Healthcare Transformation Focus of Internal Medicine Meeting

Miriam E. Tucker

April 27, 2016

WASHINGTON, DC — The rapid changes occurring in healthcare delivery will be at the center of the upcoming American College of Physicians (ACP) Internal Medicine meeting. Other hot topics featured at the conference will include opioid prescribing, the Zika virus, and in-office ultrasound.

"Attendees can get a very broad overview of the important clinical and healthcare issues that physicians need to address at the present time," said Steven Weinberger, MD, ACP executive vice president and chief executive officer. "What we really like is the opportunity for physicians to network with each other and reinforce their participation as part of the overall internal medicine community and the healthcare community."

Although the bulk of the meeting is aimed at delivering practical information on clinical topics — including reviews of several clinical guidelines published in the past year — considerable attention will be devoted to the major health policy changes affecting the way physicians practice and how they get paid.

"One of our initiatives here at the college is to help physicians navigate the needed transformation of their clinical practices in order to meet the new reimbursement models coming from the Centers for Medicare and Medicaid Services," Patrick Alguire, MD, senior ACP vice president for education, told Medscape Medical News.

Sylvia Burwell

To that end, Sylvia Burwell, secretary of Health and Human Services, will kick off the meeting with a keynote talk.

"We don't know exactly what she will be speaking about, but obviously, in these days of a lot of transitions in terms of what's happening in healthcare, it will be very important to have her there," Dr Weinberger said.

Another key session — entitled 60 Minutes: Special Report on Hot Topics in Health Policy — will include a discussion of the expected impact on physicians and patients of the 2015 Medicare Access and CHIP Reauthorization Act and the recently announced Comprehensive Primary Care Plus, and what the ACP is doing to help members meet the new requirements.

Those topics will also be covered in other sessions. "Most physicians have absolutely no understanding of the alternative reimbursement pathways coming down the pike," Dr Alguire pointed out.

Safe Opioid Prescribing

The risk evaluation and mitigation strategy for extended-release and long-acting opioid analgesics will be addressed in a 4-hour preconference workshop — funded by member companies — entitled SAFE Opioid Prescribing: Strategies, Assessment, Fundamentals, Education. Attendees can earn up to 3.5 Maintenance of Certification (MOC) points and patient safety credit in the American Board of Internal Medicine MOC program.

Guidelines for opioid prescription issued by the Centers for Disease Control and Prevention in March will be reviewed during the workshop. The safe prescription of opioids is emerging as a major clinical challenge; physicians must walk a tightrope — ensuring that patients have appropriate pain control without overprescribing and contributing to opioid overdose. "It's an incredibly tough balance," Dr Weinberger told Medscape Medical News.

"It's a complex area where physicians need a lot of help," Dr Alguire added. "ACP, like many other professional societies, is presenting this standard curriculum to sensitize physicians and increase their ability to prescribe appropriately and safely."

In-Office Ultrasound

A 2-day preconference course — Point-of-Care Ultrasound for Internists and Hospitalists — will feature hands-on learning, including practice on phantoms and computer-based simulations. Point-of-care ultrasound can help clinicians with a multitude of diagnostic tasks, such as assessing cardiac function, diagnosing abdominal pain or dyspnea, and evaluating a swollen leg for possible deep vein thrombosis.

In previous years, this was a 1-day course. "This reflects what's out there in medicine. People are understanding that they can improve their diagnostic acumen by using ultrasound at the bedside," Dr Alguire told Medscape Medical News.

"As the cost of these units is coming down, quite dramatically, and the units become smaller, use by internal medicine doctors is increasing. That's being reflected by the increased interest in these courses," he explained.

The latest information on the Zika virus and its link to microcephaly and other adverse events will be addressed during the meeting in two sessions.

Zika Virus: A Last-Minute Addition

Update in Infectious Diseases will be presented by John Bartlett, MD, from Johns Hopkins University School of Medicine in Baltimore, and Vector-Borne Infections in the United States will be presented by Stephen Gluckman, MD, from the Hospital of the University of Pennsylvania in Philadelphia.

When the ACP initially organized the program, the virus wasn't even on the radar, Dr Alguire pointed out. The two renowned speakers were asked to update their prepared talks to include the latest Zika developments. Although it's not mentioned in the program, "both speakers will address the epidemic and what it means for the United States," he explained.

"The challenges faced by providers and patients when young adults with physical and intellectual disabilities reach adulthood and enter adult primary care and specialty practices" will be addressed in the session entitled Accepting Patients With Disabilities Into Your Practice: Tools and Tips to Make the Transition Work for Everyone, Dr Alguire reported. A toolkit to assist physicians will be provided.

And there's much more in the way of hot-button topics, including updates on osteoporosis controversies, post-traumatic stress disorder, a progress report on the Affordable Care Act coverage expansion, the medication treatment of addiction, direct patient contracting practices, gluten and wheat sensitivity, medical informatics, and the clinical care of lesbian, gay, bisexual, and transgender people.

To encourage healthcare delivery innovation, the meeting will debut a competition session, entitled ACP's Dragon's Lair: Breathing Fire Into Healthcare Transformation. Speakers will discuss ideas and projects they have developed to transform clinical practice so that it meets the Triple Aim Initiative of better health, better care, and lower cost.

"This is a lot of what people are interested in these days, Dr Weinberger pointed out. "How can practices be transformed for better delivery of high-quality care, for addressing the whole issue of value and decreasing the cost of care while not decreasing quality and hopefully improving it?"

The Osler Cup

During Doctor's Dilemma, which has gathered momentum over the past several years, teams of internal medicine residents play a medical version of Jeopardy. Participants compete all year long for a chance to come to the annual meeting and go head to head with winners from state and local levels around the country. The winners take home the Osler Cup, named after the pioneering clinician. "It's pretty tense, and pretty exciting to see," Dr Alguire reported.

Residents, fellows, and medical students will also compete in oral abstract presentations of unpublished research, the only such presentations at the conference.

"Our meeting is probably the best clinical-update meeting of any of the societies. We do not compete with them in terms of presenting new science," Dr Weinberger explained. "People come to the meeting for the clinical updates, primarily."

Dr Alguire reports receiving royalty payments from UpToDate, owning stock in ExpressScripts and Amgen, and serving as a consultant for the National Board of Medical Examiners. Dr Weinberger has disclosed no relevant financial relationships.

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