Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine.

PART 1

In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim.  It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum.

PART 2 

Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine.

PART 1

In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim.  It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum.

PART 2 

Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.

Megan Conklin serves as Program Manager of Rusk Pediatric Therapy Services, which is part of Hassenfeld Children’s Hospital at NYU Langone Health. She earned her Doctor of Physical Therapy degree from the University of Scranton and has been practicing physical therapy for 15 years, all of them spent at NYU. In 2012, she was awarded the professional designation of board-certified clinical specialist in pediatric physical therapy by the American Board of Physical Therapy Specialties of the American Physical Therapy Association. Since 2017, she also has been a part-time faculty member at the University of Scranton teaching pediatric specialty for the doctoral physical therapy program.

In this interview, she discusses the following topics:  the kinds of pediatric patients she and the rest of a health care team treat and the nature of health problems involved; how therapies provided in the hospital differ from therapies furnished in the early intervention or school settings; challenges for patients with long-term health problems who have to make the transition from pediatric to adult care; how telehealth differs from care provided in the clinical setting; how COVID-19 has affected how health care services are delivered; and description of a case study that was challenging, interesting, and rewarding for both patients and their caregivers.

Dr. Pham is the Section Chief of Infectious Disease at NYU Langone Medical Center. In this interview, he discusses COVID-19 updates, testing, and precautions.

The interview is done by Dr. Lyn Weiss, Chair NYU Winthrop, Nocturnist on COVID + Medicine Unit. 

Dr. Marcalee Alexander specializes in the treatment of patients with spinal cord injury. In 2019 she and her husband Craig took a break from full-time practice to educate people about climate change and disability by starting a walk from Canada to Key West to bring attention to issues of persons of disabilities in climate change by educating both professionals and communities. Along with being the first female president of the American Spinal Injury Association, Dr. Alexander has published more than 125 articles and chapters in professional journals and is currently the editor of the journal Spinal Cord Series and Cases. Throughout most of her career, her research has focused on sexuality and spinal cord injury and she is known for performing significant laboratory-based research outlining the impact of specific neurologic injuries on sexual responses. Over the past 15 years she also has had an interest in telemedicine, and she currently has a sexuality telehealth clinic at Spaulding rehabilitation hospital. At present, she also is working on a summit in 2021 to bring together leaders from the climate change and disabilities fields. In conjunction with this work, she started a nonprofit called Telerehabilitation International with a mission to bring attention to climate change and disability and to use telemedicine to start a volunteer network of physiatrists to provide consults for persons with disabilities in areas of disaster relief. A graduate of Jefferson Medical College, she completed her residency in physical medicine and rehabilitation there. 

This is part 2 of a 2-part series, in which she discusses examples of the kinds of consequences from a health perspective that stem from weather-related events of varying lengths of time;  ways in which climate change has the potential to result in the increased incidence of infectious diseases; whether climate change warrants any alterations in how rehabilitation health professionals are educated; kinds of core competencies that would serve as a suitable basis for such education; current status of efforts to educate rehabilitation professionals about the impact of climate change on health; kinds of mechanisms it would be advantageous to establish to advance educational efforts; and types of studies that would benefit the field of rehabilitation benefit on the topic of climate change. 

Dr. Marcalee Alexander specializes in the treatment of patients with spinal cord injury. In 2019 she and her husband Craig took a break from full-time practice to educate people about climate change and disability by starting a walk from Canada to Key West to bring attention to issues of persons of disabilities in climate change by educating both professionals and communities. Along with being the first female president of the American Spinal Injury Association, Dr. Alexander has published more than 125 articles and chapters in professional journals and is currently the editor of the journal Spinal Cord Series and Cases. Throughout most of her career, her research has focused on sexuality and spinal cord injury and she is known for performing significant laboratory-based research outlining the impact of specific neurologic injuries on sexual responses. Over the past 15 years she also has had an interest in telemedicine, and she currently has a sexuality telehealth clinic at Spaulding rehabilitation hospital. At present, she also is working on a summit in 2021 to bring together leaders from the climate change and disabilities fields. In conjunction with this work, she started a nonprofit called Telerehabilitation International with a mission to bring attention to climate change and disability and to use telemedicine to start a volunteer network of physiatrists to provide consults for persons with disabilities in areas of disaster relief. A graduate of Jefferson Medical College, she completed her residency in physical medicine and rehabilitation there. 

This is part 1 of a 2-part series in which she discusses what inspired her interest in how climate change influences individual and community health status; how individuals with spinal cord injury (SCI) might be at a heightened risk to experience adverse health impacts from climate change; the degree to which mental health impacts should be taken into account when discussing climate change; and how various sub-groups, such as individuals who are characterized by having low-income, being geographically isolated, living in poor housing conditions, and who differ on the basis of age, gender, level of frailty, and presence of chronic disease might be affected differently by climate change.

Join us for this special edition of a Grand Rounds given by multiple presenters entitled: Wounds after COVID-19: Understanding Pathophysiology, Assessment, Treatment and Nomenclature. 

Join us for this special edition of a Grand Rounds given by multiple presenters entitled: Wounds after COVID-19: Understanding Pathophysiology, Assessment, Treatment and Nomenclature. 

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro. 

Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).

William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.

Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.

The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs

This interview is a special front-line discussion with Dr. John Corcoran, William Finley, and Vincent Cavallaro. 

Dr. John Corcoran is the Site Director for Rehabilitation Therapy Services and Director of Inpatient Therapy Services at NYU Langone Health - Rusk Rehabilitation. He is a CARF Medical Rehabilitation Surveyor and surveys rehabilitation hospitals both nationally and internationally. He is a Clinical Assistant Professor in the Department of Rehabilitation Medicine, NYU Grossman School of Medicine - specializing in rehabilitation, critical care rehabilitation and pain rehabilitation. His Doctor of Physical Therapy Degree is from Long Island University Health Sciences Center and he won the Division of Physical Therapy Academic Excellence Award. He has won two awards at the NYU Langone Health Annual Quality and Safety Day (2015) for his work on Early Mobilization (lead author of the team award) and the Children’s Hospital Safety Network Fall Prevention Program (team award).

William Finley is the Program Manager of the Safe Patient Handling and Mobility Department at NYU Langone Health and is on the faculty at NYU Medical Center. He received his Master’s Degree in Occupational Therapy and Bachelor’s Degree in Health Science from Quinnipiac University. He obtained his Master’s of Business Administration degree with a dual specialty in Accounting and Health Care Administration from the University of Scranton. He has over a decade of experience as an occupational therapist in acute care and outpatient orthopedics and sports medicine. The focus of much of his research relates to biomechanics of the upper extremity and safe patient handling. His other professional interests include healthcare informatics, program development, and value based practice.

Vincent Cavallaro serves as a Vice President for hospital operations at NYU Langone Hospital – Brooklyn. He began his career as a staff physical therapist at Lutheran Medical Center in 1981. He was instrumental in the development and regulatory planning of a 30-bed Inpatient Rehabilitation Facility (IRF). He assumed various roles across the rehabilitation continuum in Acute Care, IRF, Subacute, Homecare and Outpatient services. He was chiefly responsible for operationalizing multiple outpatient Rehabilitation therapy sites within the Lutheran Family Health Center Network. He assumed operational responsibilities for Neurology and Epilepsy services as the Vice President of Hospital Operations for Neurology and Rehabilitation Services. Lutheran Medical Center underwent a merger with NYU Langone Health. His degree in physical therapy is from SUNY Downstate.

The three interviewees discussed the following: the technique of prone positioning; differences between proning in the ICU vs. proning of acute care patients; challenges in treating coronavirus patients; different stages when occupational therapy and physical therapy are most effective when coronavirus patients are hospitalized; engaging with patients using telehealth; differences between providing hands-on care in a clinical setting and a telehealth approach for treatment; stresses and strains being experienced by caregivers; specific challenges that must be addressed in treating patients with different personal characteristics, such as age; questions that arise worth pursuing in future research studies; and based on experiences working with coronavirus patients, what could possibly be incorporated in occupational therapy and physical therapy education programs

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

This discussion is a special presentation from Rusk Rehabilitation that features a group of faculty and staff battling the pandemic on the front lines at the middle of the epicenter in New York City. 

Questions from around the country are answered in this exciting and extremely important episode!

Please excuse any issues with sound. 

Dr. Jeffrey Fine serves as Vice Chairman of NYU Langone Health Brooklyn Rehabilitation & Rusk Rehabilitation Network Development. He is a clinician educator and administrator who has been practicing in academic medicine at Level I Trauma Center teaching hospitals for over 20 years. Dr. Fine is chairperson of the VBM ICU early mobilization program at NYU Langone Hospital Brooklyn and also chairperson of the  Brooklyn brain injury outpatient care planning team. He holds four certifications from the American Board of Medical Specialties in the following areas: Physical Medicine & Rehabilitation; Spinal Cord Injury; Brain Injury Medicine; and Pain Medicine. He also has published several articles regarding patient safety during transitions of care including communication during handoffs, and identification/reconciliation of barriers to safe community discharge with resultant enhanced patient satisfaction. His medical degree is from New York Medical College and he completed his residency at Mount Sinai School of Medicine in New York City. Among his many prestigious awards, on more than one occasion he was honored as Best Teacher Of The Year in the Department of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai.

In this interview, Dr. Fine discusses the following: kinds of patients he is treating for COVID-19; patient pathways to arrive for treatment; differential susceptibility of patients entering the health care setting on the basis of age, gender, socioeconomic factors, genetic variations and other characteristics, such as preexisting conditions like diabetes; whether accurate predictors are being employed, along with any kinds of measures or rating scales to help distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; access to all necessary therapies, including those considered still at an experimental stage of effectiveness; role of telehealth in treating COVID-19; possible impact on daily activities of wearing full-body PPE by clinicians in the hospital; and how as a health professional life may have changed since the appearance of COVID-19.

Dr. Brian Im serves as director of brain injury rehabilitation at the Rusk Rehabilitation Institute at NYU Langone Health. He is heavily involved in program development and academic medicine. He has an active role in TBI research with a focus on studying health care disparities and differences that exist in traumatic brain injury care for different populations. After completing medical school at SUNY, Syracuse, a rehabilitation residency at NYU School of Medicine/Rusk Rehabilitation, and a fellowship in brain injury medicine at UMDNJ/Johnson Rehabilitation Institute, his subsequent tenure at Bellevue Hospital focused upon an interest in improving brain injury rehabilitation for underserved populations.

In this episode, Dr Im discusses the kinds of patients he has been treating for COVID-19, after-effects that are caused or associated with the onset of coronavirus that might not have occurred in the absence of a COVID-19 infection; patterns that characterize these patients; when triage becomes necessary; whether any kinds of measures or rating scales are being used at Rusk as a means of helping to distinguish patients who can expect to be discharged to their homes compared to individuals with more life-limiting medical conditions; whether accurate predictors exist to help determine whether a patient’s condition may be prone to deteriorate rapidly as opposed to achieving recovery eventually from what ails them; if Rusk has access to all necessary therapies, including those considered still at an experimental stage of effectiveness; if wearing full-body PPE in the hospital results in physical barriers that hinder personal activities; ways is which his life has changed since the appearance of COVID-19; and whether telehealth plays a role in treating either patients who have been discharged after being treated for COVID-19 or patients who already were being treated by Rusk clinicians prior to the outbreak of that disease.

Dr. Naomi Gerber serves as the Director of Research for the Department of Medicine at Inova Fairfax Hospital in Virginia and the Outcomes Program at the Beatty Center for Integrated Research. After graduating from Tufts University School of Medicine, Dr. Gerber completed two residencies in internal medicine and rehabilitation medicine and a fellowship in rheumatology. She served as the Chief of the Rehabilitation Medicine Department at the Clinical Center, National Institutes of Health in Bethesda, Maryland and was instrumental in helping to develop the sub-specialty of rehabilitative rheumatology. In 2006, Dr. Gerber joined the faculty of George Mason University in the Health Administration and Policy Department and is co-director of the Laboratory for the Study and Simulation of Human Movement. 

Listeners to Part 1 of Dr. Gerber’s presentation will recall that she talked about fatigue in the context of proteomics, performance, and perception. In Part 2, she began by asking how do we separate central fatigue from depression? It is a difficult question and may be why the biosignatures are so important. From a clinical perspective, sad and despairing feelings, anhedonia, really is the hallmark of depression. It’s not the hallmark of central fatigue, which is a different pathway. Many important factors here originate in the liver. We need to be attentive to the way we measure the specifics of both peripheral and central fatigue. We have objective measures that are quantitative and we have self-reports. Both are needed, along with observer-recorded reports to obtain a full picture of what we mean by fatigue. A perfect fatigue instrument has not been found yet. She described the fatigue severity scale and indicated some of its deficiencies. She also described the kinds of procedures undertaken in her laboratory to obtain a fuller understanding of fatigue. She indicated who can be considered fatigued. It’s usually women, individuals who are less active, who are obese or overweight, who are smokers with more than moderate alcohol intake, often complaining of depressed symptomology, and they are anxious. In her view, metabolic issues are under appreciated by our specialty.