Home Internal Medicine American College of Physicians, April 30-May 2

American College of Physicians, April 30-May 2

The American College of Physicians’ Internal Medicine 2015

The annual meeting of the American College of Physicians (ACP) was held from April 30 to May 2 in Boston and attracted more than 6,000 participants from around the world, including internists, adult medicine specialists, sub-specialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.

During the conference, the ACP announced the release of the new edition of the Medical Knowledge Self-Assessment Program (MKSAP).

“The MKSAP was developed by ACP as a way to help internists to keep up to date on the latest in clinical practice,” said Philip A. Masters, M.D., a senior physician educator in the medical education division of the ACP. “There are two parts, which include the text that provides insight into current medical content and 11 sub areas of internal medicine as well as a series of questions for text. These questions are clinically based and ask the reader to make clinical decisions. The text and the questions are linked together and help provide internists information to keep them current with what is going on in medicine, which is a common challenge, especially for internists who are first starting out.”

The new version is being released in July and is updated every three years. Other issues have had approximately 60,000 practicing clinicians using it, according to Masters. For the updated version, there are a number of changes but the core piece of it remains the same.

“In terms of enhancements, we added a pre-test with 120 questions that internists can use to help them identify areas in which they need to study more. Internists can see their score and take it again, etc. It provides a guide to help direct studying more efficiently,” Masters said. “Another thing we added in is something that used to be freestanding, virtual DX, which consists of image-based interpretive questions. Basically, these 430 questions are geared toward image assessment. It was previously an independent tool and now part of the content. The third big thing we are doing is developing electronic flash cards that link to key points in the questions.”

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Also, during the conference, health and legal profession organizations issued a policy that called for action to reduce firearm injuries and death.

“We (the ACP) had put out a paper that was done along with six other medical professional societies: the American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, American Congress of Obstetricians and Gynecologists, American College of Surgeons, and American Psychiatric Association. Support was also garnered from the American Public Health Association and the American Bar Association. The point of the paper was to have a call to action that firearm-related injury is a major public health problem,” said Steven E. Weinberger, M.D., the executive vice president and chief executive officer of the ACP. “By putting this group together that included a collaboration between health professionals and the legal profession, we are hoping to bring more needed attention to the issue and address it more effectively.”

According to Weinberger, an additional 28 organizations support the paper and others are expected to endorse the paper going forward.

“Our hope is that there will be a ground swell of interest in endorsement. We believe the recommendations are sensible and rational, not radical. The major recommendations include universal background checks, no high-capacity magazines or military-style assault weapons, no interference with patient and physician relationships, better mental health access, and funding for research into firearm-related violence and death,” Weinberger said.

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During a briefing and panel discussion, the key provisions of the new Medicare Access and CHIP Reauthorization Act (MACRA) were discussed, along with an explanation of how they will put Medicare on a pathway to “value-based” payments.

“Practicing clinicians need to transform how they practice medicine in order to move forward with the new value-based payment model. Physicians need to adopt and upgrade their electronic health records, develop office work flows with a team-based approach that will allow them to report on performance measures and receive higher payments,” said N.S. Damle, M.D., president-elect of the ACP. “Registries and performance measures will identify good care as well as gaps in care (e.g., blood glucose control in diabetes and hypertension control in coronary heart disease). Physicians should participate in the Physician Quality Reporting System and Meaningful Use programs, as new legislation will harmonize these programs into the Merit-Based Incentive Payment System (MIPS) beginning in 2019.”

According to Damle, the MIPS program offers opportunities for physicians to earn up to 15 percent more in payments, presuming they meet the quality measure parameters. If practices enroll in an accountable care organization (ACO), they will receive 5 percent annual bonuses in addition to shared savings.

“Practices have reached a fork in the road and will need to decide if they want to participate in MIPS or an ACO (they cannot participate in both). Smaller practices will have to collaborate with other practices and hospitals to gain enough ‘covered lives’ to assume risk,” Damle said. “The U.S. Department of Health and Human Services has put out a guideline and mandate to convert from pure fee-for-service to a more value-based approach over the next five years (90 percent value-based by 2018 and 50 percent alternative payment models by that same year). It is a challenging time with opportunities, but physicians will need to make decisions now to continue to evolve with the transformation to more value-based care.”

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