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GOVERNOR'S NEWSLETTER Arizona July 2015

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From the Governor

Robert Aaronson, MD, FACP

Robert Aaronson, MD, FACP, ACP Governor, Arizona Chapter

Hello Colleagues,
 

I hope this finds each of you well, and that you are enjoying our Arizona summer, despite (or maybe because of) the Arizona heat and monsoons. As you no doubt recall, July 1 marks the beginning of the medical academic year. This also happens to be the start of our ACP fiscal year, so this is a good time to take stock of our chapter's accomplishments and our challenges.

This has been quite a year for me and for the Arizona Chapter of the American College of Physicians!

On the national stage, ACP efforts were an important contributor to this year's successful repeal of the SGR, and remain essential in advocating for rational, balanced and evidence-based legislation that will protect the health of our patients and our profession.

On the state level, with the great work of so many of you, your ACP Arizona chapter has continued to advocate, to educate and to serve as a forum for networking and collegiality. We participated in the 100-year anniversary celebration of ACP at the national IM meeting in Boston this April, where we welcomed new Fellows, celebrated the recipient of a national educator award from our Arizona chapter and cheered on our chapter Poster Competition winners, our Doctor's Dilemma team and our physician artists during their competitions there. We've had student and resident Journal Clubs, a number of social outings and, just recently, a welcoming program for new Internal Medicine residents statewide. We had a great "ACP Day at the AZ State Legislature" in February, where our sizable contingent was joined by colleagues from the Arizona Medical Association (ArMA) and where our members advocated for Internists and our patients, influencing several important decisions. More recently, our Arizona Chapter was represented by a strong delegation in Washington DC at our ACP National Leadership Days on May 20-21, where our members were both educated on the process of successful advocacy and given the opportunity to meaningfully influence national healthcare legislation during their meetings at the offices of our Arizona members of Congress.

Membership remains our richest resource but is also our greatest challenge. Now, with the guidance and support of the Governor's Council and Membership Chair Dr. James Keane, we move ahead with plans to make Arizona ACP a healthier and more engaged Chapter. During the coming year, watch for exciting opportunities for you to learn, to engage, to enjoy your ACP friends and colleagues, and all the benefits ACP brings your way. Also, watch for opportunities to help us reach out to colleagues not yet members. Tell your specialist and subspecialist internist friends why you are an ACP member, and why they should be. We need your help to remain a vital organization, in order to accomplish all you want us to do.

Check a little later in this newsletter for a new feature - Members' Forum. It will be a continuing feature, and I invite you to submit brief referenced articles on issues affecting internal medicine physicians. Our inaugural essay is from medical student Juhyung Sun, Medical Student, University of Arizona College of Medicine Tucson, and Shakaib U. Rehman, MD, FACP, VA Health Care System, Phoenix. The article is a close look at implementing electronic medical records…don't miss it!!

I look forward to seeing you at our exciting, entertaining and informative Annual Arizona Chapter Meeting, in Tucson at the DoubleTree Hilton Hotel, Reid Park, November 13-15!!

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Internal Medicine 2015 ACP 100th Anniversary in Historic Boston!

The ACP's annual get together was an outstanding event again this year! Thousands gathered to debate, to honor, to explore! It was an impressive time for many Arizona Chapter members as they presented, competed and accepted honors! Many congratulations are in order!

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Doctor's Dilemma Team Journeys to Boston!

Pictured here are Irbaz Riaz, MD, Mohammed A. H. Hudeeb, MD, Juston Zon-ern Lee, MD
Pictured here are Irbaz Riaz, MD, Mohammed A. H. Hudeeb, MD, Juston Zon-ern Lee, MD

Posters and Abstracts: ACP Arizona was well-represented in the Poster and Abstracts competitions. Attending and presenting were Adebisi Alli, DO, G. Joseph Orme DO, MPH, Irbaz Riaz, MD, Melissa A. Crawley, MD, Kyle J. Henry, MD, Jawad Bilal, MD, Edward R. Maharam, MD Namit Rohant, MD along with medical students James Lish and Andrew Welch. Pictured here is Melissa Crawley, MD.
Posters and Abstracts: ACP Arizona was well-represented in the Poster and Abstracts competitions. Attending and presenting were Adebisi Alli, DO, G. Joseph Orme DO, MPH, Irbaz Riaz, MD, Melissa A. Crawley, MD, Kyle J. Henry, MD, Jawad Bilal, MD, Edward R. Maharam, MD Namit Rohant, MD along with medical students James Lish and Andrew Welch. Pictured here is Melissa Crawley, MD.

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Arizona Physicians Elected to ACP Fellowship

Pictured here, with Governor Aaronson, at the Convocation event in Boston, are new Fellows, Doctors Mary E. Evans, Ipuole Ogar and Scott L. Bernstein.
Pictured here, with Governor Aaronson, at the Convocation event in Boston, are new Fellows, Doctors Mary E. Evans, Ipuole Ogar and Scott L. Bernstein.

A highlight of every IM Meeting is the Thursday evening Convocation. Arizona was well-represented this year as quite a few new Fellows journeyed to Boston to be recognized.

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2015 Leadership Day in Washington D. C.

ACP AZ was represented by six informed and energetic folks at the annual ACP Leadership Day Event, May 20-21, 2015. Shown here with Senator Flack's staff member, the Arizona Delegation - Gajapathiraju Chamarthi, MBBS, Timothy C. Fagan, MD, FACP, Kirat Gill, MD, Sathish Karmegam, MD, FACP and medical student Juhyung Sun.
ACP AZ was represented by five informed and energetic folks at the annual ACP Leadership Day Event, May 20-21, 2015. Shown here with Senator Flack's staff member, the Arizona Delegation - Gajapathiraju Chamarthi, MBBS, Timothy C. Fagan, MD, FACP, Kirat Gill, MD, Sathish Karmegam, MD, FACP and medical student Juhyung Sun.

They had a wonderful time and made a difference. The members of the delegation visited the offices of our Arizona Congressional Representatives and our Senators with timely and targeted messages. All of these visits were composed of energetic conversations with our national representatives and/or their staff. Should you see any of these fine folks, please thank them for their volunteer work for the Chapter - and their profession!!

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ACP AZ Chapter-Day at the Arizona State Legislature, February 4, 2015

This spring a large group of ACP members, held an informative and very interesting
This spring a large group of ACP members held an informative and very interesting "Day at the Arizona State Legislature." Highlights of the day in the Majority Caucus Room at the State Capitol, were face-to-face visits with individual State legislators and helpful information about how to lobby. Pictured: Newly elected Tucson Representative Rep. Randall Friese, MD, District 9 House Health & Human Service Committee.

Pictured here is a room full of interested Chapter members, attending the event!!
Pictured here is a room full of interested Chapter members, attending the event!!

Watch for announcements of 2016 Day at the Arizona State Legislature…it is an experience you will enjoy and remember!!

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ACP Arizona extends Congratulations to 2015 Arizona Internal Medicine Resident Graduates

This is the time of year we say hello to new medical students and residents all over the state, and goodbye to some valuable medical school and residency colleagues. We would like to acknowledge the recent Internal Medicine Resident Grads from vital programs around the state.

Banner University Medical Center Phoenix

Elissa Abbruscato, MD
Appu Basnet, MD
Kurtis Bradley, DO
Jonathan Byrdy, DO
Sarah Corral, DO
Santosh Desai, DO
Michael Germain, MD
Margaret Girgis, MD
Ryan Kessel, MD
Doug Larsen, MD
Nicolina Martinez, MD
Scott McShane, DO
Joe Orme, DO
Krushangi Patel, MD
Krystal Renszel, DO
George Rodriguez, MD<<br /> Dmitriy Scherbak, DO
Samir Sultan, DO
Jessica Weiss, DO
Ruth Wyckoff, MD

St. Joseph's Hospital and Medical Center

Saifuleen Al-Qaisi, MD
Fadi Alrabadi, MD
Giang Bui, MD
Yunhee Im, MD
Arooj Kayani, MD
Rashmi Kumar, MD
Christopher Savage, MD
Nisarg Sheth, MD
Mohamed Zghouzi, MD

Maricopa Medical Center

Nedda Alemi, MD
Layth Al-Jashaami, MD
Jagman Chahal, MD (Continuing as Chief Resident)
Ricky Chang, MD
Hasan Chaudhry, MD
Erik Contreras, MD
Carlos Echevarria, MD
Veenu Gupta, MD
Carlos Hartmann, MD
Michael Igwe, MD
Firoozeh Isfahani, MD
Ahmad Kadhim, MD
Yasmine, Kenani, MD
Marwan Oleiwi, MD
Mircea Puscas, DO
Zohreh Movahedi Smith, MD
Ming Zhang, MD

Mayo Clinic

Anjuli Brighton MD
Nam Chan, MD
Molly Disbrow, MD, (Continuing as Chief Resident)
Colin Fitterer, MD
Diana Franco, MD
Carlo Guerrero, MD
Syed Hassan, MD
Karen Sapienza, MD
Robyn Scherber, MD
Maja Udovcic, MD

Canyon Vista Medical Center, Sierra Vista

Nathan Duffin, DO
Rachel Erickson, DO
Mansoor Jatoi, DO
Kelly Noyes, DO
Jaspreet Singh, DO

University of Arizona Internal Medicine Residency Program - Main Campus

Laila Abu Zaid, MD (Continuing as Chief Resident)
Kefah Al-Ramahi, MD
Amanda Bisla, MD
Nathan Copeland, MD
Jeffrey Costas, MD
Melissa Crawley, MD
Nicholas Dembitsky, MD (Continuing as Chief Resident)
Cristian Dominguez, MD
Tammer Elaini, MD
Thomas Enzler, MD
Sumaya Farran, MD
Hyon-he Garza, MD
Khaled Hamed, MD
Emad Hammode, MD
Shubha Kollampare, MD (Continuing as Chief Resident)
Andrew Kovoor, MD
Hao Li, MD
Elisa McDaniel, MD
Rachelle Miles, MD
Eric Ong, MD
Gustavo Ortega, MD
Toral Parikh, MD
Soyoung Park, MD
Snehal Patel, MD
Anish Peter, MD
Preethi Reddy, MD
Irbaz Riaz, MD
Brentin Roller, MD
Scott Rosen, MD
Courtney Walker, MD (Continuing as Chief Resident)
Jessica Yan, MD (Continuing as Chief Resident)

University of Arizona Internal Medicine Residency Program South Campus

Seth Assar, MD
Aaron Fernandes, MD
Jennifer Huang-Tsang, MD
Adil Lokhandwala, MD
Krunal Patel, MD
Gowri Radhakrishnan, MD
Natasha Sharda, MD
Elizabeth Ulliman, MD
Qi Yu, MD

Verde Valley

Romi Coolidge, DO, Chief Resident
Nidhi Saini, DO
Bryce Swenson, DO
Umema Burney-Wood, DO

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Member's Forum

Implement electronic medical records (EMR) or pay the penalty? An overview of the issues related to EMR adoption.

Juhyung Sun, Medical Student, University of Arizona College of Medicine Tucson
Shakaib U. Rehman, MD, FACP, VA Health Care System, Phoenix

CMS penalties and meaningful use

Under the American Recovery and Reinvestment Act of 2009 (ARRA), Medicare Eligible Professionals (EPs) are to be penalized for not demonstrating Meaningful Use (MU) of a certified EMR platform. MU is defined as compliance of EMR features with core objectives and a number of elective menu objectives.

Physician penalties took effect in 2015 as 1% downward yearly adjustments to Medicare reimbursement payments, reducing them to 97% of the pre-penalty fee schedule amount by 2017. If fewer than 75% of EPs use MU-compliant EMRs by 2018, this adjustment will continue until payments are 95% of the pre-penalty fee schedule amount.

Non-MU-compliant EPs may avoid penalties by applying for a hardship exception and demonstrating that MU implementation would be impossible or cause significant disruption. These exceptions must be renewed every year for no more than five years.

Current rates of EHR adoption

According to the 2013 National Ambulatory Medical Care (NAMCS) Survey, 78% of office-based physicians used an EMR system, of which 48% met "basic" requirements (e.g., patient history, problem lists, etc.). Significant variability in usage also existed from state to state.

If 22% of physicians did not use EMRs and if 40% did not report "basic" requirements, one could surmise that at least 62% of 2013 providers potentially lagged in MU-compliant implementation.

Clinical evidence for benefits.

Physician experience

In the early 2000s, noted benefits of EMRs included decreased staff hours for finding patient information, reduced records management and transcription expenses, improved capture of billable services, and availability/timeliness of care-related messages.

In the 2011 NAMCS Physician Workflow survey, most agreed that EMR usage increased records availability (>90%), reduced costs by lowering paper records management (~70%), and improved overall patient care (~70%). Physicians also reported time savings in specific areas, such as medication prescription and laboratory result release. However, more than 75% reported needing more time overall to plan, review, order, and document care; for example, one-third of physicians required extra time to answer pharmacy calls.

In general, MU-compliant physicians in the 2011 NAMCS were more likely to see EMR-related benefits and enhanced data confidentiality than non-MU-compliant physicians, as well as report less disruption in patient interaction. However, there seemed to be no specific correlation between MU and reporting of financial and selected clinical benefits.

Clinical outcomes

Although 2005-2007 NACMS data failed to show a consistent association between EMRs and care outcomes, more recent data suggest a link between EMR usage and health outcomes. An analysis of 154 studies found that 92% of these articles reported positive results in a variety of metrics. 2011 NACMS data also suggested the importance of EMRs in alerting physicians to medication errors and critical lab values (~60% of responding physicians). In addition, 30-46% of EMR adopters reported benefits in compliance with formularies, reminders for preventative care and clinical guidelines, laboratory tests (quantity and precision), and direct communication with patients. In a more regional example, a retrospective cohort from Cleveland healthcare organizations reported improved adherence to standards of diabetes care in primary care practices using EMRs. The Taconic Independent Practice Association of the greater Hudson area reported better adherence to standards for HbA1c testing and screening for breast cancer, chlamydia, and colorectal cancer in practices using EMRs. In addition, a cohort study of 213 primary care physicians using EMRs in New York State found that practices achieving Stage 1 MU experienced fewer primary care visits and laboratory tests.

Incentives and barriers for EMR adoption

Incentives

CMS administers the Medicare and Medicaid EHR Incentive Programs. EPs independent of hospitals may qualify for Medicare incentive payments upon MU compliance; they may also qualify for Medicaid payments under certain conditions of Medicaid patient volume.

Medicare incentive payments may continue for up to five years. Total incentives through 2016 range from $24,000 for those who began participating in 2014 to $44,000 for those who began in 2011.

Barriers

Initial EMR implementation costs for the first five years may range from $30,000 to over $45,000. While free EMRs are available, their adoption is often limited by a lack of ongoing technical or customer support. EMR usability (or lack thereof) and "complementary changes" (i.e., activities required to "complement" EMR implementation, such as training, customer support, and adapting EMRs to individual physician workflow) constitute the biggest barriers to implementation. Large physician groups and hospitals enjoy some advantages here, due to increased management expertise, financial resources, and personnel support; smaller practices may struggle.

EMR effectiveness often remains a function of physician mentality; pro-EMR physicians are better able to bear the initial costs of implementation. By contrast, less supportive physicians tend to be easily discouraged and remain low-level users without significant outside support.

Relation of EMRs to Chronic Care Management (CCM) Program

CMS established Current Procedural Terminology (CPT) code 99490 as a billable charge beginning in 2015. CPT 99490 is defined as "20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month" with patients who are managed under comprehensive care plans and possess multiple chronic conditions; these conditions must be expected to last at least 12 months (or until death) and place the patient at risk of functional decline or death.

Physicians who wish to bill for this service must use EMRs that include certain features, including information on demographics, problems, medications, and medication allergies; structured clinical summary records; documentation of care plan; ability to share care plan information with other practitioners, documentation of communication regarding psychosocial needs and functional deficits, and documentation of written consent and authorization. These standards largely parallel MU requirements; thus, one may expect eligibility in this program to roughly parallel wider trends of EMR adoption.

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Call for Spring 2016 Board of Governors Resolutions

Are you concerned about a practice or clinical issue or have an idea you'd like to suggest? If so, 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. 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 2015-2016 Priority Initiatives 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 2016 Board of Governors Meeting is October7, 2015. 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? Contact Governor Aaronson or Dixie Swan, Executive Director to start the ball rolling. Share your good ideas!! Draft a resolution.

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DynaMed Plus….New Member Benefit

DynoMed Plus

Coming in August

ACP and EBSCO Health are collaborating to focus on delivering the most current, evidence-based clinical decision support tool - DynaMed Plus™. As a result of this partnership, ACP members will receive free access to DynaMed Plus. This clinical decision support resource is updated daily and analyzed systematically through the lens of an expert editorial team, providing relevant information in an easy to digest format for fast implementation at the point-of-care.

Much more information.

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New, Free CME is available from Annals of Internal Medicine!

Introducing The Consult Guys! A unique and entertaining way to earn FREE CME from Annals of Internal Medicine! Hosted by Geno Merli & Howard Weitz, two, seasoned clinicians, educators, and comedians who answer questions from preoperative evaluations to clinical puzzlers. Each episode reviews topics essential for anyone practicing internal medicine or its subspecialties.

Enjoy, learn, and laugh while Geno and Howard entertain and teach you on their medical consult talk show - here is all the information you will need!

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ACP Offers Resources to Help Raise Immunization Rates

Sensitive to the rising concern about current immunization rates, ACP has some helpful resources! Start here, to make sure your information is current: Center for Disease Control's Recommended Adult Immunization Schedule. Keep in mind that "Flu shots and other immunizations can prevent people from suffering serious illnesses," said David L. Bronson, MD, FACP, president, ACP. "We need to improve immunization rates for all adults, especially for people between the ages of 18 to 65 with chronic conditions."

When your patients visit, go over these vaccinations: T dap (tetanus-diphtheria-pertussis, whooping cough), HPV (human papillomavirus), herpes zoster (shingles), MMR (measles, mumps, and rubella), pneumococcal pneumonia, hepatitis B (for adults with diabetes), and varicella (chickenpox). Rates for adult immunization are low!

Check these links - ACP's Adult Immunization Portal provides resources for clinicians such as the ACP Guide to Adult Immunization, ACP Immunization Advisor App, and the Medical Home Builder Adult Immunization Model.

Become an "Advocates in Internal Medicine network" (AIMn) Member--sign up today.

Follow Us! "Friend" ACP Arizona on Facebook. ACP Arizona Chapter Facebook Page

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