Governor's Newsletter—Winter 2000
David C. Dale, MD, FACP
Governor, Washington Chapter
I enjoyed very much this year's Annual Meeting of our Washington Chapter of ACP-ASIM. We met at the new Bell Harbor Convention Center, a truly beautiful facility on the waterfront in Seattle. A notable change this year was having a Friday-Saturday meeting, with a banquet on Friday night and the Associates Program on Saturday afternoon. The evaluations of the program are in, and the attendees really enjoyed the meeting. Congratulations and thanks are due to this year's Program Chairs Drs. Jan Bridge, Rebecca Ruud and Elaine Sachter. Dr. Whitney Addington, President of the ACP-ASIM, attended the entire meeting and spoke with us about his strong interest in improving access to health care.
If you have not recently attended our regional meeting, I encourage you to come next year. We are planning to move the meeting to an earlier time October 27-28, 2000 to escape the busy December holiday period. We hope that this will be a convenient time for you and that you will attend. We will send you more information soon; Dr. Linda Pinsky, a leader in the University's teaching program, will be the Program Chair for the 2000 meeting.
On the national scene, the ACP-ASIM continues to be active in promoting universal health care coverage. On our web site, www.acponline.org, you can review statements from each of the presidential candidates in response to our study entitled, "No Health Insurance? It's Enough to Make You Sick." You will also find a good literature review on the price we pay, individually and nationally, for not having health insurance. The web site is also a good way to pick up information and register online for the upcoming Annual Session for ACP-ASIM in Philadelphia, April 13-16, 2000. It is a superb meeting, and Philadelphia has become an excellent convention city.
Recently, the Board of Regents for ACP-ASIM concluded its discussions on formation of a political action committee (PAC). The decision was made at the January 25, 2000 meeting not to form a PAC, but rather to continue the current successful advocacy efforts of the College through our careful study of national health issues and personal contacts with our elected representatives, both at the state and national level. In talking with members of the Board of Regents, including Dr. Eric Larson, I am impressed by the thoroughness of the review and the
wisdom of this decision.
An important activity of the College is promoting community-based teaching. In our region, many members are involved through the programs at the University of Washington and through our residency and fellowship programs. Because of my involvement with the academic programs at the University, I know how much the leaders of our courses for the introduction of clinical medicine and preceptorships in internal medicine, Drs. Erika Goldstein and Doug Paauw, appreciate your willingness to take students into your practice activities and give them real-life experience in internal medicine. This year, at our Annual Meeting, we will be recognizing outstanding community-based teachers. If you are already doing this, the College appreciates it very much and if not, please consider becoming involved. If you're at all interested in becoming more involved in community-based teaching, please contact Dr. Paauw at (206) 543-3604 or firstname.lastname@example.org.
I received a letter from ACP-ASIM this week, reminding me that it is soon time to begin the process of selecting my successor as Governor for the Washington Chapter of ACP-ASIM. A Nominating Committee needs to be appointed this spring, with the election in the fall for the Governor-Elect to begin activities early in 2001. The letter reminded me just how quickly my term is passing. I have just returned from Philadelphia. I was there to chair the Clinical Ethicacy Assessment Subcommittee, which works on practice guidelines, and for the meeting of the Education Committee, which among other activities, oversees the MKSAP Project and the Annual Session. It is a long way to Philadelphia and the days are very busy there, but I returned home again feeling very good about the College and its leadership. I hope you do as well.
It is now the legislative season here in Washington and our representative to the WSMA Interspecialty Council, Dr. Hugh Maloney, is representing us well. If there are particular legislative issues of interest to you, please pass this information to Hugh at (206) 386-9500 or email@example.com. I notice that there is a bill in the legislature to require doctors to write legibly. You may want to pass on your opinion of this bill or others; it is important for us to be heard and it is very valuable for us to have the WSMA coordinate our efforts to reach the leaders of our state legislature. If there is something special that you would like for me to do, I would be pleased to hear from you.
David C. Dale, MD, FACP
Professor of Medicine
ACP-ASIM has recently published a Catalog of Programs, Products and Services called Resources for Internists 2000. This is a great publication.
For more information call Customer Services at 800-523-1546, ext. 2600 or 215-351-2600.
Washington State Medical Association
By: W. Hugh Maloney, MD, FACP
The Council has met every two weeks during this legislative session. WSMA staff and lobbyists are working diligently in the interests of all practicing physicians and their patients. Len Eddinger and his staff rely on reactions and feedback from the Council to pursue and refine WSMA policy during the legislative season.
1. Access to Care.
- Disease Management coupled with curtailing
- drug reimbursement costs are a risk for primary care physicians, with pressures to by-pass the primary care and be directed into specialty clinics, along with funding drug costs with patient care dollars.
- Contraction of the insurance market any solution will involve a return to the nine month or longer pre-existing illness exclusion.
- WSMA supports expanding access and adequate funding of the program. Currently, the legislature finds it easier to offer and promise services, but resists funding such endeavors or funds it at the expense of the practitioner.
2. Support for "Citizens United for Reform (CURE)" Program and the legislative agenda "Patient Bill of Rights," WSMA supports both SB 6199 and HB 2331.
- CURE is a WSMA program that draws on the strength of the patient-physician relationship.
- The recent WSMA "Report Card" was well received. Basically, the plans are only average (C grade). Let your patients know how their plan fared.
3. Opposition to increasing scope of practice.
- Naturopaths want access to narcotics.
- Optometrists WSMA strongly opposes Optometrists Prescriptive Authority SB 5874: access to narcotics is a ruse for ability and legislation to do surgery.
- Physical Therapists SB 6522/HB 2951 Only PT can do PT, not chiropractors; but there is a substantial expansion of PT practice including airway clearance, debridement of wounds. WSMA opposes this bill.
- Midwives SB 5920/HB 2031 expands their coverage to the totality of women's health care.
- Chiropractors SB 5776 direct access to their services, without referral. This is a Level I, strong opposition, from the WSMA.
4. Preservation of Funds from Tobacco Settlement Agreement for Tobacco Prevention and Control Programs WSMA supports the TPCP appropriation request of $26.24 million.
- WSMA is part of the WATCH Coalition (Washington Alliance for Tobacco Control and Children's Health) and supports funding the comprehensive program, anything less will not deliver any meaningful results.
5. Fraud and Abuse Legislation Any changes from 1999 compromise will cause WSMA opposition to SB 5439. 6. WSMA opposes legislatively mandated sharps protection opposes SB 6416 and HB 2669. Federal directive from OSHA already requires compliance; therefore, no need for more stringent state rules. 7. WSMA supports the agenda of the liability reform coalition (LRC).
Peer Review and Hospital Disclosure HB 1711/SB 5540
Newspapers want more disclosure in general and want more public disclosure of hospital issues. They oppose this bill. WSMA argues for effective peer review and that confidentiality is essential for the system to work.
No Code Clarification/Do Not Resuscitate SB 6214
This bill is about the incompetent patient without an advanced directive in an acute or chronic care setting and about who and how should a code should be applied. WSMA argues that this is a medical decision and that the personal physician should make the call based on the patient's condition.
So, what's an internist to do right now. First, if you have concerns, let your leadership know. Secondly, your best defense at the state level is to support your Washington State Medical Association. Third, your Council can help articulate a position, support an idea, or create alliances. Let a representative know. Lastly, if you want to participate either in the ACP-ASIM agenda or the WSMA agenda, let Kory Diemert know. She can help direct you to the right person.
The issues as presented by WSMA are fairly representative of internal medicine issues and primary care. ACP-ASIM is well represented at all levels of the WSMA. There is always room for informed and passionate voices. At your local level, contact your county medical society or let your local leadership know of your interest.
Medicare Liaison Update
By: Bruce C. Smith, MD
Recent updates from HCFA and our Medicare Carrier include the following:
- The Medicare physician fee schedules 2000 conversion factor is $36.6137 representing a 5.4% boost.
- Critical care services work codes were
- revised downward by 10% for 2000.
- New E&M coding guidelines are in "clinical trials." Don't expect final approval or implementation until at least next fall, likely much later.
- Medicare now pays for annual screening digital rectal exams (DRE) and PSA assays for men over age 50. Use code G0102 for the DRE and G0103 for the PSA. A DRE that is provided on the same day as a covered E&M service is bundled into the payment for the E&M service. If the DRE is the only service provided then code G0102 would be separately payable.
- Primary care physicians may bill a consultation code for doing a pre-operative exam on their own patients as long as it has been requested by the surgeon.
- Post-operative care by the physician who did pre-operative clearance consultation should be coded with E&M codes rather than follow-up consultations.
- Payment has been discontinued for pulseoximetry, temperature gradient, and venous pressure determinations (CPT 94760, 94761, 94762 and 93770). These studies are now considered bundled into payment for other services.
Noridian Government Services, our local Medicare Part B carrier, is offering half- and full-day Medicare Update Workshops across the state this spring. Learn the rules of the game from the referee. Details available at www.Noridian.com.
It was with distinct pleasure that the Washington Chapter honored Neil Elgee, MD, MACP, at our Annual Meeting on December 10, 1999, with the Laureate Award. Dr. Elgee is a long standing and loyal supporter of the College, who has rendered distinguished service to the Washington Chapter and has upheld the high ideals and professional standards for which the College is known. We salute and honor him on this occasion, and we wish him well in the future.
Medical Student Award
Scott Sears from Spokane, was recognized as the Outstanding Student in Internal Medicine from the University of Washington, Class of 2000. Dr. Doug Paauw presented Scott with a Certification of Appreciation monetary award at the Friday evening Banquet on December 10, 1999, in conjunction with our Annual Meeting.
News From Residency Programs
University of Washington Seattle
By: J. Findlay Wallace, MD, Director
I have just learned that two of our current residents, who are members of the Washington ACP-ASIM Chapter, have been chosen to make oral presentations of their abstracts at the upcoming Annual Meeting of ACP-ASIM in Philadelphia. Emily Transue is one of eight who will present a clinical vignette and Sara Mostad is one of eight who will present a research abstract. Their abstracts were selected from over 1,300, which were submitted in the Associates' Abstract Competition. We should be very proud of their achievements.
University of Washington Spokane
By: George Novan, MD, Director
Internal Medicine Spokane is purchasing palm-size computers for every resident in the program. While these pocketable computers have an "electronic address book" use, they can also store educational calendars, house stall manuals, goals and objectives for rotations and other information that might need frequent referencing. In addition, they will contain databases to track the procedures done by each resident for future credentialing needs. Residents will also be able to store information about their patients on them. As these computers find more use in the medical profession, we anticipate being able to add medical calculators and reference materials to their memory further enhancing their value to the residents.
|David C. Dale, MD—Governor
U/W, Dept of Medicine
Seattle, WA 98195-6422
|Work: (206) 543-7215
Home: (206) 523-7219
Fax: (206) 685-4458
|Bruce C. Smith, MD—Vice-Governor
925 - 116th Ave NE, Ste 104
Medicare Advisory Liaison
Bellevue, WA 98004
|Work: (425) 688-5858
Home: (425) 392-9339
Fax: (425) 688-5894
Pager: (206) 559-2228
|Paul A. Smith, MD—Secretary/Treasurer
Virginia Mason, C8-GIM
PO Box 900
Seattle, WA 98111
|Work: (206) 625-7373, ext. 63378
Home: (206) 286-0753
Fax: (206) 223-6377
Pager: (206) 671-1014
|Roger W. Bush, MD—1/99 - 12/01
Prog Dir, Internal Medicine Residency
Virginia Mason Medical Center
PO Box 900, C8-GIM
Seattle, WA 98111
|Work: (206) 625-7373, ext. 63380
Home: (206) 725-9121
Fax: (206) 223-6377
|Mark D. Fischer, MD—1/99 - 12/01
912 Caroline St
Port Angeles, WA 98362
|Work: (360) 457-4496
Fax: (360) 457-2181
|Mark Lindenbaum, MD—1/00 - 12/02
4545 Cordata Pkwy
Bellingham, WA 98226
|Work: (360) 738-2200
Home: (360) 671-3276
Fax: (360) 734-7588
|Stephen R. Shaul, MD—1/00 - 12/02
1111 W Spruce, Ste 28
Yakima, WA 98902
|Work: (509) 248-1232 Fax: (509) 575-6999 E-mail: firstname.lastname@example.org|
|George Novan, MD—1/99 - 12/01
101 W 8th Ave, PO Box 2555
Spokane, WA 99220
|Work: (509) 455-3022
Home: (509) 448-6441
Fax: (509) 455-5316
|Doug S. Paauw, MD—1/99 - 12/01 U/W, Dept. of Medicine Box 356420 Seattle, WA 98195-6420||Work: (206) 543-3604
Home: (425) 881-3422
Fax: (206) 685-8652
|W. Hugh Maloney, MD—1/00 - 12/02
515 Minor Ave, #300
Seattle, WA 98104
|Work: (206) 386-9500
Home: (206) 772-8806
Fax: (206) 386-9605
|Rebecca T. Ruud, MD—1/00 - 12/02
1100 - 9th Ave, H8-E
Seattle, WA 98101
|Work: (206) 625-7373, ext. 62471 Home: (206) 232-1805 Fax: (206) 223-6377 Pager: (206) 680-1293 E-mail: email@example.com|
|Elizabeth McKinnis, MD—1/99 - 12/01 4202 55th Ave NE Seattle, WA 98105||Home: (206) 985-2940 Fax: (206) 685-8652 Pager: (206) 680-1038 E-mail: firstname.lastname@example.org|
|John Peng, MD—6/99 - 12/01
11309 - 23rd Ave NE
Seattle, WA 98125
|Work: (206) 223-6600 Home: (206) 367-8326 Pager: (206) 982-6664 E-mail: email@example.com|
2535 Crane Dr W
Seattle, WA 98199
|Home: (206) 281-8866
Pager: (206) 680-6161
2524 Boyer Ave E, #318
Seattle, WA 98102
|Home: (206) 325-8372|
|Alvin J. Thompson, MD
WSMA Alternate Delegate
8222 Avalon Drive
Mercer Island, WA 98040
|Home: (206) 232-3144
Fax: (206) 232-2941
|Annual Meeting Program Chair|
|Linda E. Pinsky, MD
U/W, Dept of Medicine
Box 354760, Div of Internal Med
Seattle, WA 98195-4760
|Work: (206) 598-5527/598-8751
Fax : (206) 598-5952
|Chapter Executive Administrator|
2033 Sixth Ave, Ste 1100
Seattle, WA 98121
|Work: (206) 441-9762, ext. 3029
(800) 552-0612, ext. 3029
Direct Line: (206) 956-3646
Home: (425) 841-8130
Fax: (206) 441-5863
ACP-ASIM Contact Information
190 N Independence Mall West
Philadelphia, PA 19106-1572
Web site: www.acponline.org
Washington Chapter Web site: www.acponline.org/chapters/wa/
Calendar Of Events
April 13-16, 2000
ACP-ASIM Annual Session (Philadelphia, PA)
April 14, 2000
Northwest Regional Reception
Sponsored by the Washington Chapter at the ACP-ASIM Annual Meeting
June 1, 2000
Fellowship Applications Due at ACP-ASIM
June 22-24, 2000
Alaska Chapter Regional Meeting
"Immunology at the Millennium"
Alaska Regional Hospital Plaza Building
Anchorage, AK. For information contact Steven B. Tucker, MD, FACP, Governor, Alaska Chapter, (907) 261-4840, or
August 22-23, 2000
ABIM Certification Examination in Internal Medicine
September 21-24, 2000
WSMA Annual Meeting (Wenatchee, WA)
October 27-28, 2000
Washington Chapter ACP-AIM Annual Meeting
Sheraton Seattle Hotel & Towers (Seattle, WA)
December 1, 2000
Fellowship Applications Due at ACP-ASIM
March 29-April 1, 2001
ACP-ASIM Annual Session (Atlanta, GA)