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Governor's Newsletter, Winter 2001

Rashida A. Khakoo, MD, FACP
Governor, West Virginia Chapter

Governor's Message

It has been a very cold winter so far, but I am sure it will warm up by May for our Chapter meeting. I hope many of you had some time off during the holidays to spend with your families and friends.

We have an exciting program for our West Virginia Chapter meeting which many of you know is scheduled for May 18th & 19th, 2001 at the Charleston Marriott. I look forward to seeing many of you there.

The theme for this year's meeting is "Recapturing the Joy in Medicine". Drs. Joseph Fuscaldo as Chair and Shelda Martin as Co-Chair of the Program Planning Committee and their entire team have done an excellent job in putting together an outstanding program.

We are also very fortunate to have Dr. George Bordage as a keynote speaker. He has done outstanding work in the field of Critical Clinical Thinking. We will also have a talk on Recapturing the Joy in Medicine by Mr. Neil Chesanow, Senior Associate Editor of Medical Economics. Dr. Barbara Schuster will be our College Representative. We are very excited to have her at our Chapter meeting. She has outstanding credentials. We will also have our popular features ­ Multiple Small Feedings of the Mind, Thieves Market, Medical Knowledge Challenge Competition, and Critical Clinical Thinking by panel members. There will also be interactive workshops which I am sure you will find outstanding.

Our Associates are looking forward to an energizing Associates Abstract Competition. In addition to a wonderful educational program, you will meet friends and colleagues from all over the State. The attendees will also be able to demonstrate their talents in playing musical instruments at the Governor's reception. If you have any musical talents and would like to be part of the conference, please let me know. We will also have an art exhibit. Please mark your calendars and plan to attend the meeting.

At the Town Hall Meeting, you will have a chance to hear remarks of the College Representative Dr. Barbara Schuster. There you will also have the opportunity to bring up issues of concern to you in which you think the College should get involved. We are looking forward to your input.

We have several committees in our Chapter. If you are interested in serving on one or more of these committees, please let me know. Please encourage other internists you know who are not members of ACP-ASIM to become members and please encourage members who are eligible for advancement to Fellowship to consider that. It is an honor to become a Fellow. We would like you to stay involved in our Chapter activities and also in the national ACP-ASIM. Please let me know if I can do anything to serve your needs.

We are also trying to enhance involvement of medical students from all the programs around the state. We have been fortunate to receive funding from ACP-ASIM to increase Internal Medicine interest groups for medical students. If you know of students who are interested in coming to the meeting, please let me know.

What ACP-ASIM is Doing for You Today

"What have you done for me lately?" is a question that ACP-ASIM strives to answer before it is asked, by making membership needs an integral part of its strategic planning process.

As such, the following is a comprehensive list of products and services that ACP-ASIM offers to its members, which was compiled by the Board of Regents at a recent meeting. Since the College leadership realizes the needs of it membership are ever-changing, they will continue to re-evaluate this list and add new products and services when appropriate. In addition, the College encourages you, the members, to submit your ideas for changes/additions to the list to Dr. Khakoo at rkhakoo2@wvu.edu.

Education

Annual Session
Chapter/regional meetings
Clinical skills teaching modules
In-training examination
Post-graduate review courses
Recertification courses
Programs for community-based teachers

Self-study

Internal medicine board review course (audio and video versions)
Internal medicine recertification preparation course (audio and video versions)
MKSAP 12 update
Annual session audiocassettes
Best Evidence (CD-ROM)
Bioterrorism resource center online
Clinical practice guidelines
Clinical problem-solving cases
Clinical skills videotapes
Firearm injury prevention resource center
MKSAP for students
MKSAP Prep for Boards
Subspecialty MKSAPs
Telemedicine resource center
Virtual Annual Session

Practice Assistance

Professional liability insurance
Center for a Competitive Advantage
Medical informatics program (Annual Session)
Medical Laboratory Evaluation Proficiency Testing Program
Qnet
Quality 101

Publications

Annals of Internal Medicine
ACP Journal Club
Effective Clinical Practice
ACP-ASIM Observer
Books and expert guides

Advocacy and Professionalism

Online membership directory
Grassroots hotline
Career opportunities
Decision 2000 campaign
Doctors for Adults public awareness campaign
Ethics case studies
ACP Ethics Manual
Legislative Action Center
Access to legislative and regulatory information, national and state
"Membership Enhancement" programs
Position and policy papers
Volunteerism project

For Associates and Medical Student Members

Residency information
Career counseling information and Web links
Career counseling brochures
Community-based teaching program support
Impact newsletter
Mentoring database
MKSAP for students
Representation through Council of Associates and Council of Student Members
Video and slides about internal medicine careers
Support for internal medicine clubs
Annual Session workshops

International Programs

Clinical skills teaching modules
Internal medicine overseas
Action in internal medicine
International speakers program
Eurasian Medical Education Project
Annual Session workshops
Representation in the International Society of Internal Medicine

Recognition Program

Fellowship credentialing process
Associate and Medical Student competitions
Convocation
Chapter awards program
Laureate awards
Mastership awards
Community-based teaching awards

Personal Benefits

College accessories and gifts
Doctors for Adults accessories and gifts
Affinity credit card
Car rental discounts
Financial planning service
Group insurance plans
Loan programs

Become An ACP-ASIM Key Congressional Contact

After hearing on the evening news about a proposed change to Medicare or a problem in the healthcare system, have you ever wanted to put your two cents in on the issues? Do you care how legislation coming through Congress affects your patients and the practice of internal medicine? Is one of your friends, family members, patients, church members or civic organization members a legislator?

If you answered "yes" to one of these questions, you would make a valuable addition to the ACP-ASIM Key Congressional Contact Program. Recruiting new Key Contacts is an ongoing process but it will be especially important when the elections are over and the new members of the 107th Congress are selected.

The College's success on Capitol Hill depends on grassroots advocacy by Key Contacts across the country who communicate with their members of Congress on issues of importance to internists and their patients. Key Contacts usually do not have established relationships with their members of Congress. ACP-ASIM gives them the tools necessary to develop and maintain relationships.

Key Contacts receive a periodic newsletter, the Capitol Key, updating them on important legislative issues. Then, as key issues approach the decision-making stage on Capitol Hill, the College sends Legislative Alerts to Key Contacts that include all the necessary information to make informative contacts with legislators. ACP-ASIM staff is always available to provide support and answer legislative questions. Key Contacts report their contacts back to staff in the Washington, DC, office of ACP-ASIM via fax, phone, e-mail or mail.

The College offers a Grassroots Hotline that Key Contacts can call to hear a legislative update and be matched-with and patched-through to their members of Congress at no cost. The Grassroots Hotline number is 1-888-218-7770. ACP-ASIM also offers the Legislative Action Center (LAC) website which allows ACP-ASIM members to view the most current ACP-ASIM Legislative Alerts, find out who their legislators are, and send an e-mail, compose a letter or a fax to their members of Congress. It provides the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with legislators. The Legislative Action Center can be accessed through the Where We Stand section of ACP-ASIM Online, or at http://congress.nw.dc.us/acp/.

The College implemented a Key Contact Awards Program to recognize the hard work of members who go above and beyond the call of duty to contact their members of Congress. Each year, ACP-ASIM selects a Key Contact of the Year and a Top Ten Key Contact Special Recognition Winners based on the quality and quantity of responses to Legislative Alerts. The awards are presented each spring at Leadership Day in Washington, DC.

If you would like to be updated on the legislation affecting internists and their patients and are interested in corresponding with your legislators a few times a year on these issues, contact Jenn Jenkins at 800-338-2746, ext. 4536, and join the College's Key Contact Program.

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

Be a part of the Colleges 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.

Advancement from Membership to Fellowship

"How do I advance from Membership to Fellowship?" is a question frequently asked by you, the ACP-ASIM members. Below, is a summary of the requirements and pathways that a candidate must fulfill and/or meet in order to become a Fellow of the College.

Requirements:

  • Be certified by the American Board of Internal Medicine, the Royal College of Physicians and Surgeons of Canada, or the American Osteopathic Board of Internal Medicine. Members residing in Québec Province have the option of being certified by the College des Médecins du Québec.
  • Have been a Member in good standing for 2 years in the ACP, ASIM, or ACP-ASIM, and in practice or in an academic position for at least 2 years since completion of training.
  • Have an active medical license in good standing (if in clinical practice).
  • Have confined his or her professional activity to internal medicine or a subspecialty of internal medicine.
  • Be proposed and seconded by two current Masters or Fellows with reference to character, ethics, and medical activities. The proposer and seconder must each write detailed letters of support for the candidate, outlining professional contributions and accomplishments.
  • Be endorsed by the appropriate ACP-ASIM Governor.
  • Have shown continuing scholarship and professional accomplishments.
  • Document continuing professional activities, including teaching, both institutional and community-based; hospital committee work; community service, especially the voluntary provision of medical care; and participation in continuing medical education activities as both teacher and student.

Pathways

The College has established four Pathways that serve as guidelines to qualify for Fellowship. For each of the following pathways, the candidates must meet the basic requirements listed above.

Pathway 1: Members must have demonstrated skill in written medical communication.

Pathway 2: Members must have significant and continuing certification activities and/or teaching (both institutional and community-based), and/or community activities that indicate professional achievement and scholarship; they must have undergone recertification, or they must have participated in the Medical Knowledge Self-Assessment Program (MKSAP) with a passing score. In addition, subspecialty certification or certificates of special competence in adolescent medicine, critical care medicine, clinical cardiac electrophysiology, geriatrics, or sports medicine can qualify a candidate for this pathway, but are not adequate by themselves.

Pathway 3: Members must have been active members in ACP or ASIM for at least 10 years, with substantial participation in programs and activities, as well as demonstration of other professional accomplishments.

Note: Outstanding candidates who have been active Members for fewer than 10 years may qualify by combining Pathways 1 and/or 2 with Pathway 3.

Pathway 4: Members must have distinguished professional activity in teaching, patient care or professional service over many years.

Candidates must document each pathway; however, a candidate may be accepted without fulfilling one pathway if his/her work in other pathways is deemed outstanding by the Credentials Committee. For a complete copy of the "Requirements for Advancement from Membership to Fellowship" and/or an advancement to Fellowship proposal, contact your local College Governor, or call ACP-ASIM Customer Service at (800) 523-1546, ext. 2600. The "Requirements for Advancement from Membership to Fellowship" can also be found on the College's web site at www.acponline.org/college/membership/required.htm.

ACP-ASIM'S Efforts to Reduce the Hassle Factor

The ACP-ASIM's Depart- ment of Managed Care and Regulatory Affairs Department has compiled a comprehensive list, which outlines the College's efforts to reduce the hassle factors faced by physicians. From meeting with the staff of the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) to influencing pending legislation on physician-assisted suicide, the ACP-ASIM is dedicated to fighting the hassle factor battles for its members.

The following is a sampling of the College's efforts as prepared by its Department of Managed Care and Regulatory Affairs Department (March 2000). For the complete list, log on to ACP-ASIM Online at http://www.acponline.org/hpp/hassles.htm.

Easing Evaluation and Management (E/M) Documentation Requirements:

Urged the Medicare Payment Advisory Commission (MedPAC) to recommend that E/M documentation requirements be made less burdensome; ACP-ASIM's recommendations were included in their March 2000 report.

Simplifying Claims Processing and Credentialling:

Reached agreement on a process that will allow ACP-ASIM leaders to meet regularly with policy making representatives from the BCBSA and the Health Insurance Association of America (HIAA). Both HIAA and BCBS have recently announced initiatives to reduce hassles affecting physicians. ACP-ASIM has been invited and agreed to participate in both efforts.

Opposing Imposition of Mandatory Hospitalist Programs:

Persuaded United Healthcare to withdraw its mandatory hospitalist plan in Rhode Island; influenced MCOs in Florida and Texas to withdraw their mandatory programs and make them voluntary.

Simplifying Billing for Laboratory Tests:

Participated in the negotiated rulemaking committee to develop standard Medicare policies for 23 clinical laboratory tests with the goal of reducing the administrative burden physicians' face when ordering lab tests and to eliminating Medicare carrier policy variability. New proposed rule has been published for comment that incorporates the rulemaking committee's recommendations, including most of ACP-ASIM's concerns.

Addressing Concerns about Fraud and Abuse:

Achieved revisions in OIG's "Who Pays, You Pay" campaign materials that are more physician friendly, and that direct patients to resolving billing issues with their physicians first, rather than calling the OIG Fraud Hotline. The revised materials note that most physicians are honest and want to work with patients to resolve questions about bills.

Improving CPT Codes for Care Plan Oversight Services:

The CPT Editorial Panel agreed to an ACP-ASIM proposal, submitted jointly with the American Academy of Family Physicians, that would allow physicians to bill for the time they spend communicating with family and other care decision-makers regarding coordination of care for home health and hospice services.

Reducing Other Hassles:

Made numerous recommendations aimed at pro- moting fairness in the way Medicare audits physi- cians and seeks recoupment of money paid to physicians based on those audits. Met with an independent auditor that prepared a report on ways to improve Medicare's review processes. ACP-ASIM's recommendations also aim to eliminate the elements of the current process that coerce physicians into accepting settlements on Medicare's terms.

Provided guidance to HCFA so the agency can ensure all of its Medicare carriers are not restrict- ing patients' ability to be evaluated by an internist (or other physician) prior to surgery.

Empowering Physicians to Influence Third Party Payers:

Lobbying for comprehensive patient bill of rights legislation (Norwood-Dingell bill) that will provide physicians and patients with greater rights to influence and appeal inappropriate denial of payments. The bill would also prohibit gag clauses, assure that physicians ­ not MCOs ­ define what is medically necessary, and allowing recourse to the courts when self-insured plans deny needed benefits. Norwood-Dingell bill was passed by the House of Representatives last year. The College is currently influencing House- Senate conferees to report legislation based on Norwood-Dingell, rather than a weaker version passed by the Senate.

Helping Internists Cope with Hassles:

The College's Department of Managed Care and Regulatory Affairs and ACP-ASIM's Center for a Competitive Advantage have developed numerous educational resources to help internists cope with requirements from Medicare and private payers in the least burdensome manner possible. Resources include a guide on compliance with federal fraud programs and Medicare audits, a laminated list of ICD-9 codes typically used by internists, and a pocket guide to coding for E/M services.

The Department of Managed Care and Regulatory Affairs authors a monthly column in the Observer on coding, coverage and payment policies.

ACP-ASIM maintains a toll-free hotline to enable internist-members to get personal assistance in resolving problems with Medicare and other payers. The hotline number is 1-800-338-2746, ext. 4533.

Young Physicians Subcommittee

The Young Physicians Subcommittee (YPS) wants to hear from young physician members of the College about the practice environment today. Your frank comments will, through the Subcommittee, have a direct impact on you and your colleagues. Visit www.acponline.org/private/committees/yps/ and let us know what's on your mind.

We'd like to know how you feel about recertification, establishing a practice, coping with stress, and time constraints. Would you like a copy of the YPS Practice Management Survival Booklet? An E/M coding card? A curbside consultation about and evaluating and improving a practice via the College's Center for a Competitive Advantage? If you answered "yes" to any of these questions, the web site can also be used to request this information. ALL e-mails will be answered.

If you have any questions, please contact Jean Elliott, YPS Staff Liaison at (800) 523-1546, ext. 2692