Scholarship Fund to be Established

With the announcement by Representative David Bentz that he will not seek another term in office, the Medical Society of Delaware recognized his legislative accomplishments in advancing health care policy in Delaware at a special event hosted by MSD Past President Nancy Fan, MD. Guests included other members of the Delaware General Assembly, members of the MSD Executive Board, Government Affairs Committee, and DELPAC Board. Rep. Bentz served as Chair of the Health and Human Development Committee and has been a legislative champion for primary care reform, advocated for the advancement of telehealth services in Delaware, supported gun violence prevention efforts and the Provider Loan Repayment Program to attract and retain medical professionals to the state. A Tribute was presented to Rep. Bentz outlining his major health care accomplishments on behalf of physicians and patients in Delaware. To honor him, MSD plans to establish a scholarship fund through the Delaware Medical Education Foundation in Rep. Bentz' s name for those pursuing education in public policy in Delaware. 

Last in Series of Presidential Receptions Held Across the State

The series of Presidential Receptions ended in Sussex County fashion at J.D. Shuckers in Georgetown on Wednesday evening, September 21st. A good crowd came out for one of the first in person membership events held in Sussex County since the beginning of the pandemic. Plenty of food, good conversation, introductions to new friends, and joyous reunions filled the evening. Thanks to all who took the time to get away for an hour and connect with MSD!

Surfrider Foundation Event Collects 35 Pounds of Trash Off the Shore

The Medical Society of Delaware participated in Delaware’s Coastal Cleanup day on Saturday, September 17, 2022, at Herring Point, Cape Henlopen State Park in Lewes.  A strong team of 13 from MSD met on a beautiful, sunny morning and teamed up with Surfrider Foundation to pick up trash and litter from the beach and surrounding areas. Armed with gloves, buckets, trash pickers, and a clip board to track what was collected, we removed 35 pounds of trash! Hundreds of plastic straws, bottle caps, cigarette butts, and lots of other trash are no longer littering the area.  Thank you to the Surfrider Foundation for arranging this event and allowing us to participate. And a very big THANK YOU to MSD’s team: Matthew Burday, DO; James Fletcher, DO and family; Sarah Mullins, MD and daughter; Cindy Siu, MD; John Turner, Jr., DO and Emily Swope; Alan Schwartz, PSYD and spouse; Mark Thompson; and Michelle Seymour.  

Award Pays Tribute to MSD's First President, James Tilton, MD

The Medical Society of Delaware together with the Tilton Society are pleased to announce this year's recipient of the Tilton Award. This award pays tribute to MSD's first President, James Tilton, MD, who was a medical pioneer, innovator, and statesperson. Each award recipient must meet the characteristics of Dr. Tilton, first and foremost being a member of MSD: 

Severe Respiratory Illnesses Associated with Rhinoviruses, Enteroviruses

Health care professionals and hospitals in several regions of the United States notified the Centers for Disease Control and Prevention (CDC) during August 2022 about increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). RVs and EVs can have clinically similar presentations and are indistinguishable from one another on multiplex assays often used in clinical settings. Upon further typing, some specimens have been positive for enterovirus D68 (EV-D68). Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years. Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness.

The purpose of the Health Alert Network (HAN) Health Advisory is to

1. Notify physicians, laboratories, infection control specialists, and public health departments about recent increases in severe respiratory illness requiring hospitalization in children;
2. Urge physicians to consider EV-D68 as a possible cause of acute, severe respiratory illness (with or without fever) in children and strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and between the months of August and November 2022;
3. Advise of the potential for an increase in AFM cases in the upcoming weeks; and
4. Provide CDC recommendations to health care professionals, laboratories, infection preventionists, public health departments, and the public.

Reports of Squamous Cell Carcinoma, Various Lymphomas in Scar Tissue Around Breast Implants

The U.S. Food and Drug Administration (FDA) is informing the public about reports of cancers, including squamous cell carcinoma (SCC) and various lymphomas, that have developed in the scar tissue (capsule) that forms around breast implants. As of September 1st, the FDA had received 10 reports about squamous cell carcinoma and 12 reports about various lymphomas related to breast implants. The various lymphomas reported are not the same as the lymphomas described in the previous FDA Communications as Breast Implant - Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). While the FDA believes that occurrences of SCC or various lymphomas in the capsule around the breast implant may be rare, health care professionals and people who have or are considering breast implants should be aware that cases have been reported to the FDA and in the literature. The FDA is asking health care professionals and people with breast implants to report cases of SCC, lymphomas, or any other cancers around the breast implant to the FDA. Those who have breast implants do not need to change their routine medical care, but they should be aware that some of the reported signs and symptoms included swelling, pain, lumps, or changes in the skin. 

Draft Recommendation Statement on Screening for Anxiety in Adults

The U.S. Preventive Services Task Force (USPSTF) on Tuesday recommended for the first time that physicians screen all adult patients under 65 for anxiety. The draft recommendation is to help primary care physicians identify early signs of anxiety during routine care, using questionnaires and other screening tools. USPSTF defines anxiety disorders as characterized by greater duration or intensity of a stress response over everyday events. Types of anxiety recognized include generalized anxiety disorder, social anxiety disorder, and agoraphobia. The draft recommendation also suggests screening for major depressive disorder in adults, consistent with recommendations for depression screening published in 2016. The proposal is open for public comment until October 17. 

Latest Online Trend Challenges Cooking OTC Drugs

In a consumer update, the U.S. Food and Drug Administration (FDA) is warning of a social media trend relying on peer pressure using online video clips of people misusing nonprescription medications and encouraging viewers to do so too. These video challenges, which often target youths, can harm people — and even cause death.  A recent social media video challenge encourages people to cook chicken in NyQuil or another similar over-the-counter (OTC) cough and cold medication, presumably to eat. Boiling a medication can make it much more concentrated and change its properties in other ways. Even if one doesn't eat the chicken, inhaling the medication’s vapors while cooking could cause high levels of the drugs to enter the body and could also damage the lungs. Someone could take a dangerously high amount of the cough and cold medicine without even realizing it. An earlier TikTok challenge urged people to take large doses of the allergy medicine diphenhydramine (sold OTC in many products, including some under the brand name Benadryl) to try to induce hallucinations. Prompted by news reports of teenagers needing to go to the emergency room or, in some cases, dying after participating in this challenge and taking too much medication, the U.S. Food and Drug Administration warned the public about the danger of high doses of diphenhydramine. Parents can keep kids safe and help prevent potentially harmful trends by keeping both OTC and prescription drugs away from children by locking up these medications to prevent accidental overdose. Discussion should also be had about the dangers of misusing drugs and how social media trends can lead to real, sometimes irreversible damage.

There is Still Time to Participate

The Centers for Medicare & Medicaid Services (CMS) is reminding that there is still time to participate in the Enhancing Oncology Model (EOM) rollout. EOM is a voluntary model that will run for five years, from July 2023 through June 2028. Model participants will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.   

For oncology practices interested in participating in EOM, the Request for Applications is available at:  https://app.innovation.cms.gov/EOM. All EOM applications must be submitted by 11:59 pm Eastern Daylight Time on September 30, 2022. Additional information can be found here. Technical questions should be directed to the EOM Help Desk at EOM@cms.hhs.gov or call 1-888-734-6433, option 3​.

Detection of Polio in New York Highlights Importance of Vaccination

On September 13, 2022, the Centers For Disease Control and Prevention (CDC) announced that the United States met the World Health Organization’s (WHO) criteria for circulating vaccine-derived poliovirus (cVDPV) after polioviruses were found in New York, both from a case of paralytic polio in an unvaccinated adult in Rockland County and in several wastewater samples from communities near the patient’s residence. While polio has not been detected in Delaware or in Delaware wastewater, the CDC and the Delaware Division of Public Health (DPH) are encouraging all persons who are not vaccinated or not fully vaccinated against poliovirus receive the vaccine as soon as possible to prevent the spread of polio in unprotected populations. The polio vaccine is routinely recommended for children in the United States, but it is important to verify the immunity status for adults as well. Although poliovirus is no longer endemic in the United States, it is important that health care professionals rule out polio infection in cases of unexplained acute flaccid paralysis (AFP) that are clinically compatible with polio. This is particularly important to those with anterior myelitis to ensure that importation of poliovirus is quickly identified and investigated. Most people infected with poliovirus will not have any visible symptoms. About one out of four people will have flu-like symptoms. These symptoms usually last two to five days, then go away on their own.

Read the DPH Health Advisory for further details and recommendations.

Prior Auth Requirements Would be Established for Medicare Advantage Carriers. Contact Our Senators to Act!

Last week the the U.S. House of Representatives passed key legislation that would require Medicare Advantage insurers to use electronic prior authorization programs, annually submit lists of items and services subject to prior authorization, and adopt beneficiary protection standards reforms to ease physician burden. Thanks to the actions of advocates like you, the "Improving Seniors' Access to Timely Care Act" was passed by a voice vote! Now it's time for the Senate to act. 

Physicians complete an average of 41 prior authorizations per week. This unnecessary burden amounts to roughly 13 hours weekly that physicians and their staff must spend on administrative work instead of seeing and treating patients. If an insurance plan covers a treatment that would benefit a patient, physicians should not have to waste time ensuring access to it. This flawed system must be fixed and now it's the Senate's turn to hold the big insurance companies accountable for the undue burden these excessive and unnecessary prior authorizations put on our country's physicians and their patients. Thankfully, Senators Marshall, MD (R-KS) and Sinema (D-AZ) have introduced companion legislation - The Improving Seniors' Timely Access to Care Act (S.3018). Like the House bill, this bipartisan legislation would require Medicare Advantage plans to adopt transparent prior authorization programs that adhere to evidence-based medical guidelines and hold plans accountable for making timely prior authorization determinations and providing rationales for denials. There are only a handful of legislative days left this year for the Senate to get this legislation over the finish line, please join in the fight today to get our health care system back on track by fixing the broken prior authorization system. Please contact your Senators today and urge them to cosponsor the Improving Seniors' Timely Access to Care Act! 

Entire Set of Electronic Health Information In Effect Starting October 6, 2022

In April 2021, the Office of the National Coordinator for Health Information Technology’s (ONC) rules on information blocking went into effect. Information blocking is defined as practices that are likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information (EHI). Physicians, hospitals, electronic health record vendors, health information exchanges, and health information networks (also known as “Actors”), are all subject to ONC's regulations. Since April 2021, information blocking requirements have been focused on a narrow subset all EHI. However, starting October 6, 2022, ONC’s information blocking requirements shift to the entire set of EHI. After October 6, physicians and other Actors will be responsible for the access, exchange, or use of the full EHI requirement. The American Medical Association has provided an overview of the information blocking regulations, EHI definition, and recommendations for physicians to prepare for the upcoming deadline. 

How to Talk to Your Patients

The Public Health Communications Collaborative (PHCC) is a partnership between the CDC Foundation, the de Beaumont Foundation, and Trust for America’s Health to provide unbiased communication about the COVID-19 pandemic. The PHCC is sharing resources for you to use.

Understandably, people are asking when the pandemic will end or if the pandemic is over. The following tips and messaging can help you communicate about the state of the pandemic and the continuing need for precautions.

• Emphasize the progress we’ve made: We have come a long way in combating COVID-19, and we are on the right track. Case numbers, hospitalizations, and deaths are on the decline, and we have effective tools to stay healthy. Our progress continues with the release of new vaccines and boosters.
• Explain that the threat remains: Though we have come far, COVID-19 continues to be a serious threat in some communities, with the U.S. still averaging hundreds of deaths per day. We must continue to take the public health measures we know work to protect people, especially those who are at highest risk of severe disease.
• Emphasize public health recommendations: We know the most effective ways to protect ourselves from COVID-19—getting vaccinated and boosted, testing when exposed or sick, and monitoring COVID-19 Community Level. Taking appropriate precautions will keep us on the right track by reducing the spread of COVID-19 and protecting against serious illness.
• Recognize uncertainty: Scientists continue to monitor COVID-19, tracking new variants and community spread. It’s likely new variants will continue to emerge, and there may be a fall or winter surge. Staying vigilant and taking up-to-date public health precautions is the best way to protect the progress we’ve made.
• Underscore the role of public health: Public health departments and guidance are here not only to keep communities safe and informed in an emergency, but also to advance health and well-being year-round. Public health measures that keep communities safe from COVID-19 will continue to be present—just like public health measures dealing with the flu, mental health, air quality, and more.

Find these answers, and answers to more questions about COVID-19 on the Public Health Communications Collaborative Q & A webpage.

By Authorizing Bivalent Boosters Earlier, 9,200 Deaths Estimated Will Be Prevented

The Delaware Division of Public Health (DPH) shared that declines in hospitalizations, test positivity rates and the 7-day average of new positive COVID-19 cases continued for the second month in a row. Deaths also remain low. However, COVID-19 is still circulating in the community and at higher levels in some counties. Additionally, while hospitalizations overall are down, in recent weeks they have increased in the 0-4 months age range and the 18-34 years age range. 

COVID-19 bivalent boosters (updated for added protection) are available at DPH clinics and many pharmacies and other locations. Those 12+ should receive the bivalent booster 2 months after their last vaccine dose (either second dose of Pfizer/Moderna/Novovax; single dose of J&J or since their last booster dose). To reduce confusion among the public and vaccine administrators, and because they do not offer the increased levels of protection provided by the bivalent boosters, the original booster formula is no longer authorized for use in those 12 and older. Those providing the vaccine booster may no longer administer the original booster formula to anyone older than 12. 

In addition, people who recently had SARS-CoV-2 infection may consider delaying a primary series dose or booster dose by 3 months from symptom onset or positive test (if infection was asymptomatic). Studies have shown that increased time between infection and vaccination may result in an improved immune response to vaccination. Individual factors such as risk of COVID-19 severe disease, COVID-19 community level, or characteristics of the predominant SARS-CoV-2 strain should be taken into account when determining whether to delay getting a COVID-19 vaccination after infection. Individuals should consult with their health care professional to make the best decision for them.

For more information, visit: de.gov/covidvaccine. By authorizing the vaccines in September rather than waiting until later this fall, the Centers for Disease Control and Prevention (CDC) estimates the prevention of over 137,000 hospitalizations and 9,200 deaths in the first two months alone. For the latest Delaware statistics, check the My Healthy Community website. "COVID-19 Vaccine Information for Medical Providers" can be found here.

By Early to Mid-October

If authorized by U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) anticipates a recommendation for bivalent COVID-19 vaccine as a booster for pediatric age groups in early to mid-October. Bivalent products expected to be under consideration include the bivalent Pfizer-BioNTech vaccine for children aged 5-11 years and bivalent Moderna vaccine in children aged 6-17 years, for those individuals who have already received their primary vaccine series. It is expected that if bivalent boosters are authorized for individuals aged 5 years and older as a booster, monovalent mRNA COVID-19 vaccines may no longer be authorized as booster doses. Physicians should review any FDA and CDC guidance for bivalent vaccine in children aged 5 years and older, since bivalent vaccines may be the only authorized and recommended COVID-19 boosters for this age group. At this time, it is expected that monovalent vaccines will remain appropriate for primary series for this age group. 

Must Be Renewed Every 30 Days

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

Published New Research from UVA Health

A genomic test being developed by a Charlottesville company can predict a patient’s risk of developing severe COVID-19, new research from UVA Health suggests. That information could help to identify patients at high risk for poor outcomes and quickly begin tailored treatment. The approach proved more than 90% accurate at predicting outcomes among more than two dozen patients in the intensive care unit at UVA and 100 patients from publicly available data generated at Duke and Harvard. The test, called CovGENE, analyzes genes expressed in a person’s blood to determine whether they may experience a severe disease course with increased risk of death. Based on the promising results of the UVA research, CovGENE’s developer, AMPEL Biosolutions, is seeking to partner with a diagnostic testing company or pharmaceutical company to bring the approach to market as a simple PCR-based blood test. The researchers have published their findings in the journal Frontiers in Immunology

In Anticipation of Fall and Winter Demand

According to the White House, within its limited funding, the U.S. is increasing its supply of at-home COVID-19 tests in the Strategic National Stockpile by purchasing more than 100 million additional at-home, rapid tests from domestic manufacturers. While insufficient to adequately replenish our existing stockpile of at-home tests, this procurement will help meet some testing needs in the months ahead and hopefully put the U.S. in a better position to manage a potential increase in testing demand this fall and winter. Congress has been called on to pass more pandemic funding.

CDC Morbidity and Mortality Report - Summary and Key Messages

Although risk for monkeypox transmission to health care personnel (HCP) is thought to be low, Centers for Disease Control and Prevention (CDC) recommends that HCP wear personal protective equipment (PPE) consisting of gown, gloves, eye protection, and an N95 (or higher-level) respirator while caring for patients with suspected or confirmed monkeypox. Among 313 Colorado HCP exposed to patients with monkeypox, recommended PPE use and receipt of postexposure prophylaxis vaccination was low. HCP were assessed for risk and actively monitored for 21 days when indicated; none acquired monkeypox. The risk for acquiring monkeypox among U.S. HCP after exposure to patients with monkeypox is very low. HCP in all health care settings can benefit from public health outreach regarding infection prevention education and training.

• Only 23% of exposed HCP wore all recommended PPE. Although respirator use was common, likely because of current COVID-19 source control recommendations, only 38% of HCP wore N95 respirators, and 64%, 40%, and 31% wore gloves, gowns, and eye protection, respectively.
• These low percentages might have been due to lack of awareness of 1) a patient’s symptoms before entering their care area, 2) community transmission, 3) monkeypox PPE recommendations, or 4) monkeypox signs and symptoms or atypical presentation.
• These data suggest that opportunities exist to improve awareness and training among frontline HCP who are most likely to see patients with monkeypox, so that they can take steps to protect themselves from exposure.

CDC Not Encouraging Broader Public Vaccination

Last week the Delaware Division of Public Health (DPH) announced that it expanded monkeypox vaccine access to those deemed to be at a higher risk for MPX infection, such as those treated for a sexually transmitted infection (STI) in the last six months, people who fall into any of the identified high-risk categories who are also experiencing homelessness or incarceration, or individuals traveling to an area with community spread of MPX cases. 

On Thursday this week, the Delaware Division of Public Health (DPH) announced vaccine eligibility being expanded to include all gay, bisexual, and transgender or nonbinary persons having sex with men, or females having sex with gay, bisexual, or nonbinary, or transgender males. 

Delaware is also expanding vaccine eligibility to health care workers who are providing direct patient care to confirmed/suspected MPX cases in areas such as Emergency Departments, urgent cares, Federally Qualified Health Centers, DPH clinics, STI/HIV or sexual health clinics, and those at occupational risk such as laboratory staff that handle MPX specimens. Recent data show the risk of MPX to exposed health care workers to be low even when use of personal protective equipment (PPE) is incomplete. However, to ensure the greatest level of protection against MPX, the Centers for Disease Control and Prevention recommends health care staff wear PPE consisting of gown, gloves, eye protection, and an N95 (or higher-level) respirator while caring for patients with suspected or confirmed MPX.

Delaware's current case count for MPX in the state is 35, including 23 cases in New Castle County, three cases in Kent County, and nine cases in Sussex County. Delaware continues to offer vaccinations to people at a higher risk of exposure. Currently, the Centers for Disease Control and Prevention is not encouraging vaccination against monkeypox for the broader public or for everyone who is sexually active.

Physicians Urged to be Judicious in Prescribing

The monkeypox virus is only one mutation away from evading a key antiviral drug being used to treat at-risk patients, federal health officials are now warning – and they’re urging physicians to be ‘judicious’ in prescribing the treatment. This new FDA guidance for the antiviral drug known as tecovirimat, or TPOXX, was published last week online and in updated labeling. The U.S. Food and Drug Administration (FDA) indicated studies, and evidence from a human case of this family of viruses, suggest monkeypox has several genetic pathways to evolve resistance to tecovirimat.

The Physicians Foundation's New Survey Unveils Disconnect Between What Physicians Want and What the Support System Around Them Provides

The Physicians Foundation, Dr. Lorna Breen Heroes’ Foundation and #FirstRespondersFirst have come together to accelerate systems change so physicians’ burnout does not become a mental health emergency. Through Vital Signs: The Campaign to Prevent Physician Suicide, the organizations are galvanizing others to take action on the system level so that each physician feels supported on an individual level.  Understandably, the past two and a half years of the COVID-19 pandemic have taken a toll on physicians’ mental health. Results from the second part of the 2022 Survey of America's Physicians conducted by The Physicians Foundation showed for a second year in a row, 60% of 1,509 physicians who completed the online survey indicated they often feel burned out, compared to 40%  before the pandemic. Also, eight in 10 physicians (80%) reported that there is stigma surrounding mental health and seeking mental health care among physicians. Further, only one-third (31%) of physicians believe suicide prevention resources for physicians exist and are easy to access. 

The steps to better support physicians are not a secret—physicians have identified who and what supports their mental health and wellbeing most. Confidential therapy, counseling or support phone lines (65%) and peer-to-peer support groups (57%) were rated as the most helpful resources among physicians who had experience with the resource. Additionally, nine workplace solutions were identified as helpful by most physicians (70-89%), including removing low-value work, ensuring adequate mental health care outside of Employee Assistance Programs (EAP), and giving physicians more flexibility and autonomy. A lasting change will result when everyone works to break down stigma and health leaders take systemwide action. Unfortunately, only about one-third (36%) of physicians agree that their workplace culture prioritizes physician wellbeing. Additionally, most physicians (50-66%) shared that their workplace rarely or never acts on eight of the workplace solutions that support physicians’ wellbeing.

Read the full survey results and methodology here.  

Health Insurance Marketplace Open Enrollment Begins November 1st   

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2023 health, dental, and small group insurance plans were announced on Monday. While premiums are rising steeply across the country, the extension of consumer-friendly subsidies through the Inflation Reduction Act, coupled with Delaware’s strong 2022 enrollment and 2023 Health Insurance Marketplace expansion, will limit consumer impact locally. Two new health insurers will be joining the Marketplace for 2023. Before tax credits and subsidies, base rates for 21-year-old non-tobacco users range from $315 to $505 across 9 Aetna CVS Health plan options, and from $283 to $402 with AmeriHealth Caritas across 4 plan options. Returning ACA issuer Highmark Blue Cross Blue Shield of Delaware will be increasing rates 5.5% on average, with base rates for 17 plan options ranging from $249 to $618 including a catastrophic plan option. In the last few years, Highmark’s average rates have decreased roughly 10% despite this needed increase. Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company. Thirty plans are available to Delawareans for the 2023 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care and telehealth, lab services, and more. Consumers should be wary of non-compliant ACA benefit requirement alternative health plans.

Includes Burden-Reducing Revisions

Building on its efforts to reduce administrative tasks in medicine—a driver of burnout and a central pillar of its Recovery Plan for America’s Physicians—the American Medical Association (AMA) has released the 2023 Current Procedural Terminology (CPT®) code set. The nation’s leading data-sharing terminology for medical procedures and services, the 2023 CPT code set contains burden-reducing revisions to the codes and guidelines for most evaluation and management (E/M) services. Modifications to the E/M codes for inpatient and observation care services, consultations, emergency department services, nursing facility services, home and residence services, and prolonged services are among 393 editorial changes in the 2023 CPT code set, which includes 225 new codes, 75 deletions and 93 revisions. With 10,969 codes that describe the medical procedures and services available to patients, the CPT code set continues to grow and evolve with the rapid pace of innovation in medical science and health technology. Learn more.

Goal Achievement Requires Commitment by All to Work Together

The Centers for Disease Control and Prevention (CDC) announced the publication of the Viral Hepatitis Surveillance Report— United States, 2020. This report includes surveillance and mortality data related to hepatitis A, hepatitis B, and hepatitis C, as well as outcome data from CDC’s Perinatal Hepatitis B Prevention Program. CDC also released the 2022 Viral Hepatitis National Progress Report, which provides an update on progress toward achieving established goals for the prevention of viral hepatitis transmission, disease, and associated mortality. During 2020 there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic. Because of the COVID-19 pandemic, the 2020 data included in this surveillance report should be interpreted with caution.

According to this year’s surveillance report, the United States experienced a 47% decrease in the rate of hepatitis A cases during 2020 compared to 2019. This follows four successive years of increasing rates due to widespread and prolonged outbreaks driven by person-to-person transmission primarily among adults who use drugs or report experiencing homelessness. Despite this substantial decline, an 80% reduction from the estimated number of infections during 2020 is needed to meet the goal of 4,000 estimated infections during 2025. Reported cases of acute hepatitis B also declined from 2019 to 2020. The 30% decrease in the corresponding rate of acute hepatitis B was likely impacted by disruptions to health care access and public health surveillance systems during the COVID-19 pandemic and may not be observed in subsequent years once testing and health department case investigations resume regular operations. Since 2013, increases in injection drug use related to the nation’s drug crisis have contributed to annual increases in newly reported cases of hepatitis C. During 2020, there was a 15% increase in the rate of reported cases of acute hepatitis C from 2019. Although the COVID-19 pandemic disrupted health care access and reduced the number of persons tested for HCV infection, the anticipated reduction in reported cases was offset by a change to the acute hepatitis C case definition introduced in 2020. You are encouraged you to learn more about the state of HCV treatment coverage through our recent CDC Morbidity and Mortality Weekly Report: Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020.

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!

Partnership with UD and Collaboration with DSU Targets Kent County

In 2021, Delaware reported 515 overdose deaths, an increase of more than 15% over 2020, according to the Delaware Division of Forensic Science (DFS). DFS also reported that 425 of the 515 deaths involved fentanyl, a synthetic pain reliever that is 50-100 times more potent than morphine. As a way to directly connect underserved community members struggling with opioid use disorder and other behavioral health issues, the Delaware Department of Health and Social Services (DHSS) this week announced an expansion of its Community Well-being Initiative, a partnership with the University of Delaware’s Partnership for Healthy Communities, to Kent County. The Community Well-being Initiative, which began in 2021 in high-risk areas of New Castle County, embeds Community Well-being Ambassadors in neighborhoods to help build trust and encourage community members to seek treatment services. The expansion to targeted neighborhoods in Kent County will be done in collaboration with Delaware State University. The initiative is funded through a federal State Opioid Response grant from the Substance Abuse and Mental Health Services Administration. 

CDC Program to Help Address Disparities in Vaccination

Local, state, and territorial health departments, as well as tribal governments and local non-governmental organizations, can partner together and begin submitting requests to access monkeypox vaccine through the recently announced Monkeypox Vaccine Equity Pilot Program. This new pilot program is intended to reach populations that may face barriers to monkeypox vaccination, which may include differences in language, location of vaccination sites, vaccine hesitancy, mistrust of government, lack of access to on-line scheduling technology, accessibility/disability issues, immigration status, and stigma. Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD stated the outbreak is affecting members of the gay, bisexual, and other men who have sex with men community at an unequal rate, and has disproportionately affected the Black and Hispanic communities. Successful proposals will demonstrate new, innovative ways to reach populations that are most affected by monkeypox based on local or national data. Special consideration will be given to projects addressing disparities among Black/African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) and transgender people who face barriers in accessing vaccines.

Those organizations interested in applying should contact their state or territorial health departments or tribal governments. More information, including details on the application, can be found here.

Alexia Wolf, MPH Assumes Lead Coordinator Position Effective 9/12/22 

Lt. Governor Bethany Governor Hall-Long announced that Alexia Wolf, MPH, will take over as the new lead coordinator of the Behavioral Health Consortium (BHC) beginning September 12, 2022. Wolf brings over 20 years of experience in community behavioral health including her most recent role as Chief of Social Determinants and Social Supports for Delaware’s Division of Substance Abuse and Mental Health (DSAMH). As lead coordinator of the Behavioral Health Consortium, Wolf will help guide the BHC’s multi-year strategy around prevention, treatment, access, and stigma for Delawareans struggling with addiction and mental illness. 

The Behavioral Health Consortium is an advisory body of community advocates, law enforcement, health care professionals, and state leaders that work to tackle issues around prevention, treatment, and recovery for mental health, substance use, and co-occurring disorders. To date, the consortium has undertaken several key initiatives including implementation of the nation’s first overdose system of care, insurer mental health parity, and expansion of telehealth services. The consortium also leads the work of the Prescription Opioid Distribution Commission, which determines how settlement funding from opioid manufacturers will be used in Delaware.

Achieve Your Employee Benefit Objectives During these Challenging Times

Small business owners have found themselves burdened over the past couple years from various pandemic, social and economic forces. With many decision makers facing urgent needs to trim costs, a reduction or even elimination of employee benefits has undoubtedly been discussed at one time or another. Most people already know that health insurance premiums represent a major portion of a company’s operating budget, but the combination of reduced overall revenue and increased insurance costs have created a financial burden most companies have not previously experienced. At the same time, employers know how much their staff values employee benefits and that eliminating them could risk losing key employees.

Fortunately, there are options available to employers who are facing this difficult decision and the staff at My Benefit Advisor can help. By understanding your business circumstances and employee demographics, they can tailor solutions involving creative strategies and the latest industry tools. Professional Employee Organizations, Discount Programs, and Individual Coverage HSAs have all enabled employers to achieve their employee benefit objectives during these challenging times. The Medical Society of Delaware Insurance Services (MSDIS) 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.

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.

October 21 - SAVE THE DATE! Tilton Annual Award Event recognizing 2022 Tilton Award recipient Richard W. Henderson, MD.

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.

Registrations Now Being Taken for This Annual Event

The Law Offices of Doroshow, Pasquale, Krawitz & Bhaya are pleased to confirm the date for this year's Workers' Compensation and Automobile Insurance seminar on Thursday, December 8, 2022, from 7:30 a.m. - 10:30 a.m. The event will be held in-person at the Christiana Hilton, La Chameleon Room, 100 Continental Drive, Newark. Presenters will be attorneys from the Law Offices of Doroshow, Pasquale, Krawitz & Bhaya. This invitation is open to all Delaware physicians and their staff who treat injured consumers. Complimentary breakfast will be served. Participation is free, but you must register. This year's seminar will feature:

• Fresh topics and updates in Delaware Workers’ Compensation
• The best ways to get your bills paid quickly by auto insurance
• The current state of affairs - court hearings, insurance commissioner arbitrations and Industrial Accident Board Hearings post Covid-19
• How a defense medical exam can torpedo an injury case
• Additional avenues that could benefit your patients    

To register, please e-mail BethP@dplaw.com and provide your name and e-mail address. You can also complete this registration form and return it to Beth Panaccione by e-mail or by fax to (302) 998-9114. Please call or e-mail Beth with any questions about the seminar. Beth can be reached by phone at (302) 636-4415. 

Fred C. Haulser, MD

It is with sadness we share that MSD member Fred C. Hausler, MD passed away on September 7, 2022, at the age of 91. After obtaining a degree in pharmacy in 1953 from the University of Pittsburgh and working in the Pittsburgh area as a pharmacist, he continued to take classes at Pitt to prepare for medical school. During that time he also served in the United States Army for two years. He later received his medical degree in 1962 from Hahnemann Medical College. His internship took him to McKeesport Hospital and then residency in anesthesiology in Youngstown, Ohio. In 1971 he relocated to Delaware where he remained on staff at Saint Francis Hospital until his retirement in 1994. While at Saint Francis Hospital, he served two terms as Chairman of the Department of Anesthesiology and was a member on numerous committees. As a Board Certified Anesthesiologist, he was a member of the American Society of Anesthesiology and served as placement Chair for the Delaware Society of Anesthesiology. Services were held on Monday, September 12th. In lieu of flowers, the family suggest contributions to either the Ministry of Caring or Alzheimer's Association.  Read obituary.

Shahmir Naveed, DO

MSD spotlights members throughout the state, highlighting medical students, residents, and practicing colleagues, whether they are new to membership or have been a member over the years.

This week's spotlight is on Shahmir Naveed, DO, Internal Medicine Resident at ChristianaCare. Read more about Dr. Naveed. 

If you would like to be featured in a future Member Spotlight, please contact Michelle Seymour, Manager of Membership. 

• 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.  

Raghda Bchech, MD - Bayhealth Family Medicine, Dover

Virginia L. Hoch, MD - Med/Peds Resident, ChristianaCare

Morgan A. Katz, MD - Primary Care at ChristianaCare, Limestone Office

Michael W. Noonan, DO - Hospice/Palliative Med Fellowship, ChristianaCare

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.