From the Director
Hi Everyone! It's been a busy week and lots more coming up. The Chiefs and interns had a great night out at Alivia's on Thursday - fantastic turnout! Under the leadership on Bonike Oloruntoba and Kim Evans, we hosted the first annual "Southeastern Mastering the Match" symposium for under represented minorities. With over 25 students attending, it was a huge success. Many thanks to AnneMarie Thompson, Betty Staples, Mike Haglund, John Migaly, Vivianna Martinez-Bianchi and Lisa Muasher for helping with the PD panel discussions and to Juan Magana, Armando Bedoya, Alyson McGhan, Kevin Smith, Brittany Dixon, Brian Rogers, and Theresa Williamson for leading the resident discussions. A big thanks to LaVerne Johnson-Pruden for all her help! Can't wait to do this again next year!
Interview season is gearing up. Thanks to all who are helping their colleagues with coverage. Remember-- if you agree to help and then get an interview yourself, please let me and the Chiefs help you find your coverage. We are also working on mock interviews - stay tuned!
Kudos this week to our 2016-2017 VA QI Chief Matt Atkins! Also, kudos to Adva Eisenberg, Joanne Wyrembak and Jon Buggey on great SAR talks and to Lauren Ring for chairs conference. Thanks to Cory Miller and Rob Harrison for code sim for our CCU residents and to Cara O'Brien for intern sim training!
Congratulations to Kara Johnson and Zach Wegermann on their wedding!!
This weeks pubmed from the program goes to Kevin Friede for his recently published article with mentor Deepak Voora.
Friede K, et al. Gene Expression Signatures and the Spectrum of Coronary Artery Disease. J Cardiovas Transl Res. 2015 Jun 19.
Have a great week!
Aimee
What did I read this week?
Submitted by Dr. Armando Bedoya
Medicare and Medicaid at 50 Years
Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers
JAMA July 28, 2015 Volume 314, Number 4
How many people were aware that Medicare and Medicaid celebrated their 50th anniversary this year?
The reason I read this article was because as physicians we have little formal education with health insurance and health policy. Both are constructs that have shaped our day-to-day interactions with patients and will continue to do so. With the upcoming presidential election next year, health care reform again will take center stage because both Medicare and Medicaid affect so many Americans and are subject to significant partisan disagreement.
Established in 1965 by President Lyndon Johnson as part of a series of Social Security Amendments, these programs have now become the two largest public health insurance programs. They provide care for 111 million Americans, which will increase to 139 million by 2025. Combined they devour 23% of the federal budget and their spending will increase by 3.7% per year for the next 10 years. They account for nearly 50% of hospital revenues.
Medicare, modeled on Social Security, is a national social insurance program administered by the federal government to insure Americans reaching retirement age. Medicaid is a joint state and federal program (unlike with Medicare, states must contribute some proportion of the cost of Medicaid, ranging from 26% to 50%) providing need-based insurance.
Since their inception, both programs have changed drastically over the years largely due to necessity. Medicare has changed its payment system for clinicians and health care organizations, expanded eligibility, added new benefits such as drug coverage, and included private plans. Medicare is now changing again to create financial incentives to improve the quality and efficiency of care. Medicaid has expanded eligibility to cover more low-income Americans, fill gaps in Medicare coverage for elderly and disabled people, facilitate development of long-term care services, and introduce delivery system reforms.
In recent memory, the federal statute Patient Protection and Affordable Care Act was signed into law in 2010, which planned to close the coverage gap in Medicare Part D by 2020. It expanded prevention benefits, established a new income-related premium for Part D, raised the Part A payroll tax for people with high earnings, reduced the growth in Medicare payments, and initiated other payment and delivery system reforms. It also expanded Medicaid to nearly all adults with family incomes at or below 138% of the FPL with mostly federal funds.
This article is a wonderful review of the roles of Medicare and Medicaid and the challenges the two programs face from the perspectives of the general public, beneficiaries, health care professionals, health care institutions, and policy makers. As you all continue to learn pathophysiology, diagnostic modalities, and treatment regiments, keep in mind that as a physician you hold a unique viewpoint. Your patients will ask your opinion on these programs as well as general information to help guide them through the quagmire of health insurance. A basic understanding of Medicare and Medicaid is now a necessity for the modern physician.
CLINIC CORNER
Submitted by: Dr. Lynn Bowlby
Hi DOC residents!!
Welcome to Patrick Hemming, our new Gen Med attending..you will begin to see him next week, he will be doing a variety of work in addition to precepting!
A familiar face to DOC returns--Joan Levitt RN is a new care manager for Medicare/Duke Well...if you have Medicare patients (over age 65 or disabled) that need help or things aren't going well, email or staff message in Maestro Joan.
She can also figure out if they qualify..
Brandie Johnson, our wonderful front desk supervisor, has a new job with Oncology, so is no longer with us..we are interviewing now, but know there will be challenges until that job is filled!
All interns have a "ramped up" schedule, much of that was done by hand, by Brandie, so be patient please if it is not correct!
A word about narcotics--we had a case last month where oxycodone 30 mg, instead of 5 mg, was prescribed. Fortunately the patient was fine. Be sure to know the # of pills and the mg of the med when you prescribe.
I function as a consultant for the challenging patients, so fine to have pt follow up with me for further discussion.
We are working on DOC Redesign 2--more ways to help our patients and improve our clinic, so keep posted for new ideas for our challenging folks!
Remember to copy the attending on all notes..
and check out the Thrive Guide on Med Hub!
just take a quick look when in clinic , it is amazing what we have to offer!
thanks all!!
Lynn, Dani, Larry, Natasha and the DOC team!
QI CORNER
Dr. Lindsay Boole, VA QI Chief Resident
Please join us this Wednesday, August 12 at 5:30pm in the Med Res Library, for the second PSQC meeting of the year. Dinner provided!
The Patient Safety and Quality Council is our internal group focused on patient safety and quality improvement. Every year, we choose several QI projects at the beginning of the year and work together to execute them. An impressive number of abstracts, posters, and manuscripts have come out of the work of this committee. Plus, this is YOUR opportunity to get involved and improve the care we deliver at Duke!
From the Chief Residents
Grand Rounds
Friday, August 14- Dr. April Salama - Oncology
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 8/10/15 | SAR Emergency Series: Acute Pain Management |
Stephanie Giattino |
12:00/2002 | Domino's |
| 8/11/15 | SAR Emergency Series: Hypercarbic Respiratory Failure |
Eric Pollak |
12:00/2002 | Chick Fil A |
| 8/12/15 | SAR Emergency Series: Decompensated ESLD (Ascites, SBP, Hepatic Encephalopathy |
Cece Zhang |
12:00/2002 | Cosmic |
| 8/13/15 | SAR Emergency Series: Common HIV Management Questions |
Jessie Seidelman |
12:00/2001 | Saladelia |
| 8/14/15 | Chair's Conference | Chiefs | 12:00/2002 | Nosh |
From the Residency Office
STEAD TREAD 2015!
Wanted to take a second to invite you all to come support the Stead Tread, the Kempner Stead Society's annual charity event, which benefits Lincoln. It was a blast this year, and since we're due for some good weather this year, I'm sure it will be even better this time around.
Some additional information:
Please access the Stead Tread 2015 website (http://www.steadtread.org) for additional information, to securely register ($25), or make a donation
Race date/time: Saturday, September 12th, 2015 at 10:00AM (registration from 8:45-9:45)
Race location: American Tobacco Trail, starting at Solite Park on Fayetteville Road in Durham (https://www.google.com/maps/place/Solite+Park/)
Race beneficiary: Lincoln Community Health Center (and all Lincoln patients walk/run for free)
Your $25 registration fee includes an official Stead Tread 2015 T-shirt – shirts are going fast, so register ASAP to reserve your size!
Participants are welcome to run or walk, and strollers are permitted - kids under 12 walk/run for free (but should be registered by their parent/guardian)
In case you cannot make the race this year, donations can be made securely through our website
Thank you for considering supporting the Stead Tread – we really hope to see you there this year. For any questions, please contact us through our website (http://www.steadtread.org), via e-mail at steadtread5K@gmail.com, or by replying directly to me (Matt Crowley, M.D. <matthew.crowley@dm.duke.edu>).
SARs
Please know there is an excellent opportunity to hone your interviewing skills. Dr. Kathryn Pollak who is a communication coach and faculty member in the SoM will provide 4 1-hour sessions from which you can choose. In the session, Dr. Pollak will cover tips to finesse interviewing skills as well and give some a chance to role play. She also will be available for practice for their interviews in September and October.
The four sessions will be held the following dates and times:
Monday, August 17th: 12:00 noon to 1:00pm
Tuesday, August 18th: 4:00 to 5:00pm
Wednesday, August 26th: 12:00 to 12:00pm
Thursday, August 27th: 4:00 to 5:00pm
Each session will be 10 people or less, that way it’s more personalized. Please let me know as soon as possible which session you would like to sign up for. This is a very valuable tool being offered!
Book Club
Every few months, the Department of Internal Medicine Book Club joins together residents, fellows, and attendings to discuss the humanistic side of medicine through reading. Please join us for our first event of this academic year on Tuesday, September 8th from 5:30 - 7:30 pm in the Faculty Lounge! This time we're reading Changing the Culture of Academic Medicine by Linda Pololi, which tackles the changing roles of women and minorities in medicine and what ground is still left to cover.
The best news: all are welcome to attend, and thanks to help from the Program for Women in Internal Medicine and the Trent Memorial Foundation, this year books are free to ALL participants who RSVP (while supplies last)! Food and drinks will be provided.
For more questions or to RSVP, please email laura.caputo@duke.edu to reserve a spot now! We're looking forward to seeing you all there!
Thank you!
Laura M. Caputo, MD
Hospital Medicine, Durham VA Medical Center
Upcoming Dates and Events
August 21 - Housestaff Welcome Event
September 12 - Stead Tread
Useful links
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response
Opportunities
http://www.ad001.info/blasts/CKS/CKS15_05431/CKS15_05431.html