ASAM Request to Complete Survey 

Preliminary results of a new American Society of Addiction Medicine (ASAM) survey found more than 100 reports of pharmacies denying or delaying access to medications for patients with a substance use disorder, including buprenorphine. ASAM began conducting the survey in 2020 and has received results from 19 states. To provide better detail and coordinate with the American Medical Association (AMA) and other medical societies, ASAM is requesting MSD members' participation in an online survey. Please help with this important project. The survey can be found here: https://www.surveymonkey.com/r/ASAMpharmacy

August Recess a Perfect Time to Contact Delaware's Congressional Delegation

The August recess is in full swing, and Delaware's Congressional Delegation is currently making time to listen to you, their constituent. There is still much work to be done before the November elections on important health care issues, including looming cuts to physician Medicare payments and fixing the cumbersome prior authorization process. 

Physician Medicare payment cuts

Late last year, physician advocates from across the country united to successfully persuade Congress to delay a “perfect storm” of Medicare payment cuts that, if enacted, would have severely impeded patient access to care. Unfortunately, if Congress does not act by the end of the year, these delayed cuts, and some new ones, will take effect in 2023 and cause serious disruption to physician practices. 

Before the end of the year, we are asking Congress to:

• Extend the Congressionally enacted 3 percent temporary increase in the Medicare physician fee schedule
• Provide relief for an additional 1.5 percent budget neutrality cut that is planned for 2023
• End the statutory annual freeze and provide an inflation-based update for the coming year
• Waive the 4 percent PAYGO sequester necessitated by passage of legislation unrelated to Medicare

Prior Authorization (PA)

If an insurance plan covers a treatment that would benefit a patient, physicians should not have to waste time ensuring access to it. Congress has already taken steps to address this by introducing the Improving Seniors' Timely Access to Care Act (H.R. 8487), which would require Medicare Advantage plans to adopt transparent PA programs that adhere to evidence-based medical guidelines and hold plans accountable for making timely PA determinations and providing rationales for denials. Momentum is building on H.R. 8487 and, with enough grassroots pressure in August, we can get it across the finish line when Congress returns in the fall.

With only a handful of legislative days left this year, please join your colleagues in the fight to get our health care system back on track. Take action on these critical issues and look for opportunities to get in front of your members of Congress and their staff over the August recess. Visit physiciansgrassrootsnetwork.org for updated resources including policy points and information on public events that lawmakers are planning. Please do your part by answering this urgent call to action! 

Vaccine Expansion Underway

On Tuesday the Delaware Division of Public Health (DPH) announced six additional cases of monkeypox (MPX), bringing the state’s total to 17. Of the six new cases, three individuals are from Sussex County and three are from New Castle County. All cases are considered probable pending confirmatory testing by the Centers for Disease Control and Prevention (CDC). None of the cases are related to one another. All patients have reported recent high-risk intimate contact prior to onset. One also reported recent travel. Currently, while there is no specific treatment for MPX, antivirals can be prescribed, though they are not always needed. 

Vaccines are available to those confirmed to have been exposed, or who are at higher risk of being exposed to the virus. Last week, medical professionals who offer HIV PrEP began administering vaccine to patients. This week, vaccine access was further expanded to include those engaging in high-risk activities, including sexual practices, that increase exposure to MPX.

Eligible persons can be vaccinated at the following locations (walk-ins are not accepted):

• Beebe Healthcare Monkeypox Vaccine Clinics (schedule online)

• DPH clinics (Call the MPX hotline at 866-408-1899 for a screening evaluation, Monday-Friday from 8:30 a.m. to 4:30 p.m.)

Individuals should be aware that the vaccine, a two-dose series given 28 days apart, is not considered effective until two weeks after the second dose. Those at higher risk should continue to use preventive measures and reduce engaging in any high-risk behaviors until that time.

Fecal Microbiota for Transplantation - Additional Safety Protections Needed

The US Food and Drug Administration (FDA) is informing physicians of the potential risk of transmission of monkeypox virus through fecal microbiota for transplantation (FMT) products and that FDA has determined that additional safety protections are needed. Recent studies have documented the presence of monkeypox virus DNA in rectal swabs and/or stool samples from infected individuals, even from individuals who reported no symptoms of monkeypox disease. Although there is an available test for detection of monkeypox virus DNA from swab samples taken directly from a lesion, at this time, there is limited information on the availability and sensitivity of direct testing of stool for monkeypox virus. 

Public Health Emergency Declarations Must Be Renewed Every 30 Days

Governor Carney last Friday formally extended the Public Health Emergency order another 30 days to allow the State of Delaware and physicians to continue COVID-19 vaccination and testing programs. Under Delaware law, Public Health Emergency declarations must be renewed every 30 days. 

Previously Authorized for Individuals 18 Years and Older

Last Friday the US Food and Drug Administration (FDA) authorized the emergency use of Novavax COVID-19 Vaccine, Adjuvanted for the prevention of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 12 through 17 years of age. This authorization follows a rigorous analysis and evaluation of the safety and effectiveness data conducted by the FDA. The agency previously authorized the vaccine for individuals 18 years and older. Additional information is available on the agency’s web site. On Monday of this week, the Centers for Disease Control and Prevention (CDC) signed off on the use of the Novavax vaccine for adolescents aged 12 through 17 following the FDA's authorization for this group. 

Administration Can Begin After CDC's Official Recommendations Released

In June 2022, the U.S. Food and Drug Administration (FDA) advised manufacturers to add Omicron BA.4 and BA.5 spike protein components to the current vaccine composition to create a bivalent booster vaccine. Pending an FDA emergency use authorization (EUA), the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) will convene to discuss potential recommendations. ACIP meetings are tentatively scheduled for September 1-2. Administration can begin only after the CDC’s official recommendations are released. Additional information is available in the CDC Fall Vaccination Operational Planning Guide. Previews of the bivalent booster packages and vaccine labels are available on DailyMed:

• MODERNA COVID-19 VACCINE, BIVALENT
• PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT

Vaccine Program Key Considerations:

• The bivalent COVID-19 vaccine will be administered as a single booster dose only to those who have previously completed a primary series of the COVID-19 vaccine.
• It is anticipated that bivalent COVID-19 vaccine booster doses may initially be authorized for people ages 12 years and older (Pfizer-BioNTech) and for people ages 18 years and older for (Moderna), followed by younger pediatric age groups. Practices are encouraged to promote primary series vaccination and boosters (for ages 5-11) with current vaccine supply.
• Bivalent booster vaccines were available for pre-ordering in two waves. Jurisdictions should continue to prioritize sites to receive the first vaccine orders based on need, such as populations with a high risk for disease.

Wave 1 pre-ordering for both vaccines began on August 17 and ended August 24 at 9:00 a.m. EDT.

Wave 2 pre-ordering began on August 24 at 10:00 a.m. EDT (with threshold expansion) and will end on or around August 30, 2022.

Novavax for Adolescents: Updated Recommendations

On August 22, 2022, CDC Director Rochelle P. Walensky, M.D., M.P.H., signed a decision memo that Novavax’s COVID-19 vaccine be used as another primary series option for adolescents ages 12 through 17. This recommendation follows FDA’s emergency use authorization of Novavax for this age group. CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines has been updated with this new guidance. CDC opened ordering of Novavax COVID-19 vaccine in VTrckS on July 25, 2022. Shipping began on July 26, 2022.

Available Novavax Resources

Novavax COVID-19 Vaccine: Information on storage, handling, and administration

Novavax COVID-19, Adjuvanted Vaccine: Overview and Safety: General information, including vaccine ingredients, safety data, and details on how well the vaccine works.

CDC Novavax COVID-19 Vaccine Operational Planning Guide

Novavax Fact Sheet for Healthcare Providers Administering Vaccine (fda.gov)

Novavax Fact Sheet for Recipients and Caregivers (fda.gov)

Clinician Outreach and Communication Activity (COCA) Webinar on Novavax

In case you missed it, the CDC COCA held an educational event in July on Recommendations for the Novavax COVID-19 Primary Series in Adults Ages 18 and Older. Presenters discussed new CDC guidance on the Novavax COVID-19 vaccine for adults, including those who are moderately or severely immunocompromised.

Expiry Look up tools:

Practices are encouraged to continually monitor its COVID-19 vaccine inventory to help reduce administration errors. Dispose of expired vaccine according to state and local regulations. Below is a list of the manufacturer expiry pages.

Pfizer

https://lotexpiry.cvdvaccine.com

Moderna

https://eua.modernatx.com/covid19vaccine-eua/providers/vial-lookup 

Novavax

https://us.novavaxcovidvaccine.com/hcp 

Johnson and Johnson/Janssen

https://vaxcheck.jnj/ 

Click for more information.

A Special Celebration for the Previous Chairman, Michael J. Bradley, DO

On Wednesday evening, August 24th, the Central Delaware Physicians Organization (CDPO) Board members met to bid a fond farewell to their Chairman of the Board, Michael J. Bradley, DO, who has served in a leadership role with the CDPO for over twenty years. Dr. Bradley retired from his primary care practice in October of 2021, however, he continues to serve on the MedNet Board of Directors as President. The CDPO Board welcomed their new leader, James Flecther, DO, a primary care physician practicing in Dover, Delaware. Dr. Fletcher will serve on the CDPO as Chairman. A plaque was presented to Dr. Bradley in recognition for his years of service and leadership to the CDPO.

The CDPO is one of Delaware’s four established Physician Organizations (POs). The POs were formed in the late 1990’s and developed by the founding physicians of MedNet. The purpose for creation of the POs was to advance the concept of physician-directed managed care, while promoting high quality, cost effective medical care in Delaware. The POs continue to serve as a resource for Delaware physicians and clinicians for the implementation of new strategies in the delivery of medical care as the market continues to evolve. Pictured are James Fletcher, DO, Michael J. Bradley, DO and Thomas Barnett, MD.

No Surprises Act Effective January 1, 2022

The Centers for Medicare and Medicaid Services (CMS) has launched a webpage containing resources and guidance regarding the federal independent dispute resolution (IDR) process under the No Surprises Act (NSA). The webpage not only includes best practices for initiating an IDR dispute, it also offers a listing of common mistakes to avoid to ensure a dispute is processed as quickly as possible. 

MSD Member Will Serve as Keynote Speaker

The International Conference on Physician Health™ (ICPH), taking place on Oct. 13-15, 2022, in Orlando, FL, is a scientific conference sponsored jointly by the American Medical Association, Canadian Medical Association and the British Medical Association. As the first Chief Wellness Officer for ChristianaCare, Heather L. Farley, MD, MHCDS, FACEP, is on the agenda as a keynote speaker at the conference. Dr. Farley’s focus is on advancing the professional fulfillment and wellbeing of health care workers.

The conference will showcase research and system-level initiatives to mitigate burnout and promote professional well-being. Engaging organizations to achieve cultural change is this year’s conference theme. The subtheme is Building a united front for cultural change while activating systems to improve physician well-being. This conference is held every other year and is hosted by one of the founding associations. The conference provides a forum for practitioners and researchers to present innovative methods and support systems, as well as educational programs and recent research findings related to physician health. This conference focuses on practice steps to make medicine a more sustainable career choice. ICPH promotes an overall healthier culture for physicians by offering practical evidence-based solutions, practice skills, and resources and tools for attendees to take back to their workplace and readily implement.

A Course for Physicians and Others Offered by the Division of Public Health

The Advanced Telehealth Coordinator certification provides a foundational understanding of the benefits and uses of telehealth, and the role of the telehealth coordinator. Participants gain the knowledge and skills necessary to support the use of telehealth applications within a health care organization.

This certification is intended for those needing an understanding of how to implement or enhance the uses of telehealth operations in their practices and clinical areas. It is beneficial for clinicians, administrators, managers and health care IT professionals. 

FALL SCHEDULE: September 12-December 19, 2022

CEUs: 4.5 (45 contact hours) 

Basic computer skills are required.

There are no academic prerequisites to enroll in this program. This is a 15-week online course that includes weekly homework, tests, and a final project. Additional information on the course can be found at: https://www.pcs.udel.edu/telehealth/

The Delaware Division of Public Health is offering this opportunity with funding provided by the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities.  

ChristianaCare and Delaware State University Exploring the Possibility

Delaware Public Media is reporting that Delaware State University (DSU) and ChristianaCare are in talks about establishing a medical school in Delaware. Discussions are in the early stages and may not lead to any agreement. With the acquisition of Wesley College and its nursing school, the site is designated as the DSU health care campus with room for expansion. ChristianaCare is looking to expand existing education infrastructure and create more opportunities for Delaware students. ChristianaCare serves as an affiliate of Sidney Kimmel Medical College at Thomas Jefferson University, which reserves 20 admission spots for Delaware students each year as part of the Delaware Institute of Medical Education and Research program, and the Philadelphia College of Osteopathic Medicine. Delaware is one of a handful of states without a medical school. 

Multinational Tech Company Challenged in Health Care Efforts

Media outlets are reporting that Amazon will shut down its medical venture, Amazon Care, at the end of the year.  The recent announcement by Amazon to acquire One Medical makes this a surprising move. Amazon Care began in 2019 to provide primary care services for Amazon employees alone, but Amazon later began offering the service to employers and today provides virtual services in all 50 states. Amazon struggled to find broad appeal among employers, indicating its services did not provide a sufficient offering for the large enterprise customers, and would not work long-term. The termination of Amazon Care is not expected to impact Amazon's many other health care projects.

September 21 - MSD Presidential Reception, 6:00 p.m., JD Shuckers, 21710 Roth Ave, Georgetown.

September 22 - MSD, MSDIS, USI, Diamond State Financial Group, Cover & Rossiter "Thinking of Retirement...Mastering Your Financial Plan," 6:00-7:30 p.m., virtual session.

October 11 - MSD's Pubs and Politics, University & Whist Club, 805 N. Broom St., Wilmington, 5:30-8:00 p.m. Registration deadline October 3.

November 5 - We are excited to announce our Annual "Superhero for Hope” 5K Run/Walk is happening again this year! The Medical Society of Delaware will host its 5th Annual Campaign for Kids..."It's OBVIOUS" 5K Run/Walk on Saturday, November 5, 2022, at Rockford Park, Wilmington. This family-friendly event is being held in conjunction with a Community Health and Wellness Fair, co-hosted by MSD, Mom's House, and Vision to Learn. Registration begins at 8:00 a.m. Back by popular demand is the "Oat Bowl" featuring a make-your-own oatmeal bowl with a variety of fixings. Race participants will also enjoy t-shirts and other post-race food and refreshments.

Bayhealth

Bayhealth is now in its fourth year as a core clinical campus for Philadelphia College of Osteopathic Medicine (PCOM), training medical students for future success. This program has flourished under the leadership of the former UME Program Director and MSD Member, Joseph Rubacky, DO, FAAFP. Dr. Rubacky recently passed the reins to Bayhealth’s new Undergraduate Medical Education (UME) Program Director and another MSD member, Shalini Shah, MD, MPH, and Associate Program Director Ellie Salinski, MD, who welcomed the latest cohort of PCOM medical students to kick off their training at Bayhealth. During their time at Bayhealth, the students will complete 11 core rotations, each lasting one month. In each rotation they follow an experienced physician, gaining hands-on learning in various specialties and patient care settings. The hope is that some will later apply to and join Bayhealth’s Graduate Medical Education (GME) program, or residencies, after graduating medical school. The GME program offers advanced training to physician residents to become skilled and compassionate family medicine, internal medicine, general surgery, and emergency medicine doctors to serve central and southern Delaware. 

The Bayhealth Foundation recently received a $50,000 donation from the WSFS CARES Foundation to support the growth of Bayhealth’s Graduate Medical Educations (GME) programs. The gift will allow Bayhealth to continue expanding the GME programs, bringing more resident physicians to care for patients in central and southern Delaware. Bayhealth currently offers GME programs in Family Medicine, Internal Medicine and General Surgery, and is actively recruiting its first cohort of Emergency Medicine program residents to begin July 2023.  

Samuel J. Mease, MD - Orthopaedic Surgery, First State Orthopaedics

John M. Picard, MD - Neurology, ChristianaCare, Newark

B. Dale Sharpe, DO - Orthopaedic Surgery, First State Orthopaedics