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July 2011 John H. O'Neill, Jr., DO, FACP, ACP Governor


From the Governor

Dr. O'Neill

It seems unfair to me that the Summer gets a little shorter every year. We’re a few days into the season and already, I’m looking at the months of August and September with regard to meetings, webinars, weekends on call, a son starting college, and my perception is: Summer is nearly over. I hope that you are planning some vacation, or at least down time, to refresh and recharge. We dedicate a lot of time and effort to the care of our patients, to our profession, to our communities, and that comes at the expense of time with our families and other interests. My family has a love for the Jersey Shore (not the TV show!) that is deeply engrained in our DNA from our childhoods. As I cross the DE Memorial Bridge this weekend, I will feel the wave of relaxation and peace that portend my destination. But, before I do, let me bring you up to date on the activities and opportunities of our DE Chapter and ACP.

I have attempted to have a theme in most of my newsletters. This time, I would like to point out some special benefits of membership in ACP. When we write a professional membership organization dues check each year that begins 3 spaces to the left of the decimal point, it is reasonable to pause and consider the value of this investment. ACP is aware of the perception of its membership about value and regularly reevaluates its programs and services with regard to their relevance. Recently, the college has consolidated its array of membership benefits in an Interactive Benefits Guide: . This tool allows ACP members to drill down into the programs and services available to them, from one convenient and well-organized starting point. In some ways, this dashboard may be easier to use than the website itself, which is rich in its content.

As more internists are required to recertify with ABIM or its subspecialty boards every 10 years, ACP has looked to how it can partner with ABIM to make the maintenance of certification (MOC) process of highest value for its members with regard to content, the learning experience, convenience, and CME credit. Personally, as a member of the 1990 ‘inaugural’ resident class that is required to recertify, I have found the MOC process to be a good source of online CME credits. It is easy to use, ACP members can use free online, evidence-based information sources to assist with the completion of the knowledge-based modules, the tests are scored immediately, and you can print down CME certificates right away. The ABIM has also approved the use of ACP’s MKSAP for the recertification/MOC process. Please see details on how this works. In addition, some of ACP’s practice-based Quality Improvement Programs can be used for credit on the MOC’s practice improvement (PIM) module, as well as for some insurers’ (eg. Aetna/diabetes) physician payment incentive programs.

Advocacy is a word that is thrown around quite a bit. We advocate on behalf of out patients on a daily basis to get them the necessary medical care that they require. In the context of ACP, advocacy refers to efforts by the college on behalf of its members to help us improve the care of our patients, to keep us up to date on regulatory issues from government and third party payers that affect our practices, and to interact with governmental agencies (particularly CMS) in a bidirectional fashion with the goal of improving the practice and physician payment environment. ACP supported the Patient Protection and Accountable Care Act of 2010, in part because it was consistent with college policy of increasing health insurance coverage and access to care of all American citizens, and has provided important information to patients [PDF] and physicians. [PDF] regarding the content of that legislation and how it really affects us, without political spin.

The college’s national policy and technical advisory committees are many, and are populated by practicing physicans and national experts on specific subject areas. They address issues important to physicians and their patients that are identified through multiple sources, including the Board of Governors Resolution Process, which reflects the efforts of the ACP Chapters and the membership. The Health and Public Policy Committee (HPPC) has been the source of many recent and important college policy papers and there is a compendium of these available to members on the college’s website. This committee, along with the MPQC (below) were responsible recently for providing guidance to the House Energy and Commerce Sub-Committee regarding "Moving beyond the SGR"[PDF] in reforming physician payment via medicare.

The Medical Practice and Quality Committee (MPQC, formerly MSC) works with the college’s Regulatory and Insurance Affairs Division at the college’s Washington, DC office, on a broad range of topics including the recent development of ACO’s (see the college’s new informational webpage for members on ACO’s), coding and reimbursement issues, physician performance measurement and professional accountability, furthering the development of the Patient Centered Medical Home (PCMH), encouraging and enhancing the adoption of EHR technology by physician practices, and the development of a national HIT infrastructure. I have had the privilege to serve on MPQC for the past 15 months, and I can’t overemphasize the importance of the committee’s efforts with regard to the work day of the practicing internist.

ACP is well known for its flagship publication, Annals of Internal Medicine, and it is worth noting that Annals content is available to ACP members, both in print and also electronic format online at www.annals.org . CME credit is available to Annals readers who complete the biweekly process, and also via the In the Clinic feature which is published monthly, alternating with the ACP Journal Club feature. Under the editorial leadership of Christine Laine, M.D., FACP, Annals has continued to innovate in improving its online content and making it relevant to the needs of physicians.

The ACP Foundation is an underutilized source of wonderful patient education information materials and health literacy resources. The Health Tips pads on numerous important health topics are available to ACP members free of charge, for their use in patient care. The wonderful patient education monograph, “Living With Diabetes”, is also available for free to members periodically, and similar health guides have been developed regarding COPD and Heart Disease. There is also a handout for patients regarding Adult Immunizations, again, free to ACP members. Please take the time to explore these pearls on the Foundation’s website!

As before, I have asked some of our colleagues who are involved in the chapter leadership to write a piece for the newsletter regarding their thoughts and involvement in recent chapter activities. I thank them for their thoughtful contributions as, clearly, they were pressed into service!

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February 2011 Annual Scientific Meeting, Delaware Chapter ACP

S. Rani Singh-Patel, D.O., FACP, Program Chair

The Delaware Chapter enjoyed a very successful regional ACP meeting this year on February 26th, 2011. We had the largest number of participants in years, with 106 attendees. The venue was the same as in past years, Clayton Hall at the University of Delaware, whose service was excellent with regard to the facility, the food, and audio/visual assistance. We opted to be in one room with ample space to walk around where all the lectures were held and lunch was served to foster a more casual but interactive atmosphere. The speakers were very well received. The program was started with a warm welcome by our Governor John O’Neill Jr., DO, FACP followed by bread and butter cases by Michael Teixido, MD, Associate Chief in Department of Otolaryngology/Head and Neck Surgery at Jefferson Medical College and Director of the Balance and Mobility Center at Christiana Care, who did an excellent job with using technology to increase our knowledge on anatomy and how to diagnose and treat patients with dizziness/vertigo.

The other morning speakers included Daniel Hussar, PhD, Remington Professor of Pharmacy, from the Philadelphia College of Pharmacy, who discussed “New Drugs in 2011”, and Matthew Keller, MD, Cinical Instructor in Dermatology at Thomas Jefferson University, who talked about “Common Dermatological Diagnoses in the Primary Care Office.” For the afternoon shift, we heard from Glenn J. Treisman, MD, Professor of Behavioral Sciences and Internal Medicine, and Director of the AIDS Psychiatry Service at Johns Hopkins, who gave an excellent lecture on the “Limitations of Evidence Based Medicine.” Our lunch time talk was done by David Brendel, MD, PhD, Assistant Professor in Psychiatry from McLean Hospital, Massachusetts, who conducted an interesting discussion about “Internet Boundaries for Physicians” using social networking sites.

We were very lucky to have such an enthusiastic participation from local residents and medical students. This year’s resident abstract winner was Amratash Malodiya, MD, who gave us his presentation “Palms that Unraveled an Occult Carcinoma.” We had several abstracts turned in, 10 poster presentations from Christiana Care internal medicine residents, as well as 10 posters from students who completed a medicine rotation at Christiana Care. These residents were mentored by several attendings in the Department of Medicine who helped with the development of these scholarly activities, especially Marci Drees, M.D., FACP. The students were mentored by Neeta Milasincic, M.D., FACP, who did a fantastic job at getting them involved early in their career. We’d like to offer a special thank you to Allen Friedland, M.D., FACP for his help and guidance with the students and residents. The student poster winners are as follows: Kathy Tran (first place), Stephanie Elysia Howe (second place), and Deepa Gosine and Mohammed Kaleel (tied for third). The resident poster winners are as follows: Kelly Billig-Figura, M.D. was the overall winner, Andi Read, M.D. (2nd place), Billy Chasanov, M.D. (3rd place), and Kathy McGill, M.D. received Honorable mention. We were so proud of the resident and student involvement that the Delaware chapter sponsored several people to present at the National ACP Internal Medicine 2011 Conference in San Diego. Nils Brolis was a podium presenter. Amratash Malodiya, Kelly Billig-Figura, Maureen Spring, David Chen, Michael Daniels, and Shweta Arakali all had poster presentations.

Overall feedback regarding our Annual Scientific Meeting was very positive and it was a very well run conference. I would like to offer my personal thanks to the program planning committee who did a wonderful job, and also to the administrative staff, headed by Debbie Brown and including Paula Barnes, Jeannette Wade, and Cindy Chuidian for making sure every detail was taken care of, and the day ran smoothly.

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ACP Leadership Day 2011

Dan Elliott, M.D., FACP, Chair, Health and Public Policy, Delaware Chapter

We had a highly successful Leadership Day again this year. I was pleased to be joined in our delegation this year by Brad Slease, M.D., FACP, Debbi Zarek, M.D., FACP, Henry Weiner, M.D., FACC, Jessica White, M.D. (resident) and Giovanna Uzelac, M.D. (student). I must admit it is great to go to Washington to advocate for improvements in our health care system -- many of which center around strengthening our primary care infrastructure -- with a hematologist and electro-physiologist helping to lead the charge! Debbi spoke clearly to the issues surrounding owning and operating a primary care internal medicine practice in today’s environment, with emphasis on the fiscal realities of making the transition to a modern medical home. We always try to bring a resident and student, so it was great to have Jessica, a PGY-3 Internal Medicine Resident at Christiana, and Giovanna, who was at the time a fourth year medical student at Jefferson, poised to begin her internship in Internal Medicine-Pediatrics at Christiana.

Delaware Delagation
The Delaware Delegation poses with Representative John Carney on Leadership Day, 2011

If you follow any news that comes from within the Beltway you are familiar with the message we heard at Leadership Day this year: “there is no more money.” The tides have changed dramatically and the emphasis now is clearly on extracting value from every dollar spent on health care. The tone was remarkably positive – dare I say optimistic – at the thought of restructuring our system to serve our patients more efficiently and in a manner that makes our lives as physicians more enjoyable and effective. The jury will be out for at least the next few years, but seeing investments in infrastructure redesign and realignment of incentives for both physicians and patients has promise.

Our focus this year was on ensuring that previous gains do not erode in the setting of intensely partisan politics. We focused primarily on three areas:

  1. Eliminating the Sustainable Growth Rate (SGR). As many of you know, the SGR as structured will result in a nearly 30% cut in Medicare payments to physicians on January 1, 2012. We advocated for elimination of SGR with a five-year period of stable payment updates during which time pilot programs for payment reform can be implemented and evaluated.
  2. Ensuring sufficient funding for high-priority discretionary and mandatory components within the Affordable Care Act passed in 2010. Namely, we advocated for a) funding of Title VII primary care educational and clinical programs and the National Health Service Corps as mechanisms for improving the supply of primary care physicians who are well-prepared to provide high quality primary medical care; b) maintaining the 10% increased payment for E&M codes for primary care physicians through 2015; and c) the support of the Center for Medicaid and Medicare Innovation (CMMI) and the Patient-Centered Outcomes Research Institute (PCORI). The CMMI and PCORI hold the promise of supporting innovative financing and structural programs that have the strong potential to improve clinical outcomes and reduce cost.
  3. This includes national pilots of Medical Home practice structures.
  4. Continuing reforms to improve the Affordable Care Act. We focused specifically on increasing state flexibility to modify the implementation of Affordable Care Act provisions like the health insurance exchange and restructuring of Medicaid programs. Finally, we advocated for malpractice reform to reduce the costs of defensive medicine, specifically supporting innovations such as health courts.

The passage of the Affordable Care Act in 2010 was a major milestone in restructuring health care delivery system. The ACP remains committed to improving the system for both patients and physicians, and we were pleased to advocate for maintenance of gains along with ongoing reform of key provisions. With the climate in Washington the way it is, our continued advocacy is crucial to realizing the progress that we seek. I encourage you all to become Key Contacts within the ACP. By signing up, you can stay up-to-date on key issues and lend your voice over the coming years.

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From our Governor-elect…

Dr. Slease

R. Bradley Slease, M.D., FACP
Bslease@dclp.com

When John O’Neill asked me to write an article for this issue of the Newsletter, several ideas came to mind, but one in particular merits attention: EHRs. Since this is a time of rapid change for Internal Medicine and its subspecialties, a certain amount of turmoil seems inevitable, especially with the mandated conversion to electronic records. Although some have made the conversion, others, like our small hematology group, are in the process of doing so.

Let me share with you my thoughts about EHRs. First, I understand and applaud the goals and eventual advantages of EHR’s over our current paper record system. Sadly, though, many of those goals, such as broad connectivity and actual improvement in patient care, have yet to be realized. With multiple EHR vendors marketing their products, instant information access between providers will not likely happen anytime soon. Nevertheless, government timelines for conversion are short in order to avoid Medicare/Medicaid compensation penalties.

Costs for these systems, both upfront and ongoing, are alarming. In fact, it seems that the vendors have increased their charges in light of the stimulus money allocated to physicians to facilitate conversion. While there will be some transcription savings eventually, net practice costs will likely be higher. So, what can we do in our own practices to develop the best EHR system possible?

No matter the size or complexion of the medical group, we should keep in mind that Internal Medicine is both art and science; it’s about developing patient relationships and evaluating the “grays”, rather than just the “blacks and whites” of our patients’ medical lives. It has been said that 90% of diagnoses were made with the History of Present Illness. One might argue with the figures, but the point remains valid: medical records must accurately reflect the historical subtleties that led to our diagnostic conclusions. The very seductive aspect of point-and-click EHRs just might sacrifice a crucial part of the language that conveys real medical information. Therefore, let us take care to keep the best features of the old records system when we convert to EHRs. We should not allow an oversimplification of electronic records to result in merely “financial notes”, with regurgitation of boilerplate verbiage and little or no meaningful content.

As I have stated before, I feel honored to have been selected as the next Governor for the Delaware ACP Chapter. I accept this challenge in times that are both exciting and daunting, and hope to learn from John and others in the ACP leadership over the next year. I welcome your thoughts on these and other matters.

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Delaware Chapter News

New Members: Delaware Chapter congratulates the following 13 new members who have joined ACP over the past 6 months:

Paul J. Alfieri, MD, Newark
Anthony D. Alfieri, DO, Newark
William M. Chasanov, II, DO, Wilmington
Joseph M. Deutsch, MD, Wilmington
Tricia Elizabeth Downing, MD, MS, Dover
Nancy Fleurancois, MD, Wilmington
Sarah L. McTighe, DO, Wilmington
Elizabeth H. Muth, MD, Wilmington
Anna Patkowska, MD, Magnolia
Lakshminarayana Potakamuri, MBBS, Newark
Bijan K. Sorouri, MD, Newark
Erin E. Watson, MD, Newark
Henry Weiner, MD, Newark

New Fellows: Delaware Chapter welcomes the following new Fellows who were elected over the past 6 months:

Ajike Ogunsulire Etumadu, MBB, FACP, Wilmington
Jason T. Nomura, MD, FACP, New Castle

Awards: On Friday evening, February 25th, our chapter’s annual awards and speakers reception was held at the Greenville Country Club. This is a festive occasion on the eve of our Annual Scientific Meeting, and we honored the following physicians with DE Chapter Awards:

Laureate Award: J. Ted Kestner, M.D., FACP

Dr. Kestner
Dr. Kestner

The Laureate Award is given annually to a physician, a Master or Fellow of the College, who has made significant contributions to their medical community, to ACP and their Chapter. It is the most esteemed award offered by ACP Chapters each year.

Leonard Lang Award: M. James Lenhard, M.D., FACP

The Leonard Lang Award is given annually to a chapter member who exemplifies the outstanding internist, with attributes of clinical excellence in patient care, medical education, medical leadership, or research, in memory of Leonard Lang, M.D., FACP.

Excellence in Hospital Medicine Award: James Ruether, M.D., FACP

This award is given by the chapter every other year (starting in 2009) and recognizes clinical excellence in Hospital Medicine, an important emerging career for many internists.

Parag Bakshi International Medicine Fellowship: Elizabeth Kunkel, D.O. (Papua, New Guinea)

Each year the DE Chapter sponsors and provides financial support for 1-3 resident physicians who attend a 1 month rotation in a developing country. They participate in a medical clinic, hospital or emergency care facility and provide care as a part of a team, to local inhabitants. This is a wonderful and unforgettable experience for the participants. They also have the privilege of making a presentation about their experience at the awards reception. Residents who are interested in applying for this experience can do so by contacting Dr. John O’Neill, or Dr. Brian Aboff. The chapter’s International Medicine Committee is available to help interested residents in choosing a destination for their rotation and making contacts.

Resident Journal Club: each year the DE Chapter sponsors a Journal Club at a local venue, where residents, faculty, and other chapter members can review and consider important aspects of unique topics, as part of their educational experience. On March, we sponsored a journal club at the Washington Ale House in their private room. The articles presented were from the health policy arena, and the discussion was lively, moderated by Dr. Dan Elliott.

Council of Young Physicians (CVP) Event: on Tuesday July 19th, at 6:30 pm, our CYP is hosting a social event at Buckley’s Tavern in Centerville, in which the guest speaker is DE State Attorney General, Beau Biden. He will be speaking on topics pertinent to Delaware physicians.

Health Literacy Project: this is an ongoing project of the chapter in which tri-fold medication list cards have been produced and are distributed in packets of 200 to interested physicians who would like to use these cards to improve medication reconciliation for their patients and to help distinguish between the brand and generic names of their medications. There is also an exam room poster to catch the interest of patients. The chapter has obtained funding for this project through a grant from the ACP Foundation. If you are interested in obtaining a new supply of these cards or joining the project, please send an email request to Dr. John O’Neill .

13th Annual Lower Shores Symposium: please plan to join us in beautiful Rehoboth Beach on Saturday, October 15th for the 13th Annual Lower Shores Symposium, hosted by Mansour Saberi, M.D., MACP and Bandu Palekhar, M.D., FACP. This CME event will be held at the Boardwalk Plaza Hotel from 7:30 am to 3 pm, and there is an evening dinner lecture at the Hotel as well. Check out the program:

8 am- “Emerging Infectious Diseases – Why Now?”, Herbert DuPont, MD, MACP

9am- “Non-operative Management of Patients with Coronary Artery and Valvular Heart Disease”, Kenneth Kent, MD

10:30 am- “What does the General Internist Need to Know about Chronic Kidney Disease”, Jeffrey Berns, MD

11:30 am- Lunch

12:30 pm- “Update on Diabetes, 2011Barry Goldstein, MD, PhD, FACE

1:30 pm- “Soft Tissue Infections – Diagnosis and Treatment”, Herbert DuPont, MD, MACP

6:00 pm- Dinner

7:30 pm- “Emerging Therapies in the Treatment and Prevention of Venous Thromboembolism”, Scott Hall, MD

Please mark your calendar for the event. We will be reminding you about registration later in the summer.

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Call for Resolutions for the Spring 2012 Board of Governors Meeting

Are you concerned about a practice or clinical issue or have an idea you'd like to suggest? If so, you might consider submitting a resolution to your Governor or chapter council.

Initiating a resolution provides ACP members an opportunity to focus attention at the ACP national level on a particular issue or topic that concerns them. Participating in the Board of Governors resolutions process provides the ACP grassroots member a voice and allows you to shape College policy that impacts the practice of internal medicine. When drafting a resolution, don't forget to consider how well it fits within ACP's Mission and Goals. In addition, be sure to use the College's Strategic Plan to guide you when proposing a resolution topic.

If effecting change interests you, the deadline for submitting new resolutions to be heard at the Spring 2012 Board of Governors Meeting is October 17, 2011. Members must submit resolutions to their Governor and/or chapter council. A resolution becomes a resolution of the chapter once the chapter council approves it.

Not sure how to begin drafting a resolution? Researching the College's position on an issue can give you a start. Visit the ACP Online homepage and click the "Advocacy" link in the right-hand, top margin to access ACP policy positions, read about recent ACP advocacy activities, or search the ACP's Public Policy Virtual Library (PPVL). Visit your chapter website, too, and click the link under "Advocacy" to access Electronic Resolutions System (ERS) where you can search past or proposed resolutions. A copy of the resolutions process is available on the ERS which furnishes more details on formatting resolutions, as well the process for submission, review, and approval.

Share your good idea with us. Draft a resolution.

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