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February 2013 Alan D. Forker, MD, MACP, Governor

Message from the Governor

Dr. Forker

WOW! What a fabulous Missouri Chapter, ACP, meeting we had in September, 2012. I want to especially thank Dr. Megan Wren, Chair, Education Committee, and her committee for arranging an excellent program—I thought the content was better than ever: migraine headaches, low back pain, Alzheimer’s vs decreased cognition of aging were just some of the interesting topics; I learned data that I hadn’t thought about before. And Dr. Michael Barr, representing the ACP home office in Philadelphia, gave an update on the Patient Centered Medical Home, and how Missouri compares with other states in some measured outcomes (we are not as good in some areas).

And you needed some inspiration: you should have heard Dr. Bridget McCandless from her personal experience of running a Free Health Clinic in Independence and the emotional rewards of such medical care. Thank you, Bridget, for trying to motivate the rest of us to do more for our community and for patients most in need.

The medical student and internal medicine residents/associates Poster competition was intense and stimulating. Those of you who haven’t been on a Judging Team should try it next year—great learning/rewarding experience. And for those of you who were Judges this year, I thank you from the bottom of my heart (I count 46 of you, so too long a list to include your names, but you know who you are—Thanks again). And special thanks to Dr. Fred Buckhold for organizing the posters, judges, and tabulating/announcing the final results. You were indispensable, Fred.

Doctors Dilemma, a competition between 6 internal medicine residencies in Missouri, was won again by the University of Missouri-Columbia, the 2nd year in a row. They will represent Missouri at the IM13 national competition in April in San Francisco. But let me tell you: the competition was intense and close. Look out, Mizzou: the other residencies will be tougher to beat next year with this experience and heighted motivation. I want to thank all the Program Directors, Chief Residents, and other residents who helped create the questions, and especially Drs. Anne Winkler, Richard Burns, Jo Reddy, and Sarah Florio for coordinating the live event.

The medical students organized a Saturday morning session with Program Directors to discuss the how and whys to get into an IM residency. At noon a faculty/student luncheon was held; and the afternoon focused on “speed dating” or a quick discussion with a panel of IM specialists and subspecialists.

Dr. Burns
Richard Burns, MD, FACP – Laureate of the Missouri Chapter with Jan Swaney, MD, FACP

The Friday night Awards Dinner focused on this year’s Laureate Award winner, Dr. Richard Burns, University of Missouri/VA Hospital, Columbia. He follows in the footsteps of his father, Tom Burns, MD, MACP, a prior Governor and Regent. Rich has been invaluable in his support of our Missouri Chapter in many areas, especially with the Education Committee, which he used to chair. Thank you, Thank you, Rich for your enthusiasm, expertise, and time volunteering for ACP.

And finally, a huge Thank You to Pat Mills, our Missouri Chapter Executive Director. This meeting would not be a success without the competent support of Pat. He spends many, many hours on the preparation for this meeting every year. We could not do it without him. Thank you, Thank you, Pat. I would invite each of you to join us for next year’s meeting —September 26-29, 2013, at Tan Tar A.

You should also know that Dr. Steve Weinberger, our national ACP Executive Vice President, will join us in September. If you missed the New England Journal of Medicine article entitled “Legislative Interference with the Patient-Physician Relationship.” October 18, 2012, by Steve and 4 other co-authors, you should read it. Punch line: “we believe that health legislation should focus on public health measures that extend beyond the individual patient” and “avoid inappropriate interference with the patient-physician relationship.” You should read it. Thanks, Steve and your colleagues, for your voices loud and clear. For those of you who might wonder sometimes why you belong to ACP, ie when the dues come due, read it and say thanks to the right voices representing the right viewpoints in medicine.

I attended the Fall meeting, Board of Governors, in Vancouver, B.C. in September. For those of you who haven’t seen Vancouver, put it on your “bucket list.” Awesome city, surrounded by water and mountains. Approximately 80 Governors attended, including international chapters from Canada, Japan, South America, and Saudi Arabia. Those are just the ones with whom I am personally acquainted.

I failed to mention in our Missouri Chapter meeting, and re-emphasized here, these meetings create opportunities for camaraderie in our profession that are irreplaceable. It feels good to be an Internist (most days). I never thought I would know internists in so many states and countries, plus all over the state of Missouri (and that says something from a native Kansan and KU alum). It says put down your swords of personal biases/preferences (I did--I can’t believe I love Missourians) and work for the common good, as our ACP position paper said in 1990: ACP supports “health insurance for all persons in need.”

The Supreme Court upheld that the Affordable Care Act was constitutional, but left to the states to decide about future and expanded coverage of Medicaid. At this point in time the Missouri Legislature shows no interest in expanding Medicaid or in health exchanges; whatever your political views, let’s be type of physician leader the public wishes and expects. Let’s support the concept of the best care for the most people at the lowest, most valuable cost. Get active locally; join the MO Chapter Health and Public Policy Committee (Dr. Peggy Barjenbruch is Chair. You are needed; SPEAK UP and OUT.

Once again some key dates to remember and put on your calendar:

Missouri Chapter Annual Meeting, Sept 26-29, 2013
Internal Medicine 2013 ACP Meeting, San Francisco, April 10-13, 2013

And you should schedule way ahead: 100th Anniversary, ACP, in Boston, April 2015. Don’t miss this celebration—should be special.


Missouri Chapter Supports Medicaid Expansion

The Council of the Missouri Chapter has met by conference call twice since the chapter meeting to discuss Medicaid expansion. The Council voted to have Dr. Forker send a letter of support for Medicaid expansion to Governor Nixon and to join the ad hoc Medicaid Expansion coalition. This letter is posted on the chapter website. The Council encourages all physicians to communicate directly with their state senator and state rep about the challenges involved in practicing medicine. You may use your nine digit zip code to identify legislators at this website.


Doctor’s Dilemma

DD Final Round
DD Final Round with Wash U on the left and MU on the right

The University of Missouri Internal Medicine Residency Program won the Doctors Dilemma contest held during the Missouri Chapter annual meeting. Other programs competing were St John’s, St Luke’s – Chesterfield, Saint Louis University, University of Missouri – Kansas City, and Washington University. The University of Missouri winners (Rolando Peralta, Andrew Ausmus, and Tariq Enezate) will compete at IM 13 in San Francisco in April. This is the second year in a row Mizzou has won the chapter contest. The Chapter will have its 2013 Doctors Dilemma contest Friday, September 27 during the chapter meeting at Tan Tar A.


Chapter Excellence Award

The Missouri Chapter has received the 2012 Chapter Excellence Award. The award recognizes chapters which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria. Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. The Missouri Chapter has won this award every year since it was initiated in 1998.


Students Learn About IM Residencies

L to R Drs. Rey, Blanchard, Buckhold, Gardner, and Koller

During the chapter meeting forty medical students from the Internal Medicine Interest Groups at Missouri medical schools had a chance to quiz Internal Medicine Program Directors. Drs. Dan Rey – St John’s Mercy; Melvin Blanchard – Wash U; Fred Buckhold – SLU; Morey Gardner – St Mary’s; and Jim Koller – MU provided candid responses to the many questions asked about what to expect and what to look for during the residency search process. The Chapter’s Student Committee has begun making plans to repeat this event Sept 28 at Tan Tar A during the 2013 chapter meeting.


Poster Contest: Associates & Students

The Missouri Chapter had 100 posters in three categories for the Associates competition and 20 in two categories for the Student competition. The first place winners in each category will compete at IM13 in San Francisco. The results of the competition follow:

Clinical Vignette - Associate
  1. Shariq Shamim – UMKC, Meningoencephalitis: A Rare Presentation of Undiagnosed Adult Still's Disease
  2. Afrin Kamal – Wash U, The Impending Storm: Hyperthyroidism At Its Worst
  3. Jad Raffoul – Saint Louis University, Guillain-Barre Syndrome and Mantle Cell Llymphoma: The Odd Couple
Research - Associate
  1. Mayank Mittal – UMC, Effects of Tiplaxtinin Eluting Stents on Vascular Remodeling in Porcine Angioplasty Model
  2. Aref Bin Abdulhak – UMKC, The Association Between Histamine 2 Receptor Antagonist Use and Clostridium Difficile Infection: A Systematic Review and Meta-analysis
  3. Carl DeSelm – Wash U, A Novel Inhibitor of Bone Loss with Favorable Side Effects in Animals
Patient Safety & QI - Associate
  1. Hariharan Regunath – UMC, Opioid Prescription Practices Among Internal Medicine Residents in Ambulatory Care Setting
  2. Cory Wilczynski – SLU, Hypercalcemia Associated with Rhabdomyolysis Frequently Goes Unrecognized in the Hospital: a Saint Louis University Hospital Case Series
  3. Tim Hayes – UMC, Screening for Tuberculosis, Hepatitis B, and Hepatitis C Prior to the Initiation of DMARD Therapy: QI project to assess the rate of screening at the University of Missouri Rheumatology Practice
Clinical Vignette - Student
  1. Ashley Deboeuf – UMKC, 5-Fluorouracil-induced Symptomatic Bradycardia
  2. Adam Fleddermann – UMKC, Tumor of the Mandible and the Significance of Maintaining a Working Differential Diagnosis
  3. Danielle Zimmerman – UMC, A Case of DRESS Syndrome Due to Vancomycin
Research - Student
  1. Kara Gulewicz – Wash U, Discovery of Regulatory Element Variants in Atopic Dermatitis Using Pooled Targeted Deep Sequencing
  2. Anand Patel – UMC, The Role of Circulating DNA in Cancer Evaluation
  3. Tosan Oyowe – UMKC, Obesity Impact on Airway and Lung: Value of TNFa Receptor Blocker


Interesting Websites


Medicaid Primary Care Fee Increase

You may have noticed you are not yet being paid at Medicare rates for your Medicaid patients even though you submitted the required certification. Medicaid is implementing required software changes before claims can be paid at the 2013-2014 enhanced reimbursement for primary care physicians. Medicaid plans to make a mass adjustment retroactively effective to January 1 for claims that were paid at the old rate. This enhanced reimbursement applies to MC+ plans too, but they will likely wait until Medicaid fee for service begins paying at the enhanced rate.


QRUR for Large Groups

The CMS Quality Resource and Utilization Reports (QRURs) are available for groups of 25 or more Eligible Provider until early April. You may request one electronic file for all your group’s QRURs by sending an email. ACP has PQRS info to help you avoid the one percent VBM penalty and the one and a half percent PQRS penalty in 2015.



April 11-13, 2013 IM 13 in San Francisco
Sept 26-29, 2013 Missouri Chapter meeting at Tan Tar A in Osage Beach
April 10-12, 2014 IM 14 in Orlando
Sept 11-14, 2014 Missouri Chapter meeting at Tan Tar A in Osage Beach



Chapter Council Ballot

Please print and fax or mail your Chapter Council ballot by March 12, 2013.