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Board Certified Pediatrician Practice Guideline Development Medical Expert Witness


Expert Witness No.487

Virginia

Qualification Summary:

Pediatric, Adolescent, and Neonatal Medicine   Computer Literate, Quality Improvement and QI Leadership  Teaching Ambulatory Care, Managed Care Administration, Practice Guideline Development, Clinical Departmental Administration, Corporate Practice Management, Utilization Management 

Current Clinical/Management Experience:

Pediatric Medical Practice: 1998-present  (60%)

Medical Director:

National PPO  (30%)

Health Plan of Virginia  (10%)

Consulting:

Capital Area Blue Cross - Blue Shield, 1993- present: Peer and Utilization Review

Medical Society of Virginia Review Organization, 1992- present: Utilization andPeer Review; Practice

Standards and Guideline Development

AETNA/ US Healthcare, Middle Atlantic Region, Physician Advisory Board, 1995- 1997

MAMSI, Quality Improvement Committee, 1997-1998

NCQA Surveyor: Certification 1991

Medical Alliance, Alexandria, va: 1998-Healthcare Consultant

George Washington University Health Plan

100,000 member HMO with commercial, PPO and Medicaid lines of business.  NCQA Accredited 1997-1998

Medical Director: Quality Improvement and Utilization Management

Reorganized the Quality Improvement Department, Appeals process and credentialing to meet NCQA standards

Reduced the cost of credentialing by 50%

Founded and Chaired the Association for Advancement of Managed Care Principle: a unique regional organization of MCO medical directors whose focus it was to reduce “provider related” redundancy and provider compliance with managed care principles

Integrated Physician Services

INOVA Hospital Corporation of Fairfax, VA: Owned and managed network of primary care practices. Approximately 200 providers.,1996-1997.

Established new primary care pediatric practice.

Chairman of Quality Improvement Committee: Development of a standardized medical record to meet NCQA and third party payer standards.
Developed pilot information system to collect data related to physician utilization of purchased patient care (resource allocation) and which when implemented will provide significant office administrative savings.

Credentialed with 27 managed care organizations.

56-provider multi-specialty group practice located in Northern Virginia which is manage care focused, has “full risk, global“ contracts and is developing an “IPA.”  Was to assume position as Medical Director of Gateway IPA effective July 1, 1996, 1991-1996.

Director of Quality Management

Initiated, developed, and managed the cultural change to "quality" in a 56 provider multi specialty medical group practice in its strategy for successful transition in the evolving managed care environment in northern Virginia.  This effort has insured the success of “V.M.A.“ in pursuit of its vision of "continued recognition by all of its “customers” as the premier medical services provider in the metropolitan area.

Developed plan for reorganization of the executive committee as a "quality council."
Developed and implemented plan for ambulatory quality improvement, customer satisfaction, and utilization management.

Chief of Pediatrics

Founded, developed, and administer a full service department of pediatrics, now six physicians. During these years, the majority of my time was spent providing direct patient care.  Administrative responsibilities were accomplished within part time appointments.  Able to see 40-45 “very satisfied” patients in 8 hours.

Developed and implemented a model medical record and documentation standards.

Group Health Association Of Washington, D.C.

157,000-member staff-model HMO covering the Washington, D.C. metropolitan area, now Humana/GHA. Clinical administrative responsibility shared jointly by physician union leadership and administrative physicians functioning in committee structure and was participative in style, 1985-1991.

Associate Medical Director for Quality Management

Advised the medical director, quality management department, administrative physicians, and appropriate committees in matters of "quality assurance, risk management, peer review, and continuous quality improvement"
Planned and promoted the transformation to "total quality management/ continuous quality improvement" with emphasis on the clinical delivery system.
Liaison to external regulators, review organizations, and malpractice carriers.

Associate Chairperson, Department of Pediatrics 

Direct Responsibility for Clinical Delivery System of 6 Physician Service to 8,000 Pediatric and Adolescent Members. The Associate Chair Acts in an Advisory Capacity to the Department Chair and the Regional Administration as Well as the Medical Director. The Department consists of 26 Physicians Caring for 40,000 Members.
Appointed Membership of All Administrative Committees from One to Five Years.
Department-wide Peer Review Implemented Quality Improvement Process Initiated.
Maternal-infant discharge program developed implemented (cost savings projection= $1,000,000/year.)
Developed neonatal coverage system for Arlington Hospital
Developed and implemented home phototherapy system.
Developed new format for the pediatric medical record and clinical documentation

Chairman of the Pharmacy and Therapeutics Committee

Initiated, developed and implemented a system-wide formulary saving $3,000,000 of $15,000,000 budget 
Improved the quality of care through the data provided from this system.

Regional Medical Director/Acting

Responsibility for the clinical and administrative staff and services of a 30,000 member region with 4 centers, 22 physician FTES, 200 support staff and more than 100 contract physician specialist.
Reorganized the regional administration
Successful initiation of peer and administrative review of all purchased care resulting in significant decline in unnecessary and questionable utilization of services.
Planned and implemented a regional after-hours and weekend medical service center for the region. This   resulted in a net 30 percent savings per visit and much higher member satisfaction.
Initiated regional referral review and preferred provider policy affecting a 33% decrease in referrals.

Fairfax Hospital, Falls Church, VA

Fairfax Hospital is a 650 bed tertiary hospital in Northern Virginia. Within it is a full service CHILDRENS hospital with 55 beds, 14 Pediatric ICU and 40 Neonatal ICU beds. The active pediatric staff is 300 physicians.

Chairperson, Pediatric Quality   Improvement Committee 1986- 1997

Served as department representative to the hospital-wide medical quality improvement committee.
Led the committee in its activities which gained hospital-wide recognition for the most effective quality assurance committee within the hospital. Its activities were used to defend the hospital, as the single example put forth, and contest a major JCAHO contingency in the 1987 survey. Again in 1990, the committee was cited for excellence during the preparation for the survey.
Initiated orientation and transformation from traditional quality assurance to continuous quality improvement (TQM) in the division of maternal-child health.
Developed and delivered a weekly lecture course on ambulatory pediatric care for medical students and residents focused on business management of private practice.
Developed the three-year curriculum guide for the “personal growth” section of the new pediatric residency program at Fairfax Children’s Hospital.

Neonatal Medicine: 1985-1990 (Part-time), Alexandria Hospital, Alexandria, VA

Practice of Pediatric Medicine 1969-Present (Full or Part Time)

U. S. Public Health Service, U. S. Public Health Service Hospital, Norfolk, Virginia: Chief of Pediatrics 1969-1971
(Rank: Lieutenant Commander/Assistant Surgeon)

Teaching:

Clinical Assistant Professor of Pediatrics, Georgetown University Medical School, Washington, DC, 1985-present

University Of Virginia Medical School/ Fairfax Children’s Hospital, Fairfax, VA
Residency Curriculum Development Committee, 1993-present

Assistant Professor of Pediatrics, Pennsylvania State University Medical School, Hershey Medical Center, Hershey, PA, 1971- 74

Harvard Teaching Fellow, Harvard University Medical School, Boston, MA, 1968-69

Certification and Education:

American Board of Pediatrics, 1972

Residency: Children’s Hospital Medical Center, Boston, MA, 1966-69

Medical School: Medical College of Virginia, 1966. Class Valedictorian

Undergraduate: Duke University, 1962

Research

“Serevent vs. Leukotriene inhibitors in asthma” (1999-2000)

Azithromycin in the treatment of streptcoccal infections in children. (1993)

Adriamycin in the treatment of metastatic sarcoma in children (Phase 2, 1972-74)

“Aerosolized bcg” in the treatment of metastatic lung cancer (Phase 1, 1972-1974)

“BCG/ Neurominidase treated tumor extract “ in the treatment of metastatic breast and colon cancer.
(Phase 1, 1972-1974)

Xopenex in the treatment of asthma in children (1999-present)

Efficaiy of MMRV Vaccine in children (1999-2000)

Linzolide (Xyvox) in the treament of Staphyloccus skin infections in Children (2000)

Galdtofloxin in the treatment of otits media in children (2001)

Evaluation of the Trinity Rapid Streptococcal Antigen Test (2001)

Antibiotic comparison taste tests in children

Publications:

Available upon request

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