July 2012 Newsletter

Department of Medicine eNewsletter
July 2012
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes

2012 Best Hospitals in America

The Department of Medicine is proud to say that UH Case Medical Center has once again received high rankings in U.S. News and World Report's Annual Ranking of American Hospitals. Of special note is the improved position of many of our Divisions. Congratulations to our faculty for their strong commitment to quality patient care.


#18 - Cancer

#14 - Digestive Disorders/Gastro

#27 - Geriatrics

#38 - Diabetes/ Endocrinology

#29 - Heart and Heart Surgery

#31 - Nephrology

#38 - Pulmonology

2012 Top Doctors in America

U.S News has published a list of nation's best doctors based on peer nomination. The Department of Medicine is proud of the outstanding achievements of its faculty members.


Dr. James Fang

Dr. Dan Simon*

Dr. Albert Waldo*



Dr. Baha Arafah


Dr. Amitabh Chak

Dr. Fabio Cominellli*

Dr. Pierre Gholam*

Dr. Jeffry Katz

Dr. Anthony Post

Dr. Richard Wong



Dr. Matthew Cooney

Dr. Brenda Cooper

Dr. Afshin Dowlati*

Dr. Stanton Gerson*

Dr. Smitha Krishnamurthi*

Dr. Hillard Lazarus*

Dr. Nathan Levitan

Dr. Sanford Markowitz*

Dr. Neal Meropol*

Dr. Paula Silverman*


Infectious Diseases/HIV

Dr. Keith Armitage

Dr. Robert Salata*


Dr. Carla Harwell

Dr. Jackson Wright*


Dr. Donald Hricik

Dr. Michael Smith

Dr. Jay Wish


Dr. Reena Mehra

Dr. Hugo Montenegro

Dr. Robert Schilz

* - Denotes that a doctor, in Castle Connolly's estimation, is among the top 1% in the nation in his or her specialty.

Doctors listed without this icon are determined to be in the top 10% in their region.

Leadership Council
July 9, 2012

Chair ::

R. Walsh


Present ::

K. Armitage

B. Arafah

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

T. Hostetter

D. Hricik

M. Jain

N. Meropol

R. Salata

K. Strohl

R. Walsh
J. Wright


Recorded by ::
A. Staruch
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department interview
We sat down with Dr. Dan Simon, Division Chief of Cardiovascular Medicine, to discuss how technology development and research funding climate are shaping the future of his division.


A cornerstone of the Harrington Heart & Vascular Institute (HHVI) is new technology acquisition and development to improve quality and gain a competitive advantage. How do you feel ever-increasing regulation, healthcare reform, etc. will impact the future rate of new technology acquisition and development?


On one hand, minimally invasive therapies and percutaneous technologies offer the opportunity to perform complex procedures in a cost-effective environment. However, the actual development of these technologies is quite expensive. The clinical trial path to approval in U.S. is more challenging than ever. The real problem lies in the fact that Health Care Reform is ultimately focused on primary care and prevention and less so on procedural sub-specialities. The ultimate challenge for us is to figure out a way to continue to develop minimally invasive, percutaneous therapies in a resource challenged health care environment.


Though most people recognize that the American public needs advanced medical technology, it is crucial for medical professionals to demonstrate that innovative, cutting-edge technologies are cost-effective. As our health care environment undergoes change, I believe we may experience the "Europeanization" of medicine in the U.S.- namely, the hurdle for new device use may no longer be simple FDA approval, but rather coverage analysis by CMS/Medicare. We are experiencing this change with TAVR (transcatheter aortic valve replacement) where CMS is tightly controlling clinical application and restricting use to precise inclusion and exclusion criteria applied in the pivotal clinical trial. However, in the end, I believe the trend to develop and improve cardiovascular technologies will be sustained even in this challenging environment.



A second significant aspect of cardiovascular medicine here is the HHVI's companion organization, the Cardiovascular Research Institute (CVRI). The strength and depth of basic research in the CVRI remains high by any measure in a difficult biomedical research funding climate. Apart from the increased competitiveness and scarcity of extramural funding, what are the greatest upcoming challenges for the CVRI?


The greatest challenge is the sustainability of the CVRI. The present extramural funding environment for biomedical researchers is at a low point in my more than 20 year career. With low funding rates, it is very difficult for a physician-scientist to carry 70% of their salary on grants alone, so this becomes the responsibility of the CVRI. In my view, ultimately affiliated departments in medical schools will likely have to provide 30-50% of salary support from endowment funds. There also needs to be an expansion of the funding pool to capture foundation and industry support.


We are also trying to raise funds for the new "rising chair" concept by working with donors interested in supporting highly valued junior faculty at the assistant professor level. This progressive chair from assistant, to associate and finally professor is appealing to many donors because they feel that they are actively participating in career development, retention and recruitment of star talent.


Currently the mission of the Cardiovascular Division in both clinical research and education is being supported by the HHVI and the School of Medicine and University Hospitals funds through the Case Research Institute. Dr. Mukesh Jain and I are working with the development team at the School of Medicine to identify donors for the CVRI. We have recently formed a CVRI Leadership Council comprised of important community leaders, who serve as ambassadors of our mission and assist us in spreading the word about our innovative discovery activities.



The traditional "business model" for most academic divisions of Cardiovascular Medicine has been high impact/high cost procedures, strong translational and applied research and robust subspecialty training. More recently prevention (risk factor) management has taken on a major focus. If you could design the optimal Cardiovascular Medicine "business model" for the next 10-15 years, what would it look like?


In the new healthcare environment, there is undoubtedly a major focus on longitudinal rather than episodic care that rewards volume and procedures. While preventative medicine will be pushed in the context of the ACO model that emphasized primary care, academic medical centers will still be needed for tertiary and quaternary services that are simply unavailable in the community. Our Division will focus on minimally invasive therapies by multidisciplinary teams, offering innovative, cost-effective therapies for complex patients.



Finally, the Cardiovascular Medicine division has been very successful at UHCMC from a number of different perspectives including quality and deployment of care, faculty development, patient satisfaction and engagement with the community. What is the next level of development for the division?


The Division has tried to retain and recruit expertise in all areas of cardiovascular disease, so our ultimate goal is to continue to be nationally recognized as a division that truly advances health care. We hope our clinician-scientists and physician-investigators will be performing fundamental discovery work that translates innovations into new therapies and ultimately raises the standard of cardiovascular care. I believe the Harrington Project provides a unique foundation for us to do this type of work.


One of the key measures of offering premier medical care is performing first-in-man trials. We will soon be starting to enroll patients in a first-in-man stem cell trial for peripheral vascular disease and the first U.S. trial for percutaneous left ventricular volume reduction for heart failure. These efforts show that our Division is truly a leader in advancing care by delivering new treatments to our patients.

department news report
Division of Gastroenterology and Liver Disease

During June 2012, the American Society for Gastrointestinal Endoscopy (ASGE) awarded the Digestive Health Institute Endoscopy Unit at UH Case Medical Center the Certificate of Recognition Award certifying that the suite has successfully met the requirements to continue to be recognized as a unit that promotes quality in endoscopy through the ASGE Endoscopy Unit Recognition Program (EURP).




Division of General Internal Medicine and Geriatrics

Dr. Ronda Mourad has joined the Internal Medicine Residency Program as an Associate Director.
Drs. Brook Watts, Amy Hirsch, and Yngve Falck-Ytter were awarded a $93,114 grant from the VA Office of Public Health, HIV/Hepatitis C Pathogens division, for their project entitled, "Implementation and Evaluation of a Hepatocellular Cancer Tracking Tool". This project aims to enhance care for patients with hepatocellular cancer through the use of an informatics system that facilitates timely tracking and measurement of clinical care benchmarks.




Division of Hematology and Oncology

Dr. Paolo Caimi has been promoted to Assistant Professor of Medicine, effective July 1. This honor recognizes Dr. Caimi's important contributions to clinical research, patient care, and education since joining our faculty two years ago.








Dr. Vinay Gudena was voted the "Best Preceptor of the Year" by the family practice residency program at Firelands Regional Medical Center, for "outstanding contribution and continued dedication to the medical education and training of the 2009-2012 Residency class."

Dr. Panos Savvides's abstract submitted by Radiation Oncology Chief Resident Charles Woods to the annual meeting of the American Society of Radiation Oncology has won first place for the Annual Meeting Resident Poster Viewing Recognition Award in the Clinical category. The research is entitled "Study of Definitive Radiotherapy with Concurrent Erlotinib and Docetaxel in Locally-Advanced Squamous Cell Carcinoma of the Head and Neck (LA-SCCHN)."




Division of Infectious Diseases and HIV Medicine

Dr. Robert Bonomo has received a 650,000 VA Merit Award for his project entitled "The Continuing Challenge of Carbapenemases in K. pneumoniae: KPC-2 &NDM-1."

Dr. Bonomo was also invited to speak at the National Transplant Society Meeting on July 15, 2012.





Marion S. Skalweit, PhD, MD

Dr. Marion Skalweit presented a poster at The American Chemical Society National Meeting in San Diego entitled "Exploring the role of Asn 152 in altering the resistance spectrum of the class C β-lactamase CMY-2".

Dr. Skalweit has also been invited to speak at the Vincent T. Andriole ID Board Review Pre-Meeting Workshop on non-infectious causes of fever.

She will also be presenting her research at this year's ICAAC and IDSA meetings. Her work to be presented at ICAAC is entitled "N148G and -S substitutions in ADC-7 β-lactamase of Acinetobacter baumannii (ACB) cause selective changes in substrate and inhibitor specificity." The research that Dr. Salweit will present at IDSA with Dr. Usha Stiefel is "Management of Bone and Joint Infections (BJI) with Outpatient Parenteral Antimicrobial Therapy (OPAT) in a Veteran Population: Risk Factors for Failure of Therapy."




Division of Rheumatology

Dr. Donald Anthony was awarded an R21 award (Role of IL28B and HIV in NK Control of HCV).  This project will investigate the effect of IL28B and race on NK and pDC-NK mediated control of HCV in vitro, and whether NK IFNaR expression and IFN dependent NK control of HCV in vitro are associated with IFN dependent therapy response in vitro.

department conferences & events

Nephrology Division Clinical Conferences

Location: Bolwell A

Time: 12:00 - 1:00 p.m.


July 26 - UHCMC Morbidity and Mortality

August 16 - VAMC Morbidity and Mortality

August 23 - UHCMC Morbidity and Mortality

September 6 - Topical Review - Dr. Don Hricik



Intern Welcome Dinner 2012

Dr. Walsh invited new interns to join him for dinner at Shoreby Club. The elegant lakeside location served as a perfect spot for residents to mingle with faculty members and enjoy Lake Erie scenery.

See all photos from Intern Welcome Dinner on our Facebook page.

department leadership council minutes

Leadership Council

Dr. Walsh reviewed the current searches for the CWRU School of Medicine and the Department of Medicine with the Council.



Leadership Council

Dr. Armitage gave an overview of the Internal Medicine Residency Match.



Leadership Council


Dr. Walsh presented the Department of Medicine 2011-2012 Progress Report to the Council. He reviewed data on departmental faculty recruitment, sources of operating support, significant research achievements including:

  • The initiation of the $250M Harrington Project for Discovery and Development (Stamler, et al).
  • Awarded $11.3M NIH Cancer SPORE grant (Markowitz)
  • Awarded $5.4M NIH Barrett's Network (Chak)
  • Awarded $6.7M NIH IBD Program Project for 5 years (Cominelli)
  • AY 11-12 extramural salary funding as a percent of the NIH cap remained high. For Physician-Scientists (MD) and Research-Scientists (PhD) at 58% and 64%, respectively.
  • Mukesh Jain, MD elected Vice President of the American Society of Clinical Investigation

New and competing renewal grant proposals, total grant awards by division and new faculty grants.

Achievements in patient care operations including:

  • CY 2012 RVU volume is projected to increased 3% in spite of several key clinical faculty vacancies.
  • CY 2012 net patient revenue per cFTE is projected to hold steady.
  • CY 2012 faculty ambulatory volume is projected to increase 5% to a total of 98,600 visits.
  • CY 2012 scheduled patient bumps are projected to decrease 12%.
  • CY 2012 YTD CMC admission at budget.

UHMG clinical productivity - wRVUs, UHMG practice indicators, financial performance by division, 2011-2012 growth strategies and "Top Doc" awards from 2012 Cleveland Magazine.

Significant achievements in education including:

  • The Internal Medicine (IM) residency received the 2011-12 Ohio Patient Safety Institute Best Practice award for education in patient safety and quality.
  • The IM residency had an outstanding match including five MSTP students and ten students from CWRU.
  • Our residents had outstanding results in the 2012 IM specialty match with the majority getting their first choice.
  • Annual Department of Medicine Research Day poster presentations by 46 residents and attendance by over 120 house staff, fellows and faculty.
  • CME Programs - Department of Medicine faculty were the activity leaders for 8 regional and national CME programs.

Faculty hours of student teaching, graduating resident career plans.

Lastly, Dr. Walsh reviewed future strategies and strategic development for the Department of Medicine in the areas of clinical productivity, research and education.


Leadership Council

Dr. Walsh updated the Council on the Deloitte report.





Dr. Walsh asked for suggestions from Council members for distinguished speakers for the Berman Lecture.



Leadership Council

Dr. Armitage also asked for suggestions regarding Grand Rounds speakers for the coming academic year.


Leadership Council


Dr. Walsh requested that Dr. Bonomo present an update of the VAMC at a future Leadership Council meeting. There will not be an August Council meeting.