicians and tells how we care for the whole patient.

A new brochure, 100 Million Adult Americans Are Overweight and at Risk of Serious Disease, supports the College's 1998-99 national campaign to alert Americans to the risk of overweight/obesity and explains the role of internal medicine. There's space on the back to stamp your name and address - in case your patients' friends or relatives want to see you.

3. Wear Your Badge and Patches

For as little as $2 you can outfit yourself with a badge and 10 iron-on white-coat patches. They will instantly identify you with the national "Doctors for Adults" program, showing your patients - at a glance - who you are. And they might open the door to a quick chat with your patients about what an internist is and does.

4. Enlist Your Staff

Does your office staff know the short answer to the question, "What is an internist?" Tell them about the "Doctors for Adults" campaign and take them through the Where We Fit brochure, so they can easily and accurately engage patients, explaining what distinguishes an internist from the other primary care physicians.

5. Use the Campaign Logo

The "Doctors for Adults" logo is being registered in the name of the College for the exclusive use by members and associate members. The more you utilize it, the more closely you will be linked with our national public education campaign, which is telling literally millions of Americans,

For additional information on the College's "Doctors for Adults" campaign, log on to www.doctorsforadults.com.

Contact Your Legislators Through the Legislative Action Center

To make participation in grassroots advocacy easier for its members, ACP-ASIM established a Legislative Action Center (LAC), which may be accessed from ACP-ASIM Online. The LAC allows you as an ACP-ASIM member to view the most current ACP-ASIM Legislative Alerts, find out who your federal legislators are, and send e-mails or faxes to your members of Congress. It also provides you with the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with your legislators. ACP-ASIM encourages you to try the LAC by sending an e-mail to your members of Congress in response to the current Legislative Alert posted on the LAC.

You can access the Legislative Action Center through the "Where We Stand " section of ACP-ASIM Online, or by going straight to the LAC at http://congress.nw.dc.us/acp/. To send a message to Congress, you are prompted for your zip code and are zip-matched to your federal legislators. You will then be asked for your name and address (so that congressional offices can identify you as a constituent). ACP-ASIM encourages you to send a message based on the sample message posted for you, with your own personal anecdotes added. If you have any questions about the LAC or ACP-ASIM's Key Contact program, please contact Jenn Jenkins, Associate for Grassroots Advocacy, at jjenkins@acponline.org, or at (800) 338-2746, ext. 4536.

Documentation and Billing When Teaching in the Office Setting

Patrick C. Alguire, MD, FACP, Director, Education and Career Development

Many internists teach students and residents in their office setting. Frequently, these preceptors have questions regarding proper documentation for Medicare billing when a learner is present. Here are some useful guidelines.

Documentation Requirements for a Resident: Current Medicare rules permit a teaching physician (preceptor) to substantiate a bill based on the combination of the resident's and the teaching physician's documentation of a specific service. The teaching physician must clearly convey that he/she saw the patient and participated personally in the patient's care up to the level of the EM services billed. The teaching physician can confirm that he or she verified the findings in the resident's note and agree with findings as documented by the resident. The teaching physician can also indicate that he or she agrees with the diagnosis and plan as written by the resident. These requirements, for the most part, permit a certain amount of time saving by using the resident's documentation as part of your own note. This will somewhat decrease the overall work associated with teaching by allowing you receive some "service" for your educational endeavors.

Documentation Requirements for a Student: The only documentation by medical students that may be used by the teaching physician is their review of systems (ROS) and past history, family history, and social history (PFSH). Currently, the teaching physician may not refer to a medical student's documentation of physical examination findings or medical decision making in his or her note. These restrictions will obviously have an impact on office efficiency. However, there are certain strategies that can be used to maximize efficiency in spite of these regulatory requirements. The use of the "wave scheduling" collaborative examinations, and presenting in the room are other methods to help manage documentation requirements when a student is present.

For more information regarding these techniques, contact the ACP-ASIM Community-Based Teaching Program at (800) 523-1546, ext. 2845, or e-mail palguire@acponline.org.

How to Contact Us

David W. Potts, MD, FACP
Greenville Memorial Hospital
Department of Internal Medicine
701 Grove Road
Greenville, SC 29605
Phone: (864) 455-8496
Fax: (864) 455-6680
E-mail: dpotts@ghsms.ghs.org