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Report from the Governor's Desk- March 2011

In this issue


From the Governor's Desk - Robert McLean, MD, FACP
"Hello Connecticut ACP colleagues"

Dr. Robert McLean, MD, FACP

As many of you have seen my use of chapter-wide e-mails over the past few months to disseminate important information about changes in our healthcare delivery system and important advocacy news from the ACP, I will not use this print newsletter opportunity to reiterate that. Instead, I will focus on the accomplishments and activities of the talented ACP members within our chapter and the important activities of the various councils and committees that keep our Chapter functioning well. Our Chapter once again in 2010 received a “Chapter Excellence Award”. This award recognizes chapters that successfully meet a number of criteria which include such activities as maintaining an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, participating in advocacy activities, recruiting and advancing members, and celebrating membership through local awards.

It was a personal honor to announce at our Chapter meeting that Dr. Norman Marieb and Dr. David Podell were elected to Mastership in the ACP and will be formally inducted as MACPs at the Convocation ceremony on Thursday April 7 at the annual meeting in San Diego. I urge anyone attending the meeting in San Diego to come to the Convocation ceremony and honor these outstanding physicians who have been role models and mentors to many of us over the years.

It was a pleasure to see so many of you at our Chapter meeting in November with over 250 Abstract posters and 3 selected to present orally to the entire meeting attendance. Thank you to Spyridon Fortis (from Bridgeport Hospital, “Factitious Respiratory Failure: Bound to the Ventilator by Pressure Support”), Victoria Costales (from Griffin Hospital, “Home Telemonitoring to Improve Clinical Outcome in Patients with Heart Failure: A Meta-Anaylsis of Randomized Trials”), and Phalgun Prativadi (from Stamford Hospital, “Temporal Trends in Red Blood Cells Transfusion in the Medical ICU”) who each gave wonderful presentations. There are photos in this newsletter of the winners of the clinical vignette and research poster abstract competition, and congratulations once again to each of them, as well as to all the residents who put in so much work and effort on their poster abstracts.

The chapter meeting is an opportunity for us to recognize physicians who have made significant contributions to our teaching and our communities. The Chapter Laureate Award honors those Fellows 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 ACP. For 2010, we presented this award to Dr. Adam Silverman and Dr. Steven Wolfson.

The George Thornton Teaching Awards were created by our chapter in memory of Dr. Thornton, a Governor of our Chapter from 1989-93 who was Chief of Medicine at Waterbury Hospital for many years where he was an exemplary teacher and a nationally recognized expert in infectious diseases. The Thornton Award is given to an individual in recognition of outstanding contributions to medical education and excellence in clinical teaching as well as his or her motivational impact on students, residents, and attendings. This year, the Chapter recognized Dr. Dan Henry from UConn, Dr. Joseph Belsky from Danbury Hospital and a previous Chapter Governor from 1985-89, and Dr. Yaw Amoateng Adjepong from Bridgeport Hospital.

The Volunteerism and Community Service Award was initiated several years ago to recognize members of our Chapter who have distinguished themselves in voluntary service in the area of medicine. This year, the Award was given to Dr. Suzanne Lagarde, who has been active delivering medical care to the Gulf coast in Biloxi, Mississippi as well as serving as a founding member and President of Project Access -New Haven.

I have placed our Awards brochure distributed at the Chapter meeting on our chapter web site where I encourage you to read some details about each of these outstanding physicians and their accomplishments. We are very proud of them.

I will continue to use e-mails every month or so to disseminate important news about advocacy and changes in rules and regulations. These are clearly challenging times technologically, economically, and politically. The ACP is trying to provide useful information, and I would encourage you to look at the ACP website frequently. I will continue to do my best to point you in specific directions when appropriate.

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Award Winners from Chapter Meeting 2010

Wolfson Laureate
Laureate Award winner, Steven Wolfson, MD, FACP

Thornton Belsky
Thornton Award winner, Joseph Belsky, MD, MACP

Thornton Henry
Dan Henry, MD, FACP, Thornton Awardee and Dr. Robert McLean

Silverman Laureate
Dr. McLean presents the Laureate Award to Adam Silverman, MD, FACP

Thornton Yaw
Dr. McLean presents Thornton Award to Yaw Amoateng Adjepong, MD

Thornton Yaw
Dr. McLean presents the Volunteerism & Community Service Award to Suzanne Lagarde, MD, FACP

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Associate Abstract Winners from Chapter Meeting November 2010

1st Vignette
Dr. Ouellette presents award to Dr. Jaime Ruszkowski, Yale Primary Care Residency Program for 1st place Best Clinical Vignette Abstract: “Expanding the Differential for TIA: When Do You Have to Think Outside the Stroke Pathway?”

2nd Vignette
Dr. Ouellette presents award to Dr. Rajesh Zacharias, UConn Primary Care Residency Program for 2nd place Clinical Vignette Abstract: “Portopulmonary Hypertension – Breathing Under Pressure!”

3rd Vignette
Dr. Ouellette presents award to Dr. Daniel Horowitz, Bridgeport Hospital Residency Program for 3rd place Clinical Vignette Abstract:“Platypnea- Orthodeoxia Syndrome after Right Pneumonectomy: Does a PFO Explain the Degree of Refactory Hypxemia?”

best research
Dr. Ouellette presents Best Research Award to Dr. Justin List, Yale Primary Care Residency Program: “Community-Based Active Case Finding of TB and HIV Patients in Kampala, Uganda Using Chronic Cough as a Screening Tool”

2nd research
Dr. Ouellette presents 2nd Place Research Award to Diego Bellavia, Hospital of St. Raphael Residency Program: “Unity of Doppler Myocardial Imaging”

3rd research
Dr. Ouellette presents 3rd Place Research Award to Mihaela Parvu, Danbury Hospital Residency Program: “An Algorithm for the Detection of Clostridium Difficile”

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Thank You to All Our Abstract Competition Judges

  • Marc Ciampi
  • Thor Tejada
  • Victorio Te
  • Patrick Koo
  • Jesse Chua-Reyes
  • Allison Magnuson
  • Vincent Quagliarello
  • Deepika Devuni
  • Bernard D’Souza
  • Lisa Adatya
  • Ardeshir Hashmi
  • Subramanian Kannan
  • Thomas Genese
  • Karlyn Huddy
  • Shawnette Alston
  • Alfred Danielian
  • Anne Mae Climaco
  • Rebecca Andrews
  • Raymond Amankona
  • Ralph Martin
  • Joseph Cleary
  • Nicole Silverstein
  • Rosemarie Fisher
  • Naseema Merchant
  • Kirsten Hohmann
  • Luis Diez
  • Suzanne Lagarde
  • Laurie Caines
  • Norm Marieb
  • Peru Venkatesh
  • Charles Seelig
  • Robert Gionfriddo
  • Danielle Ramsden
  • Keith vom Eigen
  • Jason Orlinick
  • Joel Wilken
  • Steve O’Mahony
  • Haq Nawaz
  • Ian Weir
  • Cony Vergara
  • Maria Maldonado
  • Mihaela Tiru
  • Noel Robin
  • Neema Stephens
  • Constantine Manthos
  • Navin Bajaj
  • Patricia Tietjen
  • Ardeshir Hashmi
  • JoAnn Petrini
  • Dino Messina
  • Neetu Nebhwani
  • Walid Shaib
  • Stephen Holt
  • Chrissy Kournioti
  • Michael Green
  • John D’Avella
  • David Miner
  • Rex Moss
  • David Baggish
  • Joshua SanVicente
  • William Rabitaille
  • Madura Saravanan

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Paper to EMR to PCMH:A Solo Practitioner’s Experience- submitted by Edward Rippel, MD

In January 2011, I became the first solo practitioner in Connecticut to be recognized by the National Committee for Quality Assurance(NCQA) in the Patient Centered Medical Home Program (PCMH). I had read that it was next to impossible to achieve this in solo practice. When I researched the details of the program, I found that I had already been doing much of what was required for recognition, and that implementing the remaining elements would likely improve the quality of care that I provide. My practice style has always been patientcentric with an emphasis on preventive care, guideline based chronic disease management, and coordination of care with specialists. My practice philosophy has always been to provide personal individualized service, with superior availability and patient communication.

After implementing eClinicalworks as our electronic medical records (EMR) application in mid 2006, marrying my style and philosophy with the adoption of technology was not as daunting a task as I had imagined. This is owed to the fact that the EMR application is customizable and almost infinitely modifiable on the fly. As a company, eClinicalworks stands behind their product. They offer complete service and assistance from contract signing all the way through going live. They provide on-site training, webinars, remote training, assistance with workflow re-design, and technical support. From a cost perspective, after viewing demos from several other EMR vendors, I found eClinicalworks to be the least expensive, as well as the most user-friendly. My initial investment of about $50,000 (including hardware and network set up) was easily recouped in just over two years. This was realized from the cost savings associated with in-house billing instead of outsourcing, enhanced practice productivity from automated reminders to patients, payments directly attributable to EMR from pay-for-performance programs, as well as incentive programs like PQRI, and e-prescribing. Also, additional real estate was not needed to accommodate a billing department; when my paper charts were placed in storage, I sold the chart racks, and converted that space into the manager’s office where billing is done.

Regarding the workflow in my office, where my team consists of a manager and 3 staff members, I quickly learned just how much room for improvement there was. Here are a few of the changes we made:

  • Instead of keeping a tickler file of postcards for routine physical reminders, we began using automated reminders.
  • I incorporated the use of order sets, a catalog of patient education materials, and electronic forms for referrals to outside providers, such as nutritionists and physical therapists.
  • I learned to use the decision support module in the application to recognize and order overdue preventive measures at the time of any office visit.
  • I have espoused the value of using registry queries to improve outcomes in chronic disease management.
  • My staff tracks tests that have been ordered until they are done and outgoing referrals until they are completed.

Reaping the benefits of these changes and others, I saw a significant increase in the percentage of patients achieving goal values for multiple measures. For example, about 70% of our diabetic patients have their Hemoglobin A1C levels at goal, where the national average is somewhere around 40% in Primary Care practices. In our patients with Ischemic Vascular Disease, about 98% of patients are on an appropriate antithrombotic agent, or have a reason documented as to why not. While these improvements in outcomes did not require any additional staffing, they did require a time investment early on.

As I gained more experience in using registry reports and the Quality Measures module in eClinicalworks, reporting to HEDIS and CMS became much easier. Also, I learned about the programs run by NCQA, and in 2009, I received recognition in the Diabetes Recognition Program (DRP). Following that, I received an additional recognition in NCQA’s Heart Stroke Recognition Program (HSRP) in 2010. With success in these programs, and the realization that my practice was in alignment with the PCMH model, I committed myself to achieving PCMH recognition, and began the process. I utilized data from the DRP and HSRP to satisfy several of the sections in the PCMH application, obviating the need to report the same data twice.

While not required for PCMH recognition, having EMR infinitely facilitated the process.

The actual application process for PCMH is time consuming. It requires careful review of the requirements, workflow improvements, and a plan of how to document each of the required elements. Being a solo practitioner, I obtained the assistance of Qualidigm, Connecticut’s Quality Improvement Organization (QIO). They worked with me on planning, workflow re-design, document creation, and in the actual application submission. Their support has proven to be extremely valuable to my practice.

Moving forward, it is my plan to work toward continual improvement in my practice by utilizing elements of the PCMH model and other quality improvement programs, as well as exploring greater practice efficiency through technology. It is my hope that these recognition programs will help to foster a paradigm shift in physician reimbursement, based on quality of care and patient outcomes, rather than the traditional volume based model. In addition, as the implementation of technology is costly, as is the labor necessary to achieve superior outcomes, there needs to be consideration of these costs in the establishment of a more appropriate physician payment system.

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Medical Student Committee

Yale --Hao Feng & Barry Wu, M.D., FACP

We are looking forward to Match Day on March 17, 2011. This year the Yale Internal Medicine Interest Group (IMIG) is planning a post Match Panel discussion for graduating students to share their residency selection and Match advice to students in internal medicine. A Residency Panel is also being organized to have current residents share their perspectives of what life is like as a resident, their future career plans and the diverse opportunities in Internal Medicine. This semester will be highlighted with a Faculty Happy Hour, which was a success last semester, for students and faculty to meet and interact. We look ahead to the May graduation and announcing the winners of the Connecticut Chapter ACP Award to a graduating student from Yale University and the University of Connecticut entering an internal medicine residency in Connecticut.

UConn-- Teresa Doucet & Ellen Nestler, MD

As the application season comes to an exciting climax with Match Day approaching, the Internal Medicine Interest Group at the UConn School of Medicine will turn its efforts to ushering our third year students into their final year. Internal Medicine Scholar’s student leaders will be representing Internal Medicine on a panel to advise the third year class about scheduling options, application timelines, and preparing for the upcoming interview season. Additionally, we are in the process of planning for a group of our students to attend the ACP’s Internal Medicine 2011 meeting in San Diego in April. Internal Medicine Scholar’s group monthly meetings continue to begin with a short student presentation featuring highlights from ACP publications (including the ACP Internist, ACP Hospitalist, and ACP Advocate). This has been a great way to introduce students to the benefits of ACP membership and to encourage enrollment. After Match Day we will select the UConn winner of the Connecticut Chapter’s ACP Award from the pool of graduates who are entering an IM Residency in the state.

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Associates Council Update- submitted --Jason Ouellette, MD, FACP

Our Associate Members, once again, had an outstanding presence at this fall’s annual meeting. Over 250 abstracts were presented and more than 10 residency programs were represented from across the state. Congratulations to all who participated through both poster and oral presentations. Planning is already underway for next year’s meeting and we are continuing to look for ways to get our students and residents involved. We had our first Associates Council meeting of the year where many ideas were exchanged as to how to increase communication and exchange information between residency programs as well as how to get residents more involved in ACP outreach. Chapter Governor Dr. McLean has been visiting various programs across the state, informing residents about what the ACP does and how to get more involved. This year’s Medical Challenge (Jeopardy) competition was just held on February 18 at St. Mary’s Hospital in Waterbury. The afternoon and evening timing seemed to allow for more residents and faculty to attend, and we appreciate the 8 teams which came out. Once again the team from the UConn traditional residency program was victorious and will be representing our chapter at the national meeting in San Diego! Congratulations

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Diversity Committee--submitted by Joshua San Vicente, MD, FACP and Naseema B. Merchant, MD, FACP

Our CT chapter‘s Diversity Committee continues to work on issues related to diverse clinical, cultural and ethnic backgrounds from which many of our physicians come. The committee has been charged to address and accomplish several goals which include:

  1. Learn from our young, diverse group of CT members how the CT ACP Chapter can best serve their interests and be more relevant to their clinical practice and career goals:
  2. Provide mentor ship and guidance to members in helping them advance to a prestigious Fellowship status with the American College of Physicians;
  3. Provide opportunities for members who are interested in pursuing a leadership role or being more active within the CT chapter or the National ACP;
  4. Increase the membership in the National ACP and CT ACP Chapter of internists from diverse backgrounds;
  5. Provide a forum for interaction and brainstorming for physicians interested in promoting diversity in Medicine.

The committee welcomes any ideas or feedback from members or non-members. For those individuals interested in serving on this committee or those wishing to share any ideas, please contact the committee chairs: joshua_sanvicente_md@midhosp.org or naseema_ merchant_md@midhosp.org

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Medicare Carrier Advisory Committee Liaison Report--submitted by Fitzhugh C. Pannill, MD, FACP

At the first quarter Advisory Committee meeting with National Government Services(NGS), our Medicare intermediary, several topics of great interest to general internists were discussed.

First, starting January 1 2011, Medicare will pay for an “Annual Wellness Visit” (first time G0348 and annual G0349) that will allow patients to review their personal health risks. This is not a physical, as the only required examination is vital signs and BMI. There are a number of specific things that must be documented including a list of the patients providers, personal and family history and screening for cognitive and functional problems. It is unclear if Medicare will also pay for a traditional physical exam.

Also coming soon will be a 10% bonus on all fees in the Primary Care Bonus Payment Program. To qualify, a physician has to be a self-designated primary care provider in Internal medicine, Family medicine, Pediatrics, or Geriatrics, and have 60% or more of their billings be for “primary care services” (presumably office visits )

Many More details on both issues can be found at the ACP website http://www.acponline.org/running_practice/practice_ management/payment_coding/medicare_changes.htm

Further information will be available at the second quarter meeting in April.

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Council of Young Physicians - submitted by Rebecca Andrews, MD, FACP and Jeanette Tetrault, MD, FACP

Happy New Year! Since our last update, we hosted the “Tri-State Young Physician Abstract Competition” at our chapter meeting on November 12. We had over 40 submissions from CT, NY and NJ Young Physicians. We would like to again congratulate our winners from this competition: 1st Place - Todd Cassese, New Haven, CT - “The Forgotten Remnant”; 2nd Place - Neel Chokshi, New York, NY - “The High Prevalence of Statins in the Very Elderly Without Clear Indication”; and 3rd Place - Saba Abolahrani, Mineola, NY - “Prevalence of Stethoscope’s Contamination after Examination of Patients on Contact Isolation and the Efficacy of Disinfection with Alcohol Swabs.”

For the coming year, we will continue to plan social events in the New Haven and Hartford areas for Young Physicians to meet, network and discuss common issues. Our major area of focus currently is on Young Physician member recruitment. A reminder to recently graduated medical residents is that you are now transitioning from an Associate status to Full Member status. You are considered a “Young Physician” if it has been 16 years or less since graduation from medical school. We invite any interested physician members to become involved. Please visit our Facebook group page (American College of Physicians Connecticut Council of Young Physicians) or email us at reandrews@uchc.edu or jeanette.tetrault@yale.edu for further information.

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Next Chapter Meeting Tuesday November 8, 2011

We are coming off another successful annual meeting, but looking ahead to November 2011 the planning committee has set sights on a format change – namely, shifting the time of the meeting from morning/afternoon to afternoon/evening. We have like the location at Aquaturf for many years and will remain there, but scheduling issues have required us to pick a Tuesday. Another new feature will be parallel tracks for office-based and hospital-based topics, and we anticipate viewing the finals of MedChallenge, the Associates’ Jeopardy-style knowledge tournament as part of the meeting. In following up on this year’s outstanding panel discussion on controversies in cancer screening, we will have a similar stimulating panel discussion on an interesting topic. Mark your calendars for Tuesday, November 8 – we hope to see you there!

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Jeopordy Team

The Victorious February 2011 Medical Jeopardy Team from UConn

The winning team from the UConn categorical medicine residency program won this year’s “Medical Jeopardy” competition held in February at St. Mary’s Hospital Conference Center and will represent our chapter at the national competition in San Diego. Thanks to Dr. Rob Nardino and Dr. Jason Ouellette for organizing and conducting this year’s chapter competition.

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ACP Awards: Nominate your Heroes, Mentors and Colleagues

The Awards Committee of our chapter invites your help in recognizing the accomplishments of distinguished individuals and organizations through the Chapter’s and the College’s awards and Masterships. Nominations are open for the next awards cycle, which will culminate with the Chapter’s presentation of the Laureate Award, Volunteerism & Community Service Award, and the George Thornton Teaching Award. As well, the College bestows a multitude of national awards and Masterships during the Convocation ceremony at Internal Medicine, the ACP’s national meeting. These awards recognize outstanding contributions in the practice of medicine, teaching, research, public service, leadership, and medical volunteerism. If you have nominations for any of these awards, please contact our Executive Secretary Nancy Sullivan to initiate the consideration process.

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Preview: Internal Medicine 2011 April 7 - 9, 2011

Internal Medicine 2010, the National (and technically International) ACP scientific meeting, will be held at the San Diego Convention Center from Thursday, April 7, 2011 through Saturday, April 9, 2011, preceded by two-days of pre-courses. Please go to the ACP website at http://www.acponline.org/meetings/internal_medicine/2011 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).

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Tri-State Young Physicians Abstract Competition

2011 New York Chapter ACP Annual Scientific Meeting
Thursday, May 26, 2011
Rye Town Hilton, Rye Brook, NY
To submit an abstract, see the link on our chapter web site
Deadline is April 15

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Welcome to New Fellows!
Congratulations to those Connecticut physicians elected to ACP Fellowship in the past 6 months:

  • Harjinder S. Chowdhary, MBBS, FACP-Glastonbury
  • Joseph E. Craft, MD, FACP, New Haven
  • Kirsten B. Hohmann, MD, FACP, Stamford
  • Silvio E. Inzucchi, MD, FACP, New Haven
  • Peter W. Marks, MD, FACP, Woodbridge
  • Rebecca O. Newell, MD, FACP, Cheshire
  • Stephen O’Mahony, MD, FACP, Norwalk
  • Julie R. Rosenbaum, MD, FACP, Fairfield
  • David D. Thompson, Jr., MD, FACP, Niantic

I hope these new Fellows and others elected will join the Connecticut delegation to march in the Convocation ceremony at the ACP meeting in San Diego in April.

Welcome to New Members!
Welcome to New Members! Congratulations to those Connecticut physicians who joined ACP in the past 6 months:

  • Gustavo D Alday, MD
  • Senai Asefaw, MD
  • Shagun Bagga, MD
  • Freda Owusua Boateng, MD
  • Nadine E Chen, MD
  • Raymond L D’Amato, MD
  • E Jennifer Edelman, MD
  • Andrew Agyei Gyang, MD
  • Kavita Joshi, MD
  • Manisha Juthani-Mehta, MD
  • Oksana Kloyzner MD
  • Joseph R Maglio, MD
  • Michaela Mocanu, MD
  • Charles B Montano, MD
  • Timothy R Mulligan, MD
  • Anika S Murray, MD
  • Joyce Reyes Thomas, MD
  • Mark Steven Schaner, DO
  • Harold H Tara, Jr., MD
  • Katarzyna Jolenta Wadolowski, MD

Page updated: 3/24/11