Preparing the Health Care System for Operation After the Public Health Emergency

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At the beginning of the COVID-19 Public Health Emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) used emergency waiver authorities and various regulatory authorities to enable flexibilities so providers could rapidly respond to people impacted by COVID-19.

CMS has developed a cross-cutting initiative to use a comprehensive, streamlined approach to reestablish certain health and safety standards and other financial and program requirements at the eventual end of the COVID-19 PHE. Most waivers and flexibilities will terminate at the conclusion of the PHE – and several have already been terminated. CMS encourages health care providers to prepare for the eventual end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards for and billing practices.

Similar to the guidance CMS has made available to states, CMS is releasing fact sheets that will help the health care sector transition to operations once the PHE ends, whenever that may occur. The fact sheets we are releasing today summarize the current status of Medicare blanket waivers and flexibilities by provider type as well as flexibilities applicable to the Medicaid community:

If you have any questions, please contact the CMS Office of Legislation.

Doctails: Join Extra Miles Pediatrics for a special event

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On September 24, Healthcare Providers who have volunteered on Extra Mile Pediatrics field teams in El Salvador and Guatemala will be at the Black Iris Social Club to pour you a drink and share some stories about the ways they’re impacting children, families, and communities in Central America

Your ticket will include:

  • Signature cocktails, beer, and wine in 3 of Black Iris’s Barrooms
  • One bar featuring Blanchard’s Coffee serving coffees sourced from Guatemala and El Salvador
  • Heavy Hors D’oeuvres
  • Silent Auction
  • Great stories about serving some amazing communities

Want to sponsor the event or donate to the silent auction? Download the sponsor packet here.

Gene Therapy Legislative Briefing – Registration Open

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Join us on September 12 to learn more about gene therapy technology, which has the potential to impact profoundly the lives of patients living with genetic disorders profoundly.

The Transformative Potential of Gene Therapies-Rare Disease Briefing will explain the science behind cell and gene therapies and their incredible potential for positively impacting patients’ lives. We will also review policies to promote patient access to these transformative therapies.

We will begin our in-person meeting with a lunch at the Virginia Bio+Tech Park in Richmond at 11:30 am and will continue with the program at 12:00 pm in person and virtually.

Register today to attend the briefing in person or virtually! 

September 12, 2022
Lunch at 11:30 p.m.
Program 12:00 p.m. – 1:00 p.m.
In Person (VA Bio+Tech Park, Richmond) / Virtual (Zoom)

Monkeypox Vaccine and Therapeutics Survey

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The Virginia Department of Health (VDH) has developed several surveys to report administration and inventory (including wastage) and redistribution associated with administering Monkeypox vaccine (JYNNEOS) and the therapeutic (TPOXX).

Vaccine:

Monkeypox Vaccine Administration & Inventory (which includes wastage reporting)

Monkeypox Vaccine and Medication Redistribution survey

Therapeutic:

TPOXX Provider Treatment Initiation Request Survey

  • All providers may request TPOXX for immediate treatment for an identified patient
  • Requests reviewed daily at 8:30am to ship same day for next day delivery
  • Select providers (Health Systems, LHDs with high cases, etc.) are able to maintain a small cache to expedite treatment.

TPOXX Patient Initiation Survey – Intended to track number of patients treated in Virginia

Breastfeeding: 6 Tips for Talking with Patients

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Despite the fact that the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a baby’s first 6 months of life, many women do not breastfeed — whether they aren’t successful, they had to stop early, or this option wasn’t accessible for them. The reasons are unique to every mother.

However, it’s never been more important to talk with your patients about breastfeeding. The AAP recently updated its breastfeeding guidelines as well as issued a call for more support for breastfeeding mothers to help overcome challenges like stigma, lack of support, and workplace barriers. In addition, the national formula shortage has certainly brought new attention to the subject. We know breastfeeding impacts our patients and their families, and as physicians, we have the opportunity to answer questions, offer support, and educate parents on the many studied health benefits of breastfeeding for mothers and babies.

So how do you talk with your patients? We have 6 helpful tips to ensure you check all the important boxes.

Start Early

The earlier you talk to patients about breastfeeding, the better. Your patients will have time to consider the information, ask questions, and even prepare well before the baby arrives. Plus, you’ll have a better chance to talk to patients who end up delivering prematurely. You can play a role in helping your patient prepare by making suggestions about talking with her partner and family members, talking with her employer, buying supplies, researching breast pump insurance coverage, determining whether there’s a lactation consultant on staff where she plans to deliver, and signing up to take a breastfeeding class.

Talk about Breastfeeding Difficulties

Breastfeeding is not easy for everyone, so set that expectation from the start. The three top reasons women stop breastfeeding relate to perceptions about breastmilk production. Addressing potential challenges up front will open the door for better communication with your patient when she has difficulties and questions, and, most importantly, will boost her confidence if she does have concerns — because she’ll understand it’s normal to have problems. Cover all the bases, from mastitis and breast engorgement to nipple confusion and latching difficulties.

Share Breastfeeding Resources

Set your patient up for success. Let her know you’re there to help and there are lots of resources available to her as well. Give her the tools and information she needs to first determine whether breastfeeding is right for her, and then how to find support if she chooses to breastfeed. This can include sharing printed materials, links to websites, links to social media pages and forums, and contact information for local support groups or lactation consultants. One free resource to share is the National Women’s Health and Breastfeeding Hotline. Other options include the March of Dimes and La Leche League. Reach out to your hospital’s lactation consultants to find out their favorite resources and what has helped their patients the most.

Be Encouraging

In addition to being up front about breastfeeding difficulties, let your patient know it takes patience and practice. Be supportive before delivery, in the hospital, and after she takes the baby home. The baby’s pediatrician will monitor the baby’s health and weight and may also offer breastfeeding support and resources. Your encouragement will reinforce the pediatrician’s involvement and recommendations. It’s also possible your patient may feel more comfortable confiding in you if she has questions or concerns, so keep that door open.

Don’t Judge

Breastfeeding is a decision that’s impacted by many variables — from personal choice to family dynamics to work circumstances and more. Your patient may choose not to breastfeed from the start. Your patient may try to breastfeed and ultimately opt not to, again for a variety of reasons. Or your patient may not be able to breastfeed due to issues with her own health. It’s important to remain judgment-free no matter what. If you’ve shared the facts and offered support and resources, you’ve given her what she needs to make her own choices and be confident in them.

Share Alternatives

If your patient won’t be breastfeeding, share resources about formula options, choosing a bottle, and other ways a new mother can bond and build attachment with her infant, like babywearing. New mothers who aren’t breastfeeding still need your support.

To learn more, check out the The American Academy of Pediatrics breastfeeding info site for physicians.

Lindsay Gould, MD
Obstetrics and Gynecology
Eastern Virginia Medical School

Additional Breastfeeding Resources to Share with Patients

The information contained in this article is for educational purposes only and does not constitute health care advice.

AMA Advocacy Update: August Recess Call to Action & More

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August recess call to action
During their August district work period, members of Congress should be reminded that there is still unfinished work on important health care issues, including looming cuts to physician Medicare payments and fixing the cumbersome prior authorization process.
Read more.

National Update

Big steps for bill to streamline prior authorization in Medicare Advantage
The House Ways and Means Committee has successfully marked up and passed “The Improving Seniors’ Timely Access to Care Act of 2022,” (H.R. 8487) legislation that would streamline prior authorization processes in Medicare Advantage plans.
Read more.

Lawsuit could stop 150 million from getting free preventive care
Kelley v. Becerra, a lawsuit before a federal district court judge in the Northern District of Texas, threatens the section of the Affordable Care Act requiring insurers and group health plans to cover more than 100 preventive health services—with no cost to consumers.
Read more.

Huge House win puts telehealth extension in Senate’s hands
The House of Representatives voted overwhelmingly for a bipartisan bill that extends Medicare telehealth payment and regulatory flexibilities through the end of 2024.
Read more.

Health care organizations press Congress to pass Conrad 30 legislation
The AMA cosigned a July 29 letter urging the House and Senate Judiciary Committees to expeditiously pass the Conrad State 30 and Physician Access Reauthorization Act, which would expand and improve the Conrad 30 program that plays an important role in helping to address the ongoing shortage of physicians.
Read more.

Patient survey shows unresolved tension over health data privacy
The AMA and Savvy, a patient-owned cooperative, surveyed 1,000 patients across the U.S. on their perspectives toward the privacy of their medical information, discovering that patients are deeply concerned over the lack of security and confidentiality of personal health information.
Read more.

Physicians appreciate Appropriate Use Criteria delay, urge improvements
The AMA appreciates the Centers for Medicare & Medicaid Services (CMS) for their recognition that physicians and their software vendors need more time before CMS begins enforcing the Appropriate Use Criteria Program.
Read more.

CMS releases 2020 MIPS and APM participation and performance data
In the long-awaited 2020 Quality Payment Program Experience Report, CMS includes data about 2020 participation in the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs), reporting options and performance categories, and final score and payment adjustments.
Read more.

Share your feedback regarding Provider Relief Fund reporting
The Government Accountability Office is conducting a review of the Health Resources and Services Administration’s oversight of the Provider Relief Fund. The AMA has been asked to provide testimonials and insights into important areas to help inform the report.
Read more.

Other News

AMA leadership video brings personal story to call for prior authorization reform
In a new video, AMA Immediate Past President Gerald E. Harmon, MD, recounts his recent frustration with trying to obtain prior authorization for his 92-year-old mother’s critical medications.
Read more.

Private practice playbook now available
This new, free AMA STEPS Forward® resource is full of information to help physicians determine if opening a private practice is the right move for them.
Read more.

Childcare stress, burnout in health care workers during COVID‑19
In this survey study recently published in the JAMA Network Open, high childcare stress was associated with 80% greater odds of burnout in all health care workers.
Read more.

AMA STEPS® Forward podcast: Electronic health record optimization and small interventions matter
The latest AMA STEPS® Forward podcast episodes discuss how eliminating unnecessary clicks in the EHR ultimately decreases physician burnout and how physicians can minimize unnecessary patient transfer using digital technology.
Read more.

Upcoming Events

Social determinants of health
Aug. 9: Join the AMA for this live AMA Steps Forward webinar on Aug. 9 at noon Central time and hear panelists from Rush University Health System present on how to engage your practice in addressing Social Determinants of Health.

Mind the gaps: Digital health issues and opportunities
Aug. 30: In this virtual Telehealth Immersion Program event on Aug. 3 at 11:00 a.m. Central time, Mayo Clinic leaders showcase efforts to advance digital health across three functional teams – strategy, research, and clinical informatics.

Addressing adult suicidal ideation in the primary care setting
Sept. 1: September is Suicide Prevention Awareness Month. Building off the Practical Strategies for Managing Suicidal Ideation & Reducing Risk, this pre-recorded webinar on Sept. 1 at noon Central time focuses on how primary care practices can address suicidal ideation within their adult patient population.

Registration open for AMPAC Campaign School
Sept. 4: For AMA members, their spouses, medical students and residents and state medical association staff who want to become more involved in the campaigning process, the 2022 AMPAC Campaign School will be taking place in-person, Sept. 29 – Oct. 2 at the AMA Offices in Washington, DC. During the two and a half day in-person portion of the program, under the direction of political experts, participants will be broken into campaign staff teams to run a simulated congressional campaign using what they’ve learned during group sessions on strategy, vote targeting, social media, advertising and more. Space is limited and the deadline to register is Sept. 4 (or sooner if maximum capacity is reached).

Dismantling stigma for all: Addressing physician and patient mental health and suicide risk
Sept. 8: As part of National Suicide Prevention Week, this live, interactive forum on Sept. 8 at Noon Central time will connect attendees with industry experts on suicidal ideation and physicians with lived experience to discuss solutions for dismantling the stigma around seeking mental health treatment.

U.S. Declares Monkeypox a Public Health Emergency

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via MedPage Today

The Biden administration declared a public health emergency (PHE) for monkeypox, signaling new urgency as cases rise in the U.S.

Since the first case was identified in the U.S. in May, the total number of cases has risen to 6,617, according to the latest data from the CDC. It’s a sharp increase from less than 5,000 last week.

“We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” HHS Secretary Xavier Becerra said in a press briefing Thursday afternoon.

Officials said they would expand the number of testing sites across the country, and accelerate the distribution of vaccines and treatments.

HHS Assistant Secretary for Preparedness and Response Dawn O’Connell, JD, said the U.S. will receive another 150,000 doses of Jynneos, the smallpox vaccine used to prevent monkeypox, for the Strategic National Stockpile in September.

The World Health Organization already declared monkeypox a public health emergency of international concern (PHEIC) last month, and several states — including New York, California, and Illinois — had declared their own emergencies to better respond to the outbreak. New York has 1,666 cases, California has 826, and Illinois has 547 cases. Texas, Florida, and Georgia follow close behind.

The designation will allow HHS Secretary Xavier Becerra to make certain funding available to respond to the emergency, modify certain Medicare, Medicaid, and other health program rules to make items and services more readily available, appoint temporary personnel to deal directly with the emergency, and change certain rules around telemedicine.

Public health experts and LGBTQ advocates have criticized the U.S. response to monkeypox, which they say has made testing unnecessarily complicated, and vaccines and treatments difficult to access, leaving the infected to deal with what can be excruciating pain for days, in some cases.

“I think from the LGBTQ perspective, this is a very clear statement of the value of the lives of people who are in the LGBTQ community,” said Demetre Daskalakis, MD, the White House National Monkeypox Response Deputy Coordinator. “It’s an opportunity for us to really be clear and to leverage the emergency [declaration] to move faster and also work, as we have been, to make sure our messaging is tight, and is intentionally designed not only to be stigma free, but to counter stigma.”

On Tuesday, President Joe Biden appointed FEMA regional administrator Robert Fenton as the National Monkeypox Response Coordinator in an effort to increase access to tests, vaccines, and treatments.

The U.S. so far has delivered more than 602,000 doses of the smallpox vaccine, Jynneos, around the country. Clinicians and pharmacists must request the antiviral tecovirimat (Tpoxx) from the Strategic National Stockpile via the CDC, making access complicated. According to CNN, only about 223 people had been treated with the antiviral as of July 22.

ABMS Response to National Board of Physicians and Surgeons’ Assertion of Certifying Body Equivalency

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The American Board of Medical Specialties (ABMS) strongly disagrees with the persistent and misleading assertions that the National Board of Physicians and Surgeons (NBPAS) recertification process provides a means of continuing ABMS board certification or is equivalent to ABMS board certification. Claims of equivalence to ABMS certification or that NBPAS is a means to maintain ABMS Member Board certification are misleading to the profession, and most importantly, to the public who depend upon the strength of ABMS board certification.

Unlike the ABMS Member Boards, NBPAS does not have a process for defining specialty specific standards for knowledge. It does not offer an external assessment of knowledge and skills, which the Institute for Credentialing Excellence defines as the essence of a certification program’s ability to validate competence, nor is the NBPAS certificate consistent with established American Medical Association policy on certification.

NBPAS does not have a requirement for improving medical practice, nor does it appear to have a means to address unprofessional conduct by its members. Lastly, it does not engage in research to provide the evidence base supporting the value of its program and informing its continued quality improvement.

ABMS and its Member Boards recently completed a comprehensive, transparent and collaborative process to review and enhance the Member Boards’ continuing certification programs, ensuring they are both relevant and supportive of diplomates’ learning and improvement needs while providing the public with a reliable and dependable credential. These program revisions address concerns that had been expressed by diplomates about continuing certification: they offer an alternative to the high-stakes exams, provide feedback to support learning, and include processes to allow diplomates to meet requirements prior to certificate loss.

All of these changes serve to reduce diplomate costs, and diplomates like them: Ninety-eight percent of surveyed diplomates prefer longitudinal assessment models over the previous high-stakes exam. At the same time, ABMS continuing certification continues to honor its obligation to the public to verify that ABMS Board Certified physicians have demonstrated the knowledge, skills, and professionalism to provide high quality specialty care.

The value of board certification should not be understated. Patients deserve access to highly skilled specialty care. They expect their physicians to be up to date with the most recent medical advances in their specialties and to demonstrate their proficiency through a rigorous Board certification process. Recognizing NBPAS as a certifying body equivalent to ABMS Member Boards will confuse the public and the profession regarding the meaning and purpose of board certification and may undermine the public trust in board certification and professional self-regulation.

VDH Monkeypox Treatment Webpage is Live

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The Virginia Department of Health (VDH) is happy to inform you that the Monkeypox Treatment webpage for healthcare providers is now LIVE, and can be accessed here. This website provides information regarding the currently available treatment, Tecovirimat (TPOXX), and includes CDC guidance and requirements for patient eligibility, precautions to consider, and how to request TPOXX for your patient(s).

TPOXX is only available through the Strategic National Stockpile (SNS) and VDH has decided to preposition Virginia’s allocation in local health departments, hospitals, and health systems.

VDH will also be prioritizing requests for TPOXX from Infectious Disease specialists in Virginia. To request TPOXX, providers may complete VDH’s TPOXX Treatment Initiation Interest Form. VDH has a small stock available for deployment upon request and has the ability to order more at any time through the SNS. VDH also has the ability to request direct shipment from the SNS to the clinician, if needed.

We thank you for your continued support as VDH works toward its goal of providing equitable access to treatment.

Last chance to apply: Health Systems Science Scholars Program

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Presented by the American Medical Association in collaboration with the AMA Accelerating Change in Medical Education Consortium, the AMA Health Systems Science Scholars Program focuses on the implementation of health systems science curricula in undergraduate and graduate medical education.

Apply now!

The program will provide an overview of how to design, implement and evaluate health systems science curriculum with particular interest on how health systems science can promote health equity. If you have responsibility—or anticipate having responsibility—for implementing or teaching topics related to health systems science, we invite you to apply for this unique learning experience.

Successful applicants will participate in a year-long longitudinal experience beginning Dec. 2 with a virtual kick-off session. This will be followed by a dynamic two-day in-person workshop May 7–8, 2023, and culminate with a graduation in December 2023. Throughout the year program scholars will participate in webinars, virtual gatherings and mentorship sessions with national experts.

Submission information
Faculty from both consortium and non-consortium institutions are welcome to apply. Applicants will be asked to submit a concrete project, which will serve as part of their focus during the program’s workshop. Applicants must be nominated by their department chair or dean. We encourage early submissions as space is limited—the deadline for submission is 5 p.m. Central time, Aug. 8.

Please share this opportunity with colleagues. Questions? Email [email protected] for more information.

Click here to apply.