VADeptMedMeetingJan24 - University Of California, Los Angeles

1/24/19Department of Medicine – 276.775 FTEOffice of the Chief (9.0)Gregory A. Brent, MD, Chief (1.0)Zhaoping Li, MD,PhD, Assoc. Chief (1.0)Neil Paige, Chief Primary Care and Education (1.0)Palliative Care (8.125)Deborah Moran, MD, Acting Chief (1.0)Mary Catherine Murphy, MD (1.0)Anne Walling, MD, PhD (0.625)Eric Prommer, MD (1.0)Emergency Department (11.875)Neil Patel, MD, Chief (1.0)Jonie Hsiao, MD, Assoc. Chief (1.0)Manuel Celedon, MD, (1.0)Frank Day, MD (0.625)Kwame Donkor, MD (1.0)Carol Lee, MD (1.0)Miguel Lemus, MD (1.0)Derrick Darmstadt, MD (1.0)Lisa Zhao, MD (1.0)Zahir Basrai, MD (1.0)Thomas Blair, MD (1.0)Andrew Grock, MD (1.0)Cynthia Koh, MD (1.0)Patricia Fermin, MD (1.0)Scott Jacobs, MD (1.0)Primary Care (3.0)Neil Paige, MD, Chief (1.0)Briana Cowan, MD (1.0)Christina Harris, MD (1.0)Christine Lam, MD, MBA (1.0)Endocrinology (5.500)Jane Weinreb, MD, Chief (1.0)Shalini Bhat, MD (0.625)Rashmi Mullur, MD (0.500)Angela Leung, MD,MS (0.625)Anna Milanesi, MD, PhD (0.875)Harold Sacks, MD (0.375)General Internal Medicine/Health ServicesResearch (10.625)Paul Shekelle, MD, PhD Chief (1.0)Bevanne Bean-Mayberry, MD (0.625)Evelyn Chang MD (1.0)Kristina Cordasco, MD (1.0)Peter Glassman, MD (1.0)Lucinda Leung, MD, PhD (1.0)Donna Washington, MD (1.0)Tannaz Moin, MD,MS (0.625)Hospitalist Program (16.000)Michael Ong, MD,PhD, Chief (0.875)Samuel Burstein, MD (1.0)Casey Kaneshiro, MD (1.0)Emily Cantor, MD (1.0)Jonathan Helali, MD (1.0)Azadeh Lankarani-Fard, MD (1.0)Roswell Quinn, MD (1.0)Maria Romanova, MD (1.0)Paul Schneider, MD (1.0.)Behram Vaghaiwalla, MD (1.0)Sondra Vazirani, MD (1.0)Gladys Martin, MD (1.0)Shannon Peter, MD (1.0)Adela Greeley, MD (1.0)Satya Patel, MD (1.0)Eric Kwoh, MD (1.0)Simon Wu, MD (1.0)Pamela Tsing, MD (1.0)Adriana Izquierdo, MD, MPH (0.750)Clinical Genetics (4.0)Maren Scheuner, MD, Chief (1.0)Jane Peredo, Counselor (1.0)Hematology/Oncology (7.25)Matthew Rettig, MD (1.0)Kathryn Henick, MD (1.0)Alan Lichtenstein, MD (0.625)Monica El-Masry, MD (1.0)Daniel Shin, MD, PhD (0.625)Infectious Diseases (10.625)Matthew Goetz, MD, Chief (1.0)David Beenhouwer, MD (1.0)Christopher Graber, MD (1.0)David Haake, MD (0.625)William Schwartzman, MD (1.0)Debika Bhattacharya, MD (0.625)Jennifer Fulcher, MD, PhD (0.375)Sharon Garner, PA (1.0)Suny Kim, PA (1.0)Nephrology (5.625)Glenn Nagami, MD, Chief (1.0)Jeffrey Kraut, MD (1.0)Richard Treger, MD (1.0)Mandana Rastegar, MD (1.0)Shilpa Sharma, MD, MPH (0.375)Rheumatology (3.0)Jay Persselin, MD, Chief (1.0)Meika Fang, MD (1.0)Ari Weinreb, MD, PhD (1.0)Jennifer King, MD, PhD (0.375)John Fitzgerald, MD, PhD (0.125)Allergy & Immunology (2.0)Joseph Yusin, MD, Chief (1.0)Integrative Medicine (1.375)Kirsten Tillisch, MD, Chief (0.625)Rashmi Muller MD, Associate Chief (0.375)Elaine Chu, MD (0.375)Terrence Brotherton, Rec Ther (0.375)Lisa Ortiz, Rec Ther (0.375)Department of MedicineCardiology (33.750)Kristina Bostrom, MD, PhD, Chief Cardiology (1.0)Donald S. Chang, MD, Assoc Chief (1.0)Malcolm Bersohn, MD, PhD (1.0)Buljubasic, Nediljka MD, PhD (1.0)Freny Mody, MD (1.0)Jesse Currier, MD (1.0)Ramin Ebrahimi, MD (1.0)Zenaida Feliciano, MD (1.0)Janet Han, MD (1.0)Shelley Shapiro, MD, PhD (1.0)Alberta Warner, MD (1.0)Tzung Hsiai, MD, PhD (0.625)Kim Lien Nguyen, MD (0.625)Boback Ziaeian MD, PhD (0.625)Rene Packard, MD, PhD (0.375)Primary Care (3.0)Neil Paige, MD, Chief (1.0)Briana Cowan, MD (1.0)Christina Harris, MD (1.0)Gastroenterology (16.75)Joseph Pisegna, MD, Chief (1.0)Hartley Cohen, MD (0.625)Felix Leung, MD (1.0)Jonathan Kaunitz, MD (1.0)Dennis Jensen, MD (0.625)Alan Sheinbaum, MD (0.625)Stephen Kim, MD (0.875)Folasade May, MD, PhD (0.625)David Padua, MD, PhD (0.625)Neville Pimstone, MD (0.5)Steven Han, MD (0.375)Jonathan Jacobs, MD, PhD (0.25)Claudia San Miguel, MD (0.625)Noam Jacobs, MD, PhD (0.625)Jihane Benhaamou, MD, PhDTracy Nwajuaki, PA (1.0)Sepulveda PACC (12.0)Wendell Ching, MD, Lead (1.0)Vacant (vice Weiss), MD (1.0)Benjamin Hassan, MD (1.0)Vacant, (vice Scremim) MD (1.0)Diane Suzuki, MD (1.0)Eric Cheng, MD (1.0)Sami ZaKzook, MD (1.0)Giulia Michelini, MD (1.0)Phoung-Mai Pham, MD (1.0)Arthur Gomez, MD (1.0)Oliva Arreola-Owen, MD (1.0)LAACC PACC (13.0)Earl Tso, MD, Lead (1.0)Daniel Garcia, MD (1.0)Youjong Ko, MD (1.0)Vacant(vice Paikal), MD (1.0)Sandra Lee, MD (1.0)Huan Nguyen, MD (1.0)Kemia Carlyle, MD (1.0)Vacant (vice Nguyen), MD (1.0)Ting-Lin Kao, MD (1.0)David Seto, MD (1.0)William Marshall, MD (1.0)Theodawn Brown, PA (1.0)Quiana Wicks, PA (1.0)Pulmonary/Critical Care (10.875)Guy Soo Hoo, MD Chief (1.0)Jaime Betancourt, MD (1.0)Steven Dubinett, MD (0.625)Gina Lee, MD (0.750)Scott Oh, MD (0.750)Michelle Zeidler, MD (1.0)Armand Ryden, MD (1.0)Melisa Chang, MD (1.0)Ramin Sale-Rad, MD, PhDRussel Buhr, MD, MPHMeighan James, PA (1.0)Virginia Moore, PA (1.0)Thriving in 2019 and Beyond Retain our current patients and expand enrollment. Provide and document high value care (outstanding qualityand cost-effective). Strengthen and support Primary Care and Patient-AlignedCare Teams (PACTs) Patient-centered scheduling, clinic structure,communications, services. Recognize the geographic challenges our patients face andprovide high quality and effective electronic consults andtelehealth. Continue to provide clinical leadership across theinstitution and identify new and emerging opportunities. Enhance communication and connections within thedepartment to promote our mission. Engage in the planning for VA West LA site developmentand position the department for a central role in promotingclinical care, education and research.Ambulatory Specialties Demand 2018 Proprietary & Confidential29CBOCs (19.75)Robert Gaines, MD, Lead (1.0)Vacant (vice Dingler), MD (1.0)Misha Shah, MD (0.75)Michael Viggianelli, MD (1.0)Mark Donaldson, MD (1.0)Brian Rees, MD (1.0)Kavita Pabby MD(1.0)Thien Van MD(1.0)Mary Jane Morash, MD (1.0)Vacant (vice Blum), MD (1.0)Alka Ohri, MD (1.0)Maung Chit Khain, MD (1.0)Pritam Badesha, MD (1.0)Vacant (vice Bopari), MD (1.0)Reetinder Sandhu, MD (1.0)Navpreet Sidhu, MD (1.0)David Lennon, MD (1.0)Ramnik Kaur, MD (1.0)Sandra Wilson MD(1.0)West LA PACC (22.0)Mehran Kashefi, MD, Lead (1.0)Leila Hashemi, MD (1.0)Lisa Davis, MD (1.0)Dalia Goldfarb, MD (1.0)Stella Izuchukwu, MD (1.0)Deborah Mendenhall, MD (1.0)Soleyman Rokhsar, MD (1.0)Bharat Chaudry MD (1.0)Sarah Naylor, MD (1.0)Ali Towfigh, MD (1.0)Robert Nisenbaum, MD (1.0)Christina Harris, MD (1.0)Boules Salib, MD (1.0)Leung Tcheung, MD (1.0)Mana Khafaf, MD (1.0)Leonard Kleinman, MD (1.0)Respiratory Therapy (37.900)Convis, Joyce RRT, RPFT, Clinical Coordinator (1.0)Monsale, Rex RRT Assistant Chief (1.0)Chavez, Katia Assistant Chief (1.0)Afremov, Igor RRT (1.0)Aleman, Randy (RT) (1.0)Ayala, David CRT (0.9)Beligan, Zosimo RRT (1.0)Bertrand, Alain CRT (1.0)Bitner, Rob CRT (1.0)Burden, Mike CRT (1.0)Cajigal, Chris CRT (1.0)Camp, Salone CRT (1.0)Cassidy, Shea CRT (1.0)Yura Chong, RRT (1.0)Vacant, CRT (1.0)Delgado, Bryan CRT (1.0)Edwards, Theresa CRT (1.0)Ferguson, Cheryl CRT (1.0)Garrick, Tracy CRT (1.0)Ho, Phillip RRT (1.0)Jefferson, Melissa CRT (1.0)Jensen, Gail RRT (1.0)Kadi, Samar CRT (1.0)Maldonado, Jaime CRT (1.0)Vacant, RRT (1.0)Martinez, Christine CRT (1.0)Morini, Luigi CRT (1.0)Mullen, Ross CRT (1.0)Oster, Tom CRT (1.0)Perez, Frank CRT (1.0)Phares, Tina CRT (1.0)Sakamoto, Rita CRT (1.0)Shell, Bernard RRT (1.0)Spikes, Carol CRT (1.0)Willis, Patrick RRT (1.0)David Asprio, Med Instrmnt Tech (poly) (1.0)Vacant, Med Instrmnt Tech (poly) (2.0)Women’s Health (5.0)Fatma Batuman, MD, Chief (1.0)Projected Vet Population and EnrolleesVAGLAHCS Projected rce: VAEHCPM§§VetPop is declining, however, enrollees are flatlined. Current market share is low at 45%. Usuallywe expect 55%.Planning needs to focus on bolstering enrollment to sustain and grow market share. 2018 Proprietary & Confidential28Demand for Primary/Home Based Care 2018 Proprietary & Confidential305

20.0 [10.4] vs 40.7 [35.0] days; P .005), and dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5]specialty care, “I always got an appointment for routine care” improved 1.4% (from 52.2% of patientsdays; P .001) (Figure 2). The VA facilities had statistically significantly longer wait times forin FY16 to 53.6% of patients FY17; P .01).orthopedics (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; P .01).For both the VA and PS, there was no significant change to mean wait times by specialty forcardiology, primary care, and dermatology between 2014 and 2017. However, PS wait times1/24/19Discussionincreased in 12 of the 15 regions for orthopedics (80%; sign test P .01), with no significant changeto mean wait time (9.9 vs 11.4 days; P .33). In contrast, mean VA wait times for orthopedicsIn a comparison of VA wait times for new appointments determined from the VA scheduling systemdecreased by 5.4 days between 2014 and 2017 (from 23.9 to 18.5 days; P .05).with a market survey of new-appointment wait times for the PS, the VA had similar new appointmentwait times to the PS in FY2014. Overall new-appointment wait times in the VA were shorter than inWait Times by Geographic Areathe PS in FY2017 and for the specialties of primary care, cardiology, and dermatology. The meanIn 2014, the PS had statistically significantly shorter mean wait times in Dallas, Texas (10.3 vs 20.6FY2017 PS wait times for primary care and dermatology were more than double the VA mean waitdays; P .02), Miami, Florida (13.8 vs 22.3 days; P .03), and Portland, Oregon (15.5 vs 42.3 days;P .047), and wait times similar to those of the VA for the other 12 regions. The overall number oftimes. In FY2017, wait times for orthopedics remained longer in the VA compared with the PS,metropolitan areas for which the PS had shorter wait times than the VA for outpatient services wasalthough wait times improved overall and for orthopedics in the VA between FY2014 and FY2017,not significant by the sign test (sign test P .30).while wait times in the PS remained static and PS orthopedic wait times increased. Concurrently,In 2017, there were no metropolitan areas with statistically significant differences in wait timesthere was an increase in the number of unique patients seen, volume of encounters, and anbetween the PS and VA. However, the point estimate mean wait time was shorter in the VAimprovement in CAHPS access score ratings within the VA, further supporting the finding that accesscompared with the PS for 22 of the 30 metropolitan areas (73.3%; sign test P .02).to care has improved over time within the VA.Although VA mean wait times improved for most regions (73.3% of the 15 major regionsanalyzed), the number of metropolitan areas for which wait times improved was statisticallynonsignificant (improved in 11 of 15 regions; sign test P .12). In contrast, the PS had increasing waitFigure 3. Number of Unique Patients and Encounters Within the Veterans Affairs (VA) Systemtimes in 12 of the 15 metropolitan areas (80%; sign test P .04).A VA unique patients by specialty in FY14 to FY17Original Investigation Health PolicyCardiology, Dermatology, and OrthopedicPatients, No.32.4% are between 65 and 79 years, and 14.7% are 80 years or older. The overall number of uniqueMadeline Penn, BS, BA; Saurabha Bhatnagar, MD; SreyRam Kuy, MD, MHS; Steven Lieberman, MD; Shereef Elnahal, MD, MBA; Carolyn Clancy, MD; David Shulkin, MDpatients seen and the volume of encounters nationally increased between fiscal year 2014 (FY14) andFY17 (FY starting in October) from 4 996 564 (FY14)to 5 118 446 (FY17) unique patients andKey Points476461tohealth17 331538 (FY17)unique encounters (Figure 3). The number of unique patientsIMPORTANCE Concerns have been16raisedaboutthe (FY14)adequacy ofcare accessamong patientsQuestion How do wait times foroutpatient appointments comparecared for within the United States Department of Veterans Affairs (VA) health care system.and volume of encounters increased for all specialties.between United States Department ofOBJECTIVES To determine wait times for newreceivingstatisticallycare at VA medicalsignificantcenters andWepatientsobservedcompare wait times in the VA medical centers with wait times in the private sector (PS).Veterans Affairs (VA) and private sectorannualincremental improvements in VA CAHPS scores forhospitals?both urgent and routine primary care and specialtycare appointments (Table). For urgent primaryFindings In this repeated cross-DESIGN, SETTING, AND PARTICIPANTSretrospective,repeatedstudy wascare,A “Ialways gotancross-sectionalappointmentforsectionalstudy ofwait timeimproveddata fromcare neededrightaway”by a mean of 1.3% annuallyconducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedicsVA facilities and private sector hospitalsat VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PSin primary care, dermatology,came from a published survey that used a secret shopper survey approach. Secondary analysescardiology, and orthopedics from 15evaluated the change in overall and unique patients seen in the entire VA system and patientmajor metropolitan areas, there was noFigure 2. Wait Time by Specialtysatisfaction survey measures of care access between 2014 and 2017.80MAIN OUTCOMES AND MEASURES The outcome of interest was patient wait time. Wait times inthe VA were determined directly from patient scheduling. Wait times in the PS were as reported inwait times in 2014. In 2017, mean waitBtimes were statistically significantlyMean private sector60sector remained unchanged.Wait Times, d[35.0] days; P .005), dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5] days; P .001), andcardiology (mean [SD], 15.3 [12.6] vs 22.8 [10.1] days; P .04). Wait times for orthopedics remainedlonger in the VA than the PS (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; 20P .01), although wait timeimproved significantly between 2014 and 2017 in the VA for orthopedics while wait times in the PSdid not change (change in mean wait times, increased 1.5 days vs decreased 5.4 days; P .02).Secondary analysis demonstrated an increase in the number of unique patients seen and0Meaning Access to care within VAafacilities appears to have improvedbetween 2014 and 2017 and appears tohave surpassed access in the privatesector for 3 of the 4 specialtiesevaluated. SupplementalSpecialtiescontent and AudioInvited Commentaryappointment encounters in the VA between 2014 and 2017 (4 996 564 to 5 Cardiology118 446, and 16 476 461Primary CareDermatologyto 17 331 538, respectively), and patient satisfaction measures of access also improved (satisfactionscores increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgentprimary care, P .05).100 000FY14FY15FY164 950 0004 900 000FY174 850 000OrthopedicsEach dot represents the mean wait time per newpatient for an appointment in the private sector andVeterans Affairs facilities in 2017, stratified by specialtyof care. The error bars indicate measures ofuncertainty in SD.aSignificant comparison at P .05.Author affiliations and article information arelisted at the end of this article.CONCLUSIONS AND RELEVANCE Althoughwaittimes in theVA andPS appeared to be 1001/jamanetworkopen.2018.7096(Reprinted)January 18, 20195/91 500 00018 000 0001 400 00017 000 0001 300 00016 000 0001 200 00015 000 0001 100 00014 000 0001 000 00013 000 000900 00012 000 0002014, there have been interval improvements in VA wait times since then, while wait times in the PS800 000appear to be static. These findings suggest that access to care within the VA has improved over time.FY14FY15FY16FY1711 000 000Primary Care and Total Encounters, No.from 2014 to 2017 improved in the VAafacilities while wait timesin the privatea [10.4] vs 40.7[5.9] vs 29.8 [16.6] days; P .001). This was true in primary care (mean [SD], 20.05 000 000CardiologyDermatologyOrthopedicsPrimary careOverall200 000VA unique encounters by specialty in FY14 to FY17private sector facilities as wait timesVeterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In2017, overall wait times for new appointments in the VA were shorter than40 in the PS (mean [SD], 17.75 050 000300 000statistically significant differencesimilar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P .20). Department ofRESULTS Compared with the PS, overall mean VA wait times for new appointments in 2014 were5 100 000400 000between private sector and VA meanaMeanwithVeteransAffairsshorter for the VA comparedtheMerritt Hawkins surveys using the secret shopper method.5 150 000500 0000Cardiology, Dermatology, and OrthopedicEncounters, No.Abstract600 000Primary Care and Total Patients, No.SecondaryComparison of WaitTimesAnalysisfor New Patients BetweenWithinVA patients,are women. In addition, of all unique veteran patients, 1.4% arethe Private an 24years, 18.5% are between 25 and 44 years, 33.0% are between 45 and 64 years,of Veterans AffairsMedicalCentersA, The number of unique patients enrolled in the VAannually by specialty overall. B, The number of uniqueencounters in the VA annually by specialty and overall.FY indicates fiscal year.JAMA Network Open. 2019;2(1):e187096. doi:10.1001/jamanetworkopen.2018.7096Downloaded From: by a University of California - Los Angeles User on 01/19/2019Open Access. This is an open access article distributed under the terms of the CC-BY License.JAMA Network Open. 2019;2(1):e187096. doi:10.1001/jamanetworkopen.2018.7096 (Reprinted)January 18, 20191/9JAMA Network Open. 2019;2(1):e187096. doi:10.1001/jamanetworkopen.2018.7096 (Reprinted)January 18, 20196/9Downloaded From: by a University of California - Los Angeles User on 01/19/2019Downloaded From: by a University of California - Los Angeles User on 01/19/2019https://www.uclahealth.org/medicine/6

1/24/19VA Research Update Transition to online submission for IRB andAnimal Protocols Recruitment for new VA Associate Chief ofStaff for Research New West LA VA Research Building, willinclude basic, health services, and clinicalresearchUCLA/VA Division Research Portfolio UCLA DOM-Administered Federal Grants (primarily NIH)- 27million total in direct costs VA Grants (laboratory, clinical, rehabilitiation, health services) VA-based UCLA DOM faculty hold 27 of 54 VA Merit ReviewGrants at VA Greater Los Angeles (representing approximately 17.5 million in total direct costs) UCLA/VA DOM Faculty with VA Recent Merit Grants––––Tzung Hsiai, MD, PhDKim Lien Nguyen, MDAnne Walling, MD, PhDAnna Milanesi, MD, PhD VA Career Development, Cooperative Study, Quality Improvement––––Michael Ong, MD, PhDTannaz Moin, MD, MPH, MBALucinda Leung, MD, PhDJonathan Jacobs, MD, PhDOverall VA Greater Los Angeles StructureHospitalDirectorChief of StaffAssociateChief of Stafffor ResearchDeanYamaguchi,MD, aging,RadiationTherapyAssociateChief of StaffforEducationArtFriedlander,DDSAssociate DirectorsNursing, Facilities,Ambulator

Tamkin Auditorium, B-130 RRUCLA Christina Harris, MD Assistant Professor of Clinical Medicine Associate Program Director, UCLA Internal Medicine Residency Director, Resident Clinic, West Los Angeles VA Department of Medicine David Geffen School of Medicine at UCLA Nev