State of the Department

1
State of the Department

• Department of Medicine
• University Hospitals Cleveland Medical Center
• Case Western Reserve University
• Veterans Affairs Medical Center
• November 29, 2016

2
Department of MedicineVision and Mission

• Mission Statement
• Improving Care. Advancing Science and Education.
  
• 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.

3
Department of Medicine

• Full Time Faculty

4
Department of MedicineFull Time Faculty
AY 11-12 AY 12-13 AY 13-14 AY 14-15 AY 15-16
Clinician Educators 152 156 173 171 176
Physician Investigators 59 57 61 57 61
Research Scientists 31 32 23 24 24
Total 242 245 257 252 261
DoM AAMC
Women 93 36 37
African American 7 3 3
Asian 77 30 18
Hispanic/Latino 19 7 2
5
Department of MedicineFaculty Recruitment
Abdelmoneim, Sahar (Card) Viau Colindres, Roberto (GIM/VA)
Farah, George (Card) Martin, Bradley (Card) Robinson, Monique (Card) Zacharis, Michael (Card) El-Asmar, Nadine (Endo) Ali, Meer A. (GI) Lam, Minh (GI) Ashraf, Stephanie (GIM/VA) Baydoun, Atallah (GIM/VA) Clark, Amanda (GIM/VA) Klein, Melissa (GIM/VA) Muyshondt, Suzanne (GIM/VA) Ramamurthi, Srideri (GIM/VA) Zajdel, Laura (GIM/VA) Huded, Jill (GIM/VA) Macaron, Carole (Ger/VA) Saade, Elie (Geriatrics ID) Singh, Mriganka (Geriatrics) Gopal, Naveen (Hem/Onc) Lee, Richard (Hem/Onc) Metheny, Leland (Hem/Onc) Tomlinson, Ben (Hem/Onc) Freeman, Michael (ID) Desai, Niraj (Neph/VA) Folz, Rodney (Pulm Chief) Mattar, Maya (Rheum)












6
Department of MedicineFaculty Awards and Honors

• Department of Medicine Faculty Dr. Sanford
  Markowitz and Dr. Jackson Wright were honored by
  the prestigious Clinical Research Forum for their
  groundbreaking clinical investigation of blood
  pressure and colon cancer in African Americans,
  providing findings that could transform how care
  is delivered. They each authored a paper
  recognized by the Forum as one of the years ten
  most outstanding biomedical research papers.
• Daniel I. Simon, MD, FACC, awarded the 2016
  Distinguished Scientist Award Basic Domain by
  the American College of Cardiology
• Amitabh Chak, MD, and colleagues have discovered
  that a rare genetic mutation is associated with
  susceptibility to familial Barrett esophagus
  (FBE) and esophageal cancer. Dr. Chak and
  colleagues set out to identify novel disease
  susceptibility variants in FBE in affected
  individuals from a large multigenerational
  family. The team used targeted next generation
  gene sequencing to find a rare mutation (S631G)
  in FBE in the uncharacterized gene VSIG10L that
  segregated with disease in affected family
  members. Functional studies revealed that this
  mutation disrupts maturation of the normal
  esophageal lining.
• W. Henry Boom, MD, received a five-year, 11
  million NIH grant to investigate why some people
  living with HIV in Africa avoid becoming infected
  with the bacterium that causes tuberculosis (TB)
  despite exposure to high-TB- risk circumstances.
• Fabio Cominelli, MD, PhD, received a 5-year 9.7
  million National Institute of Diabetes and
  Digestive and Kidney Diseases of the National
  Institute of Health grant. The grant will be used
  with the goal of better understanding the origins
  of Crohn's disease and eventually developing a
  cure.
• James D. Reynolds, PhD, received a significant
  grant from the U.S. Department of Defense for his
  transplant research. He is leading a
  multi-disciplinary team examining a new class of
  drug aimed at stabilizing donor limb and tissue
  biology after brain death.

7
Department of MedicineFaculty Awards and Honors

• Stanton Gerson, MD, participated with Vice
  President Joe Biden in the roll out of the
  nations Cancer Moonshot Initiative. Through the
  Initiative, the Cancer Center will work to
  overcome current barriers to progress and develop
  specific ways to better coordinate federal
  efforts to support cancer research and care,
  partnerships with stakeholders, and
  implementation of findings.
• Michael Lederman, MD, Donald Anthony, MD, PhD,
  Robert Bonomo, MD, in partnership with the
  Department of Pathology faculty, have launched a
  new journal entitled "Pathogens and Immunity."
  The electronic, open access journal focuses on
  original research in microbiology, immunology and
  infectious diseases.
• Albert Waldo, MD, received the 2015 Maurice
  Saltzman award from the Mt. Sinai Health Care
  Foundation. The award recognizes Dr. Waldo's
  notorious achievements in the field of
  cardiovascular medicine as well as his
  significant contributions to the health interests
  of the Cleveland community.
• Michael Lederman, MD, received the 2015 Honorary
  Alumnus award from Case Western Reserve
  University School of Medicine. The award
  celebrates Dr. Lederman's distinguished career
  and national recognition in the field of
  infectious diseases.
• Jackson Wright, MD, PhD, received the 2015
  Clinical Research Award from the American Heart
  Association for his outstanding contributions in
  clinical cardiovascular science.
• Rajesh Chandra, MD, became the Vice Chair for
  Clinical Affairs and Transformation in the
  Department of Medicine.
• Robert Salata, MD, was appointed the inaugural
  Master Clinician in Infectious Diseases. 
• Charles Malemud, PhD, was named the Founding
  Editor and Editor-in-Chief of Global Vaccines and
  Immunology.
• Daniel Simon, MD, became President of University
  Hospitals Cleveland Medical Center. In his new
  role, Dr. Simon will lead initiatives to further
  UH Cleveland Medical Center's national reputation
  for excellence.

8
Department of MedicineFaculty Awards and Honors

• Fabio Cominelli, MD, PhD, became the Associate
  Dean of Program Development in the Case Western
  Reserve University School of Medicine. In his new
  role, Dr. Cominelli will help develop and
  implement new programs to promote connectivity
  and cooperation throughout the School of
  Medicine.
• Cynthia Owusu, MD, was selected as one of the
  health care innovators to watch by Crain's
  Cleveland Business. Dr. Owusu's premier work with
  older patients who have breast cancer and
  long-term health of breast cancer survivors was
  particularly highlighted.
• Yngve Falck-Ytter, MD, was found to be one of the
  most highly cited researchers in 2015 by Thomson
  Reuters. This finding recognizes Dr.
  Falck-Ytter's meaningful contributions to
  clinical epidemiology.
• Jackson Wright, Jr., MD, PhD, was selected as one
  of Cleveland's 2016 Health Care Heroes by Crain's
  Cleveland Business in recognition of his
  significant contributions to the field of
  hypertension and his leading role on many
  clinical trials focusing on African-American
  population.
• Goutham Narla, MD, PhD, was elected to the
  American Society of Clinical Investigation. The
  election recognizes and celebrates Dr. Narla's
  significant research accomplishments.
• Evi Stavrou, MD, was appointed to the Board of
  Trustees of Case Western Reserve University as
  the inaugural occupant of the Oscar Ratnoff
  Professorship in Medicine and Hematology.
• Curtis Donskey, MD, received the 2016 Award for
  Publication Excellence from the Association for
  Professionals in Infection Control and
  Epidemiology (APIC) and the American Journal of
  Infection Control (AJIC) Editorial Board of
  Directors.
• Michael Lederman, MD, received the Faculty
  Distinguished Research award. This honor
  recognizes Dr. Lederman's outstanding
  contributions to research that made a lasting
  impact in the field of infectious diseases.
• Usha Stiefel, MD, received the 2016 Helen Evans
  Mid-Career Faculty Development award from the
  Women Faculty of the School of Medicine. The
  prestigious award is given to faculty members
  demonstrating outstanding potential for a
  promising career in academic medicine.

9
Department of MedicineFaculty Awards and Honors

• Mimi Singh, MD, received the Society of General
  Internal Medicine Midwest award for excellence in
  clinician education..
• Marcos de Lima, MD, became the inaugural
  recipient of the Don C. Dangler Endowed Director
  in Stem Cell Transplant.
• Joshua Augustine, MD, was appointed Associate
  Editor of Clinical Transplantation Journal.
• Donald Hricik, MD, was appointed Associate Editor
  of the Clinical Journal of the American Society
  of Nephrology.
• Varun Sundaram, MD, received the Eric N.
  Prystowsky Early Career Research Award for his
  abstract entitled "Outcomes with Cardiac
  Resynchronization Therapy and Standard
  Implantable Cardioverter Defibrillators in
  Patients with a Very Wide QRS Duration (QRS180
  ms) A Medicare ICD Registry Analysis with
  Propensity Matching" from the Heart Rhythm
  Society.
• Gerard Isenberg, MD, was the first physician in
  Ohio to perform PillCam COLON, a new endoscopic
  technology utilizing pill cameras to visualize
  the colon.
• Robert Bonomo, MD, was selected for the 2016
  Excellence Award from the European Society of
  Clinical Microbiology and Infectious Diseases
  (ESCMID), Europe's leading Infectious Diseases
  society.
• Yngve Falck-Ytter, MD, was found to be one of the
  most highly cited researchers in 2015 by Thomson
  Reuters. This recognition speaks highly of Dr.
  Falck-Ytter's meaningful contributions to
  clinical epidemiology.

10
Department of MedicineFaculty Promotions
Assistant Professor Amanda Clark, MD Maneesh Dave, MD, MPH Xudong Liao, Ph.D. Charles LoPresti, MD Yuan Lu, MD Alexander Rodriguez-Palacios, DMV, PHD Puja Van Epps, MD   Professor Donald Anthony, MD, Ph.D. Curtis Donskey, MD Yngve Falck-Ytter, MD Karen Horowitz, MD Susan Kirsh, MD Clifford Packer, MD, FACP Richard Silver, MD   Associate Professor Hiram Bezerra, MD, PhD Rajesh Chandra, MD, FHM Henry Koon, MD Debra Leizman, MD Goutham Narla, MD, Ph.D. Cynthia Owusu, MD Mathilde Pioro, MD Amy Jo Ray, MD Usha Stiefel, MD
11
Department of MedicineCleveland Magazine 2016
Full-Time Faculty Top Doctors
Cardiovascular Medicine Hematology/Oncology Geriatric Medicine Pulmonary Disease
Ivan Cakulev Joseph Baar Taryn Lee Rodney Folz
Marco Costa Matthew Cooney Kingman Strohl
Barry Effron Brenda Cooper Infectious Disease
Daniel Simon Marcos de Lima Keith Armitage Rheumatology
Thomas Wilson Afshin Dowlati Robert Bonomo Donald Anthony
Stanton Gerson Barbara Gripshover
Endocrinology Joseph Gibbons Michael Lederman
Baha Arafah Michael Gibson Robert Salata
Henry Koon, Jr.
Gastroenterology Smitha Krishnamurthi Internal Medicine
Amitabh Chak Hillard Lazarus Carla Harwell
Fabio Cominelli Jane Little Debra Leizman
Gregory Cooper Sanford Markowitz
Ashley Faulx Neal Meropol Nephrology
Pierre Gholam Joel Saltzman Joshua Augustine
Jeffry Katz Alvin Schmaier Donald Hricik
Anthony Post Paula Silverman
Sapna Thomas
Richard Wong
12
Department of MedicineCleveland Magazine 2016
Community Physicians Top Doctors
Cardiovascular Medicine Hematology/Oncology Pulmonary
Agustus Beck Brian Bolwell Lee Babbott
David Joyce Judah Friedman Matthew Krauza
Geetha Mohan Timothy Gilligan Brian White
Kara Quan
David Rubin Internal Medicine Rheumatology
Krishnan Sundararajan Debra DeJoseph Elizabeth Brooks
Michael Vacante David Fantelli Douglas Flagg
Philip Wendschuh David Headen
Alan Hirsh
Endocrinology Karen Hummel
James Myers Philip Junglas
Mohammed Khan
Gastroenterology Chenguttai Manohar
Fadi Bashour Janet Morgan
Robert Cameron Erika Mulligan
Michael Kohler Kala Ravichandran
David Myers Suzana Sarac-Leonard
Raymond Rozman William Steiner
Eric Shapiro Virginia Vatev
13
Department of Medicine

• Research Programs

14
Department of MedicineGrant Proposal
TrendDirect Costs per FTE
FTE PS 59, RS 31 FTE PS 57, RS 32
FTE PS 61, RS 23 FTE PS 57, RS 24
FTE PS 61, RS 24
15
Department of MedicineGrant Award TrendDirect
Costs per FTE
FTE PS 59, RS 31 FTE PS 57, RS 32
FTE PS 61, RS 23 FTE PS 57, RS 24
FTE PS 61, RS 24
Percentage change PS 23, RS (5)
PS (11), RS 29 PS 15, RS (18)
PS 5, RS (30)
16
Department of MedicineAward Total by Period
AY 2011-12 AY 2012-13 AY 2013-14 AY 2014-15 AY 2015-16
CV Med 5,674,283 5,354,682 4,925,995 6,516,884 8,737,136
Endocrine 876,015 2,033,616 2,872,031 2,925,215 2,611,896
GI 3,574,394 4,981,180 3,780,772 5,763,182 5,425,282
Gen Med 435,750 313,600 0 0 0
Geriatrics 70,229 0 0 0 0
HemOnc-CC 10,298,894 18,404,262 13,707,579 12,483,880 14,939,143
ID 20,772,138 25,938,806 13,985,426 12,844,645 15,360,333
ITMM 3,342,200 4,038,678 2,704,799 2,308,666 1,202,132
Neph 4,758,218 2,956,438 6,909,501 5,989,833 4,169,302
Pulm 3,094,745 2,165,156 2,070,504 1,627,798 2,666,618
Rheum 0 322,750 291,189 0 0

Total 52,896,866 66,509,168 51,247,796 50,460,103 55,111,842
Includes CWRU and VA based awards from all
sources, excludes awards to UHCMC
17
Department of MedicineTotal Research
Expenditures Direct Costs(millions)
42.6
18
Department of MedicineAverage Funded Salary to
the NIH Cap
AY 11-12 AY 12-13 AY 13-14 AY 14-15 AY 15-16
Physician Scientists 58.1 56.1 51.7 50.7 51.5
Research Scientists 64.0 72.0 66.5 59.6 63.2
19
Department of Medicine

• Patient Care Operations

20
Department of MedicineU.S. News and World Report
Rankings

• Cancer 28
• Gastroenterology 27
• Geriatrics 41

21
Department of MedicinePhysician ServiceswRVU
Trend
2012 2013 2014 2015 2016
(projected)
Cardiovascular Medicine 210,480 203,168 220,169 221,712 229,258
Endocrinology 12,713 11,365 14,059 15,416 17,359
Gastroenterology 71,630 75,862 77,347 90,045 89,952
General Medicine 49,925 54,101 55,026 60,141 63,582
Geriatrics 4,198 3,373 7,861 11,102 14,531
Hem/Onc 78,180 85,335 91,523 97,276 91,404
ID/HIV Medicine 38,710 42,698 41,007 45,567 43,990
Nephrology 40,807 33,973 32,709 35,939 36,730
Pulmonary/CC/Sleep 50,297 39,590 43,106 51,863 71,597
Rheumatology 12,674 15,926 16,433 17,048 19,056
Total 569,614 565,391 599,240 646,109 677,459
Year to year percentage change 2.9
(0.7) 6.7
7.8 4.9
Includes Oncology hospitalists based in Gen Med
22
Department of MedicinePhysician ServicesNet
Collections Trend
2012 2013 2014 2015 2016
(projected)
Cardiovascular Medicine 10,814,065 10,355,130 11,588,595 11,464,276 11,246,748
Endocrinology 967,221 867,180 1,053,164 1,235,002 1,396,879
Gastroenterology 4,133,167 4,160,896 4,332,381 4,763,459 4,623,988
General Medicine 2,194,192 1,916,197 2,5254,997 2,536,708 2,468,866
Geriatrics 139,255 143,773 376,360 557,196 669,909
Hem/Onc 3,960,947 4,772,812 4,840,369 4,959,263 4,312,994
ID/HIV Medicine 2,070,563 2,156,663 2,279,124 2,290,858 2,106,818
Nephrology 1,935,428 1,674,118 1,574,002 1,699,939 1,669,670
Pulmonary/CC/Sleep 2,348,111 2,034,286 2,179,358 2,382,672 3,201,100
Rheumatology 1,703,202 1,735,060 1,840,019 1,663,217 1,733,544
Total 30,266,165 29,816,115 32,588,369 33,552,589 33,430,516
Includes Oncology hospitalists based in Gen Med
23
Department of MedicinePhysician ServicesVolumes
and Margins
2014 2015 2016 (Projected) Change
Discharges 13,777 13,491 13,330 (1.2)
ALOS 6.20 6.30 6.60 4.8
CMI 1.58 1.69 1.77 4.7
Outpatient Encounters 223,026 232,869 238,500 2.4
Direct Contribution Margin (Millions) 192.5 201.2 218.8 8.8
Total Margin (Millions) 74.0 72.1 91.4 26.9
24
Department of MedicineUHMG Financial Performance

• Net Income Variance to Budget

Projected
CY 2012 CY 2013 CY2014 CY 2015 CY 2016
1,534,060 257,224 2,184,823 153,298 268,256
25
Department of Medicine

• Educational Programs

26
Department of MedicineEducation Programs

• Student Teaching Time
• Third Year Core Clerkship Student 3,180 hours
• Basic Science Curriculum 2,040 hours
• Fourth Year Students 3,120 hours
• 25 direct contact time
• Total hours represents approximately 30 of total
  faculty teaching time in the School of Medicine
  (Includes teaching time at UH and VAMC)

27
Department of MedicineEducation Programs
AY 11-12 AY 12-13 AY 13-14 AY 14-15 AY 15-16
Composition of House Staff
Categorical 104 104 105 106 104
Special Programs 16 18 19 19 20
Harrington -- -- 2 4 6

Fellows 81 82 82 84 85
International Health, Leadership in Medical
Education, Primary Care, Med-Peds, Med-Genetics
28
Department of MedicineEducation Programs

• Graduating Resident Career Plans

UHCMC Non-UHCMC UHHS-Affiliated Non-UHHS
Fellowships Fellowships General Medicine General Medicine
2009 10 15 3 2
2010 12 13 3 1
2011 9 15 1 6
2012 11 13 3 7
2013 8 12 6 6
2014 8 20 4 4
2015 6 26 3 6
2016 11 15 2 5
29
Department of Medicine

• Significant Accomplishments

30
Department of MedicineSignificant
AccomplishmentsClinical Activities

• 47 Department of Medicine full-time faculty
  members recognized as Best Doctors by Cleveland
  Magazine.
• In-hospital productivity under a high case mix
  index again grew positively in 2015 as defined by
  hospital contribution margin.
• Ambulatory and inpatient Top Box for overall
  Doctor Rating and Satisfaction with Care were at
  92 and 74, respectively.
• Time to first available appointment reduced from
  28 days to 11 days with a goal of 10 days by end
  of 2016.
• Ambulatory visits projected to increase 3.2 over
  2015 while acute visits are projected to increase
  by 8.8

31
Department of MedicineSignificant
AccomplishmentsResearch Activities

• Overall, research support to the Department of
  Medicine remains strong. Total awarded funds to
  departmental faculty, including the cancer
  center, exceeded 67 million in 2015 2016.
• For 2015-16, 50 of all research awards involved
  collaborators from other departments or other
  institutions.
• Research awards were associated with the
  competitive and prestigious national venue with
  nearly 71 percent coming from federal sources.
• Research activities of department trainees grew
  significantly, reflected by the growing success
  of the Harrington Physician Scientist Program and
  the record number of residents presenting
  original research findings at national meetings
  and at the Department of Medicine Research Day.
• The 6th annual Research Day featured 119 poster
  presentations from Department of Medicine
  trainees (79 Residents, 19 Fellows and 21
  Graduate/Post-Doc students) and plenary
  presentations by 3 faculty scientists.
• The 3rd round of Team Science Challenge awards
  were made to Department of Medicine faculty Henry
  Boom, Alan Levine and Nagaraju Sarabu and
  collaborators.

32
Department of MedicineSignificant
AccomplishmentsEducation

• The 2016 residency match was highly successful
  with 36 interns from strong medical schools
  (e.g., CWRU, Cornell, University of Chicago)
  including six underrepresented minorities.
• In addition to our residents entering strong
  subspecialty fellowships, several will be joining
  UH and VAMC in general medical practices.
• UH and VAMC remain the teaching hospitals of
  choice for core medical clerkship and acting
  interns.
• Clerkship and residency leaders continue to have
  high visibility at national educational meetings
  with multiple posters, presentations and
  workshops.
• The program introduced a new wellness program for
  interns which includes a coaching initiative for
  all categorical interns and protected time for a
  wellness visit to the employee assistance program.

33
Department of Medicine

• Future Strategies

34
Department of MedicineFuture StrategiesResearch
Activities

• Continue to manage post-Affiliation Agreement
  challenges.
• Acquire CWRU commitments for continued support of
  investigators and research programs.
• Continue influencing re-investment in the
  academic mission through leadership in UH
  Research Development committees and the Chairs
  package with the recruitment of physician
  scientists. This effort will be amplified by the
  faculty participating in Shaping the Future of
  the Department of Medicine.
• Engage John Peterson, Ph.D. in clinical trial
  business development.
• Support enhancement of an infrastructure for
  Innovation and Technology development
  system-wide.
• Further diversify research funding sources to
  including enhanced industry, foundation and
  philanthropic support.
• Enhance Team Science Challenge support at the
  department and institutional levels.

35
Department of MedicineFuture StrategiesClinical
Activities

• Accelerate the development of the RHI and
  system-wide ICU initiatives
• Enhance diabetes and obesity management through
  development of a Diabetes and Obesity Center.
• Augment growth in Cardiovascular services and
  research through strategic recruitments
  identified in commitment to Dr. Rajagopalan.
• Strengthen bone disease management program.
• Secure appropriate and sustained levels of
  programmatic support for new recruits.
• Continue to support adaption of new clinical
  management support systems such as electronic
  charge capture.
• Expansion of the Antibiotic Stewardship Program
  and Infection Control and Prevention in stem cell
  and solid organ transplant programs.
• Advance Palliative Care at UHCMC and UHHS.
• Strengthen mentoring programs in Department of
  Medicine

36
Department of MedicineFuture StrategiesEducation
al Activities

• 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.
• Enhance our CME offerings.
• Maintain unblemished accreditation status for all
  training programs.
• Increase scholarly output of educational leaders
  and trainees.