From the Offices of Stuart Markowitz, MD and Jeffry Nestler, MD

In This Issue...

November 17, 2013 Edition

Wash In - Wash Out



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HH Facts and Firsts:

2001 - Hartford Hospital, under Dr. Francis Kiernan, was the first hospital in Connecticut to use new drug-coated stents that reduce the need for further care following angioplasty.

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Voting is now underway to fill eight open positions in medical staff leadership – four officers: president, vice president, treasurer and secretary - and four at-large members of the Medical Executive Committee (replacing these current members whose terms are expiring: Drs. Saverio Ligato; Leah Meisterling; Jarrod Post; and Andrew Wakefield).

Current officers whose terms are expiring are Dr. Jeffry Nestler, president; Dr. Stacy Nerenstone, vice president; Dr. Jeffrey Cohen, treasurer; and Dr. Matthew Saidel, secretary.

Candidates are:

President: Dr. Stacy Nerenstone

Vice president: Dr. Matt Saidel

Treasurer: Dr. William Sardella or Dr. Ken Robinson

Secretary: Dr. Herbert Keating or Dr. John D'Avella

Medical executive committee (four open positions):

Drs. Alex Cech, Jeff Finkelstein, April Goller, Fran Gurtman, Syed Hadi, John Hammond, Leah Meisterling (incumbent), Sam Pope, Jarrod Post (incumbent), Bob Spilane, Cune Vergara, Andy Wakefield (incumbent).


Voting will end at 5 p.m. on Tuesday, November 19, and results will be announced Nov. 21 at the Semi-annual meeting of the Medical Staff. Please vote- access the ballot here.

Top News

President Markowitz Addresses System Changes

To All Hartford Hospital Staff Members:

On Nov. 14, Jeff Flaks, Hartford HealthCare’s chief operating officer, wrote a letter to staff about staff reductions among senior and middle management across our system that are the result of the critically important streamlining of our leadership structure. As he reported, 179 positions in senior and middle management will be eliminated.

I want to explain to you the effect on our staff and to underscore the importance of this organizational transformation to Hartford Hospital.

At Hartford Hospital, we reviewed the management structure of each department, including the manager-to-staff ratio, or what we call manager “span-of-control.” Where we saw duplication or opportunities where we could combine work units, we did so. As a result, 18 members of senior and middle management will be departing. Twelve unfilled positions at all levels of the organization either have been eliminated or will have reduced hours. We also have restructured roles, which will result in the departure of 20 supervisory and individual contributor roles.

As Jeff Flaks noted in his letter, the individuals who are leaving have been valued staff members. We are treating them with the respect and gratitude they deserve. In accordance with our values, we are providing them with severance, outplacement assistance and other transition support, including help with options related to retirement and 401k/403b plans. They will have access to the Employee Assistance Program. Most of these employees will depart by the end of November.

I don’t want to minimize the effect of these departures on those who will no longer work here or on those who remain. There is no painless way to consolidate our leadership structure in order to make it more efficient, more responsive and more productive. We owe it to our communities to sustain and grow all of the community-based, not-for-profit organizations that make up Hartford HealthCare. We need to improve and maintain consistent high quality and drive down variation across our system. We also must provide an excellent patient experience for every patient. To ensure we reach everyone who needs us across Connecticut, we must also become more efficient – so that our care can be affordable.

This isn’t a random shake-up or arbitrary budget slashing. This is a thoughtful, disciplined and difficult transformation on behalf of those we serve. The team members who remain are exceptionally well suited to the task ahead, and I have every confidence that with support from HHC Leadership and Organizational Development, and with input from our H3W work groups, they will succeed in this new leadership framework.

At Hartford Hospital, we will benefit greatly from this new structure. We can achieve economies of scale, share best practices and collaborate in many new and different ways – especially through H3W. Together, we can look with fresh eyes at the work we do and find better and more efficient ways to serve our communities. Our new structure also will create new professional and educational opportunities for our staff as we invent, adopt and embrace new methods and technologies.

I’m sure many of you are wondering if we are done with change for now. The truth is that change is the new constant, and we’ve reorganized so that we can continue to lead the transformation of health care. This new structure will help Hartford HealthCare become more flexible and stronger in a quickly shifting industry environment. We owe that to our patients and families.

Thank you for your hard work and understanding.


Stuart K Markowitz, MD FACR


Teams of the Year Named

The 2013 Teams of the Year were announced at the State of the Hospital meeting Nov. 12. We recognize both clinical and clinical support teams, in recognition of the fact that everyone plays a vital role in improving the patient experience and general hospital operations. Forty-eight teams were nominated this year.

The Clinical Team of the Year is the Patient Progression Team, which engaged our entire organization to effect a truly monumental change in how we move patients through our hospital to provide the right care, in the right place, at the right time. The team reduced average length of stay from 5.9 days in January to 5.6 days in August for an annualized patient-day savings of nearly 6,200 days.

Finalists for Clinical Team of the Year were the Improving Patient Communications Team and the Department of Hospitalists Medicine Team.

The Clinical Support Team of the Year is the Public Safety Team, which responded to more than 80,000 calls for assistance from employees and provided more than 14,000 employee escorts around campus, as well as dispatching LifeStar and rapid-response teams and managing parking.

Finalists for Clinical Support Team of the Year were the Food and Nutrition Department Team and the No One Dies Alone Team.


Hospitalists Named Finalist for Clinical Team of the Year

The Department of Hospitalists Medicine Team was one of the three finalists named for Clinical Team of the Year.

This team has made a significant impact on our inpatient care process, and helped implement clinical-progression rounds and electronic patient progress notes. Both of these efforts promote timely patient throughput, specific patient plans of care, and better communication practices.

This Hospitalists Team provides care for an average of 35 to 40 percent of Hartford Hospital’s patients at any one time. The hospital’s increased HCAP scores in quality metrics – from 1 to 6 over the national average in the last five years – illustrates the positive impact this team has made on patient satisfaction.

The team’s consistent promotion of standardized care has made an impact on quality and outcomes. The Department of Medicine’s low mortality rate exceeds expectations for standards of care, compared to like-sized facilities in the state.

Members of this team participate in numerous initiatives and have improved the quality of resident training. Their work continues to make a difference in how we deliver care.

Congratulations to the Department of Hospitalists Medicine Team.


Thank You for Your Support

Members of the Medical Staff contributed $165,898 to Hartford Hospital’s Annual Campaign in fiscal year 2013.

Of that, $89,803 was directed to the Medical Staff Annual Fund, which supported a summer pre-med research program, committed a donation to the Health Assistance Intervention Education Network, helped in the transformation of the Transplant Center, and more.

Thank you for your support. As we continue to realize our vision to be the regional destination provider for innovative and complex care, please consider making a gift in fiscal year 2014 to help us meet our goal of $200,000.


Hospital Auxiliary Funds Several Projects

The Hartford Hospital Auxiliary committed to funding several exciting projects this fall for a total of $125,686.

The Auxiliary awarded:

  • $38,595 to the Transplant Program for the purchase of a Sonosite Turbo Ultrasound
  • $27,243 to Women’s Ambulatory Health Services to acquire 21 new exam tables
  • $25,000 to the Stroke Center for the purchase of a 3D imaging workstation
  • $27,626 to the Ambulatory Dental Clinic for the acquisition of two new oral surgery chairs

Other recipients of funding by the Auxiliary for fall 2013 include a hemorrhage cart for Bliss 6 Maternal/Newborn, an ISTAT machine for Cardiology/Transplant, a new panini grill for Food & Nutrition Services, and brochures for the pharmacy’s medication assistance program.


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 (secure HIPAA compliant text app) To Be Provided Free For All Providers

Rollout is underway to all providers at Hartford Hospital for TigerText, a secure HIPAA compliant texting app. 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 will provide you with convenient texting functionality which:

  • Allows secure text messaging from your mobile device
  • Improves efficiency of provider communication
  • Does not require you to know other providers' cell phone numbers
  • Does not use cell phone minutes
  • Tracks the status of the message so you know if it has been read

TigerText, a closed network health care professional communication application, will enable you to use your smartphone, tablet or laptop to securely send and receive HIPAA compliant text messages and easily collaborate to make rapid, accurate decisions about diagnoses and treatments.

TigerText takes less than five minutes to install and learn, and we are delivering it directly to your mobile device. You have gotten or will get an email inviting you to download ‘Air Watch,’ and we will push Tiger Text to your mobile device via this application.

Representatives from the hospital IT Department and TigerText will be on campus during deployment to show you how it works, and will provide support after launch. In addition, there are instructional videos and documents posted on the Medical Staff pages on the intranet.


CESI Wins BEACON Medical Technology Award

Hartford Hospital’s Center for Education, Simulation and Innovation 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, to be presented at the annual BEACON members meeting Dec. 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 introduction of new devices as they become available on the market. BEACON, founded in 2000, is a non-profit trade association for the medical device industry.


Dr. Lewis Presents Plans for Bone and Joint Institute at the Honorary and Retired Medical Society Luncheon

Dr. Cortland Lewis, chief of the Department of Orthopedics, was the featured medical presenter at the Honorary and Retired Medical Society Luncheon on October 31.

He presented plans for the new Hartford HealthCare Bone and Joint Institute, which will be the first new comprehensive musculoskeletal hospital in New England in decades; and the third patient-centered, disease-specific institute created at Hartford Hospital. The first two were the Helen & Harry Gray Cancer Center and the Tallwood Urology and Kidney Institute.

Attending the luncheon were:

Drs. Morven and Peter Barwick
Ms. Ingrid Boelhouwer
Barbara and Donald Bradley, M.D.
Ann Bucknam
David Crombie, M.D.
Kenneth DeCarolis, M.D.
John Franklin, M.D.
Robert Fredrickson, M.D.
Mohamed Hassan, M.D.
Elaine and Bill Henry, M.D.
Janice Johnston, M.D.
Lydia and Alan Klatsky, M.D.
Terri and Marvin Levine, M.D.
William Macaulay, M.D.
Anita and William Mancoll, MD
Mimi and Peyton Mead, M.D.
Arthur Phinney, M.D.
Michael Reed, M.D.
Robert Rosson, M.D.
Peggy and Ruben Shapiro, M.D.
Herbert Silver, M.D.
Fay and Phillip Trowbridge, M.D.
John Welch, M.D.
Lilo and Herbert Werner, M.D.


AllenOBITUARY: Dr. Gretchen Allen

Dr. Gretchen Allen (OB/GYN) passed away Nov. 11 after a heroic battle with cancer. She was 50.

Gretchen studied medicine at the University of Vermont and completed her residency in Obstetrics and Gynecology at the University of Connecticut School of Medicine. She then settled in West Hartford to practice medicine and raise her family.

She held a variety of positions at Hartford Hospital and Community Health Services. She dedicated her life to those less fortunate and had many offers to join private practices but chose to serve those who needed it most in women’s clinics. As a result, Hartford Hospital has created the Gretchen Allen MD Community Service Award, for outstanding patient care in underserved populations.

Gretchen leaves behind her daughter, Rebecca; her husband, Steven Allen; her mother and father, two brothers; and a niece and three nephews. In addition to her family, Gretchen leaves behind a legacy of caring through her wonderful friends and colleagues, the dedicated health care professionals that studied under her and each beautiful baby that she helped deliver into this world.

In lieu of flowers, memorial donations may be made to the Hartford Hospital Women’s Health Program, Attn: Fund Development, 80 Seymour St., P.O. Box 5037, Hartford, CT 06102-5037.


HH Genetics Research Center/IOL Receive $1.25 Million Grant to Study Genetic Testing And Psychiatric Medications

The Pharmacogenetic Decision Support for Psychiatric Hospitalization Program was funded with a $1.25 million award to the Hartford Hospital Genetics Research Center (Dr. Gualberto Ruano, principal investigator ) and IOL (Dr. John Goethe, co-investigator) by the Agency for Healthcare Research and Quality (AHRQ), the leading federal agency focused on patient care and clinical outcomes.

The program addresses fundamental metrics of accountable care such as length of hospitalization, patient re-admission and drug formulary management, propelling IOL to the national center stage of genomics and personalized psychiatry in clinical practice.

This major program is significant to the mission and future of Hartford Hospital as an academic medical center in key strategic ways:

MISSION: The program exemplifies the thematic thrust of research at our Institution: Quality, Safety, Personalized Medicine in patient care. Research efforts at Hartford Hospital, the Genetics Research Center and the Institute of Living are decisively bearing fruit to improve the quality and safety of patient care at our Institution.

PORTFOLIO: The program represents the successful diversification of our research funding to federal sources outside NIH, and brings Hartford Hospital to prominence at AHRQ, the leading HHS agency focused on patient care and clinical outcomes.

INTEGRATION: The program examines the delivery of decision support from personalized medicine diagnostics to patient care via novel electronic alerts pioneered at IOL by Dr. John Goethe and coupled in the future to the electronic health record.

VALUE: The program addresses fundamental metrics of accountable care such as length of hospitalization, patient re-admission and drug formulary management.

REPUTATION: The program bolsters the credentials of IOL under the leadership of Dr. Harold Schwartz and of the Genetics Research Center under the leadership of Dr. Gualberto Ruano propelling Hartford Hospital to the national center stage of personalized medicine in clinical practice.

SCHOLARSHIP: The program coincides with the publication of the fundamental manuscript and letter to the editor establishing the feasibility of the program, Length of Psychiatric Hospitalization Correlated with CYP2D6 Functional Status in Inpatients with Major Depressive Disorder.


Hartford Hospital Receives Gold Award for Raising Organ Donation Awareness

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services has awarded Hartford Hospital with a “Gold Award” for all of the work we have done in support of raising organ donation awareness, registering new donors, supporting donor families, etc.


Dr. David Crombie Receives Distinguished Service Award From CT Chapter of American College of Surgeons

Dr. David Crombie, emeritus chief of surgery at HH and founding chair of the ethics committee was recognized at the Annual Meeting of the Connecticut Chapter of the American College of Surgeons with its Distinguished Service Award. The award recognized his contributions as a medical educator and humanitarian.


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 Dec. 18 called "Strategies to Improve Blood Utilization." Click here to register for this webinar:


Dr. Rocco Orlando Presents To American College of Physician Executives

Dr. Rocco Orlando, senior vice president and chief medical officer of Hartford HealthCare, gave a presentation on the HHC Physician Leadership Development Institute at the Fall Institute of the American College of Physician Executives on Nov. 11.


Dr. Joel Sorosky Appointed to American College of Surgeons Advisory Council

Dr. Joel I. Sorosky, chief of the Department of Ob-Gyn, has been appointed by the Board of Regents of the American College of Surgeons to serve a three-year term on the Advisory Council for Gynecology and Obstetrics as a representative for the Society of Gynecologic Oncology.


Garry Lapidus Receives Award From Coalition Against Domestic Violence

Garry Lapidus, PA-C, MPH, direcgtor of the Injury Prevention Center and Trauma Institute at Hartford Hospital, is receiving "Coalition Crusader" award from the CT Coalition Against Domestic Violence on Nov. 19. Governor Dannel Malloy and Attorney General George Jepsent will offer remarks at the ceremony.


MarkowitzCT GI Sponsors Team From Crohn's & Colitis Foundation

Connecticut GI has been a corporate sponsor this season for "Team Challenge" from the Crohn's & Colitis Foundation of America. They will be participating in the Las Vegas Rock 'n' Roll Half Marathon today.





Our Physicians Are Great Sources For Local Media

Dr. Vasanth Kainkaryam was interviewed live on Nov. 11 by Channel 3 on egg-free flu vaccine.

Dr. Kelly Johnson-Arbor was interviewed live on NBC CT on Nov. 5 to discuss carbon monoxide safety. She also appeared live on Nov. 8 on NBC CT to discuss head lice and a policy shift in many states opting not to send students home.

Dr. David Tolin and Dr. Elizabeth Davis were interviewed Nov. 6 by Ch. 3 on the Canary Trial – testing patients with panic disorders. Attached to a tablet, is a Nasal cannula which measures respiration rate as a patient is exhaling carbon dioxide. It interrupts the cycle of rapid breathing before it escalates into a full-blown panic disorder. The story aired on Nov. 13.

Dr. Len Jacobs was interviewed Nov 12 by NBC and FOX CT about the drill at CESI to train police officers from across the state in mass casualty incidents.

Dr. Adam Steinberg was interviewed on the Ray Dunaway show on Nov. 15 about bladder awareness month and new procedures for incontinence being performed at Hartford Hospital.

Dr. Stacey Nerenstone was interviewed on NBC CT Nov. 15 about the recent breast cancer diagnosis and radical double mastectomy of NBC news anchor Amy Robach.

Dr. Frederick Rau was interviewed on WFSB about endometriosis.


These physicians are scheduled to appear on Medical Rounds:

Nov. 20 - Dr. Colin Swales, fibroscan

Nov. 27 - Dr. Ryan Dorin, Movember

Dec. 4 - Dr. Len Jacobs, Hartford Consensus II

Dec. 11 - Dr. Stacey Nerenstone, MSKCC Update

Dec. 18 - Dr. Ken Robinson, winter weather safety

Research and Academics

Arrhythmia Research Presented at Conference in Italy

Dr. Dalia Giedrimiene, professor of biology and pharmaceutical sciences at the University of Saint Joseph, was an invited presenter at the Venice 2013 Arrhythmias conference in Venice, Italy on October 29. She made three presentations based on research done in collaboration with Hartford Hospital physicians Dr. Jeffrey Kluger, director of heart rhythm management; Dr. Detlef Wenker, Dr. Jason Gluck, cardiology-heart failure; and Dr. Joseph Radojevic, director of the Heart Failure and Transplant Center. More than 1,500 people attended the conference, coming from over 60 countries.

The presentations were:

  • The utilization of implantable cardioverter defibrillators in patients with chronic heart failure
  • Health care utilization by patients experiencing appropriate ICD shocks
  • Gender difference in presentation, management and survival of patients with heart failure


Medical ICU Team Participating in IMPRESS Study on Sepsis

The medical ICU team, under the leadership of Dr. Eric Shore, director of the medical intensive care unit, is participating in “The IMPRESS study” (International Multicenter Prevalence Study on Sepsis).

This international quality improvement study is aimed at determining the extent to which hospitals throughout the world are providing care according to current evidence-based guidelines.


IOL Staff Participates in Important Research on Bipolar Disorder and Schizophrenia

Staff from the Olin Neuropsychiatry Research Center at the Institute of Living participated in research and writing several recently published articles discussing the B-SNIP (Bipolar-Schizophrenia Network on Intermediate Phenotypes) study, which is challenging traditional psychiatric diagnoses.

Participating from the Olin Center were Dr. Godfrey Pearlson, director of the Olin Center; Dr. David Glahn, director of affective disorders and psychosis trials; Dr. Michael Stevens, director of clinical neuroscience and development laboratory; Dr. Pawel Skudlarski, senior research scientist; Shashwath Meda, imaging analyst; Kasey O'Neil, research assistant; and Sabin Khadka, data analyst.

A fundamental diagnostic distinction recognized by psychiatrists is that between schizophrenia and bipolar disorder, first proposed over100 years ago. However, it is increasingly recognized that substantial overlap exists between the two illnesses. In addition, known risk genes for the conditions overlap significantly and similar treatments are used to address both illnesses.

Traditional diagnostic classifications persist because no laboratory tests exist based on a solid understanding of the true cause of the disorders. In the absence of such proper biological definitions for validating these disease categories, physicians are forced to rely on clinical features, outcome and family history, although these overlap significantly.

Researchers from Baltimore, Chicago, Dallas, Detroit, Boston, and Hartford collaborated to create the NIMH-funded B-SNIP consortium to examine over 20 potential biological disease indicators in 3,000 individuals with schizophrenia and bipolar disorder, as well as their close relatives and unrelated healthy controls. Biological measures included assessments of cognition, EEG, brain structure and function using MRI, eye movement patterns and genetics.

Already, it is clear that only differences in degree of abnormality, rather than any distinctions in kind or quality of biological abnormality, characterize these illnesses. This holds true for symptoms also. Biomarkers clearly do not characterize clinical diagnoses in the way that clinicians believed, adding to diminishing support for the classic diagnostic model.

The next step in this study is twofold;
1. To see which genes underpin the various biological measurements. This views psychiatric disorders from the point of view of biology, rather than clinical symptoms.

2. To see whether the biological markers themselves cluster together in meaningful patterns in a way that might suggest new "diseases" that are more biologically homogeneous in structure than are the classic diagnoses.

Publications that the Olin Center staff contributed to are:

  • Clinical Phenotypes of Psychosis in the Bipolar and Schizophrenia Network on Intermediate Phenotypes (B-SNIP); American Journal of Psychiatry, 2013 November
  • Diffusion tensor imaging white matter endophenotypes in patients with schizophrenia or psychotic bipolar disorder and their relatives; American Journal of Psychiatry, 2013 Aug 1
  • Neuropsychological Impairments in Schizophrenia and Psychotic Bipolar Disorder: Findings from the Bipolar and Schizophrenia Network on Intermediate Phenotypes (B-SNIP) Study; American Journal of Psychiatry, 2013 June 17
  • Is aberrant functional connectivity a psychosis endophenotype? A resting state functional magnetic resonance imaging study; Biological Psychiatry, 2013 Sep 15
  • A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar Scale; Schizophrenia Research, 2011 Dec
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


Patient Safety Starts With Each of Us

Patient safety starts with each of us. Patient harm in hospitals is the third leading cause of mortality in this country. We must do better. Each one of us must do our part to prevent harm.

At Hartford HealthCare, we are embarking on a journey to become a high reliability organization with a goal to eliminate patient harm. The Connecticut Hospital Association has worked with Healthcare Performance Improvement (HPI) group to roll out an educational program about this important topic. The education is based on the science of human error and the great work done in the fields of aviation and nuclear energy safety. Hospitals across the country which have engaged HPI have seen dramatic decreases in serious safety events.

This program will be rolled out to all hospitals in Connecticut. Training sessions for our staff have recently begun and the feedback has been uniformly positive.

Involvement of the Hartford Hospital medical staff is critical to the success of this initiative. We are currently developing a focused educational session for our physicians. I hope you will be supportive of this important initiative. We owe this to our patients.

You will hear more about this over the coming months as our educational plan is rolled out.

Enhancing The Patient Experience

Voices of Our Patients: Kudos To Dr. Aized Imtiaz

Dear Dr. Markowitz,

On Oct. 7 I was admitted to Hartford Hospital. During my week stay, I received exceptional care, and I feel compelled to comment on how outstanding your facility is.

To begin with, my room in the Conklin Building was beautiful and greatly contributed to making my stay very pleasant.

The nurses and PCAs were very caring and oriented to patient comfort. Everything they did was geared toward helping me get better with a minimum of pain.

I had both a CAT scan and MRI performed. Again, the technicians and medical personnel were always concerned about my comfort.

Most outstanding of all was my attending physician, Dr. Aized Imtiaz. He brought new meaning to how a doctor should interact with his patients. He was very professional, but at the same time, treated me and my husband, who was with me everyday, as people, and not merely patients.

Day after day, he would check on me and spend time talking with us. He totally made me forget that I was a sick patient in a hospital. To me, Dr. Imtiaz is a perfect example of what a doctor should be, and I just wanted to let you know the caliber of this member of your staff.

We were very pleased with two practices that particularly stood out. When nurses changed shifts, the one going off duty brought in the new one coming on and introduced her. Very nice indeed.

The other is the security you provided for my husband when he was leaving late at night. I was very worried about him having to go alone into a dark parking garage. Your security guard drove him to his car and waited until he had left the garage. Yet another service that is geared toward patient comfort, as my concern was immediately taken away.

To sum it up; no one wants to be sick in the hospital, but the outstanding treatment that I received made my experience as pleasant as it could be.

Very truly yours,
Charlene O’Brien

Operational Update

Semi-Annual Meeting of Medical Staff is Thursday

The Semi-Annual Meeting of the Medical Staff will be held this Thursday, Nov. 21 at 6:45 a.m. in Gilman Auditorium.


Training Required To Perform Point of Care Testing

JCAHO requires training for point of care testing for fecal occult blood, urine pregnancy test and pH of body fluids. If you wish to continue to perform these tests, please contact your chief of your department to sign up for a short training module.


Appropriate Use of B10 SD Beds

Given the lack of SD beds, we must utilize our resources appropriately. Our B10SD is staffed by experienced APs 24/7 who follow all patients admitted on that unit very closely.

The APs have experienced a delay in providers approving transfers of patients out of SD to floor beds due to late decisions or delayed rounding. This proposed policy is to address this issue of delay while keeping patient safety in context

  • The B10SD APs have the liberty to make minute to minute adjustments on the plan of care for the stepdown patients, while keeping primary team in loop regarding changes.
  • APs will make decisions to move patients out of SD when medically appropriate but APs will communicate the plan to the respective team before actual transfer of patient.
  • If the patient is in ED for a longer period of time on SD status, APs will re-assess patients prior to transfer and make decisions re appropriateness of SD bed. If AP feels that patient needs to be upgraded or downgraded then they will make the changes they feel are appropriate while keeping primary team in loop.


CT Doctors' Orchestra To Perform in Support of Dental Missions

The Connecticut Doctors' Orchestra will perform a concert called "Strings for Dental Health" on Sunday, Dec. 8 at 4 p.m. in Keller Auditorium at the UConn Health Center in Farmington. The concert will support UConn dental students' mission trips to Uganda, Chile, Ecuador, the Galapagos, Honduras and Montana.

The Connecticut Doctors’ Orchestra is pleased to support this wonderful volunteer project by the UCONN dental students to serve those who have limited access to dental care.
Your tax deductible donation will help to pay for the cost of airfare, lodging, and food for the students. Checks can be made out to: UCONN Foundation – Dental Outreach.


Nominate a Connecticut Hero

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.

Questions? Contact Maryanne Pappas at


New Issue of Clinical Integration Newsletter, Connected Care, Available Here First

In the new Nov. 4 issue of Connected Care, the Clinical Integration newsletter for Hartford HealthCare, Dr. James Cardon, CEO of Integrated Care Partners and HHC chief integration officer, writes about HHC's acceptance as an ACO.

"We were accepted as an accountable care organization (ACO) in the Centers for Medicaid & Medicare Services Medicare Shared-Savings Program, an Obamacare initiative designed to lower health care costs by rewarding ACOs for effectively managing the care and health of Medicare patients who fall under the Medicare fee-for-service plan. We are among 400 such ACOs in the nation," wrote Dr. Cardon. "Our ACO has a targeted population of about 9,500 Medicare fee-for-service patients, who use HHC primary care services. Our goal is for us and for them to manage their health more effectively so they stay out of emergency departments and avoid hospital readmissions. This includes medication and disease management with a focus on wellness."

Did You Know?

Supply Cost Stats

Hartford Hospital spends $6.8 million on blood products each year.

HH In the News

New Cholesterol Advice Startles Even Some Doctors

The New York Times, Nov. 13

Steven L. Zweibel has been taking a statin drug to lower his cholesterol for seven years. It has worked, and he has suffered no problems or side effects. But, like many patients taking these drugs, he is perplexed by new guidelines on preventing heart disease and stroke — despite the fact that he is the director of cardiac electrophysiology at Hartford Hospital.

“I am very happy to be on Zocor,” said Dr. Zweibel, 47, referring to the statin he takes. “But now the real question in my head is whether I need to be on it.”

The new guidelines, released on Tuesday by the American College of Cardiology and the American Heart Association, represent a remarkable and sudden departure from decades of advice on preventing cardiovascular disease.

The guidelines tell doctors and patients to use a new online risk calculator to determine whether they need treatment. Dr. Zweibel would like to use the calculator to assess his own risk of heart attack or stroke. But it requires a person’s baseline cholesterol measurement, and Dr. Zweibel has no idea what his is without the statin.

He could, and says he probably will, stop taking the drug for a couple of months and then have his cholesterol measured. But what then? Should he stop taking the drug if the calculator says his 10-year risk of a heart attack or stroke is less than 7.5 percent, the new cutoff point for treatment?

He worries about letting his cholesterol drift up. There is dementia in his family, and cardiovascular risk factors are also risk factors for dementia.

“I wonder if Zocor could help” prevent dementia, he said. “It’s a very tough decision.”


Tainted Heroin Circulating in Greater Hartford, Health Officials Say

Hartford Courant, Nov. 1

A strain of heroin circulating in the Hartford area is believed to be tainted with animal asthma medicine and has caused three hospitalizations, a health official says.

Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital and a consultant to the Connecticut Poison Control Center, said the three people began feeling very ill after taking a particular strain of heroin. She said officials believe the heroin had been supplemented with clenbuterol, a drug commonly used by veterinarians to treat asthma in animals.

"It's pretty bad," Johnson-Arbor said. "I have not heard of anyone that's died from it, but the patients do get very sick." The patients showed up at different hospitals last week and this week in Greater Hartford, she said. So far, she said, there have been no cases reported outside the area or in any state other than Connecticut.


Urgently Needed: Urgent Care Centers

Hartford Magazine, November issue

The need to see a physician often doesn’t coincide with the doctor’s regular office hours, and that fact has given rise to an alternative. The concept of Urgent Care Centers – a walk-in clinic that treats non-life-threatening conditions – isn’t new. Their introduction in the U.S. dates back to the 1970s, but these no-appointment-needed facilities are popping up with more regularity in the Greater Hartford area. Some centers are affiliated with hospitals and primary care medical practices, while others are independently owned.

“With increased patient responsibility for health care costs and a greater co-pay for emergency care, a trip to the emergency room [that costs the patient] $600, that’s something you stop and think about,” says Dr. Kent Stahl, interim president and CEO of Hartford Health Care Medical Group that operates six centers in the Hartford suburbs. “It’s cheaper to go to an urgent care center.”

“The general trend is to economize in health care,” he says. “Urgent care is a very important part of the solution.


Hartford Hospital Auxiliary Golf Event Nets $400K For Psychiatry Unit Renovations

Hartford Business Journal, November 11

The Hartford Hospital Auxiliary's 24th Annual Benefit Golf Tournament held at Tumble Brook Country Club in Bloomfield raised more than $400,000 to benefit the “Purple Pod,” a section of Hartford Hospital's emergency department dedicated to psychiatry, which is currently undergoing renovations for expansion.


Wasted: Eating Disorders Are Worse Than Ever

Hartford Magazine, November issue

In the 1980s, television specials covered eating disorders—primarily anorexia—with intense and morbid interest. New Haven native Karen Carpenter’s death from heart failure brought on by anorexia in 1983 fanned the flames.

According to research by the National Eating Disorders Association, nearly 30 million people in the United States suffer from eating disorders. “These are not rare conditions,” says Margo Maine, a clinical psychologist who started the eating disorders program at Newington Children's Hospital in the early 1980s, ran the eating disorders program at Hartford Hospital’s Institute of Living (IOL) for eight years and is now in private practice in West Hartford. “But despite the fact that eating disorders have grown in numbers and have started to affect people we thought were immune,we still don’t pay much attention to them. That, to me, is the mystery: How we have decided to accept that eating disorders just are, instead of realizing that they are a major public health problem.”

Despite their prevalence, in many cases those suffering from eating disorders have limited treatment options. In Hartford, until last year the only local choice was the IOL program. Though long-lived—opened in 1987, it was one of the first programs in the country—it is small, offering no residential component and serving only females and adolescent boys.


Hospitals Working to Prevent Falls in the Acute Care Setting

CT Hospital Association, November 7

On November 5, nearly 100 patient safety leaders and caregivers across Connecticut participated in an exciting educational session about preventing patient falls in the acute care setting. During the day-long program, several hospitals described their fall prevention strategies.

Danette Alexander, RN, MSN, NEA-BC, and Christine Waszynski, RN, MSN, GNP-BC, Hartford Hospital, shared information about the hospital’s work to prevent falls in the emergency department. The hospital’s program included volunteer hourly rounding.

This educational program was part of Partnership for Patients, a national initiative in which all Connecticut hospitals participate. The program seeks to reduce preventable inpatient harm by 40 percent and readmissions by 20 percent by the end of this year.


State's Doctors At Odds Over Medical Marijuana: Compassionate Solution or a Reckless Leap?

Hartford Courant, Nov. 10

Years of debate and fine-tuning in the state legislature over allowing medical marijuana still have not settled all the questions Connecticut doctors have about medical marijuana. Is it, as some contend, a humane solution for patients who can't get relief from other medicines, or a reckless move toward something that hasn't been fully tested scientifically? The Connecticut State Medical Society, which has a membership of about 7,000 practicing and training physicians, opposed the bill.

"I think there's some anxiety about what the federal government's attitude will be about it," said Dr. Andrew Salner, chief of the department of radiation oncology at Hartford Hospital, who has long been an advocate for medical marijuana. Salner said he doesn't believe federal regulations will be a problem in Connecticut. "Clearly, there's a groundswell that this is the right thing to do for people who don't respond to other medications," he said.

As for dosages, Salner said, "I think each person needs to do that by trial and error to see what works for them. Generally speaking, a small amount will work." Salner said he estimates that 1 percent of the patients he sees can benefit from medical marijuana. He has for the last few years occasionally suggested it to patients.

"I'll recommend it, and some patients say, 'Oh, yeah, I know where I can get it,'" he said. "Others have said they've already tried it. And other patients say, 'I wouldn't dare, that's illegal and I wouldn't put myself or family at risk by going to someone on the street.'" A law allowing medical marijuana would eliminate that risk, Salner said. "If I tell a patient that they might benefit from medical marijuana for their nausea and pain, I put myself at risk and making that recommendation puts [patients] at risk," he said.

Dr. Kelly Johnson-Arbor, a toxicologist at Hartford Hospital, said allowing medical marijuana in the state "is a good idea in principle," but adds that she has several questions about it. For instance, how would pharmacies dispensing marijuana protect themselves against robberies, and how would residents react to a marijuana dispensary in their neighborhood? "I think there are so many details that have to be worked out," she said.


Tourniquets Gain New Respect

The Wall Street Journal, Oct. 23

The school shooting in Newtown, Conn., and the Boston Marathon bombing are prompting medical experts to change their thinking about the long-disdained technique of using tourniquets to save lives. Drawing on lessons from those attacks and battlefields in Afghanistan and Iraq, emergency-medicine doctors are recommending that rescue personnel carry tourniquets and be prepared to use them in mass-casualty events.

Now a group of surgeons is challenging that view, advocating tourniquet training not just for police officers but for teachers and others who work in public places.

Lenworth Jacobs, a Connecticut doctor, said tourniquets wouldn't have prevented the deaths of children in last December's shootings in Newtown, because so many of the wounds were to vital organs. But tourniquets, he argued, would save lives in other cases, including the recent terror attack at a mall in Nairobi, Kenya.

After the Newtown shooting, Dr. Jacobs was among the medical experts asked by the American College of Surgeons and the Federal Bureau of Investigation to draft recommendations for the best way to respond to such events. Those recommendations, called the Hartford Consensus, included a call for wider use of tourniquets.


"Life Saver" course Teaches Emergency Medical Care To Police Officers

Hartford Courant, Nov. 13

Through classroom instruction and simulations at the Hartford Hospital Center for Education, Simulation and Innovation and Wednesday's "real-world" scenarios, members of police departments around the state learned how to provide medical care to themselves, other officers and victims of critical incidents such as bombings and active shooter situations.


New Stretcher Allows Quicker Lifestar Trip From Meriden to Hartford

Meriden Record Journal, Nov. 15

A new stretcher that is compatible with Life Star will allow MidState Medical Center to cut between four to eight minutes in the amount of time it takes to transfer STEMI patients from the local hospital to Hartford Hospital, ultimately increasing their chances of survival.

Patients that have a ST-elevation myocardial infarction, or STEMI, require quick treatment because a specific blockage prevents blood from circulating in one of the heart’s main arteries. With the blockage, the heart can’t receive the appropriate oxygen supply from the blood, causing irreparable damage to the heart. MidState receives between four to six of these patients a month, according to Lynn Amarante, assistant vice president of emergency services at MidState.

The new stretchers, which cost $14,500 a piece, will allow MidState staff to prepare the patient to be transferred to Hartford via Life Star without having to waste time switching stretchers. A routine stretcher at MidState won’t fit in the helicopter, according to George Spivack, of the Cardiology Association of Central Connecticut. Spivack added that transferring a patient from one stretcher to another isn’t as simple as picking them up and moving them because of equipment such as IVs.

In the HHC System

HHS OIG Reports CMS Not Catching All Overpayments

Policy and Medicine, Nov. 6

As reported by FierceHealth, a recent report by the Office of Inspector General claimed the Centers for Medicare & Medicaid Services may not be catching all overpaid claims and therefore allowing high amounts of improper payments to persist.

The report found problems with CMS' action--or inaction--regarding improper payment vulnerabilities and referrals for potential fraud, as well as with RAC performance evaluations.

This is not the first time a criticism has been raised with a focus on RACs. In a previous story, FierceHealth noted: "Hospital and health system leaders briefed congressional staff Friday on the problems they face due to inappropriate payment denials by Medicare recovery audit contractors, AHA News reported. Steven Hanks, M.D., executive vice president and chief medical officer at The Hospital of Central Connecticut, said that despite medical need, too often RACs deny payment for inpatients on the grounds that the services should have been provided in the outpatient setting. Hospitals have appealed 96% of the denials and successfully overturned 94% of them, Hanks said. While he agreed that RACs should go after hospitals and health systems that are involved with fraudulent and abusive practices, Hanks said they should not indiscriminately deny claims."


Health Care Leaders Strive To Connect More With Community

New Britain Herald, Nov. 9

“Health care change is coming, and whether we like it or not, we want to be leaders of that change, to be proactive rather than reactive.” That is the message from Lucille Janatka, president of Hartford HealthCare’s new Central Region, which includes The Hospital of Central Connecticut and the MidState Medical Center in Meriden. Janatka is now chief executive of both facilities and retains oversight of VNA HealthCare and Connecticut Senior Health Services.

Introducing her management team this week at HOCC, Janatka stressed that in restructuring, HHC can become a leader in health care transformation while delivering high-quality care efficiently at a lower cost.

HHC made the strategic decision in September to keep ahead of health care changes by creating three regions in the state — East, Central and Hartford. Hartford HealthCare, parent organization of Hospital of Central Connecticut, is a health care network with more than 16,000 employees and $2 billion in net revenue.

For the most part, Janatka was upbeat about the reorganization. However, she said the team faces the challenge of adopting a new mind set.

“It’s not about the walls of the hospital; it’s about patients,” she said. “Our true north is the patient; that’s who we care for. When everything is flying around you and you don’t know which end is up, the reason we exist is still to give excellent patient care.”


20 Laid Off at Backus, Windham Hospitals

Norwich Bulletin, Nov. 14

Twenty senior and middle management personnel at The William W. Backus Hospital received layoff notices this week. The cuts amount to about 10 people at Backus and 10 at and Windham Hospital, Director of Communications and Community Relations Shawn Mawhiney said.

Additionally, 17 positions between both hospitals will be eliminated by leaving vacancies unfilled, Mawhiney said. Another eight are the result of retirements, resignations or transfers. The layoffs are part of a reorganization of the leadership structure being done by Hartford HealthCare, the regional multi-hospital network which includes Backus. “We’re financially strong, and none of the reductions impacts patient care,” Mawhiney said.

The move means that fewer managers will be overseeing more people, which should result in an improvement in efficiency, Mawhiney said. “It’s not a reflection on the work they did. But the regional healthcare system needs to be a regional team,” he said. “This is being done in preparation for the healthcare changes we’re expecting in the future.”

The cuts are part of 179 layoffs being implemented across the Hartford HealthCare system, Mawhiney said. The employees affected were told this week, Mawhiney said. No unionized positions are part of the layoffs, he said. Backus and Hartford HealthCare won state approval for their partnership in July.

With 213 beds, Backus is the third largest hospital in Hartford HealthCare’s network, behind Hartford Hospital and the Hospital of Central Connecticut in New Britain. Backus and Hartford HealthCare have teamed over the past 12 years to operate the state’s Life Star system, which transports about 1,400 patients by helicopter annually. Backus handles 40 percent of those calls.


Hospital Network Eliminates Managers

Meriden Record Journal, Nov. 14

Layoffs, voluntary resignations and unfilled positions in the Hartford HealthCare network announced this week have reduced senior and middle managers in local hospitals including the Hospital of Central Connecticut, which has campuses in Southington and New Britain. Among the departures was that of Clarence Silvia, president and CEO.

Lucille Janatka, CEO of MidState Medical Center in Meriden, now also leads the Hospital of Central Connecticut as president of the network’s central region.

Job reductions were part of consolidation within Hartford HealthCare aimed at eliminating redundancies among hospitals that are no longer in competition, according to officials. The changes won’t hurt patient care, they said.

“There’s a dramatic amount of change in health care,” said Rebecca Stewart, Hartford Healthcare spokeswoman. The new system “is agile and more productive.”

At MidState and the Hospital of Central Connecticut, 22 managers were laid off, 18 took voluntary resignations or retirements, and 10 positions will be left unfilled.

Throughout Connecticut, Hartford HealthCare eliminated 179 positions through layoffs, resignations and unfilled vacancies.

Stewart declined to comment on what types of jobs were being eliminated other than mentioning that Silvia was no longer with the system but will remain as a consultant for six months.


Hospitals Show Financials Gains, But Smaller Facilities Struggle

Hartford Courant, Oct. 31

Connecticut's acute-care hospitals ended the last fiscal year in slightly better financial health than in the prior year, with just five of 30 hospitals reporting losses, according to a new state report. Data filed with the state Office of Health Care Access (OHCA) shows that six hospitals had operating losses in the 2012 fiscal year – the same number as in 2011, but fewer than in 2010. When non-operating gains and losses are included, five hospitals had negative total margins, or deficits – down from eight in 2011.

The annual OHCA report paints a positive picture of the overall financial health of hospitals, highlighting that Connecticut's hospitals had a total gain from operations of about $513 million in the last fiscal year – a substantial increase, of close to 70 percent, over the prior year. Total hospital net assets also increased.

The report credits "improvement in (hospitals') financial operational performance" and a rebound in investment income, tied to the economy, for the positive changes.

But the new data also shows that several smaller hospitals are struggling. Milford, New Milford, Windham and Griffin hospitals all ended the year with deficits. The fifth hospital in that group was Saint Francis Hospital & Medical Center in Hartford.

Despite efforts to reduce reliance on emergency departments for care, statewide emergency room visits increased at a higher rate in 2012 than the previous year, climbing 3.2 percent. The hospitals with the highest emergency department volume were Yale, Hartford, the Hospital of Central Connecticut, Middlesex, MidState Medical Center and Lawrence & Memorial, all located in urban areas.

Health Care News In the Region

Hospitals at Crossroads; Can Cummings Deliver?

Hartford Business Journal, Nov. 11

The future of Connecticut's hospital system may soon be in the hands of someone who has the urgency of an emergency room nurse — fearless, quick to assess the situation with the confidence to take charge amid chaos.

In a few months, Bruce Cummings, the CEO of Lawrence & Memorial Hospital in New London, will be the new chairman of the Connecticut Hospital Association, and his ascension might be just what the health care community ordered. Cummings is no nonsense and he is not afraid to stand up for his people or the industry. Cummings already has proven he can take it and dish it back.

Other hospitals, including those in urban areas — Hartford Hospital, Bridgeport and New Haven — who face huge challenges, should be grateful that Cummings is aboard. Cummings has shown his mettle by standing his ground against the Malloy Administration recently, when Lawrence & Memorial and its unions were engaged in a dispute over recent layoffs.


Photo, Painful Memory Drives Doctor's Mission in Haiti

Hartford Courant, Nov. 2

Dr. Michael Bourque, is a leading force behind the International Medical Missions of Saint Francis Hospital and Medical Center in Hartford, whose volunteers have created a medical beachhead in the remote town of Dame Marie in western Haiti. Bourque's team makes week-long visits to the town several times a year to perform surgeries in the local hospital — the only surgeries that operating room sees all year. Now the organization is forming alliances with community and Haitian medical authorities and planning to create a sustaining presence in the coastal town of 40,000.

For his efforts, Bourque was designated, last month, as a Daily Point of Light by a national foundation that recognizes outstanding feats of public service by private citizens.

Sister Judy Carey, hospital vice president for mission integration, said the missions group is working, step by step, to create a greater medical presence in Dame Marie. They would like to interest other hospitals in sending teams and helping to train Haitian medical staff.


St. Vincent's Launches Affiliation With MD Anderson Cancer Network

Bridgeport News, Nov. 2

St. Vincent’s Medical Center has become the first and only hospital in Connecticut to become a member of MD Anderson Cancer Network, a program of The University of Texas MD Anderson Cancer Center.

This affiliation will provide certified physicians at St. Vincent’s, through the medical center and its Elizabeth Pfriem Swim Center for Cancer Care, access to evidence-based guidelines, treatment plans and best practices developed by MD Anderson experts. These are disease-specific guidelines for cancer treatment, cancer prevention, early detection and follow-up care.

This collaboration will bring new hope to local cancer patients by using protocols developed by a national leader in cancer care. For 10 of the past 12 years, including 2013, MD Anderson has ranked number one in the nation in cancer care in the “Best Hospitals” survey published by U.S. News & World Report.


Outpatient Facility Work Snags Hospital Union Negotiations

Hartford Courant, Nov. 8

With a week to go in negotiations between Lawrence+Memorial Hospital management and about 1,600 nurses and skilled technicians, the big question is: Will unionized nurses and technicians keep their jobs as more work moves from inside the hospital to outpatient facilities?

The union says about half of the 44 union members laid off by the hospital in the last year were due to work moving to outpatient facilities, in ob/gyn, behavioral health and cardiology. Most of the affected workers have been secretaries and aides.


Profit Slides at Chain Seeking to Acquire ECHN

Journal Inquirer, Nov. 6

Tenet Healthcare Corp., the for-profit hospital chain seeking to buy the nonprofit Eastern Connecticut Health Network, has reported a 32 percent drop in quarterly profits, missing analysts’ expectations.

The Dallas company said Tuesday that its third-quarter income was $28 million compared with $41 million for the same period last year, reportedly in part because of higher expenses associated with its takeover last month of a smaller for-profit hospital chain, Vanguard Health Systems of Tennessee.

Before the acquisition in a deal valued at $4.3 billion, Vanguard had initiated the bid for ECHN and its Manchester Memorial and Rockville General hospitals.


Medical Societies To Request Temporary Restraining Order Against United HealthCare

Hartford Courant, Nov. 14

Two state medical societies will seek a temporary restraining order against United healthCare from dropping more than 2,000 doctors from its Medicare Advantage network next year, their attorney said.

Roy W. Breitenbach, the attorney, said he expects to file papers seeking the order Friday in U.S. District Court on behalf of the Fairfield County Medical Association and the Hartford County Medical Association.

Breitenbach said federal Judge Stefan Underhill will probably hold a hearing on the matter the week of Nov. 25 .If granted, the restraining order would be in effect until Underhill begins hearings on a lawsuit filed last week by the two medical societies against UnitedhealthCare. That lawsuit seeks a permanent injunction that would allow doctors to continue to be in UnitedhealthCare's Medicare Advantage network.

Dr. Bollepalli Subbarao, president-elect of the Hartford County Medical Society, said the temporary restraining order wouldn't completely relieve the anxiety that some patients have about losing their doctors. It would mean that any changes wouldn't take effect as abruptly as UnitedhealthCare has planned.

"It creates a kind of limbo situation, but at least the doctors are treating their patients and the attention to care is going to go on while this thing is being resolved," Subbarao said.

Hot Topics in Health Care

Grading a Physician's Value - The Misapplication of Performance Measurement

NEJM, Nov. 6

Perhaps the only health policy issue on which Republicans and Democrats agree is the need to move from volume-based to value-based payment for health care providers. Rather than paying for activity, the aspirational goal is to pay for outcomes that take into account quality and costs.

In keeping with this notion of paying for value rather than volume, the Affordable Care Act (ACA) created the “value-based payment modifier,” or “value modifier,” a pay-for-performance approach for physicians who actively participate in Medicare. By 2017, physicians will be rewarded or penalized on the basis of the relative calculated value of the care they provide to Medicare beneficiaries.

Although we agree that value-based payment is appropriate as a concept, the practical reality is that the Centers for Medicare and Medicaid Services (CMS), despite heroic efforts, cannot accurately measure any physician's overall value, now or in the foreseeable future. Instead of helping to establish a central role for performance measurement in holding providers more accountable for the care they provide and in informing quality- and safety-improvement projects, this policy overreach could undermine the quest for higher-value health care. Yet the medical profession has been remarkably quiet as this flawed approach proceeds.


The Importance of Foreign-educated Health Workers in the US Health System

Medical News Today, Nov. 6

Foreign-educated and foreign-born health professionals play a vital role in the U.S. health care workforce, but strategic shifts such as changes in immigration laws may be needed to stabilize the nation's health workforce, according to a new RAND Corporation study.

The two groups fill important gaps in the U.S. health care workforce, particularly among primary care physicians, nurses in hospital settings and other areas with worker shortages, according to findings published in the November edition of the journal Health Affairs.

However, continuing to rely on foreign-educated and foreign-born health workers may reduce incentives for the nation to address problems such as the inadequate supply of primary care physicians and lead to a less-stable U.S. health care workforce, researchers say.

Physicians who were educated outside the United States account for about 25 percent of the U.S. physician workforce, with the largest groups being from India, the Philippines, Pakistan, Mexico and the Dominican Republic.


Making the OR Accountable

Hospitals & Health Networks, Nov. 7

The value proposition of health care reform is simple: Greater collaboration will result in better care for less money. So far, the attention has been on cutting the cost of chronic disease. But in the hospital, one of the biggest challenges lies in the operating room.

Surgical services account for about two-fifths of hospital expenses and more than two-thirds of hospital income. At the same time, surgery is a considerable source of outcome risk. If collaboration falters in the OR, hospital-led accountable care organizations will be unable to deliver fully on the "more for less" value proposition.

What is standing in the way? A century of poor relations between hospitals and surgeons.

Coming Events

November 21 (Thursday)

Annual Meeting of the Hartford Hospital Corporators

Heublein Hall, 11:45 a.m.-2 p.m.


November 21 (Thursday)

Semi-Annual Meeting of Medical Staff

Gilman Auditorium, 6:45 a.m.


November 21 (Thursday)

Emergency Medicine Grand Rounds

Gilman Auditorium, 12 p.m.

Dr. Isaac Silverman, Hartford Hospital Stroke Center: Stroke Update


November 21 (Thursday)

Psychiatric Grand Rounds

IOL Commons Building, Hartford Room, 12 p.m.

Dr. Steven Sandler, Albany Medical Center: Short-term Dynamic Psychotherapy


December 4 (Wednesday)

Hartford Hospital Staff Holiday Party


December 6 (Friday)

Surgery Grand Rounds

Gilman Auditorium, 6:45 a.m.

When Worlds Collide: Surgical Patients with Concurrent Stroke – Current NeuroEndovascular Therapies

Dr. Gary R. Spiegel, co-medical director of the Hartford Hospital Stroke Center and director of Neurointerventional Surgery at Hartford Hospital; and Dr. Lauren Sansing, assistant professor, Department of Neurology and Neurosurgery, and director of Translational Cerebrovascular Research at Hartford Hospital


December 10 (Tuesday)

Schwartz Rounds

Gilman Auditorium, 11:30 a.m.

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


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. Jeffry Nestler, Medical Staff President, at (860) 836-7313.