 SCMS Medical Resource Guide
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2010 President's Message
 By Lawrence J. Smith, M.D.
Nephrologist
Central Illinois Kidney & Dialysis Associates
As one decade ends and we prepare to enter into a new one, physicians face far more challenges than ever. Besides the technological and medical advances that drive how we treat patients, we now are on the precipice of health care reform.
If health care reform does pass, your local medical society stands prepared to help navigate such changes. However challenging implementation of reform might be, our response mechanisms will ultimately steer us on a course of adaptability, and hopefully sustainability.
The nation's economic recession continues at the local level as we see the number of uninsured patients rise, the increased number of first-time visitors to homeless shelters and food pantries, and the growing burden on already strained social service agencies. One of the main reasons I have remained involved in SCMS is their work over the years towards helping the uninsured. My primary goal for the year ahead is to see what started as an SCMS initiative in 2009, the Access Project, begin to enroll uninsured patients.
The Sangamon County Medical Society and our Alliance - SCMS' volunteer arm comprised of physicians' spouses - have long been committed to building healthy communities. This on-going effort requires an educated and engaged medical community, which we fortunately have in abundance here. As we move forward in this new venture of professional volunteerism, and as we continue to partner with local health care and community leaders, I remain hopeful that each and every one of our members will do his or her part to grow the Access Project into a viable safety net for our most vulnerable citizens.
Speaking of challenges and sustainability, the Sangamon County Medical Society (SCMS) recently learned SIU School of Medicine will not remain as a group dues paying member for 2010 for both SCMS and the Illinois State Medical Society (ISMS), due to the state of Illinois owing SIU $115 million. We understand the economic reality of Dean Dorsey's decision, and know he and his faculty will weather this financial storm.
SCMS, too, will weather these financial challenges and shall sustain our commitment to our ever-growing physician community, and continue to demonstrate our value and "return on your investment." However, we need your continued support through your membership dollars. Simply call ISMS at 1.800.782.4767 and ask for the Membership Department, or go to www.isms.org, to renew or become a member today.
At this time, I wish to thank Dr. Dennis McManus, 2009 SCMS President, and Dr. Janet Albers, Chair of SCMS' Community Health Committee, for their leadership roles in driving the Access Project forward. We invite you to step into a leadership role as well, and to help us succeed in achieving healthy practices and building an even healthier community in 2010. Here's wishing you and your family a healthy and peace-filled New Year.
2009 President's Message
 By Dennis Q. McManus, M.D.
Neurologist & Internist
OSF Healthcare
As of this writing, the U.S. Senate continues debate on health system reform legislation, particularly on H.R. 3590, the "Patient Protection and Affordable Care Act." One recent proposal has caused the most consternation - creation of a Medicare "buy-in" or "opt-in" program for those aged 55-64. Physicians, along with senior citizens, military personnel, and their families and caregivers, know too well now how difficult it is to gain access to primary and specialty care.
Recently, the U.S. House passed a two-month extension of the sustainable growth rate (SGR), which will stop the 21.2% Medicare pay cut scheduled to take effect January 1, for a period that will end March 1, 2010.
Whether it's January 1 or March 1, physicians still face further difficult decisions. Combined with the aging population there will be further diminished access to care. Fair health insurance market reform should remain as the top priority for Senators right now.
Effective competition amongst health insurers to bring down the obscene administrative waste should be the goal of health care reform. Physicians have been divided by powerful health insurance lobbies to further squeeze reimbursement for physician services. In the last 15 years physician income has steadily fallen by 10%, while health care administrative costs have risen to 30%, two-thirds of which is pure waste. We have the largest health care system in the world; however, economy of scale does not apply because there is no effective competition amongst health insurers.
Current reform proposed by the health care insurance industry is clear. The sickest portion of our population will be covered by Medicare, with the healthy, younger population forced to pay for theirs through private health insurance companies. When the unfortunate healthy person becomes truly ill, they will be enrolled in Medicaid and Medicare, with taxpayers paying for both. Finally, the typical linking of physician reimbursement by health insurers as a percentage of Medicare rates will automatically reduce private insurance reimbursement by 21% when cuts in Medicare rates go into effect. In one stroke, the health insurance lobby will have markedly reduced the numbers of unhealthy older persons they have to cover, increase their paying healthy younger customers, and receive a 21% windfall profit on any payout they have to make. Physicians will be working much harder for much less, while big bonuses await insurance industry executives.
The excess waste in health insurers' administrative costs (estimated at $480 billion and more than twice the take-home pay for all physicians) is put to good use by the health care insurance industry. There are 15 health insurance lobbyists for every member of Congress with millions of dollars of contributions made to key politicians. Physicians are the main driver of the care in healthcare, and we need to have our voices heard. Although much is aimed at physicians in this health bill, there are some helpful portions — ending preexisting condition clauses, allowing portability across state lines and an insurance exchange may offer more choices of affordable health care and increase competition amongst health care insurers. In 2006, Massachusetts enacted legislation to create an exchange that would facilitate the buying, selling and administration of private health insurance coverage. To help us understand this type of reform, please see below where you will find an article entitled "Understanding Massachusetts' Insurance Exchange System," by Michael Sinha, M.D./J.D. candidate, and Student Representative on SCMS' Board of Directors.
Of benefit to our local health care delivery system, work has continued on the physician- and community-led initiative that addresses issues of access to quality healthcare. This integrated program coordinates the full continuum of healthcare for uninsured patients, including identifying a medical home, specialty care referrals, medication assistance, and scheduling of diagnostic services, hospitalizations and surgeries. This local solution to a national problem will improve the overall health of our community.
Work has continued this fall and early winter by the "Design Team," a committed group of allied healthcare and social service agency representatives who have contributed substantially in defining and structuring this program. Final recommendations will be presented to the SCMS Board of Directors in the near future.
We appreciate your support as members, and hope you will renew your membership for 2010 Although opinions may differ on health care reform, we must remain united and face these generational, and profound, changes to our profession together. Best wishes for a warm and memorable holiday season.
Access Project Update:
Design Team Plan Nears Completion
 By Janet R. Albers, M.D.
Family Medicine - SIU School of Medicine
Chair - SCMS Community Health Committee
Access Projects are proving to be vital in establishing medical homes for uninsured patients, with currently more than 50 Access Projects successfully operating in the U.S., from rural communities to major metropolitan areas.
Often started by county medical societies, with the first one established by the Buncombe County Medical Society in 1996, these programs are physician- and community-led initiatives that address access issues and coordinate the full continuum of healthcare for the uninsured. It provides them efficient and cost-effective care, and helps them to get well and stay well. The overall health of a community also improves when uninsured patients have primary and preventive care versus sporadic care via the emergency room.
The main design element for Access Projects to adopt in order to be successful is the "mosaic strategy." This approach incorporates multiple existing programs, models, and organizations into a collaborative structure that allows each of these components to do what they do best, while emphasizing coordination, integration, and non-duplication in the design of how various components interact with each other. This synergy is driven by community spirit, which allows us to provide the greatest good for the greatest number of people.
This dynamic is the approach that the Sangamon County Medical Society's (SCMS) "Design Team" has embraced these past five months, which has been spearheaded by Richard Endress, Ph.D., President of Access DuPage (in DuPage County near Chicago). SCMS, in partnership with our members, hospitals, medical clinics, county public health department, federally qualified health clinic (FQHC, also known as Capitol Community Health Center) and social service agencies have been working diligently to structure an Access Project here that will synergize the various components of our local health care system.
Until a name is formally adopted, the program is currently referred to as "Coordinated Access to Community Health" or CATCH. The Design Team as of this writing has concluded its series of planning meetings, and is now prepared to finalize its recommendations. We wish to recognize those who have contributed significantly to this collaborative, community-wide effort that seeks to ensure that all low-income, medically uninsured residents of Sangamon County have equal access to the coordinated and excellent medical services available here. Please see boxed area below for a complete list of Design Team members.
How does this program work? A patient's eligibility is based on household income at or below 200% of the Federal poverty level, and if eligible, then enrolled as a "member" of CATCH, and provided with a "medical home" or primary care doctor. As needed, a patient then will have coordinated access to specialty care, medication assistance, laboratory and diagnostic services, and hospitalizations and surgical care. The administrative burden of coordinating all these facets of care is absorbed by CATCH, and not by the primary care or specialty care physicians' offices. This program also helps uninsured patients navigate the health care system, and advocates on their behalf.
As a physician, why should you get involved? It makes common sense as well as economic sense. When patients have access to primary medical homes, ER visits are reduced for routine health care, and as chronic illnesses are managed, unnecessary hospitalizations are reduced as well. Businesses also benefit from reduced absenteeism, improved productivity and a healthier workforce.
The Illinois Good Samaritan Act was amended in 2008 and grants physicians medical liability immunity when they see patients in their own office at no charge. This legislative change occurred in part due to efforts spearheaded by Dr. Endress. The amended law protects physicians who see patients enrolled in an Access Program, or as referred to in the legislation - a "Free Medical Clinic without Premises" or "free clinic without walls." According to section 745 ILCS 49/30.5 of the Illinois Good Samaritan Act, the physician "will not be liable for civil damages as a result of the health care providers' acts or omissions in providing that medical treatment, except for willful or wanton misconduct."
Recruitment of volunteer physicians for the CATCH program will begin the first quarter of 2010. We have the medical resources and assets already in abundance here to make CATCH a successful reality. We hope you will support our efforts as we seek to expand access to health care for those who need it the most. Please begin thinking of how you can play an integral role in this program.
Sangamon County Medical Society's
Access Project Design Team
We wish to recognize those who
generously contributed their time
and expertise to our planning process
Janet Albers, MD
SIU Center for Family Medicine
Brian Allen, LCSW, MPA
Hope Institute, Noll Medical Pavilion
Michael Brewer, MD
Springfield Clinic, LLP
Sharon Brown
Kumler Outreach Ministries
Brad Buzzard
Capitol Community Health Center
Larry Deal, RN, BSN
St. John's Hospital
Sharmin Doering
Sangamon County Community Resources
Richard Endress, PhD
Access DuPage
John Endris, RPh
Complete Care Pharmacy
Sara Froelich
Office of U.S. Senator Dick Durbin
Sam Gaines, MD
Illinois Department of Public Health
Jan Gambach
Mental Health Centers of Central Illinois
Paula Gramley
Memorial Medical Center
Carol Harms, MA
Catholic Charities
John M. Holland, MD
St. John's Hospice
Jane Jackman, MD
Capitol HealthCare Medical Associates
Dorothy A. Kane, RN
Former Health First Free Clinic Volunteer
Robert Kane, JD
Illinois State Medical Society
John Kelker
United Way of Central Illinois
Bill Kienzle
Contact Ministries
Mark Kuhn
Springfield Clinic
Connie Marzinzik, RN
Catholic Charities
Isabel Manker
Sangamon County Medical Society
Dennis McManus, MD
Sangamon County Medical Society
Wesley McNeese, MD
SIU School of Medicine
Forrest Olson
Capitol Community Health Center
Gail O'Neill
Sangamon County Department of Public Health
Public Health Department
Kathy Pierce
Capital Township
Doug Rahn
Memorial Health System
Dora Ramos, MD
Capitol Community Health Center
Sandy Robinson
City of Springfield
Tracey Smith
SIU Center for Family Medicine
James D. Stone, MA
Sangamon County Department of Public Health
Tina Todd
Catholic Charities
Michele Tucker
Sangamon County Medical Society
Debbie Woodford, RN, BS
St. John's Hospital
Gayle Woodson, MD
SIU School of Medicine
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Call for Member Articles for BeHealthySpringfield.com
The State Journal-Register Seeks Physicians' Input
 By Gayle E. Woodson, M.D., Chair, SCMS SJ-R Editorial Panel
Otolaryngologist, SIU School of Medicine
We invite all SCMS members to submit articles to our Editorial Panel for possible posting on The State Journal-Register's (SJ-R) new health Web site, www.behealthyspringfield.com. We are proud to have been invited by the SJ-R to partner with them as they seek to grow this new site. This is a new member benefit as you will have an opportunity to share your expertise and knowledge with readers from throughout central Illinois.
Recently the SCMS Executive Officers identified five physician members to serve on our Editorial Panel who will peer review member submitted articles for medical and scientific efficacy. The panel consists of prior inductees into the "Medical Innovators" program, which recognizes the leading edge medical and scientific physicians and/or researchers in our robust medical community, a program jointly sponsored by SCMS and The Greater Springfield Chamber of Commerce's Quantum Growth Partnership in support of the Mid-Illinois Medical District.
Joining me on this panel are: James T. Dove, MD, Cardiologist, Immediate Past President, American College of Cardiology; Donald R. Graham, MD, FACP, Infectious Diseases, Springfield Clinic; K. Thomas Robbins, MD, Otolaryngologist, SIU School of Medicine, Director - SIU SimmonsCooper Cancer Institute; and Thomas G. Shanahan, MD, Radiation Oncology, University Radiologists. The panel will serve a one-year term, and will also serve in an advisory role to the newspaper, and provide guidance and feedback on medical and scientific content on BHS.
See the writing tips below this article. The SJ-R is also seeking editorials on timely and hot-button issues, along with physicians who are willing to participate in blogs on BHS.
 To contribute to the broader medical discussion on the web, and to lend your local voice to national and international health care issues and topics, we encourage you to send your articles and editorials to Isabel Manker, SCMS Executive Director, at doctors@scmsdocs.info, and she will forward them to the panel for further review. We will notify you if the SJ-R will be posting your submission. Sometimes you might be contacted directly by the SJ-R if they wish to expand upon your article in their print version. Happy writing!
SJ-R's BeHealthySpringfield.com writing tips:
- articles should be brief, no more than one page, single-spaced
- gear articles toward the general public, i.e. steer away from use of too many medical or scientific terms, or if used, clearly explain them
- use sub-headers to break up text or sections
- bullet points are often more effective than long lists within a paragraph
- brevity is your friend - sometimes it's more important determining what to leave out rather than what to leave in
- make it relevant, help portray the issue in terms that ordinary folks can relate to
- help the reader understand why they need to be aware of this topic
- personal anecdotes can go a long way toward increasing understanding
- think of "add-ons", i.e. breakout boxes with quick tips to aid readers who have little time
- don't worry about formatting text boxes - just send us the text and BHS will format
- "selling" or self-promotion of your practice prohibited
Understanding Massachusetts'
Insurance Exchange System
 By Michael S. Sinha, M.D./J.D. Dual Degree Candidate
Southern Illinois University Schools of Medicine and Law
President, AMA Student Section, SIU; Student Representative - SCMS Board of Directors
The Massachusetts health care system enters into virtually any discourse on national health care reform in the U.S. because several of its innovative approaches have been incorporated into the U.S. House and Senate bills currently under debate. Enacted in 2006 as a bipartisan compromise between then-Governor Republican Mitt Romney and a Democratic-majority state legislature, the Massachusetts reform radically altered their health care insurance system.
In order to implement lasting and successful reform, Massachusetts state legislators first sought to gain a better understanding of the demographics of the uninsured population in the U.S. One longitudinal study assessing instability of health care coverage over a four-year period found that of the total population experiencing one or more gaps in coverage, only 12% were consistently uninsured over that period.
Of that same population, 29% were covered for the majority of the time with some coverage gaps, 33% were repeatedly cycling in and out of coverage, and 26% had coverage at some point during the four-year period, but were, for the most part, uninsured. The Commonwealth Health Insurance Connector Authority, established by Massachusetts law, would attempt to address the needs of each of these populations.
In order to ensure compliance with its law, Massachusetts became the first state to impose a mandate on both individuals and employers regarding health insurance coverage. By July 2007, individuals were required to have some form of health insurance coverage or pay a fine, which would gradually increase up to a maximum of $917.00, or half the value of an average health care plan in the state. Employers were required to contribute to their employees' health care coverage or pay a "Fair Share" contribution of $295.00 annually. Additionally, if employers opted not to offer employees options for health care coverage, they could be assessed a "free-rider surcharge" on top of their "Fair Share" contribution if their employees, as a result, relied excessively upon uncompensated care.
To ease the transition and expand coverage for the great majority of the state's residents, Massachusetts developed programs for each of the two major demographics of their uninsured population: one for the mostly insured, and one for the mostly uninsured. Among those who were mostly insured, lapses were often related to some change in employment status. In order to remedy this, insurance coverage became portable under Massachusetts law.
The Commonwealth Health Insurance Connector, a health exchange program, was created to facilitate the transition from employer-run to individual-maintained health insurance. The Connector offers assistance in selection and purchase of cost-effective private insurance plans by both individuals and small businesses.
After soliciting major private health insurance carriers in the state to submit health plans, the Connector approved plans that offered broad coverage while keeping premiums low via the pooling of risk. Merging of the individual and small business insurance markets would further pool risk and lower premiums. A menu of pre-approved health insurance options was offered to any legal resident of the state.
In compliance with federal law, employee contributions would remain tax-free. Employers' contributions could be put toward an employee's plan through the Connector. Because Connector coverage is portable, health insurance would not be discontinued during employment transitions, eliminating the need for the provision of continuation coverage by employers. In addition, responsibility for oversight and administration of employee health insurance plans would shift from the employer to the Connector. Upon finding a new job, any individual could apply new employers' contributions toward their existing health care plan.
The second major program sought to address the needs of the generally uninsured. The Uncompensated Care Pool that historically reimbursed providers for uncompensated care was converted to the Health Safety Net Trust Fund, designed to ensure compensation for services rendered, but to be gradually phased out as more and more residents became covered by health insurance under the state mandate.
Ultimately, all the funds that would have reimbursed providers for uncompensated care (estimated in 2005 to be $1.3 billion) will eventually go toward subsidies for health insurance plans. The poorest of Massachusetts residents are given vouchers or discounts, with which they select their own private insurance plan through the Connector. A sliding scale determines subsidies provided to individuals between 100% and 300% of the federal poverty level. All individuals below the federal poverty level do not pay any premiums for coverage.
As of June 30, 2008, only 2.6% of Massachusetts residents did not have some form of health insurance coverage. Legislation in August 2008, representing phase two of comprehensive health care reform in Massachusetts, addressed the issues of quality and cost. The effects of that legislation are yet to be determined. The Massachusetts Medical Society surveyed physicians' satisfaction with practicing conditions in the state, and since 2006, family practice and internal medicine specialists have become increasingly dissatisfied with their workplace environment, likely a reflection of the shortage of primary care physicians and the resulting increase in workload. However, across all specialties, physicians are in fact becoming increasingly satisfied with the overall practice environment in the state. This could well be a reflection of the reforms instituted there. It remains to be seen whether the second phase of health reform, focusing on quality improvement and cost containment, will be as well received.
AMA House of Delegates Meeting Review
Dear SCMS Member:
 Jane Jackman and I attended the AMA House of Delegates in Houston November 6-10 as a delegate and alternate delegate respectively. Dave Bitzer attended the Organized Medical Staff Section on November 6-7. Howard Chodash was unable to attend and he was missed.
The meeting was characterized by lively and passionate debate, particularly about the support expressed by the AMA Board of Trustees for HR 3962 in response to an imminent vote in the House of Representatives on November 7, 2009. The bill narrowly passed the House as scheduled.
HR 3962 is a step in the process. It contains many things we support including meaningful expansion of coverage to more Americans, insurance reforms that would prevent loss of coverage when needed the most, and a specific "public option" that is compatible with our principles. We want to see more robust language to reform the liability system that drives much of the unneeded cost of care, but we will continue to work for inclusion of such reforms in the final bill.
AMA Reference Committee debate on 11/8/09 lasted 8 hours compared to a more usual 3 hours. If I had testified in the House of Delegates after hearing all the debate, I would have summarized my thoughts as follows:
"I came to this meeting with a combination of fear and hope. I came to listen to all sides and then decide which would prevail.
My fears were that the AMA Board and our officers had become enamored with the priority to make history; that they had compromised our principles and policies out of fear of exclusion from the development of legislation that would harm our profession and our patients.
My hope was that the AMA Board had acted in good faith and had carried out their fiduciary responsibility to implement House policy in a turbulent and ever changing environment. My hope was that those who were critical and skeptical coming into the meeting would be reassured by the facts that were missing from our understanding. My hope was that we would be able to craft policy and strategy that would propel reform in the right, not the wrong direction, for our members and our patients and that our AMA would come from this meeting unified in voice and principle.
The results of this meeting served to allay my fears and raise my hopes for the AMA, our members and our patients. The next step is up to us, the next layer of leadership. The ultimate elimination of my fears and realization of my hopes will depend on our ability to educate our members on the facts which are not identical with the media message. It will depend on our ability to encourage physicians to remember which way to aim when we circle our wagons in response to threat. It will depend on our commitment to constructive dialogue and change from within membership as opposed to withdrawing from membership. It will depend upon if, as Franklin so eloquently stated, we hang together or we shall surely hang separately."
I hope that after you have read the final resolution passed by a 2:1 margin, click here to view resolution, you will agree with my assessment. If you disagree, we need to continue the dialogue internally but unite in our message to our national leaders and our patients. I encourage you to attend the SCMS General Membership meeting featuring distinguished health policy scholar Robert F. Rich, Ph.D., with CME entitled "Health Care Reform in the U.S.: Challenges & Opportunities," where we can continue this dialogue locally - click here for SCMS meeting information.
Together, we are and will be stronger.
Sincerely,
Craig A. Backs, M.D., AMA Alternate Delegate
A Message from
the Sangamon County Medical Society
Offering Health, Heart and Hope for Over 100 Years
The Sangamon County Medical Society welcomed the opportunity to partner once again with The State Journal-Register on our third annual Medical Resource Guide — a community and public health reference tool for patients and health care providers.
We applaud The State Journal-Register for recently launching their new health Web site, www.behealthyspringfield.com, also referred to as BHS. And again, we welcomed the opportunity to partner with them by helping to populate their physician search engine that prominently features our members. Their new site helps patients become better health care consumers, and in the coming months, SCMS will continue to support The State Journal-Register's efforts in making BHS a regular stop for important and valuable health and medical information and resources.
I am particularly pleased to announce the names of the physicians who will be serving a one-year term as the Sangamon County Medical Society's (SCMS) Editorial Panel for The State Journal-Register's new health Web site. Selected by the SCMS Executive Officers, all panelists are inductees into the "Medical Innovators" program, which recognizes the leading edge medical and scientific physicians and/or researchers in our robust medical community, and jointly sponsored by SCMS and The Greater Springfield Chamber of Commerce's Quantum Growth Partnership in support of the Mid-Illinois Medical District.
I hope you will agree it is a preeminent panel: Chair - Gayle E. Woodson, MD, Otolaryngologist, SIU School of Medicine; James T. Dove, MD, Cardiologist, Immediate Past President, American College of Cardiology; Donald R. Graham, MD, FACP, Infectious Diseases, Springfield Clinic; K. Thomas Robbins, MD, Otolaryngologist, SIU School of Medicine, Director - SIU SimmonsCooper Cancer Institute; and Thomas G. Shanahan, MD, Radiation Oncology, University Radiologists. The panel will serve in an advisory role to the newspaper and provide guidance and feedback on medical and scientific content on BHS.
Health system reform is on everyone's mind these days. U.S. health care is the most expensive system in the world with the greatest inefficiencies and mediocre outcomes.
Where are we in Sangamon County in this healthcare boondoggle? Popular politics this year is to look at the Dartmouth Atlas of Health Care (www.dartmouthatlas.org, see data tables) for Medicare reimbursement per enrollee. Most notably, the cost of a physician-run system in Grand Junction, CO, and Rochester, MN, where Medicare reimbursement per enrollee is $6,010.40 and $7,223.60 respectively. These two areas are being touted as efficient users of health care dollars compared to Miami, FL, and McAllen, TX, with Medicare reimbursement rates of $17,364.42 and $14,834.37 respectively.
The Springfield, IL, Medicare reimbursement rate is $6,600.67. I applaud our members for this significant accomplishment. In the fight for health care dollars we should be recognized and not penalized for our ability to provide quality care at affordable prices. On October 21, 2009, the U.S. Senate dealt their latest blow to physicians, senior citizens, and members of the military and their families by voting 53-47 to block consideration of S. 1776, the Medicare Physician Fair Payment Act. This bill would have provided the foundation for implementing a new Medicare physician payment system — the effort to permanently fix the sustainable growth rate (SGR) formula.
Medicare physician payments are scheduled to be cut by 21% on January 1, 2010. Nearly 90% of people age 50 and older are concerned that the current formula threatens their access to care and it undoubtedly does — quite seriously. In a report issued by the American Medical Association the same day this vote occurred, SGR repeal would have prevented a loss of $580 million in 2010 for the care of elderly and disabled patients in Illinois.
115,935 employees, 1,594,917 Medicare patients and 155,872 TRICARE patients in Illinois would have been helped by the passage of S. 1776. In Illinois, 39% of practicing physicians are over 50, an age at which surveys have shown many consider reducing their patient care activities.
As President of the Sangamon County Medical Society, I will endeavor to make sure our physician members help protect access to care for seniors, baby boomers and military families. Please call your U.S. Senators and U.S. Representatives today to tell them they need to fulfill their obligation to seniors and the physicians who care for them.
In the near future, both the U.S. Senate and House will hold floor votes on their respective health reform bills. SCMS continues to move forward with our own health system reform — a local solution to a national problem. I encourage you to read the article by Janet R. Albers, MD, entitled "Local Program Will Expand Care for Uninsured Patients: What is an Access Project?" located in the News section of our web site.
We encourage you to invest in your health by reading and saving our Guide. Our goal is to connect patients to the resources in our community, and to provide important medical information that will help you better understand our complicated health care system. And for those less fortunate in our community who are uninsured or underinsured, we have included information about the many assistance programs in our community.
The Society continues to be the second largest in Illinois, representing more than 640 physicians practicing in Springfield and Sangamon County who have a long tradition of providing quality care for their patients in our immediate community and throughout downstate Illinois.
Our active community volunteer affiliate, the Sangamon County Medical Society Alliance (SCMSA), is an organization of physicians' spouses, whose purpose is to assist us in improving the health care and quality of life for citizens of Sangamon County through their health education projects and services. To learn more about our Alliance, please see the message from their President, Kathy O'Marro.
Here's a brief list of what's inside our Medical Resource Guide:
• list of doctors by their specialty - handy pull-out section
• list of doctors by their last name
• definitions of medical specialties so patients can better understand what type of doctor they are being referred to
• list of frequently called phone numbers for assistance agencies in our community - handy pull-out section
• public health resources and services
• pharmaceutical assistance programs
As we all grapple with the layered complexities of health system reform, and search for the most appropriate and effective solutions to this generational debate, we hope you will do your part by adopting healthier lifestyles that will ultimately ease personal, economic and social stress.
Our deepest gratitude to The State Journal-Register for their support of our efforts to help make our community healthier by publishing our Medical Resource Guide.
Sincerely,
Dennis Q. McManus, MD, Neurologist & Internist
President - Sangamon County Medical Society
Congratulations to the 2009 Medical Innovators!
The Sangamon County Medical Society and the Quantum Growth Partnership (Q5), in support of the Mid-Illinois Medical District (MIMD) hosted "Medical Innovations" on March 30, 2009. To view the press release and the list of those inducted into the 2009 Medical Innovators recognition program, click here. To view the "Medical Innovators" brochure, click here.
Citizens Club of Springfield's Health Care
Forum on Access 4 Cable TV
The Citizens Club's forum, "A Model for Sangamon County Health Care," was held in early 2009. The forum focused on national and local health care needs, challenges and opportunities, and featured: James Dove, M.D., Jerry Kruse, M.D., and Janet Albers, M.D., Chair of SCMS' Community Health Committee, who spoke about our proposed Access Project, along with other panel members. See below where you can link to the panel members' PowerPoint presentations. [Need a PowerPoint viewer? Click here.]
Presentations from the Citizens Club of Springfield's Health Care Forum, held February 23, 2009 (in order of appearance):
• James Stone - Director, Sangamon County Public Health Department
• Janet R. Albers, M.D., Chair, Sangamon County Medical Society's Community Health Committee, Associate Professor & Director, Springfield Family Medicine Residency Program, SIU School of Medicine
• Janice Bonneville, Deputy Director, Illinois Department of Central Management Services, Bureau of Benefits
• Jerry Kruse, M.D., Professor & Chair, Family/Community Medicine, SIU School of Medicine, and
• James T. Dove, M.D., Founder, Prairie Heart Institute, and Immediate Past President, American College of Cardiology
SIU School of Medicine to Participate In
National Pediatric Health Study in Macoupin County
The National Institutes of Health has chosen Macoupin County to be a site for the National Children’s Study, the largest study of child health ever conducted in the U.S. Pregnant women, whose children will be followed for 21 years, will be recruited to participate. To learn more, CLICK HERE.
3rd Annual Public Health Update Held
Presented by the Sangamon County Department of Public Health
The Sangamon County Department of Public Health (SCDPH) invited area physicians, nurses, pharmacists, laboratory personnel, and medical staff to their Third Annual Public Health Update during March, 2009, at Memorial Medical Center's Wedeberg Conference Center.
Participants learned how to recognize the current practice in evaluation and treatment of patients with Hepatitis C, learned about the myriad of services available at SCDPH, and identifed essentials of emergency preparedness plans to ensure continuity of operations.
The program was free, and included continental breakfast and lunch.
ISMS District V Trustees' Report
By Donald R. Graham, M.D., F.A.C.P.
Good news! Sangamon County, or District V, will host the 2010 annual meeting of the House of Delegates of the Illinois State Medical Society (ISMS). Thanks to a decision by the ISMS Board of Trustees at their June meeting, the House will return to Springfield.
Many of you will recall our successful meetings here in 2001 and 2005. In recent years, we have met at Oak Brook. Before 1950, the House rotated throughout the state, but in order to establish more consistent planning, the meetings have gravitated to Chicago or Oak Brook. The rotation reflects the change in membership for the ISMS. Sangamon County represents the second largest membership in the state after Cook County. Our actively practicing physicians, residents, and students have combined to provide us a total of 1,102 members.
We await the decision of the Illinois Supreme Court regarding the challenge to tort reform. During the summer, ISMS will sponsor a public awareness campaign to focus attention on this very important matter.
I had the pleasure of attending the installation in June of William McDade, M.D., Ph.D. as President of the Chicago Medical Society. Also attending was Gail Kacich, AMA Alliance Board of Directors. Dr. McDade, affiliated with the University of Chicago, is a very dynamic, talented, and well-spoken physician who represents Chicago and all of Illinois extremely well. His knowledge of organized medicine and individual medical practice is very impressive. We look to great developments from Dr. McDade in the future.
Your ISMS Council on Economics, on which I serve, has addressed many issues regarding the corporate practice of medicine. Clinics and pharmacies in large retail stores are becoming quite common throughout the country. Although downstate Illinois has seen very few, Chicago has numerous clinics. We expect to see more throughout the state.
While these clinics may occasionally offer some convenience to patients, ISMS is concerned about the quality and continuity of care provided. Complex illnesses are not treated. Records are of necessity limited, potentially hindering the ability of the physician or nurse practitioner in the clinic to provide a full diagnosis. In addition, some observers have taken an active stand about limiting harmful substances in proximity to the clinic. For example, stores that sell tobacco and alcohol next to their medical office may be providing the wrong message to patients.
Although the membership of SCMS continues to rise, we encourage you to contact your colleagues who may not yet be members. Some nonmember physicians may feel that they can "ride the coat tails" of member physicians. However, many benefits are available uniquely to members. Our voice is more effective as our membership rises.
We are sad to acknowledge the death of L. R. (Bud) Brosi. Bud was the first Executive Director of the Sangamon County Medical Society and helped establish it as the full-time, vibrant organization it is today. Originally operated out of a file drawer in the office of William DeHollander, M.D., a radiologist at St. John's Hospital and secretary of SCMS from 1946-1965, the Society outgrew his wonderful, voluntary capacities in the 1960s.
Mr. Brosi had worked in state government and came at just the right time. He served from 1968 to 1986 and helped welcome many of Sangamon County's current physicians into practice. I well remember his soft-spoken, indirect, but definite greeting, "The Board thought it would be a good idea if you..." He was a gentle, dignified, organized, and friendly man whom I greatly appreciated in my early years in medicine in Springfield. Condolences to his son Bruce, his daughter Judith, and their families.
Highlights of the "Medicare Improvements for
Patients & Providers Act", P.L. 110-275
• Medical Home Demonstration Project will be expanded & funding increased.
• Mental Health Parity — a 5% pay increase for certain mental health services will be provided from July 1, 2008 - December 31, 2009.
— reduced co-payments for mental health services to achieve parity with other outpatient services will be phased in.
• Teaching Anesthesiologists — payment rules for them were brought into conformance with those applied to other physicians in the operating room.
• Quality data reporting — the Physician Quality Reporting Initiative (PQRI) was extended through 2010, and the payment bonus for physicians who successfully report on the PQRI measures was increased to 2% — up from 1.5% in 2007-08.
• Electronic prescribing — physicians who do this in 2009 and 2010 will be eligible for 2% Medicare payment bonus, which will be phased down to 1% in 2011 and 2012, and 0.5% in 2013. Physicians who do not use electronic prescribing will be penalized by -1% in 2012, and by -1.5% in 2013.
• Medicare Advantage program reforms — the law limits the ability of Medicare Advantage (MA) private fee-for-services plans to "deem" individual physicians as part of a plan network and hold them to the terms and conditions of contracts they have not signed.
— the law establishes prohibited federal marketing practices and confers states with authority to regulate MA and Part D marketing abuses. These prohibitions include no marketing activities in physician offices.
See the article below for further information. Also, reference these links:
Update on Medicare Claims Processing
Summary of Medicare Bill, July 21, 2008
ISMS Releases New Medicaid Billing Guide
The Illinois State Medical Society (ISMS) has released their fourth Medicaid guide for physicians, Medicaid Billing Basics, Resources and Tools, (click here for this guide). It's designed to help physicians and billing staffs submit clean claims to reduce turnaround time and expedite payments.
Macoupin County Chosen as a Site
In Landmark National Children's Study
Regional Academic Institutions Collaborate to Learn about Pediatric Health
Macoupin County has been selected by the National Institutes of Health to be a site for the National Children’s Study, the largest study of child health ever conducted in the U.S.
The extensive population-based study looks at the impact of environmental exposures on the health and development of children from before birth to adulthood. Pregnant women, whose children will be followed for 21 years, will be recruited to participate in the National Children’s Study starting in 2010.
Macoupin County is joined with the City of St. Louis to form the Gateway Study Center, one of 29 such centers in the National Children’s Study. Institution members of the Gateway Study Center research team are from Southern Illinois University Medical School, Southern Illinois University Edwardsville School of Nursing, Saint Louis University School of Public Health, Washington University School of Medicine, Saint Louis University School of Medicine, and St. Louis Battelle Centers for Public Health Research and Evaluation.
Gateway Study Center researchers have developed community advisory boards and are working with community physicians, hospital administrators and nurses to plan for prenatal and birth data collection. Nearly 30 percent of Macoupin County mothers receive prenatal care and deliver in Springfield, while 33 percent deliver in Litchfield, with the rest receiving care in Alton, Jerseyville and Maryville, Illinois.
The researchers seek advice and suggestions on ways to reach women in their first trimester of pregnancy. Speakers are available to discuss the National Children’s Study and its implication for Macoupin County patients and the greater community.
The study will follow a representative sample of 100,000 children from before birth to age 21 and seeks information to prevent and treat some of the nation’s most pressing health problems, including autism, asthma, birth defects, diabetes and obesity.
The study is similar in scope to the Framingham Heart Study and the Women’s Health Initiative, which also investigated risk factors for major chronic diseases. Data collection in homes and in health clinics will assess the child’s genetic makeup, as well as factors from the biological, chemical, physical and psychosocial environments. Researchers will collect samples from the air, soil and water to learn about potential exposures. They will analyze blood, urine, hair and fingernail samples from children and screen them for asthma, birth defects, diabetes, obesity and physical, mental and developmental disorders.
For more information, contact Janet Albers, MD, (SIU School of Medicine, 217-757-8197, jalbers@siumed.edu) or Victoria Nichols-Johnson, MD (SIU School of Medicine, 217-545-7938, vnicholsjohnson@siumed.edu).
What's Hot On Sermo This Week?
Topics receiving a great deal of attention recently on Sermo, the largest online discussion community for thousands of physicians nationwide, include steps doctors can take to help prevent medical liability claims, and physicians' opinions about the possible reasons for the rising costs of prescription and generic drugs.
Sermo has quickly become the "go-to" place for physicians around the country to ask and answer questions of one another and exchange insights from their practices. Sermo is free, has no advertising and is for physicians only. The American Medical Association (AMA) recently announced a partnership agreement with Sermo.
Improving Efficiencies:
Improving our Local Health Care System
An Update on Proposed Free Clinic,
What is Project Access?
by Janet R. Albers, M.D., Chair,
SCMS Community Health Committee
The Community Health Committee is proceeding with the needs assessment to determine whether a free medical clinic should be established in Springfield. During the course of our discussions with other county medical societies about their free clinics and their foundations, it came to our attention that in addition to having free clinics, Project Access programs go further in improving the overall health of a community. (For your information, SCMS is proceeding with establishing its own 501(c)(3) or foundation.)
County medical societies across the country, some through their foundations, have established coordinated, integrated programs that improve access to care for uninsured, low-income county residents. Project Access programs identify a "medical home" for patients, coordinate the full continuum of health care, and provide an organized and streamlined referral resource for medical and surgical specialty care. Efficiency in the local health care system is increased through centralized patient encounter information.
One of the challenges in helping under- and uninsured in our communities is to know all of the resources available to them. Many times there are overlaps in resources, as well as gaps. Having a coordinated system in place that can tap into the entire safety net will ultimately improve the overall health of our community. Physicians, hospitals, social service agencies, community health centers, free clinics and the health department can work together in providing these solutions. This "mosaic" approach is what we hope to replicate here.
The mosaic structure emphasizes coordination, integration, non-duplication, and synergy. If patients use the health care system more effectively, primary care visits and use of diagnostic services should increase and emergency room visits decline. Inter-agency cooperation and inter-sector communication add to such efficiencies.
In addition to hospitals and health care providers, partners in Project Access programs include strong participation by safety-net agencies, along with both public and private school systems, and church groups. Programs are frugal in operation, and report annually to the community.
Physician volunteers, both primary care and specialty, commit to participation in the program and patient referrals are managed through a centralized database, thus creating a more equitable distribution of such referrals. In addition, access to pharmaceutical support, diagnostic services, and community agencies are coordinated.
We believe that locally if such a model were in place, the efficiency of our health care system would improve exponentially. If physicians can care for vulnerable patients in a more efficient and rewarding system and in their own offices, together they can improve access to both primary and sub-specialty care and improve overall outcomes leading to a healthier community.
Through such a program, patients are pre-screened for eligibility. Currently, one such program, Access DuPage, uses a one-page form and has 35 enrollment sites. atients are assigned to a "medical home" — a clinic or a physician that provides on-going routine medical care. Having access to on-going primary care is a prerequisite for having access to other types of medical services. The medical home provides preventive services and chronic illness management.
Each patient is given a program card that identifies his or her primary care provider and pharmaceutical assistance information. An effective date is listed on the card. The patient must also sign a "responsibility" form that identifies their commitment to the program and reasons for ineligibility if they are non-compliant. Eligibility is reconfirmed annually.
The Project Access office coordinates specialty care referrals, tracks the dollar amount of charity care provided, coordinates medication assistance, schedules laboratory and imaging services, schedules hospitalization and outpatient surgeries (health care offices' protocol is followed), and identifies access to ancillary services, such as physical therapy or durable medical equipment. Access Dupage has grown to include mental health and dental services in recent years as well.
As the Community Health Committee continues to assess the viability of such a program in Sangamon County with other community partners, we welcome your interest, feedback, and ideas.
ISMS On-Line News Keeps Pulse on Health Care Legislation & Issues
The Illinois State Medical Society (ISMS) now has two exclusive, members-only publications: Capitol MEDLOG and Medical News Wire.
Visit www.isms.org where the MEDLOG tracks bills on Methicillin-Resistant Staphylococcus Aureus (MRSA), insurance mandates, and HPV Vaccine.
The News Wire provides info on California and Massachusetts approaches to health system reform, scope of practice bills, electronic health records, advance directive lawsuit, Medicare and "pay-for-performance", and the "arms race" between doctors and hospitals.
A Message From the
Sangamon County Department of Public Health
Are you reporting communicable diseases and sexually transmissible diseases? Do you know which diseases to report or who to report to?
According to the Illinois Department of Public Health Rules and Regulations for the Control of Communicable Diseases (77 Ill. Adm. Code 690), it is the duty of physicians, health care practitioners or any other person having knowledge of a known or suspected case or carrier of communicable disease or communicable disease death to report to the local health authority.
The local health authority for providers in Sangamon County is the Sangamon County Department of Public Health (SCDPH).
The Control of Communicable Disease Code outlines which diseases to report and what the time-frame is for reporting:
- Class I (a) diseases are to be reported immediately (within 3 hours) upon initial clinical suspicion of the disease
- Class I (b) diseases are to be reported as soon as possible during normal business hours, but within 24 hours.
- Class II diseases are to be reported as soon as possible during normal business hours, but within 7 days
Reports can be submitted by mail to:
Sangamon County Department of Public Health, Lab Services
1415 E. Jefferson Street
Springfield, IL 62703
Phone: Don Hunt, B.S., Director of Adult & Lab Services at 789-2182,
or FAX to: 789-2203.
Timely reporting enables SCDPH staff to make contact with the case or suspect case, initiate the investigation and halt the spread of disease.
Reports are electronically entered into the Illinois National Electronic Disease Surveillance System (INEDSS) for tracking purposes. The system is designed to detect abnormal occurrences of disease, notify local and state health officials, and share information between different pubic health partners.
A goal of INEDSS is to gather health data on a real-time basis and to assist in the on-going analysis of trends and detection of emerging public health problems.
AMA-Foundation Student Loan Fund
Southern Illinois University School of Medicine has established an account known as the AMA-Foundation Student Loan Fund. The money will be loaned to the senior student who has incurred the greatest amount of educational debt as a substitute for a high interest loan the student may need during his/her final year of medical school. The interest rate will be fixed at 5%, simple, with repayment and interest accrual to begin three years following graduation. The borrower will be given five years to repay the loan. At the time the student borrows the funds and signs a promissory note, he/she will be provided information on the source of these funds.
SholarshipHelp.org
Get the facts about scholarships as well as advice about how to succeed in winning scholarships at ScholarshipHelp.org.
Medicare Prescription Drug Resources
For Physicians:
The Illinois State Medical Society (ISMS) has a free brochure for its members that may be freely copied and distributed to patients. To access a printable version, click here: www.isms.org/professional/md_brochure.pdf.
#1 Medicare Prescription Drug Benefit: The Basics
Please visit ISMS’s Web site, www.isms.org, for additional resources and links to Medicare Prescription Drug Benefit information.
Centers for Medicare and Medicaid Services (CMS) prescription drug coverage information for physicians:
EARN Continuing Education Credit - Take the Medicare Rx Training Course: Important Information for Health Care Professionals, 1.5 CME Category 1 Credit
www.cms.hhs.gov/medlearn/drugcoverage.asp
CMS MedLearn materials on Medicare-approved drug discount cards:
http://www.cms.hhs.gov/medlearn/drugcard.asp
CMS has publications you may order directly from their Web site simply by setting up an account and password. It usually takes about 3-4 weeks for delivery of materials. Click here for CMS Publication Mailing List Instructions: (insert CMS instructions)
To set up an account & password, go to:
http://pubordering.cms.hhs.gov/mailinglist/login.asp
For Patients:
General information for patients:
www.medicare.gov
Social Security Administration – Help with Prescription Drug Costs:
Social Security Administration, 800-772-1213
www.ssa.gov/prescriptionhelp
SeniorCare Illinois (formerly Circuit Breaker), 800-252-8966:
www.seniorcareillinois.com
Partnership for Prescription Assistance:
www.pparx.org
Patients with limited financial resources should be advised to contact the Social Security Administration (see information above) and the Illinois Senior Health Insurance Program (SHIP), to determine their eligibility for extra assistance:
IL Senior Health Insurance Program (SHIP)
800-548-9034
www.idfpr.com/DOI/Ship/ship_help.asp
IMPORTANT PHONE NUMBERS
Prescription drug benefit questions: 800-MEDICARE (800-633-4227)
Low income assistance requirements: 800-772-1213
SeniorCare Illinois: 800-252-8966
Illinois KidCare: 866-468-7543
Contact us for more info
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