Edward Rippel, MD
Quinnipiac Internal Medicine, PC
A Hamden sole practitioner makes high-tech headway in primary care
At Quinnipiac Internal Medicine, what some see as the future of medicine is happening now.
Electronic medical records allow Edward Rippel, MD, the office’s primary-care physician, to communicate more efficiently with patients, track and monitor chronic conditions such as diabetes and heart disease and ultimately achieve better outcomes.
Moreover, Rippel says, using medical software technology has proven to be a better way to run his business.
Rippel drew attention earlier this year when he became the first sole practitioner in Connecticut to be as recognized as a Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA) at Level 3, the highest level.
The program “recognizes clinician practices functioning as medical ‘homes’ by using systematic, patient-centered and coordinated care management processes,” according to the NCQA.
“The basic principle is most of the care that a patient gets should be under the aegis of the primary care office, any care outside of office we coordinate, and we track those elements to completion,” says Rippel, who views the recognition as a reflection of his approach to medicine.
He says his “practice style has always been patient-centric with an emphasis on preventive care, guideline-based chronic disease management and coordination of care with specialists.” Moreover, his “practice philosophy” hinges on “personal individualized service, with superior availability and patient communication.”
A New York native, Rippel attended the Bronx High School of Science, where he discovered “a penchant for biological science.” He majored in biology at New York University, graduated from New York Medical College, interned at Montefiore Hospital in the Bronx and was a resident at Morristown (N.J.) Memorial Hospital. He then worked in a Colorado federal prison and a Spanish Harlem (N.Y.) community center to fulfill his obligation to the National Health Services Corps, which helped finance his medical education.
In 1993, Rippel joined a primary care group in Hamden. When the practice dissolved in 1999, he opened his own practice.
While working in Spanish Harlem, Rippel used a ruler and spreadsheet to track preventive care and disease management.
“You had a fairly good snapshot but could not do more,” he recalls. “In the 1990s, I heard about the advent of electronic medical records, and it seemed sort of a fantasy. The industry evolved fairly quickly but it really was a very expensive proposition, not feasible in primary care."
A decade later, the situation changed when insurance companies began implementing pay-for-performance models for achieving or exceeding certain health benchmarks.
“Now you had another source of revenue, and here’s this wonderful tool that could help me to realize my vision of chronic disease management and preventive care,” says Rippel, who speaks Spanish and Italian (he says 15 to 18 percent of his patients are Spanish-speaking). He began interviewing vendors. In summer 2006, he selected eClinicalWorks to set up an electronic medical record system, and set out to improve patient care.
“I thought I was doing a pretty good job, but there’s nothing like real data to sober you,” Rippel says. He found out around 40 percent of his patients had well controlled diabetes, which was “about the same as the national average.” By focusing on those patients with follow-up visits, the percentage “at goal” for diabetes control rose to 70 percent over the next several years.
In 2009, Rippel earned recognition from the NCQA for providing high-quality care to diabetes patients. The following year he earned NCQA recognition for providing high-quality care to patients with cardiac problems.
When Rippel became the first solo practice in Connecticut to achieve patient-centered medical home recognition this February, the NCQA dubbed him a “triple crown winner.”
“Practices that earn medical home recognition are really the leading edge of where health care needs to go, and that is a system that combines integration and technology to deliver better care at lower costs,” says NCQA spokesperson Andy Reynolds.
The ranks are swelling. As of September 30, there were 108 patient-centered medical homes in Connecticut recognized by the NCQA (105 at Level 3). Of those, 24 were sole practitioners.
Electronic medical record-keeping also has been good for Rippel’s business. With increased visits and other measures, including in-house rather than outsourced billing and pay-for-performance programs, Rippel has been able to enhance office productivity. He says his $50,000 investment in software technology “was recouped in just over two years.”
During office visits, Rippel takes notes on an tablet PC, which allows him to send a prescription directly to a drugstore or order a diagnostic test. “It’s not just data-capture,” he says. “It’s sharing of data.” Patients receive a printed summary of their visit and educational materials related to treatment.
They can submit questions, which he answers by e-mail, via a patient portal he launched four months ago. The system already has helped several patients, including a student who needed to quickly send his immunization records to a law school where he had been accepted for admission and a patient able to download his medical records from an emergency room in France.
The proactive approach suits Susan Rapini, executive vice president of the New Haven Chamber of Commerce
“The whole key with him is prevention before things become a problem,” says Rapini, who began seeing Rippel this spring. “You don’t leave the office without having your whole plan done and your appointments, and he’s so sincere and doesn’t rush you.
“You have your medical portal, where you can see all your lab results online,” Rapini adds. “You can e-mail him, and he’s meticulous about getting the right information and helping you manage your care.”
Rippel plans “to continue in the pursuit of realizing my vision of improving quality of health care at the level of the patient and helping to offset the cost for health care.
“If you look at performance measures and quality of care outcomes, the practices that are primary care-heavy are the ones that have the highest success rates and lower costs.”
Steve Glick, president of Chamber Insurance Trust, regards Rippel as “an innovator, visionary and example of how primary-care doctors should perform.
“He represents the future of primary care technology and personal communication, and in a way he’s like the old doctor Marcus Welby,” Glick says, referring to the 1970s TV series starring Robert Young, who embraced the role of general practitioner.
Make that Dr. Welby with a 21st-century twist.
Director, RN to BSN Program, Assistant Professor
Sacred Heart University Department of Nursing, College of Health Professions.
Helping those in greatest makes Strong true to her name
Linda Lee Strong defines herself, first and foremost, as a public health nurse — a “street nurse” in her own words — and has been since her graduation with a BSN from the University of Bridgeport College of Nursing in 1976. She went on to earn her MSN from the Catholic University of America, Community Health School of Nursing in 1980, and an Ed.D. degree in nursing education from Columbia University Teachers College in 1996.
“I fell in love with nursing in my senior year in college and have had a passionate love affair with public health nursing all my life,” says Strong. “Public health nursing cuts across all segments of society, whether it’s underserved populations or the man down the street. We protect the population’s health, work to prevent illness and premature death and promote healthy lifestyles in the community.”
To that end, she founded and co-directed the Sacred Heart University/St. Charles Health & Wellness Clinic in 2000, which has moved to a new location near the old one and operates today in the Hall Neighborhood House. The no-cost clinic, renamed the Center for Community Health and Wellness, serves thousands of patients from a diverse population of older residents as well as ethnic groups including Irish, Polish, Asian, Latino and African-American people. It serves as a training ground for learning, clinical practice and internship services for Sacred Heart University nursing students.
Strong also established the Aging With Grace seniors program in 2005 that specifically serves older adults. She has held blood pressure and flu clinics literally on the street, advising her nursing students that they will have their greatest impact when they work in the midst of the community.
“Wherever the people are is where we go to provide nursing — whether it’s in the home, at a grocery store or in a community clinic,” says Strong. “You talk to people to learn their perception of what is going on with their health. It’s all about communication.”
And with that communication comes a reward for her students that’s not part of the curriculum taught in the classroom, Strong explains.
“They get to talk to people face-to-face and they learn about more than just peoples’ health concerns,” she says. “They learn about their cultures, their families, what they like to cook and eat, where they like to travel.” About 20 of her students travel every year to Guatemala for a one-week stint in public health clinics in that Central American country, further expanding their experience in nursing, diversity and culture.
Closer to home, she found devastation and despair aplenty on her first visit to Mississippi one month after Hurricane Katrina ripped through the region, upending thousands of lives and wreaking havoc on families who could ill afford to repair the damage or restore order to their lives.
“I don’t even have to close my eyes and I can be there,” says Strong about the Katrina-stricken Lakeshore, Miss., region when she and her co-workers arrived. “We went into communities that looked all right on the outside but the interiors of the buildings were destroyed and the people fled elsewhere. What we saw wasn’t terror caused by people: it was terror caused by nature.”
She recognized that mobilizing the kind of response needed couldn’t happen quickly enough because of the scope of the damage. “It takes time to put these things in place,” Strong says. “But time is precious when you are hungry, when you’re wet, when your entire world has vanished – and you are very frustrated about the slow response.”
Strong and the Aging With Grace group that traveled to Mississippi with her began a project to hand sew rag dolls to bring to the people who had been driven from the neighborhoods.
“To see the look in peoples’ eyes when we brought them these rag dolls — it brought back memories to them of their own childhood that they could then give to their child or grandchild, and this gave them a sense of comfort, a sense that ‘Someone else made these for me, someone who cares about me,’” says Strong. The health-care system was thin or virtually non-existent so that her group became both the health-care providers as well as recorders of the history of what had occurred during and after the storm.
At Sacred Heart, Strong teaches online throughout the year and in the classroom for the fall and spring semesters, in addition to her administrative role as director of the RN to BSN program. When she finds time to relax, she reads history books (“We can learn a lot from our past mistakes”), gardening (“I’m not a professional gardener — I just tinker”) and travels. Ever conscious of her public health background and experiences with Katrina, Strong co-hosted a seminar with Sigma Theta Tau, the nurses’ professional sorority, titled “Preparedness: Radiological and Nuclear Emergencies: Medical and Public Health Response to Radiation Incidents” at SHU’s Cambridge Campus.
Strong acknowledges that challenges lie ahead. She cites diminishing resources, tight grant money and shrinking local and state budgets where money for expansion of public health programs has been reduced or eliminated. She hopes that private resources will provide what is missing and credits the Agency on Aging of South Central Connecticut with providing badly needed funding for elder residents.
“I am a public health nurse,” says Strong. “I believe what is global is local. Illness and disease doesn’t stop at a town’s borders. Sickness costs money but a superb health system equals a healthy population. The wealth of a country is measured by the good health of its citizens, so if I can make a difference in peoples’ lives as a public health nurse, then they will be stronger.”
HARTFORD — A compromise bill on the controversial SustiNet state-run health plan passed the House May 27, and it drew praise from both supporters and opponents of the original proposal — albeit for different reasons.
SustiNet supporters say the bill represents concrete steps toward their ultimate goal: offering a state-run insurance plan to the public.
Opponents of the original proposal, meanwhile, said the compromise rightly focuses the state on implementing federal health reform, not the so-called public option that SustiNet backers sought.
The bill, which passed 88-48 and was to go to the Senate after this edition of BNH went to press, calls for allowing municipalities to buy insurance through the state beginning in 2012. Nonprofits that contract with the state would be allowed to buy in in 2013. It would not offer state-run insurance to small businesses or the public, as the original SustiNet proposal called for.
But the bill creates an advisory board, called the SustiNet Health Care Cabinet, that would make health care policy recommendations and develop a business plan that evaluates "private or public mechanisms that will provide adequate health insurance products" — including alternatives to private insurance. The cabinet would make implementation recommendations for the governor's consideration.
The bill also establishes an Office of Health Reform and Innovation within the lieutenant governor's office to coordinate state and federal reform efforts. It would be headed by Jeannette DeJesús, the governor's special adviser for health care reform and a deputy commissioner of public health.
Although the bill does not commit the state to a public option, Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, called it "a major piece of health care legislation."
"This bill has concrete steps toward charting a clear course for a home-grown, affordable nonprofit health care option for individuals and small businesses," Figueroa said in a statement following the vote.
In recent weeks, after Gov. Dannel P. Malloy expressed concerns about SustiNet and Democratic legislative leaders agreed to a deal with the administration that did not include the public option, some said SustiNet was dead. Figueroa said he's been telling people that the bill that passed May 27 the product of an agreement between SustiNet supporters and the Malloy administration — represents a "SustiNet rebirth."
The bill requires the state comptroller to establish a "partnership plan" that would offer health insurance to municipalities and other non-state public employers, and to nonprofits that contract with the state. Each group could also cover their retirees through the plan. The partnership plan's risk pool could be joined with the state employee and retiree health insurance pool, although the comptroller could also run it without doing so.
The SustiNet cabinet would be charged with advising the governor and Office of Health Reform and Innovation and would address multiple health policy issues, including the feasibility of offering a state-run health plan for low-income adults who don't qualify for Medicaid under federal reform, identifying opportunities, issues and gaps created by federal health reform, examining ways to ensure an adequate health care workforce and coordinating health care delivery system reforms with the Office of Health Reform and Innovation.
SustiNet was originally proposed as a plan for universal health care in 2009, before Congress began work on federal health reform. After the federal reform law, SustiNet supporters pitched their plan as a way to go beyond the federal plan by creating a public option and controlling health care costs.
The original bill proposed this session called for joining the health plans the state already pays for, including Medicaid and the state employee and retiree health plan, under a quasi-public authority. The authority would then offer health insurance to municipalities, small businesses, nonprofits and, ultimately, the public.
This article originally appeared in CTMirror.com.
WATERBURY — A Norwalk couple was awarded $58.6 million May 25, a record for a single incident of medical malpractice in Connecticut, in a case involving an obstetrician accused of waiting too long to perform a cesarean section and a boy who was permanently brain-damaged.
The jury at Superior Court in Waterbury found for Domenic and Cathy D'Attilo, whose son Daniel, now eight years old, has had severe cerebral palsy since he was born on February 2, 2003. He must be fed through a tube, uses a wheelchair, is unable to eat, talk or walk and is incontinent.
D'Attilo, her husband and son said in their lawsuit that Viscarello did not perform timely incisions to relieve the upper uterine area, delayed the cesarean section, didn't create space for an a traumatic delivery and caused a delay in the delivery that led to permanent brain damage.
The defendant's attorney, James Rosenblum of Rosenblum Newfield LLC in Stamford, said he will appeal if Judge Kevin Dubay allows the jury's decision to stand.
BRANFORD — Yale-New Haven Hospital (YNHH) has opened a cardiac rehab center at 84 North Main Street in Branford. YNHH Cardiac Rehabilitation Center offers individualized, medically supervised exercise and education programs and counseling for individuals who have experienced a cardiac event or need to reduce their risk of heart disease.
YNHH Cardiac Rehabilitation Center is a physician-referred program staffed by exercise physiologists and an onsite cardiologist. The center is accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation.
The center is open from 8 a.m. to 7 p.m. Mondays Tuesdays and Thursdays, and from 8 a.m. to 3 p.m. Wednesdays and Fridays. For particulars phone
NEW HAVEN — For women undergoing cancer treatment, the appearance-related side effects can be devastating. The American Cancer Society is working to improve the quality of life for cancer patients with a program that teaches beauty and self-image techniques to help cope with the side-effects of chemotherapy and radiation. Currently a need exists for certified cosmetologists who would be willing to give an hour or two per month to help implement the program at the Hospital of St. Raphael and Smilow Cancer Hospital in New Haven as well as Middlesex Hospital Cancer Center in Middletown.
“Look Good, Feel Better” is a free, community based, national program of the American Cancer Society that uses the volunteer services of licensed cosmetologists to offer services including makeup, skin care, nail care, and options related to hair loss, such as wigs, turbans and scarves.
NEW HAVEN — Women at high risk for breast cancer due to family or medical history are the focus of a new program at the Women’s Center for Breast Health at the Hospital of Saint Raphael. Under the initiative, community surgeons active in the care of breast disease are teaming up with Saint Raphael’s physicians to identify and screen women at high risk.
But feds warn of prosecutions elsewhere
HARTFORD — Top state lawmakers in Connecticut are pushing ahead with plans to legalize marijuana for medicinal use, despite recent warnings to officials in other states of possible federal prosecution.
"States have a right to decide this for themselves," said Michael P. Lawlor, Gov. Dannel P. Malloy's senior criminal justice adviser.
Malloy and Democratic leaders are proposing allowing physicians to write prescriptions that would permit their patients to grow marijuana indoors. The current bill does not provide for operation of marijuana dispensaries, as other states' laws do, but some backers are considering a dispensary amendment.
U.S. attorneys in several states, including Washington and Rhode Island, have warned state officials that while the Justice Department does not plan to prosecute sick people who use marijuana for medical purposes, it is prepared to prosecute those who grow or distribute the substance, regardless of state law.
But State Rep. Gerald M. Fox (D-146) of Stamford, the Judiciary Committee’s co-chairman, said that while he is keeping an eye on the potential legal challenges going on in other states, he does not believe that will kill the momentum of this bill.
"I don't think that will hold up the bill," said Fox. "I will certainly pay attention to the federal government when something happens."
"The feds haven't done anything yet. We're just trying to get a sense of what these letters mean," he said. "There are definitely mixed messages coming from Washington on this."
The U.S. Attorney General's office in October 2009 issued a memorandum announcing the Department of Justice would not pursue prosecutions against cultivators, distributors and patients as long as they adhere to state laws. But federal officials recently raided several dispensaries in Montana and Washington.
State officials say they have not received any communications on the issue from Connecticut's U.S. attorney's office. A spokesman said the office would not comment on whether it plans to pursue legal action if Connecticut lawmakers move forward with the bill.
But State Rep. John Hetherington (R-125), the ranking Republican on the Judiciary Committee, said the law is there for a reason and it is up to state legislators to abide by it.
"We can't just disregard and ignore the laws we don't like," he said. "I'm all for making this available to people who may healthily benefit, but not when it's illegal. Are we really going to start the practice of disobeying laws?"
Members of the Public Health Committee decided May 3 to move the proposal out of committee, but some said they are reserving judgment whether they will be able to vote for final approval with legal uncertainty hanging over it.
"There are some concerns," said State Rep. Elizabeth B. Ritter (D-38), co-chairwoman of the Public Health Committee. "This is probably not the first time we've run afoul of the federal government on something."
The proposal next heads to the State Senate.
Page 32 of 32