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Governor's Newsletter, Winter 2000/2001

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

Governor's Message

Hello to all!

Once again we had an excellent South Carolina Annual Scientific Session in September. The turn out was, I believe, the highest ever and the program was extremely high quality. My thanks once again to our committee for their outstanding work in producing this meeting. Barry Blackston and Theresa Gallagher chaired the committee this year. They had a great deal of assistance from Nadine Hultz, Debbie Shealy, Dawn Clancy, Mike Hawkins, Paula Woods, Mike Kunkle, and Marie Blackston. All of their assistance is greatly appreciated. Also a very special thanks to Dr. Munsey Wheby, our College Representative, who provided for us an excellent scientific update on anemia, as well as great insight on the activities of the ACP-ASIM.

Theresa Gallagher and Mike Hawkins are busily planning for next year's meeting, which will most likely be held in Charleston in September- please send them any ideas or concerns.

Dr. Shawn Stinson and his committee, Julius Sagel and Scott Arnold, put on a superb Associates Program on Friday morning. Each year this program has continued to grow, including this year with forty Associate's presentations and posters. I find it extremely exciting to see the excellent work these young physicians and students present. Individuals that worry about the future of medicine have surely not attended a presentation such as this. I am also personally glad there will be a good supply of superb physicians to take care of me as I continue to age.

Thanks to all the Associate and Student presenters. A special thanks to the winners: William Curran from Greenville, Bryan May, a student at USC working in Greenville, and Lee Butterfield from MUSC. These winners will be able to present their work this year at the National ACP-ASIM Annual Session in Atlanta with expenses paid by the South Carolina ACP-ASIM.

Again this year the highlight of the Annual Session was the Laureate Award. This is presented each year to a South Carolina physician with a long history of excellence and peer approval in the specialty of Internal Medicine, who has also served the South Carolina Chapter. This year's award went to Dr. Bruce Usher, MD, FACP, who has worked with the Medical University of South Carolina for many years in providing superb care in Cardiology, as well as Medical Education for the Students, Residents, and Fellows of that institution. He has also has served in the past, with great distinction as Governor of the South Carolina Chapter of the ACP-ASIM. CONGRATULATIONS BRUCE!

Bruce joins our previous esteemed Laureate winners: 1991 - Roy A. Howell, Jr., FACP
1992 - William W. Pryor, Sr., FACP
1993 - Charles S. Bryan, FACP
1995 - O'Neill Barrett, FACP
1996 - J. O'Neal Humphries, FACP
1997 - Edward M. Mobley, Jr., FACP
1998 - James A. McFarland, Jr., FACP
1999 - Donald E. Saunders, Jr., FACP

Once again during this year's Annual Session, we held elections for the SC ACP-ASIM officers.

The following individuals will serve as the Council for the ACP-ASIM South Carolina Chapter for the next year:

Bill Boulware, Florence
Chair-Health and Public Policy

Jim McFarland, Columbia
Chair- Nominations and Awards

Robert Walker, Greenville
Chair- Membership and Credentials

Mike Hawkins and Theresa Gallagher
Co-Chairs- Scientific Program

Shawn Stinson, Columbia
Chair- Associates Program

Ann Cook, Anderson
Secretary

Dawn Clancy, Charleston
Treasurer

Carl Mitchell, Columbia
Member at Large

Theresa Gallagher, Florence
Member at Large

Vanessa Dixon, Greenville
Student Member

Desmond Smith, Greenville
Member at Large

Kim Davis, Charleston
Member at Large

My thanks to all of the above for their willingness to serve and assist with the work of our local chapter.

Soon you will have the opportunity to vote for the Governor-Elect for the South Carolina Chapter of the ACP-ASIM. We are very pleased to have two excellent candidates for this position- Sompong Kraikit and Bill Boulware. Please exercise your right to vote when the ballots arrive in the near future.

This year we have two Associates interested in serving on the SC ACP-ASIM Council- Mary Beth Poston, MD, a resident in Columbia and Jim Arter, MD, a resident in Greenville.

This year's Annual Session of the ACP-ASIM will be held in Atlanta, Georgia, from March 29 thru April 1, 2001. This will be an excellent opportunity for each of us to attend a superb meeting without the need for extensive travel. We also have several people who have been elected to Fellowship, but have not yet chosen to participate in the Commencement ceremony. Each of you in this category should plan to avail yourself of this opportunity.

The National organization continues to work diligently for the benefit of both our patients and us. The numerous educational offerings such as Annual Sessions, State Sessions, MKSAP and now the new student MKSAP, are respected worldwide. The ACP-ASIM continues working on our behalf with other medical organizations such as the ABIM, the AMA, and of course our government to preserve and improve our opportunities. One of the
current potential areas of controversy concerns the re-certification process. This has been expanded as both an educational and certification process through the ABIM. Any ideas or concerns you have about this should be given to me, or presented directly to the National organization utilizing their web page, the phone or mail.

Additional information about these and all other issues is available through the South Carolina web page http://www.acponline.org/chapters/sc/ or the ACP-ASIM web page http://www.acponline.org.

As always, please feel free to contact me with any areas of issues or concerns.

David W. Potts, MD, FACP
Governor SC ACP-ASIM
Greenville Memorial Hospital
Medical Center Clinic
Internal Medicine
876 W. Faris Road
Greenville, SC 29605
Phone: (864) 455-8496
Fax: (864) 455-6559
E-mail: dpotts@ghs.org

The Future of Internal Medicine Will Be in Atlanta - March 29-April 1

Be a part of the College's vision of upholding the best traditions and creating opportunities for excellence in the future. Join us for Annual Session 2001.

Discover... The Next Generation of Multiple Small Feedings of the Mind

Back and better than before! Creative formats, short, focused presentations, and practical topics combine to make these sessions a popular favorite. Each session is based on a series of practice- derived questions related to several clinical areas that address some of the most common, yet controversial, patient-management issues.

Discover... The Most Recent Breakthroughs at the Annual Update Series

Stay current on the latest information and perspectives from the nation's foremost experts in 20 subspecialty areas. The Update series is a valuable resource to ensure that you're up on the year's most significant findings and their impact on patient care.

Discover... Meet the Professor Sessions

Go right to the source. Take this opportunity to hear the experts discuss cases illustrating controversial issues and innovative techniques in patient care. Then get up-close and personal in the new Meet and Eat with the Professor sessions. Sit down with these same experts over breakfast and lunch and get answers to your specific questions in a smaller, more intimate setting.

Discover... Interactive Learning for the Next Millennium

Hands-on learning activities are an excellent way to refresh your skills or learn new ones. Take advantage of the Learning Center to help you gain experience or refine your abilities in such vital areas as medical interviewing, physical examination, and office-based procedures. The Learning Center is also the ideal place to familiarize yourself with medical informatics software that can have an immediate impact on your daily practice.

Discover... Annual Session and Beyond at the Many Special College Events

Get in the spirit of Annual Session. Meet fellow internists from around the globe. Share your discoveries and learn from one another. Annual Session is more than a time for learning, it is a time to honor our colleagues' achievements at Convocation, to find out about the latest College initiatives at the Annual Business Meeting, and to meet old friends and make new ones at Regional and Chapter receptions, plus a variety of other events.

Discover tomorrow- Register today.

Registration is available online at http://www.acponline.org/cme/as/2001/register, or by calling (215) 351-2600.

A Weekly Publication of the South Carolina Medical Association

October 30-November 3, 2000

SCHA Switches Back to South Carolina Hospital Association

At a retreat this past weekend, the Board of Trustees of the South Carolina Health Alliance (SCHA) voted to change the name of the Alliance back to the South Carolina Hospital Association. According to SCHA's Patti Smoak, plans for reinstating the former name have not been finalized.

Medicare + Choice Moves Into South Carolina

Sterling Life Insurance Company has been approved to offer a Medicare Choice plan to beneficiaries in South Carolina. Sterling Option 1, is a private fee-for-service plan that receives a capitated payment from HCFA, but reimburses hospitals, physicians, and other providers at a rate predetermined by the plan. Sterling Option 1 offers patients the freedom of choice of physicians and hospitals, the ability to see specialists without referral, and to travel without losing coverage. The patient must continue to pay the Medicare Part B premium and is responsible for the plan's premium and any cost-sharing, such as co-payments. All claims are handled by Sterling and not the S.C. Medicare Intermediary.

If you have any questions regarding Sterling Option 1, contact their Provider Relations Department at (888) 858-8550. They are available Monday through Friday from 5 a.m. until 5 p.m. Pacific Time.

Natural Medicines Comprehensive Database

The Natural Medicines Comprehensive Database contains current scientific information of practical and clinical importance to health professionals covering herbal medicines, dietary supplements, and other natural medicines.

The web-based version is updated daily. The book contains all the information that was available on the web the date the book was sent to the printer. Contact Natural Database at (209) 472-2244 or via e-mail at mail@NaturalDatabase.com.

Medicaid Implements Pharmacy Point of Sale

Effective November 1, South Carolina DHHS implemented a new and enhanced system of pharmacy claims processing for the Medicaid fee-for-service program. DHHS contracted with First Health Services Corporation to operate DHHS' statewide pharmacy point of sale and prospective drug utilization review system. This system will serve to facilitate the submission and adjudication of pharmacy claims while assessing the full range of medications that a patient received through the Medicaid program.

Under the new pharmacy claims processing system, when a Medicaid patient submits a prescription to be filled, the pharmacist will transmit patient identification and prescription information via the pharmacy computer and

point of sale equipment. In an on-line, real time mode, the system will: (1) review the prescription claim, (2) determine whether the claim is payable or inform the pharmacist of procedures which must be followed in order for the prescription claim to be Medicaid reimbursable, and (3) screen the utilization review criteria. The system will then respond to the pharmacy, indicating whether the claim is payable or whether there is a potential drug therapy problem (e.g./ drug to drug interaction).

Beginning November 1, when a Medicaid patient presents a prescription for one of the following products, the pharmacist should contact the prescriber and ask the prescriber to telephone First Health's Clinical Call Center. The prescriber will be asked to provide Clinical Call Center staff with the necessary information in order for Medicaid coverage to be considered. Prescriptions for Serostim, Xenical, Panretin, Targretin, and Erectile Dysfunction Drugs must be pre-authorized through the Clinical Call Center at (866) 247-1181 (toll free). Additional questions may directed to Medicaid's Department of Pharmacy Services at (803) 898-2876.

HCFA Announces Education Initiative as Part of Medicare Integrity Program

The Health Care Financing Administration (HCFA) has announced the new Provider Education Project, a multi-year educational component of the Medicare Integrity Program. According to HCFA, they will work in partnership with practitioners, providers, and billing professionals to ensure that they have the resources they need to understand complex Medicare rules and regulations on claims coding and submission.

During the first year of the project, HCFA will conduct a national needs assessment to determine what types of educational resources will help providers and practitioners submit accurate claims for Medicare services and, in turn, receive timely payment of those claims. HCFA will gather input from Medicare Part B practitioners, a selected group of Medicare Part A providers, and billing professionals through a series of focus groups. The information obtained from the focus groups and survey will be used to design a national education plan. The education plan will include an innovative array of tools and programs that deliver clear, consistent information about Medicare claims submission.

The Medicare Integrity Program is an outgrowth of the concern of HCFA and Congress that health benefits for its 39 million beneficiaries are paid promptly and appropriately. For more information, contact Edward A. Sommers, Program Director, Provider Education, at (301) 519-5662 or by e-mail at esommers@aspensys.com.

Collective Bargaining Bill Dies; Supporters Vow to Try Again

A bill that would have let physicians bargain collectively with insurers died in the Senate this congressional session because it never found a sponsor. But backers say once the dust settles from the Nov. 7 election, they'll again try to get Congress to pass the legislation. Many agree it will be easier to pass an antitrust bill, aimed at giving independent physicians more leverage against managed care companies, if Democrats control Congress.

But no matter what the outcome of the election, proponents say they are optimistic that a bill that would allow physicians to collectively bargain could pass the House quickly next year because it had strong bipartisan support there this year. In June, members of the House passed the Campbell antitrust bill by a 276-136 vote.

TMA Oks Suing Insurers Over Late Physician Payments

After years of unsuccessful attempts to work with insurers in Texas to make sure physicians get reimbursed in a reasonable amount of time and get paid for necessary patient services, state medical association members have decided it is time to take the battle to the courtroom. The Texas Medical Association's policy-making body passed a resolution in September that allows the group to file or join in lawsuits where there seem to be abuses. At press time, TMA had not yet joined in any lawsuits, but was considering some cases. It is one of a growing number of medical associations putting their weight behind lawsuits that accuse insurers of not paying physicians promptly. In addition, the SCMA is considering the feasibility of a prompt pay bill for the 2001 Legislative Session. The Interspecialty Council will be discussing the issue at their upcoming Retreat on November 11-12, 2000.

The SCMA Alert is circulated weekly via mail, fax, and e-mail. For subscription information, contact Dana Yow at (800) 327-1021, extension 234 or Hayley Driggers at (800) 327-1021, extension 420.