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December 2011 Michael F. Rein, MD, FACP, Interim Governor


Interim Governor's Notes

Dr. Rein

Dear Colleagues,

New Governor-Elect

The Virginia Chapter is recovering from the tragic loss of our previous Governor, Paul Florentino, MD, FACP. I am pleased to tell you that through our special election, you have selected Lisa Ellis, MD, FACP to serve as Governor-Elect, and she will take office after Internal Medicine 2012 in April. Lisa has been a member of the American College of Physicians since she was a medical student at Virginia Commonwealth University. She was awarded her ACP Fellowship in 2009 and is currently serving in her 7th year on the Governor’s Council for Virginia. She has been a member of the planning committee for “Multiple Small Feedings of the Mind” for the national ACP conferences since 2006.

Dr. Ellis holds a faculty appointment as Associate Professor of Internal Medicine and Ob/Gyn and serves in the Office of Strategic Initiatives at Virginia Commonwealth University. She is the Executive Director of Clinical Services for their Stony Point campus of clinics and ancillary services in the Richmond, Virginia area. In addition to her administrative position and project development for VCU, she also practices at the Stony Point Women’s Health Center with a special interest in women’s health.

Lisa’s husband is a Dermatopathologist in the Richmond area, and her two sons live in Indianapolis and in Richmond as well. Lisa has a variety of interests including golfing, fishing, singing, gardening and bow-hunting. The Chapter is in excellent hands.

We very much appreciate the willingness of Ranjodh Gill, MD, FACP to serve as Governor and to run for election. Ranjodh, too, has been a long-term member of the Governor’s Council and has been active in many Chapter programs.

Chapter Dues for 2012-2013

We have applied to the College for an increase in Chapter dues for the coming fiscal year. Our current dues are $60, and we are requesting $65 for next year. The average dues rate for large chapters, like ours, is $64. In order to provide some more support for small chapters, there will be a change in Governor’s Office Allowance, annually received from the College, and our amount will be reduced by approximately $3,600. We have some increased expenses for projects that are important for the Chapter: We have added a medical student program to the annual Virginia Chapter Meeting and Clinical Update. We are supporting Internal Medicine Interest Groups at our two newest medical schools. Our Council of Young Physicians is providing a series of seminars on the practicalities of entering and running a practice for our Associates at residency programs throughout the state. Despite saving money by holding our Associates’ Day competition at medical schools, the cost of this important program will continue to increase. We plan to continue to contribute toward the cost of sending our State Champion Medical Jeopardy team to compete at IM2012. Given the current economic and regulatory environments, we expect pharmaceutical support of our educational programs to continue to decline.

Chapter Contributions

The Virginia Chapter contributed $500 to the Whitman-Walker Clinic in Washington, DC in memory of Paul Florentino, MD, FACP. Paul volunteered at this clinic. We also continued our annual $500 contributions to the ACP Foundation and the MSV Foundation, the latter was also made in Paul’s honor.

The Council has decided to name our Chapter’s annual award for volunteerism as the Paul Florentino, MD, FACP Volunteerism Award.

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Governor-elect's Note

Dr. Ellis
Dr. Lisa Ellis

As the Virginia Chapter Governor-Elect, I am honored to serve this upcoming term. I look forward to getting to know our ACP members and determining how I can work with our Virginia Council to best serve your needs. Change is inevitable in these trying times of health care reform. I believe it is vital that we join forces and support our colleagues. Our ACP membership and involvement offers us the finest in professional relationships and opportunities in decision making to help guide us through the changes ahead. I look forward to this challenge and hearing your ideas for strengthening our Virginia chapter. Dr. Ellis may be contacted at znlellis@gmail.com.

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Executive Director's Column

I was pleased to be asked to submit an article for this newsletter. I have worked with the Virginia Chapter since 1999 and find it to be the best and brightest in the nation. We are so fortunate to have five superior medical schools and five medical residency programs. All of the programs support the Chapter in its various endeavors and by having a representative on your Governor’s Council.

In the 12 years that I have worked for you, my position has changed quite a bit. When I began, I was working approximately 10 hours a week; now I am working an average of 28-30 hours a week. The position of the Executive Director (ED) has become more rewarding, as the Executive Directors Group has evolved into an entity that is a respected part of the College.

For several years, the EDs have met together at each of the national Internal Medicine meetings, where we have held a “Best Practices” session. The session started as a half-day meeting and is now a full day. The EDs meet and have formal presentations on topics such as College Programs and Resources; Tips and Tricks; Successful Recruiting Efforts; and Strategic Planning; and we meet with the College leadership to voice concerns and learn of new initiatives and products that will be offered. We have become a close group and share what works for us for chapter meetings and getting membership involved with programs.

At the IM 2010 meeting, the EDs were invited to attend the Board of Governors’ meeting. This was something our group had really wanted to accomplish. No one knew what to expect, but it turned out to be invaluable to the Governors and to the chapter staff. In the past we were given information piecemeal as each topic came up. This way we were there firsthand to gather the information. We learned how the leadership of the College makes decisions. The most informative session was watching the resolution’s process. I have come to admire those behind the scenes that do the investigating for the resolutions. There is much research that is done on each resolution to ascertain whether the proposed resolution has been discussed previously, and if so, the findings at that point and if changes have occurred which warrant revisiting the topic.

The EDs are now a part of each Board of Governor’s meeting. The ED from Florida and I am co-chairing the 2012 “Best Practices” meeting in New Orleans. We are looking forward to putting together a program from which each of the attendees will take something back to their Chapter that contributes to the betterment of the Chapter membership. Topics which may be covered include a session to help us understand how we can better serve you, the member, with the practice management and EMR College websites; developing a website specific for our individual chapters; membership recruitment and retention; and an update on the CME process, including the addition of webinars in obtaining CME for our meetings.

With the passing of our Governor, Paul Florentino, MD, FACP, the Chapter was very fortunate that our immediate Past Governor agreed to step in as Interim Governor. Michael Rein, MD FACP has given the Chapter 100% during this very sad and unfortunate time for the Chapter. Under his leadership, however, we never missed a step. I want to thank Michael for being there for the Chapter and for me.

We were very fortunate to have had two exceptional candidates, Lisa Ellis, MD, FACP and Ranjodh Gill, MD, FACP, in the recent election for Governor. I have worked with Dr. Ellis for many years, as she served in various positions for the Virginia membership. Congratulations to her as she begins a shortened Governor-elect term!

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Advocacy Report

National Issues
William Fox, MD FACP, Chair, Virginia Health and Public Policy Committee

Prospects for a long-term fix to the SGR this year have become somewhat dim, in light of the failure of The Joint Select Committee (a.k.a Supercommittee) to reach a deficit reduction deal. On January 1, 2012, physicians will sustain a payment cut from Medicare of 27.4%, unless congress steps in once again to reverse this.

As the process for deficit reduction played out, the ACP remained fully engaged, advocating for a two-stage solution to the SGR which involves both five years of stable updates followed by a transition to more efficient payment mechanisms to physicians. The ACP also proposed many areas of savings within the Medicare system to more than pay for the over $300 billion it will cost to finally put the SGR to rest. See the full ACP letter to Congress.

MedPAC, the Medicare Payment Advisory Committee, an independent agency that advises Medicare on issues related to the Medicare Program, advocated for their own solution. Their recommendation includes keeping E/M payments to self-designated primary care physicians flat for the next ten years. All other payments would be cut by 5.9% per year for the next three years followed by seven years of flat payments. This payment adjustment would save $100 billion. Along with $200 billion in other savings that MedPAC identified, the committee feels it has identified the money it needs to end the SGR.

The ACP raised strong objections to the MedPAC proposal, because the payment updates do not keep up with the cost of inflation and unfairly penalizes specialists, even when they provide efficient, cost effective care. For ACP’s complete response to the MedPAC proposal.

In a recent development, Representative Allyson Schwartz has drafted legislation focused on repealing the SGR using a framework broadly similar to the ACP proposal. It includes five years of stable physician payments with higher targets and updates for primary care services provided by internal medicine specialists and other primary care physicians, and smaller but positive updates for all other physician services, a process for broadly implementing and evaluating different models aligned with value during this period of stability, a process where the most effective models will be selected by the Department of Health and Human Services, and a defined period of transition to the new model

As usual, we will need to stay tuned. Members can help by communicating with their legislators about the need to permanently repeal the SGR.

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Virginia Issues

Stuart Henochowicz, MD, FACP, Vice-Chair, Virginia Health and Public Policy Committee

William Fox, MD, FACP and I had the opportunity to represent the ACP at the annual meeting of the Medical Society of Virginia, which was held from October 27th- 30th at the Homestead Resort in Hot Springs. The setting was lovely; the snow cover from the early fall Nor’Easter provided a picture postcard look to the grounds.

The physicians at the meeting were a diverse group from all parts of the state. Hugh Bryan, M.D., an orthopedist from Gloucester, took over as president of the society in an elaborate ceremony that befitted the 191 year old organization. The House of Delegates met to discuss and vote on resolutions that were raised at the various reference committees.

The resolutions approved included an expansion of membership to physician assistants, and support for HR 1409, a bill in Congress that proposes that physicians be allowed to collectively negotiate with insurance companies.

Members of the ACP met in caucus on the 29th. This was a very productive and interactive meeting. A suggestion was made to send MSV members who are also members of the ACP e-mails prior to a meeting of the Virginia ACP Health and Public Policy Committee (HPPC) to get their views on upcoming resolutions. William Fox, MD, FACP suggested that MSV could get on board with supporting a Patient Centered Medical Home (PCMH) management fee. There was a discussion regarding the Relative Value Scale Update Committee (RUC) and the need for a greater voice for primary care in the committee. Mr. Cal Whitehead came to discuss an upcoming bill in the Virginia House that would define surgery. The intent of the legislation was to limit the scope of nonphysicians in the independent practice of certain procedures. There were questions raised about what ancillary providers would or would not be allowed to do if the bill was enacted into law. There was concern raised about ancillary providers doing specialty referrals and a suggestion that the ACP comment on discouraging this practice.

The MSV sponsored White Coats on Call Day for the ACP will take place on Thursday, February 9th, 2012 in Richmond. This will give us an opportunity to have our voices heard during the Virginia legislative session. The next MSV annual meeting will take place on November 1st-4th ,2012 in Williamsburg.

Virginia 2012 White Coats on Call Dates

Jan. 11 (Wednesday) – First day of session
Jan. 17 (Tuesday) – MSV District 8 and District 6 and Urology (VUS) day
Jan. 18 (Wednesday) – District 5
Jan. 19 (Thursday) – Radiology day and District 10
Jan. 23 (Monday) – District 7 and District 9 Jan. 24 (Tuesday) – District 3
Jan. 26 (Thursday) – Pediatric day Jan. 31 (Tuesday) – District 1 and District 2
Feb. 2 (Thursday) – Otolaryngology (VSO) and Pathology (VSP) day
Feb. 9 (Thursday) – American College of Physicians
Feb. 15 (Wednesday) – Surgeons’ (VA-ACS) day
Feb. 21 (Tuesday) – District 5 and District 10
Feb. 22 (Wednesday) – District 3
Feb. 23 (Thursday) – District 2 and District 7
Feb. 28 (Tuesday) – District 1, District 6 and VACEP day
March 1 (Thursday) – District 8 and District 9, March 10 – Sine die – Session adjourns

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Chapter Excellence Award

Chapter Excellence

I am pleased to announce that our chapter is in receipt of the 2011 Chapter Excellence Award! The award recognizes chapters that 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. I would like to extend a special thanks to those chapter members and to Ann Tennett, our Executive Director, who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

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Council Membership

The Governor’s Council includes three representatives from each region of the state, whom you have elected to represent you on issues at the local and national level. Each year, one of the three rotates off council, and you, our membership, elect a successor. These representatives, elected in 2011, will remain on our Council until the first Governor’s Council meeting following Internal Medicine 2014. They are:

Region 1, Northern Virginia: Brad Pontz, MD, FACP
Region 2, Richmond Area: Lisa Ellis, MD, FACP, (Dr. Ellis will make an appointment to fill her remaining term on Council when she becomes Governor.)
Region 3 Tidewater: Dean Gianakos, MD, FACP
Region 4 Charlottesville/Shenandoah Valley Area: Douglas Keim, MD, FACP

Your other representatives are as follows:
Region 1: James Long, MD, FACP (2012), Stuart Henochowicz, MD, FACP (2013)
Region 2: Alan Dow, MD, FACP (2012); Ranjodh Gill, MD, FACP (2013)
Region 3: William Atchley, MD, FACP (2012); Sami Tahhan, MD, FACP (2013)
Region 4: Jeri Lantz, MD, FACP (2012); William Fox, MD, FACP (2013)

We are most interested in obtaining nominations (including self-nominations) for new Councilors from any part of the state and from any form of practice. Service on the Council involves attending three meetings each year. The meetings are held at various locations throughout the state. A meeting in January is held in connection with Associates’ Day, a meeting in March immediately precedes our annual Virginia state meeting, and a third meeting is held in September. Much of the work of the Council is conducted electronically. The Council does much of the planning for the Chapter and is actively involved in issues related to advocacy, relations with other organizations, finances, education, communication, and Chapter membership. If you are interested in serving on the Council or if you know someone who might be interested, please contact Brad Pontz, MD, FACP, Chair, Nominations Committee.

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Annual Chapter Meeting and Clinical Update

Our Council of Young Physicians, chaired by John Port, MD, ACP Member, worked hard as the Program Committee for the 2012 ACP Virginia Annual Meeting and Clinical Update, which will be held at the Omni Charlottesville Hotel, March 16-17, 2012. The program is interesting, timely, and relevant for all internists. The meeting will provide 15.25 hours of CME credit and will include the clinical topics of:

Genetic Medicine
New Antibiotics in an Era of “Superbugs”
Top 5 Recent Papers in Ambulatory Medicine
Women’s Health Update: An Approach to Menopause After the Women’s Health Initiative
Assessment and Management of Mild Traumatic Brain Injury: Current Practices and Future Directions
Lactic Acidosis
Multiple Small Feedings of the Mind: Thyroid disease
Multiple Small Feedings of the Mind: New cardiovascular imaging
Accountable Care Organizations: Not Your Father's Fee for Service
Medical Weight Loss
Frailty: Will You Know It When You See It?
Adult ADD
Hepatitis B and C Management
Top 5 Inpatient Papers of 2011
Sleep and Insomnia Update on Osteoporosis Management
Clinical Pearls: Ophthalmology for the Internist
Clinical Pearls: Asthma Update
Chemoprophylaxis of Cancer
Multiple Small Feedings of the Mind: Advanced Lipid Testing
Multiple Small Feedings of the Mind: Colon Cancer screening 2012
Tick-Borne Diseases in Virginia: To the Vectors Go the Spoils

In addition, we will hold sessions on: ACP Washington Update; ACP College Update, Virginia Hood MD FACP, President, American College of Physicians; and our Town Hall Meeting to hear issues from our membership. We will also host breakout breakfast sessions on Advancement to Fellowship and Issues of Interest to Associates and Medical Students. We plan to continue our medical student participation with a program led by our new medical student rep, Neha Chande, Student Member.

We have purposely planned the meeting in a central part of the state for ease of travel and lower hotel costs. I hope we can count on your attendance! As always, we are interested in hearing from those of you who do not attend the meeting. Please let us know how we can make this meeting more attractive to you.

If you are interested in attending but have not received information on the meeting, please contact Ann Tennett, Executive Director, ACP Virginia Chapter

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Report from the Fall 2011 Board of Governors Meeting

Michael F. Rein, MD, FACP, Interim Governor

The resolutions process is the key mechanism by which the membership of the College influences its policy. A major topic at the last BOG meeting was a revision of the process, which was aimed at reducing the number of resolutions that were redundant or fell outside the purview of the College. At many past meetings, the number of resolutions being considered required their simultaneous discussion in two rooms, forcing Governors to run back and forth in order to be able to testify at those hearings of particular interest to their Chapters and Council. The revised system is as follows (emphasis mine):

Six months prior to each Board of Governors meeting, the Call for Resolutions will be given. Resolutions may be initiated at any level of a chapter, including members, committees, councils, officers, or Governors. Resolutions initiated at the chapter level are to be presented first to the Governor and chapter council for approval. In advance of the deadline for formal submission, Governors will be responsible for performing a critical evaluation of past resolutions (using the Electronic Resolutions System [ERS]) and existing policy (using the Public Policy Virtual Library). Governors or their staff should discuss the potential resolution with staff content experts in the domain of the resolution to determine if a resolution is consistent with or advances College policy and goals. The Executive Committee of the Board of Governors (ECBOG) will review proposed resolutions considering their relevance to ACP’s current Strategic Plan and the ACP Mission and Goals. The resolution sponsor will be notified if the ECBOG has concerns and recommends that the resolution be modified or withdrawn. The sponsor may withdraw, modify, or continue to move the resolution forward without modifications, in which case the ECBOG’s concerns and recommendations will be presented at the Reference Committee hearing. After the four-month deadline, the Resolutions Administrator posts all new resolutions to the Governors’ Information Center for the Board of Governors to review with their councils and committees prior to the BOG meeting. This will enable the Governors more effectively to report the thoughts of their members.

Governors will always be able to bring forth resolutions; even if the ECBOG feels they are not warranted. At the BOG we presented concerns over an appearance of top-down management, reminiscent of the approach that elicited the formation of the American Society of Internal Medicine. We also suggested that the opinion of the ECBOG not be presented to the BOG in advance of the meeting at which the resolution was to be discussed. I will keep you informed of the progress of this process.

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VA Chapter of ACP Will be Well-Represented Among Awardees at IM 2012

Eugene C Corbett, Jr., MD, FACP has won the 2012 ACP Jane F. Desforges Distinguished Teacher Award. The award was established in 1968 in Honor of Dr. Jane F. Desforges, a Master of the College and the first woman to receive the award. The award was named in her honor in 2007 and is bestowed upon a Fellow or Master of the College who has demonstrated the ennobling qualities of a great teacher as judged by the acclaim and accomplishments of former students who have been inspired and have achieved positions of leadership in the field of medical education, primarily as teachers. Dr. Corbett will be awarded a Mastership when elected.??

Craig E. Cheifetz, MD, FACP has won the 2012 ACP Walter J. McDonald Award for Young Physicians. This award was established in 2003 to honor Dr. Walter J. McDonald, former Governor and Regent who served as Executive Vice President of the College from 1995 to 2002. The award recognizes outstanding achievement by a physician member who is within 16 years of graduating medical school and who is not an ACP Medical Student Member or Associate. Areas of achievement may include leadership; academics, including publishing, teaching, and mentoring; and/or volunteerism.

Michael F. Rein, MD, FACP has been awarded a Mastership.

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Share & Converse in Online Member Forums

You asked. We listened. ACP is pleased to introduce Special Interest Groups, an online forum for members only.

  • Share: Experiences and questions.
  • Inform: Creative solutions and ideas.
  • Gather: Virtual meeting place with like-minded physicians.
  • Member-Driven: Groups of interest fueled by ACP members.
  • Private: Secure physician online community.
  • Free: Benefit of membership.
  • Simple: Sign up to connect with ACP peers now.

Groups include: Hospital Medicine, Small Practice, Work/Life Balance, ACOs/New Practice Models, Emerging Technology and Physician Educators.

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New Innovation Center Comprehensive Primary Care Initiative

The Center for Medicare and Medicaid Innovation (CMMI) recently released a new multi-payer initiative to stimulate the expansion of primary care through the medical home care delivery model. This four-year, Comprehensive Primary Care (CPC) Initiative will be implemented within approximately 75 practices within 5 – 7 geographic markets throughout the country. Markets will be chosen primarily based on the number of payers in the area, which can include private health plans, Medicaid, Medicaid managed care plans, Medicare Advantage programs, and self insured employers, willing to provide assistance to primary practices to engage in practice transformation consistent with the patient centered medical home model and expand the comprehensiveness of the services provided. Assistance can include:

  • A monthly, non-visit based, risk adjusted fee
  • Practice embedded services (e.g. case managers)

The monthly fee is in addition to traditional fee-for-service (FFS) payments, and selected practices will also be eligible to participate in any shared saving accrued within the geographic market. Medicare’s participation within the chosen markets will consist of a risk adjusted monthly per member fee of $20 on average for years 1 and 2, and $15 on average for years 3 and 4.

Once markets are chosen, practices would be invited to apply for participation. Participating practices would be expected to deliver care that fulfills the following 5 functions:

  1. Risk-stratified Care Management;
  2. Access and Continuity;
  3. Planned Care for Chronic Conditions and Preventative Care;
  4. Patient and Caregiver Engagement;
  5. Coordination of Care Across the Medical Neighborhood.

The first step is for public and private payers (including states) to indicate their interest to CMS, including the level and type of support for primary care practices being offered. Interested payers must submit a nonbinding letter of intent and a completed Geographic Service Area Worksheet by November 15, 2011 via email.

Final applications, to be completed by the payers only after the letter of intent has been submitted, must be received on or before January 17, 2012. Once CMS evaluates these proposals and selects the markets, a second solicitation will be issued for primary care practices in those markets.

Given the short application deadline, this initiative is most suitable for those geographic areas already organized for multiple payers to provide support to the delivery of patient centered medical home care. Given the potential for the expansion of this program to additional markets in the future, ACP Chapters may be interested in participating in existing area multi-payer efforts and/or joining with other groups in their area to organize payers in preparation for this and future related proposals.

Additional information regarding this initiative is available.

If you have questions about the CMMI Comprehensive Primary Care Initiative, please contact Neil Kirschner, PhD, Senior Associate, ACP Regulatory and Insurer Affairs, or call him at 202-261-4535.

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Nurses, Physicians Assistants, and Others Now Can Join ACP As Affiliate Members

ACP has expanded its domestic Affiliate membership category to include a variety of allied health professionals, such as physician assistants; nurse practitioners and other advanced practice nurses; registered nurses; pharmacists and doctors of pharmacy; and clinical psychologists.

The College has long been supportive of patient-centered care delivered in a team-based environment. Allied health professionals that work with internal medicine physicians can benefit from the College’s resources and increased collaboration with ACP’s physician members.

ACP Non-Physician Affiliate members have online access to a variety of benefits, including Annals of Internal Medicine®, featuring In the Clinic® and ACP Journal Club® access to the College’s practice management and quality improvement tools; and, the Physicians' Information and Education Resource (PIER) ®. In addition, they receive discounts on many of the College's products and services, such as Internal Medicine 2012 and MKSAP 15®.

Non-Physician Affiliate members do not have voting privileges, and will not be able to hold office or become a Fellow in the College.

Dues for the Non-Physician Affiliates are $119.

To learn more, or to share this opportunity with allied health professionals in your office, visit here.

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Upcoming Events

Associates’ Day

Norfolk, VA
January 21, 2012

ACP/MSV White Coats on Call

Richmond, VA
February 9, 2012

Virginia Chapter ACP Annual Meeting and Clinical Update

Omni, Charlottesville, VA
March 16-17, 2012

Internal Medicine 2012

New Orleans, LA
April 19-21, 2012

Leadership Day 2012

Washington, DC
June 6-7, 2012
Please note change of date

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Contact Information

Lisa Ellis, MD, FACP
Governor, Virginia Chapter

Ann Tennett
Executive Director
E-mail: astacp@hotmail.com
Phone: 540-631-0426