MSD Office Hours, Newsletter Publication Holiday Schedule

Kwanzaa, the seven-day celebration honoring African heritage, takes place from December 26th to January 1st. The seven principles of Kwanzaa include unity, self-determination, responsibility, cooperative economics, purpose, creativity, and faith. Kwanzaa is a reminder that good things happen around a table. Wishing you warmth and togetherness this Kwanzaa.

MSD Offices will be closing at 2:00 p.m. on Thursday, December 21st to begin the holiday break and will reopen at 8:00 a.m. on Tuesday, December 26.

The MSD eNews and Views weekly newsletter will take a year-end break following the December 21st issue. The newsletter will resume with the January 4, 2024 issue. However, any high priority communications will be sent to the membership during the break, as needed.

Happy Holidays!

Focus is to Improve Health Outcomes for Those in Medicaid, CHIP

Last Friday, the Centers for Medicare & Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model. The TMaH Model’s primary focus is to improve health outcomes for mothers and their infants enrolled in Medicaid and Childrens’ Health Insurance Program (CHIP). State Medicaid agencies (SMAs) selected to participate in the TMaH Model will receive support to develop a whole-person approach to pregnancy, childbirth, and postpartum care. The TMaH Model seeks to support access for midwives, birth centers, and doula services. Each participating SMA will be eligible for up to $17 million during the model’s 10-year period. The TMaH Model aims to foster an environment where mothers and their infants feel safe and supported throughout pregnancy and postpartum by providing them with the care and resources needed to support their physical and mental health, as well as their social needs. CMS will release a Notice of Funding Opportunity (NOFO) for state Medicaid agencies in spring 2024. Applications will be due in summer 2024. To learn more about the TMaH Model, please visit the model website and register for the model listserv. Questions about the model can be submitted to TMAHModel@cms.hhs.gov.

Medication Cost Raises Concerns for Access

The first oral pill approved in the United States to treat postpartum depression is now available by prescription, according to the drugmakers Biogen, Inc. and Sage Therapeutics, Inc. Zurzuvae (zuranolone) was approved by the US Food and Drug Administration in August and is now at specialty pharmacies, can also be shipped directly to patients. Zurzuvae (two 25 mg capsules per day) is the first and only oral, 14-day treatment course for adults that is said to provide rapid improvements in depressive symptoms at day 15 and as early as day 3. Notably, the medication will cost $15,900 per course before insurance, raising some concerns about how many people will be able to access it. The drugmakers launched a patient support program, ZURZUVAE For You, which provides educational resources, help with understanding insurance coverage, and assistance navigating the prescription fulfillment process. The program also includes financial assistance, such as a copay assistance program, and product at no cost for eligible patients.

FDA Approves Test To Identify Those Who May Develop Opioid Use Disorder

The U.S. Food and Drug Administration (FDA) approved the first test that uses DNA in assessing whether certain individuals may have an elevated risk of developing opioid use disorder. As part of a clinical evaluation, the AutoGenomics Inc. AvertD test is intended to be used prior to first exposure to oral opioid pain medications in patients being considered for a 4-30 day prescription for the treatment of acute pain, such as in patients scheduled to undergo a planned surgical procedure. The AvertD test, a prescription-use only genetic laboratory test for patients 18 years and older, is to be used only with patients who consent to the test and have no prior use of oral opioid analgesics.

AMA Shares Report and Webinar; Series of Briefs on Telehealth Published

As we wrap up 2023 and look ahead to 2024, the American Medical Association (AMA) is sharing a report they recently released in partnership with Manatt Health - State Telehealth Policy Trends: 2023 Year in Review. A recording of the webinar discussing the report is available on demand here. In addition to the 2023 Year in Review, the AMA also published a series of issue briefs on telehealth including the following:

1. Issue Brief: Telehealth Licensure: emerging state models of licensure flexibility for telehealth 
2. Issue Brief: Network Adequacy and Telehealth  
3. Issue Brief: Medication Abortion via Telehealth – still to come 

Approaches to Protect the Public From Algorithmic Discrimination

The use of algorithms is expanding in many realms of health care, from diagnostics and treatments to payer systems and business processes. Every sector of the health care system is using these technologies to try to improve patient outcomes and reduce costs. A new paper published Friday in JAMA Network Open addresses the use of algorithms in health care, their impact on racial/ethnic disparities in care, and approaches to identify and mitigate biases. This work was conducted by a technical expert panel that included researchers at the Agency for Healthcare Research and Quality (AHRQ). It supports the Biden Administration Executive Order 14091, Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government, issued on February 16, 2023. The paper, Guiding Principles to Address the Impact of Algorithm Bias on Racial and Ethnic Disparities in Health and Health Care, may be found in JAMA Network Open available here . The journal also links to an accompanying podcast interview of panel co-chairs Marshall Chin, MD, MPH, and Lucila Ohno-Machado, MD, PhD, MBA. The final EPC report, Impact of Healthcare Algorithms on Racial and Ethnic Disparities in Health and Healthcare, can be found here.

JAMA Health Forum

In a Viewpoint published in the JAMA Health Forum today, National Institute on Minority Health and Health Disparities (NIMHD) Director Eliseo J. Pérez-Stable, M.D. and Deputy Director Monica Webb Hooper, Ph.D. highlight the two fundamental pillars of health disparities science: race and ethnicity; and socioeconomic status. These pillars are fundamental to addressing the root causes of health disparities and implementing interventions to promote health equity. Focusing health disparities science on race and ethnicity and socioeconomic status anchored in the principles of justice and inclusivity can help achieve health equity for all.

Increase in MIS-C

The Centers for Disease Control and Prevention (CDC) has alerted the Delaware Division of Public Health of a nationwide increase of multisystem inflammatory syndrome in children (MIS-C). MIS-C is a rare condition associated with the COVID-19 virus which usually occurs two to six weeks after a child is infected with COVID-19. This syndrome causes different body parts to become inflamed including but not limited to the heart, lungs, and brain. MIS-C can be very serious and even deadly, but most children who are diagnosed with this condition get better with medical care. The reason for this increase of MIS-C is due to the low vaccination rates against COVID-19. Because of this, CDC issued a Health Alert Network Health Advisory on December 14 (information published in the December 14th issue of MSD eNews & Views) recommending that health care professionals administer COVID-19, influenza, and RSV immunization now to patients, if recommended. To assist in the immunization effort, there are resources that you can utilize when talking to patients about vaccinations (read the vaccination conversation guide on speaking with patients to protect against fall and winter respiratory viruses). The initial treatment for MIS-C includes both immunomodulatory and antithrombotic therapy. Access information on the therapeutic management of hospitalized children with MIS-C. If you see a child that you believe has MIS-C, please alert the Delaware Office of Infectious Disease Epidemiology by calling 302-744-4700 or by fax using the number 302-739-6659. 

Decreases in Hospitalizations, ED Visits in Infants After Birth

A CDC study published in JAMA Pediatrics shows that infants younger than 6 months born to people who were vaccinated during their pregnancy were protected from flu-related emergency department visits and hospitalizations. Infants are at higher risk of being hospitalized compared to other children but cannot get a flu shot until they turn 6 months. The study underscores the importance of pregnant people getting vaccinated since both pregnant people and their infants are at higher risk of being hospitalized with flu.  

Poses Low Risk

The World Health Organization (WHO) on Tuesday classified the JN.1 coronavirus strain as a "variant of interest" and indicated current evidence shows risk to public health was low from the strain. While the strain can evade the immune system and transmit more easily than other currently circulating variants, it has not shown any signs of more severe disease. JN.1 was previously classified a variant of interest as part of its parent lineage BA.2.86 (or Pirola), however, WHO has now classified it as a separate variant of interest. WHO indicated current vaccines will continue to protect against severe disease and death from JN.1 and other circulating variants of the COVID-19 virus. The U.S. Centers for Disease Control and Prevention (CDC) estimates that JN.1 is now causing about 15%-29% of new COVID-19 infections in the U.S. and is the fastest-growing strain of the virus. The CDC had said currently there was no evidence that JN.1 presents an increased risk to public health relative to other currently circulating variants and an updated shot could keep Americans protected against the variant. JN.1 was first detected in the United States in September, according to the CDC.

As the U.S. confronts respiratory virus season, the highly mutated COVID-19 Omicron subvariant JN.1 has quickly become a prevalent strain. The American Medical Association has provided tips on how to answer patients' questions about the JN.1 subvariant.

January 15, 2024 Deadline

Open Enrollment closed on December 15th, however, Delawareans looking to purchase health insurance coverage for 2024 through the Marketplace still have until January 15, 2024, to enroll for coverage starting February 1, 2024. Last year, nearly 35,000 Delawareans signed up for health insurance on Delaware’s marketplace, the highest number yet. Remember that if patients already have a health insurance plan through the Marketplace, they will need to re-enroll to maintain your coverage for 2024. To review a current plan, enroll in a new plan, or get more information, go to healthcare.gov or choosehealthde.com. 

Effective January 1, 2024

Developed to simplify communication throughout the health care industry, the CPT Standard Data File is optimized for use by health IT vendors, hospitals, health plans, laboratories, retail pharmacies, payers, medical coders, and others working across the health care ecosystem to improve patient care.

Access valuable new content and usability improvements available in the CPT 2024 Standard Data File, including:

• NEW! CPT Consumer-Friendly Descriptors in Spanish to bridge the language gap, improve patient access to price transparency and advance health equity.
• User-friendly file structure with all codes and most data in a consolidated list, including: 

o Six distinct CPT Descriptor types 

o Helpful code descriptor date for visibility into new and revised content 

o CPT Proprietary Laboratory Analyses (PLA) codes updated quarterly 

• CPT and Healthcare Common Procedure Coding System (HCPCS) Level I and II code modifiers included in one file. 
• All appendices from the AMA's CPT 2024 Professional Edition book.
• Updated naming conventions to avoid ambiguity around file contents and usage dates.
• ReadMe improvements overhaul, including expanded documentation on the code set contents, code release timeframe, and data file elements. 

PREPARE TO USE THE CPT 2024 CODE SET

Defining the Chief Wellness Officer's Crucial Role

A chief wellness officer (CWO) is responsible for developing a strategy that encompasses education, advocacy and leadership, guiding an organization toward improved well-being. The CWO is not responsible for the burnout scores of the organization, and many factors that are crucial to well-being (i.e., compensation, productivity expectations and staffing levels) are not under a CWO’s control.

LEARN MORE:

Toolkit:

• Chief Wellness Officer Road Map

Playbook:

• Wellness-Centered Leadership

Podcast:

• How a Chief Wellness Officer Manages his Own Burnout

Resource:

• How Do I Set Up a CWO Position at My Organization? (PDF)

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

Linked to CitrixBleed Vulnerability

Comcast's Xfinity has indicated there was unauthorized access to its internal systems between Oct. 16 and Oct. 19. The breach, involving 35.9 million customers, took place just a week after Citrix released a patch for a critical flaw. Comcast is notifying Xfinity customers of a “data security incident” it says resulted in the likely theft of customer information, including usernames, passwords, contact information, partial social security numbers, and more. Xfinity has required customers to reset their passwords to protect affected accounts. In addition, Xfinity strongly recommends that customers enable two-factor or multi-factor authentication to secure their Xfinity account. The company is recommending that customers change passwords for other accounts for which they use the same username and password or security question. The data breach was due to a Citrix software vulnerability and the software-related risk is now resolved. Data analysis for the breach, first detected on Oct. 25 during a routine cybersecurity exercise, is still ongoing.

$700 Million Agreement Over Google Play Store

Attorney General Kathy Jennings and a bipartisan group of 52 other attorneys general today announced a $700 million agreement with Google in their lawsuit about Google’s anticompetitive conduct with the Google Play Store. Google will pay $630 million in restitution, minus costs and fees, to consumers who made purchases on the Google Play Store between August 2016 and September 2023 and were harmed by Google’s anticompetitive practices. Google will pay the states an additional $70 million for their sovereign claims. People eligible for restitution do not have to submit a claim – they will receive automatic payments through PayPal or Venmo, or they can elect to receive a check or ACH transfer. More details about that process will be forthcoming. The agreement also requires Google to make their business practices more procompetitive in a number of important ways.

Confidential, Voluntary Questionnaire Developed to Capture Information

We continue to move the needle. We are now at 18% of our membership providing this information. The MSD Committee on Diversity, Equity, and Inclusion is working to support a diverse physician workforce and inclusive organizational culture. Previously, MSD did not collect racial, ethnic, and gender information about our members. As a starting point toward understanding and improving our membership diversity, your help is greatly appreciated in submitting this information. A brief, four-answer questionnaire has been developed and will take less than a minute to complete. Your information will remain confidential, however, it will be used in aggregate to assess the diversity of our membership, how that correlates with the diversity of our leadership and to understanding the diversity of the physician workforce in Delaware. Access the questionnaire.

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

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

Discover MSD's Engaging YouTube Presence

Dive into a world of valuable insights and knowledge on the Medical Society of Delaware's YouTube channel. From engaging educational webinars to the latest health care news, our channel is your go-to destination for staying informed and inspired. Whether you're looking to enhance your medical expertise or stay updated on industry trends, our vast catalog of content has you covered. Join us on this exciting journey of learning and discovery. Simply follow the link below to start your MSD video experience today! Don't forget to subscribe to stay updated with our latest releases and be part of our growing community of medical professionals.

Start your MSD video binge today!

Due to Risk of Explosion

Philips North America LLC is recalling Panorama 1.0T HFO, a magnetic resonance imaging (MRI) system, due to a risk of explosion during a quench procedure caused by excessive pressure buildup of helium gas. During a quench, a large amount of helium evaporates and is vented outside the building. If an unknown blockage is present in the venting system and the pressure exceeds design limits, the structural integrity of the system could be compromised. The FDA has identified this as a Class I recall, the most serious type of recall. Please be aware, this recall is a correction, not a product removal. Use of these devices may cause serious injuries or death.   

Due to a Software Glitch

Medtronic Navigation Inc. is recalling StealthStation S8 Application Version 2.0 and 2.0.1 due to a software glitch. This can make the surgical plan data shift location(s) after the initial test is changed. This can cause the study plan data to be in an unintended location for the surgery. The U.S. Food and Drug Administration (FDA) has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.   

Due to Possibility of Burns and Fire

Olympus Corporation of the Americas is recalling bronchofiberscopes and broncho-videoscopes because they can lead to burns and fire. Using the bronchoscopes may cause serious adverse health consequences including critical burns in a person’s airways or lungs, airway bleeding, trouble breathing, apnea, loss of consciousness, or death. Please be aware, this recall is a correction, not a product removal. 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.  

FDA Updates Advisory

On Monday this week, the U.S. Food and Drug Administration (FDA) updated the advisory for the Investigation of Elevated Lead Levels in Cinnamon Applesauce Pouches. The FDA’s onsite inspection of the Austrofoods facility in Ecuador has ended. However, the FDA investigation of the elevated lead levels in recalled cinnamon applesauce pouches continues. During the inspection, investigators collected samples of cinnamon supplied by Negasmart to Austrofoods. These samples have undergone analysis and results show extremely high levels of lead contamination, 5110 parts per million (ppm) and 2270 ppm. For context, the international standard-setting body, Codex Alimentarius Commission (Codex)External Link Disclaimer is considering adopting a maximum level of 2.5 ppm for lead in bark spices, including cinnamon, in 2024. The FDA will update the advisory as information becomes available.

Due to Possible Health Risk

Wine Country Gift Baskets / Houdini Inc. of Fullerton, CA is taking precautionary measures of voluntarily recalling all gift baskets produced with Quaker Chewy Granola bars due to a recall by the Quaker Oats company because it has the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis. Wine Country Gift Basket/Houdini Inc. is committed to providing only the highest quality of product and is taking this action out of an abundance of caution in the interest of consumer protection.

Brush May Damage Tubing, Cause Injury, Have Bristle Detachment

Medline Industries, LP. announced a voluntary nationwide recall on October 10th, 2023, of several lots and SKUs of Tracheostomy Care and Cleaning Trays. The Tracheostomy Care and Cleaning Trays include a tracheostomy brush as a component that may have sharp edges at the tip that can puncture tubing during use and/or cause user injury during handling. In addition, complaints describe bristles of the tracheostomy brush detaching before and potentially during use. If bristles reach a patient’s airway, they may cause unexplained increases in sputum or pulmonary secretions, signs of infection, or difficulty breathing. If a patient exposed to the brush experiences any of these signs or symptoms, they should seek medical attention promptly. To date, Medline Industries, LP. has received one adverse event associated with this product. Tracheostomy Care Trays are medical devices intended to be used for the care and maintenance of a stoma site.

Bayhealth

Beebe Healthcare

Philip L. Rothbart, MD, JD

It is with sadness we share the passing of MSD member Philip Lee Rothbart, MD on December 3, 2023. Dr. Rothbart was 92. He was an accomplished physician and lawyer who lived life to the fullest. He received his M.D. from the University of Bonn, Germany, and later his J.D. from the Delaware Law School of Widener University. He served in the United States Army, stationed in France. Dr. Rothbart and his family began their life in Wilmington, Delaware in 1960. After serving as Associate Medical Director for the Squibb Institute for Medical Research in New Jersey for three years, the family returned to Wilmington where he opened his private medical practice. He served his many patients with dedication for over three decades and was an active member of the Medical Society of Delaware, serving on many boards and on numerous other medical committees and organizations in Delaware. Dr. Rothbart attended law school at night, rising as a top student and member of the Law Review and enjoyed his new academic pursuits while continuing to practice medicine full time. Upon graduation, he was admitted to the Bars of Pennsylvania, New Jersey and the District of Columbia. He and his daughter Marion opened their own law practice in Media, Pennsylvania, while Dr. Rothbart continued to practice medicine. He also served as an Adjunct Professor of Law, and then later as a Visiting Professor of Law, at his alma mater, the Delaware Law School, also teaching courses at the programs abroad in Geneva, Switzerland. He later joined the law firm of Maron Marvel. He left Kennett Square for life in Florida and later moved to Georgia. Earlier this year he returned to Delaware to be closer to family. A memorial service will be held at 11 am on January 15, 2024, at Christ Church Christiana Hundred, 505 Buck Rd., Wilmington, DE 19807. The family will receive friends at a reception following the service. In lieu of flowers, please consider contributions in Phil’s name to Saint Jude Children’s Research Hospital (stjude.org/donate), Wounded Warriors (support.woundedwarriorproject.org), Tunnel to Towers Foundation (dogood.t2t.org/give) or the Delaware Humane Society (humaneanimalpartners.org/give). Read obituary.

Danielle Sanders, MD - ChristianaCare Pediatric Associates

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 being part of 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.

• Updates to Clinical Testing Guidance Algorithms - CDC has updated several testing guidance pages for patients with acute respiratory illness (1) not being hospitalized, (2) being hospitalized, and (3) hospitalized and non-hospitalized patients when SARS-CoV-2 and influenza viruses are co-circulating. Clinicians can use these updated resources to inform clinical decision making. (12/8/2023)
• Ellume tests available for those who are blind or have low vision (free at-home COVID-19 tests) https://acl.gov/accessibletests
• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)