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Department of Medicine

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Department of Medicine Quarterly Faculty Meeting September 19, 2012 * * To qualify for the incentive and avoid the penalty in 2014 Providers must: Successfully send ... – PowerPoint PPT presentation

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Title: Department of Medicine


1
Department of Medicine Quarterly Faculty
Meeting September 19, 2012
2
  • 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)

3
  • 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

4
  • New Administrative Appointments
  • Executive Vice Chair Bill Wertheim
  • Vice Chair for Clinical Affairs Donna Heinemann
  • Residency Program Director Rob Reilly
  • Residency Associate Program Directors Kim
    Kranz Rachel Wong
  • Chief Residents John Asheld, Chelsea Estrada,
    Nirali Shah, Vesh Srivatana
  • Administrator Susan Kalish
  • Research Administrator Dennis Mynarcik
  • Interim Chief/GI Ellen Li
  • Chair/Research Committee Marie Gelato
  • Chair/Faculty Development Committee Bill
    Wertheim

5
  • Faculty Under Active Recruitment
  • Chief Division of Cardiology
  • Chief Division of Gastroenterology/Hepatology
  • Clinical Faculty Various divisions
  • Physician Scientists

6
PROMOTION CRITERIA ATsuny stony brookDr. Ed
Nord
7
WHAT is up for discussion?
  • 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

8
CRITERIA FOR PROMOTION
  • The criteria are divided into 3 categories
  • Research/scholarship 1-4 points
  • Teaching 1-4 points
  • Professional service 1-3 points

9
Current Points Required
10
Old criteria Scholarship 1 point
  • 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.

11
New criteria 1 point For scholarship
  • 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

12
  • 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

13
New points system
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.
14
CITizenship
  • 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

15
TIME FRAME FOR IMPLEMENTATION
  • 3 years
  • How does this impact new incoming faculty?
  • How does this impact current faculty

16
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17
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18
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19
The New ACGME Accreditation System Rules
September 19, 2012
  • Rob Reilly MD, FACP
  • Internal Medicine Program Director

20
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.

21
The Old System
What Site Visits Emphasized
  • 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

22
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23
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

24
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 residents 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

25
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)

26
Challenges/Opportunities
  • Culture Change and Faculty Development
  • Program Directors, Designated Institutional
    Officials
  • Faculty
  • Review Committee Members
  • Improving quality of faculty observations/document
    ation!!
  • 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

27
FACULTY DEVELOPMENT COMMITTEEDR. BILL WERTHEIM
  • MENTORSHIP
  • Aims
  • Survey
  • Target
  • PROMOTION AND TENURE
  • FACULTY EVALUATION

28
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

29
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

30
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)

31
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

32
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

33
Electronic Prescribing (eRx)Cindy Farrell
  • 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.
2012 2013 2014 Future
Incentive 1 0.5 None None
Penalty -1 -1.5 -2 -2
34
  • 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.

35
Current Status of eRx
  • 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

36
Going Forward
  • 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

37
DOM Research Committee
  • Marie C. Gelato, MD, PhD
  • Chair

38
Committee Members
  • Hussein Foda
  • Ian Hitchcock
  • Ellen Li
  • Richard Lin
  • Dennis Mynarcik
  • Lina Obeid
  • Hal Skopicki
  • Roy Steigbigel
  • Vincent Yang

39
Items Under Consideration
  • Faculty Development
  • Pilot Project Program
  • Research Seminar Series
  • Research Infrastructure
  • Research Space

40
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.

41
Progress to Date
  • Pilot Project Program
  • Yearly announcement (Request for application,
    RFA) September 1, 2012
  • Full-time DOM faculty including those at the rank
    of Assistant Professor or lower within 7 years of
    hire
  • Clinical and Translational Research
  • Funded by the Clinical Trial account
  • Number awarded dependent upon funds available (a
    minimum of two)

42
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

43
Progress to Date
  • Research 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

44
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

45
WEBSITE DEVELOPMENTDR. DENNIS MYNARCIK
46
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47
Hospital
48
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49
  • MENU
  • Home
  • Chair Message
  • Grand Rounds
  • Research seminar
  • Faculty and staff (Administration)
  • Org Chart
  • Group Photos
  • Divisions
  • Org charts
  • Faculty pages
  • Appt. link to CPMP
  • Fellowship program
  • Patient Care (for Patients)
  • This will be altered
  • Residency Program
  • Fellowships
  • Need new
  • Life on LI

50
  • For Faculty
  • Will need log on
  • Research Admin
  • Help with Grants, trials, IRB
  • Help with campus bureaucracy
  • Help with passwords
  • Help with IT
  • Faculty Development
  • Archive of ppts and articles, educators
    portfolio, etc.
  • Presentations
  • Archives of Grand Rounds, etc.
  • Core Facilities
  • Research infrastructure

51
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53
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
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