SMJ : April 2019 Issue

April 8, 2019 // Randy Glick

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal • Vol. 112 • No. 04 • April 2019

Mental Health
Evaluating the Burnout-Thriving Index in a Multidisciplinary Cohort at a Large Academic Medical Center
Rebecca Gates, BS, David Musick, PhD, Mark Greenawald, MD, Kimberly Carter, PhD, RN, Richard Bogue, PhD, and Lauren Penwell-Waines, PhD

Medicine & Medical Specialties
Outcomes in an Interdisciplinary Diabetes Clinic in Rural Primary Care
Dana E. King, MD, MS, Ashley B. Petrone, PhD, Frederick M. Alcantara, MD, Megan M. Elavsky, PharmD, Michelle O. Prestoza, MD, Judy Siebart, MS, RD, and Greg Castelli, PharmD

Is Endurance Exercise Safe? The Myth of Pheidippides
Christine Rutlen, BA, and David L. Rutlen, MD

Commentary on “Is Endurance Exercise Safe? The Myth of Pheidippides”
G. Richard Holt, MD, MSE, MPH, MABE, DBioethics

Mycobacterium fortuitum Meningitis: Approach to Lumboperitoneal Shunt Infection
Jack Zakrzewski, BS, Kimberly Hu, BS, Brandon L. Neisewander, BA, Darian R. Esfahani, MD, MPH, Abhiraj D. Bhimani, BS, Harsh P. Shah, MD, Dafer W. Haddadin, MD, and Ankit I. Mehta, MD

OPEN: Inconsistencies in Colonic Tattooing Practice: Differences in Reported and Actual Practices at a Tertiary Medical Center
Joshua P. Spaete, MD, Jiayin Zheng, PhD, Shein-Chung Chow, PhD, Rebecca A. Burbridge, MD, and Katherine S. Garman, MD

A Brief Review of the Pharmacology of Hyperkalemia: Causes and Treatment
James M. Wooten, PharmD, Fernanda E. Kupferman, MD, and Juan C. Kupferman, MD, MPH

Quality Care & Patient Safety
Objectively Measured Physical Activity and All-Cause Mortality Among Cancer Survivors: National Prospective Cohort Study
Paul D. Loprinzi, PhD, and Allison Nooe, BS

Native Joint Septic Arthritis: Comparison of Outcomes with Medical and Surgical Management
Kaoru Harada, MD, Ian McConnell, MD, Eric C. DeRycke, MPH, Jürgen L. Holleck, MD, and Shaili Gupta, MD

CME Article: Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2)
Eric Dietrich, PharmD, BCPS, Kyle Davis, PharmD, BCPS, Lisa Chacko, MD, MPH, Kiarash P. Rahmanian, MPH, Lauren Bielick, BSN, RN, David Quillen, MD, David Feller, MD, Maribeth Porter, MD, MS, John Malaty, MD, and Peter J. Carek, MD, MS

Public Health & Environmental Medicine
Know the New HIV Testing Guidelines?
Pradeepthi Badugu, MD, and Steven Lippmann, MD

Bioethics & Medical Education
On “Importance of Interdisciplinary Medical Education: A Frontline Perspective”
Regwaan Choudhury, Third Year MBBS Student, and Jai Mathur, Fifth Year MBBS Student

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Introducing the 2021-2022 SMA President: Donna L. Breen, MD

March 27, 2019 // Randy Glick

I am an Otolaryngologist practicing general ENT and allergy for the past 30 years in Marksville, Louisiana after finishing my residency at Tulane Medical Center in 1988. I graduated from University of Alabama Medical School cum laude in 1983. Also, I completed a fellowship in Otolaryngic Allergy in 1992. I am proud to serve the needs of a semirural small town community and take care of adults and children with ear, nose, and throat problems who would have to travel many miles for their care.

Practicing in a small community was very new to me when I first came here. I grew up in New Orleans, Louisiana and was educated in the public and parochial schools there. Living in a smaller community remained a challenge for me in adjustment, but I have come to realize that this environment is perfect for me. I get to know my patients and their families, and their extended families, and relatives, which engages me in their lives, both as a medical doctor, friend and mentor. It is truly the best of both worlds and I have come to treasure my practice as a small town doctor in this community.

I joined the SMA in 1984, while I was a resident and I have been a member ever since. I enjoyed the collegiality as well as the learning experience. It is a big organization with a small town atmosphere in that we are emboldened to learn from the experts in a spirit of congeniality and relaxed learning experience. It is an organization where everyone has equal time, every question has equal value, and everyone has the right to understand the concepts that are being presented. No question or thirst for knowledge is too little and everyone is included in the quest for medical knowledge and skills in the healing arts.

Donna L. Breen, M.D.

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Quality Payment Program (QPP)

March 25, 2019 // Randy Glick

The Centers for Medicare & Medicaid Services has issued a new report that offers a look at how physicians fared the first year of its Quality Payment Program (QPP).

According to CMS, the goal of releasing the data in the report is to highlight successes and pain points that can inform QPP participation in the future.

The QPP includes two possible tracks for doctors, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model. In 2017, more than 1 million doctors enrolled in MIPS, about 95% of those eligible, while more than 99,000 qualified for APM, which is a higher risk-bearing, according to the report.

The participation numbers outperform CMS’ projections and goals for the program’s first year. According to the report, the agency was aiming for 90% participation in MIPS and for about 70,000 physicians to enter the more advanced models.

According to the findings, clinicians in rural practices participated in MIPS at a rate of 94%, which was effectively equal to the overall average and a remarkable accomplishment.

“We look forward to continuing to listen and identify ways to improve the Quality Payment Program to help drive value, reduce burden, and improve outcomes for our beneficiaries,” CMS wrote.

NIH Funded Trial Finds Vitamin D Does Not Prevent Type 2 Diabetes in People at High Risk

March 25, 2019 // Randy Glick

In a study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) it was found that taking a vitamin D supplement does not prevent type 2 diabetes in adults at high risk. D2d(link is external) is the largest study to directly examine if daily vitamin D supplementation helps keep people at high risk for type 2 diabetes from developing the disease.

The study included adults aged 30 or older and assigned participants randomly to either take 4,000 International Units (IU) of the D3 (cholecalciferol) form of vitamin D or a placebo pill daily. All study participants had their vitamin D levels measured at the start of the study. At that time, about 80% of participants had vitamin D levels considered sufficient by U.S. nutritional standards.

A diverse group of participants with a range of physical characteristics, including sex, age, and body mass index, as well as racial and ethnic diversity were enrolled in the D2d study. This representation helps ensure that the study findings could be widely applicable to people at high risk for developing type 2 diabetes.

“In addition to the study’s size, one of its major strengths is the diversity of its participants, which enabled us to examine the effect of vitamin D across a large variety of people,” said lead author Anastassios G. Pittas, M.D., principal investigator from Tufts Medical Center, Boston.

At the end of the study, 293 out of 1211 participants (24.2%) in the vitamin D group developed diabetes compared to 323 out of 1212 (26.7%) in the placebo group – a difference that did not reach statistical significance. The study was designed to detect a risk reduction of 25% or more.

Dr. Veronica Piziak will be speaking on the topic of Diabetes at the upcoming Focus on Women’s Health Conference, July 15-18 in Kiawah Island, South Carolina. Visit sma.org/womens-health for additional information.

FOR MORE INFORMATION
FOCUS ON WOMEN'S HEALTH CONFERENCE

Drug Delays Type 1 Diabetes in People at High Risk

March 25, 2019 // Randy Glick

An NIH funded study finds immunotherapy slows progression to clinical disease by 2 years or more using a treatment affecting the immune system. The study is the first to show that clinical type 1 diabetes can be delayed by two or more years among people who are at high risk. “The difference in outcomes was striking. This discovery is the first evidence we’ve seen that clinical type 1 diabetes can be delayed with early preventive treatment,” said Lisa Spain, Ph.D., Project Scientist from the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The study, involving treatment with an anti-CD3 monoclonal antibody (teplizumab), was conducted by Type 1 Diabetes TrialNet(link is external), an international collaboration aimed at discovering ways to delay or prevent type 1 diabetes. 76 participants ages 8-49 who were relatives of people with type 1 diabetes, had at least two types of diabetes-related autoantibodies (proteins made by the immune system), and abnormal glucose (sugar) tolerance were enrolled in the study.

The participants were randomly assigned to either the control group, which received a placebo or the treatment group, which received a 14-day course of teplizumab. Participants received glucose tolerance tests regularly until the study was completed or they developed type 1 diabetes – whichever came first.

Dr. Griffin P. Rodgers, NIDDK Director stated, “This trial illustrates how decades of research on the biology of type 1 diabetes can lead to promising treatments that have a real impact on people’s lives. We’re very excited to see the next steps in this research.”

Dr. Veronica Piziak will be speaking on the topic of Diabetes at the upcoming Focus on Women’s Health Conference, July 15-18 in Kiawah Island, South Carolina. Visit sma.org/womens-health for additional information.

FOR MORE INFORMATION
FOCUS ON WOMEN'S HEALTH CONFERENCE

SMJ : March 2019 Issue

March 8, 2019 // Randy Glick

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal • Vol. 112 • No. 03 • March 2019

Bioethics & Medical Education
A 5-Step Framework for the Assessment and Remediation of a Struggling Medical Learner in the Clinical Environment
Sarah B. Merriam, MD, MS, Melissa A. McNeil, MD, MPH, and Carla L. Spagnoletti, MD, MS

Development of a Vertically Integrated Trainee Program: Linking Future and Young Physicians
Jaron L. Pettis, BS, Daelan T. Johnson, Joshua T. Bosak, BS, Ian M. Brastauskas, MD, Erika A. Jansen, BS, Ryan McNutt, Rahul S. Raghavan, Sammy L. Huynh, BS, Alvin Lee Day, MD, Nancy Walborn, MEd, and Donald J. DiPette, MD

On “Improving Underrepresented Minority in Medicine Representation in Medical School”
Lagasthija Vijayaratnam and Jai Mathur

Medicine & Medical Specialties
CME Article: Characteristics of Syncope Admissions Among Hospitals of Varying Teaching Intensity
Michael I. Ellenbogen, MD, Daniel J. Brotman, MD, Jungwha Lee, PhD, MPH, Kimberly Koloms, MS, and Kevin J. O’Leary, MD, MS

Awareness of Birth Cohort Hepatitis C Testing Recommendation Among Baby Boomers: An Exploratory Survey Study
Vabhave Pal, MD, Yasir Ahmed, MD, Shikha Singh, MD, Kalpana Bhairavarasu, MD, and Lavi Oud, MD

Flexible Sigmoidoscopy Rather than Colonoscopy Is Adequate for the Diagnosis of Ipilimumab-Associated Colitis
J. Daniel Herlihy, MD, Stephen Beasley, MD, Andrew Simmelink, MD, Vinaya Maddukuri, MD, Asim Amin, MD, Michal Kamionek, MD, Carl Jacobs, MD, Krista Bossi, MS, and Martin Scobey, MD

Emergency Medicine & Disaster Preparedness
Trauma Providers’ Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs
Thomas H. Shoultz, MD, Megan Moore, PhD, MSW, May J. Reed, MD, Stephen J. Kaplan, MD, MPH, Itay Bentov, MD, PhD, Catherine Hough, MD, Lisa A. Taitsman, MD, MPH, Steven H. Mitchell, MD, Grace E. So, BA, Saman Arbabi, MD, MPH, Herb Phelan, MD, and Tam Pham, MD

Women's & Children's Health
Impact of Holidays on Pediatric Trauma Admissions to a Community Hospital in South Florida
Stephanie Eyerly-Webb, PhD, Rachele Solomon, MPH, LeAnne Young, MSN, RN, Keren Bard, Carrie Laituri, MD, Andrew Rosenthal, MD, and Julie Long, MD

Antibiotic Prophylaxis for Cesarean Delivery Among Alabama Providers
Dana Watson, MS, Alan Tita, MD, PhD, Lisa Dimperio, BS, Tera Howard, MD, and Lorie Harper, MD

Contraceptive Methods and the Impact of Menstruation on Daily Functioning in Women with Sickle Cell Disease
Melissa E. Day, BS, Sarah-Jo Stimpson, MD, Mark Rodeghier, PhD, Djamila Ghafuri, MBBS, Michael Callaghan, MD, Ahmar Urooj Zaidi, MD, Bryan Hannan, MS, Adetola Kassim, MD, MS, Andra H. James, MD, MPH, Michael R. DeBaun, MD, MPH, and Deva Sharma, MD, MS

Advanced Prescription of Emergency Contraceptive Pills Among Adolescents and Young Adults
Somsook Santibenchakul, MD, MPH, Mary Tschann, PhD, MPH, Alyssa Dee P. Carlson, MPH, Eric L. Hurwitz, PhD, DC, and Jennifer Salcedo, MD, MPH, MPP

Improving Documentation of Obstetric Anal Sphincter Injuries (OASIS) Using a Standardized Electronic Template at Two University-Affiliated Institutions
Padraic Chisholm, MD, Allison Sellner, Charles C. Kilpatrick, MD, MEd, Laurie S. Swaim, MD, and Francisco J. Orejuela, MD, MS

Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program
Wally R. Smith, MD, India Y. Sisler, MD, Shirley Johnson, BA, Thokozeni J. Lipato, MD, Jennifer S. Newlin, PA, Zakiya S. Owens, PA, Alma M. Morgan, MEd, Marsha J. Treadwell, PhD, and Kathryn Polak, MS

Commentary on “Lessons Learned from Building a Pediatric-to-Adult Sickle Cell Transition Program”
Sara Mixter, MD, MPH, and Rosalyn W. Stewart, MD, MS, MBA

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Diabetes-Focused Continuing Medical Education: A Partnership between SMA and Clinical Care Options

March 8, 2019 // Randy Glick

Diabetes in the South: Focus on Prevention

Richard E. Pratley, MD

LEARN MORE

Individualizing Diabetes Management in Early T2DM

Guillermo E. Umpierrez, MD, CDE

LEARN MORE

Navigating Insulin-based Therapy

Veronica K. Piziak, MD, PhD, FACP

LEARN MORE

“Southern Medical Association is very excited to work with CCO to advance the care of patients with or at risk for T2DM. Designed as an interdisciplinary initiative, this program targets the specific needs and challenges of clinicians practicing in the US diabetes belt,” says Randy Glick, Executive Director. “This collaboration also supports SMA’s mission to improve quality of care for patients in the southeastern region of the United States. The prevalence of T2DM and cardiovascular disease, coupled with fewer care providers in our regions of focus, makes this type of project much more meaningful. We are very grateful to be a part of this effort.”

“We are honored to be partnering with SMA and look forward to engaging with clinicians throughout the South to help them navigate the challenges of managing patients with T2DM and associated cardiovascular risk factors,” adds Alyce Kuklinski, NP, RN, General Manager, Internal Medicine, CCO.

About Clinical Care Options 
Clinical Care Options, LLC, is a global leader in the development of innovative educational programs and technology platforms. CCO’s team has been a pioneer in the creation of continuing education and decision support resources for healthcare professionals both in the United States and around the world for more than 2 decades. For more information, visit http://www.clinicaloptions.com

President-Elect Designate Nominee: Lawrence Stroud Carter, Jr., MD

February 27, 2019 // Randy Glick

This is the ballot for Dr. Carter who is running for the position of President-Elect Designate for the 2020-2021 term.

The President-Elect Designate shall assume all responsibilities as assigned by the President-Elect. In the absence or incapacity of the President-Elect, the President-Elect Designate shall assume the duties and responsibilities of the President-Elect.

Lawrence Stroud Carter, Jr., MD
Chairman of Department of Medicine, Frye Regional Medical Center
Chair of SMA's Membership Committee
Bowman Gray School of Medicine
Hickory, NC  28601

 

Having been raised in North Carolina as part of a military family, Dr. Lawrence Carter appreciated early on the diversity of our population. He realized three distinct cultures in his State: Coastal flatlands, the Piedmont, and the Mountains, each with their own dialects and style of foods. He did not realize until medical school that besides living in the Bible Belt we were also living in the kidney stone, heart attack, stroke, and diabetic/metabolic syndrome belt. While paying back his time in the United States Air Force, Dr. Carter discovered his passion for empowering his patients instead of just enabling them. He joined the ACP, AMA, ADA, Southeastern Lipid Association, National Lipid Association, COSEHC and Southern Medical Association. He has learned from the experiences of experts on how to apply strategies in taking great care of his patients here in his home town of Hickory. This entails educating his patients about healthy diets and activities and helping them develop a personalized wellness plan. While serving on the board of Catawba County Health Partners,

Dr. Carter helped develop the “Eat Smart, Move More” campaign to encourage more activity in his community. He also spearheaded a nationally recognized program partnering local farmer’s markets with the Health Department to provide access to healthy food choices for those with limited resources. Dr. Carter enjoys being a part of the SMA because it provides him the opportunity to collaborate with multidisciplinary professionals for the purpose of improving healthcare. On the weekends he coaches youth soccer at the local YMCA and enjoys hiking the beautiful Carolina mountains with his love Krystal, her son Liam, and man’s best friend Jersey.

His Vision:
Continue working to support the four pillars of Relevance, Collaboration, Engaging Academia, and Youth Strategy by introducing new opportunities. I want to keep increasing membership value by improving membership benefits. I support finding a place in SMA for all licensed healthcare providers. I believe SMA ties the art and science of medicine together by fostering relationships between multi-disciplinary teams and I am excited to be a part of the future. 

Dr. Carter's Resume/CV Members Vote Here

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A Message From the Executive Director

February 27, 2019 // Randy Glick
Randall E. Glick, BSB/PM MCP

Randall E. Glick, BSB/PM MCP
Executive Director

Greetings from the Southern Medical Association. I wanted to take a few moments to share with you our new vision, “The Business of Medicine Simplified”. We hear over and over again how the business side of medicine wreaks havoc on your career, jeopardizing the quality of care you provide your patients. We hear you … you’re angry, frustrated, and in some cases totally burned out. We believe the business of medicine should be easy and we plan to help you make it that way.

We are developing podcasts on the Business of Medicine which will cover relevant business topics, including:

  • Tech Frustration and Burnout: Making Technology Work for You
  • Choice Apps That Will Help Make Your Practice Run More Smoothly
  • Office Design, Practice Workflow Improvements

We plan to launch the first podcast on March 13; be sure to download it and listen!

I would also like to invite you to our Southern Regional Assembly taking place June 27-29 at the Hyatt Regency Birmingham - The Wynfrey Hotel in Birmingham, AL. The meeting’s theme is Business of Medicine Simplified and will provide practical, real-world information and tips you can use on a daily basis. For additional information and to register, visit sma.org/assembly.

We do want to hear what you need as it relates to the Business of Medicine. What topics should we cover? What do you want to hear in a podcast or as a webcast? Let us know. Send your wish list to education@sma.org.

Posted in: CME

CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures

February 27, 2019 // Randy Glick

Growth in national health spending over the next decade remains similar from last year’s projected average annual growth of 5.5 percent

National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).

Growth in national health spending is projected to be faster than projected growth in Gross Domestic Product (GDP) by 0.8 percentage points over the same period.  As a result, the report projects the health share of GDP to rise from 17.9 percent in 2017 to 19.4 percent by 2027. Read More.

The outlook for national health spending and enrollment over the next decade is expected to be driven primarily by:

  • Key economic factors, such as growth in income and employment, and demographic factors, such as the baby-boom generation continuing to age from private insurance into Medicare; and
  • Increases in prices for medical goods and services (projected to grow 2.5 percent over 2018-2027 compared to 1.1 percent during the period of 2014-2017).

Similar to the findings in last year’s report, the report found that by 2027, federal, state and local governments are projected to finance 47 percent of national health spending, an increase of 2 percentage points from 45 percent in 2017.  As a result of comparatively higher projected enrollment growth in Medicare, average annual spending growth in Medicare (7.4 percent) is expected to exceed that of Medicaid (5.5 percent) and private health insurance (4.8 percent).

Selected highlights in projected health insurance enrollment and national health expenditures by sector and payer include:

Health Insurance Enrollment: Net enrollment gains across all sources are generally expected to keep pace with population growth with the insured share of the population going from 90.9 percent in 2017 to 89.7 percent in 2027.

Medicare: Medicare spending growth is projected to average 7.4 percent over 2018-2027, the fastest rate among the major payers.  Underlying the strong average annual Medicare spending growth are projected sustained strong enrollment growth as the baby-boomers continue to age into the program and growth in the use and intensity of covered services that is consistent with the rates observed during Medicare’s long-term history.

Medicaid: Average annual growth of 5.5 percent is projected for Medicaid spending for 2018-2027.  Medicaid expansions during 2019 in Idaho, Maine, Nebraska, Utah, and Virginia are expected to result in the first acceleration in growth in spending for the program since 2014 (from 2.2 percent in 2018 to 4.8 percent in 2019).  Medicaid spending growth is then projected to average 6.0 percent for 2020 through 2027 as the program’s spending patterns reflect an enrollment mix more heavily influenced by comparatively more expensive aged and disabled enrollees.

Private Health Insurance and Out-of-Pocket: For 2018-2027, private health insurance spending growth is projected to average 4.8 percent, slowest among the major payers, which is partly due to slow enrollment growth related to the baby-boomers transitioning from private coverage into Medicare.  Out-of-pocket expenditures are also projected to grow at an average rate of 4.8 percent over 2018-2027 and to represent 9.8 percent of total spending by 2027 (down from 10.5 percent in 2017).

Prescription Drugs:  Spending growth for prescription drugs is projected to generally accelerate over 2018-2027 (and average 5.6 percent) mostly as a result of faster utilization growth.  Underlying faster growth in the utilization of prescription drugs, particularly over 2020-2027, are a number of factors including efforts on the part of employers and insurers to encourage better medication adherence among those with chronic conditions, changing pharmacotherapy guidelines, faster projected private health insurance spending growth in lagged response to higher income growth, and an expected influx of new and expensive innovative drugs into the market towards the latter stage of the period.

Hospital:  Hospital spending growth is projected to average 5.6 percent for 2018-2027. This includes a projected acceleration in 2019, to 5.1 percent from 4.4 percent in 2018, reflecting the net result of faster expected growth in both Medicare (higher payment updates) and Medicaid (as a result of expansion in five states), but slower projected growth in private health insurance as enrollment declines slightly due to the repeal of the individual mandate.

Physician and Clinical Services: Physician and clinical services spending is projected to grow an average of 5.4 percent per year over 2018-2027.  This includes faster growth in prices over 2020-2027 for physician and clinical services due to anticipated rising wage growth related to increased demand from the aging population.

The Office of the Actuary’s report will appear at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html

An article about the study is also being published by Health Affairs and is available here: https://protect2.fireeye.com/url?k=529199bd-0ec4906d-5291a882-0cc47a6a52de-97641bdac742d461&u=http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05499

Posted in: CME

CMS: 2020 ICD-10 PCS

February 27, 2019 // Randy Glick

The 2020 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2020. These 2020 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020.

Note: There is no GEMs file. As stated in the FY 2016 IPPS/LTCH PPS final rule (80 FR 49388), the GEMs have been updated on an annual basis as part of the ICD-10 Coordination and Maintenance Committee meetings process and will continue to be updated for approximately 3 years after ICD-10 is implemented.

We made the GEMs files available for FY 2016, FY 2017 and FY 2018.

An announcement was also made at the September 2017 ICD-10 Coordination and Maintenance Committee meeting that FY 2018 would be the last GEMs file update.

Posted in: CME

Matthew Fadel, MBA

February 26, 2019 // Randy Glick

Matthew Fadel, MBA
Senior Consulting Director, Sg2

Emerging Issues

As a leader on Sg2’s Consulting team, Matt focuses on physician-hospital alignment models (eg, accountable care organizations [ACOs], clinically integrated networks [CINs], co-management) and strategic planning, both service line–wide and enterprise-wide. He specializes in engagements around the design, development and implementation of ACOs, CINs and co-management agreements.

Prior to Sg2, Matt served as senior manager within the National Strategy Practice (NSP) of Dixon Hughes Goodman (DHG). In this role, he designed a CIN playbook for a large regional health system in the southeast that has expanded across 2 states and over 7 different health system partners. He also was involved in several internal cost savings/gainsharing engagements to help health systems, hospitals and large physician groups improve quality and reduce costs. Furthermore, Matt acquired technical expertise in developing funds flow methodologies based on rewards and created through value-based agreements (eg, shared savings, pay-for-performance, capitation).

Additionally, Matt worked in the performance improvement consulting division at Ernst and Young, where he designed a new operating model for a state health care agency. He also worked with numerous health systems on meaningful use attestation requirements.

Matt holds a Master of Business Administration with a concentration in finance and financial reporting and a master in the science of management from Case Western Reserve University. He earned a Bachelor of Arts in political science from Denison University.

Matt has written extensively on his areas of expertise, including clinical integration, funds flow methodology, risk-based payments, narrow networks and community health needs assessments. His work has been published through DHG and Beckers Hospital Review.

Colin Goldfinch

February 26, 2019 // Randy Glick

Colin Goldfinch

Emerging Issues

Colin is a senior health policy advisor to Ranking Member Patty Murray (D-WA) on the Senate HELP committee. He works on policy areas including the Affordable Care Act, regulation of commercial insurance, health information technology, and delivery system reform. Before coming to the committee, Colin spent a year as a David Winston Health Policy Fellow with the Senate Finance Committee where he worked on Medicare physician payment policy. Before coming to the Hill, Colin worked at Group Health Cooperative (Now Kaiser Permanente of Washington) in Seattle as a public policy analyst. While in Seattle he also completed his Master of Public Health and Master of Health Administration at the University of Washington.

Julius W. Hobson, Jr.

February 26, 2019 // Randy Glick

Julius W. Hobson, Jr.

Emerging Issues

Julius W. Hobson, Jr. has over 47 years of experience dealing with the Congress and Federal departments and agencies. As Senior Policy Advisor at Polsinelli, he advises and lobbies on a number of issues including health care, appropriations and budget, education, financial services, urban affairs, and taxes. Mr. Hobson previously served over 13 years as lobbyist and Director of Congressional Affairs, American Medical Association. Prior to joining the AMA, Mr. Hobson served on the staff of Senator Charles Robb [D-VA] where he was responsible for appropriations, budget, taxes, and banking issues. He previously served as Congressional and Executive Branch liaison for the District of Columbia Government. Mr. Hobson was Chief of Staff to a Member of Congress and Staff Director of a House Subcommittee.

He also handled Congressional and Federal Affairs for Howard University. Mr. Hobson served a four-year term as an elected member of the D.C. Board of Education.

Currently, Mr. Hobson is Adjunct Professor, Graduate School of Political Management, George Washington University, where, since 1994, he has taught Lobbying.  He also teaches Legislative Writing and Research.  Mr. Hobson is a member of the D.C. Hospital Association Board of Directors.

Dianne B. Love, PhD

February 26, 2019 // Randy Glick

Dianne B. Love, PhD

Emerging Issues

Dianne B. Love, PhD, (Activity Chair and Faculty) is a healthcare consultant specializing in the development and strategic management of physician organizations. She has developed more than 75 physician organizations -  both multi-specialty and single specialty. Since forming DB Love & Associates in 2000, Dr. Love has developed Group Practices Without Walls (GPWW), physician-owned ambulatory surgery centers and physician-owned short-stay surgical hospitals.  Dr. Love is the founder and served as the director of the MBA for Physicians Program at the University of Houston, Clear Lake, where she is an Associate Professor of Healthcare Administration. Dr. Love is also an Adjunct Professor at the University of Texas Medical Branch in Galveston.

Molly MacHarris

February 26, 2019 // Randy Glick

Molly MacHarris

Emerging Issues

Molly MacHarris leads the Merit-Based Incentive Payment System (MIPS) program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in the Center for Clinical Standards & Quality at the Centers for Medicare & Medicaid Services (CMS).

Robert E. Moffit, PhD

February 26, 2019 // Randy Glick

Robert E. Moffit, PhD

Emerging Issues

Robert E. Moffit is a senior fellow at The Heritage Foundation. He is also Chairman of the Maryland Health Care Commission as an appointee of Governor Larry Hogan.

Moffit long has specialized in health care and entitlement programs, especially Medicare. He brings to the health reform effort his government experience as a Principal Deputy Assistant Secretary at the U.S. Department of Health and Human Services (HHS) and a senior official of the Office of Personnel Management (OPM), where he served during the Reagan administration. In 2010, Modern Healthcare magazine named Moffit as one of the 100 most influential Americans in health care. He has frequently testified before congressional committees.

Moffit’s articles have appeared in The Wall Street Journal, The Washington Post, The Hill, Fortune, The Irish Independent, The National Interest and National Review. He has also published in numerous professional and specialty journals, among them Health Affairs, Health Systems Review, Harvard Health Policy Review, Inquiry, Journal of Law, Medicine and Ethics, National Affairs, New England Journal of Medicine, Postgraduate Medicine, and Journal of Medicine and Philosophy.

Moffit holds both a master's degree and a doctorate in government from the University of Arizona. He received his bachelor's degree in political science from LaSalle University in Philadelphia. His essays on political science have appeared in The Catholic Historical Review, Law and Liberty Review, Modern Age and The Political Science Reviewer.

Moffit serves on the advisory board of the Buckley School of Public Speaking in Camden, South Carolina. Recognition for his work includes public service awards from diverse organizations such as the American College of Eye Surgery, the International Hyperbaric Medical Association, and the National Hispanic Family Against Drug Abuse.

Dr. Moffit is married and lives with his wife, Barbara, in Severna Park, Maryland.

Stephen W. Nesbit, DO, MBA

February 26, 2019 // Randy Glick

Stephen W. Nesbit, DO, MBA

Emerging Issues

Dr. Nesbit has over 35 years experience as a board certified family physician with half of those years focusing on physician executive roles.  His clinical experience ranges from a rural solo family practice in West Texas, including OB, emergency medicine, to ownership of multiple extended-hour clinics in Southeast Texas.  In his physician executive roles he has had senior management responsibilities for quality, medical management, credentialing, physician recruitment, service line operations, provider contracting/relations and population health plan operations.  For the last 18 years, Dr. Nesbit has held chief medical officer roles in both health plans and hospitals, which includes his present role as Chief Medical Officer, HCA Gulf Coast Division, based in Houston, TX.  HCA GCD is the largest division in the HCA family of hospitals which includes some 18 facilities.

Training and experience in public speaking, media communications, GE Change Acceleration Process, Program Management, Lean Six Sigma methodology, Dale Carnegie, leadership development, conflict resolution, disruptive physician behavior, physician communications and medical staff affairs.

Dharmesh Patel, M.D.

February 26, 2019 // Randy Glick

Dharmesh Patel, M.D.

Emerging Issues

AMD Global and AMD Healthcare is a Houston-based development firm with a broad portfolio of assets in healthcare, commercial real estate, energy, and occupational care. AMD offers full-service development, management, and investment services for partners and third-party investors providing exposure to distinct opportunities in these diversified sectors while operating to the very highest ethical, moral, and qualitative standards. From conception to implementation, our assortment of projects maintains a unified message of social responsibility while preserving maximum profitability.

AMD Global’s founder and CEO, Dharmesh Patel, MD is a board-certified emergency room physician and former co-founder of Neighbors Health. As the system’s COO, Patel helped steer and expand Neighbors Emergency Center from its infancy in 2008 to becoming one of the largest independently-held system of freestanding emergency rooms in the nation, at one time having more than 30 locations across several states. Through Dr. Patel’s vision, AMD Global has expanded its list of projects to include medical office buildings (MOBs), ambulatory surgical centers (ASCs), and micro-hospitals or community based hospitals.  To support the hospital infrastructure, Dr. Patel started his own medical billing company to handle the entire revenue cycle for each of his owned healthcare facilities.  It’s accomplishments include outperforming other revenue cycle companies with an expertise on out-of-network billing while bringing value to the patients and communities it serves.

In addition, he is the founder of Avail Health, a newly-formed, progressive hospital system with facilities being developed in multiple states including Texas, Arizona, and Louisiana. The system’s first completed micro-hospital site location opened in Lake Charles, LA. in January 2018. With only one year of operation and its success, Avail Hospital in Lake Charles will undergo an expansion to add additional service lines, inpatient beds, surgical suites and clinic space starting Q3 of 2019.  Other developments include the Heights Hospital in the heart of Houston, a community landmark site completely renovated as a healthcare destination, Hedwig Place, a five-story medical office building (MOB) on two acres in Houston's Memorial Villages, recently announced in partnership with Stream Realty Partners; the Pearland Shadow Creek Professional Plaza; an ambulatory surgical center (ASC) and a number of freestanding emergency rooms.

Dharmesh Patel, M.D. grew up in Chicago where he attended most of this education. Dr. Patel studied Chemistry and Physics for his undergraduate degree at North Park University in Chicago. While completing his undergraduate degree, Dr. Patel worked at North Park University in a medical science laboratory, conducting research on finding a cure for cancer in children. Dr. Patel eventually joined the PhD program at Rush University to continue his work in cancer research. During this time, he was admitted to the medical college at Rush and finished his medical degree. The journey in Chicago ended with his move to Baton Rouge, Louisiana to start his Emergency Medicine Residency training where he spent the next three years of his life. The journey to the south landed Dr. Patel a job as an Emergency Medicine physician in Houston at one of the major medical institutions. He now calls Houston his home, where he resides with his lovely wife, Mayuri, and his 11-year-old son, Arjun, and his 7-year-old daughter, Anjali.

Cathy Schoen

February 26, 2019 // Randy Glick

Cathy Schoen

Emerging Issues

Cathy Schoen is an economic and senior scholar at the New York Academy of Medicine. Her research includes analysis and policy development to address health care costs, access and health system performance, with attention to populations vulnerable due to income, age or health status. From 2014 through 2016, she was the Executive Director of the Commonwealth Fund Council of Economic Advisors and Health Cost Initiative with a focus on sustaining slow growth in health care spending while improving access, quality of care and health outcomes. Until she retired in July 2014 she was senior vice president of The Commonwealth Fund for Policy and Research, where she was on the executive management team and led various initiatives, including:  Controlling Health Care Costs;  US state and local health system scorecards to compare, monitor and assess performance across the United States; international surveys to compare experiences of doctor and patients in the US with their counterparts in other high-income countries; and analysis of U.S. and international policy initiatives. As research director for the Fund’s Commission on a High Performance Health System from its inception in 2005 to its closing 2013, she developed policy options and a series of  “scorecards” designed to track and provide targets to improve health system performance. Prior to joining the Fund in 1995, Ms. Schoen taught health economics at the University of Massachusetts. In the 1970s, she was at the Brookings Institution and then staff to President Carter's health insurance task force, including oversight of Medicaid, access and health benefit design.  In the 1980s was research and policy director for the SEIU international union. She has authored numerous articles on health policy, insurance, and comparative national and international health system performance, and coauthored the book, Health and the War on Poverty. She holds an undergraduate degree in economics from Smith College and a graduate degree in economics from Boston College.

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