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December 2013

From the Governor

This month’s newsletter provides details about our annual Chapter Meeting last week, and some other informational items. As we wind down on 2013 and get ready for the challenges of the next year, I would like to wish everyone happy holidays and safe travels. It is my pleasure to represent the Indiana Chapter.

J. Matthew Neal, MD, MBA, CPE, FACE, FACP


Medical Licensing Board Adopts new Prescribing Rules

The Indiana MLB adopted new prescribing rules regarding opioid prescribing in November. The new rules delineate how long a patient may go between visits, how many pills may be prescribed for certain substances, etc. Physicians, physician assistants and advanced practice nurses who prescribe scheduled drugs need to immediately become acquainted with these new rules, effective Dec. 15.


Upcoming Indiana Chapter Webinar!

Tuesday, January 14, 2014
6:30 pm EST
Physician Practice Panel – From Employment to Private Practice and Back

Deepak Azad, MD, FACP
Derrick Williams, MD



Recap of 2013 Indiana Chapter Meeting

The 2013 Indiana Chapter Meeting was held November 14-16 at the Marten House Hotel & Lilly Conference Center, and was a great success. Dr. Carol Kauffman, Professor of Medicine at the University of Michigan, gave our keynote address on “Adult Immunization Update.”

Dr. Kauffman

Dr. Carol Kauffman

Thanks to Randy Lee, our Program Chair this year, for his immense assistance pulling off a smooth meeting.

Dr. Lee

Dr. Randy Lee

Also thanks to our Education Committee of Brandon Dickey, Marla Current, Heidi Lakanen, Todd James, and Michael Sha (Immediate Past Governor). Thanks also to our Resident/Fellow Member Chair, Jeff Glant, for his organizational efforts, and to our other RFM members who helped obtain speakers and poster judges. Thanks also to our Chapter Staff of Donna Seawards (Executive Director) and Renee Douglas.

Dr. Michael Sha, Immediate Past Governor, was given the Laureate Award by the Indiana Chapter. The Laureate Award is the highest individual award given by our Chapter and recognizes an exemplary internist who has served the Chapter and Internal Medicine in distinctive fashion. He was introduced by IUSM faculty member Dr. Michael Ryan.

Dr. Michael Ryan presents Dr. Michael Sha with the Laureate Award.

Dr. Michael Ryan presents Dr. Michael Sha with the Laureate Award.

The Governor’s Award was given to Dr. Heidi Lakanen. A native of Michigan, Dr. Lakanen has practiced in the East Central Indiana area for over 15 years and has been very active in medical education and the Indiana Chapter.

Dr. Heidi Lakanen

Dr. Heidi Lakanen

A total of 41 resident and medical student abstracts were submitted for the meeting, and 16 were selected by the pre-judges for poster presentation.

Poster Presenters

Poster Presenters: (left to right): Ahmed Behery, Todd Rickett, Amber Oberle, Jenny Cheng, Kate Goeller, Maryam Gondal, Mason Brown, Daniel Hugenberg, Lina Gordy, Chrissie Tran, Nicolas Knauss, Anita Rajagopal.

IUSM resident Jenny Cheng

Jenny Cheng

IUSM resident Jenny Cheng won 1st place in the Clinical Vignette category for her poster “Acute Unilateral Leg Swelling and Pain After Arthroscopic Knee Surgery - It’s Not Just a DVT: A Case of Intraoperative Tourniquet-Induced Rhabdomyolysis.

2nd place in the Clinical Vignette category went to St. Vincent resident Todd Rickett for his poster “A sweet reminder that not all vesicles are herpes.” 3rd place went to IUSM resident Amber Oberle for her poster “Hypokalemic periodic paralysis and respiratory failure: a weak case of poison ivy.”

IUSM resident Kate Goeller

Kate Goeller

IUSM senior medical student Kate Goeller won the Research category for her poster “Skin Cancer & young women: are we doing enough?

The Research 2nd place award went to IUSM resident Lina Gordy for her poster “Patients with advanced stage germ cell tumors have a high risk of thromboembolic events.” 3rd place went to IUSM resident Daniel Hugenberg for his poster “The Diagnostic Utility of Fever to Predict the Presence Infective Endocarditis in Patients with Bacteremia.

Anita Rajagopal

Anita Rajagopal

St. Vincent resident Anita Rajagopal won the Clinical Quality Improvement category with her poster “Topiramate use in women of childbearing potential in a primary care setting.”

The 1st place winners from each category gave a brief presentation of their posters at the Scientific Meeting on Nov. 15.

Many thanks to our eclectic group of poster judges who spent several hours Thursday evening going through and scoring all the posters.

Poster Judges

Poster Judges (left to right): Dr. Richard Kohler, Dr. Heidi Lakanen, Dr. Kapil Mehta, Dr. Michelle Wolschager, Dr. Brandon Dickey, Dr. Bradley Allen.

Another highlight of the meeting was the annual resident “Doctors’ Dilemma” competition, with residents from our three residency programs (IU School of Medicine, St. Vincent, and IU Health Ball Memorial Hospital) facing off against each other. St. Vincent dominated the competition this year and will be representing the Indiana Chapter at the National Championships in Orlando.

Jeopardy 2013

2013 Indiana Chapter Doctor’s Dilemma Champions (left to right): Dr. Luiz Nunez, Dr. Jennifer Mundell, Dr. Emily Cochard, and program director Dr. Lannie Cation.

Saturday’s meeting consisted of three ABIM Self-Assessment Modules: Update in Internal Medicine, Update in Hospital Medicine, and Update in Geriatric Medicine.

Handouts from Friday’s meeting.

Finally, thanks to all our faculty who gave immense time and effort to present at our meeting. Without you we could not have pulled it off.

The meeting dates for next year will be announced soon.


Items of Interest

Insurance Sold On Marketplaces May Limit Access To Doctors, Hospitals.

In a front-page story titled “Insurers Restricting Choice Of Doctors And Hospitals To Keep Costs Down,” the Washington Post (11/21, A1, Somashekhar, Cha) reports that “Americans...are discovering that insurers” selling plans on the Affordable Care Act’s marketplaces, “are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.” According to the Post, there is now “a two-tier system” as “many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.” The Post says this situation has been exacerbated by some “providers” that “have balked at being in exchange networks because they are unhappy with the reimbursement rates or are concerned that the exchanges could be dominated by sick people who won’t be able to pay their portion of the bills.”

As the AP (11/21, Alonso-Zaldivar, Ramer) notes, President Obama “promised people could keep their doctors,” which could make this “the next health overhaul issue.” American Medical Association president Dr. Ardis Dee Hoven is quoted as saying, “Although it may be too early to reach any definitive conclusions, we are monitoring the adequacy of the exchange networks and will be analyzing the impact of these restrictive strategies on patient access to care.”

Moreover, the Washington Examiner (11/21, Pollock) reports that consumers visiting healthcare.gov are not able “to learn whether their doctors participate in an Obamacare-approved health care plan because the website doesn’t include such information.” Jessica Waltman, Senior Vice President of Government Affairs for the National Association of Health Underwriters, explained to the Examiner: “Under the exchanges, the government did not require health plans to submit detailed network information. That’s why the networks aren’t listed on healthcare.gov. When you go to look in at the plan choices, you can’t see the provider networks.”

Many “Top” NYC Hospitals Will Not Accept Most Exchange Plans. The AP (11/21, Caruso) reports that some of the “top hospitals” in New York City are not accepting insurance plans sold through health insurance exchanges. Nationwide, in order to reduce costs, many plans offer limited provider networks. Another reason for the New York plan refusals comes from “hospitals being cautious about agreeing to take new, untested insurance products.” Although the number of accepted plans differs, Memorial Sloan-Kettering Cancer Center, NYU Langone Medical Center, and New York-Presbyterian Hospital will accept at most a minimum of available plans.

The Wall Street Journal (11/21, Dawsey, Subscription Publication) reports that other hospitals in New York City are working to sign up people for coverage in order to avoid what the ACA calls “disproportionate-share hospital payments.” These payments are given to hospitals that provide a large share of unreimbursed care.

Report Links Historically Low Health Spending Growth To ACA.

A handful of outlets cover a report from the Obama Administration offering good news about the growth of healthcare costs in the United States. And while the White House attempted to link the low growth to the Affordable Care Act, not everyone agrees. USA Today (11/21, Kennedy) reports that the Council of Economic Advisers released a report Wednesday which shows “health care spending has risen by the lowest rate ever recorded,” which the Council said “could lead to more jobs and lower-than-expected costs.” Chairman Jason Furman, along with other health experts, believe “the Affordable Care Act is, in part, responsible for the lower costs.” However, Republicans “say the declining rate of increases comes purely because of the slowed economy.”

Bloomberg News (11/21, Runningen) notes too that the report “linked slower growth of health costs to passage of the Affordable Care Act in 2010,” coming amid “an onslaught of criticism after the flawed opening of the federal online insurance exchange and the cancellation of individual policies for hundreds of thousands of Americans.”

Reuters (11/21, Felsenthal, Rampton) reports specific figures from the analysis: spending grew an average of 1.3% per capita over the last three years, the lowest ever recorded, and healthcare inflation is at its lowest rate in 50 years.

Additional coverage, much of which explores the link between the low growth and the Affordable Care Act, is offered by the Christian Science Monitor (11/21, Feldmann), the CNN (11/20, Acosta) “Political Ticker” blog, MSNBC (11/21, Benen), the Politico (11/21, Brown), The Hill (11/21, Easley) “Healthwatch” blog, and the CQ (11/21, Adams, Subscription Publication).

Small Businesses, Individual Purchasers To Pay Bulk Of ACA Fee.

The Wall Street Journal (11/21, Needleman, Subscription Publication) reports on a little known aspect of the Affordable Care Act in an article titled “Smaller Companies Expected to Bear the Brunt of Little-Known Fee for Insurers.” The ACA creates an annual fee on health insurers that is expected to generate $8 billion in 2014 and up to $14.3 billion by 2018. The Journal cites experts and a Congressional Budget Office report who say that small businesses and individual insurance purchasers will have to pay a disproportionate share of the fee.

Poll: Most Uninsured Not Satisfied With Exchange User Experience.

The Hill (11/20, Shabad) reports in its “Healthwatch” blog on a Gallup poll released yesterday that found “a majority of uninsured people who have visited a federal or state health insurance exchange website said they were unhappy with their experience.” The survey found that 80% of uninsured people had not visited an exchange website. Of those who had, 30% reported “very negative” experiences, 33% “negative,” 29% “positive,” and only 5% told Gallup that their experience with the health insurance exchange was “very positive.”

Several States Still Considering Medicaid Expansion.

Several media outlets, mostly regional, describe several states that are considering the Medicaid expansion called for in the Affordable Care Act.

Maine To Pay Nearly $1 Million To Consider Medicaid Expansion. The AP (11/20, Durkin) reports that Maine’s Department of Health and Human Services plans to pay the Alexander Group “nearly $1 million... to evaluate the state’s Medicaid program and study whether it should be expanded under the federal health care overhaul.” The Group is headed by Gary Alexander, whom the AP describes as “a former welfare chief in Rhode Island and Pennsylvania, who has opposed an expansion of Medicaid and been criticized by Democrats and advocates for the poor and disabled for his cost-cutting efforts toward welfare.”

The Bangor (ME) Daily News (11/19, Moretto) characterizes Alexander as “a conservative former welfare administrator with a history of slashing benefits.” and the Kennebec (ME) Journal (11/20, Mistler) refers to him in its headline as a “controversial Medicaid reformist.”

Medicaid Expansion Talks Break Down Between Missouri Governor, Legislature. The St. Louis Post-Dispatch (11/20, Young) reports that Missouri Governor Jay Nixon (D) canceled a planned meeting with legislators because of a disagreement over the format of the meeting. Nixon released a letter yesterday accusing Sen. Gary Romine (R-Farmington) and Rep. Jay Barnes (R-Jefferson City) of playing a “political game” over the pair’s proposal that the meeting be held as a hearing in which the governor would be the only witness. Nixon wants to expand Medicaid under the Affordable Care Act, but the Republican led legislature has thus far opposed the move.

The Columbia (MO) Missourian (11/20, Matson) reports that the breakdown over the meeting format is “a sign of the contentious fight likely to unfold during the upcoming legislative session.


Contact Information

Indiana Chapter Governor:
J. Matthew Neal, MD, MBA, CPE, FACP, FACE
Email: jneal6@iuhealth.org
(765) 747-4350; Fax (765) 751-1451

Donna Seawards
Executive Director
Email: donnaseawards@gmail.com
Ph: 623-225-5527

Chapter Address:
4319 West Clara Lane, PMB #288
Muncie, Indiana 47304