2019 March AANnews by American Academy of Neurology

VOLUME 33 · ISSUE 3 · March 2019

GREAT SCIENCE COMING TO PHILLY Check out 2019 Scientific Program Book 2019 Annual Meeting attendees can expect a particularly comprehensive program that is bigger—and more innovative—than ever. Keep an eye out for the Annual Meeting Scientific Program book, scheduled to be delivered to mailboxes this month, and available online now at AAN.com/view/AM19. “One of secrets to the Annual Meeting’s enduring success is its ability to evolve, and the Annual Meeting Science Program is a prime example,” said AAN Science Committee Chair Natalia S. Rost, MD, MPH, FAHA, FAAN. “We are bigger and more diverse than ever in the way we represent various neurology subspecialties and areas of neuroscience research; we constantly innovate with new delivery formats and forums; and we are continually striving to create opportunities for budding young researchers, women, and other diverse segments of the AAN membership.” Continued on page 24

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Axon Registry Experts on Hand to Answer Your Questions in Philly

Participate in New Survey on Compensation and Productivity

Have you ever wondered what the AAN’s Axon Registry ® can do for your practice? To learn more and get hands on experience with this FREE AAN product that will help unlock your practice data, stop by the Axon Registry booth at the 2019 Annual Meeting in Philadelphia. Located in the Broad Street atrium, the booth will have opportunities to test the Axon Registry dashboard, talk with registry staff, and get all your questions answered. The Axon Registry, a quality-improvement and qualified clinical data registry, is your solution to fulfilling multiple regulatory requirements. It can also be used by your practice to meet

The AAN’s 2019 Neurology Compensation and Productivity Survey, launching this month, is the largest survey devoted to the neurology specialty. It provides vital information for neurologists, advanced practice providers (APPs), and business administrators to have the tools to negotiate on their own behalf and compare practice benchmarks against peers and other practices. The collected data is secure and de-identified for anonymity. AAN members who respond by May 25 will receive free access to the data via a customizable dashboard, a $600 value.

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Exhibit Hall Promises Four Days of Not-to-bemissed Happenings

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The revamped survey includes new questions on in-demand topics, including on-call compensation and productivity,

Meet the AAN and AAN Institute Boards of Directors Nominees

Continued on page 28

26 MIPS: Get to 30 Points,

Avoid Negative Payment Adjustment

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In Multiple Sclerosis–

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

GREY MATTERS, TOO

PHARMA AD

AANnews · March 2019

CONTENTS

News Briefs

Cover Great science coming to Philly Axon Registry Experts on Hand to Answer Your Questions in Philly Participate in New Survey on Compensation and Productivity President’s Column AAN Focuses on Member Needs in 2019 Goals · · · · · · · · 4 Conferences & Community Grand Experience Features Science, Experiential Learning, More · · · · · · · · · · · 5 Exhibit Hall Promises Four Days of Not-to-be-missed Happenings · · · · · · · · · · · · · 5 Meet the AAN and AAN Institute Boards of Directors Nominees · · · · · · · · 6 New BrainDome Offers Immersive Exploration · · · · · · 21 Expanded Symposium Offers Robust Opportunities for Medical Students · · · · · · · 21 Save the Date: July Sports Concussion Conference Coming to Indianapolis · · · · · 21

“Transformational” Program Makes a Change Maker out of Graduate · · · · · · · · · · 22 Industry Roundtable: Thank You for 25 Years of Support · · · · · · · · · · · · · 23 Stronger Business Administrators Make a Stronger Practice · · · · · · · · · 24 Tools & Resources Do You Know How You Get Paid? You Should · · · · · · · · · 25 MIPS: Get to 30 Points, Avoid Negative Payment Adjustment · · · · · · · · · · · · 26 Education & Research Subspecialty Fellowship Training Program Accreditation Applications Due June 1 · · · · · · · · · · · · · 28 New Diplomates Certified and Recertified by UCNS · · · · · 28 Policy & Guidelines Capitol Hill Report · · · · · · · · 29 Careers · · · · · · · · · · · · · · · · ·30

The Vision of the AAN is to be indispensable to our members. The Mission of the AAN is to promote the highest quality patient-centered neurologic care and enhance member career satisfaction. Contact 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

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

memberservices@aan.com

Website: AAN.com

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

Transforming Leaders Program The 2019 Transforming Leaders Program cohort is working on a project selected by AAN President Ralph L. Sacco, MD, MS, FAHA, FAAN: “How can the AAN address the mismatch between the supply of neurologists and the increasing need for neurologic care?” The group will present its recommendations to the Board in June.

Diversity Leadership Program The 2019 Diversity Leadership Program kicked off in January. The 10 recipients worked on leadership development curriculum and were assigned their project. President Elect James C. Stevens, MD, FAAN, asked the group to consider: “How can the Academy effectively engage patients, caregivers, the public, and other organizations to help advocate for those who are affected by neurologic disease, demonstrate the value of neurologists, and promote funding for research in neurology?” The cohort will present its findings and recommendations to the AAN Board of Directors in September 2019.

Health Services Research The AAN published a study in Neurology ® on the health care use and cost outcomes for people with incident epilepsy, which is the latest study developed by the AAN’s Health Services Research Subcommittee. The study found that patients who saw a neurologist were more likely to have higher medical costs and health care utilization than those who saw a primary care physician, which may be due to higher disease severity. Read the study at https://bit.ly/2SQ2C7c. 

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 Designers: Siu Lee Email: aannews@aan.com

AANnews is published monthly by the American Academy of Neurology for its 36,000 members worldwide. Access this magazine and other AAN publications online at AAN.com. 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 Focuses on Member Needs in 2019 Goals We’re about eight weeks away from our big Annual Meeting in Philadelphia, and our member volunteers and staff are working hard to make this the most informative, productive, and inspiring meeting yet. But we also have many other goals and ambitions for 2019 which I’d like to take a moment to share with you. The Board of Directors takes in a considerable amount of information as we deliberate on the Academy’s annual goals and create our strategic plan. We evaluate the completion or progress of last year’s goals. We examine the landscape of today’s health care based on a thorough environmental scan, researched and produced by our Insights Sacco Team. Their Insights Report includes previous year’s data and information the AAN has received from members through surveys, focus groups, and evaluations. This report also includes perceptions and recommendations from the Member Research Subcommittee, which provides us with a better understanding of member needs. And, we take into account what we, ourselves, have heard from members and what we’ve experienced in our work lives. The components of the Academy’s strategic plan include the Academy’s mission, vision, core values, Board goals, and committee objectives and major tactics. The Board measures progress on its goals through a Board Scorecard, which helps guide staff on direction and priorities. For 2019, the Board has established these goals: Demonstrate and assert the value of neurology to policymakers and other major stakeholders Expand the neurology workforce to meet future needs for patient care Ensure the health of the organization by enhancing member satisfaction, well-being, and engagement Provide resources to support the financial well-being of the practice of neurology Expand neuroscience training and research funding Educate and assist members in providing high-value clinical care Strengthen advocacy on behalf of members and their patients You can learn more about our 2019 goals and strategies—as well as last year’s accomplishments—in the 2018 Annual Report at AAN.com/view/AnnualReport. (You also can see if your AAN portrait photo is among the scores of members featured in this report!) There are two subjects that the AAN—indeed, all of medicine—has given strong attention to over recent years: wellness and diversity. These are issues that transcend practice environment, subspecialty, or geography. Because we have many committees, member volunteers, and staff addressing these issues from various angles, the board has set up two joint coordinating councils. The Joint Coordinating Council on Wellness will coordinate wellness efforts throughout the Academy and address the factors contributing to burnout, including regulatory hassles, excessive workload, loss of autonomy, lack of recognition of

professionalism, clerical burden, inadequate support staff, and poor work-life balance. The council’s objectives include: Collaborate with other organizations to advocate for and develop solutions to mitigate burnout and promote well-being Develop additional resources to address the issue of burnout and well-being at the work unit and organizational levels, including evolution of the Live Well, Lead Well Leadership Program Develop and disseminate personalized mitigation resources for trainees and program directors Continue to evaluate well-being and career satisfaction among AAN members, including important subgroups of our membership To improve equity, diversity, and inclusion (EDI), the board established the Joint Coordinating Council on Equity, Diversity, and Inclusion. As envisioned by the 2018 Diversity Leadership Program participants, this group will gather and publish data pertinent to neurologic health equity and practitioner workforce diversity; develop and maintain effective guidelines and education programs for departmental leadership regarding EDI issues, initiatives, and standards; foster transparency and monitor progress; coordinate EDI efforts across AAN committees; coordinate with AAN advocacy to support legislation pertinent to neurologic health equity; support departmental EDI officers; and administer EDI-related service awards. There is much on our plate this year. But as the Academy addresses these issues, we seek to anticipate what may be around the corner. Through careful planning, executing our objectives to meet our goals, and having the agility to respond quickly to the curve balls that come our way, the AAN should have a successful 2019 serving you, our members. 

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

Conferences & Community

Grand Experience Features Science, Experiential Learning, More Make your way to The Grand Experience in the Grand Hall of the Pennsylvania Convention Center every day of the Annual Meeting for engaging, innovative, creative, and unique opportunities. In one space, attendees can expect to experience science, networking, and mentoring in a grand new way through scientific platform sessions; academic medicine offerings; small-group conversations about careers roles and stages; mentoring sessions; and casual lounge areas for relaxing and networking. Scientific award presentations will take the stage with Q&A panels with past recipients of the John Dystel Prize for MS Research, Potamkin Prize for Research, and Sheila Essey Award. The Grand Experience will also host the first ever National Institutes of Health Day on Sunday, May 5. In addition, the area will host two of the meeting’s most popular experiential learning areas: Navigating Your Career Regardless of where you are in your professional journey, you’ll want to stop by this area for essential tips, tools, and resources to power your success. Those from academic departments will want to look for Academic Medicine Track programming. Additional new programs cover subspecialty career paths; issues that arise during early-, mid-, and latecareer stages; and Spanish-language presentations. For the first time, some talks will offer CME. Research Corner Discover how you can shape the future of research—no matter where you’re at in your research career. Improve

your knowledge and skills through practical tools and resources you won’t find anywhere else at the Annual Meeting. Trainees interested in careers in research should look for new morning courses in the Futures in Neurological Research track. The area will also offer practical “How To” talks that explore tangible steps for identifying research questions, funding your research, publishing and presenting research, talking to your biostatician, what to do if your paper isn’t accepted, and more. For more information about The Grand Experience, visit AAN.com/view/ELAs. 

Exhibit Hall Promises Four Days of Not-to-be-missed Happenings The Exhibit Hall at the 2019 Annual Meeting is not your typical exhibit hall—and it’s four days of the meeting you won’t want to miss. Set to kick off with an Opening Luncheon on Sunday, May 5, the Exhibit Hall will run through Wednesday, May 8. Not only will the hall offer opportunities to meet, mingle, and learn from pharmaceutical and medical device industry representatives, but this year’s attendees can expect to: Connect with other health organizations throughout the Association Neighborhood Discover emerging technologies within the Technology Pavilion Keep up-to-date on what’s new at Publishers Row Gather career resources and more during the Career Fair Preview the latest products and services at Vendor Booths

Experience an array of dynamic events at the Innovation Hub Grab a cup of joe and mingle at the Exhibit Hall Buzz Cafes Keep your devices charged in the comfort of the Exhibit Hall Charging Lounges Take a break and relax at the Exhibit Hall Picnic Area Unwind twice daily with Wine and Paint Sessions Play daily bingo or take part in fun food plating competitions In addition, the Exhibit Hall will feature these not-to-bemissed special events: Opening Luncheon Sunday, May 5, 11:30 a.m.–1:00 p.m. Exhibit Hall Networking Reception Monday, May 6, 4:00 p.m.–6:00 p.m. Brainstorm: A Competition for the Innovator in All of Us Monday, May 6, 4:00 p.m.–5:30 p.m. Bingo Daily, 1:00 p.m.–2:00 p.m. Food Plating Competitions Monday, May 6–Wednesday, May 8, 12:15 p.m.–12:45 p.m. 

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Conferences & Community

Meet the AAN and AAN Institute Boards of Directors Nominees The slate of nominees for AAN officer and director positions for the 2019–2021 term 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. 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 secretary-treasurer and additional members who serve in ex officio capacities. 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.

consortium, and is a past president of the Indiana Neurological Society. He also served on the executive committee for the Lutheran Hospital of Indiana and serves as chair of the board of directors for Physicians Health Plan of Indiana.

President—James C. Stevens, MD, FAAN

He has been recognized annually as one the “Best Doctors in America,” and has been a recipient of the “Patients Choice Award” since 2008 as one of the outstanding physicians in the United States. Stevens has received multi-year recognition as the “Top Doc” in neurology by the Fort Wayne Journal Gazette.

James C. Stevens, MD, FAAN, has been a private practicing neurologist and specialist in sleep disorders medicine at the Fort Wayne Neurological Center for the past 31 years. He received his medical degree from the Indiana University School of Medicine (IUSM), where he graduated at the top of his class, receiving AOA honors his junior year. He completed his neurology resident training at Indiana University, where he was a multi-year recipient of the Alexander Ross Award for outstanding neurologic research. He currently serves as a professor of neurology for the IUSM. Stevens has been a participant, coauthor, and/or principal investigator in over 80 clinical trials dealing with a wide variety of neurologic diseases. He has also been involved with the development, authorship, and/or review of more than 100 clinical practice guidelines submitted by the AAN. He has held many leadership positions within the Academy, serving as the chair of the Practice Committee, chair of the AAN Board Planning Committee, member of the Quality Standards Subcommittee and the Therapeutics and Technology Subcommittee, as well as serving on numerous work groups and task forces, including the Health Reform Task Force, the Solo and Small Group Task Force, and is currently serving as AAN president elect. Stevens is a graduate of the Palatucci Advocacy Leadership Forum, has been a special advisor to the NINDS clinical research

AANnews • March 2019

Immediate Past President— Ralph L. Sacco, MD, MS, FAHA, FAAN Ralph L. Sacco, MD, MS, FAHA, FAAN, is the chairman of neurology; Olemberg Family Chair in Neurological Disorders; Miller Professor of Neurology Public Health Sciences, Human Genetics, and Neurosurgery; executive director of the Evelyn McKnight Brain Institute; Senior Associate Dean for Clinical and Translational Science, University of Miami, Miller School of Medicine; and chief of the neurology service at Jackson Memorial Hospital. A graduate of Cornell University and a cum laude graduate of Boston University School of Medicine, he also holds a master's in epidemiology from Columbia University, School of Public Health. Sacco completed his neurology residency training and postdoctoral training in stroke and epidemiology at Columbia Presbyterian in New York. He was previously professor of neurology, chief of Stroke and Critical Care Division, and associate chairman at Columbia University before taking his current position in 2007. Sacco is an international expert in stroke epidemiology and health disparities. He is

the principal investigator of the Northern Manhattan Study, the Florida Puerto Rico Collaboration to Reduce Stroke Disparities, AHA/ASA Bugher Center of Excellence, as well as co-investigator of multiple other NIH grants. Sacco has published extensively with over 600 peer-reviewed articles (h-index 101) in the areas of stroke prevention, treatment, epidemiology, risk factors, vascular cognitive impairment, human genetics, and outcomes. He has been the recipient of numerous awards, including the AAN Wartenberg Lecture, AHA Feinberg Award of Excellence in Clinical Stroke, the WSO Global Stroke Leadership Award, AHA Gold Heart Award, the NINDS Javits Award in neuroscience, and numerous named lectures. Sacco is a fellow of both the Stroke and Epidemiology Councils of the American Heart Association, a Fellow of the ANA, and an elected member of the American Association of Physicians. He was the first neurologist to serve as the president of the American Heart Association from 2010 to 2011.

Officers President Elect— Orly Avitzur, MD, MBA, FAAN Orly Avitzur, MD, MBA, FAAN, is the chair of the AAN's Medical Economics and Management Committee. She is a medical writer and the editor-in-chief of Brain & Life®, the AAN’s patient magazine. Since 2001, she has been a writer for Neurology Today ®, reporting on trends in the practice of neurology, and is an associate editor for the publication. Avitzur was the former medical director at Consumer Reports and has been a frequent contributor to the Washington

Post. She writes and frequently speaks about consumer health and wellness, medical economics, medical practice management, and leadership, and has been the recipient of several APEX writing awards and the 2009 AAN Journalism Fellowship award. Vice President—Ann H. Tilton, MD, FAAN Ann H. Tilton, MD, FAAN, is a professor of neurology and pediatrics and section chair of child neurology at Louisiana State Health Science Center in New Orleans, LA. She is director of the Rehabilitation Center at Children’s Hospital of New Orleans and director of the Comprehensive Spasticity Program. Special interests include neurorehabilitation, neuromuscular disorders, and clinical applications and research in novel uses of botulinum toxin and intrathecal baclofen in the care of children and young adults with abnormal tone. Tilton has been involved on the executive committee of the Professors of Child Neurology and active in the national Child Neurology Society as a councilor, secretary/treasurer, and served as president of the organization. She is currently the president of the Child Neurology Foundation. She is actively involved in the AAN Board of Directors, where she serves as the vice president of the AAN. Residency education is one of her priorities, and she served as a member and vice chair of the ACGME Neurology Residency Review Committee. She is just completing her role as the chair of the American Board of Psychiatry and Neurology. Tilton's interest in children with disabilities extends to the American Academy of Pediatrics where she served on the national Council for Children with Developmental Disabilities. Tilton has been board certified by the American Board of Pediatrics, the American Board of Psychiatry and Neurology with special qualifications in child neurology, and the American Board of Psychiatry and Neurology in clinical neurophysiology. She has published on numerous topics and has spoken nationally and internationally

on child neurology, rehabilitation, and spasticity management.

Hill. She has served as a mentor in the Emerging Leaders, the Diversity Leaders, the Transforming Leaders, and the Women Leading in Neurology programs. She was awarded the AAN Leading in Excellence Mentorship Award in 2017.

Secretary—Carlayne E. Jackson, MD, FAAN Carlayne E. Jackson, MD, FAAN, is currently professor of neurology and otolaryngology at the University of Texas Health Science Center San Antonio (UTHSCSA). She also serves as chief of the neuromuscular section and vice chair of Faculty Development and Wellness. Jackson is a graduate of Texas A&M University, where she received a Bachelor of Science degree in Chemical Engineering. She obtained her medical degree at UTHSCSA, where she subsequently completed her neurology residency training and clinical neurophysiology fellowship. She has obtained board subspecialty certification in both clinical neurophysiology and neuromuscular medicine. She is a graduate of the Executive Leadership in Academic Medicine (ELAM) program sponsored by Drexel University College of Medicine.

Treasurer—Janis M. Miyasaki, MD, MEd, FRCPC, FAAN Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, is a graduate of the University of Toronto Medical Faculty, neurology residency program, and a movement disorders fellowship. From 1994 to 1998, she was a community neurologist seeing general neurology patients and providing in-hospital care at a regional cancer and dialysis hospital. In 1999, she joined the faculty of medicine at the University of Toronto as full-time faculty, assuming the roles for various periods of director of education for neurology for four hospitals, ward chief, member of the Board of Trustees for the University Health Network, president of the Medical Staff Association, president of the Canadian Movement Disorders Group, deputy physician-in-chief at Toronto Western Hospital, and associate clinical director of the Movement Disorders Centre at Toronto Western Hospital from 2001 to 2013. Her practice consisted of movement disorders, clinical trials, and the development of an interdisciplinary Palliative Care Program for Parkinson's Disease and Related Disorders, the first of its kind in the world.

Jackson serves as medical director for the South Texas ALSA Center of Excellence and the MDA ALS Research Center. She is a member of the Western ALS Study Group, Northeast ALS Research Group, and the Muscle Study Group. She has participated in over 60 multi-center clinical trials in the areas of ALS, muscular dystrophy, and myasthenia gravis and has published over 200 abstracts, journal articles, and book chapters.

Since 2014, Miyasaki has been a member of the division of neurology at the University of Alberta and active in local and provincial initiatives in palliative care for neurologic patients.

Jackson has served the AAN as a member of the Science Committee, Meeting Management Committee, Leadership Development Committee, and the Board of Directors. She currently chairs the Board Planning Committee and serves as Secretary for the Board of Directors. She has been a member of the Continuum® editorial board, co-chaired the ALS Measurement Development Panel, and co-authored the ALS Practice Parameters. She has actively participated on the Education Subcommittee and the Neuromuscular Topic Work Group. Jackson participated in the Palatucci Advocacy Leadership Forum in 2013 and has been a delegate to Neurology on the

Her AAN activities began in 2000 with writing a guideline on Parkinson's disease. Since that time, she has worked on many AAN committees, including the Practice Committee, Therapeutics and Technology Subcommittee, Practice Improvement Subcommittee, Patient Safety Subcommittee, and co-chaired the Therapeutics and Technology Subcommittee (now the Guideline Development Subcommittee) and Education Committee. Between producing educational content, Continued on page 8

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Conferences & Community

Meet the AAN and AAN Institute Boards of Directors Nominees continued from page 7 committees, working groups, and meetings, she estimates since 2000 spending one day per month to a half-day per week on AAN work. It has been rewarding and energizing work.

Directors Brenda Banwell, MD, FAAN Brenda Banwell, MD, FAAN, currently serves as the chief of child neurology and professor of neurology and pediatrics at The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania. Banwell’s clinical and research focus is in the area of pediatric multiple sclerosis, and she leads a 24-site North American prospective study of clinical outcomes, genetics, immunology, and neuroimaging features of MS in children. Banwell also serves as the chair of the International Pediatric Multiple Sclerosis Study Group. Banwell studied medicine at the University of Western Ontario, followed by residencies in pediatrics at the University of Western Ontario and Child Neurology at the University of Toronto. She then pursued a Neuromuscular Fellowship at the Mayo Clinic in Rochester, MN. In 1999 Banwell was appointed assistant professor of pediatrics and neurology at The Hospital for Sick Children at the University of Toronto, and rose to the rank of full professor prior to relocating to The Children's Hospital of Philadelphia in 2012. She remains as adjunct senior scientist in the Research Institute at The Hospital for Sick Children. Banwell has been a member of the AAN since 1996 and has since attended every Annual Meeting. She served on the Science Committee from 2005 to 2011 and is an active member of the AAN Meeting Management Committee. Banwell was a selected attendee at the Leadership Development Program in 2007 and 2008 and has more recently served as a mentor in the AAN Emerging Leaders Program. She serves on the

AANnews • March 2019

Brain Health Fair Committee where she has been an active annual participant in Brain Health Fair activities. Sarah M. Benish, MD, FAAN Sarah M. Benish, MD, FAAN, is currently the physician co-chief for M Health/Fairview Neuroscience service line. She works for University of Minnesota Physicians and is also section head for general neurology at the University of Minnesota. She enjoys her clinic time as a general neurologist. Over her career she has developed an interest in treating headache patients but continues to enjoy caring for all neurologic diseases. Prior to joining the University of Minnesota, she was a physician owner/ partner at Minneapolis Clinic of Neurology (MCN), one of the largest physician-owned, single-specialty neurology clinics in the country. She spent seven years on its board of directors and was treasurer for one year. During her decade with this clinic, she learned a lot about the business of medicine and what it takes to survive in the days of modern medicine and payment reform. Benish began her involvement with the AAN as a member of the inaugural class of the Emerging Leaders Forum. At the end of the forum, she joined the Practice Committee, where she led a work group investigating whether the AAN should invest in a registry. When the Axon Registry® was started, she joined the Registry Committee and chaired the Registry Analytics Subcommittee. In 2019, she is looking forward to starting her third term on the AAN Board of Directors, and serving as the chair of the Registry Subcommittee and member of the newly formed Quality Committee. She has found her involvement in the AAN to be the antidote to burnout. She views herself as a clinician first and tries hard to represent the views of all neurologists in her roles at the AAN.

Charlene Gamaldo, MD, FAAN Charlene Gamaldo, MD, FAAN, has been a faculty member of the Johns Hopkins School of Medicine neurology department since 2004, with joint appointments in the department of psychiatry, nursing, anesthesiology, and schools of public health. She is currently the medical director of the Johns Hopkins Center for Sleep and the vice chair for faculty development for the neurology department. Gamaldo's research interest is studying the impact of sleep on manifestation and progression of neurologic diseases. Her research activities have relied heavily on the interdisciplinary and inter-professional collaborative model for conducting sleep research using the efforts of a diverse group of collaborators and, as a result, have led to ongoing and evolving research projects that now include a growing list of collaborators at Johns Hopkins in neurology, psychiatry, urology, biomedical engineering, Schools of Nursing and Public Health, along with the National Institute on Aging. In addition, upon considering the projected shortage of sleep practitioners, she has developed programs to involve and expose undergraduates (sleep learning module), medical students (sleep learning module), graduate students, post-docs, and residents to the sleep medicine field in order to attract the best and the brightest early on in their career. Gamaldo has served as co-chair for the AAN Sleep Section presentations, served as the Johns Hopkins School of Medicine neurology clerkship co-director for six years, and has recently been appointed to the AAN Sleep Section Leadership Committee, as well as the AAN Medical Student Pipeline Committee, the Undergraduate Education Subcommittee, and the Minority Scholars Subcommittee.

James N. Goldenberg, MD, CPI, FAPCR, FAAN James N. Goldenberg, MD, FAAN, is a boardcertified neurologist who practiced in Palm Beach County for 25 years. He currently serves as medical director for Atlantic Coast Health Network, a regional super clinically integrated network representing over 1,700 physicians and 170,000 lives in South Florida. In this role, he is responsible for strategy, value-based care initiatives, population health, and patient safety. His undergraduate training is in psychology from the University of Florida, and he received his medical degree from the University of South Florida. His neurology training and fellowship in neuromuscular disease were completed at the University of Miami. Goldenberg has served JFK Hospital in Atlantis Florida in multiple leadership roles including chair of the Board of Trustees, chair of the Credentials Committee, chair of the Bylaws Committee, and chief of the department of psychiatry and neurology. He was the founding medical director of JFK Hospital’s stroke program and has helped develop their Comprehensive Stroke Center. Goldenberg founded the JEM Research Institute, a clinical research organization that performs predominantly industry sponsored phase II–IV clinical trials to help develop new treatments in the area of neurology. Goldenberg has also served The Joint Commission as a diseasespecific surveyor in stroke―the first physician to hold that position nationally. Goldenberg is an affiliated assistant professor of neurology at the Leonard M. Miller School of Medicine at the University of Miami. He has coordinated the neurology rotation for second-year residents at JFK Hospital’s University of Miami-sponsored internal medicine residency program. He has also coordinated the neurology medical student rotation for fourth-year medical students at the University of Miami’s Palm Beach Regional Campus.

Goldenberg is an advocate for patients and physicians at the local, regional, and national levels. He is a past president of the Palm Beach County Medical Society and currently serves on the Board of Trustees. He is responsible for the development of the Physician Leadership Academy of South Florida. He is serving the Florida Medical Association on the Board of Governors and the Council on Medical Economics and Practice Innovation. Goldenberg is an alternate delegate to the American Medical Association. He is serving the AAN on the Board of Directors, Government Relations Committee, and Leadership Development Committee. Through advocacy, education, and the promotion of physician leadership training, he would like to help physicians prepare for the changing health care landscape.

for his service. He currently serves on the Board of King's College in WilkesBarre, PA, of which he is an alumnus. He is married to Linda M. Famiglio, MD, FAAP, a pediatric neurologist, and has two children. Elaine C. Jones, MD, FAAN Elaine C. Jones, MD, FAAN, received her MD from the Medical University of South Carolina in 1994 before completing her neurology residency at Brown University and Rhode Island Hospital in 1998. After her residency, she returned to Brown to complete her fellowship in neurophysiology in 1999. Jones is board certified with the American Board of Psychiatry and Neurology. She is a former president of the Rhode Island Neurological Society, former president of the Rhode Island Medical Society, and is currently a member of the AAN Board of Directors and chairs the Payer Policy Subcommittee. She previously chaired the AAN’s Gender Disparity Task Force. She is an honored Fellow of the AAN.

Jonathan P. Hosey, MD, FAAN Jonathan P. Hosey, MD, FAAN, is currently the chair of Neurobehavioral Science Service Line for the St. Luke’s University Health Network in Bethlehem, PA, which is composed of 11 hospitals in two states. In 1990, he was involved with the development of neurology residency programs at the Madigan Army Medical Center in Tacoma, and as the founding director of the Geisinger Health System program in 2010. He is a professor of neurology at the Lewis Katz School of Medicine at Temple University and has served on numerous AAN subcommittees and committees. He is most proud of being in the inaugural class of the Palatucci Advocacy Leadership Forum.

Jones has worked in a variety of positions including chief of the division of neurology for Roger Williams Medical Center. She worked for 11 years in her own solo private practice, Southern New England Neurology, LLC. Named one of Rhode Island Monthly’s Top Doctors for five years straight, Jones currently works doing teleneurology for SOC Telemed, LLC. She has also contributed several articles examining the politics of health care and the methods, guidelines, and future of clinical neurology practices. Shannon M. Kilgore, MD, FAAN*

Hosey is active in his community, having served as a past president of the American Heart Association/American Stroke Association (AHA/ASA) of Pennsylvania/Delaware chapter. He has served on many boards, including the Three Rivers Affiliate of the AHA/ASA, Geisinger Health Plan, Pennsylvania Rural Stroke Institute, and was a longserving trustee of Wyoming Seminary Preparatory School of Pennsylvania, where he was awarded the Joseph Donchess Lifetime Achievement Award

Shannon M. Kilgore, MD, FAAN, practices neurology within the Veterans Affairs Health Care System in Palo Alto, CA. She works as both the director of stroke services, and the Palo Alto representative of the National VA Parkinson’s Disease Consortium. Kilgore cares greatly about pharmaceutical pricing and medication safety, leading Palo Alto’s Medical Management Continued on page 10

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AANnews • March 2019 9

Conferences & Community

Meet the AAN and AAN Institute Boards of Directors Nominees continued from page 9 Committee and co-leading the regional VA Pharmacy Benefits Committee. Additionally, she represents neurology on the Medical Advisory Panel to Pharmacy Benefits Management, which determines the formulary for the entire Department of Veterans Affairs. Raised in the Texas Hill Country, Kilgore obtained her Bachelor of Arts in psychology from the University of Texas at Austin, and her Doctor of Medicine from the University of Texas Health Science Center at Houston. She then completed her neurology residency and fellowships in both cerebrovascular disease and movement disorders at Stanford. In 2003, she brought this unique combination expertise to the VA, where she has taught medical students, neurology residents, and geriatrics fellows in both outpatient and inpatient settings, as a member of Stanford’s clinical faculty. Kilgore has maintained a long-held interest in combining both education and advocacy. She has joined the Neurology Review Committee for the Accreditation Council for Graduate Medical Education twice, first as a resident/fellow, and then again as a regular member, ultimately serving as chair, before rotating off in 2017. During her time on the committee, she participated in revision of all the programs requirements, development of the milestones, and recognition of child neurology on equal footing with adult neurology within the ACGME. She first became involved with the Academy when she joined the AAN’s delegation to the American Medical Association in 2004, bringing her knowledge of advocacy and AMA proceedings gained as an AMA resident and student delegate. Now chair of the delegation, she has sought to broaden the influence of neurology within the greater medical community. Kilgore also serves the Academy on the Government Relations Committee, the Education Committee, the Editorial Board of Continuum: Lifelong Learning in Neurology®, and on the recent Drug Pricing Task Force. A member of the 2014–2015 Emerging Leaders Forum class, she now enjoys giving back

AANnews • March 2019

as a mentor within the various AAN leadership programs. *New nominee to the Board of Directors

Brett M. Kissela, MD, MS, FAAN Brett M. Kissela, MD, MS, FAAN, is professor and chair of the department of neurology and rehabilitation medicine at the University of Cincinnati College of Medicine. He has been a member of the University of Cincinnati Stroke team since 2000, and co-director of the Stroke Recovery Center at Drake since 2008. Since November 2017, Kissela has served as the senior associate dean for clinical research at the University of Cincinnati College of Medicine, as well as chief of research services at UC Health. He is fellowship-trained in vascular neurology and has extensive clinical trial experience in acute stroke treatment, prevention, and recovery trials. He is an internationally recognized expert on causes, outcomes, and recovery of stroke, with a special interest in the impact of diabetes on stroke and factors that influence stroke outcomes. He also participates in a variety of stroke recovery projects which look to improve recovery with the use of innovative techniques and devices. Kissela’s honors and awards include the Cincinnati Business Courier's Forty Under 40 Award, Michael S. Pessin Stroke Leadership Prize from the American Academy of Neurology, Alpha Omega Alpha membership, National Medical Honor Society, Phi Beta Kappa, and a UC Faculty Senate Award. Thomas R. Vidic, MD, FAAN Thomas R. Vidic, MD, FAAN, has dedicated his professional life to patient care, advocacy, teaching, and clinical research. He is a practicing general neurologist at the Elkhart Clinic in Indiana, the director of the regional MDA clinic, and co-director of the rehabilitation unit at Elkhart General Hospital. Vidic established

Indiana Medical Research and is its medical director. He is past chair of the Elkhart Clinic, past chief of staff of Elkhart General Hospital, and chair of the bylaws committee. Advocacy has been a passion for Vidic. He is a member of the Indiana Neurological Society and has served many roles, including president. He has worked with the Indiana State Medical Association on legislative advocacy and has served as speaker, president, and current chair of the PAC. He currently represents Indiana as an alternate delegate to the AMA. Vidic is a clinical associate professor at the Indiana School of Medicine/South Bend and co-teaches the third-year clerkship in neurology. He is on the Medical Foundation Board, which has helped develop and finance the transition of a regional campus to a four-year program. Vidic was introduced to AAN leadership through the Palatucci Advocacy Leadership Forum and has been active in both advocacy and member issues. He has been a member of AAN committees such as State Affairs, Legislative Affairs, BrainPAC, and as an alternate delegate to the AMA. He has chaired the Membership Committee and currently chairs the Member Research Subcommittee. He was co-author of “Supply and Demand Analysis of the Current and Future US Neurology Work Force” and is a co-author of the Neurology ® article on neurologist burnout. Vidic believes in the importance of neurologists in the medical community and the need to support neurologists through the AAN. He has developed an interdisciplinary skillset to analyze medical/political issues and the interpersonal skills to implement effective strategies. He is excited about continuing to serve the AAN on its board.

Ex officio (voting) Nicholas E. Johnson, MD, MS-CI, FAAN, Chair, Advocacy Committee Nicholas E. Johnson, MD, MS-CI, FAAN, is an associate professor and vice chair of research in the department of neurology at Virginia Commonwealth University with a focus in inherited neuromuscular disorders. He received his undergraduate degree in molecular and cellular biology and psychology at the University of Arizona. He then obtained his medical degree at the University of Arizona. He completed his neurology residency and combined fellowship in neuromuscular medicine and experimental therapeutics at the University of Rochester. His laboratory is focused on identifying the pathogenesis of myotonic dystrophy and facioscapulohumeral muscular dystrophy and identifying appropriate clinical endpoints for these conditions. Johnson conducts therapeutic trials in many other inherited nerve and muscle disorders. Johnson serves as chair of the AAN Government Relations Committee. He is also a member of the Academy’s delegation to the American Medical Association. In these roles, Johnson advocates for improving the practice of neurology for neurologists and their patients. Brad C. Klein, MD, MBA, FAAN, Chair, Medical Economics and Practice Committee Brad C. Klein, MD, MBA, FAAN, is a full-time practicing neurologist with additional certifications in headache medicine and electromyography in his private practice at Abington Neurological Associates, Ltd., in Willow Grove, PA. He has been a participant and/or principal investigator in more than 20 clinical trials and further serves as the practice’s chief operating officer. He is also the director of the Abington Headache Center, AbingtonJefferson Health and a clinical associate

an internal medicine residency at Duke University in Durham, NC, and a neurology residency and clinical neurophysiology fellowship at the Massachusetts General Hospital in Boston, MA. In 1988, Cascino joined the staff of the Mayo Clinic. His interests have included the identification of surgically remediable epileptic syndromes and advanced neuroimaging in patients with drug-resistant focal epilepsy. He has published over 200 peer-reviewed articles and presented approximately 400 invited lectures. Cascino has participated in the training of over 75 epilepsy-EEG fellows. He is currently an associate editor of Neurology®, chair of the AAN Member Engagement Committee, and an ex officio member of the AAN Board of Directors. He previously served on the American Epilepsy Society (AES) Board of Directors, the Council of the American Clinical Neurophysiology Society, and the Professional Advisory Board Executive Committee of the Epilepsy Foundation of America, and is past-chair of the AAN's Epilepsy Section. Cascino was the recipient of the J. Kiffin Penry Excellence in Epilepsy Care Award presented by the AES in 2013. He is married to Teresa Griffin Cascino and has two sons (Dr. Matthew and Dr. Gregory Joseph), one daughter (Mary), two daughters-in-law (Dr. Missy Haehn and Sarah), and two terrific grandkids (Ira and Charles).

professor of neurology at Thomas Jefferson University (TJU). He received his medical degree from Sidney Kimmel Medical College, previously known as Jefferson Medical College, at TJU in Philadelphia, concurrently with his Master of Business Administration degree at Widener University. He completed his neurology residency and headache fellowship at Thomas Jefferson University Hospital. During Klein’s residency, he graduated from the Palatucci Advocacy Leadership Forum and founded the Pennsylvania Neurological Society, serving as its first president. Through his tenure, he provided multiple testimonies to the state legislature and was an advisor on many legislative bills. Thereafter, he served in a number of other state and national leadership roles, including treasurer of the Alliance for Headache Disorders Advocacy, chair of the Practice Committee of the American Headache Society, and as a member of the Pennsylvania Health Care Cost Containment Council. Within the AAN, Klein has served as a member of the Practice Management and Technology Subcommittee, Health Services Research Subcommittee, Benchmark Survey Work Group, Solo and Small Practice Work Group, Meeting Management Committee, multiple education topic work groups, and vice chair of the Medical Economics and Management Committee.

Robert A. Gross, MD, PhD, FANA, FAAN, Editor-in-Chief of Neurology ® Robert A. Gross, MD, PhD, FANA, FAAN, graduated from Harvard College in 1975 with an AB in biology, summa cum laude, and from Washington University, MD and PhD (pharmacology) in 1981. After his internship at the Jewish Hospital in St. Louis, he completed his neurology residency at the Massachusetts General Hospital, where he served as chief resident. Faculty positions followed at the University of Michigan and the University of Minnesota, followed by the University of Rochester Medical Center (1994).

He has been the recipient of numerous local, regional, and national awards, including “Patient’s Choice Award,” and Castle Connolly’s “Top Doctor.” Gregory D. Cascino, MD, FAAN, Chair, Member Engagement Committee Gregory D. Cascino, MD, FAAN, is the Whitney MacMillan, Jr. Professor of Neuroscience at the Mayo Clinic College of Medicine and the Enterprise Director of Epilepsy at Mayo Clinic, Rochester, MN. He attended Northwestern University and received his degree in medicine from Rush Medical College in Chicago, IL. Cascino completed

Research interests have centered on various aspects of cellular Continued on page 12

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AANnews • March 2019 11

Conferences & Community

Meet the AAN and AAN Institute Boards of Directors Nominees continued from page 11 neuropharmacology and, collaboratively, on mechanisms of excitotoxicity and chemobrain. He participated in clinical trials of novel anticonvulsants and served on a multi-center task force to design trials to compare brand to generic AEDs. He was the recipient of the S. Weir Mitchell Award of the American Academy of Neurology in 1988. He sees patients in the Strong Epilepsy Center and is the associate chair for academic affairs in neurology. Gross' educational efforts are diverse. He founded and directs the Academic Research Track; funded by URMC's Clinical and Translational Science Award, this supports medical students for a year-out mentored experience in medical research. He helps direct and lectures (neuropharmacology) in the medical student course “Mind, Brain and Behavior.” He directs a novel basic science course for fourth-year medical students, “Process of Discovery,” in which students design cutting-edge research programs to address gaps in clinical care. He also teaches in AAN Annual Meeting courses, including the Career Development symposium. He served as an associate editor of Neurology® for 10 years, two of which were as deputy editor, and is the current editor-in-chief of the Neurology journals. Gross is a fellow of the AAN and American Neurological Association, and a member

of the American Epilepsy Society. He has appeared on the PBS program “Second Opinion” and on local radio shows on the topic of epilepsy. Catherine M. Rydell, CAE, Executive Director/CEO (non-voting) Catherine M. Rydell, CAE, has been the American Academy of Neurology's executive director and chief executive officer since 1999. Along with her executive team, she oversees 198 staff. Under Rydell's leadership, AAN membership has grown from 16,000 to over 36,000 members. Since joining the AAN, Rydell has focused on strengthening advocacy and coalitionbuilding efforts, increasing staff development, improving communication with members, and implementing its strategic plan. Under her leadership, the Academy increased educational offerings and established a companion organization to help support new member services and advocacy. Rydell also has been instrumental in expanding the influence and reach of the AAN by creating entities and initiatives to promote and advance the specialty of neurology. Rydell is a Certified Association Executive (CAE), the highest professional credential in the association industry. Less than five percent of all association professionals have earned a CAE designation.

Rydell serves on the Board of Directors of the American Brain Foundation and is a member of the American Board of Medical Specialties (ABMS) Continuing Board Certification: Vision for the Future Initiative Commission. She is a member and past chair of the Specialty Society CEO Coalition, and an ex officio member of the Neurology Residency Review Committee and the United Council of Neurologic Subspecialties. She also serves on the Board of the University of North Dakota Foundation and Alumni Association. Prior to joining the AAN, Rydell served as executive director of the North Dakota Medical Association. From 1984 through 1996, Rydell served as a state representative in the North Dakota State Legislature, where she chaired the House Human Services Committee and the House Education Committee. She was also the director of Women's and Children's Services as well as Surgical Services for St. Alexius Medical Center, a tertiary care center in Bismarck, ND. Rydell has served on numerous national, regional, and state boards and commissions including Robert Wood Johnson North Dakota Single Payer Study Commission, Blue Cross Blue Shield of North Dakota, American Medical Association CEO Advisory Committee, Council of Medical Specialty Societies, the American Brain Coalition, the Theodore Roosevelt Medora Foundation, and the American Society of Association Executives.

2019–2021 AAN Institute Board of Directors The AAN Institute Board of Directors will include the following additional members.

Officer Charles C. Flippen II, MD, FAAN, AAN Institute Secretary-Treasurer Charles C. Flippen II, MD, FAAN, is a faculty member of the Headache Research and Treatment Program at the Ronald Reagan UCLA Medical Center, attending neurologist at the Olive View-UCLA Medical Center, and professor of neurology and director of the residency

AANnews • March 2019

program in clinical neurology at the Geffen School of Medicine at UCLA. Flippen is a diplomate of adult neurology of the American Board of Psychiatry Neurology (ABPN) and of headache medicine of the United Council of Neurologic Subspecialties. He is a member of the American Headache Society, International Headache Society, Fellow of the American Neurological Association, and Fellow of the American Academy of Neurology, where he is active in headache education, having directed several courses,

and as chair of the Headache Topic Work Group of the Education Committee. He also serves on the Quality and Safety Subcommittee, the AAN Institute Minority Scholars Subcommittee, and served on the AAN Nomination Committee. In addition to his activity on the AAN Education Committee, Flippen represents the ABPN on the Neurology Residency Review Committee of the Accreditation Council of Graduate Medical Education, is conducting education research funded by the ABPN Faculty Fellowship award, and

serves on several intramural committees charged with curricular innovation in the Geffen School of Medicine. Flippen is also active within the general Los Angeles community through his service as a former trustee of the Carlthorp School, board member of 100 Black Men of Los Angeles, assistant scoutmaster and Merit Badge counselor for Troop 223 (Pacific Palisades) of the Boy Scouts of America, West Region Health and Wellness committee member for Alpha Phi Alpha Fraternity Inc., and member of Sigma Pi Phi Fraternity, Inc.

Ex Officio (voting) Natalia S. Rost, MD, MPH, FAHA, FAAN, Chair, Science Committee Natalia S. Rost, MD, MPH, FAHA, FAAN, is chief of the stroke division in the department of neurology at Massachusetts General Hospital, associate director of the MGH Comprehensive Stroke Center, and associate professor of neurology at Harvard Medical School. A cum laude graduate of Boston University School of Medicine, she also holds a master's degree from Harvard School of Public Health. Rost trained in neurology and vascular neurology at Massachusetts General Hospital and Brigham and Women's Hospital (Partners) residency and fellowship programs. Rost is a clinician-scientist and international expert on neuroimaging markers of cerebrovascular disease, stroke genetics, and outcome prediction in patients with acute stroke. Her line of research on the role of white matter disease burden in ischemic stroke has been continuously funded since 2007, and she is currently the PI of two NIH R01 awards, and co-investigator of numerous multi-disciplinary, multicenter collaborations involving the NINDS StrokeNET clinical trials network and the International Stroke Genetics Consortium, where she serves as chair of the Neuroimaging Working Group. Rost is a recipient of the AAN’s Michael S. Pessin Stroke Leadership Award. Rost is an author of numerous peerreviewed publications, book chapters, a co-author of the MGH Handbook of

Neurology, and medical editor of the HMS Special Health Report on stroke. She is an accomplished mentor, clinical educator, and recipient of the 2017 MGH Neurology Department’s Ray Adams Clinical Mentor Award. She serves as assistant editor of the journal STROKE, and she is past president of the Boston Board of the American Heart Association (2014–2016).

has been the program director of the Mayo Clinic–Rochester Adult Neurology Residency Program. Alongside his interest in resident education, Jones has developed with his colleagues a competency-based neurology assessment system and co-edited the two-volume Mayo Clinic Neurology Board Review. He has been recognized with the AAN Program Director Award, the ACGME Parker J. Palmer Courage to Teach Award, and has been inducted into the Mayo Clinic Teacher of the Year Hall of Fame.

Rost is a Fellow of the American Academy of Neurology, the Stroke Council of the American Heart Association, and the European Stroke Organization. Among her professional accomplishments, Rost is particularly proud of her careerlong involvement with the AAN, where she currently serves as chair of the Science Committee.

A. Gordon Smith, MD, FAAN, Chair, Education Committee A. Gordon Smith, MD, FAAN, is professor and chair of neurology and Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research (Neurology) at VCU Health at the Virginia Commonwealth University. Prior to that, he was professor of neurology and vice chair for research at the University of Utah, where he also served as chief of the division of neuromuscular medicine and director of the Jack H. Petajan EMG Laboratory. Smith is a graduate of the University of Virginia and the Mayo Medical School. He completed his neurology residency and a neuromuscular fellowship at the University of Michigan.

Lyell K. Jones, Jr., MD, FAAN, Chair, Quality Committee Lyell K. Jones, Jr., MD, FAAN, is a consultant and associate professor of neurology at the Mayo Clinic in Rochester, MN. Jones received his undergraduate and medical degrees from Wake Forest University before completing his neurology residency and neurophysiology fellowship at the Mayo Clinic, where he has been a member of the consulting staff since 2009. Jones’s clinical and research focus is in neuromuscular medicine, particularly neurodegenerative, infectious, and autoimmune neuromuscular disorders. Jones has additional interests in health care policy and economics, specifically value-based care systems. He is a former medical director for the Mayo Clinic Office of Patient Experience and chair of Payment Model Operations at Mayo. He has served on several national society committees including the AAN Medical Economics and Management Committee, the AAN Payment Alternatives Team, the AANEM Quality Committee, and as chair of the AAN Registry Committee, all which are devoted to improving quality of care for patients and providing neurologists with the tools they need to thrive in an era of evolving value-based care models.

Smith's research team focuses on peripheral neuropathy in diabetes and obesity. He has a particular interest in biomarker development and novel clinical trial design in peripheral neuropathy and longstanding and ongoing NIH and major foundation funding. He is principal investigator of the Utah Regional site in the NINDS-funded Network for Excellence in Neuroscience Clinical Trials. He has led or participated in numerous clinical trials in neuromuscular disorders. He serves as chair of the Education Committee and is a member of the American Brain Foundation Board of Trustees. Smith chaired the Distance Learning Subcommittee and was the Education Editor of AAN.com. He also serves as editor for NeuroLearnSM. He is active in the Peripheral Nerve Society, where he is a former member of the board of directors. 

Prior to joining the staff at the Mayo Clinic, Jones served on active duty in the US Air Force at Wilford Hall Medical Center in San Antonio, TX. Since 2013, Jones

AANnews • March 2019 13

IN PATIENTS WITH RELAPSING FORMS OF MULTIPLE SCLEROSIS (RMS)

START WITH THE POWER AND EXPERIENCE OF TYSABRI

IN THE FIGHT AGAINST RMS In the 2-year AFFIRM pivotal trial:

83%

of patients taking TYSABRI had no sustained physical disability progression for 12 weeks vs 71% with placebo (primary endpoint: percentage with sustained increase in disability was 17% vs 29%; p<0.001)1,2

INDICATION TYSABRI® (natalizumab) is indicated as monotherapy for the treatment of patients with relapsing forms of multiple sclerosis. TYSABRI increases the risk of PML. When initiating and continuing treatment with TYSABRI, physicians should consider whether the expected benefit of TYSABRI is sufficient to offset this risk. See Important Safety Information regarding the risk of PML with TYSABRI. IMPORTANT SAFETY INFORMATION WARNING: Progressive Multifocal Leukoencephalopathy (PML) TYSABRI® (natalizumab) increases the risk of PML, an opportunistic viral infection of the brain that usually leads to death or severe disability. Risk factors for the development of PML include duration of therapy, prior use of immunosuppressants, and presence of anti-JCV antibodies. These factors should be considered in the context of expected benefit when initiating and continuing treatment with TYSABRI. Healthcare professionals should monitor patients on TYSABRI for any new sign or symptom that may be suggestive of PML. TYSABRI dosing should be withheld immediately at the first sign or symptom suggestive of PML. For diagnosis, an evaluation including a gadoliniumenhanced MRI scan of the brain and, when indicated, cerebrospinal fluid analysis for JC viral DNA are recommended. Because of the risk of PML, TYSABRI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the TOUCH Prescribing Program.  Infection by the JC Virus (JCV) is required for the development of PML.  There are no known interventions that can reliably prevent PML or that can adequately treat PML if it occurs.  Postmarketing data suggest that the risk of developing PML may be associated with relative levels of serum anti-JCV antibody compared to a calibrator as measured by ELISA (often described as an anti-JCV antibody index value).  MRI findings may be apparent before clinical signs or symptoms suggestive of PML. 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. Consider monitoring patients at high risk for PML more frequently. Lower PML-related mortality and morbidity have been reported following TYSABRI discontinuation in patients with PML who were initially asymptomatic compared to patients with PML who had characteristic clinical signs and symptoms at diagnosis. Important Safety Information continues on the following pages. Please see accompanying brief summary of full Prescribing Information, including Boxed Warning.

T R U S T I N T H E E X P E R I E N C E O F T Y S A B R I ® (n at a l iz u m a b) Choose the power of an established therapy

NEARLY

ALWAYS

APPROXIMATELY

200,000

COMMITTED TO SAFETY

NEW PATIENTS

for relapsing MS with the established therapy of TYSABRI, and counting3,a

The TOUCH® Prescribing Program helps you support patients throughout their treatment on TYSABRI

in the US who start TYSABRI have received no previous DMT4,b

PATIENTS TREATED

1 IN 5

OVER A DECADE OF REAL-WORLD EXPERIENCE VISIT TimeForTYSABRI.com OR TALK TO YOUR BIOGEN REPRESENTATIVE TO LEARN MORE DMT=disease-modifying therapy; a190,800 patients as of August 20183; bAs of July 2017. 4

IMPORTANT SAFETY INFORMATION WARNING: Progressive Multifocal Leukoencephalopathy (PML) (cont’d)  PML has been reported after discontinuation of TYSABRI in patients who did not have findings suggestive of PML at the time of discontinuation. Patients should continue to be monitored for any new signs or symptoms that may be suggestive of PML for approximately 6 months after discontinuation of TYSABRI.  Adverse events that may occur during plasma exchange include clearance of other medications and volume shifts, which have the potential to lead to hypotension or pulmonary edema. Although plasma exchange has not been studied in TYSABRI-treated patients with PML, it has been used in such patients in the postmarketing setting to remove TYSABRI more quickly from the circulation.  JCV infection of granule cell neurons in the cerebellum, i.e., JCV granule cell neuronopathy (GCN), with symptoms similar to PML, has been reported in patients treated with TYSABRI. JCV GCN can occur with or without concomitant PML and can cause cerebellar dysfunction. Diagnosis and management of JCV GCN should follow guidance provided for PML.  Immune reconstitution inflammatory syndrome (IRIS) has been reported in the majority of TYSABRI-treated patients who developed PML and subsequently discontinued TYSABRI. In almost all cases, IRIS occurred after plasma exchange was used to eliminate circulating TYSABRI. It presents as a clinical decline in the patient’s condition after TYSABRI removal (and, in some cases, after apparent clinical improvement) that may be rapid, can lead to serious neurological complications or death, and is often associated with characteristic changes in the MRI. TYSABRI has not been associated with IRIS in patients discontinuing treatment with TYSABRI for reasons unrelated to PML. In TYSABRI-treated patients with PML, IRIS has been reported within days to several weeks after plasma exchange. Monitoring for development of IRIS and appropriate treatment of the associated inflammation should be undertaken. Contraindications  TYSABRI is contraindicated in patients who have or have had PML.  TYSABRI is contraindicated in patients who have had a hypersensitivity reaction to TYSABRI. TYSABRI TOUCH Prescribing Program  Because of the risk of PML, TYSABRI is available only through a restricted distribution program under a REMS called the TOUCH® Prescribing Program.  Patients must be enrolled in the TOUCH Prescribing Program, read the Medication Guide, understand the risks associated with TYSABRI, and complete and sign the Patient-Prescriber Enrollment Form. Herpes Infections – Encephalitis, Meningitis and Acute Retinal Necrosis  TYSABRI increases the risk of developing encephalitis and meningitis caused by herpes simplex and varicella zoster viruses.  Serious, life-threatening, and sometimes fatal cases have been reported in the postmarketing setting in multiple sclerosis patients receiving TYSABRI.  The duration of treatment with TYSABRI prior to onset ranged from a few months to several years.  Monitor patients receiving TYSABRI for signs and symptoms of meningitis and encephalitis. If herpes encephalitis or meningitis occurs, TYSABRI should be discontinued, and appropriate treatment for herpes encephalitis/meningitis should be administered. Important Safety Information continues on the following pages. Please see accompanying brief summary of full Prescribing Information, including Boxed Warning.

IMPORTANT SAFETY INFORMATION (cont’d) Herpes Infections – Encephalitis, Meningitis and Acute Retinal Necrosis (cont’d)  Patients being administered TYSABRI are at a higher risk of acute retinal necrosis (ARN), a fulminant viral infection of the retina caused by the family of herpes viruses. Patients with eye symptoms such as decreased visual acuity, redness or eye pain should be referred for retinal screening as serious cases of ARN can lead to blindness of one or both eyes.  Following clinical diagnosis of ARN, consider discontinuation of TYSABRI. Hepatotoxicity  Clinically significant liver injury, including acute liver failure requiring transplant, has been reported in patients treated with TYSABRI in the postmarketing setting.  Signs of liver injury, including markedly elevated serum hepatic enzymes and elevated total bilirubin, occurred as early as six days after the first dose; signs of liver injury have also been reported for the first time after multiple doses.  TYSABRI should be discontinued in patients with jaundice or other evidence of significant liver injury (e.g., laboratory evidence). Hypersensitivity/Antibody Formation  Hypersensitivity reactions have occurred in patients receiving TYSABRI, including serious systemic reactions (e.g., anaphylaxis) which occurred at an incidence of <1%.  Reactions usually occur within 2 hours of the start of the infusion. Symptoms associated with these reactions can include urticaria, dizziness, fever, rash, rigors, pruritus, nausea, flushing, hypotension, dyspnea, and chest pain.  If a hypersensitivity reaction occurs, discontinue administration of TYSABRI and initiate appropriate therapy. Patients who experience a hypersensitivity reaction should not be re-treated with TYSABRI.  Hypersensitivity reactions were more frequent in patients with antibodies to TYSABRI compared with patients who did not develop antibodies to TYSABRI in both MS and CD studies.  Patients who receive TYSABRI for a short exposure (1 to 2 infusions) followed by an extended period without treatment are at higher risk of developing anti-natalizumab antibodies and/or hypersensitivity reactions on re-exposure, compared to patients who received regularly scheduled treatment. Immunosuppression/Infections  The immune system effects of TYSABRI may increase the risk for infections.  In Study MS1, certain types of infections—including pneumonias and urinary tract infections (including serious cases), gastroenteritis, vaginal infections, tooth infections, tonsillitis, and herpes infections—occurred more often in TYSABRI-treated patients than in placebotreated patients. One opportunistic infection, a cryptosporidial gastroenteritis with a prolonged course, was observed in a patient who received TYSABRI in Study MS1.  In Studies MS1 and MS2, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in TYSABRI-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids.  In a long-term safety study of patients, opportunistic infections (pulmonary mycobacterium avium intracellulare, aspergilloma, cryptococcal fungemia and meningitis, and Candida pneumonia) have been observed in <1% of TYSABRI-treated patients.  Concurrent use of antineoplastic, immunosuppressant, or immunomodulating agents may further increase the risk of infections over the risk observed with use of TYSABRI alone.  In Studies MS1 and MS2, the rate of any type of infection was approximately 1.5 per patient-year in both TYSABRI-treated patients and placebo-treated patients.  In Study MS1, the incidence of serious infections was approximately 3% in TYSABRI-treated patients and in placebo-treated patients. Most patients did not interrupt treatment with TYSABRI during infections. Laboratory Test Abnormalities  In clinical trials, TYSABRI was observed to induce increases in circulating lymphocytes, monocytes, eosinophils, basophils, and nucleated red blood cells. Observed changes persisted during TYSABRI exposure, but were reversible, returning to baseline levels usually within 16 weeks after the last dose. Elevations of neutrophils were not observed. TYSABRI induces mild decreases in hemoglobin levels (mean decrease of 0.6 g/dL) that are frequently transient. Adverse Reactions  The most common adverse reactions reported at an incidence of ≥10% with TYSABRI and ≥2% difference with placebo were headache (38% vs 33%), fatigue (27% vs 21%), infusion reactions (24% vs 18%), urinary tract infections (21% vs 17%), arthralgia (19% vs 14%), depression (19% vs 16%), pain in extremity (16% vs 14%), rash (12% vs 9%), gastroenteritis (11% vs 9%), and vaginitis (10% vs 6%).  The most frequently reported serious adverse reactions in Study MS1 were infections (3.2% vs 2.6% placebo), including urinary tract infection (0.8% vs 0.3%) and pneumonia (0.6% vs 0%), acute hypersensitivity reactions (1.1% vs 0.3%, including anaphylaxis/anaphylactoid reaction [0.8% vs 0%]), depression (1.0% vs 1.0%, including suicidal ideation or attempt [0.6% vs 0.3%]), and cholelithiasis (1.0% vs 0.3%).  Based on animal data, TYSABRI may cause fetal harm. TYSABRI should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Please see accompanying brief summary of full Prescribing Information, including Boxed Warning. STUDY DESCRIPTION: The AFFIRM (NAtalizumab Safety and EFFIcacy in Relapsing-Remitting MS) study was a pivotal 2-year, double-blind, randomized, controlled trial with 942 relapsing MS patients who received either TYSABRI therapy (300 mg by intravenous infusion [n=627]) or placebo (n=315) every 4 weeks for up to 28 months (30 infusions).1,2 References: 1. TYSABRI Prescribing Information, Cambridge, MA: Biogen Inc. 2. Polman CH, O’Connor PW, Havrdova E, et al; for the AFFIRM investigators. A randomized, placebocontrolled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899-910. 3. Data on file as of August 2018, Biogen Inc. 4. Data on file as of July 2017, Biogen Inc.

TYSABRI (natalizumab) injection, for intravenous use

Table 1:

Estimated United States Incidence of PML Stratified by Risk Factor

Brief Summary of Full Prescribing Information

WARNING: PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY TYSABRI increases the risk of progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the brain that usually leads to death or severe disability. Risk factors for the development of PML include duration of therapy, prior use of immunosuppressants, and presence of anti-JCV antibodies. These factors should be considered in the context of expected benefit when initiating and continuing treatment with TYSABRI [see Warnings and Precautions (5.1)]. • Healthcare professionals should monitor patients on TYSABRI for any new sign or symptom that may be suggestive of PML. TYSABRI dosing shouldbe withheld immediately at the first sign or symptom suggestive of PML. For diagnosis, an evaluation that includes a gadoliniumenhancedmagnetic enhanced magnetic resonance resonance imaging imaging (MRI) (MRI) scan scan ofof the the brain brain and, and, when when indicated, cerebrospinal fluid analysis for JC viral DNA are recommended [see Contraindications (4), Warnings and Precautions (5.1)]. • Because of the risk of PML, TYSABRI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the TOUCH® Prescribing Program [see Warnings and Precautions (5.2)]. 1.

INDICATIONS AND USAGE

1.1. Multiple Sclerosis (MS) TYSABRI is indicated as monotherapy for the treatment of patients with relapsing forms of multiple sclerosis. TYSABRI increases the risk of PML. When initiating and continuing treatment with TYSABRI, physicians should consider whether the expected benefit of TYSABRI is sufficient to offset this risk. See important information regarding the risk of PML with TYSABRI [see Warnings and Precautions (5.1)]. 2.

DOSAGE AND ADMINISTRATION

2.1. Multiple Sclerosis (MS) Only prescribers registered in the MS TOUCH® Prescribing Program may prescribe TYSABRI for multiple sclerosis [see Warnings and Precautions (5.2)]. The recommended dose of TYSABRI for multiple sclerosis is 300 mg intravenous infusion over one hour every four weeks. 2.3. Dilution Instructions 1. Use aseptic technique when preparing TYSABRI solution for intravenous infusion. Each vial is intended for single use only. Discard any unused portion. 2. TYSABRI is a colorless, clear to slightly opalescent solution. Inspect the TYSABRI vial for particulate material and discoloration prior to dilution and administration. If visible particulates are observed and/or the liquid in the vial is discolored, the vial must not be used. 3. To prepare the diluted solution, withdraw 15 mL of TYSABRI from the vial using a sterile needle and syringe. Inject TYSABRI into 100 mL of 0.9% Sodium Chloride Injection, USP. No other intravenous diluents may be used to prepare the TYSABRI diluted solution. 4. Gently invert the TYSABRI diluted solution to mix completely. Do not shake. Inspect the solution visually for particulate material prior to administration. 5. The final dosage diluted solution has a concentration of 2.6 mg/mL. 6. Following dilution, infuse TYSABRI solution immediately, or refrigerate the diluted solution at 2°C to 8°C, and use within 8 hours. If stored at 2°C to 8°C, allow the diluted solution to warm to room temperature prior to infusion. DO NOT FREEZE. 2.4. Administration Instructions • Infuse TYSABRI 300 mg in 100 mL 0.9% Sodium Chloride Injection, USP, over approximately one hour (infusion rate approximately 5 mg per minute). Do not administer TYSABRI as an intravenous push or bolus injection. After the infusion is complete, flush with 0.9% Sodium Chloride Injection, USP. • Observe patients during the infusion and for one hour after the infusion is complete. Promptly discontinue the infusion upon the first observation of any signs or symptoms consistent with a hypersensitivity-type reaction [see Warnings and Precautions (5.5)]. • Use of filtration devices during administration has not been evaluated. Other medications should not be injected into infusion set side ports or mixed with TYSABRI. 3. DOSAGE FORMS AND STRENGTHS Injection: 300 mg/15 mL (20 mg/mL) colorless and clear to slightly opalescent solution in a single-dose vial for dilution prior to infusion. 4.

CONTRAINDICATIONS

• TYSABRI is contraindicated in patients who have or have had progressive multifocal leukoencephalopathy (PML) [see Warnings and Precautions (5.1)].

• TYSABRI is contraindicated in patients who have had a hypersensitivity reaction to TYSABRI. Observed reactions range from urticaria to anaphylaxis [see Warnings and Precautions (5.5)].

WARNINGS AND PRECAUTIONS

5.1. Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML), 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, has occurred in patients who have received TYSABRI. Three factors that are known to increase the risk of PML in TYSABRI-treated patients have been identified: • Longer treatment duration, especially beyond 2 years. There is limited experience in patients who have received more than 6 years of TYSABRI treatment. • Prior treatment with an immunosuppressant (e.g., mitoxantrone, azathioprine, methotrexate, cyclophosphamide, mycophenolate mofetil). • The presence of anti-JCV antibodies. Patients who are anti-JCV antibody positive have a higher risk for developing PML. These factors should be considered in the context of expected benefit when initiating and continuing treatment with TYSABRI.

Anti-JCV Antibody Positive Anti-JCV Antibody Negative

TYSABRI Exposure†

No Prior Immunosuppressant Use

1-24 months

<1/1,000

1/1,000

<1/1,000

25-48 months

3/1,000

12/1,000

49-72 months

6/1,000

13/1,000

Prior Immunosuppressant Use

Notes: The risk estimates are based on postmarketing data in the United States from approximately 69,000 TYSABRI exposed patients. †Data beyond 6 years of treatment are limited. The anti-JCV antibody status was determined using an anti-JCV antibody test (ELISA)that has been analytically and clinically validated and is configured with detection and inhibition steps to confirm the presence of JCV-specific antibodies with an analytical false negative rate of 3%.

Retrospective analyses of postmarketing data from various sources, including observational studies and spontaneous reports obtained worldwide, suggest that the risk of developing PML may be associated with relative levels of serum anti-JCV antibody compared to a calibrator as measured by ELISA (often described as an anti-JCV antibody index value). Ordinarily, patients receiving chronic immunosuppressant or immunomodulatory therapy or who have systemic medical conditions resulting in significantly compromised immune system function should not be treated with TYSABRI. Infection by the JC virus is required for the development of PML. Anti-JCV antibody testing should not be used to diagnose PML. Anti-JCV antibody negative status indicates that antibodies to the JC virus have not been detected. Patients who are anti-JCV antibody negative have a lower risk of PML than those who are positive. Patients who are anti-JCV antibody negative are still at risk for the development of PML due to the potential for a new JCV infection or a false negative test result. The reported rate of seroconversion in patients with MS (changing from anti-JCV antibody negative to positive and remaining positive in subsequent testing) is 3 to 8 percent annually. In addition, some patients’ serostatus may change intermittently. Therefore, patients with a negative anti-JCV antibody test result should be retested periodically. For purposes of risk assessment, a patient with a positive anti-JCV antibody test at any time is considered anti-JCV antibody positive regardless of the results of any prior or subsequent anti-JCV antibody testing. When assessed, anti-JCV antibody status should be determined using an analytically and clinically validated immunoassay. After plasma exchange, wait at least two weeks to test for anti-JCV antibodies to avoid false negative test results caused by the removal of serum antibodies. After infusion of intravenous immunoglobulin (IVIg), wait at least 6 months (5 half-lives) for the IVIg to clear in order to avoid false positive anti-JCV antibody test results. Healthcare professionals should monitor patients on TYSABRI for any new sign or symptom suggestive of PML. 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. The progression of deficits usually leads to death or severe disability over weeks or months. Withhold TYSABRI dosing immediately and perform an appropriate diagnostic evaluation at the first sign or symptom suggestive of PML. 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. 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. Consider monitoring patients at high risk for PML more frequently. Lower PML-related mortality and morbidity have been reported following TYSABRI discontinuation 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 TYSABRI or due to differences in disease in these patients. There are no known interventions that can reliably prevent PML or that can adequately treat PML if it occurs. PML has been reported following discontinuation of TYSABRI in patients who did not have findings suggestive of PML at the time of discontinuation. Patients should continue to be monitored for any new signs or symptoms that may be suggestive of PML for at least six months following discontinuation of TYSABRI. Because of the risk of PML, TYSABRI is available only under a restricted distribution program, the TOUCH® Prescribing Program. In multiple sclerosis patients, an MRI scan should be obtained prior to initiating therapy with TYSABRI. This MRI may be helpful in differentiating subsequent multiple sclerosis symptoms from PML. For diagnosis of PML, an evaluation including a gadolinium-enhanced MRI scan of the brain and, when indicated, cerebrospinal fluid analysis for JC viral DNA are recommended. If the initial evaluations for PML are negative but clinical suspicion for PML remains, continue to withhold TYSABRI dosing, and repeat the evaluations. There are no known interventions that can adequately treat PML if it occurs. Three sessions of plasma exchange over 5 to 8 days were shown to accelerate TYSABRI clearance in a study of 12 patients with MS who did not have PML, although in the majority of patients, alpha-4 integrin receptor binding remained high. Adverse events which may occur during plasma exchange include clearance of other medications and volume shifts, which have the potential to lead to hypotension or pulmonary edema. Although plasma exchange has not been studied in TYSABRI treated patients with PML, it has been used in such patients in the postmarketing setting to remove TYSABRI more quickly from the circulation. JC virus infection of granule cell neurons in the cerebellum (i.e., JC virus granule cell neuronopathy [JCV GCN]) has been reported in patients treated with TYSABRI. JCV GCN can occur with or without concomitant PML. JCV GCN can cause cerebellar dysfunction (e.g., ataxia, incoordination, apraxia, visual disorders), and neuroimaging can show cerebellar atrophy. For diagnosis of JCV GCN, an evaluation that includes a gadolinium-enhanced MRI scan of the brain and, when indicated, cerebrospinal fluid analysis for JC viral DNA, is recommended. JCV GCN should be managed similarly to PML. Immune reconstitution inflammatory syndrome (IRIS) has been reported in the majority of TYSABRI treated patients who developed PML and subsequently discontinued TYSABRI. In almost all cases, IRIS occurred after plasma exchange was used to eliminate circulating TYSABRI. It presents as a clinical decline in the patient’s condition after TYSABRI removal (and in some cases after apparent clinical improvement) that may be rapid, can lead to serious neurological complications or death, and is often associated with characteristic changes in the MRI. TYSABRI has not been associated with IRIS in patients discontinuing

treatment with TYSABRI for reasons unrelated to PML. In TYSABRI treated patients with PML, IRIS has been reported within days to several weeks after plasma exchange. Monitoring for development of IRIS and appropriate treatment of the associated inflammation should be undertaken. 5.2. TYSABRI TOUCH® Prescribing Program TYSABRI is available only through a restricted program under a REMS called the TOUCH® Prescribing Program because of the risk of PML [see Warnings and Precautions (5.1)]. For prescribers and patients, the TOUCH® Prescribing Program has two components: MS TOUCH® (for patients with multiple sclerosis) and CD TOUCH® (for patients with Crohn’s disease). Selected requirements of the TOUCH® Prescribing Program include the following: • Prescribers must be certified and comply with the following: – Review the TOUCH® Prescribing Program prescriber educational materials, including the full prescribing information. – Educate patients on the benefits and risks of treatment with TYSABRI, ensure that patients receive the Medication Guide, and encourage them to ask questions. – Review, complete, and sign the Patient-Prescriber Enrollment Form. – Evaluate patients three months after the first infusion, six months after the first infusion, every six months thereafter, and for at least six months after discontinuing TYSABRI. – Determine every six months whether patients should continue on treatment and, if so, authorize treatment for another six months. – Submit to Biogen the “TYSABRI Patient Status Report and Reauthorization Questionnaire” six months after initiating treatment and every six months thereafter. – Complete an “Initial Discontinuation Questionnaire” when TYSABRI is discontinued, and a “6-Month Discontinuation Questionnaire” following discontinuation of TYSABRI. – Report cases of PML, hospitalizations due to opportunistic infections, and deaths to Biogen at 1-800-456-2255 as soon as possible. • Patients must be enrolled in the TOUCH® Prescribing Program, read the Medication Guide, understand the risks associated with TYSABRI, and complete and sign the Patient-Prescriber Enrollment Form. • Pharmacies and infusion centers must be specially certified to dispense or infuse TYSABRI. 5.3. Herpes Infections Herpes Encephalitis and Meningitis TYSABRI increases the risk of developing encephalitis and meningitis caused by herpes simplex and varicella zoster viruses. Serious, life-threatening, and sometimes fatal cases have been reported in the postmarketing setting in multiple sclerosis patients receiving TYSABRI. Laboratory confirmation in those cases was based on positive PCR for viral DNA in the cerebrospinal fluid. The duration of treatment with TYSABRI prior to onset ranged from a few months to several years. Monitor patients receiving TYSABRI for signs and symptoms of meningitis and encephalitis. If herpes encephalitis or meningitis occurs, TYSABRI should be discontinued, and appropriate treatment for herpes encephalitis/meningitis should be administered. Acute Retinal Necrosis Acute retinal necrosis (ARN) is a fulminant viral infection of the retina caused by the family of herpes viruses (e.g., varicella zoster, herpes simplex virus). A higher risk of ARN has been observed in patients being administered TYSABRI. Patients presenting with eye symptoms, including decreased visual acuity, redness, or eye pain, should be referred for retinal screening for ARN. Some ARN cases occurred in patients with central nervous system (CNS) herpes infections (e.g., herpes meningitis or encephalitis). Serious cases of ARN led to blindness of one or both eyes in some patients. Following clinical diagnosis of ARN, consider discontinuation of TYSABRI. The treatment reported in ARN cases included anti-viral therapy and, in some cases, surgery. 5.4. Hepatotoxicity Clinically significant liver injury, including acute liver failure requiring transplant, has been reported in patients treated with TYSABRI in the postmarketing setting. Signs of liver injury, including markedly elevated serum hepatic enzymes and elevated total bilirubin, occurred as early as six days after the first dose; signs of liver injury have also been reported for the first time after multiple doses. In some patients, liver injury recurred upon rechallenge, providing evidence that TYSABRI caused the injury. The combination of transaminase elevations and elevated bilirubin without evidence of obstruction is generally recognized as an important predictor of severe liver injury that may lead to death or the need for a liver transplant in some patients. TYSABRI should be discontinued in patients with jaundice or other evidence of significant liver injury (e.g., laboratory evidence). 5.5. Hypersensitivity/Antibody Formation Hypersensitivity reactions have occurred in patients receiving TYSABRI, including serious systemic reactions (e.g., anaphylaxis), which occurred at an incidence of <1%. These reactions usually occur within two hours of the start of the infusion. Symptoms associated with these reactions can include urticaria, dizziness, fever, rash, rigors, pruritus, nausea, flushing, hypotension, dyspnea, and chest pain. Generally, these reactions are associated with antibodies to TYSABRI. If a hypersensitivity reaction occurs, discontinue administration of TYSABRI, and initiate appropriate therapy. Patients who experience a hypersensitivity reaction should not be re-treated with TYSABRI. Hypersensitivity reactions were more frequent in patients with antibodies to TYSABRI compared to patients who did not develop antibodies to TYSABRI in both MS and CD studies. Therefore, the possibility of antibodies to TYSABRI should be considered in patients who have hypersensitivity reactions [see Adverse Reactions (6.2)]. Antibody testing: If the presence of persistent antibodies is suspected, antibody testing should be performed. Antibodies may be detected and confirmed with sequential serum antibody tests. Antibodies detected early in the treatment course (e.g., within the first six months) may be transient and may disappear with continued dosing. It is recommended that testing be repeated three months after an initial positive result to confirm that antibodies are persistent. Prescribers should consider the overall benefits and risks of TYSABRI in a patient with persistent antibodies. Patients who receive TYSABRI for a short exposure (1 to 2 infusions) followed by an extended period without treatment are at higher risk of developing anti-natalizumab antibodies and/or hypersensitivity reactions on re-exposure, compared to patients who received regularly scheduled treatment. Given that patients with persistent antibodies to TYSABRI experience reduced efficacy, and that hypersensitivity reactions are more common in such patients, consideration should be given to testing for the presence of antibodies in patients who wish to recommence therapy following a dose interruption. Following a period of dose interruption, patients testing negative for antibodies prior to re-dosing have a risk of antibody development with re-treatment that is similar to TYSABRI naïve patients [see Adverse Reactions (6.2)].

5.6. Immunosuppression/Infections The immune system effects of TYSABRI may increase the risk for infections. In Study MS1 [see Clinical Studies (14.1)], certain types of infections, including pneumonias and urinary tract infections (including serious cases), gastroenteritis, vaginal infections, tooth infections, tonsillitis, and herpes infections, occurred more often in TYSABRI-treated patients than in placebo-treated patients [see Warnings and Precautions (5.1), Adverse Reactions (6.1)]. One opportunistic infection, a cryptosporidial gastroenteritis with a prolonged course, was observed in a patient who received TYSABRI in Study MS1. In Studies MS1 and MS2, an increase in infections was seen in patients concurrently receiving short courses of corticosteroids. However, the increase in infections in TYSABRI-treated patients who received steroids was similar to the increase in placebo-treated patients who received steroids. In a long-term safety study of patients treated with TYSABRI for multiple sclerosis, opportunistic infections (pulmonary mycobacterium avium intracellulare, aspergilloma, cryptococcal fungemia and meningitis, and Candida pneumonia) have been observed in <1% of TYSABRI-treated patients. In CD clinical studies, opportunistic infections (pneumocystis carinii pneumonia, pulmonary mycobacterium avium intracellulare, bronchopulmonary aspergillosis, and burkholderia cepacia) have been observed in <1% of TYSABRI-treated patients; some of these patients were receiving concurrent immunosuppressants [see Warnings and Precautions (5.1), Adverse Reactions (6.1)]. In Studies CD1 and CD2, an increase in infections was seen in patients concurrently receiving corticosteroids. However, the increase in infections was similar in placebo-treated and TYSABRI-treated patients who received steroids. Concurrent use of antineoplastic, immunosuppressant, or immunomodulating agents may further increase the risk of infections, including PML and other opportunistic infections, over the risk observed with use of TYSABRI alone [see Warnings and Precautions (5.1), Adverse Reactions (6.1)]. The safety and efficacy of TYSABRI in combination with antineoplastic, immunosuppressant, or immunomodulating agents have not been established. Patients receiving chronic immunosuppressant or immunomodulatory therapy or who have systemic medical conditions resulting in significantly compromised immune system function should not ordinarily be treated with TYSABRI. The risk of PML is also increased in patients who have been treated with an immunosuppressant prior to receiving TYSABRI [see Warnings and Precautions (5.1)]. 5.7. Laboratory Test Abnormalities In clinical trials, TYSABRI was observed to induce increases in circulating lymphocytes, monocytes, eosinophils, basophils, and nucleated red blood cells. Observed changes persisted during TYSABRI exposure, but were reversible, returning to baseline levels usually within 16 weeks after the last dose. Elevations of neutrophils were not observed. TYSABRI induces mild decreases in hemoglobin levels (mean decrease of 0.6 g/dL) that are frequently transient. 5.8. Immunizations No data are available on the effects of vaccination in patients receiving TYSABRI. No data are available on the secondary transmission of infection by live vaccines in patients receiving TYSABRI. 6. ADVERSE REACTIONS The following serious adverse reactions are described below and elsewhere in the labeling: • Progressive Multifocal Leukoencephalopathy (PML) [see Warnings and Precautions (5.1)] • Herpes Infections [see Warnings and Precautions (5.3)] • Hepatotoxicity [see Warnings and Precautions (5.4)] • Hypersensitivity/Antibody Formation [see Warnings and Precautions (5.5)] • Immunosuppression/Infections [see Warnings and Precautions (5.6)] 6.1. Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the 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 practice. The most common adverse reactions (incidence ≥ 10%) were headache and fatigue in both the multiple sclerosis (MS) and Crohn’s disease (CD) studies. Other common adverse reactions (incidence ≥ 10%) in the MS population were arthralgia, urinary tract infection, lower respiratory tract infection, gastroenteritis, vaginitis, depression, pain in extremity, abdominal discomfort, diarrhea NOS, and rash. Other common adverse reactions (incidence ≥ 10%) in the CD population were upper respiratory tract infections and nausea. The most frequently reported adverse reactions resulting in clinical intervention (i.e., discontinuation of TYSABRI) in the MS studies were urticaria (1%) and other hypersensitivity reactions (1%), and in the CD studies (Studies CD1 and CD2) were the exacerbation of Crohn’s disease (4.2%) and acute hypersensitivity reactions (1.5%) [see Warnings and Precautions (5.5)]. A total of 1617 multiple sclerosis patients in controlled studies received TYSABRI, with a median duration of exposure of 28 months. A total of 1563 patients received TYSABRI in all CD studies for a median exposure of 5 months; of these patients, 33% (n=518) received at least one year of treatment and 19% (n=297) received at least two years of treatment. Multiple Sclerosis Clinical Studies The most common serious adverse reactions in Study MS1 [see Clinical Studies (14.1)] with TYSABRI were infections (3.2% versus 2.6% in placebo, including urinary tract infection [0.8% versus 0.3%] and pneumonia [0.6% versus 0%]), acute hypersensitivity reactions (1.1% versus 0.3%, including anaphylaxis/anaphylactoid reaction [0.8% versus 0%]), depression (1.0% versus 1.0%, including suicidal ideation or attempt [0.6% versus 0.3%]), and cholelithiasis (1.0% versus 0.3%). In Study MS2, serious adverse reactions of appendicitis were also more common in patients who received TYSABRI (0.8% versus 0.2% in placebo). Table 2 enumerates adverse reactions and selected laboratory abnormalities that occurred in Study MS1 at an incidence of at least 1 percentage point higher in TYSABRI-treated patients than was observed in placebo-treated patients.

Table 2:

Table 3:

Adverse Reactions in Study MS1 (Monotherapy Study) Adverse Reactions (Preferred Term)

TYSABRI n=627 %

Placebo n=312 %

General Headache Fatigue Arthralgia Chest discomfort Other hypersensitivity reactions** Acute hypersensitivity reactions** Seasonal allergy Rigors Weight increased Weight decreased

38 27 19 5 5 4 3 3 2 2

33 21 14 3 2 <1 2 <1 <1 <1

Infection Urinary tract infection Lower respiratory tract infection Gastroenteritis Vaginitis* Tooth infections Herpes Tonsillitis

21 17 11 10 9 8 7

17 16 9 6 7 7 5

Psychiatric Depression

Musculoskeletal/Connective Tissue Disorders Pain in extremity Muscle cramp Joint swelling

16 5 2

14 3 1

Gastrointestinal Abdominal discomfort Diarrhea NOS Abnormal liver function test

11 10 5

10 9 4

Skin Rash Dermatitis Pruritus Night sweats

12 7 4 1

9 4 2 0

Menstrual Disorders* Irregular menstruation Dysmenorrhea Amenorrhea Ovarian cyst

5 3 2 2

4 <1 1 <1

Neurologic Disorders Vertigo Somnolence

6 2

5 <1

Renal and Urinary Disorders Urinary urgency/frequency Urinary incontinence

9 4

7 3

Injury Limb injury NOS Skin laceration Thermal burn

3 2 1

2 <1 <1

* Percentage based on female patients only. ** Acute versus other hypersensitivity reactions are defined as occurring within 2 hours post-infusion versus more than 2 hours. In Study MS2, peripheral edema was more common in patients who received TYSABRI (5% versus 1% in placebo).

Infections Progressive Multifocal Leukoencephalopathy (PML) occurred in three patients who received TYSABRI in clinical trials [see Warnings and Precautions (5.1)]. Two cases of PML were observed in the 1869 patients with multiple sclerosis who were treated for a median of 120 weeks. These two patients had received TYSABRI in addition to interferon beta-1a [see Warnings and Precautions (5.1)]. The third case occurred after eight doses in one of the 1043 patients with Crohnâ&#x20AC;&#x2122;s disease who were evaluated for PML. In the postmarketing setting, additional cases of PML have been reported in TYSABRI-treated multiple sclerosis and Crohnâ&#x20AC;&#x2122;s disease patients who were not receiving concomitant immunomodulatory therapy. In Studies MS1 and MS2 [see Clinical Studies (14.1)], the rate of any type of infection was approximately 1.5 per patient-year in both TYSABRI-treated patients and placebo-treated patients. The infections were predominately upper respiratory tract infections, influenza, and urinary tract infections. In Study MS1, the incidence of serious infection was approximately 3% in TYSABRI-treated patients and placebo-treated patients. Most patients did not interrupt treatment with TYSABRI during infections. The only opportunistic infection in the multiple sclerosis clinical trials was a case of cryptosporidial gastroenteritis with a prolonged course. In Studies CD1 and CD2 [see Clinical Studies (14.2)], the rate of any type of infection was 1.7 per patient-year in TYSABRI-treated patients and 1.4 per patient-year in placebo-treated patients. In Study CD3, the incidence of any type of infection was 1.7 per patient-year in TYSABRI-treated patients and was similar in placebo-treated patients. The most common infections were nasopharyngitis, upper respiratory tract infection, and influenza. The majority of patients did not interrupt TYSABRI therapy during infections, and recovery occurred with appropriate treatment. Concurrent use of TYSABRI in CD clinical trials with chronic steroids and/or methotrexate, 6-MP, and azathioprine did not result in an increase in overall

Adverse Reactions in Studies CD1 and CD2 (Induction Studies)

Adverse Reactions*

TYSABRI n=983 %

Placebo n=431 %

General Headache Fatigue Arthralgia Influenza-like illness Acute hypersensitivity reactions Tremor

32 10 8 5 2 1

23 8 6 4 <1 <1

Infection Upper respiratory tract infection Vaginal infections** Viral infection Urinary tract infection

22 4 3 3

16 2 2 1

6 3

4 <1

17 5 4 3 2

15 3 2 2 <1

Skin Rash Dry skin

6 1

4 0

Menstrual Disorder Dysmenorrhea**

Respiratory Pharyngolaryngeal pain Cough Gastrointestinal Nausea Dyspepsia Constipation Flatulence Aphthous stomatitis

* Occurred at an incidence of at least 1% higher in TYSABRI-treated patients than placebo-treated patients. ** Percentage based on female patients only. Table 4:

Adverse Reactions in Study CD3 (Maintenance Study)

Adverse Reactions*

TYSABRI n=214 %

Placebo n=214 %

General Headache Influenza-like illness Peripheral edema Toothache

37 11 6 4

31 6 3 <1

Infection Influenza Sinusitis Vaginal infections** Viral infection

12 8 8 7

5 4 <1 3

Respiratory Cough

Gastrointestinal Lower abdominal pain

Musculoskeletal and Connective Tissue Back pain Menstrual Disorder Dysmenorrhea**

* Occurred at an incidence of at least 2% higher in TYSABRI-treated patients than placebo-treated patients. ** Percentage based on female patients only. infections compared to TYSABRI alone; however, the concomitant use of such agents could lead to an increased risk of serious infections. In Studies CD1 and CD2, the incidence of serious infection was approximately 2.1% in both TYSABRItreated patients and placebo-treated patients. In Study CD3, the incidence of serious infection was approximately 3.3% in TYSABRI-treated patients and approximately 2.8% in placebo-treated patients. In clinical studies for CD, opportunistic infections (pneumocystis carinii pneumonia, pulmonary mycobacterium avium intracellulare, bronchopulmonary aspergillosis, and burkholderia cepacia) have been observed in <1% of TYSABRI-treated patients; some of these patients were receiving concurrent immunosuppressants [see Warnings and Precautions (5.6)]. Two serious non-bacterial meningitides occurred in TYSABRI-treated patients compared to none in placebo-treated patients. Infusion-related Reactions An infusion-related reaction was defined in clinical trials as any adverse event occurring within two hours of the start of an infusion. In MS clinical trials, approximately 24% of TYSABRI-treated multiple sclerosis patients experienced an infusion-related reaction, compared to 18% of placebo-treated patients. In the controlled CD clinical trials, infusion-related reactions occurred in approximately 11% of patients treated with TYSABRI compared to 7% of placebo-treated patients. Reactions more common in the TYSABRI-treated MS patients compared to the placebo-treated MS patients included headache, dizziness, fatigue, urticaria, pruritus, and rigors. Acute urticaria was observed in approximately 2% of patients. Other hypersensitivity reactions were observed in 1% of patients receiving TYSABRI. Serious systemic hypersensitivity infusion reactions occurred in <1% of patients [see Warnings and Precautions (5.5)]. All patients recovered with treatment and/or discontinuation of the infusion.

Infusion-related reactions that were more common in CD patients receiving TYSABRI than those receiving placebo included headache, nausea, urticaria, pruritus, and flushing. Serious infusion reactions occurred in Studies CD1, CD2, and CD3 at an incidence of <1% in TYSABRI-treated patients. MS and CD patients who became persistently positive for antibodies to TYSABRI were more likely to have an infusion-related reaction than those who were antibody-negative. 6.2. Immunogenicity As with all therapeutic proteins, there is a potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to natalizumab in the studies described below with the incidence of antibodies in other studies or to other products may be misleading. Patients in Study MS1 [see Clinical Studies (14.1)] were tested for antibodies to natalizumab every 12 weeks. The assays used were unable to detect low to moderate levels of antibodies to natalizumab. Approximately 9% of patients receiving TYSABRI developed detectable antibodies at least once during treatment. Approximately 6% of patients had positive antibodies on more than one occasion. Approximately 82% of patients who became persistently antibody-positive developed detectable antibodies by 12 weeks. Anti-natalizumab antibodies were neutralizing in vitro. The presence of anti-natalizumab antibodies was correlated with a reduction in serum natalizumab levels. In Study MS1, the Week 12 pre-infusion mean natalizumab serum concentration in antibody-negative patients was 15 mcg/mL compared to 1.3 mcg/mL in antibody-positive patients. Persistent antibodypositivity resulted in a substantial decrease in the effectiveness of TYSABRI. The risk of increased disability and the annualized relapse rate were similar in persistently antibody-positive TYSABRI-treated patients and patients who received placebo. A similar phenomenon was also observed in Study MS2. Infusion-related reactions that were most often associated with persistent antibody-positivity included urticaria, rigors, nausea, vomiting, headache, flushing, dizziness, pruritus, tremor, feeling cold, and pyrexia. Additional adverse reactions more common in persistently antibody-positive patients included myalgia, hypertension, dyspnea, anxiety, and tachycardia. Patients in CD studies [see Clinical Studies (14.2)] were first tested for antibodies at Week 12, and in a substantial proportion of patients, this was the only test performed given the 12-week duration of placebocontrolled studies. Approximately 10% of patients were found to have anti-natalizumab antibodies on at least one occasion. Five percent (5%) of patients had positive antibodies on more than one occasion. Persistent antibodies resulted in reduced efficacy and an increase in infusion-related reactions with symptoms that include urticaria, pruritus, nausea, flushing, and dyspnea. The long-term immunogenicity of TYSABRI and the effects of low to moderate levels of antibody to natalizumab are unknown [see Warnings and Precautions (5.5), Adverse Reactions (6.1)]. 6.3. Postmarketing Experience The following adverse reactions have been identified during post approval use of TYSABRI. 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. Blood disorders: hemolytic anemia 8.

USE IN SPECIFIC POPULATIONS

8.1.

Pregnancy

Risk Summary There are no adequate data on the developmental risk associated with the use of TYSABRI in pregnant women. In animal studies, administration of natalizumab during pregnancy produced fetal immunologic and hematologic effects in monkeys at doses similar to the human dose and reduced offspring survival in guinea pigs at doses greater than the human dose. These doses were not maternally toxic but produced the expected pharmacological effects in maternal animals [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 developmental toxicity studies conducted in guinea pigs and monkeys, at natalizumab doses up to 30 mg/kg (7 times the recommended human dose based on body weight [mg/kg]), transplacental transfer and in utero exposure of the embryo/fetus was demonstrated in both species. In a study in which pregnant guinea pigs were administered natalizumab (0, 3, 10, or 30 mg/kg) by intravenous (IV) infusion on alternate days throughout organogenesis (gestation days [GD] 4-30), no effects on embryofetal development were observed. When pregnant monkeys were administered natalizumab (0, 3, 10, or 30 mg/kg) by IV infusion on alternative days throughout organogenesis (GDs 20-70), serum levels in fetuses at delivery were approximately 35% of maternal serum natalizumab levels. There were no effects on embryofetal development; however, natalizumabrelated immunological and hematologic changes were observed in the fetuses at the two highest doses. These changes included decreases in lymphocytes (CD3+ and CD20+), changes in lymphocyte subpopulation percentages, mild anemia, reduced platelet count, increased spleen weights, and reduced liver and thymus weights associated with increased splenic extramedullary hematopoiesis, thymic atrophy, and decreased hepatic hematopoiesis. In a study in which monkeys were exposed to natalizumab during pregnancy (IV infusion of 30 mg/kg) on alternate days from GD20 to GD70 or GD20 to term, abortions were increased approximately 2-fold compared to controls. In offspring born to mothers administered natalizumab on alternate days from GD20 until delivery, hematologic effects (decreased lymphocyte and platelet counts) were also observed. These effects were reversed upon clearance of natalizumab. There was no evidence of anemia in these offspring. Offspring exposed in utero and during lactation had a normal immune response to challenge with a T-cell dependent antigen. In a study in which pregnant guinea pigs were exposed to natalizumab (30 mg/kg IV) on alternate dates during GDs 30-64, a reduction in pup survival was observed.

8.2.

Lactation

Risk Summary Natalizumab has been detected in human milk. There are no data on the effects of this exposure on the breastfed infant or the effects of the drug on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for TYSABRI and any potential adverse effects on the breastfed infant from TYSABRI or from the underlying maternal condition. 8.4. Pediatric Use Safety and effectiveness in pediatric patients with multiple sclerosis or Crohn’s disease below the age of 18 years have not been established. TYSABRI is not indicated for use in pediatric patients. 8.5. Geriatric Use Clinical studies of TYSABRI did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently than younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. 17. PATIENT COUNSELING INFORMATION Advise the patient to read the FDA-approved patient labeling (Medication Guide). General Counseling Information Counsel patients to understand the risks and benefits of TYSABRI before an initial prescription is written. The patient may be educated by either the enrolled prescriber or a healthcare provider under that prescriber’s direction. INSTRUCT PATIENTS USING TYSABRI TO: • Read the Medication Guide before starting TYSABRI and before each TYSABRI infusion. • Promptly report any new or continuously worsening symptoms that persist over several days to their prescriber [see Warnings and Precautions (5.1)]. • Inform all of their physicians that they are receiving TYSABRI. • Plan to see their prescriber three months after the first infusion, six months after the first infusion, every six months thereafter, and for at least six months after discontinuing TYSABRI. Progressive Multifocal Leukoencephalopathy Inform patients that Progressive Multifocal Leukoencephalopathy (PML) has occurred in patients who received TYSABRI. Instruct the patient of the importance of contacting their doctor if they develop any symptoms suggestive of PML. Instruct 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. Instruct the patient that the progression of deficits usually leads to death or severe disability over weeks or months. Instruct patients to continue to look for new signs and symptoms suggestive of PML for approximately 6 months following discontinuation of TYSABRI [see Warnings and Precautions (5.1)]. TYSABRI TOUCH® Prescribing Program Advise the patient that TYSABRI is only available through a restricted program called the TOUCH® Prescribing Program. Inform the patient of the following requirements: Patients must read the Medication Guide and sign the Patient Prescriber Enrollment Form. Advise patients that TYSABRI is available only from certified pharmacies and infusion centers participating in the program [see Warnings and Precautions (5.2)]. Herpes Infections Inform patients that TYSABRI increases the risk of developing encephalitis, and meningitis, which could be fatal, and acute retinal necrosis, which could lead to blindness, caused by the family of herpes viruses (e.g., herpes simplex and varicella zoster viruses). Instruct patients to immediately report any possible symptoms of encephalitis and meningitis (such as fever, headache, and confusion) or acute retinal necrosis (such as decreased visual acuity, eye redness, or eye pain) [see Warnings and Precautions (5.3)]. Hepatotoxicity Inform patients that TYSABRI may cause liver injury. Instruct patients treated with TYSABRI to report promptly any symptoms that may indicate liver injury, including fatigue, anorexia, right upper abdominal discomfort, dark urine, or jaundice [see Warnings and Precautions (5.4)]. Hypersensitivity Reactions Instruct patients to report immediately if they experience symptoms consistent with a hypersensitivity reaction (e.g., urticaria with or without associated symptoms) during or following an infusion of TYSABRI [see Warnings and Precautions (5.5)]. Immunosuppression/Infections Inform patients that TYSABRI may lower the ability of their immune system to fight infections. Instruct the patient of the importance of contacting their doctor if they develop any symptoms of infection [see Warnings and Precautions (5.6)]. Full Prescribing Information is available at TYSABRIhcp.com. TYSABRI (natalizumab) Manufactured by: Biogen Inc. Cambridge, MA 02142 USA US License No. 1697 1-800-456-2255 © 2015-2018 Biogen Inc. All rights reserved. 09/2018 U.S. Patent Numbers: 5,840,299; 6,602,503

Conferences & Community

New BrainDome Offers Immersive Exploration Get ready for a completely new Annual Meeting experience: step inside the one-ofa-kind BrainDome for a 10-minute journey of learning and exploration like no other. Open Sunday through Wednesday of the meeting from 12:00 p.m. to 5:00 p.m., and again on Friday from 12:00 p.m. to 4:00 p.m. in Exhibit Hall A, the giant BrainDome will allow attendees to immerse themselves in the inner workings of the brain via a state-of-the-art guided audio-visual spectacle.

BrainDome

Visit AAN.com/view/AM19 as more information becomes available about this exciting new Annual Meeting happening! 

Expanded Symposium Offers Robust Opportunities for Medical Students By all accounts, the inaugural Medical Student Symposium at the 2018 Annual Meeting in Los Angeles was a huge success with more than 200 attendees, half of those being scholarship recipients. The popular event will be making a much-anticipated return to the 2019 meeting in Philadelphia with an updated and expanded program designed to offer medical students an even more immersive and engaging exploration of the many exciting neurology career options and unparalleled networking opportunities. Set to take place on Sunday, May 5, from 12:30 p.m. to 5:30 p.m. in the Philadelphia Marriott Downtown this year’s attendees can expect to experience physician-led treatment and diagnosis demonstrations, meet with physicians from various subspecialties, and learn about the occurrence and impact of neurology in today’s pop culture. The afternoon’s programming includes: 12:30 p.m.–1:30 p.m. Welcome and Lunch Sit with AAN physician members for the opportunity to discuss various topics. 1:30 p.m.–2:45 p.m. Demonstrations See neurology demonstrations showcasing various aspects of neurologyspecific diagnosis and treatment.

2:45 p.m.–3:15 p.m. Neurology in Pop Culture Hear from presenters who will use pop culture references to showcase how neurology is portrayed and the science around these conditions is being depicted, as well as share an impact story on working with neurology patients.

3:15 p.m.–4:30 p.m. Round Robin Meet and ask questions of physicians representing various neurology subspecialties. 4:30 p.m.–5:30 p.m. Mixer Network with physicians and peers. Learn more at AAN.com/view/AMTrainee. 

Save the Date: July Sports Concussion Conference Coming to Indianapolis After experiencing record-breaking attendance in 2018, the popular AAN Sports Concussion Conference is returning to the JW Marriott in Indianapolis, IN, July 26 through 28, 2019. Registration opens in April, and attendees can once again expect

to find top experts presenting the latest scientific information and best practices for all clinicians, scientists, and care teams involved in the prevention, diagnosis, and management of sport-related concussion at the youth, high school, collegiate, and professional levels. Enhancements to the

2019 program will include a greater focus on clinical updates, an optional hands-on boot camp, and a separate afternoon track geared specifically toward athletic trainers. Continue to visit AAN.com/view/SCC as more programming and other information becomes available. 

SPORTS CONCUSSION JULY 26–28, 2019 INDIANAPOLIS, IN

CONFERENCE

Conferences & Community

“Transformational” Program Makes a Change Maker out of Graduate Jennifer Bickel, MD, FAAN, had just been appointed to chief of the headache section at Children’s Mercy Hospital at the University of Missouri - Kansas City, when she was applied for the inaugural 2016 Transforming Leaders Program. “I had little expectation of being accepted,” she admitted. “I had witnessed the caliber of the graduates from the AAN Leadership Programs and, honestly, only hoped to one day be like them. They were authentic, passionate, impactful, dedicated, and masters at communication—real change makers, making real differences in our field. Despite my fears of rejection, I applied, as I knew I’d regret not even trying.” Little did Bickel know that she, too, would go on to be a change maker of the very caliber she had so admired. “For 10 months straight, every week I gained new knowledge about communication, teamwork, leadership, system awareness, the AAN, and, most importantly, myself,” said Bickel of her experience in the program. “It was a time commitment, but the value was so high that it was a no brainer to prioritize it. There is not a single element I found most beneficial. Instead the program was so clearly designed to maximize impact through diverse experiences and real challenges.” Through her improved self-awareness, Bickel found herself better able to mitigate patterns of conflict to which she now admits she had previously, unknowingly, contributed. “I learned how to slow down and ensure my team is knowledgeable and engaged before moving forward on new projects. And I finally became comfortable with my skills as an innovator, yet more aware of the fears that change can bring to others.” The new insight and skills proved invaluable when Bickel and her team opened a new type of clinic at her institution. The Headache Treatment Center offers open access to treat headache acutely in a headache-friendly environment, reaching patients earlier in their condition. “To make this happen, I had to collaborate with EVP’s, ER/UC, community providers, billing, marketing, social work, child life, strategic development, nursing, scheduling, physician services, school nurses, and more,” said Bickel. Bickel’s team also recently trained 20 emergency room physicians in two basic acupuncture protocols via a 10-hour CME/ MOC program designed to expand access to non-pharmaceutical treatments for children in pain. “This, of course, required huge hurdles to overcome, but I learned through the Transforming Leaders Program to gather stakeholder support first. As a result, this program has not encountered any controversy and, actually, has received far more support than I ever expected,” she said. In fact, the demand for training is so high that Bickel and her team expect to continue to train about 40 doctors a year through the various hospital departments. In addition, as the director of a medical neuroscience course at the University of Missouri, Bickel recently added a new research project that gave more than 100 students the opportunity to learn how to perform data analytic research in neurology-related

AANnews • March 2019

topics. The project requires the coordination of more than 40 doctors and biostatisticians to act as mentors, and culminates with each student group presenting their poster to judges, much like in professional meetings. In 2018, she won the Senior Achievement Award in Mentoring in the Department Bickel of Pediatrics, which includes more than 500 doctors. And even more recently, she was appointed director of neurology faculty development. As if these impressive accomplishments weren’t enough, most recently Bickel was appointed as the new medical director of the Center for Professional Wellbeing at Children’s Mercy Hospital where she will focus on building a program that supports clinicians, helps reduce burnout, and promotes well-being throughout the organization. “I’m not typically one for work social events,” explained Bickel, “but the networking opportunities within Transforming Leaders were truly a gift of inspiration. I had never really been involved in the AAN before, yet suddenly I found myself in a position to discuss my thoughts and ideas with board members. And, I was pleasantly surprised to find that our AAN board members are just like the rest of us: neurologists trying their best to do what’s right for our field and our patients. By recognizing that the AAN leadership was truly invested, I felt compelled to make a similar investment in the Academy.” And make an investment she has. Today Bickel is making big changes of her own within the AAN, serving on the Undergraduate Education Subcommittee, Leadership Engagement Subcommittee, Neurology Today ® editorial board, and as a participant in Neurology on the Hill and champion for BrainPAC in her home state of Missouri. “I’m so involved in the AAN now that the staff feels like a second family,” she exclaimed. “The Academy has certainly found ways to utilize my creative side, too, by being a member of the HeadTalks work group, giving talks on zombies, and, next year, Medical Improv! But perhaps the role I cherish the most is as the Emerging Leaders Project Advisor where I have the honor of working with some of the brightest young neurologists in the country to develop strategies to address problems in our field.” Added Bickel, “The Transforming Leaders Program was truly transformational, and it’s hard to pinpoint exactly what technique I learned that helped me to succeed in any given situation. I believe it was the actual transformational process that made leadership become less effortful and more effective. Over the past two years, I have encountered more successes and been given more opportunities for impact than I thought I’d have in my entire career.” The Transforming Leaders Program has been supported in part by Allergan, Inc., Lundbeck LLC, Neurocrine Biosciences, Sanofi Genzyme, and Supernus Pharmaceuticals, Inc. 

Conferences & Community

Industry Roundtable: Thank You for 25 Years of Support The AAN has long recognized the value of collaborating with industry. Since its founding in 1994, the Industry Roundtable (IRT) has comprised more than 100 pharmaceutical, medical device, and imaging companies who partner with the AAN to share vision, intellect, and financial resources with the focus on improving the quality of patient care. Prior to 1994, industry involvement in the AAN consisted primarily of support of entertainment, Satellite Symposia, and exhibits. As policies regarding industry involvement in medical societies changed, so too did the relationship between the AAN and industry. Upon its launch, the mission of the Industry—then “Corporate”—Roundtable was to work with the AAN Foundation (now the American Brain Foundation) and Academy to identify and enhance opportunities for achieving mutual goals and objectives toward improving quality of care and life for people with neurologic disease. This goal continues today.

Hosey

The AAN directly benefits through industry support of many continuing medical programs, publications, conferences, public education opportunities, and more—either through financial or hardware/software contributions. In turn, IRT provides a unique forum for industry partners to stay connected and informed of priorities in neurology and to offer their insights in areas of mutual interest. “Within the AAN and the IRT relationship, we look for areas where our objectives and resources align, then we work together with transparency,” said AAN Board Member Jonathan P. Hosey, MD, FAAN, physician liaison to the AAN’s IRT. “We are sincerely grateful for this support that furthers the field of neurology and helps improve the lives of patients living with neurologic diseases.”

Thank you to our 1994 founding members: Abbott Laboratories Allergan, Inc. Armour Pharmaceutical Company Athena Neurosciences, Inc. Berlex Laboratories Bristol-Myers Squibb Company Burroughs Wellcome Co. Cerenex Pharmaceuticals, Division of Glaxo Inc. Ciba-Geigy Corporation The DuPont Merck Pharmaceutical Company GATE Pharmaceuticals Hoechst- Roussel Marion Merrell Dow Inc. Nicolet Biomedical, Inc. Parke-Davis Sandoz Pharmaceuticals Corporation Syntex Laboratories TECA Corporation

Thank you to our current members*: The Upjohn Company AbbVie, Inc. ACADIA Pharmaceuticals Inc. Acorda Therapeutics Inc. Adamas Pharmaceuticals Akcea Therapeutics Alexion Pharmaceuticals Allergan, Inc. Amgen Amneal Specialty, a division of Amneal Pharmaceuticals LLC Avanir Pharmaceuticals, Inc. AveXis, Inc. Biogen Celgene Corporation CSL Behring Eisai Inc. Eli Lilly and Company EMD Serono, Inc. Genentech, a Member of the Roche Group Greenwich Biosciences, Inc. IPSEN Biopharmaceuticals Inc.

Lundbeck Medtronic, Inc. Merck & Co., Inc. Mitsubishi Tanabe Pharma America, Inc. Neurelis, Inc. Neurocrine Biosciences Novartis Pharmaceuticals Corporation Ovid Therapeutics Philips Sanofi Genzyme SK life science, a subsidiary of SK biopharmaceuticals Sunovion Pharmaceuticals Inc. Supernus Pharmaceuticals, Inc. Teva CNS  *As of January 1, 2019

AANnews • March 2019 23

Conferences & Community

Stronger Business Administrators Make a Stronger Practice Each member of the neurology practice is essential to high-quality patient care. Why not give your business administrators an edge with access to the world’s best neurology resources and education to help them better reduce costs and increase revenue for your practice? For only $250, business administrators receive exclusive, career-strengthening AAN member benefits valued at up to $4,000, including: Free registration for the AAN’s Practice Management Webinar series Prestigious publications including Neurology ® Clinical Practice, the AAN’s peer-reviewed clinical practice journal, and Neurology Today ®, highlighting breaking news, issues, and trends in the practice and science of neurology (both print and digital access) In-person networking opportunities with other AAN member business administrators at the AAN Annual Meeting and Fall Conference Virtual networking opportunities with their colleagues via a member-only online forum Significant discounts on registration to the Annual Meeting with programming developed specifically for Business Administrators

Complimentary access to compensation and productivity data for participating members Access to member-only tools on AAN.com, the leading online resource for neurologists worldwide Free AAN online education resources like NeuroSAE®, NeuroPISM, and NeuroLearnSM For as little as $115, business administrators can receive all of the benefits above, excluding the Practice Management Webinar series, Neurology Today (print), and free access to NeuroSAE, NeuroPI, and NeuroLearn. We know how important strong business administrators are to help a neurology practice stand out from the competition, so sign yours up today at AAN.com/view/careteam. 

Great Science Coming to Philly continued from cover To this end, attendees will find plenty of new Science Program offerings in 2019, including: Advancing Medicine: Inspiration and Innovation Tune into a new series of three talks that explore the medicine and the water crisis in Flint, MI; how neurology interfaces with AI and robotics; and what happens when neuroscience and philosophy collide. BrainDome Immerse yourself in the brain’s inner workings with a guided audio-visual tour through a larger-than-life brain. Friday Grand Finale Be sure to stay through the end of the week to enjoy these thought-provoking events and a lively end to the meeting: Neurology Year in Review Plenary Session Science Innovation Lunch Neurology Update Programs and Scientific Sessions Education Blitz Programs Closing Party Celebrating May Day The Grand Experience Don’t miss this new space for presenting cutting-edge scientific advances in an innovative, exciting, and grand new way.

AANnews • March 2019

Invited Science Sessions Encore presentations of top abstracts previously presented at subspecialty meetings, including Alzheimer’s Association and International Parkinson and Movement Disorder Society.

Rost

Added Rost, “Whoever you are and no matter what your career path, you will find what you are looking for at the Annual Meeting—and then some. Whether you are looking to discover cuttingedge neuroscience, an unparalleled educational experience, the latest practice-enhancing tools and tips, or top careerdevelopment advice, the Annual Meeting has you covered.” 

Last Chance! Get Best Rates on Registration and Hotel Before March 7 Don’t wait—visit AAN.com/view/AM19 today to secure the very best rates on registration and your preferred hotel. Prices increase after March 7. 

Tools & Resources

Do You Know How You Get Paid? You Should Sure, you know you have to code to get reimbursed, but did you ever wonder why? This webinar will walk you through the complete process—from the development of codes to a case study that quizzes you on what you’ve learned—ensuring that your next billing attempts are successful.

Understanding How You Get Paid

Cohen

Villanueva

Waugh

Williams

Bruce H. Cohen, MD, FAAN; Raissa Villanueva, MD, FAAN; Jeffrey Waugh, MD, PhD; Korwyn Williams, MD, PhD March 12, 2019, 12:00 p.m. ET Deadline to Register for Live Webinar: March 11 A live, 30-minute session with all course faculty will introduce the topic and enable registrants to ask questions. Several shorter recorded lectures will be posted on learning.aan.com the week following the overview that explore the topic in greater depth, and participants can access these at their convenience. Finally, each topic will conclude with a 30-minute live webchat, so participants can ask further questions. Both live components take place at 12:00 p.m. ET and can be accessed at learning.aan.com.

Schedule

March 12, 12:00 p.m. ET: Live overview and introduction to the course Lectures posted week of March 18: Lecture I: Coding Essentials Overview Lecture II: Where Do These Codes Come From? The CPT and RUC Process Lecture III: Non-face-to-face and Other ‘Tricky’ Codes Lecture IV: How Do I Code for This? Inpatient and Outpatient Case Studies April 2, 12:00 p.m. ET: Understanding How You Get Paid live webchat

All course materials are posted on learning.aan.com.

Learning Objectives

Understand the CPT and RUC coding process Learn the basics of how you get paid, including understanding RVUs and professional liability insurance

Explore case studies to demonstrate the correct way to bill for both inpatient and outpatient procedures Identify potential opportunities to increase your reimbursement in your own practice You can purchase a single webinar series for $99 or purchase a 2019 Practice Management Webinar subscription for only $189—that’s less than $32 per webinar! Webinars are accessible through the AAN Online Learning Center and feature: Convenient live sessions starting at 12:00 p.m. ET On-demand access to recording and presentation slides if you miss the live event On-demand access to shorter, in-depth chapters for you to access at your convenience 2 AMA PRA Category 1 Credits™ per webinar for physicians, or certificate of completion for non-physicians Visit AAN.com/view/pmw19 to learn more and register or contact Jessica Nickrand at jnickrand@aan.com.

Axon Registry Experts on Hand to Answer Your Questions in Philly continued from cover

Merit-based Incentive Payment System (MIPS) reporting requirements and certain MOC requirements for the American Board of Psychiatry and Neurology (ABPN). Physician experts will be on hand for the entire meeting. Additionally, from May 4 to 8, a representative from registry vendor FIGmd will be available to answer technical questions and share information about the process. Stop by to see demonstrations of the dashboard and

be used to waive eight credits of Part II self-assessment.”

discover how having registry data at your fingertips can be a valuable resource for your practice. “Now is the time to decide how you will fulfill Quality Payment Program requirements,” said Lyell K. Jones, Jr., MD, FAAN, chair of the Registry Committee. “The Axon Registry will help neurologists satisfy three out of four MIPS components. Also, the Axon Registry participation is approved by the ABPN as an MOC Part IV PIP Clinical Module activity and can

If you’re looking for how Axon Registry participation will help your practice save time and be more efficient in handling reporting requirements and implement quality improvement initiatives, stop by the booth and get all your questions answered. Don’t miss this opportunity to learn how to successfully track the quality of care in your practice. 

AANnews • March 2019 25

Tools & Resources

MIPS: Get to 30 Points, Avoid Negative Payment Adjustment In 2019, neurologists need to obtain 30 points in the Quality Payment Program Merit-based Incentive Payment System (MIPS) to avoid a negative payment adjustment in 2021. While there are four performance categories—Quality, Cost, Promoting Interoperability (PI), and Improvement Activities (IA)—neurologists may choose to earn the necessary 30 points solely by accumulating points in the Quality and IA categories. The chart below is an example of a possible scenario for a general neurologist who is not in a small practice to meet the minimum requirements established by the Centers for Medicare & Medicaid Services (CMS) to avoid a penalty.

Scoring for Quality In this example, the neurologist identified six quality measures in the Quality category with benchmarks available that are relevant for her population. By outperforming some of her peers in 2019, she was able to collect three to 10 points for each quality measure. Note that benchmarking data is not available for all quality measures, and if benchmarking data is not available, the maximum points for a single measure reported is three. Data must be submitted for the full 2019 calendar year and providers must meet CMS’ data completeness thresholds which vary depending on how measures are being reported. For quality measures reported via a Qualified Clinical Data Registry (QCDR), like the AAN’s Axon Registry®, 60 percent of the individual MIPS eligible

clinician’s or group’s patients across all payers must be reported for the performance period. Be aware only solo and small practices are able to report using Medicare Part B claims starting in 2019. Additional bonus points were added for reporting via an end-to-end method like a QCDR or EHR system and for reporting more than one high priority measure.

Scoring for Improvement Activities This neurologist also identified quality measures that tie to IA. Improvement activities are processes of care that improve health care quality. Improvement activities need to be done for at least 90 days out of the 2019 calendar year. Providers in practices of 15 or more individuals can earn up to 40 points for IA. Activities are weighted either medium or high. Medium-weighted activities earn

10 points per activity, and high-weighted activities earn 20 points per activity. This scoring system enables the neurologist to pick the number and desired type of activity. There is no half credit for reporting an IA; one either gets all the points for the activity or none. Extra points may not be gained by attesting to additional activities. If reporting for a group, only one person in the TIN needs to attest to having completed IAs. Many MIPS improvement activities correlate to MIPS quality measures and some may be things neurologists are already doing in practice, such as consulting the prescription monitoring program. The raw scores obtained through reporting IA and quality measures are converted into MIPS points using the 2019 weights identified by CMS.

The AAN provides additional MIPS resources at AAN.com/practice/MACRA. Visit QPP.cms.gov to see other available QPP quality measures.  Description

Raw Score

MIPS Points

Quality Quality measures are worth between one to 10 points for clinicians in groups (more than 15 clinicians). Quality measures are worth three to 10 points for small and solo providers (15 or fewer clinicians). This example assumes an eligible provider has met CMS’ data completeness and case minimum requirements and has a performance score greater than zero. Quality ID: 286 Safety Concerns Screening and Mitigation Recommendations or Referral for Patients with Dementia (High Priority Measure)

Quality ID: 130 Documentation of Current Medication in the Medical Record (High Priority Measure)

Quality ID: 408 Opioid Therapy Follow-up Evaluation

Quality ID: 290 Parkinson’s Disease: Psychiatric Symptoms Assessment for Patients

Quality ID: 412 Documentation of Signed Opioid Treatment Agreement

Quality ID: 435 Quality of Life Assessment for Patients with Primary Headache Disorders (Outcome)

Potential Bonus Points: 1 bonus point for second high priority measure 1 bonus point for end-to-end reporting

2 Quality Category Subtotal

Improvement Activity Improvement Activity: Offer integrated behavioral health services to support patients with behavioral health needs, dementia, and poorly controlled chronic conditions

Annual registration in the prescription drug monitoring program

Manage medications to maximize efficiency, effectiveness, and safety

Improvement Activity Category Subtotal Combined Final Scores

15.75

15 30.75

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Tools & Resources

Education & Research

Participate in New Survey on Compensation and Productivity

Subspecialty Fellowship Training Program Accreditation Applications Due June 1

continued from cover

telemedicine benchmarks, and practice information such as ancillary services, patient wait times, and compensation methods. Neurologists can learn: How other practices perform in cost measures and benchmarking Benchmark compensation and RVUs to others in their subspecialty The average payer mixes for neurologic practices The average size of other practices and their employee mix Advanced practice providers can: Discover key productivity and compensation metrics for APPs working in neurology Compare their productivity with other APPs Benchmark the compensation for their work Explore neurology APP salaries using subspecialty data Business administrators can: Find out how other practices perform in cost measures and benchmarking Learn the average size of other practices and their use of APPs in their employee mix Discover the payer mix for neurologic practices Benchmark their salary against other practice managers working in neurologic practice settings Use a downloadable and savable spreadsheet to import data on behalf of the neurologists in their practice More than 1,300 AAN members took the most recent survey in 2017. Based on feedback from previous respondents and several work groups, the new survey has been overhauled to make it faster and easier to complete, obtain compensation and productivity data for APPs, and deliver the data in a new, interactive and user-friendly online dashboard. Respondents will be able to filter the data to benchmark themselves against others within the same subspecialty, geographic region, practice setting, and practice size. Take a few minutes to collect the following information you will need when the survey opens: 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 The survey takes about 30-60 minutes to complete once you’ve compiled your documentation. The deadline to complete the survey is May 25, 2019. For more information, visit AAN.com/view/BenchmarkReport. If you have questions, email benchmark@aan.com. 

AANnews • March 2019

Programs seeking accreditation in any of the nine neurologic subspecialty areas recognized by the United Council for Neurologic Subspecialties (UCNS) should submit applications by June 1, 2019. Accreditation is a voluntary process of evaluation and peer review. Programs that attain accreditation status offer the core curriculum established by the subspecialty and meet the required quality standards established by UCNS. Fellows graduating from UCNS-accredited training programs meet the training eligibility requirements for certification in their respective UCNS-recognized subspecialty, creating a strong career path for fellow graduates. Accreditation applications are accepted throughout the year with spring and fall review deadlines. New applications received by the June 1 deadline will be reviewed for approval in the fall of 2018. The next deadline for program applications will be December 1, 2019, for a spring 2020 application review. To begin the application process, programs must first request access to the online application at tools.ucns.org/ai/ request/accreditationrequest. For more information, visit UCNS.org or contact Amanda Carpenter at (612) 928-6065 or acarpenter@ucns.org. 

New Diplomates Certified and Recertified by UCNS The United Council for Neurologic Subspecialties (UCNS) recently administered initial certification examinations in Behavioral Neurology & Neuropsychiatry (BNNP) and Autonomic Disorders. The 50 physicians successfully earning initial certification demonstrated their expert knowledge in the subspecialty. BNNP and Neurocritical Care recertification examinations were also offered, with 76 physicians maintaining recertification, demonstrating their commitment to lifelong learning by meeting the continuing medical education and subspecialty knowledge requirements. Lists of the diplomates are available at UCNS.org. 

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.

AAN, CMS Discuss Appropriate Valuation for New EEG Monitoring Codes AAN physician experts and staff met with leadership at CMS to discuss a new code set for long-term EEG monitoring. Representatives from the National Association of Epilepsy Centers also participated. The goals of the meeting were to ensure CMS understands the indications for long-term EEG monitoring and appropriate coding of the services and to influence the CMS reimbursement levels for EEG in the upcoming proposed 2020 Medicare Physician Fee Schedule that will be published in July. The code set that was passed at the May 2018 AMA CPT Editorial Panel meeting includes deletion of 95827, 95950, 95951, 95953, 95956, the addition of 10 new codes for reporting professional services and 13 new codes for reporting technologist services. The full 2020 CPT code set, including revised language and descriptors, are under AMA embargo until fall 2019.

AAN Submits Comments on Major Drug Rule and EHR Draft Strategy The AAN submitted regulatory advocacy comments in response to two significant administration proposals. The first comments were in response to a proposed rule from CMS that would significantly reform the Medicare drug benefit through changes to Medicare Advantage and Medicare Part D. In the comments, the AAN opposed the expansion of prior authorization and step therapy protocols but was supportive of several other provisions that are aimed at improving price transparency and lowering drug costs. The comments also detail a set of needed guardrails that are supported by the AAN, if CMS does not reverse its decision to allow step therapy in Medicare Advantage.

The second comments were in response to the Office of the National Coordinator’s “Draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” In the comments, the AAN addressed several recommendations made in the draft strategy related to clinical documentation simplification, EHR usability and design, EHR reporting, public health reporting, and issues related to qualified clinical data registries.

AAN Welcomes New Director of Congressional Affairs Andrew Schwab came on board February 4 as director of congressional affairs and joins the AAN Washington, DC, office having spent almost 20 years in and around health care policy and politics. He began his career as deputy press secretary to then-US Sen. Jon Corzine (D-NJ), where he led press advance at the 2004 Democratic National Convention. From 2006 to 2013, Andrew served as chief of staff to the chairman of the Financial Institutions & Insurance Committee in the New Jersey legislature. In 2013, Andrew was recruited by AARP to lobby the federal government to protect Americans aged 50+ on all private health insurance matters including the Affordable Care Act (ACA). For the past two and a half years, Andrew served as chief of advocacy at the Alliance of Community Health Plans, representing the nation's highest-quality, provider-aligned insurers and led them through the 2017 ACA repeal and replace debate. Andrew holds an undergraduate degree in history and policy studies from the Maxwell School of Citizenship & Public Affairs at Syracuse University and a Master of Public Administration from Rutgers University. 

AANnews • March 2019 29

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.

Associate Professor/Professor Opportunities in Houston, TX The University of Texas Health Science Center at Houston (UTHealth) seeks an Assistant Professor for the Department of Neurology at McGovern Medical School (The Woodlands, TX; Shenandoah, TX; & Houston, TX). This is a non-tenure, full-time faculty member position. The Assistant Professor shall serve as the Clinical Endovascular & Stroke Director at UTHealth’s affiliated Memorial Hermann Hospital (“MHH”) in The Woodlands, TX (a Joint Commission certified Primary Stroke Center). Oversight of Neuro ICU, development of a clinical stroke service at MHH in the Woodlands, & initiation of endovascular services for stroke & cerebral vascular disease plus in-patient service. Teach residents & fellows (on rotation) in Neurology, Vascular Neurology and Endovascular Neurology for robust Neurology residency program and ACGME vascular neurology fellowship program. Provide clinical services in outpatient clinic (pertaining to MHH) in Shenandoah, Texas. Render up to 6 weeks of services per year at MHH in the medical center in Houston, TX. To apply, please visit: p.rfer.us/UTHPya3is or uth.referrals.selectminds. com/faculty 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. Applicants must be board certified/eligible in neurology. Neurohospitalist fellowship training is not required. Applicants with fellowship training in other neurological specialties or an interest in general outpatient neurology will have the opportunity to combine neurohospitalist work with their other area of interest. To apply, Email: ll18@cumc.columbia.edu or pa334.peopleadmin.com/postings/2115. General Neurologist for Busy Practice in Florida. Excellent opportunity for a new or experienced neurologist seeking a busy, collegial physician owned group. Our neuroscience program is dedicated to the comprehensive diagnosis and treatment of patients with a wide variety of neurological disorders so fellowship training in Headache, Behavioral Neurology, Sleep Medicine, Neuromuscular, Stroke, or Movement Disorders is helpful. Our expanding in-house neuroscience program boasts an accredited Sleep Disorders Center, EEG, EMG, evoked potential capabilities and neuroimaging capabilities (MRI, CT, PET, SPEC). Convenient access to one 800-bed hospital located 2 blocks from the Clinic. Watson Clinic is a physician-owned group practice with over 220 physicians and maintains a strong referral base with over 50 primary care specialists in outpatient and inpatient practices. Our convenient location between Tampa & Orlando provides easy access to 2 international airports just 45 minutes away. Watson Clinic fosters an atmosphere of clinical excellence in an area offering a high quality of life, complete with affordable housing, safe neighborhoods, and a wealth of recreational activities year-round including golf, football, hockey, baseball, basketball as well as local attractions and no state income tax. In addition to a salary guarantee, we offer a signing bonus, paid relocation assistance, retirement program, malpractice insurance along with many other benefits. Partnership is offered after 2 years. Board

AANnews • March 2019

certification or eligibility by the American Board of Psychiatry and Neurology. To apply for this job, contact Kacee Fagan at WCPhysicians@watsonclinic.com, (863) 680-7380. West Virginia Pediatric Neurology Job 180420. Pediatric Neurology. Opportunity to join two practicing Pediatric Neurologists. Join medical school Department of Neuroscience including Neurology, Neurosurgery & Neurophysiology. Faculty members including Child & Adult Neurologists, as well as Functional, Pediatric & Spine Neurosurgeons. Established, Accredited Long-Term Epilepsy Monitoring Unit. 36 Bed NICU; 12 Bed Pediatric ICU Level III Center. New, $30 Million Pediatric Hospital Expansion. Clinical Research Interest Encourage. New Neurology Residency Program. Excellent starting salary, full benefits and sign-on bonus. Educational stipend available. An outdoor enthusiast´s haven. Enjoy the scenic shores of a historic River. Take in the fourseason views while mountain hiking. Enjoy a sunset cruise under the stars. The region´s best skiing at your doorstep. Year-round family fun. A down-to-earth place to live combined with amazing cultural sensations. NCAA Division One Intercollegiate Sports Teams. Excellent Public and Private Schools. Short Distance to 4 Major Metro Areas. Grand prize winner America´s Best Communities Competition. Mention code 180420 CHN. Minimum Requirements: MD or DO Medical Degree, eligible to be state licensed in the United States, and United States Residency and / or Fellowship training. To apply, contact Rob Rector, rrectorweb@phg.com, (404) 591-4218. Oregon Neurology Opportunity in picturesque mid-Willamette Valley. The Corvallis Clinic is actively recruiting a board certified or board eligible neurologist. This is a unique opportunity to join a regional program with an established reputation of providing exceptional care for a wide variety of neurological conditions. General neurology practice. Diverse inpatient and outpatient cases. Built-in referrals, appropriate consultations. Opportunity to participate in graduate medical education, supervise medical residents. Competitive compensation, comprehensive benefits, generous CME. Oregon’s Mid-Willamette Valley. Considered one of the most desirable areas to live in Oregon. Thriving communities offering abundant outdoor recreation, cultural events and festivals, superb schools and Pac-12 University. Easy access to outdoor recreation, Oregon Coast, Cascade Mountains, Portland Metropolitan area and Oregon wine country. Interested? Please Contact: Karrie Wuerch, Director, Physician Recruitment and Relations. (541) 768-233, karrie.wuerch@ corvallisclinic.co Neurology opportunities—Minneapolis/St. Paul, MN. Fairview Health Services / HealthEast (Minneapolis/St. Paul), an award-winning nonprofit health system (Fairview.org) has multiple Neurology opportunities. Fairview is one of the most comprehensive and geographically accessible systems in the state, serving the greater Twin Cities metro area and north-central Minnesota. Our progressive and passionoriented culture allows our Neurologists to work together in offering the full continuum of highly technical and specialized neurological health services. Practice Details: Join an established team of Neurology providers dedicated to offering high-quality, comprehensive neurological care and education. Practice Neurology in either outpatient or inpatient settings, or a combination of both at our Hospitals and Clinic locations located in Minneapolis/St. Paul and surrounding suburban communities. Provide a full spectrum of adult and young adult Neurology. Enjoy our strong primary care referral base. Opportunity to practice and further develop clinical interests such as clinical neurophysiology with special interest in stroke, electromyography (EMG), electroencephalography (EEG), and Botox injections. Our staff includes nurses with specialized neurological training and highly skilled registered electro diagnostic technologists. Opportunity to provide Inpatient Neurology/Stroke coverage. Call coverage is dependent on each practice location. Fully integrated Electronic Medical Record (EPIC). Income Details/Benefits: Market competitive salary guarantee with ability to exceed on production compensation program with comprehensive benefits package that includes generous time off, annual CME allowance, malpractice insurance, a retirement plan,

relocation & more. Sign-on bonus offered. The Twin Cities area is a vibrant metropolitan area with a population of 3.5 million, home to 20 Fortune 500 companies, nationally recognized educational system, major universities, professional sporting teams, fine dining and numerous arts and cultural activities. For additional information, please contact Jill Herrera, recruit1@fairview.org, (800) 842-6469, https://www.fairview.org/careers/career-opportunities/ physicians-and-advanced-practice-providers Private Neurologist. Private Neurology practice position is available in Tampa, Florida for a neurologist with any subspecialty interest to join a well-established inpatient/outpatient practice affiliated with Tampa General Hospital, the primary teaching hospital for USF College of Medicine. Our clinic is conveniently connected to TGH and located on the water front of Davis Islands. This independent practice is a partner of a multispecialty group of physicians, Florida Physicians Alliance with a fully staffed Neurodiagnostic laboratory. This job is located in the gorgeous, fast growing city of Tampa, provides an easy access to one of America's most beautiful beaches at Clearwater, where you would enjoy great weather, arts, education, professional sports, business and many outdoor entertainments. No ER on call coverage is required. Board Certified/Eligible in Neurology with any subspecialty interest except pain. Active, Florida Medical License To apply for this job, contact Erfan Albakri, MD, ealbakri@floridastroke.com, (813) 250-9101. West Virginia Neurohospitalist Job 180418. Opportunity to join growing Neurology department of 8 Neurologists. Faculty members including General, Pediatric, Neuromuscular, Movement, Epilepsy and Vascular. 7 days on 7 days off schedule with opportunity for outpatient clinic. Accredited Neurophysiology Center on site. Multidisciplinary team includes Radiologists, Pharmacists, Nursing, Dietitians, Physical, Occupational and Speech Therapists. New Neurology Residency Program. Comprehensive benefits package including malpractice. Excellent starting salary and sign-on bonus. Academic Appointment. Educational stipend available. An outdoor enthusiast´s haven. Enjoy the scenic shores of a historic River. Take in the four-season views while mountain hiking. Enjoy a sunset cruise under the stars. The region´s best skiing at your doorstep. Year-round family fun. A down-toearth place to live combined with amazing cultural sensations. NCAA Division One Intercollegiate Sports Teams. Excellent Public and Private Schools. Short Distance to 4 Major Metro Areas. Grand prize winner America´s Best Communities Competition. Mention code 180418 NHO. Must have a MD or DO Medical Degree, eligible to be state licensed in the United States, and United States Residency and / or Fellowship training. To apply for this job, contact Rob Rector, rrectorweb@ phg.com, (404) 591-4218. Outpatient Neurologists, Subspecialists, Neurohospitalists to join our 40+ physicians in South Florida—locations in Palm Beach, Fort Lauderdale, Miami. Tenet Florida's Advanced Neuroscience Network includes over 40 employed physicians (neurologists, interventional neurologists, neurosurgeons, stroke and vascular neurologists, and neuropsychologists), 10 award winning hospitals, 4 comprehensive stroke centers, and multiple full-service outpatient centers across Miami-Dade, Fort Lauderdale and Palm Beach counties. We are looking for additional outpatient general neurologists, subspecialists, neurohospitalists, and stroke neurologists. Please check out our websites at: Tenet Florida Physician Services Neuro (www.tenetfloridaphysicianservices. com/neurology) Palm Beach Neuroscience Institute (www. pbni.com) Our team provides comprehensive neurological & ancillary services and features some of the leading neurologists in South Florida. Many professionals and programs come together under the Advanced Neuroscience Network with the goal of providing the highest quality care possible. We are adding further staff due to increased patient volumes. Some of the benefits of becoming employed by Tenet include: Guaranteed salary with production bonus. Physician paid time off (vacation + CME with stipend). Malpractice insurance. Health, dental, life insurance, retirement benefits. Residents & Fellows are welcome to apply. I am

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.

currently conducting a nationwide, confidential search for qualified candidates. If you would like to obtain additional information about this opportunity, please contact me or send a copy of your Curriculum Vitae for consideration. For further information, please submit CV to: Lane Mitnick, Florida Region Physician Recruiter, Tenet Health System. Lane.Mitnick@tenethealth.com, (561) 288-5511. West Virginia Vascular Neurology Job 180419. Vascular Neurology. Join medical school Department of Neurology including General Neurology & Neurophysiology. Faculty members including General, Pediatric, Neuromuscular, Movement and Epilepsy specialists. Established, Accredited Long-Term Epilepsy Monitoring Unit. Opportunity to focus on any and all subspecialties. New Intensive Care Units. New Neurology Residency Program. Flexible call schedule, Excellent starting salary, full benefits and sign-on bonus. Educational stipend available. An outdoor enthusiast´s haven. Enjoy the scenic shores of a historic River. Take in the fourseason views while mountain hiking. Enjoy a sunset cruise under the stars. The region´s best skiing at your doorstep. Year-round family fun. A down-to-earth place to live combined with amazing cultural sensations. NCAA Division One Intercollegiate Sports Teams. Excellent Public and Private Schools. Short Distance to 4 Major Metro Areas. Grand prize winner America´s Best Communities Competition. Mention code 180419 VN. Job Requirements: MD or DO Medical Degree, eligible to be state licensed in the United States, and United States Residency and / or Fellowship training. To apply for this job, contact Rob Rector at rrectorweb@phg.com, (404) 591-4218. Outstanding Neurology opportunity with the premiere medical group practice just outside of NYC. Exceptional opportunity to join the leading physician-owned, physician-led multispecialty group medical practice consisting of over 450 providers in more than 40 specialties in New York. Work with outstanding colleagues in state-of-the-art facilities. We offer top starting compensation and income potential, as well as outstanding support and ancillary services. Ownership offered at 2 years. We are currently recruiting additional Neurologist physicians for our locations only 60 miles from NYC. Beautiful new state-of-the-art office; close to New York City but without all the tolls, traffic, and expense; many quaint and very desirable villages, towns, or cities to call home; outstanding public and private schools; when big city amenities call out, NYC is an hour away. Contact William Carpini (845) 703-6105 or Debra Napolitano (845) 703-3635, physicianrecruitment@crystalrunhealthcare.com, www.crystalrunhealthcare.com Neurology Medical Director. Envision Physician Services and Kendall Regional Medical Center are seeking a Director of Neurology to lead our newly established inpatient neurology program located in beautiful Miami, Florida. This position is full time, Monday-Friday with an 8am–5pm schedule. Physicians with previous leadership experience or physicians looking to advance their career into a leadership position are encouraged to apply. Candidate must be a vascular trained neurologist. Facility Information: Kendall Regional Medical Center has been honored by being nationally recognized with many prestigious awards and accolades, including: Thomson Reuters 100 Top Hospitals, a HealthGrades Distinguished Hospital (Top 5%) for Clinical Excellence, The Joint Commission Certification as a Primary Stroke Center, accredited Chest Pain Center with PCI, and most recently, by the Joint Commission as a “Top Performer” on key quality measures. Kendall Regional Medical Center, an award-winning 417-bed hospital, is recognized for providing a wide array of services to the residents of South Florida, as well as visitors from around the world. This prestigious facility offers 24-hour comprehensive medical, surgical and diagnostic services, including trauma and burn care, pediatrics and maternity services, an orthopedic and spine institute, along with patient and community services. For over 40 years, we have been committed to expanding and improving every facet of the organization, devoting significant time and resources to enhancing the facility, staff and medical care. Kendall Regional

Medical Center has grown into a major tertiary-care teaching facility with an outstanding staff. Community Information: The City of Miami is known as the “Magic City” and is located in Southeast Florida, between the Florida Everglades and the Atlantic Ocean. It is known for its diverse culture, ethnicities, and is recognized worldwide as an international hub. Kendall offers warm weather, inviting water, soft sandy beaches, and a sizzling nightlife. Outdoor enthusiasts can golf, snorkel, and boat their way through Miami or enjoy the art deco style museums, shops and boutiques. The area is home to several highly rated public and charter schools and universities including Florida International University and University of Miami. Kendall offers the option of both city and suburban living and has several communities offering a variety of family entertainment including swimming pools, sporting events, shopping malls and many other activities. The location is ideal with easy access to airports and the Port of Miami home to several cruise ships travelling to the Caribbean Islands and South America. Envision Physician Services is a dynamic, physician-led organization which has been offering exceptional career opportunities since 1972. With more than 14,000 affiliated providers coast-to-coast, Envision Physician Services is nationally-recognized for delivering clinical excellence supported through innovation, integration and exceptional leadership. Whether you are considering full-time, part-time or independent contractor opportunities with Envision Physician Services, you can rest assured you will be working for an industry-leader who delivers a vast array of benefits unmatched within the industry, including: Physician-led organization Strong leadership on a local, regional and national level Exceptional quality of practice backed by comprehensive support services Optimal staffing ratios and flexible scheduling options “A” rated professional liability insurance Extensive variety of practice settings coast-to-coast Competitive compensation including several benefit options Opportunities for professional development, mentoring and career advancement Comprehensive education and training on leadership, management and clinical best practices, including a wide variety of CME programs Colleague referral bonus program *Benefits vary by division, clinical specialty and employment status Company Information Quality people. Quality care. Quality of LIFE.(TM) Envision Physician Services is a national physician-led practice management company. This privately held company provides outsourced clinical department recruitment, staffing, management and billing/ collection services for hundreds of hospitals and health systems nationwide. Known for its unique structure, Envision Physician Services develops local practices, supports them with regionally-located clinical leadership and operational personnel and provides them access to unprecedented national resources. Each Envision Physician Services practice has its own unique culture, but all sites recruit and hire clinicians who share the company's core values of being patient-focused, customer-centered and caregiver-inspired. Envision Physician Services is a family of companies, each of which has clinical staffing needs. Full-time, part-time, and independent contractor opportunities are available through Envision Physician Services. Candidates considering a career within the Envision Physician Services family of companies will find a variety of community types (from small towns to major urban areas), practice settings (small hospitals to major academic health systems), job levels (entry level to senior management), and competitive pay with exceptional benefits. Specialties supported include Emergency Medicine, Hospital Medicine, Women’s and Children’s, Surgery, Anesthesia and Radiology/Teleradiology. Envision Physician Services is proud to be an EOE/AA employer. To apply for this job, contact Jaime Crosse at Jaime.Crosse@ emcare.com.

Neuro Interventional Program. 24-hour EEG. DHART Program – the only ‘helicopter’ EMS in NH and VT. Level 1 Trauma Center. Education of Neurology and Neurosurgery residents. Outstanding opportunities in neurological disorders. Successful candidates will be recommended for a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank commensurate with experience. Tertiary referral center for northern New England. What we are looking for: BC Neurology and Neurointensivist or Neurocritical Care Fellowship trained. Neurocritical care experience preferred. Leadership experience. The Dartmouth-Hitchcock health system stretches over New Hampshire and Vermont and offers the quintessential New England experience. With no income or sales tax, this beautiful area combines history, industry and business and has been ranked consistently as one of the best places in the US to live and work. With destinations like Boston, New York, the seacoast and ski country within driving distance, the opportunities - both career and personal - truly make New Hampshire the ideal place to work and play. Applicants are encouraged to apply online with CV and cover letter on our Provider Career site: DHproviders.org. Cover letters should be addressed to: Jeffrey A. Cohen, MD. Chair, Department of Neurology. Dartmouth-Hitchcock is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, veteran status, gender identity or expression, or any other characteristic protected by law. careers.dhproviders.org/director-of-neuro-icu. West Virginia Neurology Opening 171116. Primarily Outpatient Neurology opportunity in new medical building. Opportunity to join growing Neurology department of 8 Neurologists. Faculty members including General, Pediatric, Neuromuscular, Movement, Epilepsy and Vascular. Accredited Neurophysiology Center on site. Multidisciplinary team includes Radiologists, Pharmacists, Nursing, Dietitians, Physical, Occupational and Speech Therapists. New Neurology Residency Program. Excellent starting salary, full benefits and sign-on bonus. H1b candidates accepted. Educational stipend available. An outdoor enthusiast’s haven. Enjoy the scenic shores of a historic river. Take in the four-season views while mountain hiking. Enjoy a sunset cruise under the stars. The region’s best skiing at your doorstep. Year-round family fun. A downto-earth place to live combined with amazing cultural sensations. NCAA Division One Intercollegiate Sports Teams. Excellent Public and Private Schools. Short Distance to 4 Major Metro Areas. Grand prize winner America’s Best Communities Competition. Mention code 171116—N. Minimum Requirements: MD or DO Medical Degree, eligible to be state licensed in the United States, and United States Residency and / or Fellowship training. To apply for this job, contact Rob Rector at rrectorweb@phg.com, (404) 591-4218.

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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 May 2019 print edition of AANnews A must be submitted by April 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.

Director of Neurology ICU. Build your career working with nationally recognized Neurologists and Neurosurgeons at Dartmouth-Hitchcock Medical Center in Lebanon, NH. If you are a Neurocritical Care/Neurointensivist Physician with the ability and desire to lead the building of a new Neuro ICU, we encourage you to apply to this Director of Neuro ICU position. What we are offering: Lead state of the art Neuro ICU. 24/7

AANnews • March 2019 31