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As I sit to write my last "Letter from the President," the 37th Annual Meeting in Las Vegas is just a few weeks away, and it hardly seems possible that it is nearly a full year since I took over the reins of SMFM from Laura Riley in Atlanta. Although a 37th anniversary is not one typically treated with fanfare, it nevertheless has been an important year for SMFM and there is much to celebrate.
The most important accomplishment this year has been the hiring of Matt Granato, our new CEO. With the retirement of Pat Stahr last spring, and the significant growth of the Society, the Board of Directors agreed that the Executive Director position should be expanded to a true CEO role. We formed a search committee and spent many hours drafting a job description and thinking about important attributes of the best candidate for this new position. I know I speak for the Board, the Executive Committee, and Dan O'Keeffe in saying that we could not have found a better individual to help lead us forward into what promises to be an exciting new era.
Over the past several years, the activities of SMFM have expanded exponentially, with creation of more committees that are active in providing education, communication, advocacy, clinical guidelines, and other components of our core mission. This year alone we accomplished the following:
- We published five consults, one clinical guideline, five clinical statements, two Obstetric Consensus Care documents (jointly with ACOG), and three other joint Committee Opinions and other documents with ACOG, as well as endorsing three other documents published by ACOG and AIUM. Many of these documents also provided the basis for patient education pieces, safety checklists, and other related documents.
- We conducted several workshops in collaboration with other organizations, and our workshop at the Annual Meeting on Prenatal Genetic Testing will be attended by a large number of stakeholders and promises to be an invaluable consideration of how to optimize care in this complex area.
- Our relationship with BabyCenter was formalized this year; we are now able to help provide high quality information for patients, by reviewing their content relevant to high-risk obstetrics, and publishing some of our material on their website.
- Advocacy efforts, including those involved with the Coalition to Advance Maternal Therapeutics, led to the creation of a federal task force to advance research and information sharing on medications in pregnancy and breastfeeding.
- We have developed in-person courses, online courses and lecture series, and the SUM (Self stUdy for Mastery) Program.
All of these many activities require staff support, and this year has seen the addition of Katie Schubert in the new position of Chief Advocacy Officer, and Kerri Wade in the position of Communication Director. Kathleen Scogna will also be helping Beth Steele with the Publications Committee. The addition of new staff requires expansion of space, and the SMFM staff will be moving into new, larger space in the building we share with ACOG. All of these many developments are exciting and speak to our vibrant activities, the engagement of our members, the endless energy of many volunteers, and the overall impressive success of SMFM.
A challenge of our success is that the number of people who want to be involved is far greater than the number of opportunities. A common concern of the members has been confusion regarding the composition of the various committees, and lack of transparency in how committee members are selected. We have responded by creating a consistent process for members to apply for committee membership, which has allowed more opportunities for interested individuals to become involved. We recognize that diversity is important not only to assure representation of the many perspectives of our Society members, but we also know that diverse representation leads to increased success of an organization. In order to assure a pipeline for diversity in the leadership of our specialty, this year we have put together the SMFM Task Force on Enhancing Diversity in MFM Leadership. We are planning a reception for interested members at the annual meeting in Las Vegas.
This year, we are embarking on a strategic planning process to thoughtfully consider what should be our priorities and focus over the next three years. An important component of that process is a member survey that will be sent out in the months after the Annual Meeting. Please do answer the survey; your feedback is important in guiding our future direction and we very much value (and need) your input!
Finally, I want to take this chance to thank you all for giving me this opportunity to serve as the SMFM President. It has been an honor and truly a pleasure to work closely with such an amazing group of volunteers, members, and dedicated staff. As I pass the gavel to Alfred Abuhamad, and Sean Blackwell joins the Executive Committee as President-Elect, I know that SMFM is in great hands and will continue on its trajectory of success. I very much look forward to seeing you all in Las Vegas, where we have the luxury of much more space, meaning we'll have more posters (and more space to enjoy them!) and more orals than in previous years.
Happy New Year!
Mary
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Reporting Complications in Pregnancy
When No Specific Codes Exists
One challenge for ICD-10-CM code selection for MFMs is the presentation of symptoms or conditions for which a precise diagnosis code does not exist. ICD-10-CM offers several categories and subcategories from which to choose. They are:
O09.89 Supervision of other high risk pregnancies
O26.89 Other specified pregnancy related conditions
O36.89 Maternal care for other specified fetal problems
O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium
O09.89
This subcategory should be the primary diagnosis when a patient is seen for a scheduled antepartum visit and they are at high risk for a condition, for which there is not a specific "high-risk" code in the other parts of the O09 category.
Example:
The patient has a history of gestational hypertension in a previous pregnancy. There is no indication of gestational hypertension yet in this pregnancy, which is in the 2nd trimester.
Primary Diagnosis: O09.892; Secondary Diagnosis: Z87.59
O26.89
This subcategory should be used when a patient presents with a condition that is likely caused by or related to the pregnancy, but for which there is not a specific code.
Example:
The patient presents in the 2nd trimester with complaints of bilateral lower abdominal and low back pain. The physician attributes the symptoms to pregnancy-related musculoskeletal changes.
Primary Diagnosis: O26.892; Secondary Diagnoses: R10.30, M54.5
O36.89
This subcategory should be used when there is a fetal issue, for which a specific code does not exist.
Example:
In the third trimester, a patient presents for a regular visit for her singleton pregnancy. During the encounter, routine antenatal screening indicates that there are abnormalities in the fetal heart rate.
Primary Diagnosis: O36.8930
O99
This category is to be used when the patient presents with a condition affecting their pregnancy. In most cases, this will be a condition that pre-dated the pregnancy, but there is not a code that describes that pre-existing condition in pregnancy (such as hypertension or Type I or Type II diabetes).
Example:
A patient in the 2nd trimester presents for a consultation regarding the management of her Crohn's disease in pregnancy.
Primary Diagnosis: O99.612; Secondary Diagnosis: K50.90
O99 has several different categories for diseases affecting pregnancy, grouped based on the organ system affected. If the patient presents with a condition not associated with one of the organ systems listed under O99 (e.g. Systemic lupus [M32.9]), then the primary diagnosis is
O99.89 (Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium).
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SMFM Annual Meeting Clearinghouse
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Official Meeting Information
Information on Las Vegas
Help Spread the Word #SMFM17
- Show your Facebook followers what MFMs and our Society do, and help spread the word on the new research being presented at #SMFM17. Click here and follow the simple instructions to temporarily change your profile picture.
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Introducing Kerri Wade, Director of Communications
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Kerri Wade joined SMFM headquarters staff on January 3rd as the Director of Communications. She will be responsible for enhancing SMFM's visibility and stature among the media, women's health organizations, industry, government entities, and the general public. 
Prior to joining SMFM, Kerri's experience includes nearly 10 years overseeing the media relations and government affairs activities at the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Before that, Kerri held positions on Capitol Hill and in the not-for-profit sector. She earned a Master's degree in Public Administration from George Washington University and a Bachelor of Arts degree in political science from the University of Michigan, Ann Arbor. Kerri, her husband, and their daughter live in Washington, DC.
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Foundation for SMFM Activities at 37th Annual Meeting
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The Pregnancy Foundation has become the Foundation for SMFM and in 2017 we are celebrating 25 years of training physician scientists in maternal-fetal medicine! Thanks to all  who made contributions in 2016 that allow us to advance care in pregnancy through research and education. We look forward to seeing SMFM members at the upcoming Annual Meeting at Caesars Palace. Here are some ways you can become involved and knowledgeable about the Foundation:
- Attend the "Foundation Update" on Friday, January 27 at 7:30 am in Augustus Ballroom. We'll be highlighting the 25th anniversary of our Scholars Program and acknowledging donors and asking for your continued support.
- Participate in the 5K Run/Walk on Saturday, January 28 at 6:30 am - register here.
- Stop by Booth #510 in the Exhibit Hall to visit with our board members, scholarship and grant recipients and learn how you can get involved in Foundation for SMFM activities.
- Take a break at the Relaxation Station located just outside the Exhibit Hall entrance! Get a ticket for a free 10-minute seated neck and shoulder massage from our sponsor, Hologic, in Booth #129.
As always, we are grateful for your continued support of the Foundation and its programs. Donation forms will be available at the meeting or contribute online today.
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 Practice Management Special Interest Group
The Association for Maternal Fetal Medicine Management (AMFMM) will again be presenting a valuable session at the Annual SMFM Pregnancy Meeting. This session will provide the attendees the chance to hear two speakers who are amongst the most knowledgeable about MFM practice management in the nation.
- Leslie Protomastro is the Chief Operating Officer of Maternal Fetal Medicine Associates which is a large practice in the competitive environment of New York City
- Frank Ciafone brings the unique perspective of decades of experience as a consultant focusing on maternal fetal medicine practices.
Their talks, followed by interaction with attendees, will make this a session you will not want to miss.
AMFMM is the practice management affiliate of SMFM, most noted for outstanding business meetings held annually. Save the date for the 2017 meeting to be held in Orlando, Florida on September 14-15.
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Informatics Committee Update
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Free App to Reduce Rate of Preterm Birth
SMFM brings the first evidence-based App aimed to optimize the management of pregnancy and to reduce the rate of preterm birth. This free App utilizes peer reviewed and Society-endorsed algorithms for mitigation of risk factors in preconception and pregnancy care. The key drivers for prevention of preterm birth are those identified and managed in the peer reviewed literature and Society guidelines.
To View the Full App Description, Click Here:
To Access the App, Visit the App Store:
The development of SMFM Preterm Birth Prevention and Management App is supported by an unrestricted educational grant from AMAG Pharmaceuticals.
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The SMFM App
You can find instructions on how to download the App here. The App contains SMFM guidelines, statements, fellow lectures, coding documents, pocket tools, newsletter links, and social media quick-links in an easy-to-navigate format.
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Update Your Member Profile Today!
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Is Your SMFM Member Profile Up-To-Date?
SMFM member profiles have the capacity to capture valuable information on the interests and professional expertise of Society members. Help us improve this important communication tool by updating your member profile today!
- Go to https://www.smfm.org/users/sign_in and sign-in to your account.
- Click on the 'Account' tab from the menu bar at the top of the page.
- Select 'Profile' from the rollover menu.
- Add or update your contact information, education information, communication preferences and areas of interest.
- Select the 'Update Preferences' icon at the bottom of the page.
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Results of the Associate Member Survey
By Jasmine Lai (Associate Member Representative)
Associate members are all SMFM members currently in fellowship, or any recent graduate of an ABOG-approved MFM fellowship who are not yet MFM board-certified. With over 600 Associate Members in SMFM, we represent a large proportion and voice of the membership. We recently conducted a survey of Associate Members to get a better understanding of their current experiences in fellowship and in practice.
Incoming Fellows were asked about their recent fellowship interview experiences:
Incoming fellows cited difficulty in arranging coverage, timing of interviews, and cost as reasons that they did not interview at more programs. Thanks to the Fellowship Committee, work is continuing in an effort to consolidate, regionalize, and improve the overall interview experience for residents applying in our field.
Second and third year fellows were asked about their current fellowship experiences. The majority of these fellows (56%) take solo in-house call, with back-up MFM faculty available by phone; 19% reported taking in-house call with back-up MFM faculty in house, and almost a third reported taking home call, coming in to the hospital for deliveries or urgent consults. A quarter of fellows responded that their programs offer an extra stipend for taking call. Two thirds of respondents reported that their program allows them to moonlight.
Responses were varied regarding the mandated ICU rotation, and fellows were mixed as to whether they rotated in the surgical or medical ICU. While several respondents wished for a more specific role in the ICU for the MFM fellow, an equal number noted that it was helpful to re-learn the basic principles of ICU management in regards to certain diagnoses that can also affect pregnant women.
For third year electives, the majority of fellows reported plans to spend that time on research, fetal echo, and ultrasound. Others plan on increasing D&E experience; CVS training; exposure to infectious disease clinic, genetics, fetal surgery, cardiology, and other medical subspecialty clinics; or finishing their MPH. Others will spend their time doing away rotations, one in global health, and another with Dr. Foley in critical care.
One of the goals of the Fellowship Committee is to increase fellow attendance at SMFM's Annual Meeting. When asked, 91% of respondents reported that their program gives fellows time to attend; 88% of fellows responded that their program provides monetary support to attend. Fellows report a median of $2,000 provided by their programs each year for meetings, textbooks, and educational expenses.
Recently graduated fellows and recent associate members in practice were asked about their current practice. All respondents replied that they do a mix of inpatient/outpatient work. About one quarter report taking in-house call, while the other three quarters take call from home. The majority (70%) are still doing research in their current practice, and 85% of respondents report having a teaching role. However, 62% of those surveyed reported that they are not affiliated with an institution that has an MFM training program.
On a ten-point Likert scale, with 10 being "strongly agree," 61% of fellows report a score of >8 for fellowship preparing them well for ultrasound reading; 53% felt well-prepared for ultrasound scanning; 23% felt well-prepared for genetic counseling; 8% felt well-prepared for billing and coding; and 15% were well-prepared for maternal critical care (scores of >8).
In regards to procedures in the last year, the majority of recent graduates and newly in practice Associate Members were doing:
- 0 CVS (mode; range 0-10)
- 14 genetic amniocenteses (mean)
- 13 cerclages (mean)
- 0 intrauterine transfusions (mode; range 0-5)
- 2 peripartum hysterectomies WITH gyn oncology (mean; range 0-5)
- 0 peripartum hysterectomies WITHOUT gyn oncology (mode; range 0-5)
When asked about how they ultimately decided on where they are currently practicing, a large number of Associate Members listed spouse's career/job as the deciding factor for where they are currently working. Others cited location (and proximity to family), desire to be at an academic practice, and desire to do maternal medicine and critical care.
These Associate Member surveys will be conducted on an annual basis, so please respond to the next set of surveys, which will be emailed in June. Thank you to all who responded!
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The women included in the ALPS trial had to have a "high probability" of delivery in the late preterm period. The indications included PROM, evidence of active preterm labor, or medical/obstetrical indications for delivery (e.g. preeclampsia). Women with preterm contractions without evidence of cervical change were not included.
- Contributor: Anonymous
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Spring 2017 Coding Course
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Registration Now Open
The 2017 Coding Course will take place May 11-12 in San Diego, California. This is a great opportunity you or your administrative staff to acquire a better understanding of MFM coding. Correct coding results in quicker reimbursements, better rates for procedures, and increased income for your practice. For more information and to register, visit the SMFM website.
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