Mental Health and Substance Use Disorder Section of My Healthy Community Dashboard

The Delaware Division of Public Health (DPH), in collaboration with the Delaware Division of Professional Regulation (DPR), announced important updates to the Mental Health and Substance Use Disorder section of the My Healthy Community (MHC) Dashboard. These updates are located within this section’s Prescription Monitoring Program (PMP) tab and present trends in prescription drug dispensing in Delaware. The most notable update to the PMP page is a color-coded matrix to identify communities that may be at higher risk of Opioid Use Disorder (OUD). The rate of prescriptions for high dose (greater than or equal to 90 Morphine Milligram Equivalents [MME]) and extended-release opioids are indicators of a high need for treatment.

Legislation Builds on Coordinated, Statewide Action to Fight Climate Change

Governor Carney joined members of the General Assembly, members of his Cabinet, and advocates on today to sign multiple pieces of legislation aimed at tackling climate change in Delaware. 

The pieces of legislation signed will:

• House Bill 99: Lays out targets to reduce net emissions by 50% by 2030 and 100% by 2050.
• House Bill 10: Sets targets for purchasing electric school buses.
• House Bill 11: Ensures large commercial buildings are equipped for solar installation.
• House Bill 12: Expands the Electric Vehicle Rebate Program
• SS 1 for Senate Bill 103: Amends Delaware code to make it easier to bring EV chargers into residential areas.
• Senate Bill 170: Commitment to study offshore wind with neighboring states and PJM.
• SS 1 for Senate Bill 7: Expands the Delaware State Energy Office.

Potentially Affects Thousands

The Centers for Disease Control and Prevention (CDC) reports that between 2010 and 2022, there were more than 110,000 suspected cases of alpha-gal syndrome identified. Alpha-gal syndrome (AGS) is an emerging, tick bite–associated allergic condition characterized by a hypersensitivity to an oligosaccharide found in most mammalian meat and products derived from it (milk, other dairy products, and some pharmaceuticals). Symptoms range from mild (e.g., a rash or gastrointestinal upset) to severe (anaphylaxis); onset typically occurs ≥2 hours after exposure to alpha-gal. No treatment or cure is currently available. Because the diagnosis of AGS requires a positive diagnostic test and a clinical exam, and some individuals with AGS may not get tested, it is estimated that as many as 450,000 people might have been affected by AGS in the U.S. Studies show that many health care professionals are not familiar with this emerging and potentially life-threatening allergic condition, also known as the red-meat allergy or the tick bite meat allergy. Of those aware of AGS, knowledge about diagnosis and management is low. When patients have symptoms two to six hours after eating meat or dairy products, consider testing for alpha-gal lgE.

New Model Enhances Care Coordination, Increases Support for Caregivers

On Monday, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services. The GUIDE Model will be tested by the Center for Medicare and Medicaid Innovation. The new pilot program will test a per-patient per-month amount payment model for those who provide support services to patients with dementia. Medicare Part B-enrolled health care professionals who are able to bill for Medicare Physician Fee Schedule services and agree to the requirements of the GUIDE model are eligible to apply. CMS will release the application for GUIDE, a voluntary, nationwide model, in fall 2023. Prior to the application release, interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023. The model will run for eight years beginning July 1, 2024. Guide Model fact sheet.

Naloxone is the Standard Treatment in Reversing Effects of Opioid Overdose

On Friday last week, the U.S. Food and Drug Administration (FDA) approved RiVive, 3 milligram (mg) naloxone hydrochloride nasal spray for over-the-counter (OTC), nonprescription use for the emergency treatment of known or suspected opioid overdose. This is the second nonprescription naloxone product the agency has approved, helping increase consumer access to naloxone without a prescription. The timeline for availability and the price of this nonprescription product will be determined by the manufacturer.

Cutting-Edge AI Gastrointestinal Lesion Software Detection System

The U.S. Food and Drug Administration (FDA) on Monday cleared an artificial intelligence (AI)-assisted colonoscopy device, the MAGENTIQ-COLO. The device offers a significant increase in Adenoma Detection Rate and helps identify lesions in real time. The device will be available in the US in the coming weeks.

Hospice Care Contributed to $3.5 Billion in Medicare Savings in 2019

Delaware Hospice’s CEO, Susan Lloyd, was one of three speakers who presented key findings from the Value of Hospice in Medicare study on Capitol Hill last week to congressional staff. The study, published in March of this year, shows that patients’ use of hospice care contributed to $3.5 billion in savings for Medicare in 2019, while providing multiple benefits to patients, families, and caregivers. The research study, conducted by the National Opinion Research Center (NORC) at the University of Chicago, is one of the most comprehensive analyses of enrollment and administrative claims data for Medicare patients covered by Medicare Advantage and Traditional Medicare. To access the full report and related materials, visit nhpco.org/hospiceworks.

Consider a Donation to DFMS or DMEF

The 2023 Annual MSD Mission Appeal is under way!  Your generous support allows MSD to provide advocacy, representation, public service, and education to equip doctors with the tools they need to keep our communities healthy. MSD has been working diligently this year on strategic legislation, critical resolutions with the AMA, targeted education, and improving the lives of those in the community. You should have received a letter from us detailing key highlights from 2023. The letter highlights the efforts across the organization to promote the practice and profession of medicine to enhance the health of our communities. Now is the time to support the Annual MSD Mission Appeal to ensure programmatic viability and sustainability. Please consider a donation to Delaware Foundation for Medical Services (DFMS) or Delaware Medical Education Foundation (DMEF). Thank you to all who have already supported the 2023 Mission Appeal. For questions, please contact Lisa Gruss, External Affairs and Development Officer at Lisa.Gruss@medsocdel.org or (302) 893-3907. 

Save on Your Yearly MSD Membership Renewal by Applying

Hospitals, physician practice groups, and affinity groups can take advantage of MSD's group membership renewal discount program and save money on the 2024 regular membership dues! Discounts are applied to those membership categories that are not already discounted. Solo practitioners - get creative and form your own network of physicians to qualify (such as your call group). All physicians within the group must be members of MSD to qualify. Eligibility for the group discount is contingent upon membership application approval for those who are not currently members. Groups must be enrolled in the program by 4pm on Friday October 13, 2023. Groups who participated in the program in previous years must re-enroll annually. If your group is interested, contact Michelle.Seymour@medsocdel.org or (302) 224-4905 for details and to start the enrollment process. Download the enrollment form for the 2024 membership cycle. (Note: one enrollment form is for Hospitals and one is for Private Practices.)

Award Pays Tribute to MSD's First President, James Tilton, MD

The Medical Society of Delaware together with the Tilton Society have begun the process to identify the 2023 recipient of the Tilton Award. This prestigious award pays tribute to MSD's first President, James Tilton, MD, who was a medical pioneer, innovator, and statesperson. The award recipient will meet the characteristics of Dr. Tilton, first and foremost being a member of MSD: 

Learn More About How You Can Help the Voluntary Initiative Program (VIP)

On Tuesday, members of the Medical Society of Delaware’s Voluntary Initiative Program (VIP) team joined the University of Delaware’s HEALTH for All program and other community partners at the Route 9 Library in New Castle. Members of the community were offered health resource materials and health screenings from multiple organizations. MSD’s VIP staff provided information on the Health Care Connection (HCC) program, a state program designed for Delawareans who are uninsured to help connect them with a health home, schedule needed medical visits with specialists, as well as medication assistance and chronic disease programs. Learn more about the UD HEALTH for All program: ttps://healthforallde.org/communitypartners. Learn more about VIP and the HCC program: http://dhss.delaware.gov/dhss/dph/dpc/chap.html. Learn how to join the VIP network of physicians and practitioners across the state who support the HCC Program: https://www.surveymonkey.com/r/VIPEnrollment.

To Comply with 21st Century Cures Act

Managed Care Organization-Only Providers (MCOPs) contracted with the Delaware Division of Medicaid and Medical Assistance (DMMA) Managed Care Organizations (MCOs) must comply with the 21st Century Cures Act, by registering with the Delaware Medical Assistance Program (DMAP). All providers are required to verify and enroll their correct Medicaid ID number and address in order to continue to receive Medicaid reimbursement for services. Failure to comply will result in the termination of their Medicaid contracts. A large number of clinicians have not registered and could be in jeopardy of having their Medicaid contract terminated. The state of Delaware continues to conduct outreach and mitigation efforts to discourage termination of contracts to ensure that Delaware maintains an optimum network to provide needed services to members. Note… Clinicians who are currently engaged (actively working) with the DMAP screening and enrollment process are not at risk of suspended payment(s) and/or termination from Delaware MCO network participation. DMMA has scheduled a lunch-time Q&A on August 10th at 12:00pm. If you have questions about this request and are available to join the Q&A event, please register. For assistance with enrollment or questions, please email the Provider Enrollment Team at delawarePRET@gainwelltechnologies.com. NOTE: This content information as given by DMMA includes the use of the word "provider" and has not been altered by MSD.

Health Care Professionals Should Closely Monitor Prescribing Practices

Amid the prescription stimulant shortage in the US, the US Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) on Tuesday penned a joint letter calling on drugmakers to boost manufacturing and on health care professionals to closely monitor prescribing practices. Although the FDA and DEA do not manufacture drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug, the agencies are working closely with manufacturers and others in the supply chain to understand, prevent, and reduce the impact of the shortages.

Central Florida Accounted for Eighty-One Percent of Cases in Florida

The CDC is reporting that cases of leprosy, also known as Hansen's disease, are showing a gradual increase in incidence in the U.S., more than doubling in the southeastern states over the last decade. According to the National Hansen's Disease Program, 159 new cases were reported in the U.S. in 2020. Florida was among the top reporting states. Central Florida, in particular, accounted for 81% of cases reported in Florida and almost one-fifth of nationally reported cases, which indicates it might be an endemic location for the disease. Travel to Florida should be considered when conducting leprosy contact tracing in any state.

Conformable Ultrasound Breast Patch for Deep Tissue Scanning, Imaging

An experimental wearable device for performing ultrasound exams of the breast would allow high-risk patients to monitor themselves at home in order to detect tumors at early stages, an early study suggests. The device would be particularly valuable for patients at high risk of developing breast cancer during periods between routine mammograms. Such "interval cancers" account for up to 30% of all breast cancer cases and tend to be more aggressive than those found on routine screening. Currently, the scanner must be connected to the same kind of machines used in hospitals in order to see the images. The researchers are developing a miniaturized version of the imaging system. Ultimately, artificial intelligence could be used to analyze how the images change over time.

First Governor to Serve on the ACHP Since 2010

An independent federal agency, the Advisory Council on Historic Preservation (ACHP) promotes the economic, educational, environmental, sustainability, and cultural values of historic preservation and advises the President and Congress on historic preservation policy. It also influences federal activities, programs, and policies that affect historic and cultural properties. ACHP Chair Sara C. Bronin on Thursday administered the oath of office to new ACHP Governor Member John Carney, the governor of Delaware. President Joe Biden appointed Carney to the ACHP for a term ending June 2025. Governor Carney is the Governor Member of the ACHP, the first governor to serve on the ACHP since 2010.

Helping Individuals Experiencing Homelessness

On Friday, August 4, Lt. Governor Bethany Hall-Long will join the Federal Delegation, elected officials, and advocates to celebrate The Springboard Collaborative’s Pallet Village in Georgetown. The Springboard Collaborative is a nonprofit focused on providing innovative solutions that help individuals experiencing homelessness thrive. The organization has worked in partnership with First State Community Action Agency, Healthy Communities Delaware, and other agencies to provide wraparound services, job training, and dignified dwellings to our most vulnerable neighbors. 

Steps to be Taking Now to Make the End of the Reporting Year Stress-Free

Make sure you’re not letting your MIPS duties lapse. To help you optimize scores and minimize practice burden, below are ways to stay on top of MIPS month by month. Being proactive now will set you up for MIPS success!

Here’s a brief look at what to be doing for MIPS in August:

• Evaluate where your practice stands in terms of Quality. If you’re not where you want to be, consider some micro-training opportunities
• The Security Risk Analysis is the #1 reason practices fail MIPS audits! This is a scoreless prerequisite. Now is a great time to secure our services to get started on your SRA
• If you haven’t already, you can download the Cost data for your TIN. Review cost by patient to manage cost while optimizing their care

AMA Debunks Myth

When patients have multiple tests ordered, separate notifications for results can overload a primary care physician’s inbox. Must each individual test result be reviewed? The American Medical Association (AMA) indicates, to the best of their knowledge, there is no federal regulatory policy mandating that all test results be sent to and reviewed by patients’ PCPs. In fact, the results reporting standards of the Clinical Laboratory Improvement Amendments, a Centers for Medicare and Medicaid Services program that ensures quality laboratory testing, requires that laboratory results be released to the ordering clinician and—as mandated by the 21st Century Cures Act—the patient. As the AMA STEPS Forward® EHR Inbox Reduction Checklist phrases it, “You order it, you own it." To support this transparency, the Office of the National Coordinator for Health Information Technology guidance emphasizes that the ordering clinician should be identifiable on all ordered tests and test reports in the electronic health record (EHR). This guidance also stresses that, if available, the clinician responsible for follow-up should be listed as well. Unless the patient’s PCP is the ordering physician or the physician responsible for follow-up, they do not need to be notified of test results. However, if the patient’s PCP requests a copy of a test result from another clinician or health system, this request should be honored because an unnecessary delay could be considered information blocking under federal regulation.

Cybercriminals Tap Power of Artificial Intelligence to Target Consumers

FBI officials warn that, as ChatGPT, Google Bard, and other artificial intelligence (AI) tools have taken the world by storm, hackers and other cybercriminals have also adopted them to use in their cyberattacks, using free, customizable open-source AI tools to develop new malware strains, launch phishing attacks, and carry out other scams aimed at consumers. AI has reduced technical barriers, allowing those with limited experience or technical expertise to write malicious code and conduct low-level cyber activities simultaneously. Bad actors can utilize AI voice generators to impersonate trusted individuals in order to defraud people. Bitdefender, Norton, McAfee and other antivirus firms are already using AI for both monitoring and behavioral analysis of new threats. For this reason, you may want to ensure you have antivirus software solutions on your PC, Mac antivirus software on your Mac, and Android antivirus apps on your Android smartphone (software links provided are not endorsed by MSD). While security software on your devices will help, you also need to be more vigilant online. Be careful when checking your inbox and social media accounts. Don't click on links contained in messages from unknown senders. Avoid downloading any attachments these emails may contain. Look for carefully crafted emails that try to elicit an emotional response.

Due to Increased Reports of False Alarms

Baxter Healthcare Corporation is recalling SIGMA Spectrum Infusion Pumps with Master Drug Library (Version 8) and Spectrum IQ Infusion Systems with Dose IQ Safety Software (Version 9) due to increased reports of false alarms for upstream occlusion after pump software upgrades to version v8.01.01 and v9.02.01. False upstream occlusion alarms cause interrupted or delayed therapy and contribute to clinician fatigue, which may cause serious adverse health consequences, especially for people receiving life-sustaining medications. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries, serious health consequences, or death.

Potential Risk of Early Structural Valve Deterioration - Letter to Physicians

On Monday, the U.S. Food and Drug Administration (FDA) provided an update to the February 27, 2023 Letter to Health Care Professionals about the potential risk of early structural valve deterioration (SVD) with Abbott Trifecta valves, including the Trifecta Valve and Trifecta Valve with Glide Technology (GT). The Trifecta and Trifecta GT valves are heart valve replacement devices intended to treat diseased, damaged, or malfunctioning native or prosthetic aortic heart valves. In a July 31, 2023, letter to health care professionals, the manufacturer announced its decision to stop selling and distributing Trifecta valves in the United States and has informed to return unused Trifecta valves. The FDA continues to work with the manufacturer to further evaluate the potential risk of early SVD in patients implanted with Trifecta valves. The FDA recommends that health care professionals: 

• Be aware of the potential risk of early SVD with Trifecta valves, and current patient management considerations, as communicated by Abbott.
• Discuss the risks and benefits of all available aortic valve treatment options with your patients and their caregivers as part of shared clinical decision-making prior to surgery.
• Read and carefully follow the Instructions for Use when implanting a Trifecta GT valve.
• Monitor patients who have undergone implantation with Trifecta valves for signs and symptoms of potential SVD.

1. Instruct patients to seek medical attention with new onset of symptoms such as shortness of breath or fatigue.
2. Ensure lifelong follow-up visits, conducted at least yearly, including transthoracic echocardiogram (TTE) assessment of the valve beginning one-year post-implant.

• Report any adverse events with Trifecta valves to the FDA. 

Due to Out of Specification Results at the 12-Month Stability Time Point

Lupin Pharmaceuticals is recalling two (2) lots of Tydemy (Drospirenone, Ethinyl Estradiol and Levomefolate Calcium Tablets 3mg/0.03mg/0.451 mg and Levomefolate Calcium Tablets 0.451 mg) due to out of specification test results at the 12-month stability time point. Specifically, one lot (L200183) tested low for ascorbic acid (an inactive ingredient) and high for a known impurity. The lots were distributed nationwide in the US to wholesalers, drug chains, mail order pharmacies and supermarkets. Lupin is recalling these two batches because if there were a significant reduction in the amount of inactive content (ascorbic acid), this could potentially impact the effectiveness of the product which could potentially result in unexpected pregnancy. To date, Lupin has received no reports of adverse events related to either recalled batches. Patients are advised to contact their physician for advice regarding alternative treatment.

Has Your Contact Info or Practice Changed? Please be Sure to Inform Us!

MSD staff works hard to ensure we have the most up-to date information for our members, but we need your help! If you are retiring, moving, need to report any changes of address, email updates, changes of practice, or any other changes, please use the Membership Information Update Form and return to MSD or directly contact Michelle Seymour, Manager of Membership and Community Outreach at Michelle.Seymour@MedSocDel.org or (302)224-4905. You can also log in to the MSD website to access your membership profile information to make most basic updates yourself, such as address, email, practice and other changes, as well as renewing your membership online.

Submit Your Idea as a Resolution and Make a Difference

Turn your idea into a resolution. MSD is accepting resolutions for health care-related issues to be considered by the Council at the MSD Annual Meeting scheduled for Saturday, November 18th. Resolutions must be submitted in writing by Sunday, October 15th (absolute deadline). This is an excellent opportunity to share your concerns with your peers and make a difference. Not sure where to start? MSD has created a Resolution Writing Guide to help! Please contact Mary LaJudice, Senior Director of Corporate Services, with any questions or to submit your resolution (Mary.LaJudice@medsocdel.org or 302/593-8589).

Bayhealth

ChristianaCare

Ariella A. Alexander, DO - IM/Peds Residency, ChristianaCare

Layla Annous, MD - IM/Peds Residency, ChristianaCare

Jeffrey Liu, MD - Emergency Medicine Residency, ChristianaCare

Cassidy A. O'Sullivan, MD - OBGYN Residency, ChristianaCare

Savanah A. Richter, MD - OBGYN Residency, ChristianaCare

Hussien Said, MD - Emergency Medicine Residency, ChristianaCare

Nakia M. Wighton, MD - OBGYN Residency, ChristianaCare

Grace J. Thole, DO - Family Medicine Residency, ChristianaCare

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Isaiah Ailes - Medical Student, SKMC/ChristianaCare Branch Campus

Zowie Barnes, MD - FM, Planned Parenthood of DE (Interim Med. Director)

Jennifer Bolick, DO - Internal Medicine Residency, ChristianaCare

Bethany Dus, MD - OBGYN Residency, ChristianaCare

Raven N. Eberth, MD - Family Medicine Residency, ChristianaCare

Matthew N. Eiman, MD - IM/Peds Residency, ChristianaCare

Gabriana M. Freire, MD - IM/Peds Residency, ChristianaCare

Chinaka N. Joseph, MD - Psychiatry Residency, ChristianaCare

Vincent C. Mack, DO - Internal Medicine Residency, ChristianaCare

Zahra A. Manji, DO - Internal Medicine Residency, ChristianaCare

Raj G. Nathwani, DO - Internal Medicine Residency, ChristianaCare

Victoria E. Powell, MD - IM/Peds Residency, ChristianaCare

Eshita Sharmin, MD - Family Medicine Residency, Bayhealth

Yamini Vepa, DO - Internal Medicine Residency, ChristianaCare

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information.

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• 2nd bivalent COVID-19 Vaccine Booster: Who Should Receive It?
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.