They Said It...

"I think sports teaches us all about life. Whether athletes or athletic pursuits are successful or not, it demonstrates the power of human relationships to fortify each other and create a common sense of purpose. This purpose drives us to gain, despite any pain, despite the losses, despite the pain in your muscles. It's that kind of attitude that we should all embrace." Dr. John Vasudevan, Associate Professor of Clinical Medicine and Rehabilitation at the University of Pennsylvania and the Department of Veterans Affairs Medical Center in Philadelphia, and newly elected President of the Philadelphia County Medical Society, speaking as part of our sports-focused edition of Philadelphia Medicine, available here.

If you are interested in writing an article for Philadelphia Medicine, please contact us at [email protected]. We are accepting articles for both the newsletter and magazine.

Between Opening Day in Pittsburgh and the last game of the season in Washington, D.C., the Phillies will face a slew of rivals, historic rivals, perennial contenders, and up-and-coming teams ready to give the Phils a run for their money. Though it's impossible to capture the energy of a 162-game baseball season in 1 game, please consider joining PCMS at Citizens Bank Park on Sunday, Sept 10, 2023 for the Phillies game and a tailgate party! Meet with colleagues and enjoy an afternoon of fun! Children, spouses and partners are welcome to attend. Space is limited so don’t delay in getting your tickets.

For more details, visit our event page  

The Food and Drug Administration provided an update in early June on medical device reports it received that are reportedly associated with the breakdown or suspected breakdown of the polyester-based polyurethane (PE-PUR) foam used in the Philips Respironics ventilators, BiPAP machines, and CPAP machines included in the recall announced in June 2021. Since April 2021, the FDA has received more than 105,000 medical device reports, including 385 reports of death. 

On June 1, 2023, the United States Supreme Court issued an important decision addressing the intent element of the False Claims Act (“FCA”) in United States ex rel. Tracy Schutte v. SuperValu Inc. The Department of Justice has used the FCA to recover more than $70 billion since 1986, largely in cases related to health care and defense contracting. Under the FCA, a defendant is liable for submitting a false claim to the government for payment if it acted “knowingly,” which the statute defines as acting with actual knowledge, deliberate ignorance, or reckless disregard.  For physicians that receive government funds like Medicare, this case highlights the importance of contemporaneous documentation. 

The Pennsylvania DOH recently issued updated guidance for healthcare settings on how to identify and report COVID-19 outbreaks originating within the facility. Key messages for healthcare settings included in the guidance: 

• COVID-19 surveillance procedures should be outlined via written policy and implemented in a way that can systematically identify clusters.
• COVID-19 outbreak definitions are provided in the guidance by healthcare facility type.
• According to the Disease Prevention and Control Law of 1955 (DPCL), unusual clusters of disease are reportable to the Department’s Bureau of Epidemiology or PDPH. This would include outbreaks of COVID-19 in healthcare settings.
• Public health response including epidemiologic and infection prevention and control recommendations will be routinely provided by the Department or PDPH for COVID-19 outbreaks in Philadelphia. 

For questions about this guidance, contact DOH at 1-877-PA-HEALTH

Registration is open through June 30, 2023 for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the Merit-based Incentive Payment System (MIPS) Survey for the 2023 performance period. The Merit-based Incentive Payment System (MIPS) is one track of the Quality Payment Program (QPP), where physicians may earn a performance-based payment adjustment to their Medicare payment.

Physicians participating in MIPS have the flexibility to choose the measures from activities that are most meaningful to their practice to demonstrate performance. The CAHPS for MIPS Survey is an optional quality measure that groups participating in MIPS can elect to administer. For additional information, please visit the QPP website. 

The CDC issued a Health Advisory on May 17 regarding an outbreak of suspected fungal meningitis among U.S. patients hospitalized in Texas after undergoing cosmetic procedures under epidural anesthesia at River Side Surgical Center and Clinica K-3, located in Matamoros, Tamaulipas, Mexico. On June 1 the advisory was updated to identify the causative organism as Fusarium solani.

As of June 1, a total of 212 residents in 25 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 14 suspected, 11 probable, and two confirmed U.S. cases have been diagnosed; three patients (two probable cases and one confirmed case) have died.

Healthcare providers should be aware that all patients, including those without symptoms, who underwent medical or surgical procedures under epidural anesthesia at River Side Surgical Center or Clinica K-3 in Matamoros, Mexico, since January 1, 2023, should be evaluated for fungal meningitis as soon as possible. Evaluation for fungal meningitis includes a lumbar puncture (LP, also known as spinal tap) and magnetic resonance imaging (MRI) of the brain.

You can learn more on the CDC website here.

The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. Access to high-quality primary care is associated with better health outcomes and equity for people and communities. MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety net and smaller or independent primary care organizations. The model seeks to improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs.

Primary care organizations within participating states may apply when the application opens in late summer 2023. The model will launch on July 1, 2024.

Click here to view the MCP webpage.

The AMA launched a new website, fixmedicarenow.org. The site provides information and resources on the Medicare physician payment system as well as a Take Action section with a prefilled form that gets submitted to legislators.

The AMA has been advocating for Medicare physician payment reform for over a decade. Physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update and as a result, Medicare physician payments have lagged 26% behind the rate of inflation growth since 2001. Additionally, temporary patches and ongoing cuts to the Medicare physician payment system have left patient access to care at serious risk.



Visit fixmedicarenow.org to learn more.

The FDA is warning patients taking compounded semaglutide that some may include alternate forms of semaglutide from those used in approved drugs and can potentially be unsafe.

Semaglutide mimics the GLP-1 hormone that is released in the gastrointestinal tract in response to eating and is used in some weight loss medications. Two of the three currently FDA-approved semaglutide products, Ozempic and Wegovy, are in shortage.

When a drug is in shortage, compounders may be able to prepare a compounded version of that drug if they meet certain requirements. These compounded drugs are not FDA-approved, and the agency does not verify the safety or effectiveness of them. Patients should only obtain drugs containing semaglutide with a prescription from a licensed health care provider, and only obtain medicines from state-licensed pharmacies or outsourcing facilities registered with FDA.

Read more on the FDA website.

The Philadelphia Department of Public Health (PDPH) released a health advisory in response to the upcoming season for tickborne infections in Philadelphia. While Lyme disease is the most frequently diagnosed tickborne illness in Philadelphia residents, cases of babesiosis, anaplasmosis, ehrlichiosis, and Rocky Mountain spotted fever (RMSF) are reported every year. Between 2013 and 2022, over 50% of blacklegged ticks collected in City parks tested positive for Lyme disease. Since 2013, blacklegged ticks were found at 10 of 17 sites sampled in the city.

Providers should also be aware of emerging tickborne infections, like Powassan virus and Borrelia miyamotoi that are transmitted by blacklegged ticks. In Philadelphia, Powassan was first identified in ticks collected in November 2019. In May 2020, the first Powassan virus infection was diagnosed in a resident of the city, though they were likely infected in another PA county. B. miyamotoi has been detected in ticks in PA and causes a relapsing febrile illness. Lone Star ticks, capable of transmitting Heartland and Bourbon viruses, were first identified in Philadelphia in 2020. As of 2022, Gulf Coast ticks infected with Rickettsia parkeri have been identified in two Philadelphia parks.

Many tickborne diseases have symptoms similar to COVID-19. During months of increased tick activity (now through October), patients presenting with rash, “flu-like” symptoms, including fever, fatigue, and lymphadenopathy, or altered mental status should also be evaluated for tickborne illnesses.

Report all suspected or confirmed cases of babesiosis, anaplasmosis, ehrlichiosis, RMSF, and Lyme disease within 5 days to PDPH by calling (215) 685-6748 or via fax at (215) 238-6947.

For more information, see the full Health Advisory here.

Due to a unique weather pattern, Philadelphia continues to be affected by smoke from the wildfires in Canada. Wildfire smoke contains fine particles, also called PM 2.5. This is one of the pollutants that the Health Department monitors during large fires in Philadelphia. PM 2.5 are tiny particles in the air that reduce visibility and cause the air to appear hazy when levels are elevated. The widths of the larger particles in the PM 2.5 size range would be about thirty times smaller than that of a human hair. PM 2.5 can be dangerous because if you inhale it, the particles are so small they can go deep in your lungs. Everyone is advised to keep an eye on the situation and change their behaviors based on the amount of smoke in the air. The Health Department publishes real-time air pollution readings at https://www.phila.gov/aqi.

The Pennsylvania Department of Health and Quality Insights have partnered to provide free virtual opioid education sessions. These webinars take one hour, and each module is worth one CME credit. Each module in this training series can be applied to the new required eight training hours on the treatment and management of patients with opioid or other substance use disorders, as mandated under the Consolidated Appropriations Act of 2023 for all Drug Enforcement Administration (DEA)-registered practitioners.

Click here for a list of pre-scheduled webinars.

PCMS at the Phillies

Date: Sunday, September 10

Time: 11:00 AM

The Philadelphia County Medical Society invites you to join us at Citizens Bank Park for the Phillies game and a tailgate party! Meet with colleagues and enjoy an afternoon of fun! Children, spouses and partners are welcome to attend.

Learn More and Sign Up Here