Medical Staff Spring Event Saw Record-Breaking Attendance

More than 350 people attended the Medical Staff Spring Event, held on May 23 at Heublein Hall. This was record-breaking attendance for the event. The annual medical staff awards were presented to:

•  Physician in Philanthropy Award: Dr. Robert Siegel
•  Young Practitioner Award: Dr. Pavlos Papasavas
•  John K. Springer Humanitarian Award: Dr. Evan Fox
•  Distinguished Service Award: Dr. Dariush Owlia
•  Quality and Safety Award: Dr. John Greene

Backus and HHC Sign Memorandum of Understanding

Backus Corporation and Hartford HealthCare have signed a Memorandum of Understanding, a legal document that outlines how a formal partnership of our healthcare systems would function. The agreement marks a significant milestone as both organizations continue to move forward with their proposed affiliation. If approved, Backus would become a member of the Hartford HealthCare network, which includes Hartford Hospital, the Hospital of Central Connecticut, MidState Medical Center, Natchaug Hospital, Windham Hospital, a large primary care physician group and a wide spectrum of additional health services. The governing boards of both organizations signed a Letter of Intent to explore a formal affiliation in February. Since then, both boards have formed subcommittees to assess the strategic alignment of Backus and Hartford HealthCare. Representatives from both potential partners have also been engaged in providing insight into their respective operations and community needs. An affiliation would enable both organizations to share the knowledge and expertise of their staffs and physicians and give patients easier access to a wider range of services, technology and treatments. Before signing the Memorandum of Understanding, both organizations performed due diligence to determine if an affiliation would be in the best interest of patients and communities served by the institutions. Backus and Hartford HealthCare will now work on creating a definitive agreement, which is expected to be in place by July. They will then work with state and federal officials to obtain regulatory approval. This process usually takes several months.

Joint Commission Grants Certification for Spine Surgery

The Joint Commission has granted the Hartford Hospital Spine Center a Certification for Disease Specific Care for Spine Surgery. This achievement represents our commitment to providing safe, high quality care and treatment, and is the result of much hard work by the entire team. Our certification means that we are one of three Certified Spine Surgery Programs in New England, two of which are in Connecticut. Hartford Hospital is the only Certified Spine Surgery Program in the region (a listing of all certified programs may be found here.

Press Ganey CEO Patrick Ryan Visits Hartford Hospital

Patrick Ryan, the newly-seated CEO of Press Ganey, visited with Jeff Flaks, president and CEO of Hartford Hospital, and other members of senior management on May 16. Press Ganey, based in South Bend, Indiana, is the industry's recognized leader in providing a number of health care performance solutions, most notably focused on enhancing staff and physician experience. Ryan shared his vision for Press Ganey, spent time learning about Hartford Hospital's cultural transformation (H3W), and toured the facility. He said he was impressed with our organization, expressed his gratitude for being hosted on our campus, and is exploring opportunities for potential future collaboration with Hartford Hospital.

Sleep Disorder Center Now Providing Home Sleep Testing

The Sleep Disorder Center at Hartford Hospital is now providing home sleep testing for patients who do not meet the in-lab sleep study guidelines issued by some insurance providers (presently, Oxford and Aetna will only approve in-lab studies for patients who have specific comorbidities (pulmonary, cardiac, sleep disorders other than Obstructive Sleep Apnea). There are clinical limitations with home sleep testing; for example, EEG and EKG are not recorded. Our Sleep Center guidelines, which reflect recommendations from the American Academy of Sleep Medicine, require a patient having a home sleep study to receive a "comprehensive sleep evaluation" by a boarded sleep specialist. The sleep specialist will be able to determine appropriateness of the home study, based on the patient's medical history and their ability to properly apply the device. Home sleep study patients are instructed in the application of the device at the Sleep Disorder Center at Hartford Hospital or at the satellite in Bloomfield. If a CPAP study is indicated for a patient who has had a home study, this will then need to be done through the use of an auto-titrating CPAP trial in the home. Referring physicians will continue to receive a copy of the sleep study results from the sleep specialist.

Dr. Rocco Orlando Addresses Healthcare Financial Management Assoc.

Dr. Rocco Orlando spoke at the Healthcare Financial Management Association New England meeting on May 18. His presentation was entitled "Hartford HealthCare: Clinical Integration To Accountable Care In A Time of Uncertainty."

Drs. Tulikangas and O'Sullivan Publish Article in AJOG

Dr. Paul Tulikangas from our division of Female Pelvic Medicine and Reconstructive Surgery (urogynecology) and Dr. David O'Sullivan from Research Administration published "Effect of Surgical approach on physician activity and pain control after sacral colpopexy," in the May 2012 edition of the American Journal of Obstetrics and Gynecology.

Dr. Madhavi Gorusu Presents To CT Assn of Physicians of Indian Origin

Dr. Madhavi Gorusu spoke on the medical oncology aspect of breast cancer at the 2012 annual convention on women's health care of the Connecticut Association of Physicians of Indian Origin (CAPI) on May 12. Her presentation was entitled "Journey from Mammogram to Treatment". The convention was in Waterbury.

Dr. Ethan Foxman Serves As Adjunct at Stanford

Dr. Ethan Foxman, chair of the Department of Radiology, spent last week at Stanford University in Palo Alto, Calif., as an adjunct clinical professor in the Neuro-radiology Department. He worked with staff, residents, and fellow and gave teaching presentations. His area of focus was chronic neuro-degenerative diseases and recent advances in MRI imaging of the hippocampus in the early detection of Alzheimers's-type dementia, a service we have been piloting at Hartford Hospital since last year. Foxman has been on the adjunct faculty at Stanford for four years.

Dr. Christopher Clyne Presents at Heart Rhythm Society's International Convocation

Dr. Christopher A. Clyne, director of Interventional Electrophysiology, was an invited faculty member for the 2012 Heart Rhythm Society's International Convocation in Boston, May 8-12. He presented several papers (one with Fellow Nitesh Sood- in collaboration with the University of Rochester), and chaired a session on ICD lead failures. Clyne was also reappointed to the Heart Rhythm Society's Education Committee for years 2012-2014.

Dr. Kenneth Dardick Supervises Travel Health Exam in Singapore

Dr. Kenneth Dardick, founding partner of Mansfield Family Practice and Connecticut Travel Medicine in Storrs, recently returned from Singapore where he supervised the certification examination in travel health for the International Society of Travel Medicine. Dr. Dardick is the chair of the Examination Committee. Over 220 doctors, nurses, pharmacists, and public health officials from Asia, Oceania, Europe and the Americas sat for the exam. Over 1,500 health professionals have earned the Certificate in Travel Health. The International Society of Travel Medicine has over 3,000 members from 80 countries and is committed to the promotion of healthy and safe travel. In cooperation with health care providers, academic centers, the travel industry and the media, ISTM advocates and facilitates education, service, and research activities in the field of travel medicine. 

Dr. Paul Thompson Quoted in New York Times

Dr. Paul D. Thompson, medical director of Cardiology, was quoted in an article by Gretchen Reynolds in the New York Times on May 24. The article discussed one of Thompson's long-time clinical and research interests, the effects of prolonged exercise such as marathon running on the heart and was prompted by the death from cardiomyopathy of Micah True, who recently became famous because of his prominence in the best seller, Born to Run.

Dr. Robert Siegel Promoted to Clinical Professor

Dr. Robert Siegel, medical director of Cancer Clinical Research, has been promoted by the University of Connecticut School of Medicine to clinical professor of medicine.

Drs. DiGiuseppe and Mnayer Contribute Book Chapter on Leukemia

Dr. Laila Mnayer, director of Molecular Pathology and Cytogenetics, and Dr. Joseph DiGiuseppe, director of Flow Cytology, wrote a chapter on "Acute Leukemias" for the book Laboratory Hematology Practice (Kottke-Marchant K, Ed.), which was just published by Wiley-Blackwell. Dr. DiGiuseppe was also a co-author of a chapter called "Myelodysplastic Disorders" in the same book.

Dr. Jabar Aslanzadeh Coauthors Microbiology Articles

Dr. Jaber Aslanzadeh, director of Clinical Microbiology, coauthored an article called "Biochemical Profile-Based Microbial Identification Systems" in the recently published book, Advanced Techniques in Diagnostic Microbiology, and an article called "Trichomonas vaginalis prevalence and STI using the APTIMAÆ Trichomonas vaginalis assay" currently in press in the Journal of Clinical Microbiology. Aslanzadeh is on the board of directors of Community Health Services in Hartford.

Dr. Joseph Wagner Presents at URA Annual Meeting

Dr. Joseph Wagner, director of Robotic Surgery, gave two presentations at the American Urological Association Annual Meeting in Atlanta May 19-23. They were entitled "Building a Successful Robotic Program" and "Is Active Surveillance Associated With Adverse Pathologic or Surgical Outcomes in Men Eventually Choosing Definitive Treatment with Radical Prostatectomy?"

Dr. Zendee Elaba Publishes Three Book Chapters

Dr. Zendee Elaba, director of Dermatopathology, has co-written three book chapters: "Technologies in the molecular diagnostics laboratory" in Molecular Diagnostics in Dermatology and Dermatopathology; and "Melanoma staging" and "Molecular pathogenesis of melanoma: established and novel pathways" in Diagnostic and Prognostic Biomarkers and Therapeutic Targets in Melanoma.

Dr. Charles McKay Elected to Medical Toxicology Board

Dr. Charles (Chuck) McKay, chief of Medical Toxicology in the Emergency Department, was elected to the Executive Board of the American College of Medical Toxicology (ACMT) by the Board of Directors this spring. He will serve as treasurer beginning in October.

Transplant Program Welcomes New Surgeon

The Transplant Program welcomes Dr. Caroline Rochon, liver and kidney transplant surgeon. Rochon comes to us from New York Medical College/Westchester Medical Center Transplant Center where she has worked as an assistant professor for liver and kidney transplantation as well as hepatobiliary surgery. Previously, she was affiliated with SUNY Downstate in Brooklyn. Dr. Rochon is also currently completing a master of science degree at McGill University (Montreal) in the Department of Experimental Surgery where she was previously awarded a Surgical Research Scholarship and did research in Proprotein Convertases Profiles in Neuroendocrine Tumors of the Pancreas and Identification of Satellite DNA Binding Proteins in HeLa Cells. Her current research interests include expanded criteria organs and quality outcomes in transplantation.

Navy Doctors Train On High Tech Mannequins
Hartford Courant, May 15

Three U.S. Navy doctors gathered around a mannequin at Hartford Hospital Tuesday, asking it questions about the pain in its arm. Dr. A. Jon Smally, emergency medical director for the hospital, controlled the mannequin's pulse and breathing with a computer in another room on the other side of a two-way mirror. Talking through a microphone, he answered the officers' questions, speaking on behalf of the mannequin.

Dr. Lenworth Jacobs + CESI Tour = Gift to Support Education at CESI

Following a tour of the Center for Education, Simulation and Innovation (CESI) with Dr. Lenworth Jacobs last month, Peggy Bliss was convinced of the need for technology to support education. Inspired by the experience, the former Hartford Hospital employee pledged a generous donation to advance the important work of CESI. Specifically, her gift will allow for the purchase of an interactive Smart Board, which will benefit all areas of CESI. An audio-visual specialist for many years at the hospital, Peggy feels very close to our institution and is committed to supporting its mission.

Dr. Paul Grundy Addressed the HPHO Clinical Integration Educational Forum

Dr. Paul Grundy, IBM's director of Healthcare, Technology and Strategic Initiatives for IBM Global Wellbeing Services and Health Benefits, addressed the HPHO's 25th Anniversary and Clinical Integration Educational Forum on May 16 at the Hartford Club. His topic was "Major Employer Groups, What Do They Want From Health Care Systems and Practitioners?" He was joined on a Panel with by Dr. Peter Bowers, Wellpoint medical director, John Dobson, UTC Benefits, and Dr. Robert Willig, Aetna medical director. The Forum, which was co-sponsored by the Hartford Hospital Medical Staff, covered the future of Primary Care Medical Home and Neighborhood concepts, as well as local employers' objectives of purchasing quality cost-effective care for their employees. 

Oncology Symposium Focused on Renal Cancer; Featured Drs. Shichman and Meraney

The 23rd annual Mary Mulready Sullivan Oncology Symposium was held May 16 in the ERC. It is conducted annually to bring state of the art cancer information to health care providers. It was entitled "Innovations in Renal Cancer: Diagnosis, Treatment and Patient Care." Approximately 150 physicians, nurses, fellows and residents, and other healthcare providers attended. Dr. Patricia DeFusco served as the symposium coordinator and moderated the event. Dr. Steven Shichman, chief of Urology and an internationally recognized expert on renal cancer, discussed surgical treatment for localized kidney cancer. Dr. Anoop Meraney, division chief of Urologic Oncology, discussed surgical treatment of locally advanced and metastatic kidney cancer. Dr. David McDermott, director of the biologic therapy program at Beth Israel Deaconness Medical Center in Boston, discussed advances in the treatment of renal cancer with a focus on new targeted drug therapies. Marcia Caruso-Bergman, oncology nurse practitioner at Hartford Hospital's Helen & Harry Gray Cancer Center, addressed holistic issues in the care of the renal cancer patient including the management of treatment side effects and support of the patient and family.Following the presentations, the speakers participated in an active panel discussion and answered audience questions. The symposium is made possible by generous gifts including major support from the Sullivan and Mulready family. Dr. Paul Sullivan, retired Hartford Hospital endocrinologist, welcomed those in attendance and was joined by his sons Dr. Paul Sullivan, Dr. Ryan Sullivan, and Jeff Sullivan.

Stroke Center Conference Featured Drs. Spiegel, Oakes, Ollenschleger, Silverman and Kureshi

The Stroke Center presented a conference entitled "Fantastic Voyages: Current Endovascular Management of Stroke, Aneurysms and Brain AVMs" on May 18 in the ERC. Conference faculty included Hartford Hospital physicians Gary Spiegel, Howard Oakes, Martin Ollenschleger, Isaac Silverman and Inam Kureshi. Other faculty members were keynote speaker Dr. Alejandro Berenstein from Beth Israel Medical Center and St. Luks'-Roosevelt Hospital Center; Dr. P. Kim Nelson from NYU Langone Medical Center; Drs. David Fiorella and Henry Woo from Stonybrook University Medical Center; and Dr. Robert Lesser from UConn School of Medicine. 

Dr. Patrick Troy To Present Hospital Medicine's Grand Rounds

Hartford Hospital physicians are invited to the Division of Hospital Medicine's May Grand Rounds on Wednesday, May 30. Dr. Patrick Troy, Pulmonary and Critical Care, will present "Update in Critical Care Medicine." This CME activity is dedicated to creating closer ties with HHC's hospitalist program, and is open for all to attend. It will be held in Taylor Conference Room A from 4-5 p.m.

Women Physicians Organization Meeting June 12

The next meeting of the Women Physicians Organization will be Tuesday, June 12 from 6:30-8 p.m. at the Hartford Golf Club in West Hartford. The event will feature a cocktail hour, dinner, and presentation by James Blazar, senior VP and chief strategy officer at HHC and Karen Goyette, VP of strategic planning and business development for HH and HHC. Their presentation, entitled "HHC 2012 Environmental Assessment: Health Care's Kodak Moment," will review the current and future regional and national trends impacting Hartford HealthCare and our service areas ñ including increased competition, shifts in patient care towards the ambulatory setting, and the need to contain costs. Register online at www.harthosp.org/event/504 or call 860-545-1888.

Get Your 6% Malpractice Discount for Completing Risk Management Education

CHS Insurance LTD is continuing participation in the Annual Risk Management Educational Program (RMEP) available to all CHS voluntary attending physicians. By successfully completing the program, eligible participants (CHS Insurance policyholders effective January 1 of this policy year) qualify for a credit of 6% on their malpractice insurance premium. Please feel free to call 860-920-5475 with any questions. There are two sessions scheduled in June:

• Leadership: Friday, June 8, 7:30-8:30 a.m., JB-118
• Surgery: Monday, June 25, 5-6 p.m., Gilman Auditorium

CT Man Infected By Flesh-eating Bacteria
News 8, May 17

A fleshing-eating bacteria has infected a 24-year-old grad student in Georgia and a man from Bloomfield who became infected while on vacation in Florida. An ER doctor at Hartford Hospital spoke with News 8 about the flesh-eating bacteria. "It can definitely be fatal, if it is untreated it has a 75 percent mortality, so as it goes on it will continue to eat into the deeper areas of your skin," said Dr. Cynthia Price. She said the flesh-eating bacteria is everywhere from doorknobs to locker rooms. She said it tends to strike people with a weak immune system, and awareness is one of the biggest ways to prevent it.  "What you would do to protect yourself from any bacteria, wash your hands if you get a cut, clean it out, keep an eye on it, the key for this flesh eating bacteria is early detection," said Price.

State's Doctors At Odds Over Medical Marijuana
Hartford Courant, May 18

Years of debate and fine-tuning in the state legislature over allowing medical marijuana still have not settled all the questions Connecticut doctors have about medical marijuana. Is it, as some contend, a humane solution for patients who can't get relief from other medicines, or a reckless move toward something that hasn't been fully tested scientifically? "I think there's some anxiety about what the federal government's attitude will be about it," said Dr. Andrew Salner, chief of the department of radiation oncology at Hartford Hospital, who has long been an advocate for medical marijuana. Salner said he doesn't believe federal regulations will be a problem in Connecticut. "Clearly, there's a groundswell that this is the right thing to do for people who don't respond to other medications," he said. Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital, said allowing medical marijuana in the state "is a good idea in principle," but adds that she has several questions about it. For instance, how would pharmacies dispensing marijuana protect themselves against robberies, and how would residents react to a marijuana dispensary in their neighborhood? "I think there are so many details that have to be worked out," she said.

OTTR Chronic Care Solutions Signs Agreement with Hartford Hospital
Albany Times Union, May 3

OTTR: Chronic Care Solutions, an Omaha-based clinical process management and informatics company, announced that they have signed an agreement with Hartford Hospital to use the OTTR: Transplant Care Platform. Hartford Hospital is comprehensively using these OTTR Chronic Care Solutionsí modules and interfaces: Heart, Liver, Kidney, VAD, Financial/Insurance, Lab, ADT, SCM, CLP Lab, Allscripts:, Quest, and Heart Demographics. Part of the OTTR: Transplant Care Platform includes the use of the TRA module - Transplant Registry Assistant. Hartford will utilize the TRA module to complete and send transplant recipient registry forms to United Network for Organ Sharing (UNOS). Furthermore, Hartford will enhance overall productivity by utilizing OTTR Interoperability tools such as external lab integration, transcription, and more.

State Medicare Costs Sixth-Highest in Nation
Connecticut Day, May 18

The average Medicare expense for hospital patients in Connecticut is the sixth highest in the nation. Of the state's 31 hospitals, the Masonic Home and Hospital in Wallingford had the highest average - $20,326 per patient, 13 percent above the national median and 10.2 percent above the Connecticut average. Johnson Memorial Hospital in Stafford Springs was second, with an average of $19,607 per patient. In Connecticut, as nationally, hospitals even a few miles apart can have wide variations in per-patient average Medicare payments. In Connecticut, there was little correlation between average hospital payment and the size or location of the hospital. The seven that fell below the national median were the Hebrew Home, Sharon Hospital, Charlotte Hungerford Hospital in Torrington, Griffin Hospital in Derby, Greenwich Hospital in Greenwich, the Hospital of Central Connecticut in New Britain and Yale-New Haven Hospital. The Hebrew Home has 45 beds while Yale-New Haven has more than 1,000.

Meriden's MidState looks to close psych ward, move beds to New Britain
Meriden Record Journal, May 22

MidState Medical Centerís intent to close its psychiatric unit is facing some, but not all, of the same concerns from psychiatrists and others who opposed a similar move in 2007. Concerns at the time prompted the hospital to keep the psychiatric unit open and not transfer long-term patients to the Institute of Living in Hartford. Cindy Russo, MidState's senior vice president of operations, said the current plan entails moving the six long-term psychiatric beds to the Hospital of Central Connecticut at New Britain. She said patients would be better served at New Britain's 32-bed unit than at MidState's "small and inefficient" six-bed unit. In a larger unit, patients could take advantage of group therapy, according to Russo. Half of emergency room patients in general are already transferred from MidState for specialized treatment, Russo said.

Children's Center Impasse With Anthem Hurting Families

The recent failure of Anthem Blue Cross and Connecticut Children's Medical Center to agree on a contract may seem like just another fight for the bottom line between an insurer and a health care provider. But it's so much more complicated.

Lasers Take Aim At Brain Tumors
Hartford Courant, May 15

After little more than two hours of preparation, Simone DiGiacomo was ready to have a tumor that was lodged 3 inches deep in her brain cooked by a laser. The 47-year-old Jewett City woman was wrapped almost entirely in blue sheets on a bed in the MRI Integrated Neuro Suite of Yale-New Haven Hospital's Smilow Cancer Center. The $11 million facility is outfitted with a 3-Tesla magnet strong enough to lift three cars, which allows doctors to see inside the brain in real time. The doctors use a system that essentially burns a tumor by laser.

Waterbury Hospital ER doctors quit amid outsourcing
Hartford Business Journal, May 24

Six emergency room doctors at Waterbury Hospital have resigned following the hospital's decision to outsource staffing in the ER beginning this fall, The Associated Press reports. Hospital spokesman Matthew Burgard said the resignations of about 37 percent of doctors staffing the ER will begin taking effect in July. He says there will be no immediate staffing problems and other physicians have agreed to step in on a per-diem basis to help staff the emergency department after the resignations take effect. The hospital recently entered into a contract with EmCare, a Dallas company that will provide emergency department physicians to the hospital. Waterbury Hospital also is in the process of merging with St. Mary's Hospital, and Burgard says the possible consolidation of some staff may also have contributed to the resignations.

St. Francis' Hfd. City Hall Care Center Debut Set
Hartford Business Journal, May 15

St. Francis Hospital and Medical Center has won formal approval to open its new urgent care center in Hartford's City Hall this week, giving the health care provider its closest presence to a downtown location. The primary care practice, located at 550 Main St. will be formally dedicated on Thursday to care for city and state employees and their families. The 1,000-square-foot space on City Hall's ground floor has been renovated to accommodate two exam rooms, a receptionist and waiting area. It will be staffed by a St. Francis Advanced Practice Registered Nurse Monday through Friday. The site provides treatment and services for common illnesses such as minor wounds, skin conditions, administration of vaccines, screening for chronic conditions, and blood pressure and other lab testing referrals. Staffing includes an off-site physician responsible for monitoring the clinic's daily activities.

St. Francis Hospital, Connecticare Form 'Mini ACO' for Hip and Knee Surgery
Becker's Hospital Review, May 16

The Joint Replacement Institute of Hartford, Conn.-based St. Francis Hospital is teaming up with Farmington, Conn-based insurer Connecticare to form a collaborative care pact aimed at coordinating treatment for total hip and knee replacement surgeries. The hospital and insurer are calling the program the 'Step Ahead Plan.' According to the report, the plan will function as a mini accountable care organization, coordinating treatment provided by the hospital, surgeon and anesthesiologist into one care episode. The mini-ACO will also monitor outcomes and quality measures. Providers involved ó including The Connecticut Joint Replacement Surgeons and Woodland Anesthesiology Associates, both based in Hartford ó will receive a single value-based price for hospital-related services rather than individual prices, according to the report.  

May 31 (Thursday):

IOL Grand Rounds:
Brain and Culture: How Our Environments Shape Our Brains and Minds

Keynote Speaker: Dr. Bruce E. Wexler, professor of psychiatry, Yale University Department of Psychiatry and the Connecticut Mental Health Center. 12 Noon, IOL Commons Building/Hartford Room.

June 1 (Friday):

Surgery Grand Rounds:
Can Surgeons Turn Veins Into Arteries?

Keynote Speaker: Dr. Alan Dardik, associate professor of vascular surgery, Yale University School of Medicine. 6:45 a.m., Gilman Auditorium.

June 16 (Saturday):

Walk With A Doc:
Preventing Lyme Disease

Dr. Walt Kupson, internist. 8:30 a.m., Farmington Canal Linear Park - Cheshire.

June 28 (Thursday):

Semi-annual Medical Staff Meeting

7 a.m., Gilman Auditorium.

Physicians Receive Federal Innovation Grants

American Medical News, May 17

Physicians and other health care professionals will be developing medical homes, employing health information technology and taking various other measures to boost access to primary care under the first series of innovation grants announced by the Centers for Medicare & Medicaid Services on May 8. The CMS Center for Medicare and Medicaid Innovation issued 26 grants totaling $122.6 million as authorized under the Patient Protection and Affordable Care Act, with an aim toward reducing health spending by $254 million over three years. The projects will involve the collaboration of physicians, hospitals, nurses, pharmacists, technology innovators, community-based organizations and patient advocacy groups in urban and rural communities, according to CMS.

The Evolving Primary Care Physician

NEJM, May 17

The primary care doctor is a rapidly evolving species ó and in the future could become an endangered one. As the United States grapples with the dual challenges of making health care more widely available and reducing the national price tag, it's hard to say how primary care physicians will fit into the delivery models that emerge. Will they be increasingly replaced by nurse practitioners and physician assistants? Will they become partners or leaders on multidisciplinary teams, spending more time supervising others and less interacting with patients? Will most become employees of large health systems, as solo and small-group practices disappear? Will having a primary care physician become a luxury, available chiefly to people who can pay a premium to enroll in a concierge practice?

Health Care Could Save Billions by Reducing Waste in Six Key Areas, Says Article

AAFP, May 16

The U.S. health care system could save hundreds of billions of dollars each year in public and private health care expenditures by adopting strategies to reduce waste in six key categories that are major drivers of health care costs. That's the conclusion of an article by former CMS Administrator Donald Berwick, M.D., and Andrew Hackbarth, M.Phil., an assistant policy analyst at the RAND Corp., in JAMA: The Journal of the American Medical Association. "In just six categories of waste -- overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse -- the sum of the lowest available estimates exceeds 20 percent of total health care expenditures," say the authors. "The actual total may be far greater. The savings potentially achievable from systematic, comprehensive and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage."

Emergency Departments, Medicaid Costs, and Access to Primary Care ó Understanding the Link

NEJM, May 16

In December, 2011, Washington State's Health Care Authority announced its intention to stop paying for emergency department (ED) visits by Medicaid beneficiaries - when those visits are not necessary for that place of service." To identify unnecessary visits, the state proposed a list of approximately 500 diagnosis codes. The proposed rule would apply to all Medicaid beneficiaries, irrespective of age, disability, or place of residence (such as a nursing home) - even if the patient, the child's parent, or the nursing home staff believed that ED care was needed.

Kudos to ED Doctors

When I was visiting in West Hartford, I apparently had a heart failure in the early morning.  By the time I arrived at the hospital by ambulance, an entire team was waiting for me and the emergency treatment was exemplary.

Within a few minutes the doctors had obtained my hospital and doctor (cardiologist) records from St. Louis and became totally familiar with my history.  After an hour or so, I apparently returned to normal, stayed overnight, and was discharged the next morning.

The entire hospital and medical treatment was outstanding, and probably saved my life.

Merle Silverstein
St. Louis, MO

The Seymour Street Journal (SSJ) has been developed to communicate key messages pertinent to our hospital's physicians. It will keep you informed and up-to-date on hospital, network, and health care news in a concise, convenient format. The SSJ will be sent to your preferred e-mail address every other Sunday. Back issues can be viewed here. For any questions or suggestions, please contact Dr. Jeffry Nestler, Medical Staff President, at (860) 836-7313.