Patients Before Paperwork

ACP provided comments on a the recent Stark Law and Anti-Kickback Proposed Regulations that had several burden reduction elements, including provisions that would allow clinicians to claim full financial risk exceptions/safe harbors without submitting any additional documentation requirements.

Noteworthy Resources

Core IM Podcast Interprofessional Education Series Listen as Dr. Shreya Trivedi and the Core IM team welcome home health aides, social workers, case managers, and other care team members to discuss their training, scope of practice, and what physicians should know to work on effective interprofessional teams.

New ACP Webinars

Mini Z Data Analysis Mark Linzer, MD, MACP, and Sara Poplau March 2, 1:00-2:00 p.m. ET

In the News

What medicine can learn from the fire department about team-based care By Pooja Desai; Kevin MD Blog Teamwork is sewn into the fabric of the fire department. Each firefighter and paramedic has clearly delineated responsibilities; they work efficiently, communicate well, and interface with other organizations (ambulance, police, trauma doctors, etc.) with little tension. Best of all, they have a great time doing it.

From the Trenches

Sowing Seeds and Cultivating Connections for Well-being By Tiffany Leung, MD, MPH, FACP, Honorary ACP Well-being Champion

February 21, 2020

Strengthening Well-being and Professional Fulfillment Through Collaboration

February 15, 2019

Announcements Hello Well-being Champions!

Patients Before Paperwork

ACP provided feedback on two CMS requests for information regarding how to improve and streamline the CMS Center for Program Integrity. Within our feedback, we highlighted our previous recommendations to CMS that more clarity is needed around what they will actually accept as far as the updated documentation requirements.

Noteworthy Resources

The Curbsiders Podcast #166 Advocacy and Hot Topics in Health Care Policy With Robert McLean MD, FACP

New ACP Webinars

Appreciative Inquiry Kerri Palamara, MD, FACP January 23, 9:00–10:00 a.m. ET

Patient Outcomes After Bone Marrow Transplant

Testosterone Treatment in Adult Men With Age-Related Low Testosterone

Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status

Colorectal Cancer Screening in Average-Risk Adults

The Effect of Technology-Based Coaching on Maintenance of Weight Loss

Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome

High-Intensity or Low-Intensity Surveillance for Patients With Colorectal Tumors

Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy

Prevalence of Mental Health Disorders Among Adults With Cerebral Palsy

Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps

ACP Physician Peer Coaching: Thriving in the Now: How to be Content Where You Are

Reflect on your current personal and professional circumstances and explore practical ways to cultivate greater satisfaction and find fulfillment in where you are today.

ACP Physician Peer Coach Training Program

Learn evidence-based, validated coaching skills to support your professional development and help your peers. Receive hands on training and personalized feedback from expert physician coaches. This 12-month program offers: Live, virtual coach training (8 hours) Session 1: January 29, 2027, 12:00-2:00PM ET Session 2: February 5, 2027, 12:00-2:00PM ET Session 3: February 12, 2027, 12:00-2:00PM ET Session 4: March 12, 2027, 12:00-2:00PM ET Follow upgroup check-in calls to reinforce coaching skills Group Check-in 1: June 4, 2027, 1:00-3:00PM ET Group Check-in 2: September 14, 2027, 4:00-6:00PM ET Group Check-in 3: December 8, 2027, 3:00-5:00PM ET 1 year of access to ACP’s Coach Training Curriculum Individualized feedback for practice coaching sessions from trained ACP coaches Access to a private online communityNote: Members will be required to accept the terms of program participation in order to participate.

19th Global Forum: Advancing Internal Medicine Through AI: Global Insights on Clinical Practice and Education

The 19th Annual ACP Global Forum brings together internal medicine physician leaders from ACP and around the world for an in-depth discussion on “Advancing Internal Medicine Through AI: Global Insights on Clinical Practice and Education.” The session will explore key questions on AI’s impact on clinical practice and medical education, followed by an interactive dialogue with attendees. Open to all meeting participants; space is limited and registration is required.

Washington Chapter Outpatient Virtual Precourse

WashingtonChapter Outpatient Virtual Precourse Registration fee includes all scientific sessions and materials, and CME documentation. Category Registration Fee ACP Member or Retired PhysicianMember $200 ACP Affiliate Member $200 Nonmember Physician or Retired PhysicianNonmember $250 Nonmember Allied Health Professional $250 Please note: Members whose dues are not active will receive the nonmember registration rate. To take advantage of the member rate, we encourage you to renew your dues or join ACP: https://www.acponline.org/membership Questions?If you have trouble registering online, please contact Member andProduct Supportat 800-ACP-1915 or direct at 215-351-2600 (M-F, 9 a.m. - 5 p.m. ET). Course code:RM2736C For additional information please contact Executive Director of theWashington Chapter Liz Truong at liz@aminc.org.

Washington Chapter Inpatient Virtual Precourse

WashingtonChapter Inpatient Virtual Precourse Registration fee includes all scientific sessions and materials, and CME documentation. Category Registration Fee ACP Physician or Retired PhysicianMember $200 ACP Affiliate Member $200 Nonmember Physician or Retired PhysicianNonmember $250 Nonmember Allied Health Professional $250 Please note: Members whose dues are not active will receive the nonmember registration rate. To take advantage of the member rate, we encourage you to renew your dues or join ACP: https://www.acponline.org/membership Questions?If you have trouble registering online, please contact Member andProduct Supportat 800-ACP-1915 or direct at 215-351-2600 (M-F, 9 a.m. - 5 p.m. ET). Course code:RM2736B For additional information please contact Executive Director of theWashington Chapter Liz Truong at liz@aminc.org.

Washington Chapter Scientific Meeting 2026 (Virtual)

WashingtonChapter Scientific Meeting 2026 (Virtual) Registration fee includes all scientific sessions and materials, and CME documentation. Category Registration Fee ACP Physician or Retired PhysicianMember $425 ACP Resident/Fellow Member $30 ACP Medical Student $0 ACP Affiliate Member $425 Nonmember Physician or Retired PhysicianNonmember $525 Nonmember Resident* $30 Nonmember Medical Student* ** $0 Nonmember Allied Health Professional $525 Please note: Members whose dues are not active will receive the nonmember registration rate. To take advantage of the member rate, we encourage you to renew your dues or join ACP: https://www.acponline.org/membership Questions?If you have trouble registering online, please contact Member andProduct Supportat 800-ACP-1915 or direct at 215-351-2600 (M-F, 9 a.m. - 5 p.m. ET). *Nonmember residents andstudents must call to register: 800-ACP-1915 (M-F, 9AM - 5PM ET). **Nonmember Students: Joining ACP as a medical student is free! Join Now: https://www.acponline.org/membership/medical-students Course code:RM2736A For additional information please contact Executive Director of theWashington Chapter Liz Truong at liz@aminc.org.

Washington Chapter Scientific Meeting 2026 (In Person)

WashingtonChapter Scientific Meeting 2026 (In Person) Registration fee includes continental breakfast, lunch, all scientific sessions and materials, and CME documentation. Watch Party for Day 2 of the meeting will be held at the Initai Foundation in Seattle. Category Registration Fee ACP Physician or Retired PhysicianMember $425 ACP Resident/Fellow Member $30 ACP Medical Student $0 ACP Affiliate Member $425 Nonmember Physician or Retired PhysicianNonmember $525 Nonmember Resident* $30 Nonmember Medical Student* ** $0 Nonmember Allied Health Professional $525 Please note: Members whose dues are not active will receive the nonmember registration rate. To take advantage of the member rate, we encourage you to renew your dues or join ACP: https://www.acponline.org/membership Questions?If you have trouble registering online, please contact Member andProduct Supportat 800-ACP-1915 or direct at 215-351-2600 (M-F, 9 a.m. - 5 p.m. ET). *Nonmember residents andstudents must call to register: 800-ACP-1915 (M-F, 9AM - 5PM ET). **Nonmember Students: Joining ACP as a medical student is free! Join Now: https://www.acponline.org/membership/medical-students Course code:RM2736 For additional information please contact Executive Director of theWashington Chapter Liz Truong at liz@aminc.org.

How to Get Your Research Published in the Best Medical Journals

Led by expert faculty, including editors from Annals of Internal Medicine, New England Journal of Medicine, and Gastroenterology, this new course will equip clinical researchers with the practical skills and strategic knowledge necessary to prepare and present their work to increase the probability of publication in their chosen, respected medical journal. Held over the course of two days at the American College of Physicians headquarters in Philadelphia, PA, attendees will benefit from highly interactive small group sessions and individual feedback to refine their own research manuscript draft currently in process. Participants must submit an in-progress manuscript by September 10, 2026, in order to receive feedback on their work during this course. Your submission should include the draft title, abstract, and any tables and figures. Space is limited. ACP members save on registration.

Practical POCUS Skills for Internal Medicine Physicians

Practical POCUS Skills for Internal Medicine Physicians Advance your POCUS training beyond the foundations with next-level instruction from expert faculty, tailored to your clinical practice setting. Choose from two clinical tracks: inpatient and outpatient. An optional 15-minute hands-on assessment of core POCUS skills will be available on a first-come, first-served basis at the end of the course. Registration Fees Register by September 1 Register on/after September 2 ACP Member, Life Member, FACP, MACP $937 $1,020 Nonmember Physician $1,434 $1,434 Prerequisite Learning Requirement All registrants must have completed ACP's POCUS: Foundational Skills for Internal Medicine Physicians course. Alternate 2-day introductory courses that include a minimum of 50% hands-on time might be considered as a surrogate for and ACP course. A course agenda and certificate of completion must be submitted for approval. Attestation of significant experience might also be considered as a surrogate at the course director’s discretion. Please submit this information to ACPPOCUS@acponline.org. You will receive a response within 10 days. If you are not approved for the course, you will receive a full refund. In order to maximize hands-on instruction and opportunities for developing advanced POCUS skills, participants in this course will be required to complete ACP's POCUS Online Learning Modules #1-13. Learners and faculty have consistently emphasized that completing these modules is essential for optimizing the value of hands-on participation in the course. Questions? If you have trouble registering online, please contact Member andProduct Supportat 800-ACP-1915 or direct at 215-351-2600 (M-F, 9am - 5pm ET). All cancellation requests must be received in writing by September 30, 2026 to obtain a full refund. An administrativefee of $100 will be deducted if the request is received from October 1 to October 29, 2026. After October 29, 2026,no refunds will be processed. Individuals who fail to attend the course (no-shows) will not be entitled to any refund. ACP reserves the right to cancel courses due to the unlikely event of insufficient enrollment or other unforeseen circumstances. If a meeting is at capacity, cancelled, or postponed, the College will refund registration fees but cannot be held responsible for other costs or expenses, including cancellation/change charges assessed by airlines, travel agencies, or hotels.

POCUS: Foundational Skills for Internal Medicine Physicians

POCUS: Foundational Skills for Internal Medicine Physicians This hands-on 2-day course is designed to teach core POCUS skills to internal medicine physicians, centering on the needed skills to use ultrasound as a patient assessment tool in a variety of settings. Registration Fees Register by September 1 Register on/after September 2 ACP Member, Life Member, FACP, MACP $1,847 $2,012 Nonmember Physician $2,350 $2,350 Prerequisite Learning Requirement In order to maximize hands-on instruction and opportunities for developing essential POCUS skills, participants in this course will be required to complete ACP's POCUS Online Learning Modules #1-7. Learners and faculty have consistently emphasized that completing these modules is essential for optimizing the value of hands-on participation in the course. Questions? If you have trouble registering online, please contact Member andProduct Support at 800-ACP-1915 or direct at 215-351-2600 (M-F, 9 a.m. - 5 p.m. ET). All cancellation requests must be received in writing by September 30, 2026 to obtain a full refund. An administrative fee of $100 will be deducted if the request is received from October 1 to October 29, 2026. After October 29, 2026, no refunds will be processed. Individuals who fail to attend the course (no-shows) will not be entitled to any refund. ACP reserves the right to cancel courses due to the unlikely event of insufficient enrollment or other unforeseen circumstances. If a meeting is at capacity, cancelled, or postponed, the College will refund registration fees but cannot be held responsible for other costs or expenses, including cancellation/change charges assessed by airlines, travel agencies, or hotels.

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Virtual board review, Internal Medicine Meeting recordings available from the College

CDC releases updated recommendations on HIV postexposure prophylaxis

MKSAP Quiz: ED visit for progressive weakness

Combo flu, COVID-19 vaccine noninferior in adults ages 50 years and older, manufacturer trial finds

Multitarget stool DNA tests not as cost-effective as FIT for early CRC detection

Put words in our mouth

New ACP position paper addresses ethics in long-term care

New ACP MKSAP CORE helps users demonstrate continuous learning

Stroke risk higher in Black women with history of gestational diabetes

Low troponin levels predict long-term cardiovascular outcomes in chest pain patients | ACP Hospitalist

High-intensity care for high utilizers | ACP Hospitalist

AHA statement calls for improvements in cardiac rehabilitation uptake among women | ACP Hospitalist

Take a quiz about the Oct. 8 issue! | ACP Hospitalist

Scores compared for predicting inpatient mortality in older medicine patients | ACP Hospitalist

Pneumonia mortality in high-risk patients no lower with broad-spectrum antibiotics than narrow | ACP Hospitalist

Mortality from a different kind of PE | ACP Hospitalist

Many patients are not informed about post-intensive care syndrome | ACP Hospitalist

Fluid management by hydration status may improve some outcomes in sepsis patients | ACP Hospitalist

CPAP and BiPAP devices recalled | ACP Hospitalist

Amyopathic Dermatomyositis Manifesting With Marked Unilateral Eyelid Swelling and Hyperpigmentation in a Darker Skin Tone | Annals of Internal Medicine: Clinical Cases

A 56-year-old man presented to the emergency department with unilateral eyelid swelling, a hyperpigmented rash, and no myositis. His physical examination showcases the variable presentation of classic dermatomyositis skin manifestations in darker skin. Dermatomyositis is an uncommon disease characterized by proximal muscle weakness and classic dermatologic manifestations. In amyopathic disease, the diagnosis relies on the identification of dermatologic findings, in which variation in manifestations can lead to delays in diagnosis and increased health disparities.

RS3PE: A Rheumatic Presentation of Lung Malignancy | Annals of Internal Medicine: Clinical Cases

We describe a previously well 56-year-old man who presented with symmetrical inflammatory polyarthralgia associated with bilateral lower limb swelling and left hand puffiness. He had noticed blood steaks in his productive cough for half a year but reported no constitutional symptoms. Inflammatory markers were elevated, whereas rheumatoid factor was negative. Imaging of the chest showed a mass in the right upper zone, which was confirmed via biopsy to be ALK-positive lung adenocarcinoma. The patient was diagnosed with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema, representing one of the first descriptions of lung adenocarcinoma–associated RS3PE.

Cachexia and Diffuse “Fish-Scale” Skin | Annals of Internal Medicine: Clinical Cases

Ichthyosis is marked by dry, thickened, scaly skin. It may be genetic or acquired. Importantly, it may be a cutaneous manifestation of an underlying malignancy. Here, we present a striking case of paraneoplastic ichthyosis.

Massive Left Ventricular Aneurysm After Inferior Infarction | Annals of Internal Medicine: Clinical Cases

True ventricular aneurysm is a rare complication of myocardial infarction. After a 53-year-old man presented late with an inferior ST-segment elevation myocardial infarction, he was found to have a massive posterobasal left ventricular aneurysm. Cardiac magnetic resonance imaging volumetric analysis highlighted the hemodynamic significance of the aneurysm. As the result of persistent symptomatic heart failure, the patient underwent surgical resection of the aneurysm and placement of a pericardial patch with excellent results at follow-up.

Massive Empyema With Edwardsiella tarda in a Patient With Liver Cirrhosis | Annals of Internal Medicine: Clinical Cases

Although infection caused by Edwardsiella tarda is rare in humans, it can be fatal if contracted. A 78-year-old man with liver cirrhosis who ate raw fish on a regular basis was emergently admitted for treatment of septic shock. Computed tomography scan showed massive empyema in his right lung. The patient was diagnosed with septic shock with empyema caused by E tarda after a positive blood culture and drainage culture from the empyema. His condition improved with multidisciplinary therapy. However, the patient died 36 days after admission because of liver failure. We recommend that patients with liver cirrhosis should avoid raw fish.

Paraneoplastic Myositis in a Patient With Extrahepatic Cholangiocarcinoma: A Case Report | Annals of Internal Medicine: Clinical Cases

Paraneoplastic myositis associated with cholangiocarcinoma is an extremely rarely reported phenomenon. Here, we present a case of paraneoplastic myositis resulting in acute renal failure in a patient who presented with a pancreatic mass that was ultimately diagnosed as an extrahepatic cholangiocarcinoma. This case demonstrates that paraneoplastic myositis has the potential to cause severe complications and that initiation of glucocorticoid therapy may be an essential component of treatment of these patients.

Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension | Annals of Internal Medicine: Clinical Cases

Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.

Mpox-Associated Pneumonia: A Case Report | Annals of Internal Medicine: Clinical Cases

Mpox classically presents with a prodrome of fevers and chills followed by a characteristic rash 3 to 4 days later, and self resolves within 2 to 4 weeks. We present a patient case of atypical mpox complicated by left lower lobe pneumonia, severe headaches, and photophobia in addition to the classic rash. These atypical features could play a role in guiding treatment with antiviral drugs such as tecovirimat.

Navigating Through the Complications of Chronic Immunosuppression in Transplant Patients | Annals of Internal Medicine: Clinical Cases

The advent of organ transplantation has given hope to patients with end-stage organ failure. Allograft rejection is a transplant complication and remains a significant cause of transplant-related morbidity and mortality. Successful transplantation is achieved with immunosuppression, and the discovery of newer immunosuppressive agents has provided transplant physicians with more effective medications in preventing allograft rejection. On the flip side, long-term immunosuppression is fraught with complications such as predisposition to infections, malignancies, and cardiovascular diseases. The patient presented in the case report developed a transplant-related lymphoma many years after his kidney and pancreatic transplant. Primary care providers should be aware of these complications and educate their patients on measures to prevent some of them.

A Case of Neisseria sicca Bacteremia Due to Eculizumab Therapy | Annals of Internal Medicine: Clinical Cases

Eculizumab is a monoclonal antibody indicated for the treatment of complement-mediated disorders. Despite its utility, eculizumab increases risk for infection with Neisseria species, owing to membrane attack complex inhibition. Although this naturally evokes thought of infection with N meningitidis, other Neisseria species also benefit from membrane attack complex disruption. N sicca is a commensal organism that is typically considered nonpathogenic. Here, we describe a case of N sicca bacteremia in a patient receiving eculizumab for atypical hemolytic uremic syndrome and seek to elucidate limitations to current prophylactic recommendations for patients receiving anticomplement therapy.