The Leg.Up Local, state and national news of interest to the physician community

December 6, 2017

A Gift that Keeps on Giving: New RAM Endowed Scholarship Link

Click here for our new & easy way to donate to the RAM Endowed Scholarship. The first scholarship recipient - Jessica Li, a third year medical student at VCU - wrote outgoing RAM President Harry Bear, thanking him and all RAM members for their continuing support.

"Dear Dr. Bear," she writes, "Thank you so much for your interest in my medical education at VCU! Words cannot describe how grateful I am for the continued financial support of the Richmond Academy of Medicine ... I truly appreciate Jessica Li with former VCU School of Medicine all of the interest Dean Dr. Jerry Strauss (l) and RAM President Dr. that RAM puts Harry Bear into enriching the experiences of its student members. The mentoring that I have received this past year through RAM is unique to the Academy.

"As a third-year medical student, I am slowly becoming more immersed in different aspects of medicine. From surgery at VCU to peds in Roanoke and family medicine on the Eastern Shore, I am being exposed to many communities around Virginia, and I continue to reinforce my aspiration to work with underserved communities."

Jessica will travel to the Dominican Republic on yet another medical mission during her elective period. "With every new experience and patient encounter, I reinforce why I chose to pursue a career in medicine" - one aided by RAM's "encouragement and financial support as I continue my education at VCU!"

So just click here to make YOUR donation to the next worthy recipient of the RAM Endowed Scholarship! Jessica can be reached at [email protected]. Click here to read her profile in the Winter, 2017 edition of Ramifications (see page 11).

CVS-Aetna Deal Starts Game of Medical Musical Chairs

CVS Health Corp.'s offer to buy Aetna Inc. for about $69 billion "would combine a large insurer with a big provider of pharmacy services and transform the U.S. healthcare landscape, reports The Wall Street Journal.

"The proposed deal is the latest and most dramatic sign Good times at CVS Pharmacy! of how the lines between traditional segments in health care are blurring as companies, saddled with mature businesses and in many cases restricted from buying rival companies, enter new areas in search of growth."

Whether it's an insurer or a hospital chain, "Everyone's moving into one another's space to position themselves for whatever happens," said Lawton Robert Burns at UPenn's Wharton School. Click here for another article on the proposed merger which comes "at a time of turbulent transformation of health care.

"Insurers, hospitals and pharmacy companies are bracing themselves for a possible disruption in government programs like Medicare as a result of the Republicans' plan to cut taxes."

Antitrust regulators last year blocked two separate mergers proposed by the large insurers: Aetna's plan to buy Humana Inc. and Anthem's acquisition of Cigna Corp, saying they would hurt consumers, the Times reports.

Unlike those deals, the CVS-Aetna combination is a "vertical" integration in which the companies do not directly overlap operations. Several antitrust experts said they expected the CVS- Aetna deal to gain approval for that reason, but that it still would be scrutinized closely by the Department of Justice.

But there's also "skepticism about what CVS and Aetna can deliver if they merge," the Times reports. One health consultant noted the potential of sharing so much patient information, yet it also resembles "two battleships that are slow to turn."

Aetna Inc. Chief Executive Mark T. Bertolini is set to pocket roughly half a billion dollars when he leaves his company if the merger survives federal antitrust scrutiny, reports The Wall Street Journal.

If the deal closes, "Mr. Bertolini stands to reap a generous exit payment and benefit from a sizable increase in the value of the stock and rights he owns because of the premium CVS is paying for Aetna. His combined payout is expected to be about $500 million," according to the Journal.

Come Celebrate RAM's Next President!

Please join us on Tuesday, January 9, 2018 for the presidential inauguration of Mark B. Monahan, MD, and the installation of officers of the Board of Trustees. The event will be held at the University of Richmond Jepson Alumni Center. Reception at 5:30 p.m., Dinner at 6:15 p.m., Installation and General Meeting at 7:00 p.m.

Salute the past and embrace the future! Share a drink and conversation with your peers. Say congratulations to Drs. Mark Monahan, Carolyn Burns, Sidney Jones, Ritsu Kuno, Ranjodh Gill, Ike Ibe, Jake O'Shea, Chip Shaia, and Tovia Smith, and Ann Honeycutt (Practice Manager Trustee). Applaud past Academy presidents who continue to carry the torch for all of us. Embrace the new 2018 leadership of RAM!

Please click here to reserve your spot or RSVP to Lara at [email protected] or 804-622-8137. Attend Tomorrow's Legislator Meet & Greet at VEI

Please join us tomorrow, Thursday, Dec. 7 for our second legislator meet and greet. Get to know your elected officials! Come out and enjoy light refreshments and a discussion of physicians' concerns. We want to see you there!

THURSDAY, DECEMBER 7 6:00 - 7:00 p.m. Virginia Eye Institute Huguenot Bridge 400 Westhampton Station Building B Richmond, VA 23226 Virginia Eye Institute

Meet with Senator Amanda Chase, Delegates Betsy Carr, , Delores McQuinn, and Chris Peace and Delegates-elect Debra Rodman and Dawn Adams.

We'd like to thank Senator Glen Sturtevant and Delegates , Riley Ingram, , and for joining us last week at St. Francis Medical Center. Legislators discussed COPN reform, the opioid crisis and advance care planning with RAM members, just to name a few issues.

Click here to sign up for the 12/7/17 Meet & Greet at Virginia Eye Institute from 6-7 p.m. or email Lara Knowles to register!

Del. Loupassi Requests Recount

Del. G. Manoli Loupassi, R- Richmond, who conceded to his Democratic challenger Dawn Adams on election night, last week filed for a recount in the 68th House District which he has represented since 2008, reports the Times-Dispatch.

Adams won by 336 votes out Del. Loupassi (l) at White Coat Day of more than 39,000 votes cast in the contest to represent parts of the city of Richmond, Chesterfield and Henrico counties. She's a nurse practitioner who runs the Office of Integrated Health at the Virginia Department of Behavioral Health and Developmental Services, the RTD reports.

"I recognize the outcome may not change," Loupassi said, "but there's no harm done in making sure that the vote is correct." His request "kicks off a process that could take weeks," including a preliminary hearing in Richmond Circuit Court within a week of last Thursday's legal filing.

Republicans are clinging to a 51-49 edge in the House following last month's gains by new candidates - including women like Adams who won in a "wave election" that's widely viewed as a rebuke of the Trump presidency. The GOP previously enjoyed a 32-seat majority in the Virginia House.

Delegate-elect Adams is among those legislators expected to attend the Legislative Meet & Greet at the Virginia Eye Institute Thursday at 6 p.m.! See item above!

Meanwhile, click here for an interesting post-election postmortem by Virginia political scientists who said attack ads by GOP gubernatorial candidate Ed Gillespie "probably backfired," reports the DailyPress.com.

His Democratic rival, Dr. Ralph Northam, often "drove many Democrats nuts during the campaign" by being so folksy on the campaign trail. But political consultant Bob Holsworth said Northam's "mild-mannered ads about being a doctor on the Eastern Shore" actually worked.

"I guess it's better to be a doctor than a lobbyist," Holsworth said, noting Gillespie's past lobbying for corporate clients in Washington.

Dr. Archuleta Named RTD Person of the Year

Dr. Bob A. Archuleta was named the 2017 RTD Person of the Year yesterday in recognition of his work at Noah's Children, the pediatric hospice and palliative care program he started 20 years ago. Click here to read more about the recognition.

Dr. Archuleta -- a long-time RAM member who practices at Pediatric Associates - is the medical director of Noah's Children. The program is located at Bon Secours' St. Mary's Hospital, which covers administrative costs. Archuleta was one of 24 people honored by the newspaper for contributions and achievements in the Richmond region.

"I certainly live in awe and admiration of the families that Noah's Children takes care of," Dr. Archuleta said as he accepted the honor during a luncheon yesterday at the Omni Richmond Hotel. "It's very special children and families that need attention and the focus... I'm honored that I am bringing some attention to their needs."

Click here to learn more about Noah's Children, whose services to children and families include specialized care, spiritual and emotional support, and home visits from social workers, nurses, and others.

Access Now: Bridging the Gap for the Uninsured

Click here for our full-page ad in the Richmond Times- Dispatch thanking more than 880 caring and compassionate physicians and healthcare staff who generously donate their medical services free of charge to thousands of patients in the greater Richmond area through Access Now!

Heart Transplant Celebrates 50th

Fifty years ago last Sunday, "The first adult human heart transplant was performed in Cape Town," South Africa, writes author Dr. Sandeep Jauhar. "It was an epoch-making advance in science - and also, perhaps, in human culture."

This New York Times Op/Ed explores the legacy of Dr. Christiaan Barnard's pioneering operation, but also notes the work of his American mentors - Dr. Norman Shumway and Dr. Richard Lower, who performed the first dog heart transplant at Stanford in 1959.

Some RAM members witnessed Dr. Lower's later ground-breaking work at the Medical College of Virginia in the mid-1960s, and recall how Dr. Barnard observed Dr. Lower's transplant techniques before returning to South Africa and winning the transplant race. Dr. Richard Lower, transplant genius Click here for a 2008 retrospective on Dr. Lower's career.

Good Medicine Transcends Borders

Amid the hyper-partisanship in Washington and beyond, this recent blog on KevinMd stands out for celebrating the shared mission of doctors around the world. Click here.

Philip A. Masters, MD, FACP, and vice- president, Membership and International Programs at the American College of Physicians, writes from the 4th Annual Qatar Internal Medicine Conference in Doha.

Noting recent changes in U.S. immigration and travel rules, he notes the many queries he's received from physician colleagues from other nations "and the genuine concern that shifting policies may adversely affect our ability to continue working together."

And yet, writes Masters, a member of the medical faculty at the University of Pennsylvania, "What I have found truly surprising is that in many ways, these changes may actually be bringing us closer together as a global physician community."

Click here to find out how, as Masters writes, "Sometimes great good comes out of the potentially negative. I have truly been heartened by the fact that in these challenging times, our global, shared commitment to medicine is actually pulling us closer together and not driving us apart."

Whose "Value" is It, Anyway?

A survey released last week by the University of Utah shows that while "value" is a centerpiece of how medicine is delivered, the word has "no universal meaning," especially when it comes to doctors vs. the rest of the world, reports STAT.

Nearly 9 in 10 doctors (88 percent) equated "value" with "quality care," while patients and employers throw in other definitions that include "measures of cost, customer service, and worker productivity."

STAT notes that this "lack of consensus is not merely a philosophical matter. It is a huge stumbling block in the effort to deliver more bang for the buck in American health care," according to the researchers, who argue that "value" actually has become a form of "propaganda" in medicine.

"It seems to be used in any way people want it to be used, to fill their own agendas," said Dr. Bob Pendleton, chief medical quality officer at the University of Utah, who worked on the study. "The conversation around value is driven by large lobby groups - hospital associations and large corporate medical groups. What's missing is the voice of practicing doctors, patients and employers."

Click here to read more about the national survey of more than 5,000 patients, 687 physicians and more than 500 employers. While employers focused on cost, "Doctors tended to focus almost entirely on quality measures."

One outside health researcher said the survey shows that more consensus is needed to get patients and doctors on the same page, STAT reports. Another major problem: the opaque nature of medical costs, with the average doctor caring for patients on multiple insurance plans.

CMS Cancels Medicare Bundled $$$ for Heart & Hips

CMS has announced the cancellation of a round of new mandatory bundled payment programs for hip fractures and cardiac care under Medicare, and for an incentive program for cardiac rehab, reports MedPage Today.

The latest round of bundled payments to reward coordinated care among different medical practices were set to begin on Jan.1 Bundled payment models pay multiple providers with a single lump- sum payment for a complete episode of care, reports FierceHealthcare.

They were part of the ACA and something the Obama administration wanted to expand from a voluntary program to a mandatory one as a way to switch from traditional "fee for service" to more "value- based care." (See item above on the "value" question).

But with the start of the Trump administration - under former HHS head Dr. Tom Price - a switch was underway to no longer mandate providers have to participate in bundled payment models for hip fractures and cardiac care.

CMS Administrator Seema Verma said the cancellations "will offer greater flexibility and choice for hospitals in providing care to Medicare patients... while CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on different bundled payment models and engaging more providers is the best way to drive health system change ... We anticipate announcing new voluntary payment bundles soon."

New Sinusitis Treatment Nothing to Sniff At

Twelve years after it was approved by the FDA, a procedure that can help patients with sinusitis is finally accepted by all the major insurance carriers in Richmond, reports the Times-Dispatch.

Anthem recently became the last insurer to deem balloon sinus dilation medically necessary, said Dr. Michael Armstrong with Richmond's Ear, Nose and Throat Specialists. Until now, the insurer considered the procedure "investigational."

Armstrong, a RAM member, helped conduct studies on the procedure when it was initially hitting the market and first used balloon sinus dilation in 2007.

Click here to read more about what he called the "almost instantaneous" recovery that often results.

OrthoVirginia Names Ingram as New CEO

OrthoVirginia, which calls itself "the state's largest provider of multi- disciplinary musculoskeletal care and therapy," announced Dale Ingram as Chief Executive Officer.

According to a press release, "An experienced healthcare leader, Ingram spent the last 16 years in leadership roles at The Cardinal Orthopaedic Institute and Orthopedic One in Columbus, Ohio."

"We are excited to have Dale join us as CEO of OrthoVirginia," said Dr. Anthony Shaia, a RAM member who is President of OrthoVirginia's Board of Directors. "Dale brings the leadership skills that we need to attain our goals of improving the quality and efficiency of patient care across the state."

Click here for more about Ingram's career.

Dale Ingram

Virginia On CHIP Standby

Given the federal foot-dragging on funding the Children's Health Insurance Program (CHIP), here's the latest about Virginia's plans to notify the parents of 68,000 children covered by the state's program that relies on CHIP - that is, Family Access to Medical Insurance Security, or FAMIS, which "acts as a safety net for families who lose coverage, or low-income families who cannot afford insurance," reports the Times-Dispatch.

FAMIS also covers more than 1,000 pregnant women who could lose coverage when the state runs out of funds by the end of January, the RTD reports. State officials are waiting to send notification letters, hoping that Congress will finally fund CHIP later in the week.

Kaiser Health News reports that more than 9 million children are facing the loss of health care coverage. Click here for a report on a stopgap bill in the House of Representatives that might address the funding crisis.

ARTS = Addiction and Recovery Treatment Services

DMAS is touting the success of its enhanced substance use disorder treatment benefit: Addiction and Recovery Treatment Services (ARTS).

"About 1.1 million people in Virginia are covered by Medicaid and FAMIS and have access now to the ARTS benefit," including an expansion of inpatient detox and residential treatment to all Medicaid and FAMIS enrolled members as well as increased provider rates for substance use disorders and medication-assisted treatment for opioid addiction.

Click here for an interactive map of the ARTS Provider Network, which includes a list of providers by managed care region. And click here to learn more about reimbursement. Questions? Click here!

A Physician's "Greatest Gift"

Dallas cardiologist and medical school professor Dr. Melanie Sulistio writes on KevinMD about a difficult discussion she had with the mother of a young man who didn't qualify for a heart transplant. Click here to read her moving piece about providing palliative care.

"I believe that the time I spend communicating with patients and families in these fearful moments, the reassurance I give that he or she will not be abandoned, the assurance that their pain and suffering will be alleviated, are all gifts I give to them. But allowing me and my team of physician trainees to walk this road with them, is by far the greatest gift."

What Happens to the Brains of Rocket Men (and Women)?

Click here for an intriguing article in the Nov. 2 New England Journal of Medicine "regarding the effects of spaceflight on the anatomical configuration of the brain and on cerebrospinal fluid (CSF) spaces."

If you were thinking about plunking down a million bucks or so to fly into space, this might give you pause!

Virginia Hospitals Do Well In Safety Survey

Virginia was fifth in the nation for hospital safety according to rankings by the non-profit watchdog, Leapfrog Group, reports USA Today.

Click here for the state rankings, and here for the Richmond-area rankings. Most hospitals received at least A or B rankings, based on medical errors and injuries, as well as patient survey responses, CMS data, information from the American Hospital Association, and data given directly to Leapfrog.

While hospitals often use such positive rankings for marketing purposes, Leapfrog's president and CEO, Leah Binder, said this one's different. "It's fine for a hospital to say they are excellent in their advertisements and brochures. But that's not good enough for patients entrusting their lives to a hospital."

Holidays & Advance Care Planning

Click here for the Fall 2017 Honoring Choices Virginia newsletter, with its timely theme, "Let's Talk Turkey!"

The holiday season offers plenty of opportunities to start conversations about advance care planning.

Click here for more food for thought!

RAM Brightens GardenFest of Lights

Great to see so many RAM members and their families out enjoying our inaugural Winter Family Event at Lewis Ginter's GardenFest of Lights. Happy Holidays from our RAM family to yours! Click here to see you and yours shining bright!

Mea Culpa

We draw from a wide range of print, online and medical journals to bring you information we hope is relevant to your practice of medicine.

But as a former reporter, editor and author, I recognize that mistakes do happen. So please contact me if you have any concerns, complaints, or ideas/articles you'd like to share by clicking here or calling 622-8136.

Click here if you'd like to see some of my books. THANK YOU for being part of the Academy and its continuing conversation about the best practice of medicine.

Click here for past editions of The Leg.Up!

Chip Jones RAM Communications & Marketing Director

STAY CONNECTED:

The Richmond Academy of Medicine, 2821 Emerywood Pkwy, Ste 200, Richmond, VA 23294

SafeUnsubscribe™ {recipient's email} Forward this email | About our service provider Sent by [email protected] in collaboration with

Try it free today