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Since there have been no new, earth-shattering events in health
care at the national level, (yes, the SGR formula is still in
place), this is a good opportunity to review some of the recent
Delaware ACP Chapter activities and alert you about upcoming
The annual ACP Chapter meeting in February was a major success.
Attendance was the highest on record, and the feedback on the
speakers was uniformly positive. Kudos to Tony Bianchetta,
FACP, for planning the program. As in previous years,
there was a large number of excellent medical student and resident
poster presentations. Congratulations to Daniel
Jacoby, ACP student member, and Don
Slack, ACP Associate, who were the grand prize winners in
the poster competition.
Next year's meeting is now being organized by Jim
Ruether, FACP, and his planning committee. Due to a
scheduling conflict, we will have the meeting in a different venue.
Details will be provided later.
The Delaware ACP Chapter sponsored a Residents Journal Club in
April, organized by Dan Elliott, FACP, and
Heather Ragozine-Bush, ACP associate. The topic -
the Time Magazine article about problems with health care economics
- was unusual for a medicine journal club. However, it did generate
a lively discussion.
Our Chapter, along with the Delaware Academy of Medicine, the
Academy of Family Medicine, the College of Emergency Physicians,
and the Society of Hospital Medicine co-sponsored a symposium in
May on "Transitions of Care". We are hopeful that this
initiative will lead to an ongoing, coordinated effort to improve
effective communication among caregivers.
Other chapter activities include representation at ACP
Leadership Day in Washington, D.C. with a Delaware contingent again
headed by Dan Elliott, FACP. Nancy
Fleurancois, heads the Delaware ACP Early Career
Physicians group which sponsored a group at Leadership Day and will
lead another session in July. Dan and Nancy have summarized these
events for this newsletter.
The ACP National Office has urged state and regional chapters to
name someone who would be willing to step into the position of
chapter Governor should a sitting Governor be unable to fulfill the
role. After a discussion with the Governor's Advisory Council and
request for volunteers, I asked Neeta Milansincic,
FACP, to assume that position, if necessary, and she has
graciously accepted. Please give her your congratulations, (or
condolences), and full support should she be needed to complete the
current Governor's term.
By now, you will have received via e-mail the proposed
resolutions to be considered at the upcoming Board of Governors
Meeting in September. Some of these resolutions have special
relevance to physicians in Delaware. Your comments and feedback on
these resolutions are important, as I would like to represent the
views of the Delaware ACP Chapter, not just my personal
Finally, let me remind you about the upcoming 15th
Annual Lower Shores Symposium in Rehoboth Beach at the Boardwalk
Plaza Hotel on October 26, 2013. Once again,
Mansour Saberi, MACP, and Bandu Palekar,
FACP, have put together an excellent program with topics
covering a broad range of issues important to primary care
physicians. Last year's symposium was very well-attended despite
the imminent arrival of Hurricane Sandy. We hope to increase
attendance again this year. Think of it as a day at the beach with
CME credits. See you in Rehoboth!
The ACP Council of Early Career Physicians, formerly known as
the Young Physicians Council, is continuing to offer events aimed
at enhancing the professional development and quality of life for
physicians who are early in their career. Past events, under the
leadership of Edmondo Robinson, FACP, have
included a presentation by Beau Biden, Attorney General, that was
very well received. The ACP has identified that physicians who are
early in their professional career have special needs that the
college is striving to meet. Fostering early involvement of
physicians with ACP programs helps them become active participating
members of the ACP throughout their career.
With a brand new team, the Council of Early Career Physicians
held an event regarding Medical Audits and how the Affordable Care
Act will affect physicians. Medical audit specialist Dr.
Todd Trusty gave a dynamic and engaging presentation that
was very helpful and eye-opening. The event was well attended and
participants looked forward to more events from the Council. A
summer event on June 25th focused on financial planning for
physicians, including a discussion of tax strategies, asset
protection, and managing debt including student loans.
Some of the topics on which we are focused are relevant to
physicians throughout their career, but the unique aspect of our
group's effort is to target early career physicians who are trying
to find balance with career advancement and enrichment and
oftentimes are too busy to seek out such opportunities. Each event
is planned with a half hour for networking, providing a chance for
us to get to know each other and perhaps make connections that can
provide opportunities in the future.
Events planned in the upcoming months include a fall event on
Advancement to Fellowship in the ACP and an event regarding work
life balance, which has been a popular topic in the past. We are
always searching for new members who are enthusiastic and willing
to share their ideas on how to Increase the value of ACP membership
for Early Career physicians. If you have any suggestions we would
love to hear from you.
It's been a crazy year for health policy - and the next few
years are certain to be bumpy as health reform continues to roll
out. My sense is that there is broad agreement on aspirational
goals of increasing efficiency, increasing quality, and decreasing
the overall cost of care - but there is wide variability in what
people think is the best way to get there!
There are two pieces of the Affordable Care Act that are most
active right now: Health Insurance Exchanges and Medicaid
Expansion. Though the Affordable Care Act has already introduced
many smaller changes, the establishment of the Health Insureance
Exchanges will be the most dramatic overhaul of the health
insurance marketplace to date. State and federal governments are
scrambling to build capacity and infrastructure to enroll people -
and all the while the majority of the population has no idea that
this is coming! At the same time states are deciding whether to
accept federal subsidies to expand Medicaid eligibility in their
states. This is very controversial - and very partisan! - as many
governors are concerned that the expansion will ultimately leave
their states with a commitment to coverage that is unsustainable.
Stay tuned to this one, as Medicaid expansion was the biggest
mechanism to decrease the number of uninsured in this country and
therefore at the center of the Affordable Care Act.
It was in the midst of this transition that a group of us headed
to Washington for ACP Leadership Day. I was pleased to be joined
this year by Eric Schwartz, MD, Marci Drees MD,
MS, and Gia Uzelac, MD. Eric is the
Medical Director of the Medical Group of Christiana Care, Marci is
the Hospital Epidemiologist at Christiana Care, and Gia is
finishing her second year as a medicine-pediatrics resident at
Christiana Care. The diversity of opinions and experience proved
helpful as we discussed with aides to our Congressional
I encourage you to read more about these and other healthy policy issues.
Are you interested in health policy and advocacy? Please
consider joining us for Leadership Day 2014 - it is never too early
I wanted to update Delaware ACP Chapter members about an
exciting new Adult Immunization Initiative that your practice will
have the opportunity to participate in this year.
The Center for Quality of ACP (from the Washington DC office)
has obtained a grant from the CDC to support a project in which
internal medicine practices can assess their current adult
immunization practices, implement a plan to improve these
practices, and measure the results of this plan. In essence, it is
a quality improvement (QI) initiative for medical practices. As you
are aware, practice based QI efforts will be part of our future as
practicing physicians. Since many of us have little or no
experience in the QI arena, ACP will be developing programs for its
member physicians that will take the mystery out of QI efforts and
make it much easier for us to participate.
Most internists provide some immunizations for their adolescent
and adult patients. Most commonly, these have included influenza
vaccine, pneumococcal vaccine, tetanus vaccines (Td and Tdap) and
herpes zoster vaccine. Nationally, we know that adult immunization
rates have been low. There are many reasons for this, and one is
the lack of practice based initiatives that promote immunization.
Other important factors are related to patient acceptance and
cost/reimbursement issues. ACP and other physician specialty
organizations have recognized these dilemmas and are promoting
adult immunization efforts on behalf of physicians and their
Those of us who have implemented EHR's in our practices have
been required to report clinical quality measures (CQM's) as part
of the meaningful use government incentive program. Some of the
easier to document and measure CQM's have been immunization
related. Starting in 2013, practices that do not participate in the
government's PQRS program for this year, will receive a penalty
linked to their medicare reimbursement in 2015. Some of the PQRS
measures are immunization related. Many of us are required to
recertify in internal medicine every 10 years through the ABIM. A
PIM (practice improvement module) will now be required every 5
years. An approved quality improvement (AQI) pathway is one way to
accomplish this requirement, and it can be immunization based, if
supported by a program through an organization such as ACPNet
(ACP's practice based QI and research network).
You can see where this is going. ACP, as a professional
organization for internal medicine is supporting its members by
developing programs that coordinate making it easier for physicians
to comply with government regulatory requirements, to avoid
penalties in reimbursement, to participate in maintenance of
certification, to facilitate receiving CME credit toward
maintenance of licensure and to improve patient care. The idea is:
practice based quality improvement efforts satisfy these multiple
requirements simultaneously, to avoid redundancy and maximize
One of the ways Delaware internists can accomplish the above is
through participation in the Adult Immunization Initiative. We are
one of 7 chapters that will have this opportunity over the next 2.5
years. We have recruited 9 Delaware practices from the chapter to
participate thus far. If you think your practice may be interested
in participating in this initiative, please feel free to contact me at for more information.
We plan to kick off the program in late September of this year.
Meanwhile, I will be providing an update on adult
immunization topics at Medical Grand Rounds at Christiana
Hospital's Ammon Education Center on Thursday, July 11th, from 8-9
am. I hope to see you there.