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2018 ANNUAL SCIENTIFIC SESSION Saturday Morning Presentations

February 23-24, 2018 • Grandover Resort • Greensboro, NCThis continuing medical education activity is sponsored by the American College of Physicians

MSK examination skills

ACP North Carolina Chapter

Claudia L Campos, MD, FACPccampos@wakehealth.edu

In one word could you describe how you feel?

• Text CLAUDIACAMPO786 to 22333

lower backshoulder

Systematic approach to patients with MSK complaints

Lower Back Pain Facts

70% of acute LBP are due to muscle strain or sprain Most resolve after 2 weeks> 6 months of sick leave 50% return to work10% develop chronic lower back painPeak between ages 35 and 55Acute back pain less than 4 weeks, subacute 4 to 12 weeks, and chronic more than 12 weeks

Lower Back Pain Facts

Estimated to affect 8 out of 10 Americans at some point in their livesMain reason for missed days at workSecond most common reason for doctor's visitsEstimated 75% to 90% of patients back pain disappears spontaneously within four to six weeks

Non spinal causes of back pain

Back/buttocks/leg pain

Hip OAPiriformis syndromeIschial bursitisSacroiliac joint dysfunction/sacroiliitisRadiculitis/ radiculopathyMyofascial pain

Common innervation

https:/Wikipedia9

The 3 minute Lower back Physical Exam

Spinous process tenderness?

Red flags associated with the highest post‐test probability of a vertebral fracture: Older ageProlonged use of corticosteroidsSevere traumaPresence of contusion or abrasion

Downie A et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013;347:f7095

Hip Osteoarthritis: pain patterns

Groin Buttock‐backAnterior thigh Posterior thighAnterior kneeShin and calf

Khan NQ et al .Hip osteoarthritis: where is the pain?Ann R Coll Surg Engl 2004;86:119–21.

Piriformis Syndrome

Special testsPain with palpation of the sciatic notchFAIR: Flexion Adduction Internal Rotation Piriformis sign

• By Patrick J. Lynch & KDS4444 ‐https://commons.wikimedia.org/wiki/File:Skeleton_whole_body_ant_lat_views.svg, CC BY‐SA 2.5, https://commons.wikimedia.org/w/index.php?curid=53169641

Sacroiliac joint pain

Rotator cuff evaluation

Clinical features

Aching pain in the top of the shoulder, lateral aspect of the upper arm, and deltoid insertionPain with movement particularly abduction and internal rotation Night pain when rolling onto the affected sideRestriction of shoulder movements and weaknesslifting, or reaching behind

Shoulder Anatomy: anterior view

http://www.investinlibya.org/analyzing‐anatomy‐of‐the‐shoulder‐and‐arm/19

Shoulder Anatomy: posterior view

http://www.investinlibya.org/analyzing‐anatomy‐of‐the‐shoulder‐and‐arm/20

Rotator cuff pathology

Among pain provocation tests, a positive painful arc test result was the only finding with a positive LR greater than 2.0 for RCD (3.7 [95% CI, 1.9‐7.0]), and a normal painful arc test result had the lowest negative LR (0.36 [95% CI, 0.23‐0.54]).

Hermans J et al. SMA: Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA. 2013, 310: 837‐847. 10.1001/jama.2013.276187.

Practice time: painful arc test

Testing for Rotator cuff tear

Drop arm test External rotation lag test

Sensitivity (%) 10–73 46–98

Specificity(%) 77–98 72–98

LR and Confidence Interval CI

3.3; 95% [CI], 1.0 to 11 7.2; 95% [CI], 1.7 to 31

Practice time: External Rotation Lag Test

Meniscus tears

• More common in men than in women 2.5:1 to 4:1.• Most common activities: cutting or pivoting (iesoccer, basketball, wrestling, football, gymnastics, and skiing)

• Medial meniscal tears are more common than lateral meniscal tears

• Incidence peaks in men in the third decade• In women, incidence remains constant beginning in the second decade

• <30 years: single traumatic event• >30 years:degenerative tears become more common

Meniscus: special tests

Smith BE, Thacker D, Crewesmith A, et al. Special tests for assessing meniscal tears within the knee: a systematic review and meta‐analysisBMJ Evidence‐Based Medicine 2015;20:88‐97 30

A ‘mechanical’ block to a full range of movement or a ‘mechanically’ unstable knee would usually indicate an MRI and a surgical opinion.

Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five

year follow-up

Surgery vs PT for a Meniscal Tear andOsteoarthritis

WOMAC 20.9 vs. 18.5

Katz et al N Engl J Med. 2013 May 2; 368(18): 1675–1684

Do you want to practice the Thesallytest?

Thank you!

ccampos@wakehealth.edu

references• Hermans J et al. Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The

Rational Clinical Examination Systematic Review. JAMA. 2013;310(8):837‐847. doi:10.1001/jama.2013.276187.

• Hegedus EJ Shoulder examination ; Systematic review. Br J Sports Med 2008;42:80‐92 doi:10.1136/bjsm.2007

• Johnson MAJ, et al Acute Knee Effusions: A Systematic Approach to Diagnosis. Am FamPhysician. 2000 Apr 15;61(8):2391‐2400.

• Katz et al. Surgery vs PT for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013 May 2; 368(18): 1675–1684

• Herrlin et al. Is arthroscopic surgery beneficial in treating non‐traumatic, degenerative medial meniscal tears? A five year follow‐up. Knee Surg Sports Traumatol Arthrosc (2013) 21:358–364

• McHale K.J. et al. Physical examination of meniscus tears. The meniscus. Springer. 2010• Smith BE, et al. Special tests for assessing meniscal tears within the knee: a systematic review and

meta‐analysis. BMJ Evidence‐Based Medicine 2015;20:88‐97.

Injection supplies for large joints• Medications: 1 cc triamcinolone 40 mg/cc

2cc lidocaine 1 or 2 %• Syringes: 3 cc for injections

10 cc for arthrocenthesis• Needles: 25 Gauge 1.5 Inch for injections

20 Gauge 1.5 Inch for injections• Clean with betadine or chlorprep• Bandaid• Gloves

SYSTEMATIC APPROACH TO EKG

Systematic Approach to ECGAdopt a systematic approach to ECG assessment

• Rate• Rhythm• Axis• P wave and PR interval• QRS• ST segment• T wave• QT interval• Additional waves

Bundle of His

http://www.yorkheart.com/Patient‐Heart‐Education/how‐your‐heart‐works.aspx2

CODE BLUE/ Management of Common Unstable Scenarios Encountered during Residency

PJ Miller, MD

Wake Forest Baptist Medical Center

Who we are:

PJ Miller, MDCombined Internal Medicine/Pediatrics

HematologyCritical Care Medicine

Crystal M. Anderson, RN, BSN, CEN, SANE

Conflicts of Interest

• I have no conflicts of interest to report

Goals and Objectives (Yours)

• To better understand common pitfalls of running a code and how to avoid them

• To learn styles of effective communication• To learn how to establish control for effective teamwork• To have fun• To have a group discussion where we all teach and all can learn

Goals and Objectives (Mine)• To lead and engage a discussion on “how” to run a code• To offer skills and insight that you can incorporate into your own style

• NOT to read overly detailed slides that you’ll forget• To use humor and poorly timed jokes as a learning process• To have fun

Overview of BLS and ACLSCrystal Anderson, BSN, RN, CEN, SANE

You found a dead guy… Now what?

• Call for HELP!!• You cannot code someone alone…

• Begin chest compressions until help arrives• 100‐120 compressions per min• At least 2” deep (2‐2.4” with feedback device)• 30:2 ratio of compressions to ventilations

Unless there is an advanced airway… Continuous compressions 1 breath every 6 seconds

The cavalry has arrived…

1. Give Oxygen2. Attach the monitor/defibrillator3. Identify the rhythm…

Wait… who are the cavalry?

Ideally you will have…• Airway• Compressor• Monitor/Defibrillator• Medications• Timer/Recorder• Team Leader

Shockable Rhythms

Wake Forest Baptist Medical Center 11

SHOCK!!CPR for 2 minIV/IO Access

Pulse/Rhythm check

SHOCK!!CPR for 2 min

Epinephrine 1mg every 3‐5 min

Pulse/Rhythm check

SHOCK!!CPR for 2 minAmiodarone 300mg IVP

Pulse/Rhythm check

SHOCK!!CPR for 2 min

Epinephrine 1mg every 3‐5 min

Pulse/Rhythm check

SHOCK!!CPR for 2 minAmiodarone 150 mg IVP

Pulse/Rhythm check

Non‐Shockable Rhythms

This isn’t TV…

CPR for 2 minIV/IO Access

Pulse/Rhythm check

CPR for 2 minEpinephrine 1mg every 3‐5 min

Pulse/Rhythm check

CPR for 2 minH’s & T’s

CPR for 2 minEpinephrine 1mg every 3‐5 min

Pulse/Rhythm check

CPR for 2 minH’s & T’s

WHY DID THIS HAPPEN!?!

H’s T’s

Hypovolemia Tension Pneumothorax

Hypoxia Tamponade (Cardiac)

Hydrogen Ion’s (Acidosis) Toxins

Hypo‐ / Hyperkalemia Thrombosis (Pulmonary)

Hypothermia Thrombosis (Coronary)

Hypoglycemia Trauma

THEY HAVE A PULSE!!!

Place an airway if not already

Maintain Oxygen

Saturation & Capnography

Maintain Blood Pressure Get an EKG

CATH LAB!

Not a STEMI

AIRWAY

BREATHING

CIRCULATION

Post Cardiac Arrest Care…

The fun isn’t over yet…Now you have to keep them alive!

http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac‐Arrest‐Statistics.jsp

Now let’s do this a bit differently…

Top 10 people you DO NOT want to be while running a code…

Mr. Freeze

ComicBook. “Arnold Schwarzenegger's Mr. Freeze Costume Almost Killed Him.” DC, ComicBook.com, 5 Sept. 2017, comicbook.com/dc/2017/06/20/arnold‐schwarzeneggers‐mr‐freeze‐costume‐almost‐killed‐him/.

Super Saiyan (high energy)

dbz‐dokkanbattle.wikia.com/wiki/Stunning_Metamorphosis_Super_Saiyan_3_Goku.

Out of control guy/girl

“Pyramids Harlem Shake ‐ Egypt ‐ .YouTube, YouTube, 22 Feb. 2013, www.youtube.com/watch?v=9DSrW_eJJy4 ”.هرم شيك

The Multi‐tasker

“The Multi‐Tasker.” Thrive With ADD, 5 Feb. 2012, thrivewithadd.com/multi_tasker_lg/.

The Know‐It‐All

www.faithfellowshipministries.net/new‐blog/2014/7/21/dont‐be‐a‐know‐it‐all.

The Houdini

www.oliverbmagic.com/2017/06/22/makes‐magic‐popular/.

The Accessorizer

i.pinimg.com/736x/bc/2d/1e/bc2d1e7b25f24521025c4f0346aaf8bb‐‐cool‐stuff‐off‐road‐jeep.jpg.

The Bicarb Guy

Cain depicted after killing his brother by Henri Vidal, Tuileries Garden, Parisen.wikipedia.org/wiki/Facepalm.

The Mime

www.gettyimages.com/detail/photo/mime‐shrugging‐high‐res‐stock‐photography/523428206.

The Never Gonna Give You Up

Debriefing

“Debriefing following a simulation event is a conversational period for reflection and feedback aimed at sustaining or improving future performance.”

Palaganas, J., Fey, M., Simon, R. Structured debriefing in simulation‐based education. Advanced Critical Care. 2016;27:78–85.

“Deep learning can be achieved during debriefing and often depends on the facilitation skills of the debriefer…”

“…poorly facilitated debriefings may create adverse learning, generate bad feelings, and may lead to a degradation of clinical performance, self‐reflection…”

Debriefing – 3 Main Phases

• Reactions Phase• Understanding Phase• Summary Phase

Unique Scenarios

Leading Together: Views From The American College Of Physicians

Darilyn V. Moyer, MD, FACPEVP/CEO American College of

Physicians

Many Thanks!

• To all on the frontlines of care who do the heavy lift of patient care

• To all members, staff and leadership at the ACP

Disclosures

• I am a full time staff member of the American College of Physicians

• I have no financial interests to disclose

Educational Objectives

• Review trends in healthcare financing and costs, industry consolidation, and advocacy initiatives

• Review provocative trends in the democratization of healthcare including telehealth, healthcare teams, and “the patient will see you now,” phenomena

• Review the challenges of the GME funding and physician pipeline

An All Too Familiar Patient…

A 40 year old patient with type 2 DM on insulin presents to the clinic (substitute ED) for the 4thtime in 3 months with a blood sugar ~400. VS are stable, PE shows no signs of dehydration, trace ketones and 4+ glucose in UA, BMP nlexcept for BS 425.What do you think could be going on?

Expand access and coverageImprove public healthSupport research and scienceOppose discriminationReduce health care disparitiesSupport primary care workforce

Lower excessive Rx pricesReform and improve paymentsImprove quality measuresReform medical liability systemMake EHRs work for doctorsReduce crushing administrative burden

ACP’s “Big Tent” advocacy agenda addresses a wide range of issuesaffecting internists and their patients . . .

And whatever else pops up!

Some background about ACP’s perspective

• Largest medical specialty society in the world: 148,000 members

• Represents the diversity of internal medicine– Ambulatory generalists, hospitalists, subspecialists– Academics, practitioners, educators, researchers, administrators

– From solo practice to large groups– Medical students, residents, fellows, practicing clinicians, retired physicians

– Domestic and international membership• Welcomes non‐physician affiliate members

ACP’s focus at a glance• The science of medicine

– Annals of Internal Medicine• The clinical practice of medicine

– Clinical standards, guidelines• The education and professional development of physicians

– MKSAP, meetings and courses• The ‘quadruple aim’ of healthcare

– Better care, better health, physician professional satisfaction, lower per capita costs

• The future of medicine– Students, residents, fellows

• Professional satisfaction– Payment reform, practice redesign

• Two areas of greatest expenditures and mostrapid growth: imaging and tests

Imaging

Physician Employment Dynamics

The $15 Billion Dollar GME Pyramid

2016 ACP/AAIM GME Financing Positions

• Maintain societal commitment• All payer• Try to get at true costs• Selectively lift caps• Infuse transparency• Combine DME/IME• Examine potential Performance Measures• Ignite innovation• Fund ambulatory training

The Flipped Healthcare Classroom 2017…

• The Patient Will See You Now• DPCP• Retail Clinics• Telehealth• Digital Media Resources• Home Hospital• Patient Wearables, etc…

How Did We Get Here? The Alliance of Acronyms…

What’s Missing From The Triple Aim?

What is the one professional challenge that concerns you most?

Challenge Percent

Limited time with patients 14.5

Too much paperwork 11.9

Work/life balance 11.8

Loss of physician autonomy 10.7

Physician burnout 6.9

Maintenance of certification (MOC) 5.8

Malpractice threats/need to practice defensive medicine 5.6

Staying current on clinical knowledge 5.5

Electronic health records (EHRs) 4.7

Physician reimbursement and payment issues 4.1

Source: ACP 2015 Member Survey 35

At the Pediatrician’s Office: Where’s My Doctor?

• The present? The future?

http://annals.org/aim/article/2614079/putting-patients-first-reducing-administrative-tasks-health-care-position-paper

What does this practically mean for your practices?

• The number 1 thing that can be done to improve physician satisfaction with practice is to ease unnecessary regulations and tasks.

• Patients will also benefit as their physicians are able to spend more time with them with less distraction.

• Making EHRs more clinically relevant and useful requires that we examine and simplify the embedded federally‐mandated documentation requirements.

• We also need an entirely new way of looking at administrative tasks, to assess their intent, impact and possible alternatives.

Source: California HealthCare Foundation 41

Strategies To Reduce Burnout

• Align leadership values with clinicians’ values– Leaders model work‐home balance; value well‐being – Understand and promote work control– Alter our “culture of endurance”

• Support work‐home balance– Support needs of parent clinicians– Offer flexible/part‐time work options

• Wellness focus – reflection, exercise, share concerns with colleagues

Linzer et al. Acad Med 2009;84:1395‐1400; Saleh et al. Clin Orthop Relat Res 2009;467:558‐65; Viviers et al. Can J Ophthalmol 2008;43:535‐46; LeMaire J. BMC HSR. 2010; 10:208

Make internal medicine practice more satisfying…

• Clinical documentation • EHRs: functionality, usefulness, clinical relevance• Patients Before Paperwork ( Captures all of ACP’s activities to reduce administrative burdens)

• Payment reform: pay more for cognitive care, chronic care

• Quality measures: relevance, burden of reporting

Have Empathy and Each Day Do Something for Another

An All Too Familiar Patient…

A 40 year old patient with type 2 DM on insulin presents to the clinic (substitute ED) for the 4thtime in 3 months with a blood sugar ~400. VS are stable, PE shows no signs of dehydration, trace ketones and 4+ glucose in UA, BMP nlexcept for BS 425.What do you think could be going on?

Stemming The Escalating Costs of Prescription Drugs‐ A Classic Case of

Grass Roots Advocacy• Several years ago, several members of an ACP Chapter brought this topic to their Health and Public Policy Committee

• The ACP Chapter submitted this as a resolution to the ACP Board of Governors for policy development

• The Board of Governors and Board of Regents passed the resolution

• In 2016, this became policy for the ACP

Impact of Obamacare in Four Maps, The Upshot, New York Times. October 31, 2016. http://www.nytimes.com/interactive/2016/10/31/upshot/up-uninsured-2016.html?action=click&contentCollection=upshot&region=rank&module=package&version=highlights&contentPlacement=1&pgtype=sectionfront&smid=tw-upshotnyt&smtyp=cur

http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-november-2016/?utm_campaign=KFF-2016-November-Tracking-Poll&utm_content=48711492&utm_medium=social&utm_source=twitter

Who loses if insurers can again waiver coverage or charge more for preexisting conditions? Your patients.

In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

Woolhandler S, Himmelstein DU. The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?. Ann Intern Med. [Epub ahead of print 27 June 2017] doi: 10.7326/M17-1403

Travel ban: health impact

These IM residents (ACP members) were prohibited from re‐entering the US because of the Executive Order

ACP: A Global Community

• International chapters: Bangladesh, Brazil, Caribbean, Canada (6), Central America, Chile, Colombia, India, Japan, Mexico, Saudi Arabia, Southeast Asia, and Venezuela

Over 14,000 ACP members reside outside the United States

Big wins for advocacy! Courts block insurer mega‐mergers

All in month’s work: 30 days of ACP advocacy: September 6 to October 6,

2017• Spoke out on Hate Crimes as a Public Health Issue

– September 5 statement on Charlottesville https://www.acponline.org/advocacy/acp‐advocate/issue/article/726073

• Defended “Dreamers” – September 5 statement on President Trump’s decision to end DACA

https://www.acponline.org/advocacy/acp‐advocate/issue/article/726647 , letter to Congress in support of DREAM Act https://www.acponline.org/acp_policy/letters/joint_letter_to_congressional_leaders_supporting_dreamers_2017.pdf and joint letter https://www.acponline.org/acp_policy/letters/joint_letter_to_congressional_leaders_supporting_dreamers_2017.pdf

2017• Advocated for Safety‐Net and Primary Care Training Programs

– September 5 Joint Letter to Congress https://www.acponline.org/acp_policy/letters/joint_letter_to_congress_supporting_extension_of_safety_net_programs_2017.pdf

– September 28 coalition letter to Congress https://www.acponline.org/acp_policy/letters/letter_to_house_and_senate_leaders_on_expiring_primary_care_workforce_programs_2017.pdf and ACP letter https://www.acponline.org/acp_policy/letters/letter_to_house_and_senate_leaders_on_expiring_primary_care_workforce_programs_2017.pdf

• Advocated to Reverse Cuts in Medicare payments to Clinical Labs– September 11 sign on letter to CMS,

https://www.dropbox.com/s/0hjl1bxl0um9fmy/PAMA%20POL%20Letter%20Aug%202017%20final.pdf?dl=0

2017• Advocated for Better Medicare Payments for Internists’ Services

– September 11, Comments on Medicare Physician Fee Schedule https://www.acponline.org/acp_policy/letters/comment_letter_to_cms_re_cy_2018_medicare_pfs_proposed_rule_2017.pdf

• Advocated for Better Quality Measurement– September 14 “Friends of NQF” letter urging continued mandatory funding for

NQF’s quality and measurement work https://www.acponline.org/acp_policy/letters/joint_letter_to_speaker_ryan_supporting_nqf_funding_2017.pdf

• Spoke Out Against Discrimination– Opposed President Trump’s decision to ban Transgender persons from military;

Sent two letter on September 14 letters in support of bills to overturn it https://www.acponline.org/acp_policy/letters/letter_to_senators_gillibrand_and_collins_supporting_transgender_servicemembers_amendment_2017.pdf and https://www.acponline.org/acp_policy/letters/letter_to_senators_mccain_and_reed_supporting_transgender_servicemembers_amendment_2017.pdf

2017• Supported Legislation to Lower Prescription Drug Prices

– September 19 joint letter supporting CREATES Act, “For too long, brand‐name pharmaceutical manufacturers have exploited patient safety tools in order to stifle generic competition and attendant lower prescription drug prices.”https://www.acponline.org/acp_policy/letters/joint_letter_to_senate_leadership_supporting_creates_act_2017.pdf

• Proposed policies to improve the Medicare Advantage Program– New position paper published on October 2 with recommendations to bring

introduce greater transparency and impose fewer administrative demands on clinicians in the MA program. https://www.acponline.org/acp‐newsroom/american‐college‐of‐physicians‐says‐medicare‐advantage‐should‐increase‐transparency‐align‐and‐reduce

2017• Advocated to protect access to health care for women including opposing

proposals to defund Planned Parenthood, eliminate coverage for contraception and other essential benefits. – September 22 joint coalition letter to Congress

https://www.acponline.org/acp_policy/letters/joint_womens_health_providers_coalition_letter_to_senate_opposing_graham_cassidy_2017.pdf

– October 6 letter opposing interim final rule to allow employers to waive contraception coverage https://www.acponline.org/acp‐newsroom/american‐college‐of‐physicians‐objects‐to‐overhaul‐of‐contraception‐mandate

• Countered the administration’s decisions to reverse commitment to mitigating health impact of climate change.– Updated climate change action kit available at this meeting reflects latest

evidence, proposes actions to counter the administration’s decision to pull out of Paris Accord and other commitments https://www.acponline.org/advocacy/advocacy‐in‐action/climate‐change‐toolkit

2017• Called for improved disaster relief response for Puerto Rico and U.S. Virgin

Islands– September 28 letter to the President

https://www.acponline.org/acp_policy/letters/letter_to_president_trump_urging_additional_hurricane_relief_support_for_puerto_rico_usvi_2017.pdf, continually updated resources for members https://www.acponline.org/acp‐newsroom/supporting‐hurricane‐aid‐efforts

• Advocated to Improve Medicare’s Quality Payment Program (MACRA)– Signed onto October 2 letter organized by AMA seeking targeted legislative

fixes. https://www.dropbox.com/s/hnsk73phmljlpge/MACRA_EAC%20‐%20Final%20Letter.pdf?dl=0

– Builds on ACP’s previous comments to CMS.

2017• Led the effort within American medicine, in alliance with

broader health care community, to stop efforts repeal the ACA and rollback coverage and protections for millions of patients. Sixteen letters from ACP, or ACP and our coalition members, in the last month alone!

Part of the EHR solution: simplify documentation requirements

Reworking Evaluation & Management (E/M) Documentation Guidelines: Based on Clinical Documentation in the 21st Century the College has held numerous

meetings with the deputy administrators at CMS and other agencies within HHS regarding reducing the administrative burden of the E/M documentation guidelines.– On June 28, 2017 ACP attended a meeting with HHS where the College outlined a

proposal to move forward with reform of E/M documentation guidelines. – This has led to Solicitation of Public Comment on the reform of the E/M

documentation guidelines through the 2018 Medicare Physician Fee Schedule NPRM.

– ACP will provide detailed comments and recommendations for simplification and alignment of E/M documentation through the rulemaking process

Link to paper: http://annals.org/aim/article/2089368/clinical‐documentation‐21st‐century‐executive‐summary‐policy‐position‐paper‐from

Expand access and coverageImprove public healthSupport research and scienceOppose discriminationReduce health care disparitiesSupport primary care workforce

Lower excessive Rx pricesReform and improve paymentsImprove quality measuresReform medical liability systemMake EHRs work for doctorsReduce crushing administrative burden

ACP’s “Big Tent” advocacy agenda addresses a wide range of issuesaffecting internists and their patients . . .

And whatever else pops up!

Resources for Educators• Teaching Medicine Series

Theory and Practice of Teaching Medicine, Teaching Methods, Teaching in the Hospital, Teaching in the Clinic, Teaching Clinical Reasoning, Mentoring in Academic Medicine, and Leadership in Medical Education

• Annals of Internal Medicine teaching tools • Internal Medicine In‐Service Training Examination for

residents• ACP Board Prep Curriculum for residents• High Value Care Curriculum for trainees at all levels• IM Essentials for medical students

Recent ACP Policy Papers

• Addressing the Increasing Burden of Health Insurance Cost Sharing (July 2016)

• Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians (May 2016)

• Climate Change and Health: A Global Call to Action (April 2016)

• Stemming the Escalating Cost of Prescription Drugs (March 2016)

• Medicaid Expansion: Premium Assistance and Other Options (March 2016)

Advocates for Internal Medicine Network (AIMn)

• Grassroots advocacy network designed to help ACP members engage with federal lawmakers on policy issues important to internists

• AIMn members receive legislative updates and alerts as key policy issues unfold, including sample messages to members of Congress

• Enroll at https://cqrcengage.com/acplac/• To learn more, contact Shuan Tomlinson:

• Tel: 202‐261‐4547• Email: stomlinson@acponline.org

ACP’s New Online Learning Center

• Available at ACPOnline.org/OLC• Enhanced search and browsing

functionality for ACP’s online learning• Easy access to more than 350 activities,

including:– Video‐based learning– Webinars– Interactive cases– Quizzes

The majority of activities offer both CME and MOC.

A centralized gateway for ACP’s online learning activities

ACPOnline.org/OLC

Resources to Help You Transform Your Practice: Prepare for New Payment

SystemACP is helping you transform your practice, choose the right path, keep up‐to‐date and meet deadlines through tools and resources: (ACPOnline.org/MACRA)• MACRA/QPP Information: Online FAQs, fact sheets, webinars

(live and recorded), articles in ACP publications • Practice Transformation: Information, resources, tools to support

practices in making strategic changes to successfully care for patients in the value‐based payment environment

• New: Quality Payment Advisor: Online tool to assist practices in determining the best path to take—MIPS or APM.

• ACP Practice Advisor: Online tool to help practices analyze and improve patient care, organization and workflow

• Physician & Practice Timeline: Online tool helps track deadlines for regulatory, payment, educational and delivery system changes and requirements. Members can sign up by texting ACPtimeline(no space) to 313131 from mobile phones

ACP’s Main Website for the QPP

www.acponline.org/qpp 75

Encouraging High Value Care

Resources to help provide the best patient care while reducing health care costs: • High Value Care Online Cases: Earn free CME credits and MOC

patient safety and medical knowledge points through web‐based cases and questions

• Curriculum For Educators, Residents and Students: Created by ACP and the Alliance for Academic Internal Medicine (AAIM), features six one‐hour interactive modules

• HVC Course For Medical Students: Students evaluate the benefits, harms and costs of tests and treatment options so they can make HVC a reality in clinical practice

Encouraging High Value Care (cont’d)

Resources to help physicians provide the best patient care while reducing costs to the health care system:• High Value Care Coordination (HVCC) Toolkit: Resources to

facilitate more effective and patient‐centered communication between primary care and subspecialist doctors.

• Pediatric to Adult Care Transitions Toolkit: Resources to facilitate more effective transition and transfer of young adults from pediatric to adult care.

• Collaboration with Consumer Reports: A series of new High Value Care Resources to help patients understand the importance of seeking appropriate care.

Support the Next Generation of IM

• Encourage a young person to understand the rewards of internal medicine as a career

• Convince a medical student to see the bright future of internal medicine

• Recommend general internal medicine to a resident

• Invite another internist to become an ACP member

• Sponsor a qualified ACP Member for Fellowship (FACP)

ACP . . . Get Connected

• MyACP 2.0 –a personalized web experience, making it easier for members to access and discover pertinent ACP content and resources while visiting ACPOnline.org.

• ACP Member Forums ACP Member Forums allow ACP members to instantly participate in discussions on a range of clinical, professional, and practice‐related topics.

• Join your local IM community through ACP Chapters– Network, gain CME, develop leadership skills– Mentor medical students and early career physicians

• Develop skills through the ACP Engagement Program– Volunteer to help in development of ACP products – Judge abstracts and mentor early career physicians

• Follow on social mediaACP and Annals of Internal Medicine are using social media more than ever to communicate and share information relevant to internal medicine.

Internal Medicine Meeting 2018:ACP’s Annual Scientific Meeting

Internal Medicine Meeting 2018April 19‐21, 2018New Orleans

Register online at https://im2018.acponline.org/

• Over 200 educational, interactive workshops and case‐based sessions and feedback on patient management problems taught by speakers

• Networking events including Women’s Networking luncheon, African American Reception and various early career events

Thank you . . .

…for your continued support of ACP and your commitment to internal medicine.

2018 annual scientific session saturday morning …€¦ · 2018 annual scientific session saturday...

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