Caduceus Newsletter:  Fall 2013.03, Week of September 1 


Image from the U.S. Department of Energy Genome Program web site:   http://genomics.energy.gov  

Dr. Stan Eisen, Director
Preprofessional Health Programs
Christian Brothers University

650 East Parkway South
Memphis, TN  38104

Home page:

Caduceus Newsletter Archives:


What nature photographers have to do to get just the right photo of an animal.




To see what it takes to photograph a nesting falcon, please go to Marginalia. 


Table of Contents:


1.  Events coming up.  
2.  Soul of Bioethics, August 22, 2013 edition.  
3.  The American Association of Colleges of Osteopathic Medicine (AACOM) announces its newest medical college at Liberty University in Lynchburg, Virginia. 
4.  Map of Osteopathic Medical Colleges in the United States. 
5.  The Ohio State University College of Optometry will be hosting on Open House & Career Day on Saturday, September 14.  
6.  The University of Tennessee Health Science Center Pre-Pharmacy Interest Group is sponsoring its Kick-Off Meeting on Tuesday, September 10, at Central BBQ on Summer Avenue.  
7.  ===AAMC STAT===, News from the Association of American Medical Colleges, August 26, 2013 issue.   
8.  Wolf River Conservancy August 2013 E-Newsletter.    
9.  A total of 35 CEPH-accredited Public Health Graduate Schools and Programs will be participating in a free Virtual Fair on September 10 and 11, 2013 for prospective students of Public Health.  
10.  What Does the Affordable Care Act Mean for Infectious Disease/HIV Specialists?  From Medscape.com, August 22, 2013.  
ACA (Affordable Care Act) Timeline: Key Dates for Providers and Patients, a slideshow from Medscape Infectious Diseases.  
12.  The Medical School for International Health is an innovative, four-year, North American-style medical school that incorporates global health coursework into all four years of the medical school curriculum

13.  Marginalia:  A truly remarkable photo of a nesting falcon.  


1.  Events coming up.  

Tuesday, September 10, starting at 4 p.m., at Central Barbecue, 4375 Summer Avenue

·         The University of Tennessee Health Science Center Pre-Pharmacy Interest Group (Pig’s)  is sponsoring its Kick-Off Meeting on Tuesday, September 10, at Central BBQ on Summer Avenue.  For more information, please contact Dr. Angela Finerson, afinerso@uthsc.edu , and look at Article #6.)


October 24, 2013, 12:45 to 1:45 p.m., in CW105.

·         Presentation regarding the University of Tennessee School of Health Sciences Pharm.D. program, by Dr. Angela Finerson, Director of Recruitment.

November 7, 2013, 10 a.m. to 2 p.m. in Sabbatini Lounge.

·         Annual Health Career Opportunities Fair, where representatives of regional clinical healthcare programs visit our campus to answer your questions.  The event is anchored by The University of Tennessee Health Science Center.  Other programs which have already committed include:

o    Union University School of Pharmacy

o    University of Memphis School of Public Health


2.  Soul of Bioethics, August 22, 2013 edition.  



                THE SOUL OF BIOETHICS

                         (Aug. 22, 2013)


                Edited by H.R. Moody


    - Passing of Generations

    - Alzheimer's & Purpose in Life

    - Learning from Dementia

    - The Rhetoric of Rationing

    - Justice and Age-groups

    - Sleepless Questions

    - Web Sites to See

    - Books of Interest

    - The Length of Life


I encourage you to subscribe to “HealthCare Chaplaincy Today,” the free, twice monthly           e-newsletter for the latest developments on the integration of palliative care and multifaith spiritual care at http://bit.ly/hycJ2O





                       PASSING OF GENERATIONS


       "There is plenty of misery in getting old, and even more in watching family and friends die. I find it hard, though, to think of it all as some kind of human tragedy. I have long accepted the evolutionary perspective that the coming and going of the generations is a source of enduring human vitality. What will too often hurt us as individuals may be good for us as a species.

It is for me a source of endless delight to be around young children, more than counterbalancing the deterioration of myself and my elderly friends."


      From "The Passing of Generations" by Daniel Callahan,  age 82, on the Over65 Blog, at the Hastings Center Visit them at: http://www.over65.thehastingscenter.org/the-passing-of-the-generations/


---------------------------------------<<< >>> --------------------------------------


                            ALZHEIMER'S & PURPOSE IN LIFE


      Recent studies have concluded that higher levels of purpose in life can reduce the effects of Alzheimer’s Disease. For details on this research, see “Effect of Purpose in Life on the Relation Between Alzheimer Disease Pathologic Changes on Cognitive Function in Advanced Age,” by Patricia A. Boyle et al, ARCHIVES OF GENERAL PSYCHIATRY, at http://archpsyc.jamanetwork.com/article.aspx?articleid=1151486


      The study by Boyle made use of Carol Ryff's Scales of Psychological Well-Being:

For details, see: http://www.macses.ucsf.edu/research/psychosocial/purpose.php


      Also see “Purpose in Life. An Overview of the Literature” at:



      Another scale of interest is the “Purpose in Life Test” at:



      See also work on “Meaning in Life” at:



---------------------------------------<<< >>> --------------------------------------                            


                                   LEARNING FROM DEMENTIA


      I learned recently that my Yale classmate (class of 1967), physician David Hilfiker, has been diagnosed with Alzheimer's Disease.  He has shared some important thoughts on the subject:


      “Alzheimer’s taught me much about my faith. I’m not afraid of the future, mostly curious. I live much more in the present now. I accept myself much more and am not striving to be anyone else. I’ve found a call that brings me great joy... It will probably be much more difficult for those close to me, especially for many of you here, to watch me decline intellectually and ultimately in many other ways, as well. But I hope you will temper your sorrow by how I experience this disease. For me it might not be so bad as we think. I trust that some of you will be able to stay with me anyway. I suspect that the worst part for the person who has Alzheimer’s is the sense of abandonment as people fall away from embarrassment, from disgust, from pain, from helplessness. But I’m coming to trust that this community will not fall away and I will not feel abandoned or isolated.”


       By David Hilfiker, M.D., at: http://www.davidhilfiker.com/index.php?option=com_content&view=article&id=90&Itemid=65 

       Read his blog “Watching the Lights Go Out” A Memoir from Inside Alzheimer's Disease at: http://www.davidhilfiker.blogspot.com/


       For those wondering if they should have an "Alzheimer's Test" (there is no definitive test, of course), look at:


       "Decision Casts Doubt on Brain Scans for Alzheimer’s"



---------------------------------------<<< >>>--------------------------------------


                          THE RHETORIC OF RATIONING  &#12288;

          “Rationing,” and particularly “government rationing” is politically charged rhetoric.

Merely mentioning the possibility of government rationing of health care services has a chilling effect on health policy debates. For example, some of the early criticisms of comparative effectiveness research (CER) were based on the possibility that the research would be used as a basis for coverage decisions in public insurance plans, especially Medicare.”


         From “Improving The Rhetoric Of Rationing” by Bryan Dowd and Kirk Allison at:



---------------------------------------<<< >>>--------------------------------------


                          JUSTICE AND AGE-GROUPS


      Philosopher Norman Daniels wrote the definitive book on inter-age-group justice, AM I MY PARENTS' KEEPER?, in which he applied the ethical approach of John Rawls with a life-course perspective.  For some recent work on this approach, see:


      "Global Aging and the Allocation of Health Care Across the Life Span" 

by Norman Daniels at:




      See also "Justice Between Age Groups: An Objection to the Prudential Lifespan Approach" by Nancy S. Jecker at:



---------------------------------------<<< >>>--------------------------------------


                                   SLEEPLESS QUESTIONS


          Sleepless questions

          In the small hours:

          Have I done right?

          Why did I act

          Just as I did?

          Over and over again

          The same steps,

          The same words;

          Never the answer.


                          Dag Hammarskjöld, Markings


---------------------------------------<<< >>>--------------------------------------


                                    WEB SITES TO SEE


      END OF LIFE CARE. “End-Of-Life Care: A Challenge In Terms Of Costs And Quality Kaiser Health News, at:



      FEMINIST BIOETHICS.  Look at the International Journal of Feminist Approaches to Bioethics at:http://www.ijfab.org


     LET THE MUSIC BEGIN. Music for funerals, wakes, and memorial services at:



---------------------------------------<<< >>> --------------------------------------


                                 BOOKS OF INTEREST


"COUNSELING CLIENTS NEAR THE END OF LIFE: A Practical Guide for Mental Health Professionals," by James Werth (Springer, 2013).



Michael Carroll and Elisabeth Shaw (Jessica Kingsley)


"A SPIRITUALITY OF CAREGIVING," by Henri Nouwen Spirituality (Upper Room, 2011).





             "From my own experience, I think it is good if a

              merciful fate sets a reasonable limit to the length of

              time we live."


                                            -Sigmund Freud

                                             (Letter to Thomas Mann)




This electronic newsletter, edited by Harry (Rick) Moody, is published by HealthCare Chaplaincy and co-sponsored by the Office of Academic Affairs at AARP.


The opinions stated are those of Mr. Moody and may not necessarily reflect those of HealthCare Chaplaincy or AARP.


The opinions stated are those of Mr. Moody and may not necessarily reflect those of HealthCare Chaplaincy or AARP.


To submit items of interest or request subscription changes, contact H.R. Moody at soulofbioethics@yahoo.com


HealthCare Chaplaincy (HCC) is a leader in integrating spirituality within health care and the growing specialty of palliative care to improve the patients’ care and experience by helping them find comfort and healing. Our professional chaplains minister to people of all faiths and of no faith. They are the spiritual care specialists on the health care team as doctors and nurses focus on caring for the body. HCC is making important advances in clinical pastoral education, online continuing professional education, research into the evidence of the value of chaplaincy interventions, and alliances with likeminded organizations. We are developing a national demonstration model for palliative care with an enhanced assisted living residence for people with serious, chronic illnesses who can no longer live independently.


To submit items of interest or request subscription changes, contact H.R. Moody at soulofbioethics@yahoo.com


(c) Copyright 2013; all rights reserved.





3.  The American Association of Colleges of Osteopathic Medicine (AACOM) announces its newest medical college at Liberty University in Lynchburg, Virginia. 

AACOM is very pleased to announce our newest member medical college at Liberty University College of Osteopathic Medicine in Lynchburg, Virginia. 

You will find Liberty’s medical school information listed in our on-line College Information Book (CIB) at: http://www.aacom.org/about/colleges/Documents/2014%20CIB%20Supplement-Liberty.pdf


Please find attached an updated 2014 COM Map and Deadlines document to share with your aspiring pre-medical students this application cycle.


Thank you in advance of your support for the nation’s Osteopathic Medical Colleges! 



Gina M. Moses, M.Ed.

Associate Director of Application Services

American Association of Colleges of Osteopathic Medicine

5550 Friendship Blvd., Suite 310

Chevy Chase, MD 20815-7231


Tel: (301) 968-4184

Fax: (301) 968-4191






Now Available!
2014 Osteopathic Medical College Information Book 

The only comprehensive resource for students applying to
osteopathic medical college for Fall 2014 entry.   Learn more



Click here to view the web version of this Email.



August 22, 2013


Lindsey Jurd
Editor and Communications Associate


AACOM Welcomes New Member College

The leadership and Board of Deans of the American Association of Colleges of Osteopathic Medicine (AACOM) are pleased to welcome the Liberty University College of Osteopathic Medicine (LUCOM) as the association’s newest member college.

LUCOM will be housed in Liberty University’s planned Center for Medical and Health Sciences in Lynchburg, VA. With Founding Dean Ronnie B. Martin, DO, RPh, at the helm, the college will open its doors to its inaugural class of students in fall 2014. LUCOM is now available as an option for prospective students applying through AACOM’s centralized application service (AACOMAS) for fall 2014 entry into osteopathic medical school.

With the addition of LUCOM to AACOM’s membership, the United States is now home to 30 colleges of osteopathic medicine (COMs), with 38 locations in 28 states. Currently, more than 20 percent of the nation’s medical students are training to be osteopathic physicians (DOs).

"AACOM is proud to welcome the Liberty University College of Osteopathic Medicine to its membership. The expansion of osteopathic medical education in this country, particularly over the past decade, is truly astounding. With COM graduate numbers growing each year, osteopathic medicine is playing an increasingly important role in the nation’s health care workforce, ensuring that the physicians graduating from our schools are well-equipped to handle the current and future health care needs of the American public and capable of providing exceptional leadership in the evolving landscape of the United States health care system,” said Stephen C. Shannon, DO, MPH, AACOM President and CEO.


The American Association of Colleges of Osteopathic Medicine (AACOM) represents the nation’s 30 colleges of osteopathic medicine at 38 locations in 28 states. Today, more than 21,000 students are enrolled in osteopathic medical schools. One in five U.S. medical students is training to become an osteopathic physician.

AACOM was founded in 1898 to support and assist the nation's osteopathic medical schools, and to serve as a unifying voice for osteopathic medical education. AACOM’s mission is to promote excellence in osteopathic medical education, in research and in service, and to foster innovation and quality among osteopathic medical colleges to improve the health of the American public.


American Association of Colleges of Osteopathic Medicine
5550 Friendship Boulevard, Suite 310, Chevy Chase, MD 20815-7231
P 301.968.4100 -- F 301.968.4101
Unsubscribe | Forward to a Friend


4.  Map of Osteopathic Medical Colleges in the United States. 


5.  The Ohio State University College of Optometry will be hosting on Open House & Career Day on Saturday, September 14.  



College of Optometry Open House & Career Day


Saturday, September 14th, 1:00 p.m.—4:30 p.m.


We welcome prospective students, advisors, alumni, and friends to our annual Open House & Career Day.  The event showcases our many clinical services, research opportunities, student organizations and much more.  Tours, admission, and financial aid presentations will occur throughout the day.


No pre-registration or RSVP are necessary.  Check our Open House website for complete details:  http://optometry.osu.edu/openhouse/


We hope to see you and your students soon,



Justin Griest    Manager, Admission & Financial Aid
College of Optometry Office of Student Affairs
A426 Starling-Loving Hall | 338 W 10th Ave. Columbus, OH 43210
614-292-8825 Office | 614-292-7493 Fax
griest.6@osu.edu   http://optometry.osu.edu

Follow the OSU College of Optometry on: cid:image003.png@01CEA275.78807180  cid:image004.png@01CEA275.78807180  cid:image005.png@01CEA275.78807180



6.  The University of Tennessee Health Science Center Pre-Pharmacy Interest Group is sponsoring its Kick-Off Meeting on Tuesday, September 10, at Central BBQ on Summer Avenue.  





7.  ===AAMC STAT===, News from the Association of American Medical Colleges, August 26, 2013 issue.   


News from the Association of American Medical Colleges

August 26, 2013

• AAMC Asks for Delay in Enforcement of Inpatient
  Admission Rule
• Register for Today’s Webinar on PCORI Peer
  Review Process
• Study Challenges Validity of U.S. News & World
• AAMC Awards Innovations in Research and
  Training Partnerships
• COGME Releases Twenty-First Report on GME
• On the Move

The next issue of AAMC STAT will run September 9.

AAMC Asks for Delay in Enforcement of Inpatient
Admission Rule


The AAMC has requested that the Centers for Medicare and Medicaid Services (CMS) delay enforcement of certain provisions related to inpatient admission criteria in the final FY 2014 Hospital Inpatient Prospective Payment System (IPPS) rule. As currently written, the final rule will not allow residents in training programs to admit patients as of October 1. CMS is aware of this issue. In a letter to the agency, the AAMC asks that no inpatient admission be denied because it was ordered by a resident under supervision of an attending until this issue is addressed. 

To read the full letter, visit the AAMC Web site

Register for Today’s Webinar on PCORI Peer Review Process

The AAMC will host a webinar today from 11:00 a.m. to noon (EDT) on the “Peer Review Process for the PCORI Cooperative Agreement Funding Announcement: National Patient-Centered Clinical Research Network: Clinical Data Research Networks.” Speakers include Ann Bonham, Ph.D., chief scientific officer, AAMC; Joe Selby, M.D., executive director, PCORI; Lori Frank, Ph.D., program director, research integration and evaluation, PCORI; and, Rachael Fleurence, Ph.D., program director, CER methods and infrastructure, PCORI. The webinar is free, but pre-registration is required.

Study Challenges Validity of
U.S. News & World

The validity and usefulness of the annual U.S. News & World Report Primary Care Medical School (PCMS) rankings were challenged in a study published in the August issue of Academic Medicine. The study’s authors pointed out flaws in the methodology and concluded that the difference between those rankings and alternative methods showed variability that “is greater than could be plausibly attributed to actual changes in training quality.”

AAMC President and CEO Darrell G. Kirch, M.D., and AAMC Chief Academic Officer John E. Prescott, M.D., co-authored a commentary on the study that discusses how individual schools’ missions are poorly represented in overly subjective ranking methodologies and explains how the AAMC has been developing tools to provide valid data that are applicable to each medical school.


AAMC Awards Innovations in Research and
Training Partnerships

The AAMC has announced four recipients of the Award for Innovative Institutional Partnerships in Research and Research-focused Training. The awards program was established to identify bright spots in research and disseminate innovations that create and sustain institutional partnerships in research and research-focused training. To view the 2013 awardees, visit the AAMC’s Web site

COGME Releases Twenty-First Report on GME

The Council on Graduate Medical Education (COGME) released a new report titled, "Improving Value in Graduate Medical Education." Among other recommendations in the report, COGME recommends increasing “funding for new residency positions in order to graduate 3,000 more physicians per year.”

On the Move

Rulon Stacey, president, and Bruce Schroffel, CEO, of the University of Colorado Health (UCHealth), will be stepping down from their positions, effective January 31, 2014. Bill Neff, M.D., who currently serves as UCHealth’s chief medical officer, will serve as interim president and CEO during the search process and will begin October 1.

Richard Kronick, Ph.D., was appointed director of the Agency for Healthcare Research and Quality (AHRQ). He succeeds Carolyn Clancy, M.D., who will step down from the position later this month. Kronick joined AHRQ in January 2010, as deputy assistant secretary for planning and evaluation and oversaw the Office of Health Policy. 


8.  Wolf River Conservancy August 2013 E-Newsletter.    

Wolf River Conservacy





August 2013

What a wonderful summer we have had this year! The relatively moderate temperatures have made it easier than ever to enjoy the great outdoors. The Conservancy has provided a variety of recreational and educational opportunities for our members and the community during the summer months. Here's a quick look:

  • In June, our Cycle the Greenway event attracted over 150 cyclists and included the newest section of the Wolf River Greenway. The Memphis Orthopaedic Group was our sponsor.
  • The Frog Chorus Walk continues to be a popular and rewarding experience for our participants. It has even been described as a “spiritual experience” by some folks.
  • The WRC has led five recreational canoe trips along the urban and rural Wolf, including one clean up paddle trip this summer.
  • Our Stream Strolls in July and August provided a great opportunity for adults and children to relax and enjoy nature at a beautiful location.
  • Thanks to support from the Plough Foundation, a total of 126 young people participated in the Wolf River Conservation Corps (WRCC) summer program which included canoeing instruction, environmental education, career information and lots of fun!
  • With support from Buckman, WRC offered another Summer Lecture Series at Memphis Botanic Garden, with speakers on Mid-South mammals, bluebirds, frogs and native grasses.

There's an activity for everyone at the Wolf River Conservancy. Tickets are now on sale for our upcoming Greenway Soiree on  Saturday, September 21 at 6pm. See you there! 

Thanks for your support.

Keith Cole
Executive Director

More Stories

Join Us for the Greenway Soiree on Sept. 21!

With the beautiful Wolf River as your backdrop, the Greenway Soiree will be an evening filled with wonderful local food, great wine, beer from Ghost River Brewing, and dancing under the stars to live music by the Sons of Mudboy Learn More...

Natural Highlights: Monarch Migration

Monarch butterflies are the great migrants of the insect world, but conservationists are concerned about recent population declines. Find out where they are now and how to report when and where you see them. Your observations are valuable!  Learn More...

CBU Serves the Wolf River Watershed

About 30 volunteers from Christian Brothers University helped to clean up the Hill Preserve north of Covington Pike on Aug. 18.  Learn More...

A Great Summer for Wolf River Conservation Corps

With support from the Plough Foundation, the Wolf River Conservation Corps (WRCC) reached over 100 young people this summer. Learn More...

Paddling Adventure on New Michigan City to LaGrange Trail, Sept. 21

Try the newest river trail on the  wildest section of the Wolf. trail. Learn More...


Upcoming Events

August 31

Family Paddle Trip


September 7

Baker's Pond Hike and Hummingbird Festival


September 7

First Saturday Paddle


September 15

Sunset Wolf River Paddle


September 21

Michigan City to LaGrange New Trail Paddle


September 21

Greenway Soiree


October 5

First Saturday Paddle

Join or RenewPhotos & VideosGive to WRC

Stay Connected

Stay in the know with Wolf River


Wolf River Conservancy | P.O. Box 11031 | Memphis, TN 38111-0031 |
Telephone (901) 452-6500 | Fax (901) 452-6541
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9.  A total of 35 CEPH-accredited Public Health Graduate Schools and Programs will be participating in a free Virtual Fair on September 10 and 11, 2013 for prospective students of Public Health.  

Exciting opportunity for your students! FREE Virtual Fair on September 10 and 11, 2013, for prospective students of Public Health, including those interested in dual degrees in MPH/MD, MPH/DO, and MPH/JD.

This is a unique opportunity for your students to meet Admission Representatives from more than 35 of the nation's leading CEPH-accredited Public Health Graduate Schools & Programs.
Registered Schools/Programs Listed Here: http://sophas.careereco.net/virtual-fair/chat-with-organizations/

Attend the fair online from anywhere! 
Register Here: http://sophas.careereco.net/students-alumni/virtual-fair-registration/

What students have said about prior events:


·         "The Virtual Fair was extremely convenient and useful. I was able to communicate with multiple schools of my interest and ask questions. This Virtual Fair also saved me time and traveling fees if I were to visit the schools’ campuses instead.”

 ·         “I thought the virtual fair was extremely helpful. Chatting with the school representatives helped give me some direction for what I’d like to pursue, as well as some helpful tips/expectations for the application process.”

 ·         “I feel that this was great concept...It gave me an opportunity to ask questions that may not have been answered on their website and to see other potential students’ questions that I may not have thought to ask.”

*It was perfect. I loved the fact that school representatives gave out their e-mail addresses and encouraged us to contact them.”

 ·         "The whole system was very user friendly.”


The announcement flyer is posted on our Facebook page- https://www.facebook.com/ThisIsPublicHealth?bookmark_t=page and can be shared through social media.

Thank you!

Penelope Bennett, PhD, MPH, CNM

Director, Medical Scholars Program

Prehealth Advisor

Instructor, Dept of Integrative Physiology

UCB 273, University Club 111

University of Colorado at Boulder





10.  What Does the Affordable Care Act Mean for Infectious Disease/HIV Specialists?  From Medscape.com, August 22, 2013.  



What Does the Affordable Care Act Mean for Infectious Disease/HIV Specialists?

Brenda Goodman, MA

Aug 22, 2013

Healthcare Reform, the ACA, and ID/HIV

A raft of new healthcare reforms enacted under the Affordable Care Act (ACA) will take effect in January 2014, and many infectious disease (ID)/HIV specialists are wondering how these will shift the practice landscape.

First, the good news: Many experts feel that the central tenet of the law -- to insure more Americans --will ultimately result in higher patient volumes for physicians who treat ID. "We're going to see more people seeing more patients," says Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente and chair of the HIV Medicine Association (HIVMA).

Now for the difficult news: ACA reforms may more tightly squeeze ID physicians in small group or individual practices, because these offices have fewer owners to split the bill for big-ticket items encouraged by the law, such as electronic health record (EHR) systems.

"I don't know where things are going. It's kind of scary," says Michael Butera, MD, a board member of the Infectious Disease Society of America who has been in private practice in California for 20 years. Given the uncertainty ahead, it's natural to feel some trepidation. But other experts believe that it's useful to remember the lessons of Medicare, which also caused tectonic shifts in healthcare, though medical practice survived.

"I think it's important to take the long view," says Andrea Weddle, executive director of HIVMA. "Medicare and Medicare Part D were both unpopular in the beginning, and now it is hard to imagine healthcare financing without them," she says.

What Do the Experts Say?

For more specifics, Medscape reached out to health policy experts for their insights on key concerns for ID/HIV specialists on everything from patient access to reimbursements to Accountable Care Organizations. Here's what they had to say.

Medscape: How will the ACA affect patient access to ID physicians and HIV specialists?

Dr. Horberg: Under the ACA, anything that the US Preventive Services Task Force says is an A- or B-level recommendation is a covered benefit for everyone. [Editor's note: A- and B-level recommendations include HIV and hepatitis C screening for all adults, and chlamydia, gonorrhea, hepatitis B, and syphilis screening for women.[1]] There are no copays associated with that. As a result, we would expect to see more people diagnosed and with increased access to healthcare. We should see more people gaining access to care, especially quality care.

Ms. Weddle: For many of the nearly 30% of people with HIV who are estimated to be uninsured, the ACA's healthcare coverage expansion will improve access to HIV care because they will have access to reliable healthcare coverage for the first time. For the nearly 20% of people living with HIV who remain undiagnosed, new rules requiring coverage of preventive services -- including routine HIV screening -- by private plans and under the Medicaid expansion should lead to earlier diagnosis if routine screening is widely adopted by primary care providers.

A critical component of the success of the healthcare coverage expansion will be the degree to which HIV medical providers have contracts with the Qualified Health Plans that will be available through their state marketplaces (formerly known as exchanges) and with the Medicaid managed care plans that will contract with their state. It is important for providers to reach out to the plans in their state to join their provider networks and to let their patients know the plans that they are contracting with to ensure continuity of care for their current patients. States are due to have the online marketplaces open by October 1, 2013, and physicians will be able to see which plans are participating then.

Medscape: There are specific ID target areas in the ACA related to healthcare-associated infections. What are the penalties for these infections and the start dates for implementation?

Mr. Rodriguez (Director of Practice & Payment Policy, Infectious Diseases Society of America): The ACA contains public reporting requirements that create greater transparency around the problem of healthcare-associated conditions, including infections.[2]

Right now, consumers can go on the Medicare Hospital Compare Website and see how hospitals are assessed for quality care.

Current measures that are important to ID specialists include bloodstream infections associated with central lines, catheter-associated urinary tract infections, surgical-site infections, rates of readmission and deaths from pneumonia, rate of readmission after hip or knee surgery, and rate of readmission after hospital discharge. Additional measures for Clostridium difficile and other conditions will be introduced in the future.

Payment adjustments apply to these measures for hospitals that do not report or do not achieve quality care. Starting in 2015, hospitals in the top quartile for hospital-associated infections will lose 1% of their annual Medicare reimbursement.[3] The law also aligns Medicaid policy on healthcare-associated infections with current Medicare rules which prohibit federal payments to hospitals for provider-preventable conditions.[4]

The Centers for Medicare & Medicaid Services (CMS) is considering ways to apply these measures at the physician level.

Currently, ID physicians should be participating in Medicare's Physician Quality Reporting System to avoid payment adjustments in 2015.

Medscape: Accountable Care Organizations (ACOs) come in several different stripes, but they all work with the goal of improving patient outcomes while encouraging more efficient use of healthcare resources. Hospitals or practice groups that elect to become an ACO are rewarded if they meet quality targets and decrease spending. At the end of the practice year, if an ACO has done both, it splits the savings with Medicare. So, what do ACOs mean for ID physicians? Does it make sense to join one?

Mr. Rodriguez: The question of whether an ID specialist should join an ACO doesn't have an easy answer. There are a ton of factors that have to be considered. If you're in Miami, Florida, you might have different options than if you're in Utah or Des Moines, Iowa.

It's still fee-for-service. Everybody goes about their business billing Medicare, but they're sort of cost-conscious now and are also trying to meet these quality indicators.

ID physicians who are employed by hospitals may not have a say in whether they join an ACO. The hospital is going to make that determination. If hospitals see savings as an ACO, that won't necessarily turn into bonus checks for physicians. It's more likely that those payments will be ploughed back into reducing overhead costs for the hospital.

Physicians in private practice have a different set of decisions to make, especially if they're in an area where there are multiple ACOs. Under the law, physicians can only participate in one ACO for the purpose of shared savings, though they can still see patients who are enrolled in other ACOs.

From the patient's perspective, they're untouched. They can see whomever they want. They may not be aware that the doctor they are seeing is part of an ACO. Medicare did that so that patients' choice is left unaffected.

Dr. Butera: One of the things we're worried about as specialists, and as ID specialists in particular, is that we may lose access to our patients. If my patient is enrolled in an ACO at Sharp Healthcare, which is currently the only ACO in my area, I'll still be able to see her. But there are some questions about whether primary care doctors who participate in ACOs will be less likely to refer to specialists outside the ACO.

We're not primary care doctors and we don't want to be exclusive to one organization. I see patients with several different hospitals. I currently don't see any benefit to joining an ACO.

Medscape: What revenue impact will the ACA have on ID practice?

Ms. Weddle: The ACA increases Medicaid reimbursement for primary care services up to Medicare levels for 2013 and 2014 for many providers, including HIV and ID specialists who provide primary care services. The enhanced reimbursement will be in effect in every state regardless of whether they expand Medicaid. For HIV providers, more patients will have some type of insurance coverage beginning in 2014, although it will likely be inadequate to support the cost of comprehensive HIV care. The Center for Medicare & Medicaid Innovation is testing new payment methods that improve the quality of care while reducing overall costs.

Dr. Horberg: There are carrot-and-stick incentives in the law for physicians to purchase one big-ticket item that's called for under health reform: EHRs. If you haven't already gotten an EHR system that's approved by the federal government, you need to start getting it because eventually it will affect your rates. [Editor's note: Physicians who demonstrate 3 consecutive months of "meaningful use" of EHR data in 2013 are eligible for incentive payment up to $12,000,[5] while those who don't report any use of EHR will face a 1% reduction in their Medicare reimbursements in 2015.[6]]

Dr. Butera: ACA rules seem to reward integrated, large practices over solo and small practices. I had to go out and buy my own EHR system. I purchased Allscripts to do electronic prescribing, so that I got my bonus and didn't get dinged, and that's a bigger burden on solo and small group practices than it would be on a large practice.

Medscape: How will the ACA change ID/HIV physician paperwork?

Dr. Horberg: I don't think anyone can say today. The hope is that it would be less.

There's a real move by the Department of Health and Human Services to lessen paperwork, reduce redundancy.[7] Secretary Kathleen Sebelius has committed to a plan to have 25% less paperwork, but we'll have to wait and see.

Medscape: Some ID physicians are concerned about whether HIV care will still be a specialty. Your thoughts?

Ms. Weddle: As the demand for HIV care increases and the supply of qualified HIV providers decreases, new strategies for building HIV care capacity will need to be explored, including support for more HIV clinical training pathways outside of ID and the expansion of the role of nurse practitioners and physician assistants when appropriate. HIVMA continues to recommend that people with HIV have access to qualified HIV providers and that HIV expertise should be defined according to ongoing management of an HIV patient panel of at least 25 patients. In addition, HIV medical providers should stay up-to-date on the latest care standards by accruing at least 10 hours of HIV-related continuing medical education per year.

Medscape: Will existing government programs survive, especially the Ryan White HIV/AIDS Program and the AIDS Drug Assistance Programs (ADAPs)?

Ms. Weddle: The Ryan White Program and its ADAPs continue to enjoy strong support among key policymakers and the Obama Administration. Two thirds of people today who receive Ryan White services have some type of insurance coverage because most insurance coverage is not designed to support complex, chronic care.

In Massachusetts, where healthcare coverage was expanded statewide in 2006, the Ryan White Program continues to play a critical role in facilitating and supporting access to effective HIV care by helping with premiums and cost sharing and covering services not adequately covered by Medicaid or private insurance.

Additionally, the Ryan White Program will remain the only source of coverage for many low-income people with HIV living in states that are not expanding Medicaid as well as for populations left out of reform. It will take time for health reform to be fully implemented, and in the short term, policymakers recognize the importance of maintaining the program in its current structure to avoid serious disruptions in care.

Medscape: Should ID physicians consider purchasing insurance through the marketplaces for their own staff or family members?

Ms. Weddle: Beginning in October 2013, small businesses with fewer than 50 employees may keep their current coverage or purchase coverage for their employees through the Small Business Health Options Program. The decision that's right for a clinical practice and family member will depend on the cost and value of their current coverage. It will be important for individuals and small businesses that currently purchase health coverage through the individual and small group market to evaluate the new options available through the marketplaces.

Web Resources

Healthcare Reform and the ACA

Health Care Reform: Health Insurance & Affordable Care Act



1.     U.S. Preventive Services Task Force. USPSTF A and B Recommendations. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htmAccessed August 6, 2013.

2.     The Patient Protection and Affordable Care Act. Title III--Improving the Quality and Efficiency of Healthcare. Subtitle A. Part. 1 http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf Accessed August 6, 2013.

3.     The Patient Protection and Affordable Care Act. Sec. 3008 Payment Adjustment for Conditions Acquired in Hospitals. http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf Accessed August 6, 2013.

4.     Medicaid. Provider Preventable Conditions. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Provider-Preventable-Conditions.html Accessed August 5, 2013.

5.     Centers for Medicare & Medicaid Services. An Introduction to the Medicare EHR Incentive Program for Eligible Professionals. Pg. 14. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/beginners_guide.pdf Accessed August 5, 2013.

6.     Quinn R. Deadline looms for ENTs to put electronic health records to meaningful use. ENT Today. June 2013. http://www.enttoday.org/details/article/4876461/Deadline_Looms_for_ENTs_to_Put_Electronic_Health_Records_to_Meaningful_Use.html Accessed August 6, 2013

7.     U.S. Department of Health and Human Services. News release: Affordable Care Act cuts health red tape, saves $12 billion. June 30, 2011. http://www.hhs.gov/news/press/2011pres/06/20110630a.html Accessed August 5, 2013.


Medscape Infectious Diseases © 2013  WebMD, LLC

Cite this article: What Does the Affordable Care Act Mean for Infectious Disease/HIV Specialists? Medscape. Aug 22, 2013.



11.  ACA (Affordable Care Act) Timeline: Key Dates for Providers and Patients, a slideshow from Medscape Infectious Diseases.  

Viewing this web page requires registration with Medscape.com, but registration is free:



12.  The Medical School for International Health is an innovative, four-year, North American-style medical school that incorporates
global health coursework into all four years of the medical school curriculum.   


Can’t see this or want to share?  Click here http://www.cumc.columbia.edu/dept/bgcu-md/ps/NAAHPmailing.html



Dear Pre-Health Advisor,


My name is Kelly Coleman and I would like to take this opportunity to introduce myself.  I am the new Recruitment Coordinator

for the Medical School for International Health (MSIH).  I am a graduate of Rutgers University and Seton Hall University, and

hold an undergraduate degree in Biology, as well as an MBA in Marketing. Prior to joining MSIH, I was a pharmaceutical sales

executive with Merck, with over ten years of experience in sales and marketing.


The Medical School for International Health is an innovative, four-year, North American-style medical school that

incorporates global health coursework into all four years of the medical school curriculum.  The MSIH prepares physicians to address

the impact of cultural, economic, political and environmental factors on the health of individuals and populations worldwide. 


I am pleased to provide you with an overview of the admissions statistics for our 2013 entering class and provide some recent residency

placements for our graduates.  I have also included some highlights and accomplishments of our current students. 


     *Our entering class of 2013 consists of students from many countries, including the United States, Canada, Israel, China and South Korea.

The entering class had an average GPA of 3.49 and an average MCAT score of 31.  Over 31% of the students in the entering class hold

advanced degrees and 44% have non-science degrees.  Over 70% of the class have volunteered, studied or worked internationally.

     *This year, five first-year medical students at the MSIH have been awarded four-year tuition scholarships as recognition of

their academic and personal accomplishments.

     *Two MSIH second-year medical students, Angelie Singh, MPH and Chris Brown were selected along with 300 researchers to

present global health research at this years’ Consortium of Universities for Global Health Conference in Washington, D.C.

     *Again, this year, our graduates were offered residency placements in competitive residency programs, including Harvard, Yale, Duke,

University of Pennsylvania, Mt. Sinai and Albert Einstein. 


I have also included the latest issue of our “Day in the Life” series, featuring second-year medical student Tim Lee. 

 Tim is a graduate of Knox College in Illinois, and is an active member of the MSIH’s AMSA chapter. 

He also volunteers with Ultimate Peace.  http://www.youtube.com/watch?v=gvO87uwYbVQ


The recruitment of outstanding applicants who seek medical careers involving diverse and under-served

communities around the world is a cornerstone of the MSIH mission.  We are currently accepting applications

for the entering class of 2014.  Should you, or a student from your institution, be interested in the Medical School for International Health,

please contact the MSIH Admissions Office at (212) 305-9587, visit our website at http://cumc.columbia.edu/dept/bgcu-md, or view the

first-year medical student blog http://firstyearmsih.blogspot.com.   I can also be reached directly via email at kac2223@columbia.edu.   




Kelly A Coleman


Kelly A. Coleman, MBA

Recruitment Coordinator

Medical School for International Health

Email Kac2223@columbia.edu

Phone 212-305-9587



13.  Marginalia:  A truly remarkable photo of a nesting falcon.  


Dr. Stan Eisen, Director
Preprofessional Health Programs
Biology Department
Christian Brothers University

650 East Parkway South
Memphis, TN 38104

E-mail: seisen@cbu.edu
Caduceus Newsletter Archives: http://www.cbu.edu/~seisen/Caduceus.html