Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Sept. 13, 2013 | Archived Issues

Covered California Insurance Exchange and Non-Employer Health Insurance

By Thomas M. Priselac, President and CEO

With California's health insurance exchange, Covered California, set to begin enrollment Oct. 1 for people who are not covered through an employer, and with other ongoing changes in the health insurance marketplace, many of our patients have questions about what they may need to do to ensure they can continue to be covered for their care from Cedars-Sinai and our medical staff.

» Read more

Roll Up Your Sleeves Early for the Flu Vaccine

Flu season is unpredictable so physicians are advised to get their flu vaccination early. Free flu shots are now available to all members of the medical staff and can be obtained at one of our convenient flu shot clinics or at Employee Health Services, located on the second floor of the Steven Spielberg Building.

» Read more

CS-Link Tip: Dealing With Results

What do you do with a result? Your options are "done," "review," "forward" and "result notes."

» Read more

MEC to Get New Members

Several physicians have been approved or nominated for positions on the Medical Executive Committee, the commitee learned at its Sept. 9 meeting.

» Read more

Annual Meeting of Medical Staff Is Oct. 21

The annual meeting of the medical staff is scheduled for 11:30 a.m. to 1:30 p.m. Monday, Oct. 21, in Harvey Morse Auditorium.

» Read more

Seferian Leads Pediatrics Teaching Mission to Armenia

Given just 48 hours, how could doctors from the United States make a lasting impact on the medical care of seriously ill children in Armenia? For a group led by Edward Seferian, MD, a pediatric critical care physician in Cedars-Sinai's Department of Pediatrics, the answer was to do one of the things they do best: Teach.

» Read more

Recognition for Di Vizio, Kateb, Mirhadi, Pfeffer and Rosen

Physician News

Dolores Di Vizio, MD, PhD, earns a $300,000 grant; Babak Kateb, MD, is lead editor of a first-of-its-kind textbook; a study by Amin J. Mirhadi, MD, will be highlighted at ASTRO's annual meeting; Glenn B. Pfeffer, MD, appears in a new documentary; and Bradley T. Rosen, MD, MBA, has a new position.

» Read more

How to Participate in Run for Her

Last year, more than 1,300 Cedars-Sinai employees, their relatives and friends participated in the Run for Her®. This year, we want to surpass that number. Whether you want to join an existing team, start a team, or participate as an individual, we've got the details on how to get started.

» Read more

Covered California Insurance Exchange and Non-Employer Health Insurance

By Thomas M. Priselac,
President and CEO

With California's health insurance exchange, Covered California, set to begin enrollment Oct. 1 for people who are not covered through an employer, and with other ongoing changes in the health insurance marketplace, many of our patients have questions about what they may need to do to ensure they can continue to be covered for their care from Cedars-Sinai and our medical staff.

To help address these questions, I'd like to share the below information with you, as well as let you know about additional resources Cedars-Sinai has developed to help inform our patients. I want to emphasize that this is a fluid situation, as there will likely be additional changes coming from the exchange and the commercial health insurance companies over the next several months.

Please note that these initial changes in the state's health insurance programs only affect people who purchase their own insurance policies for themselves and their families; they will not affect those who receive health insurance through their employer, such as Cedars-Sinai employees.

Open enrollment for these non-employer, individual plans – including the Covered California insurance exchange – runs from Oct. 1, 2013, through March 31, 2014. As open enrollment approaches, we are anticipating questions from Cedars-Sinai patients who have non-employer provided commercial health insurance plans.

Many of these people will want to know which insurance plan to choose to ensure that they continue to be fully covered for care from Cedars-Sinai and its physicians. However, as of now, not all individual plans – both within and outside the Covered California insurance exchange – provide this coverage. To assist our patients, we have developed a number of resources to provide up-to-date information on what they need to do to ensure that they continue to have insurance that provides them with full coverage for care from Cedars-Sinai Medical Center and our physicians.

In the coming days, patients who purchase private health insurance plans will be receiving a letter from Cedars-Sinai, a copy of which is attached (see PDF link below). If you receive questions from patients about which insurance plan they should choose to ensure they are fully covered for care from Cedars-Sinai and our medical staff, please direct them to the following resources, which will be updated with additional information and guidance as we receive details from the insurance companies about coverage. Patients can:

Since Covered California and the commercial health insurance companies are still finalizing some of their plans and coverage, and there will likely be additional changes from them over the coming months, this will be a fluid situation. We will continue to keep you posted as we receive additional information from the insurance companies and Covered California.

Patient Letter - Insurance Exchanges - September 2013 (PDF)

Roll Up Your Sleeves Early for the Flu Vaccine

Gail Grant, MD, MPH, gets a flu shot from Amanda Mongiello, RN.

Flu season is unpredictable so physicians are advised to get their flu vaccination early. Free flu shots are now available to all members of the medical staff and can be obtained at one of our convenient flu shot clinics or at Employee Health Services, located on the second floor of the Steven Spielberg Building.

"Our goal this year is to ensure that at least 85 percent of our direct patient care providers get the flu shot. We are asking all medical staff to help lead the way by not only getting vaccinated but also by urging other care providers to do the same to help protect their patients, themselves and their families," says Rekha Murthy, MD, director of Hospital Epidemiology. "Please encourage your colleagues, staff and patients to get the flu shot."

Click here to access the Centers for Disease Control and Prevention's website on "What You Should Know for the 2013-14 Influenza Season."

Free flu vaccinations are available to medical staff, employees and volunteers at the following clinics:

Sept. 13

  • 7:30 a.m. to 3 p.m. in Thalians West 135

Sept. 16-17

  • 7:30 a.m. to 3 p.m. in Thalians West 135
  • 4 p.m. to 10 p.m. in AHSP PEC 3

Sept. 18-19

  • 7:30 a.m. to 3 p.m. in Thalians West 135
  • 4 p.m. to 10 p.m. in HMCC 3

Sept. 20

  • 7:30 a.m. to 3 p.m. in Thalians West 135
  • 9 a.m. to 2 p.m. in Harvey Morse Patio
  • 4 p.m. to 10 p.m. in AHSP PEC 3

Sept. 23–26

  • 7:30 a.m. to 3 p.m. in Thalians West 135
  • 4 p.m. to 10 p.m. in AHSP PEC 3

Sept. 27

  • 7:30 a.m. to 3 p.m. in Thalians West 135
  • 9 a.m. to 2 p.m. in Harvey Morse Patio
  • 4 p.m. to 10 p.m. in AHSP PEC 3

For more information, or to schedule an appointment for a flu vaccination, please call Employee Health Services at ext. 3-3322.

CS-Link Tip: Dealing With Results

What do you do with a result?

Your options are "done," "review," "forward" and "result notes."

"Done" removes the result from your InBasket. It means you are "done" with this result, but it doesn't tell anyone what you did or thought. "Reviewed" will leave your signature and time stamp. You can forward the results to someone else, and you can leave a note on the result and forward it.

To view screen shots of this tip, please click this CS-Link Central link, scroll to the section titled Tip of the Week, and click on the tip for Sept. 8, "Dealing With Results."

MEC to Get New Members

Several physicians have been approved or nominated for positions on the Medical Executive Committee, the commitee learned at its Sept. 9 meeting.

Approved as clinical department chiefs for 2014-15 were:

  • Pediatrics — Valerie Watiker, MD
  • Medicine — Clement C. Yang, MD

Nominated as department representatives to the MEC were:

  • Anesthesiology — Maria De Castro, MD
  • Imaging — Marcel Maya, MD
  • Pathology — Cynthia Nast, MD

It was noted that these individuals will be presented for approval at the annual meeting of the medical staff on Oct. 21.

Also at the meeting:

  • The MEC was told about a Nov. 19 symposium on the treatment of end-of-life patients, and about a group statement being developed on the issue.
  • A revision to the smoking-cessation protocol was approved that e-cigarettes are not allowed on the Cedars-Sinai campus.
  • Thirty-seven new members of the medical staff were noted. Click the PDF link below to see their names and specialties.

Morning After Report - September 2013 (PDF)

Annual Meeting of Medical Staff Is Oct. 21

The annual meeting of the medical staff is scheduled for 11:30 a.m. to 1:30 p.m. Monday, Oct. 21, in Harvey Morse Auditorium.

Agenda items include the chief of staff report, CEO report and executive update, the Chief of Staff Award, and the 2013 Pioneer in Medicine Award.

Annual Meeting of the Medical Staff - Oct. 21 (PDF)

Seferian Leads Pediatrics Teaching Mission to Armenia

Edward Seferian, MD, (second from right) led a medical mission to teach healthcare providers in Armenia the latest techniques in pediatric intensive care.

Given just 48 hours, how could doctors from the United States make a lasting impact on the medical care of seriously ill children in Armenia? For a group led by Edward Seferian, MD, a pediatric critical care physician in Cedars-Sinai's Department of Pediatrics, the answer was to do one of the things they do best: Teach.

In a rigorous, two-day seminar in Yerevan, Armenia, in mid-July, Seferian and four colleagues taught some of the latest techniques and advances in pediatric intensive care to that nation's leading pediatricians and nurses. The American team also laid the groundwork for the Armenian participants to become teachers themselves, arming them with knowledge to share with colleagues at their home institutions.

"After the independence of Armenia in 1991 from the Soviet Union, the healthcare system, which had been heavily subsidized, fell apart," Seferian said. "They've been rebuilding over the past 20 years. A large part of the goal of this mission was to educate the doctors and nurses in the most current methods and techniques."

The visit was sponsored by the Fund for Armenian Relief, an organization that oversees both short- and long-term programs for economic growth and social development.

Developed by the Society of Critical Care Medicine, the course the physicians taught included in-depth lectures, simulated situations using mannequins and medical equipment, and intensive review and discussion of case scenarios. Topics included stabilization of patients with organ dysfunction, organ failure, respiratory and heart failure, septic shock, neurological injuries and diseases.

"We didn't really know what to expect when we first began teaching the course," said Seferian, who is also a medical director in the Department of Medical Affairs at Cedars-Sinai. "But the doctors and nurses we worked with were very engaged, very involved, and were grateful for the chance to learn."

When Seferian and his colleagues visited the local hospitals, they got an education themselves about the challenges the Armenian doctors and nurses face in aging facilities where medical equipment is scarce or outdated. One hospital had just acquired a high-frequency oscillatory ventilator, a device used in the United States for 20 years to treat respiratory failure in newborns and children. No one on the hospital staff knew how to operate it. But before the end of the visit, Seferian and his colleagues had taught them how.

Another stark reality in the Armenian hospitals, due to the scarcity of modern equipment, is the lack of home care for chronically ill patients. As a result, many patients end up living in the wards.

"There was a former premature infant with chronic respiratory failure and a tracheostomy who was on a ventilator and had been in the hospital for a year," Seferian said. "In the U.S., you would get a portable ventilator and send the patient home. But for this patient, it just wasn't an option."

All of which is why Seferian, whose grandparents emigrated from Armenia to the Boston area, hopes the trip will be the first in a series of missions to his ancestral homeland.

"There was a pre-course and a post-course exam, and we saw a great improvement in the scores," Seferian said. "We saw how these doctors and nurses do so much with not a lot of equipment, with great dedication and perseverance, and my hope is to expand this program and do more."

Joining Seferian on the mission were Mohan Mysore, MD, professor of pediatrics at the University of Nebraska College of Medicine; Mudit Mathur, MD, assistant professor of pediatrics at Loma Linda University Children's Hospital; Yves Ouellette, MD, assistant professor of pediatrics at the Mayo Clinic Children's Center in Minnesota; and Ndidiamaka Musa, MD, associate professor of pediatrics at the University of Washington School of Medicine and Seattle Children's Hospital.

Recognition for Di Vizio, Kateb, Mirhadi, Pfeffer and Rosen

Physician News

Di Vizio Earns $300,000 Grant to Study Aggressive Breast Cancer

The Avon Foundation for Women has awarded a $300,000 grant to Dolores Di Vizio, MD, PhD, to advance scientific research in aggressive breast cancer. Di Vizio is associate professor in the Department of Surgery and the Department of Pathology and Laboratory Medicine and a member of the Cancer Biology and Urologic Oncology Research Programs at the Samuel Oschin Comprehensive Cancer Institute.

Di Vizio will collaborate with the Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute to investigate biomarkers in patient blood samples that may identify individuals with aggressive breast cancer.

Research findings have the potential to create a novel standard of care and a new source of biomarkers known as large oncosomes.

Working with Di Vizio on the study is Beth Y. Karlan, MD, director of the Women's Cancer Program, director of the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology, the Cedars-Sinai Board of Governors Chair in Gynecologic Oncology and the director of the Cedars-Sinai Gilda Radner Hereditary Cancer Program.

This is the first study on large oncosomes analyses in patients with breast cancer.

Babak Kateb, MD, (right) at the White House presenting a copy of the textbook to Philip Rubin, chair of the BRAIN Initiative committee.

Cedars-Sinai Physicians and Researchers Have Large Presence in Milestone Textbook on Nanoneurosurgery

Cedars-Sinai physicians and researchers played a fundamental role in the recent publication of The Textbook of Nanoneuroscience and Nanoneurosurgery, the first such book in the field. The book's first editor is Babak Kateb, MD, a research scientist at the Maxine Dunitz Neurosurgical Institute, chair of the board of the Society for Brain Mapping and Therapeutics and an adviser to President Obama on the BRAIN Initiative.

Among the more than 120 researchers who contributed chapters to the book are several from Cedars-Sinai: Keith L. Black, MD, Dwain Morris-Irvin, PhD, MPH, Bong Seop Lee, PhD, Chirag G. Patil, MD, Jian Tajbakhsh, PhD, and John S. Yu, MD. Kateb also contributed to several chapters.

The book presents a state-of-the-art review of the emerging field, providing current information about nanoplatforms and their use in neurosurgery, neurology, neuroscience and neuroradiology. The text also reviews the latest regulatory guidelines that influence nanotechnological research, and it highlights presidential and congressional initiatives and programs that may significantly impact the field in the near future.

Kateb was at the White House when a copy of the book was signed and presented to President Obama. Nanoneuroscience is a major part of the president's BRAIN Initiative, an effort to revolutionize our understanding of the human mind and uncover new ways to treat, prevent, and cure brain disorders like Alzheimer’s, schizophrenia, autism, epilepsy, and traumatic brain injury. BRAIN stands for Brain Research through Advancing Innovative Neurotechnologies.

ASTRO Highlights Mirhadi's Study Comparing Short- Vs. Long-Term Hormonal Therapy

Radiation oncologist Amin J. Mirhadi, MD, found that "less may be more" when it comes to hormonal therapy in men with intermediate risk prostate cancer. The subset analysis study comparing short-term vs. long-term hormonal therapy was selected to be highlighted in the press program for the American Society for Radiation Oncology's 55th annual meeting, "Patients: Hope, Guide, Heal." The meeting will be held Sept. 22-25 in Atlanta.

The study, titled "Effect of Long-Term Hormonal Therapy (vs. Short-Term Hormonal Therapy): A Secondary Analysis of Intermediate Risk Prostate Cancer Patients Treated on RTOG 9202," used data from an older study, known as RTOG 9202. In the RTOG 9202 study, researchers found that men taking anti-testosterone treatment for two years benefited more than those who took it for four months.

In his new analysis, Mirhadi evaluated a subset of men classified as "intermediate" risk and found that there was no additional benefit to prolonged anti-testosterone therapy in the subset of patients.

"Clinicians tend to feel that 'more is better' when it comes to blocking testosterone in the body of a man with prostate cancer," Mirhadi said. "Our research proves otherwise, which may provide an enormous impact on men's health."

By blocking testosterone for a shorter period of time, men may see a reduction in common side effects, including decreased libido, bone loss, weight gain and an increased risk for heart disease, Mirhadi said.

Pfeffer Appears in Documentary About Charcot-Marie-Tooth Disease

Glenn B. Pfeffer, MD, appears in a new documentary about Charcot-Marie-Tooth disease, a neurological disorder that can weaken and contort the feet.

The film, "Bernadette," tells the story of a young woman who lives a full life even as she struggles with the physical and emotional challenges of the disorder.

Pfeffer, one of the leaders of Cedars-Sinai's Charcot-Marie-Tooth/Hereditary Neuropathy Center, has played a major role in the treatment of Charcot-Marie-Tooth disease. He and others involved in the documentary are speaking out ahead of its Sept. 17 premiere at the ArcLight Hollywood cinemas in the hope of drawing attention to the little-known disease, which affects one in 2,500 people and is among the most common inherited neurological disorders.

The film was sponsored by the Hereditary Neuropathy Foundation.

Pfeffer is director of the Cedars-Sinai Foot and Ankle Program and co-director of the Cedars-Sinai/USC Glorya Kaufman Dance Medicine Center.

Rosen Becomes Director of Care Transitions and Complex Medical Management

Bradley T. Rosen, MD, MBA, has been promoted to director of Care Transitions and Complex Medical Management for the Cedars-Sinai Health System.

In his new role, Rosen will build upon his extensive experience leading difficult conversations with patients and families about advanced disease and end-of-life care and, with his recent board certification in Hospice and Palliative Care Medicine, will create a Health System-wide Supportive Care Medicine program. This new entity will collaborate closely with patients' primary care physicians and specialists to provide critical services for the most fragile patients, both in and out of the hospital, whether they choose to focus on comfort-oriented goals or to pursue a full range of more aggressive treatments for their illnesses.

Rosen also will work closely with the medical center and Medical Care Foundation to help design and implement innovative programs that will effectively manage our ACO patient population, ensure well-coordinated hand-offs and focus on safe care transitions

Rosen will continue as medical director of the Inpatient Specialty Program, which he launched in 2006, and the Enhanced Care Program, whose creation he led in 2012. The ISP hospitalist service is the largest admitting entity to the medical center, and the NP-driven ECP has partnered with over 80 private physicians to improve the care of patients at local skilled nursing facilities and led to a significant reduction in 30-day readmissions for this vulnerable population.

How to Participate in Run for Her

A scene from the 2012 Run for Her

Ninth Annual Event to Support Ovarian Cancer Research Is Nov. 10

Last year, more than 1,300 Cedars-Sinai community members, their relatives and friends participated in the Run for Her®. This year, we want to surpass that number. Whether you want to join an existing team, start a team, or participate as an individual, we've got the details on how to get started.

The ninth annual Run for Her 5K Run and Friendship Walk to raise funds for ovarian cancer research and awareness will be held Sunday, Nov. 10, at Pan Pacific Park.

Want to participate?

  1. Go to runforher.com
  2. Click on the word "Register" on the left hand side of the page
  3. Read the waiver and, if you agree the terms, click "I agree"
  4. Select "Start a Team," "Join a team" or "Join as an Individual" (If you select join a team or start a team, select the Cedars-Sinai Group option.)
  5. Create your username and password (If you have previously participated in Run for Her, your former username and password will work.)
  6. Fill out the online registration form
  7. Use discount code CSMC13 to get $10 off the registration fee

If you can't attend Run for Her, you can still participate by selecting the "sleepwalker" option on the registration form and you will receive a T-shirt and goodie bag in the mail before event day.

After registering, you'll get an email with your login and password confirmation. Also, a personal fundraising page will be created so you can collect donations online and easily keep track of your donation-collection status.

Questions?

Marina Gudelman, senior event coordinator and Run for Her team coordinator, has answers. Call 323-866-6250 or reach her by email at marina.gudelman@cshs.org.