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Report from the Governor's Desk- September 2010

In this issue

From the Governor's Desk - Robert McLean, MD, FACP
"Greetings ACP Colleagues"

Dr. Robert McLean, MD, FACP

With the passage of the most significant health care legislation since Medicare, we are in the midst of a transformative time in Medicine. That’s both a blessing and a curse. As I detailed in my e-mail in early August, we all face the challenges which come with significant change. I will not repeat those comments here but point you to our chapter website www.acponline.org/about_acp/chapters/ct under “What’s New” where my e-mail is available. If you are one of the 500+ chapter members without an e-mail address registered with the ACP, then please provide this crucial communication information at www.acponline.org (under My Membership then My Member Profile) so you do not miss news I send out to the chapter listserv every 1-2 months.

In April I attended Internal Medicine 2010 in Toronto as well as the preceding Board of Governors Meeting. In addition to hearing updates on healthcare reform and the College’s recruitment and retention efforts and its solid financial standing, we voted to adopt 7 resolutions addressing: registering a complaint with ABIM regarding its proposed licensing fee increase for SEP modules (which led to subsequent retraction by ABIM), assessment of ACP’s governing structure, adopting policy to work with the FDA to ensure the content and purity of dietary supplements, adopt mechanisms to assist members with Recovery Audit Contractor (RAC) audits, redeveloping state health policy networking forums at National ACP sessions, and finally engaging ACP members and specialty societies to recognize unnecessary and unproven treatment strategies that reduce quality and increase costs.

Congratulations to M. Adnan Sohail, a resident in the St. Mary’s Hospital Program, who was one of ten winners of the 2010 ACP Associates Research Poster Competition for “P2X7 receptor activation up-stream of the NLRP3 inflammasome is required for Acetaminophen(APAP) hepatotoxicity in mice”. Our chapter was well-represented at the annual Doctor’s Dilemma competition (“Medical Jeopardy” at the national level) by the team from UConn which almost won their first round match after an exciting comeback after playing the first half with faulty buzzers. After driving through the night to get there and then performing so admirably, I salute them and thank them for the tremendous effort.

The convocation ceremony was beautiful, as thousands of ACP Members, Fellows, and Masters were in full regalia. I was proud to be there representing all of you in our chapter and to lead a group of 11 newly inducted Fellows. It was the final meeting for John Tooker as EVP/CEO, and he was awarded a Mastership. The ACP President Joseph Stubbs from Georgia handed over the one-year leadership reigns to incoming President Fred Ralston from Tennessee. I note that both of these physicians are full-time practicing primary care internists just like many of us and live the same challenges of managing a practice and delivering good patient care.

The passage of the health reform legislation was really just the start as the ACP is now working with policymakers on understanding how implementation needs to proceed for effective change to occur for both patients and physicians. But it will not be easy. At the national level, I serve on the College’s Health & Public Policy Committee, currently as Vice-Chairman, and I can personally attest to the ongoing involvement of the ACP with health reform legislation’s implementation. With the Center for Medicare Services (CMS) finally having a chief for the first time in over 5 years with the recent appointment of Donald Berwick, we hope to see the CMS bureaucracy more responsive and efficient. Please see the comments in this newsletter from our chapter’s Health & Public Policy Chairman Keith Vom Eigen about health reform changes at both the national and state level. He led a delegation of CT ACP members that traveled to D.C. in May on Leadership Day, an annual event that allows personal interaction with congressional members and staffers, as we seek to educate them regarding the importance of internal medicine and primary care in the United States.

Please save the date of Friday November 12 for our next annual Chapter meeting. We have another excellent program this year organized by Robert Nardino, including abstract presentations by both associates/residents and young physicians, a panel session on evidence-based cancer screening, multiple small feedings of the mind sessions in rheumatology, endocrinology, and pulmonary, award presentations, and more. I look forward to seeing you there.


Photos from ACP in Toronto, April 2010

2010 Convocation

Toronto CN Tower

CT New Fellows
CT New Fellows: Drs. Ashan Manohar, Danilo Pangilinan, Stephen Ducey, Matthew Ellman, Robert McLean (CT Chapter Governor), Amenuve Bekui, Elizabeth Bekui, Anamaria Apoltan, Pacey Pet,Temitope Imevbore, Peter Dixon and Joseph Lim

2010 Convocation Names


ACP Mission and Goals

ACP Mission: To enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

ACP Goals:
I. To establish and promote the highest clinical standards and ethical ideals;
II. To be the foremost comprehensive education and information resource for all internists;
III. To advocate responsible positions on individual health and on public policy relating to health care for the benefit of the public, our patients, the medical profession, and our members;
IV. To serve the professional needs of the membership, support healthy lives for physicians, and advance internal medicine as a career;
V. To promote and conduct research to enhance the quality of practice, the education and continuing education of internists, and the attractiveness of internal medicine to physicians and the public.
VI. To recognize excellence and distinguished contributions to internal medicine; and
VII. To unify the many voices of internal medicine and its subspecialties for the benefit of our patients, our members, and our profession.


The Value of ACP Membership

When I ask ACP members why they have joined or remain members of the College, I receive a variety of responses listed below. I find this list helpful in my role as Governor representing our chapter at the national level and representing the ACP and internists locally.

  • Strength in numbers
  • Make a difference in the life of the internist
  • Validates professional identity
  • Supports growth of our profession
  • Learn & grow from friendly professional exchange with others who share common purpose
  • Nobility in supporting our profession and good patient care
  • Represents the ideals & professionalism – for the greater good and not just self
  • Support legislative and regulatory ends
  • Access to resources & health policy information
  • Personal contacts
  • Voice in healthcare policy
  • Be member of professional association
  • Group term life insurance
  • Involved in organized medicine
  • Mechanism for reform
  • Strong support for joining from a role mode
  • Joined as a resident, with goal to become Fellow
  • Be involved in changing policy
  • Professionalism
  • Respect goals of ACP and those goals align with my own
  • There is truly strength in numbers with the ACP now about 130,000 nationally, the largest medical specialty society in the country (only AMA is larger). But many internists are not ACP members (in Connecticut, only 40% of internists are ACP members!) yet still benefit from the strong advocacy work done by the College. No physician organization works harder in trying to keep cognitive physician services reimbursed adequately (Evaluation & Management billing codes) than the ACP nor has the policy development underlying its advocacy efforts. I urge you to reach out to non-member internist colleagues to become ACP members, and through the “Recruit-a-Colleague” program , you can get yourself some dues reduction to reward your efforts! Our local chapter’s membership efforts are being spearheaded by David Miner from Middletown, with assistance from our Diversity Committee chairmen Joshua San Vicente and Naseema B. Merchant. Please contact them if you are interested in helping with this important effort.


    New Fellows - Past 6 Months
    Our Chapter membership has grown to 2118 members as of June 30. Congratulations to the following new Fellows:

    Rebecca A. Andrews, MD FACP
    David A. Baggish, MD FACP
    Peter S. Dixon, MD FACP
    Sanjay Fernando, MD FACP
    John D. Fisher, MD FACP
    Cary P. Gross MD FACP
    Ashan Manohar MD FACP
    Wajahat Mehal MD FACP
    Pinar Oray-Schrom MD FACP
    Vincent James Quagliarello MD FACP
    Joshua G. San Vicente MD FACP
    Lisa Sanders MD FACP
    Sachin S. Sule MD FACP
    Jeanette M. Tetrault MD FACP
    Daniel G. Tobin MD FACP
    Keith vom Eigen MD FACP


    New Members - Past 6 Months
    Congratulations to the following new Members:

    Olumuyiwa O. Adeboye MBBS
    Fatima Ajaz MD
    Anil Nair MD
    Pia Marie E Ajero MD
    Mujahed M. Alikhan MD
    Oluremi A. Aliyu MD
    Rina Ayepah MBchB
    Sudeep Bansal MBBS
    Kevin M. Baran MD
    Cedric Benson MD
    Anat Bergner MD
    Lana C. Brenes MD
    Viviane M. Bunin MD
    Andrei Cepol MD
    John J. Chang MD
    Cristian Nicu Chetie MD
    Irfan S. Chughtal
    Anne Mae B. Climaco MD
    Nichole M. Corry MD
    Daniel Cotrell
    SzeHoay Ding MBchB
    Rupert Dogbey MBchB
    Adiba A. Geeti MBBS
    Catherine Leadon Giordano MD
    April Gotter DO
    B M Pampana Gowd MD MRCP
    Ankur Ved Gupta MD
    Anne M. Hyson MD
    Farhan Ibrahimi MD
    Deanna L. Kasperski MD
    Jayakrishnan A. Krishnakurup MBBS
    Christopher S. Luthi MD
    Kathleen F. Maurer MD
    Jocelyn D. Maw MD
    Giles McNeill DO
    Carrie A. Mihordin DO
    Dana Murphy MD
    Steven A. Murphy MD
    Snehal Naik MD
    Nava Nasr MD
    Leenhapong Navaravong MD
    Chinyelu E. Oraedu MBBS
    Maria Minamahal C Patino MD
    Nipaporn Pichetshote MD
    Raymond Raut MD
    Mario Rodenas MD
    Ingrid Salcedo MD
    Rolando R. Santos MD
    Sharad Sathyan MD
    Nidhi Shan MD MPH
    Naveed Raza Sheikh BSC MBBS MD
    Hanna B. Slim MD
    Sandra A. Springer MD
    Sudeep Kumar Thumma MBBS
    Brian A. Timko MD
    Sandeep B. Varma MD
    Gregory Vornovitsky MD
    Benjamin Yeboah MBchB


    CT Chapter ACP Governor's Council

    As the Governor of the ACP Chapter, I serve as the coordinator of our various activities, the liaison to the national ACP, and ambassador of sorts. A great deal of work is performed by the members of our chapter listed below who serve in various roles on my Governor’s Council and our invaluable Executive Secretary, Nancy Sullivan. I express my gratitude to all of them for helping make our chapter function so well, and I encourage any chapter members with specific areas of interest to contact the appropriate personnel to start to get more involved.

    George G. Abdelsayed MD FACP
    Rebecca A. Andrews MD FACP - Co-Chair, Young Physicians Committee
    Steven V. Angus MD FACP - Treasurer/Secretary
    Joseph P. Cleary MD MACP - Co-Chair Awards/ Nominations Committee
    John F. D’Avella MD FACP
    Rosemarie L. Fisher MD FACP
    Claudia B. Gruss MD FACP
    Eric M. Mazur MD FACP - Co-Chair, Awards/ Nominations Committee
    Robert M. McLean MD FACP - Governor
    Naseema B. Merchant MBBS FACP - Co-Chair, Diversity Committee
    Joshua G. San Vicente MD FACP - Co-Chair, Diversity Committee
    David J. Miner MD FACP - Chair, Membership Committee
    Robert J. Nardino MD FACP - Chair, Chapter Meeting Program Committee
    Stephen O’Mahony MD - Health Information Technology Liaison
    Jason Ouellette MD FACP - Co-Chair, Associates Committee
    Fitzhugh C. Pannill III MD FACP - Medicare Carrier Advisory Committee Liaison
    Walid Labib Shaib MD - Chief Resident/ Associates Chair
    Adam R. Silverman, MD FACP - Co-Chair, Associates Committee
    Jeanette M. Tetrault MD FACP - Co-Chair, Young Physicians Committee
    Keith vom Eigen MD FACP - Chair, Health & Public Policy Comm.
    Ruth E. Weissberger MD
    Barry J Wu MD FACP - Chair, Medical Students Committee
    Nancy L. Sullivan - Executive Secretary


    Associates Council

    Associates will once again have the opportunity to present their research and clinical vignettes at our annual chapter meeting on November 12. Residents must submit abstracts to residency program directors by the deadline provided by the program.

    The “Chief” Associate this year leading our Associate Council is Walid Shaib, a chief resident at the Hospital of St. Raphael. The Associates Council has typically consisted of chief residents from around the state, but we welcome the involvement of any associates interested in getting involved more with our ACP activities.

    In addition to the abstract competition in November, we will once again conduct the “Medical Jeopardy” competition between residency program teams, with the winning team having the honor (and responsibility) of representing our chapter at the national “Doctor’s Dilemma” competition at the ACP national meeting next April in San Diego. Date and location for the Medical Jeopardy competition will be announced in the near future.

    This Fall, Adam Silverman will be stepping down as the Chairman of Associate activities, and Jason Ouellette will be taking over this position. We thank Dr. Silverman for the several years of wonderful leadership and hard work he contributed to our chapter in coordinating our Associate activities.


    Medical Student Committee - submitted by Barry J. Wu, MD, FACP

    This year 10 of 75 (13%) students from the University of Connecticut and 22 of 108 (20%) students from Yale University School of Medicine matched in internal medicine.

    The ACP Internal Medicine Award with $500 was established in 1999 to a medical student matching to an internal medicine residency program in Connecticut. This year the award was given to Sudipa Sarkar, MD from Yale University School of Medicine, who will be doing her categorical internal medicine training at Yale-New Haven Hospital.

    We are thankful for the student leadership of Bryan Piccirillo from the University of Connecticut and Samir Guatam and Sameer Sheth from Yale School of Medicine this past academic year. We look forward to Teresa Doucet from the University of Connecticut and Hao Feng and Samir Zaidi from Yale School of Medicine joining us on the council and their new ideas and contributio


    Health and Public Policy Committee Report - submitted by Keith von Eigen, MD, FACP

    The national health reform act, known as PPACA was passed by Congress and signed by the President on March 23, 2010. As reported previously, the provisions of PPACA contain a number of policies that were supported by ACP. This is the result ongoing ACP advocacy and its evidence-based, patient-centered approach to formulating and promoting policies. Now that it has passed, our advocacy efforts have shifted to convincing legislators to fund the various initiatives as they were intended in the act, and to encourage regulatory and administrative bodies to implement them effectively. (See Annals of Internal Medicine, 152:679-82 for a good summary by Bob Doherty of the key elements of PPACA)

    Several Chapter members (Rebecca Andrews, Steve Angus, George Abdelsayed, Keith vom Eigen, Rob McLean) traveled to Washington DC for ACP Leadership Day on May 18-19. The delegation met with Congressmen Murphy, Himes and Courtney, and with staffers of Congressmen Larson and DeLauro and Senators Lieberman and Dodd. Overall we had a successful day in educating the legislators and their staffs regarding crucial funding issues for high priority elements of the reform legislation. The Connecticut delegation is generally very supportive of ACP’s recommendations regarding health reform, and would like to see the reform legislation succeed in providing better access to affordable, high quality health care.

    The elements of the reform act that will take effect this year include extending family health coverage eligibility to children up to age 26, and the creation of state high risk pools to expand coverage to those having difficulty finding insurance prior to implementation of health insurance exchanges.

    On the State level, we have been working closely with CSMS to identify legislation that might affect our members and patients, and to advocate for ACP’s positions when they are relevant to proposed legislation. Some of the key legislation that CSMS focused on during the latest session includes laws related to medical liability, temporary licensing for out-of-state volunteers, protections for student athletes with concussions, oral chemotherapy coverage, and contracting transparency. (See the CSMS website for details).

    Claudia Gruss and I have been serving on the Specialty Society Advisory Committee to the CSMS Legislative Committee. This committee has been focusing particularly on scope of practice issues regarding non-physicians who have been working to expand their practice into areas traditionally limited to physicians. This has included opposing legislation that would allow this expansion in the state, as well as calling attention to situations in which unauthorized practice is already occurring. CSMS may ask ACP to get involved in creating a database to document reports of unauthorized practice when it occurs, as the state Department of Public Health doesn’t have the resources to police this effectively.

    Our chapter has been represented by Robert McLean and myself in the Primary Care Coalition of CT (PCCC), a consortium of Connecticut groups whose mission is to promote primary care in the state. ACP is playing a key role in promoting the testing and adoption of medical home models of practice, and provides some useful tools such as the Medical Home Builder to help physicians work towards NCQA Medical Home certification. The PCCC has been discussing the possibility of putting together a multipayer Medical Home demonstration project in CT, as several other New England states have already been doing. The problem in CT has been a lack of leadership from the state health agencies, and the executive branch. CT is the only New England state not participating in a proposed regional Medicare Medical Home demonstration project. So we have a long way to go in this regard. But we feel our involvement in the PCCC is a good way for ACP to play a role in the Medical Home process as it plays out in our state.

    The Medical Home model is also a key part of the Sustinet plan for state health care that ACP supported. The Sustinet Plan is currently being developed with several advisory subcommittees currently discussing various elements of the plan. Several ACP members are serving on these subcommittees, and one member (Bruce Gould) is on the governing committee. The Medical Home subcommittee on which I and other members serve, has highlighted the ACP Medical Home Builder as an important tool for helping practices achieve accreditation.

    2010 Leadership Day
    Leadership Day: Rep. Chris Murphy, Drs. Rebecca Andrews, Keith vom Eigen, George Abdelsayed, Steve Angus, Robert McLean and Rep. Jim Himes

    2010 Leadership Day
    Leadership Day: Drs. George Abdelsayed, Keith vom Eigen, Rep. Joseph Courtney, Drs. Rebecca Andrews, Robert McLean and Steve Angus


    Electronic Health Records: looking for guidance? - submitted by Stephen O'Mahoney, MD, CT ACP Chapter liaision to the local Regional Extension Center

    There are two exciting resources available to Connecticut practitioners interested in implementing an Electronic Health Record (EHR) system: e-HealthCT and American EHR Partners.

    E-HealthCT is a Regional Extension Center (REC) supported by a governmental grant to help Connecticut’s providers select, implement, and achieve meaningful use EHR systems in order to enhance health care quality, safety and efficiency. For a small fee, e-HealthCT will subsidize and arrange expert technical assistance and consultation for individual providers and groups.

    This will include:

    • Education
    • EHR Vendor Selection
    • Implementation Support
    • Practice Workflow Design
    • Quality Improvement
    • Meaningful Use Achievement
    • Privacy and Security, Health Information Exchange

    AmericanEHR Partners is a coalition between the ACP and Cientis technology that provides free access to tools necessary to identify, implement and effectively use EHRs. AmericanEHR achieves this through identifying EHR Vendor capabilities, posting verified user ratings, and allowing side by side comparisons on their website.

    Although complementary to eHealthCT and also unbiased, AmericanEHR Partners do not provide a practice with individualized consultative services to recommend an EHR. Their goal is to provide the data necessary for informed decisions.

    More information can be obtained on their websites at www.ehealthconnecticut.org and www.americanehr.com.


    Local Medicare Issues from Medicare Carrier Advisory Committee - submitted by Fitzhugh Pannill, MD, FACP, CT ACP Chapter liaision to Medicare CAC

    National Government Services (NGS) held its quarterly CAC meeting in early June to discuss a number of issues. Several Local Medical determinations were reviewed about colonoscopy and other specialty procedures.

    The issue of most concern to ACP was the audit of high level nursing home codes 99310 that NGS has done. In the NY/CT region there were 1300 99310s A DAY. Only 15 to 20% were properly documented and the rest were down-coded, if NGS received a copy of the notes. About 40% of MDs didn’t even bother to reply to the request for documentation. Other members pointed out the absurdity of the documentation requirements for nursing home patients (how do you do an 11-point ROS in a demented patient?).

    I raised the concern that if physicians can’t be sure they will be paid for complex, usually emergency visits to a nursing home, many of them will just say “Send the patient to the ER” where the costs will be far higher. The argument did not seem to carry much weight. NGS said their hands were tied, as the documentation standards are established by CMS. They welcomed any efforts by professional organizations to change these requirements. (this is their stance on most issues...they are only doing what CMS mandates).

    I think ACP has a huge stake here, along with AAFP and the Medical Directors association. I would like to see if we can generate some national interest in 1) changing the documentation requirements and 2) monitoring the utilization of ER visits as these codes are not paid for.

    Please contact me if there are issues you would like me to address with the local Medicare carrier.


    Young Physicians Council

    We will again this year plan several social events around the state for purposes of local networking and learning more about the ACP (advancement to Fellowship, advocacy issues, etc). We are planning a wine tasting social networking event on September 30 in West Hartford. Please see the web site for details.

    This year we are hosting the “Tri-State Young Physician Abstract Competition” at our chapter meeting on November 12, open to young physicians from Connecticut, New York, and New Jersey. See details on the chapter web site.

    A reminder to recently “graduated” medical residents that you are now transitioning out of Associate status to regular Members. You are considered a “Young Physician” if it’s 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 Rebecca Andrews or Jeanette Tetrault for further information.


    Save the Date: 2010 ACP Connecticut Chapter Scientific Meeting

    Date: November 12, 2010
    Location: Aqua Turf Club, Southington, Connecticut
    For more information, please see the Program Brochure and Registration Form


    Why and How the ACP is an important voice in the health policy arena - See these ACP Policy Papers from the Past 2 Years

    • Racial and Ethnic Disparities in Health Care, Updated 2010, ACP Policy Paper (July 2010, update)
    • Tobacco Control and Prevention (May 2010)
    • Internists and Physicians Assistants: Team-Based Primary Care (May 2010)
    • ACP Policy Positions on the Development of Accountable Care Organizations (April 2010)
    • EHR – Based Quality Measurement & Reporting: Critical for Meaningful Use and Health Care Improvement (April 2010)
    • State of the Nation’s Health Care 2010: The Declining State of the Nation’s Health Care (February 2010)
    • Improving FDA Regulation of Prescription Drugs (September 2009)
    • Controlling Health Care Costs While Promoting The Best Possible Health Outcomes (September 2009)
    • Individual Mandates in Health Insurance Reform (August 2009)
    • Reforming the Tax Exclusion for Health Insurance (August 2009)
    • A Public Plan Option in a Health Insurance Connector (August 2009)
    • Reforming Physician Payments to Achieve Greater Value in Health Care Spending (July 2009)
    • Health Information Technology & Privacy (April 2009)
    • Solutions to the Challenges Facing Primary Care Medicine (April 2009)
    • Comprehensive Payment Reform Position Paper: Reforming Physician Payments to Achieve Greater Value in Health Care Spending (April 2009)
    • HIV Policy: The Path Forward; a Joint Statement of ACP and the HIV Medicine Association (April 2009)
    • Nurse Practitioners in Primary Care (February 2009)
    • State of the Nation’s Health Care 2009: Assuring universal access to health coverage and primary care (February 2009)
    • How is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care? (November 2008)
    • The Role of International Medical Graduates in the U.S. Physician Workforce (September 2008)

    Page updated: 10/1/10

    Contact Information

    Robert Nardino, MD, FACP
    ACP Governor, Connecticut Chapter

    Nancy Sullivan
    30 Dwight Drive, Middlefield, CT 06455
    Phone: (860) 349-8995
    Fax: (860) 349-3004 or
    E-mail: ctacp@comcast.net

    Visit the CT Chapter Blog