Report on Healthcare Disparities Symposium

Resident member Katrin S Sadigh, MD, a PGY2 resident in the Yale Internal Medicine Primary Care Program, attended the recent “Symposium: Racial and Ethnic Disparities in Readmission Rates” and submitted the following report:

The Symposium on Racial and Ethnic Disparities in Readmission Rates took place on 4 February 2015, sponsored by the Connecticut State Medical Society (CSMS) and Connecticut Health Foundation. Hospital administrators, patient advocacy groups, social service administrators and leaders, policy makers, mental health clinicians, physicians, nurses, and students convened from all over the state. Research conducted by CSMS was presented on significant disparities in readmission rates of Black and Latino patients in the areas of uncomplicated delivery, joint replacement surgery, heart failure/chest pain and digestive disorders with the hope of initiating a discussion of ways to address these disparities. The day’s events included a guest appearance by Robert Wah, MD, President of the American Medical Association (AMA), who described ways in which minorities are disproportionately affected by hypertension and diabetes mellitus. He offered the example of Jackie Robinson, the first African American to play in Major League Baseball and who contributed profoundly to the Civil Rights Movement, but ultimately died at the age of 54 from complications of diabetes. Dr. Wah also outlined several key initiatives to combat racial disparity, including joining ranks with YMCAs and implementing Doctors Back to School, which places doctors in classrooms with sixth through eighth graders to expose the young to “real life” doctors, and to fill in the gap in cultural training. Other speakers included M. Natalie Achong, MD, Chair of CSMS Health Equity Committee, who outlined the disparities spectrum from cardiovascular disease to diabetes to HIV/AIDS, and Robert Aseltine, Jr., PhD, who presented data from the analysis of disparities in hospital readmission. Lawrence Sanders, Jr., MD, President of the National Medical Association (NMA), passionately combined personal and historical narrative, from Harry Truman and the desegregation of armed services in 1948 via executive order to President Obama’s second State of the Union address, to advocate for continued combined efforts towards health care equity and fairness. Towards the end of the day, participants broke out into smaller groups for more targeted discussion of ways to address disparities in readmission in the four specific areas of medicine as outlined above. Post symposium, attendees will receive a summary of these brainstorming sessions with the hope that they may add additional comments and contribute to solution development.

A More Welcome MOC Update!

Hello Everyone!  By now, I am sure you have seen the email from Richard Baron, President and CEO of the ABIM, regarding MOC and the changes being implemented.  Also, you should have received a follow-up communication from Steven Weinberger, EVP/CEO of ACP.   This is a remarkable turn of events and evidence of the effectiveness of our ACP leadership in representing the voice of members.

I want to clarify one important point, after reading some responses from members.  MOC has not gone away.  It is being rebooted, so to speak.  Here are the salient points:

1) The ABIM has temporarily suspended three MOC requirements:  Practice Assessment, Patient Voice and Patient Safety;

2) They will be changing the wording of credentials on the website from “Meeting MOC Requirements” to “Participating in MOC” (so it does not imply a requirement for those with unlimited lifetime certificates to remain certified);

3) They are revising (but not eliminating) the secure exam to be more relevant to what internists do daily – this will go into effect with the Fall 2015 exam.

To be clear – MOC still exists.  If you are in the process of recertifying, you still need to accumulate 100 MOC points and take the secure exam.  As it stands now, it appears you can obtain all points by completing medical knowledge modules (and it appears we can also anticipate a wider array of activities that will be accepted for this purpose).  If not due in the next two years, you still have to complete some activity by the end of 2017 to stay current with MOC.  The individual MOC status pages on the ABIM website have not yet been updated, so check in periodically.

Most of your questions regarding these changes can be answered by going to the ABIM MOC FAQ page.

Introducing Chapter Members on National Committees: Auguste Fortin

We have several members serving on national committees for the College, and I wanted to introduce you to what they are up to.  Auguste H. Fortin VI, MD, MPH, FACP, who is a member of the Yale-New Haven Medical Center (Primary Care) Program, sits on the ACP Clinical Skills Committee.  Dr. Fortin writes:

“I have had the pleasure of serving on the ACP Clinical Skills Committee from 2001-2008, and again since 2012. I chaired the committee from 2004 to 2008. The Clinical Skills Committee is responsible for the educational content of the Herbert S. Waxman Clinical Skills Center at ACP Internal Medicine meetings. The committee (aided by superb staff), requests proposals for clinical skills sessions and evaluates submissions, selecting the most highly rated ones for inclusion. These workshops range from skin biopsy techniques to ultrasound-guided lumbar puncture to using motivational interviewing for behavior change. Committee members monitor accepted workshops, evaluating their quality and providing the presenters with feedback.  We also review applications from chief residents who are competing to be Waxman Teaching Scholars at the Clinical Skills Center, learning how to teach procedures and getting feedback and mentoring from committee members. Many members of the committee help to teach hands-on skill sessions at ACP Internal Medicine. I will be doing so this spring at ACP Internal Medicine Boston; please stop by to say hello and, better still, sign up for a clinical skills workshop!”

MOC, One Year Later

Well, it has been one year since the new MOC requirements went into effect, but there has been no reduction in the surrounding controversy.  ACP continues to represent the concerns of membership in frequent discussions with the ABIM.  One of the positions advocated by ACP regards the wording that describes a diplomate’s MOC status.  The College sought a change from “Meeting MOC Requirements” to “Participating in MOC” (with an indication that this is voluntary for those who had previously obtained time-unlimited certificates).  ABIM has conceded on this point, while they continue to stand firm on the necessity of the secure examination.  The American Board of Medical Specialties (ABMS) apparently has the final say on this wording change.  Stay tuned for email updates from ACP EVP/CEO Steven Weingberger.

Former Board of Regents Chair Chuck Cutler participated in a debate with ABIM President Richard Baron at a meeting of the Philadelphia County Medical Society, which you can view here.

In the meantime, we are committed to helping members who choose to participate in MOC achieve recertification. If you haven’t checked out the ACP MOC Navigator, established by the College to help members find MOC activities that are most suited to their practice, take a look.

World AIDS Day, 2014

Last year, I wrote about World AIDS Day and I reflected briefly on the changes in HIV care over the years.  Once again, I want to remind you that while we have made great progress, there is much still to be done.

Here are some additional facts about HIV in the United States:

• As of 2011, 1.2 million people in the US were living with HIV infection;
• Only 4 in 10 people living with HIV were in HIV medical care;
• Only 3 in 10 people living with HIV achieved viral suppression, which is the key to managing the disease (compared to 76% for those who are receiving HIV medical care).
  Check out CDC Vital Signs for more data.

The 2014 theme for World AIDS Day is “Focus, Partner Achieve: an AIDS-Free Generation.” AIDS.gov has a listing of various activities and events that are planned in association with World AIDS Day. For local activities, see AIDS Connecticut’s website.

What can you do?
Test your patients. 14% of people infected with HIV don’t know it. Patients can learn more at CDC’s GET TESTED site.
Counsel patients who don’t have HIV about how to prevent it.  More discussion of HIV prevention in the clinical setting can be found in this article in the JAMA HIV/AIDS theme issue from July 23/30, 2014.
Make sure patients with HIV get appropriate care, and take medication.  A person aged 20 diagnosed with HIV who receives current HIV medication has an average of 71 years of life; without medicines, that average plummets to 32 years.
Be a champion for organizations that provide supportive services that make it more likely to achieve the therapeutic goal. This includes organizations that provide housing, mental health services, addiction treatment, and so on. Since I practice in New Haven, I will put a shout out to Leeway, AIDS Project New Haven, the APT Foundation, and Columbus House. Get to know the organizations in your community and advocate for them!
Familiarize yourself with available resources. A great place to start is the AIDS.gov Provider Tools site.

An “AIDS-free generation”, the ambitious goal set by the President’s Emergency Plan for AIDS Relief (PEPFAR), will require some new advances, most particularly a vaccine. However, we can continue to make strides in that direction by connecting people infected with HIV to the right care and services and emphasizing detection and prevention in our daily practice.

Providing Care For Our Veterans

Today’s entry was inspired by Dr. Lucile Burgo, a general internist at the VA Connecticut Healthcare System and National Co-Director of the Post-Deployment Integrated Care Initiative (and recent ACP Fellow!).  It is in honor of Veterans’ Day last week.  Dr. Burgo and colleagues have published a guide to the care of the returning combat veteran in the Journal of General Internal Medicine.

It is important to recognize that of the nearly 1.5 million individuals who served in Iraq and Afghanistan and have since separated from the military, only about half have received care in the VA system.  That means a large group of veterans are receiving care from non-VA providers, indicating a need for familiarity with the particular needs of this population.

Dr. Burgo urged me to call your attention to two additional articles.  First, in this Annals On Being a Doctor piece, The Forever War, Dr. Ross Boyce chronicles the struggle of transitioning from soldier to physician and the unaddressed psychic pain caused by war.  Second, appearing in JAMA’s A Piece of My Mind series  in November 2012, is The Unasked Question by Dr. Jeffrey Brown.  Dr. Brown is a pediatrician and Vietnam War veteran; he reminds us the importance of taking a military service history.  To quote from his article: “Few of the veterans who visit their physician have the stereotyped appearance of young amputees, older men wearing gold-embroidered “I Am a Veteran” caps, or anxious patients taking tranquilizers. They represent one of every six average-looking adult male (and an increasing number of female) patients. And because they served their country, many are at risk for potentially serious problems that are not being addressed by our medical community.”  What better way to honor our country’s defenders than to acknowledge their experience and its important role in their overall health.

MedChallenge – The Connecticut Chapter’s Medical Knowledge Competition

For the past 17 years, the Connecticut Chapter has been conducting a Jeopardy-style medical knowledge tournament for internal medicine residents in the state. This is a rousing event, one of the best the chapter has to offer. Throughout most of its existence, it has been held at one of the residency program’s institutions. Since 2011, the final round has been held at the Chapter Annual Meeting, after a preliminary round at another site. It has been great to welcome this excitement to the setting of the annual meeting. Every year, talented women and men amaze us with their ability to recall exact details of routine and obscure medical conditions, and the treatments required, under tremendous pressure. It is one thing to come up with the answer while sitting in the audience, and yet another to do so with buzzer in hand – with everything on the line. This year, the initial round was held at the Frank H. Netter M.D. School of Medicine, on the North Haven Campus of Quinnipiac University. Eight teams battled in three preliminary heats to become one of the four teams that will play in the final round on October 31. In the first match, St. Vincent’s Medical Center advanced by edging out Norwalk Hospital and Waterbury Hospital. In the next match, the University of Connecticut Primary Care Program prevailed over Griffin Hospital, whose second place point total still had them in the running for the fourth advancing spot. In a thrilling third match, University of Connecticut outlasted Saint Mary’s and the Yale Traditional Program, who eclipsed Griffin Hospital to earn the fourth spot in the October 31 final by achieving the highest second place score.

Below is a list of winners from past years:
1998-1999: University of Connecticut*
1999-2000: Hospital of Saint Raphael
2000-2001: University of Connecticut
2001-2002: Hospital of Saint Raphael
2002-2003: Hospital of Saint Raphael
2003-2004: University of Connecticut Primary Care
2004-2005: University of Connecticut
2005-2006: University of Connecticut
2006-2007: University of Connecticut
2007-2008: University of Connecticut
2008-2009: University of Connecticut
2009-2010: University of Connecticut
2010-2011: University of Connecticut
2011-2012: University of Connecticut
2012-2013: University of Connecticut
2013-2014: University of Connecticut

*In 1999, as our inaugural entry into the national ACP Doctor’s Dilemma competition, the University of Connecticut won the competition. For more on the ACP Doctor’s Dilemma, including a list of past winners, click here.

Will this be the year that the University of Connecticut stranglehold is finally broken? Please come to the Annual Meeting to support the four programs that will face off in this year’s MedChallenge: St. Vincent’s Medical Center, University of Connecticut Primary Care, University of Connecticut, and the Yale Traditional Program.  The final starts at 3 p.m.  To see the Annual Meeting agenda, click here.