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July 2013 Thomas A. Bledsoe, MD, FACP Governor

Governor's Newsletter

Dr. Bledsoe

Annual Scientific Meeting a Big Success!

Thanks to Russ Corcoran and the members of the program committee for their work to put together a super program for this year’s meeting, held for the second year in a row at the historically significant Rhodes-on-the-Pawtuxet ballroom in Cranston. Hearty and warm congratulations to Chapter Award winners Michele Cyr, Janice Kizirian and Diane Siedlecki (details below). Congratulations also to medical student Alyssa Doody from The University of New England College of Osteopathic Medicine/Roger Williams Medical Center for her winning medical student poster “Tuberculosis Peritonitis: An Elusive Diagnosis in a Patient with Ascites and Spiking Fever” and especially to resident research project podium presenters Kristin Robinson from the Brown/RIH/Miriam Internal Medicine residency program, first place winner for her presentation entitled “Clinical Use of Loop Gain Measures to Determine CPAP Efficiency in Patients with Complex Sleep Apnea”, Jeffrey Nadelson from Boston University/Roger Williams Medical Center for his 2nd place award winning presentation entitled “Safety of Treatment in Cirrhotics in the Era of New Antiviral Therapies for Hepatitis C Virus”, and Tim Amass also from the RIH/Miriam program for his research presentation “End of Life Curriculum for Third Year Medical Students. These three along with runners-up Amrita Desai, Michael Marsh and Naushaba Khan were selected from over 150 submissions by residents in the Rhode Island Chapter!

The scientific program this year featured an enlightening and hope-inspiring talk on the future of the electronic medical record entitled “Beyond Meaningful Use: How EHR Use Should Improve Care “ by Peter Basch MD FACP who is the current chair of the College’s Health Informatics Committee. View the slides from Dr. Basch’s presentation.

Breakout topics this year addressed important topics including an update on Hepatitis C by Jack Wands, Director of Gastroenterology at Lifespan/University Medicine, a talk focusing on rational (and prudent) antibiotic use by Lou Rice, Physician-in-Chief at Lifespan and Chair of the Department of Medicine at Brown, issues related to the screening for and treatment of prostate cancer by local expert Tony Mega, novel fecal transplant therapy for recurrent C. difficile infection by Colleen Kelly from Brown and Lifespan’s Women’s Medicine Collaborative, an update in Celiac Disease by Alan Epstein (from Boston University School of Medicine and Director of GI at Roger Williams Medical Center) as well as an update in sepsis by international expert and Director of Pulmonary and Critical Care at Lifespan Mitchell Levy.

The meeting also featured, for the first time in Rhode Island, two SEP modules, worth 10 points each toward ABIM recertification. Thanks to Iris Tong from Providence and Lou Rubenstein for their help serving as faculty for these collaborative learning sessions!


Chapter Laureates Honored

At the chapter meeting, we were pleased to honor Michele Cyr MD FACP with the Milton Hamolsky Lifetime Achievement Award. Dr. Cyr is currently serving as Associate Dean for Academic Affairs at the Warren Alpert Medical School and recently completed a term as Regent of the College. The Hamolsky Award recognizes a senior College member who has demonstrated academic, clinical, research and administrative excellence. The recipient is a physician who epitomizes the attributes of the award's namesake, Dr. Milton Hamolsky, (who was on hand to deliver some kind words in recognition of Dr. Cyr’s accomplishments to date!).

Janice Kizirian MD FACP was awarded the Irving Addison Beck Award, named for a true icon of the Rhode Island medical community. Dr. Beck established a private internal medicine practice in Providence, yet found time to serve as chief of medical service at the former Providence Lying-In Hospital, now the Women & Infants' Hospital. He also served as chief of medicine for The Miriam Hospital and Rhode Island Hospital.

Like Dr. Beck, Dr. Kizirian is a well-respected member of the medical community who mixes compassion and kindness to give her patients the very best care available. Dr. Kizirian practices in Lincoln.

Diane Siedlecki MD FACP was this year’s recipient of the chapter’s Governor’s Award, given at the discretion of the Governor to a chapter member active in the chapter’s work in advocacy. Dr. Siedlecki has perfected the art of advocacy as an integral part of her professional life and presents ample evidence of the good a single physician can do in making the system work better!


Leadership Day Update

The College’s Annual “Leadership Day” took place on May 21 and 22 in Washington, D.C. The delegation this year had a particularly youthful air with Warren Alpert Medical School 3rd year student (and ACP national Council of Students member) Rahul Banerjee joining residents Megha Garg and Zoe Tseng (member of the ACP’s national Council of Residents and Fellows), both from the Rhode Island Hospital/Miriam Hospital residency program and Chapter Governor Tom Bledsoe.

Tuesday featured a series of presentations by the Washington office starting with a very useful “Advocacy Workshop” followed by an excellent presentation by College Senior VP Bob Doherty entitled, “The turbulent political/policy environment affecting health care and what we want Congress to do about it". The afternoon was rounded out with panel presentations on the impact of the budget sequester on practices and key federal health care programs and on the latest developments in physician payment reform and workforce. On Wednesday, prior to our visits with our Rhode Island congressional delegation, we were given some inside information presented by representatives Ami Bera, (an emergency medicine physician, D-CA) and Joe Heck (R-NV); Dr. Heck is the cosponsor (with Alison Schwartz of Pennsylvania) of the Medicare Physician Payment Innovation Act (H.R. 574) which seeks to permanently repeal the much loathed SGR by tying it to significant payment and incentive reforms.

Our specific asks to the congressional delegation were related to 4 areas:

  • Elimination of Medicare's Sustainable Growth Rate (SGR) with a transition to better payment systems
  • Ensure full funding for essential health programs (Including the National Health Service Corps, Section 747 Training in Primary Care Medicine, funding for the Affordable Care Act’s National Healthcare Workforce Commission, the CDC, NIH and HRSA among others)
  • Authorization and funding for a national pilot for no-fault health courts
  • Reformed and sustained graduate medical education financing, including a proposal for an "all payor” funding mechanism (currently, GME is funded almost entirely through Medicare)

Generally, we were very well received by staff members who asked probing questions about medical practice in the current medical practice environment. Everything discussed in Washington was discussed in context of the current budgetary problems. The College has generally been quite careful to advocate for medical treatment that is both more effective and equally importantly more cost-effective. I was proud to see the American College of Physicians is well regarded as a trusted resource in Washington. Details about the College’s key priorities as well as presentations from the Advocacy workshop are available at http://capwiz.com/acponline/home/LD.

As I have become more involved with the ACP, I have come to the belief that advocacy is a key responsibility for members of our profession, and have found the College to be both a very effective tool and a very effective vehicle for that advocacy. If you have not yet joined the College’s advocacy effort today (Advocates for Internal Medicine network), please consider doing so now. More information at http://www.acponline.org/advocacy/aimn/

“Where does the College stand on immigration reform?” What is our position on health care reform, or using “physician extenders” in practice?” you may ask. The College has recently updated the search function on the Advocacy page so that policy papers and position statements from the College are now quite easy to find. Simply click on the Advocacy tab on the top right of the College’s Web site and give the search function a test drive! You will be pleased by the results!


IM 2013

Rhode Island team competes at national Doctor’s Dilemma™ competition

Hearty congratulations to Brown/RIH/Miriam medical residents Matt Lynch, Tim Amass and Steve Kassakian for their valiant efforts at the Doctor’s Dilemma™. Despite ultimately going down in the first round in San Francisco, our team was in good shape going into Double Jeopardy before an unfortunate strings of incorrect responses took them out of the running. The winning team from Albert Einstein Medical Center will be gunning for a “3-peat” in 2014, keep an eye out for an announcement about our next local competition in December or January.

Residents and Students represent Rhode Island well at national poster competition

We were happy to see student Andy Crawford and residents Dan Chen and Deb Banerjee from Brown/RIH/Miriam and Amrita John from Brown/Memorial for their poster presentations. The 2012 chapter meeting podium winner Michael Agustin was also chosen to represent RI at the meeting but was unable to attend due to plans related to his wedding and honeymoon! Congratulations to all, but especially to Michael for his excellent judgment related to work-life balance!!

Mastering the Match

Chapter members and ACP fellows Dom Tammaro and Kelly McGarry brought back their popular “Mastering the Match” session for medical student ACP members in San Francisco and were joined on stage at the last minute by Earl Stewart recent Meharry Medical College graduate and now Brown/RIH/Miriam intern YYY for another highly regarded and extremely helpful session.


Congratulations to New Fellows

Antony Chu from West Warwick, Courtney Clark Bilodeau from East Providence, Al Kurose and Bill Sikov from Providence have all advanced to fellowship in the College this past year. Recently-named fellow Herman Ayvazyan also of East Providence took advantage of the opportunity to march in the College’s Convocation ceremony at IM 2013 this year. New fellows have a 3 year window during which they have the opportunity to march in full academic regalia at the Convocation ceremony. Marching proudly with new fellows has been one of the real highlights of my time as Governor!

Since 1975, over 35,000 physicians have earned ACP Fellowship, a mark of distinction representing the pinnacle of integrity, professionalism, and scholarship for those who aspire to pursue careers in internal medicine. Fellowship in the College is an honor. Being an FACP is a distinction earned from colleagues who recognize your accomplishments and achievements over and above the practice of medicine.
ACP members who are more than two years out of residency should consider applying for fellowship along one of the several “pathways to Fellowship”:
Pathway 1 — the Published Academician
Pathway 2 — the Physician with a Commitment to Continuing Education
Pathway 3 — the Active ACP Member
Pathway 4 — the Senior Physician

Details are available at http://www.acponline.org/membership/fellowship.


Board of Governors Update

The Board of Governors had an interesting and very productive meeting in San Francisco prior to the College’s national meeting IM2013. In addition to an inspiring presentation by physician, author and UCSF faculty member Abraham Verghese ("My own country: A Doctor’s Story," and "The Tennis Partner," and more recently the very well-received "Cutting for Stone") on the connections between literature and medicine, we were given a vibrant update from College Senior VP Bob Doherty on the situation in Washington. Bob’s slides are available on the advocacy site mentioned above. A big part of his presentation was related to “ObamaCare” and specifically the largely federally-funded Medicaid expansion that a number of state governors have chosen to pass on, in effect turning their backs on millions of dollars of federal investment in the care of the uninsured and poor in their states. (Gov. Chafee in Rhode Island has chosen to accept this federal support.)

The Governors also extensively discussed a policy paper that has been in draft form and extensively revised entitled, “Principles on Supporting Dynamic Clinical Care Teams for the Benefit of Patients” to be released shortly. As the “Patient-centered Medical Home” concept becomes more developed and more widely distributed and as the “Patient-centered Medical Neighborhood” seeks to involved medical sub-specialists and non-internal medicine specialists in care, the College has struggled with the role of various members of the “team”. Issues of team leadership, autonomous practice, collaboration and consultation were all discussed in detail. This policy paper is expected to be released by the College over the coming year and should be helpful to you as you negotiate issues related to team-based care in the near future in your own practice environment.


Why PCMH? Costs and Benefits of Transformation

The Brown Primary Care Initiative’s next installment in our Best Practices Sharing series will be held on Friday, August 2 from 7:30AM to 9:00AM at Alpert Medical School (222 Richmond St. Providence, RI 02912).

This from the initiative:

While many of you have placed or are considering to place the extraordinary amount of effort required for successful PCMH transformations, we understand that this investment in becoming more patient centered is large, and the return on that investment is often initially unclear. It is with that in mind that we have brought together a panel of speakers who should be able to provide some insight about how to fund your transformation, changing reimbursement models and generally present the financial case for investing your time, effort and money in this process.

We are excited to say that we will have 4 guest speakers to discuss some of these issues and how it relates to practices, patients and their respective organizations followed by a question and answer session to discuss each of your progress and barriers in this regard.

Our speakers include:

Michael Lichtenstein, President and CEO Wood River Health Services, discussing: Why move towards a PCMH model of care? The case of WRHS.

Debra Hurwitz, Co-Director of CSI-RI, discussing: What is the CSI business model, does it benefit patients, and how does it affect a practice's bottom line?

Andrea Galgay, Director of Practice Innovation and Provider Relations BCBS-RI, discussing: Why has BCBS chosen PCMH? What does it offer to practices and how does it set the stage for a successful PCMH transition?

Meryl Moss, COO Coastal Medical, discussing: What is Coastal's model? What have been the results thus far? How does it benefit practices and patients in both the short-term and long-term?

In preparation for this session we ask that you begin thinking about some of the barriers/challenges that financing your PCMH transition has presented for you to date.

Please RSVP at http://goo.gl/Zm4z7 if you plan to attend or call Scott Hewitt at 401-729-2818.

Breakfast will be served.

Memorial Hospital of Rhode Island designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

You are welcome to forward this invitation to any of your colleagues who may be interested in attending.


SIM Update

As you may have heard, Rhode Island was awarded $1.5M to work on a State Innovation Model (“SIM”) by the Centers for Medicare and Medicaid Innovation at CMS. This will lead to the development of a State Health Innovation Plan (“SHIP”). The project has been dubbed “Healthy Rhode Island” and is being led by the Lt. Governor Elizabeth Roberts. The purpose statement for the project is that it “… aims to achieve measurable improvement in health and productivity of all Rhode Islanders while decreasing the overall cost of care.” Furthermore, the plan is “to transition from a disparate and health care provider and payer-centric environment to an organized delivery and payment system that is outcomes-oriented and person-centric.” Rhode Island will be submitting a “SHIP” proposal on October 1 and if successful will bring $20-$60 million dollars to Rhode Island to fund a transformation designed to make medical care in Rhode Island more effective and more cost-effective. The process as it has been designed has not been very inviting to working physicians, but as a community of experts who know what works and what does not, it is crucial that we remain engaged. Recommendations and guidance from the CSI RI project to the Lt. Governor is available at http://www.pcmhri.org/node/329. As noted, College policy can be a very effective tool for a massive state-wide process like this. To quote from recent Chapter Laureate Diane Siedlecki, if you are not at the table, you are at risk of being eaten!


Koller Departure

Best wishes and many thanks to out-going Rhode Island Health Insurance Commissioner Chris Koller who is leaving Rhode Island this summer to take over as President of the Milbank Memorial Fund, which seeks to improve “the quality and affordability of health services and [contain] the rate of increase in their cost. The Fund works with leaders in the legislative and executive branches of government, provider organizations, health plans, and the business community to address problems in and seek opportunities for fostering quality and affordable care without escalating costs…” Chris has been no less than visionary in his work as the first Health Care Commissioner for Rhode Island and we wish him all success in his new position!