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President's Column

Two events, one voice: Leadership Day, OIG meeting showcase the 'new' College

From the July/August 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

This spring, the College participated in two events that provide tangible evidence that our merged organization is working toward a common goal—looking out for the interests of internists.

This year's seventh annual Leadership Day, which was held on Capitol Hill in late May, created what I can only describe as palpable energy. The College's Governors and other chapter representatives thoroughly enjoyed the opportunity to advocate for the College's public policy agenda. On that same day, College officials met with representatives from the Office of the Inspector General (OIG) to discuss a topic near and dear to all of us: the government's campaign to weed out fraud and abuse.

One voice

This year's Leadership Day was more exciting than ever, in part because of the added expertise of former ASIM leaders and staff. (For more details on Leadership Day, see "Internists raise College profile at this year's Leadership Day.")

A central purpose of the merger between ACP and ASIM was to give internal medicine "one voice," and nowhere is that goal more important than in Washington. Internal medicine needs one strong, clear voice to give us a fighting chance to be heard by legislators, who are bombarded with differing views on every issue.

I was particularly impressed with a number of the presentations at a meeting the day before we actually visited with legislators. Stanley E. Collender, senior vice president of international communications company Fleishman-Hillard, Inc., spoke about the federal budget process. His suggestion that the paralysis in Congress results from an inability to deal with a budget surplus made me realize that good news can have a downside, and that we need to elect a less dysfunctional Congress.

I would like to thank the College's Washington Office staff, whose outstanding planning and organization made Leadership Day such a success. This includes the leadership of Alan Nelson, FACP, Associate Executive Vice President, along with Bob Doherty, Elizabeth Prewitt, Cathy Sullivan, Shuan Tomlinson and Jennifer Jenkins.

OIG meeting

On the same afternoon as Leadership Day, College leaders met with June Gibbs Brown, Inspector General of HHS, to discuss internists' concerns about fraud and abuse. The College was represented by David J. Gullen, FACP, Chair of the Board of Regents; Regent Cecil B. Wilson, FACP; Executive Vice President Walter J. McDonald, FACP; Dr. Nelson; Mr. Doherty and myself. Ms. Brown was accompanied by several senior division heads from the OIG.

The meeting was held at Ms. Brown's invitation in response to an earlier exchange of letters between ACP-ASIM and the OIG. In our letter, written earlier this year by the College's Immediate Past President Harold C. Sox, MACP, the College took strong issue with the OIG's apparent unwillingness to seriously address internists' concerns about the government's attempt to stamp out fraud.

In response to our letter, Ms. Brown took issue with what she called inaccurate perceptions by physicians about "overzealous prosecutors." At the same time, however, she invited us to meet with her to discuss our concerns.

Dr. Wilson was a superb spokesman for our side. He relayed the College's belief that HCFA's "Who Pays? You Pay" campaign, which asks Medicare beneficiaries to scrutinize their physicians' bills, is misguided. All of us protested the OIG's inflated estimates of fraud, waste and abuse and the OIG's characterization of coding discrepancies and lack of documentation in medical records as "improper payments."

The meeting was cordial, candid and, I believe, constructive. College leaders left with a better understanding of why the OIG believes that our concern about "overzealous prosecutors" is contradicted by the relatively few actions it has brought against physicians. In turn, we believe that the OIG gained a better understanding of the total impact of its actions. Though the OIG uses the number of physicians who have been convicted of fraud and abuse as a measure of its efforts, internists experience additional consequences such as increased paperwork and eroding patient trust.

Perhaps more importantly, I believe that the meeting helped both ACP-ASIM and the OIG recognize the potential benefits of closer communication and collaboration on issues that directly affect internists and their patients. We discussed the idea of allowing the College to have input into OIG reports on internists' coding and billing before they are published. This would help to educate both internists and patients on fraud and abuse while giving the College a chance to review examples of what the OIG considers to be improper coding and documentation.

Ms. Brown agreed in principle with our suggestions. It remains to be seen, however, how far the OIG is willing to go to provide us with meaningful input on issues that have a direct impact on internists and their patients. It also remains to be seen if having input earlier in the process will encourage the OIG to modify objectionable practices that in the past have so alienated internists. Regardless, the meeting represented an important first step toward establishing a mutually beneficial relationship between ACP-ASIM and the OIG.

Leadership Day and the College's meeting with the OIG represent the kinds of actions the College is pursuing to represent your interests. Both events fulfill the College's mission to enhance the quality and effectiveness of health care and to advocate responsible positions on individual health and public policy.

If you have any suggestions, please contact me at waddingt@rsh.net.

—Whitney W. Addington, FACP

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