Start Building Your Ideal Neurology Subspecialties for...
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YOUR MONTHLY AAN MEMBERSHIP MAGAZINE VOLUME 25 ISSUE 10 OCTOBER 2012 AAN Statement Defines Neurology Subspecialties for Coding New Patient Visits Determining whether a patient is new or established can be tricky, particularly with regard to whether a patient has been seen during the previous three years within the same group practice. In addition, revisions to the 2012 Current Procedural Terminology (CPT) E/M guidelines now allow a physician of the same group practice to report a new patient encounter if the physician is not of the same subspecialty as the physician who reported an initial encounter. To assist members in determining whether a new patient encounter may be reported in light of the new guidelines, the AAN has published a new position statement defining neurology subspecialties. Neurologists may refer payers to this position statement to support the validity of a reported new patient visit. The AAN also will proactively share the position statement with insurers. The Definition of Neurology Subspecialty Position Statement can be read in its entirety on the AAN website at www.aan.com/go/about/position. Start Building Your Ideal Annual Meeting Experience Online Registration Available This Month Beginning later this month, AAN members can start building their ideal 2013 AAN Annual Meeting experience by visiting www.aan.com/go/am13 to take advantage of early registration discounts, make housing arrangements, and completely customize their time in San Diego by selecting from a wide array of top education programs, breakthrough scientific research, and boundless networking opportunities and events. The 65 th AAN Annual Meeting will take place nearly one month earlier than past Annual Meetings—March 16 through 23—so mark your calendars and visit www.aan.com/go/am13 to secure a spot in your favorite programs and build the experience that best matches your interest, career stage, and schedule. AAN members also should watch their mailboxes in late October for delivery of the Annual Meeting Registration and Advance Program. The publication offers an in-depth look at the upcoming Education Program and other important information to help you plan your Annual Meeting experience. p 4 Introduce Your Research to the World of Neurology p 10 Review PQRS Measures for 2013, Plan to Avoid 2015 Penalty p 18 Grassroots Alliance Rises to Meet Advocacy Challenges Continued on page 6 AAN Helps Members Prepare for 2013 Coding Changes In order to accurately report the new 2013 Current Procedural Terminology (CPT) codes when they go into effect January 1, 2013, neurologists should be aware of several changes, including: the establishment of new codes for pediatric polysomnography, intraoperative neurophysiology monitoring, autonomic function tests, chemodenervation for chronic migraine, complex chronic care coordination services, transitional care management and a new coding structure for nerve conduction studies. Nerve Conduction Tests Nerve conduction study codes 95900, 95903, 95904, and H-reflex codes 95934 and 95936 have been deleted. Seven new nerve conduction codes (95907-95913) have been established. In the new coding structure, the unit of service in codes 95907- 95913 is the number of nerve conduction studies performed; whereas the unit of service in previous codes 95900-95904 was each nerve. For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with an F-wave or without an F-wave test, or an H-reflex test. Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use. “CMS is slowly shifting toward bundling of services and requested these changes in coding for nerve conduction testing,” said Neil A. Busis, MD, FAAN, chair of the AAN’s Medical Economics and Management Committee. “The AAN worked tirelessly throughout the process to ensure the best outcome possible for neurologists. The new codes for 2013 build on the 2012 EMG add-on codes that physicians began using this year.” Neil A. Busis, MD, FAAN
Transcript of Start Building Your Ideal Neurology Subspecialties for...
YOUR MONTHLY AAN MEMBERSHIP MAGAZINE VOLUME 25 ISSUE 10 OCTOBER 2012
AAN Statement Defines Neurology Subspecialties for Coding New Patient VisitsDetermining whether a patient is new or established can be tricky, particularly with regard to whether a patient has been seen during the previous three years within the same group practice. In addition, revisions to the 2012 Current Procedural Terminology (CPT) E/M guidelines now allow a physician of the same group practice to report a new patient encounter if the physician is not of the same subspecialty as the physician who reported an initial encounter.
To assist members in determining whether a new patient encounter may be reported in light of the new guidelines, the AAN has published a new position statement defining neurology subspecialties. Neurologists may refer payers to this position statement to support the validity of a reported new patient visit. The AAN also will proactively share the position statement with insurers.
The Definition of Neurology Subspecialty Position Statement can be read in its entirety on the AAN website at www.aan.com/go/about/position.
Start Building Your Ideal Annual Meeting ExperienceOnline Registration Available This MonthBeginning later this month, AAN members can start building their ideal 2013 AAN Annual Meeting experience by visiting www.aan.com/go/am13 to take advantage of early registration discounts, make housing arrangements, and completely customize their time in San Diego by selecting from a wide array of top education programs, breakthrough scientific research, and boundless networking opportunities and events.
The 65th AAN Annual Meeting will take place nearly one month earlier than past Annual Meetings—March 16 through 23—so mark your calendars and visit www.aan.com/go/am13 to secure a spot in your favorite programs and build the experience that best matches your interest, career stage, and schedule.
AAN members also should watch their mailboxes in late October for delivery of the Annual Meeting Registration and Advance Program. The publication offers an in-depth look at the upcoming Education Program and other important information to help you plan your Annual Meeting experience.
p 4 Introduce Your Research to the World of Neurology p 10 Review PQRS Measures for 2013,
Plan to Avoid 2015 Penalty p 18 Grassroots Alliance Rises to Meet Advocacy Challenges
Continued on page 6
AAN Helps Members Prepare for 2013 Coding ChangesIn order to accurately report the new 2013 Current Procedural Terminology (CPT) codes when they go into effect January 1, 2013, neurologists should be aware of several changes, including: the establishment of new codes for pediatric polysomnography, intraoperative neurophysiology monitoring, autonomic function tests, chemodenervation for chronic migraine, complex chronic care coordination services, transitional care management and a new coding structure for nerve conduction studies.
Nerve Conduction TestsNerve conduction study codes 95900, 95903, 95904, and H-reflex codes 95934 and 95936 have been deleted. Seven new nerve conduction codes (95907-95913) have been established. In the new coding structure, the unit of service in codes 95907-95913 is the number of nerve conduction studies performed; whereas the unit of service in previous codes 95900-95904 was each nerve. For the purposes of coding, a single conduction study is defined as a sensory conduction test, a motor conduction test with an F-wave or without an F-wave test,
or an H-reflex test. Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded. The numbers of these separate tests should be added to determine which code to use.
“CMS is slowly shifting toward bundling of services and requested these changes in coding for nerve conduction testing,” said Neil A. Busis, MD, FAAN, chair of the AAN’s Medical Economics and Management Committee. “The AAN worked tirelessly throughout the process to ensure the best outcome possible for neurologists. The new codes for 2013 build on the 2012 EMG add-on codes that physicians began using this year.”
Neil A. Busis, MD, FAAN
President’s Column
ANNUAL MEETING COMING ONE MONTH EARLY• Abstract Submission Deadline: October 15, 2012• Annual Meeting: March 16–23, 2013
tABle oF ContentsOFFICIAL PUBLICATION OF THE
AMERICAN ACADEMY OF NEUROLOGY
2 October 2012 • AANnews
Opioid Misuse Across the Country Reaches Epidemic ProportionsIncreasingly over the past decades, opioids have been prescribed for non-cancer chronic pain. Pain experts have become comfortable with prescribing substantial doses of medications for this population. However, the data supporting the efficacy of these interventions in terms of quality of life and long-term mitigation of symptoms is lacking. In certain conditions such as low back pain and headache, the use of long-term opioids is associated with worsening outcomes, greater pain, and disability. Chronic pain has become a focus of entrepreneurial activities for some. For example, the reimbursement for methadone clinics has resulted in an industry springing up.
There is evidence that the diversion of prescription medications, and in particular opioids, is occurring with disastrous results. Sales over the decade from 1999 to 2010 increased four-fold. The Centers for Disease Control and Prevention estimates that in 2008 there were more than 14,000 deaths related to prescription medications, mostly opioids.
The state I live in, Maine, has the highest rate of diversion of prescription medications in the country. However, no area is exempt. The vast majority of the abused medications are prescribed. At the state level, there is increasing pressure for prescribers to monitor and question the need for chronic opioids. There also is increasing interest in required prescriber education. Deaths, overdoses, and obvious diversion of prescription medications are widespread.
Federally, the Food and Drug Administration is addressing the epidemic by requiring manufacturers to establish a risk evaluation and mitigation strategy, referred to as REMS, for long-acting opioids. Manufacturers are required to develop educational materials that focus on the appropriate use of opioids, counseling the patient and the identification of misuse, dependency, and addiction.
In response to the CDC’s report on prescription painkiller overdose deaths, the AAN is addressing this problem by
collaborating with the American Pain Society on a NeuroPISM module on Chronic Opioid Therapy (COT), specifically for non-cancer pain. The measures address strategies neurologists should employ to mitigate opioid misuse for COT patients.
What does this mean for neurologists? Most prescribe few medications with abuse potential. Some, particularly those with an interest in chronic pain, prescribe opioids frequently. Whether an occasional or frequent prescriber, particularly for chronic medications, we need to adopt a proactive strategy to avoid diversion and abuse as much as possible. For example, every patient should be on a contract that permits random testing and pill counts. The frequency of refills must be carefully tracked. Those caring for the patient should coordinate who will be responsible for the refills. In the past I know that I personally have been manipulated into prescribing opioids. Hopefully, I am smarter now. An individual I cut off years ago died of an overdose about three months later from prescription medications prescribed by others. In addition to falls, medication mix-ups, and other safety concerns, abuse and diversion of narcotics must be a daily consideration.
Going forward, the federal government is likely to place more restrictions on prescribers and mandatory education is likely. Whether these bureaucratic steps have an impact or not, it is our responsibility to be alert to and act when concerned about misuse of opioids.
The Vision of the AAN is to be indispensable to our members.
The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.
Contact InformationAmerican Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415
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AANnews is published monthly by the American Academy of Neurology for its 25,000 members worldwide. Access this magazine and other AAN publications online at www.aan.com/go/elibrary.
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NEWS BRIEFSThe AAN submitted comments in response to the Society of General Internal Medicine Payment Reform Commission’s request for recommendations on how the Medicare payment system could be reformed to constrain health care costs while optimizing outcomes and increasing quality. The AAN recommended that the payment system should be reformed to recognize the importance of cognitive care services by shifting away from a procedure-centered reimbursement model to a patient-centered system. The Academy also recommended that new care coordination models should give incentives not only to primary care physicians, but also to neurologists and other cognitive specialists who provide the majority of E/M services for patients with complex chronic conditions.
Neurology® continues to be the most-cited journal in the field for the tenth consecutive year. The recently reported Impact Factor for Neurology increased from 8.017 to 8.312 in 2011. The Impact Factor is a measure of the frequency with which the “average article” in a journal has been cited in a given period of time. The Impact Factor is from Journal Citation Reports, a product of Thomson ISI (Institute for Scientific Information), which provides quantitative tools for evaluating journals.
COVER
AAN Helps Members Prepare for 2013 Coding Changes
AAN Statement Defines Neurology Subspecialties for Coding New Patient Visits
Start Building Your Ideal Annual Meeting Experience
PRESIDENT’S COLUMN
3 Opioid Misuse Across the Country Reaches Epidemic Proportions
ANNUAL MEETING
4 Introduce Your Research to the World of Neurology
5 Seeking Entries for Fourth Annual Neuro Film Festival
5 Join the Team, Submit Cases for Neurobowl Quiz Show at San Diego Meeting
FOCUS ON PRACTICE
6 AAN Helps Members Prepare for 2013 Coding Changes
6 Apply by November 2 for Viste Patient Advocate of the Year Award
8 Webinar Provides the Facts on Transition to ICD-10
8 Avoid Payer Hassles with Improved Payer Relations Toolkit
9 Guideline Examines Diagnostic Accuracy of CSF 14-3-3 Protein in Sporadic Creutzfeldt-Jakob Disease
9 Learn and Share EHR Experiences at Fall Conference User Group Meetings
10 Review PQRS Measures for 2013, Plan to Avoid 2015 Penalty
10 Comedian Josh Blue Shares His Positive Approach to Living with Cerebral Palsy in Latest Neurology Now
10 Deadline Is December 31 to Avoid 2014 eRx Penalty
EDUCATION
12 On-site Registration Available for 2012 Fall Conference in Las Vegas
12 December 1 Is Registration Deadline for 2013 RITE
14 Tame Dizziness, Other Neuro-otologic Symptoms with Continuum
14 Neuro-oncology Certification Exam Applications Available; Practice Track Expiring
ADVOCACY IN ACTION
16 Academy Encourages Members to Attend State Society Meetings
17 Elections Highlight BrainPAC’s Critical Role for Neurologists
18 Grassroots Alliance Rises to Meet Advocacy Challenges
MEMBERSHIP
18 In Memoriam: Dewey K. Ziegler, MD, FAAN
AMERICAN BRAIN FOUNDATION
20 Foundation Friends
24 | NEUROLOGY CAREER CENTER
27 | DATES AND DEADLINESBruce Sigsbee, MD, FAANPresident, AAN
AnnuAl meeting
AANnews • October 2012 54 October 2012 • AANnews
Introduce Your Research to the World of Neurology Submit Your 2013 Annual Meeting Abstracts by Earlier October 15 DeadlineThe deadline to submit abstracts in key topic areas to round out scientific programming at the 2013 Annual Meeting is earlier this year: October 15, 2012. In addition to abstracts in a wide variety of neuroscience topics, specific abstracts are sought for the following high-profile sessions.
NEW TOPICS for 2013 Abstract Submission•Global Health•Sports Neurology
Integrated Neuroscience Sessions These half-day sessions provide in-depth subspecialty concentration around a topic using a combination of presentations such as invited lectures, data blitz sessions, poster rounds, and discussions.
•Acute Stroke•Advances in the Biology and
Therapy of Gliomas•Alzheimer’s Biomarkers in
Clinical Practice •Assessing Neurological Disease via
the Visual and Ocular Motor Systems•Brain Stimulation: Clinical and
Neuroscience Implications •Global Impact of Non-communicable
Neurological Diseases• Inflammation in Epilepsy •New Insights into Molecular
Mechanisms in Parkinson’s Disease •Pediatric Neuromuscular Diseases•Sports Neurology•Toward a Dimorphic Neurology:
Implications for Men’s and Women’s Health
Subspecialty in FocusThe Subspecialty in Focus Program is a special, one-day intensive program designed for subspecialists, combining a half-day education course with an Integrated Neuroscience Session.
•Geriatric Neurology Corresponding Integrated Neuroscience Topic: Alzheimer’s Biomarkers in Clinical Practice
•Behavioral Neurology/Neurorehabilitation Corresponding Integrated Neuroscience Topic: Brain Stimulation: Clinical and Neuroscience Implications
•Child Neurology Corresponding Integrated Neuroscience Topic: Pediatric Neuromuscular Diseases
•Epilepsy Corresponding Integrated Neuroscience Topic: Inflammation in Epilepsy
•Movement Disorders Corresponding Integrated Neuroscience Topic: New Insights into Molecular Mechanisms in Parkinson’s Disease
•Neuro-ophthalmology/ Neuro-otology Corresponding Integrated Neuroscience Topic: Assessing Neurological Disease via the Visual and Ocular Motor Systems
Submitters should complete the online form at www.aan.com/go/am13 for their work to be considered. For more information, contact Erin Jackson at [email protected] or (612) 928-6112.
2013 AAN Awards Applications Deadlines Approaching The deadlines to apply for the 2013 AAN Awards are quickly approaching. The deadline for all Scientific Awards is October 15, 2012, and the deadline for other awards and fellowships varies. Visit www.aan.com/go/science/awards to view all award descriptions, application criteria, and deadlines.
Minority Scholars and Medical Student Scholarship Applications Due October 15The American Brain Foundation Minority Scholars Program encourages diversity in the field of neurology by providing minority medical school students the opportunity to attend the 2013 AAN Annual Meeting to augment their education, training, and networking. Minority medical school students are encouraged to visit www.aan.com/view/minorityscholars to apply for the program by the October 15, 2012, deadline.
Medical student scholarships are sponsored through a partnership with the AAN and the Association of University Professors of Neurology (AUPN), and provide approximately 40 $1,000 scholarships to US and Canadian medical students to attend the 2013 AAN Annual Meeting. Applicants must be members of the AAN (medical students can join the Academy free of cost and their Annual Meeting registration is waived) and also be active members of a SIGN chapter. For more information and to apply by the October 15 deadline, visit www.aan.com/view/scholarship.
Seeking Entries for Fourth Annual Neuro Film Festival The American Brain Foundation, the foundation of the AAN, is once again hosting its annual Neuro Film Festival® competition, which will be the feature event of the new Closing Party on Friday, March 22, at the 2013 AAN Annual Meeting in San Diego. AAN members, patients, their families, and the public are encouraged to enter a five-minute video telling their story about being affected by a neurologic disease and why more research is needed to find cures for brain disorders.
The deadline to submit a film is January 31, 2013. Each video entry must include the phrase “Let’s put our brains together to cure brain disease” and be uploaded to YouTube as a reply to the official Call for Entries video, found on the festival’s website at www.NeuroFilmFestival.com.
Three winners will be selected, including one Grand Prize winner who will receive up to $1,000 and a chance to attend the Neuro Film Festival in San Diego on Friday, March 22, 2013. A runner-up also will be designated by the Neuro Film Festival jury, as well as a Fan Favorite which will be voted on by the public. The runner-up recipient also receives $500 and a trip to San Diego.
Help us make a case for why more research is needed to find cures—visit www.NeuroFilmFestival.com today for complete contest details and to submit your video. For more information, contact Andrew Halverson at [email protected] or (612) 928-6117.
Join the Team, Submit Cases for Neurobowl Quiz Show at San Diego MeetingCan you rattle off answers to questions on rare and not so rare neurologic cases? Can you make quick diagnoses based on a short video clip or movie segment? If so, you should put your name in the hat to join a team for Neurobowl®, the popular quiz show at the Annual Meeting.
Challenging or unusual cases that may stump the experts or make a teaching point are also needed for the quiz show.
“We’re looking for some fast-thinking diagnosticians who can give these veteran teams a run for their money, along with tricky cases to keep them all on their toes,” said Neurobowl host and former AAN president Thomas R. Swift, MD, FAAN.
Team members plus alternates will be selected to play at the San Diego Annual Meeting. Team candidates should be available from 5:00 p.m. to 8:30 p.m. on Sunday, March 17. Players will receive a $200 honorarium.
To receive an application or submit a case for consideration, email Wendy Vokaty at [email protected]. Applications and cases are due December 1, 2012.
Introduce Your Research
to the World of Neurology
Submit your abstracts for the 2013 AAN Annual Meeting.
www.call4abstracts.
com/aan
S a n D i e g o C o n v e n t i o n C e n t e r
M a r c h 1 6 – 2 3 , 2 0 1 3
Deadline to submit: October 15, 2012
Judge Kapil D. Sethi, MD, FRCP, (left) and the victorious Krewe of Athena (above).
Cynthia L. Comella, MD, FAAN, with Grand Prize winner Zach Jankovic (above) and runner up Patrick Moeschen (below).
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AAN Practice Management WebinarsHelp for Your Practice, CME for Your CareerThe AAN’s Practice Management Webinars provide real value to you and your practice at a price you can afford. Attend live or enjoy convenient on-demand recorded sessions available after each webinar.
October 16 ICD-10: Are You Prepared?
November 6 Coding Accurately for Stroke and Critical Care
See the full 2012 schedule and register today at www.aan.com/view/pmweb12.
6 October 2012 • AANnews
�(95900, 95903, 95904 have been deleted. For nerve conduction studies, see 95907-95913)�
● 95907 1-2 nerve conduction studies● 95908 3-4 nerve conduction studies● 95909 5-6 nerve conduction studies● 95910 7-8 nerve conduction studies● 95911 9-10 nerve conduction studies● 95912 11-12 nerve conduction studies● 95913 13 or more nerve conduction studies
Pediatric PolysomnographyTwo new codes (95782, 95783) have been created to report pediatric polysomnography for children younger than 6 years of age. These patients are typically monitored for a longer period of time than adults (on average 9 hours) and typically require a 1:1 technologist to patient ratio. Pediatric studies tend to be more complex to review due to longer recordings and more data.95808 Polysomnography; any age, sleep staging with 1-3
additional parameters of sleep, attended by a technologist95810 age 6 years or older, sleep staging with 4 or more
additional parameters of sleep, attended by a technologist
95811 age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
● 95782 younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
● 95783 younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
Intraoperative NeurophysiologyCode +95920 has been deleted. Two new codes (+95940 and +95941) for neurophysiology monitoring either inside or outside the operating room.
New code 95940 is reported per 15 minutes of service and requires reporting only the portion of time the monitoring professional was physically present in the operating room providing one-on-one patient monitoring, and no other cases may be monitored at the same time.
+● 95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
�(Use 95940 in conjunction with the study performed, 92585, 95822, 95860-95870, 95907-95913, 95925-95939)�
New code 95941 is reported for all cases in which there was no physical presence by the monitoring professional in the operating room during the monitoring time or when monitoring more than one case while in an operating room.
+● 95941 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure)
�(Use 95941 in conjunction with the study performed, 92585, 95822, 95860-95870, 95907-95913, 95925-95939)�
Autonomic Function TestsA new code (95924) has been created to report when both parasympathetic (92921) and adrenergic function (92922) types of autonomic testing are performed together. It includes the use of a tilt table.
Code 95943 has been established to report when an autonomic function testing does not include beat-to-beat recording, or for testing without the use of a tilt table. This is a simpler, automated procedure compared to the other autonomic codes.
● 95924 combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt
�(Do not report 95924 in conjunction with 95921 or 95922)�
● 95943 Simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, paced (deep) breathing, Valsalva maneuvers, and head-up postural change
�(Do not report 95943 in conjunction with 93040, 95921, 95922, 95924)�
Chemodenervation for Chronic MigraineEffective January 1, 2013, physicians will be able to report new code 64615 when performing chemodenervation to treat chronic migraine.
● 64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)
Evaluation and ManagementThree new codes have been created for complex chronic care coordination. Codes 99487-99489 are reported only once per calendar month and include all non-face-to-face complex chronic care coordination services and none or 1 face-to-face
office or other outpatient, home, or domiciliary evaluation and management (E/M) visit related to care for the patient’s chronic condition(s).
● 99487 Complex chronic care coordination services; first hour of clinical staff time directed by a physician or other qualified health care professional with no face-to-face visit, per calendar month
● 99488 first hour of clinical staff time directed by a physician or other qualified health care professional with one face-to-face visit, per calendar month
+● 99489 each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month
�(List separately in addition to code for primary procedure)�
Two transition care management service codes have been created to report services for an established patient whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care.
● 99495 Transitional Care Management Services with the following required elements:
•Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
•Medical decision making of at least moderate complexity during the service period
•Face-to-face visit, within 14 calendar days of discharge
● 99496 Transitional Care Management Services with the following required elements•Communication (direct contact, telephone,
electronic) with the patient and/or caregiver within 2 business days of discharge
•Medical decision making of high complexity during the service period
•Face-to-face visit, within 7 calendar days of discharge
For more information, contact Luana Ciccarelli at [email protected].
CPT Process Manual AvailableThe AAN plays an active role in the CPT process with physicians and staff representing the Academy three times a year at each CPT Editorial Meeting. To help better explain the AMA CPT process and the AAN’s involvement to members, the Academy has published a CPT Process Manual. The AMA has asked that all specialty societies make such a document available to their members. The AAN document covers the process from start to finish, and explains the AMA’s criteria for considering a new CPT code request, as well as the AAN’s criteria for considering support for such a request from its members. It can be found at www.aan.com/view/CPTprocess.
AAN Helps Members Prepare for 2013 Coding ChangesContinued from cover
Apply by November 2 for Viste Patient Advocate of the Year AwardApply or nominate a colleague by November 2 for the 2013 Kenneth M. Viste, Jr., MD, Patient Advocate of the Year Award. This prestigious award recognizes one neurologist per year who exemplifies Viste’s leadership and commitment to advocating for the patient community, along with individualized recognition at the upcoming AAN Annual Meeting. To learn more about this award and apply, visit www.aan.com/visteaward2013.
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8 October 2012 • AANnews
Webinar Provides the Facts on Transition to ICD-10Even though ICD-10 has been used by many countries in the World Health Organization since 1994, it has not yet been adopted in the United States. That is expected to change on October 1, 2014, as compliance will become mandatory for US providers, payers, and vendors.
To help neurologists begin to understand and prepare for the arrival of ICD-10, the AAN urges doctors and practice managers to attend “ICD-10: Are You Prepared?,” an AAN Practice Management Webinar offered online on Tuesday, October 16, at 12:00 p.m. ET. Registration is online only at www.aan.com/view/pmw12, and the deadline to register is Monday, October 15.
“The delay in the required switch to ICD-10 gives us a chance to more fully prepare for the transition,” said presenter Jeffrey R. Buchhalter, MD, FAAN, a member of the AAN Coding Subcommittee. “As the neurologist is ultimately responsible for the correct code, we should understand the new system and the required documentation.”
The program begins with 60 minutes of lecture followed by 30 minutes of questions and answers. Recordings will be available free of charge following the webinar for all who register for the live event. Slides will also be available for all participants. Upon completion, participants should be able to:
•Understand the differences between ICD-9-CM and ICD-10-CM
•Be aware of the mechanics of the ICD-10-CM system and its updates
•Evaluate your preparation for ICD-10-CM implementation and if you are on track
•Create a training plan for the October 1, 2014, implementation date
This is the ninth of 10 practice management webinars scheduled for 2012. The discounted cost for members to participate in the webinars is $149 for the first and $50 for each additional webinar—a special 25-percent savings from the pricing for nonmembers. Recordings of the webinars will be provided free of charge for all live webinar participants. Slides are included with all webinar purchases.
For more information, visit www.aan.com/view/pmw12 or contact Christi Kokaisel at [email protected].
Upcoming Practice Webinars•Tuesday, October 16 ICD-10: Are You Prepared?•Tuesday, November 6 Coding Accurately for Stroke
and Critical Care
Avoid Payer Hassles with Improved Payer Relations Toolkit Creating positive relationships with third party payers is a smart way to help grease the wheels before payment problems arise. To help AAN members build and nurture these relationships—and take the right steps when coverage or payment does become an issue—the Academy is providing an updated and improved Payer Relations Toolkit.
“We encourage AAN members to look to the toolkit as a great resource when they have problems with payers,” said Joel M. Kaufman, MD, FAAN, a member of the AAN Medical Economics and Management Committee. “The AAN also has added tools that can help neurologists work toward patient-centered health care solutions with payers.”
The Payer Relations Toolkit contains helpful insider advice on developing relationships and submitting claims. Template letters include an introduction to payers with whom the neurologist currently does not have relationships and an appeal to insurers when claims are disputed. The toolkit also provides tips on how to avoid an audit, or survive one if audited, and a Payer Feedback Form that members can submit to the AAN so the Academy can gauge if a particular problem or insurer issue is happening more broadly across the country.
“The Payer Feedback Form is a way the AAN can evaluate whether it needs to step in and engage the insurer about a widespread issue,” said Kaufman.
The Payer Relations Toolkit is a free member benefit available online at www.aan.com/go/practice/insurertoolkit. For more information, contact Christi Kokaisel at [email protected].
Jeffrey R. Buchhalter, MD, FAAN
Joel M. Kaufman, MD, FAAN
FoCus on PrACtiCe
AANnews • October 2012 1110 October 2012 • AANnews
Deadline Is December 31 to Avoid 2014 eRx PenaltyThe reporting period to avoid the 2014 eRx 2.0-percent payment reduction is January 1, 2012, through December 31, 2012. For successful reporting under the 2012 eRx Incentive Program—and to avoid the 2.0-percent penalty in 2014—neurologists must generate at least one e-prescription associated with a patient visit on 25 or more unique events during this year’s reporting period using the G-code G8553 (for alternate reporting options, visit www.aan.com/go/practice/pay/erx).
Those who successfully meet the requirements can earn a 1-percent incentive bonus for successfully reporting in 2012 plus avoid the 2.0-percent penalty in 2014 to the physician fee schedule amount for covered professional services furnished by the eligible neurologist who is not a successful e-prescriber. A neurologist who successfully e-prescribes in the 2012 eRx Incentive Program will be considered exempt from the 2014 payment adjustment.
For more information about the eRx Incentive Program and Academy resources to help members implement the program, visit www.aan.com/go/practice/pay/eRx, or contact Christi Kokaisel at [email protected].
Review PQRS Measures for 2013, Plan to Avoid 2015 PenaltyMembers should review the list of measures for 2013 in the final rule from the Centers for Medicare & Medicaid Services that will be published by the end of October. Each year, there are revisions to measures and new measures are added. Members are encouraged to develop a plan on how to participate in 2013 and avoid the penalty for 2015.
Still Time to Earn Incentive for 2012Neurologists who participate in the PQRS program in 2012 could receive a bonus of as much as $1,000.
Members choosing to report on PQRS measures using the registry reporting option should review the reporting criteria required in order to be eligible for the 2012 incentive payment. There
are two options available to participants: reporting on 80 percent of all eligible patients seen January 1, 2012, to December 31, 2012; or reporting on one or more measure groups for 30 unique patients.
To learn more about PQRS, visit www.aan.com/go/practice/pay/pqrs.
Register by October 15 for $100 Discount on PQRIwizardThe AAN is providing members with an introductory rate that will save them $100 to access PQRIwizard, a new tool to report PQRS measures.
PQRIwizard is an online registry that enables members to report on PQRS measures that currently are reportable only through a registry. Measures related
to neurology include Parkinson’s disease, dementia, and sleep apnea. PQRIwizard is produced by CECity and is a qualified registry for the PQRS under the Centers for Medicare & Medicaid Services program.
AAN members who sign up by October 15, 2012, will be eligible for a $100 discount on use of the PQRIwizard, which normally costs $299 to create an account. Through the PQRIwizard, participating AAN members can quickly and easily enter their data, validate, report, and submit their results on PQRS measures to CMS.
Visit pqriwizard.com for more information, or contact Gina Gjorvad at [email protected] or (612) 928-6123.
Comedian Josh Blue Shares His Positive Approach to Living with Cerebral Palsy in Latest Neurology NowIn an interview for the October/November issue of Neurology Now ®, comedian Josh Blue shares his positive—and inspiring—approach to living with cerebral palsy.
In the article, the 2006 winner of NBC’s Last Comic Standing shares his experience of being born in Cameroon, West Africa, and at two days old being medically evacuated to the United States after experiencing complications during childbirth. A year later, he was diagnosed with cerebral palsy.
Blue, who is married with two children, also discusses his positive approach to his condition and how that translates to his hands-on approach to advocacy. “I don’t think I’d know I had cerebral palsy if other people didn’t tell me,” Blue tells Neurology Now. “That’s my viewpoint; I just tackle the world,
whatever comes at me. This is just how I’ve grown up and how I live.” Adds Blue, “I think there’s a lot more to doing something as opposed to just talking about it…. I can tell you all about the triumphs that I had or I can have more triumphs.”
Blue’s story also will be available via podcast for the web and iPad®.
For more information about Neurology Now, the AAN’s free bi-monthly magazine for neurology patients, their families, and caregivers, visit www.neurologynow.org. AAN members may receive up to 30 free copies of each issue to distribute to patients. To adjust the number of copies of Neurology Now received in your office, contact AAN Member Services at (800) 879-1960, or update your member profile at www.aan.com/view/profile.
Learn and Share EHR Experiences at Fall Conference User Group Meetings To provide education and networking opportunities for neurologists who use the same electronic health records (EHR) software, the AAN is holding two EHR User Group meetings during the Fall Conference at the Encore at Wynn Hotel in Las Vegas. The meetings will be led by AAN experts who have experience with EHR systems.
“For the 2012 Fall Conference, we will be focusing on two EHR systems that are widely used by our membership, and plan on expanding vendor options for EHR User Groups at the 2013 Annual Meeting in San Diego,” said Allison Weathers, MD, member of the AAN Practice Management & Technology Subcommittee. “Attendees of the user group meetings can learn how other neurologists who use the same EHR have optimized their system to provide the best care for their patients. They can discuss the challenges of their EHR system with fellow users, and discover practices and tips about that specific EHR to take back to their office or institution. The event also gives the Academy the opportunity to gather feedback from neurologists to pass on to the EHR vendors.”
Saturday, October 27, 6:30 a.m.–7:30 a.m.
•eClinicalWorks EHR User Group Meeting, Mozart Room •Epic EHR User Group Meeting, Chopin 2 Room
The user group meetings are free with registration for the Fall Conference. No advance registration for the meetings is required, but RSVPs are requested. For more information or to RSVP, contact Christi Kokaisel at [email protected].
Guideline Examines Diagnostic Accuracy of CSF 14-3-3 Protein in Sporadic Creutzfeldt-Jakob DiseaseIn people with rapidly progressing dementia, testing for the 14-3-3 protein in spinal fluid may aid in the diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD), a rare and always fatal brain disorder that involves quickly progressing dementia. This is the primary finding in “Diagnostic Accuracy of CSF 14-3-3 Protein in Sporadic Creutzfeldt-Jakob Disease,” a new guideline from the AAN that was published electronically ahead of print on September 19, 2012, and appears in the October 2, 2012, print edition of Neurology ®.
The test may help when used in cases where doctors suspect sCJD may be present. However, the test lacks the accuracy either to make an sCJD diagnosis with certainty or to rule out the disease completely.
“The 14-3-3 protein assay can be useful in specific instances, namely, when patients present with rapidly progressing dementia suspected to be caused by sCJD but for which diagnosis is uncertain,” said Taim Muayqil, MBBS, FRCPC, lead author of the guideline. “Our analysis found that a pretest probability of about 20 percent to 90 percent for diagnostic accuracy should cue the physician that testing may be helpful.”
The guideline states that the usefulness of the 14-3-3 test will largely depend on a clinician’s judgment of the pretest probability of sCJD for a given patient. Such judgments will reasonably consider the rarity of sCJD (incidence 1 per million per year), the patient’s clinical presentation, and the results of already obtained ancillary tests such as brain MRI. However, how the test should be used in conjunction with EEG and MRI findings suggestive of sCJD needs further investigation.
The authors also contend that only physicians experienced in dementia diagnosis should determine whether the 14-3-3 protein test is needed and how results should be understood. As with any diagnostic instrument, having a solid understanding of statistical concepts is key to interpretation of test results. Indeed, for circumstances wherein the physician thinks the likelihood of sCJD is extremely low or extremely high, testing for 14-3-3 would not be useful regardless of the result. Further, the test results will not importantly change the probability of sCJD in patients who are unlikely to have sCJD to begin with. “Analyzing test results and understanding them in the context in which they are applied are key to making an accurate sCJD diagnosis,” said Muayqil. “A positive 14-3-3 assay result in patients who are unlikely to have sCJD should not distract the investigator from considering a different dementing illness, or, more important, a reversible cause of dementia.”
Muayqil added, “when analyzing 14-3-3 test results, it is important to remember that there is significant variation in the way the 14-3-3 protein assays are performed.”
To read the guideline and access clinician and patient summaries, a slide presentation, and a clinical example, visit www.aan.com/go/practice/guidelines. For more information, contact Julie Cox at [email protected] or (612) 928-6069.
Allison Weathers, MD
Taim Muayqil, MBBS, FRCPC
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12 October 2012 • AANnews
On-site Registration Available for 2012 Fall Conference in Las VegasEarly online registration may have passed, but you still can register onsite for the 2012 Fall Conference set for October 26 through 28 at the Encore at Wynn Las Vegas. This popular three-day program is a convenient way to access top clinical and practice management education—and earn up to 17.5 AMA PRA Category 1 credits™ before the end of the year.
Registering for one of these two program tracks saves you an additional 10 percent:
Those looking to enhance their clinical knowledge should consider the Neurology Update track:•Neurology Update I
- Headache - Neuro-ophthalmology - Movement Disorders
•Neurology Update II - Neuro-oncology - Epilepsy - Neuromuscular Disease
•Neurology Update III - Dementia
- Neurologic Complications of Medical Disease
- Demyelinating Disease•Stroke Update•Continuum® Test Your Knowledge: A
Multiple-Choice Question Review
Practitioners looking to focus on coding, reimbursement, incentive programs and other essentials to running a practice in today’s evolving health care environment will want to register for the Practice Management track:•Practice Management 101:
Coding and Billing Today—A Case-based Approach
•Practice Management 201: How to Succeed in an Environment in Transition
•Practice Management 301: Change Management and the Future Practice of Neurology
Additional ProgramsThose looking to discover the latest treatment techniques for dystonia and spasticity will want to register for the
Dystonia Skills Workshop.
A new physician-led advocacy program has been added to assist those in search of the skills to act as leaders in advocating for changes that benefit their patients and the profession.
For additional information, visit www.aan.com/go/education/conferences/fall2012, or contact Kevin Heinz at [email protected] or (612) 928-6098.
The 2012 AAN Fall Conference is an ABPN-approved program for maintenance of certification that is geared toward practitioners, academicians, residents, fellows, practice managers, and office administrators.
December 1 Is Registration Deadline for 2013 RITEThe deadline to register for the AAN’s 2013 RITE® is December 1, 2012. The test is scheduled for February 28, March 1, 2, or 3, 2013, as determined by the neurology residency program test sites in your area. On-site registration will not be available, so contact your neurology program director today.
The fee to sit for the examination is $155 for AAN resident members—a savings of more than 50 percent from the nonmember fee of $365. To take advantage of this reduced rate, you must first submit your membership application and dues for the 2013 membership year to the AAN on or before December 1, 2012.
Program Directors will receive an email the first week of October providing registration instructions for their residents. For more information, visit www.aan.com/go/education/residents/rite or contact Lori Strachota at [email protected] or (612) 928-6029 or Mary Cress at [email protected] or (612) 928-6004.
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ANN NEWS
Tame Dizziness, Other Neuro-otologic Symptoms with ContinuumDizziness is the quintessential symptom presentation in all of medicine, according to Kevin A. Kerber, MD, MS, guest editor of the October Continuum: Lifelong Learning in Neurology ® on Neuro-otology.
“The effective management hinges on obtaining an informed history and bedside examination, not on laboratory or imaging studies,” Kerber said. “In this issue, an international panel of experts has written articles to equip readers with the knowledge to manage the most common types of dizziness presentations.”
Two articles in the issue, discussing acute constant dizziness and positional dizziness, have video content that can be viewed online or in the Continuum® iPad® app available to subscribers. In addition to these articles, the issue also covers the history and future of neuro-otology, symptoms and signs of neuro-otologic disorders, recurrent spontaneous attacks of dizziness, migraine and motion sensitivity, chronic subjective dizziness, and less common neuro-otologic disorders. The ethics case discusses disequilibrium in an airline pilot. A practice article on the importance of communication in improving outcomes in anxiety in a dizzy patient and an article on coding for vestibular tests will be included, along with a Guidelines in Practice article on therapies for benign paroxysmal positional vertigo. The issue offers participants the opportunity to earn up to 12 hours of AMA PRA Category 1 Credits™.
Upon completion of the issue, participants will be able to:•Describe an approach to the evaluation and management
of patients who present with dizziness
•Explain how to diagnose and treat benign paroxysmal positional vertigo
•Differentiate stroke from nonstroke in patients presenting with acute dizziness
•Recognize unusual causes of dizziness and when these causes should be considered
•Summarize the current evidence for the diagnosis and management of vestibular migraine
Continuum is the AAN’s highly regarded and convenient review journal. With a total of 72 CME credits available annually, Continuum is published six times per year and includes a multiple-choice self-assessment examination and a patient management problem. Subscribers access CME online by visiting www.aan.com/continuum/cme, where they may complete the CME activities and receive CME credits within two business days. Subscribe to Continuum today by contacting Lippincott Williams & Wilkins at (800) 361-0633, (301) 223-2300 (international), or www.lww.com/aancontinuumsub. Junior members who are transitioning to Active or Associate memberships are eligible to receive a 50-percent discount on Continuum subscriptions.
Neuro-oncology Certification Exam Applications Available; Practice Track ExpiringApplications are available for the United Council for Neurologic Subspecialties certification examination in neuro-oncology. The deadline to apply is January 15, 2013.
The practice track pathway for certification will expire after the 2013 application cycle. After the 2013 examination, only those physicians who have completed a UCNS-accredited fellowship program will be eligible to apply for certification in neuro-oncology.
For more information, visit www.ucns.org.
Kevin Kerber, MD, MS
AdvoCACy in ACtion
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16 October 2012 • AANnews
Academy Encourages Members to Attend State Society MeetingsThe AAN continues to collaborate with and support state neurological societies, and encourages members to attend their state meetings to work on local issues of concern and share insights on improving their practices and patient care. With the focus on health care reform over the past several years, many state societies have seen greater activity among concerned neurologists. The California Neurology Society (CNS) is a case in point.
“During these critical and rapidly changing times in health care delivery, the role of state specialty societies could never be greater,” said Steven J. Holtz, MD, FAAN, president of the society. “The number of dollars available to pay for health care is steadily decreasing while rapidly developing technology and sophistication of physician skills for treating patients and improving their lives has increased exponentially in the last two decades. The recent Supreme Court ruling affirming the Affordable Care Act solidifies its provisions for state by state health insurance exchanges. We must strongly advocate to make sure that adequate funds are available for the needs of our highly specialized group of patients, many of whom depend solely on neurologists for primary care.”
The CNS has undergone an impressive transformation in the last two years, according to Holtz. “We have attempted to provide value to our state’s neurologists by utilizing focused committees on such important topics as proposed health care legislation relevant to neurologists and their patients, workers compensation, and mandatory reporting.”
More neurologist involvement in the society has been seen at annual meetings as well. “Last spring, we drew a significant attendance to our annual meeting in Anaheim featuring speakers discussing the novel but relevant issues of neuro-terrorism and neuro-disaster management. This fall, we will be having another
educational meeting in San Diego where more traditional subjects such as neuro-rheumatology, autoimmune neuropathy, neuromuscular disease, multiple sclerosis, Parkinson disease, restless leg syndrome, hyperkinetic movement disorders, neuro-radiology, and pediatric/adult epilepsy will be presented.
Fellows, residents, and medical students are invited free of charge to the CNS annual meeting, which is being held October 5 to 7. “It is essential to involve young neurologists in the state advocacy process as they will be most affected by health care delivery’s dynamic changes,” said Holtz. “It is imperative that these young neurologists understand that good patient care does not just involve the tapping of a reflex and eliciting a plantar response. Patient care is all encompassing and increasingly dependent on individual state’s ability to guarantee that care.”
Many state meetings in 2012 will have participation from members of the Academy’s advocacy staff, who often make presentations, answer questions about how the organization is addressing health care policy issues, and assist the state groups. This fall, AAN staff will be on hand at meetings in California, Indiana, Massachusetts, Minnesota, New York, Washington, and Wisconsin.
Now is the perfect time to get involved with your local neurosociety. For more information, visit www.aan.com/go/advocacy/states or contact Dave Showers at [email protected].
South Carolina Neurological Association October 5–6 Grove Park Inn, Asheville, NC
California Neurology Society October 5–7 Coronado Island Marriott, San Diego acn.aan.com
Washington State Neurological Society October 13 Hyatt Regency Bellevue, Bellevue www.washingtonneurology.org
New York State Neurological Society October 20 Hospital for Special Surgery, New York nysns.aan.com
Hawaii Neurological Society October 23 John A. Burns School of Medicine, Honolulu hns.aan.com
Wisconsin Neurological Society October 26–28 Kalahari Resort, Wisconsin Dells www.wineurolsoc.com
Massachusetts Neurologic Association November 1 MMS Headquarters, Waltham mna.aan.com
Minnesota Society of Neurological Sciences November 3 AAN Headquarters, Minneapolis msns.aan.com
Indiana Neurological Society November 9 Neuroscience Center of Excellence, Indianapolis ina.aan.com
Steven J. Holtz, MD, FAAN
AdvoCACy in ACtion
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18 October 2012 • AANnews
Grassroots Alliance Rises to Meet Advocacy ChallengesThe AAN is seeking members in 10 pilot states to participate in the new AAN Grassroots Alliance. The program aims to help neurologists take a stronger role in the advocacy process by developing and nurturing relationships with their local and national lawmakers to help them understand key neurology issues and how legislation affects patients and constituents.
The Grassroots Alliance is launching in Arizona, Colorado, Georgia, Illinois, Michigan, Minnesota, North Carolina, Ohio, Pennsylvania, and Wisconsin.
“The most important voices elected officials can hear are those of their constituents,” said Pushpa Narayanaswami, MD, FAAN, chair of the Member Relations Work Group of the AAN Government Relations Committee. “By building positive and respectful relationships with policy makers and their staff through the Alliance, we ensure they understand issues affecting our patients, work toward moving the AAN’s legislative goals forward, and halt any bills that do not reflect the AAN’s mission, which is to promote the highest quality patient-centered neurologic care.”
Alliance participants in each participating state will be asked to do one or more of the following:
•Submit letters-to-the-editor to their paper•Speak to neurology’s issues with
legislators and in front of committees•Speak to neurology’s issues at state
neurosociety meetings or state medical associations
•Connect with elected officials through social media
•Host a site visit at their practice•Attend a local fundraiser on behalf
of BrainPAC•Represent the AAN in front of
policymakers at the state capitol
For more information, visit www.aan.com/view/alliance or contact Dave Showers at [email protected].
In Memoriam: Dewey K. Ziegler, MD, FAANDewey K. Ziegler, MD, FAAN, who served as AAN president from 1979 to 1981, passed away on September 13, 2012, at his home in Prairie Village, KS. He was 92.
Ziegler’s tenure as AAN president was marked by significant changes to the education activities of the Academy, as he appointed Theodore Munsat, MD, FAAN, to lead the Special Course Committee and modernize offerings for the Annual Meeting and other CME opportunities.
Former AAN President Thomas R. Swift, MD, FAAN, recalled Ziegler as “a great man and a true gentleman. We could use more like him and he will be sorely missed.”
Ziegler was born in Omaha, NE. After receiving both his BA and MD from Harvard University, Ziegler did a three-month internship with Derek Denny-Brown at Boston City Hospital. The experience helped focus his interest on the brain. However, he was drafted and assigned to Navy hospitals in Bethesda, MD, and San Diego, CA. Because of a shortage of psychiatrists, he was assigned to that duty. After his discharge in 1948, be began two years of training with H. Houston Merritt at the New York Neurological Institute. He then did two years of psychiatry training at what is now Boston Mental Health Center. By the conclusion of this training, Ziegler opted for a career in neurology, and joined the faculty at Montefiore Hospital in New York.
In the mid-1950s, Ziegler was recruited by AAN founder A.B. Baker to become assistant professor at the University of Minnesota. But in time Ziegler decided to leave academia and set up private practice in Kansas City, KS. He took a part-time appointment at the University of Kansas Medical Center in 1958. In 1966, he left private practice to work full time at the University of Kansas as chief of the neurology section until 1974, when he was named chair of the of neurology department. He served in that capacity until 1985.
Ziegler had an international reputation as an expert in migraine and other causes of headache. As professor emeritus, he continued his research and did teaching rounds with residents. Ziegler served on the editorial boards of Headache and Cephalalgia. Along with his leadership of the AAN, he also served as second vice-president, secretary, and member of the board of directors for the American Neurological Association.
Pushpa Narayanaswami, MD, FAAN
Dewey K. Ziegler, MD, FAAN
AAN GRASSROOTS ALLIANCE
AmeriCAn BrAin FoundAtionAPPROVED FOR
RRMSSINCE 19961
Demonstrated ef� cacy and safety
In patients with CIS and RRMS
· Effective in CIS1,2
· Reduced relapse rates1,3,4
· Reduced MRI lesions1,2,5
Indication• COPAXONE® (glatiramer acetate injection) is indicated for reduction of relapses in patients with relapsing-remitting multiple sclerosis,
including patients who have experienced a fi rst clinical episode and have MRI features consistent with multiple sclerosis
Important safety information about COPAXONE®
• Most common adverse effects were injection site reactions (including lipoatrophy and, rarely, skin necrosis), vasodilatation, rash, dyspnea, and chest pain. Patients should be advised to follow proper injection technique and to rotate injection sites daily
• About 16% of patients experienced an immediate postinjection reaction (fl ushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, and urticaria). The symptoms were transient and self-limited, and did not require specifi c treatment
• Transient chest pain was noted in 13% of COPAXONE® patients (vs 6% placebo); no long-term sequelae
Maria Z., on COPAXONE® for RRMS
Mike W., on COPAXONE® for RRMS
CIS=clinically isolated syndrome; MRI=magnetic resonance imaging; RRMS=relapsing-remitting multiple sclerosis.
References: 1. COPAXONE® (glatiramer acetate injection) prescribing information. Teva Neuroscience, Inc. 2. Comi G, Martinelli V, Rodegher M, et al; for the PreCISe study group. Lancet. 2009;374(9700):1503-1511. 3. Bornstein MB, Miller A, Slagle S, et al. N Engl J Med. 1987;317(7):408-414. 4. Johnson KP, Brooks BR, Cohen JA, et al. Neurology. 1995;45(7):1268-1276. 5. Comi G, Filippi M, Wolinsky JS. Ann Neurol. 2001;49(3):290-297.
COPAXONE® is a registered trademark of Teva Pharmaceutical Industries Ltd. © 2012 Teva Neuroscience, Inc. COP129900201/122062 www.copaxone.com
Please see brief summary of prescribing information on the next page.
74356ha_lotA.indd 1 8/6/12 3:22 PM
Get Your Daily Dose of Academy and Neurology News at
AAN.COM
20 October 2012 • AANnews
Help Us Continue Our Critical Work. Give to the American Brain Foundation Annual Campaign.
Foundation Friends The American Brain Foundation greatly appreciates gifts and pledges received from the following donors between July 1 and July 31, 2012. Cumulative annual gifts and pledges of $1,000 or more are recognized as Champions Circle members, and gifts and pledges of $100 and greater are recognized as Foundation Friends in AANnews®.
For secure online giving options, visit www.CureBrainDisease.org. For more information about the American Brain Foundation, contact Suzi Sherman at [email protected] or (612) 928-6315.
“The Annual Campaign is a critical element of the American Brain Foundation’s fundraising efforts. If you aren’t currently a ‘Foundation Friend’ and haven’t given in the past, there has never been a more critical time to step up and support our vision to cure brain disease. If you have given, thank you—and please consider a larger gift in 2012. Simply put: We can’t do what we do without you.”
—John C. Mazziotta, MD, PhD, FAAN Chair, American Brain Foundation Board of Trustees
Champion Circle($1,000–$4,999)The Bloch Family (In memory of Melvin J. Brass)
Lisa M. DeAngelis, MD, FAANE. Penn Jackson, DDS, and Carlayne E. Jackson, MD, FAAN
Foundation Friends($500–$999)Richard and Mary Beth Gemperle (In memory of Joseph B. Green, MD, FAAN)
($100–$499)Robert J. Baumann, MD, FAANThe Bloch Family (In memory of Edna Barnes)Oscar H. Del Brutto, MD, FAAN
Briseida E. Feliciano-Astacio, MDWilliam J. Golini, MD, FAANGregory A. Jicha, MD, PhD+
Iyad Khoudeir Husseini, MDHerbert A. Manosalva Alzate, MDTanya N. Turan, MD+
Bianca Weinstock-Guttman, MD
+Denotes Honoraria Donors
12 ABF_STROKE_MemberAds v001.indd 1 4/12/12 2:36 PM
BRIEF SUMMARY OF PRESCRIBING INFORMATION FORCOPAXONE® (glatiramer acetate injection)
SEE PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE COPAXONE is indicated for reduction of the frequency of relapses in pa-
tients with Relapsing-Remitting Multiple Sclerosis (RRMS), including patientswho have experienced a first clinical episode and have MRI features consistentwith multiple sclerosis.
4 CONTRAINDICATIONSCOPAXONE is contraindicated in patients with known hypersensitivity to
glatiramer acetate or mannitol.
5 WARNINGS AND PRECAUTIONS5.1 Immediate Post-Injection ReactionApproximately 16% of patients exposed to COPAXONE in the 5 placebo-
controlled trials compared to 4% of those on placebo experienced a constellationof symptoms immediately after injection that included at least two of the follow-ing: flushing, chest pain, palpitations, anxiety, dyspnea, constriction of the throat,and urticaria. The symptoms were generally transient and self-limited and did notrequire treatment. In general, these symptoms have their onset several monthsafter the initiation of treatment, although they may occur earlier, and a given pa-tient may experience one or several episodes of these symptoms. Whether or notany of these symptoms actually represent a specific syndrome is uncertain. Dur-ing the postmarketing period, there have been reports of patients with similarsymptoms who received emergency medical care.
Whether an immunologic or nonimmunologic mechanism mediates theseepisodes, or whether several similar episodes seen in a given patient have identi-cal mechanisms, is unknown.
5.2 Chest PainApproximately 13% of COPAXONE patients in the 5 placebo-controlled
studies compared to 6% of placebo patients experienced at least one episode ofwhat was described as transient chest pain. While some of these episodes occurredin the context of the Immediate Post-Injection Reaction described above, many didnot. The temporal relationship of this chest pain to an injection of COPAXONEwas not always known. The pain was transient (usually lasting only a few minutes),often unassociated with other symptoms, and appeared to have no clinical seque-lae. Some patients experienced more than one such episode, and episodes usuallybegan at least 1 month after the initiation of treatment. The pathogenesis of thissymptom is unknown.
5.3 Lipoatrophy and Skin NecrosisAt injection sites, localized lipoatrophy and, rarely, injection site skin necro-
sis have been reported during the postmarketing experience. Lipoatrophy mayoccur at various times after treatment onset (sometimes after several months) andis thought to be permanent. There is no known therapy for lipoatrophy. To assistin possibly minimizing these events, the patient should be advised to follow properinjection technique and to rotate injection sites daily.
5.4 Potential Effects on Immune ResponseBecause COPAXONE can modify immune response, it may interfere with
immune functions. For example, treatment with COPAXONE may interfere withthe recognition of foreign antigens in a way that would undermine the body’stumor surveillance and its defenses against infection. There is no evidence thatCOPAXONE does this, but there has not been a systematic evaluation of this risk.Because COPAXONE is an antigenic material, it is possible that its use may leadto the induction of host responses that are untoward, but systematic surveillancefor these effects has not been undertaken.
Although COPAXONE is intended to minimize the autoimmune responseto myelin, there is the possibility that continued alteration of cellular immunity dueto chronic treatment with COPAXONE may result in untoward effects.
Glatiramer acetate-reactive antibodies are formed in most patients exposed todaily treatment with the recommended dose. Studies in both the rat and monkey havesuggested that immune complexes are deposited in the renal glomeruli. Furthermore,in a controlled trial of 125 RRMS patients given COPAXONE, 20 mg, subcutaneouslyevery day for 2 years, serum IgG levels reached at least 3 times baseline values in 80%of patients by 3 months of initiation of treatment. By 12 months of treatment, however,30% of patients still had IgG levels at least 3 times baseline values, and 90% had lev-els above baseline by 12 months. The antibodies are exclusively of the IgG subtype andpredominantly of the IgG-1 subtype. No IgE type antibodies could be detected in anyof the 94 sera tested; nevertheless, anaphylaxis can be associated with the adminis-tration of most any foreign substance, and therefore, this risk cannot be excluded.
6 ADVERSE REACTIONS 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, ad-
verse reaction rates observed in the clinical trials of a drug cannot be directly com-pared to rates in the clinical trials of another drug and may not reflect the ratesobserved in clinical practice.
Incidence in Controlled Clinical TrialsAmong 563 patients treated with COPAXONE in blinded placebo con-
trolled trials, approximately 5% of the subjects discontinued treatment becauseof an adverse reaction. The adverse reactions most commonly associated with dis-continuation were: injection site reactions, dyspnea, urticaria, vasodilatation, andhypersensitivity. The most common adverse reactions were: injection site reac-tions, vasodilatation, rash, dyspnea, and chest pain.
Table 1 lists treatment-emergent signs and symptoms that occurred in atleast 2% of patients treated with COPAXONE in the placebo-controlled trials.These signs and symptoms were numerically more common in patients treatedwith COPAXONE than in patients treated with placebo. Adverse reactions wereusually mild in intensity.
Table 1: Adverse reactions in controlled clinical trials with an incidence ≥2%of patients and more frequent with COPAXONE than with placebo
*Injection site atrophy comprises terms relating to localized lipoatrophy at injec-tion site
Adverse reactions which occurred only in 4-5 more subjects in the COPAXONE group than in the placebo group (less than 1% difference), but forwhich a relationship to COPAXONE could not be excluded, were arthralgia andherpes simplex.
Laboratory analyses were performed on all patients participating in the clini-cal program for COPAXONE. Clinically significant laboratory values for hematol-ogy, chemistry, and urinalysis were similar for both COPAXONE and placebo groupsin blinded clinical trials. In controlled trials one patient discontinued treatment dueto thrombocytopenia (16 x109/L), which resolved after discontinuation of treatment.
Data on adverse reactions occurring in the controlled clinical trials wereanalyzed to evaluate differences based on sex. No clinically significant differ-ences were identified. Ninety-six percent of patients in these clinical trials wereCaucasian. The majority of patients treated with COPAXONE were between theages of 18 and 45. Consequently, data are inadequate to perform an analysis of theadverse reaction incidence related to clinically relevant age subgroups.
Other Adverse ReactionsIn the paragraphs that follow, the frequencies of less commonly reported ad-
verse clinical reactions are presented. Because the reports include reactions observedin open and uncontrolled premarketing studies (n= 979), the role of COPAXONE intheir causation cannot be reliably determined. Furthermore, variability associatedwith adverse reaction reporting, the terminology used to describe adverse reactions,etc., limit the value of the quantitative frequency estimates provided. Reaction fre-quencies are calculated as the number of patients who used COPAXONE and re-ported a reaction divided by the total number of patients exposed to COPAXONE.All reported reactions are included except those already listed in the previous table,those too general to be informative, and those not reasonably associated with theuse of the drug. Reactions are further classified within body system categories andenumerated in order of decreasing frequency using the following definitions: Fre-quent adverse reactions are defined as those occurring in at least 1/100 patientsand infrequent adverse reactions are those occurring in 1/100 to 1/1,000 patients.Body as a Whole:
Frequent: AbscessInfrequent: Injection site hematoma, injection site fibrosis, moon face, cellulitis, generalized edema, hernia, injection site abscess, serum sickness,suicide attempt, injection site hypertrophy, injection site melanosis,lipoma, and photosensitivity reaction.
Cardiovascular:Frequent: Hypertension.Infrequent: Hypotension, midsystolic click, systolic murmur, atrial fibrillation, bradycardia, fourth heart sound, postural hypotension, andvaricose veins.
Digestive:Infrequent: Dry mouth, stomatitis, burning sensation on tongue, cholecystitis, colitis, esophageal ulcer, esophagitis, gastrointestinal carcinoma, gum hemorrhage, hepatomegaly, increased appetite, melena,mouth ulceration, pancreas disorder, pancreatitis, rectal hemorrhage,tenesmus, tongue discoloration, and duodenal ulcer.
Endocrine:Infrequent: Goiter, hyperthyroidism, and hypothyroidism.
Gastrointestinal:Frequent: Bowel urgency, oral moniliasis, salivary gland enlargement,tooth caries, and ulcerative stomatitis.
Hemic and Lymphatic:Infrequent: Leukopenia, anemia, cyanosis, eosinophilia, hematemesis,lymphedema, pancytopenia, and splenomegaly.
Metabolic and Nutritional:Infrequent: Weight loss, alcohol intolerance, Cushing’s syndrome, gout,abnormal healing, and xanthoma.
Musculoskeletal:Infrequent: Arthritis, muscle atrophy, bone pain, bursitis, kidney pain,muscle disorder, myopathy, osteomyelitis, tendon pain, and tenosynovitis.
Nervous:Frequent: Abnormal dreams, emotional lability, and stupor.Infrequent: Aphasia, ataxia, convulsion, circumoral paresthesia, depersonalization, hallucinations, hostility, hypokinesia, coma, concentration disorder, facial paralysis, decreased libido, manic reaction,memory impairment, myoclonus, neuralgia, paranoid reaction, paraplegia, psychotic depression, and transient stupor.
Respiratory:Frequent: Hyperventilation and hay fever.Infrequent: Asthma, pneumonia, epistaxis, hypoventilation, and voice alteration.
Skin and Appendages:Frequent: Eczema, herpes zoster, pustular rash, skin atrophy, and warts.Infrequent: Dry skin, skin hypertrophy, dermatitis, furunculosis, psoriasis,angioedema, contact dermatitis, erythema nodosum, fungal dermatitis,maculopapular rash, pigmentation, benign skin neoplasm, skin carcinoma, skin striae, and vesiculobullous rash.
Special Senses:Frequent: Visual field defect.Infrequent: Dry eyes, otitis externa, ptosis, cataract, corneal ulcer, mydriasis, optic neuritis, photophobia, and taste loss.
Urogenital:Frequent: Amenorrhea, hematuria, impotence, menorrhagia, suspiciouspapanicolaou smear, urinary frequency, and vaginal hemorrhage.Infrequent: Vaginitis, flank pain (kidney), abortion, breast engorgement,breast enlargement, carcinoma in situ cervix, fibrocystic breast, kidneycalculus, nocturia, ovarian cyst, priapism, pyelonephritis, abnormal sexualfunction, and urethritis.6.2 Postmarketing ExperienceReports of adverse events occurring under treatment with COPAXONE not
mentioned above that have been received since market introduction and may ormay not have causal relationship to COPAXONE are listed below. Because theseevents are reported voluntarily from a population of uncertain size, it is not alwayspossible to reliably estimate their frequency or establish a causal relationship todrug exposure.Body as a Whole: sepsis; SLE syndrome; hydrocephalus; enlarged abdomen; in-jection site hypersensitivity; allergic reaction; anaphylactoid reactionCardiovascular System: thrombosis; peripheral vascular disease; pericardial ef-fusion; myocardial infarct; deep thrombophlebitis; coronary occlusion; congestiveheart failure; cardiomyopathy; cardiomegaly; arrhythmia; angina pectorisDigestive System: tongue edema; stomach ulcer; hemorrhage; liver function ab-normality; liver damage; hepatitis; eructation; cirrhosis of the liver; cholelithiasisHemic and Lymphatic System: thrombocytopenia; lymphoma-like reaction; acuteleukemiaMetabolic and Nutritional Disorders: hypercholesterolemiaMusculoskeletal System: rheumatoid arthritis; generalized spasmNervous System: myelitis; meningitis; CNS neoplasm; cerebrovascular accident;brain edema; abnormal dreams; aphasia; convulsion; neuralgiaRespiratory System: pulmonary embolus; pleural effusion; carcinoma of lung; hayfeverSpecial Senses: glaucoma; blindness; visual field defectUrogenital System: urogenital neoplasm; urine abnormality; ovarian carcinoma;nephrosis; kidney failure; breast carcinoma; bladder carcinoma; urinary frequency
7 DRUG INTERACTIONS Interactions between COPAXONE and other drugs have not been fully eval-
uated. Results from existing clinical trials do not suggest any significant interac-tions of COPAXONE with therapies commonly used in MS patients, includingthe concurrent use of corticosteroids for up to 28 days. COPAXONE has not beenformally evaluated in combination with interferon beta.
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category B. Administration of glatiramer acetate by subcutaneous injection to pregnant
rats and rabbits resulted in no adverse effects on offspring development. Thereare no adequate and well-controlled studies in pregnant women. Because animalreproduction studies are not always predictive of human response, COPAXONEshould be used during pregnancy only if clearly needed.
In rats or rabbits receiving glatiramer acetate by subcutaneous injection duringthe period of organogenesis, no adverse effects on embryo-fetal development were ob-served at doses up to 37.5 mg/kg/day (18 and 36 times, respectively, the therapeutichuman dose of 20 mg/day on a mg/m2 basis). In rats receiving subcutaneous glatirameracetate at doses of up to 36 mg/kg from day 15 of pregnancy throughout lactation, nosignificant effects on delivery or on offspring growth and development were observed.
8.2 Labor and Delivery The effects of COPAXONE on labor and delivery in pregnant women are
unknown.8.3 Nursing Mothers It is not known if glatiramer acetate is excreted in human milk. Because many
drugs are excreted in human milk, caution should be exercised when COPAXONEis administered to a nursing woman.
8.4 Pediatric Use The safety and effectiveness of COPAXONE have not been established in
patients under 18 years of age.8.5 Geriatric Use COPAXONE has not been studied in elderly patients.8.6 Use in Patients with Impaired Renal FunctionThe pharmacokinetics of glatiramer acetate in patients with impaired renal
function have not been determined.
U.S. Patent Nos. 5981589, 6054430, 6342476, 6362161, 6620847, 6939539, 7199098.
Marketed by: TEVA Neuroscience, Inc., Kansas City, MO 64131Distributed by: TEVA Pharmaceuticals USA, Inc., North Wales, PA 19454Product of Israel© Teva Neuroscience, Inc. All rights reserved.COPAXONE® is a registered trademark of Teva Pharmaceuticals Ltd.
Copp0209BPK
GA 20 mg(N=563)
Placebo(N=564)
Blood And LymphaticSystem Disorders
Lymphadenopathy7% 3%
Cardiac Disorders Palpitations 9% 4%Tachycardia 5% 2%
Eye Disorders Eye Disorder 3% 1%Diplopia 3% 2%
Gastrointestinal Disorders
Nausea 15% 11%Vomiting 7% 4%Dysphagia 2% 1%
General Disorders And Administration Site Conditions
Injection Site Erythema 43% 10%Injection Site Pain 40% 20%Injection Site Pruritus 27% 4%Injection Site Mass 26% 6%Asthenia 22% 21%Pain 20% 17%Injection Site Edema 19% 4%Chest Pain 13% 6%Injection Site Inflammation 9% 1%Edema 8% 2%Injection Site Reaction 8% 1%Pyrexia 6% 5%Injection Site Hypersensitivity 4% 0%Local Reaction 3% 1%Chills 3% 1%Face Edema 3% 1%Edema Peripheral 3% 2%Injection Site Fibrosis 2% 1%Injection Site Atrophy* 2% 0%
Immune System Disorders Hypersensitivity 3% 2%Infections And Infestations
Infection 30% 28%Influenza 14% 13%Rhinitis 7% 5%Bronchitis 6% 5%Gastroenteritis 6% 4%Vaginal Candidiasis 4% 2%
Metabolism And Nutrition Disorders
Weight Increased3% 1%
Musculoskeletal And Con-nective Tissue Disorders
Back Pain12% 10%
Neoplasms Benign, Ma-lignant And Unspecified(Incl Cysts And Polyps)
Benign Neoplasm of Skin
2% 1%
Nervous System Disorders
Tremor 4% 2%Migraine 4% 2%Syncope 3% 2%Speech Disorder 2% 1%
Psychiatric Disorders Anxiety 13% 10%Nervousness 2% 1%
Renal And Urinary Disorders
Micturition Urgency5% 4%
Respiratory, ThoracicAnd Mediastinal Disorders
Dyspnea 14% 4%Cough 6% 5%Laryngospasm 2% 1%
Skin And SubcutaneousTissue Disorders
Rash 19% 11%Hyperhidrosis 7% 5%Pruritus 5% 4%Urticaria 3% 1%Skin Disorder 3% 1%
Vascular Disorders Vasodilatation 20% 5%
®
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BRIEF SUMMARY OF PRESCRIBING INFORMATION FORCOPAXONE® (glatiramer acetate injection)
SEE PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE COPAXONE is indicated for reduction of the frequency of relapses in pa-
tients with Relapsing-Remitting Multiple Sclerosis (RRMS), including patientswho have experienced a first clinical episode and have MRI features consistentwith multiple sclerosis.
4 CONTRAINDICATIONSCOPAXONE is contraindicated in patients with known hypersensitivity to
glatiramer acetate or mannitol.
5 WARNINGS AND PRECAUTIONS5.1 Immediate Post-Injection ReactionApproximately 16% of patients exposed to COPAXONE in the 5 placebo-
controlled trials compared to 4% of those on placebo experienced a constellationof symptoms immediately after injection that included at least two of the follow-ing: flushing, chest pain, palpitations, anxiety, dyspnea, constriction of the throat,and urticaria. The symptoms were generally transient and self-limited and did notrequire treatment. In general, these symptoms have their onset several monthsafter the initiation of treatment, although they may occur earlier, and a given pa-tient may experience one or several episodes of these symptoms. Whether or notany of these symptoms actually represent a specific syndrome is uncertain. Dur-ing the postmarketing period, there have been reports of patients with similarsymptoms who received emergency medical care.
Whether an immunologic or nonimmunologic mechanism mediates theseepisodes, or whether several similar episodes seen in a given patient have identi-cal mechanisms, is unknown.
5.2 Chest PainApproximately 13% of COPAXONE patients in the 5 placebo-controlled
studies compared to 6% of placebo patients experienced at least one episode ofwhat was described as transient chest pain. While some of these episodes occurredin the context of the Immediate Post-Injection Reaction described above, many didnot. The temporal relationship of this chest pain to an injection of COPAXONEwas not always known. The pain was transient (usually lasting only a few minutes),often unassociated with other symptoms, and appeared to have no clinical seque-lae. Some patients experienced more than one such episode, and episodes usuallybegan at least 1 month after the initiation of treatment. The pathogenesis of thissymptom is unknown.
5.3 Lipoatrophy and Skin NecrosisAt injection sites, localized lipoatrophy and, rarely, injection site skin necro-
sis have been reported during the postmarketing experience. Lipoatrophy mayoccur at various times after treatment onset (sometimes after several months) andis thought to be permanent. There is no known therapy for lipoatrophy. To assistin possibly minimizing these events, the patient should be advised to follow properinjection technique and to rotate injection sites daily.
5.4 Potential Effects on Immune ResponseBecause COPAXONE can modify immune response, it may interfere with
immune functions. For example, treatment with COPAXONE may interfere withthe recognition of foreign antigens in a way that would undermine the body’stumor surveillance and its defenses against infection. There is no evidence thatCOPAXONE does this, but there has not been a systematic evaluation of this risk.Because COPAXONE is an antigenic material, it is possible that its use may leadto the induction of host responses that are untoward, but systematic surveillancefor these effects has not been undertaken.
Although COPAXONE is intended to minimize the autoimmune responseto myelin, there is the possibility that continued alteration of cellular immunity dueto chronic treatment with COPAXONE may result in untoward effects.
Glatiramer acetate-reactive antibodies are formed in most patients exposed todaily treatment with the recommended dose. Studies in both the rat and monkey havesuggested that immune complexes are deposited in the renal glomeruli. Furthermore,in a controlled trial of 125 RRMS patients given COPAXONE, 20 mg, subcutaneouslyevery day for 2 years, serum IgG levels reached at least 3 times baseline values in 80%of patients by 3 months of initiation of treatment. By 12 months of treatment, however,30% of patients still had IgG levels at least 3 times baseline values, and 90% had lev-els above baseline by 12 months. The antibodies are exclusively of the IgG subtype andpredominantly of the IgG-1 subtype. No IgE type antibodies could be detected in anyof the 94 sera tested; nevertheless, anaphylaxis can be associated with the adminis-tration of most any foreign substance, and therefore, this risk cannot be excluded.
6 ADVERSE REACTIONS 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, ad-
verse reaction rates observed in the clinical trials of a drug cannot be directly com-pared to rates in the clinical trials of another drug and may not reflect the ratesobserved in clinical practice.
Incidence in Controlled Clinical TrialsAmong 563 patients treated with COPAXONE in blinded placebo con-
trolled trials, approximately 5% of the subjects discontinued treatment becauseof an adverse reaction. The adverse reactions most commonly associated with dis-continuation were: injection site reactions, dyspnea, urticaria, vasodilatation, andhypersensitivity. The most common adverse reactions were: injection site reac-tions, vasodilatation, rash, dyspnea, and chest pain.
Table 1 lists treatment-emergent signs and symptoms that occurred in atleast 2% of patients treated with COPAXONE in the placebo-controlled trials.These signs and symptoms were numerically more common in patients treatedwith COPAXONE than in patients treated with placebo. Adverse reactions wereusually mild in intensity.
Table 1: Adverse reactions in controlled clinical trials with an incidence ≥2%of patients and more frequent with COPAXONE than with placebo
*Injection site atrophy comprises terms relating to localized lipoatrophy at injec-tion site
Adverse reactions which occurred only in 4-5 more subjects in the COPAXONE group than in the placebo group (less than 1% difference), but forwhich a relationship to COPAXONE could not be excluded, were arthralgia andherpes simplex.
Laboratory analyses were performed on all patients participating in the clini-cal program for COPAXONE. Clinically significant laboratory values for hematol-ogy, chemistry, and urinalysis were similar for both COPAXONE and placebo groupsin blinded clinical trials. In controlled trials one patient discontinued treatment dueto thrombocytopenia (16 x109/L), which resolved after discontinuation of treatment.
Data on adverse reactions occurring in the controlled clinical trials wereanalyzed to evaluate differences based on sex. No clinically significant differ-ences were identified. Ninety-six percent of patients in these clinical trials wereCaucasian. The majority of patients treated with COPAXONE were between theages of 18 and 45. Consequently, data are inadequate to perform an analysis of theadverse reaction incidence related to clinically relevant age subgroups.
Other Adverse ReactionsIn the paragraphs that follow, the frequencies of less commonly reported ad-
verse clinical reactions are presented. Because the reports include reactions observedin open and uncontrolled premarketing studies (n= 979), the role of COPAXONE intheir causation cannot be reliably determined. Furthermore, variability associatedwith adverse reaction reporting, the terminology used to describe adverse reactions,etc., limit the value of the quantitative frequency estimates provided. Reaction fre-quencies are calculated as the number of patients who used COPAXONE and re-ported a reaction divided by the total number of patients exposed to COPAXONE.All reported reactions are included except those already listed in the previous table,those too general to be informative, and those not reasonably associated with theuse of the drug. Reactions are further classified within body system categories andenumerated in order of decreasing frequency using the following definitions: Fre-quent adverse reactions are defined as those occurring in at least 1/100 patientsand infrequent adverse reactions are those occurring in 1/100 to 1/1,000 patients.Body as a Whole:
Frequent: AbscessInfrequent: Injection site hematoma, injection site fibrosis, moon face, cellulitis, generalized edema, hernia, injection site abscess, serum sickness,suicide attempt, injection site hypertrophy, injection site melanosis,lipoma, and photosensitivity reaction.
Cardiovascular:Frequent: Hypertension.Infrequent: Hypotension, midsystolic click, systolic murmur, atrial fibrillation, bradycardia, fourth heart sound, postural hypotension, andvaricose veins.
Digestive:Infrequent: Dry mouth, stomatitis, burning sensation on tongue, cholecystitis, colitis, esophageal ulcer, esophagitis, gastrointestinal carcinoma, gum hemorrhage, hepatomegaly, increased appetite, melena,mouth ulceration, pancreas disorder, pancreatitis, rectal hemorrhage,tenesmus, tongue discoloration, and duodenal ulcer.
Endocrine:Infrequent: Goiter, hyperthyroidism, and hypothyroidism.
Gastrointestinal:Frequent: Bowel urgency, oral moniliasis, salivary gland enlargement,tooth caries, and ulcerative stomatitis.
Hemic and Lymphatic:Infrequent: Leukopenia, anemia, cyanosis, eosinophilia, hematemesis,lymphedema, pancytopenia, and splenomegaly.
Metabolic and Nutritional:Infrequent: Weight loss, alcohol intolerance, Cushing’s syndrome, gout,abnormal healing, and xanthoma.
Musculoskeletal:Infrequent: Arthritis, muscle atrophy, bone pain, bursitis, kidney pain,muscle disorder, myopathy, osteomyelitis, tendon pain, and tenosynovitis.
Nervous:Frequent: Abnormal dreams, emotional lability, and stupor.Infrequent: Aphasia, ataxia, convulsion, circumoral paresthesia, depersonalization, hallucinations, hostility, hypokinesia, coma, concentration disorder, facial paralysis, decreased libido, manic reaction,memory impairment, myoclonus, neuralgia, paranoid reaction, paraplegia, psychotic depression, and transient stupor.
Respiratory:Frequent: Hyperventilation and hay fever.Infrequent: Asthma, pneumonia, epistaxis, hypoventilation, and voice alteration.
Skin and Appendages:Frequent: Eczema, herpes zoster, pustular rash, skin atrophy, and warts.Infrequent: Dry skin, skin hypertrophy, dermatitis, furunculosis, psoriasis,angioedema, contact dermatitis, erythema nodosum, fungal dermatitis,maculopapular rash, pigmentation, benign skin neoplasm, skin carcinoma, skin striae, and vesiculobullous rash.
Special Senses:Frequent: Visual field defect.Infrequent: Dry eyes, otitis externa, ptosis, cataract, corneal ulcer, mydriasis, optic neuritis, photophobia, and taste loss.
Urogenital:Frequent: Amenorrhea, hematuria, impotence, menorrhagia, suspiciouspapanicolaou smear, urinary frequency, and vaginal hemorrhage.Infrequent: Vaginitis, flank pain (kidney), abortion, breast engorgement,breast enlargement, carcinoma in situ cervix, fibrocystic breast, kidneycalculus, nocturia, ovarian cyst, priapism, pyelonephritis, abnormal sexualfunction, and urethritis.6.2 Postmarketing ExperienceReports of adverse events occurring under treatment with COPAXONE not
mentioned above that have been received since market introduction and may ormay not have causal relationship to COPAXONE are listed below. Because theseevents are reported voluntarily from a population of uncertain size, it is not alwayspossible to reliably estimate their frequency or establish a causal relationship todrug exposure.Body as a Whole: sepsis; SLE syndrome; hydrocephalus; enlarged abdomen; in-jection site hypersensitivity; allergic reaction; anaphylactoid reactionCardiovascular System: thrombosis; peripheral vascular disease; pericardial ef-fusion; myocardial infarct; deep thrombophlebitis; coronary occlusion; congestiveheart failure; cardiomyopathy; cardiomegaly; arrhythmia; angina pectorisDigestive System: tongue edema; stomach ulcer; hemorrhage; liver function ab-normality; liver damage; hepatitis; eructation; cirrhosis of the liver; cholelithiasisHemic and Lymphatic System: thrombocytopenia; lymphoma-like reaction; acuteleukemiaMetabolic and Nutritional Disorders: hypercholesterolemiaMusculoskeletal System: rheumatoid arthritis; generalized spasmNervous System: myelitis; meningitis; CNS neoplasm; cerebrovascular accident;brain edema; abnormal dreams; aphasia; convulsion; neuralgiaRespiratory System: pulmonary embolus; pleural effusion; carcinoma of lung; hayfeverSpecial Senses: glaucoma; blindness; visual field defectUrogenital System: urogenital neoplasm; urine abnormality; ovarian carcinoma;nephrosis; kidney failure; breast carcinoma; bladder carcinoma; urinary frequency
7 DRUG INTERACTIONS Interactions between COPAXONE and other drugs have not been fully eval-
uated. Results from existing clinical trials do not suggest any significant interac-tions of COPAXONE with therapies commonly used in MS patients, includingthe concurrent use of corticosteroids for up to 28 days. COPAXONE has not beenformally evaluated in combination with interferon beta.
8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category B. Administration of glatiramer acetate by subcutaneous injection to pregnant
rats and rabbits resulted in no adverse effects on offspring development. Thereare no adequate and well-controlled studies in pregnant women. Because animalreproduction studies are not always predictive of human response, COPAXONEshould be used during pregnancy only if clearly needed.
In rats or rabbits receiving glatiramer acetate by subcutaneous injection duringthe period of organogenesis, no adverse effects on embryo-fetal development were ob-served at doses up to 37.5 mg/kg/day (18 and 36 times, respectively, the therapeutichuman dose of 20 mg/day on a mg/m2 basis). In rats receiving subcutaneous glatirameracetate at doses of up to 36 mg/kg from day 15 of pregnancy throughout lactation, nosignificant effects on delivery or on offspring growth and development were observed.
8.2 Labor and Delivery The effects of COPAXONE on labor and delivery in pregnant women are
unknown.8.3 Nursing Mothers It is not known if glatiramer acetate is excreted in human milk. Because many
drugs are excreted in human milk, caution should be exercised when COPAXONEis administered to a nursing woman.
8.4 Pediatric Use The safety and effectiveness of COPAXONE have not been established in
patients under 18 years of age.8.5 Geriatric Use COPAXONE has not been studied in elderly patients.8.6 Use in Patients with Impaired Renal FunctionThe pharmacokinetics of glatiramer acetate in patients with impaired renal
function have not been determined.
U.S. Patent Nos. 5981589, 6054430, 6342476, 6362161, 6620847, 6939539, 7199098.
Marketed by: TEVA Neuroscience, Inc., Kansas City, MO 64131Distributed by: TEVA Pharmaceuticals USA, Inc., North Wales, PA 19454Product of Israel© Teva Neuroscience, Inc. All rights reserved.COPAXONE® is a registered trademark of Teva Pharmaceuticals Ltd.
Copp0209BPK
GA 20 mg(N=563)
Placebo(N=564)
Blood And LymphaticSystem Disorders
Lymphadenopathy7% 3%
Cardiac Disorders Palpitations 9% 4%Tachycardia 5% 2%
Eye Disorders Eye Disorder 3% 1%Diplopia 3% 2%
Gastrointestinal Disorders
Nausea 15% 11%Vomiting 7% 4%Dysphagia 2% 1%
General Disorders And Administration Site Conditions
Injection Site Erythema 43% 10%Injection Site Pain 40% 20%Injection Site Pruritus 27% 4%Injection Site Mass 26% 6%Asthenia 22% 21%Pain 20% 17%Injection Site Edema 19% 4%Chest Pain 13% 6%Injection Site Inflammation 9% 1%Edema 8% 2%Injection Site Reaction 8% 1%Pyrexia 6% 5%Injection Site Hypersensitivity 4% 0%Local Reaction 3% 1%Chills 3% 1%Face Edema 3% 1%Edema Peripheral 3% 2%Injection Site Fibrosis 2% 1%Injection Site Atrophy* 2% 0%
Immune System Disorders Hypersensitivity 3% 2%Infections And Infestations
Infection 30% 28%Influenza 14% 13%Rhinitis 7% 5%Bronchitis 6% 5%Gastroenteritis 6% 4%Vaginal Candidiasis 4% 2%
Metabolism And Nutrition Disorders
Weight Increased3% 1%
Musculoskeletal And Con-nective Tissue Disorders
Back Pain12% 10%
Neoplasms Benign, Ma-lignant And Unspecified(Incl Cysts And Polyps)
Benign Neoplasm of Skin
2% 1%
Nervous System Disorders
Tremor 4% 2%Migraine 4% 2%Syncope 3% 2%Speech Disorder 2% 1%
Psychiatric Disorders Anxiety 13% 10%Nervousness 2% 1%
Renal And Urinary Disorders
Micturition Urgency5% 4%
Respiratory, ThoracicAnd Mediastinal Disorders
Dyspnea 14% 4%Cough 6% 5%Laryngospasm 2% 1%
Skin And SubcutaneousTissue Disorders
Rash 19% 11%Hyperhidrosis 7% 5%Pruritus 5% 4%Urticaria 3% 1%Skin Disorder 3% 1%
Vascular Disorders Vasodilatation 20% 5%
®
74356ha_lotA.indd 3 8/6/12 3:22 PM
AANnews • October 2012 2524 October 2012 • AANnews
Visit AAN’s Neurology Career Center for job postings and to sign up for customized, confidential notifications when positions of interest are added.
Neurologist (MS Specialist) - Charlotte NC The Neurology Department at CMC is seeking a Neurologist, specializing in MS to join their high caliber team of faculty providers and well-known MS Center. Qualified candidates will be BC/BE in Neurology with extensive experience in treating MS. Ideal candidates will be ACGME fellowship trained in MS and have an interest in education and research. The MS Center offers state-of-the-art resources along with an active clinical research program supported by 10 research coordinators and assistants. The clinical staff includes on-site nurses, physical therapists, occupational therapists, speech therapists, social workers and a dietician. CMC Neurology offers an attractive hybrid model of private practice and academics. The Neurology faculty has the flexibility to see patients in physically attractive clinic, teach residents and medical students, and participate in clinical research. The MS Center is situated near uptown Charlotte in a beautiful residential area. Carolinas HealthCare System (CHS) is a not-for-profit, self-supporting public organization. It is the largest healthcare system in the Carolinas, and one of the largest public systems in the nation. Charlotte, NC is a growing and vibrant city and is 2 hours from the mountains of NC and 3-4 hours from the beaches of NC and SC. To send a CV for consideration, please contact: Tracey Black, Physician Recruiter, phone: (704) 355-0159 or (800) 847-5084. Email: [email protected]
Two Neurology Opportunities: Out-patient Clinic and Neuro-hospitalist, Charlotte Metro Area Outstanding opportunity for BE/BC General Neurologists (EEG interpretation required) to join busy and established practice located in Gastonia, NC, just minutes from Charlotte, one of the fastest growing cities in the country. One position will be in outpatient single specialty clinic and the other opportunity is for a Neuro-hospitalist providing only inpatient neurology services. Sub specialty interest in headache, sleep medicine, multiple sclerosis or epilepsy would also be supported in the out-patient setting. Weekend and weeknight call for all physicians will be 1:5 or 1:6. Active medical staff of over 300 physicians representing all medical sub specialties serves a patient base of over 350,000. Employed opportunity offering competitive compensation package including RVU based compensation, generous benefits and relocation allowance. CaroMont Medical Group operates under the guidance of a physician-led Governance Committee allowing for an active partnership with the Medical Staff. Located just minutes from international airport and uptown Charlotte, the area offers amenities of any large metropolitan city including professional sports, the performing arts and upscale shopping and dining while providing residents of Gastonia the benefits of living in a small, family oriented community with lovely neighborhoods and good choice of public and private schools. If interested in being considered for this opportunity, please send CV to: Celia G. Billings, Manager, Physician Recruitment. CaroMont Health, 2240 Remount Road, Gastonia, North Carolina 28054. Phone: (704) 834-2153 Fax: (704) 834-4615. Email: [email protected]. Website: www.caromonthealth.org.
General Neurologist - No afterhours call Neurologist Opening - Charming College Town Seeking General Neurologist to join our medical community at CENTRA Southside Community Hospital in Farmville, Virginia. This opportunity offers; - Established patient base at start. - Opportunity to develop practice interests in areas including stroke, EEG, EMG, migraine, dementia, and sleep. - Great referral base with 6 primary care offices in the area. - Hospital employment. - No afterhours call. Relocation assistance and educational loan repayment options available. If interested, please submit resume to [email protected]
General Neurologist Central Vermont Medical Center is seeking a full time BC/BE general neurologist to join our team. We have a community need to expand services and are looking for the right person to join our practice. EMG and EEG experience a plus. The practice currently includes two very well respected physicians who have served our community for several years. We have an abundance of natural resources and community spirit that contributes to the high quality of life we enjoy in our region. Benefits include loan repayment, relocation assistance and guaranteed salary. Please contact Sarah Child,
Manager of Physician Service at [email protected] or phone: (802) 225-1739
Neuro-Hospitalist - Adult Neuro-hospitalist. Primarily hospital-based with some outpatient duties if desired. Full or part time considered. Wonderful opportunity to join well-established, highly-regarded neurology practice with great working environment in Central Delaware, less than 2 hours away from Washington, Baltimore and Philadelphia and 45 minutes to Rehoboth Beach. Full service practice with MRI, EEG, EMG, Sleep Center, Vascular Lab; Headache Treatment Center, with shared call (every 7-8th weekend). Perfect location, close to major metropolitan areas and ocean beaches. Competitive pay structure, shareholder and benefit package. Contact Dr. Varipapa at (302) 242-8181 for additional details. Send CV to [email protected]. See our website at http://www.cnmri.com and https://www.facebook.com/cnmri for practice details. See http://www.bayhealth.org for hospital details.
BC/BE Neurologist Upstate New York - Adirondack Mountains - Lake Champlain Region CVPH Medical Center (www.cvph.org) seeks two BC/BE neurologists to join its medical staff. Candidates with a particular interest in stroke medicine is a plus. Enjoy being a hospital employee with a comprehensive benefit package and call of 1:3. Competitive salary with productivity incentive, sign-on and loan repayment. Significant loan repayment potential through the Doctors Across New York program of $150,000. Big hospital, small city on Lake Champlain, near the Adirondack Mountains, the Olympic-Lake Placid region, Burlington, VT, and Montreal. For more information please log onto www.northcountrygoodlife.com or email Rebecca Larkin at [email protected]. 75 Beekman St., Plattsburgh, New York 12901. Phone: (518) 314-3025. Fax: (518) 562-7012
Neurohospitalist Palm Springs, California Primary Critical Care Medical Group provides hospitalist services at Desert Regional Medical Center in Palm Springs, CA. DRMC is a 387 bed acute care facility that provides comprehensive services to the Coachella Valley (110 miles east of Los Angeles). Stroke certification was obtained in 2010, and a neuro ICU was opened in the first quarter of 2011. DRMC is a Level 2 trauma center and is also a key training site for the neurosurgical residency program based at Arrowhead Regional Medical Center. We are actively recruiting for a neurohospitalist who can provide acute stroke and other inpatient consultative services in conjunction with the hospitalist program. A teleneurology program provides after hours coverage. Interested candidates should send a CV and/or call: Dann Stubblefield, PCCMG Recruitment, (888) 761-3600, [email protected] or Bruce Gipe, MD, PCCMG Medical Director, (818) 421-6961 (cell) or [email protected]
Stroke, MS and Movement Disorder Specialists Lehigh Valley Health Network (LVHN) is one of the largest tertiary care hospitals in the state of Pennsylvania. The network is a regional referral center for neurosciences. We seek 5 BC/BE neurologists to join our network-owned neurology practice. Our greatest need is for stroke specialists but we would also like to hear from neurologists with expertise in MS and movement disorders. Successful candidates will have the opportunity to develop their subspecialty practice, teach residents and medical students and conduct clinical research, if interested. The Division Of Neurosciences at Lehigh Valley Health Network: - comprises 15 neurologists and 5 neurosurgeons under one roof - has the region’s only neuroscience intensive care unit - the region’s first JCAHO Certified Primary Stroke Center - established programs in stroke, movement disorder, MS, headache, epilepsy and neuromuscular disease - neuro-oncology and complex spine conditions - advanced neurovascular treatments - rapid response to traumatic brain injury and potential stroke patients - fellowship-trained neurointerventional radiologists. Lehigh Valley Health Network: - blends the finest aspects of a large community hospital and an academic medical center - 988 tertiary care beds; 4 helicopters - high volume clinical programs - 18 freestanding, fully accredited residency and fellowship programs - academic affiliation with the University of South Florida where our physicians are eligible for faculty appointment - internal funding sources which provide opportunities to conduct clinical research. We are located in Pennsylvania, one hour north of Philadelphia and 90 minutes
west of NYC. The suburban area with sophisticated charm offers great schools and 10 colleges, affordable housing, moderate 4 seasons and cultural and recreational activities to satisfy all. Call (610) 969-0213 or email [email protected] if you would like to hear more about these opportunities.
Academic Neurohospitalist The Department of Neurology of the Albert Einstein College of Medicine and Montefiore Medical Center seeks a board-certified neurologist with interests in hospital-based patient care and clinical teaching for the position of an academic neurohospitalist. The role will require coordinating patient care with the Emergency Department by providing timely consults, working closely with the Stroke Team, and supervising the clinical activities of residents, medical students, and PAs. Clinical duties will include staffing the Neurology Consult Service and attending on the Neurology Inpatient Service. Interest in developing a clinical research career is strongly encouraged, and the position may be customized to fit the specific clinical and research interests of the successful applicant. Interested candidates should contact Fred Lado MD, Chief of Service, Moses and North Divisions, phone: (718) 920-8499 C/O: Leticia Roldan, email: [email protected]. EOE
Neurologist Neurology clinic focused in neurophysiology is looking for highly accomplished neurologists to join our team in a high energy, fun, and exciting practice. The primary focus of the clinic is on the consultation and performance of neurodiagnostic procedures. A candidate with existing licensure is a plus, as well as, a fellowship in clinical neurophysiology, and or EMG. Neurologists in part-time private practice are excellent candidates and have the ability to have challenging cases outside their normal practice in addition to great income potential and benefits. We have part time and full time positions available. This position has a convenient schedule with no hospital calls. Email: [email protected]
Neurology Center of Nevada A growing and prestigious Neurology practice in Nevada is looking for a Neurologist to join a group of three physicians. Seeking a physician that is interested to practice in an extensive outpatient service/testings and in a private community hospital. Majority of our service is in the outpatient setting. Offers above average compensation and benefits (medical insurance, 401k) with partnership. J1 status considered. Please contact: Judith, phone: (702) 247-9994, fax: (702) 651-9995 or email: [email protected]/[email protected]
Chair, Department of Neurology Ochsner Health System in New Orleans is searching for a System Chair Of The Department of Neurology. The successful candidate will be board-certified, an excellent clinician, possess proven leadership, team building, and managerial experience, and have a strong academic background. Salary offered will be competitive and commensurate with experience and training. Ochsner Health System’s growing 21-physician Neurology team includes neurologists with subspecialty expertise in stroke, neurointensive care, movement disorders, epilepsy, pain management, neuroimmunology, neuromuscular disorders, and neuroimaging. Ochsner’s Department of Neurology is a recipient of the HealthGrades Stroke Care Excellence Award with a five-star ranking. In addition, we ranked #1 in Louisiana for the treatment of stroke. We also have an EMG and accredited Sleep lab. Ochsner and LSU Health Science Center have a joint Neurology residency training program. Ochsner Health System is a physician-led, non-profit, academic, multi-specialty healthcare delivery system dedicated to patient care, research, and education. Our mission is to serve, heal, lead, educate and innovate. The system includes 8 hospitals and more than 38 health centers throughout Southeast Louisiana. Ochsner employs over 800 physicians representing all major medical specialties and subspecialties. We conduct over 300 ongoing clinical research trials annually. Please visit our website at www.ochsner.org. Ochsner Health System and The University of Queensland Medical School in Brisbane, Australia began a unique, joint partnership in 2009 by opening the University of Queensland School of Medicine Clinical School at Ochsner. The successful candidate for Chair of the Department of Neurology will be eligible for an academic professorship appointment from
> www.aan.com/careersthe University of Queensland, as well as through Tulane and Louisiana State University. Interested physicians should send curriculum vitae and vision statement for review to Joseph R. Dalovisio, MD, Associate Medical Director, Medical Specialties. Email: [email protected], Ref. # ACNNO4. Information: (800) 488-2240. EOE
BE/BC Neurology Opportunity in Albuquerque, NM Presbyterian Healthcare Services in Albuquerque, NM is actively recruiting for two (2) Neurology trained physicians to join the outpatient clinic. Minimal call expectations and no admitting. This is an employed opportunity to join Presbyterian Medical Group (PMG) which employs over 600 providers and is the fastest growing employed physician group in the state. Guaranteed base salary plus incentive bonus, sign-on bonus, paid malpractice (occurrence-type), relocation, health, dental, vision, life, 403(b) w/match, 457(b), short, long term disability, etc. Albuquerque: Albuquerque thrives as New Mexico’s largest metropolitan center with a population of 700,000. Albuquerque has been listed as one of the best places to live in the United States by Newsweek, U.S. News & World Report, Money and Entrepreneur Magazines. Albuquerque is considered a destination city for most types of outdoor activities with 310 days of sunshine. Albuquerque is recognized as one of the most culturally diverse cities in the country. Its ethnic diversity is carried into its architecture, art, music, dance and cuisine. A truly diverse and multicultural city, Albuquerque offers you and your family a great variety of activities and entertainment including national theater productions, sporting events, golf courses ranked among the best in the country, the largest hot air balloon festival in the US, American Indian Cultural activities and much more. http://www.newmexico.org/ or www.abqjournal.com/. If you are interested, please contact: Kelly Herrera, Physician Recruiter, Presbyterian Healthcare Services. Phone: (505) 823-8771, fax: (505) 823-8743, email: [email protected], website: http://www.phs.org
General Neurology The Renown Institute for Neurosciences, under the leadership of John Rothrock, MD as Medical Director, is seeking general neurologists to join our team and work in our out-patient clinics. Renown Health is Nevada’s only Top 100 Integrated Health Network. The Institute is based at Renown Regional Medical Center, an 800 bed hospital that is the region’s only level II trauma center and home of Nevada’s first Certified Stroke Center. Renown Regional is the primary teaching hospital for the University of Nevada/Reno School of Medicine, and this unique partnership provides opportunities for teaching, research and an academic appointment. Comprehensive employment compensation, with full benefits that include a relocation package, malpractice coverage and educational leave. All candidates must be BC/BE. Reno offers the benefits of four seasons, world class skiing, proximity to Lake Tahoe and no state income tax. If interested, contact Dee Schafer at (775) 982-4249 or email: [email protected]
Epileptologist Reno, NV The Renown Institute for Neurosciences, under the leadership of John Rothrock, MD as Medical Director, is seeking an epileptologist to develop and direct a center of excellence in epilepsy. Renown Health is Nevada’s only Top 100 Integrated Health Network. The Institute is based at Renown Regional Medical Center, an 800 bed hospital that is the region’s only level II trauma center and home of Nevada’s first Certified Stroke Center. Renown Regional is the primary teaching hospital for the University of Nevada/Reno School of Medicine, and this unique partnership provides opportunities for teaching, research and an academic appointment. Comprehensive employment compensation, with full benefits that include a relocation package and malpractice coverage. All candidates must be BC/BE. Reno offers the benefits of a four seasons climate, world class skiing, proximity to Lake Tahoe and no state income tax. If interested, contact Dee Schafer, Director of Recruiting. Phone: (775) 982-4249 or email: [email protected]
Neuro-hospitalists Reno NV The Renown Institute for Neurosciences, under the leadership of John Rothrock, MD as Medical Director, is seeking neuro-hospitalists to join our team. Renown Health is Nevada’s only Top 100 Integrated Health Network. The Institute is based at Renown Regional Medical Center, an 800 bed hospital that is the region’s only level II trauma center and home of Nevada’s first Certified Stroke Center. Renown Regional is the primary teaching hospital for the University of Nevada/Reno School of Medicine, and this unique partnership provides opportunities for teaching, research and an academic appointment. Comprehensive employment compensation, with full benefits that include a relocation package, malpractice coverage and educational leave. All candidates must be BC/BE. Reno offers the benefits of four
seasons, world class skiing, proximity to Lake Tahoe and no state income tax. If interested, contact Dee Schafer at (775) 982-4249 or email [email protected]
General Neurologist (Denver/Boulder, Colorado) We believe in getting more out of life. When you join Kaiser Permanente Colorado, you’ll be able to get more out of your life and your career. That’s because, as a physician-managed, multi-specialty, integrated health care delivery operation, we know firsthand what it takes to advance professionally and thrive personally. We have over 900 physicians in 36 specialties who provide care at 22 clinics in Colorado. General Neurologist: Denver/Boulder, Colorado. We’re seeking a BC/BE Neurologist with general neurology skills to work with a wide variety of adult only patients. Must be able to read EEGs and EMGs. This opening offers a flexible call schedule and senior physician support. Our leadership in the Colorado region is focused on creating a positive work environment where health care professionals can build a rewarding career. Kaiser Permanente Colorado has been named the highest-rated health plan in Colorado as well as one of the Top 10 plans in the nation in 36 of the 40 effectiveness of care measures used to rank plans this year. The Centers for Medicare & Medicaid Services (CMS) announced their final 2012 Medicare star quality ratings and KPCO earned the highest rating “5 stars” and we’re the only Medicare health plan in the state to receive that top rating. For 2011-2012, the KP Health Plan ranked No. 1 in Colorado and No. 6 in the nation by the NCQA (National Committee on Quality Assurance). In Denver, you’ll enjoy metropolitan living near the Rocky Mountains and all that our region has to offer such as excellent sports and recreation opportunities, including hiking, camping, skiing and mountain biking. Join us and you’ll find Colorado is a great place to work and live. Please contact Amy Chang at (303) 344-7246 or email: [email protected]. Visit our website: www.physiciancareers.kp.org/co. EOE/M/F/V
Headache Neurologist Swedish Neuroscience Institute is seeking a Headache-Trained Neurologist in Seattle, WA. Swedish Neuroscience Institute (SNI) is in search of a neurologist to lead a new clinical and research program in headache disorders. The headache program at SNI will include medical and procedural approaches to pain control. Investigational approaches will be an important component of the program. The ideal candidate will have experience establishing and expanding a headache program, although junior individuals with a strong interest in clinical care, research, and program development will also be considered. SNI is part of the largest non-profit healthcare system in the Pacific Northwest. Members of SNI have access to a wide range of sub-specialty neurology and neurosurgery colleagues. The institute has a strong emphasis in continuing medical education. Individuals interested in learning more about this opportunity should submit a CV and letter of interest to Dr. John Henson, Director of Neurology, Swedish Neuroscience Institute, at [email protected]
Memory Disorders/Dementia Subspecialist Neurologist Scott & White Healthcare System Austin/Round Rock, TX. Scott & White Healthcare, Round Rock, TX, is seeking a Board Certified or Board Eligible Fellowship Trained Memory Disorders Neurologist to join a team of 3 established Neurologists at our Round Rock Clinic. The selected Neurologist will establish and grow a Dementia program and practice with support from our regional hospital and clinics. The Neurology Department at Scott & White consists of 17 Physicians in 4 clinic locations, delivering the most advanced and comprehensive care for Neurological disorders in Central Texas. The primary emphasis is clinical; however opportunities for research and teaching are available. The position includes the option of a tenured or non-tenured faculty appointment with Texas A&M University Health Science Center. Scott & White is a fully integrated health system and is the largest multi-specialty practice in Texas and the sixth largest group practice in the nation. Scott & White employs more than 1,100 providers and research scientists who care for patients covering 25,000 square miles across Central Texas. Scott & White owns, is partnered with, or manages 13 hospitals and 55 clinics across Central Texas. Scott & White offer a competitive salary and comprehensive benefit package, which begins with 4 weeks’ vacation, three weeks CME and a generous retirement plan. Join us, and believe in your career. To learn more about this position, visit our careers link at: http://careers.sw.org/physicians/. Contact: David A. Allen, Physician Recruiter, Scott & White Healthcare. Phone: (512) 509-1242. Email: [email protected]. Scott & White is an Equal Opportunity Employer. Tobacco-Free Environment.
Exciting Neurology Opportunities in North Carolina The Department of Neurology is seeking exceptional BC/BE Neurologists (General, Pediatric Neurology, MS) to join us in our Mission to Care, Mission to Cure at Wake Forest Baptist Medical Center. These are open-rank, faculty opportunities with the ideal candidates possessing the following qualifications: MD/DO; BC/BE; Successful record of clinical and service excellence and interest in graduate medical education; North Carolina medical license or eligible. Responsibilities would include some limited inpatient duties and after hours work, but will largely focus on specific neurology services in our outpatient clinic at both our main campus as well as clinic sites in the surrounding community. Winston-Salem, North Carolina, with a population of approximately 220,000, is home to Wake Forest Baptist. The city is nestled in the northwestern region of North Carolina, within easy driving distance to the beautiful Blue Ridge Mountains and the pristine beaches of North Carolina. Wake Forest University Baptist Medical Center is an affirmative action and equal opportunity employer with a strong commitment to achieving diversity among its faculty and staff. Please send your CV to Chantelle L. Johnson, MBA, at [email protected] or call (336) 716-7580 for more information. (Direct hires only)
NeuroImaging Fellowship Fellowship in Neuroimaging: Winchester Neurological Consultants, Inc. in conjunction with Virginia Commonwealth University and Winchester Medical Center is offering a one year fellowship in clinical Neuroimaging for BC/BE neurology graduates. Located approximately an hour from Washington, DC, our United Council of Neurologic Subspecialties fully accredited fellowship offers extensive training in the performance and interpretation of diagnostic inpatient and outpatient MRI, CT, Doppler, TCD, and myelography, utilizing four state of the art MRI scanners and four multi-slice CT units. Responsibilities include supervision and interpretation of imaging, assisting with acute stroke protocols, and direct patient care. Initial availability July 1, 2012. Requires one year commitment. Research interests are encouraged. Salary is $60,000.00 plus benefits. CV’s should be emailed to [email protected] or faxed to (540) 722-6207
Out-patient Hospital Employed Neurology Position - Northern, DE Christiana Care Health System (CCHS) is one of the largest, privately owned, not-for-profit academic affiliated health care systems in the United States. Based in Wilmington, Delaware, Christiana Care is the region’s premier healthcare provider, serving Delaware and neighboring areas of Pennsylvania, Maryland, and New Jersey. We are currently recruiting BC/BE Neurologists to join a large outpatient practice. Limited in-patient coverage required. Subspecialists are welcome to apply. Opportunities for EEG, Sleep and EMG exist in the office and at the hospital. Christiana Care Health System, comprised of both Christiana Hospital and Wilmington Hospital, is a major regional heart center and has the only Level I trauma service on the East Coast corridor between Philadelphia and Baltimore. Christiana Care is affiliated with Jefferson Medical School and educates over 200 residents annually. Christiana Care possesses the region’s leading stroke program, a dedicated stroke treatment and recovery unit and a technologically advanced Invasive Neuro-radiology program. The suburban Wilmington area will offer you and your family many social and recreational amenities, outstanding schools, beautiful homes, and a great deal more. You will also enjoy close proximity to Philadelphia, Baltimore, Washington DC and a number of beautiful beaches. It will be easy for you to see why the Wilmington area is a very desirable location for physicians to practice and to raise their families. Contact Ken Sammut at (888) 372-9415; email: [email protected] or visit our website: www.cejkasearch.com. ID#147031DE.
Neurology Opportunity Kansas City, Missouri The University of Missouri-Kansas City (UMKC) School of Medicine and Truman Medical Centers (TMC), in partnership with University Physician Associates (UPA), are accepting applications for a full-time academic neurologist to serve as a faculty member in a new Department of Neurology. There is strong institutional interest and support for initiating a neurology residency training program and fostering neurosciences research as part of this new Department. Applicants must be eligible for Missouri licensure and must be board-eligible or certified in Neurology. Commitment to patient care, teaching, and scholarship is preferred. The UMKC School of Medicine is fully LCME and ACGME accredited and has a major responsibility for teaching medical students and residents. The School of Medicine sponsors over 40 accredited residency and fellowship programs, with nearly 500 residents and fellows, 800-full time faculty, and over 600 students, the majority of which are enrolled in the innovative 6-year combined BA/MD program. UPA is an equal access, equal opportunity, affirmative action employer that is
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fully committed to achieving a diverse faculty and staff. Faculty appointment and salary are commensurate with experience. A competitive salary and fringe package is offered. Applications will be accepted until the position is filled. J-1 and H-1B candidates will be considered. To learn more, contact Beth Briggs at (800) 678-7858 or via email: [email protected]. ID#146840DE.
Neurologists Well-established, quality oriented neuroscience group seeks to add additional neurologists to our team. Opportunity for a rehabilitative neurologist, pediatric neurologist, MS specialist, and general neurologist. We are a multidisciplinary neuroscience group providing a strongly team oriented environment and opportunities for professional growth. Our location offers easy access to the cultural institutions of Boston, the mountains, the ocean, as well as outstanding private and public school opportunities for children. Send CV to Howard M. Gardner, MD, Medical Director, New England Neurological Associates, P.C., RIVERWALK, 354 Merrimack Street, Lawrence, MA 01843, or email to [email protected]. Visit us on the web at www.neneuro.com.
Neurologist The Neuro Clinic is looking for a Neurologist to join the group; we are a growing practice dealing in all aspects of Neurology. Currently, we are doing EMG, EEG, Prolong EEG, Doppler’s testing and Sleep studies in our clinic. The Neurologist will be expected to cover hospitals and deal with the clinic patients also. The prospective candidate should be able to do EMG’s and read EEG’s. We have a very cordial work environment and there are chances of growth within the company. The benefits and salary will be in accordance with the market rates. If interested please feel free to fax your resume at (703) 888-3175 or email: [email protected]
UW Madison General Neurologist Applications are invited for a 50% to 100% clinical faculty position(s) in the Department of Neurology at the University of Wisconsin Hospital and Clinics. Three (3) to four (4) days per week in outpatient clinical activities dedicated to general neurology in the Department’s general neurology and community outreach clinics. Clinical duties would also include attending on the inpatient and consultation
services, clinical teaching activities, and participation in community medical education. The majority of effort would be devoted to general neurology but subspecialty interest can be accommodated depending on demand for service and subspecialty background of the applicant. Person would also be involved in triaging and coordinating requests for new patient consults and communication with requesting physicians. Candidates must be board certified or board eligible in neurology and committed to contributing in an active academic department through clinical and teaching activities. Please send curriculum vitae and the names of at least three references to Thomas Sutula, MD, PhD, Neurology Department Chair at [email protected]. Unless confidentiality is requested in writing, information regarding the applicants must be released upon request. The University of Wisconsin is an Affirmative Action/Equal Opportunity Employer.
UW Madison Stroke Neurologist Applications are invited for an assistant professor faculty position in the Stroke Program in the Department of Neurology at the University of Wisconsin Medical School. The position involves patient care, research, and teaching. The stroke section currently consists of 3 energetic, fellowship-trained, vascular neurologists who run a highly-regarded clinical program. We care for the full spectrum of cerebrovascular patients in a highly interdisciplinary manner including neurosurgery, diagnostic and interventional neuroradiology, intensive care and cardiovascular specialists. Nursing, allied health, and administrative support for the program are outstanding. We currently have one telestroke site and will soon be adding several others. The stroke section is very active in neurologic education, and is engaged in both basic science and clinical research. There are ample opportunities for such research both within the department and throughout this world-class university. Candidates must be board certified or board eligible in neurology with additional stroke training or experience. Please send letter of interest and CV and arrange for at least three references to be sent electronically to [email protected]. Unless confidentiality is requested in writing, information regarding the applicants must be released upon request. The University of Wisconsin is an Affirmative Action/Equal Opportunity Employer.
October 26–28Early Registration Deadline: October 1, 2012
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