AMDA ON-THE-GO

The latest policy news from Director of Policy and Advocacy Alex Bardakh.     Questions? Email Alex at abardakh@paltc.org   * AMDA-On-The-Hill podcasts are not eligible for CMD credits     

Joseph G. Ouslander, MD Joseph G. Ouslander, M.D., is Professor and Senior Associate Dean for Geriatric Programs at the Charles E. Schmidt College of Medicine at Florida Atlantic University and Professor (Courtesy) at the Christine E. Lynn College of Nursing at FAU in Boca Raton, Florida. He is a graduate of Johns Hopkins University and the Case Western Reserve School of Medicine. Among Dr. Ouslanders' many achievements and contributions in the field of geriatric medicine and care is the creation and dissemination of Interventions to Reduce Acute Care Transfers (INTERACT), a quality improvement program that assists long-term care facilities and programs in improving care, and reducing unnecessary hospitalizations and their related complications and costs.   References: J. Ouslander, et. al., "Evaluation of Nursing Facility Resident Safety During Implementation of the INTERACT Quality Improvement Program", JAMDA, 2018 Jencks, SF, et. al., "Rehospitalizations among Patients in the Medicare Fee-for-Service Program", NEJM, 2009 Gozalo, P, et. al., "End-of-Life Transitions among Nursing Home Residents with Cognitive Issues", NEJM, 2011 Ouslander, JG, et al, "Interventions to Reduce Hospitalizations from Nursing Homes: Evaluation of the INTERACT II Collaborative Quality Improvement Project", JAGS, 2011 Ouslander, JG, et al, "Hospital Transfers of Skilled Nursing Facility (SNF) Patients Within 48 Hours and 30 Days After SNF Admission", JAMDA, 2016 Flint, LA, et al, "Perspective: Rehabbed to Death", NEJM, 2019

Episode 24 Winston Liu, BS, Duke Univ. Winston Liu, BS is an MD/PhD student at the Duke University School of Medicine. He graduated from the University of Maryland in 2015 with a degree in bioengineering. He recently joined the Bohórquez Laboratory for his PhD training, and he is dissecting a neural circuit that transduces sensory cues from gut luminal microbes to brain areas that control behavior. During his first two years of medical school, he helped to develop a personalized music listening program for assisted living residents with dementia. Winston aims to become an independent physician-scientist focused on the interactions between our mind and other organ systems.   References: Kelly Murphy MD, Winston Liu BS, et al, "Implementation of personalized music listening for assisted living residents with dementia", Geriatric Nursing, 2018 Cohen, Dan MSW "More Music, Fewer Meds", AMDA 2016 Conference CDC.gov American Music Therapy Association Linda Gerdner, Stanford geriatric education center

Milta Little, DO, CMD Milta Little, DO, CMD, is an Associate Professor of Medicine at St. Louis University in the Division of Geriatric Medicine. She is board certified in General Internal Medicine, with added qualifications in Geriatric Medicine. She serves the division as Program Director of the Geriatric Medicine Fellowship. Her primary scholarly interest is interprofessional health education to improve the care of the frail geriatric patient. Dr. Little has been on the St. Louis Magazine Best Doctor list since 2013. She is a Certified Medical Director and as such, has been a medical director at a number of Skilled Nursing Facilities. She served AMDA on the board of directors from 2012-2016 and from 2017 to present.   References: M. Little, "TREATING AND PREVENTING CLOSTRIDIUM DIFFICILE INFECTION IN LONG-TERM CARE FACILITIES", Managed Healthcare Connect, Nov, 2018 C. McDonald, et. al."Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)", Clinical Infectious Diseases, Volume 66, Issue 7, 19 March 2018 Leffler, DA and Lamont JT, "Clostridium difficile Infection”, New England Journal of Medicine, 2015 Lessa, FC, et. al., “Burden of Clostridium difficile Infection in the United States", New England Journal of Medicine, 2015

Ethics - SED by AD James Wright, MD, PhD, CMD James Wright, MD, PhD, CMD, is Vice Chair of AMDA-PALTC’s Ethics Committee. He holds a Masters of Arts in Theological Studies from Union Presbyterian Seminary and a Certificate in Bioethics from Loyola University, Chicago. Dr. Wright is currently writing a book addressing the theological, medical and ethical implications of dementia, called “Love Endures”. He is medical director of three facilities in Richmond, Virginia. References: AMDA White Paper, "The Role of a Facility Ethics Committee in Decision-Making at the End of Life", March, 2008 Paula Span, "The VSED Exit: A Way to Speed Up Dying, Without Asking Permission", York Times, 2016 Ivanovic, N., et al, "Voluntary stopping of eating and drinking at the end of life - a 'systematic search and review' giving insight into an option of hastening death in capacitated adults at the end of life.”, BMC-Palliative Care, 2014 Wax, J. et al, "Voluntary Stopping Eating and Drinking”, Journal of the American Geriatrics Society, 2018

Episode 21: SNF/ER Transition Process Dr. Adam Perry   Adam Perry, MD, is an emergency physician and fellowship trained geriatrician. He is Assistant Professor of Medicine at the Geisinger Commonwealth College of Medicine. He is also a faculty member of the Geriatric Emergency Department Collaborative, in which capacity he presents nationally on clinical and quality improvement topics at health systems implementing emergency department geriatric initiatives.     References: Gettel et. al. The Impact of Incomplete Nursing Home Transfer Documentation on Emergency Department Care", JAMDA, October, 2018 Adam Perry, MD; Firas Saidi, MD, CMD "The Emergency Department Joins the Interdisciplinary Team: Strategies to Improve Acute Care Transitions and Reduce ED Capture", AMDA Annual Conference, Grapevine, TX Robert Burke, et al. "Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States", JAMDA, 2015

  The latest policy news from Director of Policy and Advocacy Alex Bardakh.   Questions? Email Alex at abardakh@paltc.org  

Episode 20: Physical Therapy in PALTC Dr. Timothy Swenson PT, DPT, OCS, CMTPT  Dr. Swenson holds a doctorate in Physical Therapy. He is a Board Certified Orthopedic Clinical Specialist, and certified to perform dry needling.       References: Barbara Resnick, PhD, CRNP, FAAN, FAANP Interdisciplinary Interventions and Teams Are Good…Can We Move Beyond That? JAMDA, July, 2013 Physical Activity Guidelines Health.gov

The latest policy news from Director of Policy and Advocacy Alex Bardakh, including a look back at another successful Hill Day. * AMDA-On-The-Hill podcasts are not eligible for CMD credits Questions? Email Alex at abardakh@paltc.org Related Resources: MACRA, MIPS and APMS: Current Requirements and Proposed Changes Advanced Care Planning Series Guide to PA/LTC Coding, Reimbursement, and Documentation

Dr. David Smith. M.D., FAAFP, CMD Dr. Smith is President at Geriatric Consultants of Central Tx, P.A., an Area MHMR Board Member. He serves on various state committees and stakeholder taskforces. He is a Texas Medical Directors Assn. Board Member, and Past President of the American Medical Directors Assn.     References: Dr. David Smith, Documented, Systematic and Individualized Communication With the Attending Physician for Fall Risk Reduction/Injury Mitigation Care Planning, JAMDA 8/18 Tinetti, ME, “Risk factors for serious injury during falls by older persons in the community”, JAGS, 1995 Soriano, TA, et al, “Falls in the community-dwelling older adult: a review for primary-care providers” Clin Interv Aging, 2007

Tim Johnston, PhD Tim R. Johnston, PhD is the Director of National Projects at Services and Advocacy for GLBT Elders (SAGE) and the National Resource Center on LGBT Aging. He is responsible for directing SAGE’s national training initiatives, developing training curricula, and providing consulting services to both aging and LGBT service providers. Before coming to SAGE Tim taught Philosophy and Women’s and Gender Studies at Stony Brook University. He has written scholarly and popular articles on gender and LGBT identity, and his first book Affirmation, Care Ethics and LGBT Identity will be published by Palgrave Macmillan in 2016. In addition to facilitating LGBT cultural competency trainings, Tim is a frequent speaker at national and international conferences. References: In The Care of LGBT Persons in The Long-Term Care Setting", AMDA White Paper

David A. Nace, MD, MPH, CMD Dr. Nace is an Associate Professor whose research focuses primarily on infectious disease in long-term care. His interest in antibiotic stewardship is funded by three AHRQ studies: two, for which he serves as co-investigator, are designing and testing a national antimicrobial stewardship toolkit for nursing facilities; the third, for which he serves as PI, will update guidelines for urinary tract infection (UTI) management and then implement a program to improve its management in 40 nursing homes in four states.   References: Dr. Theresa Rowe, 2018 NHSN LTCF Training - Epidemiology and Prevention of UTI Cohen CC, Choi YJ, Stone PW., Costs of Infection Prevention Practices in Long-Term Care Settings: A Systematic Review., Nursing Economics, 2016 Dr. David A. Nace, et. al. The Improving Outcomes of UTI Management in Long-Term Care..., JAMDA, 2018

Jeffrey Nichols, MD, CMD Dr. Jeffrey Nichols, CMD, is Chief Medical Officer of the Gouverneur Skilled Nursing Facility, a division of New York City Health + Hospitals. Dr. Nichols teaches both Geriatrics and Palliative Care fellows and is an Associate Professor at the NYU Langone Medical School as well as the Icahn Mount Sinai School of Medicine. Dr. Nichols is Board Certified in Hospice and Palliative Care as well as Geriatrics. A long time AMDA leader, he currently serves as AMDA's Treasurer and Finance Committee Chair and writes the Dear Dr. Jeff column for Caring for the Ages. References: M C Reid, et al. "Pain Management in Long-Term Care Communities: A Quality Improvement Initiative”, Annals of Long Term Care, 2015 Laura B. Farless, MD; Christine S. Ritchie, MD, MSPH / ”Challenges of Pain Management in Long-Term Care”, Annals of Long Term Care, 2012 Brat, GA, et al, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study”, British Medical Journal, 2018 “Aging and Addicted”: The Opioid Epidemic Affects Older Adults, Too”, Kaiser Health News, 2016 CMS Roadmap to Address the Opioid Epidemic, CMS.gov, June, 2018

Kathleen Unroe, MD, MHA Research Scientist, Regenstrief Institute Assistant Professor of Medicine, Indiana University School of Medicine Center Scientist, Indiana University Center for Aging Research Dr. Unroe is focused on health policy relevant research in long term care, including the use of palliative care and hospice in this setting, transitions of care, quality of medical care in nursing homes, and staffing models in long term care. She is co-PI of the Optimistic model project   References: Unroe KT, Nazir A, Holtz LR et al. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project. J Am Geriatr Soc 2015;63:165-169. Hickman, S. E., Unroe, K. T., Ersek, M. T., Buente, B., Nazir, A., & Sachs, G. A. (2016). An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting. Journal of the American Geriatrics Society, 64(11), 2385–2392. Unroe, et. al., “Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2”, Journal of the American Geriatrics Association, 2018

Naushira Pandya, MD, CMD Dr. Pandya is board certified in internal Medicine, Geriatrics, and Endocrinology. She is also a certified medical director of long-term care facilities, and a recognized authority in diabetes management in the elderly. In addition, she oversees the training of medical students, residents and fellows in Geriatrics, and is a research mentor students, residents and faculty. She has over 20 publications and is a national and international speaker. Dr.Pandya has held several state and national leadership positions, including the presidency of AMDA, Society for Post-Acute and Long-Term Care Medicine. She holds the distinction of being a Fulbright Senior Specialist Scholar in Geriatrics in Slovakia in 2009.   References: Centers for Disease Control Diabetes Data, cdc.org Munshi, M., et. al., Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association, Diabetes Care 2016 Feb; 39(2): 308-318. Haas, Linda, Special Considerations for Older Adults With Diabetes Residing in Skilled Nursing Facilities, Diabetes Spectrum 2014 Feb; 27 (1): 37 McKnight’s Long Term Care News, August 5, 2015, profile on Naushira Pandya MD Pandya N, et. al., Optimizing insulin delivery for patients with diabetes, Geriatric Nursing, 2018, 39:138