No Newsletter Published Next Week

The regular issue of MSD eNews and Views will not be published next week. Look for the next issue to resume the following week. In the event of an urgent communication, MSD will be sure to disseminate the information to its members during the off week. 

Physicians to Cease Administration of Monovalent Boosters

Last Thursday, Centers for Disease Control and Prevention (CDC) Director Rochelle P. Walensky, MD, MPH, endorsed the CDC Advisory Committee on Immunization Practices' (ACIP) recommendations for use of updated COVID-19 Boosters (bivalent formulation) from Pfizer-BioNTech for people ages 12 years and older and from Moderna for people ages 18 years and older. Updated COVID-19 boosters add Omicron BA.4 and BA.5 spike protein components to the current vaccine composition. Eligible individuals for the COVID-19 Vaccine, Bivalent are those who are at least two months removed from the completion of their primary vaccination series or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine. The emergency use authorization (EUA) expressly instructs physicians to no longer use the monovalent booster shots. In the coming weeks, CDC also expects to recommend updated COVID-19 boosters for other pediatric groups, per the discussion and evaluation of the data by ACIP on September 1st.

Labeling, Packaging of Vaccines and Bivalent Boosters Have Similarities

The Delaware Division of Public Health (DPH) is encouraging both physicians and patients to confirm administration of the correct COVID-19 product. Due to the similarities in vaccine packaging and labels, DPH is urging physicians to institute extra safeguards to ensure correct administration. You are encouraged to share the patient document prior to administration of COVID-19 vaccinations. Patients are also being encouraged to confirm with the vaccine administrator that they are receiving the correct product by asking to see the vial from which the dose was drawn. This is good health education practice, and physicians are encouraged to work with their patients to reduce administration errors. Refer to both the physician and patient documents provided by DPH.

AMA Editorial Update Addresses Bivalent Boosters

The American Medical Association (AMA) announced an editorial update to Current Procedural Terminology (CPT)^® that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech.

Four of the eight CPT codes (91312, 91313, 0124A and 0134A) are effective for use immediately, as the U.S. Food and Drug Administration (FDA) has authorized and the Centers for Disease Control and Prevention (CDC) endorsed Moderna’s new COVID-19 booster in individuals 18 years of age and older and Pfizer-BioNTech’s new COVID-19 booster in individuals 12 years of age and older.

Four CPT codes (91314, 91315, 0144A and 0154A) will be effective for use on the condition that the FDA authorizes Moderna’s new COVID-19 booster in individuals 6 years through 11 years of age and Pfizer-BioNTech’s new COVID-19 booster in individuals 5 years through 11 years of age.

For quick reference on the new product and administration codes assigned to each bivalent COVID-19 vaccine booster, please click to the AMA announcement.

Similar to Annual Flu Vaccination

President Biden announced a new approach to fighting coronavirus, following the FDA and CDC authorization of the updated COVID-19 booster. COVID-19 vaccinations will likely shift to an annual shot in the fall through routine doctor visits or at the same time a patient receives an annual flu shot. More frequent doses would be offered for higher-risk people. As the virus continues to change, the annual vaccines would be tailored to the latest strains, targeting the dominant variant. Dr. Ashish Jha, White House COVID-19 Response Coordinator called on Congress to allocate new funding to continue the availability of vaccines and treatments to keep ahead of the virus.   

Recommendations, Guidance on Coadministration with COVID-19 Vaccines

A Centers for Disease Control and Prevention (CDC) Clinician Outreach and Communication Activity (COCA) call was presented on Thursday, September 8th, beginning at 2 p.m. ET. During this COCA Call, presenters provided updates on the Advisory Committee on Immunization Practices (ACIP) recommendations for the 2022-2023 influenza vaccination season, including information on a new preferential vaccine recommendation for adults ages 65 and older. In addition, presenters outlined guidance for the co-administration of the influenza and COVID-19 vaccines. For those unable to attend the live COCA Call, the recording will be available for viewing on the COCA Call webpage. The slide set is available on the COCA Call webpage under Call Materials. 

You're Invited to Join the Surveillance Program

The Division of Public Health (DPH) Office of Infectious Disease Epidemiology would like to extend an invite to you and your facility to join Delaware Public Health’s ILINet Sentinel Provider Program! The Centers for Disease Control and Prevention’s (CDC) Influenza-like Illness Surveillance Program (ILINet) is a collaborative effort between health care professionals, DPH, and the CDC. Data reported by ILINet sentinel enrollees, in combination with other influenza surveillance data, provide a picture of influenza virus and influenza-like illness (ILI) activity in Delaware and the United States.

By signing up you will be enrolled to go onto a digital portal weekly and report patients visits with ILI symptoms. In addition, you benefit by being able to submit up to five cases per week based on clinical evaluation (symptomatic) as well as 10 cases each week that are random (asymptomatic cases) to the Delaware Public Health Laboratory for virus testing and sub-typing. All shipping supplies and testing fees are covered by the program. 

The ILI FAQ contains more information. If you would like to sign up for the program, DPH asks that you fill out and return the ILI provider enrollment form. You can reach out to Abby Haycraft at Abigail.Haycraft@delaware.gov with questions. Thank you for helping to protect Delawareans against influenza!

Updates to Monkeypox Cases, Vaccine Access

The Delaware Division of Public Health (DPH) announced several Monkypox virus (MPX) updates including the launch of a Public Health Alert web portal providing access to an updated monkeypox web page. The website, which can be found at de.gov/PublicHealthAlerts, was created by the Department of State’s Government Information Center and is a central landing page from which to access individual web pages for COVID-19, MPX and flu. It is intended to highlight public health issues of elevated concern at the time. 

The updated MPX page, which can still be found at de.gov/monkeypox, provides information on the disease in a more user-friendly format. (COVID-19 information can also continue to be found at de.gov/coronavirus, and flu information at flu.delaware.gov). The updated MPX site includes a separate section for medical professionals seeking information and highlights the most current data related to cases. Delaware now has 25 total MPX cases in the state, which remains low compared to neighboring states which have hundreds. DPH will no longer issue press releases solely for case updates, as the data will be more frequently updated on the webpage. Delaware is taking action to continue to ensure the most at-risk persons are vaccinated against the virus. Starting Sept. 5, DPH will expand access to the MPX vaccine to those who are immunocompromised. Additionally, DPH announced that Newark Urgent Care began administering MPX vaccine to eligible individuals. 

Eligible persons can be vaccinated at the following locations:

• Newark Urgent Care: Vaccination available by appointment only (NewarkUrgenCare.org)
• Beebe Healthcare: Individuals can schedule an appointment at beebehealthcare.org/online-scheduling. Walk-ins will not be accepted.
• DPH clinics: Individuals should call the MPX hotline at 866-408-1899 for a screening evaluation. Walk-ins at DPH clinics will not be accepted. Monkeypox vaccinations at DPH clinics will continue to prioritize individuals at highest risk after a DPH evaluation: persons known or presumed to be exposed to someone with MPX in the last 14 days, and certain individuals who have sex with men and who have had multiple sex partners within the past 14 days. As a result, appointments may need to be scheduled a few days out.



Monkeypox vaccines are available to those confirmed to have been exposed, or who are at higher risk of being exposed to the virus, as well as the immunocompromised, and those engaging in high-risk activities, including sexual practices, that increase exposure to MPX. 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. 

DHA Report on Fiscal Year 2020 Statewide Community Benefit Activities

Nearly $978 million in community benefit spending during Fiscal Year 2020 was provided by Delaware's hospitals and health systems.  This information was included in the Delaware Healthcare Association's Fiscal Year 2022 Statewide Community Benefit Activities Report, a biennial report of the public health and economic benefits Delaware hospitals and health systems provide to the state. Community benefit spending includes charity care, bad debt, losses on government-sponsored health insurance and support for community programs. This report also included the impact of COVID-19 on hospital budgets. The health systems that provided data for this report include Bayhealth, Beebe Healthcare, ChristianaCare, TidalHealth Nanticoke, Nemours Children’s Health and Saint Francis Hospital.

Patient Access at Risk Unless Congress Reforms Medicare Payment System

The American Medical Association (AMA) and other groups called on the Centers for Medicare and Medicaid (CMS) to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for physicians next year. In July, CMS proposed to decrease the Fee Schedule conversion factor by $1.53 to $33.08 in 2023. If finalized, the Fee Schedule cut would harm patient access to care, according to the AMA. AMA and 120 state medical and national specialty societies, including the Medical Society of Delaware, have created the "Characteristics of a Rational Medicare Physician Payment System" that includes three core principles: ensuring financial stability and predictability, promoting value-based care, and safeguarding access to high-quality care. Editor’s Note: To read the full press release on the Medicare Physician Payment Schedule from AMA, click here.

Due to Safety Issue with Magnets That May Affect Other Medical Devices

On Tuesday, the U.S. Food and Drug Administration (FDA) alerted patients, caregivers and health care professionals that Philips Respironics (Philips) has recalled certain masks used with bilevel positive airway pressure (also known as Bilevel PAP, BiPAP or BPAP) machines and continuous positive airway pressure (CPAP) machines due to a serious safety concern. More than 17 million masks are impacted by this recall.

What you need to know: 

• The recalled masks are worn by a person when using a BiPAP or CPAP machine and have magnets that connect the mask components to hold the device in place. 
• The magnets can potentially affect the functioning of or cause movement of certain implanted metallic medical devices, which could result in injury or death to the mask user or people near the patient wearing the recalled mask, such as a bed partner, who have such devices. Medical devices that could potentially be affected by these magnets include brain stents, aneurysm clips, pacemakers, implantable cardioverter defibrillators, ventriculoperitoneal shunts, ocular implants, magnetic denture attachments, insulin pumps, certain neurostimulators used in and around the neck, cochlear implants or any metallic implanted medical device affected by magnets. 
• The magnets could also affect mask users who have metallic objects in their body, such as shrapnel or splinters in their eyes, including people near the patient wearing the affected mask, such as a bed partner.
• Five mask types are affected by this recall: the DreamWisp, DreamWear, Amara View, Wisp and Wisp Youth masks.
• To date, Philips reported 14 serious injuries, including pacemaker failure, arrhythmia, seizures and irregular blood pressure related to use of the recalled masks. The FDA is providing recommendations in a safety communication for patients, caregivers and health care professionals concerning use of the recalled masks with magnets, which patients may be using with Philips BiPAP and CPAP machines or those of other manufacturers.

This recall is not associated with the polyester-based polyurethane (PE-PUR) foam issue for certain ventilators, BiPAP machines and CPAP machines recalled in June 2021. However, this recall affects masks used with some of the devices that were recalled in June 2021.

Nervous System Chapter Updates

A proposal to update the nervous system chapter of the AMA Guides® is being considered by the AMA Guides Editorial Panel for adoption, with an effective date of January 1, 2023. Proposals build upon the update to the sixth edition issued in 2022.  Interested parties and organizations who utilize the AMA Guides are invited to participate in the process to comment on the proposed changes to the medicine and impairment ratings. The AMA Guides Editorial Panel will consider all available information and comments prior to adopting these changes as part of AMA Guides Sixth 2023.  The public comment period is Sept. 5 - Oct. 3, 2022. The deadline to request a copy of the proposal is Thursday, September 29, 2022. 

For more information on how to participate and to begin the request process, please visit https://ama-guides.ama-assn.org/books/pages/public_comment.  

The AMA Guides Editorial Panel is comprised of knowledgeable physicians, allied health professionals and regulatory and legal advisors to deliver timely enhancements to the AMA Guides reflecting current evidence-based medical practice. 

Disturbing Trends Require All-Hands Approach

With a report issued today detailing the horrific toll of the nation’s overdose and death epidemic, the American Medical Association (AMA) calls for an all-hands approach -- policymakers, public health experts, educators, faith leaders, and employers – to help save lives. While physicians and other health care professionals have reduced opioid prescribing in every state—by nearly 50% nationally – that by itself cannot reverse the trend of drug-related overdose deaths. In fact, for the first time, in 2021 drug-related overdose deaths exceeded 100,000—primarily due to illicitly manufactured fentanyl, methamphetamine and cocaine. Overdose deaths are amplified by underlying social needs including housing and transportation.

The report calls for a campaign to include:

• Policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and remove barriers – such as prior authorization -- to evidence-based care. States should require health insurance companies and other payers to make non-opioid pain care alternatives more accessible and affordable.
• Medical and other health care professional licensing boards to help patients with pain by reviewing and rescinding arbitrary restrictions on opioid therapy—as now recommended by the Centers for Disease Control and Prevention. 
• State officials to remove punitive policies against pregnant individuals and parents who have a substance use disorder. State departments of corrections and private jails and prisons need to ensure that all individuals with an opioid use disorder or mental illness receive evidence-based care while incarcerated -- and are linked to care upon release. This includes ensuring access to medications for opioid use disorder (MOUD).
• Employers to review their health insurance and benefits plans to ensure employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide MOUD, and psychiatrists who are in the employer’s network.
• Public health officials to help control infectious disease spread through supporting comprehensive syringe services programs, reduce overdose through widespread, community-level distribution of naloxone and fentanyl test strips and pilot projects in support of overdose prevention centers.
• Faith leaders to help destigmatize substance used disorders and harm reduction by educating their members and holding overdose awareness events.

The use of prescription drug monitoring programs (PDMPs) also continued its upward trajectory with physicians and other health care professions surpassing the 1 billion mark for the first time. PDMPs are electronic databases that track controlled substance prescriptions and help identify patients with uncoordinated care who might be receiving multiple prescriptions from multiple prescribers. Read the report here, including state-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use.

In addition to the new report, the AMA has updated several additional documents:

• State-level reports about the worsening epidemic
• Select research
• State-level initiatives to help

You Could Be Eligible for MOC Part IV Credit

Several years back, the Medical Society of Delaware responded to our members' concerns about hardships related to the ABMS/ABIM Maintenance of Certification (MOC) process. MSD is fully supportive of a continued certification process for physicians; however, not to the extent that the process creates a hardship. MSD continues to advocate for options to meet maintenance of certification requirements and, along those lines understands that some are satisfied with the ABMS MOC process.

In the spirit of having options available for meeting the requirements of MOC, ChristianaCare wants you to be aware that it has simplified the process.  Physicians and Physician Assistants who have participated in a quality improvement initiative may not know their project could be eligible for MOC Part IV Credit. ChristianaCare is an ABMS Multi-Specialty Portfolio Program Sponsor for MOC Improvement in Medical Practice (MOC Part IV) and is granted authority to review and approve Quality Improvement efforts as meeting specialty board standards and guidelines, allowing participating physicians and physician assistants to earn continuing certification (MOC Part IV) credit from their participating ABMS specialty board or from the NCCPA. If you have new quality improvement efforts potentially meeting Part IV requirements, contact MOC@ChristianaCare.org for further information and assistance.

JUUL Had Been the Dominant Player in the Vaping Market

Delaware Attorney General Jennings announced Tuesday a $438.5 million agreement in principle between JUUL Labs and 34 states and territories resolving a two-year bipartisan investigation into the e-cigarette manufacturer’s marketing and sales practices. In addition to the financial terms, the settlement would force JUUL to comply with a series of strict injunctive terms severely limiting their marketing and sales practices. JUUL engaged in an advertising campaign that appealed to youth, even though its e-cigarettes are both illegal for them to purchase and are unhealthy for youth to use. The investigation found that JUUL relentlessly marketed to underage users with launch parties, advertisements using young and trendy-looking models, social media posts, and free samples. It marketed a technology-focused, sleek design that could be easily concealed and sold its product in flavors known to be attractive to underage users. JUUL also manipulated the chemical composition of its product to make the vapor less harsh on the throats of the young and inexperienced users. To preserve its young customer base, JUUL relied on age verification techniques that it knew were ineffective. JUUL's original packaging was misleading in that it did not clearly disclose that it contained nicotine and implied that it contained a lower concentration of nicotine than it actually did. JUUL also misrepresented that its product was a smoking cessation device without FDA approval to make such claims. Delaware stands to recover between $7.8 million and $8.5 million under the agreement. The $438.5 million would be paid out over a period of six to ten years, with the amounts paid increasing the longer the company takes to make the payments. If JUUL chooses to extend the payment period up to ten years, the final settlement would reach $476.6 million. Both the financial and injunctive terms exceed any prior agreement JUUL has reached with states to date. 

Discussion of Medicare Advantage Program

Highmark would like to invite you to an information session on Wednesday, September 21 at 12:00 p.m., on its Medicare Advantage program. The new plan was effective January 1, 2022, and will soon be the benefit solution for the State of Delaware retiree population.

Microsoft Teams meeting

Join on your computer, mobile app or room device

Click here to join the meeting

Meeting ID: 289 091 000 242

Passcode: Wna8jX

Or call in (audio only)

+1 302-319-3063,,682931227#

Phone Conference ID: 682 931 227#

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’s Education Department has renamed its PACE Program to the Bayhealth Community Wellness Program. The program is aimed at helping community members live healthier through participation in monthly health assessments. The PACE Program — which stood for Promoting Active Community Engagement — has been helping underserved and homeless populations, as well as those with limited or no health care options, since 2019. Prior to that, Bayhealth had its STEPS to Healthy Aging Program, which helped participants for over 20 years. The newly named program will continue to hold monthly clinics with individualized counseling from a registered nurse based on each participant’s health problems and medications. Bayhealth’s Community Wellness Program is free, registration is not required, and participants may invite others to join them. Clinics are held monthly on designated dates in Dover and Lincoln. First-timers receive a full health assessment that covers lifestyle habits, as well as weight, blood pressure and pulse rate/oximetry. Beginning this fall, Bayhealth Internal Medicine residents will also join the program to enhance services offered. 

ChristianaCare

ChristianaCare announced the eBrightHealth Accountable Care Organization (ACO) reduced health care spending by $7 million in performance year 2021 and, with new reporting requirements, earned a quality score of 82.1%. That’s according to recently released performance data by the U.S. Centers for Medicare & Medicaid Services. With these favorable results, the ACO has earned approximately $3.5 million in shared savings. This is the second consecutive year shared savings have been achieved. During the 2021 reporting period, eBrightHealth ACO consisted of four regional health systems — Bayhealth, Beebe Healthcare, ChristianaCare and TidalHealth Nanticoke — six private primary care practices and two federally qualified health centers, Westside Family Healthcare and La Red Health Center. The eBrightHealth ACO helps clinicians address clinical, behavioral, social and other needs of Medicare beneficiaries while improving their access to primary care, preventing unnecessary emergency department visits and decreasing the amount of time they spend in hospitals. Through regular communications, eBrightHealth ACO also educates and engages beneficiaries to take control of their health through medication adherence, annual wellness visits and other important wellness activities. The result is improved health and quality of life for beneficiaries and reduced health care spending. For the 2021 reporting period, the eBrightHealth ACO achieved maximum performance for screening beneficiaries for hemoglobin A1C, falls and tobacco use and cessation.

Robert B. Flinn, MD

It is with sadness we share that MSD Past President and member Robert Barr Flinn, MD passed away on September 2, 2022, of metastatic melanoma. He was 91 years of age. He graduated from Princeton University in 1952 and received his medical degree from Johns Hopkins University School of Medicine in 1956. He subsequently interned at Yale University and Grace New Haven Community Hospital, before moving to Boston in 1958 for his residency in internal medicine and fellowship in nephrology at the Brigham Hospital. From 1961 to 1963 he and his family lived in Wiesbad, Germany where he worked as a physician at the U.S. Air Force Base Hospital. He moved to Wilmington in 1963 working at Christiana Care Health System as head of the Section of Nephrology and the Director of the Medical Education and Residency Programs. In 1972, he was named Associate Director of the Department of Medicine and then Chairman of the Department of Medicine in 1980, a position he held for 26 years until he retired in 2006 at the age of 75. His accomplishments include being part of the team at Brigham Hospital that performed the first successful kidney transplant in non-identical twins; and, along with his colleagues, he developed the first dialysis centers in Delaware outside of a hospital. He was also the first to be named the Hugh R. Sharp, Jr. Chair of Medicine in 1995. Dr. Flinn served as President of the Medical Society of Delaware from 1979-1980. A Memorial Service will be held on Sunday, September 18, 2022, 1:30 p.m., at Christ Church Christiana Hundred, 505 East Buck Road, Wilmington, Delaware. Read obituary.

• DPH Public Health Alerts: de.gov/publichealthalerts
• DPH Hotline - (866) 408-1899 (Monday -Friday, 8:30 a.m. to 4:30 p.m.) or DPHCall@delaware.gov
• Reporting suspected monkeypox rash in Delaware: Contact DPH Office of Infectious Disease Epidemiology (OIDE), at 302-744-4990 (business hours) or 1-888-295-5156 (after hours).
• Delaware health care facilities that require specimen collection kits can order through OEMS@delaware.gov using a SHOC Request form.
• DPH website: de.gov/monkeypox
• DPH Social Channels: Facebook (@DEPublicHealth), Instagram (@depublichealth), DHSS Twitter (@Delaware_DHSS)
• FDA Monkeypox Response Website
• CDC Monkeypox Website
• CDC Case Definitions for 2022 Monkeypox Response
• CDC Considerations for Monkeypox Vaccination for the recommended use of vaccine in the U.S.
• CDC Monkeypox Treatment Information for Healthcare Professionals
• Specimen collection: Follow Lab Advisory: CDC Updates Specimen Collection Guidelines for Monkeypox Virus 

• DPH Public Health Alerts: de.gov/publichealthalerts
• DPH COVID-19 Booster Information: de.gov/boosters
• Federal website for information on navigating COVID: COVID.gov
• CDC COVID-19 Quarantine and Isolation Calculator
• COVID-19 Treatment Options
• Medical Provider Guidance for Administering Therapeutics
• COVID-19 Therapeutics Locator
• For testing flyers (available in English, Spanish, Haitian Creole): https://covidmaterialsde.com/resources/community-organizer
• For all testing site referral locations, visit: de.gov/gettested
• For vaccination site referral locations, visit: de.gov/getmyvaccine
• Pfizer/Moderna pediatric vaccine information: de.gov/youthvaccine
• 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
• Know the COVID-19 Community Level where you live
• DPH COVID-19 Vaccine Fact Check Page
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.  

Valerie Lim, MD - Internal Medicine/Pediatrics Resident, ChristianaCare

MSD's Membership Department is pleased to announce the newest members of the Medical Society of Delaware. Welcome to the third oldest medical society in the country! If you know someone who is interested in joining MSD, please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any questions. You could be eligible for a referral discount!