Governor's Newsletter, Spring 2002
Douglas S. Paauw, MD, FACP
Governor, Washington Chapter
I am very excited to start my term as Governor. I appreciate having the opportunity to serve in this role, and very much want to put great energy and thought into what we all want to achieve over the next four years. I greatly appreciate the support of David Dale and Tom Reis in helping to prepare me for this position, and I very much welcome input from the entire membership of ACP-ASIM on where our focus should be. I see a number of major issues that will grow over the next several years. Elsewhere in this newsletter you will see the Board of Governors response to the issue of recertification. I know this has been a topic of great consideration for a number of our ACP-ASIM membership.The ACP-ASIM has heard loudly and clearly the financial and time concerns, and difficulty with the current recertification system that many individuals have expressed.
I would very much like to hear from our members on what their most pressing concerns are, and any thoughts they have on how our local ACP-ASIM Chapter can help. We certainly have the ability to put together initiatives to present to the Board of Governors to see if we can get widespread support for issues we think are important. My email is (firstname.lastname@example.org) and my phone number is (206-543-3604). I do welcome your thoughts and would love to hear from you.
Medical Student Report
Matt Ashbach, Heather Rogers, Osler Club Co-presidents
The Osler Internal Medicine Interest Group at the University of Washington has had a productive and encouraging year thus far. The mission of the Osler Club is to teach students clinical skills and to address topics not covered in the curriculum.The Club also strives to promote interest in the field and subspecialties of internal medicine. This year, quarterly meetings regularly draw over 60 participants, most of whom have become student members of the ACP-ASIM.
At our first club meeting, during the fall, Dr. Paauw talked about clinical insights available from patients' hands. Dr. Paauw walked the students through Terry's nails, Heberden's and Bouchard's nodes, Beau's lines and many other manifestations of disease that have hand findings. Our second meeting focused on interactions and complications of the most popular drugs. The lecture became an informative and entertaining review of interactions found with both prescribed and OTC drugs.
Our most recent meeting hosted medicine directors for the Seattle clerkship sites. Drs. McGee (VA), Paauw (UWMC), and Schoene (Providence) discussed expectations, preparations and typical schedules for the medicine clerkship for third year students. The meeting also included demonstrations of oral case presentations by third and fourth year students. An upcoming meeting scheduled for the end of May will focus on educating students about handheld computers, a tool each of us is likely to buy prior to clerkships.
In early April, the ACP-ASIM sent the co-presidents to the Annual Meeting in Philadelphia and we were very excited about the trip. We attended seminars on physical exam skills, acid-base abnormalities, infectious diseases, and heart sounds. Yet, one of the best parts of the conference was meeting the many wonderful and inspirational members of the Pacific Northwest ACP-ASIM community. Notably, Heather was selected a national poster winner for her research on patients' and medical students preferences for location of oral case presentations. We also found time for two Philadelphia musts, indulging in a Philly cheese steak sandwich and running the Rocky steps.
As this summer approaches, the second year class has just two more weeks of class, which will be followed by a 3-4 weeks of preparation for Step 1 of the USMLE boards. Our class is very excited to get to the wards and out of the T-wing. We've worked hard to get here and feel the time has come to make the transition to the clinical setting.
Mark Your Callendars And Save The Date!
2002 Washington Chapter Annual Meeting, November 1-2, 2002
The Westin Hotel, Seattle, WA
- Evidence based Physical Diagnosis
- Pearls in: Infectious Diseases, Cardiology, Dermatology, Geriatrics and Men's Health
- Skills Workshops in: Skin Biopsies and Joint Injections
Medicare Access Limited In Whatcom County
Mark Lindenbaum MD, PhD
This March found my group, Madrona Medical Group, on the news at Seattle TV station KOMO for our decision to close our primary care internal medicine practices to new Medicare and Medicaid patients. This decision required some difficult and fundamental soul-searching on the part of our 12 general internists, and seems worthy of an account of our situation to our colleagues around the state.
Madrona Medical Group is a multi-specialty group formed in Whatcom County 7 years ago. Like many other groups around the state we have struggled in the current environment of increasing administrative requirements from payers, regional discrimination in Medicare reimbursement, increasing competition for specialists, and slimmer margins for commercial payers. This winter we began for the first time to debate at our weekly internal medicine department meetings whether we could maintain our traditional stance of having open practices be open to all payers. We reviewed information from the WSMA's surveys of health of medical practices in Washington State. As internists we have traditionally provided care for many of our community's frail and elderly, and Medicare/Medicaid percentages for most of our practices were well above the WMSA's danger threshold of 30%, some by large margins. The combination of rising costs, flat to declining reimbursement (Medicare's 5.4% cut was certainly considered), and the need to stay competitive for recruitment of new physicians to the community all were factors influencing our ultimate decision. We also considered hassle factors and administrative load related to various payers. Weighing in against these factors were arguments for the traditional role of internists as the physicians for the elderly and medically complex, as well as our sense of service to the community.
Our final decision in March to close practices to new Medicare patients was the subject of a local newspaper article, reflecting significant community interest and concern. Since most of our primary care internal medicine practices have been full and closed to all new patients, the decision was more symbolic than substantive, as in reality Medicare access for new patients in our community has been limited for some time. However, our public decision served to underline a situation that has been becoming increasingly apparent to my community. The response of patients in my largely geriatric panel has been overwhelmingly supportive. Though concerned for their own healthcare, they see the need for change in a system that bogs both them and their physician down in endless paperwork and red tape.
Our local story was picked up by the national news services and by the TV news media in Seattle, who came to interview physicians in our group as part of a feature on Medicare. It eventually echoed as far as Washington, D.C., resulting in a call from Tom Scully of CMS to our medical director, Mike Geist, MD followed by an offer to send the regional CMS administrator, Linda Ruiz, to attend one of our weekly department meetings. She came accompanied by Peter Houck, MD, a regional CMS medical director, and by Richard Whitten, MD, medical director for Noridian, the local Medicare intermediary. At our meeting in late March they presented us with pamphlets of 100+ un-indexed pages describing Medicare's efforts to be more open and responsive. However, they cited statutory and congressional restrictions limiting action on the concerns we expressed regarding odious, time consuming and un-reimbursed requirements currently bundled with Medicare E/M services. We were left with the feeling that our concerns about poor reimbursement and wasteful bureaucracy were heard, but that no substantial action is eminent.
In the future we hope to be able to re-open practices to Medicare, as we are able to recruit general internists to our group. As we do so we will monitor the makeup of panels and limit the percentage of Medicare and Medicaid patients to a level that will allow for the further recruitment and retention and balance the need for service to our community with the need for economic survival. Although we appreciate the role that our medical societies, and in particular ACP-ASIM, play in spurring changes in the Medicare program, we are increasingly convinced that ultimately it will be the concerns of our communities to our elected representatives that will determine the shape Medicare programs take in the future. In the meantime, our decision to limit access to Medicare, echoed by other groups across the state, reflects our careful deliberation that we can no longer continue to carry the burden of a program toppling under its own weight silently on our backs.
Calendar Of Events
September 19-21, 2002
WSMA Annual Meeting
November 1-2, 2002
2002 Washington Chapter Annual Meeting
The Westin Hotel
September 18-20, 2003
WSMA Annual Meeting
April 3-6, 2003
ACP-ASIM Annual Session
San Diego, CA
Pier Is Here…The Physicians' Information And Education Resource
PIER, The Physicians' Information and Education Resource, is now available for exclusive preview by ACP-ASIM members
What Pier Is - Integrated with the College's other medical information and education resources, PIER is ACP-ASIM's new, electronic, Web-based, decision support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for physicians. PIER contains modules focusing on the diagnosis and treatment of diseases, and will eventually include sections on prevention and screening, procedures, ethical and legal issues, complementary and alternative medicine, and patient education. ACP-ASIM members can visit the PIER web site at (http://pier.acponline.org).
Why PIER is the Best Choice - All information in PIER has gone through a rigorous review process, so you can be sure that the information found in PIER is credible, up to date, and accurate.
How PIER Can Help You -
- Get answers to clinical questions fast.
- Rapidly review diagnostic and therapeutic strategies.
- Find focused drug information.
- Provide clear information to patients in print or electronic format.
- Be up to date on the newest data.
- Have ready access to the evidence and related literature.
What to Expect From PIER in the Future -
- Ongoing coverage of the newest data.
- Integrated links to electronic medical records.
- Customizable patient information.
- Clinical question archiving.
Visit today and see how PIER can work for you!
Members in the News
Dawn E. DeWitt, MD from the University of Washington was elected to the honor society AOA (Alpha Omega Alpha) by vote of the medical students.
George Novan, MD from Spokane is receiving the WWAMI Excellence in Teaching Award from the Department of Medicine, and also the school-wide Teaching Award from the School of Medicine.
Ki Shin, MD from Montesano, WA is receiving a WWAMI Excellence in Teaching Award from the Department of Medicine.
Bruce C. Smith, MD from Bellevue was named one of the "Top Ten Key Contact Special Recognition Winners" by ASP-ASIM and will be recognized at the Legislative Day in Washington, DC on May 21-22, 2002. ACP-ASIM's Key Contact Program encourages members to play an active role in educating members of Congress on issues of concern to physicians. Thousands of ACP-ASIM members participate each year. An awards program was implemented in 1995 to recognize individuals who have made exceptional efforts to advance the College's policy agenda. Each year, a "Key Contact of the Year" and the "Top Ten Key Contact Special Recognition Winners" are chosen from the participants.
If you know of a member that should be recognized, please email the information to: (email@example.com.)
Board of Regents Take Action on Spring 2002 Recertification Resolutions
At the April 9, 2002 meeting of the Board of Regents, Dr. David Dale, Chair-elect, Board of Governors, presented for discussion and vote four Spring 2002 Recertification Resolutions from the Board of Governors, along with recommendations for their referral and implementation. As such, the BOR took the following action on these resolutions:
The Board of Regents voted to refer Resolution 5-S02, Accountable, Literature-based Continuous Medical Education, to the Education Committee for study and report back with recommendations:
RESOLVED, that the Board of Regents investigate the feasibility of developing programs of accountable, literature-based continuous medical education specifically for general internists as well as for all the subspecialty practitioners of internal medicine with consideration of awarding a certificate of accomplishment for those physicians who successfully participate in the program and this could be presented as a possible pathway for recertification.
The Board of Regents voted unanimously to amend and then adopt and refer Resolution 28-S02, Recertification Positions of the ACP-ASIM, to the Recertification Negotiating Team for implementation:
RESOLVED, that the Board of Regents insist that the proposed plan for a Peer and Patient evaluation module be optional; and be it further
RESOLVED, that the Board of Regents advocate that educational resources, such as MKSAP, serve as substitutes for all ABIM self-evaluation modules.
The Board of Regents voted unanimously to amend and then adopt and refer Resolution 30-S02, Recertification Positions of the ACP-ASIM, to the Recertification Negotiating Team for implementation:
RESOLVED, that ACP-ASIM reaffirm its commitment to life long learning and professional accountability through the process of recertification; and be it further
RESOLVED, that the Board of Regents work towards a formal and ongoing "Recertification Partnership" between ABIM and ACP-ASIM that preserves the important separation of responsibilities between these organizations while recognizing a common goal of establishing a rational and effective process for recertification of internists and subspecialty internists. This process would include a review for comment on proposals for new components and revisions of existing components with key stakeholders prior to implementation; and be it further
RESOLVED, that the Board of Regents work with ABIM to establish multiple pathways for recertification, one of which would be a process that includes a secure exam; and be it further
RESOLVED, that all pathways meet the following criteria: relevance to a variety of practice settings, elimination of redundancy, accommodation to different learning styles and sensitivity to cost and time; and be it further
RESOLVED, that whatever methods of recertification are chosen to be subject to continuous testing and validation; and be it further
RESOLVED, that it is the position of the ACP-ASIM to encourage the maintenance of certification of subspecialists in both general internal medicine and their subspecialties and therefore continue to work with the ABIM to eliminate barriers and facilitate the process of dual recertification in both general internal medicine and the subspecialties; and be it further
RESOLVED, that if the ACP-ASIM and ABIM cannot reach a mutually agreeable solution, the Board of Regents consider the possibility of committing ACP-ASIM resources to developing an alternative to an ABIM recertification process.
The Board of Regents voted unanimously to adopt and refer Resolution 31-S02, Recertification Negotiating Team, to the Chair, Board of Regents for implementation:
RESOLVED, that the Board of Regents support that the ongoing negotiating team include the Chair, Board of Governors and a Governor from the Education Committee.
If you need additional information regarding the Spring 2002 Recertification Resolutions, or if you have any questions regarding the BOG Resolutions Process, please contact Alison Dufner, Resolutions Administrator at (800) 523-1546, ext. 2716, or (firstname.lastname@example.org).
The Glass is Half Full
Douglas Paauw, MD, FACP, Governor, Washington Chapter
I met with one of my first year medical students today (Ann) and she told me the warnings and comments she has been hearing from the doctors in her hometown. "Every time I go home and visit the hospital where I was a volunteer, all the doctors ask me why in the world would I want to become a doctor? They seem shocked I would knowingly choose the medical profession." She explained that she was told the "Golden Age" of medicine was long gone. So why then would any student in their right mind want to be a doctor?
She has heard it all, that reimbursement is poor, spending hours on the phone with insurance companies, the threat of the Medicare police and the endless need for documentation. Why then be a doctor? Maybe it is because other careers have their warts as well. Maybe because of the rush she felt the first time a patient called her doctor at her first medical interview. Or maybe it is as simple as her explanation to me "Patients tell doctors their innermost secrets and trust them to help them. Very few other jobs offer that level of trust".
That is true. Even with all that is wrong with our current system, our patients still trust us and appreciate the difference we can make in their lives. What other careers offer that privilege? Banker? Broker? Venture Capitalist? Lawyer? The physicians in her hometown have seen the marked changes that have made practicing difficult over the past 15 years. Ann understands how hard it must be for physicians who grew up with one set of rules see everything change and become more difficult. Many of these physicians have told her they will retire early rather than continue to see the erosion of their autonomy and practices. Nevertheless, Ann is excited to join the fray, learn the tools of the trade and join our profession. She can hardly wait to make a difference in patient's lives.Talking to Ann today reminded me once again that our profession is truly more about service than anything else.
I said goodbye to one of my patients who I have cared for the past 10 years yesterday. He has a disease that will be fatal very soon. He thanked me for being his doctor and for helping him leave the hospital to die in the dream home he has been building for the last 8 years. As we both became teary eyed I thanked him for the trust he had in me. I can understand why Ann is so excited about becoming a doctor.
Southeast ACP-ASIM District Meeting
The Southeast ACP-ASIM district in coordination with the Benton County Medical Society had its first joint annual spring medical continuing educational conference on May 4, 2002. There were 76 participants who attended the event at the Tri-City Coliseum, Founders Club in Kennewick, Washington. The theme was "What's New in Medicine, 2002." It started at 8:AM and ended at 7:30 PM with 9 category 1 CME hours. There were 8 topics and 10 speakers. The topics were Pneumonia and Microbiology, Glycoprotein Inhibitors, Acute Coronary Syndromes, Headaches and Treatment Updates, Diabetes Mellitus, Hepatitis C, Hematology and Oncology Updates.
Dr. David Dale gave the lecture on complete blood count and introduced the philosophy and functions of the ACP-ASIM. Dr. Dale then met briefly with the organizers of the meeting: Dr. James Newman, Dr. Stephen Ewer, Dr. Teresita Clair De Jesus, Dr. Roderick Coler, Dr. Luzcel Tuazon and Dr. Jimmy Chua (Coordinator for the SE Washington ACP-ASIM).
Sixty-seven percent of the participants submitted their evaluation form. Majority of the overall general comment for the event was from good to excellent in terms of location, setup, length and organization.
Northwest Regional Reception
The Northwest Regional Reception was held at the Philadelphia Marriott Hotel on April 12, 2002 at the ACP-ASIM Annual Meeting. Washington, Oregon, Montana, Idaho and Alaska participated in this event that had 100 attendees.
Congratulations to Newly Elected Fellows in 2001-2002
Rex Hoffmeister, MD, FACP - Spokane
Stuart Bursten, MD, FACP - Issaquah
Stephen Ewer, MD, FACP - Richland
Thomas Payne, MD, FACP - Seattle
Katherine Tuttle, MD, FACP - Spokane
Jeanne Marrazzo, MD, FACP - Seattle
Clark Coler, MD, FACP - Seattle
Steven Goodell, MD, FACP - Spokane
Bruce Smith, MD, FACP - Bellevue
Future Annual Sessions of the College
Annual Session 2003
April 3-5, 2003, San Diego
Annual Session 2004
April 22-24, 2004, New Orleans
Annual Session 2005
April 14-16, 2005, San Francisco
Annual Session 2006
April 6-8, 2006, Philadelphia
Annual Session 2007
April 19-21, 2007, San Diego
College Mounts Public Affairs Effort on Excessive Medicare Cuts
The College's Public Affairs office has mounted a campaign to educate the public about the recent cuts in Medicare and what they will mean to the future quality of care in the United States. In mid-March ACP-ASIM released a video news release featuring College President William Hall, MD, FACP, which dramatized the impact of excessive Medicare cuts on patient care. The release, titled "Medicare Cuts May Mean Trouble Ahead for Patients and the Physicians Who Treat Them," noted that Medicare patients may soon be faced with a serious reduction in available physicians and services if Congress doesn't act soon. A nearly 30 percent decrease in physician reimbursement over four years is forcing physicians to cut practice expenses and reconsider their participation in the Medicare program. In Dr. Hall's geriatric practice in New York state a five percent cut in funding has already led to the reduction of two staff positions. The College is working with Congress to avoid additional cuts that will force further reductions in services for Medicare patients between now and 2005.
In addition to the video news release, Public Affairs is working with members around the country to write and place op-ed letters in local newspapers. Op-ed pieces are an excellent tool to reach a broad audience with a targeted message. Physicians who are interested in lending their name and support to an op-ed piece may contact Carolyn Albert in the Public Affairs office at (800-338-2746) or (email@example.com).
How to Reach Us
Douglas S. Paauw, MD, FACP
U/W, Dept. of Medicine
Seattle, WA 98105-6420
Phone: (206) 543-3604, FAX: (206) 221-3559
Washington Chapter ACP-ASIM
2033 Sixth Avenue, Suite 1100
Seattle, WA 98121
Phone: (206) 956-3646, FAX: (206) 441-5863
ACP-ASIM Email Campaign
ACP-ASIM wants your email address. In an effort to ensure that you receive urgent health communications from the College, go to ACP Online and submit your current email address. ACP-ASIM will not sell or share your e-mail address and will ensure the judicious use of your e-mail address.