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Internal Medicine 2011

The ACP annual meeting, Internal Medicine 2011, was a hit! We drew the second largest registration ever (more than 9000), in spite of the much cooler and wetter weather than is normal for San Diego in early April. The program was outstanding and many rooms were packed. Our Northern California pair, Paul Aronowitz and Faith Fitzgerald, with their new format (photo unknowns) was so popular that latecomers were denied admission due to fire regulations.

The Business Meeting was highlighted by a brief presentation by Steve Weinberger, our new Executive Vice President. He listed 4 ACP priorities:

  1. To be the premier synthesizer and distributor of education and information
  2. To be the professional home for all internists (specialists, subspecialists and hospitalists) through focused and customized membership development
  3. To define and communicate the unique value of internal medicine
  4. To support changes in the U.S. health care system that improve patient care, improve health and promote cost conscious care

Congratulations to the following members who were honored at the meeting: Dr. Robert Sparks, MACP, was honored as a new Master of the College. Dr. Shagufta Yasmeen, FACP, received the ACP Award for Diversity and Access to Care for her leadership with one of the UC Davis student-run clinics. Forty-five CANO Chapter members were recognized for their advancement to Fellowship, including the Deans of Touro College of Osteopathic Medicine and the University of California at Davis. I wish to thank Deans Clearfield and Pomeroy for making the time to attend.

Dr. George Meyer with Dr. Robert Sparks
Dr. George Meyer with Dr. Robert Sparks

Dr. George Meyer with Dr. Shagufta Yasmeen
Dr. George Meyer with Dr. Shagufta Yasmeen

Congratulations to Kelley Skeff, MD MACP, who was named a new Regent in the ACP.
Congratulations to Preetha Basaviah, MD FACP, 2011 SGIM National Award for Scholarship in Medical Education.

Our Associates represented us very well. Our Jeopardy team from Kaiser Oakland was quite competitive but lost in the first round, not because of a knowledge deficit. They were tied for the lead going into final Jeopardy. Unfortunately their competitors also got the final answer correct and bet more money, so we lost. They represented us well.

Kaiser Jeopardy team: left to right: Amit Garg, MD, Stephanie Chang, MD, Alex Krassner, DO
Kaiser Jeopardy team: left to right: Amit Garg, MD, Stephanie Chang, MD, Alex Krassner, DO

Associate posters were presented by Gina Fujikami MD, Erika Maria Moseson, MD, Ye K. Aung, MD, Lee A. Trujillo, MD, Brandon Boesch, DO, Anna H. Chodos, MD, and Stacy H. Shoshan, MD. We had two posters presented by medical students, Rachel Stern from UCSF and Xiaoqian Yu from Touro College of Osteopathic Medicine.

Dr. George Meyer with Dr. Rachel Stern
Dr. George Meyer with Dr. Rachel Stern

Dr. Xiaoquian Yu presented Poster
Dr. Yu presented a poster at IM 2011

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Thank You!

Our Chapter has more than 4,500 members, and we want to reach 5000. Thank you for your continued support of the ACP and California Northern Chapter! Do you realize more than two-thirds of eligible general internists do not belong to the ACP? We can do so much more for internal medicine if everyone participates (we could probably lower chapter dues and national dues). I want to ask each of you to recruit one new member in 2011-2012.

A special thanks to those of you who gave extra to support our programs for medical students and residents, the future of our organization. More than 500 of you did. Thank you!

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Recruit a Colleague

The need for a strong voice to speak on behalf of medicine and, in particular, internal medicine has never been greater than it is today. It is critically important that we unify to address the specific needs of our medical specialty. There are advocacy efforts to champion, practice management issues to simplify, and a time-honored profession to foster. There is strength in numbers. Together, we can change the direction of internal medicine.

Ask your colleagues to join ACP today. To thank you for your time and effort, we offer the following recruitment program. Between now and March 15, 2012:

  • Recruit one colleague and receive a $100 credit toward your 2012-13 annual dues
  • Recruit two colleagues and receive a $200 credit toward your 2012-13 annual dues
  • Recruit three colleagues and receive a $300 credit toward your 2012-13 annual dues
  • Recruit four colleagues and enjoy free annual dues in 2012-13

Plus, for every Member recruited within the promotional period, you will receive an entry into a grand-prize drawing for a trip to Internal Medicine 2013 in San Francisco, California that includes registration, airfare (up to $500), and four days of hotel accommodations.

To be considered a "recruited" Member, your colleague must:

  • Be a nonmember who is eligible for the "full" ACP Member category and pay $100 or more in dues.
  • Submit a Membership application, along with his or her dues payment, between April 1, 2011 and March 15, 2012.
  • Write your name in the recruiter box on the top of the Membership application.**

Send a recruitment e-mail to a colleague today, or download and print an application[PDF] to personally deliver.

You may also request a Membership Inquiry Kit from Customer Service at 800-523-1546, ext. 2600, (M-F 9 a.m. - 5 p.m. ET).

It is the collective effort that makes a difference. Call on the support of your colleagues today.

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Governor-Elect

This fall we will be electing my replacement. The new Governor will serve from 2012-2013 as Governor-elect and will assume the position of Governor at the end of the Internal Medicine 2013 meeting in San Francisco. Please think about possible candidates for this position. Ted Rose has declined to run, for personal reasons, but has agreed to chair the search committee.

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California Northern Chapter Meeting

We hope to see you at the 2011 Chapter meeting to be held October 28-30 at the Fairmont Hotel San Jose -- the preliminary program follows. Watch your email boxes for the complete program and registration information.

Friday, October 28

7 AM: Registration/Continental Breakfast

8 AM – 10 AM: Self-Evaluation Program (SEP) for Maintenance of Certification,
Zachary Holt, MD, Moderator

9 AM – 4:30 PM: Chief Residents’ Leadership Training,
Kelley Skeff, MD, MACP

10:00 – Noon: Self-Evaluation Program (SEP) for Maintenance of Certification

1 – 5 PM: LEAD Program (Leadership Enhancement and Development),
Steven C. Roey, MD, FACP

1:30 – 3 PM: Workshop: Examining the Bedridden Patient,
Abraham Verghese, MD, MACP

3:15 – 4:45 PM: Workshop: Examining the Bedridden Patient (repeated)

Saturday, October 29

7 AM: Registration/Continental Breakfast

7:50 – 8 AM: Welcome
George W Meyer, MD, FACP, Governor, Northern California Chapter ACP

8 – 8:45 AM: Keynote Address: Making Sense of Electronic Health Records and the EHR Incentive Program: What You Need to Know and Why,
Michael Barr, MD, FACP

8:45 - 9:15 AM: Didactic session - Hospital-outpatient transition in care

9:15 – 10:15 AM: Update in Hospital Medicine,
Michael Hwa, MD, UCSF

10:15 – 11 AM: Break: Visit Exhibits

11 AM – Noon: Stump the Professor
Faith Fitzgerald, MD, MACP

12:15 PM – 2:30: Awards Luncheon and Presentations
ACP Representative: Phyllis Guze, MD, FACP
Washington Update:Robert Doherty

2:30 PM: Poster Viewing and Judging; CMA diabetes session concurrent with poster viewing

4 – 6 PM: Medical Jeopardy
R. Jeffrey Kohlwes, MD, FACP, Moderator

4 – 6 PM: Concurrent session on kidney and diabetes (courtesy of CMA) during poster viewing)

6:15 PM: Welcoming Reception Poster Winners Announced; Raffle Drawing (must be present to win)

Sunday, October 30

7 AM: Registration/Continental Breakfast

8 AM – 9:30 AM: Three concurrent workshops, with a break at 10 AM for chapter meeting and an update from our lobbyist. Two of the workshops repeated at 11 AM.

  • Quality Improvement Project/PIMS Module
    Kathleen Clanon, MD

  • Radiology review focusing on algorithms for workup of problems like lung mass, abd pain, etc. (Speaker to be announced)

  • Practice Management: Coding for Success – Appropriate Documentation
    Arthur N. Lurvey, MD, FACP

9:30 – 10 AM: Break

10 – 11 AM: California Update and Chapter Business Meeting
George W Meyer, MD, FACP

State Legislative Update Tom Riley, Legislative Consultant

11 AM – 12:30: PM Hands-on Skills Concurrent Workshops (repeated)

Workshop: Radiology Review (speaker to be announced)

Practice Management: Coding for Success: Responding to Challenges/Fighting Back
(gear to residents getting their Medicare provider number, etc., billing for hospital services)

Arthur N Lurvey, MD, FACP

12:30 PM: Adjourn

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Call for Nominations for Chapter Awards

It’s time to start thinking of Members, Fellows and Associates who deserved to be recognized by their peers at our Annual Meeting in October.

Please send a letter of nomination stating the reasons for your nomination and a brief bio of the nominee. Deadline for submissions is October 9. Email your letter to ACPCalifornia@aol.com.

Laureate Award

The Laureate Award honors those Fellows or Masters of the College who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education, or research, and in service to their community, their Chapter, and the American College of Physicians.

The awardees shall be senior physicians and Fellows or Masters of long-standing, with acknowledged excellence and peer approval in the field of internal medicine. In addition, the awardees should have served the Chapter with distinction. Exceptional circumstances may modify these requirements.

Volunteerism and Community Service Award

The award for outstanding community service will be presented at the Northern California Chapter meeting. The award is given to a Chapter member or fellow who has responded to a community health care need outside clinic walls. The selected individual must be seen to be making a significant impact in approaching a health-related problem with innovation and dedication (e.g. organizing community collaboratives to address community-wide health problems and needs, running homeless/HIV/free clinics, trips abroad to help in needy countries, work with churches/schools/senior centers to address health needs).

Associate Leadership and Recognition Award

Recognizes an associate with qualities that exemplify the College's mission to "enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine;" who has made exemplary contributions to the College's mission on a local or regional level. Such activities may include evidence of outstanding leadership or professionalism, service to the ACP (e.g. ACP membership drives, organizing local chapters, committee work)

Distinguished Teacher/Mentorship Award

This award is given to a College Member or Fellow who has demonstrated outstanding mentorship of students, residents, or colleagues as demonstrated by a sustained commitment to providing personal and professional guidance to other health care professionals.

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Congratulations to Paul Aronowitz!

Dr. Paul Aronowitz, MD, FACP

Paul Aronowitz, MD, FACP is Program Director of the Internal Medicine Residency Program at California Pacific Medical Center in San Francisco. He is a graduate of Case Western Reserve School of Medicine and completed his residency and chief residency at UCSF.

Paul currently holds a faculty appointment as an Adjunct Associate Professor of Medicine with Dartmouth Medical School as well as an Associate Professor of Clinical Medicine appointment with UCSF.

He was one of the first hospitalists in the United States and was interviewed for Lee Goldman’s and Bob Wachter's landmark article about Hospitalists, “The Emerging Role of 'Hospitalists' in the American Healthcare System" published in the New England Journal of Medicine in 1996.

Paul is an Associate Editor of the Journal of Hospital Medicine where he has edited the Hospital Images section the past five years, is a past Deputy Editor of the Journal of General Medicine and has recently completed a textbook of hospitalist images for Wiley-Blackwell called Hospital Images: A Clinical Atlas and Board Review.

Paul is very active nationally with the Association of Program Directors of Internal Medicine (APDIM) and becomes President-Elect for that organization beginning July 2011 and President in 2012-13.

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Accountable Care Organizations

On March 31, 2011, the Department of Health and Human Services took a major step toward establishing ACOs by issuing a notice of proposed rule-making that will define how physicians, hospitals, and other key constituents can adopt this new organizational form. The issuing of the proposed rule follows months of obtaining informal and formal input from throughout the health care delivery system, but at this point the rule is only a proposal. The Centers for Medicare and Medicaid Services (CMS) will carefully review the comments we receive in response to the proposed rule before issuing a final rule later this year.

Here is the Proposed Measures for ACP Quality-Performance Standards[PDF]

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Medicare 2011

Below is information you need to know about changes to the Medicare program in 2011.
ACP Resources are available here.

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Transition to Standard Format 5010 or Your Claims Will Not be Processed

As part of new Health Insurance Portability and Accountability (HIPAA) legislation, all covered entities must submit claims under the new Version 5010 transaction standards by January 1, 2012. Claims will only be processed by payers under this new format!

Think back to 2005 when you were implementing the new transaction code sets imposed by HIPAA. In hindsight, that wasn’t so bad, was it? Back then, the standard format required was American National Standards Institute (ANSI) X12N version 4010. (Currently, the standard that you are using is version 4010A1.)

What should practices do now? The key is to ensure that submission of claims will not be interrupted. If claims do not conform to 5010, they will be rejected. Both sending and receiving systems must test transactions under Version 5010 together to ensure that everything is working properly prior to the January deadline. For example, if you use a clearinghouse to send claims to six different payers, you need to ensure that your clearinghouse performs successful tests with each of those payers. If you use your own software to send claims directly, you must make sure that the vendor of your software performs the same tests with each payer you use. What you should do right now is ask your clearinghouse or software vendor exactly when they are scheduled to perform 5010 conformance testing with each of the payers that you deal with. Also, you should request formal notification upon successful test conclusion with each. If you do not get firm dates and plans at this point, you have reason to be concerned. You may need to escalate your concerns quickly up the organization’s management chain. End-to-end testing must be complete and successful well in advance of the December 31, 2011 deadline.

For a checklist of how to get ready, go to:
www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf
[PDF]

To understand all the reasons for the standard format upgrade, go here: http://www.cms.gov/Versions5010andD0/Downloads/w5010BasicsFctSht.pdf[PDF]

Get more information on how to get ready for 5010 (and ultimately ICD10)

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Begin the Journey Towards a Successful PCMH Practice

ACP has gathered a comprehensive collection of information, resources and demonstration projects to assist you in planning for a complete Patient-Centered Medical Home. Visit /running_practice/pcmh

ACP has developed a medical home builder at /running_practice/pcmh/help.htm

For more information about the PCMH, contact the NCQA Customer Support at 888-275-7585 or go to NCQA's web site

The AAFP has produced Road to Recognition, a guide to simplify the process.

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Primary Care Residency Programs See Continued Growth

The following article is from the March 17, 2011 Amednews

The number of U.S. medical school seniors who will begin residency training in family medicine in July 2011 climbed 11.3% over 2010, marking the second consecutive year of growth in the field. Growth also was seen in the number of U.S. seniors pursuing first-year residency training in other primary care fields, according to preliminary data from the National Resident Matching Program.

U.S. seniors filled 1,301 family medicine positions, up from 1,169 in 2010. In 2011, 48% of available family medicine slots were filled by U.S. seniors, up from 44.8% in 2010. Meanwhile, internal medicine matches for U.S. seniors increased 8%, to 2,940 from 2,722, and also grew for a second straight year. In 2011, 57.4% of available internal medicine residency slots were filled by U.S. seniors, up from 54.5% in 2010. In both internal and family medicine, a greater percentage of slots were filled even as the overall number of available positions increased.

Overall, 2011 was the first year that the number of successful matches for U.S. seniors passed the 15,000 mark, representing a match rate of 94%. Of those, 81% matched to one of their top three choices.

"We were pleased that this year's Match was able to offer more positions," Mona M. Signer, NRMP executive director, said in a statement. "There will no doubt be wonderful cause for celebration at the nation's medical schools today and for all participants as they experience this defining moment in their careers as physicians."

More than 17,000 seniors and graduates of U.S. allopathic and osteopathic medical schools simultaneously ripped open envelopes containing their residency assignments at noon Central Daylight Time March 17 for annual Match Day ceremonies hosted by medical schools nationwide.

Data released by the NRMP showed a 7.3% bump in first-year emergency medicine residency positions filled by U.S. seniors, from 1,182 in 2010 to 1,268 this year. The most competitive slots were dermatology, orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery and vascular surgery, according to the NRMP. At least 90% of the available residency slots in each of those specialties were filled by U.S. seniors.

Overall, the number of U.S. seniors entering their first year of residency training increased to 15,588 over 14,992 last year, continuing a steady climb in recent years fueled largely by the opening of new medical schools and the expansion of existing medical schools.

Such expansions have led to a 9.7% increase in the number of U.S. seniors entering internships during the past five years. The overall number of residency positions filled by U.S. medical school seniors and graduates nationwide, including those entering both first- and second-year residency positions, increased by 630, or 3.7%, over 2010 to 17,607 this year. The 2011 Match offered 23,421 first-year and 2,737 second-year positions, 638 more overall than 2010. Overall, 37,735 applicants -- 179 more than in 2010 -- participated in the Match, a total that includes foreign graduates of international medical schools and U.S. citizens who attended medical school abroad.

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Message from CDC re: Gonorrhea Resistance to Cephalosporin Antibiotics

Dear Colleague,

Because of concerns about emerging antimicrobial resistance of Neisseria gonorrhoeae to cephalosporin antibiotics, new recommendations regarding gonorrhea treatment have been released by the Centers for Disease Control and Prevention (CDC) in their 2010 STD Treatment Guidelines (pages 50-52), available online

The three key changes are:

  1. Ceftriaxone (Rocephin®) by intramuscular (IM) injection is now the preferred antimicrobial agent for uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx.
  2. The dose of ceftriaxone for uncomplicated anogenital and pharyngeal gonococcal infections has been increased from 125 mg IM to 250 mg IM.
  3. Dual antibiotic therapy with a cephalosporin plus azithromycin or doxycycline is recommended for all suspected and confirmed cases of gonorrhea regardless of chlamydia test result.

Recommended regimen for treatment of uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx:

Though cefixime 400 mg orally in a single dose is included as a treatment option for gonorrhea in the 2010 CDC Guidelines, it does not provide as high nor as sustained a bactericidal level as that provided by ceftriaxone 250 mg. Furthermore, cefixime and other oral cephalosporins have limited efficacy for treating gonococcal infections of the pharynx. Therefore, clinics in California should make every effort to provide ceftriaxone 250 mg as their first-line treatment regimen for gonorrhea.

In cases of suspected cephalosporin treatment failure, please call the California STD Control Branch at 510-620-3400 for clinical consultation.

The California STD Control Branch will release in the coming months more detailed guidelines available online at: for gonorrhea management. For questions about gonorrhea treatment or clinical management of other STDs, please call the California STD Control Branch at 510-620- 3400.

Yours truly,

Heidi M. Bauer, MD, MS, MPH
Chief, Program Development and Evaluation
STD Control Branch
California Department of Public Health
510-620-3400

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MICRA, the Medical Injury Compensation and Reform Act of 1975

MICRA was once referred to by the California Trial Attorneys Association as the California Medical Association’s “Holy Grail”. That’s probably an overstatement. But it’s close. MICRA is responsible for keeping premiums relatively affordable for physicians, dentists and community clinics in California and is the model that other states emulate. There are only two limits placed by MICRA on a settlement or award; a limit of $250,000 for actual pain and suffering and a limit on attorney fees. There is a chance that a bill to increase the cap and thereby increase attorney fees will be submitted to the legislature this year. Professional liability premiums are a significant part of operating a medical practice. Whether you are a solo physician or member of a group, maintaining and/or controlling expenses is vital for all concerned. If you want a feeling for what it took to win the MICRA fight and pass the legislation, go to: SSVMS MICRA History.

With all the problems with radiation at the Fukushima plant in Japan, we are publishing some data collected by the editor of the Sierra Sacramento Medical Society for your referral information.[PDF]

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Future Meetings of Interest

June 4: Update on Medicare and Your Practice

The Northern California Chapter (CANO) is offering a FREE session for CANO members: Update on Medicare and Your Practice, June 4 at the San Jose Convention Center. Art Lurvey, MD FACP, Palmetto Medicare contract medical director, Jerry Rogan, MD, MediCal contract medical director, and Dr Kwabena Adubofour, a practicing internist from Stockton, will discuss MediCare and MediCal reimbursement issues. Some of the topics to be covered are: enrollment, problems, suggestions and snafus; E&M special situations: preventive and concierge services, opting out, etc.; use of modifiers, timed codes, complex diagnoses; documentation guidelines and much more. Go to the preliminary program and registration information.[PDF] Reserve your seat now—attendance is limited to the first 100 registrants.

June 11: Transition to Practice

The last in the Transition to Practice series for residents in Internal Medicine will be held on Saturday 11 June 2011 at the Doctors Company in Napa from 2-5 PM. The topic will be insurance issues for young physicians. If you plan to attend, please RSVP to Kathy Matikonis by June 8.

August 12-13

ACP Summer Session: Back by popular demand is a two-day summer session in Chicago on August 12 and 13, 2011 (Sheraton Chicago Hotel and Towers). If you register before 2 June 2011 the tuition is only $79. If you know non-members, early registration is $99. Topics will include Atrial Fibrillation, Coronary Artery Disease, Acute Coronary Syndrome, Vitamin D, Thyroid Disease, Diabetes, Hyperlipidemia, Antimicrobials, Drug Interaction, and Anticoagulation. Register at www.acponline.org/summersession11b Refer to Priority Code SS0022. Or call 1-800-523-1546, ext. 2600 or 215-351-2600 (M – F, 9 a.m. – 5 p.m. ET).

October 28-30

CANO Annual Meeting: Don’t forget to join us at our CANO annual meeting at the Fairmont Hotel in San Jose, October 28, 29, and 30 (see program above).

IM 2012

Internal Medicine 2012 will be in New Orleans April 19-21 2012. Y’all come!

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Leadership Day Summary

The California-ACP Sacramento Leadership Day was a huge success. Here is the full summary.[PDF]

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