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


Free CME for License Renewal: Click here for instant access

In This Issue... July 20, 2014 Edition

Wash In - Wash Out









Improving hand hygiene remains a top priority for Hartford HealthCare. Significant progress continues.

In June, Hartford Hospital achieved 85 percent hand hygiene compliance with 83 percent entry rate, 87 percent exit rate.

It is vitally important physicians perform hand hygiene each time and gently and consistently reinforce compliance with colleagues.

Click Headlines Above to Read Full Story

Note: Some stories may link to content on the hospital's Intranet.
If a login screen appears, simply enter your Novell username/password.



"This year, Hartford Hospital celebrates 160 years of medical firsts and continues to deliver excellent, compassionate care to the communities we serve."

- Dr. Stu Markowitz, President


HH Facts and Firsts:

2006 - For the first time in New England, Dr. Robert Gallagher took out a small anterior mediastinal mass and some lymph nodes with the robot. It was the first general thoracic robotic case in New England.




Follow Hartford Hospital on facebook, youtube and twitter


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.



Also, we have put in place a dedicated email box for the medical staff, called "Ask Jack." The emails will be picked up each day, and I will be responsible for making sure that you receive feedback. Send your concerns to


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


Coding Tips

Accuracy in coding is imperative as it drives reimbursement in addition to quality and mortality metrics.

What impacts the diagnoses coded on discharge?

Present on Admission - Consistency - Accuracy

Determining the Principal and Secondary Diagnoses:

The principle diagnosis is the condition chiefly responsible for the patient’s admission.  Secondary diagnoses are all conditions that coexisted at the time of admission, developed subsequently, or affected the treatment received and/or the length of stay.

Your role to achieving accurate coding:

  • Maintain a well-documented, accurate record.
  • Document all possible, probable or likely diagnoses being evaluated and/or treated.
  •  Avoid the use of “versus.”
  • Be sure to include when a suspected diagnosis has been ruled in, ruled out, or resolved.
  • Specify if a condition is acute, chronic, or acute on chronic.  
  • No surprises in the Discharge Summary. 

State if conditions such as infection or VTE are present on admission. 

These diagnoses will be coded as a hospital acquired complication if not clearly identified as POA. Hospital acquired complications impact reimbursement as well as physician and hospital quality data.

Establish any underlying etiology link. 

Key words to use are “due to”, “with”, “secondary to” to clearly indicate the clinical connection. 

Coders may not code from orders, abnormal lab results, abnormal radiographic reports, pathological findings, EKG or other cardiovascular tests.  All results, interpretations, and findings need to be confirmed and documented in the progress notes by the physician. 

Review progress notes and other documentation by colleagues and providers you supervise and document your agreement or clarification as needed.  The attending physician has ultimate responsibility of the record.


GreeneInauguration of an Attending-staffed Acute Care Surgery Service Will Occur in September

By Dr. Orlando Kirton

After two and a half years of discussion, planning and a series of hires, the inauguration of an attending-staffed acute care surgery service [with dedicated OR block time] will occur in September 2014.

The current White General Surgery Service will be the clinical infrastructure home for the new Acute Care Surgery (ACS) service. ACS is the evolution of the specialty trauma surgery to a broad-based inpatient specialty that includes trauma, surgical critical care and emergency (acute) general surgery.

Furthermore, acute care [emergent] general surgery is undergoing formalization to an evidence based practice. I draw your attention to the commentary which appeared in the Spring edition of the American Association for the Surgery of Trauma (AAST - the national organization that is leading the transformation of trauma surgery into ACS) newsletter authored by Dr. Shalid Shafi, chair of the patient (injury) assessment and outcome committee of the AAST.

I also include two articles published in the past two years in the Journal of Trauma and Acute Care Surgery:

1) Emergency general surgery : Definition and estimated burden of disease

2) Measuring anatomic severity of disease in emergency general surgery

I want to thank those who worked with me on the Acute Care Surgery Steering Committee for their hard work and perseverance: Drs. Paul Vignati, Karyn Butler, D’Andrea Joseph, Bill Sardella, and Jeff Cohen.

From the President of the Medical Staff

Save the Date: Medical Staff Town Hall Meeting, Sept. 24

NerenstoneDr. Stacy Nerenstone

Please save the date for an upcoming Medical Staff Town Hall Meeting – Wednesday, September 24 from 6:30-7:30 a.m. in Gilman Auditorium. It will be well worth your hour.

Dr. Stu Markowitz, Jeff Flaks, Elliot Joseph and myself are all planning to be there, and answer any questions or concerns you may have.

I will accept questions for the meeting beforehand, as well as open questions from the floor. If you have something on your mind that you would like to have addressed, please email it to me at

It promises to be an interesting and enlightening time. I hope you will join us.

Top News

Hartford Hospital Earns High Marks From U.S. News & World Report, Others

  • In the recent U.S. News & World Report listings, Hartford Hospital had more categories ranked higher than any other hospital in the state, and was ranked the second top hospital in the state (after Yale-New Haven) .

    Hartford Hospital led all other Connecticut hospitals with a high-performance ranking in 11 specialties, two more than 2013. The specialties are cardiology and heart surgery, diabetes and endocrinology, gastroenterology and GI surgery, geriatrics, gynecology, nephrology, orthopedics, pulmonology, urology, cancer (new this year) and psychiatry (new this year).

    In addition, the U.S. News ranking wrote that HH "scored high in patient safety, demonstrating commitment to reducing accidents and medical mistakes."


  • In addition, CareChex rated Hartford Hospital first in the state for cancer care, women’s health, and heart attack and stroke care. We are rated among the top 100 in the nation in medical excellence and patient safety in cancer care, heart-attack treatment, gall-bladder removal and pneumonia care. CareChex is the quality-rating system for Comparion, a privately held health care information service company.


  • Hartford Hospital was also named 22nd among the 30 most technologically advanced hospitals in the world by Top Master's in Healthcare Administration.


  • Also, Hartford Hospital received a gold level of achievement from the U.S. Department of Health and Human Services for its organ donor recruitment activities through LifeChoice Donor Services. HH was one of 400 hospitals awarded recognition. Three other HHC facilities also received awards: William Backus Hospital - silver; MidState Medical Center - bronze; and Windham Community Memorial Hospital- bronze.


BHN Chosen as Centralized Hub for ACCESS, Providing Child Psychiatry Consults to PCPs

The Hartford HealthCare (HHC) Behavioral Health Network (BHN) has been chosen by ValueOptions and the Connecticut Department of Children and Families as one of three centralized hubs for the ACCESS-MH CT program, providing consultative psychiatry services to primary care physicians treating children and adolescents in Connecticut.

Services based at the HHC BHN hub became available to pediatricians in 78 Connecticut towns on June 16, 2014. Additional hubs serving Connecticut’s children are based at Wheeler Clinic and the Yale Child Study Center.

Dr. Kim Brownell, a former pediatrician turned child psychiatrist, has been named the medical director of the HHC BHN hub.

Serving approximately 272,000 children, the HHC IOL ACCESS-MH CT hub includes the city of Hartford as well as all municipalities east of the Connecticut River. This provides a naturally strong service partnership between the IOL and other HHC BHN affiliates, including Natchaug Hospital, Rushford and the behavioral health departments of the Hospital of Central Connecticut, MidState Medical Center, and The William W. Backus Hospital.

“This program is about the relationship between a child’s primary care provider and the child psychiatrists within the HHC BHN who will support them either through telephone consultations or seeing their patients in person when a face-to-face consult is necessary,” said Dr. Brownell.


Hartford HealthCare Creates New Centers for Surgical Weight Loss

Hartford HealthCare has strengthened its surgical weight loss programs in the Central and Hartford regions by creating one Hartford HealthCare service line. This single program has one common standard of care, a single point of entry and access to five highly experienced bariatric surgeons with integrated multi-disciplinary health care teams. A new name and logo have been developed to reflect the breadth and scope of our services, including multiple locations.

The enhanced program will now be called Hartford HealthCare Centers for Surgical Weight Loss – the largest in Connecticut. Information sessions will be offered regularly in Hartford, Enfield, Glastonbury, South Windsor, Meriden, New Britain, Bristol and Farmington – with one phone number as the access point to all services (1-866-668-5070). Our ability to reach more patients will increase at the community level with our new program structure. There will also be a landing page at

Patients are encouraged to complete presurgery consultations with their local providers, whether through a Hartford HealthCare Medical Group physician, or their private physician.

Surgery is performed at Hartford Hospital and MidState Medical Center. Patients will be seen locally by bariatric surgeons at one of our locations, which are fully supported by physicians, nurses, medical assistants, mid-level practitioners and administrative staff. At Hartford Hospital, Drs. Pavlos Papasavas and Darren Tishler adjustable band, gastric bypass and sleeve gastrectomy. At MidState Medical Center, gastric bypass and gastric sleeve are performed by Drs. Aziz Benbrahim, Edward Hannoush and Nicholas Verdura. For appropriate candidates, Dr. Hannoush offers adjustable gastric banding.


Improper Vaccine Storage Discovered at Four HHC MG Offices

Four Hartford HealthCare Medical Group offices recently discovered that 5,003 doses of vaccines given from Jan. 1, 2013 to the present to 3,833 patients at locations in Enfield, South Main/West Hartford, Storrs and Unionville may not have been stored in accordance with the manufacturers’ recommended temperature guidelines. Slight fluctuations in storage temperature are normal. However, we believe that the temperatures at issue may have been out of range long enough to reduce the effectiveness of these vaccine doses. No other Hartford HealthCare Medical Group locations have had temperature-control issues.

The vaccine doses in question are not harmful. However, our physicians are likely to recommend that patients be revaccinated to be fully protected against vaccine-preventable diseases. We are reaching out to every patient who received a vaccine that might have been compromised to answer questions and offer appointments for them to receive the appropriate vaccination, if needed, at no charge.

We are asking patients to contact their primary care providers for further information. In addition, patients and family members may call our information hotline at (877) 707-4442 and consult the following website:

This incident is the result of a lapse in our safety practices. However, the discovery and ongoing resolution of this problem is a tribute to our H3W behaviors. Staff members brought the issue to light and Hartford HealthCare Medical Group leaders and staff members – as well as colleagues across our system – teamed up to thoroughly analyze the situation and appropriately care for our patients and families. In addition, the medical group is providing further training to its vaccination specialists and has assessed – and will continue to monitor – the effectiveness of all of its refrigeration units to ensure that all vaccines are being properly stored.


New Ad Campaign Promotes HHC Cancer Institute and MSK Alliance

Hartford Hospital has joined the other four Hartford HealthCare (HHC) cancer centers in rolling out a new ad campaign promoting our membership in the HHC Cancer Institute and our membership in the Memorial Sloan Kettering Cancer Alliance. The five cancer centers are located at Hartford Hospital, Backus Hospital, MidState Medical Center, The Hospital of Central Connecticut and Windham Hospital.

The ads emphasize that the HHC Cancer Institute is working across the system to provide a single standard of the best possible care for patients, right in their own communities. The ads focus on nurse navigators at each center.

In the Hartford Region, the ads feature the five navigators from Hartford Hospital. The ads also promote Cancer Connect - a phone line that provides information about cancer treatment options, educational events, support services, cancer screenings and general information.

The campaign kicked off with newspaper ads June 29 and a social media blitz on Facebook and Twitter June 30.


Dr. Kent Stahl Named VP for Physician Network Development for ICP

On July 7, Dr. Kent Stahl moved from his position as vice president for primary care of Hartford HealthCare Medical Group to become vice president for physician network development for Integrated Care Partners (ICP). Dr. Stahl is a veteran of Hartford Hospital and Hartford HealthCare, having held various leadership posts since 1995.

In his new role, he will take the lead both in supporting current physician members as they work to transform care and also in recruiting new physicians into ICP (and into Hartford HealthCare Medical Group, when appropriate). One of our most important goals is to expand our primary care capacity.


Chief Financial Officer Thomas Marchozzi To Leave HHC

Thomas Marchozzi, HHC executive vice president and chief financial officer, has announced his decision to leave Hartford HealthCare. He will relocate to New Jersey to be closer to his family.

He has agreed to provide transitional support through the remainder of this fiscal year. Gerald Boisvert, system vice president for finance, will serve as interim CFO. We will conduct a thoughtful and deliberate national search for this important position.

During his six years in the senior financial leadership role of our organization, Marchozzi has been instrumental in creating management systems and developing processes that have enabled us to lead and innovate. His work began with the financial turn-around of Hartford Hospital – an effort that culminated in an across-the-board “A” rating for our bonds, reflecting our system’s fiscal strength and stability. His strategic thinking has been instrumental as we form the state’s first true integrated health care delivery system, with state-of-the-art information and finance systems.


June Finances: On Budget; Up From Last Year

Inpatient volumes based on discharges for the month of June were on budget.  The comparison to the prior year shows June, 2014 discharges approximately 3.1% above the prior year.  Outpatient revenues exceeded budget by 4.1% for the month.  The favorable outpatient revenue variances were in Cardiology and Radiology services.                 

Through the first nine months of fiscal year 2014, inpatient discharges were above budget by 0.6% and were 2.1% greater than the prior fiscal year.  Outpatient revenues were 4.2% above budget for the nine months ending June, 2014.   Year to date, the favorable outpatient revenue variances continue to be in Radiology, Cardiology, Perioperative, Emergency and Laboratory services. 


Stop the Stigma of Mental Illness

We are asking all HHC medical staff to take a pledge and sign their name to the following:

  • I pledge: To teach by sharing my own experiences with mental illness and encouraging others to share their stories with me; I will learn in order to change.
  • I pledge: To show compassion by reaching out to those in need of help; I will not let anyone suffer in silence.
  • I pledge: To have the courage to speak up and challenge stereotypes and attitudes; I will not tolerate or perpetuate stigma.
  • I pledge: To demand a change in how we view and address mental illness; I will help lead the way.

The goal is to obtain 10,000 individual pledges, spreading the message that changing attitudes can begin to change minds. So far, more than 9,600 have taken the pledge.

Ask everyone — fellow employees, volunteers, patients, the community — to “take a pledge.” It is online now at


First Iliac Pacemaker Implant at Hartford Hospital

The first iliac pacemaker implant at Hartford Hospital took place on July 9.

The procedure was performed by Dr. Edmond Cronin, interventional electrophysiologist, assisted by Dr. Steven Zweibel, director of Electrophysiology.

The iliac route is an option for patients requiring a pacemaker or ICD but with contraindications to implant via the usual subclavian vein route on both sides. The patient had prior bilateral mastectomies, making both subclavian veins unsuitable for use for the procedure.

Dr. Cronin, who has previously authored a book chapter on the technique, has a special interest in lead management, lead extraction and alternative device implant techniques.


Drs. Kluger and Parker Work With Team To Devlop Scoring System for ICD Safety

Hartford Hospital cardiologists Drs. Jeffrey Kluger and Matthew Parker, along with former Hartford Hospital cardiology fellow Nitesh Sood, collaborated with researchers at the University of California San Diego, Yale University, and Duke University to develop a scoring system for inadequate defibrillation safety margin using data from 132,000 patients receiving implantable cardioverter defibrillators (ICDs).

The findings were published in the July 14 issue of the Journal of the American College of Cardiology and featured at



Our Physicians Are Great Sources For Local Media

Dr. Rebecca Beebe was interviewed on WNPR's All Things Considered on July 17 about domestic violence.

Dr. Andrew Caputo interviewed on Channel 3 July 6 and on WTIC AM on July 11 to preview/promote ERRACE - ride/run against cancer.

Dr. Vasanth Kainkaryam was interviewed on NBC CT July 15 about administering medications to children.

Dr. Caleb Peck was interviewed on Channel 3 on July 8 about ADHD being more common in women.

Dr. Andrew Salner was interviewed on WTIC on July 8 about medical marijuana.

Dr. Paul Thompson was quoted in the Wall Street Journal on June 23 in a story about heart tests for young athletes. Read it here.



You can always view a list of media interviews on the website under Hartford Hospital Making Headlines.

Academics and Research

AutoGenomics and Genomas Announce Strategic Partnership for the Development of DNA-Guided Diagnostic Systems for the Treatment of Cardiovascular Disease, Obesity and Diabetes

Market Watch, July 7

AutoGenomics, Inc, a leader in automated microarray technology for molecular diagnostics, and Genomas, a biomedical company enabling DNA-guided medicine for personal healthcare, have signed an agreement to jointly develop genetic tests and DNA-guided diagnostic systems for optimal selection of statins and for improved delivery of statin therapy for the treatment of cardiovascular disease, obesity and diabetes.

This pioneering collaboration will provide clinicians and physicians with newly developed genetic tests and a decision support system which will allow them to manage statins, prescribe and dose these drugs on a DNA-guided, personalized basis to more effectively guide the therapy for each patient.

According to the Center for Disease Control and Prevention, there are currently more than 71 million American adults (over 20 years of age) with high LDL and it is estimated that over 43 million Americans are currently prescribed the statin class of cholesterol lowering drugs. However, statin LDL-lowering drugs can cause muscle aches, cramps and muscle weakness, and if not controlled, can lead to muscular injury. The newly developed DNA-guided statin diagnostic tests are designed to identify individuals who are genetically susceptible to muscle pain (myalgia) while on these statins and who may develop muscular injury (myopathy) while on high dose statin therapy.

Gualberto Ruano, M.D., Ph.D., President of Genomas and Director of Genetics Research at Hartford Hospital said, "The SINM PhyzioType® System combined with AutoGenomics' INFINITI® multiplexing genetic test platform will enable cardiologists and clinicians to manage the variable lipid-altering efficacy and the risk of neuromuscular side effects that are prevalent in high-risk patients with heart disease and diabetes."

Paul D. Thompson, M.D., Chief of Cardiology at the Henry Low Heart Center of Hartford Hospital commented: "Growing evidence indicates that genetics determines who develops muscle complaints with statins. The partnership will allow us to pursue the final implementation studies of the multi-gene biomarker system to personalize cardiovascular therapy."

Read more here.


Updates in Liver Disease for the PCP

September 13 (Saturday)

Join Hartford Hospital Comprehensive Liver Center experts as they present cutting-edge diagnostic and treatment information at this half-day conference, Saturday, Sept. 13 from 8 a.m.-12 p.m. in Gilman Auditorium.

Faculty will be Drs. Michael Einstein, Eva Urtasun Sotil, Jonathan Israel, and Colin Swales.

Effective Oct. 1, 2014, Connecticut primary care providers will be required to offer patients born between 1945-1965 a hepatitis C screening test. Early screening and detection of liver disease may result in improved outcomes.

Cost is $50. Register online at or by phone 860-545-1888 or toll free 800-545-7664. For more information, contact Regina Radikas at


30th Annual Cardiovascular Symposium

SAVE THE DATE: Wednesday, Oct. 8

The 30th Annual Cardiovascular Symposium will be held on Wednesday, Oct. 8 at the CT Convention Center.

Speakers include: Dr. Christine Albert, Dr. Joshua Beckman and Dr. Christopher Cannon from Brigham and Women's Hospital; Dr. George William Dec, Jr. from Massachusetts General Hospital Heart Center; Dr. Jennifer Mieres, North Shore-LiJ Health System; Dr. Vivek Reddy from Mount Sinai Medical Center; and Dr. Jeffrey Rich from Sentara Norfolk General Hospital.

7:30 a.m. - 3:30 p.m. Fee is $75 for physicians, $30 for non-physicians; free for residents, fellows and medical students.

For more information and registration, click here.


9th Annual Interdisciplinary Transplant Symposium

SAVE THE DATE: Thursday, Nov. 6

The 9th Annual Interdisciplinary Transplant Symposium will be held on Thursday, Nov. 6 at the Sheraton Hartford South Hotel in Rocky Hill. Details to follow.

Voices of Our Patients

Voices of Our Patients: Kudos to Dr. Peter Barnett

I recently had a total shoulder replacement performed by Dr. Peter Barnett.

This is the first time I have been in Hartford Hospital. I have been in Bridgeport, St. Vincent’s, Stamford and Danbury Hospitals, and I was the caregiver for my mother in the last five years of her life - thus I am familiar with the hospital setting.

One thing I learned from my experience with institutionalized medicine is that it is the caring, kindness and the desire to help of the caregivers that makes the difference.

I must share with you how extraordinary your staff was. They exhibited in spades the following: kindness, personal care, continual explanation of what was being done to me (and knowledge is a very necessary placebo); and a strong desire to make me better.

What really amazed me was that this behavior was across the board, it was consistent, and I saw it with other patients.

I do not remember the names of all the personnel in pre-op as I was a bit out of it, but I do remember the kind actions.

I do remember the ward staff: nurses Caitlin and Chrissy, the patient techs Tomarra and David, and the PA Lisa.

For this level of care, I must say thank you.


Dennis Spector

Operational Update

Capital Campaign Nears $30 Million

Hartford Hospital's Capital Campaign, under the leadership of Geo Estes, is nearing the $30 million mark.

All hospital vice presidents have made personal commitments to contribute, which is an important endorsement of our hospital and sends a strong message to our hospital family and the community.


July Network News Available Here

Click here for the July issue of Network News.

Highlights include: Our urgent care locations featured in a HealthyU article, and the ribbon cutting for HH's Storrs Family Health Center.


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.” Follow this link for instant access.

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.


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.

High Reliability Training

High Reliability Training Sessions for Physicians

Sessions for physician training in high reliability training are scheduled. All doctors who go into the hospital should plan on taking the 90-minute course.

Pick a time today! Email to register.

Sessions will be held in JB-118 on Wednesday, August 13 from 6:45-8:15 a.m. and Thursday, August 14 from 5:30-7 p.m.

ICP News

ICP News! An Example of Managing Population Health

Please find attached the July issue of ICP News.

This month’s feature story is: ICP launches employee population health-management program; Plans to expand into the community

Read what ICP is doing and what it means for you.

HH In the News

Children Stuck in Crisis - CT's Psychiatric Emergency Gets Worse

CT Mirror, July 10

The number of children and teens going to emergency rooms in mental health crisis, some waiting days for an inpatient bed, has been growing for more than a decade.

Dr. Lisa Namerow called it a crisis several years ago when there were five kids spending four days in the ER at Connecticut Children's. Now it’s worse. Some days this spring, there were 20 kids waiting for a place to go or for an evaluation. And the number waiting three or more days in the ER has reached new highs.

“We’re running out of adjectives,” said Namerow, a child and adolescent psychiatrist at the Institute of Living who directs the child psychiatry consultation services at Connecticut Children’s in Hartford.

Because there weren’t always enough rooms for all the children with mental health needs, some stayed on stretchers in the hallway. Parents stayed overnight in their children’s sparse rooms or slept on Barcaloungers in the hallway between kids in stretchers.

“It’s like walking into a train station sometimes,” said Dr. Lynn Mangini, a child and adolescent psychiatrist at the Institute of Living and Connecticut Children’s.

Read more here.


Rubber Band Bracelets Bring Smiles, Hope To Cancer Patients

Hartford Courant, July 10

Although rubber band bracelets are a trend at their school, Keeley Joyal and Lindsay Masamery had more than fashion in mind when they started making the bracelets by the dozen. On Thursday, the two girls went to Hartford Hospital to deliver nearly 500 of the bracelets to cancer patients.

The idea for the bracelets began when Keeley's mother, Katie, was diagnosed with stage four colon cancer in May. The only piece of jewelry Katie Joyal could safely wear to treatment was a rubber bracelet. So Keeley decided to start a bracelet-making club.

Keeley, 10, involved best friend Lindsay, 11. The two live across the street from one another in Somers and have been friends since birth. They share a special bond, both having been affected by cancer. Lindsay's mother, Julie, was diagnosed with stage three breast cancer in 2009 and is currently in remission. Katie Joyal continues to undergo treatment.

Dr. Andrew Salner, medical director of the cancer center, said he was impressed by the girls' creativity and compassion. An act like this "really enriches the lives" of cancer patients, he said.

"What a great thing to take an experience that is traumatic, like your mother being diagnosed with cancer, and turn it into an expression of love," Salner said.

Read more here.


Yale-New Haven Tops Connecticut Hospitals In Magazine's Latest Ranking

Hartford Courant, July 15

Yale-New Haven Hospital ranked No. 1 in Connecticut in the latest best hospitals ranking released July 15 by U.S. News & World Report.

Hartford Hospital placed second in the state.

None of the hospitals in Connecticut appeared on the overall national Honor Roll, a list of the nation's best 17 hospitals, led by Mayo Clinic in Rochester, Minn. Yale-New Haven, however, was ranked nationally in 11 of 16 specialty categories. Each category lists the top 50 hospitals nationwide. Yale-New Haven's top national rankings were No. 7 in diabetes and endocrinology — it was No. 6 last year — and No. 11 in psychiatry, same as last year.

Hartford Hospital, which placed second in the state, led all Connecticut institutions with a high performance ranking in 11 categories.

"It is an honor to be recognized once again as being among the best in the region," Stuart Markowitz, president of Hartford Hospital and senior vice president of Hartford HealthCare, said in a prepared statement. "It solidifies our reputation for excellence in several service line areas, thanks to the steadfast dedication of every single Hartford Hospital staff member to deliver the best care in the safest environment."

Read more here.

In the HHC System

Co-pay cap on breast screenings is lauded

New Britain Herald, July 13

Lt. Gov. Nancy Wyman recently visited The Hospital of Central Connecticut Imaging Center in West Hartford, where she met with supporters of a new law that will cap insurance co-payments for breast health ultrasound screenings at no more than $20.

The event at Blue Back Square celebrated the legislation’s passage and enactment. On June 6, Gov. Dannel P. Malloy signed Senate Bill 10, PA 14-97, an Act Concerning Copayments for Breast Ultrasound Screenings and Occupational Therapy Services. It will go into effect Jan. 1, 2015.

Speakers at the imaging center included Wyman; HOCC Director of Breast Imaging Jean Weigert; state Sen. Joseph J. Crisco Jr., D-17th District; state Rep. Sandy Nafis, D-27th District; and Nancy Cappello, executive director of Are You Dense Inc.

Read more here.


Backus names new head of hospitalist program

New London Day, July 9

Dr. Naomi Nomizu has been named chief of the hospitalist program at The William W. Backus Hospital.

Nomizu began working as a full-time hospitalist in 2009 and was named associate chief hospitalist in 2010. She earned her medical degree from the Brown University School of Medicine and completed her residency in internal medicine at Miriam Hospital in Providence.

"Dr. Nomizu combines an excellent clinical acumen coupled with administrative experience, both key ingredients for success in operations, quality assurance and leadership,” Backus Medical Director Dr. Robert Sidman said in a news release.

Dr. Maria Goral, a hospitalist at Backus since 2009, has been named the program’s new associate chief.

Health Care News In the Region

Portal gives Backus patients access to their medical records, other health information

Bristol Press, June 24

More than 1,000 William W. Backus Hospital patients have signed on to a high-tech, secure Internet portal to access medical records and information through a cutting edge system launched in the spring.

“I think it’s really going to take off. It’s already grown very quickly,” said Michael Cushing, a senior applications system manager at Backus and architect of the hospital’s Backus Patient Portal, which provides details such as immunization histories, diagnostic imaging results and current medications.

Patients can also review appointments, but the portal still doesn’t have the ability to allow them to be scheduled.

Since the portal’s mid-May introduction, 1,200 patients or people with access to patients have enrolled. The project is unique to Backus, though its parent company Hartford HealthCare expects to have a single portal in place for all of its facilities within a few years.

Read more here.


Saint Mary's Hospital To Be Acquired By Tenet Healthcare

Hartford Courant, July 8

A Texas-based hospital chain that is buying four Connecticut hospitals said in a surprise announcement Tuesday it will add a fifth to its roster: Saint Mary's in Waterbury.

Connecticut's legislature this year passed a bill allowing for-profit hospitals to employ doctors, removing a hurdle that jeopardized Tenet Healthcare Corp.'s plans to buy four nonprofit hospitals in Connecticut: Waterbury, Bristol, Manchester Memorial and Rockville General.

Tenet Healthcare said it had been in talks privately with executives at Saint Mary's for some time, but the hospital's board had to approve the acquisition, which it did last week.

Read more here.


Day Kimball Hospital earns high quality rating

Hartford Courant/Reminder News, July 7

A preliminary report issued by the Centers for Medicare and Medicaid Services indicates that Day Kimball Hospital, part of the Day Kimball Healthcare (DKH) integrated system, has earned a "two" rating in the Hospital Acquired Condition (HAC) Reduction Program, which is the second best score among 30 Connecticut hospitals. New Milford Hospital earned a score of one.

According to Kaiser Health News, Medicare calculated preliminary HAC scores from one to 10, "…with the higher number indicating that the hospital had a greater rate of patient harm." Hospitals with scores of seven or more are in jeopardy of being penalized with lower Medicare reimbursements as part of the "pay for performance" standards initiated in the 2010 Patient Protection and Affordable Care Act.

The three measures that Medicare is using to calculate the HAC scores are: Central Line-Associated Bloodstream Infections, Catheter-Associated Urinary Tract Infections, and Serious Infections (of which there are eight types).


Opinion: Tenet Plan Seems Best

Republican American, July 15

Back in the good old days — the summer of 2008 — when Waterbury's two hospitals were talking about merging, Martin G. Morrissey, a former board member, chief financial officer, chief operating officer and interim chief executive officer for Saint Mary's Hospital, wrote an op-ed column in which he offered a reality check: "Saint Mary's and Waterbury Hospital ... compete in a one-hospital-sized market."

Agreed orthopedic surgeon William F. Flynn Jr., in a letter to the editor published nearly four years later: "Under the current dynamic, the hospitals compete in a market that is much more suitable for a single hospital, and they face enormous financial pressures that have become commonplace for independent community hospitals."

Both men advocated merging Saint Mary's and Waterbury hospitals, and building a state-of-the-art medical center in the Brass City. Hospital officials have conceded the current arrangement of two separate institutions, both nonprofit, is unsustainable. But merger plans have fallen through, in part because of Ethical and Religious Directives (ERDs) required by the Archdiocese of Hartford, with which Saint Mary's is affiliated.

With the arrival of Tenet Healthcare Corp. of Texas, which is taking steps to buy several hospitals in Connecticut, Saint Mary's and Waterbury hospitals seem to be finding a middle ground. They would remain separate institutions, so the ERDs probably wouldn't present an obstacle. Indeed, Archbishop Leonard P. Blair "is supportive of us moving forward in the process," Saint Mary's President and CEO Chad Wable said July 8.

The hospitals would benefit from Tenet's considerable purchasing power — it operates medical facilities in 16 states — and would be able to merge business-office functions. They also would become for-profit institutions, meaning the city would be able to tax their buildings and equipment.

Officials for Tenet Healthcare Corp. and the hospitals aren't saying exactly how they would deal with the hospital buildings, some of which are more than a century old. Presumably, the buildings would be modernized, but a shiny new medical center does not appear to be in Waterbury's future. Residents and officials also are concerned about what the Republican-American referred to July 9 as "Tenet's shady past," which includes payment of $2 billion in fines to the federal government for overbilling of Medicare claims and other violations over the past 20 years. Waterbury, with its own ugly history of crime and corruption in municipal government, is obligated to be wary of associating with companies that come to the table with similarly tainted portfolios.

If Tenet's assertions that its legal and ethical problems are in the past prove true, however, the deal this company is offering Waterbury appears to be the best solution to financial and health-care problems that will only get worse if the hospitals are compelled to continue operating as they have.


CVS Inks Clinical Affiliation with Farmington Doc Group

Hartford Business Journal, July 16

CVS Caremark said it has entered into a new clinical affiliation with Farmington's ProHealth Physicians, which has more than 220 doctors across Connecticut.

The agreement gives ProHealth patients access to clinical support, medication counseling, disease monitoring and wellness programs at CVS pharmacies and MinuteClinic locations. CVS will also share prescription and visit information with ProHealth.

Hartford Healthcare signed a similar agreement with CVS in May.

CVS said it now has 40 such deals with health systems and providers across the country.

Hot Topics in Health Care

Patient Navigator Role Growing in Popularity

Hospitals and Health Networks, July 9

Care coordination — a fundamental piece of many of the models being tested under health care reform — already is gaining popularity in the treatment of cancer through the role known as a patient navigator. The use of patient navigators has been boosted by a mandate tied to federal grant money, expected future accreditation requirements and research that backs the concept.

The navigator position can be assumed by lay people or clinicians who assist patients in the various stages of the cancer journey — from screening and diagnosis to treatment and survivorship or end-of-life needs. Cancer patients carry a lot of fear about the future.

“Research has demonstrated that patient navigators can help to improve care, making sure that patients get the appropriate screenings and treatments in a timely fashion,” says Electra Paskett, an epidemiologist at the Ohio State University.

Read more here


MSSP Program May Add New Quality Measures

Health Leaders Media, July 14

The proposed 2015 rules for Medicare B payments add a dozen new quality measures and patient outcome-based metrics, including unplanned admissions for patients with diabetes, heart failure, or multiple chronic conditions.

With the Medicare Shared Savings Program preparing to enter its fourth year in 2015, federal officials are recasting the list of quality metrics and providing "bonus payments" to incentivize year-to-year performance gains.

The proposed Medicare B rules both refresh and cull quality measures. A dozen new quality measures add patient outcome-based metrics to the list, including unplanned admissions for patients with diabetes, heart failure, or multiple chronic conditions.

Read more here.


An E.R., Not a Hospital, Is Set to Open at St. Vincent's Site in NYC

The New York Times, July 14

Four years after St. Vincent’s closed, the hulking white building, between West 12th and West 13th Streets, is reopening in the coming days, not as a hospital, but as a free-standing emergency room.

Free-standing emergency rooms — which are distinct from urgent care centers, which treat non-life-threatening illnesses and injuries at low cost — have sprouted up around the country in recent years, driven by competition to capture lucrative markets, like the neighborhoods around Greenwich Village.

They can bring in significant revenue, since they are allowed to charge the same high fees that hospitals charge while having lower overhead. And, since half of admissions come from the emergency room, free-standing E.R.s can funnel patient business to their parent hospitals.

Read more here.


Emergency Room Docs Struggle With Two-Midnight Rule, Observation Status

Fierce Healthcare, July 16

As hospitals across the nation face the complications involved with the two-midnight rule, emergency physicians may experience the most conflicts as they strive to balance patient needs with the federal government requirements for short inpatient stays. Emergency and internal medicine physicians often struggle to get the right designation and status for the patient.

In order to qualify for Medicare reimbursement under inpatient rates, the two-midnight rule requires that physicians deem the patient's condition as serious enough to require at least two overnight stays. Patients who aren't formally admitted may remain under outpatient or observation status--an action that may leave patients with high out-of-pocket expenses. The federal government delayed enforcement of the rule until October at which time hospitals may face financial penalties if auditors determine the hospital could have met the patient's needs in an outpatient setting.

Read more here.


Walgreens: Patients Flocking to Retail Clinics For Routine Care

Becker's Hospital Review, July 17

Patients are increasingly relying on nurse practitioners at retail clinics for the provision of chronic and preventative health services, according to new research released by Walgreens.

Data indicated increases in the number of patients making return visits to retail clinics, from 15 percent in 2007 to more than 50 percent in 2013. Patients headed to Walgreens clinics for chronic or preventative care increased from 4 percent in 2007 to 17 percent in 2013.

A Walgreens vice president said convenience, reputation and Walgreens' expansion of chronic and preventative services are driving the trend.

With approximately 400 clinics throughout the United States, Walgreens operates the second largest chain of retail clinics in the United States behind CVS' Caremark Clinics.

Coming Events

July 25 (Friday)

American Red Cross Blood Drive

7 a.m.-12:30 p.m.

The Save-a-Life bus will be parked outside Hartford Hospital. To schedule an appointment call1-800-RED-CROSS (1-800-733-2767) or sign-up online at and enter the Sponsor Code harthosp. For more information, call Erin at 860-545-2079.

August 1 (Friday)

Surgery Grand Rounds

Gilman, 6:45-7:45 a.m.

Topic: Breast Surgery: Past, Present and Future

Speaker: Dr. Heather King, breat surgeon

August 13 (Wednesday)

High Reliability Training Session for Physicians

JB-118, 6:45-8:15 a.m.

August 14 (Thursday)

High Reliability Training Session for Physicians

JB-118, 5:30-7 p.m.

September 8 (Monday)

Hospital Auxiliary Golf Tournament

Tumble Brook Country Club, Bloomfield

September 10 (Wednesday)

Worldwide Suicide Prevention Day Conference: Suicide Prevention in Older Adults

Heublein Hall in the ERC, 8:30 a.m.-12 p.m.

Hartford Hospital invites you to a free educational seminar called "Suicide Prevention in Older Adults" on Wednesday, Sept. 10 from 8:30 a.m.-12 p.m. in Heublein Hall in the ERC.The "golden years" are no myth; older adults are more likely to rate their lives as happy and fulfilling than younger and middle aged individuals. Yet worldwide suicide rates rise with age, and in the U.S. it is older men who are the highest risk segment of the population. Registration is required; call the Health Referral Service at 860-545-1888.

September 13 (Saturday)

Updates in Liver Disease for the PCP

Gilman, 8 a.m.-12 p.m.

Join Hartford Hospital Comprehensive Liver Center experts as they present cutting-edge diagnostic and treatment information at this half-day conference, Saturday, Sept. 13 from 8 a.m.-12 p.m. in Gilman Auditorium.

Effective 10/1/14, Connecticut primary care providers will be required to offer patients born between 1945-1965 a hepatitis C screening test. Early screening and detection of liver disease may result in improved outcomes.

Cost is $50. Register online at or by phone 860-545-1888 or toll free 800-545-7664. For more information, contact Regina Radikas at

September 18 (Thursday)

The Mind-Body Connection: Integrating Behavioral Health and Primary Care

Maneeley's in South Windsor, 4. to 8 p.m.

Integrated Care Partners is offering its first annual conference on The Mind-Body Connection: Integrating Behavioral Health and Primary Care on Thursday, Sept. 18. Keynote speaker will be Dr. Henry Chung, VP and CMO of Montefiore Care Management Organization. Welcome remarks will come from CT LT. Gov. Nancy Wyman.

For more information go to

October 8 (Wednesday)

30th Annual Cardiovascular Symposium

CT Convention Center, 7:30 a.m. to 3:30 p.m.

The 30th Annual Cardiovascular Symposium will be held on Wednesday, Oct. 8 at the CT Convention Center.

Speakers include: Dr. Christine Albert, Dr. Joshua Beckman and Dr. Christopher Cannon from Brigham and Women's Hospital; Dr. George William Dec Jr. from Massachusetts General Hospital Heart Center; Dr. Jennifer Mieres, North Shore-LiJ Health System; Dr. Vivek Reddy from Mount Sinai Medical Center; and Dr. Jeffrey Rich from Sentara Norfolk General Hospital.

For more information and registration, go to

November 6 (Thursday)

9th Annual Interdisciplinary Transplant Symposium

Sheraton Hartford South Hotel in Rocky Hill

November 20 (Thursday)

Annual Meeting of Hartford Hospital Corporators

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



January 24, 2015 (Saturday)

Black & Red

The Bushnell

Join us for a night with the Blues Brothers Starring Dan Aykroyd & Jim Belushi and a celebration of the dedication and extraordinary work of the Hartford Hospital Trauma Center at the 24th annual Black & Red gala on Saturday, January 24, 2015, at The Bushnell in Hartford. Stay tuned for ticket and sponsorship information. For up-to-the-minute details, visit

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.