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State of the Department

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Title: State of the Department


1
Louis Stokes Cleveland VA Medical Center
State of the Department
Department of Medicine Case Western Reserve
University University Hospitals Case Medical
Center Veteran Affairs Medical Center
October 20, 2015
Case Medical Center Louis Stokes Cleveland VA
Medical Center Case School of Medicine Case
Research Institute University Hospitals UH
Medical Group University Hospitals at Case
Medical Center is the primary affiliate of Case
Western Reserve University School of Medicine.
2
Department of Medicine Vision and Mission
  • Mission Statement
  • Advancing Science and Education. Improving Care.
  • Vision Statement
  • To maintain and enhance our cutting-edge
    clinical expertise for the care and treatment of
    all patients and their families. To draw upon and
    balance this clinical excellence with the other
    elements of our tripartite mission (medical
    research and education). To remain equally
    committed to all elements of this mission through
    our outstanding faculty, staff and trainees and
    nimbly navigate the ever changing landscape in
    health care delivery with commitment to diversity
    among our ranks.

10/20/2015
3
Department of Medicine At a Glance
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
3
10/20/2015
4
Department of Medicine At a Glance
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
4
10/20/2015
5
Department of Medicine Sources of Operating
Support
6
Department of Medicine
  • Full-Time
    Faculty

7
Department of Medicine Full Time Faculty
AY 10-11 AY 11-12 AY 12-13 AY 13-14 AY 14-15
Clinician-Educators 146 152 156 173 171
Physician-Scientists 59 59 57 61 57
Research-Scientists 31 31 32 23 24
Total 236 242 245 257 252
Women African-American Mid-East/Asian Hispanic/Latino Source AAMC median - Faculty Roster System 2010 Estimated 2016 hires 26 Clinician Educators 92 5 82 17 DOM (37) AAMC (34) DOM (2) AAMC (3) DOM (30) AAMC (14) DOM (7) AAMC (4)



8
Department of Medicine Faculty Compensation
Funding
9
UH-based Faculty Recruitment July 2014 - Present
  Abdelmoneim, Sahar (Card) Malek, Ehsan
(Hem/Onc) Attizzani, Guilherme (Card) Metheny,
Leland (Hem/Onc) Farah, George (Card)
Tomlinson, Ben (Hem/Onc) Oliveira, Guilherme
(Card) Prosdocimo, Domenick (Card) Zacharis,
Michael (Card) Saha, Sharmeela (Neph)   Ali,
Meer A. (GI) Fabien, Andre (Pulm) Dave,
Maneesh (GI) Folz, Rodney (Pulm) Glessing,
Brooke (GI) McKell, Joanne (Pulm) Teba,
Catalina (Pulm) Thomas, Patricia (GIM)
Venizelos, Paul (Pulm)   Kirkova,
Yordanka (Ger) Mattar, Maya (Rheum) Khatibi,
Parisa (Ger) Saade, Elie (Ger-ID) Singh,
Mriganka (Ger)
10
Department of Medicine Faculty Awards and
Honors 2014 -2015
  • Marco Costa, MD, PhD, was selected to lead the
    Executive Office of Innovation as a Vice
    President and Chief Innovation Officer of
    University Hospitals.
  • Mukesh Jain, MD, PhD, was named Chief Scientific
    Officer for University Hospitals. Dr. Jain also
    received the Faculty Distinguished Research Award
    from Case Western Reserve University and was
    presented with the 2015 North American Vascular
    Biology Organization (NAVBO) Judah Folkman Award
    in Vascular Biology.
  • Daniel Simon, MD, became the President of the
    University Hospitals Harrington Heart Vascular
    Institute.
  • Donald Hricik, MD, received the American Society
    of Transplantation's Lifetime Achievement Award
    at the American Transplant Congress.
  • Joshua Augustine, MD, received the 2015 Person of
    the Year Award from the Kidney Foundation of
    Ohio.
  • Sandy Markowitz, MD, PhD, became the
    Distinguished University Professor.
  • Stanton Gerson, MD, received the Academy of
    Medicine of Cleveland and Northeast Ohio
    Distinguished Membership award at the 2015 annual
    meeting.
  • Robert Salata, MD, became the Master Clinician in
    Infectious Diseases.
  • Goutham Narla, MD, PhD, became the James T.
    Pardee - Carl A. Gerstacker Professor of Cancer
    Research at Case Western Reserve University
    School of Medicine. Dr. Narla also received the
    John S. Diekoff Award for Mentoring.
  • Clark Distelhorst, MD, became a 2015 recipient of
    Harrington Scholar-Innovator award for his work
    entitled "Targeting a New Pathway to Treat Blood
    Cancers."

11
Department of Medicine Faculty Awards and
Honors 2014 -2015
  • Robert Bonomo, MD, was selected as a 2015
    Harrington Scholar-Innovator recipient for his
    work on novel bacterial agents to treat
    drug-resistant infections.
  • Sahil Parikh, MD, was appointed Director of the
    Center for Research Innovation at UH Harrington
    Heart Vascular Institute.
  • Hiram Bezerra, MD, PhD, was appointed Director of
    Cardiac Catheterization Laboratory at UH Case
    Medical Center.
  • Richard Josephson, MD, was appointed as head of
    the Cardiac Rehabilitation Work Group for the
    American College of Cardiology.
  • Shaveta Vinayak, MD, became the inaugural Becky
    Hennessy Endowed Master Clinician in Breast
    Cancer Genomics.
  • Judith Mackall, MD, received the Irving B. and
    Virginia Spitz Master Clinician in Cardiology
    award from University Hospitals Harrington Heart
    Vascular Institute.
  • Kingman Strohl, MD, was recognized for his
    leadership in sleep research and community
    service with a Resolution of Recognition by the
    Cleveland City Council.
  • Jennifer Eads, MD, was selected as a 2015 Mary
    Hellerstein Junior Faculty Professional
    Development awardee.
  • Charles Malemud, PhD, received the 2015 Gender
    Equity award for preclinical faculty and was
    named the Founding Editor and Editor-in-Chief of
    Global Vaccines and Immunology.
  • Keith Armitage, MD, Karen Horowitz, MD, and
    Arthur Halle, MD, were presented with Master
    Clinician Educator awards.

12
Department of Medicine Faculty Awards and
Honors 2014 -2015
  • Usha Stiefel, MD, became the Vice Chair for
    Diversity and Faculty Development
  • Mimi Singh, MD, was presented with SGIM Midwest
    award for Excellence in Clinical Education
  • Megan McNamara, MD, received the I CARE award for
    LGBT veteran service
  • Najeeb Osman, MD, had the first percutaneous
    right ventricular assist device placed in Ohio at
    the LSVAMC
  • Anselma Intini, MD, and Jay Sahadevan, MD, had
    the first implantable cardioverter defibrillator
    (ICD) system approved for use with magnetic
    resonance imaging at the LSVAMC
  • Raj Chandra became the Vice Chair for Clinical
    Affairs and Transformation

13
Department of Medicine Faculty Promotions and
Tenure 2014 -2015
  • Clinical Assistant Professor
  • May Al-Abousi, MD
  • Clinical Associate Professor
  • Haspreet Kaur, MD
  • Assistant Professor
  • Hiloni Bhavsar, MD
  • Mirela Dobre, MD
  • Stephen Fink, PhD
  • Xudong Liao, PhD
  • Charles LoPresti, MD
  • Yuan Lu, MD
  • Krisztina Papp-Wallace, MD
  • Mohammad Shatat, MBBS
  • Rehan Waheed, MD
  • Associate Professor
  • Rajesh Chandra, MD
  • Anne Hamik, MD
  • Amy Ray, MD
  • Usha Stiefel, MD
  • Professor
  • Curtis Donskey, MD
  • Richard Silver, MD
  • Tenure
  • Curtis Donskey, MD
  • Anne Hamik, MD
  • Frank Jacono, MD

14
Department of Medicine Cleveland Magazine 2015
Full-Time Faculty Top Doctors
Cardiovascular Medicine Mauricio Arruda Ivan Cakulev Marco Costa Barry Effron Daniel Simon Albert Waldo Endocrinology Baha Arafah Gastroenterology Liver Disease Amitabh Chak Fabio Cominelli Gregory Cooper Ashley Faulx Pierre Gholam Jeffry Katz Anthony Post Sapna Thomas Richard Wong Geriatrics Palliative Care Taryn Lee General Internal Medicine Carla Harwell Debra Leizman Jackson Wright Hematology Oncology Joseph Baar Matthew Cooney Brenda Cooper Marcos de Lima Afshin Dowlati Stanton Gerson Joseph Gibbons Lyndsay Harris Henry Koon Smitha Krishnamurthi Hillard Lazarus Jane Little Sanford Markowitz Neal Meropol Alvin Schmaier Paula Silverman Infectious Diseases HIV Medicine Keith Armitage Robert Bonomo Barbara Gripshover Michael Lederman Robert Salata Nephrology Hypertension Donald Hricik Pulmonary, Critical Care Sleep Medicine Lee Baggott Hugo Montenegro Robert Schilz Kingman Strohl Rheumatology Donald Anthony
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
14
10/20/2015
15
Department of Medicine Cleveland Magazine 2015
Community Physicians Top Doctors
Cardiovascular Medicine Ismail Ahmed Agustus Beck Thomas Wilson Gastroenterology Liver Disease Robert Cameron Michael Koehler Raymond Rozman General Internal Medicine Debra Anne DeJoseph David Headen Alan Hirsh Karen Hummel Philip Junglas Jonathan Klarfeld Chenguttai Manohar Janet Morgan William Steiner Virginia Vatev Hematology Oncology Judah Friedman Joel Salzman Pulmonary, Critical Care Sleep Medicine Samuel Friedlander Rheumatology Elizabeth Brooks Douglas Flagg Richard Stein
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
15
10/20/2015
16
Department of Medicine
  • Research Programs

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
16
17
Department of Medicine New and Competing Renewal
Grant Proposals (Based on grant start date)
18
Department of Medicine Grant Proposal
Trend Direct Costs per FTE
FTEPS 59,RS 31 FTE PS 59, RS 31
FTEPS 57, RS 32 FTE
PS61, RS 23 FTE PS 57, RS 24
19
Department of Medicine Award Total by Period
AY 2009-10 AY 2010-11 AY 2011-12 AY 2012-13 AY 2013-14 AY 2014-15
CV Med 4,414,696 5,188,815 5,674,283 5,354,682 4,925,995 6,516,884
Endocrine 4,990,102 3,340,343 876,015 2,033,616 2,872,031 2,925,215
GI 5,706,619 3,911,888 3,574,394 4,981,180 3,780,772 5,763,182
Gen Med 219,480 299,500 435,750 313,600 0 0
Geriatrics 112,361 105,945 70,229 0 0 0
HemOnc-SCC 23,378,669 15,919,572 10,298,894 18,404,262 13,707,579 12,483,880
ID 16,343,991 24,077,082 20,772,138 25,938,806 13,985,426 12,844,645
ITMM 1,140,228 4,069,321 3,342,200 4,038,678 2,704,799 2,308,666
Neph 5,661,722 3,196,268 4,758,218 2,956,438 6,909,501 5,989,833
Pulm 2,065,948 3,101,377 3,094,745 2,165,156 2,070,504 1,627,798
Rheum 241,111 447,284 0 322,750 291,189 0

Total 64,274,927 63,657,395 52,896,866 66,509,168 51,247,796 50,460,103
Includes CWRU and VA-based awards
20
Department of Medicine Grant Award Trend Direct
Costs per FTE
FTEPS 59, RS 31 FTE PS 59, RS
31 FTEPS 57, RS 32
FTEPS 61, RS 23 FTEPS 57, RS
24
21
Department of Medicine Total Research
Expenditures Direct Costs (millions)
45.0
42.6
41.6
44.5
22
Department of Medicine Average funded salary to
the NIH cap
AY 10-11 AY 10-11 AY 11-12 AY 12-13 AY 13-14 AY 14-15 AY 12-13 AY 13-14 AY 14-15
Physician- Scientists 63.1 63.1 58.1 56.1 51.7 50.7 56.1 51.7 50.7
PhD Scientists 66.6 66.6 64.0 72.0 66.5 59.6 72.0 66.5 59.6


Extramural salary funding as a of the cap.
Where salary is below the cap, actual salary is
used.
23
Department of Medicine
  • Patient Care Operations

24
Department of Medicine U.S. News World Report
Rankings
  • 2014 - 2015
  • Cancer 30
  • Cardiology 38
  • Gastroenterology 27
  • Geriatrics 34
  • Nephrology 48

25
Department of Medicine UH Clinical Activity and
Hospital Margin CY 2014 vs. CY 2015 (projected)
  • 2014 2015 Change
  • Admissions 14,000 13,486 (3.6)
  • Outpatient Encounters 200,000 227,730
    13.9
  • UH direct contribution margin 192.5M 204.8M
    6.4
  • UH total contribution margin 73.9M 77.8M
    5.3

26
Year to year percentage change 2.9
(0.7) 6.7 6.3
27
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28
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29
Department of Medicine
  • Educational Programs

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
29
30
Department of Medicine Education Programs
Student Teaching Time Student Teaching Time
Third-Year Core Clerkship Student 3,120 hours
Basic Science Curriculum 2,200 hours
Fourth-Year Students 25 direct contact time Total hours represents approximately 30 of total faculty teaching time in the School of Medicine 3,080 hours
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
30
31
Department of Medicine Educational Programs
  • AY 10-11 AY 11-12 AY 12-13 AY 13-14 AY 14-15
  • Composition of House Staff
  • Categorical 105 104 104 105 106
  • Special Programs 14 16 18 19 19
  • Harrington -- -- -- 2 4
  • Fellows 81 81 82 82 84
  • International Health, Leadership in Medical
    Education, Primary Care, Med-Peds, Med-Genetics

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
31
10/20/2015
32
Department of Medicine Educational Programs
  • Graduating Resident Career Plans
  • UHCMC Non-UHCMC
    UHHS-affiliated Non-UHHS
  • Fellowships Fellowships General
    Medicine General Medicine
  • 10 15
    3
    2
  • 12 13
    3
    1
  • 9 15
    1
    6
  • 11 13
    3
    7
  • 2013 8 12
    6 6
  • 2014 8 20 4
    4
  • 2015 6 26 3
    6

In 2015 65 of graduates placed in their first
choice
33
Department of Medicine
  • Significant Accomplishments
  • AY 2014-15

34
Significant Accomplishments
  • CLINICAL
  • 47 Department of Medicine full-time faculty
    members recognized as Top Doctors by Cleveland
    Magazine.
  • The trend in benchmarked physician services
    remained positive with year over year gains of 7
    wRVU/cFTE and 10 net patient revenue/cFTE.
  • In-hospital productivity under a high case mix
    index again grew positively in 2014 as defined by
    hospital contribution margin.
  • Ambulatory and inpatient Top Box for overall
    Doctor Rating and Satisfaction with Care were at
    an impressive 82 and 72, respectively. The Fifth
    Annual Medicine Quality Summit again contributed
    to these quality initiatives.

35
Significant Accomplishments
  • RESEARCH
  • Overall, research support to the Department of
    Medicine remains strong. Total awarded funds to
    departmental faculty, including the cancer
    center, totaled 63 million in 2014 2015.
    Direct cost expenditures were nearly 50 million,
    with 67 percent coming from federal sources.
  • In 2014 2015, the fraction of funded salary to
    the NIH cap for physician-scientists and PhD
    scientists remained impressive at 51 percent and
    60 percent, respectively.
  • The Division of Gastroenterology and Liver
    Disease. Fabio Cominelli, MD, PhD, was awarded 6
    million from the NIH to establish a Silvio O.
    Conte Digestive Diseases Research Core Center.
  • The Division of Clinical and Molecular
    Endocrinology Tim Kern, PhD, received a new
    5-year R24 focusing on characterizing and testing
    potential therapies for diabetic and other
    ischemic retinopathies with total costs for the
    project life of the grant in excess of 8
    million.

36
Significant Accomplishments RESEARCH cont.
  • The Division of Infectious Diseases and HIV
    Medicine. Henry Boom, MD, secured a new 3.5M UO1
    for the study and identification of natural
    resistance mechanisms to Mycobacterium
    tuberculosis. Michael Lederman, MD, was awarded a
    new R56 and R21 totaling nearly 1 million
    supporting work in the study of vascular
    inflammation in treated HIV infection and
    targeting cytolytic cells to lymphoid sites of
    HIV persistence.
  • The Division of Cardiovascular Medicine. Mukesh
    Jain, MD, received another RO1 totaling over 1
    million to define the mechanisms by which
    endothelial cells Krüppel-like transcription
    factors regulate the prothrombotic response to
    antiphospholipid antibodies. Dan Simon, MD,
    received a new RO1 for the study of MRP-14, CD36
    and Thrombosis.
  • The Louis Stokes Cleveland VA Medical Center has
    highly funded programs in implementation, quality
    and education research, and is home to one of
    eight VA National Quality Scholars Sites.
  • Research Day 2015 attracted 87 posters from a
    record number of house staff, fellows, graduate
    students and post-docs.
  • A second round of intramural Team Science
    challenge grants were awarded. The three awardees
    from the inaugural round where center stage at
    the 2015 Research Day presenting their progress
    under the award.

37
Significant Accomplishments
  • EDUCATION
  • The 2015 residency match was highly successful
    with 36 interns from strong medical schools (e.g.
    CWRU, Cornell, Rush) including seven
    underrepresented minorities.
  • The program introduced the new Leadership in
    Medical Education track focused on training
    future educators.
  • In addition to our residents entering strong
    subspecialty fellowships, several will be joining
    UH and VAMC in general medical practices.
  • UH and the VAMC remain the teaching hospitals of
    choice for core medical clerkship and acting
    internships.
  • Clerkship and residency leaders continue to have
    high visibility at national educational meetings
    with multiple posters, presentations and
    workshops.

38
Department of Medicine Media and Communication
Enhancements
  • On average, the website receives over 9,100 hits
    a month
  • 38 more people are visiting the website as
    compared to last year we are reaching a larger
    audience
  • 34 increase in the amount of time users spend on
    the departments website visitors are spending
    more time reading the website
  • 25 increase in total number of pages viewed when
    visiting the website visitors are more active
    in exploring the website resources
  • A total of 112 new pages were added to the
    website over the past year website documents and
    links are updated on a daily basis
  • User opinions are captured through 18 annual
    surveys, user feedback is implemented into new
    initiatives and content

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
38
10/20/2015
39
Department of Medicine Media and Communication
Enhancements
  • 9 fellowship programs restructured and
    standardized to include overview, clinical
    training, research training, curriculum,
    conferences, application and benefits
  • Growth of Internal Medicine Residency website
    from 7 basic webpages in 2012 to 96 webpages
    (including Med-Peds) with resources, links,
    presentations, graphics in 2015. The main page of
    Internal Medicine Residency program is the most
    visited page on the website.
  • Medical student education program (including
    Clerkship and AI) total 44 webpages
  • Enhanced viewing for Grand Rounds compiled into
    playlists by specialty, a library comprised of
    over 80 videos
  • Designated pages for Leadership Council and
    Senior Advisory Committee minutes
  • Protected webpages for committees, leadership and
    trainees

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
39
10/20/2015
40
Department of Medicine
  • Future Strategies

41
Department of Medicine Future Strategies 2015
  • Clinical
  • Expansion of the Antibiotic Stewardship Program.
  • Expanded involvement of the hospitalists in
    ACO-based care initiatives.
  • Accelerate the development of the RHI and
    system-wide MICU initiatives.
  • Enhance diabetes/obesity management, bone disease
    and Geriatrics/palliative care.
  • Secure appropriate and sustained levels of
    programmatic support for a new Chief of
    Cardiovascular Medicine.
  • Continue to support the adaption of new clinical
    management support systems such as electronic
    charge capture.

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
41
42
Department of Medicine 2015 VA Initiatives
  • Enhanced patient care through improvements in
    access and efficiency
  • Real-time, same-day access system in all
    subspecialties
  • Increase in hours of operations
  • Decrease wait time for new patients to lt30 days
    in all specialties
  • New telehealth programs to provide specialty
    services to access remote areas (gt40 miles)
  • Identify section specific clinical goals and work
    to improve patient care
  • Renal insufficiency and hypertension
  • Diabetes, obesity and diabetes care coordination
  • Active clinic profile review to improve
    efficiency and access
  • Outpatient Clinic Room Committee participation to
    maximize usage and identify opportunity across
    services

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
43
Department of Medicine Potential challenges to
the clinical mission
  • Securing appropriate and sustained levels of
    programmatic and developmental support for a new
    Chair.
  • Managing 2016 financial and volume targets to
    realistic levels.
  • Greater patient consumerism/choice.
  • The new faculty compensation plan.
  • The movement from volume to value-based metrics.
  • The ICD-10 change and electronic charge capture.
  • Incomplete and unsigned EMR notes.
  • Reputational scores, access and new system
    affiliations.
  • FACULTY MORALE!

44
Department of Medicine Future Strategies 2015
  • Research
  • Ensure a re-investment in the academic mission by
    our continued visibility in affiliation
    discussions, and through the new Chief Scientific
    Officer role for the health system
  • As part of new departmental development, procure
    support packages that assist long-standing
    successful programs to maintain their momentum.
  • Support the enhancement of an infrastructure for
    Innovation and Technology development
    system-wide.
  • Further diversify research funding sources to
    including enhanced industry and philanthropic
    support.
  • Explore the feasibility of clinically-related
    team or team science on a national and even
    international basis.
  • Work with institutional partners to develop a
    philanthropic support base for trainees in
    clinical investigation.

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
44
45
Department of Medicine Future Strategies 2015
  • Education
  • Enhance our role as a leader in innovative
    teaching of patient safety and quality.
  • Increase system-wide involvement (MP) in the
    ambulatory aspects of house staff training and
    precepting.
  • Continue to enhance the depth and diversity of
    the residency.
  • Strengthen the ABIM Resident (Harrington)
    Research Pathway and enhance recruitment of
    research oriented applicants.
  • Resurrect and re-invigorate our CME offerings.
  • Maintain unblemished accreditation status for all
    training programs.
  • Increase scholarly output of educational leaders
    and trainees.

45
46
Department of Medicine Future Strategies 2015
  • Strategic Development
  • Restore a perfect balance in our tripartite
    mission
  • Recruit and develop new roles for Vice Chair for
    Faculty Development and Diversity and Clinical
    Affairs.
  • Increase faculty diversity and development.
  • Increase intramural mentoring of new recruits,
    early career faculty and young investigators.
  • Redouble efforts associated with enhanced
    philanthropic support of the Department.
  • Fully engage our VA affiliate and enhance
    research opportunities to complement their
    outstanding educational and clinical activities.
  • New Interim Chairmans Strategic Plan

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
46
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