The Medical Society of Delaware is hosting a Hot Topic CME event on Thursday, August 11th at 5:30 p.m. via zoom. "Monkeypox Update" will provide MSD members an update on the Monkeypox virus, symptoms, and vaccination. Presenters from the Delaware Division of Public Health (DPH) will include: Rick Hong, MD, Interim Director; Michael Coletta, MD, Associate DPH Physician; Camille Moreno-Gorrin, Lead Epidemiologist; and Jill Austin, Incident Response Lead. Those interested in joining must register at: https://reg.planetreg.com/MonkeypoxUpdate. This activity has been approved for a maximum of 1 AMA PRA Category 1 Credit™.

Governor John Carney was joined by MSD President Matthew Burday, DO and Richard Henderson, MD, Chair of the MSD Government Affairs Committee, and others to recognize the signing of Senate Bill 300. This legislation amends Title 24 of the Delaware Code relating to medical practice by updating the mandatory reporting requirements for Delaware physicians with anxiety, depression, and other mental health challenges. These changes help to ensure that physicians are able to seek treatment without undue stigma or fear of loss of medical licensure. These changes are designed to appropriately balance the need to continue to maintain proper safeguards for patients in accessing safe, high quality health care services without causing undue stigma and negative licensure consequences for physicians. MSD helped to draft this legislation. The signing took place last Friday at the Gateway Conference Center at ChristianaCare Wilmington Hospital.

Governor Carney joined Lt. Governor Bethany Hall-Long, House Majority Leader Valerie Longhurst, Secretary Molly Magarik, members of the General Assembly, and advocates on Wednesday for the signing of multiple pieces of legislation related to mental health.

House Bill 300 - establishes a mental health services unit for Delaware middle schools;

House Amendment 1 for House Bill 301 - implements statewide mental health educational programs for each grade, kindergarten through grade 12; and

House Amendment 2 for House Bill 303 - requires coverage for an annual behavioral health wellness check and creates an advisory committee of health professionals tasked with creating recommendations for implementation of the Act.

As monkeypox cases continue to spread in the US, the Department of Health and Human Services (HHS) is providing another 786,000 doses of monkeypox vaccine (JYNNEOS) with the goal of distributing to areas where monkeypox spread is most prevalent. The Food and Drug Administration (FDA) cleared the smallpox vaccine (JYNNEOS) to also prevent monkeypox in adults 18 years of age and older and determined to be at high risk for smallpox or monkeypox infection. JYNNEOS is licensed for a 2-dose series given at an interval of 28 days. US physicians have indicated they continue to face challenges getting access to the vaccine. HHS continues to monitor the response to the outbreak, but as of yet has not granted a monkeypox Public Health Emergency. So far, there are more than 6,300 known cases in the U.S., almost entirely among men who have sex with men. New York, California, Illinois and some cities have declared states of emergency, following the World Health Organization’s own declaration of a global emergency.

In findings published in the European infectious disease journal Eurosurveillance, researchers have found monkeypox virus lingering throughout the surfaces in patients' hospital rooms and rooms used by medical staff, underscoring the need to maintain infection control and sanitation protocol.

As of July 28, 2022, the Centers for Disease Control and Prevention (CDC) is reporting 4,907 cases of monkeypox in the United States across 46 states, Washington, D.C., and Puerto Rico. CDC is also tracking multiple clusters of monkeypox that have been reported globally, including in 71 countries that normally do not report monkeypox.

Since May 2022, CDC has been urging physicians to be on alert for patients who have rash illnesses consistent with monkeypox. Distinguishing features of the rash include papules, vesicles, pustules, or scabs that are deep-seated, firm or rubbery, and have well-defined round borders. Vesicular or pustular stages of the lesions are often umbilicated (i.e., have a dent in the middle of them). They may be painful, painless, or itchy. People with monkeypox may develop symptoms including fever, headache, muscle aches, exhaustion or swollen lymph nodes during the prodromal period preceding the rash or with the rash.

Tests should be performed on persons for whom monkeypox is suspected based on clinical presentation and epidemiologic criteria. Positive diagnostic results from testing of skin lesion material for Orthopoxvirus or Monkeypox virus DNA in persons without epidemiologic criteria or known risk factors should be verified through repeat testing and/or confirmatory testing. The recommended specimen type is material collected from the surface of a lesion or crust from a healing lesion. CDC recommends that three lesions per patient be swabbed. Swab the surface of the lesion vigorously to collect adequate DNA. It is not necessary to de-roof or lance the lesion before swabbing. For some individuals, the lesions may not be overtly visible (such as within the oral cavity or within the rectum), therefore clinicians should perform a thorough evaluation including a full body skin, oral, genital, and rectal examination to identify appropriate lesions for sampling.

Tecovirimat (also known as TPOXX or ST-246) is approved by the Food and Drug Administration (FDA) for treating human smallpox disease caused by Variola virus in adults and children. Its use for other Orthopoxvirus infections, including monkeypox, is not approved by the FDA. However, CDC has an expanded access Investigational New Drug application (EA-IND) to allow access to and use of TPOXX to treat monkeypox in adults and children of all ages. TPOXX is available through the Strategic National Stockpile, and multiple state and territorial health departments are pre-positioning supplies of TPOXX within their jurisdictions. All clinicians and care facility pharmacists requesting TPOXX should contact their state/territorial health department. For urgent clinical situations after hours, physicians may contact CDC’s Emergency Operations Center (770-488-7100) to discuss the case with a clinician but pre-positioned TPOXX may be the fastest route to obtain the therapeutic. Treatment with TPOXX can begin upon receiving the medication and after obtaining informed consent. No pre-registration is required for clinicians or facilities to begin treatment.

The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a laboratory test CPT code for the orthopoxvirus and two CPT codes for the monkeypox vaccines. The updated CPT codes are effective for immediate use and are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting, and analysis necessary for resource planning and allocation during the public health response to the outbreak. The new laboratory test CPT code (87593) describes molecular diagnostic testing that detects the nucleic signature of an orthopoxvirus, including the monkeypox virus.

The two new vaccine codes are designed to describe the two smallpox and monkeypox virus products currently available. The first code (90622) describes the existing FDA-approved ACAM2000 vaccine manufactured by Sanofi Pastuer Biologics Co. for active immunization against smallpox disease for persons determined to be at high risk for smallpox infection. The second code (90611) describes the FDA-approved JYNNEOS vaccine manufactured by Bavarian Nordic for prevention of smallpox and monkeypox disease in adults 18 years of age and older at high risk for smallpox or monkeypox infection. Short, medium and long descriptors for new CPT codes can be accessed on the AMA website.

In the Proposed Rule for the 2023 Medicare Physician Payment Schedule, Centers for Medicare and Medicaid Services (CMS) is proposing to move away from using America Medical Association (AMA) data to inform the Medical Economic Index (MEI). CMS is concerned that the 2006 Physician Practice Information (PPI) Survey is outdated, and they propose to instead utilize data collected by the United States Census Bureau. This proposal would result in significant redistribution within physician payments. The AMA understands that this proposal is concerning to many in the Federation. Consequently, the AMA is involved in a new data collection effort and has significant concerns with the CMS proposal. The AMA has provided a brief document outlining its concerns and data collection efforts. 

The Department of Health and Human Services (HHS) is creating a new long COVID office as part of a White House plan to better understand why some patients continue to face symptoms long after they’ve shed the infection. The new “Office of Long COVID Research and Practice" will fall under the Health and Human Services assistant secretary for health, according to the National Research Action Plan on Long COVID released Wednesday.

The Federation of American Hospitals (FAH) has urged the Department of Health and Human Services (HHS) to extend the COVID-19 public health emergency (PHE) into 2023, stressing that hospitals across the country still rely on the accompanying regulatory waivers and flexibilities. The public health emergency is set to expire in October, but the group urged HHS to renew it for two additional 90-day periods, extending the emergency into 2023. In the letter to HHS, a list of critical PHE waivers and policies was included that FAH urged the Centers for Medicare & Medicaid Services (CMS) to make permanent. 

The Blood Bank of Delmarva (BBD) announced a blood emergency on Tuesday, as the region’s ongoing heatwave, summer travel, and a recent spike in COVID-19 cases have caused a significant decrease in donations over the past several weeks. Hospitals and patients rely upon a steady flow of donors to receive life-saving blood donations, but these factors have caused the blood supply to become unstable. BBD continues to partner with local breweries for their “Blood for a Brew” campaign, which continues until September 10th. Donors can give blood onsite at brewery blood drives or select the drop-down option when completing their health history at any donation location. As a part of this campaign, each presenting donor will receive a coupon and/or gift card dependent on the participating brewery. Nine establishments are participating in this campaign, sponsored by TD Bank, across the region. A full list of participating breweries and restaurants can be found here. To make an appointment at a blood drive near you, donors can call 1-888-8-BLOOD-8 or visit delmarvablood.org/give-blood/blood-brew/. Can’t donate blood? You can still support BBD’s mission by texting the letters “BBD” to 20222 to donate $25.

Last Friday, the U.S. Department of Health and Human Services (HHS), alongside the Departments of Labor and of the Treasury (Departments), took action to clarify protections for birth control coverage under the Affordable Care Act (ACA). Under the ACA, most private health plans are required to provide birth control and family planning counseling at no additional cost. In response to increasing complaints from women and covered dependents about not receiving this coverage, the Departments issued guidance to remind plans and issuers of the ACA’s contraceptive coverage requirements and emphasize the Departments’ commitment to enforcement. The ACA guarantees coverage of women’s preventive services, including free birth control and contraceptive counseling, for all individuals and covered dependents with reproductive capacity. This includes, but is not limited to:

The National Comprehensive Cancer Network® (NCCN®) has published new NCCN Guidelines for Patients®: Breast Cancer Screening and Diagnosis to help patients understand their personal risk for breast cancer, when they should begin screening, and how often to screen—in order to detect cancer earlier, for more treatment options and better outcomes. With this information, they are equipped to have more informed conversations with their physicians and be active decision-makers in their long-term health. The new evidence-based patient-facing breast cancer guidelines call for annual mammograms for all average-risk women over age 40 years. With many, often conflicting recommendations surrounding breast cancer screening, this effort hopes to simplify the message and eliminate confusion and apprehension. A chart developed by the Centers for Disease Control and Prevention highlights variations in breast cancer screening across guidelines published by the US Preventive Services Task Force (USPSTF, individualized approach to screening for women before age 50 years), the American Cancer Society (ACS, those aged 40-44 years should have the choice to start annual screening), the American College of Obstetricians and Gynecologists (ACOG, supports personal choice and shared decision-making after appropriate counseling with mammography offered annually or biannually), the American College of Radiology (ACR, informed decision-making about annual mammography after age 40), and others.

The Drug Enforcement Administration (DEA) has recently rescinded previous guidance that allowed pharmacists to modify or add missing elements to controlled substance prescriptions. Effective immediately, for all controlled substance prescriptions, all elements required by 21 CFR 1306.05 -- Manner of issuance of prescriptions must be present on the prescription when it is received. According to 21 CFR 1306.05, all prescriptions for controlled substances shall be dated as of, and signed on, the day when issued and shall bear the full name and address of the patient, the drug name, strength, dosage form, quantity prescribed, directions for use, and the name, address, and registration number of the prescriber. If, at the time of dispensing, any of the required elements are missing or incorrect, then the prescriber must issue a new prescription. New prescriptions for CIII-CV medications may be accepted verbally if allowed by state law. Any element not listed in 21 CFR 1306.05(a), such as phone, date of birth, or diagnosis may be added or modified. Numerical or written words are acceptable for the date or quantity. If state law is more stringent, the pharmacist may contact the prescriber and annotate the prescription.

Attorney General Kathy Jennings applauded several policy changes implemented by the Criminal Justice Council (CJC) as part of its ongoing efforts to strengthen rights for survivors of sexual assault. The new policies establish timelines for the collection, documentation, processing and investigation of assault evidence “kits.” This policy is a result of funding received from the U.S. Department of Justice’s Bureau of Justice Assistance, through the Sexual Assault Kit Initiative (SAKI) program. The policy, based on input from law enforcement, the DOJ, and the Division of Forensic Science (DFS) and best practices and model legislation nationwide, details standards and processes for healthcare facilities, law enforcement agencies, DFS, law enforcement-based victim advocacy services, and the Department of Justice to help prevent future sexual assault kit backlogs from forming in Delaware. The new policy also serves to inform survivors about what to expect from state institutions, in addition to the existing Delaware Victim’s Bill of Rights. 

Attorney General Kathy Jennings on Tuesday announced that Delaware is joining a nationwide Anti-Robocall Litigation Task Force of 50 attorneys general to investigate and take legal action against the telecommunications companies responsible for bringing a majority of foreign robocalls into the United States. This bipartisan nationwide Task Force has one goal: to cut down on illegal robocalls. 

Gateway providers that bring foreign traffic into the U.S. telephone network have a responsibility to ensure the traffic is legal, but these providers are not taking sufficient action to stop robocall traffic. The Task Force will focus on the bad actors throughout the telecommunications industry, to help reduce the number robocalls that consumers receive and benefit the companies that are following the rules. 

All current phone numbers, fax numbers, and email addresses for MSD, MSD staff, MSD subsidiaries and foundations will remain in place with the move to the new location. Thank you for your patience as we work to serve our members and our communities leading the way to a healthy Delaware!

The Centers for Disease Control and Prevention (CDC) has announced its next EPIC webinar, Becoming Comfortable with Health Equity Concepts and Language¸ which will help all audiences understand the place of health communications in removing social obstacles that lead to poor health outcomes and health disparities. Through CDC’s Health Equity Guiding Principles for Inclusive Communication, you’ll learn about the importance of ensuring communication products and strategies adapt to the specific cultural, linguistic, environmental, and historical situation of each population or audience of focus.

When: Monday, August 8th, 2022, 2-3 p.m. (Eastern Time)

Webinar August 8th, 2022 - Becoming Comfortable with Health Equity Concepts and Language 

Webinar ID: 160 507 8987

Passcode: 203188

SIP: 1605078987@sip.zoomgov.com

August 9 - MSD HOT TOPIC CME - "COVID-19 Update and Motivational Interviewing skills for the Pediatric Population," 6:00 p.m., virtual event. This activity has been approved for a maximum of 1 AMA PRA Category 1 Credit^TM.

August 11 - Highmark BCBS Delaware Mid-Year Update, 12 Noon-1:00 p.m., virtual. Recommended for physicians and staff. Session is free to MSD Members and Staff. Non-member fee is $25. This activity has been approved for a maximum of 1 AMA PRA Category 1 Credit^TM.

August 11 - Hot Topic CME: "Monkeypox Update," 5:30 p.m. via zoom. Register at: https://reg.planetreg.com/MonkeypoxUpdate. This activity has been approved for a maximum of 1 AMA PRA Category 1 Credit™.

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., complimentary virtual session.

Thursday, Sept. 1 | 12 p.m. CT 

September is Suicide Prevention Awareness Month. Building off the Practical Strategies for Managing Suicidal Ideation & Reducing Risk, this pre-recorded webinar focuses on how primary care practices can address suicidal ideation within their adult patient population. REGISTER NOW.

REGISTER NOW.

LISTEN HERE: (Apple Podcasts | Spotify)

LISTEN HERE: (Apple Podcasts | Spotify)

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 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!

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.