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Governor's Newsletter, Winter 2002

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

Message from the Governor

There are no words to describe the horrific events of September 11th. Almost everyone's life has changed in some way since then. Our special thoughts remain with the victims and their families. The bioterrorism activity that followed in the aftermath of September 11th continues to be of great concern. We are very grateful to all those who volunteered and spent countless hours to help in a variety of ways during these difficult times. Even in these turbulent times, it is important that we continue to have our resolve and continue to serve our patients and our learners in the best possible way, they are counting on us.

I hope that many of you at least had some time off with your family and friends during the holidays. We are very excited about our upcoming West Virginia Chapter Meeting which as you know will be held in Morgantown at the Lakeview Scanticon Resort from May 2-4, 2002. We have a very exciting program and I hope to see many if not all of you there. The Program Planning Committee, under the leadership of Dr. Rebecca Schmidt, has done an outstanding job in putting an excellent program together. The theme of the conference is "Medicine: A Quest for Life Long Learning".

This year in addition to our ever-popular features of Thieves Market and Medical Knowledge Challenge Competition, we have added new features. We will have "Learning Extravaganza" at the Opening Session. There we will share new learning tools that you will find exciting. Another new feature that we have added is what we will call "Visual Twisters and Mental Teasers from the Clinicians". We are requesting as many of you as possible to submit patient studies (all identifiers removed) as unknowns to Dr. Rebecca Schmidt. Submissions should include; pertinent history and physical examination, appropriate laboratory, radiological, and histopathological information (if applicable). The patient studies will be exhibited and people will have a chance to make diagnoses from the data that is provided. This will be a great learning opportunity, as selected patient studies will be discussed by respective experts. A panel will select and award the three best submissions. In order to qualify to win an award, you must attend the meeting. We look forward to receiving this material from you. I think this will be a fabulous learning opportunity for all.

As usual we will have the Associates' Competition. Again we are expecting a large number of abstracts to be submitted and a wonderful competition. Dr. Sarwari will coordinate this effort. We are fortunate to have Dr. David Kelley from the University of Pittsburgh as our keynote speaker on the common problem of "Diabesity: Tracking Diabetes Mellitus by Tracking Obesity". Dr. Melanie Fisher will lead a discussion for the current times "Medical Response to Bioterrorism". Dr. Isabel Hoverman, FACP will serve as our College Representative. In addition to the Town Hall meeting where she will provide an update from the college, she will give a talk entitled "Patient Safety: Crossing the Chasm and Beyond".

We also have a number of exciting workshops. In addition to many excellent learning opportunities you will have a great time meeting colleagues and have some time to relax and enjoy the surroundings. Following the meeting, those of you with "golf genes" (and those without), can enjoy some time on the great golf course at Lakeview.

Our Student and Associates Council has been active. We have had student interest group sessions in Charleston, Huntington and Morgantown. We look forward to increasing our Associate and Student membership. Our Associate Council Chair Dr. Laura Davisson has also played a leadership role in providing input in our Chapter Program. Lauren Morgan, Chair of the Student Council and her team have also been very active in inviting medical students to join ACP-ASIM. She and her team have been extremely valuable in the various interest groups, which have been quite successful. Lauren has provided exemplary leadership.

I want to take this opportunity to congratulate Dr. Greg Rosencrance on his election to Governor, ACP-ASIM WV Chapter for 2003. Also, I want to thank Dr. John Holloway, who was nominated and graciously accepted the nomination, for his continued help. Thanks to all of you for your help and insight in many ways.

I encourage those who are not members to join ACP-ASIM. It is a wonderful and excellent organization that will serve your needs. Those who are already members of the College, I encourage you to consider advancement to fellowship. Please let me know if you need any information. I look forward to your continued commitment and participation. We have a number of committees. Please let me know if you have any interest in serving on one or more of these committees. I may be contacted by email at (rkhakoo2@wvu.edu). I always value your input. Please let me know if you have any questions.

Update from THE Student Council Committee

The Internal Medicine Interest Groups at WVU-Morgantown, WVU-Charleston, and Marshall University have started again with a bang. All three campuses have been hard at work. Here's a peak at what each campus has been up to:

The Internal Medicine Interest Group at WVU-Morgantown campus held their 1st meeting on October 8, 2001 with over 40 students in attendance. Dr. Rashida Khakoo, FACP spoke about life as an internist, and the various subspecialties available. MS4s Sujoy Gill, Dan Chaksupa, and Michelle Paulson reflected on why they choose to go into Internal Medicine. MS1 Rola Gharib and MS2 Melinda Hooton worked hard for World AIDS Week Information Booths for the week of November 26. We also had a successful meeting with persons affected with HIV who were able to share their thoughts with the students.

WVU-Charleston campus Internal Medicine Interest Group held 2 meetings under the supervision of Dr. Cathy Funk, Chief Resident, Department of Medicine. The focus of the meetings have been geared towards helping MS3s and MS4s choose residency programs, the ERAS application process, and thinking about the subspecialties internal medicine has to offer.

Marshall University had its first meeting in conjunction with National Primary Care Week on October 17, 2001. Dr. Larry Dial, Chief Resident in the Department of Medicine at Marshall, spoke to students about Internal Medicine and its subspecialties. Free boxed lunches from Heavenly Ham were provided. Twenty-eight first year students were in attendance.

Special Thanks to all Student Council Members for all their hard work as we continue to increase membership in the ACP-ASIM and student interest in Internal Medicine.

Reflections of a Medical Student

Soha Abbott, MS 1

Early in my MS 1 experience, I realized that my summer time anticipation, daydreaming, and anxiety over medical school had done little to help me grasp the demands and gravity of my new academic role. Orientation week and Jacksons Mill served an important social function, breaking the ice and allowing me to get to know nearly everyone in our very friendly (and very cool) class. But personally, my mental orientation to medical school came with Drs. Cather and Ferrari's lectures on professionalism, the Physical Diagnosis and Clinical Integration and Patient Centered Health Center lectures on fiduciary duty, and clinical applications of Problem Based Learning and shadowing experiences. Clinical exposure and the idea that the medical student is a professional from day one have helped me to shift my mindset from a biology major who strived to be accepted to medical school so that she could be a physician to a medical student training to become a physician. With the goal of becoming competent and compassionate professionals in mind, my classmates and I have realized that every concept we are exposed to is equally and extremely important. The change is subtle, but essential to success as a medical school student. As we wrap up block three, I assure you that I am enjoying the process.

Update from THE Associates' Council Committee

The WV APC-ASIM 2001/02 Associates' Council is working on ways to encourage resident participation in the ACP-ASIM Annual Meeting and the WV Chapter ACP-ASIM Meeting. The associates are represented on the Planning Committee for the State Meeting, and will hopefully be very active in case or research abstract presentations. We are also in communication with medical student interest groups to develop ways we can work together. Finally, we are corresponding with the National Associate Council to enhance awareness of national issues and resources available to us.

ACP-ASIM Announces Bioterrorism Response Recommendations

At a press conference held in Washington in late November, ACP-ASIM President William J. Hall, MD, FACP, announced that the College is initiating steps to help primary care physicians respond to a biological or chemical attack. Those steps are outlined in a new position paper on bioterrorism.

In addition to expanding ACP-ASIM's Bioterrorism Resource Center, Dr. Hall said that the College is making a series of recommendations to procure more resources for physicians from federal, state and local governments and public health departments.

The College's recommendations call for increased funding for health departments and hospitals to help them develop crisis management strategies, stock adequate supplies and expand training for medical personnel. The full text of the College's bioterrorism position paper is online at (http://www.acponline.org/hpp/attack_prepare.htm).

The College has also added new information to its Bioterrorism Resource Center to help physicians distinguish diseases caused by biological agents from other conditions. Images include cutaneous anthrax, smallpox and an inhalation anthrax chest X-ray. The Bioterrorism Resource Center (http://www.acponline.org/bioterro/index.html) is available on the College's website.

Free College Help with HIPAA - Coming Soon!

In the long run HIPAA should yield huge savings for the US healthcare system, but in the coming months HIPAA will pose a major administrative challenge for providers, payors, and vendors. The Administrative Simplification section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will require practices to protect patients' identifiable health information in any form - written, oral or electronic. The specific HIPAA regulations now being promulgated are divided into three basic Rules-Electronic Data Transactions, Privacy and Security. Physician practices will need to do substantial advance preparation to meet the following legally enforceable compliance deadlines:

Rule Compliance Deadline
Electronic Transactions October 16, 2002 (an extension to October 2003 may be requested)
Privacy April 14, 2003
Security 26 months from release of final rule (expected early 2002)


HIPAA Components:

The Transactions Rule— is designed to simplify the administrative processing of electronic claim and remittance forms and other patient encounter information through standardized electronic formatting. While the ultimate outcome could simplify various aspects of practice management and yield enormous savings by transforming information exchange between healthcare organizations, it will be no easy task getting to that point. Computer software programs as well as office procedures will need to be rewritten to accommodate the new requirements. For the most part, practices will depend on their computer vendors and payers to make these technical changes. However, if any one of the practice's business partners is not ready on time, transactions and therefore practice reimbursement and cash flow will be disrupted. Thus, it is critical that practices understand what needs to be done, make sure that their vendors and other business partners are supporting the practice appropriately, and will be able to meet the compliance deadline. If not, new legislation enables the practices to obtain an extension to April 2003 for testing its systems and October 2003 for final compliance.

The Privacy Rule— mandates how providers, health plans, and clearinghouses may use and transmit personal health information. As a result of media and consultant attention, many physicians are generally aware of the potential impact that the privacy rule can have on their practices. While many practices probably already do some of the things required by the Privacy Rule, compliance with its specific legal provisions will require significant effort, including implementation of new forms, policies and procedures, staff training, and patient education.

The Security Rule— which is still only in proposed form, has to do with the physical and electronic security of the information that is stored, maintained, used or transmitted. In other words, technological controls on computer systems and the security of data transmissions will be required for compliance. The "proposed" rule is generally intended to be scalable to small practices and technologically neutral. As of this date, however, it is still unknown what changes the "final" Rule may bring, especially with regard to oral and printed communications (such non-electronic information was not addressed in the original proposed security rule but has since been added to HIPAA's purview). It may be prudent to put in place a risk management process now that can be revised and updated later, recognizing that the final security rule, when published, could require significant adjustments in the practice's security planning and operations.

Practice Management Center Assistance to Members:

Few physicians truly understand the potential impact HIPAA will have on their practices. Although the HIPAA rules are still in various stages of finalization, a host of consultants have already begun marketing manuals, seminars, and advice to physicians. Before sifting through such often-costly options, college members should be aware that ACP-ASIM's Practice Management Center (PMC) is developing sound, practical tools to be offered as free member benefits.

The "HIPAA Overview" is already posted on PMC's web page (under Regulatory Requirements) for members needing a basic explanation of these complex regulations. Very soon PMC will also begin releasing three separate manuals, each covering one of the HIPAA rules. These valuable tools will provide practical guidance, sample templates, forms, job descriptions, contracts, checklists, and other resources that members will need to comply with the new HIPAA rules. They are being developed with special emphasis on the compliance needs of small practices.

The requirements of the electronic data transactions rule are the most rigid and the least well understood of the three rules with which practices must comply. PMC therefore believes that transactions should be the initial focus of HIPAA compliance efforts by College members. PMC's Electronic Transactions Manual will be available in early 2002. ACP-ASIM and the American Academy of Pediatrics have contracted with one of the most recognized experts in this field, Margret\A Consulting, LLC, to develop a transactions toolset that will provide our members what they need to prepare for compliance with the electronic transactions regulations. The toolset is expected to be available on PMC's web page in early 2002. Members should check the web page's "What's New" listing for announcement of this and other manuals.

ACP-ASIM is also one of ten medical specialty societies, representing over 400,000 physicians that have contracted with a leading consulting firm, Gates, Moore & Company, to develop Privacy and Security Manuals for members. The Privacy Manual will be available in early 2002 and the Security Manual will be produced shortly after the final Security Rule is eventually published. The Privacy and Security Manuals will also be available in Spanish.

Free to Members Online:

College members will be able to download all of these manuals free of charge from the PMC web page. Members who do not have good Internet access will be offered CD-ROM or other versions (shipping and handling charges apply). Keep your eye on the PMC web site for release of the latest HIPAA compliance tools. They will be valuable benefits of your College membership.

Experience Annual Session - Philadelphia Style

Join the College April 11-14, 2002 and be a part of Annual Session 2002 in Philadelphia. Experience over 275 sessions covering the spectrum of internal medicine and the subspecialties. Upholding tradition, ACP-ASIM promises to offer a rich educational experience with an emphasis placed on content that is clinically relevant and practice oriented. Be Sure Not to Miss...

Clinical Pearls— Remember those words of wisdom from your most respected clinical teachers? Those Pearls were based on an experience of depth and knowledge of medical literature of remarkable scope. Pearls are noteworthy for their clarity, timelessness, and clinical applicability.

Introduced at the 2001 Annual Session and an instant hit, Clinical Pearls rekindles the joy of bedside learning, using a highly engaging, case-based format. With the audience-response keypad-system, you'll have a chance to test the depth of your clinical acumen. You'll leave each session with a rich collection of Pearls, ready to be applied directly to the patients.

Multiple Small Feedings of the Mind— Rated by many as the best of Annual Session, Multiple Small Feedings of the Mind uses a creative format to address some of the most common, yet challenging or controversial, patient-management issues. In these highly focused, fast-paced sessions, faculty offers answers to some of the most frequently faced dilemmas in patient care.

The Learning Center— Experience the excitement of the Learning Center. Refine your techniques in a variety of office-based examination and procedural skills. Take advantage of small group or individual tutorials with experts in the field. The Learning Center is unique to Annual Session and offers a wide range of opportunities for closely supervised, hands-on practice. Become familiar with procedures and examinations you don't perform on a routine basis. Try out the latest software for clinical information management and patient care. The Learning Center is a dynamic collection of hands-on activities, which you can immediately apply to your clinical practice.

Update— Keep up to date on the year's most important published papers in the subspecialty areas. Learn significant findings and their impact on patient care. Nationally recognized faculty reviews the literature and presents the year's highlights.

Experience Annual Session... Registration and other meeting information is available online. Visit the College website at (http://www.acponline.org/cme/as/2002/index.html), or contact Customer Service at (800-523-1546, extension 2600). Early sign-up is encouraged for the best selection of workshops and seating at breakfast/lunch sessions.

College Seeks to Make Drug Formularies More Uniform and Less Restrictive

ACP-ASIM has asked the National Association of Insurance Commissioners to support the establishment of uniform state laws which would ensure that members of health plans are not subjected to restricted drug formularies. There is ample evidence in the medical literature, as well as from physicians' personal experiences, that patients can be harmed, or at least less effectively treated, when drug choices are limited. The reasons for this are many: patients often differ in their response to drugs within a particular class (e.g., having an adverse reaction to one member of the class and not to other member(s) of the same class), one class of drug for treating a condition (when two or more classes exist but are excluded from a particular formulary) may be ineffectual or contraindicated due to a patient's history or potential for harmful interactions with other medications, and generic substitution may not always have the same bio-equivalency and therapeutic effect as brand name medications.

Restricted formularies also harm patients in other critical way. Financially, patients may be forced to pay for drugs that are crucial to their health but not covered by their health plan, and continuity of patient care can be disrupted if patients are forced to change health plans solely in order to obtain medically necessary medicine not covered by the original health plan. The letter to the NAIC can be viewed at (http://www.acponline.org/hpp/uniform_drug.htm).

Supporting Your Chapter through Chapter Dues

Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives. When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

Free CD-ROM Immunization Resource to be sent to Members

The ACP-ASIM Adult Immunization Initiative will release a CD-based Adult Immunization Toolkit the first week of April 2002. This free CD-ROM will be distributed by mail to general internist members and will be available on request to all members. It will include a variety of immunization resources, including:

An immunization program from the Centers for Disease Control and Prevention (CME credit available) Electronic files of all the immunization educational materials developed by the Adult Immunization Initiative PDA downloads with vaccine reference information A copy of the Guide to Billing and Coding for Adult Immunization A presentation module including slides and speaking points for members who want to educate the public about adult immunization The Adult Immunization Harmonized Schedule from the Advisory Committee on Immunization Practices.

Additional components may include reminder recall materials, professionally designed ads to help members advertise their immunization services, and more. Copies of the CD-ROM Toolkit will also be available at the Adult Immunization Booth in the exhibit hall at Annual Session 2002.

For more information on the Adult Immunization Initiative please contact Leslie Gurowitz at 800-523-1546, ext. 2477 (lgurowitz@acponline.org).

Medication Samples and Safety

Medication samples are an everyday part of ambulatory medicine. They can insure that low-income patients get the medications they need, and they help patients get started on their medication as quickly as possible. However, samples bring with them risks that can lead to accidents. To use samples safely, consider the following tips:

  • Keep a sample distribution log of what medications patients were given, and how much.
  • Use stickers or otherwise mark or separate look-alike and sound-alike items.
  • Make sure the sample storage area is well lit and secure.
  • Provide explicit written directions on how to use the medication.
  • Involve patients in the safety check: ask them to repeat back to you how they should take the medicine.
  • Provide empty childproof bottles to store the samples in to patients living with children.

The Scientific Policy Department of the ACP-ASIM is working to improve patient safety through its new CME series, Patient Safety: The Other Side of the Quality Equation. If you are interested in having this program presented at our next Chapter meeting, please contact me at (rkhakoo2@wvu.edu).

Lend A Hand To Tobacco Prevention

Tobacco use, primarily smoking, causes heart disease, lung disease and many cancers. More than 400,000 deaths in the United States every year are a direct result of tobacco use. According to the American Lung Association, 100 billion dollars a year are spent in health care costs and lost productivity due to tobacco use. Tobacco use and addiction is the leading preventable cause of death and disease in the United States.

The amount of CME time devoted to educating physicians and medical students about the health effects of tobacco use and the treatment of tobacco addiction is extremely small in proportion to the health importance of tobacco use and addiction. As a result, the College encourages members to join local anti-smoking campaigns and discourage the use of tobacco, particularly by young people.

Get involved in the campaign to limit tobacco. Help educate the public on the prevention of tobacco use and cessation of smoking. The following organizations maintain websites that will help get you started in the fight against tobacco:

Center for Disease Control (CDC) - The CDC hosts a "tip" page that contains specific information on smoking cessation.

Campaign for Tobacco Free Kids - An organization dedicated to protecting kids and adolescents from tobacco exposure. The website features tobacco initiatives on the state, federal and global levels.

American Lung Association - Articles, data and statistics educating on the use and effects of tobacco products.

The Truth.com - A site funded by the American Legacy Foundation, established in November 1998 after the Master Settlement Agreement (MSA) between 46 states, 5 US territories and the tobacco industry. Exposes the truth about tobacco and the companies that sell it.

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 (http://www.acponline.org/college/aboutacp/email_change.htm) 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.