Division of General Internal Medicine Week-in-Review | November 2, 2024
Dear DGIM,
Congratulations to Andrew Maier. He received the 2024 Penn Sylvan Eisman Outstanding Primary Care Physician Award.
Congratulations to Marilyn Schapira. She received the 2024 Penn Samuel Martin Health Evaluation Sciences Research Award.
Congratulations to Jaya Aysola, Jen Myers (DHM), and Meghan Lane-Fall (Anesthesiology). They just received a large grant to establish a national coordinating center for the new network of Learning Health System Embedded Scientist Training and Research (LHS E-STaR) Centers funded AHRQ and PCORI. You can read more about it on the LDI website.
We had a lovely retirement party for Jeff Jaeger. He is heading off to the Cooper University Health System for a second career as an addiction medicine specialist. A highlight was seeing some people at the party we have not seen for a while including Susie Day (former DGIM faculty) and Angela Starnes (former PIMUC practice manager).
Paula Chatterjee and Eric Roberts have a new paper in the Annals of Internal Medicine. This paper quantifies the extent of financial precarity among Medicare beneficiaries with low-to-moderate incomes, defining financial precarity as having insufficient resources to cover the $1,600 deductible for a Part A hospital stay. They estimate that 35-51% of Medicare beneficiaries with incomes >100% to <400% of the poverty level would face significant challenges affording the Part A deductible, risking financial hardship or even impoverishment to say nothing of the costs of downstream post-acute and long-term care. Not surprisingly there were significant disparities in financial precarity by race, ethnicity, and health status. The findings highlight a need for policies to improve financial protections in Medicare for individuals who make too much for Medicaid but lack the resources to cover Medicare’s high out-of-pocket costs for hospital care.
Mark Neuman (Anesthesiology), Marilyn Schapira, and other Penn colleagues report in JAMA Network Open on a trial aimed at limiting benzodiazepines use in anesthesiology for older adults getting surgeries or procedures. This large stepped-wedge RCT with over 500,000 participants tested 1. Provider peer comparisons, 2. Direct mailed patient education, 3. Both, or 4. Neither. Compared to nothing, no approach lead to a decline in benzodiazepine use. Regardless of arm, satisfaction with care was high. While peer comparisons and direct to patient education have worked in other settings, it did not seem to in this one. Other approaches are needed if this is an important goal. Negative trials can be disappointing but just as important to publish.
Matt Klebanoff (DGIM Fellow), Paula Chatterjee, and Jalpa Doshi have an article in JAMA Health Forum looking at adoption in US hospitals of real-time prescription benefit tools (RTBTs) that show out of pocket costs for patients. According to data from the American Hospital Association's 2022 Information Technology Supplement, 68% of hospitals reported having RTBTs; however, this figure may be inflated since only 56% of acute care hospitals responded to this question. Smaller, for-profit hospitals, those not affiliated with health systems, rural hospitals, and those located in counties with lower household incomes and poorer health metrics showed lower adoption rates of these tools. Now we need to see how these tools translate into savings for patients or do providers just ignore them.
Amol Navathe, Vishnu Potluri (Nephrology), Yuvaram Reddy (Nephrology), and their collaborators have published an article in the Clinical Journal of the American Society of Nephrology evaluating a payment incentive aimed at increasing kidney transplantation and home dialysis. Using an interrupted time series approach, they examined whether the number of people listed for transplantation increased in markets where the incentive was implemented in 2021. Overall, the results revealed no significant increase in waitlist additions in the intervention markets compared to the control markets. On a positive note, the findings were consistent across different racial and ethnic groups, indicating that the program did not exacerbate existing disparities.
Congratulations to Alex Glaser and family. Their son Jordan was born last week. Everyone is doing great, most importantly their daughter is excited to be a big sister (for now).
Carmen Guerra shared a NASEM report she has been working on for the past year and was released this week titled "Rethinking Race and Ethnicity in Biomedical Research". This report urges researchers to reconsider how we use race and ethnicity in each step in biomedical research - from design to implementation/dissemination - and whether there may be more appropriate variables that are entangled with race and ethnicity that could be measured more directly (such as biology, genetics, epigenetics, diet, skin color, social determinants, etc.) which would make our science more precise. The report is already getting quite of bit of coverage. Here are links to articles in Science and STAT about the report.
Eric Roberts has a JAMA Viewpoint with his project manager Syama Patel discussing ongoing challenges with low enrollment in the Medicare Savings Programs (MSPs) - Medicaid benefits that pay for Medicare premiums and cost-sharing. They note that up to 83% of Medicare beneficiaries who likely qualify for the MSPs were not enrolled, and as a result, forgo $2,100 in premium assistance annually, plus help with cost sharing. The article describes strategies for policymakers and clinicians to help eligible individuals enroll in these programs (including using the www.BenefitsCheckUp.org portal sponsored by the National Council on Aging).
Teddy Wu enjoyed PMX week with Gritty. Love the Philly pride.
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 Medicine