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MASSACHUSETTS CHAPTER of the ACC

NEWSLETTER

MARCH, 2016


The Massachusetts Chapter ACC is pleased to bring you this latest issue of the Chapter Newsletter, with updates on Chapter activities, what the leadership has been up to and, and upcoming events.

Communications Committee

Puja Banka, Chair
Jennifer Lewey, Mayank Sardana, David Dudzinski

INSIDE THIS ISSUE:

Message from the President Elect

As the incoming President of the Massachusetts Chapter of the American College of Cardiology Council, I want to take this opportunity to reiterate the significance of everyone’s participation as we reshape our Chapter’s structure, and move forward with a reinvigorated vision to be current, engaged, relevant, and of support to our colleagues, patients, and peers who battle with cardiovascular diseases in the State of Massachusetts. We are hopeful that with yours and the council members’ efforts that the Massachusetts Chapter becomes the leading State Chapter within the American College of Cardiology Council. Addressing current and future challenges at the local and national level, we hope to engage you in novel programs and provide solutions that can be emulated nationwide. Our minds are on reimbursement and regulatory changes, public reporting and barriers to our ability to provide our patients the best care possible. The limited manpower available for these efforts in the State Chapter means that we cannot fulfil this vision without you and enthusiastically invite participation from all fellows-in-training and society members at teaching hospitals, and practicing cardiologists to help us bear the flag of our State Chapter. Your participation is invaluable to the success of our Chapter. Please do not hesitate to reach out to me in person, or any of the Chapter’s council members with issues or problems facing your everyday practice, or ideas and solutions for the betterment of healthcare delivery in the State of Massachusetts.

Welcome aboard.
Duane S. Pinto, MD, MPH, FACC, President Elect

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ACC '16 in Chicago

We hope you are planning to join your cardiology colleagues in Chicago this weekend. Registration for ACC.16 is still available! Don’t miss your chance to be there in person to listen to the experts, join the discussions and understand first-hand the impact of the changes to your practice.

Please visit the ACC website for additional information.

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MEET THE GOVERNORS AT ACC

Stop by the M/X Bar at the Hyatt McCormick Place (connected to the Convention Center) on Saturday from 4:30 -5:30 pm for a reprieve from the meeting, a quick libation, and to chat with the Massachusetts' Chapter outgoing governor Ken Rosenfield, and incoming Governor Duane Pinto.

If you are interested in becoming involved the Massachusetts Chapter, please contact the Administrative Office.

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What event at the ACC Annual Meeting do you NOT want to miss?

The Answer: The Fellows Jeopardy Competition

The Massachusetts Chapter of the American College of Cardiology Council assembled at the Leventhal Conference Room on Monday, March 14, 2016 for a mix ’n’ mingle session. Participants included cardiovascular medicine faculty and fellows from various Boston teaching hospitals, all gathered to prepare a team of fellows that will represent the Chapter at the Fellows’ Jeopardy competition during the upcoming American College of Cardiology annual scientific sessions from April 1-4, 2016 in Chicago, IL. Massachusetts is competing against California, Illinois and Oregon, all pooled in Group 5 in a “Battle of the States" for a semi-final berth in the competition (session details below).

During the Monday meeting, the fellows were split into two teams and practiced jeopardy-style questions from content based on cardiovascular medicine eponyms, history, trials and trivia, as audience, comprising fellows and faculty, engaged with the participants.

The jeopardy contest was organized by the Chapter's fellows-in-training section co-chairs Jordan Strom, MD, and Ada Stefanescu, MD, clinical and research fellows at the Beth Israel Deaconess Medical Center and Massachusetts General Hospital, respectively, under the guidance and leadership of Ami Bhatt, MD, Chapter’s Lt. Governor.

The evening was presided over by the Chapter Governors, Drs. Duane S. Pinto and Kenneth Rosenfield.

The Massachusetts Team:

Sardana Mayank, University of Massachusetts
Muthiah Vaduganathan, MD MPH, Brigham and Women's Hospital
James Sawalla Guseh, MD, Massachusetts General Hospital
COACH/ALTERNATE: Kunal Gurav, MD, Lahey Hospital and Medical Center

FELLOWS JEOPARDY COMPETITION
EXPO HALL - MCCORMICK COVENTION CENTER, CHICAGO
Saturday April 2 - Preliminary Rounds: 9.45-11.45 am; 2.00 pm -3.45 pm.

9.45-11.45 am (4 rounds)

Group 1: Virginia, Kentucky, Maryland, Canada (Atlantic Coast Conference)
Group 2: Florida, Connecticut, Louisiana, New Jersey (American Athletic Conference)
Group 3: Iowa, Minnesota, Nebraska, Wisconsin (Big-10 conference- west)
Group 4: Georgia, Missouri, Alabama, Mississippi (SEC conference)

2.00 pm -3.45 pm (3 rounds)

Group 5: California, Washington, Massachusetts, Illinois (Pac-12)
Group 6: Ohio, Michigan, Pennsylvania, Indiana (Big-10 conference- east)
Group 7: Kansas, Texas, West Virginia, South Dakota (Big-12 conference)

Sunday, April 3 - Semi-finals

9.45-10.45 am - Group A: team winners from Groups 1 – 4, will participate in 2 rounds of competition.
10.45-11.45 am -Group B: team winners from Group 5 – 7, will participate in 2 rounds of competition.
Finals - 2.15 -3.15 pm. (2 rounds) Group A winner vs Group B winner

Prizes:

The Champions: The champion state chapter will receive a trophy and three (3) $1000 USD travel awards to send a FIT Jeopardy team to ACC.17.
Each FIT team member will receive a complimentary Gold Package Registration to ACC’s 2016 Cardiovascular Board Review course (which includes ACCSAP 9) and $1,000 to cover travel costs to attend.
The second-place team: The second-place FIT team members will each receive a free subscription to ACCSAP 9 and an iPad.
All FIT Jeopardy participants will be officially recognized by the College.

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Member Spotlight: Heba Wasif, MD, MPH

Dr. Wassif is a non-invasive cardiologist at Baystate Medical Center and serves on the Early Career Committee for the Massachusetts ACC Chapter. In this spotlight, she describes her involvement in a cardiology telehealth program being rolled out at Baystate to improve the quality of inpatient cardiovascular care provided at community hospitals in western Massachusetts.

How did you come to your current position?

I was born in Cairo, Egypt and completed my medicine residency at University of Minnesota. I completed a Masters in Public Health at Johns Hopkins, where I also completed my general cardiology fellowship. I then moved to Boston and completed a fellowship in interventional cardiology at Brigham and Women’s Hospital. Currently I work for Baystate Medical Center and I see inpatients and outpatients at our locations in Springfield, Greenfield, and North Hampton; I also read echo and nuclear studies.

What are some of the opportunities and challenges of working in western Massachusetts?

Baystate Medical Center is one of the busiest hospitals in Massachusetts because it is a referral center for all of western Massachusetts and some of the surrounding states. It’s a great program for the fellows because of the high clinical volume, especially within echocardiography. One of the challenges is that there is a lot of travel between different sites. This is also hard for patients because they want to get their care locally. Patients care very strongly about staying in their community and it sometimes takes a lot to convince people to travel to Springfield for interventional cath or EP studies and some types of specialized testing.

How can access to high-quality cardiovascular care be improved when the population you serve is so spread out?

Baystate has received a Community Hospital Acceleration and Revitalization and Transformation (CHART) grant to use telehealth cardiology consults in order to reduce the number of transfers of less acute patients from community hospitals to Baystate Medical Center. The main goal is to provide better service for patients and families closer to home in community hospitals while maintaining availability of intensive care beds in Springfield, where a higher level of care can be provided if necessary.

What will the telemedicine cardiology consults look like?

If the hospitalist has a level 1 or level 2 patient, such as a patient with chest pain or heart failure without shock, they will contact the covering cardiologist for a consult. If appropriate, the patient’s permission for a telehealth consult will be obtained. The telepresenter is then connected which allows the cardiologist to communicate with the patient real-time via webcam. There is a stethoscope connected to the teleprompter to allow auscultation and the webcam can be manipulated in order to examine JVP. Right now we’re starting with inpatients at one hospital which will be covered by a group of seven cardiologists.

What will a successful program look like?

The goal is to make care more coordinated between community and referral hospitals and provide high-level and high-quality consults. There is a lot of travel for physicians between hospitals; real-time consults can expedite patient care. The goal is to minimize transfers of lower acuity patients who can be appropriately cared for in the community. We will also be surveying participating physicians and asking patients about their satisfaction with the program.

Why did you get involved with the Massachusetts chapter of the ACC?

I’m currently on the early career committee and this is my first involvement with local chapter. Currently I feel like I can make an impact in the lives of patients and I want to make more of an impact on a policy level to improve quality of care.

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Lessons from Big Sky: Teaching Tomorrow’s Teachers’ Program

by Ada Stefanescu, MD

The American College of Cardiology hosted its 38th annual Cardiology at Big Sky course in beautiful Montana this past February. This year, course directors Drs. Kim Eagle and Patrick O’Gara introduced the Teaching Tomorrow’s Teachers program, created by Craig Alpert, Michael Cullen and Shashank Sinha, an innovative curriculum that brought 18 ACC Fellow-in-Training members interested in education to Big Sky to improve their teaching and presentation skills. Here are some of the pearls we learned:

Public speaking: Aristotle put it best, it turns out. To give a good talk, one must have ethos, pathos and logos: confidence, passion and logical thinking. Confidence and credibility come from preparation and practice- to master the content of your talk, but also the setting. A speaker who is comfortable enough with the audiovisual setup and the space to walk out from behind the podium commands more attention. Practice your talk at home several times, and once in the room where you will give it, the day before or morning of.

Resources: TED Talks are a good model of an effective talk. ACC has a Teaching Skills Workshop that can be done online, and several short presentations. Many business schools have free online resources as well.

Presentation skills: many talks have lived or died by the quality of the powerpoints. Prioritizing the structure, focusing the content, and simplifying the esthetics are the three pillars of preparing a good presentation.

It is more effective to plan the talk and create a storyboard on paper (or even better, notecards or post-its that can be rearranged as you define the most logical path). As a starting point, think about your learners: what do they know already? What can they learn? What are the 3 objectives of your talk?

If giving an invited talk, ask the conference organizers what their objectives are- and, if possible, what are the other talks in your session, to avoid overlapping with them.

When giving your talk, be prepared for the audience’s short attention span. Every 5 to 7 minutes, plan a “reset”: ask the audience a question, present a lively slide, use humor. In more didactic talks, a bold trick is to tell the learners in advance they will have to ask you a question every 5 minutes (you can plant empty slides in your talk)- and pause until they do.

Design your slides as supporting your presentation- and not as a document with all the information for the audience to review afterwards. If you intend to give them a handout, it is worth taking the time to make a separate, more detailed document.

Don’t apologize for AV malfunctions or technical difficulties- it’s usually not your fault, and dwelling on it focuses attention on the problem instead of your talk, and wastes time. Similarly, don’t apologize for a “busy” slide: if you feel bad about it, take it out of the talk; if it’s necessary, then no apologies needed.

Avoid text that people will read faster than you can say it.

Aim for 32-size or larger, sans serif font.

As we’ve discussed, prioritizing the structure, focusing the content, and simplifying the esthetics are the three pillars of preparing a good presentation- and repetition is the fourth!

Resources:

  • How to give a killer presentation from the Harvard Business School
  • More on fonts (and what you can learn about good presentations from Forrest Gump)
  • Giving good feedback is the third skill that is necessary to develop when pursuing a career in education.
  • Feedback is formative, and best if given frequently and iteratively?. Evaluations, on the other hand, are summative and standardized across learners.
  • Ask your colleagues and learners what their goals are early in the rotation or encounter, to know what they are aiming for and to make sure your priorities, teaching points and expectations are aligned.
  • When giving feedback, set time aside, find a private or quiet area, and state clearly that you’re giving feedback. Start by asking the learner how they think it went, and how they feel; while often you will get a vague answer (“It went well, I think”), there are times you will pick up a divergent perspective from your own (“I think I did so well on this rotation, that I don’t need this feedback session”), or learn about external factors (“I feel so guilty that I wasn’t able to focus on the rotation this month, with my parent being ill”) that will drastically change the way you approach the feedback session.
  • Emphasize behaviors that can be changed, not personality traits
  • The closer the feedback is delivered to the time of the behavior, the higher the likelihood it will be constructive, appreciated and lead to behavior change.
  • Ask a colleague or mentor to give you feedback on your talks- by coming to your teaching sessions or lectures.

Interested in learning more? We will organize a session on teaching skills at the Massachusetts Chapter Meeting- email us if you are interested in moderating it or attending! Other resources are below.

Sessions of interest at ACC include:

FIT Forum: Scholarship and Education. April 3, 2016, 12:30 - 1:45 PM, Room S502

Professional Enhancement and the Nonclinical Competencies: Leadership, Communication and Quality, April 3, 2016, 12:30 - 1:45 PM; 2-3:30PM; 4:5PM-6PM, Grand Ballroom S100a

Many thanks to Shashank Sinha, chair of ACC’s FIT Council, for his tips on public speaking; Michael Cullen, past chair of the ACC FIT Council and non-invasive cardiologist at Mayo, for teaching us about effective feedback; and Craig Alpert, FIT from UMichigan, for sharing his advice on good powerpoint presentations.

For more reading:

ACC at Big Sky: http://www.acc.org/education-and-meetings/meetings/meeting-items/2015/07/16/17/11/2016-big-sky

ACC-on-the-go post from Dr. Sandeep Krishnan, a fellow attendee in the Teaching Tomorrow’s Teachers program: http://blog.acc.org/post/going-going-gone-acc-knocks-park-big-sky/

ACC Resources on their Faculty Development section: http://www.acc.org/education-and-meetings/products-and-resources/faculty-development

Harvard Business School:

More on fonts (and what you can learn about good presentations from Forrest Gump): https://blog.slideshare.net/2014/03/10/serif-vs-sans-whats-right-for-your-presentation

“Blind Eye” by James Stewart, a chilling account a series of murders and serious complications that were missed due to the lack of confidence in 360° feedback (http://books.simonandschuster.com/Blind-Eye/James-B-Stewart/9780684865638)

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Massachusetts Chapter Governor Ken Rosenfield
Meets with Congressman Kennedy

Legislator Practice Visit Program: Saving Lives, Improving Heart Health

On February 18, 2016, Massachusetts Chapter ACC Governor, Kenneth Rosenfield, MD, FACC, met with Congressman Joe Kennedy, and the Congressman’s Chief of Staff, Nick Clemons.

Dr. Rosenfield outlined the most important priorities for cardiovascular physicians. “We are about quality and providing the most appropriate and optimal care for our patients,” stressed Dr. Rosenfield. “We support research and innovation to enable us to deliver the best care for our patients, and to provide access to the treatments that improve outcomes.”

Dr. Rosenfield also addressed changes in cardiovascular medicine that have created challenges and opportunities for all cardiovascular physicians.

Health care costs

Bending the cost curve; “living with the Affordable Care Act.”

We agree that we all have the responsibility to be good “stewards” of the health care dollar, and to take responsibility for how it is spent. Dr. Rosenfield described how this has influenced our practices, and the future impact it will have, some good, some representing challenges to be addressed.

Reimbursement issues/Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

The implementation of this new payment systems creates a significant amount of uncertainty. It is imperative that we continue open discussion as it rolls out, so we can analyze and tweak it to optimize patient care, and our ability to deliver such care.

National Institutes of Health (NIH) funding increase

The 21st Century Cures Act provides increases in current NIH funding, and we thanked the Congressman for his support, as he sits on the Energy and Commerce Committee.

There are several issues directly affecting our ability to deliver high-quality and optimal care.

  1. Electronic Health Record (EHR) – challenges regarding usability and interface.
  2. Cardiovascular (CV) Rehabilitation Bill – we need the Congressman’s support in funding rehabilitation programs which improve patients’ functional status, and keep people out of the hospital.
  3. Innovation and device approvals - we appreciate the Congressman’s support of Robert Califf, MD for Food and Drug Administration (FDA) commissioner (he has now been appointed for the post).
  4. Transparency and public reporting is good for the public, but only if the information is transmitted in a way that our patients and the public can understand. If we do not provide the context, it could actually undermine our ability to provide good care.
  5. Registries and databases provide unique opportunities to increase our knowledge, and we encouraged Congressman Kennedy to support these efforts.
  6. Team-based care – “heart teams” and PERTs (Pulmonary Embolism Response Teams) are examples of our need to perform as an entire “heart health team.” We asked for the Congressman’s support of any initiatives that incentivize team-based care in the health care system.
  7. Ethical problems we face in treating cardiac patients.

Real Patients, Real Lives

Dr. Rosenfield had two patients join him to meet with the Congressman, and each told their unique story.

Patient #1: Out-of-hospital cardiac arrest survivor with ST-elevation myocardial infarction (STEMI)

A 50-year-old gentleman collapsed while hiking with his wife. His wife performed “hands-only” cardiopulmonary resuscitation (CPR) for 15-20 minutes, while directing paramedics to their location through her speaker phone. Upon arrival at the hospital, he was comatose. We had to decide whether to perform early invasive approach with percutaneous coronary intervention (PCI) in his occluded left anterior descending (LAD) coronary artery or manage conservatively, knowing that his chances of survival after 30 minute of CPR in the field would be low. In the era of public reporting of outcomes, a likely mortality makes us less interested in taking on such cases. We did, of course, perform PCI, since that is what we do! He survived and is alive, well and productive 8 years later. But public reporting has caused all of us, in similar situations, to think long and hard before proceeding. There is evidence to suggest that there is “risk avoidance” behavior in our world. This may harm patients by reducing access to treatments from which they might stand to benefit.

Message: “Let’s not throw out the baby with the bathwater.”

Congressman Kennedy understood the issue!

Patient #2: Young woman who sustained a massive pulmonary embolism (PE) while pregnant

She told her story of how her life was saved as a result of institutions working together, and the fact that there was a team-based approach to care. She too is now highly functional.

Congressman Kennedy does appreciate the importance of aligning incentives to support and promote team-based care.

About Congressman Joe Kennedy

As member of the influential House Energy & Commerce Committee, Joe has prioritized economic opportunity for working families. A vocal advocate for Science, Technology, Engineering, and Mathematics (STEM) education, vocational schools and community colleges, he has authored several pieces of legislation in Washington aimed at improving access to our modern economy, including the Perkins Modernization Act and STEM Gateways Act. A powerful voice for social justice, he has championed issues like employment non-discrimination, pay equity, marriage equality and comprehensive immigration reform.

Prior to being elected to Congress, Joe served the Commonwealth of Massachusetts as an Assistant District Attorney in both the Middlesex County, and Cape and Island’s District Attorneys’ Offices. Before that he served as a member of the Peace Corps in the Dominican Republic where he designed and implemented an economic development project near Puerto Plata.

Born and raised in Massachusetts, Joe is fluent in Spanish and holds a bachelor’s degree in Management Science and Engineering from Stanford University as well as a J.D. from Harvard Law School. He lives with his wife, Lauren, a health policy expert, and their dog, Banjo, in Brookline.

Health Care

Access to quality health care is a right that belongs to every American. The Affordable Care Act (ACA) achieved a historic milestone when it turned this principle into law, extending high quality coverage to millions of Americans who previously had no coverage at all. Since its enactment in 2010, the ACA has made significant changes to America’s health care system including comprehensive insurance reforms to prevent unfair practices, and the creation of state-based health insurance exchanges and tax credits for small business. The ACA has also helped to slow down the skyrocketing cost of health care in this country. In fact, the growth of national health care expenditures is at its lowest rate in over 50 years. I will continue to support efforts that slow health care spending, while increasing quality, accessibility, and efficiency of health care.

As we strengthen and streamline our health care system so that it can accommodate the increasing demands of a larger and an older population, we must improve system-wide efficiency by coordinating comprehensive care. From full implementation of the ACA’s provisions to electronic health records to the demands of caring for an aging population, our country’s health care system will require new and thoughtful approaches to efficiency, cost containment, and innovation. As we continue to seek the new treatments and technologies that lower costs and improve outcomes, we will need to make a sustained commitment to research. That’s why we must prioritize funding for the NIH as we make tough choices about federal spending and deficit reduction. Massachusetts receives more per capita NIH funding than any other state, more than million in the 4th District alone in 2014. This funding saves lives, and its protection is a moral and economic imperative. National Institutes of Health support for Acquired Immunodeficiency Syndrome (AIDS) research, for example, has significantly decreased the amount of deaths from the disease worldwide. We can make similar gains in Alzheimer’s disease, cancer, diabetes and autism, but we must fund the research that gets us there.

The United States has built the world’s leading medical schools and research hospitals through a commitment to education, research, and innovation. If we maintain this focus today, we will also be able to maintain our commitment to ensuring that every American has access to quality healthcare.

Here in Massachusetts, medical innovation is an integral part of our economy. Massachusetts is the number one state in total life sciences employment per capita. As of 2012, over 600 life sciences firms, 500 medical device companies and 200 drug development firms were located in our state. Protecting this ecosystem will not only fuel economic growth, but continue the research and development of life-changing technologies as our health care system faces unprecedented demographic demands.

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