Delaware Division of Public Health Issues Health Alert

The Delaware Division of Public Health (DPH) issued a health alert to inform clinicians and public health care professionals in Delaware of poor air quality. Wildfires in Canada and current weather conditions are bringing wildfire smoke into our region. Wildfires are continuing to burn due to dry and windy conditions that increase the potential for fine particulate matter, also known as particulate matter, less than 2.5 micrometers in size (PM2.5), to accumulate at the ground-level. This increases the likelihood of inhalation exposure to PM2.5. Health effects from wildfire smoke or PM2.5 exposure include respiratory symptoms and effects, irritation of the eyes and respiratory tract, cardiovascular effects. Poor air quality may increase visits and calls to doctor’s offices, visits to emergency departments, urgent care centers, and hospitalizations. As of 8 a.m. on June 8, 2023, all of Delaware is experiencing “unhealthy,” “very unhealthy,” or “hazardous” conditions. The website www.airnow.gov or AirNow Mobile App | AirNow.gov can give location-specific air quality index, which uses categories to provide recommendations for outdoor and indoor activity for the general population and sensitive populations (people with heart or lung disease, older adults, children and teens, pregnant people, outdoor workers, people of low socio-economic status). Contact DPH at hspcontact@delaware.gov or 302-744-4700. Read the alert.

Campaign Key Issues: Health Care, Affordable Housing, and Education

New Castle County Executive Matt Meyer has announced he will run for Governor in the 2024 Delaware gubernatorial election, becoming the first candidate to enter the race, as Governor John Carney finishes out his final term. He stated that health care, affordable housing, and education will be key issues in his campaign. His campaign is touting his accomplishments as county executive including a program that taught children to code, establishment of the Hope Center to assist the county's homeless, and monitoring sewage as a way of tracking COVID. He previously served as a diplomat in Iraq, an economic advisor to Delaware Governor Jack Markell, and started two successful businesses. He has worked as an attorney at the New York law firm of Simpson Thacher, at the Potomac Law Group, and as a Skadden Arps Fellow at Community Legal Aid Society, Inc. in Delaware. Prior to his election as county executive, he was a public school math teacher. Read more.

Rescinds the Requirement at Medicare, Medicaid-Certified Facilities

The Centers for Medicare and Medicaid Services (CMS) has formally withdrawn the COVID-19 vaccine mandate for health care workers, according to a final rule published in the Federal Register on Monday. The Omnibus COVID-19 Health Care Staff Vaccination interim final rule rescinds the requirement for workers and contractors at Medicare- and Medicaid-certified facilities to be fully vaccinated against COVID-19. The COVID-19 vaccine mandate for health care workers has been in place since November 2021.

Emergency Regulation Ordered by Secretary of State

Delaware Secretary of State Jeff Bullock has placed xylazine, also known as “Tranq,” a non-opioid drug used primarily in veterinary medicine, in Schedule III of the Uniform Controlled Substance Act. Tranq has been used increasingly as an additive in opioid abuse to create a “zombie-like” condition for users. Secretary Bullock’s actions follow a recommendation from the Delaware Controlled Substance Advisory Committee on May 5, 2023, to adopt an emergency regulation placing xylazine in Scheduled III to protect the public and address the dangers posed by the drug.

Both MSD and the Delaware Academy of Ophthalmology Support SB 148

Delaware Senate Bill 148 (SB 148) has been introduced, was quickly reported out of the Senate Health and Social Services Committee, and passed in the Senate today (Thursday). Known as the "Topical Waste Reduction Act," SB 148 will allow physicians and other practitioners the ability to dispense the unused portion of the creams, drops or ointments that were used after a surgical or other procedure to the patient. This Act would allow physicians and practitioners to better serve their patients by helping decrease direct cost to them. This will reduce the wasteful discarding of perfectly good medications and help reduce health care expenses. It further would promote better continuity of care during the post-operative period, eliminating unnecessary trips to the pharmacy and assuring the patients are receiving the therapy they need. Both MSD and the Delaware Academy of Ophthalmology (DAO) have sent letters in support of SB 148. The bill has now been sent to the House for consideration.

Legislation Aims to Reduce Greenhouse Gas Emissions to Zero by 2050

The "Delaware Climate Change Solutions Act of 2023," House Bill 99, passed in the House on Tuesday. This bill establishes a statutory target of greenhouse gas emissions reductions over the medium and long term to mitigate the adverse effects of climate change due to anthropogenic greenhouse gas emissions in the state. The bill puts into Delaware Code a planning process to guide the state in meeting the goals, requiring a climate action plan to serve as a guide for state agencies. The plan would be updated every five years. HB 99 would set net emissions reduction targets of 50% from the 2005 baseline by 2030 and a 100% reduction by 2050. As of this publication, the bill awaits consideration in the Senate Environment, Energy and Transportation Committee.

Senate Bill 106 Passes Despite Challenges to Gender Pronoun Changes

Delaware Senate Bill 106 (SB 106) modernizes and expands the concept of maternal mental health by replacing the definition of maternal depression with the more encompassing definition of perinatal mood and anxiety disorder. This Act contemplates treatment for any caregiver who may be affected by perinatal mood and anxiety disorder and avoids the use of gender-based pronouns as recommended by the Legislative Drafting Manual. SB 106 now goes to the House for consideration.

Pilot Program Aims to Boost Value-Based Primary Care

The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states (Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington). The model will support participants with varying levels of accountable care experience, including Federally Qualified Health Centers (FQHCs) and physician practices with limited experience in value-based care, in driving toward a system that reduces disparities in care and results in better patient experience and outcomes. The MCP Model will provide participants with additional revenue to build infrastructure, make primary care services more accessible, as well as better coordinate care with specialists. CMS expects this work to lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations. MCP will run for 10.5 years, from July 1, 2024, to December 31, 2034. The model will build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program (MDPCP). For more information, review the detailed official press release.

FDA Provides List of Best Practices for Cleaning and Sterilization/Disinfection

On Monday, the U.S. Food and Drug Administration (FDA) issued a letter recommending health care facilities and health care professionals implement conservation strategies for non-sterile, single-use pneumatic tourniquet cuffs in the United States. To this end, the FDA has provided a list of best practices and instructions for cleaning and sterilization/disinfection of these devices, as well as recommending the use of alternative devices while the localized supply constraints last. These devices are mainly used in elective limb surgeries and in emergency and trauma settings.

Addressing Social Needs Through Electronic Clinical Quality Measure

The Centers for Medicare & Medicaid Services (CMS) has contracted with Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) to develop a re-designed measure of screening for social needs (food insecurity, housing insecurity, transportation insecurity, and utility insecurity). The re-designed measure will be an electronic clinical quality measure (eCQM) evaluating hospitals on screening and following-up on social needs of patients. CMS is inviting stakeholders and other interested members of the public to review and comment on the measure under development. The public comment period will close on July 2, 2023. To participate in the public comment or if you have questions, please e-mail cmsaddressingsocialneeds@yale.edu. For more information and to access the measure specifications, please visit: https://mmshub.cms.gov/get-involved/public-comments/current. Please note that at the end of the public comment period, all comments will be posted on the website.

AORN and The Joint Commission: Make Time for Time Out

Despite decades focused on preventing wrong site surgery, it continues to occur at a predictable rate. National Time Out Day, on June 14, brings renewed attention for everyone on the surgical team to pause before a surgical procedure begins to ensure it is the right site, right procedure and right person. The Joint Commission addresses the Time Out in its Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery™. For this year’s National Time Out Day, the Association of periOperative Registered Nurses (AORN) and The Joint Commission are focusing on the full attention of all team members during the Time Out, as well as the importance of visible site markings. Read more.

What Should You Be Working On Currently?

The Merit-based Incentive Payment System (MIPS) program can be overwhelming. June is a great time to check on your MIPS reporting to see if you are on track. To help optimize scores and minimize practice burden, Chirpy Bird, a health care quality and regulatory consulting firm, has provided a list of some things to look at right now. With an approach of reviewing MIPS duties month by month, you may be able to earn a higher MIPS score and focus on your practice. 

• It is an ideal time to check in on your Quality measure data to see what is working and what is not
• If you haven’t already, start documenting your improvement activities now
• A relatively new requirement, MIPS Safety Assurance Factors for EHR Resilience (SAFER) guides are a prerequisite that should be completed as soon as possible.

US Patients Who Underwent Surgical Procedures in Mexico

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Update to supplement the CDC HAN Health Advisory issued on May 17, 2023. This Health Update provides updates on the status of the ongoing fungal meningitis outbreak and highlights interim recommendations for diagnosis and treatment. As of June 1, 2023, a multistate outbreak of fungal meningitis is ongoing among patients who underwent procedures under epidural anesthesia in the city of Matamoros, Tamaulipas, Mexico, at two clinics: River Side Surgical Center and Clinica K-3. Physicians, other health care professionals, public health officials, and the public should be aware that all patients, including those without symptoms, who underwent medical or surgical procedures under epidural anesthesia at River Side Surgical Center or Clinica K-3 in Matamoros, Mexico, since January 1, 2023, should be evaluated for fungal meningitis as soon as possible. Evaluation for fungal meningitis includes a lumbar puncture (LP, also known as spinal tap) and magnetic resonance imaging (MRI) of the brain.

First At-Home COVID Test Granted Marketing Authorization Outside of EUAs

On Tuesday, the U.S. Food and Drug Administration (FDA) granted marketing authorization for the Cue COVID-19 Molecular Test. The product is a molecular nucleic acid amplification test (NAAT) that is intended to detect genetic material from SARS-CoV-2 virus present in nasal swabs from adults with signs and symptoms of upper respiratory infection. This authorization is the first at-home COVID-19 test granted marketing authorization outside of emergency use authorities, representing a new era of consumer access to diagnostic tests that can be performed entirely at home. In a study reviewed by the FDA, this test correctly identified 98.7% of negative and 92.9% of positive samples in individuals with signs and symptoms of upper respiratory infection.

Purge Fluid Leakage

Abiomed is recalling specific Impella 5.5 with SmartAssist sets after receiving customer complaints about purge fluid leaking from the purge sidearm of the pump. If the leak issue is not resolved, persistent low purge pressure and purge flow may lead to pump stop and loss of therapy. In patients who are critical, failure of the pump’s support can lead to further deterioration and worsening of their already critical condition, and may even lead to death. 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, serious health consequences, or death.

Proclamation Emphasizes that Summer is Time to Educate, Raise Awareness

Lt. Governor Bethany Hall-Long joined state officials and community leaders on Monday this week to sign a proclamation marking the first full week of June as Gun Violence Awareness Week in Delaware. As school wraps up for the year, it’s important to increase public awareness for children and caregivers around the safe storage of firearms. National data shows that gun violence is the leading cause of death for children and teens in the U.S. The event was a call-to-action for awareness and safety.  

On Tuesday, Governor Carney joined Lt. Governor Hall-Long, members of the General Assembly, members of his cabinet, and advocates to sign a proclamation recognizing June as Pride Month.

Controlled Substance Registration, MATE Act Training Requirements

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.

As MSD has reported, the US Drug Enforcement Administration (DEA) informed DEA-registered practitioners of the training that will meet the requirements of the Medication Access and Training Expansion (MATE) Act that was passed as part of the Consolidated Appropriations Act of 2023. The Act requires new or renewing DEA registrants, as of June 27, 2023, to have completed a total of at least eight hours of accredited continuing education on the treatment and management of patients with opioid or other substance use disorders before renewing their registration. The letter also states that physicians will be able to simply check a box on their DEA registration application or renewal form indicating that they have satisfied this training requirement. The DEA letter includes information on prior trainings on the treatment and management of patients with opioid or other substance use disorders that can count towards a practitioner meeting this requirement. Please refer to the DEA letter for specifics about qualifying education in meeting the requirements. The AMA also has worked to identify the educational resources that will satisfy the MATE Act. Please visit the AMA EdHub™ for courses that satisfy the MATE Act.  

Experts, Advocates, Government Will Share Best Practices, Exchange Ideas

Lt. Governor Bethany Hall-Long will host Delaware’s first summit spotlighting the social and economic importance of mental and behavioral health in Delaware on Monday, June 12 from 9:00 a.m. - 3:00 p.m. at the Chase Center on the Riverfront in Wilmington. The 2023 Mental and Behavioral Health Summit: Pathways and Partnerships for a Stronger Delaware will bring together a variety of stakeholders including local and national thought leaders, community advocates, and government officials.  

Featured panel discussions will highlight mental and behavioral health data, Delaware’s legislative and policy response to the behavioral health crisis, frontline work led by Delaware community advocates, and more. The Summit will close with a fireside chat with Lt. Governor Hall-Long and The Kennedy Forum founder and former U.S. Representative Patrick Kennedy around strategies to enhance behavioral and mental health support – from insurance parity to holistic treatment solutions.

Members of the public are welcome to register for the 2023 Mental and Behavioral Health Summit: Pathways and Partnerships for a Stronger Delaware at this Google Docs link. 

Events Run Throughout Sussex County in June

La Red Health Center (LRHC) is offering individuals who are not up-to-date on their COVID-19 vaccines several opportunities in June to get current on their vaccinations. People do not have to be a LRHC patient to receive the vaccine. LRHC’s Vaccination Team is offering the following COVID-19 vaccination clinics to the general public: 

• Monday, June 5th, 10 am to 12 pm at the Selbyville Public Library

• Saturday, June 10th, La Red Health Center, Seaford 

• Monday, June 12th, 10 am to 12 pm at the Lewes Public Library

• Thursday, June 15th, 4 pm to 6 pm La Red Health Center, Georgetown

• Sunday, June 25th, 12 pm to 4 pm Bicentennial Park Milford Riverfront

• Thursday, June 29, 4 pm to 6 pm, La Red Health Center, Georgetown

For more information about La Red Health Center visit www.laredhealthcenter.org/

MSD's Statewide Safety Net Program for HCC Patients

The MSD Voluntary Initiative Program (VIP) is part of Health Care Connection (HCC), a state-funded program that helps coordinate charitable medical services and provides additional health service resources for uninsured and under-insured patients. In addition, VIP’s Medication Assistance program saves patients significant money on their medication and medical supplies. Physician participation adds value and improves medical outcomes for patients enrolled in HCC. Physicians and other health care professionals who are employed by Delaware hospitals (Beebe Healthcare, ChristianaCare, Saint Francis Healthcare, and Tidal Health) are automatically participants in VIP. A corresponding questionnaire has been developed for new physicians and other health care professionals joining health systems or for private practicing physicians who wish to enroll in VIP. If you have questions regarding the VIP program, please contact Michelle Seymour at 302-224-4905 or email Michelle.Seymour@medsocdel.org.

Employed Physicians and Health Care Professionals - use this link to update your information for VIP - https://www.surveymonkey.com/r/VIPEmployedNetwork

Private Physicians and Health Care Professionals - use this link to enroll in VIP - https://www.surveymonkey.com/r/VIPEnrollment

AMA Offers Five Factors Physicians Should Evaluate

Many physicians wait to retire until their late 60s or 70s, but if you’re considering an early transition to retirement, you’re not alone. Nearly 30% of physicians retire between 60 and 65 years old, and 12% retire before 60, according to survey research conducted by AMA Insurance Agency Inc., a subsidiary of the American Medical Association (AMA). A common piece of advice from successfully retired physicians is to retire while you are still healthy enough to enjoy your retirement, assuming your finances are in order. At the same time, physicians who retire early are the most likely to be very dissatisfied with retirement. The AMA Insurance research found that 8% of physicians who retired before 60 identified themselves as very dissatisfied, compared with 4% of physicians 60–65 years old and 3% of those 66–70. Read the five questions to include on your list of things to think through before making a decision to retire early.

Free, Money-Saving Membership Benefit for You!

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, and help create healthier communities. The program adds just 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 $1,000s 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

The Bayhealth Medical Group has entered New Castle County with the opening of the Bayhealth Primary Care, Middletown practice. The Bayhealth Primary Care, Middletown team consists of two board-certified family medicine physicians who are are currently accepting new patients. The Bayhealth Primary Care, Middletown practice is located at 209 East Main Street.

ChristianaCare

ChristianaCare's Helen F. Graham Cancer Center & Research Institute is partnering with Susan G. Komen®, the world’s leading breast cancer organization, in an expansion of Komen’s screening and diagnostics program to income-eligible residents of Delaware. Under the program, Delaware women who meet income qualifications will be able to access no-cost breast cancer screening mammograms and necessary diagnostic follow-up tests. Once approved by Susan G. Komen for care, they can select ChristianaCare for services.

Pankaj Sanwal, MD - Rainbow Pediatrics

Sai Charan R. Chilumula, DO - Emergency Medicine Residency, 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!

Julia Elcock-Vengen, MD - Family Medicine, Trinity Medical Associates

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!

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 At Home: https://qualitynet.cms.gov/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 COVID-19 Quarantine and Isolation Calculator
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker Weekly Review.
• 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)
• 2nd bivalent COVID-19 Vaccine Booster: Who Should Receive It?
• (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)

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.