Indiana Academy of Family Physicians FALL 2003

A Publication of the Indiana Academy of Family Physicians FALL 2003

What’s Right For Family Practice! An Interview with Dr. Kintanar pg15

Thomas Kintanar, MD

Indiana’s Candidate for AAFP Board of Directors

P H Y S I C I A N Contents Volume 4 • Issue 3

FRONTLINE PHYSICIAN is the official FEATURES magazine of the Indiana Academy of Family Physicians and is published quarterly. An Interview with Dr. Kintanar...... 15

Indiana Academy of Family Physicians IAFP 55th Annual Meeting Attendance Exceeds 350 ...... 16 55 Monument Circle, Suite 400 Indianapolis, Indiana 46204 Family Practice Management Conference - October 2003 ...... 18 317.237.4237 317.237.4006 Fax Report from the AAFP Spring Legislative Conference...... 23 888.422.4237 email: [email protected] IAFP Past President, Edward L. Langston, web site: www.in-afp.org elected to the AMA Board of Trustees...... 26 IAFP 2003-04 Officers President EXTRAS Richard D. Feldman, MD President-Elect 2003 IAFP Congress of Delegates Report ...... 10 W. David Pepple, MD IAFP Physician of the Day Volunteer Program...... 12 1st Vice President Daniel A. Walters, MD The Future of Family Medicine Project ...... 13 2nd Vice President Legislative Update...... 14 Windel Stracener What’s Happening at the IAFP Foundation?...... 22 Speaker of the Congress Kenneth E. Elek, MD Report from the AAFP Spring Vice Speaker of the Congress Legislative Conference in Washington D.C...... 23 Larry D. Allen, MD Treasurer Medicare Coalition Summary ...... 24 Teresa L. Lovins, MD Executive Vice President Kevin P. Speer, JD DEPARTMENTS AAFP Delegate President’s Message...... 5 HIPAA Update...... 23 Frederick R. Ridge, MD ® AAFP Delegate IAFP Calendar ...... 7 Tar Wars ...... 27 Thomas A. Kintanar, MD Executive VP ...... 9 Consultants Directory...... 28 AAFP Alternate Delegate H. Clifton Knight, MD Foundation News...... 20 New Members...... 29 AAFP Alternate Delegate Thomas A. Felger, MD

Staff Kevin P. Speer, J.D. Executive Vice President and General Counsel Deeda L. Ferree Assistant EVP and Director of Education Amanda C. Bowling The MISSION of the Indiana Academy of Family Physicians is to promote Coordinator, Membership Services and Communications excellence in health care and the betterment of the health of the American Laura Hahn people. Purposes in support of this mission are: Director, Legislative and District Affairs Melissa C. Lewis • To provide responsible advocacy for and education of patients and the public in all Tar Wars Coordinator Coral Cosway health-related matters; Foundation Director • To preserve and promote quality cost-effective health care; Bethany L. Ward • To promote the science and art of family medicine and to ensure an optimal supply of Administrative Assistant well-trained family physicians; Editor • To promote and maintain high standards among Stacey McArthur physicians who practice family medicine; • To preserve the right of family physicians to engage in INDIANA Publisher medical and surgical procedures for which they are CADEMY qualified by training and experience; ACADEMY • To provide advocacy, representation and leadership for OF FAMILY 502.423.7272 • www.ipipublishing.com the specialty of family practice; PHYSICIANS • To maintain and provide an organization with high standards to fulfill the above purposes and to represent the needs of its members. 3

President’s Message

s I begin my year as your Academy of Family Medicine Project. The initiative’s goal president, I look forward to the is to identify our core attributes and develop a Achallenges before us with optimism and strategy to transform and renew the specialty of pride. The IAFP is a progressive organization family practice to meet the needs and housed in a magnificent new state headquarters expectations of the American public. It will on Monument Circle. We have a cohesive position family medicine for a central role within membership, a fine dedicated staff, and the health care system in the future. It places our outstanding leadership provided by our executive entire specialty, even our name, on the table. The vice-president Kevin Speer. study found that the specialty has been successful Richard Feldman, M.D., President, in many important respects over the past 34 Indiana Academy of Family Physicians I would like to discuss my vision for the coming years, solving many of America’s public health year by relating some of my thoughts expressed ills and by filling the void in our medical system in my installation address at our Annual Scientific produced by over-specialization. It also Assembly in French Lick. I spoke that evening concluded that family medicine must re-articulate about our specialty, about our past and future. I and communicate our core values to the public, talked about my father, Max Feldman, who reformulate itself to meet the public’s passed away in January. He was 93 years old and expectations, and reconstruct its place in a family physician for nearly 40 years in South medicine to assure confidence with the American Bend. I’m very proud of him. He was typical of public. But I’m pleased to report that the core that greatest generation—the generation that built values of family medicine will remain our specialty. My father did not routinely refer to unchanged. I’m not surprised. These core himself as a family physician, but as a general concepts define our very identity and our practitioner. In those days, it was not a uniqueness. It’s simply who we are. "It is more demeaning term or a term that signified something less than what you were. Family physicians are not better than other doctors, but we are different. We are the heart important to No one taught my father the core principles of and soul of medicine. We, more than any other family medicine—continuity and specialty, humanize the healthcare experience comprehensiveness of care, disease prevention and focus our attention on the person, not the know the and health promotion and commitment to disease. We are driven by the need to develop community. No one taught him to be a patient relationships with the patients and families we advocate, integrator of care, trusted advisor and care for and by the need to help make people compassionate counselor. No one taught general whole. patient than practitioners in those days inter-personal skills, the value of patient communication, on-going Please join with me this year in celebrating our relationship, and of treating the patient in the specialty, in renewing your commitment to the to know what context of the family and environment. No one principles of family medicine, and reflecting on was there to teach my father that as William your values that led you to this challenging and Osler once said, "It is more important to know rewarding career. No matter how medicine disease the the patient than to know what disease the patient changes, I believe the future will belong to those has." These principles of personalized medicine family doctors that deliver comprehensive, came to him, and to the best general practitioners caring, humanistic, and compassionate care. patient has." of his generation, by experience and sensitivity to We’re family physicians. That’s what we do. the needs of patients. Join with me this year in expressing your passion My father and many physicians like him were for family medicine because we have a fulfilling exemplary of the best traditions and attributes of life and profession. Become a role model for a general practice—the roots by which the new bright promising young person in your specialty of family practice grew and developed community. Inspire a medical student. Mentor a and now is incorporated into formal standardized family practice resident. residency training and board certification. It was that greatest generation of general practitioners, Join with me this year in supporting the our founding fathers, like Lester Bibler who development of an historic family physician’s created our specialty, as we know it today. office at the Indiana Medical History Museum and contributing to the related IAFP book yet to Many of you are aware that our specialty is in the be published, Family Practice Stories. This book process of an in-depth self-evaluation, the Future will be told by, and about, Hoosier family

continues to page 7

5 doctors. These projects will create control coalition to help assure visible sources of pride in our adequate tobacco control funding and IAFP Calendar specialty and educate the public better plan for tobacco control about who we are, what we do, and advocacy in the future. We should the traditions from which we come. lead in this regard because we’re We’re family physicians. We’re family physicians. We are compelled IAFP MEETINGS different. And we have a story to tell. to do so because it’s critical to the health of our patients and our Would you join with me this year in communities, especially our children. 2003 working to actively protect our Family Practice Club Dinner, 14th (Student) specialty at the state and federal Finally, would you join with me in legislative levels? While fighting for helping those in need of medical care District Meeting and Family Practice appropriate reimbursement and other in our communities who are without Residency Exhibits practice issues is a priority, we must resources, without public or private October 16 maintain public health issues that health coverage? My father would enhance the health and quality of life collect $5 a month from some of his Indianapolis of our patients foremost on our patients who were in financial political agenda. In doing so, we will difficulties and owed him large bills. Practice Management Conference not only engender respect with the Even though he knew at that rate public and policy makers but also collecting it made no business sense, October 16 & 17 maintain our credibility and integrity. what was more important was that Crowne Plaza Hotel, Indianapolis Join with me in working these patients and their families collaboratively with our colleagues in preserved their sense of pride and the medical community on important self-respect. During these IAFP Board of Directors Meeting health-related issues but always extraordinary harsh economic times, October 19 maintaining our own strong separate would you make a special effort to identity at the General Assembly. give your services to some of those Crowne Plaza Hotel, Indianapolis Why? Because we’re family in your community in need without physicians and we’re different, and an expectation of being paid? It’s the sometimes we see things differently. right thing to do. 2004 Would you join with me this year in I was recently reminded of the Family Practice Update continuing our commitment to thought that we see the future by January 22 – 25 Downtown Adam’s Mark Hotel, Indianapolis

Join with me this year in expressing your IAFP Board of Directors Meeting passion for family medicine because we January 25 Downtown Adam’s Mark Hotel, Indianapolis have a fulfilling life and profession. Faculty Development Workshop March 3 fighting tobacco use and exposure to standing on the shoulders of the past. environmental tobacco smoke in our Let’s proceed with the understanding Airport Holiday Inn, Indianapolis state? Teach children about tobacco of the strengths of our specialty and through participating in our Tar Wars the inspiration and wisdom of our Residents Day and Research Forum program and fight for clean-air laws founding fathers. The medical world in our communities. Tobacco use is has changed radically in the last 25 March 3 the greatest cause of preventable years, and the family physician has Airport Holiday Inn, Indianapolis illness and premature death among not been immune to these our patients, and we should not developments. These are troubled, tolerate the fact that the General uncertain times in medicine. The IAFP Annual Scientific Assembly Assembly gutted Indiana’s statewide only stability we have is each other. July 21 – 25 comprehensive tobacco prevention Let us, this year, gather around and and cessation program by reducing support each other through our French Lick Springs Resort, French Lick its funding by $22 million a year. The Academy and show the world who Academy will take a leadership we are, what we believe in, and that position in the medical community in we are the specialty that holds a an effort to restore full funding for central role in the American health this endeavor and to assist in the care system in the new millennium. formation in a statewide tobacco

7 8 INDIANA ACADEMY Executive Vice-President OF FAMILY F KEVIN P. SPEER, JD PHYSICIANS The Lasting Legacy of Charitable Giving District Directors By, Jeanne Lee McMains, J.D. Hall, Render, Killian, Heath & Lyman, P.S.C. 1st Douglas Hatler, MD 2nd Mike Gamble, MD 3rd Kalen Carty, MD 4th Teresa Lovins, MD hat impact will your life have allowing you to draw income from the 5th Melissa Pavelka, MD on others? On the day of assets throughout your remaining lifetime. If your assets are not readily 6th Andrew Deitsch, MD your death, what legacy will W liquid (i.e. medical practice or real 7th Bernard Emkes, MD you leave behind? Creative charitable estate), do not be discouraged. With 8th Marvin McBride, MD giving can allow you to provide for your favorite causes without sacrificing the appropriate skill and caution, these 9th Deanna Willis, MD financial security of your loved ones. illiquid assets can be valuable resources 10th Garry Patton, MD Whether your gift is small or large, for furthering your charitable vision. 11th William Mohr, MD simple or complex, immediate or Many individuals desire to structure their 12th Ashraf Hanna, MD deferred, that gift will have an impact on charitable gift so they can continue to 13th Jason Marker, MD the lives of others. All that is truly be involved in the ongoing charitable 14th Vacant required is the desire and willingness to use of their gifted assets. A private 15th Scott Frankenfield, MD make a difference. family foundation or a donor-advised fund with an existing charity allow you Alternate Directors Most people can see and understand and your loved ones to be involved in how their time and abilities directly deciding how the charitable funds are used each year. What a tremendous 1st Randy Stoltz, MD influence the world around them. legacy to leave your heirs: the 2nd Fred Ridge, MD However, many people fail to explore how their asset holdings can impact the opportunity to make a difference 3rd Pamela Middleton, MD lives of those outside their immediate themselves! 4th Dan Walters, MD family. For many of these individuals, 5th Vacant trying to direct every asset to the Lastly, your charitable giving strategy 6th Wylie McGlothin, MD immediate family will oftentimes result needs to carefully consider the legal and 7th Brenda O’Hara, MD in estate taxes. When this happens, the tax implications involved. In many 8th Mark Haggenjos, MD charitable impact of their asset holdings cases, the income tax and estate tax 9th Vacant is effectively delegated to the benefits generated can result in all, or 10th Olusegun Ishmael, MD Government to direct. Careful charitable most, of the charitable gift coming from 11th Michael Mull, MD planning can allow you to provide for assets that would have otherwise been paid to the IRS in the form of taxes. 12th Thomas Mason, MD the financial security of your loved ones, 13th Don Troyer, MD as well as, take back the control of the charitable impact of your asset holdings. The opportunity to make a significant 14th Vacant difference is present in every lifetime. 15th Jason Cash, MD When considering a charitable gift, We encourage you to incorporate an explore whether you would like to give aspect of charitable giving into the Directors-At-Large now while you are able to enjoy and legacy you leave behind, and we stand influence the impact of your gift or later ready to work with you and your trusted Alan Sidel, MD as part of your after-death distribution of advisors to make this desire a reality. Worthe Holt, MD assets. If your current financial situation For inquiries about how you might Larry Allen, MD requires the use of all your resources, a explore these possibilities through the charitable remainder trust is one option IAFP, please call the IAFP Foundation that will generate attractive tax Planned Giving Director, Coral Cosway deductions for you today while still at (317) 237-4237.

9 2003 Congress of Delegates Report IAFP

This year’s Congress of Delegates was one of the smoothest running meetings that the IAFP has had in a very long time. There were a total of four resolutions, including two emergency ones. The following shows the title of the resolution and the end result.

03-1, Post Partum Administration by non- 03-2, AAFP Delegate and Alternate 03-3, (emergency resolution) IAFP licensed practitioners in home birth settings Delegate Term Limits Restructuring: A Transition from 13 districts to 3 regions (South, Central and Resolved Portion of Resolved Portion of North.) Formation of a statewide Resolution Resolution Resident’s Council and a Student Council. The Congress of Delegates would allow RESOLVED, that the prescribing practice RESOLVED, that the Indiana Academy of all members present to vote. of Pitocin be changed to similar to an Family Physicians' bylaws be amended to Epinephrine injection (Epi-Pen or Anapin) limit the number of terms a member can Resolved Portion of so that a non-licensed midwife or "helper" serve as a Delegate and Alternate would be able to administer it in an Delegate; and be it further Resolution emergent post partum setting and be it RESOLVED, that the proposed changes to further RESOLVED, that Delegates and Alternate the governance and structure a move to three Delegates be limited to two (2) terms; and regions, be accepted as recommended RESOLVED, that Pitocin would only be be it further changes; and be it further available when a written prescription is provided to a patient in the patient’s name RESOLVED, that both Delegates and RESOLVED, that these recommended and after that patient has been established Alternate Delegates be allowed to petition changes be referred to the IAFP Bylaws as a patient in that physician’s office and the Indiana Academy of Family Committee; and be it further received counseling/education regarding Physicians' Board for revisions, with good the risks of home birth (possibly signed cause, to serve one additional term. RESOLVED, that the IAFP Bylaws refusal or hospital care). Education would Committee return to the 2004 IAFP include proper administration of Pitocin. Submitted by: Congress a report containing recommended bylaws changes necessary to implement the Worthe Holt, M.D. Indianapolis, IN Submitted by: changes outlined. Kalen Carty, M.D., Salem, IN, and Final Outcome: Submitted by: Yolanda Yoder, M.D. Paoli, IN The Congress voted to adopt a substitute IAFP Task Force on Restructuring: resolution which is the same as the Larry Allen, M.D. Chair, Scott Ries, M.D. Final Outcome: original with the following editorial Richard Feldman, M.D., Clif Knight, M.D. The Congress of Delegates voted to adopt change to the second "resolved" portion: Dan Walters, M.D., Debra McClain, M.D. the following substitute resolution which Doug McKeag, M.D., Scott Frankenfield, M.D., reads: RESOLVED, that Delegates and Alternate Kevin Speer, J.D., EVP Delegates be limited to two (2) Resolved, that the prescription of Pitocin consecutive terms; and Final Outcome: for home use be brought before the Board The Congress voted to adopt the following of Directors for further study and substitute resolution: education of the IAFP membership. RESOLVED, that this issue be referred back to the IAFP Board of Directors along with the report from the task force, to consider the next steps of the Restructuring Process.

10 03-4 (emergency resolution) Residency Program support for Recommendations of the 1st Vice President Resident Council The IAFP, working in coordination with interested public health Resolved Portion of Resolution entities, should assume a leadership position within the medical RESOLVED, that the IAFP work with each residency program and healthcare communities in gaining legislative and public and encourage them to choose one or more residents to attend support for the re-appropriation of adequate funding for the and participate in the Residents’ Council; and therefore be it Indiana Tobacco Use Prevention and Cessation Agency.

RESOLVED, that the IAFP strongly encourage each residency The IAFP should be involved in the formation of a new statewide program to make time away available and reimburse for travel tobacco control coalition to help assure adequate funding for expenses to a quarterly council meeting tobacco control and coordinated programming and advocacy into the future. Submitted by: Residents’ Council Submitted by: Richard Feldman, M.D. Final Outcome: The Congress voted to adopt the following substitute resolution: Final Outcome: The Congress voted to accept these two recommendations. RESOLVED, that the IAFP recognize the IAFP’s Residents’ Council as the ideal vehicle to help create a beneficial working relationship among residents and residency programs; and therefore be it INDIANA ACADEMY OF RESOLVED, that the IAFP work with each residency program and FAMILY PHYSICIANS encourage them to choose one or more residents to attend and participate in the IAFP’s Resident Council; and therefore be it

RESOLVED, that the IAFP strongly encourage each residency program to make time away available and reimburse for travel expenses to a quarterly council meeting © IU Medical Group 2001

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for testicular cancer or transplanting the youngest hearts, receive tomorrow’s medicine today. Advancing Medicine. Enhancing Lives. IU Medical Group physicians collaborate to advance To consult with or refer to an IU physician, please call 1-800-622-4989 (IMACS) • www.iumg.iu.edu medicine through patient care, research and teaching. IMACS, your toll-free, 24-hour direct line, at 1-800-622-4989. While “high-tech” makes for good medicine, our most For more information, visit the health professionals page of important commitment is listening to you and your patients. our web site at www.iumg.iu.edu/forhealthpro.htm.

11 PHYSICIAN OF THE DAY Volunteers Needed For January & March 2004

he Indiana Academy of Family The Physician of the Day Program is We are in the process of scheduling Physicians and the Indiana one in which IAFP members volunteer physician volunteers for the months of TState Medical Association to spend one or more days at the January and March. If you are (ISMA) will once again sponsor the Statehouse during the legislative interested in serving as the Physician of Physician of the Day Program at the session. The purpose of the Physician the Day, please circle the day or days 2004 General Assembly. Your of the Day Program is to provide that you want to serve and fill out the assistance is needed. The 2004 episodic primary care services, as a calendar form and return it to the IAFP legislative session is sure to be an convenience, for the governor, office as soon as possible, but no later exciting one. In this short session, it is legislators and their staff during the than Nov. 30, 2003. Or, feel free to call most important that family medicine time the state legislature is in session. the IAFP office toll free at (888) 422- make an impression on our legislators. The Physician of the Day will be 4237 or (317) 237-4237 to schedule This valuable program allows you to introduced at the beginning of the day. your Physician of the Day shift. observe the legislative process first Your day at the Statehouse will be hand and to meet with your area from 8:30 a.m. to 4:30 p.m. Thank you in advance for your assistance representatives. with this important program.

JANUARY 2004

SUN MON TUE WED THU FRI SAT NO NO NO PHYSICIAN OF THE DAY NO NO NO NO NO NO NO January & March 2004

NO NO 13 14 15 NO NO Please fill out this form and send to: NO NO 20 21 22 NO NO Indiana Academy of Family Physicians 55 Monument Circle, Suite 400 NO 26 27 28 29 NO NO Indianapolis, Indiana 46204 Holidays and observances: 1: New Year's Day, 19: Martin Luther Phone: 317.237.4237 King Day. Phases of the moon: 7: 15: 21: 29: Fax: 317.237.4006 888.422.4237 MARCH 2004 NAME:______SUN MON TUE WED THU FRI SAT 1234NONO PHONE NUMBER:______NO 8 9 10 11 NO NO NO 15 NO NO NO NO NO MALPRACTICE INSURANCE CARRIER:______NO NO NO NO NO NO NO DAY(S) NO NO NO NO REQUESTED:______Phases of the moon: 6: 13: 20: 28:

12 The Future of American Health Network Family Medicine Group One Carmel Project Specialists Clif Knight, M.D., Alternate Delegate to AAFP William H. Cooper, MD "When all is said and done, will it Neurology/EMG make any difference?" hat seems to be the typical response have concluded their initial reviews and I receive when I talk with our provided preliminary recommendations to Tmembers about the Future of the Future of Family Medicine Project Family Medicine Project. The answer to Leadership Committee. These reports are that questions remains to be seen. being incorporated into an interim final Jarvis Earl, MD Orthopaedics report which should be available soon. What I do know is that our American Academy of Family Physicians, along with Some of the preliminary findings and the alphabet soup of related Family recommendations were previewed at the Medicine organizations – STFM, AAFP-F, AAFP Annual Leadership Forum this past ABFP, ADFM, AFPRD, and NAPCRG – April. It is anticipated that the final has invested a great amount of time, effort, recommendations may be very bold and Bradford R. Hale, MD and money in this huge project. I could potentially lead to significant Pediatric encourage you to become aware of the changes within our specialty. Neurology/EEG project and the potential for some great reformation of our specialty and even the Approximately 25% of the 822 million health care system in which we practice. office visits to physicians in our country are to family physicians and general The Future of Family Medicine Project practitioners. Without family physicians, was conceived in April 2001 as a follow vast areas of our country would become J. Michael Miller, DPM up to the acclaimed "Keystone III" summit primary care shortage areas. Our specialty Podiatry of leaders of our specialty in October is vital to the health care of our country 2000. Five task forces have been formed and we need to help decision-makers to evaluate the current state of our understand this fact. specialty and the environment in which we function, identify priorities, and formulate Bold changes ARE possible when a an action plan for improvement. significant percentage of our members William S. Sobat, MD become aware and empowered. Great General Surgery The charge of the project is "develop a effort and resources will be utilized in the Endoscopy strategy to transform and renew the implementation of the Future of Family specialty of family practice to meet the Medicine Project recommendations. We needs of people and society in a changing all need to become aware and empowered environment.” by the data and the truth. Working together, we can transform our specialty The early phases of the project included and our health care system for the benefit information and opinion gathering from of our patients and our communities. Let’s Christopher L. Winters, DPM Podiatry physicians (family physicians and non- not choose the status quo – let’s make family physicians), students, residents, things better. representative payers, and patients (those who go to family physicians and those Please go to the Future of Family who don’t). The task forces reviewed the Medicine Project Web site at available data as well as comments www.futurefamilymed.org for updated, in- American Health Network/Group One Carmel solicited from AAFP members and other depth information about the project. 12425 Old Meridian Street, Suite A-1 interested parties. The first five task forces Carmel, IN 46032 317.848.1402

13 Legislative Update: Most Time Spent on Budget Issues By Douglas M. Kinser

Conclusion of the 2003 Session Other Issues The 2003 General Assembly adjourned April 26 with • There was a discussion on niche or specialty hospitals in late approximately 280 bills becoming law from the approximately August. Certificate of Need could be a possible consideration. 1,600 bills introduced. The budget bill was the key issue in 2003. While 280 bills became law, the majority of attention was • On Aug. 8, the Indiana Department of Insurance notified focused on how the state would continue its operations with its physicians that the surcharge for the Patient’s Compensation fiscal constraints. Fund would increase approximately 73% to physicians effective August 15. An actuarial study by Milliman, USA was recently The legislature started the session with a projected $850 million completed that concluded the viability of the fund was under deficit. Projected deficits ended with a $400 million deficit at pressure and recommended increases. the end of the biennium, June 30, 2005. In July 2003, the first month of the new biennium showed further deterioration with • On Aug. 13, the Court of Appeals ruled against the state in an additional shortfall of $65 million in revenue. Most fiscal D & M Healthcare, et al vs. Indiana FSSA et al. Medicaid leaders agreed the 2003 budget is a one-year "maintenance" implemented cuts in nursing home reimbursement may now be budget and the budget may need to be reopened in November. disallowed. Other vetoed bills may have further negative impact on the state's fiscal condition. The Medicaid section of the budget was equally bleak. It was estimated that after the budget passed, the Medicaid deficit will • On Aug. 14, John Hamilton resigned and Gov. O’Bannon be $218 million on June 30, 2005. Some relief was afforded appointed Pat Rios as Secretary of the Family and Social with a new supplemental federal Medicaid funding of $168 Services Administration (FSSA). million. • In July, Medicaid issued a bulletin to request information about Where could the cuts occur? provider discounts as required under the budget bill. It has In the budget bill, a reduction in nursing home reimbursement created confusion, and I expect the physician groups will seek requires a recommendation from the Select Joint Commission clarification in the 2004 session. on Medicaid Oversight. Without a state-based supplemental rebate program—and except for curbs on drug utilization— • Your lobbyists have participated in fundraisers of key legislative pharmaceutical reimbursement under Indiana’s Medicaid leaders and others that generally support physician positions. program is largely insulated from cuts. Physicians and hospitals are among the easiest targets for cuts in reimbursement. The 2004 Session It will begin with Organization Day on Nov. 18. Between Interim Study Committees 2003 Organization Day and Jan. 5, legislators will have bills drafted and • In the Health Finance Commission, Sen. Pat Miller begin building support for issues. The 2004 session will be a short (R-Indianapolis) invited certain interested parties to discuss session and must conclude by March 15. Approximately 900 bills the rising number of the uninsured. A study of the uninsured will be introduced, and it is likely that between 100 to 180 bills was required under SCR 11. No conclusions were reached. will become law.

• In the Select Joint Committee on Medicaid Oversight, While it is not a budget session in 2004, and depending upon the discussions have included long-term care, reimbursement revenue forecast for the remaining 2003, shortfalls must be issues, and a Medicaid update. At the request of Sen. Miller, I addressed and emergencies may be considered. Many expect the was prepared to testify regarding Medicaid physician fees. fiscal issues will again drive the session in 2004. She then changed the direction of the reimbursement discussion and I was unable to present. In 2004, there will be races for president, governor, congress, and the Statehouse. During the summer, study committees have only begun meeting and there are limited conclusions at the point this report was written in August.

14 An Interview with Malpractice Tort Reform • Limits on Liability • Impartial Physician Review Dr. Kintanar • Limiting Fees Future of FP Q. Though the majority of Family is currently being undertaken at this time. The other Residencies Physicians express satisfaction with comment I would like to make is to continue to ask their career, a significant percentage of for privileges as it applies in your community. Asking • Preservation if IME Medical Family Physicians are expressing in a respectful and a peaceful manner may not gain Education Pass-Throughs frustration and dissatisfaction. What do you friends initially, but it will gain you respect. It is • Government Funding (Title VII) you feel is the most important priority the respect and the persistence over time and the to address for the improvement of demonstration of competency that will soon give us Accessibility to Care Family Physician satisfaction? the opportunity to practice the full scope for which we • Reimbursement are trained. A. For any practicing clinician to provide the highest • Development & Nuturing Future quality of care to their patients with the least amount Q. The AAFP, like most organizations, Family Physicians of headaches is a very tall order. I believe that the has recently been faced with increasing advocacy that has been demonstrated through the financial restraints. What are some Future Family Medicine American Academy of Family Physicians and our services or programs that the AAFP Indiana Academy of Family Physicians is able to currently supports that could be Project enhance relationships which enables other large eliminated as new programs or priorities • Advance & Maintain Scope of bodies to understand who and what we are as family are initiated and funded? Family Practice physicians. The Future of Family Medicine Project will give us an opportunity to define who and what A. Most large organizations have many small we are and where we are headed. Along the way, segments which have specific interests, needs, and the simplification process may be a windfall that will benefits which collectively add to the benefit of the benefit all of us in our practices. general membership. The Committee on Scientific Programs was asked by our executive Vice Q. Family Physicians across the country President, Doug Henley, to creatively be part are facing challenges to their of the process of finding ways to decrease opportunity to practice the full scope of the budgetary burden on the Academy. Our practice for which they are trained. How initial response was to decrease our can the AAFP better support members meeting schedule by one meeting per in their local privileging battles? year in order to save a substantial amount of travel time and honorarium pay A. Each community has a climate or culture which to committee members. I thought this was is germane to that particular area. I have always an extremely fine example of the executive shared with colleagues whenever trying to consider a staff of our organization enabling the credentialing piece that they have to "do the volunteer members of the organization to be landscape" if you will. They have to know the an active part of the process. There are many semantics of the community and know whether the programs which the AAFP provides that are of privileging question will be contested or welcomed. great benefit to the membership and I believe As a fully credentialed practicing endoscopist, I have that it is important that the members of those learned to adapt to the culture in the past 12-15 particular programs evaluate the benefit to the years that I have been providing endoscopic general membership much as we did on the privileges in my community. One overwhelming Scientific Program Committee to determine the comment that has been repeated in credential importance of maintaining those particular committees, not only in my community but across programs by ability. The excellent talent the nation is: show us the data. At this point in time pool at our Academy seems to from the endocopic standpoint the AAFP has begun generate and enable us through its pilot project to study competencies of endoscopic natural selection to determine which skills of beginning endoscopists. It is my sincere programs may need more hope that along with other practicing endoscopists emphasis, i.e. Tar Wars, The across this nation, we can provide the data that is so Future of Family Medicine, HIPAA crucially needed to substantiate our skills not only in Compliance, Electronic Medical endoscopy, but also in obstetrics, C-sections and Records versus other programs other areas of our training that are so vital to many of which have less emphasis at this our members. The AAFP has been very active in point in time. supporting privileging battles. However, I believe that it is the commitment to provide data for the medical literature that will truly demonstrate our strength. This

15 IAFP 55th Annual Meeting

Attendance IAFP members in reference committee hearings listened to testimony and Exceeds 350 consider resolutions submitted to the 2003 IAFP Congress of Delegates

July 23-27, 2003 French Lick, Indiana By Amanda C. Bowling

otal registration for the 2003 IAFP Annual Meeting reached 356. This figures included 180 physicians, Ttheir families, ancillary personnel, and visiting dignitaries. In addition, 60 companies were represented in Family Practice Residents enjoy the All Member Party the exhibit center.

During the five day event, educational, business, and social activities were held—including the Congress of Delegates, more than 30 hours of CME offerings, the First Annual Chuck Schilling Memorial Golf Tournament, the All Member Party, and the Annual Banquet. Many special activities were also planned for children.

Thanks to its many supporters, this year’s IAFP annual meeting was again a great success. Each year financial contributions made by supporters of the IAFP make the meeting possible. Support from friends of family practice is provided in many forms. Educational grants are solicited for the overall CME program. Only grants that allow the Dr. Daniel Walters, for his work as Chairman of the Commission on Education and making the past several Scientific Assemblies so successful; Dr. Scott Eller, IAFP to maintain independence in the selection of content, Outstanding Resident Award, and Dr. Heidi Harris Bromund, A. Alan Fischer Award faculty and topics are accepted. Sponsorships are solicited for social activities and meals. Companies may reach different levels of support with a combination of educational grant monies, exhibit fess and event sponsorships.

The primary mission of the IAFP is to offer members outstanding educational opportunities and the IAFP greatly appreciates all support of our high quality CME offerings. We would like to give special recognition to the supporters listed on page 17 and ask that our members take the opportunity to thank their representatives personally when they call on you in your office. Dr. Fred Rigde, Lester D. Bibler Award; Dr. Richard Huber, Distinguished Public Service Award; and Dr. J. Paul Gentile, Family Physician of the Year. 16 PLATINUM Merck France Foundation AstraZeneca GOLD American Academy of Family Physicians TAP Pharmaceuticals Aventis SILVER Illinois Academy of Family Physicians GlaxoSmithKline Wyeth-Ayerst Pharmaceuticals Boehringer-Ingelheim Pharmaceuticals Pfizer BRONZE King Pharmaceuticals

Exhibiting Companies at the 55th Annual Scientific Assembly Abbott Labs (2 booths) Merck and Company Alcon Laboratories, Inc. Merck Vaccines AstraZencea Meretek Diagnostic, Inc. Aventis (2 booths) Midwest Hemostasis & Aventis Pasteur Thrombosis Labs Bayer Corporation Novartis (2 booths) Beacon/Joy Newby Associates Organon Pharmaceuticals Boehringer-Ingelheim Ortho-McNeil Abott Labs Pharmaceuticals Braintree Labs Otsuka of America Bristol-Myers Squibb Pfizer, Inc. (2 booths) Bristol-Myers Pharmacia Diagnostics a Div. Squibb Neuroscience Of Pfizer Celltech Pharmaceuticals PowderJect Vaccines Center for Diagnostics Professional Office Systems, Imaging Inc. Clarian Health Purdue Pharma Corvasc MD's P.C. Reliant Pharmaceuticals Eli Lilly Romark Laboratories Extendicare Schering Corporation Forest Pharmaceuticals Schneck Medical Center- Genesis Center Health Dev. Ctr GlaxoSmithKline (3 booths) St. Francis Hospital & Health Indianapolis Neurosurgical Centers Group St. Vincent Children's Hospital INET Suburban Health Organization Isprit Systems of Medicine TAP Pharmaceuticals Janssen Pharmaceuticals Tar Wars/IAFP Foundation King Pharmaceuticals UCB Pharma, Inc. McNeil Consumer Specialty Williams Brothers Health Care MedImmune, Inc. Pharmacy MedMate Systems by Wyeth (2 booths) VersaCom, Inc

17 Indiana Academy of Family Physicians Presents Practice Management Conference October 16 & 17

Crowne Plaza Hotel At Historic Union Station Indianapolis, IN Reduced Fee of $119 for IAFP members & their staff.

Practical information and tools you can use to build and grow your medical practice. Including practice start-up, risk management, reimbursement issues, negotiating contracts, HIPAA, employee issues, and more!

18 Thursday, October 16 Speakers include experts in each field from 7:00 am Registration Opens & Breakfast IUSM Department of Family Medicine, Blue Individuals With Disabilities: If you Available & Company and more. have a disability which requires a special 7:50 am Welcome, Introductions & Program service to enable you to attend this Overview GENERAL INFORMATION conference, please contact the IAFP office by 8:00 am –10:00 am Program October 8, 2003 to speak with our staff 10:00 am –11:00 am Break & Exhibit Time regarding your needs. Advance notification 11:00 am –12:30 pm Program Program Goals: Registrants for this program will receive current information on of any special need or service helps us serve 12:30 pm Lunch starting and maintaining a medical practice. you better. 1:30 pm Program Topics were chosen based on information 3:00 pm Break & View Exhibits gleaned in earlier program evaluations and Meeting Location: Crowne Plaza 3:30 pm Program needs assessments. At the conclusion of the Hotel at Historic Union Station 5:00 pm Adjournment for the Day program, registrants should have a working Located in the heart of downtown and applicable understanding of the topics. Indianapolis and connected to the RCA Topics for the day include: Practice Start- Dome and adjacent to Pan Am Plaza, the up Issues, Reimbursement, Risk Who Should Attend: Physicians and hotel’s proximity to other attractions such as Management, Contracts, etc. office managers that need an update on Circle Center Mall, the new Conseco Fieldhouse, NCAA Headquarters and more Speakers include experts in each field from current practice management topics indicated make it an ideal location for Indianapolis Hall, Render, Killian, Heath, & Lyman, PC, in the agenda, residents, physicians in their Joy Newby & Associates and Ent & Imler first years of practice, and physicians meetings. CPA Group. considering a change in their practice type. Overnight Accommodations: A block AAFP CME Credit: This program has of rooms are being held at the Crowne Plaza Friday, October 17 Hotel, 123 West Louisiana Street, 7:00 am Breakfast been reviewed and is acceptable for 10 hours Indianapolis, IN 46225. Rooms are available 8:00 am Program of prescribed credit by the American 10:00 am Break Academy of Family Physicians. AMA at @ $119 per night and reservations may be 10:30 am Program Credit: The IAFP is accredited by the made by calling 317-631-2221. 12:00 noon Lunch ISMA to sponsor continuing medical 1:00 pm Program education for physicians. The IAFP To Register: Complete the attached 2:00 pm Adjournment designates this educational activity for a registration form and mail to the IAFP, along maximum of 10 hours in Category 1 towards with your check, to: IAFP, 55 Monument Topics for the day include: the AMA PRA award. Each physician Circle, # 400, Indianapolis, IN 46204 Incorporating Quality Improvement into should claim only those hours of credit that your Office Practice, What Can I Do For additional information contact the About Clinic Flow? Personal & he/she actually spent in the educational IAFP at [email protected] or phone 317- Professional Finance, etc. activity. 10 hours. 237-4237

Registration Card IAFP 2003 Practice Management Conference

October 16 & 17, 2003 – Crowne Plaza Hotel, Indianapolis Name: ______MD ______DO ______Other_____ Address______City______State______Zip______Phone #:______Fax #:______E:Mail:______One Day Only Fees for IAFP Members and Ancillary Personnel: Thursday Only $75 Full Conference Fees: Friday Only $60 IAFP Member Physician $119 Non-Member Physician of the AAFP/IAFP $200 One Day Only Fees for Non-Member Physicians: Ancillary Personnel $119 Thursday Only $125 Friday Only $110

To Register: Please complete this card and return it in an envelope (along with your check) to: IAFP, 55 Monument Circle, # 400, Indianapolis, IN 46204. One registrant per card please — You may copy this card — Sorry, we cannot accept credit or debit cards for this conference.

19 Thank You The Board of Trustees of the Indiana Academy of Family Physicians Foundation would like to thank the individuals and organizations that have donated to the Foundation this year. Your generosity has provided the Foundation with critical resources needed to fulfill its mission:

"to enhance the health care delivered to the people of Indiana by developing and providing research, education and charitable resources for the promotion and support of the specialty of Family Practice in Indiana."

FOUNDER’S CLUB MEMBERS PLANNED GIVING Founder’s Club Members have committed to giving $2,500 to the IAFP Foundation over CONTRIBUTORS a 5-year period. Members noted with a check mark have completed their commitment. Ralph E. Barnett, MD The Board would like to acknowledge that many of the Members on this list also give to Raymond W. Nicholson, MD the Foundation in addition to their Founder’s Club commitment. Members who have done so in 2003 are noted with a diamond. Platinum Level Deborah I. Allen, MD ✓◆ Worthe Holt, MD ◆ ($2,500 and above) Dr. Jennifer & Lee Bigelow Richard Juergens, MD ✓ Eli Lilly and Company Kenneth Bobb, MD ✓ Thomas Kintanar, MD ✓◆ Debra R. McClain, MD Bruce Burton, MD ✓◆ H. Clifton Knight, MD ✓◆ Kalen A. Carty, MD ◆ Theresa Lovins, MD ◆ Gold Level ($1,000-$2,499) Clarence G. Clarkson, MD ✓◆ Debra R. McClain, MD ✓◆ Richard D. Feldman, MD Dr. Robert & Donna Clutter ✓◆ Robert Mouser, MD ✓ Yetta Feldman Dianna L. Dowdy, MD Raymond W. Nicholson, MD ✓◆ Dr. Raymond and Cynthia Nicholson Richard D. Feldman, MD ◆ Frederick Ridge, MD ✓◆ Pfizer, Inc. Thomas Felger, MD ✓◆ Jackie Schilling ✓◆ Fred Haggerty, MD ✓ Paul Siebenmorgen, MD ✓◆ Silver Level Alvin J. Haley, MD ✓◆ Kevin Speer, JD (IAFP EVP) ◆ ($100-$999) John L. Haste, MD ✓◆ Daniel A. Walters, MD ✓◆ Deborah I. Allen, MD Jack W. Higgins, MD ✓◆ Dr. Jennifer and Lee Bigelow I A F P F O U N D A T I O N

Name______Please direct my donation to the following: Address______Shared donation between the AAFP Historic Family Physician Office and IAFP Foundations Project ______City State Zip______Adopt-A-Student Program Jackie Schilling Family Practice Medical Student/Resident Fund E-mail Address (optional)______Tar Wars® Family Practice Stories Book Return donation to: IAFP Foundation 55 Monument Circle, Suite 400 Patient Education Conference Indianapolis, IN 46204 Memorial contribution in memory of Amount Enclosed: $20 $50 $100 $250 $500 Other______

Thank you for your generosity. It will support: Assuring access to family physicians and the quality, comprehensive and affordable healthcare they provide; Enhancing the recruitment, education and training of prospective family physicians; and Supporting other initiatives that further the vision of the Foundation to enhance the quality of healthcare services delivered to Indiana residents. 20 Cathy A. Bryant, MD Ken Elek, MD Bruce Burton, MD Bernard J. Emkes, MD Clarence G. Clarkson, MD Evansville Surgical Associates Clarian Health Partners Edward Everett Dianna Dowdy, MD Thomas A. Felger, MD Ent and Imler CPA Group Larry Fields, MD Excel Decorators Maria Fletcher, MD Deeda Ferree Scott Frankenfield, MD Forest Pharmaceuticals Ashraf Hanna, MD Green County Medical Society Heidi Harris Alvin J. Haley, MD Steve Hayden Hall, Render, Killian, Heath & Daryl Hershberger, MD Lyman Seymour Holt Garnet R. Harris, MD Diane Houin John L. Haste, MD Mary K. Hunteman Jack W. Higgins, MD Indiana Osteopathic Worthe S. Holt, MD Association IAFP 1st District Indianapolis Neurosurgical IAFP 7th District Group Dr. Richard and Carolyn George H. James, MD Kiovsky Albert Katz H. Clifton Knight, MD Doug Kinser, JD Merck and Company, Inc. Thomas Kintanar, MD Judy Monroe, MD Edward Langston, MD Novartis Teresa Lovins, MD Terry Reagan Joan Mallis Ridge Medical Center Marion Marciel J. Christopher Satore, MD William Marcrum Jackie Schilling Emma McGonigal Alan Sidel, MD Douglas McKeag, MD, MS Sisters of St. Francis Health Shane McMains Kevin Speer, JD (IAFP EVP) Suzanne Montgomery, MD Daniel A. Walters, MD Marie L. Mueller Williams Brother Pharmacy Henry and Adele Paskin Wyeth Pharmaceuticals David Pepple, MD Lawrence Reitz, MD Bronze Level Frederick Ridge, MD ($1-$99) James Schaefer Robert D. Aiello, MD Mark E. Seib, MD Larry Allen, MD Constance J. Sidles Max Baim Paul Siebenmorgen, MD Lou Belch James Soare James Black, MD Windel Stracener, MD Nicole Boersma, MD Steve Stucky Dr. James and Candyce Butler Suburban Health Organization Brian Butts Virginia L. Terpening John Carter, MD Della Quinn Kalen Carty, MD Rosalind D. Tucker Eric D. Clark, MD George Underwood, MD Dr. Robert and Donna Clutter Jean Virkus Coral Cosway Ken Wilhelmus, MD Bryan Coyne Beth Yegerlehner, MD Chris Davies Jim Zieba, JD Ryan Eggemeyer

21 What’s Happening at the IAFP Foundation? by Coral Cosway

The first Raymond W. Nicholson Award was President Jackie Schilling. This event was July 23-27, 2003 presented during the IAFP annual convention chosen to honor Mr. Schilling because of his in French Lick, Ind. in July to Dr. Debra efforts as event founder and his service as French Lick, McClain. Dr. McClain is a family physician golf chair for more than a decade. practicing in South Bend, Ind. and is also Mr. Schilling’s work on behalf of the Indiana, the most recent IAFP Past President. Her tournament was an integral part of its efforts on behalf of the Foundation were success, and his work provided many hours significant in both time spent and financial of fun for IAFP members, spouses and Raymond W. generosity during this past year. (Photo to guests who have participated in the event the left is Dr. Nicholson and Dr. McClain over the years. To honor Mr. Schilling’s Nicholson Award after the presentation of the award in service, the tournament has been named in French Lick.) his honor. All proceeds from the event will This year the IAFP Foundation established now benefit the IAFP Foundation in his the Raymond W. Nicholson Award. This The Foundation Board of Trustees would memory. honor is intended to annually recognize an like to thank Dr. Nicholson for allowing the individual or entity for making significant Foundation to use his name for this award, The First Annual Chuck Schilling Memorial contributions to the Foundation. This support as well as his continued support of the Golf Tournament was played this past July at can be made in organization. Additionally, we would like to the IAFP annual meeting. Proceeds from the various congratulate Dr. McClain for becoming its tournament were designated to the Jackie forms— first recipient and thank her for her efforts Schilling Family Practice Medical including time as well. Student/Resident Fund. With great weather, a and energy full contingent of golfers, and a good cause, spent on this year’s tournament was an enormous Foundation success. (Photo below from left, Drs. Windel administration, Chuck Schilling Stracener, Maria Fletcher, Worthe Holt and participation in Holly Brannon from the Indianapolis Foundation Memorial Golf Neurosurgical Group) programs and/or Tournament The Foundation Board of Trustees would like activities, or to thank Jackie Schilling for allowing the monetary In another first for the Foundation, the Foundation to use her husband’s name. contributions— Additionally, we would like to thank all of all help the Foundation achieve its mission. IAFP’s annual golf tournament, held in conjunction with our association’s annual the golfers who participated in this year’s meeting in July, has been permanently event. We hope to see all of you on the The award has been named for Dr. Ray course next year! "Nick" Nicholson, a family physician from dedicated to Chuck Schilling, the late Evansville who is one of the original husband of former IAFP Executive Vice organizers of the Foundation. Dr. Nicholson helped establish the Foundation’s mission, bylaws and structure and then continued to give significant amounts of his time and money to help it grow. Presenting Dr. Nicholson with an award for his efforts on behalf of the Foundation for just one year could not appropriately recognize him for this work. Thus, the Foundation created this annual award, in part, to honor his considerable contributions.

22 HIPAA Update Act Now To Protect Your Practice!

ost practices are behind in the HIPAA transactions and code sets testing effort. Many vendors, clearing-house and health plans are also behind. But there are steps you can take right now to prevent disruption of claims payments in October, Msays David C. Kibbe, M.D., AAFP’s director of health information technology. Here are four steps to get you started. • Talk to your practice management system or billing system vendor to determine your practice’s readiness to send HIPAA- compliant claims to payers, including Medicare, Medicaid and other commercial health plans. • Reject such vendor statements as "Don’t worry, we’re HIPAA compliant" in response to your queries.

• Request that your vendor immediately engage in end-to-end testing (from your office all the way to the health plan’s computer system) of these new HIPAA-standard transactions with each payer or health plan.

• Plan now for disruptions in cash flow next fall by anticipating a 10 to 20 percent increase in rejected or delayed claims during the fourth quarter of 2003. Put aside additional savings and cash reserves, put off new expenditures during this period, and be prepared to get a commercial loan if necessary.

Article provided by AAFP FP Report.

For more information access the full article at: http://www.aafp.org/fpr/. Click on "August 2003" and headline or contact the IAFP office at 317-237-4237 to have a copy sent to you.

Report from the AAFP Spring Legislative Conference Washington D.C. May 18-20, 2003 by Clif Knight, M.D. Chair IAFP Commission on Legislative and Governmental Affairs 2002-2003

n behalf of the IAFP, I attended the AAFP Annual Spring Legislative Conference in Washington, DC on May 18-20, 2003. During the conference I visited the offices of Senators Richard Lugar and Evan Bayh, Representatives Julia Carson, Dan OBurton, and Steve Buyer, all of Indiana, as well as Representative Don Sherwood of Pennsylvania, and Representative Heather Wilson of New Mexico. The importance of actions to improve Medicare reimbursement, repeal Medicare Indirect Medical Education cuts, continue Title VII Medical Education Grants, increase funding for the Agency on Healthcare Research and Quality, strengthen Medical Liability reform, provide Prescription Medication Coverage for Medicare recipients, reform the Geographic Index, and other topics were covered with the legislative assistants in these

23 Medicare Coalition

July 18, 2003 By: Joy Newby, LPN, CPC Summary Consultant, Commission on Health Care Services

HIPAA UPDATE The Carrier had 49 HIPAA Educational Programs scheduled throughout the state between July 22 and Aug. 27. This series of programs was designed to include the Connie Nichols presented the latest update on HIPAA majority of small providers defined as providers of services transaction standards taking effect on Oct. 16. The having fewer than 25 full-time equivalent employees or for AdminaStar Federal’s (ASF) 4010A1 version has been fully physicians, practitioners, facilities, or suppliers with fewer implemented including claim status inquiry. According to than 10 employees. Ms. Nichols, 5 percent of providers are fully implemented and billing with the ANSI format necessary to be HIPAA complaint. An additional 40 percent of providers have FILING OF CLAIMS WHEN MEDICARE IS completed their testing. The remaining 55 percent of SECONDARY PAYER (MSP) providers has Medicare concerned that they will not receive Medicare payment after Oct. 16. Claims with a single primary payer should be submitted electronically. Under HIPAA, the payer isn’t allowed to The External Affairs Part B Provider Relations Team request additional paper documentation as long as the recently contacted approximately 400 providers asking coordination of benefits (COB) information regarding the them about their HIPAA readiness. Based on the majority primary payer is included in the COB segment of the ANSI of responses, the Carrier believes there is a lack of urgency 837 4010A1 MSP claims. in the providers’ minds about becoming HIPAA compliant. This may be partly due to the Medicare Program’s frequent CMS Program Memorandum B03-050, CR #2758, issued extension of their deadlines. What makes HIPAA so July 3, 2003, instructs physicians and suppliers "that MSP important is that the deadline was established in the Health claims with multiple primary payers shall be submitted on Insurance Portability and Accountability Act of 1996. Only paper with the appropriate explanation of benefits or Congress can change the deadline and then only through remittance advice, and shall not be submitted legislation. electronically."

The External Affairs Part B Provider EVALUATION AND MANAGEMENT (E/M) Relations Team recently contacted CODING WITH COUMADIN LEVEL approximately 400 providers asking The description of CPT code 99211 is "Office or other them about their HIPAA readiness. outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually the presenting problem(s) are minimal. Ms. Nichols stated that ASF expects to receive additional Typically, 5 minutes are spent performing or supervising instructions from the Centers for Medicare & Medicaid these services." There are no special guidelines nor Services (CMS) in August. At presstime, the Carrier’s exceptions for visits related to patients for whom position is that for any practice having 10 or more full-time anticoagulation is being monitored. Any such visit would employees, all claims, even those that are corrected and need to meet the usual criteria for CPT code 99211 and resubmitted or were "lost" in the system and are being when not performed by the physician or nonphysician resubmitted after Oct. 16, must be submitted in the required practitioner, the "incident to" guidelines. HIPAA transaction standard.

24 Scheduled visits to the physician’s office to obtain blood for prothrombin time and INR should be billed as G0001. CPT code 99211 should NOT be additionally billed.

Adjustments in medications based on laboratory results are frequently made for patients with chronic medical illnesses, e.g., diabetes mellitus. Medication adjustment, alone, is not separately payable. The CPT codes 99371-99373 for "Telephone Calls" have a "B" = "bundled code" status on the Medicare Physician Fee Schedule Database (MPFSDB). WEBINAR DEMONSTRATION

Susan Hodge, External Affairs, presented an excellent overview of Medicare’s webinars. The Carrier expects to have additional webinars in the future months. The Provider Communications Advisory Group has suggested topics for the future webinars.

Webinars are cost effective for both Medicare and the physician community. At this time, there is no cost to the physician for participation in the webinar.

Previous webinar slides and frequently asked questions can be reviewed at the Carrier’s website, adminastar.com. Topics include Quarterly Updates, 1500 Claim Form, Local PET Education Training, and Dermatology.

Webinars are cost effective for both Medicare and the physician community. At this time, there is no cost to the physician for participation in the webinar. There is no travel involved and the whole office can participate. The Carrier is attempting to keep the webinars to a one or two hour time frame and not to provide these programs at peak work time, e.g., the first and last week of the month.

25 IAFP Past President, IAFP Logo Golf Shirts, Edward L. Langston, Wind Vests & Button Down Shirts For Sale!! elected to the AMA

Golf Shirt: $35 size:____ Board of Trustees

Wind Vest: $40 size:____ Indiana family physician, Button Down Shirts: $45 size:____ pharmacist and member of Name______the American Academy of Family Physicians and the Address______Indiana Chapter, Edward L. ______Langston, M.D., was City, State, Zip______elected to the American E-mail Address (optional)______Medical Association Board of Trustees at the AMA’s Phone______annual meeting in Chicago Return to: on June 17. One of 20 IAFP board members, Langston will serve a four-year term. 55 Monument Circle, Suite 400 Indianapolis, IN 46204 Fax: 317.237.4006 Langston proposes three areas of focus for the AMA:

• Access to healthcare coverage to all • Advocacy for patients and physicians at the state and federal level • Action to create a more responsive and efficient AMA

"I’m honored to have been elected by my colleagues to represent their interest to the American Medical Association," said Langston.

A member of the AAFP/IAFP since 1978, Langston has served the Academy in a variety of roles. Including President of the Indiana Chapter and Vice President of the AAFP Board of Directors, Langston is a past director of the Community Hospital Family Practice Residency Program, Indianapolis.

Langston’s career in health care spans many issues and regions, including member of the ISMA Board of Trustees, Vice President of Medical Affairs and Medical Education for the Trinity Regional Health Systems, Rock Island, IL, and Family Practice Program Director for the Memorial Family Practice Residency Program at Memorial Hospital Southwest in Houston, TX.

26 correspondent and presented him with a framed copy of her poster for the senator. In addition to the activities for kids, there were also a number of coordinator workshops that Missy attended. With the current cuts to the Tar Wars® grant from ITPC, it was a valuable opportunity to be able to network Indiana – Update with other state coordinators. Missy hopes to gain even more insight into ar Wars® certainly had an exciting summer this year! The Tar the National Tar Wars® program this Wars ® Celebration took place at Victory Field on June 15th. year, as she has been selected to TOne thousand tickets were distributed to poster contestants, serve as an AAFP Tar Wars® presenters, youth groups, and classes around the state. We were Program Advisor in 2004. Ollie Harriston & Kayla Logsdon in fortunate enough to have a perfect day for a visit to the ballpark. Senator Bayh’s Washington D.C. office. Prior to the game, Karla Sneegas, Executive Director of Indiana The 2003-2004 school year is now Tobacco Prevention and Cessation (ITPC) made a presentation to our well underway, which means it is time to recruit new and returning winners on the field. The top four winners and four special Tar Wars® presenters. There are already schools registered from all recognition winners were presented with $100 savings bonds, while across the state, which means that we need family physicians from all all poster contestants received small prize packs. Thanks to Victory over to volunteer this year! Please don’t let our Hoosier children Field, the Indianapolis Indians, and ITPC for providing us with down…volunteer an hour of your time today! giveaways for all of the students involved! Please note: If you schedule a presentation on your own, it is In July, Kayla Logsdon, our state poster contest winner; her father, CRUCIAL that you inform us at the IAFP! We need this Jeff; and Missy Lewis, our state Tar Wars® coordinator, traveled to information for our annual grant reports so that we can show that Tar Washington, D. C. for the National Tar Wars® Poster Contest and Wars® does have a presence in Indiana schools! Conference. While there, Kayla took part in workshops organized by the Campaign for Tobacco-free Kids, visited the Capitol Building, and made friends with other tobacco-free kids from all over the country. She also met with Senator Evan Bayh’s legislative

Name ______You Are the Missing Piece!! Address ______City______County ______Zip Code ______In just one hour, you can give children in your Email ______community the gift of longer, healthier lives! Phone ______Fax ______Tar Wars ® is an effective and inexpensive tobacco prevention Would you like for us to personally contact a school in your area on program for forth and fifth-grade students. It is one piece of an interlocking puzzle that complements other school -and your behalf? If so, please include the contact information below! community- based tobacco-free education programs. School ______When you present Tar Wars® you’ll feel the enthusiasm of the Name of contact person ______children who look up to you as a role model. You’ll have the Contact person’s occupation ______opportunity to go beyond your practice walls and positively Email (if available) ______impact the health of children in your community. Best of all, Phone ______Fax ______you’ll get the satisfaction of knowing that just one hour of your time may have turned an entire room of children away I prefer to be reached by: ____ Phone ____ Fax ____ Email from tobacco use. Please return this form to: ® ® Missy Lewis, MS, CHES, Coordinator, Tar Wars ‚ Indiana Tar Wars is nationally supported in part by educational grants Indiana Academy of Family Physicians Foundation from the American Academy of Family Physicians Foundation 55 Monument Circle, Suite 400 • Indianapolis, IN 46204 and Schering and locally funded by Indiana Tobacco 317.237.4006 (fax) Prevention & Cessation.

To learn more about Tar Wars® and how to get involved, visit www.tarwarsindiana.org today! Or, call (317) 237-4237 to speak with our program staff.

27 Patient’s Compensation Fund Consultants Surcharge Rates Increase For Directory Physicians And Hospitals

In an Aug. 8 bulletin, Sally McCarty, Commissioner of the Department of Insurance, Gastroenterology/ announced the following surcharge rate increases effective Aug. 15, 2003. Hepatology CLASS ANNUAL RATE The percentage increase to the physician rates is the same for each Indiana University Medical Center 0 $2,334 Division of Gastroenterology/ Hepatology specialty class. A complete list of Indiana University Medical Group physician specialty class codes is 1 $3,112 550 North University Blvd., UH 4100 published in760 IAC 1-60. Indianapolis, IN 46202 2 $4,357 317-274-7887 While these increases are 317-872-2877 3 $5,602 significant, the surcharge rates Any Bax, Ph.D. have not been increased since July 4 $7,002 Naga P. Chalasani, M.D. 1, 1999, and the Commissioner felt Won K. Cho, M.D. 5 $9,336 it was necessary to implement Dan Ciaccia, M.D. these new rates on August 15, David W. Crabb, M.D. 6 $14,004 2003. Directions for implementing John DeWitt, M.D. Evan L. Fogel, M.D. the surcharge are on the 7 $21,784 Debra J. Helper, M.D. department’s website Angelo P. Horatagis, M.D. 8 $26,452 www.in.gov/idoi. Thomas E. Imperiale, M.D. Paul Y. Kwo M.D. Julia K. LeBlanc, M.D. Look for more information in our next issue or call 888-422-IAFP! Glen A. Lehman, M.D. Lawrence Lumeng, M.D. Lee McHenry, M.D. Omar Nehme, M.D. Prashant Pandya, D.O. Emad Rahmani, M.D. Having three servings of Douglas K. Rex, M.D. dairy products a day is a Stuart Sherman, M.D. Azade Yedidag, M.D. delicious and simple Hwan Yoo, M.D. way to get more Hematology/ Oncology

calcium. Calcium Hematology-Oncology Associates helps make bones Devena Alston, M.D. Serge Dauphin, M.D. stronger. Beatrice Hernandez, M.D. Treatment Centers: 1007 Lincolnway LaPorte, IN 46350 219-326-2624 800-471-3004

Medical Plaza 241 Good health starts Michigan City, IN 46360 219-874-3300

with good dairy. If you would like to have your practice listed in the Consultant’s Directory, please contact Jerry Stains at 502.423.7272.

28 Membership Update Re-election Reminder If you joined the IAFP or were last re-elected in 2000, you have until the end of this year to report 150 hours of CME in order to maintain your membership. Requirements include at least 75 AAFP prescribed credit hours, a minimum of 25 group learning activities, and no more than 25 from enrichment activities. Hours reported must be obtained between Jan. 1, 2001 through Dec. 31, 2003. For more details, review the AAFP CME Requirements for Members reprint 101 or visit www.in-afp.org, www.aafp.org or call Amanda Bowling at (317) 237-4237 or (888) 422-4237.

Please Keep Us Up-To-Date Membership Status Totals

Members, please be sure to Acitve 1542 keep your contact information up-to-date Supporting 4 with the AAFP and the IAFP, including your: Inactive 21 address, phone, fax, and e-mail. Life 187 To update, please call Amanda at IAFP: (317) 237-4237 or in-state toll free (888) 422-4237 Resident 395 Student 255 New Members The Academy extends a warm welcome to the following new members:

Active Roger Curtis Collicott, MD Jennifer L. Fletcher, MD Saira Jamal, MD Plainfield, IN Evansville, IN Schererville, IN Benjamin J. Adkins, MD South Bend, IN Diane Sue Cook, MD Leanne M. Fortner, MD Chris R. Jensen, MD Elkhart, IN Indianapolis, IN South Bend, IN Saquib M. Ahmed, MD Fort Wayne, IN Carolyn J. Cooke, MD Tricia Foster, DO Bijal Desai Katarki, MD Evansville, IN South Bend, IN Fort Wayne, IN Gregory Andrews, MD Allentown, PA Sara Cox, MD John L. Fye, MD Robert G. Kennedy, MD Elwood, IN Seymour, IN South Bend, IN Alan J. Anthony, MD Fort Wayne, IN Yu Cui, MD Renee Michelle Galen, MD Stephanie J. Kinnaman, MD Evansville, IN Evansville, IN Greenfield, IN Tricia Lynn Baird, MD Cloverdale, IN Rebecca S. Davisson, MD Christopher C. Hall, MD Stephanie M. Kirts-Johnson, MD New Castle, IN South Bend, IN Beech Grove, IN Enrique P. Baires, MD Fort Wayne, IN Gregory S. Daynes, MD Kaleb M. Hamilton, MD Anette C. Lane, MD Merriman, UT South Bend, IN Markle, IN Edward Bantamoi, MD Griffith, IN Robert De las Alas, DO Gordon W. Harkness, MD Erica D. Leazenby, MD Indianapolis, IN South Bend, IN Indianapolis, IN Jill Beavins, MD Franklin, IN Elena A. Dolgonos, MD Lance M. Harmon, MD Henry Lemley, MD Fort Wayne, IN Farmington, NM South Bend, IN Bentz Bechert, MD Fort Wayne, IN David Dunkle, MD Katy Hartman, MD Nicholas R. Lemming, MD Indianapolis, IN Indianapolis, IN Seymour, IN Michael Seth Brody, MD Indianapolis, IN Dennis Dunsmore, MD Sandra Elizabeth Henderson, MD Mark Allan Litz, MD Evansville, IN Muncie, IN Muncie, IN Randy K. Brown, MD Edinburgh, IN Jordan Dutter, MD Mary Beth Hensley, MD Tonya P. Meade, DO Indianapolis, IN Franklin, IN Evansville, IN David A. Cheesman, MD Indianapolis, IN Scott R. Eller, MD Andy Sundy Hipskind, MD Amanda L. Meeks, MD Indianapolis, IN Philadelphia, PA Terre Haute, IN Gary W. Cole, DO Clarksville, TN Douglas N. Esplin, MD Vipin Jain, MD Rodney Musselman, MD Mendon, UT Anderson, IN Peru, IN

29 New Members

Sacha Zuleika Niemi, MD Eric D. Wallisa, MD Ms. Jill Stader Mary Ellen Mason, DO Indianapolis, IN Indianapolis, IN Terre Haute, IN Fort Wayne, IN Waldemar T. Niklinski, MD Alla N. Weisz, MD Ms. Jamie Ulbrich Michelle Jennifer McCarthy, MD Granger, IN Carmel, IN Merrillville, IN Indianapolis, IN Chad Michael O'Nan, MD Amy H. Welker, MD Mr. Timothy James VonFange Kenneth K. Namkung, MD Indianapolis, IN Roanoke, IN Indianapolis, IN Evansville, IN David M. Page, MD Jennifer K. Winders, MD Mr. Timothy Aaron Zeller Joseph Andrew Nicholas, MD Evansville, IN Greenwood, IN West Lafayette, IN South Bend, IN Sue Goh Pallekonda, MD Gary Alan Wright, MD Carrie Beth Nicholson, MD Indianapolis, IN Anderson, IN Residents Terre Haute, IN Sumathy T. Pathy, MD Misuzu Yuasa, MD Thurman V. Alvey III, DO Paul Thomas Osmun, DO Medina, WA Kanbe, Suzuka Mie JAPAN Terre Haute, IN Fort Wayne, IN Christopher Charles Peine, DO Martin C. Baur, MD Chandra Lee Ostrognai, MD Indianapolis, IN Students South Bend, IN Muncie, IN Krista Pellicore, MD Ms. Emily Abernathy Paul L. Beckett, DO Denise Angel Pine Mattas, MD Chicago, IL Evansville, IN Fort Wayne, IN Terre Haute, IN John Charles Peterson, MD Ms. Ajiri S. Barnes Brian Houston Black, DO Jami Beth Rayles, MD Muncie, IN Carmel, IN Terre Haute, IN Muncie, IN Matthew J. Priddy, MD Mr. Michael Boger Evelyn E. Bose, MD John B. Reinoehl, MD Indianapolis, IN Fort Wayne, IN Newburgh, IN South Bend, IN Stephen Rogers, MD Ms. Patrice M. Cates Marvin Cusi Campos, MD Rebekkah Ann Ross, MD Monticello, IN Indianapolis, IN Evansville, IN Gary, IN Jeffrey F. Roylance, MD Ms. Erika Conner Curtis Allan Carter, MD Kevin W. Schreiber, MD Fort Wayne, IN Indianapolis, IN Fort Wayne, IN Fort Wayne, IN Danielle R. Russo, MD Ms. Barbara Dene Sarah M. Davis, MD Michael Gerald Angeles Mishawaka, IN Bloomington, IN South Bend, IN Sebastian, MD Evansville, IN Matthew E. Schantz, MD Mr. Erik Finlayson Amanda Marie Dornfeld, MD Indianapolis, IN Indianapolis, IN Muncie, IN Maria Mosqueda Soller, MD Evansville, IN Douglas A. Scott, MD Mr. Jason Hanna G. Blair Dowden, MD Fort Wayne, IN Spencerville, IN South Bend, IN Ryan Douglas Torrie, MD Muncie, IN Andrey P. Seluzhitskiy, MD Ms. Zoe Hollenbeck Timothy P. Gerst, MD Auburn, WA Indianapolis, IN South Bend, IN Farhat Usman, MD Fort Wayne, IN Momodu Sheriff, MD Ms. Rachel Lesser David Eric Hall, DO Hobart, IN Fort Wayne, IN Fort Wayne, IN Erin Elizabeth Vinson, DO Muncie, IN Sharon J. Singleton, MD Ms. Lindsay Ligler Nadia Fawzy Hanna, MD Fort Wayne, IN Covington, IN Evansville, IN Cody L. Wagner, MD Selma, IN Chad E. Smoker, MD Ms. Laura Mathis Elizabeth Ann Henriott, MD Spruce Pine, NC Vincennes, IN Terre Haute, IN Cynthia Suzzanne Williams, MD Indianapolis, IN Jerome Brent Sneed, MD Mr. Andy McAfee William C. Hoover, MD Indianapolis, IN Bloomington, IN Indianapolis, IN Kevin James Wilson, MD Fort Wayne, IN Valerie A. Snyder, MD Ms. Maureen McGinness Joel Matthew Kary, MD Vincennes, IN Indianapolis, IN Beech Grove, IN Justin David Wright, MD Lebanon, IN Perkin K. Stang, MD Mr. Alexander Menze Joshua D. Kline, MD Terre Haute, IN Bloomington, IN Granger, IN Tetsuji Yoneyama, MD Terre Haute, IN Hamsa Subramaniam, MD Ms. Jennifer Overton Dawn D. Lagerkvist, MD Bellingham, WA Bloomington, IN Marion, IN Sami K. Zeineddine, MD Fort Wayne, IN Julia Denice Swanson, MD Ms. Brechin M. Polley Thomas F. Lahr, MD Lafayette, IN Indianapolis, IN Martinsville, IN Robert Steven LeGrow, MD South Bend, IN

30 Innovative Publishing Ink! has assisted several physician group practices to successfully reach referring physicians and spheres of influence. Through the use of a targeted custom magazine, your practice can announce new hires and additions, and inform potential patients and family physicians of the latest trends and technologies in your specialty field. IPI can coordinate the entire project (including editing, design and layout, printing and fulfillment), so that you can focus on core business issues. And we can do it at a very affordable price. More affordable than you may think.

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CARDIOLOGY • ONCOLOGY • SURGICAL • PLASTIC SURGERY • PEDIATRICS • ORTHOPEDICS

31 8th Annual Continuing Medical Education Conference PULMONARYDISEASES Diagnosis & Evaluation of Pulmonary Nodules Friday, December 5, 2003 Suzanne L. H. Aquino, M.D. 1:00 p.m. – 5:15 p.m. Assistant Professor of Radiology Harvard Medical School St. Vincent Marten House Hotel & Lilly Conference Center 1801 W. 86th Street Update on Pneumonia Management Indianapolis, Indiana John G. Bartlett, M.D. Chief, Division of Infectious Diseases To register, send contact information Johns Hopkins University and a $35 check, payable to School of Medicine Northwest Radiology Network, to Linda G. Hughes, M.A., Marketing Director, Management of COPD Northwest Radiology Network, Stephen S. Lefrak, M.D. 5756 W. 71st Street, Indianapolis, IN 46278. Professor of Medicine Washington University School of Medicine Residents may attend for free.

Asthma Management in 2003 & Beyond (317) 328-5067 ■ (800) 400-XRAY (9729), ext. 233 William J. Calhoun, M.D. [email protected] Associate Professor of Medicine University of Pittsburgh School of Medicine Accreditation details will be available at a later date.

www.northwestradiology.com

PRESORTED STANDARD IAFP U.S. POSTAGE PAID 55 Monument Circle, Suite 400 LOUISVILLE, KY Indianapolis, IN 46204 PERMIT NO. 1477