2019 February AANnews by American Academy of Neurology

VOLUME 33 · ISSUE 2 · FEBRUARY 2019

PROPOSED SLATE OF AAN BOARD OF DIRECTORS NOMINEES ANNOUNCED Vote on May 4 at Business Meeting The AAN Nominations Committee, chaired by former AAN President Timothy A. Pedley, MD, FAAN, has announced the slate of nominees for AAN officer and director positions for the 2019–2021 term.

Stevens

Sacco

Avitzur

Tilton

Jackson

Miyasaki

Officers:

President Elect | Orly Avitzur, MD, MBA, FAAN Vice President | Ann H. Tilton, MD, FAAN Secretary | Carlayne E. Jackson, MD, FAAN Treasurer | Janis M. Miyasaki, MD, MEd, FRCPC, FAAN The current President Elect, James C. Stevens, MD, FAAN, will begin his term as President on May 11, 2019. The current President, Ralph L. Sacco, MD, MS, FAHA, FAAN, will then serve on the Board of Directors as Immediate Past President. Continued on page 7

›

Passion + Purpose = Power

Career-focused Program Tracks Provide Curated Content

Apply for the 2019 Palatucci Advocacy Leadership Program

Don’t miss these specially curated course lineups, designed to help maximize your time at the Annual Meeting based on your career path and interests.

Do you see opportunities to create change in your practice, institution, or the health care of your community? The AAN can help you develop the advocacy skills you need to harness your passion for neurology with a strongly articulated purpose to produce the most powerful advocate you can be.

NEW Academic Medicine

The 17th annual Palatucci Advocacy Leadership Forum will take place July 18 to 21, 2019, at the Rancho Bernardo Inn near San Diego, CA. The AAN is accepting applications for this intensive four-day program until March 4. The forum provides the tools and resources to be successful in implementing an action plan and establishing critical relationships with legislators, colleagues, and the media to make a difference in the lives of your patients. More than 400 AAN members have graduated from the forum and are Continued on page 19

Experiential Learning Areas Offer Out-of-the-box Learning

Provides a variety of offerings for academic neurologists across career roles and stages. Programming will cover faculty development, leadership, research, team building, career development, improving communication, and more.

Business of Neurology

›

Perfect for individuals interested in starting a new practice or learning the fundamentals of neurology business.

February 13 Is Last Chance to Submit Emerging Science Abstracts

Continued on page 9

Last Call: Brainstorm Competition Entries

›

In Multiple Sclerosis–

THE ART OF BRAIN PRESERVATION Adding Grey to the Palette Completes the Picture

GREY MATTERS, TOO

AANnews · February 2019

CONTENTS

News Briefs

Cover Proposed Slate of AAN Board of Directors Nominees Announced Passion + Purpose = Power Career-focused Program Tracks Provide Curated Content President’s Column AAN’s 2018 a Resounding Success for Members, Neurology · · · · · · · · · · · · · · 4 Conferences & Community Experiential Learning Areas Offer Out-of-the-box Learning · · · · · · · · · · · · · · 5 February 13 Is Last Chance to Submit Emerging Science Abstracts · · · · · · · · · · · · · · 5 New Series Explores Inspiration and Innovation on Global Scale · · · · · · · · · · · · · 7 Last Call: Brainstorm Competition Entries · · · · · · · · 9 Do You Qualify for Prestigious Fellow (FAAN) Status? · · · · · · 11 Newly Envisioned Neuro Center Is Hub for Daily Discovery · · · · · · · · · · · · · · 11 Strengthen Your Team, Care with Specially Priced Memberships for Advanced Practice Providers · · · · · · · · · 11 Tools & Resources AAN Calls for Uniformity of Brain Death Determination · · · 12

Marilu Henner Shares Memory-improving Skills · · · · 12

Registry Grew in Participation, Value in 2018 · · · · · · · · · · · · 14

A record number of residents registered for the 2019 RITE® exam, which will be offered online for the first time this year. A total of 3,145 residents are registered for the exam, which will take place February 12 through February 17.

Journal Takes Aim at Warfare and Neurologic Injuries · · · · · · 14

Drug Pricing

Neurology Compensation and Productivity Survey to Launch March 11 · · · · · · · · · 13

AAN Collaborates with Verana Health to Improve Treatments and Discover Cures for Neurologic Disease · · · · · · · · 15 Academy Launches Pilot Program to Promote Quality Improvement · · · · · · · 16 The AAN’s Role in Advancing Coding and Reimbursement for Neurology · · · · · · · · · · · · 17 Are You Taking Advantage of These Practice Management Resources? · · · · · · · · · · · · · 18 Policy & Guidelines · · · · · · · · · 19 Capitol Hill Report · · · · · · · · · 19

Fellowship Programs Receive UCNS Accreditation · · · · · · · 25 New Diplomates Certified in Headache Medicine · · · · · · · · 25 Careers · · · · · · · · · · · · · · · · · 26

The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction. Contact Information

For advertising rates, contact:

American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415

Eileen R. Henry Wolters Kluwer Health | Medical Research Lippincott, Williams & Wilkins

Email:

memberservices@aan.com

Website: AAN.com

Drug pricing is a top regulatory advocacy priority for the AAN. The Academy recently contributed regulatory responses to two major drug pricing rules. The first set of comments was in support of a proposed rule that would increase drug price transparency by requiring pharmaceutical manufacturers to disclose drug list prices in direct-toconsumer advertising. The second set of comments expressed concern with a proposal to implement a mandatory model that would benchmark payment for Part B drugs against an index of international prices. 

Education & Research Get Up-to-date on Dementia with Continuum · · · · · · · · · · 25

The Vision of the AAN is to be indispensable to our members.

Phone: (800) 879-1960 (toll free) (612) 928-6000 (international)

RITE Exam

Phone: (732) 778-2261 Email: Eileen.Henry@wolterskluwer.com

AAN Executive Director: Catherine M. Rydell, CAE Editor-in-Chief: John D. Hixson, MD Managing Editor: Angela Babb, CAE Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designer: Siu Lee Email: aannews@aan.com

AANnews is published monthly by the American Academy of Neurology for its 34,000 members worldwide. Access this magazine and other AAN publications online at AAN.com/go/elibrary. The American Academy of Neurology ’ s registered trademarks and service marks are registered in the United States and various other countries around the world. “American Brain Foundation” is a registered service mark of the American Brain Foundation and is registered in the United States.

President’s Column

AAN’s 2018 a Resounding Success for Members, Neurology Would A.B. Baker, the AAN’s founder and first president, recognize what has become of the organization he launched in 1948 with 50 charter fellows and 326 active members? Would he be astounded that our membership has grown to 35,000 and includes not only neurologists and neuroscience professionals, but business administrators and advanced practice providers as well? Could Doris McKinley, the Academy’s first executive secretary who worked from her small home and stored membership cards in a box in her oven, fathom leading a staff of 200 dedicated professionals who go the extra mile to ensure that our members benefit from the highest quality events, products, and services that enable them to Sacco succeed? How would Stanley Nelson, our first executive director who managed a staff of three in 1966, react to seeing it now takes scores of staff and member volunteers to deliver an innovative week-long Annual Meeting that attracts 14,000 attendees? As the AAN celebrated its 70th anniversary in 2018, it continued a path of strategic growth and broke records as we: Demonstrated the value of the AAN by achieving several membership records: 96-percent retention of US neurologist members 91-percent retention of US neurologists early in their career (five years or fewer) Record number of medical student members Record number of advanced practice provider members Record number of international members

Achieved one of our largest regulatory advocacy wins by successfully lobbying to delay proposed cuts to the E/M codes—we hope you read our plea in the Washington Post Achieved record attendance at our Annual Meeting in Los Angeles and the Sports Concussion Conference in Indianapolis Welcomed 70 percent of US neurologist members visiting the redesigned and personalized AAN.com Redefined the look and feel of Continuum® with a bright, modern design and complementary website to appeal to its record 13,700 subscribers Made it easier for members to digest the superlative content in Neurology ® with a sleek new look, format, and digital experience Secured actress Sharon Stone to grace the inaugural cover of Brain & Life® magazine for patients and caregivers and the new BrainandLife.org website Published a fourth study on neurologist burnout through the Wellness Task Force Expanded the Axon Registry® to nearly 1,150 members Implemented task force recommendations to address health care disparities

Grew participation in the AAN’s 56 SynapseSM online communities to more than 20,000 members Created a new learning management system to help members learn from anywhere in the world Addressed the high costs of neurologic drugs through the Drug Pricing Task Force Hosted more than 100 neurology department chairs at the first Neurology Chair Summit to discuss issues facing academic medicine Launched an academic year membership so Junior members can receive benefits, including their AAN publications, immediately in July Applied 86 cents of every dollar to member benefits Only a handful of these efforts, like the Annual Meeting, the journal, and member recruitment, would have been on our predecessors’ radars. The Academy evolves and grows as your needs change. What remains constant is the AAN’s desire to be an invaluable part of your professional life, your personal success, and your expert care for your patients. You can find our Annual Report online at AAN.com/view/ annualreport. We hope you enjoy reading about our many accomplishments in 2018, and that we see you at the 2019 Annual Meeting in Philadelphia! 

Ralph L. Sacco, MD, MS, FAHA, FAAN President, AAN rsacco@aan.com @DrSaccoNeuro on Twitter

Conferences & Community

Experiential Learning Areas Offer Out-of-the-box Learning Visit all seven experiential learning areas throughout the week and throughout the Pennsylvania Convention Center for out-of-the-box learning experiences. 2019 audiences can expect a fresh lineup of fun and innovative presentations that will employ various teaching and presentation styles and compelling visuals to push the boundaries of storytelling, learning, reflection, and engagement even further. For a full experiential learning area schedule, visit AAN.com/view/19AMSearch.

Advocacy to Action: Empowering Patients and Physicians Learn about legislative priorities, find out how you can get involved in advocacy activities, and network with successful advocates. Highlights include: Meet a Member of Congress—US Representative Brendan Boyle (D-PA) will visit on Monday, May 6, from 12:00 p.m. to 1:00 p.m. to provide a health care update and answer your questions Advocacy Booth—Find out about priority issues, successes, and training programs Presentation Stage—Learn about advocacy priorities and how to get involved BrainPAC Booth—Meet with federal advocacy staff and show your support Polling Station—Tell us what matters most to you—your voice can make a difference Involvement Opportunities—Find out how you can stay informed with Capitol Hill Report or by attending the popular Neurology on the Hill, Neurology off the Hill, and the Palatucci Advocacy Leadership Forum

Maximizing Your Value: Maximize Your Team, Maximize Your Tools, Maximize Yourself

Discover AAN practice management tools and techniques to create more efficient neurology practices, regardless of practice level. Learn how to increase revenue, improve business strategies, identify strategies for better adherence to reimbursement and payment policies, maximize technology, and minimize burnout due to increased administrative burden. Highlights include: Practice Programs—Learn about telemedicine; the benefits of team-based care; shared decision-making; the Neurology Compensation and Productivity Survey; 2019 Practice Management Webinars; and more Resident-specific Education—Visit the ELA stage at 8:00 a.m. daily for a talk on practice management tailored specifically for residents and trainees

Axon Registry®—Discover the benefits of the registry for research and improved patient treatment, and sign up to participate AAN Guidelines—Hear from experts on the latest evidence-based guidelines to help you make decisions on treatment options Quality Measures—Find out how AAN measures and quality improvement (QI) products can be used to meet MACRA/QPP requirements, and learn about AAN and CMS resources to support participation in MIPS MACRA/QPP—Learn how you can improve competency and adherence to regulations that determine your Medicare reimbursement Coding—Hear about the changes to CPT and E/M coding effective January 1, 2019, and learn how these coding changes happen

Experience the AAN: Make the Most of Your Membership Connect, engage, and personalize your member experience to make the most of your Academy. Highlights include: Professional Headshots—Get your picture taken between 11:30 a.m. and 3:30 p.m. Saturday through Tuesday and upload it to your profile, SynapseSM, and social media Synapse Online Communities—Join and engage with others who share your same specialty interests Social Media—Get engaged and spark conversations with attendees and social media influencers Recognition Wall—Check out and congratulate your deserving colleagues FAAN Status—See if you qualify for this prestigious membership designation AAN.com—Learn how to get the most out of this invaluable resource 

February 13 Is Last Chance to Submit Emerging Science Abstracts

FEBRUARY

Don’t wait: If you’ve conducted major research since October 22, 2018, then be sure and submit your abstract for the 2019 AAN Emerging Science program by no later than February 13! The submission fee is $100 for AAN member first authors, $200 for nonmember first authors, and free for Junior and Student member and nonmember first authors. Submit online at AAN.com/view/19Abstracts or contact Callie Barnette at cbarnette@aan.com or (612) 928-6147 with questions. 

AANnews • February 2019 5

Why Do You Want To Be At The Worldâ&#x20AC;&#x2122;s Best Neurology Conference? A new, innovative, high-quality science experience Customizable, experiential, and inspirational education and CME opportunities Unparalleled networking opportunities with your community of 14,000+ neurology professionals from around the globe Unique and creative experiences in exciting and inspirational formats to fuel your mind, body, and spirit Register by March 7 for the best rates. AAN.com/view/AM19

ADVANCING NEUROLOGY. ADVANCING YOU.

Conferences & Community

New Series Explores Inspiration and Innovation on Global Scale A series of three new Annual Meeting talks, called Advancing Medicine: Inspiration and Innovation, will explore where neuroscience intersects with global themes. From bionics to the Flint water crisis, and even social morals, these unique talks will engage audiences through powerful and timely discussion. Topics and speakers include: Hugh Herr, PhD The New Era of Extreme Bionics Saturday, May 4, at 6:00 p.m. Herr, who heads the Biomechatronics group at the MIT Media Lab, is creating bionic limbs that emulate the function of natural limbs. In 2011, TIME magazine coined him the “Leader of the Bionic Age” because of his revolutionary work in the emerging field of biomechatronics— technology that marries human physiology with electromechanics. Free food and beverages will be available immediately following Herr’s talk during the Annual Meeting’s Opening Reception.

Mona Hanna-Attisha, MD, MPH What the Eyes Don’t See: Stories from the Frontlines of the Flint Water Crisis Monday, May 6, at 1:00 p.m.

Patricia Churchland The Origin of Moral Intuitions Wednesday, May 8, at 1:00 p.m. Churchland has contributed to the fields of neurophilosophy, philosophy of the mind, and neuroethics. Her research has centered on the interface between neuroscience and philosophy with a current focus on the association of morality and the social brain. Dr. Churchland is a professor emeritus of philosophy at the University of California, San Diego and adjunct professor at the Salk Institute. 

Hanna-Attisha is a pediatrician, professor, and public health advocate whose research exposed the Flint water crisis. Her bestselling book, What the Eyes Don’t See: A Story of Crisis, Resistance, and Hope in an American City, is a fascinating account of a shameful disaster that became a tale of activism and hope. A limited number of free books will be available to attendees along with copies for purchase.

Proposed Slate of AAN Board of Directors Nominees Announced continued from cover

Directors:

Brenda Banwell, MD, FAAN Sarah M. Benish, MD, FAAN Charlene Gamaldo, MD, FAAN James N. Goldenberg, MD, FAAN Jonathan P. Hosey, MD, FAAN Elaine C. Jones, MD, FAAN Shannon M. Kilgore, MD, FAAN Brett M. Kissela, MD, MS, FAAN Thomas R. Vidic, MD, FAAN

The following additional directors will serve as ex officio directors beginning on May 11: Nicholas E. Johnson, MD, FAAN Chair, Advocacy Committee (ex officio) Brad C. Klein, MD, MBA, FAAN Chair, Medical Economics and Practice Committee (ex officio) Gregory D. Cascino, MD, FAAN Chair, Member Engagement Committee (ex officio) Robert A. Gross, MD, PhD, FAAN Editor-in-Chief of Neurology ®

Catherine M. Rydell, CAE Executive Director/CEO (ex officio, non-voting)

Robert A. Gross, MD, PhD, FAAN Editor-in-Chief of Neurology (ex officio) Catherine M. Rydell, CAE Executive Director/CEO (ex officio, non-voting)

The Academy is comprised of two legal entities, the AAN and the AAN Institute. Most of the elected members of the AAN Board of Directors also serve ex officio on the Board of Directors of the AAN Institute, which includes an independent secretarytreasurer and additional members who serve in ex officio capacities. The AAN Institute Board of Directors will continue to include the following members: Charles C. Flippen II, MD, FAAN AAN Institute Secretary-Treasurer Natalia S. Rost, MD, MPH, FAAN, FAHA Chair, Science Committee (ex officio) Lyell K. Jones, Jr., MD, FAAN Chair, Quality Committee (ex officio) A. Gordon Smith, MD, FAAN Chair, Education Committee (ex officio)

The slate of nominees will be presented to the voting membership for approval during the AAN’s 2019 Business Meeting on Saturday, May 4, 2019, at 3:00 p.m. during the Annual Meeting in Philadelphia, PA. Members are encouraged to attend the Business Meeting and participate in this election and other matters, including reports from officers on the accomplishments of the AAN during 2018 and a review of the organizations’ fiscal health. Visit AAN.com/view/BOD to see the full slate of candidates and their bios. For more information, contact Karen Kasmirski, Executive Assistant, at kkasmirski @aan.com or (612) 928-6118. 

AANnews • February 2019 7

Conferences & Community

Committee Chairs Weigh in on What Makes Annual Meeting So Unique AANnews interviewed Science Committee Chair Natalia S. Rost, MD, MPH, FAAN, FAHA; Conference Subcommittee Chair Joseph I. Sirven, MD, FAAN; Medical Economics and Management Committee Chair Orly Avitzur, MD, MBA, FAAN; and Practice Committee Chair Heidi Schwarz, MD, FAAN, to learn more about the roles of their committees and subcommittees in helping to make the 2019 Annual Meeting the go-to meeting for all neurology professionals. As chair of the Science Committee, can you share how its work efforts are reflected in the Annual Meeting? Rost: Science is at the core of the Annual Meeting, and our committee plays a crucial role in developing and overseeing the implementation of the Scientific Program. Every Plenary Session, platform or poster presentation, and even research career development program offering has been thoughtfully selected, thoroughly discussed, and enthusiastically implemented by the members of the Science Committee, leading to what we see year after year—a dynamic, robust, and diverse AAN Annual Meeting Scientific Program. This is a highly satisfying effort for me, and I am certain to the members of my committee. How would you describe the Annual Meeting to a neurologist who has never attended? Rost: The AAN’s Annual Meeting is, in one word, an EXPERIENCE. Whoever you are and whatever career path you are coming from, you will find what you are looking for at the Annual Meeting— and then some. Whether you are looking for cutting-edge neuroscience, educational experience, practice highlights, or career development advice—you got it. The AAN Science Program offers a daily dose of exciting research programs—including our plenaries, Neuroscience in the Clinic sessions, oral platform and poster presentations, and the Invited Science sessions as a highlight of collaboration with the subspecialty societies. To me, a day at the AAN Annual Meeting is worth a year in a neurologist’s life as we are trying to catch up with the dynamic field of neurologic research. At the Annual Meeting, you are instantly immersed and connected. This is a brilliant experience! How are the efforts of the Conference Subcommittee reflected in the Annual Meeting programming? Sirven: The Conference Subcommittee actively responds to the growing and diverse needs of membership. It is so important that the Annual Meeting not be the same experience for attendees year-in and year-out. The Conference Subcommittee is always looking to try new things and experiment with different learning formats, tailor programs for specific audiences, etc., to make every year a fresh new approach to the meeting. By taking this approach, I really feel that anyone attending the meeting can design their own experience to have the greatest impact.

AANnews • February 2019

How has the Annual Meeting evolved over the years to meet the growing diversity of AAN members? Sirven: The meeting underwent a massive redesign in 2016. When designing the meeting, we tried to closely listen to what makes the Annual Meeting indispensable to members. Based on that member feedback, we have increased programming to improve resilience and combat burnout, and designed special programs geared to meet specific needs of individuals, such as offerings in career development, leadership, and wellness. Additionally, we’ve worked to create unique, novel formats (such as Continuing the Conversation programs) and developed a series of clinical programs in Spanish. The philosophy of the Conference Subcommittee is to anticipate the latest changes in neurologic education at the moment they occur, so that we are ahead of the curve for our diverse audience and not have to be reactive. I am excited about programs that are designed to meet the needs of specific demographics within the AAN. For instance, we are offering additional educational opportunities for advanced practice providers, looking at programs designed to meet the needs of neurohospitalists, additional focus on targeted programs to various subspecialties, and doing additional collaborating with our colleagues from the Science Committee and Practice Committee to determine how to best provide programming for attendees with interests in research and the business of neurology. How is the work of the Medical Economics and Management (MEM) Committee reflected in the Annual Meeting programming? Avitzur: One of the committee's top goals has always been the education of members and almost every member of the committee gets involved in teaching at one time or another. MEM has worked hard to expand its repertoire of course offerings over the years to meet the challenges of new members and membership types. It has also worked to meet the growing demand for information from neurologists who are not just private practitioners. The current health care marketplace has led to increasing interest from sources outside of traditional private practice. At the 2019 Annual Meeting, we have created educational opportunities for just about everyone. Can you share a memory about a past Annual Meeting that made an impact on you? Avitzur: In 1999, I was finishing up my MBA and wondering how I should use my newfound business knowledge, when I decided to attend an Annual Meeting. I signed up for a couple of practice

management courses and heard several members of the thenMedical Economics Subcommittee speak about coding, billing, and reimbursement, and I knew in an instant that I wanted to join that group. It's nearly 20 years later but I can still recall my excitement as I listened to them talk about medical economics. Although my first couple of attempts to reach out to its leadership ended in failure, I persisted because I thought it would be a perfect fit...and it was! What new practice-oriented programming elements are you excited about? Schwarz: There are more opportunities to help neurologists develop a relationship with advanced practice providers (APPs) that is effective for patient care and cost-effective care. We’ve talked a lot about educating the APPs and the

importance of team-based care. This year we are expanding into how to operationalize using APPs, giving the tools to both sides (APP and neurologist) to make this a relationship a win-win. We’re evolving the Live Well, Lead Well programs to be open to more people than just the initial program to help promote resilience. How would you describe the Annual Meeting to a neurologist who has never been before? Schwarz: It’s like being a kid in a candy shop—so many opportunities of interest to appeal to you and so many opportunities for interactions. There’s so much to take in. I suggest using the mobile app before you go to highlight the activities you really don’t want to miss. The app helps you keep a few things high on your priority list. The Annual Meeting offers the most interaction. It is a rich community of people interested in your same passions. It’s the opportunity for a chance encounter…the ability to find a collaborator, a mentor, someone who likes your passion. 

Career-focused Program Tracks Provide Curated Content continued from cover NEW Career Essentials Whether you are early in your career and seeking help with career development, looking to launch into private practice or academics, or interested in the finer points of financial planning and wellness, this track is for you.

Foundations of Clinical Neurology

Created for advanced practice providers who are new to neurology, this track focuses on laying the foundations for success in clinical neurology.

Neurohospitalist

Created specifically for neurohospitalists whose primary focus is inpatient care, or for anyone who would like to learn more about the care of hospitalized patients, this lineup covers everything from prevention, telestroke, critical care monitoring and consultations, and issues encountered in the ICU.

Spanish-language Curriculum

Look for education courses, scientific updates, and experiential learning area talks on a wide range of topics including MS, teleneurology, transnational research opportunities, and the challenges and opportunities of different career paths in neurology— all taught entirely in Spanish. Also of special interest to both Spanish and English speakers is a new experiential learning area program on cross-cultural communication that will be taught in English.

NEW Futures in Neurological Research

This track offers both formal coursework and learning sessions to round out research-interested trainees’ Annual Meeting experience. Look for popular events such as the Futures in Neurology Boot Camp, Luncheon, and Subspecialty Mentoring Sessions. For more information, visit AAN.com/view/19AMSearch. 

Last Call: Brainstorm Competition Entries If you have an innovative solution to challenges related to patients, practice, or any other medicalrelated issue—we want to hear it! March 1 is the last chance to submit your groundbreaking idea to the highly popular Brainstorm: A Competition for the Innovator in All of Us, set to take place on Monday, May 6, from 4:00 p.m. to 5:30 p.m. at the Innovation Hub presentation stage during the Exhibit Hall Networking Reception. The game-style event offers at least two finalists the opportunity to present their original ideas on stage, before a panel of AAN judges, with the grand-prize winner taking home $1,500 and a consultation with the AAN Business Innovation team. Visit AAN.com/view/19AMBrainstorm to submit your idea today via a video no more than 90 seconds long, giving a brief description of the challenge and solution. 

AANnews • February 2019 9

my heart loves

YOUR BRAIN

This Valentineâ&#x20AC;&#x2122;s Day

honor your family or loved one with a gift that supports brain research. AmericanBrainFoundation.org/MyValentine

Conferences & Community

Do You Qualify for Prestigious Fellow (FAAN) Status? Elevating your AAN membership by adding the prestigious FAAN designation to your credentials acknowledges your exemplary work and achievements in the neurosciences, the clinical practice of neurology, or academic/administrative neurology. FAAN designation not only sets you apart within the Academy and throughout your professional career, but only FAAN members are eligible to serve on the AAN Board of Directors—a unique opportunity that could allow you to have a significant impact on the future direction of the AAN. Visit AAN.com/view/FAAN to see if you qualify and to apply, or consider nominating a deserving colleague.

If you have questions about Fellow status, how to nominate, or the application process, contact FAAN @aan.com or (800) 879-1960. 

Congratulations to Recent FAANs!

Congratulations to all new FAAN members in 2018. See who joined this esteemed community by visiting AAN.com/view/FAAN for a full listing. 

Newly Envisioned Neuro Center Is Hub for Daily Discovery Be sure to check out the new Neuro Center each day of the 2019 Annual Meeting. This newly imagined Annual Meeting hub combines presentations, exhibits, an experiential learning area, and more into a single destination in Exhibit Halls B-E of the Pennsylvania Convention Center. Don’t miss: Scientific Poster Presentations— Visit the Poster Neighborhoods and network with colleagues while learning about the latest breakthroughs in neurologic research. Innovation Hub—Enjoy daily Wine and Paint Sessions and innovative physician-led presentations in this experiential learning area.

ePoster Presentations—Interactive presentations on digital monitors feature videos, 3D models/graphics, and more.

Exhibits—Hear about the latest in the field, learn about career opportunities, find patient resources, and more.

Charging Areas—Relax and recharge—both yourself and your phone—before your next course.

Lunch and Picnic Space—Registered attendees can select from a variety of nutritious lunch options, and the AAN’s picnic space offers fun each day the Exhibit Hall is open, including music, bingo, and more. 

Buzz Cafes—Take a break with your colleagues with complimentary coffee and comfy seating.

Strengthen Your Team, Care with Specially Priced Memberships for Advanced Practice Providers Advanced practice providers (APPs) can impact a neurology practice in many ways by increasing patient volume, improving quality of care, and improving physician focus. If you have APPs on your neurology team, did you know they can take advantage of specially priced AAN memberships that provide them with incomparable career support and essential resources that can help strengthen their knowledge and skills in neurology—which can in turn strengthen your practice and patient care? The specially priced $270 PLUS membership represents the best value for your APPs by offering exclusive opportunities to: Complete online education courses through the AAN at no additional cost Access the Neurology ® journal, Neurology ® Clinical Practice, and Neurology Today ® Connect with a network of advanced practice providers, neurologists, and neuroscience professionals worldwide through SynapseSM Online Communities

Visit AAN.com//view/CareTeam to view the full listing of valuable APP member benefits and sign your APPs up today. 

Save big on AAN conference registration, Continuum®, and other AAN products and services A $115 membership level option offers many of the same membership benefits, excluding online education courses, Neurology journal (print and online), and Neurology Today (print).

AANnews • February 2019 11

Tools & Resources

AAN Calls for Uniformity of Brain Death Determination The AAN is calling for uniform brain death laws, policies, and practices in a new position statement published in the January 2, 2019, online issue of Neurology ® at Neurology.org. The position statement is endorsed by the American Neurological Association and the Child Neurology Society.

Russell

Brain death is defined as the death of the individual due to irreversible loss of function to the entire brain. It is the equivalent of circulatory death, which is due to irreversible loss of function of the circulatory system, which includes the heart. The brain death standards for adults and children that are widely accepted by the medical profession are these two guidelines: the AAN’s 2010 Evidence-based Guideline Update: Determining Brain Death in Adults and the 2011 Guidelines for the Determination of Brain Death in Infants and Children, published by the Pediatric Section of the Society of Critical Care Medicine, the Sections of Neurology and Critical Care of the American Academy of Pediatrics and the Child Neurology Society. The AAN is not aware of any cases in which following these guidelines led to inaccurate determination of death with return of any brain function, including consciousness, brainstem reflexes, or breathing. Yet only the state of Nevada has adopted legislation that requires using these widely accepted brain death guidelines as the medical standard, as authorized by the Uniform Determination of Death Act, for the determination of brain death. “The AAN believes that a specific, uniform standard for the determination of brain death is critically important to provide

the highest quality patient-centered neurologic and end-of-life care,” said position statement author James A. Russell, DO, MS, FAAN, of Lahey Hospital and Medical Center in Burlington, MA, and chair of the Ethics, Law, and Humanities Committee. “The AAN supports the development of legislation in every state modeled after the Nevada statute, which specifically defers to these current adult and pediatric brain death guidelines and any future updates.” The AAN position statement also calls for uniform policies in medical facilities across the country that would ensure compliance to the brain death guidelines. “The lack of specificity in most states’ laws, coupled with inconsistency among brain death protocols in medical facilities, has contributed to differing interpretations by the courts in a few high-profile cases,” said Russell. “The AAN wants the general public to know that when these guidelines are followed, the result is an accurate determination of brain death.” The position statement also supports the development of programs that train and credential physicians that determine death by neurologic criteria and that provide public and professional education regarding brain death and its determination. Recognizing that each case is unique, the AAN position statement also provides guidance to medical professionals when a family may not accept a determination of death of their loved one due to religious, moral, or cultural reasons, and requests continued life support. The position statement states that continuing to provide life support when a person is dead may deprive that person of dignity or provide false hope to the family. 

Marilu Henner Shares Memory-improving Skills Actress Marilu Henner is best known for her role in the legendary TV show Taxi. But she also is recognized for her highly superior autobiographical memory, a rare condition shared by only 100 people in the world. She’s been featured on 60 Minutes and has participated in clinical research to determine how memory skills like hers can help others with cognitive disorders such as Alzheimer’s disease. She’s also written books about how to improve memory. In the February/March issue of Brain & Life® magazine, Henner talks about her extraordinary powers of recall and provides helpful tips for retaining memories. Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free. If you would like to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen@ WasteFreeMail.com. All members have online access to the magazine articles and additional resources at BrainandLife.org. Share the website with your patients! 

AANnews • February 2019

F E B R UA

RY/ M A

RCH 20 19

Genetic What At- Tests Home Kit Do and Do s n’t Tell Yo u Essential Therapie Tremor s Strategie and s Th at Make Lif e Easier

Eve has gre rybody memoriaet but I kn s, sometheinw very un g was about musual ine.”

—AC TR

ESS M A R I LU

HENNE

Tools & Resources

Neurology Compensation and Productivity Survey to Launch March 11 The AAN’s Neurology Compensation and Productivity Report is the largest survey and report dedicated solely to the field of neurology, providing insightful practice data to help you benchmark your compensation and performance to make smart business decisions. This valuable data, which will be compiled in the 2019 Neurology Compensation and Productivity Report, is available for free to members who participate—a $600 value! The deadline to complete the survey is May 25. We heard your feedback and have made several changes to the survey this year, making it easier to complete and provide more meaningful data. Improvements include: Compensation and productivity benchmarking for advanced practice providers (APPs) specializing in neurology. As important members of the care team, AAN member nurse practitioners, physician assistants, and other advanced practice providers will be included in the survey collection so you can benchmark your compensation and productivity. Conditional questioning: If a set of questions doesn’t pertain to you, you can skip past them, making the survey less time consuming to complete. New, user-friendly dashboard allowing filtering of the data by subspecialty, geographic region, gender, and more. While we’ve shortened the length of time it takes to answer the survey questions, having specific documentation handy will make your survey experience even better. Start gathering the following documentation now to prepare for the survey in March: Physician salary spreadsheets, W2s, and/or K1s Physician RVU reports Financial and accounting report(s) Payer mix analysis Staff and physician benefits reports EHR and billing system reports (charges and collections) Department, school (for academic centers), and practice reports

All data collected is confidentially secured and used to report only aggregate data. The best part? Access to the new interactive dashboard to benchmark you and your practice is free with survey participation—a $600 AAN member benefit. Watch for details on how to participate. For more information, visit AAN.com/view/BenchmarkReport. Email questions to benchmark@aan.com. 

Did You Know Neurologists’ Compensation Went up by Three Percent from 2015 to 2016? Help us see if this changed in 2018 by completing the Neurology Compensation and Productivity survey, coming in March. 

"This Report includes vital information to advocate for ourselves including negotiations with employers and health care administrators, among other purposes."

AANnews • February 2019 13

Tools & Resources

Registry Grew in Participation, Value in 2018 The Axon Registry® was created by the AAN in 2014 as a tool for neurologists to track the quality of care in their practice. Since 2017, US neurologists have been able to use this free tool to see real-time data for measures relevant to their practice. The registry experienced many successes in 2018 as it continued to grow. Lyell K. Jones, Jr., MD, FAAN, chair of the Registry Committee, said, “In 2018, Axon focused on including measures for subspecialists, validating the data within the database, and establishing itself as a leader in promoting Patient Reported Outcomes. With the movement to value-based systems of care, Axon is positioned to be an invaluable tool for neurologists to achieve success.” To make the Axon Registry relevant for the many subspecialties within neurology, the number of measures in the registry expanded in 2018. There are 11 subspecialties included in the registry and multiple measures that are cross-cutting. The various disease states include epilepsy, Parkinson’s disease, dementia, distal symmetric polyneuropathy, headaches, multiple sclerosis, sleep, child neurology, amyotrophic lateral sclerosis, essential tremor, and ophthalmology. There are multiple process measures, outcome measures, high-priority measures, and newly integrated Patient Reported Outcomes. The American Board of Psychiatry and Neurology (ABPN) has approved the Axon Registry as a maintenance of certification Part IV PIP clinical module activity, and the registry can be used for up to eight credits of Part II Self-assessment. Providers that have fully integrated with Axon can reap the benefits of participation for those certification purposes.

the Registry Committee is preparing to use the data to identify gaps in care to assist in improving the quality of care in neurology. A large data validation plan was executed in 2017 and follow-up on the results was completed in 2018. The registry data covers a wide breadth of neurology practices, Jones from solo practitioners to large academic centers and using more than 33 electronic medical record (EMR) systems. Also, in 2018 the AAN registry vendor, FIGmd, Inc., signed a contract with Epic to be a third-party vendor. In pilot testing, this will create an easier data transfer method for practices using Epic as their EMR. The Axon Registry has applied, and was approved, to be a Qualified Clinical Data Registry for the fourth year in a row. The Axon Registry can be used by participants to meet up to three reporting requirements for the MIPS track of the Quality Payment Program. Once providers receive a dashboard and complete the measure mapping, they can use the Axon Registry for MIPS reporting to the Centers for Medicare & Medicaid Services for Quality, Advancing Care Information, and Improvement Activity categories. Visit AAN.com/view/Axon to learn more about the registry and contact registry@aan.com with any questions. 

With the registry maturing and amassing more than 4.5 million patent visits and over 1.3 million unique patients,

Journal Takes Aim at Warfare and Neurologic Injuries

Volume

Neurology: Clinical Practice, published six times a year, is a member benefit available in print (for US members only) and online. Visit Neurology.org/cp for more information. 

AANnews • February 2019

1, February

Neurolo

2019

gy.org/C

A peer-revi

The latest issue of Neurology® Clinical Practice examines the plight of military who suffer neurologic injuries in armed conflicts. US military veteran Mill Etienne, MPH, FAAN, pens an editorial on the subject, “Wartime Neurology: Serving the Neediest in an Austere Environment,” and Yasmeen El Hajj Abdallah sheds light on “Devastating Neurologic Injuries in the Syrian War.” Other articles include research on MS patients’ health care use as a predictor of nursing home entry and quality of life outcomes associated with tumors of the central nervous system.

9, Number

ewed clini

cal neurolo

gy journal

personnel and civilians MD, for the prac

ticing neu

rologist

RESEARCH

Quality of life outcom es in patient for evaluat ion of CN s presenting S tumors REVIEW

Recent adv ancement s in lateral Parkinson trunk flex disease

ion in

RESEARCH

Devastating neurologic injuries

COMMEN

TARY

Using EH

Rs to advanc e epilepsy

in the Syrian care

War

Tools & Resources

AAN Collaborates with Verana Health to Improve Treatments and Discover Cures for Neurologic Disease In a new development in the AAN’s ongoing efforts to advance high-quality neurologic care through the AAN’s Axon Registry®, the Academy has entered into a collaboration with Verana Health, a company structuring and curating health care data to accelerate innovation for patients. This relationship will facilitate the development and delivery of de-identified clinical data solutions for use by the Axon Registry, its participants, partners, and the broader neurologic community—aiming to improve treatments and discover cures for the one in six people affected by neurologic disease. “We are entering an exciting era,” said AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN, “where data-driven medicine is improving the quality of the care we’re providing and giving us clues about which therapies work best, and how we may be able to better predict and prevent disease. By collaborating with Verana Health, we will be able to accelerate research projects using our growing Axon Registry to ultimately benefit and provide hope for our patients.” Created in 2014, the Axon Registry is a qualified clinical data registry developed to help AAN members improve patient care, enable scientific discovery, and simplify federal government reporting. It is a data warehouse that collects relevant patient data from electronic health records provided by participating AAN members. “The AAN Board of Directors has approved licensing de-identified data from the Axon Registry to Verana Health for use by our members and industry partners—in alignment with the AAN’s mission—in producing practical applications, such as data-driven analysis to help determine which therapies are producing the greatest patient benefit,” said Sacco. “Any research project commissioned by third parties, such as pharmaceutical companies, will be developed using only de-identified data provided in aggregate form. In compliance with HIPAA, identifiable data cannot, and will not, be sold. “We want to assure you that safeguarding privacy remains our number one priority,” Sacco continued. “The AAN and Verana Health are committed to compliant, secure, and responsible data governance, including compliance with the privacy and security requirements established by the Axon Registry Participation Agreement, applicable law, and industry standards for data security. The data provided to Verana Health is verified

by a third-party statistician as being de-identified, in order to protect the privacy of our members and their patients.”

Sacco

The AAN continues to own and control the Axon Registry. Member neurologists’ relationships to the AAN and the Axon Registry will remain unchanged: Participation in the Axon Registry remains free to all US AAN members in good standing Member physicians will continue to benefit from federal government quality reporting capabilities and performance benchmarking Compliant, secure, and responsible data governance continues The new collaboration will help ensure the long-term sustainability of the Axon Registry as a key asset for neurologists in providing the highest quality patient-centered neurologic care. Royalties from the collaboration will help support the AAN’s ability to markedly expand the Axon Registry and continue to offer participation free to AAN members in the US, provide best-in-class analytical tools to member participants, as well as support scientific studies using the Axon Registry to improve neurologic care. “A tremendous amount of effort went into selecting Verana Health as the right collaborator for this exciting initiative,” said Sacco. “We look forward to sharing future successes with you as we work together to drive innovation and advance neurologic care.” For more information on the Axon Registry, visit AAN.com/view/Axon. 

AANnews • February 2019 15

Tools & Resources

Academy Launches Pilot Program to Promote Quality Improvement The AAN is initiating a new program in 2019 called QI Pioneers. This program will teach providers how to create and implement a quality improvement project in their practice. The AAN is working to encourage Axon Registry® participants and the broader membership to embrace quality improvement in their practices and this program will establish a road map for implementation. The Axon Registry is the AAN’s clinical quality data registry offered free to US members and dedicated to helping neurologists track their quality of care in practice and provide data to affect change. An online dashboard is provided with real-time performance rates on 40 neurology-specific quality measures. Providers can access the dashboard and drill down through the data to do quality assessment at no additional cost. The goal of this new QI Pioneers education program is to increase use of the registry data for quality improvement, which was one of the primary motivators for the AAN to develop a registry. In the first year of the QI Pioneers program, 10 current Axon practices will be selected to participate. Each practice will select one measure for performance improvement. Quality improvement methodology will be taught at a one-day training session for representatives from the 10 practices. These representatives would most likely be business administrators, nurses, or PubPolicy: 19 PMW Ad—Half Page Horizontal> AN advanced practice providers. Placed in AANnews

Quality and Safety Subcommittee member Cristina Victorio, MD, explained, “It is anticipated that by starting with one measure, the value of Axon data will be demonstrated without burdening providers and overwhelming their practices. We also anticipate individual participants will be able to scale up their quality improvement efforts to other projects following the close of the project.”

Victorio

Quality improvement projects often are tied to reduced costs and increased efficiency. Following the close of the pilot project, the AAN will evaluate if clinical outcomes improved through use of Axon data, if cost savings can be tied to use of Axon data, and if participants scale up their quality improvement efforts. Lessons demonstrating how to improve outcomes for patients will be shared with AAN membership and ideally drive improvement for all neurology, tying directly to the AAN mission. If the pilot year is successful, the first group of QI Pioneers would become advisors for future program participants. To learn more, contact quality@aan.com. 

8.25 x 5.25 +0.125 bleed, 4C

2019 PRACTICE MANAGEMENT WEBINARS GO DEEPER. GET SMARTER.

Our exciting new format presents a live webinar followed by several shorter recorded online lectures that explore the topic in greater depth. A final live webchat enables additional Q&A with the experts.

2019 WEBINAR SERIES JANUARY 15

MARCH 12

MAY 21

AUGUST 13

OCTOBER 1

NOVEMBER 19

Boss, MD: Managing a Better Practice

Understanding How You Get Paid

Everything You Wanted to Know About Your Patients but Were Afraid to Ask: Having Difficult Conversations with Patients from Vulnerable Populations

Increasing Revenue in Your Practice: Care Models, Ancillary Services, and Other Strategies

Using Technology for Better Practice Management of Stroke

Seeing the Future Clearly: How to Succeed in 2020

GREAT VALUE!

Single webinar series: $99 2019 webinar series subscription: $189—less than $32 per webinar! Receive 2 CME credits or certificate for each webinar completed.

Learn more and register at

AAN.com/view/webinar

Tools & Resources

The AAN’s Role in Advancing Coding and Reimbursement for Neurology An important component of a successful neurology practice is correct coding and claims submission for the critical services provided by a neurologist. The AAN strives to ensure appropriate reimbursement for neurology and to provide coding resources to support members and answer their questions quickly. This is especially critical given the rapidly changing landscape of health care. Physician volunteers and Academy staff participate in several external processes and strategic discussions that have allowed the AAN to be “at the table” when it comes to proposed payment changes that impact our members.

How the AAN Participates in the CPT Process The Current Procedural Terminology (CPT) code set created by the American Medical Association (AMA) is used to bill outpatient and office procedures. These five-digit codes provide a standard system to report medical procedures and services under public and private health insurance programs. The AMA’s CPT Editorial Panel meets three times each year to discuss and approve any CPT code additions, deletions, and revisions. The AAN has appointed several members as CPT advisors who review all proposed changes and, where appropriate, submit comments or requests for changes on behalf of neurology. The panel considers these written comments. AAN representatives and staff attend panel meetings and speak about any issues of relevance to neurology. The AMA publishes an updated CPT manual on an annual basis. New and revised codes are released in August with the publication of the AMA’s CPT® Professional and go into effect the following January. Because the AMA maintains the rights to the CPT code set, societies are bound by its confidentiality rules until the embargo lifts each year.

How the AAN Participates in the RUC Process The next phase of the process is an annual update to the physician work relative values. These values are based on recommendations from a committee involving the AMA and national medical specialty societies, known as the AMA/ Specialty Society Relative Value Scale Update Committee (RUC). The RUC acts as an expert panel in developing and delivering relative value recommendations for new or revised CPT codes to the Centers for Medicare & Medicaid Services (CMS). The RUC gives physicians a voice in shaping Medicare relative values. The RUC represents the entire medical profession—including the AAN, which holds a permanent seat

on the committee. Academy members and staff attend the RUC meetings (also three times a year) to share recommendations on physician work and practice expense inputs (including staff time, equipment, and supplies) for codes.

How Can Members Get Involved? The recommendations presented by the AAN are based on survey data on the time and intensity of a given service. The AMA has a standard survey tool that is used by all medical specialties when surveying a CPT code and is distributed to physician members within the organization who are familiar with the service. If you receive a RUC survey from the AAN, please take the time to participate in this important process. The survey is the crucial foundation upon which the AAN develops recommendations to be considered by the RUC. Annually, the AMA submits the RUC recommended values to CMS, which has the final decision on payment rates that are published each year in the CMS Physician Fee Schedule. AAN coding and regulatory staff work as a team when anticipating new CPT codes and determining the need for outreach to CMS officials to raise awareness on the value of services provided by neurologists.

Use These AAN Resources! The AAN provides online support to our members, including Coding FAQs, E/M templates, and Care Management Service coding tables located at AAN.com/view/practicing. The Practice Management Webinar Series includes several topics geared toward coding and reimbursement. Register for the March 12 webinar “Understanding How You Get Paid” at AAN.com/view/pmw19. Members also can email practice@aan.com with coding and reimbursement questions. 

Neurology ® Podcasts:

20 Minutes Pack a Punch! Download the latest podcast at neurology.org/podcast

AANnews • February 2019 17

Tools & Resources

Are You Taking Advantage of These Practice Management Resources? Like all clinicians, practitioners working in small practices face challenges as the reimbursement landscapes changes and administrative burdens increase. But unlike larger practices, small and solo practices often don’t have support staff to help navigate these changes, leaving it to the clinician to learn about new regulations, train staff, and implement changes—all while seeing enough patients to keep their doors open. These busy schedules leave little time to volunteer on AAN committees and subcommittees or even respond to surveys. Consequently, the Academy has developed numerous resources to assist these members and better understand their needs.

Practice Ambassador Small Practice Site Visits A vision of the Solo and Small Practice Task Force, the Practice Ambassador Program sends AAN staff to personally visit small and solo practices across the country to observe firsthand their challenges, learn what AAN resources are helpful, understand the issues affecting their ability to stay independent, and, most importantly, ensure their voices are heard. After each visit, AAN staff meets to debrief on lessons learned from the practice, and site feedback is passed along to AAN teams ensuring the perspective of the small and solo practitioner is incorporated into developing resources. Fourteen visits were completed between 2017 and 2018. Perhaps not surprising, challenges facing small and solo practices include increased administrative burden of prior authorizations, increased distress about having to fight to get patients the care they need, and increased frustration about continually changing regulations. Ideas garnered from these site visits have influenced 2019 Annual Meeting Experiential Learning Area talks (AAN.com/view/AMProgram) and Practice Management Webinars (AAN.com/view/pmw19). Are you a clinician working in a small (five clinicians or less) or solo neurology practice and interested in hosting a Practice Ambassador site visit? Please email practice@aan.com.

Neurology Compensation and Productivity Survey In 2017, more than 1,300 neurologists completed the Neurology Compensation and Productivity survey, making it the largest survey devoted to the neurology specialty. It provides vital information for neurologists, advanced practice providers, and business administrators to have the tools to negotiate on their own behalf and compare practice benchmarks against peers and other practices. The new 2019 Neurology Compensation and Productivity survey kicks off in March. Learn more about the exciting changes in the survey and what you need to do to prepare for it on page 19.

Practice Management and Technology Subcommittee Tools Serving under the Medical Economics and Management Committee, the Practice Management and Technology

AANnews • February 2019

Subcommittee’s focus is on developing resources to assist AAN members with managing their practice. New tools include: EHR SynapseSM Online Community: Earlier this year, a new Synapse community was created to discuss all things EHR-related. Discussions have included EHR efficiency, considerations when choosing a cloud-based vs. on-premises EHR system, and several discussions pertaining to specific EHR systems including Epic and Greenway. Currently, this is a private community; if you are interested in joining, email practice@aan.com. Business Administration Resource Library: Hosted in the Business Administration Synapse community, the Resource Library is a place for members to share resources such referral management, practice workflows, job descriptions, and many other topics. The library is still gathering documents. If you have resources you would be willing to share, please consider uploading them to the library to help your fellow neurology administrators. practice@aan.com: Do you have questions regarding code use? Commercial payers? Practice management? Email practice@aan.com and AAN staff will respond within one business day directing you to resources. Additionally, you can seek the expertise of subcommittee members and the Practice Support Network, a group of 10 practicing neurologists and recent graduates of the AAN’s Practice Leadership Program. The practice@aan.com address is a great way to quickly reach out to a network of practice administrators and practicing neurologists to help your practice succeed. The Practice Management and Technology Subcommittee supports practice administrators and spent 2018 conducting focus groups and deep dive interviews to better understand their needs. Stay tuned to your email and other AAN communications for new resources to help you grow in your career as a neurology executive. The first step is to renew your AAN Business Administrator membership. The “Plus” level of membership will give you access to our Practice Management Webinar series, link you to colleagues in the Synapse community, and keep you connected to AAN communications regarding new resources. For more information, visit AAN.com/dues. 

Policy & Guidelines

Capitol Hill Report Capitol Hill Report presents regular updates on legislative and regulatory actions and how the Academy ensures that the voice of neurology is heard on Capitol Hill. It is emailed to US members twice monthly and is posted at AAN.com/view/HillReport. Below are some recent highlights.

Two More Wins for AAN Advocacy In December, Congress passed the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (S. 2076/H.R. 4256) which: Establishes Alzheimer’s Centers of Excellence around the country to expand and promote innovative and effective Alzheimer’s interventions Provides funding to state, local, and tribal public health departments to implement those interventions and to carry out the Public Health Road Map, including promoting early detection and diagnosis, reducing risk, and preventing avoidable hospitalizations Increases the collection, analysis, and timely reporting of data on cognitive decline and caregiving to inform future public health actions. Congress also passed into law the Traumatic Brain Injury Program Reauthorization Act of 2018, which reauthorizes the CDC’s Traumatic Brain Injury initiatives and establishes a national concussion surveillance system. Rep. Bill Pascrell, Jr. (D-NJ), the co-chairman of the Congressional Brain Injury Task Force,

mentioned the AAN’s support of the bill in his press release and statement on the House floor. The AAN supported both bills and worked with neurologic patient groups such as the Brain Injury Association of America and the Leaders Engaged on Alzheimer’s Disease Coalition to build awareness of their importance.

116th Congress Begins with a Shutdown Hangover The 116th US Congress opened last month with the swearing in of 435 House members, including 101 freshmen, and 33 senators, including 10 freshmen. On the day of the swearing-in ceremonies, many congressional offices held open houses and the AAN took advantage to meet personally with two dozen members of the House, including returning Speaker of the House Nancy Pelosi (D-CA) and Rep. Frank Pallone (D-NJ), chair of the House Energy & Commerce Committee, along with many other health care leaders, physicians, and freshman members of Congress from both sides of the aisle. The day was spent walking the halls of Congress congratulating members, discussing a little politics and, of course, talking about neurology. 

Passion + Purpose = Power continued from cover helping change health care locally, nationally, and internationally—as well as within key AAN leadership positions, including the Board of Directors. Give your passion a greater sense of purpose by empowering yourself through critical training in the areas of grassroots advocacy, leadership, relationship building, and media skills. Apply for the Palatucci Advocacy Leadership Forum by March 4.

AANnews • February 2019 19

TRUST IN THE EXPERIENCE THE #1 PRESCRIBED

oral RMS therapy in the US since September 2013 Based on number of prescriptions from IMS NPA™ Weekly Data (September 6, 2013–September 7, 2018).

>340,000 >625,000 Over

people have been treated with TECFIDERA worldwide1*

*This includes clinical trial use and patients prescribed TECFIDERA.

global patient-years of treatment1*

*This includes clinical trial use and patients prescribed TECFIDERA.

of combined clinical trial and real-world experience1,2

INDICATION Tecfidera® (dimethyl fumarate) is indicated for the treatment of patients with relapsing forms of multiple sclerosis. IMPORTANT SAFETY INFORMATION TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or any of the excipients of TECFIDERA. TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Patients experiencing signs and symptoms of anaphylaxis and angioedema (which have included difficulty breathing, urticaria, and swelling of the throat and tongue) should discontinue TECFIDERA and seek immediate medical care. Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA in a clinical trial. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. The symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. At the first sign or symptom suggestive of PML, withhold TECFIDERA and perform an appropriate diagnostic evaluation. MRI findings may be apparent before clinical signs or symptoms. TECFIDERA may decrease lymphocyte counts; in clinical trials there was a mean decrease of ~30% in lymphocyte counts during the first year which then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but not to baseline. Six percent of TECFIDERA patients and <1% of placebo patients had lymphocyte counts <0.5x109/L. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years). In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months. In these patients, the majority of lymphocyte counts remained <0.5x109/L with continued therapy. A complete blood count including lymphocyte count should be obtained before initiating treatment, 6 months after starting, every 6 to 12 months thereafter and as clinically indicated. Consider treatment interruption if lymphocyte counts <0.5x109/L persist for more than six months and follow lymphocyte counts until lymphopenia is resolved. Consider withholding treatment in patients with serious infections until resolved. Decisions about whether or not to restart TECFIDERA should be based on clinical circumstances. Clinically significant cases of liver injury have been reported in patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than

5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels before initiating TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. TECFIDERA may cause flushing (e.g. warmth, redness, itching, and/or burning sensation). 40% of patients taking TECFIDERA reported flushing, which was mostly mild to moderate in severity. Three percent of patients discontinued TECFIDERA for flushing and <1% had serious flushing events that led to hospitalization. Taking TECFIDERA with food may reduce flushing. Alternatively, administration of non-enteric coated aspirin prior to dosing may reduce the incidence or severity of flushing. TECFIDERA may cause gastrointestinal (GI) events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). Four percent of TECFIDERA patients and <1% of placebo patients discontinued due to GI events. The incidence of serious GI events was 1%. The most common adverse reactions associated with TECFIDERA versus placebo are flushing (40% vs 6%) and GI events: abdominal pain (18% vs 10%), diarrhea (14% vs 11%), nausea (12% vs 9%). A transient increase in mean eosinophil counts was seen during the first two months. TECFIDERA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Encourage patients who become pregnant while taking TECFIDERA to enroll in the TECFIDERA pregnancy registry by calling 1-866-810-1462 or visiting www.TECFIDERApregnancyregistry.com.

Please see following pages for Brief Summary of full Prescribing Information. References: 1. Data on file, Biogen. 2. TECFIDERA Prescribing Information, Biogen, Cambridge, MA.

To get started, simply fill out a Start Form at

www.tecfiderahcp.com

Tecfidera® (dimethyl fumarate) delayed-release capsules, for oral use Brief Summary of Full Prescribing Information 1 INDICATIONS AND USAGE TECFIDERA is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 2 DOSAGE AND ADMINISTRATION 2.1 Dosing Information The starting dose for TECFIDERA is 120 mg twice a day orally. After 7 days, the dose should be increased to the maintenance dose of 240 mg twice a day orally. Temporary dose reductions to 120 mg twice a day may be considered for individuals who do not tolerate the maintenance dose. Within 4 weeks, the recommended dose of 240 mg twice a day should be resumed. Discontinuation of TECFIDERA should be considered for patients unable to tolerate return to the maintenance dose. The incidence of flushing may be reduced by administration of TECFIDERA with food. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Clinical Pharmacology (12.3)]. TECFIDERA should be swallowed whole and intact. TECFIDERA should not be crushed or chewed and the capsule contents should not be sprinkled on food. TECFIDERA can be taken with or without food. 2.2 Blood Tests Prior to Initiation of Therapy Obtain a complete blood cell count (CBC) including lymphocyte count before initiation of therapy [see Warnings and Precautions (5.3)]. Obtain serum aminotransferase, alkaline phosphatase, and total bilirubin levels prior to treatment with TECFIDERA [see Warnings and Precautions (5.4)]. 3 DOSAGE FORMS AND STRENGTHS TECFIDERA is available as hard gelatin delayed-release capsules containing 120 mg or 240 mg of dimethyl fumarate. The 120 mg capsules have a green cap and white body, printed with “BG-12 120 mg” in black ink on the body. The 240 mg capsules have a green cap and a green body, printed with “BG-12 240 mg” in black ink on the body. 4 CONTRAINDICATIONS TECFIDERA is contraindicated in patients with known hypersensitivity to dimethyl fumarate or to any of the excipients of TECFIDERA. Reactions have included anaphylaxis and angioedema [see Warnings and Precautions (5.1)]. 5 WARNINGS AND PRECAUTIONS 5.1 Anaphylaxis and Angioedema TECFIDERA can cause anaphylaxis and angioedema after the first dose or at any time during treatment. Signs and symptoms have included difficulty breathing, urticaria, and swelling of the throat and tongue. Patients should be instructed to discontinue TECFIDERA and seek immediate medical care should they experience signs and symptoms of anaphylaxis or angioedema. 5.2 Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) has occurred in patients with MS treated with TECFIDERA. PML is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically only occurs in patients who are immunocompromised, and that usually leads to death or severe disability. A fatal case of PML occurred in a patient who received TECFIDERA for 4 years while enrolled in a clinical trial. During the clinical trial, the patient experienced prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) while taking TECFIDERA [see Warnings and Precautions (5.3)]. The patient had no other identified systemic medical conditions resulting in compromised immune system function and had not previously been treated with natalizumab, which has a known association with PML. The patient was also not taking any immunosuppressive or immunomodulatory medications concomitantly. PML has also occurred in the postmarketing setting in the presence of lymphopenia (<0.8x109/L) persisting for more than 6 months. While the role of lymphopenia in these cases is uncertain, the majority of cases occurred in patients with lymphocyte counts <0.5x109/L. At the first sign or symptom suggestive of PML, withhold TECFIDERA and perform an appropriate diagnostic evaluation. Typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes. MRI findings may be apparent before clinical signs or symptoms. Cases of PML, diagnosed based on MRI findings and the detection of JCV DNA in the cerebrospinal fluid in the absence of clinical signs or symptoms specific to PML, have been reported in patients treated with

other MS medications associated with PML. Many of these patients subsequently became symptomatic with PML. Therefore, monitoring with MRI for signs that may be consistent with PML may be useful, and any suspicious findings should lead to further investigation to allow for an early diagnosis of PML, if present. Lower PML-related mortality and morbidity have been reported following discontinuation of another MS medication associated with PML in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. It is not known whether these differences are due to early detection and discontinuation of MS treatment or due to differences in disease in these patients. 5.3 Lymphopenia TECFIDERA may decrease lymphocyte counts. In the MS placebo controlled trials, mean lymphocyte counts decreased by approximately 30% during the first year of treatment with TECFIDERA and then remained stable. Four weeks after stopping TECFIDERA, mean lymphocyte counts increased but did not return to baseline. Six percent (6%) of TECFIDERA patients and <1% of placebo patients experienced lymphocyte counts <0.5x109/L (lower limit of normal 0.91x109/L). The incidence of infections (60% vs 58%) and serious infections (2% vs 2%) was similar in patients treated with TECFIDERA or placebo, respectively. There was no increased incidence of serious infections observed in patients with lymphocyte counts <0.8x109/L or ≤0.5x109/L in controlled trials, although one patient in an extension study developed PML in the setting of prolonged lymphopenia (lymphocyte counts predominantly <0.5x109/L for 3.5 years) [see Warnings and Precautions (5.2)]. In controlled and uncontrolled clinical trials, 2% of patients experienced lymphocyte counts <0.5x109/L for at least six months, and in this group the majority of lymphocyte counts remained <0.5x109/L with continued therapy. TECFIDERA has not been studied in patients with pre-existing low lymphocyte counts. Obtain a CBC, including lymphocyte count, before initiating treatment with TECFIDERA, 6 months after starting treatment, and then every 6 to 12 months thereafter, and as clinically indicated. Consider interruption of TECFIDERA in patients with lymphocyte counts less than 0.5x109/L persisting for more than six months. Given the potential for delayed recovery of lymphocyte counts, continue to obtain lymphocyte counts until their recovery if TECFIDERA is discontinued or interrupted due to lymphopenia. Consider withholding treatment from patients with serious infections until resolution. Decisions about whether or not to restart TECFIDERA should be individualized based on clinical circumstances. 5.4 Liver Injury Clinically significant cases of liver injury have been reported in patients treated with TECFIDERA in the postmarketing setting. The onset has ranged from a few days to several months after initiation of treatment with TECFIDERA. Signs and symptoms of liver injury, including elevation of serum aminotransferases to greater than 5-fold the upper limit of normal and elevation of total bilirubin to greater than 2-fold the upper limit of normal have been observed. These abnormalities resolved upon treatment discontinuation. Some cases required hospitalization. None of the reported cases resulted in liver failure, liver transplant, or death. However, the combination of new serum aminotransferase elevations with increased levels of bilirubin caused by drug-induced hepatocellular injury is an important predictor of serious liver injury that may lead to acute liver failure, liver transplant, or death in some patients. Elevations of hepatic transaminases (most no greater than 3 times the upper limit of normal) were observed during controlled trials [see Adverse Reactions (6.1)]. Obtain serum aminotransferase, alkaline phosphatase (ALP), and total bilirubin levels prior to treatment with TECFIDERA and during treatment, as clinically indicated. Discontinue TECFIDERA if clinically significant liver injury induced by TECFIDERA is suspected. 5.5 Flushing TECFIDERA may cause flushing (e.g., warmth, redness, itching, and/or burning sensation). In clinical trials, 40% of TECFIDERA treated patients experienced flushing. Flushing symptoms generally began soon after initiating TECFIDERA and usually improved or resolved over time. In the majority of patients who experienced flushing, it was mild or moderate in severity. Three percent (3%) of patients discontinued TECFIDERA for flushing and <1% had serious flushing symptoms that were not lifethreatening but led to hospitalization. Administration of TECFIDERA with food may reduce the incidence of flushing. Alternatively, administration of non-enteric coated aspirin (up to a dose of 325 mg) 30 minutes prior to TECFIDERA dosing may reduce the incidence or severity of flushing [see Dosing and Administration (2.1) and Clinical Pharmacology (12.3)]. 6 ADVERSE REACTIONS The following important adverse reactions are described elsewhere in labeling: Anaphylaxis and Angioedema (5.1), Progressive multifocal leukoencephalopathy (5.2), Lymphopenia (5.3), Liver Injury (5.4), Flushing (5.5) [see Warnings and Precautions].

6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The most common adverse reactions (incidence ≥10% and ≥2% more than placebo) for TECFIDERA were flushing, abdominal pain, diarrhea, and nausea. Adverse Reactions in Placebo-Controlled Trials In the two well-controlled studies demonstrating effectiveness, 1529 patients received TECFIDERA with an overall exposure of 2244 person-years [see Clinical Studies (14)]. The adverse reactions presented in the table below are based on safety information from 769 patients treated with TECFIDERA 240 mg twice a day and 771 placebo-treated patients. Table 1: Adverse Reactions in Study 1 and 2 reported for TECFIDERA 240 mg BID at ≥2% higher incidence than placebo

Flushing Abdominal pain Diarrhea Nausea Vomiting Pruritus Rash Albumin urine present Erythema Dyspepsia Aspartate aminotransferase increased Lymphopenia

TECFIDERA N=769 %

Placebo N=771 %

40 18 14 12 9 8 8 6 5 5 4 2

6 10 11 9 5 4 3 4 1 3 2 <1

Gastrointestinal TECFIDERA caused GI events (e.g., nausea, vomiting, diarrhea, abdominal pain, and dyspepsia). The incidence of GI events was higher early in the course of treatment (primarily in month 1) and usually decreased over time in patients treated with TECFIDERA compared with placebo. Four percent (4%) of patients treated with TECFIDERA and less than 1% of placebo patients discontinued due to gastrointestinal events. The incidence of serious GI events was 1% in patients treated with TECFIDERA. Hepatic Transaminases An increased incidence of elevations of hepatic transaminases in patients treated with TECFIDERA was seen primarily during the first six months of treatment, and most patients with elevations had levels <3 times the upper limit of normal (ULN) during controlled trials. Elevations of alanine aminotransferase and aspartate aminotransferase to ≥3 times the ULN occurred in a small number of patients treated with both TECFIDERA and placebo and were balanced between groups. There were no elevations in transaminases ≥3 times the ULN with concomitant elevations in total bilirubin >2 times the ULN. Discontinuations due to elevated hepatic transaminases were <1% and were similar in patients treated with TECFIDERA or placebo. Eosinophilia A transient increase in mean eosinophil counts was seen during the first 2 months of therapy. Adverse Reactions in Placebo-Controlled and Uncontrolled Studies In placebo-controlled and uncontrolled clinical studies, a total of 2513 patients have received TECFIDERA and been followed for periods up to 4 years with an overall exposure of 4603 person-years. Approximately 1162 patients have received more than 2 years of treatment with TECFIDERA. The adverse reaction profile of TECFIDERA in the uncontrolled clinical studies was consistent with the experience in the placebo-controlled clinical trials. 6.2 Post Marketing Experience The following adverse reaction has been identified during post approval use of TECFIDERA. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Liver function abnormalities (elevations in transaminases ≥3 times ULN with concomitant elevations in total bilirubin >2 times ULN) have been reported following TECFIDERA administration in post marketing experience [See Warnings and Precautions (5.4)].

8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to TECFIDERA during pregnancy. Encourage patients to enroll by calling 1-866-810-1462 or visiting www.tecfiderapregnancyregistry.com. Risk Summary There are no adequate data on the developmental risk associated with the use of TECFIDERA in pregnant women. In animals, adverse effects on offspring survival, growth, sexual maturation, and neurobehavioral function were observed when dimethyl fumarate (DMF) was administered during pregnancy and lactation at clinically relevant doses. [see data]. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown. Data Animal Data In rats administered DMF orally (25, 100, 250 mg/kg/day) throughout organogenesis, embryofetal toxicity (reduced fetal body weight and delayed ossification) were observed at the highest dose tested. This dose also produced evidence of maternal toxicity (reduced body weight). Plasma exposure (AUC) for monomethyl fumarate (MMF), the major circulating metabolite, at the no-effect dose is approximately three times that in humans at the recommended human dose (RHD) of 480 mg/day. In rabbits administered DMF orally (25, 75, and 150 mg/kg/day) throughout organogenesis, embryolethality and decreased maternal body weight were observed at the highest dose tested. The plasma AUC for MMF at the no-effect dose is approximately 5 times that in humans at the RHD. Oral administration of DMF (25, 100, and 250 mg/kg/day) to rats throughout organogenesis and lactation resulted in increased lethality, persistent reductions in body weight, delayed sexual maturation (male and female pups), and reduced testicular weight at the highest dose tested. Neurobehavioral impairment was observed at all doses. A no-effect dose for developmental toxicity was not identified. The lowest dose tested was associated with plasma AUC for MMF lower than that in humans at the RHD. 8.2 Lactation Risk Summary There are no data on the presence of DMF or MMF in human milk. The effects on the breastfed infant and on milk production are unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for TECFIDERA and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use Clinical studies of TECFIDERA did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. 10 OVERDOSE Cases of overdose with TECFIDERA have been reported. The symptoms described in these cases were consistent with the known adverse event profile of TECFIDERA. There are no known therapeutic interventions to enhance elimination of TECFIDERA nor is there a known antidote. In the event of overdose, initiate symptomatic supportive treatment as clinically indicated. 17 PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Patient Information) Dosage Inform patients that they will be provided two strengths of TECFIDERA when starting treatment: 120 mg capsules for the 7 day starter dose and 240 mg capsules for the maintenance dose, both to be taken twice daily. Inform patients to swallow TECFIDERA capsules whole and intact. Inform patients to not crush, chew, or sprinkle capsule contents on food. Inform patients that TECFIDERA can be taken with or without food [see Dosage and Administration (2.1)].

Anaphylaxis and Angioedema Advise patients to discontinue TECFIDERA and seek medical care if they develop signs and symptoms of anaphylaxis or angioedema [see Warnings and Precautions (5.1)]. Progressive Multifocal Leukoencephalopathy Inform patients that progressive multifocal leukoencephalopathy (PML) has occurred in patients who received TECFIDERA. Inform the patient that PML is characterized by a progression of deficits and usually leads to death or severe disability over weeks or months. Instruct the patient of the importance of contacting their doctor if they develop any symptoms suggestive of PML. Inform the patient that typical symptoms associated with PML are diverse, progress over days to weeks, and include progressive weakness on one side of the body or clumsiness of limbs, disturbance of vision, and changes in thinking, memory, and orientation leading to confusion and personality changes [see Warnings and Precautions (5.2)]. Lymphocyte Counts Inform patients that TECFIDERA may decrease lymphocyte counts. A blood test should be obtained before they start therapy. Blood tests are also recommended after 6 months of treatment, every 6 to 12 months thereafter, and as clinically indicated [see Warnings and Precautions (5.3), Adverse Reactions (6.1)]. Liver Injury Inform patients that TECFIDERA may cause liver injury. Instruct patients treated with TECFIDERA to report promptly any symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine, or jaundice. A blood test should be obtained before patients start therapy and during treatment, as clinically indicated [see Warnings and Precautions (5.4)]. Flushing and Gastrointestinal (GI) Reactions Flushing and GI reactions (abdominal pain, diarrhea, and nausea) are the most common reactions, especially at the initiation of therapy, and may decrease over time. Advise patients to contact their healthcare provider if they experience persistent and/or severe flushing or GI reactions. Advise patients experiencing flushing that taking TECFIDERA with food or taking a non-enteric coated aspirin prior to taking TECFIDERA may help [see Adverse Reactions (6.1)]. Pregnancy and Pregnancy Registry Instruct patients that if they are pregnant or plan to become pregnant while taking TECFIDERA they should inform their physician. Encourage patients to enroll in the TECFIDERA Pregnancy Registry if they become pregnant while taking TECFIDERA. [see Use in Specific Populations (8.1)]. 41347-09 Manufactured by: Biogen Cambridge, MA 02142 TECFIDERA is a trademark of Biogen. ÂŠ 2013-2017 Biogen 2/18

Education & Research

Get Up-to-date on Dementia with Continuum Update your knowledge of the diagnosis and management of dementia with the February issue of Continuum: Lifelong Learning in Neurology ®. “The field of dementia research is rapidly growing. In this issue, neurologists will be introduced to the new research framework for defining Alzheimer's disease purely on biological grounds,” said Guest Editor Graff-Radford Jonathan Graff-Radford, MD. “In addition, they will learn about recent diagnostic criteria for dementia with Lewy bodies and posterior cortical atrophy, atypical and young-onset presentations of dementia, and red flags in the history that may indicate a reversible dementia is present.” AAN members pay only $349 per year for a subscription to

Continuum® and Continuum® Audio. Subscribe now by contacting Wolters Kluwer at (800) 361-0633, (301) 223-2300 (international); or Shop.LWW. com/continuum. AAN Junior members who are transitioning to neurologist memberships can receive a 50-percent discount on the already low member rate for the Continuum and Continuum Audio subscription. 

Continuum LIFE LON G LEA RNI NG

IN NEU ROL OGY ®

Dementia

FEBRUA RY 2019

VOL. 25

NO. 1

EDITOR -IN-CHI EF: STEVEN L. LEWIS, MD, GUEST EDITOR FA AN : JONATH AN GRAFF- RADFOR D, MD

CONTIN UUMJOU

RNAL.C OM

Fellowship Programs Receive UCNS Accreditation Four new fellowship programs have achieved accreditation from the United Council for Neurologic Subspecialties (UCNS) effective December 1. There are 201 training programs now accredited by the UCNS. The new programs and directors are:

Behavioral Neurology & Neuropsychiatry

Boston VA Medical Center; Boston University Academic Affiliate Andrew E. Budson, MD

Neuro-oncology

Headache Medicine

Wake Forest Baptist Medical Center Lauren Doyle Strauss, DO, FAHS

Oregon Health and Science University Prakash Ambady, MD Virginia Commonwealth University Alicia Zukas, MD

UCNS-accredited training programs have demonstrated they meet the accreditation standards established by experts in the field through a peer-review process that ensures there is ongoing evaluation of program excellence. Accredited status assists programs in their fellow recruitment efforts and preparation of the next generation of neurologic subspecialists. The next deadline for accreditation applications is June 1, 2019. Contact Amanda Carpenter, Senior Manager, Accreditation, at acarpenter@ucns.org with questions. 

New Diplomates Certified in Headache Medicine Demonstrating expert knowledge in Headache Medicine, 92 physicians passed the 2018 United Council for Neurologic Subspecialties (UCNS) Headache Medicine initial certification examination. These physicians now hold the distinction of being UCNS diplomates. A total of 42 physicians passed the Headache Medicine recertification examination and have demonstrated their commitment to lifelong learning by meeting the continuing medical education and subspecialty knowledge requirements. There are currently 570 physician diplomates certified in Headache Medicine. Physicians in the United States and Canada who meet the eligibility requirements may apply for certification in Headache Medicine. The next initial certification examination will take place in 2020. For a complete list of all Headache Medicine diplomates, UCNS accredited training programs, and information about Headache Medicine certification, visit UCNS.org. 

AANnews • February 2019 25

AAN.com/careers

Visit the AAN’s Neurology Career Center to view hundreds of additional jobs and sign up for customized, confidential notifications when positions of interest are added.

West Virginia Pediatric Neurology Opening Join one of the best health care providers and teaching hospital in the state. Pediatric Neurology. Employed Position. Competitive salary with full benefit package. $50K sign-on bonus. More than 30 specialties are represented. Procedures performed: Advanced MS infusion therapies, Electromyography (EMG), Electroencephalogram (EEG), Evoked potentials studies, Lumbar puncture, Nerve conduction studies, Therapeutic injections for migraine and Epilepsy Monitoring Unit for long-term monitoring. Neurology department specializes in the following conditions Autism, Cerebral palsy, Dementia, Epilepsy, Multiple sclerosis (MS), Neuropathy, Stroke, Seizures, Migraine, Nerve and muscle disorders and Tremors. "Hip, Historic and Almost Heaven"—Tourism Board. The cultural, recreational, and business capital of the Appalachian Mountains. Excellent Public and Private Schools. NCAA Division I Intercollegiate Sports Teams. Driving distance for skiing, water sports, hiking, etc. Bike friendly community with a network of trails. Art walks, downtown street festivals and brown bag concert series. Come play—multiple family friendly venues and activities. Contact Timothy Stanley, Direct: (404) 591-4224; (800) 492-7771; tstanleyweb@phg.com; Fax: (404) 591-4237, Cell/Text: (770) 265-2001. Mention Code 180802—CHN. Neurologist – Hiring Multiple Sub-Specialties We are a private practice multi-specialty group in North San Diego County consisting of 22 Physicians, 2 Neuropsychologists, 1 Psychiatrist, and 9 Nurse Practitioners/Physician Assistants, practicing in a number of different disciplines. Our practice includes multiple fellowship trained and boarded sub-specialists with expertise in neurophysiology, epilepsy monitoring, sleep medicine, headache medicine, stroke care, neuro-rehabilitation, neuropsychology, movement disorders, and psychiatry. We have a sleep lab and four offices in the region. We practice MEM: 18 BUSM Recruitment Ad—Half Page Horizontal> AN at Scripps Memorial Hospital in Encinitas, Scripps Memorial Hospital in La Jolla, Palomar Medical Center in Escondido, Placed in AANnews Pomerado Hospital 8.25 x 5.25 +0.125 bleed, 4C in Poway, and Tri-City Medical Center in Oceanside. All locations are in San Diego County, California.

We have affiliations with all the major health systems in San Diego including Scripps, UCSD, Sharp and Kaiser. This practice has been in existence since 1977 and is well positioned in the community to provide neurological services. Most partners have academic appointments at UCSD as volunteer faculty. We have a busy clinical trials practice. Our practice has grown out of a desire to combine the benefits of private practice with elements of research and academics. Our desire is to attract several BC/BE, highly qualified, energetic and motivated physicians for our Multidisciplinary Neurology practice as we continue to grow. We are recruiting for the following positions: Neurologist with focus on MS, Neurologist with focus on Headache, Neurohospitalist, Neurologist Boarded in Sleep, General Neurologist, Neuropsychiatrist, Psychiatrist. There is partnership opportunity. Our practice uses EPIC EMR. We are Joint Commission accredited. You can visit our website at www.neurocenter.com Please email CV directly to ainocelda@neurocenter.com as well as rossies@neurocenter.com Subject line should read: CV, your name and the position you wish you apply for i.e. CV, John Smith MD, General Neurology/Sleep Medicine.

Assistant Professor/Associate Professor/Professor (Non-Tenure-Track) The Department of Neurology at Columbia University, nationally renowned for research, clinical care, and education, is seeking full-time neurologists at the assistant, associate, or professor level specialized in the area of Hospitalist Neurology. The Columbia Hospitalist Neurology program includes clinical responsibilities at New York Presbyterian Hospital—Columbia University Medical Center, a tertiary care hospital in Manhattan; New York Presbyterian —Allen Hospital, a community hospital in Manhattan; and New York Presbyterian—Lawrence Hospital, a community hospital in southern Westchester County, New York. Each successful applicant will have an academic appointment at the College of Physicians and Surgeons, Columbia University, and be eligible for all of the Columbia University benefits available for the faculty appointment. Each Neurohospitalist recruited will attend on the Inpatient Neurology Service and

the Neurology Consult Service, train residents and medical students, and develop and participate in Quality Improvement initiatives. These are full-time positions, which may combine Neurohospitalist and specialty neurology practice and research, based on the specialty training and research interests of applicants for the positions. Please apply by following this link: http://pa334.peopleadmin.com/postings/2115

Director of Neurology Director of Neurology opportunity at Kendall Regional Medical Center located in sunny Miami, FL. This position will lead our newly established inpatient neurology program and is full-time with a Monday-Friday, 8am-5pm schedule with an excellent compensation package. Physicians with previous leadership experience or physicians looking to advance their career into a leadership position are encouraged to apply. Candidates must be a vascular trained neurologist. Kendall Regional Medical Center is an awardwinning hospital recognized with many prestigious awards and accolades. To learn more about this exciting opportunity, contact Kimberly Parker at (214) 712-2480 or kimberly. parker@evhc.net AANnews® Classified Advertising

he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities. Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the April 2019 print edition of AANnews A must be submitted by March 1, 2019. The same deadline applies to changes/cancellations. he American Academy of Neurology reserves the T right to decline, withdraw, or edit advertisements at its discretion. Every care is taken to avoid mistakes, but the responsibility for clerical or printer errors does not exceed the cost of the ad.

STRONGER BUSINESS ADMINISTRATORS MAKE A MORE EFFICIENT PRACTICE Strengthen your BUSINESS ADMINISTRATOR’S knowledge and skills in neurology with special, reduced rate AAN memberships.

AANnews • February 2019

Sign your team up today at

AAN.com/view/careteam.