SCMS Medical Resource Guide
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SCMS' Legacy on Race Relations:
Two Faces of Our History

The following are excerpts from the Sangamon County Medical Society's history entitled "Cultivating the Science and Art of Medicine, 1899-2001," by Kathryn Wrigley, medical librarian and historian. Director of the Health Sciences Library at St. John's Hospital, she is a former editor of the Papers of the Abraham Lincoln Association.


DR. ALONZO H. KENNIEBREW

Dr. Alonzo H. Kenniebrew, whose patients included Booker T. Washington and George Washington Carver, was denied membership in the Sangamon County Medical Society in 1929. Photo courtesy of the Lincoln Library Sangamon Valley Collection.

While the public good was not forgotten, the Sangamon County Medical Society's actions in the years between the wars had the tenor of an insular and complacent membership. Earlier innovative and energetic activities gave way to a tone of watchfulness, distrust and exclusion. Early in 1921 the membership unanimously adopted a resolution to expel any member who was "found guilty" of "professionally associating with an osteopath, chiropractor or Christian Scientist." While these groups had been condemned as quacks in earlier years, this action was clearly directed inward at its own members, who became reluctant to voice opposing views. A physician who had practiced in Springfield for 20 years lost membership for a year because he placed an advertisement in the newspaper. This infringement of the ethics code carried a more serious penalty than in earlier years because the Society had finally managed to convince local hospitals to require Society membership as a criterion for admitting patients.

These insular qualities also led the Society into at least one prejudicial action that its own constitution and bylaws did not support. Included in Springfield's rapid growth at the turn of the century was an influx of African Americans from southern states. By 1900, Springfield's 6.5 percent African American population was proportionately greater than that of Peoria, Chicago, Decatur or East St. Louis. Ironically, Lincoln's hometown was not hospitable toward these newcomers. In the summer of 1908 prejudices erupted into a race riot that gained national attention. When the riot ended, two black men had been murdered, dozens of black homes and businesses were destroyed and at least a half dozen other deaths and 100 injuries were reported. The riot in Lincoln's hometown moved the nation's African American leaders to form the National Association for the Advancement of Colored People.

Despite the horrors of the riot, it did not turn Springfield into a community free from racial bigotry. These sentiments lingered even among the best educated, the community's physicians. Among the large number of African Americans who moved to northern industrial areas in the early 1900s was Dr. Alonzo H. Kenniebrew. An 1897 graduate of Meharry Medical College, Kenniebrew became the first resident physician at Tuskegee Institute in Alabama. Among his patients were the school's first president, Booker T. Washington, and faculty scientist, George Washington Carver. Weary of southern bigotry, Kenniebrew moved to Jacksonville, Illinois in 1902. There he established his own hospital, New Home Sanitarium, in 1909. Though his hospital employed only African Americans, more than 90 percent of his patients were white. He was one of the few physicians in the area who performed thyroidectomies and "rare lung operations" so he drew referrals from Canada, the Mayo Clinic and 19 other states. Kenniebrew also recognized the health hazards of smoking and did not allow it in his office, home or hospital.

For a number of years, Dr. Kenniebrew was apparently able to do some work at the Springfield hospitals, whose wards were segregated at that time. A 1918 newspaper account noted that he had performed three surgeries at a Springfield hospital. But as the Sangamon County Medical Society became more exclusive, it was able to persuade these hospitals to restrict admitting privileges to those physicians who were Society members. While the action served to keep the charlatans out of the local hospitals, it unfortunately also kept out Dr. Kenniebrew. When he could no longer admit patients, he applied for Society membership in late 1929. Society officials could find no officially sanctioned excuse to reject his application so they simply voted to postpone action indefinitely. When Dr. Kenniebew heard nothing from the Society for three months, he wrote a letter which was once again tabled.

Kenniebrew had suffered a stroke and subsequently closed his hospital and moved to the Chicago area where he joined the Cook County Medical Society. In 1934 he returned to central Illinois and applied for a transfer membership into the Sangamon County Medical Society. Usually a formality, this transfer application was also "held for investigation." Dr. Kenniebrew was never admitted to the Sangamon County Medical Society. He was fond of the phrase, "results win all arguments," and had it printed on his letterhead. As an African American he was undoubtedly used to being snubbed but he did not allow these actions to impede a long and distinguished career.


DR. EDWIN A. LEE

Dr. Edwin A. Lee was the first African American officer of the Sangamon County Medical Society and one of the most widely admired and respected members in its history. Photo courtesy of The State Journal-Register.

Fifty years after its founding (in 1899), the Sangamon County Medical Society unanimously accepted its first African American member, Dr. Edwin A. Lee. There was no discussion regarding his membership application which was handled routinely. Dr. Lee's photograph and biography were published in the Bulletin along with those of other applicants. The Society's members had changed and the experience of the Second World War may have contributed to a more enlightened viewpoint.

After graduating from Meharry Medical College in 1941, Dr. Lee served in the Army medical corps then entered a surgery residency at St. Mary's Infirmary in St. Louis. He had intended to open a practice in Peoria when Springfield African American Dr. William H. Wilson died suddenly at age 33. Dr. Lee assumed Wilson's practice, which was housed in a South Fifth Street building, the only one in Springfield where black physicians and dentists could rent space. Local hospitals continued to segregate patients. This was not unusual, as Veterans Administration hospitals did not end segregation until 1953. The Supreme Court had not yet ruled against racial segregation in schools.

From this humble beginning, Dr. Lee achieved a remarkable career and record of public service. Lee slowly and steadily built his practice and his reputation. Just a few years after moving to Springfield, he was appointed to fill a vacancy on the Illinois Public Aid Commission. By 1958 he and other African American physicians moved into Lee Medical Building, Springfield's first medical office building owned by black physicians. Both hospitals integrated their patient rooms in the 1950s and Dr. Gwendolyn White recalled that Ed Lee always kept an eye on the wards to make sure they were not "too segregated."

Dr. Edwin Lee was clearly one of the most respected and accomplished members in the Society's history. He holds the "first African American" designation for president of the Springfield School Board, president of St. John's Hospital medical staff, and officer of the Sangamon County Medical Society. He served the community as president of the Springfield Urban League and founder and president of the Sangamon State University Foundation (later University of Illinois at Springfield). More than 50 years after the race riot that inspired the NAACP, Dr. Lee was appointed to its national board of directors. In 1972 he won the Copley Press First Citizen award and in 1993 was awarded an honorary doctorate from Sangamon State University. When the Society opened its door to Dr. Lee, it fulfilled one of its significant but unwritten functions.



President's Message

By Eric Bleyer, M.D.

The Congressional override that took place July 15, 2008, of the Presidential veto of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) speaks volumes for the impact physicians' voices can have when they unite to protect patients' access to care. This tremendous grassroots advocacy effort nationwide by physicians and their patients led to an override in the House of 383-41 (285 votes were needed), and in the Senate of 70-26 (65 votes were needed). This is definitive proof that together, we can make a difference.

The bill, now known as P.L. 110-275, replaces the 10.6% payment cut that went into effect on July 1, 2008, with a 0.5% update — retroactive to July 1 — that was extended through to December 31, 2008. It also provides an additional 1.1% update for 2009, rather than the anticipated -5.4% cut. This 18-month reprieve allows Congress to work with physicians on developing a long-term solution to a payment system that is fatally flawed. Should the Sustainable Growth Rate (SGR) method of physician reimbursement remain in place, the baseline trend for future updates will result in an estimated 21% payment cut in 2010.

According to the American Medical Association (AMA), this most recent exercise has prompted a shift in the Congressional dialogue about the urgency of identifying a real solution to the dysfunctional SGR formula. Although we as physicians understand why it doesn't work, have you ever tried to explain it to your patients?

The SGR is the reimbursement method used by the Centers for Medicare and Medicaid Services, and is based on the Gross Domestic Product (GDP) and not on actual healthcare practice costs. The SGR is an arbitrary target percentage of the GDP designed to minimize the growth of healthcare costs to the U.S. government. If actual healthcare expenditures exceed the SGR, physicians' payments are cut.

The use of the SGR formula over the past 11 years has resulted in continued cuts in reimbursement rates. Congress continues to postpone its impact yearly. This postponement results in keeping reimbursement rates similar each year. Rates today are about the same as in 2001, which now due to the increase in practice costs threatens the viability of our medical practices.

The Medicare Economic Index (MEI) is the U.S. Department of Health & Human Services measure of the annual increases in the cost of medical practice. Physicians believe that Medicare reimbursement should be based more directly on the MEI.

Of significant historical note, the July 16, 2008, edition of JAMA reviewed past actions taken by organized medicine and officially apologized to African American physicians for barring them from membership. The article, entitled "African American Physicians and Organized Medicine, 1846-1968, Origins of a Racial Divide," acknowledges the legacy of racial bias and segregation practiced by many state and local medical societies, and sanctioned by the AMA.

The Sangamon County Medical Society feels it is appropriate that the AMA has sought to rectify these practices of exclusion that occurred in the distant past with such a national apology. In reviewing our own history, we also wish to convey our apology for past actions that may have disenfranchised African American physicians, and seek forgiveness for any past misdeeds. Unfortunately, we know of one particular instance where an African-American physician, Dr. Alonzo H. Kenniebrew, was denied membership in the Sangamon County Medical Society in 1929.

As we near the 100th anniversary of Springfield's Race Riot — August 14 - 15, 1908 — SCMS must also acknowledge our own legacy on race relations. It is important to note that in the JAMA article, it indicates that "after 1900, hospital privileges (for physicians) became closely linked to medical society membership." In our August printed newsletter and here on our web site, you will find two excerpts from our history book, Cultivating the Science and Art of Medicine, 1899-2001, that discusses membership applications for two prominent African American physicians, Dr. Kenniebrew and Dr. Edwin A. Lee. Fortunately history did not repeat itself, and in 1949 Dr. Lee was accepted as a member into SCMS. The goal before us now is to create an atmosphere of openness and trust as we strive to move forward and ensure that SCMS remains a most tolerant and just professional organization that represents all physicians in Sangamon County, regardless of ethnic origin, gender or religion.

SCMS is very proud of the fact that we have had two Presidents of African American origin, Dr. Donald S. Ross in 1994, and Dr. Sam Gaines, in 2000; both continued in significant leadership roles after their term as President. We look forward to continued participation and inclusion of all physicians. The goal of the JAMA article "is to encourage a discussion within the profession of medicine about how to heal and unify the profession in the pursuit of providing equitable health care for all." This will continue to be the policy of the Sangamon County Medical Society and its Board of Directors.

On a final note, with the growing challenges facing organized medicine, it's imperative we support the Illinois State Medical Society's (ISMS) Political Action Committee, IMPAC. At the ISMS Board of Trustees' meeting in June, it was reported that District 5, which encompasses Sangamon County, is now second to last in the state for the number of physicians who contribute to IMPAC. This was a major embarrassment! In 2008, only 7% or 44 SCMS members — out of a total of 605 active physician members — have contributed to IMPAC, compared to 16% or 94 in 2007.

We could have greater impact at both the federal and state levels if we had more IMPAC support from our members, particularly since the fight to keep doctors in Illinois has heated up with the constitutional challenge now being waged before the state supreme court. ISMS deserves our support as they defend medical lawsuit reform on behalf of all physicians in Illinois. Go to www.isms.org/govt/impac to contribute on-line.



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.

[See the additional article on this page regarding the passing of L.R. (Bud) Brosi]



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



New 2008 Medicare Physician Fee Schedule
Payment Rates Effective for Dates of Service
July 1, 2008 through December 30, 2008

The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with a 0.5 percent update, retroactive to July 1, 2008.

Physicians, non-physician practitioners and other providers of services paid under the MPFS should begin to receive payment at the 0.5 % update rates in approximately 10 business days, or less. Medicare contractors are currently working to update their payment system with the new rates.

In the meantime, to avoid a disruption to the payment of claims for physicians, non-physician practitioners and other providers of services paid under the MPFS, Medicare contractors will continue to process the claims that have been on hold on a rolling basis (first in/first out) for payment at the -10.6% update level. After your local contractor begins to pay claims at the new 0.5% rate, to the extent possible, the contractor will begin to automatically reprocess any claims paid at the lower rates.

Under the Medicare statute, Medicare pays the lower of submitted charges or the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1 - June 30, 2008, fee schedule amount will be automatically reprocessed. Any lesser amount will require providers to contact their local contractor for direction on obtaining adjustments. Non-participating physicians who submitted unassigned claims at the reduced nonparticipation amount also will need to request an adjustment.

Contractor websites are being updated with the new rates and these should be available shortly.

Be aware that any published MLN Matters articles affected by the new law will be revised or rescinded as appropriate.

Finally, be on the alert for more information about other legislative provisions which may affect you.

Further instructions regarding other provisions of MIPPA will be forthcoming.



2008 Mini-Internship Program

On April 16, invited community leaders experienced first-hand what the practice of medicine is all about.

Area physicians participated in the Sangamon County Medical Society and Alliance's restructured, members-only Mini-Internship program this spring. Previously, participation in this program was limited to the SCMS Board of Directors with only a handful of doctors participating. This year was the first time it was made available to our general membership, and to a wide array of business and civic leaders. We had strong response from both invited sectors.

[Read more about our 2008 Mini-Internship Program plus view photos and comments by participants online in our special Mini-Internship section of the Web site.]

Pictured left to right: Donald R. Graham, M.D., ISMS District V Trustee and Infectious Disease specialist, Springfield Clinic, LLP, pictured with Mini-Intern Mike Boer, President, Mid-Illinois Medical District, as they prepare to enter a patient's room at St. John's Hospital.

"It is my goal to educate others about the challenges faced by our physicians so that they, too, appreciate the contributions the local health care providers make to the quality of life and economy of Springfield and Central Illinois."

• Has kept average 2008 Medicare physician payment rates about the same as they were in 2001
• Prevents physicians from making needed investments in staff and health information technology to support quality measurement
• Punishes physicians for participating in initiatives that encourage greater use of preventive care in order to reduce hospitalizations
• Has led to a severe shortfalls in Medicare's budget for physician services that have driven Congress to enact short-term interventions with funding methods that have increased the duration of cuts, as well as the cost of a long-term solution
• Hurts access to care for America's military families, as payment rates in the Department of Defense's TRICARE program are tied to Medicare rates

• 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