PM&R Resident E-Newsletter

Tariq Rajnarine, MD
Mount Sinai Hospital, New York
Recent Graduate

1) How and why did you decide on pursuing a fellowship in spinal cord injury?
I have a very strong interest in cancer rehabilitation, especially cancer of the spine. Spinal cord injury medicine cultivated that interest. I also loved the various aspects and complexity of medical care that SCI encompasses such as bowel, bladder, cardiac, pulmonary, skin, etc.

2) In what ways did you broaden your exposure to SCI patients during residency?
The majority of my spinal cord injury exposure as a resident was at the James J. Peters Bronx Veterans Affair Medical Center. The experience exposed me to a unique population and gave me the opportunity to get involved in ongoing projects including observation at the Spinal Cord Injury Patient Care Center and the development of a fecal transplant protocol for C. Diff.

3) What is the most rewarding part of working with the SCI population?
The ability to help return some independence to this population whether it be helping to coordinate their care or providing education to patients and families regarding bowel or bladder programs.

4) What advice do you offer to those considering applying for SCI fellowship?
There are many programs around the country; find a few in terms of location/availability that work for you. Consider doing an elective at those programs.

5) What was the most valuable aspect of your SCI fellowship?
I really enjoyed my role as an educator in the program. I had a weekly fellow lecture series that was not only a good way for me to review, but gave me the opportunity to teach residents rotating on spinal cord injury.

6) What are your plans now that you have completed the SCI fellowship?
I am joining the neurorehabilitation team at MossRehab.

Interested in entering a fellowship? Check out AAPM&R's Fellowship Database (incorporated in the Job Board) to browse opportunities across the U.S. 

Hello all! My name is Carlo Milani, PGY-4 at the University of Washington. I am the AAPM&R Resident Physician Council’s Liaison to the American Medical Association (AMA). This means I am a resident peer who represents you and your interests to the AMA and AAPM&R. With this article, I hope to keep you up-to-date on the latest health policy developments at the AMA during the last 12 months and how they will affect the practice of physiatry and residents in the near future.

1) Understanding the relationship of our Academy with the AMA.
Each June, the AMA holds its annual health policy meeting in Chicago, IL. This year, with help from our Academy’s delegation, the AMA again adopted policy that will strengthen the practice of medicine and the patient physician relationship. This year, the AMA passed policy calling for Maintenance of Certification (MOC) to be less onerous and more relevant for physicians. With input from state and specialty medical societies, policies adopted at the AMA can influence health care policy at the local and national level (see graphic below).

2) Highlights of newly-adopted health policy at the AMA Annual Meeting.

1. Opposing Limits on Care Based Solely on ICD-10 Code Specificity: This resolution was brought forward by AAPM&R and asked the AMA to “oppose limitations in coverage for medical services based solely on diagnostic code specificity.” This policy has a particular effect for certain inpatient rehab stays where reimbursement is denied by insurance based on disputes of diagnostic code specificity.
2. Dry Needling is an Invasive Procedure: This resolution was brought forward by AAPM&R and asked the AMA to “recognize dry needling as an invasive procedure and maintain that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.”
3. Single Payer Health Care Study: This resolution asked the AMA to research and analyze the benefits and difficulties of a single-payer health care system in the United States with report back to the House of Delegates (HOD).
4. Pain as the Fifth Vital Sign: This report from the AMA's Board of Trustees combined with a separate resolution advocated for the elimination of “pain as the fifth vital sign” from professional standards and usage. This action also called for the AMA to advocate for the removal of pain management from patient satisfaction surveys that influence payment and quality metrics.
5. Legislative Pain Care Restrictions: In response to recent state actions based on new guidelines from the CDC for opioid prescription, this resolution asked the AMA to oppose legislative policies that arbitrarily restrict a patient’s ability to receive comprehensive pain care, including legal limitations on the dose and/or duration of opioid prescriptions.
6. Resident and Fellow Compensation and Health Care System Value: This report from the Council on Medical Education recommended that the AMA monitor trends that may lead to reduction in stipends, compensation, and benefits to resident physicians. The report also recommended that the AMA encourage that teaching institutions explore benefits to residents and fellows that reduce personal cost of living expenditures, such as allowances for housing, childcare, and transportation.
7. Creation of a Physician Entrepreneur Academy: This report from the AMA's Board of Trustees recommended the AMA’s creation of a physician entrepreneur academy to include a speaker series and the development of an online forum to connect physicians with entrepreneurs.
8. Support for Persons with Intellectual Disabilities: This resolution asked the AMA to encourage appropriate government agencies, non-profit organizations, and specialty societies to develop and implement policy guidelines to provide psychosocial resources for persons with intellectual disabilities, with the goal of independent function when possible.
9. Continuing Medical Education Pathways for Recertification: This resolution asked that the AMA call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination for maintenance of certification.
10. Gun Violence as a Public Health Crisis: With multiple recent mass shootings including the shooting at the Orlando nightclub Pulse, this emergency resolution was written and had more than 50 co-sponsors including AAPM&R. This resolution asked that the AMA “immediately make a public statement that gun violence represents a public health crisis that requires a comprehensive public health response and solution” and that the AMA “actively lobby Congress to lift the effective ban on research into gun violence.” This resolution passed with an overwhelming majority in the HOD and a public statement from the AMA was made the same day.
    

3) Revisiting the AMA’s partnership with MATTER, and the STEPSForward™ Campaign.
Twelve months after its inception, the AMA’s strategic plan to enhancing physicians’ business and entrepreneurial education through sponsorship of the health care information technology incubator MATTER, the AMA has continued to provide AMA member physicians the opportunity to connect with entrepreneurs and to develop new technologies, services, and products. This partnership permits physicians to work with developers at the point of “idea conception.” As a reminder, in collaboration with MATTER, the AMA has built a digital health lab called the AMA Interaction Studio. The lab has created an environment where entrepreneurs can directly collaborate with physicians and the health care community.

The STEPSForward™ initiative has also grown over the past 12 months. The goal of STEPSForward™ is to provide physicians with proven strategies that can improve practice efficiency and help reach the Quadruple Aim of: better patient experience, better population health, lower costs, and improved professional satisfaction. STEPSForward™ has a variety of finely-engineered efficiency modules, which have more than doubled in number over the past year. The modules aim to help practices from all specialties improve in multiple areas including EHR selection, purchase, and implementation; implementing lean health care; conducting effective team meetings; expanded rooming and discharging protocols; patient panel management; medication adherence; preventing physician burnout; team documentation, and more. The modules are straightforward, self-directed, and provide immediate implementable strategies.

4) Acting administrator of the Centers for Medicare & Medicaid Services (CMS) addresses the AMA HOD about transitioning to MACRA, MIPS, and APMs.
In the effort to describe the design of the new Medicare payment system, Andy Slavitt, MD, the acting administrator of the Centers for Medicare & Medicaid Services (CMS), addressed the HOD of the AMA during the annual meeting. Dr. Slavitt noted that the driving factor behind the Medicare change was physician input. Dr. Slavitt provided some clarity on the details regarding the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), quality reporting, the Merit-Based Incentive Payment System (MIPS), and participation in alternative payment models (APMs). He reported through CMS’s listening sessions with physicians, 4 cross-cutting themes to incorporate with the changes:

1. Keep patients at the center of care.
2. Allow practices the flexibility to drive how they use the program to support the unique needs of their patients.
3. Focus on policies that are based on the needs of small practices or practices in rural or underserved areas.
4. Simplify wherever and whenever possible, and give physicians back the time to spend with patients. To hear Dr. Slavitt’s full address, watch this YouTube video posted by the AMA.