Many Attend to Honor Dr. Fan for Her Professionalism and Achievements

The 2023 Tilton Award Reception for medical achievement in the State of Delaware took place on Thursday evening, October 12, 2023, in the ballroom of the Tilton Mansion, home to The University and Whist Club. This year the Tilton Award was presented to Nancy Fan M.D., Obstetrician/ Gynecologist with Saint Francis Hospital; Chair of the Delaware Health Care Commission; and Past President of the Medical Society of Delaware. On behalf of Governor John Carney, Mr. Thompson read a tribute to Dr. Fan that recognized her for her many contributions, as well as dedication “to treating her patients with care and professionalism." Dr. Fan graciously accepted the award and tribute from the Governor. Guests included current and prior legislators, prior Tilton awardees, MSD staff, former MSD presidents, and members, including a contingent of peers from Saint Francis Hospital. MSD and the Tilton Society wish to thank Trinity Health Mid-Atlantic/Saint Francis Hospital for being the event sponsor this year. 

Saturday, November 18 - Christiana Hilton, Newark

Registration is open for the 234th MSD Annual Meeting to be held on Saturday, November 18th. This year's meeting will be held at the Christiana Hilton in Newark. All MSD members are encouraged to attend. Thank you to our Council members for their service to MSD and their constituents. Your fork is the most powerful tool to heal your body. Learn about the influence of nutrition on patients' wellbeing and how food can help manage chronic diseases and improve overall health during the planned education sessions. Register for the presentation (and cooking demo!) and discover the power of nutrition. It is vital for physicians to be able to educate their patients about nutrition to achieve optimal health.

Things to know:

• Registration deadline is Friday, November 10th!
• The Inaugural Gala is on hold for this year. View the Annual Meeting agenda.
• There will be two education sessions on the topic of "Food as Medicine." The Medical Society of Delaware designates this live activity for a maximum of 2 AMA PRA Category 1 Credit™. 
• Those members who graduated medical school fifty years ago (1973) will be recognized in a ceremony following the first education session.
• Delaware Medical Political Action Committee (DELPAC) members can enjoy gourmet coffee and conversation with Delaware lawmakers. Join DELPAC if you are not already a member.
• Resolutions are a vehicle to submit your issues to the Council. Resolutions must be submitted via email to Mary LaJudice no later than October 27th. The MSD Resolution Writing Guideline should be utilized to ensure proper creation and format of the resolution. Dr. Varipapa has also created video instructions on writing a resolution. Check it out here.
• For anyone who wishes to stay overnight at the Christiana Hilton, when making reservations, use code MEDSD to obtain the discounted room rate of $149/night. Reservation cut off is Friday, October 27th.

Congratulations to our 50 Year Medical Service Award recipients:

MSD Subsidiary That Directs Technology, Vision/Mission, and Needs

Do you have an interest in all things technology? Do you have an interest in Artificial Intelligence and want to help direct how it is utilized in health care? Serving on the Health Hub Board of Directors may be the place for you! The Health Hub Board was instrumental in identifying telehealth vendors to use by medical practices, which was done prior to the pandemic, allowing MSD to provide information to its members who were seeking telehealth technology during the pandemic and beyond. Those vendors were already vetted and ready to go when there was an immediate need! As Artificial Intelligence (AI) continues to emerge and be part of every aspect of our lives, including health care, appropriate guardrails need to be in place and education provided for an understanding of AI's power and benefits. Digital technology is here and many issues need to be considered for its use: health equity, cybersecurity, etc. Health Hub, LLC is a for profit subsidiary of the Medical Society of Delaware and helps to direct and manage MSD's technology, vision/mission and needs as appropriate. Health Hub, LLC is for the benefit of members. Meetings are usually held virtually on a quarterly frequency. If you have an interest, please contact Mary.LaJudice@medsocdel.org or (302) 593-8589. Elections to the Health Hub Board of Directors will take place next month. Don't wait and miss your opportunity!

Health Care Community Urged to Get Ahead of the "Tranq" Crisis

Medscape reports, the widening threat of the animal tranquilizer xylazine, otherwise known as tranq, which has been found in illegally manufactured fentanyl, necessitates wider testing, a better understanding of its effects, and more research on treatment options, according to a narrative review published Monday in the Annals of Internal Medicine. The review calls for more education of health care professionals, including primary care physicians, on the treatment and care of patients who have used xylazine and fentanyl. The authors also call for expanding standard urine analysis to test for xylazine and for intensifying surveillance of the drug supply and distribution of xylazine test strips. The authors of an editorial that accompanied the journal article urged the health care community to get ahead of xylazine before the crisis worsens. Xylazine was detected in 90% of street opioid samples tested in Philadelphia in 2021, and a toxic surveillance study of drug paraphernalia in Maryland found xylazine in 80% of samples tested between 2021 and 2022.

REGISTER NOW for the MSD Hot Topic CME: Fentanyl Laced with Xylazine - A Public Health Crisis. This virtual presentation will be held on Thursday, October 26, 2023, 6:00 - 7:00 p.m. and will be presented by Robert A. Rosenbaum, MD, FACEP, FAEMS, Delaware EMS Medical Director at Delaware Office of EMS and Gregory A. Wanner, DO, Emergency Physician & Academic Faculty, ChristianaCare Chief Physician, Delaware Division of Public Health.

As a Convenience, Your AMA Membership Dues Collected Simultaneously

Membership renewal for 2024 will be starting in the next few weeks and MSD wants to remind you that it participates in the American Medical Association (AMA) Partnership for Growth Agreement, whereby dues for both MSD and the AMA can be paid directly to MSD in one lump payment as a convenience for you, and MSD will submit the payment to the AMA on your behalf.

At this time, Delaware has only one representative delegate to the AMA. The more Delaware physicians who are members of the AMA, the more likely we are to increase that representation to two, doubling our ability to advocate for you at the national level. Please consider joining the AMA if you are not a member already and submit your AMA membership dues along with the MSD membership renewal. It is one less stamp, credit card payment, or check you have to write! 

Next Event Will Be Held in December. Register Now!

The American College of Physicians and the Delaware Academy of Family Physicians joined MSD at Brick Works in Smyrna for our most recent Pubs & Politics event on October 11. We had a great turnout, bringing together our members and several Delaware legislators. Lincoln Willis, Kim Gomes and Rebecca Byrd, MSD's lobbying team, helped make connections with the legislators and physicians, while Sharon Ruth from MSDIS/USI shared benefits and give-aways. Thank you to MSDIS/USI sponsoring our events this year!

Register now for our final Pubs and Politics of the year to be held on December 5 at Iron Hill, Riverfront, Wilmington. Plan to attend and make your voice heard as we get ready for the beginning of the next legislative session in January! Link to register: http://c.planetreg.com/MSDPubsPoliticsDec2023.

Supports Behavioral, Physical Health Physicians to Improve Care Coordination

The Delaware Department of Health and Social Services’ Division of Substance Abuse and Mental Health (DSAMH) announces significant advancement in capabilities for the Delaware Treatment and Referral Network (DTRN) with the launch of DTRN360, a Behavioral Health Coordination platform. DTRN360 is designed to bridge the gaps experienced by physicians and other health care professionals in caring for Delaware residents suffering from mental health and substance use disorders within the State. The system will connect community-based professionals, supports systems, and behavioral health professionals within one workflow. Two organizations were chosen to build out the care coordination solution: Bamboo Health, for the single integrated platform, and FindHelp for non-medical determinants of health referrals, which will be accessible within the integrated DTRN360 digital platform. 

Details the State's Progress Through the Trauma-Informed Perspective

Governor John Carney on Thursday released the Family Services Cabinet Council’s 2023 Trauma Informed Care Report. The report details the State’s progress in serving Delaware families through the trauma-informed perspective and establishes goals for the future. The report was discussed at a roundtable Thursday with First Lady Tracey Quillen Carney, members of the Cabinet, State of Delaware leaders, Trauma Matters Delaware, and trauma advocates. In 2018, Governor Carney signed Executive Order 24, making Delaware a trauma-informed state. Executive Order 24 directs the Family Services Cabinet Council to lead state agencies and state employees in improving services and outreach for children and families exposed to trauma.

Delaware's Mortality Rate Continues to Decline

According to the latest cancer data from the Delaware Department of Health and Social Services (DHSS), Division of Public Health (DPH), Delaware’s mortality rate continues to decline.  Between 2006 and 2020, mortality rates for all-site cancer decreased an average of 1.8% per year in Delaware and decreased an average of 1.7% per year in the U.S.  Delaware’s current ranking of 15th among the states for highest all-site cancer mortality is the same ranking as in the 2022 report, which examined the 2015-2019 time period. This represents considerable continued progress since the 1990s, when the state ranked second among the states for all-site cancer mortality. DPH presented its data report, Cancer Incidence and Mortality in Delaware, 2015-2020, to the Delaware Cancer Consortium (DCC) on Monday. In this report, DPH compares Delaware’s cancer incidence and mortality statistics to those of the U.S. The COVID-19 pandemic resulted in delays and reductions in cancer screening and diagnosis, which subsequently led to a decline in 2020 incidence counts and rates that were considered an anomaly. Therefore, in this report, cancer incidence rates are compared for the period of 2006 to 2019. Cancer mortality rates are compared for the period of 2006 to 2020. A compendium report, Census Tract-Level Cancer Incidence in Delaware, 2015-2020, was also released which presents calculations and detailed maps with all-site cancer incidence rates by census tract. 

Increasing Efforts to Mitigate the Opioid Crisis

The US Food and Drug Administration (FDA) has approved Hyloris Pharmaceuticals’ non-opioid, intravenous painkiller, Maxigesic IV, under the trade name Combogesic IV. The drug will be used to provide relief of mild to moderate pain and the management of moderate to severe pain as an adjunct to opioid analgesics in adults. Maxigesic IV will be distributed in US hospitals in early 2024.

Examines the Status of Digital Health Advancement in Commercial Health

The American Medical Association (AMA) recently issued new research examining the status of digital health advancement in the commercial health insurance industry by comparing current coverage across private health insurers and exploring how coverage decisions are made for digitally enabled care services. The new research, completed by the AMA and Manatt Health, summarizes publicly available coverage policies created by commercial health insurers for 21 unique digital medicine services, as identified and defined by reporting codes found in the Current Procedural Terminology (CPT^®) code set. The 21 digital medical services fall into four distinct categories: remote physiologic monitoring, remote therapeutic monitoring, electronic consultations, and electronic visits. Learn more.

Eight Key Themes for Physicians

Enforcement of federal information-blocking rules is underway and could result in fines of up to $1 million for health IT developers, health information exchanges and health information networks for every violation. This includes instances in which these entities are blocking information unnecessarily or using legal or financial roadblocks to prevent access to patients’ medical records. Meanwhile, the American Medical Association (AMA) is awaiting the government’s proposed regulations that would apply to physicians and other health professionals who are deemed information blockers. The Office of the National Coordinator for Health Information Technology (ONC) and the Department of Health and Human Services Office of Inspector General (OIG) are working on this separate regulatory process and the ONC is expected to publish a proposed regulation this fall. Physicians and hospitals are not subject to the information-blocking fines that went into effect Sept. 1 unless they could also be considered a health IT developer, a health information exchange or health information network. However, the OIG did include information that can be helpful to physicians as they evaluate their ongoing compliance with information-blocking rules. The AMA expects that the ONC and OIG will frame future regulation around several themes and will use them to guide physician information blocking investigations. Read more.

National Substance Abuse Prevention Month

On October 13 and 14, Lt. Governor Bethany Hall-Long joined NFL Hall of Famer Randy White, state officials, DisposeRx and Delaware Goes Purple at two Delaware high school football games to kick-off the Coaches vs. Overdoses prescription drug disposal initiative aimed at curbing opioid abuse among Delaware student athletes. As part of the two-day event, White returned to his high school alma mater Thomas McKean High School, in addition to Caesar Rodney High School, to speak about the personal impacts of prescription drug misuse within his family. 

Governor Carney Joins Bipartisan Coalition of Governors Standing in Solidarity with Israel

U.S. Representative Lisa Blunt Rochester and her staff have put together a resource page on her website for U.S. citizens in Israel and the region. If you have any questions or concerns, please contact her office. Her staff and she remain ready to assist Delawareans during this evolving situation. 



Governor John Carney has joined 17 governors standing in solidarity with Israel, issuing a joint letter to federal leaders to express the broad support for Israel and condemnation of terror attacks from Hamas. The governors also reaffirmed their commitment to work with the U.S. Department of State to ensure the safe return of Americans.

Health Care Clearinghouse Breach Impacts 1.5 Million Consumers

Attorney General Jennings announced on Tuesday that Delaware, along with 32 other attorneys general, has reached a settlement with health care clearinghouse Inmediata for a coding issue that exposed the protected health information (“PHI”) of approximately 1.5 million consumers for almost three years. Under the settlement, Inmediata has agreed to overhaul its data security and breach notification practices and make a $1.4 million payment to states. Delaware will receive $15,470 from the settlement. As a health care clearinghouse, Inmediata facilitates transactions between health care professionals and insurers across the United States. On January 15, 2019, the U.S. Department of Health & Human Services’ Office of Civil Rights alerted Inmediata that PHI maintained by Inmediata was available online and had been indexed by search engines. As a result, sensitive patient information could be viewed through online searches, and potentially downloaded by anyone with access to an internet search engine. Although Inmediata was alerted to the breach on January 15, 2019, Inmediata delayed notification to impacted consumers for over three months and sent misaddressed notices. Further, the notices were far from clear—many consumers complained that without sufficient details or context, they had no idea why Inmediata had their data, which may have caused recipients to dismiss the notices as illegitimate.

One of Seven Hubs Nationally to Advance Clean Energy

The United States Department of Energy announced that the Mid-Atlantic Clean Hydrogen Hub (MACH2) was selected for award negotiations to receive up to $750 million in funding from the Hydrogen Hubs program to support the development of a clean hydrogen hub–a network of hydrogen producers, consumers, and local connective infrastructure–in Delaware, Southeastern Pennsylvania and South Jersey. MACH2 was ranked among the most pro-labor and greenest hubs in the nation. All projects will be constructed with project labor agreements and all clean hydrogen production will come from renewable energy, nuclear energy, and capturing wastewater emissions (no fossil fuel extraction). It was chosen as one of seven regional clean hydrogen hubs nationally. The University of Delaware, Delaware State University and Delaware Tech are among the schools that will be involved in clean hydrogen - related research and workforce development.

Capacitator Leaks and Short Circuits

Hamilton Medical, Inc. is recalling the HAMILTON-C1, T1, MR-1 ventilators because the capacitators may leak electrolyte fluid onto the ventilator’s control board. If the control board contacts the electrolyte fluid, the control board or installed spare parts could short circuit. As a result of the short circuit, the ventilator may switch to “Ambient State.” Hamilton ventilators are used to support adults, children, infants and newborns with breathing. Health care professionals use them during patient transport in or outside hospital settings. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death. This recall is a voluntary correction, not a product removal.

Update on Recommendations - Letter to Health Care Professionals

On Monday, the U.S. Food and Drug Administration (FDA) provided an update from ongoing evaluation of the potential for exposure to airborne chemicals that may be released from neonatal incubators. This update is based on new information from GE HealthCare for its newly manufactured neonatal incubators.

The Joint Commission Sentinel Event Alert

Surgical fires continue to occur and represent a significant risk to patients and health care professionals. The Joint Commission is providing a Sentinel Event Alert that updates information and replaces one on this topic that published in 2003. The Joint Commission issues this alert to help health care organizations recommit to surgical fire prevention. Most surgical fires and burns are associated with the use of an electrosurgical device while performing head and neck surgery. Surgical fires can be prevented by creating awareness of and carefully monitoring elements of the “fire triangle:” 1) oxygen, 2) ignition sources and 3) fuel.

AMA Provides Insights

There’s a lot on the minds of fourth-year medical students as they prepare for residency interviews, which are largely going to take place virtually. A few key topics have emerged that offer insight on how to prepare for residency interviews. Read more.

Deadline Extended to November 16th

The Physicians Foundation recently launched the new Physicians Foundation’s Leadership Award Program to honor the next generation of physician leaders. Award winners will receive a $10,000 scholarship to elevate their efforts to address drivers of health (DOH) or to advance innovative solutions to make their communities or practices a healthier place for patients and physicians. New or early-career physicians are encouraged to apply by November 16th. 

What Physicians Should Know

The student loan repayment pause has ended, but physicians repaying loans might be in a better situation than they were even a few years ago. Learn what options you have moving ahead. 

Check Out the Key Takeaways

This week we are sharing a CRITICAL update about MIPS audits - MIPS Data Validation and Audit (DVA) for Performance Year 2022. As a professional committed to health care excellence, this is one update you won't want to miss! Failure to acknowledge and respond can mean a score and payment adjustment and no one wants that!

Key Takeaways:

• Audit Commencement: Learn how the November start date will require you to keep a close eye on your email inbox!
• The CMS-Guidehouse Collaboration: Discover the partnership's implications for MIPS participants.
• Communication Alert: Learn what you need to do if you're selected for DVA.
• What's at Stake: Get insights on potential payment adjustments and selection implications for future DVAs.

Whether you're a seasoned MIPS participant or just getting started, this guide is designed to ensure you're well-prepared and informed.

Click here to read the full blog post from Chirpy Bird.

Improve Outcomes With Health Coaching

A nurse, medical assistant or care coordinator can serve as an effective health coach—although regulations on the role can differ from state to state. Patients who receive health coaching will better understand their care plans and are more likely to adhere to their medications. Physicians appreciate that health coaches keep their patients engaged and motivated.

LEARN MORE:

Toolkits:

• Health Coaching
• Sharing Clinical Notes With Patients

Webinar: Fostering Physician Humanism and Connection With Patients

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

Register With My Green Doctor

If your home or business has an unshaded roof, now is the time to install solar panels and claim a $7,500 credit on your 2023 tax filings. The 2022 U.S. Inflation Reduction Act is an opportunity for Society members that should not be missed! The electricity you save is expected to pay for the panels in eight years and then you’ll have free power for another twenty. This month, MSD’s My Green Doctor explains in a three-minute blog everything you need to know to get started.



My Green Doctor is a free money-saving membership benefit from the Medical Society of Delaware. Members use the “Meeting-by-Meeting Guide” to learn how to adopt environmental sustainability, save resources, address the health threats of climate change, and help create healthier communities. The program requires adding only five minutes to each regular office staff meeting or weekly office “huddle”, making small changes at each meeting that over time really add up. Everyone in your practice can register as Partner Society members at www.MyGreenDoctor.org or at www.MyGreenDoctor.es (si, en espanol). Use the discount code MGDMSD to get full free access to My Green Doctor, save $60 instantly, and save $1000s in the first year. Ask your practice manager to register today and to put My Green Doctor on your next agenda. You can do this!

Bayhealth

ChristianaCare

TidalHealth Nanticoke

Delaware Hospital for the Chronically Ill

Steven Calamita, MD - Southern Delaware Imaging Associates

Joseph Cardinale, MD - Orthopaedic Associates of Southern Delaware, PA

Rachel Chang, MD - Brandywine Pediatrics, PA

Neilay Dedhia, DO - Internal Medicine, Middletown Family Care Associates

Shannon FitzPatrick, MD-Orthopaedic Associates of Southern Delaware, PA  

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

The CDC adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza (flu) vaccination for everyone 6 months and older in the United States on June 27, 2023. There were small changes to the annual recommendations around flu vaccination, including an acknowledgement of the updated flu vaccine composition for the 2023-2024 flu season and a change in the recommendations for vaccination of people with egg allergies. The adoption of the ACIP recommendations makes them official CDC policy, which have been published in the Morbidity and Mortality Weekly Recommendation Report August 23, 2023. Health care professionals should begin vaccinating patients according to CDC’s recommended timing, which remains the same as last season. Read the CDC Vaccine Recommendations for the 2023-2024 flu season.

Flu Vaccination Guidance for Children

Flu can be a serious threat to children. During a COCA call on August 31, 2023, presenters discussed flu prevention and treatment recommendations from the American Academy of Pediatrics and CDC. If you’ve missed it, this recording is a great update on vaccination, coadministration of flu vaccines, coverage, and health disparities.

The FDA has outlined the following brief guidelines for the updated COVID-19 vaccines to simplify the questions regarding whom should receive the vaccine and when: 

• Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.  
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).  
• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 Vaccine. 
• On October 3, 2023, the FDA amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted for use in individuals 12 years of age and older to include the 2023-2024 formula. Individuals 12 years of age and older previously vaccinated with a COVID-19 vaccine (and who have not already been vaccinated with a recently updated mRNA COVID-19 vaccine) are eligible to receive one dose and unvaccinated individuals receive two doses. As part of this action, the Novavax COVID-19 Vaccine, Adjuvanted (Original monovalent) is no longer authorized for use in the United States.

Vaccination will be available free for everyone through one of three methods.

• Most Private and government insurance plans - cost fully covered by insurance (receive through pharmacies, health care professionals)
• Uninsured, underinsured - cost covered through FQHCs; public health clinics; pharmacies; health care professionals via Delaware Immunization Program; and Walgreens, CVS, and pharmacies affiliated with ETrue North pharmacy network through Bridge Access Program.
• Children participating in CDC's Vaccines for Children Program - free from where they receive routine vaccinations.

 A full listing of vaccine locations is posted on www.vaccines.gov.

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information.

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)