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Greetings ACP Colleagues,
With summer underway, I hope that you find a few days to relax,
recharge, and spend time with family. As you will read in this
newsletter, our chapter has been busy over the past few months.
Historical Boston offered a great setting for the 2015 annual
meeting, with the ACP celebrating its 100-year anniversary. South
Dakota native Tom Daschle provided this year's
keynote, outlining the "unprecedented transformation" underway in
America's healthcare system. In addition to a great scientific
meeting, highlights included the convocation ceremony, where
Dr. Richard Holm received his Mastership and
Dr. Michael Pietila his Fellowship
The week wrapped up with a reception on Boston Harbor for 23 SD
ACP members and guests.
After years of hard work, advocacy truly paid dividends this
spring with the long-awaited repeal of the SGR. Ambitious and
committed leaders from small states can truly make a difference in
local and national policy. Such efforts were recognized at a
special ceremony at Leadership Day where Dr. Rob
Allison received the Richard Neubauer Advocate for
Internal Medicine Award - the first South Dakotan to receive this
honor (see full article later in the newsletter)! Congratulations
Rob and thank you for your time and dedication.
Membership is key to accomplishing all goals of the chapter,
advocacy and otherwise. While our state leads the nation in many
member categories, we have significant room to grow, especially
among hospitalists and subspecialists. I would encourage each of
you to seek out a colleague and share with them the benefits of
membership in the ACP and invite them to join you at our next state
On that note, fall is fast approaching. A special
combined South Dakota/Nebraska meeting will be held in Omaha,
Nebraska, September 16-18. See the special section in this
newsletter for all of the details. We have a great meeting planned,
so invite a colleague or make it a fall weekend getaway with your
In closing, I am truly honored to serve as your ACP Governor.
Please be in touch if you have concerns to raise, ideas to share,
or would like to be more involved in the chapter. I hope to see you
Matt Bien, MD FACP FAAP, Governor, South Dakota Chapter ACP
Leadership Day 2015 has come and gone. Prior to our visit to
Washington DC the world was already a better place for the practice
of medicine - The SGR had been repealed! For years I feared that
those words would never be uttered and we would be doomed to beg
Washington, DC for another patch fix as there was never enough
money to go around. The agony that started in 1997 finally gained
enough momentum from both houses of Congress and by a huge majority
was repealed as if the legislation was a "no brainer" to fix.
I was fortunate to attend the meeting with Dr. Kelly
Stacy, my Health and Public Policy co-chair from Rapid
City, and Kate Branick, a second year medical
student from the Sanford School of Medicine at the University of
South Dakota. Getting to DC from South Dakota is not easy. For some
reason it makes sense to go West and then South to head East.
Travel was even more difficult for Kate as mechanical delays caused
her to miss all of our South Dakota meetings. Despite the failure
to give Kate the 'experience' of Washington DC South Dakota style
we did get her visits with our brethren in the Nebraska Chapter and
I look forward to her report (see her article below) on her visits
Our delegation met face-to-face with Senator Rounds and Senator
Thune. Representative Noem was unable to attend, but her staff made
special effort to meet with us and answer questions. I'll give my
thoughts on how they viewed the ACP agenda in a few paragraphs.
Rob Allison, Sen. John Thune, Kelly Stacy
Rob Allison, Sen. Mike Rounds, Kelly Stacy
The ACP agenda covered four main topics:
Many of us will be affected by the expiration of incentives to
provide Medicare primary care physician services at the end of this
year. This program has been paying a 10% bonus to physicians, who
in their practice, bill at least 60% of their Medicare-allowed
charges on primary care services, such as office visits and nursing
home visits. It was intended to be an incentive for medical
students to see primary care as a viable practice career choice.
This incentive has allowed South Dakota providers to achieve better
outcomes, lower costs, and invest in their own practices. We need
Congress to continue this incentive program and prevent a 10% cut
in pay for these physicians which otherwise will create deeper
physician shortage areas in rural South Dakota. We may have
survived another SGR patch, but this 10% reduction in a huge part
of physician codes will be devastating to practices.
Medicaid pay parity expired in January of this year and we need
to bring it back. Having Medicaid coverage doesn't guarantee access
to care. Medicaid patients improved access to care by 7.7% when the
government paid physicians Medicare rates for Medicaid services.
Providers were willing to take on new patients because of this
incentive. South Dakota primary care physicians were 27th in the
nation with a rate of .69, compared to South Dakota OB providers at
.84 and other providers at 0.82. With removal of this legislation
providers of Medicaid services are already taking deep discounts of
$.31 versus the Medicare equivalent reimbursement. We need Congress
to bring this back to prevent further access to care issues.
The topic of GME funding has received a lot of press recently.
It is clear that physician workforce limits will be decided not on
the number of medical students in the pipeline but by the number of
residency training slots available. Medical schools have
proliferated but resident slots are still capped at 1996 levels.
GME funding comes primarily from Medicare and is $9.5 billion
annually. Recent criticism on how GME money is distributed through
direct GME payments and indirect GME payments has caused heartburn
in DC. President Obama is planning a $16.3 billion reduction over
10 years in GME payments based on flawed reports from the IOM
(Institute of Medicine) and misinterpretation of data from MedPAC
reports. We need Congress to see the value of GME funding. Several
pieces of legislature are working to get 3,000 new residency
training slots each year, for 5 years, to infuse the workforce. As
Congress looks for money, the ACP has suggested looking to the
private sector for funding of GME as all payers benefit from GME
training one way or another.
Congress needs to pass its yearly appropriations bills and needs
to increase funding for vital healthcare programs such as the Title
VII Health Professions program and the National Health Service
Corps. These funding programs for primary care scholarships and
loan forgiveness, in exchange for service in underserved areas, are
critical to care in South Dakota. Sequestration across the board
cuts in 2013 and partial sequestration due to caps in 2014 and 2015
have significantly reduced funding in these programs. The numbers
are a bit staggering on the underfunding and it will be a hard to
ask for money in DC after the recent SGR reversal. Congress created
a National Workforce Commission in 2010 but never funded it. It is
time to fund that commission and give it oversight to develop and
review a national workforce policy.
Our South Dakota Congressional delegations were very attentive
to our requests during our visit. We thanked them for their SGR
votes as all three voted in favor of repeal. Bringing back the
Medicare Primary Care Incentive Program and Medicaid Primary Care
Pay Parity both seemed like a large obstacle to overcome with the
recent SGR reversal. Money is tight in DC but they were willing to
look over the legislation. I received no commitments to cosign on
as a sponsor from any of our representatives. The national speakers
and Washington DC insiders at the round table lectures also
confirmed that asking for these programs to be funded would be
difficult if not impossible, nevertheless I am optimistic.
GME funding needs to happen. It is critical to the workforce in
our small state. A large percentage (70%) of South Dakota residents
that train in-state stay in-state to practice. I have been
participating on Governor Daugaard's Primary Care Task Force and we
are in the exploration phase of the costs and regulations of
expansion in South Dakota. When I have more to share I will report
to you and our Congressional representatives.
Finally I would like to thank the South Dakota Chapter of the
ACP for their nomination for the 2015 Richard Neubauer Advocate in
Internal Medicine Award (Please read more about Dr. Allison's award
below). I was humbled to win this award and was presented the award
at Leadership Day on May 20th. Robert L Allison, MD, FACP
Shuan Tomlinson, Rob Allison, ACP President Wayne Riley, BOG
Chair-Elect Doug DeLong
To Dr. Robert Allison, advocating for
legislation is like treating a chronic disease: The persistence and
creativity needed to treat chronic conditions also apply in the
state house and halls of Congress.
This year's recipient of the Richard Neubauer Advocate for
Internal Medicine Award, Allison was singled out for the role he
has played in support of the American College of Physicians'
advocacy efforts on the federal level as well as in his home state
of South Dakota.
"I have learned to treat the SGR, and other pieces of
legislation, like a chronic disease," Allison said in accepting the
award during ACP's Leadership Day festivities in Washington, D.C.
"New treatments arise, setbacks may occur, but sometimes -- like
with the SGR -- there may even be a cure. The legislators need the
education, just like our patients do, and we are the only ones who
can deliver the message with such authority."
An advocacy effort that ACP noted in Allison's selection was his
work as a member of South Dakota Governor Dennis Daugaard's Primary
Care Task Force, actively championing the need for more rural
residency and medical training opportunities.
ACP was pleased to learn that Allison's efforts "helped to
influence the governor's opinion on the federal importance of
Graduate Medical Education," Bob Doherty, ACP's senior vice
president for governmental affairs and public policy, wrote in a
letter to Allison informing him of the award. "The success of this
task force eventually led to the addition of 44 students to the
medical school class at the University of South Dakota School of
Allison said that his commitment to "making a difference on a
local and national level" grew out of the first time he dipped his
toes into the political pool.
"Most physicians view themselves as having limited political
experience and clout, and I started out being no exception to that
rule," Allison said in his acceptance speech. Then one day he
decided to sit in on a hearing on smoking legislation. "I listened
to the proponents, rose and gave my personal testimony, listened to
the opponent arguments and then saw the committee close the hearing
and make their vote," he said. "As I walked out, I remembered being
surprised at who was considered an 'expert' and what was considered
'factual' information. After the meeting, one of the physician
legislators on the panel approached me and thanked me for taking
time to come and give testimony. He then said something that set me
back: 'You know, not enough physicians are willing to take time out
of their day to help us out -- and we really need that help.'"
"That was a day that would change my willingness to participate
for years to come," Allison said.
In the years since, Allison said, he's developed several
strategies to make his advocacy more effective.
"I bend my advocacy to what legislators have been assigned or
what they are interested in," he said. For example, before meeting
legislators, he researches their committee assignments, stated
interests and recent health-care-related bills or votes. Then he
builds a connection based on that information.
"If a legislator is interested in small business issues, I
stress that, as a physician, I am also running a small business,"
he said. "If a legislator is working on veterans affairs, I
emphasize that I also treat veterans."
He also tries to personalize an issue, such as when he's working
on one of his priorities -- enhancing rural medical residency
That means pointing out to legislators -- who are likely to have
friends and family who depend on a rural physician or clinic for
their care -- that "if we can't train physicians to come back to
Pierre, South Dakota, we are going to have a different care
He also emphasizes the importance of continuing to maintain
relationships with legislators over time. After meeting with a
legislator, he immediately sends a thank-you note. He also reports
back to his fellow South Dakota physician advocates about the
meeting and its results.
To Allison, advocacy "comes down to the work I am willing to do
for my patients and for future physicians," he said. "Patients
deserve the ability to seek care from the provider of their choice,
and physicians deserve the ability to practice medicine with fair
compensation for the work provided."
Dr. Allison's full acceptance
Dear South Dakota ACP Members,
My name is Kate Branick, and I am a third year
medical student on the Avera campus in Sioux Falls. I am the class
representative for the ACP, and I was chosen to attend Leadership
Day in Washington D.C. this last April. My trip did not exactly go
as planned. After having multiple flight delays while still in
Sioux Falls, I made it to Minneapolis only to find out I had missed
my plane by minutes. Naturally, there were no more planes going to
Washington D.C. that night, so I got to spend ten hours enjoying
the comforts of the Minneapolis airport. The flight the next
morning took off half way through my first meeting with Senator
Thune, and it landed in Washington right after my meeting with
Despite this rough start, I still had hope I could make it to
the meeting with Senator Rounds. After two different taxi drivers
took me to the wrong hotel, I finally ended up in the correct place
about twenty minutes after all my meetings had concluded. I was
able to watch part of the talks given directly to the ACP members,
but I still felt defeated. I was ready to give up on this trip all
together, but luckily Dr. Allison knew a few of the Nebraska ACP
members. He requested that I accompany them on their meetings.
We attended five meetings with five very different people. The
meetings usually began with thanking the person for finally getting
rid of SGR. Then, we began to explain our position. Instead of
attempting to cover all the available bills that are in both the
House and the Senate, we focused in Graduate Medical Education. I
was surprised at the number of people who did not know about the
residency process. They were aware that many of their constituents
want more health care access, and they were aware that there is a
shortage of physicians. Hopefully, after having a discussion with
them, they will understand how they can help their constituents get
access to more health care.
Overall, the experience in Washington D.C. was amazing. I did
not realize how focused I had become about medical-political
issues, and I just assumed everyone else had that same level of
focus. This was a wonderful opportunity for me to learn to advocate
for my cause. Our representatives and senators have to have a
little knowledge about a wide range of topics. They are only going
to learn more about what is important to me if I tell them.
The advocating process takes patience and practice, but, as seen
with SGR, the hard work will eventually be worth it. Now that I am
home, I have started explain to my fellow students what I have
learned. We all need to learn to advocate for our position as
physicians. I am also planning on meeting with Senators Thune and
Rounds and Representative Noem later this summer in order to follow
up on the meetings I missed in April.
I would like to thank the South Dakota Chapter of the ACP for
providing me with the opportunity to attend the ACP conference. I
would also like to thank the Nebraska Chapter of the ACP for taking
me in after a few setbacks.
Kate Branick, MSIII
Hello friends! Summertime with its family reunions reminds me of
the wonderful get-togethers with our Internal Medicine family
through the ACP. The feeling of belonging was particularly poignant
at our recent annual meeting celebrating 100 years of physicians
dedicated to our ACP mission: "to enhance the quality and
effectiveness of health care by fostering excellence and
professionalism in the practice of medicine." I was awed by the
6000+ members present and the influence of all those who came
before us. Think how many lives we have touched as a group
throughout this century!
Today, with our specialty so fast-paced and diverse, maintaining
our Internal Medicine roots is crucial. I find I'm most fulfilled
professionally when I attend our chapter meetings full of kindred
spirits with a similar love for this amazing discipline. As chair
of our SD Chapter Membership Committee, I urge you to invite your
colleagues, sub-specialists, and locums physicians alike to join
our fold. This website
is an excellent starting point, outlining the benefits of ACP and
containing a link for membership.
If you haven't already registered for the September joint SD/NE
chapter meeting in Omaha, I urge you to do so. It will be a
wonderful opportunity to learn side by side with old friends and
acquaintances, or-if you are a young'un-make new connections that
will last a lifetime. See you there!
Catherine A. Leadabrand, MD, FACP
It's that time of year again…..time to start planning to
attend the South Dakota ACP Scientific Meeting. This year we are
partnering with Nebraska, and I want to personally invite each of
you to our joint meeting on September 16-18 in Omaha.
Meeting highlights include:
Other great sessions and topics include Doctor's Dilemma, Have I
Got A Case For You!, Liver Diseases and Their Treatment,
Rheumatology Update, Cutaneous Manifestations of Systemic Disease,
Physician Burnout, Update in Hospital Medicine, COPD Diagnosis and
Management and Clinical Management of Patients with Ebola, and
Many opportunities to network and share ideas. Meeting details
can be found in our brochure.
Here is a
direct link to the registration site.