State of the Department

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Louis Stokes Cleveland VA Medical Center
State of the Department
Department of Medicine Case Western Reserve
UniversityUniversity Hospitals Case Medical
CenterVeteran Affairs Medical Center
October 20, 2015
Case Medical Center Louis Stokes Cleveland VA
Medical Center Case School of Medicine Case
Research Institute University Hospitals UH
Medical Group University Hospitals at Case
Medical Center is the primary affiliate of Case
Western Reserve University School of Medicine.
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Department of MedicineVision and Mission

• Mission Statement
• Advancing Science and Education. Improving Care.
• Vision Statement
• To maintain and enhance our cutting-edge
  clinical expertise for the care and treatment of
  all patients and their families. To draw upon and
  balance this clinical excellence with the other
  elements of our tripartite mission (medical
  research and education). To remain equally
  committed to all elements of this mission through
  our outstanding faculty, staff and trainees and
  nimbly navigate the ever changing landscape in
  health care delivery with commitment to diversity
  among our ranks.

10/20/2015
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Department of MedicineAt a Glance
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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10/20/2015
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Department of MedicineAt a Glance
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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10/20/2015
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Department of MedicineSources of Operating
Support
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Department of Medicine

• Full-Time
  Faculty

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



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Department of MedicineFaculty Compensation
Funding
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UH-based Faculty RecruitmentJuly 2014 - Present
  Abdelmoneim, Sahar (Card) Malek, Ehsan
(Hem/Onc) Attizzani, Guilherme (Card) Metheny,
Leland (Hem/Onc) Farah, George (Card)
Tomlinson, Ben (Hem/Onc) Oliveira, Guilherme
(Card) Prosdocimo, Domenick (Card) Zacharis,
Michael (Card) Saha, Sharmeela (Neph)   Ali,
Meer A. (GI) Fabien, Andre (Pulm) Dave,
Maneesh (GI) Folz, Rodney (Pulm) Glessing,
Brooke (GI) McKell, Joanne (Pulm) Teba,
Catalina (Pulm) Thomas, Patricia (GIM)
Venizelos, Paul (Pulm)   Kirkova,
Yordanka (Ger) Mattar, Maya (Rheum) Khatibi,
Parisa (Ger) Saade, Elie (Ger-ID) Singh,
Mriganka (Ger)
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Department of MedicineFaculty Awards and
Honors2014 -2015

• Marco Costa, MD, PhD, was selected to lead the
  Executive Office of Innovation as a Vice
  President and Chief Innovation Officer of
  University Hospitals.
• Mukesh Jain, MD, PhD, was named Chief Scientific
  Officer for University Hospitals. Dr. Jain also
  received the Faculty Distinguished Research Award
  from Case Western Reserve University and was
  presented with the 2015 North American Vascular
  Biology Organization (NAVBO) Judah Folkman Award
  in Vascular Biology.
• Daniel Simon, MD, became the President of the
  University Hospitals Harrington Heart Vascular
  Institute.
• Donald Hricik, MD, received the American Society
  of Transplantation's Lifetime Achievement Award
  at the American Transplant Congress.
• Joshua Augustine, MD, received the 2015 Person of
  the Year Award from the Kidney Foundation of
  Ohio.
• Sandy Markowitz, MD, PhD, became the
  Distinguished University Professor.
• Stanton Gerson, MD, received the Academy of
  Medicine of Cleveland and Northeast Ohio
  Distinguished Membership award at the 2015 annual
  meeting.
• Robert Salata, MD, became the Master Clinician in
  Infectious Diseases.
• Goutham Narla, MD, PhD, became the James T.
  Pardee - Carl A. Gerstacker Professor of Cancer
  Research at Case Western Reserve University
  School of Medicine. Dr. Narla also received the
  John S. Diekoff Award for Mentoring.
• Clark Distelhorst, MD, became a 2015 recipient of
  Harrington Scholar-Innovator award for his work
  entitled "Targeting a New Pathway to Treat Blood
  Cancers."

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Department of MedicineFaculty Awards and
Honors2014 -2015

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

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Department of MedicineFaculty Awards and
Honors2014 -2015

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

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Department of MedicineFaculty Promotions and
Tenure2014 -2015

• Clinical Assistant Professor
• May Al-Abousi, MD
• Clinical Associate Professor
• Haspreet Kaur, MD
• Assistant Professor
• Hiloni Bhavsar, MD
• Mirela Dobre, MD
• Stephen Fink, PhD
• Xudong Liao, PhD
• Charles LoPresti, MD
• Yuan Lu, MD
• Krisztina Papp-Wallace, MD
• Mohammad Shatat, MBBS
• Rehan Waheed, MD

• Associate Professor
• Rajesh Chandra, MD
• Anne Hamik, MD
• Amy Ray, MD
• Usha Stiefel, MD
• Professor
• Curtis Donskey, MD
• Richard Silver, MD
• Tenure
• Curtis Donskey, MD
• Anne Hamik, MD
• Frank Jacono, MD

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

• Research Programs

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

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


Extramural salary funding as a of the cap.
Where salary is below the cap, actual salary is
used.
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Department of Medicine

• Patient Care Operations

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Department of MedicineU.S. News World Report
Rankings

• 2014 - 2015
• Cancer 30
• Cardiology 38
• Gastroenterology 27
• Geriatrics 34
• Nephrology 48

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Department of MedicineUH Clinical Activity and
Hospital MarginCY 2014 vs. CY 2015 (projected)

• 2014 2015 Change
• Admissions 14,000 13,486 (3.6)
• Outpatient Encounters 200,000 227,730
  13.9
• UH direct contribution margin 192.5M 204.8M
  6.4
• UH total contribution margin 73.9M 77.8M
  5.3

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Year to year percentage change 2.9
(0.7) 6.7 6.3
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Department of Medicine

• Educational Programs

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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Department of MedicineEducation Programs
Student Teaching Time Student Teaching Time
Third-Year Core Clerkship Student 3,120 hours
Basic Science Curriculum 2,200 hours
Fourth-Year Students 25 direct contact time Total hours represents approximately 30 of total faculty teaching time in the School of Medicine 3,080 hours
University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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Department of MedicineEducational Programs

• AY 10-11 AY 11-12 AY 12-13 AY 13-14 AY 14-15
• Composition of House Staff
• Categorical 105 104 104 105 106
• Special Programs 14 16 18 19 19
• Harrington -- -- -- 2 4
• Fellows 81 81 82 82 84
• International Health, Leadership in Medical
  Education, Primary Care, Med-Peds, Med-Genetics

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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10/20/2015
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Department of MedicineEducational Programs

• Graduating Resident Career Plans
• UHCMC Non-UHCMC
  UHHS-affiliated Non-UHHS
• Fellowships Fellowships General
  Medicine General Medicine
• 10 15
  3
  2
• 12 13
  3
  1
• 9 15
  1
  6
• 11 13
  3
  7
• 2013 8 12
  6 6
• 2014 8 20 4
  4
• 2015 6 26 3
  6

In 2015 65 of graduates placed in their first
choice
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Department of Medicine

• Significant Accomplishments
• AY 2014-15

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Significant Accomplishments

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

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Significant Accomplishments

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

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Significant AccomplishmentsRESEARCH cont.

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

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Significant Accomplishments

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

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Department of MedicineMedia and Communication
Enhancements

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

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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10/20/2015
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Department of MedicineMedia and Communication
Enhancements

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

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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10/20/2015
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Department of Medicine

• Future Strategies

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Department of MedicineFuture Strategies 2015

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

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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Department of Medicine2015 VA Initiatives

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

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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Department of MedicinePotential challenges to
the clinical mission

• Securing appropriate and sustained levels of
  programmatic and developmental support for a new
  Chair.
• Managing 2016 financial and volume targets to
  realistic levels.
• Greater patient consumerism/choice.
• The new faculty compensation plan.
• The movement from volume to value-based metrics.
• The ICD-10 change and electronic charge capture.
• Incomplete and unsigned EMR notes.
• Reputational scores, access and new system
  affiliations.
• FACULTY MORALE!

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Department of MedicineFuture Strategies 2015

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

University Hospitals Case Medical Center / Case
Western Reserve University School of Medicine /
Cleveland VA Medical Center
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Department of MedicineFuture Strategies 2015

• Education
• Enhance our role as a leader in innovative
  teaching of patient safety and quality.
• Increase system-wide involvement (MP) in the
  ambulatory aspects of house staff training and
  precepting.
• Continue to enhance the depth and diversity of
  the residency.
• Strengthen the ABIM Resident (Harrington)
  Research Pathway and enhance recruitment of
  research oriented applicants.
• Resurrect and re-invigorate our CME offerings.
• Maintain unblemished accreditation status for all
  training programs.
• Increase scholarly output of educational leaders
  and trainees.

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Department of MedicineFuture Strategies 2015

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

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