Office Hours, Newsletter Holiday Schedule

MSD shares the spirit of the season with all our members, friends, and family. Thank you for your support of MSD this past year, however slight or great, to improve the lives of Delaware patients and the members we serve. Happy holidays from all of us at the Medical Society of Delaware!

Our office will be closing early at 3 p.m. on Thursday, December 22 and Thursday, December 29. In addition, our office will be closed on the following days in observance of the Christmas and New Year's holidays: Friday, December 23; Monday, December 26; Friday, December 30; and Monday, January 2.

The eNews & Views holiday break will take place beginning Dec. 22 with the newsletter returning on Jan. 5. Content will be disseminated during that period as warranted.

Donate to Help Those In Need

MSD is raising money to help the Food Bank of Delaware address the increase in need for

hungry Delawareans. With every $1 raised, the Food Bank of Delaware can provide three

meals. Let's help our fellow citizens in their time of need. Access the virtual donation site to

make your donation. It is quick, easy, and convenient. Donations will be accepted through

Friday, December 30th. Thank you for making a difference!

2024 Will Bring At Least a 1.25% Cut From the Omnibus Spending Deal

An advocacy campaign led by the American Medical Association (AMA) and joined by more than 150 organizations representing over 1 million physicians, including the Medical Society of Delaware and its members, helped stave off many of the Medicare payment reductions facing physicians in 2023. The advocacy campaign asked Congress to stop the entire 4.5% Medicare cut stemming from the combination of the expiring 3% increase to the conversion factor that Congress enacted via the Protecting Medicare and American Farmers from Sequester Cuts Act and a new 1.5% budget neutrality reduction related to payment changes for evaluation and management services in the non-office setting. Congress faced a December 23 deadline to avoid a government shutdown and a smaller legislative package has been called for by lawmakers.

A draft government spending bill released on Tuesday morning proposes a much smaller-than-planned cuts to Medicare payments. Physicians face a 2% cut in Medicare payment in 2023, and 2024 will bring at least a 1.25% cut under a massive, must-pass omnibus spending deal struck by Congressional leaders. Congress is anticipated to act on the bill over the next few days in order to keep the government funded and avert a shutdown. The medical community is disappointed that the entire cut facing physicians was not averted. AMA President, Jack Resneck, Jr., MD stated, "This 2% cut, following two decades of flat payment rates, will have consequences on health care access for older Americans."

To Improve the Care Experience for Patients and Physicians

The Centers for Medicare & Medicaid Services (CMS), on behalf of, the U.S. Department of Health and Human Services (HHS), issued the proposed rule, “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P).” If finalized, the proposed rule, would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. The modifications to the adopted Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The proposed rule estimates a savings of $454 million annually in administrative costs and is a part of HHS’ and CMS' ongoing efforts to significantly reduce paperwork burdens and empower physicians to focus on direct patient care and streamline the care experience for patients and physicians.

Please refer to the Proposed Rule, Press Release and Fact Sheet for more details. The deadline to submit comments is March 22, 2023.

DPH Urges Vaccination Prior to End of Year

The Delaware Division of Public Health (DPH) announced last Friday the state's first suspected flu-related death for the 2022-2023 influenza season. The patient was a Kent County resident between the ages of 55 – 64 and is not reported as being vaccinated against the flu. Getting the annual flu vaccine is important for all people ages 6 months and older to prevent serious illness, hospitalization and death that can result from the flu virus. Hospitalization and death from the flu can occur in previously healthy individuals, though persons with underlying health conditions are at significantly increased risk for serious outcomes.  

According to the recently launched Influenza Dashboard on My Healthy Community (https://myhealthycommunity.dhss.delaware.gov/portals/flu/locations/state/seasons/2022-2023/overview), a total of 5,609 total flu cases have been reported as of December 16th during the 2022-2023 flu season. The flu season began Oct 2, 2022. For the week of Dec. 4 to Dec 10, the most recent week for which case data is available at the time of this publication, there were 1,125 laboratory-confirmed cases of the flu reported. Although there have been 276,911 flu vaccine doses administered through Dec 10, it only accounts for 28.6% of the population. 

Seniors ages 65 and older have the highest vaccination rate of any age group in Delaware with 63.3% vaccinated. Every other age group has a vaccination rate of under 30% with persons in the 18-34 age demographic having the lowest at 11.1%. The influenza data dashboard is updated weekly on Thursdays at the state and county level, and monthly for other geographies. While flu cases continue to be high, flu hospitalizations remain relatively low. As of Dec. 3, the most recently available data for flu hospitalizations, there have been 47 hospitalizations for the season to date.

As a reminder, it is safe to get a flu shot and COVID-19 booster the same day if eligible for both.  

Because Flu, RSV (Respiratory syncytial virus) and COVID-19 share many of the same signs and symptoms, it is often difficult to tell the difference between them. Common symptoms between these viruses include fever, cough, fatigue, runny or stuffy nose, and several others. Testing is needed to confirm sickness with these viruses. DPH recommends patients contact their primary care physician if they need to get tested for the flu and to determine whether influenza antiviral drug treatment is recommended.

Curative Not Renewing Its Contract with the State for Testing Services

The Delaware Division of Public Health (DPH) has announced changes to COVID-19 testing access in Delaware. Based on operational needs, Curative has decided to not to renew its contract with the State to provide testing services when it expires at the end of the year. As a result, Wednesday, Dec. 28 will be the last day for Curative test site collections. Other Curative sites, such as the one at the University of Delaware, have already closed. Friday Dec. 23, will be the last day for Curative testing at Delaware State Service Centers. While some people may find this concerning, DPH wants to assure there is ample access to COVID-19 testing in the state, particularly in the event of a winter surge. 

What options remain available for testing in Delaware?

1. Search the online testing locator at de.gov/gettested for other available testing locations such as pharmacies, Federally Qualified Health Centers or physician offices.*Most sites will require a person to show their insurance card. Those without insurance will be charged. Contact the site in advance to confirm insurance requirements. Those traveling who need test results should identify sites that offer PCR tests, as rapid antigen tests are not accepted for federal travel requirements.
2. Patients can contact their primary care physician.
3. Those who are uninsured and underinsured can visit a DPH Public Health Clinic for free testing.
4. Secure an at-home test kit.

• The White House is making up to four free at-home tests per household available on Covidtest.gov. Households can now order either standard at-home tests or tests that are more accessible for people who are blind or have low vision. Shipping is free.
• Insured individuals are eligible for up to eight free at-home tests per covered member per month. Most people with a health plan can go online, or to a pharmacy or store to get an at-home COVID-19 test at no cost, either through reimbursement or free of charge through their insurance. Learn more details here.
• Medicare Part B Recipients – Delawareans with Medicare Part B, including those enrolled in a Medicare Advantage plan, have access to over-the-counter COVID-19 tests at no cost. The initiative continues until the COVID-19 public health emergency ends. People with Medicare can get up to eight tests per calendar month from participating pharmacies and health care professionals.
• Community Organizations – you can order cases of free at-home test kits from DPH to distribute within your communities by filling out this form: https://coronavirus.delaware.gov/wp-content/uploads/sites/177/2020/10/SHOC-Resource-Request-Form.pdf and emailing it to dhss06sg_shoc_operations@delaware.gov . If you have questions about completing the form, email the staff at SHOC operations and they will reply to you.
• At-home test kits are available for purchase at pharmacies, grocery stores and many other locations throughout the state (most cost in the range between $10 and $25).

Medically related questions regarding testing, symptoms, and health-related guidance can be submitted by email at DPHCall@delaware.gov.   

DPH will continue to update the public as more information becomes available. For the latest on Delaware's response, go to de.gov/coronavirus.   

COVID-19 Therapeutics for Treatment and Prevention

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Update to supplement the CDC HAN Health Advisories issued on April 25, 2022 and May 24, 2022 to emphasize that the majority of Omicron sublineages circulating in the United States have reduced susceptibility to the monoclonal antibody, bebtelovimab and the monoclonal antibody combination, cilgavimab and tixagevimab (EvusheldTM). Antiviral therapeutics for the treatment of COVID-19, ritonavir-boosted nirmatrelvir (Paxlovid^TM), remdesivir (Veklury®), and molnupiravir (Lagevrio^TM), retain activity against currently circulating Omicron sublineages. These medications can prevent severe disease, hospitalization, and death and are widely available but have been underused. The HAN Health Update provides guidance on improving use of therapeutics for treatment of COVID-19 and strategies to prevent serious outcomes of COVID-19. Learn more.

Discussion on the Future of COVID-19 Vaccines

On January 26, 2023, the US Food and Drug Administration (FDA) will hold a meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) to consider whether and how the composition for primary doses of the currently available COVID-19 vaccines should be modified and how and whether the composition and schedule for booster doses should be adjusted moving forward. Read the statement.

For Qualitative Detection of DNA from Mpox Virus in Swab Specimens

The US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to Life Technologies Corporation (a part of Thermo Fisher Scientific Inc.) for the TaqPath Monkeypox/Orthopox Virus DNA Kit, for qualitative detection of DNA from monkeypox (mpox) virus (clade I/II) in human lesion swab specimens from individuals suspected of mpox by their health care professional. Testing is limited to laboratories certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), 42 U.S.C. §263a, that meet the requirements to perform high complexity tests.

Small, Positive Health Choices Can Have Long-Lasting Effects

As the new year approaches, the American Medical Association (AMA) is offering 10 recommendations to help Americans make the most impactful, long-lasting improvements to their health in 2023 and beyond.

The AMA’s 10 recommendations for a healthier new year, include the following:

1. Be more physically active
2. Make sure your family is up-to-date on their vaccines
3. Get screened
4. Know your blood pressure numbers
5. Learn your risk for type 2 diabetes
6. Manage stress
7. Reduce your intake of processed foods and sugar-sweetened beverages, especially those with added sodium and sugar
8. Drink alcohol in moderation
9. Talk with your doctor about tobacco and e-cigarette use (or vaping) and how to quit
10. Follow your physician’s instructions if prescribed pain medication or antibiotics

To Help Reduce Misclassification and Complexity

The Centers for Disease Control and Prevention (CDC) and Council of State and Territorial Epidemiologists published a revised case definition of multisystem inflammatory syndrome in children, a potentially serious complication of SARS-CoV-2 infection. The CDC said the new definition is intended to help reduce misclassification and complexity and will be used to monitor MIS-C epidemiology and trends. This new definition, published in the CDC’s Morbidity and Mortality Weekly Report, removes a required duration of subjective or measured fever, narrows the signs and symptoms that qualify as clinical criteria, and adds a time frame for receipt of a positive COVID-19 test relative to MIS-C illness: up to 60 days before or during hospitalization. 

Affects Hospital Safety and Quality Standards

As reported by Modern Healthcare (12/20, Subscription), the Joint Commission is retiring 14% of its quality standards during the first round of a review process that seeks to refocus hospital safety and quality goals and decrease administrative burden. The changes are to remove redundancies and obsolete measurers from the accreditation process and make room for new standards on health equity, environmental sustainability, infection control, and workforce development. The revisions are set to go into effect in January and affect 56 of the Joint Commission's more than 250 standards.

Effective January 1, 2023

The second in a four-series incremental increase, Delaware earners with the lowest legal wages for most industries will receive a 12% raise beginning January 1st, from $10.50 to $11.75 per hour. Employees from specific industries, US government, and inmates are exempt. The incremental increase is a stepped strategy to raise the minimum wage to $15 per hour by 2025. Last year, the minimum wage was increased from $9.25 to $10.50 per hour. As of January 1, 2024, the minimum wage will be increased to $13.25. The minimum wage will reach the $15 per hour goal in 2025.

Governor Carney to Serve One-Year Term as CSG National President

Delaware Governor John Carney was elected National President of The Council of State Governments (CSG) during the organization's national conference in Honolulu, Hawaii, last week. His one-year term as CSG National President will begin on January 1, 2023. CSG is a national, nonpartisan association of all elected and appointed state officials from all three branches of the state government. Governor Carney succeeds Hawaii Governor David Ige, who served as CSG National President this year.

Interim Director Appointed

MSD was notified on Monday that Geoffrey Christ, R.Ph., J.D., Director of the Delaware Division of Professional Regulation (DPR), has tendered his resignation to pursue an out-of-state opportunity. His last day with DPR will be Monday, December 26th. Ms. Shauna Slaughter will serve as Interim Director. DPR provides regulatory oversight for 34 boards and commissions, including the Board of Medical Licensure and Discipline, comprised of Governor-appointed public and professional members. DPR issues over 11,000 new licenses and renews over 30,000 licenses each year across the boards and commissions it oversees. In addition, DPR receives over 900 complaints and conducts over 600 investigations in a 12 month period.

Get Ready for 2023: Physician Medical Licensure Renewal Year

Delaware law requires that, in order for medical professionals to renew their license, they must attest that they have completed training on:

• how to recognize child sexual and physical abuse, exploitation and domestic violence
• your reporting obligations under the Medical Practice Act and Regulatory Provisions Concerning Public Health

The 2023 Mandatory Reporting Training for Medical Professionals will be available on January 1, 2023, and features videos from professionals within the child welfare field that walk participants through how to detect and respond to child abuse and neglect.

Licensed physicians must take the 2023 Mandatory Reporting training even if they recently completed mandatory reporting training. This training must be completed before every medical license renewal. Physicians are required to attest to completing the training on their renewal application. Failure to do so will delay the renewal of the medical license.  

This training is provided by the Office of the Child Advocate. To complete the training on or after January 1, 2023, go to https://stateofdelaware.csod.com/default.aspx?c=courts-oca to create an account. If you already have an account, just click the “login in” icon and sign in User ID and Password. Once training is completed, medical professionals can then reapply for licensure through the Division of Professional Regulation's website at https://delpros.delaware.gov/OH_HomePage.

For Those Working with Adult Patients or in the Field of Gerontology

The Board of Medical Licensure and Discipline and the Board of Nursing are responsible for establishing continuing education requirements for medical professionals licensed by these Boards. Senate Bill 283 requires practitioners who treat adults to take continuing education on the diagnosis, treatment, and care of patients with Alzheimer’s or other dementias. MSD opposed this legislation on all fronts (read the MSD/DNA Joint letter of opposition). The legislation passed both chambers and was signed by the Governor on September 8, 2022, changing the law governing continuing education requirements for medical professionals.

According to the Delaware Board of Medical Licensure and Discipline, the following requirement must be completed during each biennial medical license renewal period beginning with the 2025 renewal cycle. Senate Bill 283 requires all medical professionals who work with adult patients or in the field of gerontology in a health care setting to complete at least one (1) hour of continuing education on the topic of diagnosis, treatment, and care of patients with Alzheimer's disease or other dementias. During license renewal in 2023, you will be required to acknowledge your understanding that, you will have to complete this mandatory CE requirement starting in renewal cycle 2025, if you work with adult patients or in the field of gerontology in a health care setting.

MSD will be working closely with the Delaware Board of Medical Licensure & Discipline to obtain further clarification on how this will effect specific practices and specialties prior to the 2025 renewal cycle. Please continue to watch your communications from MSD.

FDA Identified This As a Class I Recall, the Most Serious Type of Recall

The US Food and Drug Administration (FDA) announced that Teleflex and Arrow International LLC are recalling both the Arrow MAC Two-Lumen Central Venous Access Kit and the Arrow Pressure Injectable Arrowg+ard Blue Plus Three-Lumen Central Venous Catheter Kit. The FDA has identified this recall as class I, the most serious type of recall. The devices may reportedly cause bleeding, fluid leakage, delayed treatment, infection, air embolism, death or other serious injuries in patients treated with them, although no injuries or deaths related to this issue have been reported by Teleflex and Arrow International. 

In a Show of Support for Potential Jobseekers, Employees, and Their Families

In the past couple years, many employers have expanded their company’s mental health benefits as a show of support for potential jobseekers, employees and their families. The intention is to help promote employee wellbeing through better access and improved benefit levels for those feeling stressed about personal or work-life matters. Workers seem to appreciate the efforts and are taking advantage of the services. Some of the changes business owners are making include:

• Increasing access to mental health services through methods like telehealth
• An expansion of access to in-network mental health providers
• Reduced cost sharing for mental healthcare visits
• The addition or expansion of employee assistance programs for mental health services
• Access to yoga, meditation and mindfulness sessions at the workplace or home
• Providing apps that support wellness, focusing on fitness, sleep and relaxation

By addressing issues like stress and anxiety on in a more proactive fashion, employers can reduce or even eliminate costly treatment for conditions such as hypertension, diabetes and cardiac problems. The small financial investment the employer makes now can often save substantial costs in the future.

The Medical Society of Delaware Insurance Services offers its members access to My Benefit Advisor as a solution for employee benefits, including voluntary offerings. For more information about My Benefit Advisor, visit our website at www.mybenefitadvisor.com or contact Sharon Ruth at (302) 397-0173.

Open Access Publishing: Transparency, Efficiency, Equitable Opportunity

Are you looking to publish your original article, case or technical report? MSD has established a designated online "Academic Channel" for MSD within the Cureus Journal of Medical Science. As an author interested in publishing your work, this online, Open Access process will make it simpler and put you in control.

The federal government recognizes the importance that Open Access publishing leads to increased transparency, greater efficiency, and more equitable opportunities. A new memorandum issued by the Office of Science and Technology Policy has mandated that by 2026 all peer-reviewed scholarly publications resulting from federally funded research must be made freely available to the public. Open Access continues to affect policies and change the world.

We invite you to review the Medical Society of Delaware Academic Channel and consider submitting your work for publication. Click to register for your free account and join the community to get started publishing!

Delaware Healthcare Association - CEO Announces Retirement

The Delaware Healthcare Association (DHA), the state’s hospital trade group, announced that longtime president and CEO Wayne Smith is stepping down. He will continue to serve DHA in an advisory capacity through February 28, 2023, while the association initiates a national search for his replacement.

Beebe Healthcare

During its most recent public meeting, the Delaware Health Resources Board voted in open session to approve Beebe Healthcare’s proposal to building a Hybrid Freestanding Adult and Pediatric Emergency Department in Millsboro. The 24/7 hybrid emergency department is planned to offer a combination of adult and pediatric emergency and walk-in care services through a blend of on-campus and virtual care. It will be housed in a forthcoming ambulatory care facility just north of Millsboro, on the corner of Dupont Boulevard and Hardscrabble Road. Beebe’s plan is to staff this facility with pediatric emergency medicine trained physicians, which would make it the only such location in Sussex County. 

Alex M. Raney, MD 

It is with sadness we share that MSD member Alex M. Raney, MD passed away on July 27, 2022, at the age of 93. Dr. Raney was born in Mashad, Persia and came to the United States to further his medical education. He graduated from Mashad University of Medical Sciences in 1956 and then completed a urology residency at Lincoln Medical Center in 1962. He was a member of the American Board of Urology and had numerous publications and presentations in urological research, especially electrohydraulic urethrolithorotripsy. Dr. Raney spent many years treating veterans at the Wilmington Medical Center and was a full professor at Thomas Jefferson University. All know that he derived great joy and satisfaction from helping the residents learn. Read obituary.

Joyce W. Anderson, MD 

We also recognize the loss of MSD member Joyce W. Anderson, MD who was also the age of 93 at the time of her passing on September 10, 2022. A retired general practitioner, she was one of only a handful of women to graduate from the University of Chicago Medical School. She completed her residency at the Delaware Hospital in Wilmington. Dr. Anderson provided impactful medical guidance and support by being part of the last generation of physicians to perform house calls in the homes of those who were ill. Read obituary.

Gregory K. Wanner, DO - Emergency Medicine, Doctors for Emergency Srvcs.

MSD's Membership Department is pleased to announce the newest members of the Medical Society of Delaware. If you know someone 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!

Rebecca J. Newbrander, MD - OB/GYN, ChristianaCare Women's Health

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 member(s) listed above.

• DPH Flu Dashboard
• DPH Delaware Weekly Influenza Surveillance Reports by week.
• CDC https://www.cdc.gov/flu/weekly/index.htm
• WHO https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenzaupdates/current-influenza-update

• Delaware "My Healthy Community" COVID-19 Dashboard (updated weekly on Wednesdays)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• COVID-19 Community Transmission (based on cases per 100,000 people and positivity rate, both measured over the last 7 days)
• Fact Sheet: Data Points on Bivalent COVID-19 Vaccination (November 16, 2022)
• 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
• CDC COVID Data Tracker Weekly Review.
• 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-BioNTech COVID-19 Vaccine Presentation Wall Chart (updated November 15, 2022)
• 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 to help separate fact from fiction.
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.  

• 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