2022 August AANnews

VOLUME 34 · ISSUE 8 · AUGUST 2022

Visit AAN.com/Covid19 for the latest pandemic information and resources to support you and your crucial work.

REGISTRATION OPEN FOR FALL CONFERENCE IN LAS VEGAS Early Registration Savings End September 8 Join your neurology colleagues in Las Vegas for a not-to-bemissed weekend of timely updates on the hottest topics in the world of neurology, practical issues in practice management, the most innovative science, long-awaited networking, and the chance to earn 42+ valuable end-of-year CME credits.

If you aren’t able to join us in Las Vegas, don’t miss out!

Register for our virtual livestream of the Fall Conference and access it wherever you are. You can also upgrade to Gold registration to have access to conference sessions through August 31, 2023.

Visit AAN.com/Fall to secure your early registration savings of up to $260 when you register by September 8, then get ready to sharpen your competitive edge in neurology, and hone strategies for practice management success, through: Continued on page 13

Call for Abstracts: 2023 Annual Meeting Abstract submission for the 2023 Annual Meeting opens later this month.

Visit AAN.com/23Abstracts to learn more and submit your breakthrough research.

Compel Creative Solutions

› CMS Publishes 2023 Medicare Physician Fee Schedule Proposed Rule

Boston & Virtual

Abstracts will be accepted until 11:59 p.m. Central Time on October 11 in all subspecialties and career levels. The non-refundable submission fee is $100 for AAN members and $200 for nonmembers. Submission is free for residents and medical students. For more information, contact Katie Anderson at science@aan.com. 

11 Ongoing Staffing Shortages

October 28–30

Each year, the Centers for Medicare & Medicaid Services (CMS) proposes regulations that impact the reimbursement of physicians. On July 7, 2022, CMS issued a proposed rule updating payment policies and rates for physicians paid under the Medicare Physician Fee Schedule in 2023. The proposed rule illustrates the importance of the AAN’s regulatory advocacy efforts on behalf of neurologists and their patients.

Due to budget neutrality requirements, CMS is projecting that the overall impact of changes contained in the proposed rule will result in a one-percent reduction in payments to neurology as a specialty broadly. Due to the expiration of temporary relief

22 Live and Online Education

Opportunities for APPs This Fall!

Continued on page 16

23 Apply by August 17 for New Diversity Grants

›

KESIMPTA® IS

DIFFERENT FOR A REASON The Only SC delivered B-cell RMS treatment1,2

Powerful efficacy.* Early and continued relapse reduction over the study period3,4

Established safety profile in pivotal trials which included treatmentnaïve patients3,5

1 Minute a Month,† when the patient is ready to administer3,6

EFFICACY • Primary end point: relative reduction in adjusted ARR vs Aubagio® (teriflunomide) of 51% (0.11 vs 0.22) in ASCLEPIOS I and 59% (0.10 vs 0.25) in ASCLEPIOS II3 • Post hoc analysis of pooled data from ASCLEPIOS I and II: cumulative ARR by time interval (KESIMPTA N=946, Aubagio N=936). Reduction in ARR seen in the first 3 months and time intervals over 2 years4,7: – Month 0 to 3: 0.236 vs 0.373 – Month 0 to 27: 0.123 vs 0.258 – No conclusions can be drawn SAFETY • Adverse events with an incidence of ≥5% with KESIMPTA and a greater incidence than Aubagio were: upper respiratory tract infections (39% vs 38%), injection-related reactions (systemic) (21% vs 15%), headache (13% vs 12%), injection-site reactions (local) (11% vs 6%), urinary tract infection (10% vs 8%), back pain (8% vs 6%), and blood immunoglobulin M decrease (6% vs 2%)3 • The overall rate of infections and serious infections in patients treated with KESIMPTA was similar to patients who were treated with Aubagio (51.6% vs 52.7%, and 2.5% vs 1.8%, respectively)3

INDICATION

KESIMPTA is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

IMPORTANT SAFETY INFORMATION

Contraindication: KESIMPTA is contraindicated in patients with active hepatitis B virus infection.

WARNINGS AND PRECAUTIONS

Infections: An increased risk of infections has been observed with other anti-CD20 B-cell depleting therapies. KESIMPTA has the potential for an increased risk of infections including serious bacterial, fungal, and new or reactivated viral infections; some have been fatal in patients treated with other anti-CD20 antibodies. The overall rate of infections and serious infections in KESIMPTAtreated patients was similar to teriflunomide-treated patients (51.6% vs 52.7%, and 2.5% vs 1.8%, respectively). The most common infections reported by KESIMPTA-treated patients in relapsing MS (RMS) trials included upper respiratory tract infection (39%) and urinary tract infection (10%). Delay KESIMPTA administration in patients with an active infection until resolved.

Consider the potential increased immunosuppressive effects when initiating KESIMPTA after an immunosuppressive therapy or initiating an immunosuppressive therapy after KESIMPTA. Please see additional Important Safety Information and Brief Summary of full Prescribing Information on the following pages.

Make KESIMPTA® your 1st choice

KesimptaHCP.com

ARR=annualized relapse rate; CDP=confirmed disability progression; CI=confidence interval; DMT=disease-modifying therapy; GdE=gadolinium-enhancing; MRI=magnetic resonance imaging; RMS=relapsing multiple sclerosis; SC=subcutaneous. *Study Design: ASCLEPIOS I and II were 2 identical randomized, active-controlled, double-blind Phase 3 studies in patients with RMS, approximately 40% of whom were DMT treatment-naïve. Patients were randomized to double-dummy subcutaneous KESIMPTA (20 mg every 4 weeks) or oral Aubagio (14 mg daily) for up to 30 months. Primary end point was ARR. Key MRI end points were number of GdE T1 lesions, and annualized rate of new or enlarging T2 lesions. A key clinical end point was reduction in risk of 3-month CDP. Treatment duration was variable based on end-of-study criteria. Maximum duration 120 weeks, median duration 85 weeks.3 Post hoc Study Design: ARR by time intervals was analyzed from the pooled pivotal trials. The ARR (95% CI) was estimated separately for each time interval by fitting a negative binomial regression model adjusted for treatment as factor.4,7 † As per stability technical specification data, when the patient is ready to inject, it typically takes less than 1 minute a month to administer. Once-monthly dosing begins after the initial dosing period, which consists of 20 mg subcutaneous doses at weeks 0, 1, and 2. Please see Instructions for Use for more detailed instructions on preparation and administration of KESIMPTA.3,6

IMPORTANT SAFETY INFORMATION (cont) WARNINGS AND PRECAUTIONS (cont) Hepatitis B Virus: Reactivation: No reports of hepatitis B virus (HBV) reactivation in patients with MS treated with KESIMPTA. However, HBV reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, has occurred in patients treated with ofatumumab at higher intravenous doses for chronic lymphocytic leukemia (CLL) than the recommended dose in MS and in patients treated with other anti-CD20 antibodies.

Infection: KESIMPTA is contraindicated in patients with active hepatitis B disease. Fatal infections caused by HBV in patients who have not been previously infected have occurred in patients treated with ofatumumab at higher intravenous doses for CLL than the recommended dose in MS. Perform HBV screening in all patients before initiation of KESIMPTA. Patients who are negative for HBsAg and positive for HB core antibody [HBcAb+] or are carriers of HBV [HBsAg+], should consult liver disease experts before starting and during KESIMPTA treatment.

Progressive Multifocal Leukoencephalopathy: No cases of progressive multifocal leukoencephalopathy (PML) have been reported for KESIMPTA in RMS clinical studies; however, PML resulting in death has occurred in patients being treated with ofatumumab at higher intravenous doses for CLL than the recommended dose in MS. In addition, JC virus infection resulting in PML has also been observed in patients treated with other anti-CD20 antibodies and other MS therapies.

If PML is suspected, withhold KESIMPTA and perform an appropriate diagnostic evaluation. If PML is confirmed, KESIMPTA should be discontinued.

Vaccinations: Administer all immunizations according to immunization guidelines: for live or live-attenuated vaccines at least 4 weeks and, whenever possible at least 2 weeks prior to starting KESIMPTA for inactivated vaccines. The safety of immunization with live or live-attenuated vaccines following KESIMPTA therapy has not been studied. Vaccination with live or live-attenuated vaccines is not recommended during treatment and after discontinuation until B-cell repletion.

Vaccination of Infants Born to Mothers Treated with KESIMPTA During Pregnancy. For infants whose mother was treated with KESIMPTA during pregnancy, assess B-cell counts prior to administration of live or live-attenuated vaccines. If the B-cell count has not recovered in the infant, do not administer the vaccine as having depleted B-cells may pose an increased risk in these infants.

KESIMPTA, the KESIMPTA logo, and SENSOREADY are registered trademarks of Novartis AG.

Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936-1080

Injection-Related Reactions: Injection-related reactions with systemic symptoms occurred most commonly within 24 hours of the first injection, but were also observed with later injections. There were no life-threatening injection reactions in RMS clinical studies.

The first injection of KESIMPTA should be performed under the guidance of an appropriately trained health care professional.

If injection-related reactions occur, symptomatic treatment is recommended.

Reduction in Immunoglobulins: As expected with any B-cell depleting therapy, decreased immunoglobulin levels were observed. Monitor the levels of quantitative serum immunoglobulins during treatment, especially in patients with opportunistic or recurrent infections and after discontinuation of therapy until B-cell repletion. Consider discontinuing KESIMPTA therapy if a patient with low immunoglobulins develops a serious opportunistic infection or recurrent infections, or if prolonged hypogammaglobulinemia requires treatment with intravenous immunoglobulins.

Fetal Risk: Based on animal data, KESIMPTA can cause fetal harm due to B-cell lymphopenia and reduce antibody response in offspring exposed to KESIMPTA in utero. Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 B-cell depleting antibodies during pregnancy. Advise females of reproductive potential to use effective contraception while receiving KESIMPTA and for at least 6 months after the last dose.

Most common adverse reactions (>10%) are upper respiratory tract infection, headache, injection-related reactions, and local injection-site reactions.

Please see additional Important Safety Information on the previous page and Brief Summary of full Prescribing Information on the following pages.

References: 1. National Multiple Sclerosis Society. Medications. Accessed February 10, 2022. https://www.nationalmssociety.org/Treating-MS/Medications 2. Torres JB, Roodselaar J, Sealey M, et al. Distribution and efficacy of ofatumumab and ocrelizumab in humanized-CD20 mice following subcutaneous or intravenous administration. P2.2-052. Poster presented at: 71st American Academy of Neurology Annual Meeting; May 4-10, 2019; Philadelphia, PA. 3. Kesimpta [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp. 4. Hauser SL, Bar-Or A, Cohen JA, et al. Ofatumumab vs teriflunomide in relapsing multiple sclerosis: analysis of no evidence of disease activity (NEDA-3) from ASCLEPIOS I and II trials. LB62. Poster presented at: 6th Congress of the European Academy of Neurology; May 23-26, 2020; Virtual. 5. Hauser SL, Bar-Or A, Cohen JA, et al; for the ASCLEPIOS I and ASCLEPIOS II trial groups.

Ofatumumab versus teriflunomide in multiple sclerosis. N Engl J Med. 2020;383(6):546-557. 6. Data on file. Injection time. Novartis Pharmaceuticals Corp; East Hanover, NJ. June 2020. 7. Data on file. OMB157G (ofatumumab). Summary of clinical efficacy in relapsing multiple sclerosis. Novartis Pharmaceuticals Corp; East Hanover, NJ. December 2019.

© 2022 Novartis

6/22

205812

KESIMPTA® (ofatumumab) injection, for subcutaneous use Initial U.S. Approval: 2009 BRIEF SUMMARY: Please see package insert for full prescribing information.

1 INDICATIONS AND USAGE KESIMPTA is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

4 CONTRAINDICATIONS KESIMPTA is contraindicated in patients with: • Active HBV infection [see Warnings and Precautions (5.1)].

5 WARNINGS AND PRECAUTIONS 5.1 Infections An increased risk of infections has been observed with other anti-CD20 B-cell depleting therapies.

KESIMPTA has the potential for an increased risk of infections, including serious bacterial, fungal, and new or reactivated viral infections; some of these infections have been fatal in patients treated with other anti-CD20 antibodies. In Study 1 and Study 2 [see Clinical Studies (14) in the full prescribing information], the overall rate of infections and serious infections in patients treated with KESIMPTA was similar to patients who were treated with teriflunomide (51.6% vs 52.7%, and 2.5% vs 1.8%, respectively).

The most common infections reported by KESIMPTA-treated patients in the randomized clinical relapsing MS (RMS) trials included upper respiratory tract infection (39%) and urinary tract infection (10%). Delay KESIMPTA administration in patients with an active infection until the infection is resolved.

Possible Increased Risk of Immunosuppressant Effects with Other Immunosuppressants When initiating KESIMPTA after an immunosuppressive therapy or initiating an immunosuppressive therapy after KESIMPTA, consider the potential for increased immunosuppressive effects [see Drug Interactions (7.1) and Clinical Pharmacology (12.2) in the full prescribing information]. KESIMPTA has not been studied in combination with other MS therapies.

Hepatitis B Virus Reactivation There were no reports of HBV reactivation in patients with MS treated with KESIMPTA. However, HBV reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, has occurred in patients being treated with ofatumumab for chronic lymphocytic leukemia (CLL) (at higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment) and in patients treated with other anti-CD20 antibodies.

Infection KESIMPTA is contraindicated in patients with active hepatitis B disease. Fatal infections caused by HBV in patients who have not been previously infected have occurred in patients being treated with ofatumumab for CLL (at higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment). HBV screening should be performed in all patients before initiation of treatment with KESIMPTA. At a minimum, screening should include Hepatitis B surface antigen (HBsAg) and Hepatitis B Core Antibody (HBcAb) testing. These can be complemented with other appropriate markers as per local guidelines. For patients who are negative for HBsAg and positive for HB core antibody [HBcAb+] or are carriers of HBV [HBsAg+], consult liver disease experts before starting and during treatment with KESIMPTA. These patients should be monitored and managed following local medical standards to prevent HBV infection or reactivation.

Progressive Multifocal Leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral infection of the brain caused by the JC virus (JCV) that typically occurs in patients who are immunocompromised, and that usually leads to death or severe disability.

Although no cases of PML have been reported for KESIMPTA in the RMS clinical studies, PML resulting in death has occurred in patients being treated with ofatumumab for CLL (at substantially higher intravenous doses than the recommended dose in MS but for a shorter duration of treatment). In addition, JCV infection resulting in PML has also been observed in patients treated with other anti-CD20 antibodies and other MS therapies. At the first sign or symptom suggestive of PML, withhold KESIMPTA and perform an appropriate diagnostic evaluation. Magnetic resonance imaging (MRI) findings may be apparent before clinical signs or symptoms. 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.

If PML is confirmed, treatment with KESIMPTA should be discontinued.

Vaccinations Administer all immunizations according to immunization guidelines at least 4 weeks prior to initiation of KESIMPTA for live or live-attenuated vaccines, and whenever possible, at least 2 weeks prior to initiation of KESIMPTA for inactivated vaccines.

KESIMPTA may interfere with the effectiveness of inactivated vaccines.

The safety of immunization with live or live-attenuated vaccines following KESIMPTA therapy has not been studied. Vaccination with live or live-attenuated vaccines is not recommended during treatment and after discontinuation until B-cell repletion [see Clinical Pharmacology (12.2) in the full prescribing information].

Vaccination of Infants Born to Mothers Treated with KESIMPTA During Pregnancy In infants of mothers treated with KESIMPTA during pregnancy, do not administer live or live-attenuated vaccines before confirming the recovery of B-cell counts. Depletion of B-cells in these infants may increase the risks from live or live-attenuated vaccines.

Inactivated vaccines may be administered, as indicated, prior to recovery from B-cell depletion, but an assessment of vaccine immune responses, including consultation with a qualified specialist, should be considered to determine whether a protective immune response was mounted.

5.2 Injection-Related Reactions In Study 1 and Study 2, systemic and local injection reactions were reported in 21% and 11% of patients treated with KESIMPTA compared to 15% and 6% of patients treated with teriflunomide who received matching placebo injections, respectively [see Adverse Reactions (6.1) and Clinical Studies (14) in the full prescribing information].

Injection-related reactions with systemic symptoms observed in clinical studies occurred most commonly within 24 hours of the first injection, but were also observed with later injections. Symptoms observed included fever, headache, myalgia, chills, and fatigue, and were predominantly (99.8%) mild to moderate in severity. There were no life-threatening injection reactions in RMS clinical studies.

Local injection-site reaction symptoms observed in clinical studies included erythema, swelling, itching, and pain.

Only limited benefit of premedication with corticosteroids, antihistamines, or acetaminophen was observed in RMS clinical studies. The first injection of KESIMPTA should be performed under the guidance of an appropriately trained healthcare professional. If injection-related reactions occur, symptomatic treatment is recommended.

5.3 Reduction in Immunoglobulins As expected with any B-cell depleting therapy, decreased immunoglobulin levels were observed.

Decrease in immunoglobulin M (IgM) was reported in 7.7% of patients treated with KESIMPTA compared to 3.1% of patients treated with teriflunomide in RMS clinical trials [see Adverse Reactions (6.1)].

Treatment was discontinued because of decreased immunoglobulins in 3.4% of patients treated with KESIMPTA and in 0.8% of patients treated with teriflunomide. No decline in immunoglobulin G (IgG) was observed at the end of the study. Monitor the levels of quantitative serum immunoglobulins during treatment, especially in patients with opportunistic or recurrent infections, and after discontinuation of therapy until B-cell repletion. Consider discontinuing KESIMPTA therapy if a patient with low immunoglobulins develops a serious opportunistic infection or recurrent infections, or if prolonged hypogammaglobulinemia requires treatment with intravenous immunoglobulins.

5.4 Fetal Risk Based on animal data, KESIMPTA can cause fetal harm due to B-cell lymphopenia and reduce antibody response in offspring exposed to KESIMPTA in utero. Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 B-cell depleting antibodies during pregnancy. Advise females of reproductive potential to use effective contraception while receiving KESIMPTA and for at least 6 months after the last dose [see Use in Specific Populations (8.1)].

6 ADVERSE REACTIONS The following clinically significant adverse reactions are discussed in greater detail elsewhere in the labeling: • Infections [see Warnings and Precautions (5.1)] • Injection-Related Reactions [see Warnings and Precautions (5.2)] • Reduction in Immunoglobulins [see Warnings and Precautions (5.3)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reactions 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 clinical practice.

Approximately 1500 patients with RMS received KESIMPTA in clinical studies. In Study 1 and Study 2, 1882 patients with RMS were randomized, 946 of whom were treated with KESIMPTA for a median duration of 85 weeks; 33% of patients receiving KESIMPTA were treated for up to 120 weeks [see Clinical Studies (14.1) in the full prescribing information]. The most common adverse reactions occurring in greater than 10% of patients treated with KESIMPTA and more frequently than in patients treated with teriflunomide were upper respiratory tract infections, injection-related reactions (systemic), headache, and injection-site reactions (local). The most common cause of discontinuation in patients treated with KESIMPTA was low immunoglobulin M (3.3%), defined in trial protocols as IgM at 10% below the lower limit of normal (LLN).

Table 1 summarizes the adverse drug reactions that occurred in Study 1 and Study 2.

Table 1: Adverse Reactions in Patients with RMS with an Incidence of at Least 5% with KESIMPTA and a Greater Incidence Than Teriflunomide (Pooled Study 1 and Study 2) Adverse Reactions

KESIMPTA 20 mg N = 946 %

Teriflunomide 14 mg N = 936 %

Upper respiratory tract infectionsa

39

38

Injection-related reactions (systemic)

21

15 12

Headache

13

Injection-site reactions (local)

11

6

Urinary tract infection

10

8

Back pain

8

6

Blood immunoglobulin M decreased

6

2

aIncludes the following: nasopharyngitis, upper respiratory tract infection, influenza, sinusitis, pharyngitis, rhinitis, viral upper respiratory infection, tonsillitis, acute sinusitis, pharyngotonsillitis, laryngitis, pharyngitis streptococcal, viral rhinitis, sinusitis bacterial, tonsillitis bacterial, viral pharyngitis, viral tonsillitis, chronic sinusitis, nasal herpes, tracheitis.

Injection-Related Reactions and Injection-Site Reactions The incidence of injection-related reactions (systemic) was highest with the first injection (14.4%), decreasing with subsequent injections (4.4% with second, less than 3% with third injection). Injectionrelated reactions were mostly (99.8%) mild to moderate in severity. Two (0.2%) patients treated with KESIMPTA reported serious injection-related reactions. There were no life-threatening injection-related reactions. Most frequently reported symptoms (2% or greater) included fever, headache, myalgia, chills, and fatigue.

In addition to systemic injection-related reactions, local reactions at the administration site were very common. Local injection-site reactions were all mild to moderate in severity. The most frequently reported symptoms (2% or greater) included erythema, pain, itching, and swelling [see Warnings and Precautions (5.2)].

Laboratory Abnormalities Immunoglobulins In Study 1 and Study 2, a decrease in the mean level of IgM was observed in KESIMPTA-treated patients but was not associated with an increased risk of infections [see Warnings and Precautions (5.3)]. In 14.3% of patients in Study 1 and Study 2, treatment with KESIMPTA resulted in a decrease in a serum IgM that reached a value below 0.34 g/dL. KESIMPTA was associated with a decrease of 4.3% in mean IgG levels after 48 weeks of treatment and an increase of 2.2% after 96 weeks.

6.2 Immunogenicity As with all therapeutic proteins, there is 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 medication, and the underlying disease. For these reasons, comparison of the incidence of antibodies in the studies described below with the incidence of antibodies in other studies or to other ofatumumab products may be misleading.

Treatment induced anti-drug antibodies (ADAs) were detected in 2 of 914 (0.2%) KESIMPTA-treated patients; no patients with treatment enhancing or neutralizing ADAs were identified. There was no impact of positive ADA titers on PK, safety profile or B-cell kinetics in any patient; however, these data are not adequate to assess the impact of ADAs on the safety and efficacy of KESIMPTA. 7 DRUG INTERACTIONS 7.1 Immunosuppressive or Immune-Modulating Therapies Concomitant usage of KESIMPTA with immunosuppressant drugs, including systemic corticosteroids, may increase the risk of infection. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with KESIMPTA.

When switching from therapies with immune effects, the duration and mechanism of action of these therapies should be taken into account because of potential additive immunosuppressive effects when initiating KESIMPTA. 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary There are no adequate data on the developmental risk associated with the use of KESIMPTA in pregnant women. Ofatumumab may cross the placenta and cause fetal B-cell depletion based on findings from animal studies (see Data).

Transient peripheral B-cell depletion and lymphocytopenia have been reported in infants born to mothers exposed to other anti-CD20 antibodies during pregnancy. B-cell levels in infants following maternal exposure to KESIMPTA have not been studied in clinical trials. The potential duration of B-cell depletion in infants exposed to ofatumumab in utero, and the impact of B-cell depletion on the safety and effectiveness of vaccines, are unknown. Avoid administering live vaccines to neonates and infants exposed to KESIMPTA in utero until B-cell recovery occurs [see Warnings and Precautions (5.2) and Clinical Pharmacology (12.2) in the full prescribing information].

Following administration of ofatumumab to pregnant monkeys, increased mortality, depletion of B-cell populations, and impaired immune function were observed in the offspring, in the absence of maternal toxicity, at plasma levels substantially higher than that in humans (see Data).

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown.

Data Animal Data Intravenous administration of ofatumumab (weekly doses of 0, 20, or 100 mg/kg) to pregnant monkeys during the period of organogenesis (gestations days 20 to 50) resulted in no adverse effects on embryofetal development; however, B-cell depletion was observed in fetuses at both doses when assessed on gestation day 100. Plasma exposure (Cave) at the no-effect dose (100 mg/kg) for adverse effects on embryofetal development was greater than 5000 times that in humans at the recommended human maintenance dose of 20 mg. A no-effect dose for effects on B-cells was not identified; plasma exposure (Cave) at the low-effect dose (20 mg/kg) was approximately 780 times that in humans at the recommended human maintenance dose (RHMD) of 20 mg/month.

Intravenous administration of ofatumumab (5 weekly doses of 0, 10, and 100 mg/kg, followed by biweekly doses of 0, 3, and 20 mg/kg) to pregnant monkeys throughout pregnancy resulted in no adverse effects on the development of the offspring. However, postnatal death, B-cell depletion, and impaired immune function were observed in the offspring at the high dose. The deaths at the high dose were considered secondary to B-cell depletion. Plasma exposure (Cave) in dams at the no-effect dose (100/20 mg/kg) for adverse developmental effects was approximately 500 times that in humans at RHMD. A no-effect level for mortality and immune effects in offspring was not established because of the limited number of evaluable offspring at the low dose.

8.2 Lactation Risk Summary There are no data on the presence of ofatumumab in human milk, the effects on the breastfed infant, or the effects of the drug on milk production. Human IgG is excreted in human milk, and the potential for absorption of ofatumumab to lead to B-cell depletion in the infant is unknown. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for KESIMPTA and any potential adverse effects on the breastfed infant from KESIMPTA or from the underlying maternal condition.

8.3 Females and Males of Reproductive Potential Contraception Females of childbearing potential should use effective contraception while receiving KESIMPTA and for 6 months after the last treatment of KESIMPTA [see Warnings and Precautions (5.4) and Clinical Pharmacology (12.3) in the full prescribing information].

8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established.

8.5 Geriatric Use Clinical studies of KESIMPTA did not include sufficient numbers of geriatric patients to determine whether they respond differently from younger subjects.

Manufactured by: Novartis Pharmaceuticals Corporation East Hanover, NJ 07936 U.S. License No.: 1244 KESIMPTA and SENSOREADY is a [registered] trademark of Novartis AG. T2020-112

AANnews · August 2022

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

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

Contact Information American Academy of Neurology 201 Chicago Avenue Minneapolis, MN 55415 Phone: (800) 879-1960 (toll free) (612) 928-6000 (international) Email:

memberservices@aan.com

Website: AAN.com For advertising rates, contact: Michael J. O’Brien II Account/Relationship Manager Wolters Kluwer Phone: (978) 578-4514 Email:

Michael.Obrien @wolterskluwer.com

AAN Chief Executive Officer: Mary E. Post, MBA, CAE

Editor-in-Chief: Melissa W. Ko, MD, MBA, CPE, FAAN Managing Editor: Angela M. Babb, MS, CAE, APR Editor: Tim Streeter Writers: Ryan Knoke and Sarah Parsons Designer: Siu Lee Email: aannews@aan.com AANnews® is published monthly by the American Academy of Neurology for its 38,000 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.

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The inclusion of advertisements and/or promotions of Sponsors and other Internet sites or resources that offer content, goods, or services on the Website does not imply endorsement of the advertised/promoted products or services by AAN.

12

Actor Shares How She Overcame Debilitating Back Pain

20

Jones Named New Continuum Editor-in-Chief

25

Transforming Leaders Program Graduate Carries out Laser-focused Vision

The Little House on the Prairie actor Melissa Gilbert broke her back in 2010 and had subsequent pain and numbness and limited function. In 2020, she underwent surgery to repair a failed spinal fusion and had an artificial disc implanted. Brain & Life® examines how advancements in spine surgery are leading to more success stories like Gilbert’s.

Lyell K. Jones, Jr., MD, FAAN, will succeed Continuum® Editor-in-Chief Steven L. Lewis, MD, FAAN, at the completion of his 10-year term in December.

As assistant dean of undergraduate medical education and director of the Health Professions Education Institute at Atrium Health Wake Forest Baptist, in WinstonSalem, NC, Roy E. Strowd, MD, MEd, MS, FAAN, has been involved in developing new and innovative education. But it was his involvement in the AAN’s Transforming Leaders Program that helped put his passion into even sharper focus.

News Briefs Prior Authorization Webinar on August 3

The AAN is offering a free webinar on prior authorization, which continues to pose challenges across the nation. AAN members will share their experiences dealing with prior authorizations and how the AAN is helping members, with time for questions, on August 3 from 5:00 p.m. to 6:00 p.m. CT. Learn more at https://bit.ly/3bWadft.

Associate Professor Survey

A survey of associate professors found that the top three resources they would like the AAN to offer are CV reviewing, an associate professor SynapseSM community, and a checklist for relocating/moving institutions. Associate professors would like webinars on balancing professional duties, contract/salary negotiation, and funds flow/financial aspects related to academic neurology.

Section Meetings

Thirty-five AAN Section meetings were held virtually in May and June, with 1,045 members attending meetings covering topics including: how section members can assist with several IDEAS-related AAN initiatives; a historical review of the field of neuroethics; and the importance of encouraging international, student, and junior members to join sections to share their perspectives and voices. 

PRESIDENT'S COLUMN Expressions of Appreciation to a Besieged Workforce A slew of surveys from employment consultants has looked at determinants of workforce engagement, retention, productivity, and performance to try to crack the code of what will drive employees to remain at their jobs—with strikingly similar results. Glassdoor’s employee appreciation survey revealed that more than half (53 percent) of employees admitted they would stay longer at their company if they felt more appreciation from their boss.

Moreover, those results were released in 2013, well prior to the Great Resignation which amplified that sentiment.

Conversely, a survey of 2,000 workers conducted by OnePoll and published in 2022 showed that nearly half of American workers (46 percent) have left a job because they have felt unappreciated.

Sadly, I have heard numerous reports of neurologists feeling underappreciated over the past three years, more than I ever recall in over 20 years of reporting for Neurology Today®. When I wrote the recent story, "Is the Pendulum Swinging Back? Why Neurologists Have Left Academia for Private Practice Settings,” this complaint appeared as a recurring theme from colleagues who left academic medicine despite their love for education and research. In myriad interviews from AAN members in other practice settings and multiple anecdotal reports throughout the pandemic, ruminations of being undervalued resonated equally strongly.

The good news, according to a recent article in the Economist, is that small gestures of appreciation can have an outsized effect on employee satisfaction and loyalty. The May 27, 2022, story, "The Power of Small Gestures,” cites a recent study at King’s College London and Harvard Business School that divided two groups of social workers: one group got a letter of thanks for their work from their manager and the other did not. A month later, recipients of the letter reported feeling much more valued than their counterparts.

More importantly, in a post-pandemic world in which expressions of gratitude have become commoditized and gratitude consulting has become a thriving industry, a positive impact, according to experts, requires an authentic and personal approach, and, as the column points out, must take effort and be unexpected.

In my Neurology To the AAN for supporting Today® interviews leadership development over the course of the programs and to all the pandemic, in which leadership participants. the preponderance ―Ava Ferdinand, MD of the discontent shared was focused on administrators, I was

ig shout out to Laura Campbell, program B coordinator and supervisor of education programs at UTSW. We are so thankful for your passion and dedication. Without your hard work, the success of our programs wouldn't be possible. #NeurologyProud ―Marisara Dieppa, MD

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AANnews • August 2022

Avitzur

struck by how well some institutions and health care systems seemed to understand this and how others did not. According to anecdotal reports, some hospital-based practices—the fastest growing segment of the neurology practice setting—appear to be exercising great effort to lure physicians and make sure that they find workplace satisfaction, feel supported, and know that they are appreciated. This shift in practice setting will continue to be monitored by the AAN, and if it continues, should be closely examined for root causes.

Thankful for all of the hard-working AAN staff who

supported and encouraged the 2021–22 Diversity Leadership Program cohort, including during evenings and weekends. Special shout out to Wendy Vokaty and Nate Kosher. #NeurologyProud ―Elizabeth A. Felton, MD, PhD There is a distinction between appreciation and recognition, as was described in a 2019 Harvard Business Review article.

Recognition is about giving positive feedback based on results or performance, whereas appreciation, on the other hand, is about acknowledging a person’s inherent value. It ends by suggesting that we tell people what we value about them and do it proactively—not because they did something great or because we want something from them. It can positively affect how your colleagues feel about themselves and your relationship with them, and even trickle down to your whole team.

Some colleagues I know do this well—like Lyell Jones, who sent me the Economist article, and demonstrates this trait regularly on @Twitter—among many others whom I have gotten to know through my work at the AAN. But some of us, including me, feel that we don’t do this enough, and fueled by the pandemic and too much death around us, are trying to do better.

Earlier this year, I had a family loss and had to travel

out of the country. My medical assistant, Leslie Martinez, and registered nurse, Lori Healy, were just a text away from accommodating a whole week of clinical work. I am grateful for their support! ―Gerson Suarez-Cedeno, MD

In early June, the AAN Board of Directors met for its quarterly meeting and heard a presentation by this year’s Diversity Leadership Program participants. Last October, I asked them to propose ways to prepare and support our members to meet a variety of workforce losses. Their thoughtful presentation was multi-pronged and comprehensive. One suggestion was to appreciate each other more and deliver those unexpected messages of gratitude on social media.

And as it turns out, there is a bonus not only to receivers but also to givers of appreciation. Studies show they, too, have higher levels of work satisfaction and suggest that people who witness individuals expressing gratitude are more helpful to them as well.

I asked the DLP Leadership Class of 2022 for real-life examples of their idea and include some here. If you have others, please Tweet your #NeurologyProud moment to us @AANmember and @OrlyA. 

Orly Avitzur, MD, MBA, FAAN President, AAN oavitzur@aan.com on Twitter Practice @OrlyA Email Ad—Half Page Horizontal> AN

My #NeurologyProud message goes to my co-presenter Dr. Nicole Gonzales who was the absolute best partner a girl could ask for.

She worked around my schedule, sent me articles on the side, delivered Zoom calendar invites, fixed my slides, took things seriously but also in stride, encouraged me to meet outside of our group times, and repeatedly kept me calm when I started freaking out. She is an absolute gem, a true role model for women in medicine, and I am so lucky that she was my partner in crime. I am forever grateful to her. She deserves a standing ovation, a retweet, a high five, and a champagne toast all in one. ―Wendy S. Vargas, MD

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PRACTICE Pandemic Affects Axon Registry 2021 MIPS Reporting One of the many benefits of the Axon Registry® is providing AAN members a solution for submitting Merit-based Incentive Payment System (MIPS) reporting to the Centers for Medicare & Medicaid Services (CMS). The 2021 MIPS submission period ended on March 31, 2022.

For the 2021 MIPS submission period, 38 practices submitted their MIPS reporting through the Axon Registry.

Nineteen practices performed individual MIPS reporting, 23 practices performed group submission, and three practices performed both. During the 2020 MIPS submission period, 90 practices used the Axon Registry to submit for MIPS submission. The decrease in practices using the Axon Registry for MIPS submission was likely because many of them opted for an exception from CMS due to the COVID-19 pandemic.

The estimated average score for practices that submitted all three categories through the Axon Registry for the 2021 submission period was 71.96. Participants who use the Axon

Registry for MIPS submission can submit for three out of the four components of the MIPS program. The fourth component, Cost, uses Medicare claims data to calculate performance, which means clinicians and groups do not have to submit any data. The Cost data usually becomes available in the late summer.

The MIPS final score will be between 0 and 100 points. Payment adjustments will be dependent on the overall

performance of clinicians. Though the MIPS quality category requires the submission of six quality measures, most submissions included more than six quality measures, which aids in benchmark creation for future reporting years.

To enroll or learn more about the Axon Registry, visit AAN.com/axon or contact registry@aan.com. 

Axon Registry Participants: Window Nears for Health IT Attestation CMS and the Office of the National Coordinator for Health Information Technology (ONC) remind registry users that the deadline for Health IT attestation for EHRs is approaching. Attestations are an indication of compliance, noncompliance, or inapplicability provided to the secretary of Health and Human Services as they apply to certified health IT developers for the certain conditions and Maintenance of Certification requirements of EHRs. Under the 21st Century Cures Act, certified health IT developers are required to submit, on a semiannual basis, their attestations of compliance for past actions under the Certification Program. The reporting window set is October 1–30, 2022, for the April 1 to September 30, 2022, attestation period.

Practices should contact their vendors/health IT developers to ensure conformance of their EHRs’ required capabilities and interoperability requirements as defined by the ONC and CMS Promoting Interoperability standards. Practices whose EHR developers are unable to attest to the rule can apply for CMS promoting interoperability program hardship exception.

The 21st Century Cures Act and the use of 2015 Certified EHRs is crucial to the Promoting Interoperability category within MIPS reporting and participation in the Axon Registry ®.

Vendors, practices, and members must understand that these attestations are the foundation for transitioning toward Fast Healthcare Interoperability Resources (FHIR) and digital quality measures. Please look for AAN communication on the transition to digital measures as more information becomes available.

The AAN is committed to assisting Axon Registry participants with using Certified Electronic Health Record Technology (CEHRT) systems and sharing resources to ensure practice success.

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AANnews • August 2022

For more information about Health IT Compliance process: https://bit.ly/3ydz3ik For more information on CMS Promoting Interoperability Hardship Exception: https://go.cms.gov/3yKy8Ya To see if your EHR is using CEHRT you can search the Certified Health IT Product List: https://bit.ly/3yjmbHC For a Hardship Exception Online Application: https://bit.ly/3ORs0De For more information about the ONC Health IT Certification Program: https://bit.ly/3OLUjml To learn more, visit HealthIT.gov/condition-ccg/attestations. If you have questions or need additional information, contact practice @aan.com or registry@aan.com if you are an Axon Registry participant. 

Ongoing Staffing Shortages Compel Creative Solutions The AAN continues to reach out to neurology business administrators from across the country to learn what unique solutions they are finding to manage the ongoing staffing crisis sparked by COVID-19. Recently, the Academy asked, “What have been your most effective recruitment tools?”

Leeann Garms, CEO, at Raleigh Neurology Associates shared, “We partnered with a local technical college to develop a training program for EEG and EMG/nerve technicians. This has created a new, long-term candidate pool from which we will be able to draw, helping both our practice and the greater medical community close gaps in these critical resource areas.”

You can find these additional tips from members, and more, at AAN.com/practice/staffing-challenges: Use online recruitment companies such as Indeed or ZipRecruiter to screen candidates Maintain a reputation that supports staff and promote from within; offer a referral bonus to staff who bring in strong candidates Offer flexible schedules, including four-day work weeks and remote opportunities when able

Build a relationship with a recruiter so they understand the organization’s needs and can find the best candidates to meet those needs Along with the new Managing Staffing Challenges web page, the Academy has Garms published several resources to help members navigate staffing challenges, including the free recording of the Ask Me Anything About Staffing Challenges webinar—where physicians and business administrators told of their experiences navigating recruiting, retaining, and optimizing staff—and an article featured in June’s AANnews®. Check the site regularly and connect with the AAN on social media at #AAN and @AANMember as we feature additional solutions throughout the year. 

Understand How MIPS Value Pathways May Affect Your Practice In 2023, the Centers for Medicare & Medicaid Services (CMS) will launch a new track within the Quality Payment Program called MIPS Value Pathways (MVP), which may affect your practice. The AAN is committed to educating our members on the changes within MVP and has created resources to help you understand the initial focus and timing. These changes may not impact you or your practice now but could potentially in the future.

For 2023, CMS has identified three MVP's relevant to neurology—stroke, neurodegenerative, and episodic neurology.

The MIPS Value Pathways track builds off the traditional MIPS pathway. CMS hopes to transition clinicians reporting MIPS toward Alternative Payment Models (APMs) over time. There will be

neurology PODCAST®

opportunities from year to year to update MVPs and in time CMS hopes they will demonstrate improvements in specific conditions and across specialties.

CMS has suggested that it will sunset traditional MIPS by 2027.

The Academy has created two helpful overviews—"Understanding MIPS Value Pathways” and the more specific stroke-

related “Understanding MIPS Value Pathways: Neurology MVPS”—to help you educate yourself on the changes in reporting requirements to be prepared for when this affects you or your practice.

Visit AAN.com/qpp to see all the tools and resources available to you as an AAN member. 

Neurology ® Podcast:

20 Minutes Pack a Punch!

Subscribe and download the latest podcast at Neurology.org/podcast AANnews • August 2022

11

PRACTICE Keep Current with Neurology: Clinical Practice The latest issue of Neurology® Clinical Practice provides an array of leading research in the specialty, including "Muscular Atrophy Type 1 in the Nusinersen Era,” by Hernan D. Gonorazky, MD, et al.; “Inpatients with Dementia Referred for Palliative Care Consultation: A Multicenter Analysis,” by Steve Pantilat, MD, et al.; “Transient Global Amnesia Recurrence: Prevalence and Risk Factor Meta-analysis,” by Micaela Anahí Hernández, MD, et al.; “Severity of Epilepsy and Response to Antiseizure Medications in Individuals with Multiple Sclerosis: Analysis of a Real-world Dataset,” by Brett K. Beaulieu-Jones, PhD, et al.; “Predictors of Disease Activity and Worsening in Relapsingremitting Multiple Sclerosis,” by Yinan Zhang, MD, et al.; and “Risk Factors for New Neurological Diagnoses in Hospitalized Patients with COVID-19: A Case-control Study in New York City,” by Kiran T. Thakur, MD, et al.

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Published continuously online and in print six times a year, Neurology: Clinical Practice is free to AAN members via the website (and available in print for US members only) who have a current subscription to Neurology®. Visit Neurology.org/cp for more information. 

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Transient Global Am ne Prevalenc e and Risk sia Recurrence: Factor Meta -analysis RESEAR CH ARTICL E Risk Facto rs for New Neurologic in Hospita al Diagno lized COVI ses DA Case-Co ntrol Study 19 Patients: in New Yo rk City REVIEW Prevalenc e of A Systema Rhinorrhea in Park ins tic Review and Meta-an on Disease: alysis

Actor Shares How She Overcame Debilitating Back Pain The Little House on the Prairie actor Melissa Gilbert broke her back in 2010 and had subsequent pain and numbness and limited function. In 2020, she underwent surgery to repair a failed spinal fusion and had an artificial disc implanted. The August/September issue of Brain & Life® looks at how advancements in spine surgery are leading to more success stories like Gilbert’s. The article also offers nonsurgical solutions to spinal disorders.

A second feature article explores what happens to the health, fitness, and genetic data collected by health registries and manufacturers of smartwatches and genetic tests and how to protect your privacy.

Readers also will learn about how pandemic-related shortages in supplies and staffing are affecting neurology practices and how patients can prepare for them.

Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free.

If you would like to adjust the number of copies you receive for your patients or update your

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AANnews • August 2022

Privacy Co How to Protncerns Your Gene ect Health Datatic and Disorders Insights on Progressive SupraNuclea r Palsy

Peop tell me thle sharing mat story of y successful spinal surge gives them ry hope.”

— M E LI S S

A G I LB E R T

AU G U S T/S

E P TE M BRAINAN BER 2022 D LI F E .O RG

clinic address, email BeGreen@ WasteFreeMail.com. All members have online access to the magazine articles and additional resources at BrainandLife.org and are encouraged to share the website with their patients.

AAN members, patients, and caregivers also can listen to the new Brain & Life podcast, an entertaining weekly podcast featuring neurology experts, celebrity advocates, and people whose lives are affected by brain conditions. Follow and subscribe wherever you get your podcasts. Learn more at BrainandLife.org/podcast. 

EVENTS Registration Open for Fall Conference in Las Vegas New programming based on updates and progress made in the field of neurology over the past six months The latest innovative science through the Neuroscience in the Clinic and Plenary Sessions Insights on practice management ranging from coding, building service lines, value-based care, and productivity to telemedicine and HR/staffing The “best of” from the 2022 Annual Meeting, including neuro-rheumatology, neuromuscular junction disorders, and more Leadership University with four sessions focused on professional development Interactive Experiential Learning Areas, including one to learn about neuro exam tips and tricks One-on-one Curbside Consults where you can bring your most challenging cases for discussion with an expert Opportunities to learn about the latest industry innovations in the Exhibit Hall 

continued from cover

Join Us a Day Early for One of the In-person Pre-conferences!

Attend either of the in-person-only pre-conferences on Thursday, October 27, as a stand-alone, or bundle one of the pre-conferences with the full Fall Conference to save! Visit AAN.com/Fall to learn more and register by the September 8 early registration deadline.

APP Training A full day of APP education programming designed especially for care team members! Learn more on page 22.

Sports Concussion A full day of sports concussion programming designed especially for residents, medical students, and general neurologists. The curriculum will focus on the physical exam, TBI, CTE, headache, and updated concussion guidelines for the general neurologist. 

Have an Idea for an Annual Meeting Course?

We want to hear it! Visit AAN.com/events/annual-meeting-course-proposals to submit your 2023 Annual Meeting course proposal(s) by August 16.

Boston & Virtual

AANnews • August 2022

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We Aren’t Just a Ma

J U N E/J U LY 2 0 2 2 B R A I N A N D LI F E .O R G

Free Magazine Articles on neurologic conditions and brain health not found anywhere else.

Available in both English and Spanish.

My mom has a strength that’s not always outwardly visible, but she has done incredible things.”

N E U R O LO G Í A PA R A L A V I DA D I A R I A INVIERNO 2021 B R A I N A N D LI F E .O R G

Seizure Management Advice from Those In the Know: Neurologists with Epilepsy

Enfermedad de Alzheimer Un nuevo fármaco genera controversia y esperanza

Back to the Office A Healthy Transition From Remote to In-Person Work

Nutrición Perder peso es bueno para la salud del cerebro

Brain Wonders Experts Explain Confabulation

Reír es importante El comediante George Lopez utiliza el humor para despertar conciencia en los latinos sobre la importancia de cuidar su salud.

— L I N D S AY VO N N

Orly Avitzur, MD, MBA, FAAN

Joseph I. Sirven, MD, FAAN

Editor-in-Chief, Brain & Life®

Editor, Brain & Life® en Español

Podcast An entertaining weekly podcast with people whose lives are affected by brain conditions, celebrity advocates, and neurology experts.

Daniel José Correa, MD, MSc, FAAN

Audrey R. Nath, MD, PhD

Brain & Life podcast co-host

Brain & Life podcast co-host

agazine Anymore!

BrainandLife.org Features Disorders A-Z, Healthy Living, Brain Science articles, and more.

Book Series Books for navigating life with brain disease, available from all major booksellers.

Ten titles available.

BrainandLife.org/Books David C. Spencer, MD, FAAN Editor, Brain & Life® Books

Join the Brain& Life Community!

ADVOCACY CMS Publishes 2023 Medicare Physician Fee Schedule Proposed Rule continued from cover measures at year end, CMS is currently predicting a reduction in the Fee Schedule conversion factor of nearly 4.5 percent. The AAN will continue to work with legislators to avert impending cuts. The AAN is committed to payment reform efforts to promote a sustainable payment system and to working with regulators and legislators to ensure that CMS appropriately values the work done by neurologists.

Evaluation and Management Visits

CMS continues its ongoing review of the evaluation and management (E/M) code descriptors and guidelines, with the next phase of revisions scheduled for January 1, 2023. Impacted E/M code sets include inpatient/observation care, consultations, emergency department, nursing facility, home and residence, and prolonged services. As with the first phase of revisions, which included outpatient E/M services, CMS will be aligning its coding and documentation policies with changes laid out by the CPT Editorial Panel for the inpatient services. The AAN remains highly supportive of the new coding and payment structure.

In a significant win for AAN advocacy, CMS is proposing to delay policies impacting split (or shared) E/M visits that were set to go into effect on January 1, 2023, until January 1, 2024, to allow for further dialogue with stakeholders. The AAN has been leading efforts to modify policies finalized in the 2022 Physician Fee Schedule that would detrimentally impact team-based care.

The AAN is pleased to see that CMS is delaying implementation of these policies to allow for additional stakeholder feedback.

The AAN recently submitted recommendations to the agency regarding how existing policies could be modified to promote team-based care and will continue to work with coalition partners in support of a permanent change.

Global Surgical Packages

The agency is soliciting comments regarding strategies for improving global surgical package valuations. The AAN has long held concerns related to inappropriate valuations of these packages and the subsequent fiscal redistributions stemming from budget neutrality requirements. The AAN has particular concerns relating to the number and level of pre-operative and post-operative E/M visits in the packages. The AAN has urged the agency on several occasions to continue its critical work in this area and is encouraged by CMS seeking comment in preparation for future rulemaking to address potentially inflated values.

Telehealth Regulations

CMS is implementing provisions of the Consolidated Appropriations Act of 2022 that extend certain flexibilities in place during the Covid-19 Public Health Emergency (PHE) for 151 days after the PHE ends, including allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems.

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AANnews • August 2022

CMS is proposing a number of policies intended to promote access to telehealth services, including making several services that are temporarily available as telehealth services for the duration of the PHE available through CY 2023 on a Category 3 basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. CMS is proposing to add CPT codes 95970, 95983, and 95984, which describe general brain nerve neurostimulation, to the Medicare Telehealth Services List on a Category 3 basis, while soliciting comment on concerns regarding patient safety and whether these services are appropriate for inclusion on the Medicare Telehealth Services List outside the circumstances of the PHE. CMS is also proposing to add CPT codes 97151–97158, 0362T, and 0373T on a Category 3 basis, which include emotional/behavior assessment, psychological, or neuropsychological Testing and Evaluation services, while soliciting comments on patient safety concerns.

CMS is declining to add Telephone E/M services on a Category 3 basis, citing statutory constraints.

The agency proposes that telehealth claims will require the appropriate place of service (POS) indicator to be included on the claim, rather than modifier “95,” after a period of 151 days following the end of the PHE and that modifier “93” will be available to indicate that a Medicare telehealth service was furnished via audio-only technology, where appropriate.

EEG National Coverage Determination Changes

Following the implementation of the revised code set for long-term EEG monitoring services in 2020, the AAN, in collaboration with the American Clinical Neurophysiology Society and the National Association of Epilepsy Centers, requested that CMS remove a national coverage determination (NCD) for ambulatory EEG monitoring. The societies assert the NCD, effective June 1984, no longer reflects the practice of medicine and coverage should be determined by local Medicare contractors. The AAN is pleased CMS is seeking feedback on this proposal and will reassert our support for removing the NCD during the comment period.

Quality Payment Program

As in previous years, the rule includes proposed policy updates impacting the Quality Payment Program (QPP), which includes the Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment Model (APM), and MIPS Value Pathways (MVPs).

As required by statute for the 2023 performance year, the weights for MIPS performance categories are as follows: 30 percent for Quality, 30 percent for Cost, 15 percent for Improvement Activities, and 25 percent for Promoting Interoperability. The category weights have not changed in comparison to last year. CMS is also proposing to maintain the 75-point performance threshold for performance year 2023.

CMS notes that performance year 2022 was the final year for MIPS adjustments for exceptional performance.

To better account for improvements made within the Cost category, CMS proposes to establish a maximum cost improvement score of one percentage point out of 100 percentage points available for the Cost performance category starting with the 2022 performance period. Within the Improvement Activities component, CMS is proposing to add four activities: two in the Achieving Health Equity category, one geared towards Expanding Practice Access, and the last for Emergency Response Preparedness relating to the COVID-19 pandemic. Within the Promoting Interoperability category, the rule proposes to change the query of prescription drug monitoring program (PDMP) from a voluntary to a required measure worth 10 points. In the Quality performance category, CMS is amending benchmarking policy and clarifying policy relating to topped out measures.

The rule proposes to make permanent the eight-percent minimum Generally Applicable Nominal Risk Standard for Advanced APMs that was set to expire in 2024.

MIPS Value Pathway

beginning with the 2023 performance year. By adding these five MVPs to the seven finalized last year, CMS is proposing that providers will have access to 12 MVPs starting in 2023, three of which are available to neurologists: Newly Proposed: “Optimal Care for Patients with Episodic Neurological Conditions MVP” focuses on the clinical theme of promoting quality care for patients suffering from episodic neurological conditions.

Newly Proposed: “Supportive Care for Neurodegenerative Conditions MVP” focuses on the clinical theme of promoting quality care for patients with cognitive-based neurological disorders such as dementia, Parkinson’s disease, and amyotrophic lateral sclerosis.

“Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes MVP,” which was finalized last year, focuses on the clinical theme of providing fundamental prevention and treatment of those patients at risk for, or that have had, a stroke. This rule proposes a minor change to what was previously finalized, with the addition of an ONC Direct Review attestation requirement for this MVP. The AAN actively engaged with CMS during the development process for these MVPs and provided the agency with feedback throughout. The AAN will continue to provide feedback to the agency in refining these models in our comments.

Access AAN resources at AAN.com/qpp to help you understand MVPs and explore the new Stroke MVP. 

The rule proposes five new MIPS Value Pathways (MVPs), two of which focus on neurologic conditions to be made available

Share New Dementia Book with Patients and Caregivers The AAN has added another title to its series of Brain & Life® books and members are encouraged to share this with patients, families, and caregivers.

Navigating Life with Dementia, by James M. Noble, MD, MS, CPH, FAAN, is a handbook that offers caregivers and loved ones of people with Alzheimer’s disease and other dementias the tools to manage the day-to-day issues and anticipate the long-term implications of the disease. From noticing the onset of symptoms of dementia through the advanced stages of the disease and its related care, this book will help families understand the complexities and what to expect as the disease progresses, as well as offer ways to manage common problems, all in an easy-to-understand format.

Point your patients and their family members to BrainandLife.org/Books where they can learn more and conveniently order the book online. 

AANnews • August 2022

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ADVOCACY

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.

Latest Advocacy News On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the 2023 Medicare Physician Fee Schedule proposed rule. See article on the cover of this issue.

As prior authorization continues to pose challenges across the nation, the AAN works tirelessly to advocate for you. Join a panel of AAN members on August 3 from 6:00 p.m.–7:00 p.m. ET to learn more about their experiences dealing with prior authorizations and how the AAN is helping you. Our panel of experts includes Kavita Nair, PhD; Tyler Allison, MD; and Donald Shook, MBA. Register for the webinar.

The House Energy and Commerce Committee hosted a hearing on June 28 focused on oversight of Medicare Advantage plans, during which a prominent theme was the need to reform the prior authorization process. During the hearing, staff from the Department of Health and Human Services Office of Inspector testified about its recent report that found that a high number of inappropriate denials of services occur in Medicare Advantage.

Issue in Focus All 12 appropriations packages have passed through the House Appropriations Committee and will head to the full House floor in the coming months. These bills include a significant number of AAN federal priorities, including: NIH is funded for FY23 at $47.5 billion, an increase of $2.5 billion from FY22.

BRAIN Initiative is funded for FY23 at $620 million, maintaining level funding from FY22.

NINDS is funded at $2.883 billion, $222 million above FY22 funding.

Significant language promoting the Department of Veterans Affairs (VA) Neurology Centers of Excellence, including: Headache Centers of Excellence are funded at least $15 million, a $5 million increase compared to FY22.

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AANnews • August 2022

Epilepsy Centers of Excellence met the AAN requested funding request at $19 million for FY23, a $9 million increase compared to FY22.

A report is commissioned about the feasibility, advisability, and cost of a significant expansion of the Parkinson’s Centers of Excellence.

Alzheimer’s Disease and Related Dementias are funded at $3.7 billion, a $200 million increase compared to FY22.

The new Advanced Research Projects Agency for Health (APRA-H) is funded at $2.75 billion, an increase of $1.75 billion. The bill would also make ARPA-H an independent agency within HHS, taking it out of NIH where it currently resides.

Telehealth expansion and research is appropriated $37.05 million, with an additional $5.2 billion for telehealth and connected care within the VA. While graduate medical education does not have a specific amount of money appropriated, the Appropriations Committee “urges CMS to prioritize applications in fiscal year 2023 from any hospitals seeking to establish or expand residency training in certain needed specialties, such as primary care, geriatrics, and general surgery, as had been the priority with previous GME slot distribution programs.”

October 1 is the deadline for all appropriations bills to pass both chambers to avoid a continuing resolution, where no new programs can be funded. The Senate has not yet released its timeline for appropriations. Negotiations are expected to continue until the end of the calendar year, with an expected continuing resolution to pass around October to fund the government in the interim.

While this is an important first step, it is important to note that the House bills were decided on a party line vote, so it is possible and likely to see varying figures when the Senate takes up its process. 

AAN Pushing Congress to Address Overly Burdensome Barriers to Care The AAN understands that among the significant factors leading to physician burnout are the daily, time-consuming bureaucratic hurdles that impede patient treatments. Decreasing such barriers to care is essential in maintaining the doctor-patient relationship and ensuring patients receive the appropriate care in a timely manner.

Recently, the American Medical Association released data on the growing issue of prior authorization (PA). The survey shows that 93 percent of patients report care delays when PA is involved. Furthermore, 82 percent of physicians report that PA can lead to treatment abandonment. Additionally, utilization management tools like step therapy protocols often cause delays in care and ignore a patient’s unique circumstances and medical history. Researchers at Tufts Medical Center recently found that step therapy was applied to 38.9 percent of drug coverage decisions, and more than half (55.6 percent) of those decisions required more steps than the clinical guidelines for diseases like multiple sclerosis, psoriasis, psoriatic arthritis, or chronic migraines. In addition, emerging evidence demonstrates that barriers to access caused by utilization management, including step therapy, increase costs for the US health system and result in poorer health outcomes. One study estimates that payers, manufacturers, physicians, and patients together incur approximately $93.3 billion in costs annually on implementing, contesting, and navigating utilization management.

The AAN has been lobbying members of Congress, both in daily interactions and during Neurology on the Hill in May, to act on legislation put forward to eliminate and reduce these burdensome barriers to care.

Prior Authorization The Improving Seniors’ Timely Access to Care Act of 2021 (S. 3018/H.R. 3173) would streamline the prior authorization process in Medicare Advantage and increase transparency by: Establishing an electronic prior authorization (ePA) program Establishing a list of items and services eligible for real-time decisions Standardizing and streamlining the process for routinely approved services Ensuring requests are reviewed by qualified medical personnel Increasing transparency Protecting beneficiaries from any disruptions in care

Step Therapy Reform The Safe Step Act (S. 464/H.R. 2163) would address the growing burden of step therapy protocols for employer sponsored health plans. The legislation aims to: Ensure employer plans are offering a clear step therapy exceptions request process Require employer plans to respond to a step therapy exceptions request within 24–72 hours Outline circumstances in which a step therapy exceptions request should be granted, such as: The patient already tried and failed required drug Delayed treatment will cause irreversible side effects Required drug will cause harm Required drug prevents a patient from fulfilling daily activities Patient is stable on their current medication

The members participating in Neurology on the Hill urged lawmakers to support the Improving Seniors’ Timely Access to Care Act of 2021 by co-sponsoring or urging a hearing or mark up of this bill, as well as co-sponsoring the Safe Step Act, which establishes common sense guardrails and a swift appeals process for step therapy protocols for patients in need.

In June, Rep. Michael C. Burgess, MD (R-TX) and Rep. Vicente Gonzalez (D-TX) introduced H.R. 7995, the Gold Card Act of 2022.

This legislation will exempt qualifying providers from requiring prior authorization for a Medicare Advantage (MA) plan year if the provider had at least 90 percent of prior authorization requests approved the preceding year. No later than 30 days prior to the first day of each plan year, an MA organization would be required to notify each provider who qualifies.

“Before coming to Congress, I practiced medicine for nearly 30 years and understand the frustration that comes from waiting on the government to tell me if I can provide certain treatments to my Medicare patients,” said Burgess in a recent press release.

“I am grateful for fellow Texan, Congressman Vincente Gonzalez, for joining me in introducing this critical legislation that will allow patients to receive quality care in a timely manner by streamlining the prior authorization process for physicians. I have seen the support of this legislation in my home state and am confident that GOLD carding policy will be effective in improving clinical results.”

“I am proud to introduce the GOLD CARD Act with Dr. Burgess to remove barriers for patients to receive the care they deserve,” said Gonzalez in the same press release. “No person’s care should be put on hold by bureaucratic red-tape. I urge our colleagues to support this critical legislation and ensure South Texans, and all Americans, receive top notch care.” 

EDUCATION Jones Named New Continuum Editor-in-Chief Lyell K. Jones, Jr., MD, FAAN, will succeed Continuum® Editor-in-Chief Steven L. Lewis, MD, FAAN, at the completion of his 10-year term in December.

Jones is a consultant and professor of neurology at the Mayo Clinic in Rochester, MN. He 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.

as a resident and now as an educator, Continuum has been with me throughout my career in neurology. It has become an indispensable educational resource for our specialty. As editor-in-chief, I look forward to continuing Continuum’s tradition of innovation and excellence and supporting the highest quality care for neurology patients worldwide.”

“I am excited to announce the selection of Dr. Lyell Jones as the next editor-in-chief for Continuum,” said James C. Stevens, MD, FAAN, chair of the Continuum Editorin-Chief Search Committee and AAN immediate past president. “The search committee had many well-qualified candidates, but Dr. Jones’ decades of experience as a medical educator, his involvement in publications concerning a variety of neurologic topics of interest, and his superb leadership skills make him the ideal choice to lead our flagship publication for comprehensive neurologic education. I have every confidence that he will continue the excellence of Continuum and lead it to new heights!”

Jones’s practice includes general neurology and neuromuscular medicine, with a clinical and research focus in neurodegenerative, infectious, and autoimmune neuromuscular disorders.

He has additional interests in health care policy and economics, specifically value-based care systems. As Mayo Clinic’s medical director of Contracting and Payer Relations and chair of Government Program Strategy, he has led systemwide implementation of novel care models such as the Mayo Clinic Accountable Care Organization (ACO) and has championed the importance of high quality, high value care for patients. Jones chairs the AAN Quality Committee, where he oversees development of AAN practice guidelines, quality measures, and implementation of the Axon Registry®. His intramural

Jones, currently an ex officio member of the AAN Board of Directors as chair of the Quality Committee, said, “First

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AANnews • August 2022

Jones

Lewis

and extramural efforts are collectively devoted to improving quality of care for all patients. He currently serves on the Boards of Directors of the AAN Institute (ex officio) and the Mayo Clinic ACO. 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. Until recently, Jones served as the program director of the Mayo Clinic – Rochester Adult Neurology Residency Program and developed with his colleagues a competency-based neurology assessment system, neurology wellness program, and health care disparities initiative. He has been recognized with the AAN Program Director Award, the Accreditation Council for Graduate Medical Education Parker J. Palmer Courage to Teach Award and has been inducted into the Mayo Clinic Teacher of the Year Hall of Fame. 

Multiple Sclerosis and Related Disorders Discussed in New Continuum The August issue of Continuum: Lifelong Learning in Neurology® delves into multiple sclerosis and related disorders.

Guest Editor Myla D. Goldman, MD, MSc, FAAN, said, “This issue highlights several developments in the field of multiple sclerosis, such as updates on disease-modifying therapies and evolving understanding of related disorders (e.g., anti-myelin oligodendrocyte glycoprotein-associated disorders), and includes important aspects of care for previously underrepresented populations in the field.”

Content for this issue includes: Epidemiology and Pathophysiology of Multiple Sclerosis Melanie Ward, MD; Myla D. Goldman, MD, MSc, FAAN Diagnosis of Multiple Sclerosis Jiwon Oh, MD, PhD, FRCPC Treatment of Multiple Sclerosis Anne Cross, MD, FAAN; Claire Riley, MD Approach to Symptom Management in Multiple Sclerosis with a Focus on Wellness Rebecca Spain, MD, MSPH, FAAN Progressive Multiple Sclerosis Lilyana Amezcua, MD, MS, FAAN

Myelin Oligodendrocyte Glycoproteinassociated Disorders Erin Longbrake, MD, PhD, FAAN

Goldman

The issue includes a postreading self-assessment and test with the opportunity to earn up to 20 AMA PRA Category 1 Credits™ toward Self-assessment CME.

Continuum LIFEL ONG LEAR NING IN NEUROLOG ® Y

Multiple Sclerosis and Related Disorders AUGUST 2022

VOL. 28

EDITOR-IN -CHIEF: STEVEN L. LEWIS, MD, FA AN GUEST EDITOR: MYLA GOLDMAN , MD, MSC, FA AN

Pediatric Acquired Demyelinating Disorders J. Nicholas Brenton, MD Neuromyelitis Optica Spectrum Disorders Fiona Costello, MD, FRCPC Leukodystrophies Laura Adang, MD, PhD, MSTR CONTINUUMJOURNA

NO. 4

AAN members pay only $399 per year for a subscription to Continuum® and Continuum® Audio. Subscribe now by contacting Wolters Kluwer at (800) 361-0633 or (301) 223-2300 (international) or visit shop.lww.com/ continuum. AAN Junior members who are transitioning to neurologist memberships are eligible to receive a 60-percent discount on the already low member rate for the Continuum and Continuum Audio subscription. 

L.COM

Seven Training Programs Achieve UCNS Accreditation The United Council for Neurologic Subspecialties (UCNS) has accredited seven new fellowship training programs. Programs attaining UCNS accreditation status offer the core curriculum established by the subspecialty and meet required quality standards established by UCNS. Accreditation is a voluntary process of evaluation and peer review based on UCNS accreditation standards. Fellows who complete a UCNS-accredited program meet the training eligibility requirements to apply for certification in the subspecialty. There are now 229 UCNS-accredited training programs in UCNS-recognized subspecialties, including the first two accredited in the newest UCNS-recognized subspecialty of Interventional Neurology.

The following programs achieved accreditation effective June 1, 2022.

For more information visit UCNS.org. 

PROGRAM Behavioral Neurology and Neuropsychiatry University of Texas Health Science Center, San Antonio Headache Medicine Nuvance Health Rush University Medical Center Cedars-Sinai Medical Center Interventional Neurology Michigan State University/ Sparrow Hospital JFK University Medical Center Neuro-oncology Brown University/Rhode Island Hospital

PROGRAM DIRECTOR

Arash Salardini, MD

Hida Nierenburg, MD Rima Dafer, MD, MPH Nasima Shadbehr, DO Anmar Razak, MD Jawad Kirmani, MD Eric Wong, MD

AANnews • August 2022

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EDUCATION Live and Online Education Opportunities for APPs Coming This Fall The AAN recognizes that each member of the neurology care team is essential to high-quality patient care. We are committed to providing the best educational and professional resources to all members, including neurologic advanced practice registered nurses and physician assistants (advanced practice providers, or APPs). To this end, the AAN is offering the following new live and online education opportunities designed specifically for APPs beginning Fall 2022.

2022 Advanced Practice Provider Neurology Education Series—Online Only This self-paced, online education series is designed and taught especially for neurology APPs by physicians and APPs. Building on the success of prior series, and based on attendee feedback, the 2022 series will be offered online only, with all video presentations, slides, and resources accessible immediately upon purchase. The 2022 series will include overviews and updates that address several core topics in clinical neurology. Registration opens early September, and you can learn more and enroll at AAN.com/APP. APP Pre-conference October 27, prior to 2022 AAN Fall Conference—In-person Only, Caesars Palace Las Vegas This full-day offering will feature special networking opportunities and programming to include neurology fundamentals and clinical case studies on headache, spine disorders and radiculopathy, and multiple sclerosis.

Attend the APP Pre-conference on a stand-alone basis ESC: 22 Research AN orProgram bundleAd—Half with thePage full Horizontal> Fall Conference registration to Placed in AANnews save.

Registration opens early August at AAN.com/Fall.

8.25 x 5.25 +0.125 bleed, 4C

Learn more about the APP Pre-conference and the Fall Conference on the cover of this issue of AANnews. 

Specially Priced AAN Memberships for Care Team Members, APPs The AAN offers specially priced memberships for advanced practice providers that provide exclusive access to topquality education, events, networking, and other practiceenhancing opportunities. AAN APP members save with deep discounts on registration for the programs APP Pre-conference and the APP Neurology Education Series, as well as other valuable education resources such as Continuum: Lifelong Learning in Neurology® ($600+ off the nonmember rate) and the online NeuroReady®: Advanced Practice Providers Edition designed for APPs who are one to three years out of graduation, or are new to the field of neurology. Learn more about the benefits of APP membership at AAN.com/CareTeam. 

Research Funding Available

Boost Your Crucial Research This AAN funding boosters my work and career in frontotemporal dementia research.

Indira Garcia Cordero, PhD

University Health Network, Clinical Research Training Scholarship in FTD

Apply for grants by September 1: AAN.com/ResearchProgram

MEMBERSHIP

Apply by August 17 for New Diversity Grants Inclusion is the reason the AAN was founded. To be an organization that is the home for all neurologists. It is what makes us stronger. To support our goal of being a fully inclusive, deliberately diverse, and anti-racist organization and our core values of Inclusion, Diversity, Equity, Anti-racism, and Social Justice (IDEAS), we are excited to share progress and updates with you.

The AAN is offering two new grants to help fund projects, events, and activities that foster IDEAS within academic neurology departments or the communities they serve. The deadline to apply for either grant is August 17, 2022. Each grant offers two $2,000 prizes, recognition, and the opportunity to virtually present projects to the AAN’s Diversity Officers Subcommittee at the end of the grant period.

AAN IDEAS Innovator Grants Designed to support new, untested, and innovative approaches to fostering IDEAS, these grants are geared toward applicants with little or no prior experience in implementing IDEAS-related projects. Students, residents, fellows, and early career faculty are strongly encouraged to apply.

AAN IDEAS Project Grants Designed to support projects, events, and activities that promote IDEAS within academic neurology departments or the communities they serve, these grants are geared to those who have experience and are already working in the IDEAS space within their academic neurology departments.  For more information or to apply, visit AAN.com/tools-resources/ diversity-officers. 

Share Your Thoughts!

Please complete a brief member survey regarding our efforts in Inclusion, Diversity, Equity, Anti-racism, Social Justice (IDEAS).

To take the survey online, visit AAN.com/IDEAS. 

Congratulations New Fellows of the American Academy of Neurology!

The AAN congratulates the following members who were named prestigious Fellows of the American Academy of Neurology (FAAN) between April and May 2022.

Ahmad Nadim Al-Sadat, MD, FAAN

Andrew Kayser, MD, PhD, FAAN

Adrienne Boire, MD, PhD, FAAN

Muhib Khan, MD, FAAN

Daniel J. Burdick, MD, FAAN

Iftikhar A. Khan, MD, FAAN

Angela L. Chandler, MD, FAAN

Arielle Marisa Kurzweil, MD, FAAN

Sampath V. Charya, MD, FAAN

Barry L. Menna, DO, FAAN

Catherine Chong, PhD, FAAN

Uma Menon, MD, MBA, FAAN

Jean E. Cibula, MD, FAAN

Bindu Menon, MD, MBBS, FAAN

Yadira Dacosta, MD, FAAN Andres Felipe Deik Acosta Madiedo, MD, FAAN

Michael Minieka, MD, FAAN

Michelle Fabian, MD, FAAN Tooba Fayyaz, DO, FAAN Dennis C. Graham, DO, FAAN Peter Hannon, MD, FAAN Gonzalo Ivar Hidalgo, MD, FAAN Asher Imam, DO, FAAN Venkata Jakkampudi, MD, FAAN

Khurram Nazir, MD, FAAN Karen Dianne Orjuela, MD, FAAN Jose-Alberto Palma, MD, PhD, FAAN Jeffrey B. Ratliff, MD, FAAN Noah Rosen, MD, FAAN Delaram Safarpour, MD, MSCE, FAAN James J. Sejvar, MD, FAAN Heewa Younis, MD, FAAN 

Interested in Elevating Your Membership Status to FAAN? Visit AAN.com/FAAN to see if you’re eligible for the FAAN designation— or encourage a qualifying colleague to apply. Applying for FAAN status is free, acknowledges exemplary work and achievements in the neurosciences, the clinical practice of neurology, or academic/ administrative neurology; helps set you apart both within the Academy and throughout your professional career; and offers eligibility to serve on the AAN Board of Directors.  AANnews • August 2022

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MEMBERSHIP 2023–2025 Board of Directors Nominations Due August 31 AAN members are encouraged to self-nominate or nominate a respected colleague by August 31, 2022, for the Board of Directors for the 2023–2025 term of office.

The 2023–2025 slate of nominees will include a president elect, vice president, secretary, treasurer, and directors. Of the current nine elected Board members, four directors have already served three terms and are ineligible for re-election to the Board as directors, and five are eligible for re-election to an additional term. The current officers of Treasurer, Secretary, and Vice President are eligible for re-election. Nominees must be Fellows of the American Academy of Neurology (FAAN) and be committed to furthering the Academy’s mission to promote the highest quality patient-centered neurologic care and enhance member career satisfaction.

The AAN Nominations Committee strives for balance and diversity among those nominated to effectively represent the Academy’s membership and incorporate members’ opinions and ideas. Prior or current Academy service of potential nominees should reflect experience that enhances the understanding and implementation of the Board’s strategic priorities, including significant committee or comparable Academy service experience. The AAN membership will vote on the proposed slate of officers at the 2023 Annual Meeting in Boston.

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in Your Area of Interest From More Than 140 Countries Around the World.

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For a complete description of the characteristics being sought of future board members based on the strategic needs of the Academy, visit AAN.com/BOD. 

Transforming Leaders Program Graduate Carries out Laser-focused Vision The AAN’s Transforming Leaders Program (TLP) was designed to engage innovative leaders with aspirations to transform their practice community and field of neurology. As assistant dean of undergraduate medical education and director of the Health Professions Education Institute at Atrium Health Wake Forest Baptist in Winston-Salem, NC, Roy E. Strowd, MD, MEd, MS, FAAN, has been involved in developing new and innovative education strategies.

But it was his involvement in the AAN’s TLP that helped put his passion into even sharper focus.

“The AAN leadership development programs are phenomenal,” he said. “Through TLP, I was able to use the time, training, and leadership development to identify my vision as a leader. In medical training, we spend so much time focusing on honing our clinical knowledge and skills. We dedicate our lives to caring deeply for our patients and making new discoveries in our research. TLP provided a valuable opportunity for me to develop a laser-focused vision for my career.”

Identify and pursue a vision he has. Strowd not only chairs the AAN’s eLearning Subcommittee, where he helps to direct all of the Academy’s online learning programs for its 38,000 members worldwide, but he was recently selected as the editor of Neurology ® Education, where he serves on the editorial board with a number of other AAN Leadership Development Program graduates. Neurology: Education is the latest installment in the Neurology ® family of journals and publishes original research articles on education research and curriculum innovations in neurologic and neuroscience education.

Strowd credits the TLP—curriculum, leadership training, mentoring, and networking—as critical in helping shape his vision for Neurology: Education, communicate effectively with leaders and stakeholders to see its value, and engage with a team that was able to help make this success a reality.

“This is an extremely exciting new outlet for dissemination of scholarship in evidence-based education and I hope that it will help expand high-quality educational scholarship in our field,” he said. Over the last couple of years, the COVID-19 pandemic necessitated new approaches to online learning, maintaining clinical exposure, and to cultivating a diverse and inclusive pipeline of future neurologists. Strowd is up for the challenge.

“This is an incredibly innovative time in medical education and neurology has an opportunity to be at the forefront of training resilient, competent, and compassionate future leaders,” said Strowd. “I am tremendously excited by the opportunity that Neurology: Education provides for our students, educators, and the field.”

Strowd sees an ongoing, critical need to support educators and evidence-based education. “Neurologists tend to be great teachers. We spend much of our time teaching our patients, colleagues, and students. As learning increasingly lives at our fingertips, investing in evidence-based educational strategies

across the continuum of training including Strowd for faculty and practicing neurologists is vital for our field to meet the future challenges with misinformation, big data, clinical complexity, burnout, and resilience.”

In recognition of his exemplary, passionate approach to teaching, Strowd was awarded the Alumnus Excellence Award for the Johns Hopkins School of Education, Master of Education in the Health Professions Program in May. It’s a high honor, with only two awards given annually—one to a current fellow and one to an alumnus. “I am humbled and grateful to have been selected for this recognition and credit much of this to the benefits of participating in TLP and other AAN-related activities which have helped to prepare and connect me with influential mentors and sponsors with the AAN,” he said.

Strowd continues to implement his TLP training on an almost daily basis in continued pursuit of his vision and goals— especially in his new editor role. “From one-on-one interactions with colleagues and patients, to leading within teams—like the Neurology: Education team—the TLP’s training is the type of practical, hands-on skill development that you use every day.

I am now so excited for the opportunity to serve as editor of this new journal, to work with our many phenomenal neurologists and educators, and to put the TLP training into practice.”

Applications for the next Transforming Leaders Program open September 7. Learn more at AAN.com/Lead. 

Thank you to the organizations supporting this program in part: AbbVie Alexion, AstraZeneca Rare Disease Lundbeck Neurocrine Biosciences, Inc. Supernus Pharmaceuticals, Inc.

AANnews • August 2022

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Meet Suzanne Schindler, MD, PhD 2012 Next Generation Research Grant Recipient In 2012, Dr. Suzanne Schindler received a Next Generation Research Grant in Alzheimer’s and dementia research from the American Brain Foundation. This grant helped her transition from a career as a clinician to that of a clinician-scientist. With this, she began studying the potential for a diagnostic test for Alzheimer’s using biomarkers.

Dr. Schindler and her colleagues recently co-authored a study evaluating the accuracy of blood tests for Alzheimer’s disease among Black and White individuals. As principal author of the study, Dr. Schindler identified inconsistencies in three of the four leading tests that may contribute to the misdiagnosis of Alzheimer’s for people of color. With a variety of Alzheimer’s drugs in the late stages of clinical trials, researchers expect blood testing to increase significantly. This study has underscored the critical need for diversity in clinical trials to ensure these important tests provide accurate results.

AMERICAN BRAIN FOUNDATION September 1 Is Last Chance to Apply for 2023 Next Generation Research Grants The September 1 application deadline is quickly approaching for the American Brain Foundation’s 2023 Next Generation Research Grants. Award opportunities are available in 11 areas, including ALS, cognitive aging, epilepsy, frontotemporal degeneration, health disparities, mal de débarquement syndrome, migraine, neuromuscular disease, Parkinson's disease, peripheral neuropathy, and stroke. Most awards consist of a commitment of $65,000 per year for two years, plus a $10,000 per year education and research-related stipend, for a total of $150,000.

Offered in collaboration with the AAN, the Foundation’s Next Generation Research Grants fund and support a broad range of innovative research by the best and brightest early-career clinician-scientists. It is the Foundation’s belief that funding research across a broad spectrum of the brain is the best hope for finding better treatments, prevention, and cures for brain diseases and disorders. To date, the Next Generation Research Grants have provided millions of dollars to fund the innovative research of early-career investigators, encouraging passion for research and laying the groundwork for future success;

and over 86 percent of past recipients have gone on to secure funding from the NIH and other national entities.

Visit AAN.com/research for more information and to apply by September 1 for these Next Generation Research Grants and other research grants offered through the American Academy of Neurology. Applicants are encouraged to give themselves plenty of time to complete the process to ensure all materials are submitted on time. 

Careers.AAN.com

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.

Opportunity for BC/BE Neurologist with MS Fellowship to Develop and Grow MS Practice—Mercy Health Services— Baltimore, Maryland

Division Chief of Vascular Stroke Neurology—University of North Carolina, Chapel Hill—Merritt Hawkins—Chapel Hill, North Carolina

A multispecialty Neurology group in Baltimore is looking to hire a multiple sclerosis neurologist to join our group of 4 neurologists at Mercy Medical Center. We are seeking a physician that is excited about developing and growing a MS practice. This is your opportunity to focus on your neurology subspecialty, Multiple Sclerosis, and make a real difference in your community. You will be busy immediately as there is an excellent primary care and neurology referral base. There is a significant demand for this specialty in our area. There is very strong subspecialty support and a full range of services available for patients and referrals. This position is primarily an outpatient position. Candidates must be board certified or board eligible in neurology and have either training or experience with multiple sclerosis to qualify. In addition to a competitive compensation, you will be offered medical/ dental/vision benefits, life insurance, long-term disability, a retirement plan with match, CME stipend, vacation time, and a wonderful work environment. For more information, please call Mary Beth Coyne at (410) 659-2824 or send your CV to mcoyne@mdmercy.com. Join a collegial group of neurologists in Baltimore, Maryland. Subspecialty focus on multiple sclerosis neurology. Must be board eligible/certified in neurology with a multiple sclerosis fellowship. On-site infusion center, MRI, CT, other imaging in satellite, multi-specialty location. Mercy Medical Center is located in downtown Baltimore, but also offers services in our satellite locations in Baltimore County, Anne Arundel County and Howard County. On site infusion and MRI at our Baltimore County location, this will be the primary location for this physician. Baltimore is a culturally diverse community that offers all of the amenities of a large city. This position offers the ability to really make a difference in the community.

The Department of Neurology at the University of North Carolina, Chapel Hill, seeks qualified applicants with strong clinical, teaching, and research skills for a full-time Division Chief Faculty position in Stroke and Vascular Neurology.

The successful candidate will lead a team of four Vascular Neurologists directing acute stroke and neuro-hospitalist care at the UNC Medical Center. The Medical Center is home to the Joint Commission-certified UNC Hospitals Comprehensive Stroke Center, an American Heart Association/American Stroke Association Gold Plus and Target Elite Plus Honor Roll program. The new chief will supervise resident-staffed acute stroke and neurohospitalist teams, with support from Emergency Medicine, Neurocritical Care, Neurosurgery, Neurointerventional Radiology, Neuroradiology, and Physical Medicine & Rehabilitation. Candidates must be board-certified or board eligible in both Neurology and Vascular Neurology.

Opportunity Highlights: Inherit a well-run, efficient program and transform it into a more academic-minded program, Lead a team of 4 Vascular Neurologists at the UNC Medical Center, which ranked the No. 2 hospital in the state (US News & World Report 2021), Myriad resources to support clinical outcomes, Everything you need is located on one medical campus—take advantage of a fantastic infrastructure, Work at a state hospital with a wide variety of pathology and medical conditions, Ranked a Best College by US News & World Report, Direct acute stroke and neuro-hospitalist care at UNC Medical Center, Supervise resident-staffed acute stroke and neurohospitalist teams, Supported by Emergency Medicine, Neurocritical Care, NS, Neurointerventional Radiology, Neuroradiology, and Physical Medicine, Active acute stroke thrombectomy program with rapid advanced stroke imaging capabilities, A CARF-certified stroke rehab hospital is also located on-site. Community Information: UNC is in Chapel Hill, one of the best places to live in the state (Niche). Commonly referred to as “the Triangle,” Raleigh,

Durham, Chapel Hill, and their suburbs offer highly soughtafter living options in this desirable area of North Carolina.

As a resident of this breathtaking area, you’ll have access to everything you need and more. You’ll enjoy an abundance of engaging outdoor activities, unique shops and restaurants, and exciting nightlife. Chapel Hill received an overall A+ grade and is one of the best places to live in North Carolina (Niche), A low cost of living and safe, family-friendly neighborhoods, Culturally diverse and economically resilient—nationally recognized as an ideal place to live, Some of the top schools in the state, including prestigious universities, Exciting collegiate sports, Convenient access to an international airport, Endless opportunities to explore the outdoors—with gorgeous scenery all around. For immediate consideration please inquire with an updated copy of your CV so we can discuss the position by phone. Also, inform me of your best available times to speak. I look forward to your reply and thank you for your review. Please do not delay as we anticipate a significant response. Please contact David King at medcareers@merritthawkins.com or at (866) 406-0269 and reference NEUS-146973. 

AANnews® Classified Advertising he AAN offers a complete package of print, online, T and in-person recruitment advertising opportunities.

Visit careers.AAN.com for all AAN options, rates, and deadlines. d copy for the October 2022 print edition of A AANnews must be submitted by September 1, 2022.

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. 

AANnews • August 2022

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Deadline: UCNS Neuroimaging Certification UCNS.org/NIcertification

Deadline: Research Applications AAN.com/ResearchProgram

AUGUST 4

Early Registration Deadline: Fall Conference AAN.com/Fall

Registration Open: AAN Fall Conference AAN.com/Fall

AUGUST 10–11

Virtual Career Fair Careers.aan.com

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OCTOBER 27

AAN Fall Pre-conferences: APP Education and Sports Concussion AAN.com/Fall

OCTOBER 28–30

AAN Fall Conference AAN.com/Fall

Advance Registration and Hotel Deadline: Fall Conference AAN.com/Fall

OCTOBER 31

Deadline: AAN Award Applications AAN.com/Awards

Write Brain: Creative Writing Workshop NPub.org/workshop

AUGUST 30

Submission Open: 2023 Annual Meeting Abstracts AAN.com/23Abstracts HP: 22 Staffing Model Toolkit Ad—Half Page Horizontal> AN

AUGUST 31

Placed in AANnews 8.25 x 5.25 +0.125 bleed, 4C

Deadline: Board of Directors Nominations AAN.com/BOD

Staffing shortages exhausting your team?

The AAN has resources for staffing, recruiting, and optimizing staff to help alleviate pressure on your team.

AAN.com/practice/staffing-challenges