Welcome to 2019! I hope that you were able to take time over the last couple weeks to celebrate the end of a successful and productive 2018, and that you are ready to approach the new year with eagerness and a renewed sense of purpose. I also want to acknowledge the commitment and dedication of many of you, including our trainees and staff who continued to care for many patients who had to spend the holidays in our hospital and clinics. As I said at the end of 2018, our guiding strategy as a department this year will be to pursue new approaches for fulfilling our missions while maintaining the excellence and successes we have already achieved. I would like our efforts to be  guided by four principles: innovation, rigor, nimbleness, and building talent (i.e., best people). As we look to strengthen our ranks and our programs across all missions, we should seek to identify those within and outside our institution whose vision aligns with our own. I believe that we are up to this challenge.

As the new year begins, there are many challenges ahead that will require innovation, creativity, and nimbleness. For example, for our clinicians, the new year brings changes to the way we are reimbursed for services we already provide. Your division administrator will continue to provide information about these changes, but a few bear mention here. We spend many hours reviewing records and results to provide the optimal care for many of our patients with chronic conditions. Until recently these efforts were un-reimbursed, but new rules from the Center for Medicare and Medicaid Services (CMS) recognize that these efforts are important facets of chronic care management. Incentives to promote telemedicine and rules that may support telephone consultations with colleagues have been announced. Although the proposal that sought to limit documentation burdens but which also limited the ability of our providers to be compensated for complex care has been delayed, we must not be complacent and should be exploring and developing new approaches to provide high quality and high value care for our patients in innovative and efficient ways. Our department is working hard to stay ahead of many of these changes and to work with you to navigate these changes. I encourage you to stay in contact with your staff and with leadership, including our Vice Chair for Clinical Programs Dr. Kim Staffey, as you are balancing these changes with your existing clinical responsibilities.

Clinical success is not only judged by attempting new things. It also means continuing to do what we do well, by maintaining the excellence with which University of Iowa Health Care is synonymous. The recent reaccreditation of our cystic fibrosis care by the Cystic Fibrosis Foundation is evidence of that. Their five-year renewal of both our adult and pediatric CF care teams is the highest level the organization provides. We often talk about the strides that our researchers make as they search for a cure, but their discoveries translate into clinical practice that are already making tremendous difference in people’s lives. Congratulations to everyone on this recognition and thank you for the work you do.

We will have more stories soon to share of recent grant awards that will allow us to explore new avenues for improving human health. For now, I will point you to two recent examples of research resulting in significant publications. First, Dr. Dan Livorsi, an Assistant Professor in Infectious Diseases and member of CADRE, and his colleagues both at the Iowa City VA and in the Department of Urology, looked at nearly 30,000 patient records to determine whether veterans were receiving appropriate antibiotic prescriptions. Dr. Livorsi’s team found that overprescribing was occurring in about half of the records they examined. Their findings appeared in a recent issue of JAMA Network Open. Second, Dr. Mo Milhem and his team within the University of Iowa Holden Comprehensive Cancer Center enrolled a significant number of people in a clinical trial of the kinase inhibitor sorafenib with desmoid tumors (also referred to as aggressive fibromatosis), for which there is no standard of care. The results of these trials were recently published in the New England Journal of Medicine, holding real promise for eventual expansion of the indications for this therapy, which is currently approved for treating liver, kidney, or thyroid cancers.

Our educators continue to innovate as well, and we look forward to sharing with you news of a clerkship being developed that will offer our residents the opportunity to get more focused and hands-on experience with research. For now, I want to thank all of you who have interviewed applicants for our residency programs over the past three months. Recruitment season is almost over, but not quite yet! So please continue to avail yourself to the residency program recruitment team as we enter the final stretch of interviews and campus visits. One additional item our recruiters will have in their toolbox is the latest issue of Foundations & Innovations, a printed document of a years’ worth of success and growth in our department. If you have not had a chance to read this yet, a digital copy is available while the physical copy makes its way to you.