Department of Medicine Quarterly Faculty Meeting September 19, 2012

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.  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   2 Assoc. Prof. Clinical X Clinical Educator   No  3   0   Professor Research X Research   No   5   3   Professor Clinical X   Clinical Educator   No 5   1   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

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. What Site Visits Emphasized 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

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 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

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/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

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 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. Medicare Incentives and Penalties

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

47. Hospital

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 • What our residents have to say • Hear them say it • IMAGES • Upper scrolling images • Who we are, changes monthly • Lower left is NEWS • Publications, grants, trials, etc.

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