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July 2013 Richard M. Dupee, MD, FACP, AGSF, Governor


Governor’s Message

Richard M. Dupee, MD, FACP, Governor

Dr. Dupee

From the Trenches

Dear Massachusetts ACP Members and Fellows,

This has been a busy year for medicine, especially as many elements of the Affordable Care Act have been initiated. Virtually every day, there is discussion in newspapers and talk shows regarding its virtues and problems. Nonetheless, it is with us to stay, and hopefully, the glitches in this massive law will be ironed out.

Throughout all of the discussions in Washington, be it the ACA or the SGR, your ACP had been involved, through incredible efforts on the part of our leadership.

Let’s consider what ACP had done for us through its advocacy efforts in the past year, efforts which have made our practice and professional lives significantly better:

  • Medicare will pay you and your staff for the work outside of a face-to-face visit involved with transitioning a patient from the hospital to the community setting—as much as $231.00 for each time you bill for this service under new codes that will be effective on January 1, 2013. Because of this and other changes advocated for by ACP, internists on average will see their Medicare payments increase by 4-5% next year
  • Also, starting on January 1, 2013 and continuing through 2014, Medicaid payments to internists for their evaluation and management services and vaccine administration will be no less than the comparable Medicare rates—a very substantial increase in Medicaid payments in most states. And, as advocated for by ACP, this increase applies to both general internists as well as internal medicine subspecialists—and will include services that are not currently paid for under Medicare, such as the consultation services codes.
  • In addition to the above payment increases, Medicare will continue to pay a 10% bonus to primary care internists, and other primary care physicians, for your office visits and other evaluation and management codes—an average annual increase in Medicare revenue of $8000 per internist over the course of 5 years (from 2011 to 2015).
  • Two additional hardship exemptions from participation in the CMS Electronic Prescribing (e-Rx) Incentive Program will become available for you in 2013 and 2014. Internists or group practices who (1) achieve meaningful use during certain e-Rx payment adjustment reporting periods and/or (2) demonstrate intent to participate in the Electronic Health Record (EHR) Incentive Program and adoption of Certified EHR Technology could be exempted. These exemptions were advocated for by ACP to help align the e-prescribing program with meaningful use and therefore reduce the burden on physicians to participate.
  • Five hundred primary care practices in seven regions will receive substantial increases in Medicare revenue—plus financial and other support services from other payers in their communities—for providing patient-centered, coordinated care. ACP has been actively engaged in advising on this project from its inception. CMS is paying the participating primary care practices a risk adjusted care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries and, when proven to be successful, the Secretary of Health and Human Services has the authority to roll out this payment approach throughout all of fee-for-service Medicare.
  • New national standards for insurance companies will simplify claims payments, allowing internists to spend more time with patients and less time on paperwork. This is due to significant improvement in the way electronic fund transfers are made for health insurance claims—across both public and private payers—and is something ACP has been advocating for over a number of years. Starting in 2014, and in some cases sooner, physician practices and other healthcare entities will receive claim payments electronically, and then be able to automatically match (reassociate) explanations regarding any adjustments to these payments by the health plans with the correct claim.
  • Most internists will have additional time before the Medicare Value-Based Payment Modifier (VBPM) will be applied to your payments. The VBPM is a program within the Affordable Care Act that will affect all physicians' payments starting in 2017 by modifying Medicare fee-for-service reimbursements depending on how well a physician scores on measures of cost and quality of service. ACP strongly advocated for CMS to phase-in the program in a way that will allow CMS to gain experience before applying the VBPM to all physicians in 2017. Therefore, CMS has decided to apply the VBPM to groups of physicians of 100 or more eligible professionals during the first year—instead of their original plan to apply it to practices of 25 or more—noting that this change will help them gain additional experience and be able to produce data to enhance physician acceptance of their methodologies and approach.
  • In addition, CMS will align the VBPM attribution method with the methodology used for the Medicare Shared Savings Program and the Physician Quality Reporting System (PQRS) – something ACP had strongly advocated for. This attribution approach involves a two-step process that emphasizes primary care services furnished by a physician or group of physicians.
  • In fact, due to the ongoing feedback from ACP and others, CMS is working toward significantly greater alignment of program requirements across their quality initiatives, including the e-Rx incentive program, EHR incentive program, Medicare Shared Savings Program, and the VBPM. There is still more work to be done on this front and ACP will continue to push CMS in this direction.
  • Finally, Medicare has initiated an additional means for internists and other physicians to successfully participate in PQRS. This new administrative claims reporting mechanism will be available for PQRS (as well as for the VBPM program) in 2015. ACP had strongly supported this option as it provides a feasible alternative for physicians and groups to participate in the program, particularly if they have not yet been able to effectively use the traditional reporting mechanisms (claims, registries, or electronic health records [EHRs]) for this purpose or have otherwise not been able to meet the criteria for successful reporting for the 2013 and/or 2014 incentives.

When I first became Governor for Massachusetts, I asked our council members to reflect on why they joined ACP. Professionalism, practice support, academic excellence, and advocacy were some of the responses. But I thought I would share with you another response, this from Molly Clark, our new President of the ACP, recently commented on why she became a member of ACP many years ago:

What cemented my relationship with ACP was the unambiguous position the College took early in the AIDS epidemic that physicians have an obligation to care for those whose problems fall within our expertise, our worries and the risk of occupational transmission notwithstanding. This was at a time that is hard for people under 50 to imagine. It was difficult to find pathologists willing to do postmortem exams, and emergency departments routinely put hypoxemic patients in taxi cabs with a canister of oxygen and sent them several hours away to San Francisco General Hospital and other AIDS centers.

And so, ACP advocacy improves the system, and reduce barriers to patient-physician relationship. ACP advocacy is paying off, with big wins for internists in Medicare and Medicaid pay. ACP is the “go to” place for info on policy, advocacy, and practical impact on members.

I am proud to report that this past year saw the addition of 171 new members and associates to our chapter, and I was pleased to support the advancement to fellowship of 23 of our members, many of whom attended a spectacular convocation at the annual scientific meeting in April! Let’s keep up the trend and expand our membership, by letting your colleagues know how much ACP can do for all of us!

Richard M. Dupee, MD, FACP

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ACP 2013 Leadership Day, May 21-22, 2013 – Healthcare Advocacy on “The Hill”

leadership day 2013

(left to right) Arvind Reddy Devanabanda, Robert Primus (Chief of Staff for Rep. Michael Capuano) Shaan Gandhi, James Yeh, MD, Kunal Domakonda, MD, Elisa Choi, MD, FACP, and Gene Lambert, MD

By Elisa Choi, MD, FACP

As clinicians, we are trained to impact the healthcare of our individual patients via our one-on-one relationships with them. However, as the healthcare landscape has become increasingly more complex and politicized, it has also become even more important for clinicians to actively engage in broad-based advocacy efforts, to help ensure that the future of healthcare remains conducive to optimal patient care. The American College of Physicians hosted its annual Leadership Day conference in Washington, DC, on May 21-22. This conference provides a unique opportunity for physicians, residents in training, and medical students to head to “The Hill”, in order to promote and discuss legislative issues of relevance to healthcare practitioners. The 2013 Massachusetts delegation consisted of six representatives, ranging from medical students and resident trainees to experienced practicing physicians, who actively engaged in lectures, seminars, and discussions, on topics ranging from Medicare’s sustainable growth rate (SGR), federal budget sequestration effects on healthcare programs, and medical malpractice reform.

Our Massachusetts delegation enjoyed the opportunity to convene with other ACP representatives from across the country, in unified efforts to advocate for healthcare policies that include support for sustained funding for the CDC, NIH, GME (Graduate Medical Education) and for alternative approaches to reforming medical malpractice liability. The first day of this 2-day meeting focused on lectures and panel discussions providing important information about physician payment reform, physician workforce predictions and estimates, the current political and policy environment affecting healthcare, and the federal budget sequestration effect on healthcare programs. These important sessions provided the necessary primer for the following day’s activities, and also provided the ACP Leadership Day delegates with the tools needed to successfully navigate “The Hill”. The second day of the conference offered the exciting hands-on experience of interacting with Massachusetts national congressional and senate offices, speaking with senior policy advisers and chiefs of staff of our various legislative representatives, and acting as “healthcare advocates.”

By the end of the 2-day immersion in healthcare legislation, policy, and advocacy, our Massachusetts ACP delegation had hit our stride, and we were able to effortlessly discuss many of these healthcare policies with relative ease, if not quite earn our MPH in healthcare policy! Our delegation greatly enjoyed the unique opportunity provided to us, via the ACP Leadership Day, to play our part in contributing efforts to promote legislative initiatives that will help support the work that we all do as patient care providers. Thank you to ACP National, for the ongoing support of this wonderful program!

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Meet Our Newest Governor’s Council Member

councilmember

Fatima Cody Stanford, MD, MPH is a fellow in obesity medicine & nutrition at Massachusetts General Hospital/ Harvard Medical School. Dr. Stanford received her BS and MPH from Emory University and her MD from the Medical College of Georgia School of Medicine. She served as a health communications fellow at the Centers for Disease Control and Prevention and worked as a behavioral sciences intern at the American Cancer Society. Upon completion of her MPH, she received the Gold Congressional Award, the highest honor that Congress bestows upon America’s youth. Dr. Stanford has completed a medicine and media internship at the Discovery Channel, and authored a USMLE Step 1 medical review text. An American Medical Association Foundation Leadership Award recipient in 2005, she was also selected for the AMA Paul Ambrose Award for national leadership among resident physicians in 2009. Dr. Stanford completed her internal medicine and pediatrics residency at the University of South Carolina School of Medicine/Palmetto Health. In 2012, she was selected as a White House Fellows Regional Candidate. She is a member of the World Medical Association Junior Doctors Network executive board. The American College of Physicians selected her as the 2013 recipient of the Joseph E. Johnson Leadership Award, an award presented to the Associate member of the College who has demonstrated qualities that exemplify the College's mission "to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine".

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Massachusetts Chapter Annual Scientific Meeting

‘Affordable Care Act’: Affordable for Whom?
Saturday, November 2, 2013
7:30 am – 5:00 pm
  1. Updates on Geriatrics and Infectious Disease
  2. Turbulence Ahead! Fasten Your Seat Belts! What Physicians and Patients Can Expect from Health Reform Over the Next Five Years presented by ACP National’s Bob Doherty
  3. Early Career Physician Panel: Dilemmas in Providing High Value Care
  4. Town Hall Meeting: The Future of the General Internist: Positioning Ourselves for Success
  5. Breakfast Session for Students with Residency Program Directors
  6. Breakfast Session – Mentoring Collaborative
  7. Medical Jeopardy and Poster Presentations
  8. Chapter Awards Presentation

We invite you to join your colleagues in internal medicine for this annual event. The program and registration are available.

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Call for Abstracts - Deadline Wednesday, August 21, 2013

The ACP Massachusetts Chapter invites you to participate in the Annual Chapter Resident & Student Abstract Competitions.

This is an excellent opportunity to showcase your talents and to meet informally with colleagues from other resident programs and medical schools in the Commonwealth. Other benefits include:

  • Opportunity to present your poster before a panel of MA ACP member judges on Poster Day, October 12, 2013
  • Opportunity to present an oral presentation or a poster presentation at the chapter meeting, November 2, 2013
  • Cash prizes & recognition
  • Travel grants to attend Internal Medicine 2014 in Orlando, FL
  • Opportunity to participate in the national poster competition
  • Recognition on the Massachusetts Chapter website

The submitted abstracts will be judged by a panel of ACP members. From the submitted abstracts, the top abstracts will be invited to present an oral presentation at the MA ACP Annual Scientific Meeting on Saturday, November 2, 2013.

Other abstracts will be chosen to participate in the new “MA ACP Poster Day” to be held Saturday, October 12, 2013, prior to the MA ACP Annual Meeting. There will be two poster judging sessions. The top posters from the competition on October 12 will be asked to return to present at the MA ACP Annual Scientific Meeting on November 2, 2013.

** To participate in the abstract competition the first author must be a current Associate or Student Member of ACP in good standing and be available to present your poster for the judges on Saturday, October 12 and potentially for the attendees of the MA ACP Annual Scientific Meeting on Saturday, November 2. To check on your membership status, please contact Chapter Administrator, Lynda Laye, CAE.

For more details about the competition and links to the guidelines, visit the chapter website.

Submit your abstract online via the Electronic Abstract Submission Form.

The deadline for submission is midnight on Wednesday, August 21, 2013. Please note the earlier deadline!

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Early Career Physician Corner

Who are we?

ACP’s official definition of an “early career physician” is a physician who has graduated from medical school within the last 16 years AND who is not currently in residency or subspecialty fellowship training. Two years ago, we formed the MA Council of Early Career Physicians (MAECP). MAECP consists of 12 internists practicing in various different contexts across MA. Our mission is “to enhance professional development and quality of life for early career physicians in Massachusetts, foster their involvement in College activities, and ensure that their voices are heard in all chapter discussions.”

How can I get involved?

We are actively recruiting new members, especially from regions outside the Greater Boston area. If you are interested in joining the MA Council of Early Career Physicians, please contact our Chapter Administrator Lynda Layer.

Recap of the Last Six Months:

In January 2013, the MA Council of Early Career Physicians (MAECP) held our second annual Winter Social Event for early career physicians at the Met Bar in Chestnut Hill, MA. It was a successful event with over 50 attendees as well as the Chapter Governor Richard Dupee and other Governor’s Council Members. Early career physicians enjoyed food and wine while they networked with one another.

At the April Internal Medicine 2013 meeting in San Francisco, the ACP officially changed the name of the national Council of Young Physicians to the Council of Early Career Physicians. We like to believe that they were following our chapter’s lead! In addition, Dr. Gene Lambert, one of our own Early Career Physician Council Members, participated on the panel of the Chapter Leadership Network Workshop entitled “Generating Change: Who will Follow? Finding the Next Generation of Leaders.” From all accounts, the workshop was a huge success and we hope to be involved again in Orlando next April.

Most recently, in June, the MAECP sponsored a CME dinner program entitled “Mentoring Across Your Career” in which 4 panelists, Drs. Azadeh Nasseh, Joan Reede, Steven Simon and Steven Van Dam shared their insights on both having a mentor and being a mentor. This event was a kickoff to a new chapter Mentoring Collaborative. MAECP’s goal in forming the Mentoring Collaborative is to teach the skills of finding mentorship and providing mentorship at various stages of one’s career; create in-person activities to nurture mentoring relationships, and create a statewide database that will help connect mentors and mentees with common interests. The next Mentoring Collaborative event will be a breakfast at the Chapter Annual Scientific Meeting on November 2, 2013. See below for more information.

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Upcoming Events for Early Career Physicians

Physicians and Social Media: Keeping it Professional
Thursday, September 26, 2013 from 6:15 – 8:45 pm at the Massachusetts Medical Society

Participate in an exciting panel discussion with expert physicians Bradley Crotty, Don Dizon, and Tara Lagu. We will talk about how social media is transforming medicine but also how they can potentially threaten medical professionalism.

This program has been approved for 1.5 AMA PRA Category 1Credits™.

View the registration brochure.

Registration is now open on the MA Chapter website.

Mentoring Collaborative Breakfast at the Annual Scientific Meeting
Saturday, November 2, 2013 at 7:30 am at the Massachusetts Medical Society

Join members of the MA Council of Early Career Physicians for breakfast and learn more about the new MA ACP Mentoring Collaborative for members in all stages of their career. There will be a brief overview of the collaborative and then time to meet and talk with members with different career paths. There is no additional charge to attend. Please check the box on the registration form to register for the breakfast.

Dilemmas in Providing High Value Care: Case Discussion

Also, as part of the Annual Scientific Meeting on Saturday, November 2, 2013 at the Massachusetts Medical Society, MAECP is presenting the case discussion “Dilemmas in Providing High Value Care.” This session will take place from 11:15 am to 12:15 pm and will feature physicians Robert S. Janett, Rajlakshmi Krishnamurthy, and Natalie Pauli.

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2013 Internal Medicine Abstract Presenters

Medical Student Poster Winner – IM 2013

I can’t see”… a late presentation of thrombotic thrombocytopenic purpuraJason Hine – Tufts University School of Medicine, Boston, MA

We were honored to have 15 chapter members represent our chapter for the Associate and Medical Student Abstract Competition held during Internal Medicine 2013 in San Francisco.

  • Shin Yin Lee, MD, Associate Oral Presentation, Clinical Research
  • Eunice Y. Chuang, MD, Associate Oral Presentation, Clinical Vignette
  • Jagriti Upadhyay, MBBS, Associate Poster, Clinical Research
  • Amir Yamin Shaikh, MD, Associate Poster, Basic Research
  • Francisco J. Hernandez Munoz, MD, Associate Poster, Clinical Vignette
  • Hassan Ziud, MD, Associate Poster, Clinical Vignette
  • Indumathy Varadarajan, MBBS, Associate Poster, Clinical Vignette
  • Jorge Alejandro Velez Garza, MD, Associate Poster, Clinical Vignette
  • Karthik Gnanapandithan, MD, Associate Poster, Clinical Vignette
  • Karuppiah Arunachalam, MBBS, Associate Poster, Clinical Vignette
  • Rattanaporn Mahatanan, MD, Associate Poster, Clinical Vignette
  • Sandeep R. Somalaraju, MBBS, Associate Poster, Clinical Vignette; Associate Poster, QI/PS - HVCCC
  • Jason Hine, Medical Student Poster, Clinical Research
  • Mitalee M. Patil, Medical Student Poster, Clinical Research
  • Ronald Nicholas Bogdasarian, Medical Student Poster, Clinical Research

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Strengthen Our Chapter: Participate in ACP’s Recruit-a-Colleague Program!

The American College of Physicians and the Massachusetts Chapter encourages all members to help strengthen the voice of internal medicine by recommending ACP Membership to colleagues. By joining the College, your colleagues will enrich their clinical knowledge and skills and have access to all of the ACP member benefits that you enjoy.

To thank you for your dedication to our organization, ACP offers dues incentives to members that recruit new members through the Recruit-a-Colleague Program. In addition, successful recruiters have the chance to win a trip to the annual Internal Medicine meeting that includes registration, airfare (up to $500), and hotel accommodations. The Recruit-a-Colleague Program runs annually from April 1 through March 15.

The Massachusetts Chapter would like to recognize the following members for participating in this program and strengthening our chapter: Michelle J. Gochioco, MD, Robert C Jandl, MD, FACP, Gene Lambert, MD, Narayana R. Lebaka, MD, James Louis Levine, MD, FACP, Sabyasachi Sen, MD, FACP, Terri L. Spencer, MD and Roy D. Welker, MD, FACP

Learn more about the Recruit-a-Colleague Program.

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New Fellows

Fellowship is an honor achieved by those recognized by their peers for personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.

The Chapter recognizes and congratulates the following physicians who were elected to Fellowship in the College in the past 6 months:

Sudeep K. Aulakh, MD, FACP
Christine L. Bryson, DO, FACP
Alexander R. Carbo, MD, FACP
Elisa I. Choi, MD, FACP
Eric R. Cohen, MD, FACP
Carolyn M. D'Ambrosio, MD, FACP
Eduardo Da Silva Haddad, MD, FACP
Henry J. Feldman, MD, FACP
Richard M. Forster, MD, FACP
Jaime A. Hernandez-Montfort, MD, FACP
Chi-Cheng Huang, MD, FACP
Tara C. Lagu, MD, FACP
Erin L. Malone, MD, FACP
Francisco M. Marty, MD, FACP
John D. Mudrock, MD, FACP
Arun Mukherjee, MD, FACP
Elizabeth A. Murphy, MD, FACP
Michael F. Murray, MD, FACP
Muthoka L. Mutinga, MD, FACP
Mark C. Pettus, MD, FACP
Yousaf A. Shaikh, MD, FACP
Gitanjali Srivastava, MD, FACP
Nitin Trivedi, MBBS, FACP

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New Members and Resident/Fellow Members

We are proud to welcome the members who have joined the Chapter during the past 6 months.

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ACP Resources

Physician & Practice Timeline helps physicians track key requirements and opportunities

ACP has launched Physician & Practice Timeline: Professional Requirements & Opportunities, a valuable online tool to help physicians stay on top of important dates and track deadlines for a variety of regulatory, payment, educational, and delivery system changes, requirements, and opportunities. The Physician & Practice Timeline allows you to track and find useful resources for everything from eRx and PQRS data collection periods to ICD-10 preparation and Meaningful Use reporting periods. The Timeline also provides information on new opportunities that physicians in practice can take advantage of, such as Transitional Care Management (TCM) codes.

The Timeline will be continually updated to reflect all new or revised target dates, deadlines, and incentives.

Join ACP’s Special Interest Groups!

ACP’s Special Interest Groups – an online forum for members only – provide members with a place to engage in discussions, share ideas, and support one another professionally and personally.

Participate by joining as many groups as you'd like, then connect with ACP members from all over the world with similar interests. Groups include: African American Members | ACOs/New Practice Models | Caring for Adults with Developmental Disability | Clinical Problem-Solving | Clinical Research | Emerging Technologies | High Value Care | Hospital Medicine | LGBT Health | Maintenance of Certification | MKSAP | Physician Educators | Small Practices | Volunteerism | Women in Medicine | Work/Life Balance | Working Abroad

Join today.

Interested in a topic not listed? Contact ACP to ask about forming a new group.

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Call for Spring 2014 Board of Governors Resolutions

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.

Suggested resolutions can be sent to the Chapter Coordinator, Lynda Layer.

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Contact Information

George M. Abraham, MD, MPH, FACP,
Governor, Massachusetts Chapter

Lynda Layer, CAE
Executive Director
Ph: 781-434-7317
E-mail: llayer@mms.org