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Governor's Newsletter, February 2000Joel S. Levine, MD,
FACP Governor, Colorado Chapter
Governor's CornerI have just returned from the Annual Scientific
Session and Business Meeting at the Broadmoor Resort; again reminded by
the breadth, content, collegiality, and overall value of our meeting. The
Program Committee chaired by Robert Swaney, MD again provided an excellent
sequence of talks with topics ranging from the management of heart failure
and arthritis to making end of life decisions. We were honored by the
visit of Whitney Addington, MD, MACP the President of the College and his
wife Ada. Dr. Addington spoke movingly about the medical consequences of
being uninsured in the United States, and the College's initiatives to
bring the construct of universal health insurance back to the forefront of
this country's political agenda in 2000 (more later on this Chapter's
participation). Our banquet speaker, Professor Steven Epstein of the
History Department at the University of Colorado, gave an outstanding talk
on 'Renaissance Astrology' that all the attendees enjoyed. Indeed, enough
of consequence occurred at the meeting that I am turning over the
remainder of this newsletter to informing the entire membership of the
highlights.
- Announcement Of Our New Governor-Elect Designee
It was a
pleasure to inform the membership that KELLY O'BRIEN-FALLS, MD FACP was
chosen as their next governor-elect (she will assume this role after the
College's Annual Meeting in Philadelphia in April). Kelly has been a
stalwart within the Chapter's leadership for almost a decade and is well
prepared for her new responsibilities. JAMES BUSH, MD, FACP, the
runner-up in the election has agreed to accept a continuing leadership
role as Vice President-elect (see by-laws changes below).
- By-Laws Change—Creation of the Office of Vice-President
The following section was unanimously approved by the Governor's
Council and at the Annual Business Meeting:
Section 7.10. The vice-president shall be a Fellow or Master of the
College who is the runner-up (second place) in the election for
Governor-Elect. The vice-president's tenure of office shall start at the
same time as the new Governor's, and continue until the next scheduled
election of the Governor-Elect. The vice-president shall be a voting
member of the Governor's Council. In the absence of a Governor-elect the
Vice President shall temporarily assume the title of 'acting-Governor'
in the event of the inability of the Governor to perform his/her duties
until the next new Governor is selected pursuant to the Bylaws of the
ACP-ASIM. The Vice-president shall perform such important leadership
duties as mutually agreed upon with the Governor-Elect and Governor.
Being Vice-President does not obligate, or preclude, this member from
running for Governor-Elect during the next election cycle.
The only concerns raised were what would happen if a candidate for
Governor-Elect did not want to share leadership responsibility as is
intended by the new position. The membership were assured that Drs.
O'Brien-Falls and Bush fully supported the intent of the amended
by-laws, because they recognized the increasing challenge of serving the
Chapter while attending to their 'regular' jobs. I suggested if a future
candidate(s) did not appreciate the increasing local and national
responsibilities of the Governor, then either they had way to much time
on their hands or hadn't been adequately informed of the evolving job
description. Since the by-laws are an evolving document it can be
modified in the future if deemed necessary by the membership.
- Annual Election
The following slate was presented by the
Nominations Committee and approved unanimously by the membership at the
Annual Business Meeting:
Secretary: Mark Levine, MD FACP Treasurer: Mark Levine, MD FACP
Governor's Advisory Council: Mark Earnest MD Frederick Walker,
III, MD FACP
- Presentation Of Laureate Award To Joseph Matthews MD FACP
It was my pleasure to award the Chapter's Laureate Award for 2000 to
Joe Matthews. Joe has been Treasurer of the Chapter since 1994 and
recently made a decision to move to Pennsylvania to resume his career as
a Pulmonary Critical Care Specialist at the Guthrie Clinic. His career
in Colorado had been characterized by excellence in clinical care,
education, and administration. We will miss him.
The Laureate Award is awarded to a member of the Chapter who has been
a Fellow for at least 10 years and has demonstrated continuing
excellence in patient care, education, and/or research. I ask that
deserving members of the Chapter who fit this description be brought to
the attention of the nominating committee by submitting the response
form appended to this newsletter.
- Presentation of the First Annual Volunteerism and Community
Service Award to Mary Chri Gray, MD.
This meeting marked the presentation of the Chapter's first
Volunteerism and Community Service Award. Our Nomination Committee could
not have picked a more fitting first awardee in Chri Gray. Chri has
provided the physician leadership that, in concert with students from
the Medical School and Nursing School, created the Globeville Clinic at
the Salvation Army Rehabilitation Shelter. This clinic provides
important preventive health care services to this underserved
population. Her continuing commitment of personal time to the
development, maintenance, and success of the Globeville Clinic
demonstrates the best of our profession.
Eligibility requirements for this award have been developed by the
College. Awardees must be members of the College who have distinguished
themselves in voluntary service in the area of medicine. The service
must have been performed on a voluntary basis and not required for the
completion of teaching, training, or position requirements. Volunteer
work must have been done as a physician and be medically related. I ask
that deserving members of the Chapter who fit this description be
brought to the attention of the nominating committee by submitting the
response form appended to this newsletter. Self-nomination is not
allowed.
- Establishment of the Task Force On the Medically Uninsured
In response to the College's national initiative to bring the
concept of universal health insurance back on the national agenda, the
Governor's Council has created an ad hoc Task Force on the Medically
Uninsured to advance this agenda in our state. Our initial approaches
will be to collectively find ways to make the electorate and politicians
aware of the public health risks and costs of being uninsured. Mark
Earnest, MD our newest member of the Governor's Council has agreed to
chair the Task Force. Mark is interested in as many
members/associates/students as possible from around the state
participating in our initiatives.
If you are interested (or just want to know more) please fill out the
appended sheet.
- Report on Fate of Chapter Resolutions
- Resources for Grassroots Activities—Starting to see a
better recognition of needs. A slow process. Our Chapter is the gadfly
on this issue. *
- Limiting the Sale of Products for Profit in the Office
—Sent to Ethics Committee. Result was policy publication in recent
Annals. *
- Concerns about PRO-HCFA 6th Scope of Work —Unanimously
approved by BOG and referred to Medical Services Committee for action.
Within 3 months the 'bounty' provisions had been removed by HCFA.
Great story of successful grassroots identification of problem leading
to successful resolution at the appropriate national venue.
- New Resolution that is Outcome of Town Hall Meeting
During the town hall meeting multiple concerns were raised that in
the pursuit of defining financing for the uninsured the College would
not pay due attention to the delivery system(s) which seem to be
crumbling around us. As a consequence a resolution was created and will
be presented to the Board of Governors at the upcoming Annual Meeting in
Philadelphia.
TITLE: TO DIRECT THE ACP-ASIM TO FORMALIZE A STRATEGIC PLAN THAT
ENUNCIATES THE ESSENTIAL COMPONENTS OF A HEALTH CARE DELIVERY SYSTEM
THAT THE COLLEGE WOULD ADVOCATE FOR IN THE COMING YEARS.
WHEREAS: The College has developed into a large organization
representing the educational, professional, and public policy aims of a
diverse group of over 110,000 students, trainees, general internists and
sub-specialists, both in practice and in academia, and ...
WHEREAS: The College has demonstrated an increasing interest,
effectiveness, and capacity to understand and represent the needs of our
patients, our specialty, and our profession at the national level, and
...
WHEREAS: The College has been at the forefront of the fight to
provide health insurance to all Americans, and ...
WHEREAS: Patients having health insurance does not guarantee access
to a health care delivery system that provides patient centered care of
high quality that respects the patient physician relationship, and
...
WHEREAS: Patients having health insurance has been associated with
onerous rules and regulations that serve accounting as opposed to
patient care functions, and ...
WHEREAS: Patients having health insurance does not guarantee
equitable payment for appropriate provider services, and ...
WHEREAS: The College published a position paper on "Access to Health
Care" (Ann Int Med May 1, 1990) that has not been reevaluated or tested
against the physician experiences with managed care and HCFA, or the
changes in delivery systems over the past decade,
THEREFORE, let it be resolved,
That the COLLEGE shall use its health policy resources to develop a
strategic plan that defines the core professional values, and specific
tenets of the optimal system(s) for the delivery of quality health
services to our patients.
I will give you an update on the BOG discussion in May.
- Committee Minutes
Program Committee - The Annual Scientific Session - Rob Swaney, MD,
Chair.
- Recognized the program Committee that put together this excellent
scientific session: Drs. Sam Ferszt, Andy Fine, Laura Lasater, Deb
Parsons, Jeanne Seibert, Hal Spritzer, Chris Unrein, and Sterling
West.
- Anyone interested in next year's Committee FILL OUT
APPENDED FORM
Medical Student Committee - Debra Parsons, MD, FACP, Chair.
- Recognized hard work of the Committee. Major functions include
finding funding for summer preceptorships (24 last year), identifying
Internists interested in the School of Medicine's teaching programs,
and helping the Internal Medicine Club at the School.
- Recognized the Chapter's Outstanding Student Awardee for 1999,
Lisa Schatena, MD, currently an intern at the SOM program. Lisa was
given a $250 financial award as well as a free weekend at the
Broadmoor.
- Identified the contributions of Eric Hester, MSIII, to the College
and this Chapter in his role on the National Medical Student Council
of the ACP-ASIM.
- Announced the contribution of a $1500 grant in aid from this
Chapter to the Globeville Health Project.
Associates Committee - Mark Reid, MD, Associate. Chair
- Drs. Ben Shukert, Tracy Lippard, Jen Kapo, Frank Dumont, Henry
Fischer, Alison Hirsh, and Kimberly Schleman entered abstracts that
were selected for presentation at the Annual Meeting in Philadelphia
- Described the new Associates Council structure that encourages the
Associates to define their own issues, apply for resources to
accomplish those goals, and participate more fully in this Chapter's
activities.
Membership Committee - David Abbey, MD, FACP, Chair.
- Nine members were advanced to Fellowship this year.
Bahri M.
Bilir, MD, Gregory T. Everson, MD, William H. Farrar Jr. MD, Monica
Kraft, MD, Robert A. Linden, MD, Michael D. Schwartz, MD, Kevin T.
Tong, MD, Edward D. Chan, MD, Donald E. Maier, MD
Health and Public Policy Committee - Christopher Unrein, DO, FACP,
Chair. Gave a brief overview of current issues:
Federal The sustained growth rate is a
calculation used by the office of management and budget to forecast
Medicare payments. Because of poor predictions and assumptions, the
forecast was grossly mistaken. Two errors were made. First, the number
of Medicare participants that were supposed to move to a managed care
product was overestimated, and the continued growth of the economy was
underestimated. This has led to a $3 billion underpayment to
physicians since 1997. Last fall, the government did correct the
flaws, but it has no plans of returning the 3 billion-dollar short
fall. The ACP-ASIM is joining the AMA in filing suit against the
federal government.
The Norwood-Dingle bill, "the Patient's Bill of Rights," is in
conference committee. Thanks to the efforts of ACP-ASIM, health care
has become a front line policy issue and there is a fair chance that
this bill could get out of the congress this year. In its current form
President Clinton is likely to sign it. Encourage your U.S. Senators
to vote in favor of this piece of legislation.
The Campbell bill that would have allowed collective bargaining and
relief of anti-trust burdens on physicians is having difficulty and is
probably a lost cause for now.
Colorado Scope of Practice: Scope of practice is an
issue that comes back every year. This year pharmacists, optometrists,
and EMTs are crafting pieces of legislation that could potentially
expand their scopes of practice in Colorado. The optometrist are
seeking legislation that allows for direct access to eye care without
a referral. Pharmacists seek collaborative drug management in nursing
homes. This bill is very broad. It makes the physician into an
accrediting body, does not limit the scope of therapeutic substitution
and perhaps masks broader agenda. Lastly on the western slope EMT's
seek to act as primary care providers. EMT and paramedic education is
much less than extensive than other health care workers and the idea
that they want to be primary care triage officers/providers is not
tenable.
Insurance laws: Senator John Evans lost his primary care physician
to a no-compete clause in a contract. As a result, he crafted a bill
that would make such clauses illegal. This bill has a broad title and
includes language that would make it illegal to contract with
physicians on the basis of financial incentives. This has the
potential of undermining managed care as we currently experience it.
Needless to say, these provisions will be difficult to pass. Also,
HMOs are traditionally under federal jurisdiction and therefore, any
state regulation is preempted by the federal statues, and is probably
not enforceable.
Public Safety: There have been several public safety initiatives.
They include primary stop laws to enforce seat belt use. Currently,
the only time a driver can be cited for not wearing his seat belt is
in conjunction with another violation. This bill would change that.
There was also a bill to outlaw the uses of cell phones while driving
unless it is a hands-free system; this initiative failed. There was
also a bill presented to lower the legal intoxication limit for
alcohol to 0.08. This bill was defeated.
Then there are the gun safety issues. We need to remember that
prior to the Columbine tragedy, Colorado was headed toward a concealed
weapons permit law. The problem with passing gun control is the Second
Amendment. In reality, it is a public safety issue. Policy makers need
to change the debate from one of a right to bear arms to a discussion
of how to do so safely. We need to instill moral responsibility and
legal duty to the citizens our state and country. Gun ownership should
be taken seriously, and irresponsible owners should suffer the
consequences. ACP-ASIM has policy on this matter. You should be able
to research in through the College's web page.
Tobacco settlement: There are three proposals on how to use the
money awarded the state by the tobacco settlements. In the first and
most likely version to pass, 37% would go to health care, 43% would go
to the governor's reading program, and 20% would go to a trust to keep
these programs self-funded. The second proposal would give 60% to
health care spending, 20% to the governor's reading program, and 20%
to the trust. The third version would entrust all the settlement money
and not allow it to be used for 20 years. It would be ideal to have as
much money as possible go to the health care of our patients, but if
we are not careful this money could be locked up for a long time.
Please contact you legislator and let them know how you feel about
health care funding from the tobacco settlement.
Term limits: The 1998 election year saw the first installment of
the effect of term limits. The governor, speaker of the house, and the
president of the Senate in Colorado all stepped aside as the result of
term limits. We had some 20 freshman legislators that year. The 2000
election cycle will bring even more. The result of this turnover is
the loss of institutional memory. Battles fought and won must be
fought again. The difference now is that the party controlling the
government in this state is the one that traditionally hates the idea
of government and regulation. Thus, the potential to loosen or remove
the public safety aspects of the various practice acts exists on an
ongoing basis. Physicians must be involved with their local
legislators as both as advisors and financial
contributors. As you can see much is happening
within the chapter and at the chapter meeting. Your involvement with any
of the myriad of issues that the chapter is dealing with can be very
fulfilling. Please look at the questionaire
and fax or mail back a response.
THANK YOU
JOEL LEVINE MD FACP GOVERNOR, COLORADO CHAPTER |