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(R. Scott Hitt, MD, President of the American Academy of HIV Medicine in Los Angeles, discusses with AIDS Alert how the academy will certify HIV specialists and provide member services that include practice management support, networking, and being an advocate for better HIV funding. Hitt is the former chair of the first Presidential Advisory Council on HIV/AIDS.)
AIDS Alert: Why is this organization needed? What will be its specific purposes and goals?
Hitt: There currently isn’t an organization whose main purpose is to represent the interests and concerns of HIV specialists. I think basically we want to gain greater access to quality care for all HIV patients. We want to establish and promote criteria to define what an HIV specialist is. Everybody has different opinions about what makes somebody an HIV specialist, and it really hasn’t been standardized.
For instance, an insurance company may say that all of its HIV patients have access to HIV specialists, who are called infectious disease physicians. And we all know that some infectious disease physicians are good at HIV. But others passed their ID boards years ago, and they really don’t take care of any HIV patients anymore. So they’re really not HIV specialists.
That’s why it’s important to establish and promote the criteria of what an HIV specialist is. For instance, there was a law that was passed in California about a month and a half ago. It mandates that health carriers make sure their HIV patients are seen by HIV specialists. This means we need a definition for what an HIV specialist is.
AIDS Alert: How are you going about defining that?
Hitt: We’ve done a couple of things. We would define a specialist as a licensed MD, DO, PA, NP, or PharmD. We are not talking about just doctors. We recognize that nurse practitioners and physician assistants can be HIV specialists. They are currently caring for at least 20 HIV patients and they show a continuous professional development. There are different ways they can show that. If they passed their infectious disease board certification in that year, then that qualifies as continuous professional development. For non-ID doctors or for ID doctors who have not passed their boards that year, the other way they can do it is to complete 30 units of HIV-related CME each year. But if they don’t want to do that many units, because that’s an awful lot of continuing education in one subject, the third way is they can complete 15 units of HIV-related CME and pass what we’re calling a maintenance of HIV competency examination. It’s an open book, take-home, Web-based concise assessment that shows that they’re up to date.
What makes HIV so unique is how fast everything is changing. If I passed my boards three years ago, I may not know that if somebody had a hypersensitivity reaction to abacavir they shouldn’t be put on trizivir. That’s a simple thing that some people don’t know. So there has got to be a way of saying, "Look, if you’re in the field today, you should know that information." That criterion means you have to do some homework.
One of the things we’re doing is we’ve put together a core curriculum committee, and their task is to develop a core curriculum that defines HIV specialty competency. They are going to suggest what defines competency in HIV. Then we’re going to certify some update programs for HIV specialists to see if the classes actually meet the core curriculum.
We’re going to use that same core curriculum to develop the annual maintenance of HIV competency exams. We’re also going to develop a self-directed HIV medicine study guide.
AIDS Alert: Are there are any other types of functions that your organization will serve?
Hitt: One of the things we’ve put together already is an Internet referral database where patients or physicians can go to a map, click on their city, and up pops a list of certified HIV specialists in their area. When they click on that doctor’s name, they actually will get information on doctors’ office hours, what insurance they take, what hospitals they go to, and a little bit of information about them. This is a personal profile of that doctor, or PA, or NP. Many AIDS services organizations in the country all keep separate lists of specialists. We’re going to have an updated list of who is the certified specialist in their area. That’s one benefit we’re offering.
We’re also offering a lot of tools to help manage HIV practices. For instance, on the Web there will be handouts that specialists can use. Our Web site will list upcoming conferences. But also we’re going to be mailing out to all of our members an 80-page book called "The HIV Specialist’s Guide to Reimbursement." This will cover things we need to know in managing our practices, including what are the issues with Medicare, Medicaid, or private payment. It will include information on coding, how to upcode, and details on items that have been found wrong with coding. We will be supplying our members with several other practice management tools, as well.
We certainly will also be involved also in the legislative arena in a couple of areas. We’re trying to get official recognition of HIV specialists, but we’re also working hard on expanding the definition of Medicaid to include those who are HIV-positive and not disabled. Of course, we’ll work on obtaining better funding for ADAP, Ryan White, etc.
AIDS Alert: There are some rural areas, particularly in the South, that have no one to specialize in HIV. What will you do about that problem?
Hitt: We want to improve access to quality care for all patients, and that would include seeing that they receive quality care in rural areas. One of the things we’d like to do is try to focus on what education a rural provider would need to become a specialist. Right now, it might be a little overwhelming. They can’t go to all the conferences. So we say, "Here’s what you need to do if you want to learn how to be an HIV specialist. But if you don’t have the time to be a true HIV specialist, let’s link you up with an HIV specialist in the nearest city who you can call when there’s a significant decision to be made."
That’s on the Web site. If you live in Macon, Georgia, and you want to find the closest HIV specialists who are certified, you can go on the Web site and do that. They can also find out information about various HIV classes on the Web site.
[Membership in the Academy costs $50 per year for primary, associate, and affiliate members, who also will receive the newsletter. The organization’s address is: American Academy of HIV Medicine, 836 North La Cienega Blvd., Suite 303, Los Angeles, CA 90069. Telephone: (520) 962-9009. Web site: www.aahivm.org.]