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GOVERNOR'S NEWSLETTER January 2015

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Governor's Notes

Dr. Slease

R. Bradley Slease, MD, FACP, ACP Governor

I trust that everyone had a happy holiday season, with at least a little time for rest and rejuvenation. Fortunately, as stressful as a busy clinical practice can be, it is at the same time invigorating. That said, there are ongoing frustrations that can detract from patient care and contribute to physician "burn out". To address these issues, the ACP Medical Practice & Quality Committee {MPQC}, whose membership includes our own John O'Neill, has launched an initiative called "Patients Before Paperwork". Along with ACP Staff, the MPQC is working to develop an evidence-based approach to address administrative complexities, i.e., activities that interfere with patient care, detract from the physician-patient relationship, and do not contribute to the good of the patient, or activities that may serve a public good but could be accomplished in a less burdensome way. On average, administrative complexities account for four hours per week of physician time and five hours per week for each staff member. Time required for insurance interactions costs physicians nearly 12% of net patient service revenue. Most of this, of course, is related to time spent preparing paperwork and contacting payors about prescriptions, diagnoses, treatment plans and referrals. MPQC has identified the three highest priority complexities, based on a recent survey of ACP members, as electronic health records (which add, on average, 48 minutes to each physician's work day in the ambulatory setting), quality reporting, and dealing with insurance companies. A policy paper is planned in the near future to summarize the MPQC findings, along with companion papers to propose specific actions to reduce these burdens. Is it naïve to be hopeful?

Once again, we had a very successful Lower Shores chapter meeting in October, as usual organized by Mansour Saberi and Bandu Palekar. Our upcoming Delaware Chapter Scientific meeting on February 14th, headed by Kate Eldridge, promises to be excellent as well. Our ACP Representative this year is Steve Weinberger, MD, FACP, Executive Vice President and CEO of the College. In addition to a discussion of interstitial lung disease, Dr. Weinberger will update us on activities at the ACP National Office.

A number of awards will be presented at the chapter meeting. In addition to those given annually, a special award will be given to a member from each chapter to help commemorate the upcoming 100th Anniversary ACP meeting in Boston this April. Termed the Chapter Centennial Legacy Award, the Delaware award will be presented to Virginia Collier, MD, MACP, whose long-term commitment to the College at the Chapter and National Levels is unparalleled.

Finally, I'm sure you are all now aware that Tabassum Salam, MD, FACP, will be our next Delaware Chapter Governor. She will spend a year as Governor-Elect, then become Governor at the National ACP meeting in 2016. Please join me in congratulating Tabassum and welcoming her at the meeting in February.

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Chapter Excellence Award

The Delaware Chapter has once again been awarded the Chapter Excellence Award for 2014. We receive national recognition as well as $2000 to support the Chapter in its operations. The award is presented to chapters who meet basic and optional criteria set by the national office.

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From the ACP Center for Quality: A Unique Opportunity for Physician Practices to Participate in a Diabetes Quality Improvement Project

By: John O'Neill, DO, FACP

ACP Quality Connect, the quality improvement arm of ACP, has made a unique project available to 10 Delaware Internal Medicine Practices that treat diabetic patients. The new Diabetes Collaborative Registry (DCR), which has been established by the National Cardiovascular Disease Registry (NCDR, which runs the acclaimed Pinnacle Cardiology Registry), is a tool that will be utilized to pull treatment data from the EHR charts of practicing clinicians, and present that data to physicians in a monthly and quarterly dashboard to allow physicians to improve care processes for their diabetic patients. This has been offered to Delaware IM practices, with an incentive stipend of $2500.00 per practice. The practices need to have an EHR, and to be willing to work with the registry staff to accomplish EHR mapping. Once set up, the registry pulls data from the charts of diabetic patients of the practice nightly, and the monthly dashboard reports on this progress for important diabetes care related metrics. The practices work closely with ACP Center for Quality staff to examine opportunities for improvement in care, and to dovetail these activities with PQRS reporting and satisfying ABIM MOC requirements. If you are interested in participating, send an email to Dr. John O'Neill ASAP.

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Medical Jeopardy Competition

By: Matthew Burday, DO, FACP

Answer: What are Batchelor, Campbell, Sethi, and Stankiewicz?
Question: Players in the Southeast Regional Jeopardy match, November 8, 2014!

The day dawned bright and beautiful as the team headed up to Einstein Medical Center to compete. Eager to go and filled with thoughts of piebaldism, Kounis syndrome, and eculizumab in their heads, the group sat quietly awaiting the first set of questions. Chris Batchelor was a big support as an alternate player as the team competed against Temple and Penn.

In the Cardiology category, the team zoomed ahead of Temple with "What is a beta blocker," the response to the question of the class of drug that worsens AR by prolonging diastole. In a similar rapid-fire vein, the team hopped ahead of the others with "Linezolid"-this quick response to the question of the antibiotic associated with serotonin syndrome. And so it went-a nail-biting, lip-smacking, headache-inducing round. When the dust settled and the points tallied, the team lost just short of Penn and things evened up with Temple-but only because of a large final Jeopardy wager…no worries as all had a great time just being there to participate. Einstein went on to win in the last round against Jefferson and will participate in the state regional competition but that doesn't matter. The fact that Christiana is the only residency outside Pennsylvania to participate is a huge win all unto itself!!!

And there was much more to the meeting! Pearl Philip won an award in the research category for her "Super-size this" poster-a discussion of obesity in the outpatient resident clinic (AMO). And S. Ali Hamid won a Professionalism award. Not to be forgotten, also one of our own who stuck it through all the way to the very last question, Julia Hiner. She documented various aspects of the competition-one of her photos made its way to the Chief Hess weekly update….hopefully you didn't miss it…along with a very sparkly and blinding photo of the good luck green shoes!

We look ahead to next year and more fun, friendly exhilarating competition. And you never know, you could be the next contestant on Jeopardy!

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ACP Offers Resources on Ebola Virus

As the situation with the Ebola virus outbreak continues to evolve, please be aware of resources to help you and your health care teams.

We encourage you to visit the CDC Ebola website for the most updated information on the Ebola virus outbreak and to share this information with your colleagues and networks. The CDC recently posted the following resources to help practicing physicians and health care teams best identify risks related to Ebola and treat accordingly:

  • Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD) in the United States
  • Ebola Virus Disease (Ebola) Algorithm for Evaluation of the Returned Traveler
  • Additionally the Department of Health and Human Services' Assistant Secretary for Preparedness and Response, Dr. Nicole Lurie, issued an Open Letter to All U.S. Healthcare Professionals regarding the current Ebola situation.

As a reminder, ACP has free clinical information and resources available to all members of the health care community and the public at large. Annals of Internal Medicine has published several articles about the virus on an emergency access initiative page. ACP Smart Medicine, the College's Web-based clinical decision support tool, includes a module on Ebola and Marburg viruses that contains evidence-based information about prevention, diagnosis, and therapy. The Ebola module is designed to help physicians advise patients who present with symptoms and who traveled to rural sub-Saharan Africa or had occupational exposure. ACP's website also includes links to information on volunteer opportunities with AmeriCares, USAID, and Medical Teams International.

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New Ethics Case Study Offers Guidance for the Care of Cognitively Impaired Patients

Preventive Health Screening, Ethics, and the Cognitively Impaired Patient is a new ACP ethics case study that is available online for CME credit. The case study presents the ethical issues in decision making regarding screening tests for patients with cognitive impairment and is designed to help primary care physicians, geriatricians, neurologists, and other physicians who care for patients with intellectual disabilities.

CME credit is available through Medscape for completion of this and other ACP case studies in the professionalism case study series are available.

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The ACP Advocate Blog

By: Bob Doherty

Monday, December 22, 2014

How the Grinch Stole Obamacare (2014 version)

On December 23, 2009, the day before the United States Senate passed its version of what later became known as Obamacare, I posted a rhyme comparing the debate to Dr. Seuss' famous tale about the Grinch who (tried) to steal Christmas, with the GOP in the role of the "Grinch" and Obamacare playing the part of Christmas. Here's my updated version-all intended to be in good (non-partisan) fun!

Every Dem
In the Congress
Liked Obamacare, a lot ...

But the GOP
Who sat to their right,
Did NOT!

The GOP hated ObamaCare! (Some called it treason)!
Now, please don't ask why. No one quite knows the reason.
It could be their base is far to the right.
It could be, perhaps, that money is tight,
But I think that the most likely reason of all
Is Republicans like their government, small.

But,
Whatever the reason,
Their base or their views,
They stood there on Christmas Eve, hating it all,
Staring down with a sour, disapproving frown
They vowed that next year, they'd bring it all down.

"We'll control the House, and the Senate!" they snarled with a sneer.
"Our chance for repeal is coming! It's practically here!"
Then they growled, with their fingers nervously drumming,
And said, "Obamacare's demise is finally coming!"
For, in 2015, they knew...

...They would finally be freed
Of having to get things past old Harry Reid,
With Mitch in charge, they'd slay the Obamacare beast.
And then they'd feast! And they'd feast!
And they'd Feast! Feast! Feast! Feast!
Because "socialized" medicine, you know, they can't stand in the least!

And the more they thought of finally prevailing,
They started to worry, about possibly failing.
Obama can veto our plans, strike them all down
We can't let him let him stop repeal from coming!
... But HOW?"

Then they got an idea!
An awful idea!
The GOP
Got a wonderful, awful idea!

"We know just what to do!" They laughed in their throat.
"We just need the Supremes to strike it down, on a 5 to 4 vote!"
And they chuckled, and clucked, "What a great GOP fix!
We'll sue Obama and let the court do the trick!
"

"We'll say that Congress never planned for the subsidies to apply,
In the GOP states that want Obamacare defied,
Who cares about the facts, or legislative intent?
As long as we can persuade five judges to relent
And strike the subsidies down, for better or worse,
We can get it tossed out, chapter and verse
."

"Pooh-pooh to Obama!" they were heard to be humming.
By June he'll find that the end is finally coming!
When the court rules against him! We know just what he'll do!
His mouth will stay open a minute or two
And Barack Obama will cry BOO-HOO!

"That's a noise," grinned the GOP,
"That we simply must hear!"
So they paused. And the GOP put a hand to their ears.

And they did hear a sound rising over DC town.
It started out low, and then got quite loud,
But the sound they heard from the White House wasn't sad!
Why, this sound sounded merry!
It couldn't be so!
But it was merry! Very!

They stared down at the Washington Post headline
And the GOP popped their eyes!
Then they shook! And they shook,
What it said was such a surprise!

On a five to 4 vote, the Roberts Court
Again upheld Obamacare, made their case naught,
They hadn't stopped ObamaCare from coming!
IT came!
Somehow or other, it came just the same!

And the GOP, even with all of the Koch brothers' dough,
Kept puzzling and puzzling: How could it be so?
Obamacare came despite our winning the midterm election!
It came though the pundits said it was an Obamacare rejection!
It came even despite the demands of Senator Cruz,
It came despite the ranting by our friends at Fox News,
They puzzled three hours, 'till their puzzler was sore.
Then they thought of something they hadn't before!
"Maybe ObamaCare," they thought, "means something more.
Maybe it really is about getting healthcare to the millions of poor
."

And what happened then…?
Well … in Washington they say
That the GOP took heart
And vowed to fight on anyway!
"We can still kill the law, if we just do it right,
We'll do it in through reconciliation, we'll continue this fight
As we promised the Tea Party, who like Obama the least
…We Ourselves …!
Won't rest until we carve up the ObamaCare beast!"

Of course, one part of my rhyme--the Supreme Court upholding Obamacare's premium subsidies--assumes that this will be the outcome of case that the court has agreed to hear, challenging the legality of the subsidies in the 36 states that opted to let the federal government run their health insurance exchange. In fact, we really won't know the outcome until the Court issues its ruling (likely in June, 2015). Let's hope that the Supreme Court upholds the subsidies-because if they don't, millions of Americans would lose their health insurance coverage. And that would truly be a reason to cry Boo-Hoo!

Today's question: No question, just my best wishes to you for a happy holiday season and prosperous and healthy New Year. (P.S., This will be my final blog post of 2014, will be back in early 2015).

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