Report from the Executive Vice President,
Provost and Dean of the School of Medicine
For the Faculty Senate Meeting, 11/18/13
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 2
CONTENTS
Letter from the Provost
3
Education
4
Surgical Simulation Center
Research
5
Recent Grant Highlights
Dr. Kathryn Cunningham Receives Grant Award from NIDA
Patient Care
New Regulations Regarding Inpatient Admissions of Medicare Patients
8
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 3
Letter from the Provost
Dear Colleagues,
I want to take a moment to wish you and yours a Happy Thanksgiving. I hope that you have a chance
to relax and enjoy your family and friends. For those of you traveling during the holiday, please be
safe.
During this special time of year, we are reminded that we are a community with a shared mission and
passion for serving others. To this end, please consider making a contribution to the 2013 State
Employee Charitable Campaign (SECC) if you have not already done so. There are many in our
community and throughout our region who could use a helping hand, and I ask that you join me in
working together to help others in their time of need.
Several initiatives are underway to improve communication. We have recently launched a “Provost’s
Blog” to stimulate ongoing discussions and introduce topics for conversation and deliberation related
to our Academic Enterprise. Our second Culture of Trust “Brown Bag Luncheon” was held on
November 13. These luncheons serve as an opportunity for employees across the Academic
Enterprise (all classified, administrative & professional and non-teaching staff) to connect with their
coworkers and discuss important activities or initiatives that are in progress. To improve
communication with our student body, I have visited with our Student Surgical Society members on
November 15 in the Old Red Amphitheater and will be hosting an open forum titled, “Pizza with the
Provost” on November 20 at 4:00 p.m. in Joe’s Café in the Jamail Center.
Finally, please join us for an evening of refreshments, music, lights and holiday cheer at our annual
tree lighting ceremony on December 3 at 5:30 p.m. in front of the John Sealy Hospital.
Sincerely yours,
Danny O. Jacobs, MD, MPH, FACS
Executive Vice President, Provost and
Dean of the School of Medicine
Thomas N. & Gleaves T. James Distinguished Chair
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 4
Education
Surgical Simulation Center
After six months of construction, our Surgical
Simulation Center is now operational. This
state‐of‐the‐art facility, located on the 6th
floor of the University Hospital Clinics and
McCullough buildings, will enable students,
residents, nurses and surgeons to work
together, practicing complex procedures in
realistic settings. In addition to providing
specialized training, the Center is home to
many ongoing educational and research
projects. In March, an elective will be offered
for 4th year medical students who choose
surgery as their professional career.
The Surgical Simulation Center is seeking accreditation as a nationally recognized comprehensive
institute through the American College of Surgeons Program for Accreditation of Education Institute
(ACS-AEI). The accreditation process involves a rigorous assessment of our Center’s curricula and
available resources, as well as a site survey by the ACS-AEI. The Center will be notified in December
regarding approval of its application for accreditation.
UTMB has long been a leader in simulation training through its Standardized Patient Program, which
trains patient actors to portray a specific condition in a consistent and realistic way. These individuals
offer our medical students the opportunity to practice communication and examination skills and also
provide feedback to the students. The SON and SHP also use standardized patients to learn
interviewing, examination and patient counseling skills.
Our University is also home to the SON Nursing Simulation Center (NSC), a state-of-the-art facility
that enables students from the SON, SOM, and SHP to participate in interprofessional education
opportunities. Students practice procedures in various clinical settings, including pediatric, neonatal,
infant, emergency and adult acute care scenarios.
Simulation training is also offered in a program, supported by the Department of Anesthesiology, for
residents and medical students, who learn simulation techniques in anesthesia, airway management,
trauma resuscitation and other areas.
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 5
Research
Recent Grant Highlights
The following is a list of grant recipients for the month of October 2013.
Principal
Investigator/Project
Director
Title
Sponsor
Amount
Dr. Karl Anderson,
Professor, Preventive
Medicine & Community
Health
Phase 2 Study of Hemin for
Treatment and Prevention
of Porphyria Attacks
Food and Drug
Administration
$1,517,147 over
four years
Dr. Yan Chen, Assistant
Professor, Ophthalmology &
Visual Sciences
Interplay between
Phagocytic and Autophagic
Pathways in the Retinal
Pigment Epithelium
International
Retinal Research
Foundation
$198,111 over
two years
Dr. Kyung Choi, Associate
Professor, Biochemistry &
Molecular Biology
Inhibiting protein-primed
replication of human
enteroviruses
Foundation for
Applied Medical
Evolution (NIAID
flow through)
$98,631 (new
subcontract on a
two-year NIH
award)
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 6
Principal
Investigator/Project
Director
Title
Sponsor
Amount
Dr. Yingzi Cong, Associate
Professor, Microbiology &
Immunology
microRNA-10a Regulation
of Inflammatory Bowel
Diseases
National Institute
of Diabetes &
Digestive &
Kidney Diseases
$1,347,413 over
three years
Dr. Xiang Fang, Assistant
Professor, Neurology
Role of PGC-1alpha in the
Pathogenesis of Myotonic
Dystrophy Type 1
National Institute
of Neurological
Disorders and
Stroke
$531,516 over
three years
Dr. James Graham,
Associate Professor, School
of Health Professions
Archiving Four New
Datasets from the
Longitudinal Hispanic
EPESE Study
National Institute
on Aging
$246,808 over
two years
Dr. Zbigniew Gugala,
Assistant Professor,
Orthopaedic Surgery &
Rehabilitation
The Comparative Efficacy of
the Masquelet Versus
Titanium Mesh Cage
Reconstruction Techniques
for the Treatment of Large
Long Bone Deficiencies
Army Medical
Research
Acquisition
Activity
$840,485 over
four years
Dr. Jacqueline Hirth,
Assistant Professor,
Obstetrics & Gynecology
Association of Region of
Residence with Human
Papillomavirus Vaccine
Uptake Among 9-17 year
Old Adolescents in the U.S.
University of
North Carolina at
Chapel Hill (flow
through from
Cervical Cancer
Free America)
$4,671 (one-year
subcontract)
Dr. Marc Morais, Associate
Professor, Biochemistry &
Molecular Biology
Bacteriophage-Based
Nanoparticles for the
Detection and Diagnosis of
Bacterial Pathogens
The Methodist
Hospital Research
Institute
$200,000 (new
one year
subcontract on
U.S. Army Award)
Dr. Tracy Toliver-Kinsky,
Associate Professor,
Anesthesiology
TP508 Mitigates
Radiotherapy-induced
Tissue Damage
Chrysalis
BioTechnology
(NCI flow through)
$114,025 (new
two-year
subcontract on a
Federal Contract)
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 7
Principal Investigator/Project
Director
Title
Sponsor
Amount
Dr. Xue-jie Yu, Professor,
Pathology
Genetic Analysis of
Rickettsia ProwazekiiVirulence Testing
University of
South Alabama
(NIAID flow
through)
$57,895 (one
year
subcontract
on NIH flow
through)
Dr. Kathryn Cunningham Receives Grant Award from
NIDA
Dr. Kathryn Cunningham, Chauncey Leake Distinguished
Professor of Pharmacology, Director of the UTMB Center for
Addiction Research and Vice Chair of the Department of
Pharmacology and Toxicology, is the Principal Investigator of a
five-year, $6.6 million grant from the National Institute on Drug
Abuse (NIDA) to support the “Translational Addiction Sciences
Center (TASC).”
The TASC will build on the success of the NIDA-funded P20
Exploratory Center, which supported the coalescence of the
scientific team that bridges chemistry, cell biology and
pharmacology with human and animal psychopharmacology to
address the complexity of addiction.
The TASC is comprised of a consortium of scientists from UTMB (Drs. Kathryn Cunningham and
Cheryl Watson), the University of Houston (Dr. Scott Gilbertson) and Virginia Commonwealth
University (Dr. Gerard Moeller). Funding from the NIDA will allow this translational team to
definitively reveal the role of serotonin neurotransmission in the disordered state of drug dependence
and to intelligently design targeted new medications to mitigate deleterious behaviors and promote
recovery. The TASC will provide not only the infrastructure for productive translational research, but
also serve as a key venue to attract and facilitate the mentoring and career development of junior
investigators in addiction biology.
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 8
Patient Care
New Regulations Regarding Inpatient
Admissions of Medicare Patients
The Centers for Medicare & Medicaid Services (CMS) has
issued new guidance regarding hospital admissions. The
regulation referred to as the “Two-Midnight Rule” is an
attempt by CMS to clarify its requirements for inpatient
admissions of Medicare patients.
As of October 1st, 2013, physicians and other admitting
practitioners are expected to follow these requirements
for the inpatient admission of Medicare patients. CMS continues to require the attending physician to
write or cosign the order for status.
For more details, please see the following communication from our Interim Chief Medical Officer and
Chief Physician Executive.
November 12, 2013
Dear Colleague,
The Centers for Medicare & Medicaid Services (CMS or Medicare) recently finalized new regulations
governing the admission of Medicare beneficiaries to hospitals. The regulation referred to as the “2Midnight rule” is an attempt by CMS to clarify its medical review criteria for medical necessity and
payment.
Although these regulations are extensive and are subject to ongoing clarification, as of October 1st,
2013 physicians and other admitting practitioners are expected to follow these requirements for the
inpatient admission of Medicare patients.
The 3 areas most important to physicians are:
1. The Time the patient is expected to stay in the hospital
2. The Order to “admit to inpatient” or “refer for observation/outpatient”
3. The Documentation & Certification of medical necessity to support the patient’s inpatient
admission
Here are the key takeaways for physicians:
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 9
Time:
If the patient medically requires hospital inpatient services and the physician believes that the
patient will need to stay in the hospital at least 2 midnights, the physician should order inpatient
admission. If the patient does not medically require inpatient hospital services or the physician
does not expect the patient to stay past 2 midnights, the physician should order observation or
outpatient services.
Guidelines:


If you believe the patient will be discharged same day or the day following
hospitalization, consider ordering Outpatient or Observation.
If you believe the patient will NOT be ready for discharge the day after hospitalization,
consider ordering Inpatient.
Of note, order changes (inpatient à observation or observation à inpatient) can be made after the
initial order is written as the hospitalization evolves. The case management team and EHR will
work with you and assist if any order changes are needed.
Order:
CMS continues to require the attending physician to write or cosign the order for status. In
addition, CMS clarified few areas related to the order:
•
•
The attending or supervising physician must cosign residents and midlevel provider’s order
prior to discharge of the patient.
Verbal orders are acceptable in accordance with state law and hospital bylaws.
Guidelines:
•
•
Inpatient Cases: should include the words Admit and Inpatient to be a valid inpatient
order
– “Admit to Tower 7” or “Admit to Dr. Smith” are not recommended
Observation/Outpatient Cases: Should include the phrase “refer for Observation
Services” or “place in outpatient status”
– Avoid using “admit” and “Observation or Outpatient” in the same order. CMS
considers this to be contradictory
Documentation & Certification:
Report from the Executive Vice President, Provost and
Dean of the School of Medicine | 10
CMS requires physician certification of the patient’s admission in the medical record, which consists
of statements establishing that the services were reasonable and necessary and signed by the
responsible physician prior to the patient’s discharge. The certification includes:
•
•
•
•
Order for inpatient admission (as above)
Diagnosis and rationale for hospitalization/inpatient medical treatment
Documentation of the estimated time the patient will need to remain in the hospital (as above)
Plans for post-hospital care, if appropriate
The certification must be signed and documented in the medical record prior to patient discharge.
Hospitals may choose to have physicians record these elements of the certification either on a
specific form or throughout the medical record such as in the orders, history and physical, or
physician progress notes.
Guidelines:



Excellent patient care should continue to be the top priority.
Document the diagnosis, medical rationale, plan of care and anticipated discharge.
Sign the admission order and certification (if appropriate) prior to discharge.
EHR has some educational resources available if you are interested. Please contact one of us and
we can send along details.
Thank you for your continued support and contact us with any questions or concerns.
Regards,
Oscar “Skip” Brown, MD
Interim Chief Medical Officer
Medical Director, Bay Colony Pediatric Center
Email: owbrown@utmb.edu; Phone: (409) 772-3303
Rex McCallum, MD
Vice President and Chief Physician Executive
Email: rex.mccallum@utmb.edu; Phone: (409) 772-3639