May 2015 Newsletter

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Department of Medicine eNewsletter
May 2015
:: Interview
:: Department News
:: Department Events
:: Leadership Council Minutes
:: Senior Advisory Committee Minutes
Leadership Council
May 2015
Richard Walsh

A. Askari

R. Bonomo

R. Chandra

F. Cominelli

F. Creighton

R. Folz

S. Gravenstein

T. Hostetter

D. Hricik

N. Meropol

L. Sayyed Kassem

R. Salata

R. Schilz

D. Simon

R. Walsh

J. Wright


C. Koniaris, MD

Medical Director, Palliative Care


Recorded by:
A. Staruch
Senior Advisory Committee
April 2015

T. Daniel

K. Geraci

L. Hoskings

R. Kellermeyer

R. Moskowitz

J. Murphy

G. Naff

R. Salata


K. Armitage


Recorded by:
A. Staruch
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department interview
Rodney Folz, MD, PhD, Division Chief of Pulmonary, Critical Care & Sleep Medicine, describes his leadership style, discusses his goals for the division and key elements essential for its success.

You have joined the faculty of Case Western Reserve University
School of Medicine and University Hospitals Case Medical Center after leaving the University of Louisville. What were some of the strengths of the institution you left behind? What are you looking forward to in the new setting?


Before joining the University of Louisville, I was working at Duke University for 18 years. Duke is very much a global name and Duke University Hospital is based on a centralized administration, which allows the institution to allocate more resources toward national and global recognition. Louisville was a much smaller metro medical center with decentralized administration that offered programs with a regional reputation. Louisville is an indigenous care hospital and has very specialized services with pockets of excellence not only in clinical care but also in research. The medical center primarily concentrated on the inner-city population and did not put a lot of effort into expanding its health care system out to the community and further into the region. The center was able to make meaningful contributions to local patients; however, its impact was not as globally visible.


I spent seven and a half years at Louisville and was fortunate to contribute a lot to program building, but on a smaller local/regional scale. Specifically, we launched programs in interstitial lung disease, adult cystic fibrosis, pulmonary hypertension, interventional pulmonology and chronic obstructive pulmonary disease (COPD). After building the subspecialty programs, we were then able to assume the leadership role of the lung transplant program, a program that had previously been run by a private practice practitioner. The first year that we ran the program, we were able to deliver the highest number of lung transplants in its history.


There were several features that attracted me to Case Western Reserve University School of Medicine and UH Case Medical Center. First, UH Case Medical Center is not only large but also highly visible, so the impact that physicians can make on improving lung health among the population is much greater. Second, UH already has a network of community hospitals established, allowing for improved access of care for the population. I am looking forward to helping guide the integration of the delivery of respiratory health services not only at UH Case Medical Center, but also moving the programs to the extent that is relevant to the community's needs, amplifying the delivery of care to the community. Finally, I was attracted to UH by the incredibly strong clinical work and research demonstrated by faculty in the Division of Pediatric Pulmonology who comprise the Pulmonary Research Institute.


You have taken over the leadership of the Division of the Pulmonary, Critical Care & Sleep Medicine. What is your long-term vision for the division?


I would like to focus on building subspecialty programs in pulmonology. We have a few pulmonary programs that are already established and well-differentiated, such as pulmonary hypertension and cystic fibrosis. We need programs in interstitial lung disease, COPD, asthma and occupational lung disease. Pulmonary rehab is so important for improving the quality of life and outcomes in patients who suffer from lung disease. We need to market and grow these respiratory services. The next goal would be developing programs of excellence in chronic disease management that focus on asthma, COPD, and obstructive sleep apnea, all of which affect a large portion of the population. We should be able to offer preventive health care to patients to keep them from developing acute problems and visiting emergency rooms, educate patients about self-management and provide quality community support. In these programs, mid-level providers can be very effective, and we hope that these programs will be readily transferrable to community sites. Our main goal is to put together programs that ensure our patients live longer, healthier lives.


Critical care has standardization of care issues that need to be addressed across the system. Our ICU is the flagship of our division; it is the service that consistently receives the best feedback from patients and families. Our nursing staff members have received awards year after year for the outstanding work that they do. Our biggest challenge is replicating this model at community hospitals, while sustaining the same high level of care and exemplary outcomes. In order to address this issue we will need to examine each community hospital individually, evaluating its resources and limitations and transitioning toward a closed-unit model, when appropriate, where intensive care physicians take care of patients in a focused manner.


One area that UH is well-known for is its sleep program led by Kingman Strohl, MD, and his prominent research program concentrating on hypoglossal nerve stimulation as an alternative intervention to treat obstructive sleep apnea. As the population becomes older and gets heavier, sleep disorders become more prevalent and are more readily diagnosed. We need to have more sleep physicians available to provide care to the population. In addition, we have to identify and develop a network of community sites delivering care to patients with sleep disorders, making sure we provide easy access and convenient locations for patients and their families. In order to address these issues, we are currently recruiting new sleep physicians and training mid-level providers to help in our sleep clinics.


Though these plans mostly have to do with divisional clinical programs, I believe patient-centered programs are key to attracting high-caliber trainees and facilitating breakthrough translational research projects.


How do you see your own research progressing? Have you identified potential areas of collaboration you would like to pursue within and outside of the department? What is your perspective on the translational research potential of the division?


I want to continue investing my time in COPD, cystic fibrosis and asthma research. My primary area of interest in basic science research is oxidative stress, a mechanistic pathway that can cause disease in a number of settings, which not only occurs in lung, but also in heart, contributing to heart attacks and stroke. So cardiovascular researchers are probably the most prominent group to collaborate with along with pediatric pulmonology.


One of the advantages of being in a medical center is easy access to basic science programs that physicians can tap into. As a clinician, you may be good at taking care of patients, but when you take advantage of collaborations with basic science researchers, your work advances to a new level. In order to further expand the research of the division, our faculty should do well to build relationships with faculty at the School of Engineering, School of Nursing and School of Dental Medicine.


How would you characterize your leadership style? What are your expectations for your faculty members?


I try to get to know each individual, identify his or her strengths and develop a plan of increasing leadership and responsibilities. I would like to develop and utilize each individual's talents and strengths to help grow and build the division as a whole. I also would not ask somebody to do something that I would not do myself. It is important for me to collect first-hand knowledge, to really understand the key factors affecting the situation and use that knowledge to develop a plan in order to address the issue at hand. So initially I plan to dive into things, collect data and, once I get a good sense of them, work on identifying ways to move the division forward. What I would like to see four or five years down the road is a division that has become strong not only because of the recruitment of new faculty but also as a result of the development, professional growth and success of its current faculty members.


Schedule a clinical appointment with Dr. Folz


department news report

Division of General Internal Medicine


Karen Horowitz, MD, recently published an article entitled "The End of the 15-20 Minute Primary Care Visit" in the Journal of General Internal Medicine as a member of the Association of Chiefs and Leaders in General Internal Medicine Writing Group. The paper recommends that the medical culture should be re-evaluated with primary care visits extended to 30 minutes as well as the cognitive care codes value recalibrated by both the relative value scale update and CMS. The authors further suggest that management approaches using LEAN methodology could be utilized to streamline primary care visits.



Attila Nemeth, MD, became the Co-Chair for the Innovations Review Committee for the upcoming Midwest Society of General Internal Medicine (SGIM) conference.





Division of Geriatrics & Palliative Care

Stefan Gravenstein, MD, published an article on improving involvement in health care among older patients entitled "Using Qualitative Methods to Create a Home Health Web Application User Interface for Patients with Low Computer Proficiency" in Generating Evidence & Methods to Improve Patient Outcomes Journal. Dr. Gravenstein and his team found that the older population need more guidance in computer usage, and web applications used by this group need to be designed so that older adults can understand, access and use them. In order to produce value, new applications need to address older adults' limitations and strengths, possibly resulting in compromising generally accepted web design principles.

In addition, Dr. Gravenstein published an article entitled "The Geriatric Cytokine Response to Trauma: Time to Consider a New Threshold" in Surgical Infections Journal. The authors argue that an appropriate geriatric inflammatory response to trauma should be updated as a lowered inflammatory response in geriatric patients is associated with the development of a subsequent infection, while at the same time geriatric patients exhibiting inflammatory responses as robust as younger patients have increased mortality.


Schedule a clinical appointment with Geriatrics & Palliative Care physicians





Division of Hematology & Oncology

Jennifer Eads, MD, was selected as a 2015 Mary Hellerstein Junior Faculty Professional Development awardee. The award from the Women Faculty of the School of Medicine at Case Western Reserve University recognizes faculty members with outstanding potential for a promising academic career in academic medicine.



Stan Gerson, MD Stanton Gerson, MD, received the Academy of Medicine of Cleveland and Northeast Ohio Distinguished Membership award at the 2015 annual meeting. The award was presented to Dr. Gerson in recognition of his unparalleled accomplishments in the field of hematologic oncology, for his outstanding contributions to leading-edge stem cell and regenerative medicine research, for preserving the professional integrity of physicians and the practice of medicine by promoting the highest ethical standards of the medical profession, and for his meritorious service to the science and art of medicine. This award is the highest honor the Academy of Medicine of Cleveland and Northeast Ohio can bestow.


Rami Manochakian, MD, was selected to serve as a member of the American Society of Clinical Oncology CME Subcommittee.




Sandy Markowitz, MD, PhD
, became the Distinguished University Professor. This is the highest honor bestowed on a faculty member at Case Western Reserve University School of Medicine. The title acknowledges the outstanding contributions of Dr. Markowitz and celebrates his distinguished academic record of extraordinary research, scholarship, teaching and service.



Division of Infectious Diseases & HIV Medicine

Robert Bonomo, MD, was elected to Patient Centered Outcomes Research Institute's (PCORI) Advisory Panel for the Assessment, Prevention, and Treatment of Disease. PCORI is an independent organization that examines the relative health outcomes, effectiveness and appropriateness of different medical treatments, focusing on including a patient voice during the process. The Advisory Panel for the Assessment, Prevention, and Treatment of the Disease will help to identify critical research questions to prioritize funding for PCORI's comparative effectiveness research.

Henry Boom, MD, is serving as a co-PI on an international project focused on resistance to infection with bacteria causing tuberculosis.The project builds on more than a decade of increasingly precise studies involving Case Western Reserve University, the University of Washington, and Makerere University and Mulago Hospital in Kampala, Uganda.The researchers hope to identify key immunity criteria in individuals resistant to tuberculosis that helps them resist and acquire the infectious disease. The researchers hope to later replicate this response with a vaccine for patients.

Division of Rheumatology

Charles Malemud, PhD,
received the 2015 Gender Equity award for preclinical faculty. This award is presented to a faculty member who exemplifies the principle of gender equality in teaching and promotes a gender-fair environment for the education and training of young physicians.





Institute of Transformative Molecular Medicine

Goutham Narla, MD, PhD,
received the John S. Diekoff Award for Mentoring. The award is presented to a faculty member who makes exemplary contribution to the education and development of graduate students at Case Western Reserve University School of Medicine. The award celebrates Dr. Narla's dedication to mentoring students to become experts in the discipline, engaging them academically and actively promoting their professional development.
Dr. Narla was also awarded a $1.25 million grant from NIH to study the effects of a novel series of small molecule PP2A activators on prostate cancer treatment.

department conferences & events

Summer Picnic

Date: Thursday, June 4

Time: 4:00 - 9:00 p.m.

Location: Squire Valleevue Farm, 37125 Fairmount Road, Hunting Valley, OH 44022

Why: To bid farewell to 2015 Chief Residents, play ultimate frisbee with your classmates and watch our famous pie-eating contest.




Chairman's Intern Welcome Dinner
Date: Wednesday, June 17
Time: 6:00 - 9:00 p.m.
Location: Shoreby Club, 40 Shoreby Drive, Bratenahl, OH 44108



Fundamentals of Clinical Medicine

This year our intern class enjoyed a variety of activities designed to enhance clinical skills: from simulation codes and Cleveland Museum of Art tours to medical communication lectures and workshops at the Cleveland Play House. Our interns had fun while learning procedural skills, effective physician-patient communication, narrative competence and cognitive biases.



Bronson's Day 2015

Our Chief Residents took the intern class to the Indian's game. The Annual Bronson's Day has been one of the favorite holidays of the residency program as our first-year residents get together for breakfast, go downtown to watch the Indians play and keep the fun going until evening over food and drinks.

Research Day 2015
The Department of Medicine is proud of the work presented by the young investigators and trainees at the Annual Research Day. It was great to witness dynamic discussions and inspirational exchanges of ideas. Outstanding research projects will be recognized at the Annual Spring Dinner later this month.


department leadership council minutes

Leadership Council

Dr. Walsh introduced Dr. Koniaris, Medical Director of Palliative Care. Dr. Koniaris presented "Palliative Care: How Do We Compare?" including: a description of current palliative care at University Hospitals Case Medical Center; how palliative care impacts the hospital by reducing costs; comparison data for palliative care at UH Case Medical Center, Summa Healthcare and Rush Medical Center including patient care, education and research; UH palliative care consults by department; age distribution of patients under palliative care; the implemented MICU palliative care trigger tool; and needs of the Palliative Care program including additional physician recruitment and establishment of a fellowship program.


Leadership Council

Dr. Walsh informed the Leadership Council members that the UHMG Steering Committee may request participation from Division Chiefs and/or some of their faculty for membership in new committees being formed under the Steering Committee. Dr. Walsh encouraged faculty participation in these important committees.


Leadership Council

Dr. Walsh gave an update on the Physician Incentive Program for the Department of Medicine. Mr. Creighton has sent Division Chiefs division-specific data on this incentive program.


Leadership Council Dr. Salata reminded council members that the Annual Department of Medicine Research Day will take place 12:00 - 4:00 p.m. on Friday, May 15, in the Wolstein Auditorium and Lobby. The program includes plenary sessions, 2014 Team Science grant award progress reports and poster presentations by fellows, residents, graduate students and postdoctoral researchers.

Dr. Walsh reviewed information on Quality and the SGR (Sustainable Growth Rate) Fix including a brief history of the Medicare SGR; a new law, Bill H.R. 2, "Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015" (MACRA); under MACRA, either a Merit-Based Incentive Payment System or Advanced Alternative Payment Model.


Leadership Council

Dr. Bonomo gave an update on the Louis Stokes Cleveland VA Medical Center.



Leadership Council

Dr. Wright updated the council on funding for the CTSA.



department senior advisory committee minutes

Leadership Council

Dr. Salata welcomed Kevin Geraci, MD, as a new member of the Senior Advisory Committee. Michael Smith, MD, has also been invited as a new committee member.


Leadership Council

Dr. Salata discussed his upcoming role as Interim Chair for the Department of Medicine to become effective July 1, 2015. In this role, he will be developing a one-year strategic plan for the department as requested by hospital and university leadership. Dr. Salata welcomed input on important issues facing the department from committee members. Minutes of the quarterly Senior Advisory Committee meetings will be distributed to members.


Leadership Council

Dr. Armitage presented and distributed information to the committee on the intern selection process and match. Nationally, applicants are, on average, applying to more residency programs than in past years. Of U.S. student applicants, 22 percent apply to internal medicine programs. This past year, the Department of Medicine interviewed 480 applicants and ranked 440 applicants. The department matched for 30 interns and there was also an outstanding fellowship match again this year in medicine subspecialties. Dr. Armitage also gave an overview of the Harrington Pathway interview process for MD/PhD candidates. Dr. Salata thanked Dr. Armitage for his presentation.

Leadership CouncilDr. Salata distributed information, and invited committee members to attend, the Annual Department of Medicine Research Day. Research Day includes plenary sessions, 2014 Team Science grant awardees progress reports and judged poster presentations by fellows, residents, graduate students and postdoctoral students. Awards for research presentations will be presented at the Department of Medicine Spring Dinner.


Dr. Salata reviewed the criteria and process for selection of Master Clinician-Educators in the Department of Medicine. The designation of Master Clinician-Educator recognizes faculty members as outstanding clinicians and teachers. The recipients will form the Academy of Master Clinicians in Medicine and may be called upon as an ad hoc committee to give advice on clinical and educational issues. The department recognizes the award of Master Clinician-Educators at the annual Spring Dinner.

Leadership Council

Dr. Salata outlined some of his initiatives for the Department of Medicine and welcomed discussion from committee members. Topics and invited speakers for future Senior Advisory Committee meetings were suggested by Dr. Salata and also by committee members.


Leadership Council

Next Senior Advisory Committee Meeting will take place at 12:00 p.m. on Monday, July 27, in Lakeside Room 3557.