From the Offices of Stuart Markowitz, MD and Stacy Nerenstone, MD


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In This Issue...

December 8, 2013 Edition

Wash In - Wash Out



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HH Facts and Firsts:

1984 - Drs. Henry Low and James Dougherty performed the first transvenous heart biopsy at Hartford Hospital as a stepping stone to building our cardiac transplant program.   Dr. Dougherty published those early experiences in the February 1985 Connecticut Medicine. Since then, we have safely performed thousands of such biopsies with essentially zero morbidity and mortality.

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Election Results Are In

The results of the medical staff election were announced on Nov. 21.

The winners are:

President: Dr. Stacy Nerenstone

Vice president: Dr. Matt Saidel

Treasurer: Dr. William Sardella

Secretary: Dr. John D'Avella

NerenstoneSaidel SardellaD'Avella





Left to right: Drs. Nerenstone, Saidel, Sardella and D'Avella

Four at-large members of the Medical Executive Committee were also elected:

Drs. April Goller, Leah Meisterling, Jarrod Post, and Andy Wakefield.

GollerMeisterling PostWakefield





Left to right: Drs. Goller, Meisterling, Post and Wakefield

Congratulations to all these winners.

Top News

Leadership Team Named for Cancer Institute

The cancer service line was formally launched as the Hartford HealthCare Cancer Institute in September. We are engaged in an effort to create a better-integrated organizational structure to align cancer services across the system. This integrated service-line structure is critical to the work we have begun as the founding member of the Memorial Sloan-Kettering Cancer Alliance. The new regional structure will support our vision of a single standard of high- quality care for the delivery of cancer services across the system. We will transform five excellent cancer programs into a single, multi-site cancer program.This approach will streamline the operation of our cancer programs and provide the leadership to execute the work plan we have developed to launch the Memorial Sloan Kettering Cancer Alliance.

The Hartford HealthCare Cancer Institute leadership team within the new HHC regional structure is:

Kris Popovitch, M.B.A., Central Region director. Kris most recently served as the executive director of the Northeast Regional Radiation Oncology Network and administrative director of Oncology Services at the Eastern Connecticut Health Network Cancer Center.

Abbi Bruce, R.N., M.S., A.O.C.N.,Hartford Region director. Abbi is moving to the Hartford Region from MidState Medical Center, where she has provided outstanding leadership in the cancer program for the last 10 years. She will move to the Hartford Region Dec. 2.

James O’Dea, Ph.D., Eastern Region director. He has been a member of the Backus Hospital team for 22 years and has been responsible for the cancer program as part of his service-line responsibilities for the last five years.

Ellen Dornelas, Ph.D., director of Quality-of-Life Program

Gene Cardarelli, Ph.D., M.P.H., director of physics and radiation oncology

Kiran Avancha, Ph.D., R.Ph., CCRP, director of the Cancer Clinical Research Office

This administrative team will partner with the physician leadership of each region as we build the cancer service line to realize the vision of excellence and a single standard of cancer care. The administrative and physician leaders will be responsible for the completion of the work plan to launch the Memorial Sloan Kettering Cancer Alliance that will bring access to clinical research and new cancer treatments to our communities and patients.


New North 9 Neuro Step-Down Unit Opened

A ribbon-cutting ceremony was held Dec. 3 for our new North 9 Neuro Step-Down Unit to support Neurosciences.

The unit has been renovated to include spacious rooms with state-of-the-art technology to meet the highly complex needs of patients and their families. It also has been expanded from six to nine beds and is part of our HH2020 project to improve our facilities.


Drs. Katigbak and Escalon Perform First Robotic Esophagectomy in CT

Dr. Mario Katigbak, assisted by Dr. Juan Escalon, performed the first robotic minimally invasive esophagectomy in the state of Connecticut Nov. 19.

Using the daVinci system, Dr. Katigback was able to achieve a fully hand-sewn esophagogastric anastomosis. This was a two-part surgery with the abdominal portion being performed laparoscopically and the chest portion robotically. The efficiency of the procedure was made possible by the flawless collaboration and choreography of an outstanding multidisciplinary OR team.

This represents another “first” for Hartford Hospital as we continue to maintain our stature as a leader in the surgical community.  


Medicare Update: The "Two Midnight" Rule

There has been confusion about Medicare's new "two midnight rule". This rule says that if a patient placed on observation needs to stay in the hospital past the second midnight of care, the patient should be upgraded to inpatient. There must be appropriate documentation in the progress notes about why the patient had to remain in the hospital. Medicare considers the time when hospital care began in determining how many midnights the patient has been in the hospital. For example, if a patient comes to the emergency room at 10 p.m., and is then admitted at 2 a.m. the next morning, the patient has already spent one midnight in the hospital.

The inpatient admission, on the other hand, starts when the inpatient order is entered. That is also considered the start time in determining whether or not the patient has had the three-day qualifying stay required if Medicare is to pay for a nursing home, sub-acute or rehab.

There are also new rules are about admission certification. If a Medicare or Medicaid patient has an admission ordered entered by anyone other than an attending physician, the attending physician MUST cosign the order prior to the patient’s discharge. If you sign into SCM you should see a request to cosign these orders. Failure to do so can result in denial of payment. If there are questions please call or e-mail Dr. Stephen Upham. Cell: 860-571-9893.


DeFusco, Handley and Morrison Named Finalists For Health Care Hero Awards

The Health Care Heroes Awards, given each year by the Hartford Business Journal, identifies outstanding leaders in the health care industry who are the epitome of a "hero." Three Hartford Hospital people were named among 19 finalists at an event Dec. 3, and one was named a Health Care Hero.

Among the finalists were Dr. Patricia DeFusco, Donna Handley, and Earl Morrison.

Morrison was named one of eight Health Care Heroes, who won in the Advancements in Healthcare - Innovation category for developing a custom cart that accommodates everything a patient on a ventilator needs to be safe while walking.


MedSled Evacuation Training

The Hartford Hospital Center for Emergency Medical Preparedness is offering one-hour training sessions in operating the MedSled patient evacuation device. This course is designed for anyone who may become involved in the response to an emergency incident or who may have an active role in the evacuation of patients.

The next class is Wednesday, Dec. 11 from in CESI. You can choose any hour within the time frame of 8 a.m.-2 p.m.

There will also be classes offered on: Jan. 21, Feb. 18, March 18, April 22 or May 13

Registration is required. Please contact Rich Leach at 860-545-1193 or


Dr. Ajay Kumar To Speak at Quest Webinar on Blood Utilization

Dr. Ajay Kumar,chief of the Department of Medicine, will be the speaker at a Quest webinar on Wednesday, Dec. 18 from 3-4 p.m. called "Strategies to Improve Blood Utilization."

Avoidable complications and over-utilization of resources are drivers of needless costs in healthcare. The focus of this QUEST sprint is on techniques and tools available to identify and reduce inappropriate use of blood products. A more conservative approach to the utilization of blood products not only saves resources but improves patient outcomes. Dr. Kumar will share successful strategies to improve blood management and related outcomes.

A sprint is a 90-day rapid cycle improvement webinar series to help drive improvement in specific indicators. Enrollment is open to any QUEST member hospital. There is no fee to participate.

Click here to register for this webinar:


Finances for October: Good News

Inpatient volumes based on discharges for the month of October were 2.5% above budget.  The comparison to the prior year shows October of 2013 discharges, approximately 4.6% above the prior year. 

Outpatient revenues exceeded budget by approximately 16.0% for the month.  The favorable outpatient revenue variance was driven by Emergency services, Perioperative services, Women’s Health Services and the Eye Surgery Center.              


Health Care Matters Dec. 15: What Can Health Care Learn From Alcoa?

Health Care Matters, the monthly HHC radio show on WTIC-AM 1080, will be broadcast on Sunday, Dec. 15 at 11 a.m. Join hosts Elliot Joseph, president and CEO of Hartford HealthCare, and Rebecca Stewart, director of media relations, with featured guest Paul O'Neill, former treasury secretary and chair of Alcoa, who led the company to become one of the safest workplaces in the world.

You can email questions in advance to, and call in during the show to 860-522-WTIC.


Advancing Medicine: Minds To Heal - Going Beyond Brain Surgery

An all new episode of Advancing Medicine, called Minds To Heal - Going Beyond Brain Surgery, aired on Dec. 5 on WFSB Channel 3. discuss a patient who was treated for a tumor on his brain stem.

Featured in the episode are: Drs. Erica Schuyler, Paul Schwartz, Brendan Killory, Inam Kureshi, and Belachew Tessema.


Remind a Colleague: Wash In, Wash Out

All health care workers and patients should feel comfortable reminding any other health care worker to sanitize regardless of their role. This should always be done in a courteous and constructive manner. All health care workers should respond courteously and gratefully when reminded.

If you remind another health care worker to sanitize, and he or she responds with irritation or hostility, please notify their department chief, Dr. Jamie Roche or Dr. Jack Ross, who will communicate with them to prevent recurrences.


Tiger Text Takes Off!

Rollout is underway to all providers at Hartford Hospital for TigerText, a secure HIPAA compliant texting app. Currently more than1,000 doctors out of 3,000 at HH are using the app, and have sent more than 22,000 secure text messages via TigerText since October's go-live.

Dr. Isaac Silverman from the Stroke Center at HH said he is using TT to improve patient care by discussing logistics for rounds with his residents from UConn. Drs. Barry Jacobs and Susan Parker, pathologists at THoCC, said they are using TigerText to send lab results and facilitate diagnoses, eliminating a wait time of 2-7 days.

We are certain that TigerText will help you by increasing the speed and ease of communication with your colleagues via text messaging, while maintaining security with patient information. Our ultimate goal is zero data breaches.

TigerText takes less than five minutes to install and learn. If you have not downloaded the app, or would like assistance, please call your local helpdesk for support.


Drs. Namerow and Mangini Named MDs of the Year by CCMC

Drs. Lisa Namerow and Lynn Mangini were named MDs of the Year at the Connecticut Children's Medical Center on Tue Nov. 19. They received a plaque that read:

Drs. Lisa Namerow and Lynn Mangini have been the backbone of child psychiatry services at Connecticut Children's for many years. They provide high level, seamless attention to all frontiers of our care - Emergency Department, inpatient units, and ambulatory sub-specialties.

They are always available for informal and formal consultation, as well as being on constant alert for patients and families who may not have been identified, but who may benefit from mental health support. Beyond providing an enormous volume of direct care, they cheerfully participate in direct teaching of legions of medical students, residents and fellows, educational conferences and Medical Center community outreach efforts.

Drs. Lisa and Lynn are a perfect example of “doing a lot with a little.” They have soldiered through the challenges of limited mental health resources, especially for the so cio-economically disadvantaged, and they have helped to build and support the capacity of all Connecticut Children's staff to address critical mental health needs of children and their families. Their devotion to collaboration has resulted in the development of new algorithms for various mental health issues, including eating disorders and somatoform disorders.

We gratefully acknowledge their tremendous contributions to the Connecticut Children's family.


First Group of Leaders Graduate From Lean Management Program

Eighteen H3W workgroup leaders graduated Nov. 20 from an intensive six-month course in Lean Management, which is focused on increasing value to customers while minimizing waste.

Hartford Hospital has begun to embed Lean Management into H3W, which also focuses on continuous improvement and enhancing the patient experience. All members of the Hartford Hospital leadership team are required to undergo training, and all H3W workgroup leaders must attend a training session.

Lean Management is an operating model and philosophy about work flow and use of resources. According to the founders of the Lean Enterprise Institute and Lean Enterprise Academy, Lean is a thought process focused on purpose, process and people: What customer problems do we need to solve to achieve our goals?  How will we adapt our processes so that each step is valuable, flexible, available, adequate and capable? How can we ensure that every important process has someone accountable and that everyone involved is engaged in operating it correctly and continually improving it?

We believe that with our new organization, Lean Management, as part of H3W, will help us achieve continued excellence.


Dr. Finkelstein Speaks at Gun Buyback

Dr. Jeff Finkelstein, chief of Emergency Medicine, spoke on our behalf at the gun buyback event Dec. 5 at Connecticut Children's Medical Center. In addition, he is turning in his own weapon so that his home is safer for his children and visitors.

"People need to understand that keeping a gun in your home is more dangerous than protective," said Brendan Campbell, director of the Pediatric Trauma Program at CCMC. "We have strong public health literature that says there is a clear association between ownership of a firearm and increased homicide or suicide in your family."


Dr. Thompson Lectures in Providence, Houston and New York

Dr. Paul D. Thompson, chief of Cardiology at Hartford Hospital, gave the Pricilla Clarkson Keynote Memorial Lecture at the New England Chapter of the American College of Sports Medicine in Providence, RI on November 14. The lecture was entitled, “Is this Marathon Going to Kill Me?”

Dr. Thompson also gave the introductory lecture entitled “The Epidemiology of Sudden Cardiac Death” at Baylor Hospital’s Anomolous Coronary Artery Symposium in Houston on December 5. He will also be visiting professor at Montefiore Hospital in the Bronx on December 12 th and give a lecture entitled “Statins in the Water?...Not so Fast.”


CESI Wins BEACON Medical Technology Award

CESI has been selected by the Biomedical Engineering Alliance and Consortium (BEACON) Board of Directors as the winner of the ninth annual BEACON Medical Technology Award, which was presented at the annual BEACON members meeting December 6 in Hartford.

The award is presented to an individual or organization/corporation in recognition of significant advancement in the development, commercialization and/or manufacturing of new medical technology. CESI, a world-class simulation center, was selected not only for future clinical training, but also for introducing new devices as they become available on the market. BEACON, founded in 2000, is a nonprofit trade association for the medical device industry.


Dr. Jeff Cohen Was Invited Faculty at ACS Annual Meeting

Dr. Jeff Cohen was an invited faculty member lecturing in "Hand assisted laparoscopic colectomy" at the American College of Surgeons annual meeting in Washington DC.


Our Physicians Are Great Sources For Local Media

Dr. Adam Borgida was interviewed on WFSB on Nov. 18 about women who choose to have babies in their 40s.

Dr. Joe Klimek was interviewed on WFSB on Nov. 19 about the meningitis outbreak at Princeton University.

Dr. Khuram Ghumman was interviewed on NBC CT Today on Nov. 19 about the overuse of antibiotics for children.

Dr. Jack Ross was interviewed on the Ray Dunaway show on Nov. 20 about the meningitis outbreak at Princeton University. He was also interviewed on the Ray Dunaway show on Dec. 3 about tuberculosis.

Dr. Geoffrey Emerick was interviewed on WFSB on Nov. 20 and on NBC CT on Nov. 21 about a new study suggesting that birth control pills may lead to glaucoma.

Dr. Jeff Finkelstein, chief of Emergency Medicine, was interviewed on WTIC AM on Nov. 19 and on the Ray Dunaway show Nov. 25 about ER wait times and our innovative implementation of Q Track for triage. He was also interviewed on WTNH Channel 8, NBC, Fox and Channel 3 on Dec. 5 about the gun buy back.

Dr. Fred Tilden was interviewed on WTNH on Nov. 22 about the cold temperatures.

Dr. Laura Saunders was interviewed on WFSB on Nov. 25 about the release of the state attorney's report on Sandy Hook, and by WKNX radio news in Los Angeles about he psychological impact of the release of the Sandy Hook 911 tapes. She was also interviewed on WFSB on Nov. 26 about holiday overspending.

Dr. Hank Schwartz was interviewed on News 8 on Nov. 25 about the release of the state attorney's report on Sandy Hook. He was also interviewed on NBC CT on Dec. 5 about "highway hypnosis" regarding the deadly train derailment in New York.

Dr. David Tolin was interviewed on NBC-CT anchor Lisa Carberg on Nov. 26 about a study of hoarders being conducted at the IOL, and by Better Connecticut on Dec. 4 about hoarding. He was also interviewed on Dec. 4 by Fox and NBC CT about wellness at Westfarms.

Dr. Paul Thompson was interviewed on WNPR on Dec. 4 about blood pressure.

Dr. Mark Shekhmanand physical therapist Ray Shaw were interviewed on Fox CT on Dec. 4 about their upcoming class on hip and knee pain.

Research and Academics

Dr. Andrew Salner Visits Sister Hospital in China

Hartford Hospital’s Cancer Center director Dr. Andrew Salner recently visited our sister hospital, Qilu Hospital of Shandong University Medical School, in Jinan, China to meet with hospital leadership, give scientific presentations at two major cancer meetings, and help commemorate the opening of Qilu’s new branch hospital, Qilu Hospital Nanshan in Longkou.

Hartford Hospital has had a long relationship with Qilu Hospital. More than 50 Chinese visiting scholars have spent several months to a year at Hartford Hospital to learn new techniques, collaborate on research, and work closely with Hartford Hospital staff and physicians. Shandong Province also is the sister province of the state of Connecticut. Strategies are under way to further develop the economic and cultural relationship between the two sister states.


Dr. Michael Drescher Published in Western Journal of Emergency Medicine

Dr. Michael Drescher, Division of Emergency Medicine, published an article in the December 2012 issue of Western Journal of Emergency Medicine, entitled "Family History is a Predictor for Appendicitis in Adults in the Emergency Department."


Colorectal Division Makes Presentation at Surgical Society Annual Meeting

The colorectal division had a podium and poster presentation at the recent New England Surgical Society annual meeting which took place in Hartford.


Dr. Hank Schwartz Announces Demise of IOL's Digest of Neurology and Psychiatry

Dr. Hank Schwartz, psychiatrist-in-chief and vice president, Behavioral Health at The Institute of Living/Hartford Hospital, published a letter in the latest issue of Digest of Psychiatry and Neurology, of which he is the editor, announcing that the journal was being eliminated after 81 years of continuous publication. The DIgest was published quarterly by the IOL, and included abstracts and reviews of selected literature in psychiatry, neurology, and their allied fields.

He wrote:

It is with great sadness that we inform our readers that this will be the last issue of the Digest of Psychiatry and Neurology after 81 years of continuous publication.  When the Digest began, it filled a unique need.  We are proud of the global reach and the impact our publication has had.

In the years since its inception, however, with the advent of new publishing technologies, a myriad of competing newsletters appeared.  As our subscriptions steadily declined, we had to reconsider the Digest’s role and transitioned to an exclusively electronic quarterly publication in 2001.  While we shortened the length of each issue, we hoped to provide greater value by focusing each on a single theme.  As in the past, each review consisted of a concise synopsis, absent any editorializing and drawn from the leading English language journals.  By publishing on the Institute of Living/Hartford Hospital website, we aimed to maintain two additional traditional values: global outreach and free access.

We remain proud of the role we have played in psychiatric education over these many years but also cognizant of the dramatic changes in the availability of information and the way professionals learn.  And so, with regret and gratitude, we say goodbye to our remaining readers, wishing you well in your efforts at continuing medical education.


Free Introductory Hyperbaric Training Course for Healthcare Providers

Hartford Hospital in collaboration with the OxyHeal University, is offeringa 40-hour course in Hyperbaric Training for Healthcare Providers on Feb. 24-28, 2014 at the Backus Wound and Hyperbaric Center in Norwich. It will meet daily from 8 a.m.-5 p.m.

The Hyperbaric Training for Healthcare Providers Course is designed to meet the requirements of a Designated Introductory Course in Hyperbaric Medicine and will introduce to physicians, registered nurses, technicians and other allied health care providers the clinical indications, documentation and operational requirements of a Clinical Hyperbaric Medicine Facility. NBDHMT 40 Category A Credits.

This course is required for physicians who wish to supervise and bill for hyperbarics, and for nurses and technicians who would like to sit for the National Certification Exam.

It is being offered free of charge to any Hartford HealthCare employee. 

Call Michael Powers at 860-798-8155 with questions. Get Registered Today:  or


Metabolic and Bariatric Surgery Research With Olin Center Presented at National Meeting in Atlanta

The Hartford Hospital Division of Metabolic and Bariatric Surgery under the leadership of Drs. Darren Tishler and Pavlos Papasavas participated at the annual meeting of the American Society for Metabolic and Bariatric Surgeons (ASMBS) with one podium and seven poster presentations. This was the first Obesity Week meeting with the participation of the Obesity Society and took place in Atlanta, GA on November 11-16.

The eight research projects included collaborations with the neuroimaging team of the Olin Center under the leadership of Dr. Godfrey Pearlson, as well as four surgical residents and one student from the Hartford Hospital Summer High School Intern Program.

Podium Presentation:

Revisional surgery following laparascopic adjustable gastric banding; presented by Pavlos Papasvas, MD. Co-authors: Janet Ng PhD, Andrea Stone BS, Delaina Pedrick, Darren Tishler MD.

Poster Presentations:

Outcomes of Patients with BMI>50 undergoing Bariatric Surgery; presented by Amanda Medoro MD, Andrea Stone BS, Darren Tishler MD, Pavlos Papasavas, MD.

Do Concurrent Procedures Performed at time of Bariatric Surgery Affect Procedural Safety?; presented by Daniel Mullins MD, Janet Ng PhD, Andrea Stone BS, Delaina Pedrick, Pavlos Papasavas MD, Darren Tishler MD.

You can’t always get what you want: gastric band to sleeve to Bypass, the ultimate bariatric experience; presented by Janet Ng PhD, Andrea Stone BS, Darren Tishler MD, Pavlos Papasavas MD.

Bariatric Surgery in Patients over the age of 70; presented by Michael Hernon MD, Janet Ng PhD, Andrea Stone BS, Pavlos Papasavas MD, Darren Tishler MD.

Does pre-operative Insulin predict post-surgical weight loss following bariatric surgery; presented by Janet Ng PhD, Andrea Stone BS, Delaina Pedrick, Darren Tishler MD, Pavlos Papasavas MD.

Case Study: Rapid progression of NASH cirrhosis after Roux-en-Y gastric bypass; presented by Mofei Liu MD, Colin Swales MD, Andrea Stone BS, Janet Ng PhD, Darren Tishler MD, Pavlos Papasavas MD.

Implementation of a patient and family advisory council improves bariatric services; presented by Sally Nelson Strange PhDc, Pavlos Papasavas MD, Andrea Stone BS, Darren Tishler MD.

In addition, Dr. Edward Hannoush gave a podium presentation on "Laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass in patients with extreme obesity? 30-day morbidity and mortality comparison: A NSQIP database analysis;" a work that he completed during his MIS fellowship.

American Society for Metabolic and Bariatric Surgeons Committee Activity

Clinical Issues Committee: Dr. Pavlos Papasavas is a member of the ASMBS Clinical Issues Committee and is part of a team drafting guidelines on reporting outcomes following weight loss surgery.

Access to Care Committee: Dr. Darren Tishler is the Connecticut State Access to Care Representative and member of the ASMBS Access to Care Committee that works on improving patient access to weight loss surgery.

Chief's Corner

GreeneWelcome To "Chief's Corner"

We recognize the need for sharing information about activities throughout the hospital more widely with our Medical Staff.

Chief's Corner will bring you highlights of activities of interest, which will be authored by our Department Chiefs. Should you have any comments or suggestions along the way, please share them with us.

- Dr. Jack Greene, Hartford HealthCare regional vice president of Medical Affairs for the Hartford Region and Hartford Hospital


“Safety Starts with Me” Training Session

Patient safety is our priority. Our goal is to train all physicians who care for patients in our hospital to fully participate in this effort.

The medical staffs at THOCC and Backus have already undergone this training. Dr. Peter Shea, the vice president for Medical Affairs in the Eastern Region, will conduct a training session for physicians on February 3 In Gilman Auditorium. This session will take place from 11:30 a.m.-1 p.m. during the time set aside for our combined clinical chiefs/MEC meeting. Members of these groups will be expected to attend. We are also inviting all members of our medical staff.

This training will mandatory over the next year and multiple other sessions will be scheduled. Please take advantage and attend this kick-off session if at all possible. Feedback from those who have attended other sessions has been outstanding.

The safety behaviors that are included in the hospitalwide training include clear communications, effective hand-offs, attention to detail, mentoring and coaching others and practicing with a questioning attitude. These safety behaviors have been successfully deployed in more than 300 other hospitals nationwide, resulting in reduction of preventable harm rates of 85-90 percent on average.

HH’s goal with the HRO journey is to substantially reduce incidents of preventable harm, to the eventual goal of to at least one year without an incident. It’s part of our commitment to do the safe thing for every patient, every time.

Enhancing The Patient Experience

Voices of Our Residents: Kudos To Dr. Salerno

Dr. Vergara,

Honestly I had a great experience at the sleep lab clinic and I just wanted to give you feedback on how it was.

I saw five patients with Dr. Edward Salerno. I saw them myself, precepted with him, then we went in the room together. Cases I saw included consults for OSA management prior to bariatric surgery, preoperative pulmonary clearance for a patient with OSA, possible OSA induced seizures, etc.

In addition to the things I learned while he was teaching patients, Dr. Salerno took a real effort in teaching me how to interpret the PSG and home sleep tests.

The experience was valuable enough for me that I think it should be on the schedule more than once for the residents, if that is possible.

Thank you for setting this up!

Ranjit Joseph

Operational Update

New Physicians Join Medical Staff

Please welcome the following physicians to the medical staff.

Jessica Bland, MD, Hartford Anesthesiology Assoc., Inc. Anesthesiology

Melanie Braganza, MD, CT Multispecialty Group, PC, Internal Medicine

Ray Victor Cabuslay, MD, CT Multispecialty Group, PC, Hospital Medicine

Edmond Cronin, MD, Hartford Hospital, Cardiology

Michael Diodato, MD, Hartford Hospital, Surgical Critical Care

William L. Duvall, MD, Hartford Hospital, Cardiology

Ahmed M. Elwan, MD, Hartford Hospital, Cardiology

Antonio B. Fernandez, MD, Hartford Hospital, Cardiology

Aidan W. Flynn, MD, Hartford Hospital, Cardiology

Elise Gates, MD, HHC PhysiciansCare, Inc, General Surgery

Khuram R. Ghumman, MD, Hartford HeatlhCare Medical Group, Internal Medicine

Akhilesh K. Jain, MD, HHC PhysiciansCare, Inc, Surgery

Jessica Lee, MD, HHC PhysiciansCare, Inc, Surgical Critical Care

Sarfaraz Memon, MD, Hartford Hospital, Cardiology

Adewale Olayode, MD, CT Multispecialty Group, PC, Internal Medicine

Felix Pacheco, MD, Hartford Hospital, Emergency Medicine

Rachel Raphael, MD, Lori L. Fritts MD, LLC, Surgery

Rania Rifaey, MD, Hartford Anesthesiology Associates, Inc., Anesthesiology

Francoise Roux, MD, CT Multispecialty Group, PC, Pulmonary

Jennifer A. Sposito, MD, Hartford Anesthesiology Assoc., Inc., Anesthesiology

David J. Thomas, MD, Hartford Hospital, Emergency Medicine

Kristy Thurston, MD, HHC PhysiciansCare, Inc, Colon and Rectal Surgery


Integrated Care Partners' (ICP) Clinical Integration Newsletter, Connected Care, Available Here

Integrated Care Partners' newsletter, called Connected Care, is available here.

The feature article in the new Dec. 2 issue is "ICP and Our Founding Members,” which lists member practices. The newsletter also includes a list of ICP accomplishments, as well as a description of ICP committees.

Integrated Care Partners (ICP) continues to engage and recruit physicians and forge partnerships with health plans, employers and providers. Our collective goal is to deliver the highest-quality, coordinated patient care and improve the overall health of populations. We continue to seek providers who are equally committed to delivering the best care and interested in the opportunity to participate in the shared savings deals ICP is negotiating with payers. At no cost to member physicians, ICP also can deliver care-management resources for high-risk patients and the infrastructure needed to achieve quality measures that will allow providers to realize and sustain cost benefits and long-term viability in the currently changing health care market.


22 New Hospital Corporators Welcomed at Annual Meeting

At the annual meeting of the Hartford Hospital Corporators on November 21, we welcomed 22 newly elected corporators to the partnership among the hospital’s board of directors, medical staff, management, and community. Our corporators play a critical role in keeping us in tune with the community and providing vital support of our mission. As of September 30, the hospital’s corporators numbered 425. We are grateful for their contribution of time, expertise, and funds. The newly elected corporators are:

Angel Arce
Melvyn Colón
Andrew Crumbie
Robert Goldschmidt
Carrie Hammond
April Haskell
I. Bradley Hoffman
Alan Lazowski
Rebecca Corbin Loree
Maura Majeski
Bonnie J. Malley
Duby McDowell
Julie Daly Meehan
Sean Meehan
Paul Mutone
Matt Poland
David E. Polk
Eugene Rosenberg
Richard Rubenstein
Joseph Santana
Michael Stotts
Virginia Van Dyk

Dr. Harold Schwartz, Hartford HealthCare regional vice president and psychiatrist-in-chief, was the featured speaker at the luncheon. He captivated the audience with a presentation titled “What’s Missing in the Mind of the Shooter?” The topic is particularly timely as the country grapples with an increasing number of mass shootings.

The evening before the annual meeting, at a gathering hosted by Governor Dannel Malloy and Cathy Malloy at the Governor’s Residence in Hartford, Dr. Schwartz spoke about the history of the Institute of Living and the work being done today in the areas of research and treatment. The gathering included friends of the Malloys, Hartford Hospital Auxiliary leadership, and supporters of the Institute of Living.


Nominate a Connecticut Hero By Dec. 31

The Red Cross is looking for people who have performed extraordinary acts of courage to save someone's life or who commits countless hours to a special cause to honor as Connecticut Heroes. Each year, the Red Cross accepts nominations for recognition of people who go above and beyond in service to others, exemplifying the spirit of the Red Cross mission. These heroes are honored in recognition of their good works at the Community Heroes Breakfast Celebrations, on March 7, 2014, in Hartford.

Nominate your Community Hero for deeds that occurred in the last 15 months. Nominations must be received by December 31, 2013 to be considered for this year’s event. The nominee must live or work in, or the event must occur in, Connecticut. Nominations may be made for both living and posthumous Heroes. Details about the Heroes Celebration and an online nomination form are available at the Red Cross website,

For more information about the Red Cross Community Heroes Celebration and sponsorship opportunities, contact Devin Cleary at (860) 678-4310 or email him at


State Mandated CME Renewal Available Free To HH Doctors on Jubilant Learning Portal

State mandated CME for physician license renewal is available free on the Hartford Hospital Jubilant Learning Platform. You will need your Novell sign on information to access the portal. If you have forgotten your sign on, please call the HELP desk 55699 (outside: 860-545-5699).

To access Jubilant from the web, go to the Hartford Hospital page and click on the gold tab “Medical Professionals.” Click on “Learning Portal” from the drop down menu, and then click on the green tab “Learning Portal Login.”

From the home page of the intranet (inside HH), click on the Learning Portal for Medical Education and Training link. Once you’ve clicked on the link, use your Novell sign in, and the CME is under Physician License renewal CME.

Once you have passed the post-test, you will be awarded a printable CME certificate. Your CME will also be maintained and easily self-service accessed on the Learning Portal site, should you need a copy in the future.

Please note that your Risk Management required activities through MRM will provide your Risk Management CME.

Did You Know?

Supply Cost Stats

Hartford Hospital spends $4.9 million annually on spinal implants, and $6.9 million on total joint implants.

HH In the News

Hartford HealthCare Cuts 179 Jobs Across Five Hospitals

Hartford Courant, Nov. 15

Hartford HealthCare is cutting 179 jobs, primarily of senior and middle managers, across five Connecticut hospitals, a spokeswoman said Friday. The cuts came through layoffs, volunteer retirements and resignations, and by eliminating unfilled positions, she said.

"We have merged our regional management teams and streamlined our management structures across every affiliate," Hartford HealthCare spokeswoman Rebecca Stewart said. "This new structure, with fewer managers responsible for a greater number of people, will create a more efficient, agile and productive care system."


Long ER Waits in Connecticut: 30-minute Average Tops National Rate

The Register Citizen, Nov. 18

In more than half of Connecticut’s emergency rooms, the waiting time to see a health-care provider exceeds the national average of 28 minutes — a problem that experts say could get worse as thousands more residents obtain health insurance. The statewide average waiting time is 30 minutes.

The longest wait time is at Hartford Hospital, a Level 1 trauma center, where patients were not seen for 82 minutes, on average; the shortest wait of 14 minutes is at Windham Hospital, the data compiled by the Centers for Medicare & Medicaid Services through 2012 show. Officials at Hartford and Bridgeport hospitals claim shorter wait times than the federal data.

At Hartford Hospital, where officials say the median door-to-provider time of 37 minutes is a better measure of its wait time than CMS’ calculation, a “quick track” room frees up ER beds while patients wait for lab results. Dr. Jeffrey A. Finkelstein, chief of emergency medicine at Hartford Hospital and The Hospital of Central Connecticut, said Hartford is shortening its ER waits through several steps, including having a fast track for people with minor ailments.

The new Quick Track program is also working well, he said, as other patients are monitored in a “results-pending area with 14 comfortable chairs, coffee and a big-screen TV.” Q Track is novel, he said, because “it speeds the care for everyone.”


Gearing Up For the Bitter Cold Weather

WTNH, November 22

Sunday is going to be bitterly cold, even dangerously cold for folks who aren't ready for it. Hospitals are gearing up to treat people but there are steps you can take to protect yourself.

As temperatures on the street start to drop, doctors at Hartford Hospital issue a frost bite and hypothermia warning. Now is the time cases start to come into the ER because people don't realize how fast and how cold it can get as an arctic blast moves into the state.

"We see people here because they don't take it so seriously. If it is the middle of February, it doesn't happen so much because people are used to the winter. But at the end of the fall, going into winter is where we see it," said Dr. Fred Tilden, Hartford Hospital. "When you are sweating and the wind blows over, your body it makes you colder than if you weren't sweating, or the wind wasn't blowing. It can drop your core temperature very significantly, very quickly."


Attorney General Asks Hospitals For Details on "Facility Fee"

Hartford Courant, Nov. 26

The state's attorney general is taking aim at a "facility fee" that he says has been surprising many patients of medical practices now affiliated with a hospital. The fee is on top of charges for in-office services and procedures provided to patients by practices that are owned by a hospital but are off the hospital's main campus. Attorney General George Jepsen said he has asked all the state's hospitals for a list of their affiliated providers; if fees are disclosed in advance; and the specific disclosures that are provided to patients.

Hartford HealthCare, parent of Hartford Hospital, four other hospitals and clinical operations, said in a statement that it "supports the goal of providing consumers with simple and understandable way to look at the cost of care, and we look forward to working with Attorney General Jepsen."


In Lanza's Chilling Book, A Search For Psychological Clues

Hartford Courant, Dec. 1

Though investigators believe Sandy Hook Elementary School gunman Adam Lanza may have taken his motive to the grave, some mental health experts are looking at a disturbing storybook authored by Lanza a decade before the massacre for clues as to why he killed 20 children and six educators.

Detectives sent "The Big Book of Granny," a black spiral-bound book with an angry-looking, cane-waving cartoon grandmother on the clear plastic cover, to investigators at the FBI's Behavioral Analysis Unit at Quantico, Va. The unit works to develop behavioral profiles of criminals, including mass killers.

Dr. Harold Schwartz called Lanza's storybook "an interesting find," and "prophetic, in retrospect," with passages that suggest " long-term and growing obsessions with guns and mass violence.'' But Schwartz, chief psychiatrist at Hartford Hospital's Institute of Living, cautioned that predicting violent behavior from the violent fantasies of children and adults is often "a precarious art only slightly influenced by science.''

Reading or hearing about someone's violent fantasies "can produce a countless number of false positives" for anyone trying to figure out if a particular person will commit murder, Schwartz said. There are people who harbor violent or deviant "fantasies all their lives, and never act them out,'' Schwartz said.


Health Care Professionals Get Free Shave in West Hartford To End Movember

West Hartford Patch, Nov. 28

A doctor and staff member from Hartford Hospital got a free shave at West Hartford’s The Final Cut Sports Barbershop to end their participation in Movember.

Dr. Josh Stein and Chief Strategy Officer Jim Blazar were two of a number of health care professionals who took part in Movember, an annual, month-long event in which men grow moustaches to raise awareness for prostate cancer and other male-related health issues.

In the HHC System

Backus Reports Boost In Operating Margin

The Norwich Bulletin, Nov. 20

The William W. Backus Hospital’s annual operating margin has more than doubled since 2010, with revenue over expenses equaling $25.4 million in fiscal year 2013, administrators announced. Backus’ 9.2 percent operating margin in 2013 was just ahead of the 8.75 percent it reported in 2012, when total gross revenue for the 120-year-old hospital totaled $675.5 million, according to the state Office of Health Care Access.

“Our margin and our mission remain strong. Backus has made difficult but necessary decisions to maintain our position as a leader in health care transformation,” hospital board Chairman Anthony Joyce said. “Partnerships at every level have positioned Backus for these times.”

Joyce’s comments came five days after 20 senior and middle managers in Hartford HealthCare’s east region, which comprises Backus and Windham hospitals, received layoff notices.

Much of Wednesday’s annual meeting — which officials opened to reporters for the first time — focused on Backus’ summer affiliation with Hartford HealthCare, which CEO Elliot Joseph called visionary.


Hartford HealthCare Adds Hedge Fund Option to Retirement Plans

Hartford Business Journal, Nov. 22

Hartford HealthCare, which oversees five hospitals and various other facilities across the state, has added a hedge fund to its employees' choices for retirement plans, according to Neuberger Berman Group.

Neuberger, the investment manager offering the new fund, said the health care network is one of the first major not-for-profit institutions to introduce hedge funds into a mutual fund format for its employee's defined contributed plans.

HHC has 18,000 employees and a retirement fund of approximately $650 million.


Finances Discussed at MidState Medical Center's Annual Meeting

Record Journal, Nov. 22

The impact of the federal Affordable Care Act and the future of the hospital were discussed at MidState Medical Center’s annual meeting on Thursday.

Members of the board of directors and hospital corporators were on hand for the introduction of the new chairman of the board, Carl Grant, and a presentation by Stephen Frayne, senior vice president for health policy at the Connecticut Hospital Association.

Outgoing board chairman Bruce Eldridge said leading the hospital through challenging times was a rewarding experience.

Elliot Joseph, president and CEO of Hartford HealthCare, which includes MidState, said the industry is experiencing the most tumultuous period he can recall in his 30-year career. Joseph said the challenges include declining revenues and the shift in health care costs from employers to patients. The core business for hospitals is inpatient care, but inpatient treatment is declining, he said.

“Patients are becoming consumers,” Joseph said. “They are asking ‘How much does that cost?’”

Hospitals have responded by restructuring to avoid duplication of services, Joseph said. "We are on a great path and seeing success," Joseph said.


Most Connecticut Hospitals Face Medicare Penalties For Quality Measures

New Haven Register, Dec. 2

More than two-thirds of Connecticut hospitals will face Medicare penalties for lagging clinical-care measures in the fiscal year that began Oct. 1, with smaller hospitals including Johnson Memorial, Windham and New Milford losing the highest percentage of reimbursement.

The penalties, under a federal program known as Value-Based Purchasing, average 0.26 percent nationally, with Connecticut’s hospitals losing an average of .023 percent, according to federal data compiled by Kaiser Health News. None of the state’s hospitals will lose the maximum possible penalty, 1.25 percent of funding, federal data shows.

Johnson Memorial and Windham are the only two hospitals that will lose more than 0.5 percent of their Medicare payments — up slightly from penalties they faced last year. Meanwhile, eight of the 28 state hospitals in the program will receive small bonuses (less than 1 percent) in Medicare reimbursements. They include: Yale-New Haven Hospital, William Backus Hospital in Norwich, Stamford Hospital, St. Vincent’s Medical Center in Bridgeport and MidState Medical Center in Meriden.

Health Care News In the Region

Yale, Tenet Seek Growth in Greater Hartford, Beyond

Hartford Business Journal, Dec. 2

Yale New Haven Health System is eyeing its first significant push into Greater Hartford with its recent affiliation with Eastern Connecticut Health Network, but its growth likely won't stop there.

The state's largest healthcare network could extend its reach and brand further into Hartford County, across the state, and even potentially outside Connecticut, a hospital official said.

"The scale of Yale New Haven Health System is self-sustaining, but there is a need for us to be part of something bigger," said Vincent Petrini, Yale New Haven's senior vice president for public affairs. "We have to be prepared for growth."

Beyond the ECHN deal, the Yale-Tenet joint venture could serve as a platform to acquire other hospitals in Connecticut and nearby states, said Trip Pilgrim, senior vice president and chief development officer of Tenet.


ECHN/Tenet Deal Expected Soon

Journal Inquirer, Nov. 15

The nonprofit Eastern Connecticut Health Network has told its 276 community volunteers known as “corporators” that it expects to strike a deal to sell itself to the nation’s third-largest for-profit hospital chain early next year, when they will be asked to approve the acquisition.

Meanwhile, an executive at the Texas company negotiating to buy ECHN, Tenet Healthcare Corp., insisted that the more than $1 billion it paid over the last decade to settle Medicare fraud, overbilling, kickback, and other allegations resulted from questionable actions taken before the company’s current leadership took command.

“Tenet is a completely different company than it was 10 years ago,” Steven Campanini, Tenet’s vice president for corporate communications, said Thursday in an interview at the Journal Inquirer. “We’re making significant investments in capital, we invest in people, we invest in communities, we do what is best from a patient care perspective. We look at people, we don’t look at conditions. We focus on health care first and what is necessary to deliver and provide that.”


Tenet's Way Around Governor's Veto is Yale New Haven

Journal Inquirer, Nov. 19

The for-profit hospital chain seeking to acquire four nonprofit hospitals in Connecticut is trying to skirt Gov. Dannel P. Malloy’s veto of a bill stalling two of the buyouts.

The temporary fix proposed by Tenet Healthcare Corp., of Texas, could remove what it says is a major obstacle to its acquisition of hospitals in Waterbury and Bristol. It would also speed its plan to follow up with the purchase of Eastern Connecticut Health Network’s Manchester Memorial and Rockville General hospitals.

The measure the governor rejected over the summer would have changed a 2009 law that allows only nonprofit hospitals to create “medical foundations” that employ physicians. The idea was to make sure treatment decisions are subject to clinical rather than corporate oversight.


The Bid To Sell Hospitals Has Very Big Weaknesses

New Britain Herald, Nov. 23

Whether Eastern Connecticut Health Network, operator of two venerable charitable institutions, Manchester Memorial and Rockville General hospitals, sells them to Tenet Healthcare, a giant for-profit corporation, will be decided in a few months by the nearly 300 people serving as ECHN’s “corporators,” community representatives.

The sale is being proposed by ECHN’s Board of Trustees on the grounds that small community hospitals cannot survive as medicine comes under more financial pressure and that big for-profit corporations can exploit economies of scale and greater access to capital for improving hospital facilities.

There are a few problems with this.

First is that, as the Journal Inquirer reported this month, Tenet Healthcare’s record is appalling. In the last decade the corporation has paid more than $1 billion in fines for defrauding its biggest customer, the federal government, and another $700 million to settle lawsuits and claims of unpaid taxes. A fraud settlement of another $3.7 million was announced just a few days ago.

Tenet says this misconduct is long past and that the corporation is under new management. Maybe, but then does the new management have enough of a record to instill confidence? Whatever their weaknesses, somehow Manchester Memorial and Rockville General have managed to operate for generations without such misconduct.

Then there’s the chance that the ECHN board’s premise — that medicine will keep getting squeezed — is wrong. Tenet itself disagrees, believing instead that medicine is likely to be a growth business as the population ages and a national insurance system turns charity cases into paying customers. While “Obamacare” is too complex, having been designed by bureaucracy-loving Democrats amid the cynical refusal of efficiency-minded Republicans to help design it, it is more likely to be simplified than repealed.


Urgent Care Planning Northeast Expansion

Hartford Business Journal, Nov. 19

Urgent Care of Connecticut, which has clinics in Glastonbury and Southbury, has taken an equity investment it says will help it expand throughout the Northeast.

The Brookfield company didn't disclose the amount, but said it comes from Pulse Equity Partners and PineBridge Structured Capital.

Urgent Care said it will look to grow its geographic footprint, which consists of seven Connecticut clinics, through acquisitions and organic growth. Dr. Robert Rohatsch, the company's CEO, will remain in his position.


Nurses, Techs Begin Strike At L&M Hospital

Hartford Courant, Nov. 27

Nurses and technicians at Lawrence + Memorial Hospital walked off the job and on to the picket line early Wednesday, commencing Connecticut's first large-scale hospital strike in 27 years. The nearly 800 employees went on strike after their AFT union and hospital management failed to reach a compromise on the major sticking point: whether current employees may transfer with their departments if those services move off-campus.

Contract negotiations broke down Tuesday afternoon. Anticipating a strike, the hospital hired temporary nurses and technicians to take care of patients and said some nursing supervisors would also fill in. The union estimated that there were 200 temps hired, and although a hospital spokesman declined to give a number, he said the union's estimate was not far off.

Most elective procedures will be postponed, at least initially. Emergency angioplasties will not be done until the strikers return, "because it's a high-risk procedure where there's a very specific nursing skill set," O'Farrell said. He said those patients would probably be taken to Yale-New Haven Hospital.


Long Emergency Room Waits Might Only Get Worse

Hartford Courant, Nov. 21

They're not called waiting rooms for nothing. In more than half the state's emergency departments, the wait exceeds the national average of 28 minutes, according to the Connecticut Health Investigative Team. In five of the state's hospitals, the typical wait is an hour or more.

Hospitals are working to reduce their ED waiting times by improving triage, adding ways for those with minor ailments to get in and out quickly, posting wait times on their websites, and more. But the backups in emergency departments are a symptom of deeper problems in the delivery of health care.

As the state's population ages, more people are needing medical treatment. When the Affordable Care Act kicks in next year, the pool of Medicaid-eligible patients will increase statewide. Nationwide, the increase will be at least 15 million people a year, experts say. They will need primary care doctors — and it's by no means certain that they will find them.

The number of primary care doctors has not increased as quickly as the demand for them, according to the American College of Emergency Physicians. Fewer doctors are accepting new patients. Many people are forced to turn to hospital emergency departments for care — even if it's not an emergency. Hence the long waits.

One way to ease the physician crunch here would be to make Connecticut a more attractive place for doctors to practice.

Rates for malpractice insurance here are among the highest in the country, says the Connecticut Medical Society. Many other states offer incentives for physicians to stay; Connecticut does not. The number of primary care physicians coming out of UConn's and Yale's medical schools is "clearly inadequate for the primary care needs of the state," according to the Connecticut chapter of the American College of Physicians.

Hospitals are doing what they can to bring down ED wait times. But it's unlikely real progress can be made on that front until the climate for practicing medicine here improves.


Questions About Hospitals' Shift To For-Profit

Hartford Courant, Dec. 3

Only one of the state's 30 hospitals is for profit, but a handful of deals in the works could soon change that. What that means for the quality of health care, for hospital workers and the sustainability of hospitals in the state depends on whom you ask.

Barbara Simonetta, president of Connecticut Health Care Associates/AFSCME, said nurses at Waterbury Hospital could have their pension eliminated if the hospital merges with Tenet HealthCare Corp., a Dallas-based for-profit company. She said the company also wants to reduce nurses' time off and raise the costs of their health benefits.

"It is critical to research what kind of poor corporate citizens for-profits can be and the pound of flesh they will require from the caregivers we rely on," she said, adding that studies suggest that for-profit hospitals have higher mortality rates and more patient-care violations.

Darlene Stromstad, president and CEO of Waterbury Hospital, said the proposed merger is the hospital's best chance to thrive. Without it, she said, "we would limp along until such time that we can't." The hospital serves largely a low-income population, she said. "By protecting our ability to deliver health care in the community, we are protecting the most vulnerable folks in Connecticut," she said.

The Waterbury-Tenet deal was the focus of Tuesday's hearing. It has been in the works since November 2012, when the hospital announced that it planned to merge with Tennessee-based Vanguard Health Systems Inc. Tenet has since acquired Vanguard and is continuing to pursue Waterbury Hospital.


CT Hospitals Join Online Market To Cut Supply Costs

Hartford Courant, Dec. 4

By now we've all heard stories of hospitals charging hundreds of dollars for an aspirin pill or a bandage, part of the screwy world of medical cost allocation that includes list prices almost no one pays, based on made-up numbers.

But how do hospitals get those aspirin pills and rolls of gauze at the lowest possible prices? The supply chain for hospital supplies, like everything else in health care, is changing fast. On Thursday, an online hospital supply marketplace founded in April is announcing that a coalition of 100 New England hospitals has signed on.

The Northeast Purchasing Coalition includes several in Connecticut: Yale-New Haven, Waterbury, Eastern Connecticut Health Network, Norwalk, Danbury and Charlotte Hungerford in Torrington. The group has joined Irving, Texas-based aptitude LLC, which claims to be the hospital industry's first online market allowing direct contracting between suppliers and buyers.

Hot Topics in Health Care

Doctors Complain They Will Be Paid Less By Exchange Plans

Kaiser Health News, Nov. 19

Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces.

Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C.

If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

But many primary care doctors say they barely have time to take care of the patients they have now.


3 Ways Obamacare is Changing How A Hospital Cares for Patients

Planet Money, Nov. 26

The Affordable Care Act is transforming more than health insurance. In hospitals around the country, the legislation could transform the way doctors and nurses actually care for patients.

Part of the law is designed to rein in the nation's exploding health care costs by creating hundreds of little experiments that test new ways for hospitals to save money. Starting on Jan. 1, the federal government, the hospital and some of the doctors there will try a new approach.

Rather than paying for that bypass operation and then paying again for bleeding, Medicare will pay one lump sum upfront to cover the surgery and any complications that occur after surgery. One payment for one operation, plus follow-up; that's it.

If the patient doesn't have problems within 30 days of being discharged from the hospital, the doctors could make even more money than they do today. But if there are lots of problems after surgery, they could lose money.


To Make Hospitals Less Deadly, a Dose of Data

The New York Times, Dec. 4

Going to the hospital is supposed to be good for you. But in an alarming number of cases, it isn’t. And often it’s fatal. In fact it is the most dangerous thing most people will do.

Until very recently, health care experts believed that preventable hospital error caused some 98,000 deaths a year in the United States — a figure based on 1984 data. But a new report from the Journal of Patient Safety using updated data holds such error responsible for many more deaths — probably around some 440,000 per year. That’s one-sixth of all deaths nationally, making preventable hospital error the third leading cause of death in the United States. And 10 to 20 times that many people suffer nonlethal but serious harm as a result of hospital mistakes.

Most of us decide which hospital to go to (that is, when we get to decide) with zero data about hospital safety. Information, however, is gradually reaching the public, and it can do more that just help us choose wisely. When patients can judge hospitals on their safety records, hospitals will become safer. Just as publishing health care prices will drive them down, publishing safety information will drive hospital safety up.

Coming Events

December 10 (Tuesday)

Cardiology Grand Rounds

JB-118, 11 a.m.

Implantable Cardiovascular Devices in the ED: What They Are, What They Do, and What You Need To Know

Dr. Khurram Nasir, director of Prevention and Wellness Research at Baptist Health, Miami

December 10 (Tuesday)

Schwartz Rounds

Gilman Auditorium, 11:30 a.m.

"Just a nurse: A nursing model, really?"



December 12 (Thursday)

Department of Medicine Monthly Meeting

Gilman Auditorium, 8 a.m.

Dr. Eric Shore, Patient Satisfaction and Critical Care

Dr. Patrick Carroll, Bending the Cost Curve; Challenges and Opportunities at HHC

Dr. Ajay Kumar, Discussion



December 15 (Sunday)

Health Care Matters: What Can Health Care Learn From Alcoa?

WTIC-AM 1080, 11 a.m.

Health Care Matters, the monthly HHC radio show on WTIC-AM 1080, will be broadcast on Sunday, Dec. 15 at 11 a.m. Join hosts Elliot Joseph, president and CEO of Hartford HealthCare, and Rebecca Stewart, director of media relations, with featured guest Paul O'Neill, former treasury secretary and chair of Alcoa, who led the company to become one of the safest workplaces in the world.

You can email questions in advance to, and call in during the show to 860-522-WTIC.



December 18 (Wednesday)

Quest Webinar: "Strategies to Improve Blood Utilization"

3-4 p.m.

Dr. Ajay Kumar,chief of the Department of Medicine, will be the speaker at a Quest webinar on Wednesday, Dec. 18from 3-4 p.m. called "Strategies to Improve Blood Utilization."

Avoidable complications and over-utilization of resources are drivers of needless costs in healthcare. The focus of this QUEST sprint is on techniques and tools available to identify and reduce inappropriate use of blood products. A more conservative approach to the utilization of blood products not only saves resources but improves patient outcomes. Dr. Kumar will share successful strategies to improve blood management and related outcomes.

A sprint is a 90-day rapid cycle improvement webinar series to help drive improvement in specific indicators. Enrollment is open to any QUEST member hospital. There is no fee to participate.

Click here to register for this webinar:


December 19 (Thursday)

Emergency Medicine Grand Rounds

Gilman Auditorium, 12 p.m.

Implantable Cardiovascular Devices in the ED: What They Are, What They Do, and What You Need To Know

Dr. Edmond Cronin, electrophysiologist



January 25, 2014 (Saturday)

Black & Red

Bushnell Center for the Performing Arts, 6 p.m.

Featuring the music of Barenaked Ladies.

Only 1,200 tickets will be sold! Don't miss out. Buy your tickets now.




For more coming events, click here.

The Seymour Street Journal (SSJ) has been developed to communicate key messages pertinent to our hospital's physicians. It will keep you informed and up-to-date on hospital, network, and health care news in a concise, convenient format. The SSJ will be sent to your preferred e-mail address every other Sunday. If you would like to be added to the Seymour Street Journal email list, or to receive it at a different email address, please opt-in at This ensures that you will receive the newsletter at your preferred email address. Back issues can be viewed here. For any questions or suggestions, please contact Dr. Stacy Nerenstone, Medical Staff president, at (860) 545-3043.