2010 Annual Meeting
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Annual Meeting in Orlando Boasts Record Attendance… Again!

by Jessica E. Quintilian, Assistant Executive Director

For the third year in a row, the Academy Annual Scientific Meeting was a sell-out. Held on May 12, 2010 at the Walt Disney World Swan and Dolphin Resort in Orlando, Florida, the meeting featured a new networking breakfast, member vignettes, panel presentations and concurrent breakout tracks focusing on home care education and practice management. Three awards were presented – The Eric Baron House Call Doctor of the Year, House Call Clinician of the Year and Poster of the Year. Board members whose terms were expiring were also re-appointed and three new Board members elected.

Academy President Dr. Thomas Edes welcomed 200 attendees to this year’s meeting and thanked our Board, staff and meeting exhibitors, Senior Care of Colorado, Doctor Alliance, Inc., Masimo Corporation and Medscribbler. Following the opening remarks given by our Program Chair and President-Elect Dr. Bruce Leff, Dr. Tracy Ramsey aptly set the stage with her "world in which I practice” presentation, an inspiring segue into Dr. Taler’s much anticipated "The World in Which we Practice” presentation.

The World in Which We Practice

Dr. George Taler presented up-to-the-minute public policy updates in four main areas of the ever-changing world of home care medicine—health care reform, Recovery Audit Contractors (RAC), billing and coding updates (RUC) and Independence at Home (IAH). His talk began with an overview of the demographics of health care spending in the U.S. and the "yawning gap” that is "frailty,” a population that accounts for 50% of all healthcare expenditures, but where we have the greatest opportunity to save money. Dr. Taler went on to describe the need to re-engineer healthcare delivery. He explained the Academy’s initiative to seek legal options regarding the RAC program and urged members to share their audit experiences so that the Academy may coordinate its response. He then presented a "where are we now?” look at IAH, which has an implementation goal by January 1, 2012. The Academy is preparing a template for CMS’ RFP on implementation guidelines. Dr. Taler stressed that the success of IAH depends increasingly on internal and external teamsmanship—physicians cannot do this job alone, and care must be coordinated among those caring for patients.

Innovations Shaping the Future of House Call Medicine

Dr. Richard Ackermann and physician assistants Kathy Kemle and Jennifer Hames kicked off a plenary panel, moderated by Dr. Bruce Leff, with their presentation "Home Visit Program + Palliative Team = Success.” They described the integration of their home visit program, geriatrics fellowship, family medicine residency and Center for Palliative Care, along with their continuum-of-care model at the Medical Center of Central Georgia. The Center for Palliative Care includes programs in life choices and transitions, a consult team and Transitional Care Unit. Dr. Steven Landers followed with his presentation on "Innovative House Call Strategies in a Bundled World.” He highlighted several factors changing the future of health care including the aging population, technology, chronic illness, finances and consumerism which are driving care into the home. Health reform has major implications for transitional and post acute care, explained Dr. Landers, and represents a fork in the road for hospitals. Changes to the current post-acute and chronic care paradigm were described and predictions made for hospitals and health systems. Dr. Landers closed with "house call secret weapons” and potential models in a bundled world. Dr. Marvin McBride then wrapped up the plenary panel with "Innovations in Shared Savings Models in House Calls, " featuring the INSPIRIS program and its impact on acute utilization, medication management and end-of-life care.

Following a networking break, Dr. June Leland presented the second vignette, describing the VA medical foster care program, an IAH-type model. The program was featured on CBS evening news on April 12, 2010 (see Member News for link).

House Call Medicine Research – What do we know, what do we need to know?

Dr. Robert Kane gave the humorous, but direct research keynote on unanswered questions in house call medicine, such as "What is it?” "For whom?” "Who does it?” Dr. Kane went on to describe that while we think we know about effectiveness, comparative effectiveness and cost effectiveness, these are the very things that we still need to know.

Homecare Literature Review

Dr. Colin Thomas, regular author of the home care literature column for Frontiers, again presented his popular "Homecare Literature Review” for the year. Most notable for 2009 was the VA Home Based Primary Care Program, House Calls for Seniors program and hip fracture risk in home care. Dr. Thomas continues to appreciate any suggestions from Academy members on topics to include in this newsletter.

Annual Meeting features three awards, re-election and three new Board Members

Dr. Edes highlighted the Academy’s accomplishments during the past year, notably the inclusion of IAH in the final passed health reform bill. He took a moment to applaud Mr. Jim Pyles and our Public Policy Committee (Drs. Taler, Boling, Bayne, DeJonge), members, sponsors, co-sponosors, volunteers, Coalition, leadership and staff that took part in this monumental three-year effort. Other accomplishments include strides taken to request exemption or workaround regarding meaningful use, continued agreement with Lockton Affinity for member malpractice insurance, continued education on audit appeals and a fundraising effort to fund a legal opinion letter, a proposal for medical director training seminars, development of a new AAHCP website and updated publications for 2010, including a new booklet on advanced issues in house call program management and an update of Medical Management of the Home Care Patient.Dr. Edes reiterated that the strength of the Academy lies in its membership and our members are making a difference! He went on to state that our members are shaping the future of healthcare and that IAH is based on your efforts. Dr. Edes opened the floor for members to suggest issues on which the Academy should focus. In turn, he charged members to consider taking part in new and existing Academy committees. Members were also asked to re-elect Board members due for reappointment and to vote on three newly nominated Board members.

Dr. Thomas Cornwell, Chair of the Awards Committee for several years running, presented two Academy members with our highest honor. The 2010 Eric Baron House Call Doctor of the Year was awarded to Dr. Jennifer Hayashi. Dr. Hayashi took on leadership of the respected Johns Hopkins Elder House Call Program in 2004 right after finishing her geriatric fellowship. She was nominated by Dr. Bruce Leff who wrote, "Dr. Hayashi set out to completely invigorate, revitalize and formalize many of the practices of the program in the clinical, education and research realms. In her role, she has done an amazing job of taking the program to the next level with a strong focus on educating medical trainees at all levels in the Johns Hopkins system.” Dr. Hayashi’s impact has gone far beyond Johns Hopkins. The program expanded to include medical residents from Sinai Hospital, and she developed a house calls curriculum to teach internal medicine residents. Her research has been published in the Journal of the American Geriatrics Society,and she served as lead author on home and community-based care in the latest edition of the Hazard Textbook of Geriatric Medicine. Praised for her outstanding clinical skills, compassion, teamwork and integrity, Dr. George Taler wrote, "She is a consummate clinician, exceptional teacher and capable researcher.” Hopkins colleagues describe Dr. Hayashi as representing "the best in our profession.” Dr. Hayahsi has truly advanced the mission of the Academy - promoting the art, science and practice of house call medicine - through her patient care, teaching of house call medicine to a new generation of providers and serving as a vital role model whose daily activities inspire us all.

The 2010 House Call Clinician of the Year was awarded to Silvia Chavez, NP,MSN, ANP-BC. Nominated by Drs. Linda DeCherrie and Theresa Soriano, Ms. Chavez has demonstrated clinical expertise, leadership, advocacy and true dedication to her work in the care of Manhattan’s elderly and homebound for over ten years. In 2002, she was hired by Cabrini Medical Center to provide medical services to an underserved and largely impoverished Latino community in New York City. She developed collaborative relationships with the New York Housing Authority and social service agencies to provide needed medical and other services. In 2005, Ms. Chavez created The Cabrini Visiting Doctors Program in collaboration with the Mount Sinai Visiting Doctors Program. A few short years later, she learned that the hospital was closing, and she had less than one month to find providers for the house call program. Overcoming significant challenges, Ms. Chavez, was able to start a small house call program at New York Downtown Hospital in 2008. She has since joined the Mount Sinai Visiting Doctors Program, where she has been instrumental in leading her office-based nurses and nurse practitioner colleagues in expanding much needed services to the homebound. She also worked extensively to assess patient satisfaction and develop a program to reduce unnecessary ED visits and hospitalizations, and is currently working on a grant-funded project that uses an interdisciplinary team approach to expand the program’s capacity and breadth of services. Writes one physician colleague, "Silvia has proven herself to be a dedicated and compassionate clinician, a respected collaborator and a tireless advocate to provide the highest quality of care to our vulnerable homebound patients.”

The 2010 Poster of the Year was awarded to Dr. Bruce Kinosian and Jean Yudin, MSN, RN, CS for their poster entitled "Elder Partnership for All-Inclusive Care: Five-Year Follow-up of Integrating Care for Frail, Community Elders, Linking Home Based Primary Care with an Area Agency on Aging as an Independence at Home Model.”

Congratulations to all of this year’s winners!

Concurrent Breakouts – Reshaping the Future through Education; Practice Management University

For the first time this year, the Academy offered a dual-track afternoon program: reshaping the future through education and house call practice management university.

Drs. Rebecca Conant and Robert Kaiser led off the education breakout session, covering topics such as how to set up home care teaching programs, getting started in house call education and starting a VA house call education program. Dr. Linda DeCherrie moderated the "models of home care education” panel, made up of Dr. Thomas Cornwell, who presented the preceptor model; Dr. Deon Cox-Hayley, who presented on formal curriculum in an academic program and Jean Yudin, MSN, RN, CS, who presented nurse practitioners as teachers. Also included was a house call curriculum swap moderated by Dr. Ella Bowman. A call for curricula went out to Academy members, and three were selected to present: Dr. Amit Shah, Dr. Peter DeGolia and Dr. David Lillich. Dr. Jennifer Hayashi wrapped up the education breakout with her review of home care education literature and how it fulfills competencies.

House Call Practice Management University opened with Drs. Alan Kronhaus and Steven Phillips presenting House Calls 101: The Early Years. Through this 101 presentation, they described the role of a house call practice within the health care delivery system, defined the application of SWOT analysis and sought to assist aspiring house call providers in heading down the correct path. Next, Dr. Thomas Lally presented House Calls 201: The Growth Years, where he described his experience as founder of Physician Housecalls, LLC and the elements of a virtual medical office. He communicated words of wisdom on audit proofing your practice and the top ten mistakes to avoid. Dr. C. Gresham Bayne rounded out the University with House Calls 301: The Maturation, where he described house calls as a disruptive change. Dr. Bayne went on to present scalability issues for house calls, HIT considerations and how to grow from the first 100 house calls per month to the 800/month barrier. The session closed with a panel discussion moderated by Brent Feorene.

Following a second networking break, Robyn Gleason, ARNP, PHD, MPH presented the final vignette on how her work shapes the world in which she practices home care medicine.

Housecall Clinical Pearls

Dr. Eric DeJonge reprised his well-received "Top Ten Housecall Clinical Pearls” talk from last year, newly updated for 2010. Among the top pearls: treat the patient not the echo; a picture is worth 1,000 words; dodging hospital minefields and how to find a SNF bed in one day. Dr. DeJonge concluded by reminding providers that most success comes by listening to patients, families, NPs/PAs and social work staff.

Immediate Past President Dr. Joe Ramsdell gave the closing remarks.