Report from the Governor's Desk- February 2010
From the Governor's Desk - Robert McLean, MD, FACP
"Future Practice Developments to Consider"
Most internists I know feel they are good doctors and deliver good care to their patients. How can or should that be measured?
Over the past 10-15 years, we have been increasingly profiled by managed care payers. It seems most frequently by medications prescribed (and percentage generic versus brand name). On the basis of billing data, we might be told by some payers how many patients have had certain preventive medicine/chronic disease management tests: mammograms, pap smears, lipid panels, diabetic eye exams, Hemoglobin A1c.
At first glance, I almost always question the accuracy of the data presented. Did only 50% of my patients with managed care company X have a mammogram last year? Did only 60% of my diabetic patients have an eye exam? Did all these patients (frequently a small sample size for a given managed care plan) even see me this past year for a visit? Or was it just a brief URI sick visit where I did not necessarily address my typical preventive checklist (because the patient subsequently cancelled that appointment)? Can I prove or disprove the data by which I am profiled? If I want to demonstrate that I am an effective doctor, then I MUST be able to access my own accurate clinical data.
If we are to take control of the care we deliver to patients (and the flow of health care dollars which follow), we must embrace HIT (health information technology) and EMRs (electronic medical records) as empowering tools. If we can prove our worth with data on clinical outcomes which save dollars for the health care system, then we can justify getting reimbursed better for all the work we do, whether as primary care internists or as sub-specialists. For the primary care internists, most of these issues are wrapped up in the Patient Centered Medical Home (PCMH). The next level in demonstrating the value you bring to your patients' health is a willingness to be "accountable" for the care you deliver and the outcomes which result. Across your population of patients, are you confident that you are providing care and availability which can prevent potentially unnecessary emergency room visits and hospitalizations? That may take more effort than you currently spend, but it would definitely save health care dollars. We all know this, but we have no incentive to really try to cut down on such unnecessary utilization. Yet, that is where the health care system needs to find savings to continue without bankrupting the economy (which is where we are headed).
Enter the Accountable Care Organization, designed to be "a provider-led organization whose mission is to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population. Multiple forms of ACOs are possible, including large integrated delivery systems, physician-hospital organizations, multispecialty practice groups with or without hospital ownership, independent practice associations, and virtual interdependent networks of physician practices".
I urge you to read the article from which I pulled this description: "Primary Care and Accountable Care- Two Essential Elements of Delivery-System Reform" by Rittenhouse, Shortell, & Fisher in the Oct 28, 2009 NEJM. These concepts are being embraced in health system reform efforts, and so I suggest you become familiar with them. Changes in our daily practice and the complex health system as a whole are difficult and painful, but we must all recognize that, "The status quo is unsustainable" (spoken by President Obama and many others). The details of health reform are still not finalized as of early February. Be assured that the ACP continues to lobby hard for universal affordable insurance coverage, improvements in physician workforce, physician reimbursement improvements, and medical liability reform. Please read the College-wide e-mail message sent on Jan 12, 2010 from ACP President Joe Stubbs providing an excellent update on the College's views and advocacy on health reform as of that date. Update information is always available at www.acponline.org/advocacy.
CT Chapter Scientific Meeting 2009 - submitted by Rob Nardino, M.D. Chair, Program Committee
The annual Connecticut Chapter Scientific Meeting was a rousing success. Held October 30, 2009 at the Aqua Turf Club in Southington CT, the meeting provided meaningful CME while also showcasing the scholarly activity of internal medicine residents from the state's thirteen residency programs. The day started out with 12 outstanding oral abstract presentations, each resident representing a different program. Associate members then presented an astounding 231 abstracts (210 clinical vignettes, 21 research abstracts). The resident poster session ran concurrently with a superb Professor in Action presentation by Andre Sofair, MD, last year's George F. Thornton Award winner and our inaugural Clinical Pearls session, highlighted by an outstanding hematology review by past governor Eric Mazur, MD, FACP. Yul Ejnes, MD, FACP, represented the ACP Board of Regents. The afternoon featured the ninth installment of our popular "Multiple Small Feedings of the Mind" (MSFM) program, featuring discussions on post-bariatric surgery nutritional management, perioperative assessment, fall prevention, an update on MRSA and a review of physical examination of the nails. Once again we presented two ABIM self-assessment modules, in an effort to aid internists with the maintenance of certification process.
We were also pleased to honor two recipients of the George Thornton Award for outstanding contributions to medical education: Noel Robin, MD, FACP of Stamford Hospital and former chapter governor David Podell, MD, FACP of Waterbury Hospital. David Miner, MD, FACP received the Chapter Laureate Award and Fred Finkelstein, MD received the Volunteerism & Community Service Award. Congratulations to these outstanding role models. Be sure to save the date for the 2010 Chapter Meeting: (Friday, November 12, 2010). We look forward to seeing you next year!
Dr. Robert McLean presents the Thornton Award to Dr. Noel Robin, Stamford Hospital
Dr. McLean presents the Thornton Award to Dr. David Podell, Waterbury Hospital
Dr. McLean presents the Legislator of the Year Award to Rep. Elizabeth Ritter. Co-Chair, Public Health Committee
Associates Council - submitted by Adam Silverman, M.D., FACP
The Annual Meeting was again a success! Thanks to all of the residents and medical students for their hard work in preparing an outstanding collection of posters. Thanks also to the judges! Your enthusiasm and flexibility was greatly appreciated! The scientific session saw a record number of clinical vignettes and research posters. The oral presentation competition showcased a number of excellent projects being done by residents within the state. Looking forward to the spring, the Associates Council is evaluating a spring meeting in May. The Medical Jeopardy competition between residency program teams will take place on March 30 at UConn, and the winning team will represent the state at the ACP Internal Medicine meeting in Toronto in April. Our Chief Resident's council is led by Muj Alikhan at UConn, and please contact him or me if you have interest or questions
Associate Abstract Award Winners from Chapter Meeting October, 2009
Dr. Adam Silverman presents the Oral Abstract Award to Dr. David Inyangetor, UConn Primary Care Residency Program
Dr. Silverman presents the Oral Abstract Award to Dr. Harm Feringa, Griffin Hospital Residency Program
Dr. Silverman presents the Oral Abstract Award to Dr. Jorge Ramos, Yale Primary Care Residency Program
Dr. Silverman presents Award to Dr. Saurabh Gupta, UConn Primary Care Residency Program for 3rd place Clinical Vignette Abstract
Dr. Silverman presents Award to Dr. Shilpa Shetty, Griffin Hospital Residency Program for 2nd place Clinical Vignette Abstract
Dr. Silverman presents Award to Dr. Susan Mozzicato, UConn IM Residency Program for 1st place Best Clinical Vignette Abstract
Dr. Silverman presents 3rd Place Research Award to Dr. Philip Ong, Bridgeport Hospital Residency Program
Dr. Silverman presents 2nd Place Research Award to Dr. Muhammad Sohail, St. Mary's Hospital Residency Program
Dr. Silverman presents Best Research Award to Dr. Grace Huong, Yale Primary Care Residency Program
Thank You to All Our Abstract Competition Judges:
Olumuyiwa Adeboye, Keith vom Eigen, Anne Climaco, George Rousch, Tom Lane, Constantine Manthos, Ruchir Trivedi, Donna Windish, Surendra Khera, John D'Avella, Saneka Chakravarty, Weishali Joshi, Ralph Martin, Nicole Silverstein, Peru Venkatesh, Priyanka Kanth, Greg Czarnecki, Ralph Salvietti, Vimal Rabdiya, Sharon Dowell, David Podell, Molly Emott, David Baggish, Scott Allen, Rebecca Andrews, Mujahed Alikhan, Jeanette Tetrault, Wendy Miller, Cony Vergara, Medhi Makki, Charles Seelig, Haq Nawaz, Kay Lovig, Steve O'Mahony, Nimisha Kalia, Parth Chowdhuri, Joseph Cleary, Ian Weir, Lionel Lim, Lily Dara, Tom Genese, Deepak Kadiyala, Maria Maldonado, Kirsten Hohmann, Norman Marieb, Olga Sakharova, William Posligua, Janaki Fonseka, Karen Hutchinson, Dino Messina, Patricia Tietjen, David Miner, JoAnn Petrini, Rex Moss, Natallia Abramovich, Yul Ejnes, Ellen Nestler, Andre Sofair.
Health & Public Policy Committee - Keith vom Eigen, M.D., Chair
The recent Senate election upset in Massachusetts has thrown a new twist into the high drama of health care reform at the federal level. If anything, it is an indicator of the uncertainty felt by many Americans when it comes to complex policy initiatives such as the health care reform bills moving through Congress. ACP has continued to work diligently to make sure the priorities we support not get lost in the political wrangling surrounding this process. ACP recently urged Congressional leaders working on a unified health care reform bill to include several key elements we feel are most important in moving towards the goal of increasing access to high quality, affordable, health care. These include workforce policies to insure a sufficient supply of primary care providers; measures to expand access to and affordability of health insurance; payment system reform to reward value, quality, and innovation; and initiatives to help rationalize the medical liability system. (For details on the policies supported by ACP go to http://www.acponline.org/advocacy/).
At this point it is unclear whether a consensus bill will emerge that can pass both Houses and reach the President's desk. Whatever the outcome, there will be a number of ongoing issues related to health care that will require ongoing input from ACP. At the top of the list is the SGR (Sustainable Growth Rate) formula problem, which will result in a 21% Medicare pay cut to physicians this spring unless corrective legislation is passed. ACP is also working to provide ongoing analysis and advice to policymakers on other issues such as changes to Medicare coding and payment formulas, which have generated considerable concern and controversy among physicians. In May, the Connecticut Chapter will be sending a contingent to the ACP Leadership Day in Washington, DC to discuss these and other critical health care issues with our legislators.
On the home front, the Connecticut Chapter continues to be closely involved, along with other with other medical organizations such as the Connecticut State Medical Society, in advising state legislators on legislative proposals in Connecticut, and providing testimony on specific bills being considered. At our annual meeting in October, the Chapter presented its Legislator of the Year Award to State Rep. Elizabeth Ritter, chairman of the House Public Health Committee, in recognition of the key role she played in passage of the Sustinet Health Plan bill last summer. In December the chapter Health and Public Policy Committee held a very informative and productive meeting with Rep. Ritter to discuss approaches to state level health care legislation, and the goals of state health care policy. In addition, several ACP members are involved in shaping the Sustinet plan through involvement in its governing board and advisory committees.
If you would like to become more involved in the chapter's health policy activities, contact Keith vom Eigen
Council of Young Physicians - Jeanette Tetrault, M.D.
On December 16, we held a dinner discussion at Carmine's Tuscan Grill in New Haven on the topic of advocacy. We had a great turn out to discuss how we can better advocate for our patients and our profession. One important way to become involved is to sign up for the Key Contact program. For further information on advocacy and ACP's position on current healthcare-related issues, please visit www.acponline.org/advocacy. We are very thankful to our chapter governor for attending this event.
We invite any interested physician members who qualify (sixteen years or less since graduating medical school) to become involved. Please visit our Facebook group page (American College of Physicians Connecticut Council of Young Physicians) or email Rebecca Andrews or Jeanette Tetrault for further information. Our next event will take place in the spring.
Medical Student Committee - Sameer Sheth, Yale Medical Student
In November, Yale Internal Medicine Interest Group hosted a very successful faculty panel that provided students insight into a career in internal medicine. Dr. Jack Elias, Chairman of the Internal Medicine Department, and other faculty from various specialties and backgrounds shared their experience and advice for the medical students. The lively discussion included topics on life style of internists, residency preparation, and opportunities to participate and engage in healthcare policy. The panel format was particularly effective in allowing active dialogue and discussion between the students and the panelists. ACP Governor , Dr. Robert McLean, and IMIG Advisor, Dr. Barry Wu, helped to introduce and expose the first year medical students to the American College of Physicians and the numerous resources it provides. This semester IMIG plans to host a few events, starting with a panel introducing students to research opportunities in medicine. We hope to show students the vast resources available for research at Yale, basic science and clinical. In March, we will have our annual Match Panel, where recently matched students in internal medicine will talk about their experiences during interviews and why they chose medicine. We hope more students start thinking about a career in medicine.
At UConn, Bryan Piccirillo is heading up the medical student interest group activities and outreach. Last year's medical student leader from UConn, Dan Henderson has spent this year in Washington, D.C. as an AMSA Health Justice Fellow working on the front lines of healthcare advocacy. He has an interesting column elsewhere in this newsletter detailing some of his experiences.
Help Us Be Environmentally Responsible and Use More Electronic Communication
The ACP national office and all chapters are working hard to "go green" by reducing paper, to decrease both paper waste and cost wherever possible. Our joint efforts will also help to keep minimized certain costs which can ultimately affect the annual membership dues rate. The CT Chapter of the ACP is 2257 members strong, yet 494 members have no email addresses provided. While our chapter plans to mail print copies of newsletters to those members without e-mail addresses, those members are not receiving intermittent e-mail correspondence either from the Governor or from the national ACP office – frequently of timely significance, especially with recent health reform activity. In addition there is clear added expense to the chapter of printing and mailing newsletters and meeting brochures. At the time of membership renewal, please consider reinstating our ability to communicate with you electronically thereby reducing our use of paper as well as the chapter's expenses. You may wish to consider providing a personal email address rather than your business email, which we all know fills too quickly over the course of the business day.
Diversity Committee - Joshua San Vicente, MD and Naseema B. Merchant, MD
Diversity is an integral part of the ACP and it impacts the organization at various levels. The diversity committee was recently created to address some of the challenges pertaining to ever growing diversity in the current environment. Some of the goals for this committee include: 1. recruitment of potential members from minority backgrounds; 2. mentoring young physicians in the ACP family; 3. providing guidance to members towards the advancement to fellowship in ACP and; 4. identification of leaders from distinct backgrounds. Addressing diversity in physicians will be a major area of focus for the ACP Connecticut chapter in 2010.
In order to fulfill the above mentioned goals the CT ACP Diversity Committee plans to reach out to medical students, residents and practicing physicians from a various backgrounds. Furthermore, to enhance our recruitment of new members, the committee plans to broaden the definition of diversity and include all possible groups. We would also like to develop programs that will help mentor medical students, residents and physicians towards their career goals. To highlight issues related to diversity, the committee also envisions organizing talks on this important topic, together with more traditional lectures at this year's annual chapter meeting. It is well known that the country is becoming home to an increasing number of individuals from distinct racial and ethnic backgrounds. If you have any questions about the scope of this committee, would like to share an idea, or want to become a member of our team or ACP, please feel free to contact any one of us.
Health Reform Advocacy from the Front Lines: A Medical Student Perspective - Dan Henderson, UConn Medical Student
Last May, I took an important step toward defining my ideal career as a physician - I left medical school. As a medical student nearing the end of my third year at the UConn School of Medicine, I had been through the boards and the wards, but found my medical training missing something. To be sure, UConn offers a superb environment for training – I feel lucky to be part of it. Still, too often as a student, one sees examples where health isn't determined by the balance of bugs and drugs, but by factors outside the traditional scope of medicine, of "doctoring:" A frail woman dies because a critical lab value was lost, and the chance to control a lethal hemorrhage missed. A patient suffers needlessly with a manageable case of A-fib when his care is fumbled between consulting doctors. In every nearly rotation, scores of patients wait for scant free clinic appointments, their health put on hold by a lack of affordable insurance coverage.
While applying to medical school, I often pictured myself as a doctor – listening to patient's heartbeats, writing prescriptions for antibiotics, giving bad news to family members - these are the vignettes most of us associate with doctors. But why stop there? What about the surgeon who spearheads the use of a checklist to decrease surgical complications? What about the primary care doctor who redesigns his practice to strengthen care coordination? What about the internist who meets with his congressman? I've been privileged to find role models in physician leaders who hold these sorts of roles. In a year away from school, I hoped to encourage medical students to embrace leadership opportunities, and to understand how one builds a career in medicine to suit such an expand definition of "doctoring."
In DC this year, amidst a tumultuous push for health care legislation, I've been on the front lines representing a national medical organization. I work with AMSA's health policy leaders to analyze policy questions and articulate a position to AMSA's members and outside the organization. A few times this summer, I nervously took to the podium to excite rally crowds about reform. A Connecticut native, I'm proud to be represented in Congress by Senator Dodd and Congressman Chris Murphy. Starting with ACP Leadership Day last May, their offices have welcomed me in to discuss medical students' views on reform, as well as to be present at a few big press conferences. I even got to meet President Obama after a rally in Maryland. In addition to being a rookie health policy advocate and occasional face in the crowd, I've been trying to understand the factors that drive some students toward activism while others back away. To explore this, I designed a new campaign for students to improve the quality and safety of health care. Students involved in the campaign will learn about health care improvement, and participate in a study comparing them to students in general. My goal is to better understand the underpinnings of student and physician involvement outside the realm of a traditional clinical role.
More than halfway through a year as Health Justice Fellow, this time has provided an unmatched opportunity for learning outside of the standard medical curriculum, and for reflection on what it means to become a professional. The considerable frustrations of politics aside, I've greatly enjoyed seeing the process at work. In the remaining months of my term, I aim to complete my examination into what makes activists tick; to engage with the political process in the last phase of health care legislation; and to ensure my work can be continued by the next student to serve in this position. I hope this year will leave me with a greater understanding of the specific health policy issues AMSA advocates for, as well as the general exercise of leadership within the role of a physician. Returning to UConn in May, I am eager to rejoin the path of those physicians whose work outside traditional clinical roles first inspired me to pursue a broader definition of doctoring.
SAVE THE DATES!!
- March 10 & 11 Pri-Med Access spring meeting – Hartford
- March 30 Medical Jeopardy Competition – UCONN Health Center
- April 22 – 24 Internal Medicine 2010 – Toronto
- April 23 CT-RI Reception (at ACP Internal Medicine 2010) 5-6:30 pm – Sheraton Centre Toronto Hotel, Dufferin Room Toronto
- October 25 & 26 Pri-Med Access fall meeting – Hartford Convention Center
- November 12 CT Chapter, ACP Annual Meeting Aqua Turf Club, Southington/CT
PREVIEW: INTERNAL MEDICINE 2010
Internal Medicine 2010, the National (and technically International) ACP scientific meeting, will be held at the Toronto Convention Center from Thursday, April 22, 2010 through Saturday, April 24, 2010, preceded by two-days of pre-courses. Please go to the ACP website at http://www.acponline.org/meetings/internal_medicine/2010 for all the information that you need for:
- Registration (general meeting and pre-course)
- Travel (air, car rentals and hotels)
- Course listings (titles, dates and times)
- Special activities (opening ceremony, Convocation ceremony, Henry S. Waxman Learning Center and special events)
- Sessions and activities especially for medical students, associates and young physicians
- Guest programs (tours, Camp ACP Child Care Program)
- Passport requirements
Welcome Newly Elected Fellows:
Robert Alpern, M.D.-New Haven
Stephen Huot, M.D.-Hamden
Anamaria Apoltan, M.D.-Cheshire
Danilo Pangilinan, M.D.-Hartford
Amenuve Bekui, M.D.-Middlefield
Pacey Pet, M.D.-New Milford
Jesse Chua-Reyes, M.D.-Middletown
Nicole Silverstein, M.D.-Avon
Marc Ciampi, M.D.-Waterbury
David Smith, M.D.-Hamden
John Concato, M.D.-West Haven
Andre Sofair, M.D.-Waterbury
Leo Cooney, M.D.-New Haven
Susan Stocker Giles, M.D.-West Hartford
Stephen Ducey, M.D.-New London
Oyebode Taiwo, M.D.-Cheshire
Jack Elias, M.D.-New Haven
Victorio Te, M.D.-Storrs
William Handelman, M.D.-Torrington
Stephen Winter, M.D.-Ridgefield
Page updated: 2/11/10