Special Delivery
The SMFM ENewsletter

President's Forum 
Katie Schubert, MPP
It used to be that April was a "quiet" month on the advocacy front. Between spring breaks and various holidays, Congress traditionally takes a recess to work in their home states and districts. While Congress did do that in 2019, the advocacy work in DC and at the state level was moving fast and furious. 

SMFM has much to celebrate, but there continues to be a need to keep beating the drum. 

We have called on Congress to prioritize funding for research in pregnant and breastfeeding women. Last week, I blogged about this for the Coalition for Health Funding. For fiscal year 2020, the House Appropriations Committee has proposed a $2 billion increase in funding for the National Institutes of Health, as well as several million dollar increases for public health programs addressing maternal mortality. They also supported language to strengthen the MFMU. We will continue to work with the Senate Appropriations Committee to fund these programs.

We also have a new advocacy action alert up in conjunction with March for Moms. Please take a few minutes to write to your Member of Congress to ask them to cosponsor the MOMMA's Act. This legislation is critical to building on the work that was done last year to provide additional funding for programs directed at maternal mortality.

At the state level, SMFM is engaging in advocacy related to reproductive health services, among other activities aimed at optimizing maternal and child health. We hosted a webinar for our State Liaison Network on April 26, 2019, and I invite you to view it here. You can also learn more about our state level advocacy resources here, and to join the State Liaison Network, please click here

Finally, we are seeking more information about what you are engaged in at the state level - specifically maternal mortality review committees and other efforts aimed at reducing maternal mortality. Please take this brief survey which will help us support your efforts in the future.

Thank you for all that you do to optimize the care of women and their babies. We could not be successful without your voices!  

Kathryn Schubert, MPP
Chief Advocacy Officer 
Editor's Note 
Amber Samuel, MD
Dr. Amber Samuel serves on the SMFM Communications Committee and was one of the editors for this month's issue of Special Delivery.  A note from her: 

Welcome to the May edition of Special Delivery, the only newsletter dedicated to your specific interests and opportunities as an MFM! In addition to exciting updates from Practice Management, Coding, Advocacy (see above) and Patient Safety, this month we introduce the SMFM Thrive Initiative, aimed at fighting burnout in you and your colleagues. 

Spotlight on Ultrasound 
Register by May 17 to Guarantee Space
Learn from the leading experts in OB ultrasound at SMFM's new Ultrasound Course. Registration for the course is open until tomorrow, May 17. After that, registration will close and, space permitting, may re-open in New Orleans on May 30. To guarantee your spot, register now. If you have questions or need assistance, please contact Darryl Diamond.
Free Ultrasound Coding Webinar
On June 18 at 1:00pm (ET) we will host a free (for SMFM members) one-hour webinar called, "Common Ultrasound Coding Mistakes." Non-members can participate for just $75. Register in advance on the SMFM website and be on the lookout for additional no-cost practice management webinars later in the year.

We Want to Hear to from YOU!
Do you want to drive what ultrasound topics are covered in our upcoming coding courses? Take this brief survey and let us know what is most important to you.
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Practice Management
A Letter from Dr. Tom Lee
It is my honor to assume the position of chairperson of the Practice Management Division (PMD) of SMFM.  I would like to thank Dr. Jim Keller for his leadership and hard work to facilitate the transition of the Association for Maternal-Fetal Medicine Management (AMFMM) to now the SMFM Practice Management Division during the past several years.  Dr. Keller will continue as the past-chair and is currently leading the coordination of the SMFM Practice Management Conference, scheduled for November 8-9, 2019 in Orlando.

I would like to provide some highlights of the resources and support that the PMD and its Advisory Board have been working on beyond the conference for the members of the Society.
  • In-Person Coding Courses: These in-person conferences, developed by members of the SMFM Coding Committee, continue to be tremendously popular and valuable for both clinicians and administrative staff, especially as coding rules continue to change. Registration is now open for the next Coding Course, which will take place Orlando, FL on November 7-8, 2019, just prior to the Practice Management Conference at the same location, so attendees are encouraged to join us for both.
  • Four PMD webinars are scheduled this year covering the following topics: 
    • Common Ultrasound Coding Mistakes - June 18, 1pm ET
    • Hiring the Right Staff for your MFM Practice - August, day TBD
    • Coding Mistakes in the Office - October 9 at 2:30pm ET
    • Introduction to SMFM Practice Management Forums - December, day TBD
Prior to each webinar, we will be soliciting questions from the SMFM membership to optimize the discussion for attendees.
  • The PMD is currently in the final collection phase of its Operational Benchmarking Survey. The first in a series of surveys involving a network of over 60 participating MFM practices from across the country, we anticipate this data set will provide the most robust information regarding MFM practice patterns and benchmarks to date, and will serve as a tremendous tool in managing your practice. We plan for our next survey to examine financial benchmarks across the different models of MFM care.
  •  White paper on value-based care in MFM is coming soon!
For more information on the Practice Management Division and to get involved, visit the SMFM website.


SMFM Thrive Initiative  
The SMFM Thrive Initiative is designed to address the alarmingly high rate of burnout in MFMs (up to 50-60% in a recent survey of SMFM members). As part of this initiative, we will ask SMFM members to share their experiences. If you would like to contribute to this new column, please contact Heather Lipkind.  
Mike Foley, MD
This month, we talked to Dr. Mike Foley, an SMFM Past-President and author of "INHALE: Reflections from a Beginner on the Path to Mastery."

Have you ever felt or currently feel burned out? If so what has specifically gotten you through that time and/or what resources do you wish existed?
I have experienced career burnout. My friends and family provided the most important support structure for my recovery. I spoke with counselors and other professionals to help me understand the situation. The best tool for recovery was to create specific and meaningful goals to create life harmony. Through introspection and family discussion, I constituted and declared goals in the domains of career, family, personal, community, spiritual and financial (strings of the harmonious chord of life). Through this process, I gained back the control I was desperately trying to recover. Creating my own blueprint, as the architect of my own life plan, helped me reestablish control and purpose. My wife, family and close friends helped clear the path for me to accomplish the harmony goals in a meaningful way.

What has helped you thrive in your career and life and what particularly keeps you resilient and optimistic?
A positive mindset!  Maintaining a positive mindset opened the door to happiness which then allowed success to flourish. It is vitally important to address proper sleep hygiene, diet, exercise, and strong interpersonal relationships. Establishing clear personal boundaries is paramount to truly being able to express empathy, compassion and love.

What advice/tips can you give fellows/junior faculty to keep from burning out?
Stop trying to live a balanced life. It is exhausting and really impossible. Focus, instead, on living a life of harmony. Tune each string of the metaphorical instrument of life by constituting and declaring meaningful goals in areas of career, family, personal, community, spiritual and financial domains. In this way, you are in charge of creating a beautiful and harmonious chord of life. Love yourself!


Fellows Corner 
Thank You for the Opportunity to Attend the Leadership Academy
Emily Fay, MD
I was fortunate to receive the first annual scholarship to the Dan O'Keeffe SMFM Leadership Academy. This scholarship is generated by gifts from SMFM members to the Foundation for SMFM and is now offered yearly to a third-year MFM fellow. The application deadline for this year is June 14, 2019 with further details found on the SMFM website
The course is led by Drs. Dan O'Keeffe, Mike Foley, and Idahlynn Karre over two long weekends in Denver. The course was invaluable in so many ways. First, I learned an amazing amount about how to lead by discovering and inspiring each team member to use their strengths, how to best communicate, especially for difficult topics ("crucial conversations"), and how to improve and foster emotional intelligence. Through this course, I learned a lot about myself, including my own strengths (no weaknesses, just "lesser talents!"), communication style, and my personal leadership and relational style. I have already had many opportunities to use these valuable skills in encounters at work with colleagues and with patients, and even outside of work.
More than just leadership skills and introspection, however, I made incredible connections with other MFM physicians from across the country, in different career paths including academic medicine, private-practice, and industry. It was wonderful to pick their brains about their career trajectories, work-life balance, and glean other helpful advice (what really is the best way to study for the boards?!). We created a group text message chain that's still going strong and I've kept in touch with several people I met in the course.  I left inspired to incorporate what I learned into my current work as a fellow, and excited to think about ways to apply these skills in my future faculty career. 

Drs. O'Keeffe, Foley, and Karre continue to send out interesting articles and thoughts to keep us engaged, learning and inspired. I look forward to attending one of the class reunions to see how we all have applied what we learned, and how we all continue to change and develop over time. I appreciate the opportunity and encourage eligible fellows to apply for the scholarship to attend the next session of the Academy. 

Patient Safety Resources
Checklists for Morbidly Adherent Placenta
The Patient Safety and Quality Committee has developed two checklists for morbidly adherent placenta, available on the SMFM website.
  • One document is a preoperative planning form for cases where the diagnosis of morbidly adherent placenta is known or suspected antenatally. 
  • Another checklist is for unexpected cases, where the diagnosis is made intrapartum or intraoperatively.
These and other SMFM checklists are offered as guides. Their goal is to improve safety by promoting consistency. The use of checklists may minimize errors of omission by reminding the care team of critical steps that might otherwise be forgotten. Prior to implementation, we expect that facilities will adapt the checklists for their particular needs. Subsequent revisions may be suggested by users of the checklists. A guide to implementation of checklists is provided in an SMFM publication, The Development and Implementation of Checklists in Obstetrics.

The SMFM Patient Safety Committee is developing new checklists for various aspects of maternal-fetal care. If you have suggestions for a new checklist, please contact Katie Schubert at kschubert@smfm.org

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Foundation for SMFM
Foundation Programs Promote Mentorship
View our new video and h ear from three past recipients of our Quilligan Scholars program, Queenan Fellowships for Global Health, and Bridge Funding award about the impact of funding from the Foundation on their careers.

Help support mentoring in maternal-fetal medicine with a gift to the Foundation for SMFM.

NEW! Research Survey
Maternal-Fetal Medicine Physicians' Response to the Measles Outbreak
Drs. Neil Silverman, Lawrence Platt, Christina Han and Ilina Datkhaeva from UCLA and the Center for Fetal Medicine and Women's Ultrasound are conducting an anonymous survey on MFM physicians' response to the measles outbreak. SMFM members can help others learn how providers are managing exposed and symptomatic pregnant women across the United States.
Participation in the survey (link below) is voluntary. Please only complete the survey one time; it should take no more than 5 minutes and is meant to assess for baseline knowledge and varying practice patterns. 

Note: by participating in the above survey, you are agreeing to let scientists use this data for research and educational purposes. This study has been reviewed as exempt by the UCLA IRB.
Global Health
The SMFM Global Health Committee plans to highlight a member's work in global health each month. This month's member is Dr. D'Angela Pitts. 

Can you describe your background (fellowship, prior institutions)?
I am currently a second year MFM fellow at the University of Michigan. I plan to focus on maternal comorbidities with emphasis on obesity and obstructive sleep apnea, along with a focus on health disparities. After receiving my undergraduate degree in Biomedical Sciences from Grand Valley State University, I completed my medical degree and residency at Howard University.
What made you decide to go into global health?
During my residency, I was able to spend two weeks in Forte Liberté, Haiti performing Cesarean deliveries and fibroid surgeries, working in the ultrasound suite and preventive health clinic, and educating the healthcare workers. The trip sparked my interest in global health and inspired me dedicate my time to helping the underserved by decreasing maternal mortality with education.
What has been the most rewarding in your career?
The most rewarding part of my career is knowing that I have made a difference in my patients' life. During my recent work in Ghana, I diagnosed an acute complication on ultrasound that could have led to an intrapartum death. After the delivery, the patient gave me a huge hug and said, "Thank you for saving my life and my baby's life." Moments like these are what keep me going and motivate me to do better.
What are some of the projects that you are currently doing?
I am the 2018 recipient of the Foundation for SMFM's Queenan Fellowship. Currently, I am spending two months in Ghana providing lectures on high-risk obstetrics, perinatal laceration simulations, fetal strip rounds, and ultrasound education. Because the MFM programs at both Komfo Anokye and Korle Bu Teaching Hospital are newly developed, I am also assisting with the creation of protocols and policies. I plan on returning in six months to evaluate the programs and write a manuscript about the early success  and challenges of starting a new fellowship in a low-income country. I am also working with their fellows to identifying factors in maternal mortality in the tertiary care centers.
What advice would you give to residents/fellows who are interested in global health?
Identify a mentor(s) who can help guide you through your journey and allow you to be successful. I am fortunate to have Drs. Timothy Johnson and Lucie Moravia as my mentors for the visiting teaching fellowship. At University of Michigan, I am privileged to be a part of the second cohort of the Global Health Research Certificate Program, which introduced me to another mentor Dr. Cheryl Moyer. The program allows participants to create a foundation for meaningful collaborative relationships and research in the global health setting, and ultimately competing for extramural funding for global health research.  
Sometimes you may not have a person at your institution, but the SMFM website is an excellent way to find mentors with a similar focus.
What do you like to do outside of work?
In my spare time, I enjoy spending quality time with my family and friends. I enjoy warm weather, dancing and dining out at various restaurants. Also a huge football fan!!
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Coding Tip: Billing for an "Incomplete" Nuchal Translucency  
Amber is a 37-year-old G2P1 patient who is referred for genetic testing at 12 weeks 3 days gestation. After discussing testing options with the patient, she elects to have a Nuchal Translucency screening test. After several different attempts during the encounter, it was determined that the procedure could not be successfully accomplished because of the fetal position.
Dr. Anderson talked to his billing staff about reporting this service to the patient's insurer. They could not arrive at a consensus as to how to report this service.
The SMFM Coding Committee identifies four possible options available to report this circumstance.
  1. 76817. This could be used if the NT was attempted transvaginally and the ultrasound report includes all the required elements of 76817.
  2. 76815. This could be used if the NT was attempted transabdominally and appropriate measurements are reflected in the ultrasound report.
  3. 76813-52. This means that the work included in this service was initiated, but not completed in full. This approach is not recommended because payers often will not recognize this modifier for ultrasound services and may not pay for another 76813, if the procedure is attempted/accomplished at some later time. Do not report 76813-52 and another ultrasound code unless there was an appropriate clinical indication for the other ultrasound service (such as 76801).
  4. If none of the first three are deemed suitable, then the provider may elect to not bill for this service and simply bill for the procedure when it is completed. 
Access more coding resources on the SMFM website.
Online Coding Resources 
As the science and practice of MFM evolves, the SMFM Coding Committee partners with payers and policymakers to ensure appropriate care is provided to our patients. The Committee has:
  • Letters available on the SMFM website that have been sent to payers when an inappropriate reduction in reimbursement or services have occurred. 
  • An ICD-10 "cheat sheet" with frequently utilized codes.
  • A new web feature that allows SMFM members to submit payer denials so that the Coding Committee can assist and advocate on your behalf.  

As always, we continue to encourage members to submit general coding questions to the committee and to attend our in-person courses for a more in-depth educational opportunity.   

Congratulations Residents!
Congratulations SMFM Residency Award of Excellence Winners!
Since 2013 the Society for Maternal-Fetal Medicine (SMFM) has awarded Ob-Gyn residents who best exemplify the qualities of the vision of our Society to improve pregnancy outcomes with the SMFM Resident Award for Excellence in Obstetrics. This year we received a record 190 nominations. Congratulations to all of those who received the award!

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Contraception for High-Risk Women
NEW! SMFM Publications
SMFM released new materials intended to educate obstetric care providers and their patients about the benefits of postpartum contraception and to advocate for widespread implementation of immediate postpartum LARC placement programs.  View, "Consult Series #48: Immediate Postpartum Long-Acting Reversible Contraception for Women at High Risk for Medical Complications," which was published this month in AJOG, as well as a related podcast and patient education materials on the SMFM website.

SMFM in the News
Select media coverage of SMFM and our members is highlighted below and available in the press room section of the SMFM website. If your institution has profiled your work in their newsletter or website, please let us know by contacting Kerri Wade at kwade@smfm.org.

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Accepting Applications for SMFM Committee Service
Get Involved with SMFM
We are now accepting applications to serve on a SMFM Committee for 2020 and beyond. Committee members have an opportunity to work hand-in-hand with the Society leadership, the staff and each other to mold the future of MFM. We are seeking volunteers from all corners of the globe and all types of practice (university, community hospital, private, corporate, government) to participate in the Committees. The deadline to apply for a 2020 committee is September 20, 2019. For a full list of Committees and to apply visit the SMFM website.

One exception to the process described above is the Clinical Informatics Committee (CIC), which is new this year. CIC is seeking volunteers for several subcommittees. Contact Katie Schubert to learn more.
Did You Know...?
Nominate Someone to Serve on the SMFM Board of Directors
Did you know that any SMFM member can nominate someone to be on the Board of Directors? We encourage members to nominate colleagues that are qualified and would contribute to the Society's mission and vision. Our goal is to receive as many nominations as possible to ensure diversity and breadth of perspective in SMFM's leadership. The deadline to nominate a member is May 24, 2019. Nominees must be regular members (MFM board certified) in good standing.
Have you ever nominated someone for the SMFM Board of Directors? Tell us more.

Now Available Online
The first issue of AJOG-MFM is now available online.  SMFM members can access AJOG-MFM free of charge until December 2021 using the code below.
AJOG MFM is the latest addition to the American Journal of Obstetrics & Gynecology journals family. AJOG MFM welcomes the latest research in the specialty of maternal-fetal medicine. Themes include: practice-changing studies on maternal complications; fetal complications including prenatal diagnosis, ultrasound and genetics; as well as prenatal care, intrapartum care, and postpartum issues.

To ensure you will not lose any of future updates from SMFM due to a spam filter error, please add SMFM@smfm.org to your address book or "safe-senders list."