Observed April 27, 2023

All too often in our lives, we find ourselves in thankless situations. We have dedicated our heart and soul to various projects, goals and even patients, only to find that, in the long run, these efforts are completely pointless. Or so that is what we are led to believe by the level of gratitude we receive from others. Thank You Thursday is a great opportunity to start making a positive change by recognizing those in your life who make things easier, those who love you, and those who just make your day better by giving you a smile and a friendly hello. When you appreciate the people who work for you and with you, for their hard work, efforts, and all that they do for you and your practice, it uplifts everyone. Remember to recognize the wonderful people in your life and that a simple thank you and smile is great to give and receive. Get out and spread happiness in someone's life today and everyday.

MSD thanks all our amazing physicians, their staff, our all partners, and each any every MSD staff person. We are thankful for you and all that you do.

House Bill 1 and House Bill 2 - Recreational Marijuana Use, Sale

Governor Carney released a statement late Friday afternoon last week, just prior to the April 22nd deadline to take action on House Bill 1. Although his views on marijuana use have not changed, the Governor stated he will not veto House Bills 1 and 2 but also would not sign them, which then allows the bills to be enacted into Delaware law. The two pieces of legislation remove all state-level civil and criminal penalties from simple marijuana possession and create a highly regulated industry to conduct recreational marijuana sales. At its Interim Meeting on April 20th, MSD Council adopted a resolution to address the amount of THC allowable, advertising, use warnings, education, and addiction support regarding the sale of recreational marijuana in Delaware.

Lt. Governor Announces Support for the Permit to Purchase Legislation

Senate Bill 2 (SB 2) was introduced last week and has been assigned to the Senate Finance Committee. SB 2 would require an individual to be fingerprinted, undergo a criminal background check, and complete a firearms training course (within 5 years before the date of application) in order to obtain a qualified purchaser permit to authorize the purchase of a handgun, valid for 180 days. Concealed carry permit holders, law enforcement officers, and retired officers would be exempt from the mandate. Lieutenant Governor Bethany Hall-Long has announced her support for SB 2, which would add Delaware to the growing number of states that require a permit and training to purchase a handgun.

H.R. 2474 Ties Annual Medicare Fee Schedule to Medicare Economic Index

H.R. 2474, the Strengthening Medicare for Patients and Providers Act, ties the annual Medicare physician fee schedule to the Medicare Economic Index, providing physicians with reimbursement rates that accurately reflect the state of the U.S. economy. More than 100 medical societies, including the Medical Society of Delaware, signed a letter in support of this legislation that could limit Medicare cuts by reforming Medicare payment policies.

Areas of Compliance, Opportunities to Continue Payment Transformation

Early in March, Insurance Commissioner Trinidad Navarro and Cristine Vogel, the Director of the Department’s Office of Value-Based Health Care Delivery, issued the Annual Review of Carrier Progress Towards Meeting Affordability Standards. Vogel leads the Department’s efforts relating to value-based care, primary care, pharmacy benefit managers, and other health-policy initiatives, including grant programs. After establishing affordability standards in 2021 and 2022, the Office collected data from insurance carriers concerning their projected compliance with the affordability standards for 2023, the first year of affordability standard implementation. Read more.

MSD President Represents MSD at Surrounding State Meetings

MSD President Robert J. Varipapa, MD began making the rounds at surrounding state medical society annual events. A tradition, MSD and the Maryland Medical Society (MedChi), Medical Society of New Jersey, and the Pennsylvania Medical Society reciprocate attending respective state meetings and social events. Dr. Varipapa began his experience by attending the MedChi Presidential Gala on Saturday, April 22nd held in Baltimore. He will later attend the MedChi Spring House of Delegates meeting on Sunday, April 30th. Also coming up on the schedule is the Medical Society of New Jersey House of Delegates Meeting on Saturday, April 29th in New Brunswick with the Kick Off Reception Friday evening.

All Members Asked to Provide Input to Direct MSD's Goals

MSD has embarked on the development of a three-year strategic plan for the organization. MSD has engaged Aloysius, Butler, and Clark (AB&C), a marketing communications and research agency to help facilitate this initiative. We're looking for all our members' input and perspectives as we develop our strategic plan for MSD. To achieve this, we ask that you complete a very brief survey, less than 5 minutes to take, to capture your opinions. AB&C is administering the confidential survey. The first 100 participants completing the survey and including an email address at the end of the survey will be eligible for a drawing for one of two $100 Amazon gift cards. Your opinions and insights are important and we encourage you to complete the survey as soon as possible, but prior to April 30th. Please know that we respect your privacy. Your answers will only be viewed by AB&C. Your email address will not be used for any third-party solicitation purposes. Access the survey.

Confidential, Voluntary Questionnaire Developed to Capture Information

The MSD Committee on Diversity, Equity, and Inclusion is working to support a diverse physician workforce and inclusive culture. Prior to 2021, MSD did not collect information on racial, ethnic, and gender identification of 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-question questionnaire has been developed and will take less than a minute to complete. Your information will not be made public but will be used in aggregate to assess the diversity of our membership with the goal of understanding the diversity of the physician workforce in Delaware. Access the questionnaire.

Deadline for Completion: June 30th

The Controlled Substance Registration (CSR) biennial renewal deadline is June 30, 2023. All active CSR renewals must be completed through the DELPROS system (https://delpros.delaware.gov/OH_CommunitiesLogin). As a condition of CSR renewal, registrants will be asked to attest to completion of two hours of continuing education in the areas of controlled substance prescribing practices, treatment of chronic pain, or other topics related to the prescribing of controlled substances.

Those who are applying for a Delaware CSR must complete a mandatory one-time, one-hour, two-part course pertaining to safe prescribing and distribution of controlled substances, treatment of pain, and recognition and treatment of opioid use disorder. Completion of this course is beneficial prior to applying for a CSR as the initial application will ask for attestation of completion of the mandatory education. To fulfill the mandatory course requirement, the Division of Professional Regulation (Office of Controlled Substances) offers the only approved course. CSR Webinar Part 1 and Part 2 can be found at: https://dpr.delaware.gov/boards/controlledsubstances/mandatory_course/. The course has received approval for continuing medical education credit and may qualify as acceptable continuing education required for maintaining other professional licenses.

All physicians and non-physicians who hold an active Delaware Controlled Substance Registration are required to register for access to the Delaware Prescription Monitoring Program.

For questions, please contact the Division of Professional Regulation at (302) 744-4500 or customerservice.dpr@delaware.gov.

To Reduce Improper Prescribing

Online prescribing rules for controlled drugs were relaxed three years ago under emergency waivers to ensure critical medications remained available during the COVID-19 pandemic. The U.S. Drug Enforcement Administration (DEA) has proposed a rule that would reinstate most previously longstanding requirements that doctors see patients in person before prescribing narcotic drugs such as OxyContin, amphetamines such as Adderall, and a host of other potentially dangerous drugs. In a letter the American Medical Association asked the DEA to carve out provisions for physicians prescribing the most dangerous category of drugs to patients receiving hospice or palliative care.

FDA Issues Letter to Health Care Professionals

The U.S. Food and Drug Administration (FDA) issued a Letter to Health Care Professionals to inform them and laboratory personnel about a cybersecurity vulnerability affecting the Universal Copy Service software in the Illumina MiSeqDx, NextSeq 550Dx, iScan, iSeq 100, MiniSeq, MiSeq, NextSeq 500, NextSeq 550, NextSeq 1000/2000, and NovaSeq 6000 sequencing instruments. These instruments may be specified either for clinical diagnostic use in sequencing a person’s DNA for various genetic conditions or for research use only (RUO). At this time, the FDA and Illumina have not received any reports indicating this vulnerability has been exploited. Read more.

Supreme Court Protects Broad Access; Appeal Proceeds

Last Friday, the Supreme Court ensured that mifepristone would remain widely available for now by blocking new restrictions set by the lower courts, and maintaining access to mifepristone by mail. The April 7 preliminary injunction issued by Texas U.S. District Judge Matthew Kacsmaryk was put on hold. The New Orleans-based U.S. Court of Appeals for the 5th Circuit will consider whether Judge Kacsmaryk was right to suspend the U.S. Food and Drug Administration (FDA) approval of mifepristone and whether to reimpose restrictions the FDA has lifted in recent years. Opening arguments in the case are set for May 17.

Agency Continues to Receive Adverse Event Reports Related to SARMs

The U.S. Food and Drug Administration is warning consumers that the agency continues to receive adverse event reports related to selective androgen receptor modulators, commonly called SARMs. Social media posts by influencers and sellers of SARMs contribute to the availability and promotion of these dangerous products. Targeting teenagers and young adults, videos on social media platforms tout SARMs as a quick or easy way to improve physical appearance, gain muscle mass, or increase athletic performance. Learn more.

In the Areas of Physician Care, Grassroots, or Education/Research

To celebrate their 50 years of using quality improvement science, education, and collaboration in health care and communities, Quality Insights is pleased to offer grant opportunities totaling $100,000 to spark innovation or give a boost to promising projects. Please review for consideration of applying for a grant in the area of physician care, grassroots, or education/research. This grant program is available to non-profit organizations and educational institutions in Delaware and certain other states and territories. Quality Insights estimates eight to fifteen awards in amounts up to $20,000. An FAQ document, submission guidelines, and application are available at their website. Grant submission opens on 4/11/2023 and ends on 6/30/2023. An overview webinar with a question-and-answer session will be held on May 2 at 2 p.m. for anyone interested in the funding. Register for the webinar.

Free for Wilmington Housing Authority Residents

The Wilmington Housing Authority (WHA) and City of Wilmington are partnering to launch a new Wellness Checker Program in June that enables WHA residents to opt-in to weekly wellness calls. These check-in calls can help make sure residents are eating properly, exercising, staying hydrated, and taking their medication and are also designed to provide companionship for residents who live alone, thereby supporting their mental and emotional health in addition to their physical needs. The voluntary program, supported by a $10,000 grant from the City, is FREE for residents who wish to participate.

Hepatitis C infections are on the rise in the U.S. Patients with hepatitis C often have no symptoms. The American College of Obstetricians and Gynecologists recommends testing all pregnant patients for hepatitis C during each pregnancy. Hepatitis C can be cured. Early detection can save lives. Talk to your patients about hepatitis C testing. Read more.

Product Distributed in Delaware

Kawasho Foods USA Inc. of New York, NY, announced an expansion of its February 26, 2023, voluntary recall of canned GEISHA Medium Shrimp 4oz. to now recall all lots of this product. Kawasho Foods is taking this step out of an abundance of caution due to a concern that there is a possibility that the product has been under processed, which could lead to the potential for spoilage organisms or pathogens. Kawasho Foods made this decision after receiving additional information from the Food and Drug Administration. The Product was distributed to retailers nationwide (AL, AR, AZ, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, MA, MI, MN, MO, NC, NH, NJ, NY, OH, OR, PA, TN, TX, UT, VA, WA, WI) from Dec 2022 to Apr 2023.

See What it Takes to Succeed

Always have a fresh pair of socks handy, and nine other hard-won bits of advice from the AMA’s top physician expert on graduate medical education. Read more.

Bayhealth

Bayhealth is collaborating with Free Bikes 4 Kidz Delaware to distribute more than 100 bikes and helmets to local kids-in-need and provide bike safety, health information stations and fun activities for families. FB4K is a non-profit organization that brings communities together to sustainably furnish bikes to kids, providing a pathway to health, happiness and opportunity. Additionally, the Food Bank of Delaware will be on site with a mobile food pantry. The event will take place Saturday, April 29th from 1-4 p.m. at the Delaware State University Alumni Stadium. 

Bayhealth welcomes health on the move to central and southern Delaware with Bayhealth Mobile Care, a new 36-foot medical Recreational Vehicle (RV). The rolling clinic will soon hit the streets to provide care to underserved and hard-to-reach communities throughout Delaware. Read more.

ChristianaCare

For exceptional care in ensuring patients are able to easily breathe during their hospital stay, ChristianaCare has earned its third consecutive Apex Award in the Acute Hospital category. Conferred by the American Association for Respiratory Care (AARC), the award recognizes ChristianaCare for its “exemplary demonstration of best practices in respiratory care.”

Information on Rabies Exposure Reporting and Instructions

Delaware’s Division of Public Health (DPH) is developing educational opportunities for health care professionals to learn more about rabies prevention and control. If you are interested in attending an educational session (live/in-person) please fill out an interest form here. DPH has also provided an infographic to remind the medical community about rabies exposure reporting and instructions on how to report.

2023 National Minority Health Month Series - "Achieving Global Health Equity: The Role of Historically Black Colleges and Universities." Friday, April 28th from 4-7 p.m., Delaware State University, Dover. Click for details.

2023 National Minority Health Month Series - "Global Health Equity: The Critical Role of Blacks in Medicine." Sunday, April 30th, 3-4:30 p.m., Wilmington Public Library. Click for details.

To kick off Hepatitis Awareness Month, the Hepatitis B Foundation and HepB United are hosting a webinar on Monday, May 1 at 3:00 pm ET titled "Universal Adult Hepatitis B Recommendations are Here - Best Practices for Implementing Universal Screening and Vaccination". Panelists will share best practices for implementing the updated hepatitis B adult screening and vaccination recommendations within their communities, challenges they have faced, and resources that are available to leverage the recommendations. This event is being sponsored in part using funds from the Centers for Disease Control and Prevention. In addition a second webinar is planned for Thursday, May 11th from 3:30-4:40 pm ET entitled "Hepatitis C Virus: Barriers to Treatment and Community-Focused Primary Care."

The Delaware Academy of Family Physicians (DAFP) is also looking to strengthen its programs and offerings to the primary care community. To help them address the concerns of primary care access and physician shortages, the DAFP Research & Education Foundation (REF) is a 501(c)(3) corporation and the philanthropic arm of the Delaware Academy of Family Physicians. The DAFP REF offers important programs to encourage medical students and residents to come to Delaware to explore the world of residents to come to Delaware to explore the world of primary care and consider becoming a family physician in our state to improve access to care and provide patient education for our Delaware communities. To support these programs the DAFP Research & Education Foundation invites you to join us as a golfer and/or sponsor to our 2023 DAFP Healthcare Heroes Golf Outing being held on Friday, May 12, 2023, at the White Clay Creek Country Club in Wilmington, DE. A Shotgun start will be at 10:00am. Learn more and register. Sponsorship information.

No cost CME! Quality Insights and AmeriHealth Caritas Delaware present the web series: Evidence-Based Interventions to Improve Wellness, Disease Management, and Health of Delawareans. The next live, interactive webinar will be held Tuesday, May 30, from 12 Noon to 1:00 p.m. This webinar will provide overview of critical topics to the Medicaid population, evidence-based interventions, and case scenarios. The information presented is appropriate for physicians, physician assistants, nurse practitioners, nurses, and other clinical support staff. The Medical Society of Delaware has approved this continuing medical education activity for AMA PRA Category 1 Credit™. Click to learn more and register.

Bryce S. Sachais, MD

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 spotllight is on Bryce S. Sachais, MD, Blood Center Director, Blood Bank of Delmarva. Read more about Dr. Sachais.

Reynold S. Agard, MD - Internal Medicine, Premiere Physicians, PA

Harrison Eckert- PCOM Class of 2023 (FM Residency at Beebe Healthcare)

Ethan F. Keller - St. George's University SOM Class of 2023 (IM Residency at Bayhealth)

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!

Emily Webster Gripp - PCOM Class of 2025, ChristianaCare Branch Campus

Karlee E. Grudi- PCOM Class of 2023 (IM Residency at ChristianaCare)

Makala Lulu Wang - PCOM Class of 2025         

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending member(s) listed above or if you know of someone interested in joining MSD. You could be eligible for a membership dues referral discount!

On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available to help you prepare for the end of the PHE, some of which have been updated based on recent action by Congress. The following materials reflect recent changes and are currently available on the CMS Emergencies Page:

• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital At Home: https://qualitynet.cms.gov/acute-hospital-care-at-home
• Loss of Medicaid or CHIP coverage
• FAQs on COVID-19 (released March 29, 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.

• (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)
• CDC COVID-19 Testing Locator Website (no-cost COVID-19 Testing. launched 1/2023)
• Delaware "My Healthy Community" COVID-19 Dashboard (updated weekly on Wednesdays)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• COVID-19 Community Transmission (based on cases per 100,000 people and positivity rate, both measured over the last 7 days)
• DPH Public Health Alerts: de.gov/publichealthalerts
• Federal website for information on navigating COVID: COVID.gov
• CDC COVID-19 Quarantine and Isolation Calculator
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker Weekly Review.
• 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
• Subscribe to the COVID-19 Update podcast - on Apple Podcasts or Simplecast.  

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.