newsletter, Vol. 111, no. 13, 2008

Throughout his campaign, President-electBarack Obama vowed to provide afford-able, accessible health care to all. The

question now is how much reform the nationcan afford during a worsening financial crisis.Some experts think that reform will come inphases, with expansion of the children’s insur-

president’s message

What does Obama win mean for health care?

ance program SCHIP as the first step. It’s beensaid that Congress could pass “health partner-ship” legislation that would provide federalgrants to states for innovations that increasecoverage and access. Mr. Obama’s other pro-posals—expanding Medicare and creating a Na-tional Health Insurance Exchange—could be

An historic opportunity lies before us,” says current CMS President Dr. William McDade, (left) shown in this 2004photo with then-State Senator Barack Obama and then-CMS President Dr. Neil Winston. Mr. Obama visited CMSto exchange ideas about health care reform, a subject over which he will now have considerable influence.

Inside:CMS Council Highlights 4ISMS Update 13AMA Interim Meeting 14

continued on page 2

"

Chicago Medicine, 2008

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president’s message (continued from first page)

harder to fund and might have to wait. Winningsupport, even from a Democratic Congress,might not be as easy as it sounds, experts havecautioned.

At an ISMS event in October featuring repre-sentatives from the Obama and McCain cam-paigns, CMS member and Obama health advi-sor Stephen Ondra, MD, described elements ofthe Obama plan. Savings would be achievedthrough reining in administrative costs andpharmaceutical profits, and by establishing theNational Health Insurance Exchange for theuninsured, said Dr. Ondra.

The Obama campaign Web site outlined othermeasures to drive down costs: state-of-the-arthealth IT systems, disease prevention and man-agement programs, increased competitionthrough market structure reform, and federalreinsurance to employers. His plan would alsolimit the ability of insurers to raise rates formedical liability insurance. “Caps” are only apart of the solution to soaring insurance premi-ums, according to Dr. Ondra.

Health care providers will be required to pro-mote patient safety, meet performance thresh-olds, make decisions based on evidence-based re-search, and tackle health care disparities. Mr.Obama has also indicated he would be open tochanging from the current Medicare physicianpayment model; he would provide incentives tostudents going into primary care and implement

the medical home model. He also favors con-sumers importing drugs from foreign countries.

Mr. Obama has nominated former Sen.Tom Daschle (D-SD) to become the new Sec-retary of the Department of Health andHuman Services. Mr. Daschle has been pro-moting health care reform proposals since1994, when he lost his Senate seat. His com-prehensive plan is outlined in his new bookCritical: What We Can Do About the Health Cri-sis. Whether or not you endorse all of hisideas, we can agree that an historic opportu-nity lies before us.

Let’s congratulate Mr. Obama for tacklinghealth system reform, and keep in mind thatthe new administration needs our bipartisansupport. It’s crucial that we physicians bepresent every step of the way, helping to leadchange, not waiting for it to happen.

So please, encourage your colleagues whoare not members to join CMS, ISMS and AMA toreinforce our work with Mr. Obama and thenew Congress toward a better health care sys-tem for all.

William A. McDade, MD, PhDPresident, Chicago Medical Society

neWs FOr CHiCagO pHYsiCians

515 N. Dearborn St.

Chicago IL 60610

Liz Sidney, Co-Editor/Editorial

Scott Warner, Co-Editor/Production

Chicago Medicine (ISSN 0009-3637) ispublished monthly with one additionalissue published each winter, spring, sum-mer and fall for $20 per year for mem-bers; $30 per year for nonmembers, bythe Chicago Medical Society, 515 N.Dearborn St. Chicago, Ill. 60610. Period-icals postage paid at Chicago, Ill. and ad-ditional mailing offices. Postmaster:Send address changes to Chicago Medi-cine, 515 N. Dearborn St., Chicago, IL60610. Telephone: (312) 670-2550.Copyright 2008, Chicago Medicine. All

rights reserved.

newsletter, 2008, Vol. 111, no. 13

Chicago medical society

Officers Of the sOciety

William A. McDade, MD

President

William N. Werner, MD

President-elect

robert W. Panton, MD

Secretary

thomas M. Anderson, MD

Treasurer

David A. Loiterman, MD

Chairman of the Council

howard Axe, MD

Vice-chairman of the Council

saroja Bharati, MD

Immediate Past President

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Chicago Medicine, 2008

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THE CMS COuNCIL MET ON TuESDAY, NOv. 4,for an abbreviated meeting at Maggiano’s Ban-quets. Members were updated on the followingCMS initiatives and events:

Membership campaign underwayApproximately 14,000 nonmembers in the Chica-

go area received a letter and statement from CMSPresident William A. McDade, MD, inviting them tojoin CMS. The letter emphasized the recent Medicarepayment victory as well as the constitutional chal-lenge to medical liability reform legislation.

Programs to promote legislative outreachDr. McDade has formed two new an ad hoc

committees. The Governmental Affairs Councilwill complement the legislative initiatives set byISMS. It will meet with Cook County legislatorson issues affecting the practice of medicine andidentify legislators for the CMS/ISMS LegislativeMini-Internship Program. Two legislators who re-cently participated have given CMS positive feed-back on the experience.

Increasing academic representationDr. McDade also formed the Committee for

Academic Physicians. This committee is address-ing the unique issues facing his academic col-leagues, such as regulatory and financial concerns.

COunCil HigHligHts

Next Young Physicians Group outing: stay tunedPossible options for the next Young Physicians

Group (YPG) outing include a Chicago Bulls bas-ketball game, Chicago Wolves hockey game, and aChicago Fire soccer game. The YPG may meetwith the Student Section. Stay tuned for dates.

The CMS/ISMS Student Sections got a boost inmembership recruitment from CMS leadership.Both Dr. McDade and President-elect William N.Werner, MD, visited several area medical schoolsto discuss the benefits of organized medicine.Staff from both organizations attended student ac-tivity fairs this fall to assist the Student Sections insigning up new members.

CMS teams up with Metropolitan ChicagoHealthcare Council

The Metropolitan Chicago Healthcare Councilis the lead agency coordinating the Medical Ser-vice Program for the 2016 Olympic and Para-lympic Games should Chicago be awarded theGames. CMS has accepted an offer from MCHC topartner with it in this endeavor.

Full slate for Public Health CommitteeThe CMS Public Health Committee is participat-

ing in three major local projects: 1) Helping to imple-ment the grassroots “Building a Healthier Chicago”

Dr. David Loiterman (left, at microphone), Chairman ofthe CMS Council, leads the Nov. 4 meeting with officersDrs. Howard Axe, Vice Chair; William Werner, President-elect; and Robert Panton, Secretary.

Membership campaign targets 14,000

Student District councilors participate in the Councilproceedings.

continued on page 6

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initiative; 2) Assisting the Chicago Department ofPublic Health in mapping out specialty care in CookCounty; and 3) Working with the AMA in imple-menting its “Healthy Life Steps Program.”

Recruitment tailored to each hospitalCMS/ISMS staff have developed a recruit-

ment/retention campaign specifically for AdvocateIllinois Masonic Medical Center and the universi-ty of Chicago Medical Center. A plan for the hos-pitals in District 4 is also under development.

Senior physicians given permanent committeeFollowing the recommendation of the Long-

Range Planning Committee, the Council voted toestablish a standing Senior Physicians Committeefor members aged 60 and older. The current enti-ty, the Senior Physicians Group, is an ad hoc com-mittee, which must be reappointed each year.

CMS to study health care rationing in IllinoisThe Council voted to refer resolution Ration

Medical Care Financed by the Illinois Department of

Public Aid to the CMS Healthcare Economics Com-mittee for study and report back to the Council.

COunCil HigHligHts (continued from page 4)

Chicago Medicine, 2008

Page 6

Dr. Shastri Swaminathan, ISMS President, updates theCMS Council on key ISMS initiatives.

continued on page 8

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the guise of a class-action settlement agreement.The revisions apply to BCBSI’s Mutual Participa-tion Provider Agreement, PPO Plus, and BlueChoice provider contracts. BCBSI began mailingcopies of its revised changes on October 15.

l ISMS POlItICal FORuMOn Oct. 16, physicians, residents and medical stu-dents attended a nonpartisan forum at ISMS head-quarters to hear the presidential candidates’health policy platforms. State Rep. Jim Durkin (R-Countryside) represented Senator McCain’s cam-paign, and ISMS member, Dr. Stephen Ondra, rep-resented Senator Obama’s campaign. Apart fromthe substantive presentations, the best part of thisevent was the host of new faces in attendance–in-cluding many medical residents and students.

l FtC Rule on Identity theft Red FlagsRecently ISMS reviewed an AMA/national

This resolution requests that CMS and ISMScause a bill to be introduced into the state legisla-ture that would bring rationing to medical care fi-nanced by the Illinois Department of Healthcareand Family Services (formerly Department ofPublic Aid). The bill would give authority to theDepartment to appoint a citizens’ committee tostudy the means by which the agency could bal-ance its budget by eliminating expensive healthcare procedures and other heroic measures thatbenefit only a few.

ISMS gives full reportISMS President Shastri Swaminathan, MD, up-

dated the Council on key ISMS initiatives:

l BCBSI Revises Onerous Changes The ISMS and AMA successfully persuaded Blue-Cross BlueShield of Illinois (BCBSI) to revise con-tracting changes imposed late last summer, under

COunCil HigHligHts (continued from page 6)

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Chicago Medicine, 2008

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specialty society joint letter commenting onFederal Trade Commission rules regardingidentity theft prevention. The new rules re-quire financial institutions and “creditors”to develop and implement written identitytheft prevention programs by May 1, 2009(extended deadline). The FTC is broadly in-terpreting the rules to include physicians as“creditors,” and thus subjecting doctors tothe new identify theft requirements. TheAMA’s letter makes a strong case that physi-cians should be excluded from the rule. Inthe event that the final rule is not altered,ISMS has authorized development and im-plementation of an ISMS identity theft pre-vention program, in accordance with FTCrules. ISMS also took a late resolution to theAMA’s interim meeting, commending AMA’saction to date to exclude physicians from therule, and urging continuing, vigorous advo-cacy to eliminate this burdensome require-ment on physicians.

continued on page 11

NOMINAtIONS PReSeNteD FOR CMS OFFICeSThe following slate of names was presented for the

2009-2010 year.

President-elect: David A. Loiterman, MDSecretary: Thomas M. Anderson, MDChairman of the Council: Howard Axe, MDVice-Chairman of the Council: Robert W. Panton, MD

trustees: Adrienne L. Fregia, MD; John N. Kiriklakis, MD

Councilors-at-Large:Bapu Arekapudi, MD; Boone Brackett, MD; Brian

P. Farrell, MD; Earl E. Fredrick, Jr., MD; Kamala A.Ghaey, MD; Nunilo Rubio, MD; Gerald E. Silver-stein, MD; Anne Szpindor, MD; Michael J. Wasser-man, MD.

Alternate Councilors-at-Large:Neelum T. Aggarwal, MD; Edgar A. Borda, MD;

Rafael Z. Campanini, MD; Mary Jo Fidler, MD;

Zahurul Huq, MD; Terrence T. Lerner, MD; ArthurR. Peterson, MD; William G. Troyer, Jr., MD.

Judicial Panel:Neil E. Winston, MD

ILLINOIS StAte MeDICAL SOCIetY:President-elect: Steven M. Malkin, MDSpeaker of the House: M. LeRoy Sprang, MDtrustees: Edgar A. Borda, MD; David A. Loiter-man, MD, William N. Werner, MD.

AMeRICAN MeDICAL ASSOCIAtION:Delegates: Sandra F. Olson, MD; M. LeRoySprang, MD; Neil E. Winston, MD.

Alternate Delegates: James P. Ahstrom, MD; DavidA. Loiterman, MD; Peter E. Eupierre, MD; StevenM. Malkin, MD; Willian N. Werner, MD, MPH.

COunCil HigHligHts (continued from page 11)

Chicago Medicine, 2008

Page 11

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isms update

On Nov. 13, the Illinois State Supreme Court heardoral arguments on Lebron v. Gottlieb Memorial Hospi-tal, the challenge case to the 2005 medical liability re-form law.

FOR THE HEARING THE PLAINTIFF AND DEFENSEwere each allocated 30 minutes to present argu-ments. The three interests (hospitals, physiciansand State of Illinois) defending the reform laweach spoke and answered questions from justicesfor about 10 minutes each.

Theodore Olson (representing physicians)spoke first and centered his comments on how theIllinois General Assembly acted rationally to es-tablish the reforms, and the law is narrowly fo-cused to alleviate the medical liability crisis.

Gary Feinerman, representing Gottlieb Memor-ial Hospital, discussed how compensatory dam-age award limits have, in fact, been constitutional-ly permissible under special circumstances undercommon law and precedent.

Illinois Solicitor General Michael A. Scodro, rep-resenting Illinois Attorney General Lisa Madigan,presented arguments reinforcing to the court thatthe medical liability reform law reached beyondtort reform and was a comprehensive legislative re-sponse to the health care access crisis in Illinois.

Michael Gottesman represented the plaintiffs inthe case and centered his arguments on the beliefthat the cap on non-economic damages is uncon-stitutional.

Although there is no definite timeline for theSupreme Court’s decision, ISMS will keep you up-dated on the latest through the Reality MedicineWeb site.

Streaming audio and video of the full hearing, aswell as background information on the challenge, isavailable online at www.RealityMedicine.com.

ISMS represents your

interest with the AMALAST MONTH, PHYSICIANS FROM ACROSS THE u.S.met to debate the latest health care issues and establishformal policies for the American Medical Association.

Chicago Medicine, 2008

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Constitutional challenge to medical liability reform

At this meeting ISMS sponsored four resolu-tions covering a range of timely topics. Our pro-posal to exempt physicians from new FederalTrade Commission provisions for creditors intend-ed to protect consumers from “identity theft” wasaccepted by the AMA.

The ISMS request to call on the FDA to assurethe efficacy of time-release mechanisms for gener-ic drugs was reaffirmed to support existing AMApolicy.

AMA delegates deliberated our suggestionto study government administrative costs asso-ciated with Congress’ ongoing failure to repairMedicare’s sustainable growth rate formula.They decided such a proposal would be toocostly and could inhibit progress at reformingthe Medicare physician payment formula in2009. Similarly, a proposal to study reformingthe reimbursement model for JCAHO-accredit-ed correctional health systems was not adoptedbecause delegates believed implementation ofthis concept could have the unintended conse-quence of lowering reimbursement rates insome states.

One of the issues generating significant inter-est at the meeting centered on new Joint Com-mission standards requiring hospitals to estab-lish protocols for dealing with “disruptive physi-cians.” Your colleagues were bothered by thelack of a clear definition of what constitutes “dis-ruptive behavior” and potential for using thisJoint Commission mandate as a means to cir-cumvent due process protocols against vocalphysicians.

The AMA plans to work with the Joint Com-mission to establish clear definitions for a “dis-ruptive physician” and rules to codify dueprocess for claims against doctors.

At this meeting Illinois’ Hans Arora was electedchair-elect of the AMA Medical Student Section.Mr. Arora is an ISMS Board member as well asTrustee of the CMS Student District. He currentlyattends the Northwestern university FeinbergSchool of Medicine.

For a full recap of the AMA Interim Meeting, visitwww.ama-assn.org.

ama interim meeting

“The AMA shares President-elect Obama’s focus on ex-panding health insurance coverage and choice throughincome-related federal subsidies,”

AMA President Nancy Nielsen, MD.

More doctors run for public officeAt least 14 physicians will serve in the next Con-

gress, an increase of two seats from the current ses-sion, according to the AMA.

Ten of the doctors are Republicans and four areDemocrats.

This past November, all nine physicians whoran for re-election in the House of Representativeskept their seats, and three physicians were newlyelected to the House. On the other hand, fourteenphysicians lost in races against incumbents. Flori-da Republican and internist Dave Weldon, MD, re-tired. The Democrat family physician who ran tofill his seat lost to a non-physician Republican.Next month a Republican family physician willrun for a seat in Louisiana.

Obstetrics-gynecology is the most common spe-cialty on the Hill, with five doctors counting them-selves as ob-gyns; they are followed by familymedicine practitioners.

Two doctors serve in the Senate: Tom Coburn(R., Okla.) and John Barrasso (R., Wyo.); neitherwas up for reelection this year.

“In my humble opinion,” says Michael Burgess,MD, (R., Tex.), an ob-gyn who was first elected tothe House in 2002, “there aren’t enough doctors inCongress. It leaves us with a pretty narrow groupof individuals, and it’s a little harder to build con-sensus on common ground.” He was quoted in

The Wall Street Journal Health Blog.CMS, ISMS, and AMA all encourage programs

that train and support physicians who run forpublic office.

CMS leaders at AMA meetingPhysicians from Cook County made their voic-

es heard at the AMA Interim Meeting this monthin Orlando, Fla. Attending as part of the IllinoisDelegation, they joined the House of Delegates,which considered policies on issues such as theuninsured, reform of the Medicare physician pay-ment system, medical students’ loan debt burden,and implementing “green” initiatives in the med-ical community. Among the policies adopted: l Support for a ban on artificial trans fats.l Support for laws against text messaging whiledriving.l Reversing the primary care physician shortage.l Increasing access to care for underserved com-munities.l Recognizing the negative health effects of globalclimate change.l Principles for a patient-centered medical home.l Improving health care for military families.l Permanent Medicare physician payment reform.

Update on earlier resolutionsCMS physicians learned how the AMA has fol-

lowed up on CMS/ISMS resolutions adopted atprevious AMA House of Delegates meetings.Such resolutions include Elder Mistreatment; Studyof Universal Health Care Systems; Modern ChemicalsPolicies; Toy Safety; and Noise Pollution.

For instance, an AMNews editorial opinion fo-cused on elder mistreatment; and the subject wasincluded in geriatric workgroup discussions at theresidency level. The AMA also prepared letters insupport of the Elder Justice Act. In other actions,the AMA wrote to the administrator of the u.S. En-vironmental Protection Agency urging restructur-ing of the Toxic Substances Control Act and devel-opment of a more suitable chemicals policy. The

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Cook County docs make voices heard in Florida

continued on page 15

Three pillars of the AMA’s

health care reform proposal:l Subsidies that would allow everyone to affordhealth insurance.l Individual choice of health insurance.l Fair market rules, including regulating marketsand protecting high-risk patients.

House also adopted language contained in theCMS resolutions, Encouraging Green Initiatives andUniform Emergency Volunteer Health PractitionersAct.

The Interim Meeting ran from Nov. 8-11.

AMA works on permanent Medicare physician payment reform

Recognizing that there is no one pathway to fix-ing the broken Medicare physician payment sys-tem, the AMA is studying various proposals to re-form the current system and also help improve thequality of patient care. Some of the specific pro-posals described at the Interim Meeting include:gainsharing, the medical home model, quality in-centives, bundling payments for medical services,and demonstration projects.

“Gaining widespread physician input and con-

sensus for these reforms will help Congressachieve its stated goal of permanent Medicare re-form in the next Congress,” said AMA BoardMember Steven J. Stack, MD.

While seniors and physicians achieved a greatvictory last summer when Congress stopped the lat-est Medicare cuts, the AMA must now build on thatmomentum and use the 13 months left in the time-frame Congress provided, before cuts begin in 2010.

To achieve greater value in the health care sys-tem, the AMA adopted principles to create a cen-tralized comparative effectiveness research (CER)entity. CER is needed to help physicians gainknowledge about whether new treatments outper-form existing treatments. The new principles in-clude a call for transparent, rigorous scientificallysound research methods, oversight by patientsand physicians, and dissemination of research tohealth care professionals.

ama (continued from page 14)

Chicago Medicine, 2008

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Cms Calendar OF eVents 2009

Chicago Medicine, 2008

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Chicago Medical Society’s

Annual Midwest Clinical Conference (MCC) 2009April 17-19

the University of Chicago

ISMS Board of Trustees MeetingISMS Board Room8 a.m. – 3 p.m.

Polish American Medical Association Physicians’ Ball Drake Hotel

CMS Council MeetingMaggiano’s Banquets6 p.m. – 9 p.m.

CMS Executive Committee Meeting Chicago Medical Society (4th Floor) 8 a.m. – 9 a.m.

CMS Board of Trustees Meeting Chicago Medical Society (4th Floor) 9 a.m. – 10 a.m.

CMS Medical StudentDistrict MeetingCMS Building (4th Floor)10 a.m. – 11:30 a.m.

February 7

February 7

February 10

February 18

February 28

February 18

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3.

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6.

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