Saturday, November 18 - Christiana Hilton, Newark

MSD's biggest event of the year will take place this Saturday at the Christiana Hilton in Newark. Those registered have received the information to prepare for a morning of nutrition education, as well as for the business of the Council. There are now 5 resolutions submitted to the Council:

• Artificial Intelligence in Health Care
• MSD Response to the Obesity Epidemic - A Chronic Disease
• Support for Refugees in Delaware
• Gun Violence is a Public Health Crisis
• Support of the AMA Board of Trustees Statement Regarding Physicians and Other Health Care Workers on the Frontlines Around the World (Late Resolution)

American Medical Association President, Jesse Ehrenfeld, MD, MPH will speak and a special President's Award will be presented to Senator Tom Carper. The 50 year medical school graduates will also be honored for their achievement.

Watch for a recap of the Annual Meeting in next week's newsletter.

Medicare Reform of High Priority

The Medical Society of Delaware was represented through our Delegation at the American Medical Association (AMA) Interim Meeting that took place at National Harbor, Maryland from November 10-14. Highlights from the meeting include:

• Through various actions at the Interim Meeting, the House of Delegates made it unmistakably clear that the unsustainable Medicare payment system poses a dire threat to patients’ access to high-quality physician care across the nation. In addition to this year’s 2% cut in Medicare physician pay, doctors face a further 3.37% cut set to take effect in January. After adjusting for inflation, physician pay actually fell by 26% since 2001.
• The AMA maintained its opposition to single-payer health reform after delegates discussed a proposal during reference committee at the Interim Meeting. The AMA has longtime, extensive policies that support a pluralistic system that ensures choice of coverage for patients and autonomy of practice for physicians. 
• It is important for health plans to have adequate networks to provide access to in-network physicians and hospitals that meet enrollees’ care needs. But when networks are inadequate, it creates obstacles for patients seeking new or continued care. It also limits patients’ choice of physicians and facilities. Regulators must do more to ensure network adequacy so that patients have options in accessing care.
• Delegates restated the need for state medical boards to maintain oversight in the regulation of non-physician health professionals.
• The collection of cost-sharing is a burden on many physicians and causes numerous adverse impacts. But it is physician private practices—especially small practices and those in rural areas—that tend to be more intensely impacted by the challenges experienced in collecting cost-sharing. Delegates adopted policy to support requiring health insurers to collect patient cost-sharing and pay physicians their full allowable amount for the health care services provided, unless the physicians opt-out to collect such cost-sharing on their own.

Read more on the highlights from the meeting.

CDC Issues Health Advisory

Multiple states have reported potential cases to the U.S. Food and Drug Administration (FDA) of high blood lead levels (BLLs) in children consuming recalled cinnamon-containing applesauce products that have high levels of lead. The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) Health Advisory to advise clinicians and health departments to consider the possibility of illness due to lead exposure and report cases to their local health authorities. Clinical laboratories should prepare for possible increases in testing volume due to these potential exposures. WanaBana, Schnucks, and Weis have initiated voluntary recalls of certain lots of their products. More information about the specific recalled products may be found on the FDA’s website: Investigation of Elevated Lead Levels: Applesauce Pouches (November 2023) | FDA. As of November 7, 2023, there are 22 cases, in states including Alabama, Arkansas, Louisiana, Maryland, Missouri, New Mexico, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Washington, ages 1 to 3 years, with BLLs ranging from 4 to 29 micrograms per deciliter (µg/dL). Cases experienced signs and symptoms including headache, nausea, vomiting, diarrhea, change in activity level, and anemia. Click for further information and recommendations for clinicians.

For WWII Veterans and Veterans Exposed to Toxins and Chemicals

On the observance of Veterans Day last Friday, the White House announced the expansion of health care coverage for the nation’s veterans, creating a no-cost system for World War II veterans seeking care and accelerating enrollment for all veterans applying for benefits after exposure to toxins. Starting this month, all living World War II veterans can access health care services from the Department of Veterans Affairs (VA) at no cost, including nursing home care. The VA will also accelerate eligibility under the PACT Act, a major law that passed last year and expanded benefits for veterans exposed to toxins and chemicals. Veterans who have yet to enroll will be able to do so next year.

The White House Initiative on Women's Health Research

The White House is convening a new program aimed at boosting funding for women's health research. Led by first lady Jill Biden, the initiative will focus on closing research gaps in areas like cardiovascular health and menopause.

Schedules Summarize the Final Recommendations Previously Adopted

The 2024 Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules were posted online on Thursday this week. As a reminder, the schedules summarize final recommendations that were previously adopted and made official by the Centers for Disease Control and Prevention (CDC) director. Therefore, these schedules are effective immediately.

Schedule changes are reflected in CDC’s health care provider web content as well as on the Immunization Schedule App.

The new schedules include October 2023 recommendations for use of Mpox and pentavalent meningococcal vaccine and updated recommendations for the following vaccines:

• COVID-19
• RSV
• Influenza  

New Report Highlights Toll of Lung Cancer in the State

The 2023 “State of Lung Cancer” report reveals that Delaware ranks 12th in the nation for early lung cancer survival. This means that Delaware is above average in the nation for lung cancer survival, however, so more work is needed to reduce the burden of lung cancer. The American Lung Association’s 6th annual report, released on Tuesday, highlights the toll of lung cancer in Delaware and examines key indicators including new cases, survival, early diagnosis, surgical treatment, lack of treatment and screening rates. The report also found that Delaware ranked 18th for lung cancer screening and 10th for early diagnosis but finds that Black individuals in the state are least likely to be diagnosed early - 20% less likely than white individuals. 

HHS Language Access Plan Critical Step Towards Accessibility for All

On Wednesday, the U.S. Department of Health and Human Services (HHS) took the next step in working to ensure greater access to the life-saving services that it provides for people with Limited English Proficiency (LEP) and people with disabilities. In releasing the HHS Language Access Plan, HHS joins agencies across the federal government in prioritizing communication in services to the public and advances racial equity and support for underserved communities, which aims to improve access to benefits and services across the Administration, including for people with LEP. HHS’s plan goes beyond solely addressing language access to individuals with limited English proficiency by recognizing the effective communication and accessibility requirements of Sections 504 and 508 of the Rehabilitation Act of 1973 to increase inclusivity of communication for persons with disabilities. Section 504 prohibits discrimination against otherwise qualified individuals on the basis of disability in programs and activities receiving financial assistance from HHS, while Section 508 requires federal agencies to ensure that their information and communication technology, including websites, electronic documents, and software applications, are accessible to individuals with disabilities. The updated Language Access Plan may be found here: https://www.hhs.gov/sites/default/files/language-access-plan-2023.pdf. The updated Language Access Plan will be available in various languages. These translations are forthcoming and once available they can be found here: hhs.gov/lep.

First Guidance for Health Care Stakeholders Since 2008

On November 6, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its General Compliance Program Guidance (GCPG), a generally applicable reference guide for health care industry stakeholders to use in building, implementing and evaluating their compliance programs; the GCPG represents the OIG’s first comprehensive update to compliance program guidance documents (CPGs) in over 15 years. These updates are a core part of the OIG’s Modernization Initiative To Improve Its Publicly Available Resources and reflect health care industry trends, input that the OIG has collected regarding its CPGs, and the OIG’s decades of experience initiating investigations and enforcement actions and monitoring corporate integrity agreements. The OIG notes that the GCPG’s contents can apply to all health care industry stakeholders but that the guidance is voluntary, non-binding and not intended to represent a comprehensive, all-inclusive, one-size-fits-all approach to health care compliance. Rather, these resources are intended to provide guidelines and tips to aid stakeholders in identifying and addressing compliance risks when establishing or updating their compliance programs. The GCPG elaborates on the seven elements of an effective compliance program that have long formed the core of the OIG’s compliance guidelines and recommendations. It also describes deviations from the seven elements that may be appropriate for stakeholders with certain attributes and other new or notable considerations of which compliance professionals should be aware. The GCPG provides compliance program tips, concrete indicators of success, and a list of questions to help flag potential compliance issues.

Marketing Authorization Granted for LetsGetChecked for Simple 2 Test

On Wednesday, the U.S. Food and Drug Administration (FDA) granted marketing authorization to LetsGetChecked for the Simple 2 Test. This is the first diagnostic test for chlamydia and gonorrhea with at-home sample collection to be granted marketing authorization. Prior to today’s authorization, the only cleared tests for either condition were used with samples collected at the point of care, such as a doctor’s office. The Simple 2 Test is available over-the-counter (OTC) and is intended for use in adult patients ages 18 years and older. It is the first FDA-authorized test with at-home sample collection for any sexually-transmitted disease other than HIV. Chlamydia and gonorrhea are the first and second most common bacterial sexually transmitted infections (STI) in the United States, and the rate of these STIs is steadily increasing, with an estimated 1.6 million cases of chlamydia and more than 700,000 cases of gonorrhea, in 2021 alone.

DE Employers Must Provide Paid Family, Medical Leave to Eligible Employees

Rules were released in July 2023 regarding implementation of the Healthy Delaware Families Act. Although payroll contributions will not go into effect until 2025 and benefits do not begin until 2026, there are several upcoming deadlines for employers to be aware of, and decisions that need to be made prior to January 1, 2024. Read more.

In Partnership with Impact Life

In partnership with Impact Life, another behavioral health nonprofit organization, atTAcK addiction will open its first storefront resource center to meet the needs of individuals and families struggling with substance use disorder, beginning on Nov. 15 in Peoples Plaza in Glasgow. The behavioral health resource center, which will be staffed by new center manager Leah Parrack and atTAcK addiction volunteers, will offer services for individuals and their families, including harm-reduction resources, a connection to treatment or recovery services, and educational, housing or family supports. The resource center, at 210 Peoples Plaza, will open at 10 a.m. Wednesday, Nov. 15. Beginning on Nov. 15, the resource center can be reached at 302-365-5221 or via email at leah.parrack@attackaddiction.org. A grand opening event will be held from 3-6 p.m. Dec. 7.

During the opening weeks, hours will vary based on the availability of volunteers and the demand for services. Initial services and resources that will be available include:

• Information, referrals and resources.
• Harm-reduction services.
• Housing supports and referrals.
• Overdose prevention training and access to Narcan, a medication that can reverse an opioid overdose.
• Educational programs.
• Family support.
• Community engagement and advocacy.
• Technology access.
• Volunteer coordination.

Need for Evidence-Based Strategies to Increase Vaccination Coverage

A new Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) highlights a decline in flu vaccination among health care professionals (HCPs) in acute care hospitals during the COVID-19 pandemic. HCPs vaccinated against flu decreased from 85.9% in 2020–2021 to 81.1% in 2022–2023. The study supports the need for evidence-based strategies to increase vaccination coverage among HCPs. 

Due to Stolen Defective Models Offered for Sale

Covidien LLC is recalling McGRATH™ MAC Video Laryngoscope in order to remove stolen defective models that have been offered for sale illegally by unauthorized third parties. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Due to Incompatibilities with Syringe Pumps

Cardinal Health is recalling some of its syringes branded as “Cardinal Health Monoject syringes.” These new syringes differ from the previously branded “Covidien Monoject syringes” as they have different dimensions. The affected Cardinal Health Monoject syringes should not be used with syringe pumps. The dimensional changes made to the affected Cardinal Health Monoject syringes when used with syringe pumps may result in pump performance issues such as overdose, underdose, delay in therapy, and delays in occlusion alarms. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Due to Blood or Heparin Leakage

Fresenius Medical Care is recalling its Sanxin Single Use Sterile Syringes due to blood or heparin leaking back or from the syringe. There have also been reports of an unknown black material inside the syringe. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death. 

Due to Potential Safety Concerns with Insanitary Conditions

Kilitch Healthcare India Limited is recalling the eye drops products with all lots within expiry with expiration dates ranging from November 2023 to September 2025. These products are being recalled due to potential safety concerns after FDA investigators found insanitary conditions. 

Add Flexibility to Patient Scheduling

With wave scheduling, your clinic can expand capacity and flexibility while minimizing running behind schedule. Rigid block scheduling makes it difficult to repurpose leftover time when a visit ends early. By contrast, front-loading the patient volume at the beginning of an hour lets you use the time not needed for one patient for another visit.

LEARN MORE:

Toolkits:

• Wave Scheduling
• Advanced Rooming and Discharge

Playbook:

• Saving Time

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

"Kind to Kids" - Children, Teens in Foster Care Affected by Trauma

The Medical Society of Delaware (MSD) has selected Kind to Kids as our winter season charity fundraising beneficiary. Our goal is to raise $1,200 to help children and teens in foster care who are victims of child abuse and neglect. Your donation will provide direct support for a child in foster care. Kind to Kids is a foundation that helps meet the needs of children and teens in foster care who are deeply affected by the trauma in their lives. 100% of every dollar donated online will go directly to help a foster child during these difficult times. Please donate now and help us make a difference in the lives of these deserving kids. You can donate online at https://www.classy.org/fundraiser/5051939. Thank you for your support! 

Bayhealth

ChristianaCare

Delaware Hospice

Louis Crevecoeur, MD - IM/ID, Delaware Primary, Care, LLC

Chantel Imran, MD - OB/GYN, University of Delaware Student Health Srvcs.

Katherine P. Lewis, MD - Pediatrics, Atracare

Shab E. Gul Rahim, MD - Nephrology, Nephrology Associates, PA

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!

Uma Chatterjee, MD - OB/GYN, Saint Francis Women's Center

Yvette Gbemudu, MD - Family Medicine, Henrietta Johnson Medical Center

Susan M. Green, MD - Occupational Medicine, Internal Medicine, Retired

Nemish Mehta, MD - Pediatrics, Bear Internal Medicine and Pediatrics, PA

Shilpa P. Mehta, MD - IM/Peds, Bear Internal Medicine and Pediatrics, PA

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(s) listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

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.

• Ellume tests available for those who are blind or have low vision (free at-home COVID-19 tests) https://acl.gov/accessibletests
• 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)
• (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)