Department of Medicine

Quarterly Faculty Meeting

September 19, 2012

Agenda

Introduction (Yang)Faculty Senate Report on APT Update (Nord)ACGME Accreditation Update (Reilly)Faculty Development (Wertheim)Practice Development (Heinemann)eRx (Farrell)Research Development (Gelato)Website Development (Mynarcik)

New Faculty Members and Administrator (since Jan.)

Cancer Center• Yusuf Hannun (Hematology/Oncology)• Lina Obeid (General Medicine/Geriatrics)• Cungai Mao (Cancer Prevention)• Ashley Snider (Gastroenterology)• 7 other Research Foundation faculty Rheumatology – Asha Patnaik Nephrology – Mekdess Abebe Pulmonary/Critical Care – Mohamed Mansour Gastroenterology/Hepatology – Pruthvi Patel General Medicine/Primary Care – Rachel Wong General Medicine/Geriatrics – Irene Hwu General Medicine/Hospitalists – 16 new faculty

Administrator – Susan Kalish

New Administrative Appointments

Executive Vice Chair – Bill WertheimVice Chair for Clinical Affairs – Donna HeinemannResidency Program Director – Rob ReillyResidency Associate Program Directors – Kim Kranz; Rachel WongChief Residents: John Asheld, Chelsea Estrada, Nirali Shah, Vesh SrivatanaAdministrator – Susan KalishResearch Administrator – Dennis MynarcikInterim Chief/GI – Ellen LiChair/Research Committee – Marie GelatoChair/Faculty Development Committee – Bill Wertheim

Faculty Under Active Recruitment

Chief – Division of CardiologyChief – Division of Gastroenterology/HepatologyClinical Faculty – Various divisionsPhysician Scientists

Discontinuation of “qualifier” titles

Everyone needs at least 1 point for scholarship

What constitutes scholarship

Should there be a “citizenship” category

Time frame for implementation

The criteria are divided into 3 categories

Research/scholarship 1-4 points

Teaching 1-4 points

Professional service 1-3 points

 Title

 

Track

 

Tenure  Eligible 

Minimum Total 

Minimum Research/ Scholar

Associate Professor X   Research Scholar   YES 5   3  

Associate Professor X   Educator/Clinical Scholar YES   5   2  

Professor X   Research Scholar   YYES  7   3  

Professor X   Educator/Clinical Scholar  

YYESS   7    2  

Assoc. Prof. Research X  Research   No   3   22  

Assoc. Prof. Clinical X Clinical Educator   No   3   0  

Professor Research X   Research   No   5   3  

Professor Clinical X   Clinical Educator   No   5   1  

• The candidate must participate in a research program or demonstrate a pattern of scholarship leading to publications in peer reviewed journals.

• The publications may involve scientific, clinical, and/or educational research or other forms of recognized scholarship.

• The specific role in collaborative work and publications must be made clear.

• Case reports or course materials generally will count for little here unless appearing in critically reviewed journals with a clearly defined and significant contribution from the candidate.

The candidate must demonstrate an ongoing pattern of scholarly activity.

Scholarship may be in print or alternative media. This activity should be incorporated into their duties and activities

as a member of the faculty at the institution. These activities may involve scientific, clinical, and/or educational

research or other forms of recognized scholarship. They may also include Quality Assurance projects, patient

informational educational materials, policy statements, presentations describing cases or outcomes that contribute to the recognition or understanding of disease processes, or development of policy documents or medical quality assurance standards for a discipline.

These presentations or materials should have a scientific basis on which public or private bodies make decisions related to health, the health sciences, education, or other pertinent areas

Educational materials, - Used in Teaching in the Schools of HSC or CAS, as well as Professional Organizations. Materials should be substantive and include references.

Policy statements, - Adapted by SBUH or outside organizations including the NYSDOH, JC, CMS or Professional Societies

Assessment tools, - Adapted for use in University activities or by professional societies or outside regulatory agencies like DOH, JC, CMS

Guidelines for patient care. Adapted for use in University activities or by professional societies or outside regulatory agencies like DOH, JC, CMS

Documented Development or testing clinical guidelines or similar techniques to improve clinical services and assessment of outcomes

Synthesizing knowledge in book chapters, monographs, and review articles Describing cases, outcomes, or other events that contribute to the

recognition and/or understanding of health problems in peer-review journals, books, monographs or alternative media as well as in educational materials, assessments or guidelines as described above

Significant involvement in the development, implementation and evaluation of clinical guidelines locally or regionally for a local, state or federal organization.

Significant contribution to policy development for the Institution Contribution to State or other policy as a member of an expert team

Assoc. Prof. of Clinical

Clinical Educator (New non-modified title)

No 4 1

Professor of Research X

Research (??Non-Modified Title)

No 6 4

Professor of Clinical X

Clinical Educator (NEW non-modified title)

No 6 2

For faculty wishing to advance from Assistant Professor to Associate Professor (“clinical track” / non-tenured), a total of 4 points will now be needed, with a requirement of 1 point in scholarship.

• To be considered for promotion (any rank) in the School of Medicine at Stony Brook the faculty member must be a good citizen.

• This is demonstrated through compassion, collegiality, kindness, professionalism and respect to others (regardless of status or station).

• These values are expected when a faculty member is being considered for appointment or promotion.

• While no “points” are awarded, this is the prime criteria that must be met prior to consideration of awarding of promotion points

3 years

How does this impact new incoming faculty?

How does this impact current faculty

The New ACGME Accreditation

System Rules

Rob Reilly MD, FACP

Internal Medicine Program Director

September 19, 2012

Next Accreditation System

On March 4, at the ACGME Annual Education Conference, CEO Dr. Tom Nasca described the next accreditation system to be phased in between now and July 1, 2014. *

Intent is to improve graduate medical education and the accreditation process in ways responsive to the IOM Duty Hours Committee, MedPAC, Congress, and others.

*Initial announcement: Nasca, T. J., Philibert, I., Brigham, T., & Flynn, T. C. (2012). The next GME accreditation system: Rationale and benefits. [Special report]. New England Journal of Medicine Posted 2/22/2012.

The Old System• Site Visits every 1-5 years

– Quality of programs and institutions based on cycle length years

• PD is responsible writing an EXCELLENT PIF– Assuring proper English and good examples of competencies

/Reviewed resident surveys

• Gather Residents and Faculty 1-2 weeks prior to site visit in conference room– Met ONLY with Program Directors, residents and faculty– Instruct them how to respond to site visitor

What Site Visits Emphasized

New Institutional Accreditation

New institutional requirements effective July 1, 2013 will focus on:

• Patient Safety• Quality Improvement• Care Transitions• Supervision•Professional responsibility for duty hours, fatigue management, honest and accurate reporting

The “Next Accreditation System” in a Nutshell • CLER Visits to Sponsoring Institutions every 18 months

• Continuous Accreditation Model annually updated based on annual data submitted, other data requested, and program trends

• Scheduled Site Visits replaced by 10 year Self Study Visit– Only if there are no trends negatively reported annually from resident’s or

faculty surveys, deficient case loads, lack of Innovation

– Standards revised every 10 years Standards Organized by Structure / Resources /Processes /Outcomes

• Demonstration of Key Faculty Development

Trended Performance Indicators

• Annual ADS Update Program Attrition – Changes in PD/Core Faculty/Residents

• Program Characteristics – Structure and Resources• Scholarly Activity• Board Pass Rate – Rolling Rates • Resident Survey – Common and Specialty Elements • Clinical Experience – Case Logs or other • Faculty Survey – Core Faculty • Semi-Annual Resident Evaluation and Feedback Milestones • Annual Sponsor Site Visit (CLER)

Challenges/Opportunities• Culture Change and Faculty Development

– Program Directors, Designated Institutional Officials– Faculty– Review Committee Members

• Improving quality of faculty observations/documentation!!

• The “Community of Educators” in each specialty has to come together and agree on:– core elements of the competencies (Milestones)– levels of performance– core methods of assessment

FACULTY DEVELOPMENT COMMITTEEDR. BILL WERTHEIM

• MENTORSHIP– Aims– Survey– Target

• PROMOTION AND TENURE• FACULTY EVALUATION

Practice Development UpdateDr. Donna Heinemann

• First practice: 205 N. Belle Mead, PCC• Meeting scheduled with Specialty Care, 26 Research

Way• Next in line will be 3 Technology Drive• Cardiology will follow.• Goal is to improve the following:

– Patient access for new patients– Focus on Stony Brook faculty and staff– Phone service – Patient satisfaction – Pivot, Avatar surveys (?internal)– Physician satisfaction – internal surveys

Patient Access

• Overall, Department of Medicine physicians see lower % of new patient visits compared to national norms

• Particularly notable in divisions with lowest numbers of new faculty

• Goal is open up more new patient spots on templates• Possible use of physician extenders (NP/PA) for routine

follow-ups and urgent care to open up MDs for new patient appointments

• Assessment to maximize room utilization and utilization of support staff

Phone Service

• Compared to other Departments, we have a longer call wait time, more abandoned calls (where patients hang up), a lower call quality score (as judged by “standardized patient requests”), and a lower percentage of completed calls (where patient ends phone call with new patient appointment)

• Encourage use of www.stonybrookphysicians.com “patient requests” feature for messages, prescription renewals, appointment scheduling to decompress phone system

• Andy Toga (CPMP) and Dennis Mynarcik (Medicine)

Managed Care Contracting• Negotiations increasingly difficult• Most payers want to tie increases to pay for

performance (P4P) measures• Payers are monitoring costs as well and in near future,

will likely tie rate increases to cost reductions• Patient-centered medical homes may be given rate

increases, dual eligible medicare-medicaid capitated programs

• Need faculty to provide clinical practice guidelines/best practices for specific disease entities

• Appropriate implementation of EHR to maximize P4P – scheduled for specialists in early 2013

Review of Billing Practices• Plan for division-specific updates and review of billing by

individual faculty (comparison to fellow division members and national norms where available)

• Please sign up for and review physician dashboard on CPMP web-site

• Billing for all services at highest level supported by documentation

• Example: Gen Med billing for Medicare preventive visit 2x revenue compared to E and M level 3-4 visit, preventive visit + acute problem billing = 2-3X revenue of E and M level 3-4 visit.

• Need division-specific billing “champion” to assist with development of billing “best practices”

Medicare Incentives and Penalties

Providers are eligible for Medicare incentives or penalties if they billed an ambulatory visit on 100 or more Medicare patients between 1/1/12-6/31/12.201

22013

2014 Future

Incentive 1%

0.5% None None

Penalty -1%

-1.5% -2% -2%

To qualify for the incentive and avoid the penalty in 2014 Providers must:

•Successfully send electronic scripts for 10 Medicare patients between January 1, 2013 and June 30, 2013•Successfully send an additional 15 scripts between July 1, 2013 and December 31, 2013• Bill an ambulatory visit in conjunction with the electronic prescription

Note: Renewals done electronically do not count toward the incentive.

• 71 Providers have the ability to E-Prescribe

• 20 did not meet the minimum of 10 by 6/30/12

• 60 of the 71 continued to use the eRx system after 6/30/12

• Providers enrolled in eRx must continue to electronically prescribe

• Providers with a high number of Medicare patients should enroll in eRx

• Any Department of Medicine provider who wishes to prescribe electronically may be enrolled in eRx

DOM Research Committee

Marie C. Gelato, MD, PhDChair

Committee Members• Hussein Foda• Ian Hitchcock• Ellen Li• Richard Lin• Dennis Mynarcik• Lina Obeid• Hal Skopicki• Roy Steigbigel• Vincent Yang

Items Under Consideration

• Faculty Development• Pilot Project Program• Research Seminar Series• Research Infrastructure• Research Space

Progress to Date

Faculty Development: Committee will assist the Chair and be advisory to the Faculty Development Committee. Departmental Committee for Faculty Development was established to address two main areas: mentoring and promotions. The Research Committee will assist the new committee in areas of synergy such as recruitment and career development awards.

Progress to DatePilot Project Program: Yearly announcement (Request for application, RFA): September 1, 2012Full-time DOM faculty including those at the rank of Assistant Professor or lower within 7 years of hireClinical and Translational ResearchFunded by the Clinical Trial accountNumber awarded dependent upon funds available (a minimum of two)

Progress to Date

Research Seminar Series: Started in prior academic year Monthly meetings: second Thursday of the month,

5PM, food!!! Introduce faculty to ongoing research in DOM Foster collaborations and collegiality Great lead off this year with Dr. Obeid Future to include outside speakers

Progress to DateResearch Infrastructure: D. Mynarcik-Research Administrator; resource for grant

submissions, IRB, IACUC and COEUS; See him FIRST! Biostatistical support for projects; first announcement sent

to DOM faculty Listing of all major equipment within DOM/SOM IT: new website-looks great; user friendly; will be

tremendous resource for faculty to know what is happening and put information about themselves on the site ; recruitment tool

Progress to Date

Research Space: Develop plan for research space utilization

in the DOM in line with SOM SOM Committee: liaisons for DOM Drs.

Obeid and Hitchcock

WEBSITE DEVELOPMENT

DR. DENNIS MYNARCIK

Hospital

MENUHome•Chair Message•Grand Rounds•Research seminarFaculty and staff (Administration)•Org Chart•Group PhotosDivisions•Org charts•Faculty pages

• Appt. link to CPMP•Fellowship programPatient Care (for Patients)•This will be alteredResidency ProgramFellowships•Need new

• Life on LI• What our residents have to say• Hear them say it

IMAGESUpper scrolling images•Who we are, changes monthlyLower left is NEWS•Publications, grants, trials, etc.

For Faculty•Will need log onResearch Admin•Help with Grants, trials, IRB•Help with campus bureaucracy•Help with passwords•Help with ITFaculty Development•Archive of ppts and articles, educators portfolio, etc.Presentations•Archives of Grand Rounds, etc.Core Facilities•Research infrastructure

Future

• Increase the number of divisional “Treatment Center” web environments

• Faculty specialty pages – Lawson EECP• Faculty Lab pages – Smaldone, Hitchcock,

Yang, Rigas……………..• Cancer Center• Vivo and database linked webpage population