From the Director
When did it become mid-November? Hope everyone took a few minutes to enjoy the beautiful fall weekend. We continue with recruitment in full swing, so thank you all for your ongoing enthusiasm and interactions with the applicants. All told, you guys are making a great impression on your future colleagues. Turkey Bowl is right around the corner, and if the current pace of facial hair growth continues, we will have an amazingly scraggly set of Marines and Jets taking the field on Thanksgiving. Looking forward to it!
Kudos this week come from night JAR Anne Weaver to Kevin Smith and Tanya Aylward for outstanding work during her night supervising them on call, and to Jordan Pomeroy for report and Taylor Bazemore for chair’s conference. Also thanks much to our tour guides Eric Pollack, Sam Lindner, Amy Jones, Jess Tucker, Rachel Feder, Kevin Friede, Andrea Sitlinger, Kahli Zeitlow, Coco Fraiche, Emily Ray and Linda Koshy and our My Take participants Jason Zhu, Adva Eisenberg, Dan Maselli, Michael Dorry, Megan Gillum, Kahli Zietlow and Jess Tucker. MUCH appreciated!
Check out the application for the first annual Narrative Medicine workshop, put together by your colleagues Amy Jones, Anubha Agarwal, Dinushika Mohottige, and Anubha Agarwal. Links to apply are on the medicine homepage, and included at the of this post. This is an amazing opportunity for those of you who enjoy writing and reflecting on your experiences in medicine. When I was checking out the homepage, I also learned that DOC NP Julia Gamble has just won a prestigious national award from the Hillman Foundation to expand the medical respite program she has spearheaded at the DOC for the most vulnerable of patients. Congratulations Julia (and Co-PI Donna Biederman from the DUSON).
I’ve recently received the minutes from the Town Hall held by the residency council last week. I am looking forward to debriefing with Jess and Dinushika later this week, as well as meeting with the rest of the council in the coming weeks.
This week’s pubmed from the program goes to Sanja Galeb for her upcoming presentation with Ophthalmology professor Julie Woodward “Transparency of Medical Spas in NC: Who is Performing my Procedure?" at the Cosmetic Surgery Forum.
Have a great week!
Aimee
What did I read this week?
Submitted by Suzanne Woods, MD
Association of Reference Payment for Colonoscopy with Consumer Choices, Insurer Spending, and Procedural Complications
Robinson JC1, Brown TT1, Whaley C1, Finlayson E2. JAMA Intern Med. 2015 Nov 1; 175(11):1783-9
And the invited commentary: New Approaches to Controlling Health Care Costs – Bending the Cost Curve for Colonoscopy by Lieberman D, Allen J. 1789-91.
Why did I read this?
I have an interest in high value care and thought this was intriguing regarding the variation in prices charged to patients undergoing screening and diagnostic colonoscopy testing.
Background
- Cost sharing at the time of a patient receiving care has been shown to decrease patient adherence to clinical care/services.
- The Affordable Care Act lists preventive services that employers and insurers must cover with NO co-payment by the patient.
- There is wide variation in the prices charged to patients for c-scopes and providers/facilities lack incentive to restrain prices given such limitations on cost sharing as per the ACA.
- Some employers are experimenting with reference payment initiatives that offer full insurance coverage at low-priced facilities. If employees choose a high-priced alternative there is substantial cost sharing as the patient pays the difference between reference payment and what the more expensive facility charges.
- The reference payment chosen should be established at an amount to fully cover the service provided at many facilities in that community.
- This study looked at the effect of a reference payment on facility choice, insurer spending, consumer cost sharing and procedural complications for colonoscopy.
Methods
- California Public Employees’ Retirement System (CalPERS)
- All insurance claims data for c-scopes submitted 1/2009 – 12/2013
- 1/2012 reference payment program initiated. CalPERS paid the facility’s negotiated price without consumer sharing if study done at ambulatory surgery center (ASC). If the patient selected a hospital based outpatient department (HOPD) the maximum employer contribution was $1500.00 unless the procedure was deemed necessary to have at the hospital facility.
- Control group – Anthem Blue Cross patients undergoing c-scope during this time and had no reference payment initiative.
Results
- Outcomes were: facility choice, prices/payments, consumer cost sharing, procedural complications
- Summary: Patients selecting c-scope at the ASC increased, price employer paid for c-scope decreased, patients who paid for HOPD spent $678-723, and there was no association of complications with the implementation of reference payment
Conclusion
- Limitations to the study but the implementation of reference payments led to a substantial reduction in the mean price paid for colonoscopy with no observed reduction in safety.
*The associated commentary notes that as the US moves towards value-based reimbursement for health care, one approach is bundled pricing for colonoscopy. This can create a fixed fee for all services related to the procedure (anesthesia, pathology, subsequent procedures if poor preparation by patient). There could be an incentive for higher quality and enhanced patient satisfaction with an emphasis on what is important in the procedure. Reference pricing, as in this article, is another option. One would not want reference pricing to lead to a price war and subsequent lower quality of services delivered. There may be adverse effects on academic centers that have higher prices due to teaching and research. A challenge in general is that patients do not have easy access to transparent information about quality provided at different centers or cost information.
QI CORNER
This feature will return next week!
CLINIC CORNER
Clinic Corner from Pickett
Happy Thanksgiving. We too are doing a food drive. The proceeds go to the Food Bank of North Carolina. See our Turkey in the waiting room and bring any non perishable goods. We will have our Annual Pickett Road Thanksgiving Clinic celebration Tuesday November 24th at noon. Stop by for some good eats!
We are hosting our first every patient Town Hall meeting 11/18/15 to hear about patient suggestions and opinions for improving clinic.
In response to the Ambulatory Town Hall suggestions, we have purchased 4 models to help with teaching the shoulder, knee, elbow and hip joint. This will help for patients with problems in those areas as teaching to them and with preceptors. Also if we are planning a joint injection we can review the anatomy.
Sincerely,
Sharon Rubin, MD, FACP
From the Chief Residents
Grand Rounds
Friday, November 20 - Dr. Thomas LeBlanc- Serious Illness Care and Shared Decision-Making: Right Care, Right Place, Right Time
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 11/16/15 |
Recruitment-Lunch with Applicants |
N/A |
12:00 | Picnic Basket |
| 11/17/15 | MPeds Recruitment-Lunch with Applicants | N/A | 12:00 | Saladelia |
| 11/18/15 |
Resident M&M |
TBD |
12:00 | Domino's |
| 11/19/15 |
QI Patient Safety |
TBD |
12:00 | Firehouse |
| 11/20/15 |
Recruitment-Lunch with Applicants |
N/A | 12:00 | Pipers in the Park |
From the Residency Office
Annual Thanksgiving Food Drive
On behalf of the Residency Council, we are pleased to announce the start of the Annual Internal Medicine Residency Thanksgiving Food Drive! We will be collecting monetary donations via the PayPal link below, in cash (which we can collect in the MedRes office during normal office ours) or in check form, made payable to Duke University. In addition, we are happy to collect any canned or non-perishable food donations which can be delivered to the MedRes office or the ACR offices at Duke, the VA or DRH.
All monetary donations will be used to purchased gift cards to local grocery stores and those, along with the food donations, will be delivered to the social workers at the DOC and VA clinics. We would like to have all monies collected no later than November 19, 2015.
Your generosity in the past has been inspiring and as we remain committed to supporting our local community, please help us provide for those families who may otherwise go without this holiday season.
Many, many thanks!
Jen
https://www.paypal.me/dukemedres
ACLT Applications Now Being Accepted!
Ambulatory Care Leadership Track (ACLT) Applications Due December 31, 2015:
Calling all interns who may be interested in either general internal medicine or a subspecialty where your focus will be ambulatory medicine, please consider applying to the ACLT. It’s a foundation for careers in general medicine leadership, primary care, academic ambulatory subspecialties, research, or education. Program highlights:
- Three blocks of ambulatory medicine throughout JAR and SAR years, with dedicated didactic time following four key themes:
- Clinical: Expanded clinical options in fields inside and outside of medicine: sports medicine, ENT, ophtho, dermatology, obesity medicine, as well as all medicine subspecialties. Maximum 4 weeks in any one medicine subspecialty (plus subspecialty continuity clinic), minimum 4 weeks general medicine ambulatory, over a total of 24 weeks.
- Teaching: Curricula in teaching and opportunities to teach in small group as a SAR
- Scholarship: Support for preparing and presenting scholarship, ambulatory journal club
- Advocacy and health policy: seminars given by faculty in government relations and health policy throughout the year, and an advocacy trip in the spring to both Washington DC and Raleigh, NC, alternating year.
Please fill out the application linked at the end of this post and submit to Armando Bedoya and Dani Zipkin before the end of the year!
Duke Narrative Writing Project
Dear Medical Trainees,
We invite you to participate in the inaugural Duke Narrative Medicine Project.
This initiative includes a special Medicine Grand Rounds by invited speaker Anna Reisman, MD from Yale School of Medicine (Director of Yale Internal Medicine Residency Writers' Workshop) as well as a one-day workshop focused on honing the craft of writing.
Duke medical students, residents, and fellows across all departments are invited to submit narrative or reflective writing samples in advance of a one-day workshop in which participants will engage in critical and constructive feedback of each other's writing.
The writing workshop will be moderated by Dr. Anna Reisman as well as Duke faculty members who will work with you to prepare your narrative writing pieces for publication.
Please see the attached flyer as well as the application link below for additional details.
Duke Narrative Medicine Project: Writing Workshop
Saturday, February 6th 2016
Duke Medicine Pavilion
Pre-workshop dinner February 5th, 2016
Application details:
https://duke.qualtrics.com/SE/?SID=SV_2fUx5jKrPKf9ZhH
Application deadline:
Rolling submissions until January 15th 2016
Please contact DukeNarrativeMedicine@duke.edu with any questions!
Sincerely,
Duke Narrative Medicine Project Team
Amy L Jones, Dinushika Mohottige, Lakshmi Krishnan, Anubha Agarwal
Attention Medicine Residents!
We're excited to announce our next Department of Medicine book club event will be held on Wednesday, Dec. 2nd from 5:30 - 7:30 pm in the Searle Center Faculty Lounge. This time we'll be reading Abraham Verghese's book, Cutting for Stone, an award-winning novel about the orphaned twin children of a surgeon and his assistant in a war-torn Ethiopia, and how love, medicine, and family impact their decisions and lives.
As always, we have a limited number of copies available to those who would like to attend the event. If you are interested in attending, please email Laura Caputo at laura.caputo@duke.edu to reserve your copy while supplies last. We're excited to see you there!
NC ACP Call for Poster Abstracts
The North Carolina Chapter is excited to announce the Call for Poster Abstracts for the 2016 Chapter Scientific Session, taking place February 26-27 at the Grandover Resort in Greensboro, NC. As always, registration fees for the Scientific Session are waived for all Residents, Fellows and Students.
The poster competition is open only to Resident/Fellow and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Resident/Fellow-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; Residents/Fellows should contact their residency program directors), please visit ACP Online to find out more and apply.
Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application. To view ACP's guidelines and tips on preparing an abstract, click here.
We will accept as many posters for display and judging as time and space permit.
The deadline for submitting entries is Friday, December 11, 2015, at midnight.
Abstracts can only be submitted electronically online. To electronically submit an abstract, go to http://www.acponline.org/about_acp/chapters/nc/abstract15.htm.
Why Submit?
Educational opportunity to showcase your work.
Best Clinical or Basic Research, Clinical Vignette, Quality Improvement, High Value Care, and Student Poster will each receive a cash award of $300 and reimbursement of travel expenses to the 2016 ACP Internal Medicine Meeting to present their poster.
Best Overall Poster will receive an additional cash award and reimbursement of travel expenses to the 2016 ACP Internal Medicine Meeting to present the winning poster.
For questions concerning this poster competition or the Scientific Session, please contact Nancy Lowe, CMP, Associate Director of the North Carolina Chapter, at nlowe@ncmedsoc.org.
Thank you,
Peter Lichstein, MD, FACP
ACP Governor, North Carolina Chapter
General Medicine Health Services Research Fellowship at Duke (Attention SARS!)
Health services research (HSR) is multi-disciplinary and focuses on the impact of systems of care, access, cost, quality, behavior and other factors on health care outcomes. We have a very robust network of support and outstanding faculty in HSR at Duke. Here is an introduction to our fellowship, courtesy of David Edelman. The application cycle begins in January!
The Division of General Internal Medicine collaborates with the Center for Health Services Research in Primary Care in the Durham VA Medical Center to offer fellowships for MD and PhD scholars with an interest in training in clinical or health services research. The fellowship is ordinarily a two year program, though three year fellowships may be available to certain candidates. Training grants are funded by the VA Office of Academic Affairs (OAA). We have trained more than 100 fellows in our 30-year history, including many leaders in Health Services Research and many of our core faculty in General Internal Medicine.
The primary goal of the post-doctoral fellowships is for fellows to perform high-quality, mentored clinical or health services research working closely with a mentor from the Division of General Internal Medicine. MD fellows ordinarily obtain a Masters in Clinical Research from Duke’s CRTP program, with tuition paid by the fellowship. All fellows also participate in a Faculty/Fellow Development Seminar Series, a set of weekly, one-hour discussions addressing a variety of career development topics. Stipend is at the appropriate PGY level.
Senior Residents wishing to apply for July 2016 should contact Dr. David Edelman, Fellowship Director (David.Edelman@duke.edu) no later than Friday, January 9 to express interest. Written application will be due February 1 with interviews competed by the 3rd week in February and applicants notified of their status by March 1.
Click the link for more info:
http://www.durham.hsrd.research.va.gov/MD_fellowship.asp.
Or, contact David Edelman, MD, Fellowship Director (david.edelman@duke.edu).
Annual Call for New Ideas
The Journal of Graduate Medical Education is seeking brief articles on novel ideas in curricula, teaching, assessment, quality and safety, program evaluation, or other topics relevant to graduate medical education. Selected papers will be published in the July 2016 issue.
Criteria
New Ideas must describe an intervention that is novel.
The intervention must have been implemented at least once; longer implementation is preferable. While outcomes data may be preliminary; feasibility (effort, costs) and acceptability (to subjects) must be discussed.
Preliminary evidence should suggest the intervention is successful.
The intervention can be replicated in other specialties.
New Ideas manuscripts must
Follow required manuscript format
No more than 650 words
Organized into 3 parts:
Setting and Problem
Intervention (the “New Idea”)
Outcomes to Date
May include 1 figure or table
Descriptions should not include a literature review or references
Be submitted via the online editorial management system by 8:00 am CT, Monday, November 16, 2015.
Acceptance decisions will be communicated by January 31, 2016.
NOTES:
Due to the brevity of these submissions, manuscripts that are not accepted will not receive editor comments.
Manuscripts not following the required submission format and/or submission deadline will not be considered.
If you have additional questions, please contact the Journal office.
Opportunities for Wellness
Feeling down? Need to talk to someone?
All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE.
https://www.hr.duke.edu/pas/
Upcoming Dates and Events
November 26 - Turkey Bowl
December 2 - Fellowship Match Day!
December 12 - DOM Holiday Party
Useful links
GME Mistreatment Reporting Site
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
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx