Division of General Internal Medicine

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Division of General Internal Medicine

News and Announcements

DGIM's Week in Review:

Genny Kanter a new member to DGIM (see below) had a recent article in JGIM looking at exposure of the American patient population to physicians who accept industry payments.  In this survey study, 65% of patients saw a physician who had received an industry payment in the previous 12 months, 12% knew that this information was publicly available and 5% knew whether their doctor had received a payment.  However, overall, based on registry data, only 41% of providers have received payments (i.e. patients are more likely to go to doctors that receive payments).  Also the payments received by physicians whom patients visited tended to be unusually high payments.  Of note these were general payments not research payments. Like the survey respondents I had no idea that the exposure to doctors receiving industry payments was so wide spread.  If you want to look people up for yourself here is the link. https://openpaymentsdata.cms.gov/  Also this is the link to the article and a link to a Chicago Tribune article in which Genny is interviewed about her work. https://www.ncbi.nlm.nih.gov/pubmed/28265803 http://www.chicagotribune.com/business/ct-physician-payments-0820-biz-20170817-story.html

Rahul Banerjee (a Penn Med resident), David Grande, and Jen Myers have a paper out this week in the Journal of Hospital Medicine. The paper describes predictors of showing up at a post discharge follow-up visits. Discharge visits were scheduled for half of hospitalized patients and no-show rates were about 25% (52% showed and 23% cancelled the appointment). People were more likely to show if they were older, had a short driving distance, or if the visit was for oncology (as opposed to primary care). Black race, longer hospitalizations and being discharged to a facility were associated with higher no-show rates. Now we know the problem, we need to think of ways to reduce the show rate. I know Jen has been working on a simple intervention around better discharge communication.  But also this links us back to CHWs.  Shreya Kangovi’s first CHW study showed that a 2 week CHW intervention improved post discharge show rates in low income vulnerable patients by about 12%. https://www.ncbi.nlm.nih.gov/pubmed/28786427

Kira Ryskina, Judy Shea and Judith Long recently has an article in the American Journal of Managed Care looking at “US Internists’ Awareness and Use of Overtreatment Guidelines.” This is a the second paper from a national physician study Kira conducted to better understand training and practice relating to high value care in physicians who completed training between 2003 and 2013.  While most physicians are aware of guidelines (89%), physicians who were in the bottom third of self-reported overtreatment guideline adoption were more likely to report inappropriately ordering x-rays, MRIs, antibiotics, and EKGs. While it was good to see an association between adoption and self-reported practice, the high awareness to these guidelines makes education alone an unlikely avenue to changing practices. http://www.ajmc.com/journals/issue/2017/2017-vol23-n7/US-Internists-Awareness-and-Use-of-Overtreatment-Guidelines-A-National-Survey/

Faculty Spotlight

Genevieve (Genny) Kanter grew up in Southern California, Virginia, Arkansas, and too many Midwestern states to mention. After schooling in the Midwest and at Harvard, she worked at the World Bank in Washington, DC, and lived and worked for 2 years in Johannesburg, South Africa, where she attended Nelson Mandela's inauguration (of course, this was with 50,000 other people on the public lawn). After returning to the States, she worked at the Federal Reserve Bank of Chicago and eventually found her way back to graduate school, earning a PhD in economics and in sociology at the University of Chicago. She subsequently completed an NIH postdoctoral fellowship in health and demography at Princeton University and a research fellowship in health policy and ethics at Harvard and Massachusetts General Hospital. Her current research focuses on conflicts of interest in medicine; pharmaceuticals, medical devices, and biotechnology; and physician incentives and decision-making. For fun, she drives her stick shift car on hills, listens to 80s New Wave music, and reads real and occasionally fake news.