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U.S. Air Force Governor's Newsletter May 2018

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COL Matthew B. Carroll, MD, FACP, USAF, ACP Governor

COL Matthew B. Carroll, MD, FACP, USAF, ACP Governor

Greetings from Ocean Springs, Mississippi! Spring has sprung, or at least it is trying to in some of the northern parts of the country which still continue to receive snow! Speaking for myself, even living in South Mississippi, winter seemed to be a little too cold and long this year.

Spring brings with it bright sun, blossoming of flowers and trees, over the top cleaning, and a sense of renewal and rejuvenation. I would ask you to ponder that last point—what are you doing to renew and rejuvenate your professional growth? Perhaps your CV is in need of tiding up? Perhaps now is the time to step into that leadership position to help make your hospital safer or more patient friendly? Do you seek a mentor to help guide you down a particular professional path? Whatever it is, now is a good time to get started! Realize that you don't need to embark on an endeavor by yourself. This chapter as well as our MTFs and AFMS have many outstanding individuals that can help mentor you and foster your growth!

 


Highlights from the National ACP Meeting

It was an honor to represent our illustrious chapter at the National ACP Meeting (IM2018) in New Orleans. Once again our chapter was well represented at the meeting. Before the conference started Dr. Alyssa McManamon attended the Wellness Champion training, getting her started as our chapter's Wellness leader. I appreciate her volunteering for this important position. At the conference were our chapter Vice Governor Dr. Angie Collamer and our member serving on the Council of Resident and Fellow Members Dr. John Hunninghake.

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Convocation was held on 19 April, Thursday. I had 2 Air Force Chapter members walk with me in the ceremony, Dr. David Lindholm and Dr. Zackary Wright (below). The honor of Fellow of the ACP represents a significant professional milestone in an Internist's career. With the tremendous talent and knowledgeable members of this chapter I hope to see many more reach this professional milestone during my governorship.

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The Air Force Doctor's Dilemma team consisting of Diana Le, Douglas Deever, and Jason Thomas did a great job battling against NY Upstate, Quebec, and several other teams (below). At one point the AF team was dominating the field! I was tremendously proud of their depth of knowledge and gamesmanship. The answer that seemed to break all the teams—nesidioblastosis. Still trying to figure that one out . . .

We had several residents present their scholastic endeavors at IM2018. I overhead several of the presentations and was impressed with the caliber of research that was presented. Below are several of the residents that I was able to take pictures of with their research:

Captain Morgan Manley with her research titled “Improving Vaccination Status in Solid Tumor Patients Receiving Chemotherapy”

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Captain Joshua Romain presenting his research titled “Palliative Care Utilization in Patients with Newly Diagnosed, Incurable Solid Tumor Malignancies: The Experiences of an Institution new to Palliative Care”

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Captains Michael Massoud and James Dizmang with their research titled “Examining the Initial Presentation Leading to Long-Term Opioid Use at a Military Medical Treatment Facility”

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Captain Jason Thomas with his clinical vignette “Scurvy—When Life Gives you Shock, Make Lemonade”

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Captain Diana Le with her clinical vignette “Enteroviral Meningoencephalitis as a Complication of Rituximab Therapy for Rheumatoid Arthritis.”

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While I tried to make it to everyone's presentations, I unfortunately fell short. Captain Matthew Rendo presented his poster “Erythrodermic Psoriasis in a Patient without Psoriasis”. I missed Dr. Andrea Keithler with her clinical vignette “Statin Induced Necrotizing Associated Myopathy: A Case of Delayed Onset Following Statin Discontinuation” and Dr. Matthew Bezzant with his clinical vignette “Unique Case of Penile Rhizopus Oryzae Infection in an Unexpected Patient”.

Overall IM2018 was a huge success and had the largest attendance to date. I will reiterate how impressed I am with the knowledge and skill that our residents, medical students, and staff bring to the meeting. IM2019 will be in Philadelphia and I am confident that we will continue to contribute our best to the American College of Physicians!

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ARMY / AIR FORCE CHAPTER MEETING

This is a friendly reminder that the combined Army/AF chapter meeting will be held again at the Gateway Club on Lackland AFB, TX from 6 – 8 September 2018. Both Dr. Mount (Army ACP Chapter Governor) and I sincerely hope that you will chose this meeting as your annual educational meeting. We are in the process of obtaining CME and MOC accreditation. We will once again have a dynamic group of speakers as well as breakout sessions, Doctor's Dilemma, and poster/podium presentations. We will also have a new feature at the meeting this year, panel discussions. These sessions will be about an hour long and consist of a panel of speakers along with a moderator discussing about the pros and cons of topics germane to all of our practices. Also, Dr. Eddie Davenport has graciously agreed to speak again for the Cardiology Plenary! How could you not enjoy listening to a doctor who tells you to drink more coffee and wine to live longer (all in moderation, of course)! We will have food Saturday morning as well.

We are also excited to announce that this year there will be a Faculty Development course that USU will graciously support along with a Medical Student Mentorship Social (food provided) on 5 September 2018. The USU Faculty Development will start at 2 PM and end at 5 PM at the conference hotel, the Marriott Plaza San Antonio (555 South Alamo Street), with the reception starting at 5 PM. More information about how to register for the USU Faculty Development is forthcoming. Plan on learning, networking, and having fun!

In addition to the educational content of this meeting, it will again be an important forum for me to update you on our chapter and its accomplishments, review chapter finances, vote, and hold a townhall meeting. The chapter meeting will thus be important for ALL chapter members, regardless of whether you're a medical student or a Master of the ACP. Please plan to attend.

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ABSTRACTS NOW BEING ACCEPTED FOR ARMY / AIR FORCE MEETING

For Air Force ACP Residents: The first call for abstracts for the 2018 Army/Air Force ACP Conference went out to Program Directors and their affiliated staff on 20 April 2018. As in years past, there will be 3 categories in this competition: Research, Quality Improvement, and Clinical Vignette. Also, like last year, we are asking that the program leadership at each institution collect abstract submissions for their respective residents and select the top abstract in each of these 3 categories. Please then submit these 3 abstracts to the following email address . The remaining abstracts from your residents will then be eligible for submission for presentation at a subspecialty breakout session (more details regarding this process will come at a later date). Use the following link to complete the template for abstract submission. PLEASE ensure that you designate to which category the abstract will be submitted. There will be a 450 word limit (not including title and authors). The final deadline for submission will be COB Tuesday 12 June 2018. For any specific questions/concerns, please contact Captain (Dr.) Kelly Chohonis or Major (Dr.) Andrew Skabelund .

For Fellows and Early Career Physicians (ECP): This is the 2018 Army/Air Force ACP Conference first call for Fellow and ECP abstracts. As in years past, there will be 3 categories for each of these competitions: Research, Quality Improvement, and Clinical Vignette. Use the following link to complete the template for abstract submission. PLEASE ensure that you designate to which category the abstract will be submitted. There will be a 450 word limit (not including title and authors). Please submit all abstracts to the following email . The final deadline for submission will be COB Tuesday, 12 June 2018. For any specific questions/concerns, please contact Captain (Dr.) Kelly Chohonis or Major (Dr.) Andrew Skabelund .

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Hot Topics

I. Continuing Board Certification: Vision for the Future

The American Board of Medical Specialties has undertaken a major initiative to reexamine and, hopefully, reimagine what they are now calling Continuing Board Certification. Follow the link to read more.

This ‘Vision Initiative’ includes physicians, professional medical organizations, national specialty and state medical societies, hospitals and health systems, the general public and patients, and the 24 Member Boards of the American Board of Medical Specialties (ABMS). Together, they comprise a Commission that will lead the effort throughout 2018 and early 2019.

The name change is significant in that it acknowledges the widespread dissatisfaction regarding existing models for MOC. The ABMS describes the initiative as follows:

“Continuing Board Certification: Vision for the Future is a collaborative effort that brings together multiple stakeholders to envision a system that is responsive to the needs of those who rely on it and that is relevant, meaningful and of value to physicians.

This ‘Vision Initiative’ includes physicians, professional medical organizations,national specialty and state medical societies, hospitals and health systems, thegeneral public and patients, and the 24 Member Boards of the American Board ofMedical Specialties (ABMS). Together, they comprise a Commission that willlead the effort throughout 2018 and early 2019.”

Internal Medicine is well represented on the newly appointed Commission. Of 24 positions, five are from internal medicine. You can sign up for monthly updates at this link

II. ACP Issues Ethical Guidance for Individuals Participating in Volunteer Medical Trips

ACP has released a position paper that aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The paper can be found at the following link

III. Patients Before Paperwork Outreach Update

Since the launch of ACP's Patient's Before Paperwork initiative in 2015, the College has worked to identify and prioritize the most burdensome administrative tasks faced by ACP members and their patients; develop significant policy recommendations for how to address these administrative tasks; and engage in ongoing outreach and stakeholder engagement efforts with external sources of administrative and regulatory burden.

Just recently, in February of 2018, ACP attended the electronic Health Initiative (eHI) Executive Roundtable to brainstorm ideas with vendor and insurer executives on how to leverage health IT to reduce administrative burden and improve value-based care and payment. Later that month, ACP attended the Centers for Medicare and Medicaid Services (CMS)/Office of the National Coordinator for Health Information Technology (ONC) listening session on reducing clinician burden where Dr. Pat Hale, Chair of ACP's Medical Informatics Committee, provided ACP's priorities and recommendations in this area. Dr. Fleming, Deputy Assistant Secretary for Health IT, closed the session by announcing the following ONC top priorities:

  • Reforming/Simplifying the Evaluation and Management (E/M) Documentation Requirements
  • Promoting Transparent and Streamlined Prior Authorization Processes
  • Improving Quality Measurement and Quality Reporting
  • Integrating Information from Prescription Drug Monitoring Programs (PDMPs) into EHRs

Other recent outreach activities include ACP Regent, Dr. Peter Basch, attending the White House listening session on interoperability. As follow-up to his discussions as well as discussions at the CMS/ONC listening session, ACP submitted feedback to CMS Administrator Verma specific to reworking the Advancing Care Information (ACI) performance category under the Quality Payment Program (QPP); streamlining or removing prior authorization; and simplifying clinical documentation requirements. And at the beginning of March, Shari Erickson, Vice President of Governmental Affairs and Medical Practice, presented at the HIMSS18 conference on “Putting Patients First by Reducing Administrative Tasks.” While at HIMSS18, the Administration reiterated their priorities to address administrative and regulatory burden and announced they would be focused on interoperability, overhauling E/M documentation, and significantly changing the reporting requirements under Meaningful Use and the Medicare QPP's ACI performance category.

ACP continues to collect from members specific administrative tasks and best practices through an online data collection tool. These examples are used for ACP advocacy efforts and most recently used in preparation for incoming ACP President-elect, Dr. Robert McLean's, statements at the House Ways and Means Subcommittee on Health Medicare Red Tape Relief Project Roundtable. ACP provided feedback on the project back in August 2017, and this invite-only roundtable is the next step in the Subcommittee's bipartisan efforts to reduce regulatory and administrative burden in Medicare.

The College's outreach efforts through the Patients Before Paperwork initiative will continue as we work to remove barriers that unnecessarily interfere with meaningful interaction between clinicians and their patients.

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Mark Your Calendar

5 September 2018 - Army/AF ACP Chapter Meeting Pre-Course (Alamo Marriott, San Antonio, TX)

  • USU Faculty Development Course
  • Medical Student Mentorship Social (food provided)

6 – 8 September 2018 - Army/Air Force ACP Chapter Meeting (Lackland AFB, TX)

4 – 5 October 2018 - Ohio/Air Force ACP Chapter Meeting (Greater Columbus Convention Center, OH)

11 – 13 April 2019 - IM 2019 (Philadelphia, PA)

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Newest Air Force Chapter Members

Please extend a hardy welcome to our newest members, resident/fellow members, and medical students honorably mentioned below. We appreciate their joining our chapter and look forward to their contribution to growing our chapter!

Devin C Kelly
CAPT Ian Matthews, MC USAF
Sandipani Sandilya, MBBS
CAPT Matthew L Bezzant, USAF
Alexander Yuan
CAPT Gyan Narayan Das, MD USAF
Abimael Jose Velez Velez, MD
CAPT William Bennett V, MD USAF
LT COL Raja Talati, MD,USAF
CAPT Jaclyn N Harris, DO
Satoshi Ryan Shin
CAPT Alexander Digregorio, DO
Daniel Moe
David Short, MD
John Levasseur
Joseph Cook, MD
Stephanie Krusz, MD USAF
Eric Karr
Jared Laney
Danielle Larson, DO
Maxwell Kruse
Haley Caldwell
Daniel Abramson
Sean T Wickers
Rafaela Izurieta
Ashley Murphy Shaw
2LT Curtis S Pacheco
Anthony Yao
Michael Wilson
Clinton Ulmer
Hamish Patel
Cody Larowe
Andrew Engle
Steven Gingues
Olivia Vaughan, DO
Caitlin Brauer
William McCallum
Matthew Nemero, DO
Monica Tillman, MD
Lauren Fehr
Dan Urbine, MD
Chelsea Tyson
Bradley Phillips
Tyson Hamilton
Daniel Bainbridge, DO USAF
Elisabeth Wynia
David Demasters
Joseph Pearman
Spencer Hart
Timothy Cho
Justen Despain
Emma Boesel
Damien Morgan, DO MC USAF
Rhiannon Flowers
Tyler Campbell
Christopher Kaatz, DO
Lauren Meziere
David Shumway
Finianne Umali
James Dreher

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