american college of physicians department of clinical ......provided expert opinion for malpractice...

†To report amount of value or income, use these ranges: a) $0 b) ≤$5,000 c) $5,001 to 10,000

d) $10,001 to 50,000 e) $50,001 to 100,000 f) ≥$100,001

American College of Physicians Department of Clinical Policy

Disclosure of Interests: Summary Report

Name: Eileen Barrett, MD, MPH, FACP______________________________ Role: __ Clinical Guidelines Committee X Performance Measurement Committee __ High Value Care Committee

___ ACP Staff or Leadership ___ Guest

ACTIVE (Current) Belongs to Description including amount of value or income†

Employment Self University of New Mexico ≥$100,000

Household Cibola General Hospital Genesis Home Care

$50,000-100,000 $10,001-50,000

Research & Consulting Support

Self AMA Practice Transformation (faculty) $5,000-10,000 Household None --

Investment & Proprietary Interests

Self None -- Household None --

Committees, Workgroups, & Advisory Roles

Self CMS Quality Measure Development Plan technical expert panel (member)

$0

$0 Household None --

Other Interests Self New Mexico Society of Hospital Medicine

chapter councilor (member) $0

Household Greater Albuquerque Medical Association board member

--

Please review the list of measures in the attached word document. Have you or any close relations contributed towards the development of one of these measures or a competing measure (measure on the same topic)? Yes x No

Please review the list of measures in the attached word document. Have you or any close relations contributed towards the development of one of these measures or a competing measure (measure on the same topic)? Yes x No

†To report amount of value or income, use these ranges: a) $0 b) ≤$5,000 c) $5,001 to 10,000

d) $10,001 to 50,000 e) $50,001 to 100,000 f) ≥$100,001

IF YES, please copy and paste relevant references into space provided below or you may send as a separate attachment.

INACTIVE (Last 3 years) Belongs to Description including amount of value or income†

Employment Self Indian Health Services, Partners in Health ≥$100,000 Household Rehoboth McKinley Christian Healthcare ≥$100,000

Research & Consulting Support





Self None -- Household New Mexico Health Resources $0

Other Interests Self None -- Household None --

DECLARATION I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

1/7/18 Signature Date

RELEVANT PUBLICATIONS Copy and paste below or send as attachment.

RELEVANT MEASURES List previous involvement below or highlight in attached document.



Name: Robert M. Centor, MD, MACP

Role:Clinical Guidelines Committee ACP Staff or LeadershipPerformance Measurement Committee GuestHigh Value Care Committee

ACTIVE (Current) Belongs to Description including amount of value or income

EmploymentSelf Birmingham VA Hospital -- + -Household Valley Foundation -- + -

Research & Consulting Self None -- + -Household None -- + -


Self None -- + -Household None -- + -


Self MDCalc Advisory Board (member) $0 + -Household The Curbsiders Podcast (contributor) $0 + -

Other Interests other affiliations, advocacy, etc.


In the last 3 years, have you or any close relations published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

cardiac imaging Yes No

electronic use of nicotine delivery systems Yes No

For staff use: ADD NEW RESET

Please review the list of measures in the attached word document. Have you or any close relations contributed towards the development of one of these measures or a competing measure (measure on the same topic)?

Yes NoHave you or any close relations published on any of the clinical topic areas covered by these measures? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Yes No

INACTIVE (Last 3 years) Belongs to Description including amount of value or income

EmploymentSelf University of Alabama at Birmingham -- + -Household None -- + -


Research & Consulting Roles

Self

Provided expert opinion for malpractice case related to sore throats -- + -Diatherix, gave speech related to sore throats -- + -Diatherix, designing a clinical study of their new product for diagnosing bacterial infection in sore throats

-- + -

Household None -- + -Investment & Proprietary Interests



Self $0 + -Household None -- + -



DECLARATIONI certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

Jan 10, 2018

Signature Date

RELEVANT PUBLICATIONS

Copy and paste into box below or send as attachment.

RELEVANT MEASURESList in box below or highlight in attached document.

Centor, Robert M (Campus) Digitally signed by Centor, Robert M (Campus) Date: 2018.01.10 09:26:05 -06'00'



Name: J. Thomas Cross, MD, MPH, FACP



Employment

Self A-Cross Medicine Reviews $100,001 or more + -

Household

St. Mary's High School, Colorado Springs $10,001 – 50,000 + -Texas A&M University Department of Biomedical Engineering $10,001 – 50,000 + -Clark County Public Schools, Las Vegas $10,001 – 50,000 + -Wells Fargo Wealth Management Division $100,001 or more + -St. Louis University Department of Graduate Studies (dependent) $10,001 – 50,000 + -



SelfTrademark: "Triple F CME: Focused, Fast, Fun" Up to $1,000 + -Copyrighted: A-Cross Medicine Reviews PowerPoints Up to $1,000 + -

Household None -- + -Committees, Workgroups, & Advisory Roles

Self American Academy of Pediatrics, Med-Peds Section (member) $0 + -

Household None -- + -Other Interests other affiliations, advocacy, etc.



Yes No

Have you or any close relations published on any of the clinical topic areas covered by these measures? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Yes No


EmploymentSelf CenseoHealth $50,001 – 100,000 + -Household St. Louis Department of Admissions (dependent) $1,001 – 5,000 + -

INACTIVE (Last 3 years) Belongs to Description including amount of value or incomeResearch & Consulting Roles









Dec 18, 2017

Signature Date

RELEVANT MEASURES

List in box below or highlight in attached document.



Jacob T Cross, MD Digitally signed by Jacob T Cross, MD DN: cn=Jacob T Cross, MD, o, ou, [email protected], c=US Date: 2017.12.18 14:37:47 -07'00'



Name: Andrew Dunn, MD, FACP, SFHM



EmploymentSelf Mount Sinai School of Medicine -- + -Household None -- + -

Research & Consulting Self

Grant administered by The Joint Commission (funded by Pfizer): Transitions of Care for Venous Thromboembolism

$100,001 or more + -




SelfAdvisory Board for ACP's Center for Quality Initiative (chair), ACP Quality Connect: Atrial Fibrillation. Funded by Bristol-Myers Squibb

$0 + -




Yes No


Yes No


EmploymentSelf None -- + -Household None -- + -



Self

Cardinal Health E3 Foundation $50,001 – 100,000 + -Desai Pharmaceuticals $10,001 – 50,000 + -Medline Foundation $50,001 – 100,000 + -Speaker's bureau: Creative Educational Concepts, Inc. (CECI), an accredited medical, pharmacy, and nursing medical educational company: Preventing avoidable readmissions: strategies to optimize ACS transitions of care (supported by Astra-Zeneca)

$1,001 – 5,000 + -




Self

Society for Hospital Medicine, Hospital Quality and Patient Safety Committee (member) $0 + -Lewin Group/Mathematica Measure Development Expert Workgroup on the overutilization of imaging for uncomplicated headache measure (member)

$0 + -




Signature Date

RELEVANT MEASURES




Andrew Dunn Digitally signed by Andrew Dunn Date: 2017.12.18 15:18:17 -05'00'



Name: Nick Fitterman MD, MACP, SFHM



EmploymentSelf Northwell Health -- + -Household Mount Sinai Health System -- + -





Self Education Committee of Society of Hospital Medicine $0 + -Household None -- + -


Self ACP PAC donation -- + -Household None -- + -

In the last 3 years, have you or any close relations published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Breast cancer screening Yes No

Obesity Yes No

Low testosterone treatment Yes No



Yes NoHave you or any close relations published on any of the clinical topic areas covered by these measures? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Yes No


EmploymentSelf none -- + -Household None -- + -






Self ABIM $5,001 – 10,000 + -Household None -- + -




Signature Date




nick fitterman Digitally signed by nick fitterman DN: cn=nick fitterman, o=northwell health, ou, [email protected], c=US Date: 2018.01.02 10:56:59 -05'00'



Name: Eve A. Kerr, MD, MPH, FACP



EmploymentSelf

Ann Arbor VA Health Services Research and Development Service Center of Innovation; Center for Healthcare Research and Transformation; University of Michigan

-- + -

Household Architect -- + -


National Institutes of Health grant: hypertension in the elderly $10,001 – 50,000 + -VA: employer grant; general support of health services research $100,001 or more + -Donaghue Foundation grant: Choosing Wisely, not condition specific $100,001 or more + -VA grant: deintensification of medical services $100,001 or more + -VA grant: use of benzodiazepines in the elderly (co-investigator) $100,001 or more + -VA grant: cardiovascular risk measurement (co-investigator) $100,001 or more + -AcademyHealth/Patient-Centered Outcomes Research Institute: Presenter $1,001 – 5,000 + -




Self

West Haven, Durham and Palo Alto VA Health Services Research and Development Service Centers of Innovation: Steering Committee (member)

$0 + -

University of Michigan Institute for Healthcare Policy and Innovation: Institute Leadership Team (member) $0 + -Choosing Wisely International Steering Committee (member) $0 + -AcademyHealth & ABIM Foundation: Research Community on Low Value Care, Steering Committee (member)

$0 + -

Mathematica/CMS: Committee on diabetes overtreatment measures $0 + -Member, Advisory Group for “Establishing Criteria and Feasibility for a Statewide Choosing Wisely Campaign in Michigan” funded by AMIMF to the Center for Healthcare Research and Transformation.

$0 + -

ACTIVE (Current) Belongs to Description including amount of value or incomeAltarum Overuse Advisory Group of Experts (member) $1,001 – 5,000 + -




Yes No


Yes No


EmploymentSelf None -- + -Household GE Healthcare (dependent) -- + -


Self

Robert Wood Johnson Foundation: training grant $1,001 – 5,000 + -University of Iowa: Visiting professor Up to $1,000 + -Mathematica: Visiting professor Up to $1,000 + -




Self

Patient-Centered Outcomes Research Institute: Advisory Panel (member) Up to $1,000 + -Northwestern University Medical School: Steering committee (member) $1,001 – 5,000 + -Health Services Research Editorial Board (member) $0 + -Center for Healthcare Research and Transformation: Research Policy Committee (chair) $0 + -ABIM Foundation: Workgroup on physician accountability (participant) $0 + -AcademyHealth/ABIM Foundation/VA HSR&D/Kaiser Permanente Symposium on Resource Utilization: Planning committee (chair)

$0 + -



DECLARATIONI certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I

will promptly disclose any changes.

Signature Date

RELEVANT MEASURES




see attached CV Rosland AM, Heisler M, Janevic M, Connell C, Langa K, Kerr EA, Piette JD. Current and potential support for chronic disease management in the United States: The perspective of family and friends of chronically ill adults. Families, Systems, and Health. 2013;31(2):119-31. PMCID: PMC3762580. Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of care for patients with multiple chronic conditions: The role of comorbidity interrelatedness. Journal of General Internal Medicine. 2014; 29(3):529-537. PMCID: PMC3930789. Klamerus M, Kerr EA, Bosworth HB, Schmittdiel J, Heisler M. Characteristics of diabetic patients associated with achieving and maintaining blood pressure targets in the Adherence and Intensification of Medications Program. Chronic Illness. 2014; 10(1):60-73. PMCID: PMC4134130. Sussman JB, Kerr EA, Saini SD, Holleman RG, Klamerus M, Min LC, Vijan S, Hofer TP. Rates of deintensification of blood pressure and glycemic medication treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA: Internal Medicine. 2015;175(12):1942-1949. PMCID: Not Required. Caverly TJ, Fagerlin A, Zikmund-Fisher BJ, Kirsh SR, Kullgren JT, Prenovost K, Kerr EA. Appropriate prescribing for diabetic patients at high-risk for hypoglycemia: National survey of VA primary care providers. JAMA: Internal Medicine. 2015;175(12):1994-1996 PMCID: Not Required.

Eve Kerr Digitally signed by Eve Kerr DN: cn=Eve Kerr, o, ou, [email protected], c=US Date: 2018.01.02 14:04:32 -05'00'



Name: Catherine MacLean, MD, PhD, FACP



EmploymentSelf Hospital for Special Surgery -- + -Household MacLean Orthodontics -- + -





Self -- + -Household None -- + -




Yes No


Yes No






SelfActivas (Allergan) stock $10,001 – 50,000 + -Gilead Pharmaceuticals stock $5,001 – 10,000 + -

Household None -- + -



Self

Medicare Evidence Development & Coverage Advisory Committee (member) $0 + -Wisconsin Value Committee (member) $0 + -National Quality Forum: Linking Cost and Quality expert panel (member) $0 + -Health Care Payment Learning and Action Network: Clinical Episode Payment Group (member) $0 + -Conference Board Health Leadership Council $0 + -




Signature Date

RELEVANT MEASURES




Catherine H MacLean Digitally signed by Catherine H MacLean Date: 2018.01.17 13:17:19 -05'00'



Name: Mark L. Metersky, MD



EmploymentSelf UConn Health -- + -Household UConn Health -- + -


MultiClonal Therapeutics: Stem cell research-$ to University $100,001 or more + -Expert witness: Various personal injury and malpractice defense and plaintiff, none for pharma industry. Cases have involved clinical issues including sepsis and pulmonary embolism.

$100,001 or more + -

Insmed: Consulting regarding bronchiectasis clinical trial design $5,001 – 10,000 + -




SelfAmerican Thoracic Society (multiple committees) $0 + -American College of Chest Physicians (multiple committees) $0 + -



SelfMy institution has received remuneration for quality improvement/performance improvement work done for AHRQ and CMS

-- + -



Yes No


Yes No





Self

Bayer: Bronchiectasis Clinical Trial-$ to University $5,001 – 10,000 + -Bayer: Bronchiectasis consultant $1,001 – 5,000 + -Grifols: Bronchiectasis advisory board $1,001 – 5,000 + -Adradigm clinical trial-$ to University $50,001 – 100,000 + -




Self Physician Consortium for Performance Improvement: multiple committees $0 + -




Jan 10, 2018

Signature Date

RELEVANT MEASURES


11. NQF 0138: Catheter-Associated Urinary Tract Infection 13. NQF 0500: Severe Sepsis and Septic Shock: Management Bundle 16. NQF 1659: Influenza Immunization 17. NQF 0039: Flu Vaccinations for Adults Ages 18 and Older 18. NQF 1659: Influenza Immunization 14. NQF 0371: Venous Thromboembolism Prophylaxis



Metersky M, Ho SY, Petrillo MK. Does hospital-based influenza vaccination result in unintended revaccination? Am J Med, 2004; 116:854-855. Metersky ML, Eldridge N, Wang Y, Mortensen EM, Meddings J. National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: Results from the Medicare Patient Safety Monitoring System. 2017; 119:83-85.

Mark Metersky Digitally signed by Mark Metersky DN: cn=Mark Metersky, o=UCHC, ou=Pulmonary, [email protected], c=US Date: 2018.01.10 11:24:27 -05'00'



Name: Robert Pendleton, MD, FACP



EmploymentSelf University of Utah Healthcare -- + -Household None -- + -





Self

Vizient: Quality and Accountability Steering Committee (member) $0 + -ECRI: Patient Safety Physician Advisory Council (member) $0 + -Vizient: Chief Quality Officers Council (member) $0 + -




Yes No


Yes No







INACTIVE (Last 3 years) Belongs to Description including amount of value or incomeCommittees, Workgroups, & Advisory Roles





Dec 18, 2017

Signature Date

RELEVANT MEASURES




Robert Pendleton Digitally signed by Robert Pendleton DN: cn=Robert Pendleton, o, ou, [email protected], c=US Date: 2017.12.18 13:10:19 -07'00'



Name: Edmondo J. Robinson, MD, MBA, FACP



EmploymentSelf Christiana Care Health System -- + -Household None -- + -

Research & Consulting Self Patient-Centered Outcomes Research Institute:

Patient and family member engagement in research $5,001 – 10,000 + -Household None -- + -








Yes No


Yes No








Self Society of Hospital Medicine, Leadership Committee $0 + -Household None -- + -




Dec 18, 2017

Signature Date

RELEVANT MEASURES




Greyson R, Harrison J, Kripilani S, Vasilevskis E, Robinson E, Metlay J, Schnipper J, Meltzer D, Sehgal N, Ruhnke G, Williams M, Auerbach A. Understanding Patient-Centered Readmission Factors: A Multi-site, Mixed-methods Study. BMJ Quality & Safety. 26(1): 33-41, 2017 Herzig S, Schnipper J, Doctoroff L, Kim C, Flanders S, Robinson E, Ruhnke G, Thomas L, Kripilani S, Lindenauer P, Williams M, Metlay J, Auerbach A. Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey. Journal of General Internal Medicine. 31(11): 1287-1293, 2016 Auerbach A, Kripilani S, Vasilevskis E, Sehgal N, Lindenauer P, Metlay J, Fletcher G, Ruhnke G, Flanders S, Kim C, Williams M, Thomas L, Giang V, Herzig S, Patel K, Boscardin J, Robinson E, Schnipper J. Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA Internal Medicine. 176(4): 484-493, 2016

Edmondo RobinsonDigitally signed by Edmondo Robinson DN: cn=Edmondo Robinson, o=Christiana Care Health System, ou=Wilmington Hospital Administration, [email protected], c=US Date: 2017.12.18 15:07:08 -05'00'



Name: Sameer D. Saini, MD, MS



EmploymentSelf VA Ann Arbor Healthcare System and University of

Michigan -- + -

Household VA Ann Arbor Healthcare system and University of Michigan -- + -


Department of Veterans Affairs: Colorectal Cancer Prevention $100,001 or more + -Department of Veterans Affairs; Performance Measure Development $100,001 or more + -American Journal of Gastroenterology: Co-editor, Red Section $5,001 – 10,000 + -




Self American College of Gastroenterology: Research Committee (member) $0 + -




Yes No


Yes No




Self FMS, Inc.: Technical consultant on simulation model development $10,001 – 50,000 + -


INACTIVE (Last 3 years) Belongs to Description including amount of value or incomeInvestment & Proprietary Interests



SelfAmerican Gastroenterological Association: Quality Measures Committee, Colorectal Cancer Measures Workgroup (lead)

$0 + -




Jan 10, 2018

Signature Date

RELEVANT MEASURES




Sameer Saini Digitally signed by Sameer Saini DN: cn=Sameer Saini, o, ou, [email protected], c=US Date: 2018.01.10 11:34:55 -05'00'



Name: Paul Shekelle, MD, MPH, PhD, FACP



EmploymentSelf Veterans Affairs; UCLA -- + -Household None -- + -


Veterans Affairs: Evidence Synthesis Program: Topics include: Evidence Maps for Complementary and Alternative Medicine Systematic reviews for: Bariatric Surgery - 2016 Multiple Sclerosis - 2016 Rural Health - 2017 Spinal Manipulation Treatment - 2017 Antiplatelet Therapy - 2017 Access Management - 2017 Cranial Electrical Stimulation - 2018 Massage for Pain - 2018

$100,001 or more + -

AHRQ: Understanding Health Care Delivery Systems PCOR Adoption and System Performance $100,001 or more + -


Self Royalties: UpToDate chapter on Spinal Manipulation Clinical Practice Guidelines Up to $1,000 + -



Self

Committee on Reproductive Health Services: Assessing the Safety and Quality of Abortion Care -- + -Committee on Evidence-Based Practices for Public Health Emergency Preparedness and Response -- + -




Yes No


Yes No




Self

AHRQ: Patient Safety Practices in Ambulatory Care Settings $100,001 or more + -AHRQ (subcontract with Cedars): When is Quality Improvement Cost Saving, Cost Effective, or Not a Good Value?

$100,001 or more + -

AHRQ: Diagnosis and Management of Gout $100,001 or more + -CMS: Analyses Related to the 2015 National Impact Assessment of Medicare Quality Measures $100,001 or more + -AHRQ: Effects of Omega-3 Fatty Acids on Child and Maternal Health $100,001 or more + -AHRQ (subcontract with USC): Partnership for Research & Dissemination of Evidence-Based Medicine in Autism

$100,001 or more + -

ACP Low Bone Density update $10,001 – 50,000 + -AHRQ: Treatment of Primary and Secondary Osteoarthritis of the Knee $100,001 or more + -ECRI Institute: Consulting, National Guidelines Clearinghouse $1,001 – 5,000 + -








Dec 21, 2017

Signature Date

RELEVANT MEASURES


Paul G Shekelle 464369 Digitally signed by Paul G Shekelle 464369 Date: 2017.12.21 11:31:44 -08'00'



Diabetes Shekelle P. ACP Journal Club. In patients with type 2 diabetes and CV disease, empagliflozin reduced a composite of CV events at 3.1 years. Ann Intern Med. Jan 19 2016;164(2):JC2. PMID: 26784492 Shekelle PG. Commentary on N Saquib et al. Does screening for disease save lives in asymptomatic adults? Systematic review of 5 meta-analyses and randomized trials. Int J Epidemiol. Feb 2015;44(1):277-278. PMID: 25596214 Qaseem A, Chou R, Humphrey LL, Shekelle P, Clinical Guidelines Committee of the American College of P. Inpatient glycemic control: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Am J Med Qual. Mar-Apr 2014;29(2):95-98. PMID: 23709472 Hypertension Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev. Jul 27 2016;5(1):126. PMID: 27460789 Shekelle P. In adults >/= 75 years of age with hypertension, intensive vs standard BP-lowering treatment reduced CV events. Ann Intern Med. Aug 16 2016;165(4):JC14. PMID: 27538175 Screening Shekelle PG. Commentary on N Saquib et al. Does screening for disease save lives in asymptomatic adults? Systematic review of 5 meta-analyses and randomized trials. Int J Epidemiol. Feb 2015;44(1):277-278. PMID: 25596214



Name: Kate Carroll, MPH



EmploymentSelf American College of Physicians -- + -Household The Beasley Firm (personal injury and medical

malpractice) -- + -








In the last 3 years, have you or any household members published on any of the following topic areas? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)


Obesity Yes No



Please review the list of measures in the attached word document. Have you or any household members contributed towards the development of one of these measures or a competing measure (measure on the same topic)?

Yes NoHave you or any household members published on any of the clinical topic areas covered by these measures? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Yes No












Signature Date




Kate Carroll Digitally signed by Kate Carroll DN: cn=Kate Carroll, o, ou, [email protected], c=US Date: 2018.01.08 10:28:13 -05'00'



Name: Sarah Dinwiddie, RN, MSN



EmploymentSelf American College of Physicians -- + -Household None -- + -





Self National Quality Forum, Interoperability Committee (member) $0 + -





Obesity Yes No





Yes No


EmploymentSelf

Drexel University -- + -Ranawat Orthopaedics -- + -







Self American Nurse's Association: Code of Ethics Committee (member) -- + -



Self The Alliance-Nursing Organization Alliance: Safe Staffing Laws (member) -- + -



Jan 5, 2018

Signature Date




Sarah DinwiddieDigitally signed by Sarah Dinwiddie DN: cn=Sarah Dinwiddie, o=American College of Physicians, ou=Clinical Policy Department, [email protected], c=US Date: 2018.01.05 13:08:43 -05'00'



Name: Shari Maguire Erickson



EmploymentSelf American College of Physicians $100,001 or more + -Household Security Industry Association $100,001 or more + -







Self Spoken publicly at Annual and other meetings on behalf of the American College of Physicians $0 + -



Yes No


Yes No












Jan 25, 2018

Signature Date

RELEVANT MEASURES




Shari Erickson Digitally signed by Shari Erickson DN: cn=Shari Erickson, o=ACP, ou, [email protected], c=US Date: 2018.01.25 11:58:06 -05'00'




Name: Darilyn V. Moyer, MD, FACP

Role: Clinical Guidelines Committee ACP Staff or Leadership Performance Measurement Committee Guest High Value Care Committee


Yes

Yes Yes



Yes No Have you or any household members published on any of the clinical topic areas covered by these measures? Please include both peer-reviewed and non-peer-reviewed sources (e.g. newspaper op-ed; blog)

Yes No


Employment

Research & Consulting Investment & Proprietary Interests

Self Household

Self

Household

Self

Household


Self


Household Self

Household

American College of Physicians Inspira Health

None

None

None

None

Council of Medical Subspecialty Societies

Subspecialty Society CEO Council

Patient Center Primary Care Collaborative

Evidence-based Benefit Design/NBGH

None

American College of Physicians PAC

None

-- --

--

--

--

--

$0

$0

$0

$0

--

$0

--

+ - + - + - + - + - + - + - + - + - + - + - + - + -


DECLARATION I certify that to my knowledge and belief that I have disclosed my financial and non-financial interests above and I will promptly disclose any changes.

January 9, 2018

Signature Date



RELEVANT MEASURES List in box below or highlight in attached document.

Self Temple University

Household Penn Jersey Pulmonary Associates

Self None

Household None

Self None

Household None

Self

American College of Physicians, Board of Regents (chair and chair-elect) Alliance for Academic Internal Medicine Advocacy Committee

Household None

Self None

Household None

Employment Research & Consulting Roles


$100,001 or more $100,001 or more

--

--

--

-- $100,001 or more

++++++

+Committees, Workgroups, & Advisory Roles $0


-- --

--

- - - - - - -

+ - + - + - + -



Name: Patricia Siemion, MS



EmploymentSelf American College of Physicians $50,001 – 100,000 + -Household International Association of Bridge, Structural,

Ornamental and Reinforcing Iron Workers (Local 401) $50,001 – 100,000 + -










Obesity Yes No





Yes No


EmploymentSelf Thomson Reuters -- + -Household None -- + -










Jan 5, 2018

Signature Date




Trish SiemionDigitally signed by Trish Siemion DN: cn=Trish Siemion, o=American College of Physicians, ou=Clinical Policy, [email protected], c=US Date: 2018.01.05 12:12:39 -05'00'



Name: Cynthia D. Smith



EmploymentSelf American College of Physicians $100,001 or more + -Household Merck and Co. $100,001 or more + -

Research & Consulting Self Centers for Medicare and Medicaid Innovation, PI,

Transforming Clinical Practice $0 + -

Household Federal Drug Administration, FDA Advisory Board, non-voting member $0 + -


Self None -- + -Household Merck: stocks, restricted stock units, stock options $100,001 or more + -






Yes No


Yes No













Jan 24, 2018

Signature Date

RELEVANT MEASURES


Measures 10, 11, 12, 13



My husband works in infectious diseases clinical research at Merck. He does not develop performance measures but designs and conducts clinical trials for antibiotics, antivirals, HIV, and other agents being developed by Merck to combat infectious diseases.

Cynthia D. Smith Digitally signed by Cynthia D. Smith DN: cn=Cynthia D. Smith, o=American College of Physicians, ou, [email protected], c=US Date: 2018.01.24 12:37:19 -05'00'



Name: Melissa Starkey, PhD



EmploymentSelf American College of Physicians $50,001 – 100,000 + -Household Teva Pharmaceuticals $100,001 or more + -





Self CMSS Clinical Practice Guidelines Component Group Vice Chair $0 + -





Obesity Yes No





Yes No








Self Guidelines International Network Membership Committee member $0 + -




Jan 5, 2018

Signature Date




Melissa Starkey Digitally signed by Melissa Starkey DN: cn=Melissa Starkey, o=ACP, ou, [email protected], c=US Date: 2018.01.05 12:10:14 -05'00'

american college of physicians department of clinical ......provided expert opinion for malpractice...

Documents