Week-in-Review | October 21, 2024
Dear DGIM,
Congratulations to Kira Ryskina. She was the recipient of this year’s FOCUS Early Achievement Award.
Congratulation to Jen Myers from Hospital Medicine and formerly DGIM. She was the recipient of this year’s FOCUS Award for the Advancement of Women in Medicine.
Congratulation to Jen Kogan. She was just named the Senior Associate Dean for Undergraduate Medical Education.
Congratulations to Bob Burke. He has been selected to co-Direct the VA Office of Rural Health’s (ORH) new Hospital Medicine Analytics Team (HMAT), which will work to improve healthcare for rural Veterans. Bob already works as a tele-hospitalist for the VA bringing care to rural veterans. This is a natural extension of both his clinical and research work.
Faculty Spotlight: Menaka Dhingra has joined Penn Center for Primary Care as an Assistant Professor of Clinical Medicine. She attended Cooper Medical School of Rowan University for medical school and then completed residency in the primary care track at Penn. Her interests include quality improvement and health disparities, refugee health, and gender affirming care. She enjoys spending time with friends and family, traveling, visiting museums and trying all the amazing food Philly has to offer.
Courtney Lee (our former fellow), along with Jaya Aysola and Gary Weissman (Pulm/Crit Care) have a new paper in JAMA Network Open based on Courtney’s fellowship work looking at stigmatizing language in medical notes. Using natural language processing, they evaluated over 50,000 UPHS admission notes looking for language expressing doubt about the patient’s clinical history. About half the notes were for Black patients and half were for White patients. Almost 71% contained language of doubt and the odds of doubt language being present in a note relating to a Black person was higher than a White person 1.21 (P < .001). These results were robust and similar across sites and terms evaluated without variation by sex. Given how much notes are carried forward, once doubt is introduced, it is likely to follow a patient for years.
Aaron Schwartz has a research letter in JAMA looking at spending by the VA for Veterans over 65 who are enrolled in Medicare Advantage (MA) plans. The MA plans get a per member per month payment for each enrollee, but if the Veteran uses VA provided care the VA pays. In effect, this means the government is paying twice for the care of these Veterans receive from the VA. Between 2011 and 2020 the number of Veterans enrolled in MA plans who also used VA care rose from 14% to 21%. In 2020 the VA spent over 12 billion on the care of these Veterans which was 12% of the VAs total health care spending. Over 10 years the VA spent 78 billion on the care of MA enrolled Veterans, while the MA plans got full funding to care for these Veterans. Community care is eating up the VA’s budget. Figuring out ways to avoid double paying for care may help preserve the VA’s budget.
Paula Chatterjee has a paper in the Annual Review of Public Health discussing how to save the health care safety net. In recent years, market pressure, workforce strain, and payment reform has jeopardized the funding of the health care safety net. In this paper Paula reviews what is the health care safety net and points out it is ill defined as well as current challenges with how the safety net is funded, noting that blanket policies aimed at improving general care can lead to decreased funding for safety net institutions. She then discusses recent efforts to standardize the definition of the safety net and improve the targeting of DSH payments to the appropriate institutions, as well as potential ways to better reward safety net care so that these institutions that provide critical services do not disappear. This paper builds of Paula’s important work in this area, I highly encourage that you read it.
Eric Roberts has a Viewpoint in JAMA discussing how to help dual eligible individuals navigate both Medicare and Medicaid. These two plans are complex and administered separately and choices in one may affect benefits in the other. While there are special plans that are meant to coordinate benefits (D-SNPs) only a few do so in a meaningful way. Assistance with navigation exists but Eric and his colleagues point out the problem with most. However the State Health Insurance Assistance Program (SHIP) is the best but underutilized and does not exist everywhere. Given that we are unlikely to change how these programs are funded, expanding and strengthening the SHIP program seems the best option.
Anita Lee is looking for more preceptors for the Intro to Clinical Medicine and Differential Diagnosis class. Contact her if you are interested anita.lee@pennmedicine.upenn.edu.
All submissions are open for the SGIM National Meeting. Don’t forget to submit your abstracts, clinical vignettes, and innovations. You can also sign up to review abstracts. https://annualmeeting.sgim.org/
Keep the news coming.
Judith
Judith A. Long, MD
Sol Katz Professor of Medicine
Chief, Division of General Internal Medicine
University of Pennsylvania Perelman School of Medicin