Governor's Newsletter, Summer 2001
David W. Potts, MD, FACP
Governor, South Carolina Chapter
Letter From The Governor
Hello to all!
Both your local chapter of the ACP-ASIM and the National remain busy working on many fronts to improve our practices and our lives.
We would enjoy seeing you at the South Carolina ACP-ASIM Scientific Session in Charleston at the Frances Marion Hotel, September 21-23. This meeting has been a growing success each year. Hopefully this year's theme, "How About Us," will continue that growth. Please see the article below by Mike Hawkins for more details.
Congratulations to Harry Morris, MD, FACP. Harry won the National Association of Inpatient Physicians Award for Clinical Excellence at this year's National ACP-ASIM meeting in Atlanta. Thanks Harry for a job well done.
Dawn Clancy, Mary Beth Poston, Bill Bouleware, and I had the chance to be in Washington for this year's Capitol Hill Day. Once again it was eye opening to appreciate how much influence decisions made in Washington have on our day-to-day practice. The ACP-ASIM has ongoing involvement in the political scene through their Washington office. Capitol Hill Day provides a snap shot for the doctors, which are hopefully then followed up with ongoing contract with our legislators. The hot topics for this year remain: access to care with some new twists such as a refund allowing those close to poverty to purchase insurance, a Patient's Bill of Rights, patient safety, and Medicare Reform. For more details, please contact Dawn Clancy at (843) 876-0888 or email her at (email@example.com.) Each of us needs to have ongoing contact with both our State and National Representatives. Please see the article on page 2 by John Black. Many other organizations are having this input, decisions are being made with tremendous impact on us without Internal Medicine being at the table. INTERESTED? Please consider joining the ACP-ASIM key contact program (call Dawn).
Also to enhance our knowledge of items of urgent interest on the political scene, Bill Bouleware and Dawn Clancy are going to start a fax out system in the very near future. We have fax numbers for approximately 1/3 of the South Carolina ACP-ASIM members. If you would like to be included in this very exciting opportunity to learn more about items of State and National interest on a fast breaking basis, please call Debbie Shealy at (803) 772-6783 and give her your fax number.
If you have issues concerning Medicare, and who doesn't, these should be brought to the attention of Bill Robinson (William.firstname.lastname@example.org), who now serves as our Medicare Advisory Board Representative.
Membership in the ACP-ASIM continues at a robust pace. We are the number one Specialty organization in the country with over 115,000 members, associates, and students. Each of you, no doubt have partners and colleagues who are not members of the organization. Please help us reach them by informing them of the activities of the organization and the benefits to each one us through these efforts. We would be pleased to send membership information to one and all.
Fellowship is now available to all internists of stature. That surely includes many of us. Currently, significant activity in any variety of worthwhile endeavors qualifies one for fellowship. Long term excellence in clinical practice, teaching and academic activities, significant activities within the ACP-ASIM and community activities are all important in making us excellent physicians and help qualify each of us for fellowship. Over the years, women, international graduates, and other minorities have been less likely to apply for membership or fellowship. I would especially welcome applications from these groups.
Speaking of excellent physicians. Please see the article by Jim McFarland on page 3.
At this year's South Carolina ACP-ASIM Scientific Session we will hold elections for several statewide offices. During this, my last year serving as your governor, I would like to continue the diversification process of the council. This diversification will allow the council to better represent Internists and ACP-ASIM members across our chapter. Please call me at 864-455-8496 or email me at (email@example.com) if you would be interested in serving on the council, applying for membership or fellowship, or if I could be of any other assistance to you.
SC Chapter 2001 Annual Meeting Update
Mike Hawkins, MD, FACP
I am pleased to announce that our program for this year has been reviewed by the Educational Meetings and Conferences Department and Chapter Education Subcommittee and has been approved for 12 CME credits. A reviewer noted that this meeting has "an excellent mixture of scientific and other issues impacting internists." We hope that everyone will mark the dates on their calendar and make this year's meeting one of the best yet. I urge everyone to look around in your communities, identify those internists that are not involved in ACP-ASIM, and urge them to become involved, and to attend this year's meeting. The best advertisement in the world is word of mouth. Make personal contacts and our membership will grow. I recently spoke with two internists that have not been involved. Because of the conversation, both have joined our chapter. Two for two so far. If every member does this, think of the impact it would have on membership. See you in September!
South Carolina Medical Association and ACP-ASIM
All Internists in ACP-ASIM need to be active members of the South Carolina Medical Association. If any of you are not involved in SCMA, then you do not have any idea what SCMA does for you in the background. Recently, I testified before the subcommittee of the Senate Medical Affairs Committee representing SCMA physicians against the House and Senate Bills that would expand the scope of practice for optometrists to include prescribing any medicines including controlled substances and oral steroids for eye diseases as well as indictable epinephrine for anaphylaxis. Based on the testimony that the SCMA provided by others, and me the optometrists have withdrawn from this portion of the bill to prescribe medicines and compromised on the other issues that physicians had already agreed with. This is a major victory for Medicine since this bill had already passed the House and was soon to be heard by the Senate.
The message is that many other non-physicians are trying to expand their scope of practice (chiropractors, nurses, pharmacists, physical therapists, physician assistants, naturopathists, etc.). Who is watching out for the practice of Medicine? You? The answer is no! None of us have the time. But, the SCMA has the time and the resources.
Not only do we need to be members of SCMA, but also we need to be members of SOCPAC. This is the political action committee of SCMA that supports legislators who might be willing to listen and hear our views. This is the real world. Contributions to campaigns count.
All Internists need to be members of SCMA, SOCPAC, and AMA. To not do this is abandonment of our profession in hopes that our specialty society will look out for us. Let us remember that we are physicians first, and Internists second. We physicians must present a united front.
Committee Service: A Pathway To Leadership
Jim Mcfarland, MD, Chairperson
The primary function of the nominating committee is to plan and carry out the election of the Governor-elect. The Treasurer, the Chairperson of each committee and the members of these committees are appointed by the Governor. This brings to the fore the secondary function of the nominating committee, that being to recommend persons, who might fill any of these positions. Committee service is one of the ways, and possibly the best, to gain experience and a better knowledge of the operations and goals of the ACP-ASIM. This in turn leads to the development of a pool of committed and informed people, who can provide the leadership we need in the future. Our present committee structure includes the following: the Executive Committee and the Health and Public Policy, membership, nominating, annual meeting program and Associates committees. The request of the nominating committee is that you give thought to this subject and suggest names of persons you feel would be interested in serving. Let us emphasize that this includes volunteering your own name. The desire to serve is the criterion for success. Please submit any names and comments to me. My e-mail address is (firstname.lastname@example.org) fax (803)738-3571 and telephone (803)787-2420.
ACP-ASIM Works To Reduce Medicare Hassles
ACP-ASIM is pleased to announce its endorsement of the "Medicare Education and Regulatory Fairness Act" (MERFA), S. 452/ H.R. 868, which directly addresses internists' concerns with Medicare red tape and hassles. Medicare's complex regulations have created a heavy paperwork burden that significantly reduces the time doctors spend with patients, according to William Hall, MD, FACP, President-Elect of ACP-ASIM and a practicing geriatrician. Dr. Hall represented the College and announced support for this important legislation at a March 7 press conference with the American Medical Association and the American College of Cardiology, as well as MERFA's Senate and House sponsors. MERFA directly addresses the Medicare procedures and rules that are the source of much frustration with the program. Under Medicare regulations, physicians must comply with numerous federal rules and local contractor policies to complete claim forms, provide advance beneficiary notices, certify medical necessity, file enrollment forms and comply with code documentation guidelines. Yet, there is no single source that physicians can access to learn Medicare's rules and policies. Introduced in the Senate by Senators Frank Murkowski (R-AK) and John Kerry (D-MA) and in the House by Representatives Shelley Berkley (D-1-NV) and Pat Toomey (R-15-PA), MERFA would allow physicians and their staff to spend more time treating patients, and less time handling needless paperwork. It would enact the following reforms: Medicare rules and policies and answers to "frequently asked questions" would be made more accessible, and physicians would be given advance notice about changes in rules. Medicare would be required to claims, without demanding more paperwork, unless there is evidence that the bill is incorrect. Medicare would be required to actually examine the records, rather than using a statistical sample, to determine that some claims were billed incorrectly. Medicare's ability to investigate fraudulent claims would be preserved, while also educating physicians on how to prevent inadvertent billing mistakes that result in overpayments. Enactment of MERFA is one of the College's highest priorities. The College strongly encourages you to ask your Senators and Representative to cosponsor this important bill if they have not already. Illustrate for your legislators your experiences with the burden of complying with regulations, and how much time it takes you and your staff to deal with complex, confusing, duplicative and unfair Medicare requirements. E-mail, fax or compose a letter to your legislators through the ACP-ASIM Legislative Action Center (draft letter provided, please personalize), or call your Senators and Representative toll-free through the ACP-ASIM Grassroots Hotline at 1-888-218-7770. (The Hotline will prompt you for your 8-digit member number, which you can find on the mailing label of ACP-ASIM publications, such as Annals of Internal Medicine.) Report your contacts to Jenn Jenkins in the ACP-ASIM Washington Office at 800-338-2746, ext. 4536, or by blind copying e-mails to(email@example.com.) Thank you for your help.
Recertification: The Dialogue with the ABIM
Herbert S. Waxman, MD, FACP
Senior Vice President, Education, ACP-ASIM
It's about a year since there began a serious dialogue between the College and the American Board of Internal Medicine (ABIM)about the many concerns the College had with the ABIM's plan to implement the proposed Continuous Professional Development (CPD) process for recertification. The core concerns of the College are as follows: The process of recertification should be clinically relevant, not excessively burdensome, and not redundant of things that are already being done in physicians' practice environments (e.g. patient and peer evaluation, practice performance measures and improvement plans.) College members have expressed very strong feelings about this! There should be a clear delineation of the responsibility for high stakes evaluation (ABIM) and education, including self-assessment (ACP-ASIM and other professional societies.) There should be a clear articulation of the fact that maintenance of competence requires more than just evaluation periodically. It should also encompass relevant continuing education, taking into account learning preferences of the individual physician. A Joint ABIM-College Committee on Recertification was set up, with three high-level governance members and a staff person representing each party. The College sought resolution of the above concerns; the ABIM sought endorsement by the College of the proposed CPD recertification process. Thus far, the dialogue has resulted in agreement in principle by the ABIM of the need to resolve the College's concerns. However, the devil is in the details, and there haven't yet been proposed details that have been perceived to satisfy the needs of the College and its members. At the meeting of the Board of Regents at the Annual Session in Atlanta, five resolutions pertaining to recertification were communicated to the ABIM, addressing the need to respond to the College's concerns and including a deadline for meaningful progress to have taken place. The Board has instructed its members of the Joint Committee to recommend in July whether the College should endorse CPD or refuse to endorse the process. In response, the ABIM requested detailed information about what we want specifically. In a letter from Drs. Bernard Rosof and William Hall (our Board of Regents chair and our President, respectively) to the ABIM leadership, we presented our requirements. In short, we are insisting that a physician's participation in a self-assessment program (such as MKSAP) or in patient or peer evaluations or in practice performance measures in his or her own hospital or health system be allowed to satisfy the corresponding requirements of the self-evaluation modules of the recertification process. Recertification should not impose on the physician requirements of what is already being done well in many physicians' practices. ACP-ASIM has not taken a position opposing the formal examination of medical knowledge. The College believes that such an evaluation is appropriate for documentation of maintenance of certification and is something the ABIM is skilled and experienced in doing. Meanwhile, our Research Center has carried out a telephone survey of over 600 College members, most with time-limited certificates. The results confirm what we have been hearing as strongly expressed individual opinions: The concept of recertification is supported, but the support for CPD is much weaker. Of the self-evaluation components of CPD, the patient and peer evaluation module is viewed most negatively, the knowledge module least negatively. There is a clear sense that the costs of recertification and of the educational programs to prepare for recertification are much greater than the perceived benefit. Supporting anecdotal reports, a high proportion of respondents are carrying out in their practice environments most of the functions embodied in CPD. For these physicians, the CPD modules would be redundant and therefore represent an excessive burden. We're now waiting to hear how the ABIM responds to the demands outlined in our letter. Based on that response, there will be a final decision made by the College on whether or not to support the ABIM's proposed CPD process. Of paramount importance to the College is that, one way or another, the strongly felt and legitimate concerns of our members be satisfactorily responded to. Stay tuned!
Volunteering in Medicine
Charles P. Duvall, MD, F.ACP
Vice Chair, VIM Institute
Hilton Head Island, South Carolina
Hassled? Harried? Sucking on some final straw? We get that way at times and then wonder what happened to the good old days, wishing for some return to the way the physician patient relationship used to be, before so many third parties. A successful retirement naturally depends on adequate financial resources and some notion of how time will be rewardingly spent. Physicians are bonded to society with that first sweep of the scalpel in Gross Anatomy and when trained, they become a new self, always learning new things but never fundamentally changing. One never really stops being a physician at the core. This reality becomes a major impediment to timely retirement. One might very well miss professional collegiality, patient interaction and the press of flesh … the diagnostic challenge, just the satisfaction we all know of being the doctor.
For me, working in the Volunteers in Medicine Clinic (VIM) here in Hilton Head Island, has solved all of the problems alluded to above, and more. The clinic was started several years ago because of the inspiration and determination of pediatrician, Jack McConnell, MD and opened its doors six years ago. Currently, it is a going concern with a fine modern physical facility and over 60 physicians of all specialties, 50 nurses, and a whole variety of ancillary medical and support personnel. Over 75, 000 patient visits have been charted since inception and the Clinic has become grafted to the backbone of our community. There is mental health, social service, and pharmaceutical support and consultative service available not only with the Clinic but through the good graces of the practicing medical community and the local hospital. Our corporate "Culture of Caring" treats the patients with the same dignity and level of true concern that would typify the manner of any practicing "good internist."
Restive, despite this success, Jack McConnell's current energies are focused on the VIM Institute whose sole mission it is to promulgate this template for caring in other areas, including, of course, the state of South Carolina. If more information is desired with regard to starting your own VIM Clinic give us a call at 843-5700 or email me at (firstname.lastname@example.org.) If you are near to retirement but are concerned about missing the elements of patient care that are most dear, come on in….the water's fine and the beach is terrific.