Joseph Apuzzio, MD
As I indicated in the last District III Reporter, one of my priorities as chair is to continue efforts on ACOG’s MOMS Initiative (Making Obstetrics and Maternity Safer) through maternal mortality review and patient safety. I am a long-time member and current chair of the New Jersey Maternal Mortality Review Team. The team met on March 17 to review 12 cases of maternal deaths that occurred up to 365 days after delivery.
Many of the deaths were considered to be not related to the pregnancy. However, several important issues arose and were discussed at the multidisciplinary meeting. Domestic violence, substance abuse, and lack of patient adherence to care plans and prescribed medications were common causes of death in the cases reviewed. They highlight how important it is for ob-gyns to screen for domestic violence and substance abuse during pregnancy and after delivery. When adherence to care plans and medications is an issue, ob-gyns should attempt to involve appropriate family members and/or social services in the plan.
One of the more common causes of maternal mortality in the US and worldwide is hemorrhage. None of the cases reviewed by the New Jersey Maternal Mortality Review Team involved hemorrhage as a cause of death. We believe that past attempts to highlight the issue of hemorrhage and provide education to ob-gyns on approaching and treating peripartum hemorrhage resulted in no recent deaths in New Jersey due to this cause.
The executive summary of the most recent report of the New Jersey Maternal Mortality Review Team contains a wealth of information. I encourage you to read it.
The ACOG website is an invaluable resource for information concerning patient care and other issues. In particular, there is an executive summary of Neonatal Encephalopathy and Neurologic Outcome in the April 2014 issue of the Green Journal that I think many members will find worthwhile.
Please feel free to contact me about District III issues or other ACOG issues at email@example.com.
Junior Fellow news
Audrey A. Merriam, MD, District III Junior Fellow chair
The Seventh Annual Junior Fellow Day will be held at Christiana Care Health System in Newark, DE, on October 3. The program will feature hands-on simulation and breakout lunch sessions, which have been well received in the past. We’re planning morning presentations on the Affordable Care Act, scientific paper presentations from Junior Fellows, and a debate session, with hot-button ob-gyn topics. Two Junior Fellows from the Dominican Republic will be joining us this year. Please save the date! We would love to break last year’s attendance record of more than 165 Junior Fellows and medical students.
Junior Fellows at the Delaware Section Lobby Day
Junior Fellows hope to host a social event at the Pennsylvania Horticultural Society’s Annual Pop-Up Garden. We’d like to use the event as a fundraiser for ACOG’s federal political action committee, Ob-GynPAC, and as a way for residents to discover more about ACOG and the PAC. More information on this event will be forthcoming. All are welcome!
The individual sections in our district have been busy. Delaware Junior Fellows are working to support cancer patients by making fleece blankets for the chemotherapy infusion suite at their local hospital. The section also had many Junior Fellows attend its statewide lobby day. Pennsylvania Junior Fellows participated in the Sandy Sprint 5k Run/Walk to raise money for ovarian cancer research. The Pennsylvania Section lobby day was also well attended by Junior Fellows.
Junior Fellows at the Sandy Sprint 5k Run/Walk
In New Jersey, Junior Fellows raised money to supply cancer patients with comfort kits through a bowl-a-thon. They were extremely successful and had a lot of fun in the process. We’re planning on making this a district-wide service project, with each section holding its own bowling event on the same day, September 6. Donations for lane reservations and a percentage of money raised from entry fees will be given to the cause.
I am pleased to announce that the District Advisory Council has approved funding for a Junior Fellow legislative chair. This person will be sponsored to attend Junior Fellow meetings as well as the Congressional Leadership Conference and section lobby days. The application process for this position will start in July.
District III ROUNDS project and patient safety efforts
Ann L. Honebrink, MD, District III vice chair
I am pleased to report that the District III ROUNDS (Regional Ob-Gyn Up-to-Date New Didactic Sessions) project is off to a great start. Talks have been given in New Jersey, Pennsylvania, and the Dominican Republic. Thomas Westover, MD, District III legislative chair and New Jersey Section secretary-treasurer, Audrey A. Merriam, MD, District III Junior Fellow chair, and I brought the ROUNDS project to our Dominican Republic colleagues when we participated in the first Dominican Republic Section-sponsored educational event in October.
I encourage District III members to visit the District III ROUNDS webpage to learn about the presentations on various topics that are offered for free to any District III institution.
The ROUNDS project is a component of District III patient safety efforts. In addition, I attended the ACOG Patient Safety Committee Meeting in March in Washington, DC. The committee discussed an online game from the Department of Health and Human Services that addresses office security and the protection of patient information. I invite you to try it as it’s kind of fun and good for medical students, residents, and support staff.
We also talked about an alert from the Institute for Safe Medication Practices (ISMP) on the potential inaccuracy of electronically transmitted medication history information used for medication reconciliation. ISMP recommends sharing this alert with your staff and colleagues.
ACOG is developing its next round of suggestions for the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The goal is to promote patient-physician discussion of tests and interventions that are currently being ordered and suggested to promote care that is supported by evidence, free from harm, truly necessary, and not duplicative of other tests or procedures already received.
The Joint Commission is developing a new optional certification program for accredited hospitals that will focus on the essential high-value requirements for mothers and newborns who have been assessed as clinically uncomplicated. Additional information may be found on the Joint Commission website.
And, finally, a report from the Robert Wood Johnson Foundation titled “Physician Network on Health Care Costs—Consensus Themes and Recommendations” contains the following recommendations:
Payment models must be evidence-based, physician-endorsed, and thoroughly tested
Protecting and creating financial incentives is critical to broad physician buy-in
Meaningful consumer engagement requires better communication and guidance from physicians, more willingness from consumers, and greater investment in prevention
Improving quality and reducing costs requires a stronger health information technology infrastructure
Major changes in education and practice are needed to help reduce costs
Legislative activities update
Thomas Westover, MD, District III legislative chair
The Congressional Leadership Conference was held March 2–4 in Washington, DC. More than 400 physicians attended the conference from all 50 states. ACOG subsidizes a substantial number of Junior Fellows to attend the conference as they will be our future leaders. District III hosts a dinner meeting at the conference, which fosters discussion of state legislation and development of valuable personal relationships among section members.
The conference began with a series of inspiring lectures by various ACOG leaders, including ACOG President Jeanne A. Conry, MD, PhD, and Lucia DiVenere, ACOG officer of government and political affairs, who reviewed the vital role that ACOG plays in advocating for the advancement of women’s health.
This year, attendees lobbied members of Congress to:
Repeal the flawed sustainable growth rate and create a value-based payment system that rewards high-quality care
Create a medical liability reform process that involves the use of clinical practice guidelines and an independent physician panel to assess the quality of care during the evaluation of a medical liability case. The purpose of this process is to promote adherence to quality guidelines (acknowledging that non-adherence does not equate to adverse outcomes), reduce the prevalence and costs of defensive medicine, and help eliminate frivolous lawsuits
Provide the Centers for Disease Control and Prevention with a funding stream to create surveillance and research initiatives regarding the incidence, prevention, and adverse outcomes associated with gestational diabetes mellitus
Study physician manpower shortages in the US, fund 15,000 additional residency slots in the next five years, and ensure that allocated medical education dollars are actually spent on medical education
The theme of the meeting, “Spotlight on the Center: Every Woman, Every Time,” sought to highlight the importance of advocating for women’s health issues and the fact that core public health concerns transcend party politics. Presentations were given on the importance of Medicaid expansion, how to remain on message during advocacy meetings on Capitol Hill, and the importance of a healthy environment to optimize reproductive and overall health.
Various districts and sections received awards for their advocacy efforts. Donald M. Chervenak, MD, New Jersey Section vice chair, received a Most Valuable Player Award for his work with ACOG’s federal political action committee, Ob-GynPAC.
Delaware Section report
Kirsten M. Smith, MD, section chair
Delaware Section members have been busy attending and planning meetings. In November, Nancy Fan, MD, section secretary, and I met with Kate DuPont Phillips, senior program analyst at Nemours Health and Prevention Services, to discuss how to promote breastfeeding in the state. Later that month, Dr. Fan was inaugurated as the 171st Medical Society of Delaware president at its annual meeting.
In March, we had nine representatives at the Congressional Leadership Conference in Washington, DC. Planning is underway for the Delaware Section Lobby Day on June 5. The evening program will focus on maternal substance abuse and neonatal abstinence syndrome. Bawn Maguire, RN, MSN, outreach coordinator at Magee Women’s Hospital in Pittsburgh, and David Paul, MD, neonatologist and interim chair of pediatrics at Christiana Care Health System in Newark, will be our speakers.
Current legislative issues in Delaware include concerns about direct-entry midwives practicing in the state. In June 2013, the Delaware Legislature passed a bill that significantly increased the fine for practicing midwifery without a permit. A collaborative agreement with a physician is a requirement for obtaining a permit from the Delaware Division of Public Health (DPH). Only one certified professional midwife has a permit in Delaware, and her practice is exclusively for the Amish population.
Supporters of the home birth community, concerned with possible loss of access to certified professional midwife care, engaged DPH to begin a discussion with legislators, practicing obstetricians and pediatricians, certified nurse-midwives, and interested certified professional midwives. The goal is to formulate a home birth policy in Delaware, acknowledging the need for safe outcomes for mothers and infants without limiting access or choice. There have been two public stakeholder meetings in Delaware, and now the discussion has moved to two subcommittees, one for policy and one for relationship building.
Legislation that would give the Delaware Department of Health and Social Services (DHSS) up-to-date information on Down syndrome every year from the Down Syndrome Association of Delaware passed the House and has been sent to the Senate. DHSS would be required to disseminate the information to all doctors, counselors, nurses, midwives, and anyone else who would be in a position to treat a parent whose fetus or infant has been diagnosed with Down syndrome.
New Jersey Section report
Sharon B. Mass, MD, section chair
The New Jersey Section is working on a breast density notification toolkit for distribution to its members, which may serve as a template for other sections. We received 250 responses to a patient survey regarding knowledge of breast density and tomosynthesis and are in the process of analyzing the data.
Section leaders were involved in modifications to a bill signed by Gov. Chris Christie in January. The final language:
Mandates health insurance coverage of any screening and/or testing deemed medically necessary by providers
Recommends a baseline mammogram at age 40 followed by yearly screening
Includes a lay letter to be sent to all patients along with their mammography report
Requires creation of a breast cancer task force that will assess and recommend strategies to improve patient awareness
The section was represented by 11 members at the Congressional Leadership Conference in March in Washington, DC. Donald M. Chervenak, MD, New Jersey Section vice chair, received a Most Valuable Player Award for his work with ACOG’s federal political action committee, Ob-GynPAC.
The New Jersey Obstetrical and Gynecological Society Annual Meeting, which is cosponsored by the New Jersey Section and the Association of Women’s Health, Obstetrics, and Neonatal Nurses New Jersey Section, will be held June 6–7 in Atlantic City.
Pennsylvania Section report
Kurt T. Barnhart, MD, immediate past section chair
The new Pennsylvania Section Advisory Council has been assembled and met in December and March. My many thanks to its outstanding members: Sherry L. Blumenthal, MD, past chair, Lynne M. Coslett-Charlton, MD, vice chair, Stephen J. Smith, MD, treasurer, and Amanda B. Flicker, MD, secretary. We have also engaged the western part of our state with new additions: Gabriella G. Gosman, MD, and Isabelle A. Wilkins, MD, who are on the faculty at Magee Women’s Hospital in Pittsburgh.
The main focus of the Pennsylvania Section continues to be supporting and reacting to legislative initiatives. We have extended and expanded the contract with our lobbying partner Milliron Associates and maintain a close collaboration with the Pennsylvania Medical Society (PAMED).
I am now a member of the PAMED Specialty Leadership Cabinet, which is a three-year term. Dr. Blumenthal was elected to the PAMED Board of Trustees in October as the new trustee representing ob-gyn. She will serve a four-year term. Other ob-gyns on the PAMED Board include John Spurlock, MD, as vice speaker, Enrique Hernandez, MD, as first district trustee, and John Gallagher, MD, as eighth district trustee.
Brandi N. Ring, MD, past section Junior Fellow chair, is our representative to the Adolescent Pregnancy, Sexually Transmitted Disease, and HIV Collaborative to assess how to better disseminate information and educate women across the state, an initiative started by Temple University.
The Pennsylvania Section Legislative Committee meets on a regular basis to prioritize its legislative efforts. We are currently supporting bills that would:
Amend the Medical Care Availability and Reduction of Error Act with liability protection for emergency physicians and emergency personnel
Establish the Patient-Centered Medical Home Advisory Council, which would provide recommendations to the Department of Public Welfare on this quality-improving and cost-containing model of health care
Provide insurance coverage for mammograms and increase eligibility for breast and cervical cancer screenings through the Pennsylvania Department of Health
We are currently opposing bills that would:
Allow state and local governments to opt out of coverage for contraception, sterilization, or abortifacient drugs or devices
Require insurance companies to offer duplicate policies to employers—one with coverage for contraception, sterilization, or abortifacient drugs or devices and one without
Prohibit employers from offering employees who don’t want coverage for contraception, sterilization, or abortifacient drugs or devices a plan that covers them
The section is working with a sponsor of a bill regarding pertussis education to remove a mandate for physicians to advise patients about the disease. We successfully worked with a sponsor of a bill requiring physicians to notify patients of dense breast tissue on its notification language. The amended bill was signed by Gov. Tom Corbett. We are in great need of informational material to disseminate to our membership on how to handle this new mandate.
The Pennsylvania Section Lobby Day is scheduled for September. Physicians will spend the day at the State Capitol discussing timely issues and bills with state senators and representatives. The section was represented by 10 members at the Congressional Leadership Conference in March in Washington, DC.
Calendar of events
Annual Clinical Meeting
Delaware Section Lobby Day
Contact: Megan Hayes, 302-224-5181 or firstname.lastname@example.org
New Jersey Obstetrical and Gynecological Society Annual Meeting
(cosponsored by the New Jersey Section)
Atlantic City, NJ
Contact: Linda Bartolo, 973-597-0938 or email@example.com
ACOG Coding Workshop
New York, NY
Seventh Annual Junior Fellow Day
Christiana Care Health System
Contact: Audrey A. Merriam, MD, firstname.lastname@example.org
Annual District Meeting (with Districts I and IV)
Contact: Chris Himes, 202-863-2561 or email@example.com