EDGE22 Symposium Recordings

Overview

Applicable to everyone who works in the PALTC setting, the 2022 EDGE Virtual Symposium covers controversial and cutting edge issues facing practitioners throughout the PALTC continuum. EDGE explores practical approaches to "mapping the future"  of the PALTC system through engaging lectures, panel discussions, and facilitated small group interaction. Attendees leave with practical takeaways they can apply to their practices.

Learning Objectives

Through this program, participants should be able to: 

• Incorporate innovative and thoughtful solutions and best practices to current and emerging leadership and ethical issues in your practice
  
• Distinguish between the principles of leadership and management and the role each plays in facilitating the work of the interdisciplinary team
  
• Identify ethical situations or conflicts, and apply the tenets of medical ethics, in routine and uncommon clinical encounters
  
• Describe the various perspectives, including legal, technological, medical, and cultural that must be considered to provide holistic patient care
  
• Explain to your patients and their families the benefits and limitations of psychotherapy in treatment
  
• Effectively discuss the potential use of alternative treatments, their evidence-base, safety, and effectiveness with your clinical team and administrators.
  

Sessions

Description
PALTC Leadership & Advocacy: The Drumbeat for Quality in Nursing Homes This session will feature a panel to discuss the call for nursing home reform that has been highlighted in the recent report from the National Academies of Science. The panel will review recommendations in the report, as well as highlights from the February issue of JAMDA and the Moving Forward Initiative. The stakeholders and areas of consensus and divergence will be discussed, as well as how AMDA’S advocacy work bridges diverse groups. Finally, it will provide a succinct overview of PALTC advocacy with tips on how, when, and where to communicate with local and national policy leaders to be most effective. Speakers: Alex Bardakh, MPP; Alice Bonner,  PhD, RN, GNP; Anne Montgomery, BA, MS; Philip Sloane, MD, MPH; Faith Wiggins Moderator: Victoria Walker, MD, CMD
Collision of Crises: Addressing Diversity, Equity, & Inclusion's Intersection with our PALTC Careforce Challenges Work with our panel of experts to develop a SWOT analysis of PALTC as we take a deeper dive into the intersection of diversity, equity and inclusion and Careforce supply and development.  Participate in small group discussions around real-life case scenarios and come away with ideas to take advantage of opportunities as well as strategize how to handle threats you see facing PALTC. Speakers: Rajeev Kumar, MD, FACP, CMD; Jasmine Travers, PhD, MHS, RN, AGPCNP-BC; Elizabeth White, PhD, APRN Moderator: Diane Sanders-Cepeda, DO, CMD
To GDR or to Not GDR – That Is the Five Star Question! Gradual Dose Reductions have been a focus in Long-Term Care for many years, but when does it do more harm to the patient than good? The level of distress and mental health issues patients have experienced as well as psychotropic medication use has increased since the start of COVID-19. This workshop will focus on the regulations regarding use of antipsychotics and gradual dose reduction. In addition, to the recognized “appropriate” diagnoses for antipsychotic use, CMS recognizes many other major mental health conditions that also warrant use of antipsychotics and for which it may not be appropriate to GDR. Correctly documenting reasons a psychotropic medication is needed can decrease the number of pharmacy GDR requests received. Finally, the use and benefit of the interdisciplinary team meeting to address the use of psychotropic medications while focusing on meeting resident needs will be discussed.  Speakers: Lea Watson, MD; Rick Foley, PharmD; Barbara Wise, MD Moderator: Deborah Theis, PhD
$#!t Happens! What Do We Do Now? —The Ethical and Legal Aspects of Medical Error in PALTC A medical error may be defined as a commission or omission of an action with potentially adverse consequences for the patient.  Medical errors occur commonly in PALTC and may result in distress and discomfort among staff and clinicians in addition to potentially causing harm to residents. This session will explore the types and frequency of medical errors in PALTC, how to respond when medical error is identified and how to prevent subsequent errors.  This session will also address questions and controversies around the legal and ethical aspects of disclosure of medical error as well as the incorporation of apology in that disclosure.  Breakout groups will allow for small group discussion of these and other issues surrounding medical error in PALTC. Speakers: Nicole Brandt, PharmD, MBA; Katja Elbert-Avila, MD, MHS; Timothy Holahan, DO, CMD; Alan C. Horowitz, Esq., RN; Fatima Naqvi, MD, CMD Moderator: Robert A. Zorowitz, MD, MBA, CMD
at the EDGE   In the center of transformation, and at the edge of innovation resides robust debate. We invite you to get in the middle of multiple controversial topics and lead the discussion.   Legalizing Medical Marijuana in LTC; Medicinal & Recreational Use Debaters: Cari Levy, MD, PhD, CMD and Alexandria Hill, MSN, GERO RN-BC, RAC-CT, QCP, CMDP “Enough is Enough…” Should We Continue or Stop Cardiac Medications for our PALTC Residents? Debaters: Allison Villegas, PA-C and Emily Nicoli, NP Are Nursing Homes Ageist? Debaters: Joanne Lynn, MD, CMD and Daniel Haimowitz, MD, CMD Moderator: Diane Sanders-Cepeda, DO, CMD

Speakers

Alex Bardakh, MPP, PLC, is the Director of Public Policy and Advocacy for AMDA – The Society. Mr. Bardakh works for the Society’s extensive Public Policy agenda through Advocacy in Congress and numerous Federal Agencies. A graduate from the University of Maryland Baltimore County (UMBC) in Political Science/Psychology and Master’s Degree in Public and Legal Policy, Mr. Bardakh has extensive experience in health policy with a specific focus on areas such as payment models and quality of care initiatives. He has been a recognized national speaker on healthcare policy and has spoken at national conferences throughout the country.

Alice Bonner, PhD, RN, FAAN, has been a nurse practitioner for over 30 years. She is currently Senior Advisor for Aging at the Institute for Healthcare Improvement (IHI) and Chair of Moving Forward: Nursing Home Quality Coalition. From 2015-2019, Bonner served as Secretary of the Executive Office of Elder Affairs for the Commonwealth of Massachusetts. From 2011 to 2013, Dr. Bonner served as Director of the Division of Nursing Homes in the Centers for Medicare and Medicaid Services (CMS) in Baltimore, MD.  

Nicole Brandt, PharmD, is a professor in the Department of Pharmacy Practice and Science and executive director of the Peter Lamy Center on Drug Therapy and Aging. Since joining the University of Maryland School of Pharmacy, she has expanded geriatric training opportunities available, including the geriatrics/palliative care pathway, ASHP-accredited geriatrics residency, and two-year post-PharmD fellowship. Dr. Brandt has been active in promoting optimal care for older adults and has affected this through her educational, clinical, as well as health care policy work. She is the past president and board chairman of American Society of Consultant Pharmacists.

Katja Elbert-Avila MD, MHS, is an Associate Professor of Medicine at Duke University. She practices Geriatric Medicine at the Durham Veterans Affairs Medical Center (DVAMC), where she serves as Medical Director for the DVAMC Community Living Center and as a Clinical Ethics Consultant. She is Associate Program Director for the Duke Geriatrics Medicine Fellowship program.

Rick Foley, PharmD, is a consultant pharmacist with CVS/Omnicare with over 30 years’ experience in the post-acute long term care market.  He is board certified in Geriatrics and is a Fellow of the American Society of Consultant Pharmacists.  He served on the Board of Directors for the Florida Society for Post-Acute and Long-Term Care (FMDA) from 2016 to 2021. He was a clinical professor of Geriatrics at the UF College of Pharmacy for 8 years.  In 2021, Dr. Foley was the first pharmacist recipient of the FMDA Quality Champion award.

Daniel Haimowitz, MD, FACP, CMD, is an internist and geriatrician in solo private practice outside of Philadelphia. He is a former president of his state AMDA affiliate, prior AMDA board member and has chaired multiple committees. He is also on the Editorial Board of Caring for the Ages.

Alexandria Hill, MSN, RN-BC, RAC-CT, QCP, CMDP, is the Director of Quality Management at Westminster Canterbury on Chesapeake Bay. Ms. Hill is also a regulatory compliance, performance improvement, and leadership development consultant with Chiles Healthcare Consulting, holds a Masters in Nursing Administration and Leadership and is currently pursuing her Doctorate of Nursing Practice at Virginia Commonwealth University. She began her career as a Licensed Practical Nurse and uses this experience to fuel her passion for professional development, shared governance, and interdisciplinary collaboration in PALTC.

Timothy Holahan, DO, CMD, is an Assistant Professor at University of Rochester School of Medicine and Dentistry. He is Board Certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. He is currently faculty at the University of Rochester School of Medicine and Dentistry. He serves as Medical Director of multiple skilled nursing facilities in the Rochester, NY area. Dr. Holahan also is currently the president of the Finger Lakes Medical Directors Association and current board member for the New York Medical Directors Association (NYMDA). Dr. Holahan currently serves as the Vice Chair of the AMDA Ethics Committee. His passion is to deliver high quality geriatric care in nursing homes and care for complex patients in the SNF setting.

Alan Horowitz, Esq., RN, is a partner at Arnall Golden Gregory, LLP and focuses his health law practice on issues concerning skilled nursing facilities, home health agencies and hospices. Before joining the firm, Mr. Horowitz served as Assistant Regional Counsel at the United States Department of Health and Human Services’ Office of the General Counsel. He worked closely with and litigated cases on behalf of the Centers for Medicare and Medicaid Services. He has litigated cases before the HHS Departmental Appeal Board and the federal courts involving enforcement actions taken by CMS as well as having worked with the U.S. Attorneys’ Office defending Medicare coverage determinations and Federal Tort Claims Act cases.

Rajeev Kumar, MD, FACP, CMD, is the Chief Medical Officer of Symbria and the managing partner of Midwest Geriatrics, a medical group in Illinois who splits his time between administrative and clinical roles while serving as a board member of AMDA and AMDA's delegate to AMA. He serves as a medical director to two nursing facilities and a hospice program.

Cari Levy, MD, PhD, CMD, is a Professor of Medicine at the University of Colorado Denver with board certification in Internal Medicine, Geriatrics and Palliative Medicine. She graduated from Pepperdine University, received her Medical Degree and PhD in health services research from the University of Colorado Medical School and completed residency and a chief resident year at Vanderbilt University. Dr. Levy is currently Director of the Denver–Seattle Center for Veteran– Centered and Value–Driven Research and Section Chief of Palliative Medicine at the Rocky Mountain Regional VA Medical Center. As a health services researcher, she focuses her research on innovative models of long-term care such. Dr. Levy has over 100 publications in peer-reviewed journals based on this work.

Joanne Lynn, MD, is an experienced geriatrician, medical director, educator, quality improvement coach, and researcher.  She now works half-time with Representative Tom Suozzi as a Health & Aging Policy Fellow and also has been working on data production describing eldercare in counties and evaluating how PACE programs responded to COVID-19.  She was one of the first hospice physicians, a tenured professor at Dartmouth and at George Washington, a medical officer in the Center for Clinical Standards and Policy at CMS, and the Director of the Bureau for Cancer and Chronic Disease in the public health office for Washington DC.

Anne Montgomery, BA, MS, develops policy and research initiatives that improve long-term services and supports medical care for older adults receiving services from Medicare, Medicaid, the Older Americans Act, and other programs.  She is co-leading efforts to implement and evaluate comprehensive culture change and quality improvement in nursing homes and is working with colleagues to develop a new volunteer-based Community Care Corps program at the national level.  Ms. Montgomery conducts workforce policy analysis for home and community-based services (HCBS) and advises on how to expand models of community-based care for older adults requiring complex services.

Fatima Naqvi, MD, CMD, is currently working as a Hospice Medical Director for Holy Cross Hospice and Home Care in Maryland. Dr. Naqvi is Board Certified in Family Medicine, Geriatrics, Palliative and Hospice Medicine. She is a MOLST Master Trainer. Her passion is to serve older adults and the staff members at all levels who are caring for them. She enjoys learning and teaching. She was appointed as Maryland Medical Director of the Year Award in 2019 by Mid-Atlantic Maryland Society. She received the Choosing Wisely Campaign Award in 2019 for Antipsychotic medication reduction in multiple facilities. Ethics Committee and Advance Care Planning Task team (Dr. Naqvi and 3 other MDs) published a 5-S CARE Plan Tool Kit and Documentation Guide. She is a member of the Ethics Committee, Education Planning Committee, Policy and Advocacy Policy Committee and Diversity Equity and Inclusion Committee. Currently, she serves as a secretary at her local Chapter of AMDA. Dr. Naqvi's passion is transformative leadership and avoiding Burnout as a physician leader. She enjoys meditation, mindfulness and Yoga for work life balance.

Emily Nicoli, CRNP, is the chief nursing officer for UnitedHealthcare Retiree Solutions who specializes in serving the retiree health care needs of employer groups. Ms. Nicoli leads the clinical team in the areas of clinical quality, clinical program oversight, and the development of customized initiatives to improve retiree outcomes and meet client specific goals. She works collaboratively with employers and plan sponsor groups nationally to address quality and affordability for their retirees. Ms. Nicoli is a nurse practitioner board-certified in Adult/Gerontology as well as Hospice and Palliative Care with over 10 years’ experience in healthcare. She has an extensive background in the care of older adults as well as a deep knowledge base on risk adjustment and Star measures and she has been with UnitedHealthcare since 2016 and previously worked for Optum in clinical leadership roles.

Diane Sanders-Cepeda, DO, CMD, is a Senior Medical Director with UnitedHealthcare Retiree Solutions. In this role, Dr. Sanders-Cepeda provides oversight and direction for multiple clinical programs and initiatives as well as creating and designing innovative solutions to meet the demands of the retirees she serves. Dr. Sanders-Cepeda serves at a national level and presents clinical results to private and public sector business entities throughout the country. Dr. Sanders-Cepeda currently serves on the AMDA Board of Directors and is President for her state chapter FMDA.

Philip Sloane, MD, MPH, is the Elizabeth and Oscar Goodwin Distinguished Professor, of Family Medicine, Associate, Chair for Academic Development, and Co-Director of the Program on Aging, Disability, and Long Term Care, and Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill. He is a nationally recognized geriatrician, the co-editor-in-chief of JAMDA, and a member of the National Academies Task Force on Nursing Home Quality of Care.

Jasmine Travers, PhD, MHS, RN, AGPCNP-BC, is an assistant professor of nursing at NYU Rory Meyers College of Nursing. Her career is dedicated to designing and conducting research to improve health outcomes and reduce health disparities in vulnerable older adult groups using both quantitative and qualitative approaches. Her current work focuses on mitigating disparities in appropriate access and use of in-home and facility-based long-term care for older adults (i.e., home & community-based settings, nursing homes, and assisted living). Dr. Travers has published widely on the topics of aging, long-term care, health disparities, workforce diversity, vaccinations, and infections. She has presented her work at regional and national health services research, gerontological, nursing, and public health conferences and most recently sat on the National Academies of Science Engineering and Medicine Committee on the Quality of Care in Nursing Homes.

Allison Villegas , PA-C, has been a Physician Assistant working in the PA/LTC setting for the last nine years. She graduated from the University of Colorado Child Health Associate/Physician Assistant Program. Ms. Villegas has served on the AMDA Board of Directors Nominating Committee and she currently serves on the Membership Committee, the Annual Program Committee, and the NP/PA Advisory Council, where she serves as Vice Chair. She is on the board of directors for her state chapter, CMDA: The Colorado Society for Post Acute and Long Term Care Medicine.

Victoria Walker, MD, CMD, FAAFP, is the Medical and Clinical Officer for the Ave eCARE Senior Care telemedicine program. She provides support and direction to an interdisciplinary team that supports nursing home staff and residents of post-acute, long-term care and assisted living in 24 states. Dr. Walker is also the Medical Director for Avera Health System Long Term Care and a Clinical professor of Family Medicine at the University of South Dakota Sanford School of Medicine.  She currently serves on the AMDA board of directors, the Clinical Issues Subcommittee of the Public Policy Committee, the Telemedicine Workgroup and the Education workgroup for the North Central Society of PALTC.

Lea Watson, MD, MPH, is a geriatric psychiatrist and consultant to the long-term care workforce on issues of behavioral health and psychopharmacology.  Dr. Watson currently runs a highly acclaimed Psychiatry Fellowship for LTC clinicians, providing practical and accessible tools for non-psychiatrists. She also leads a Behavioral Health Integration program for a large NH practice serving over 500