via AMA

An examination of cost data for the South Mississippi system’s accountable care organization (ACO) revealed that care provided by nonphysician providers working on their own patient panels was more expensive than care delivered by doctors.

This prompted Hattiesburg Clinic leaders to redesign the clinic’s care model and to publish their findings. Hattiesburg Clinic employed a total of 26 physician assistants (PAs) and nurse practitioners (NPs) in 2005 and today there are 118. Along with certified registered nurse anesthetists and optometrists, they are part of a team of 186 nonphysician providers at the clinic, also called advanced practice providers (APPs).

“Over the past 15 years, in the face of physician shortages, especially in primary care, Hattiesburg Clinic made decisions to expand our care teams with the use of advanced practice providers,” says a study entitled “Targeting Value-based Care with Physician-led Care Teams” that was published in the Journal of the Mississippi State Medical Association.

“Focusing specifically on primary care, because our shortage of physicians there was so dire—due to retirements, massive panel sizes and lack of medical students entering primary care residencies—we allowed APPs to function with separate primary care panels, side by side with their collaborating physicians,” the study adds.

In hindsight and “with a wealth of internal data,” which includes cost data on more than 33,000 patients enrolled in Medicare, “the results are consistent and clear: By allowing APPs to function with independent panels under physician supervision, we failed to meet our goals in the primary care setting of providing patients with an equivalent value-based experience.”

A private multispecialty clinic with more than 300 physicians, Hattiesburg Clinic is a member of the AMA Health System Program. Its ACO was ranked first in quality in its cohort in 2016 and 2017, amongst a total of 471 other participants, and has been recognized by the Centers for Medicare & Medicaid Services (CMS) for delivering high-quality care at a low cost.

The 2017–2019 CMS cost data on Medicare patients without end-stage renal disease and who were not in a nursing home showed that per-member, per-month spending was $43 higher for patients whose primary health professional was a nonphysician instead of a doctor. This could translate to $10.3 million more in spending annually if all patients were followed by APPs, says the analysis. When risk-adjusted for patient complexity, the difference was $119 per member, per month, or $28.5 million annually…

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The American Medical Association (AMA) applauds the Centers for Medicare and Medicaid Services (CMS) for expeditiously releasing the Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule, which would place new requirements on Medicare Advantage (MA) plans, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicaid and CHIP managed care plans, and Qualified Health Plan issuers on the Federally Facilitated Exchanges to streamline prior authorization (PA) processes to reduce physician practice burdens and prevent patient care delays.

While we are still digesting the 400-page rule, we expect it to align with our PA reform campaign, which is a pillar of the AMA Recovery Plan for Physicians. Importantly, the rule reflects the AMA’s successful advocacy to address PA programs in MA plans, as they were excluded from a previous iteration of the rule that CMS released in late 2020. The AMA’s initial review suggests that the rule will bring much-needed transparency to both plans’ PA requirements and program metrics, such as approval/denial rates and average PA processing time. We look forward to providing our feedback to CMS within the 90-day comment period.

As you recall, after garnering more than 300 bipartisan cosponsors, H.R. 3173, the Improving Seniors’ Timely Access to Care Act of 2022, passed the House of Representatives via voice vote in September. The associated score from the Congressional Budget Office (CBO) for this legislation, however, was $16 billion. This high score was driven by what the AMA perceives as an incorrect assumption that reductions in prior authorization subsequently permit physicians to perform more services, which, in turn, leads to higher spending for Medicare Advantage plans. The release of this regulation is supposed to play a positive role in reducing the total CBO score.

Congressional leaders are already in the process of trying to obtain a new CBO score in hopes that it is substantially lower and, as a result, more politically viable. The timing of a new CBO score, however, is unclear. In the meantime, we will continue to urge Congress to pass the bipartisan Improving Seniors’ Timely Access to Care Act before the end of 2022.

November 2022 marked two spectacular space-related news events. The new era of space exploration officially kicked off with the launch of the NASA Artemis mission which will pave the way for future human lunar exploration, and the announcement of the most exciting musical experience: Chopin. The Space Concert. The timeless music of Frédéric Chopin will be performed live alongside the unique NASA space footage.

The Medical Society of Virginia (MSV) and the Alliance for Innovation Polish American Foundation (AFI) will co-sponsor Chopin. The Space Concert on Saturday, March 18, 2023, at the National Air and Space Museum’s Steven F. Udvar-Hazy Center in Chantilly, Va.

This is the third time the MSV and AFI have joined together to share the relationship between the arts and science, but the first time the general public have been able to participate in person in this event featuring the award-winning film, Chopin. The Space Concert, by Director Adam Ustynowicz and music by Polish composer, Frédéric Chopin. Renowned Polish musicians will perform the timeless music of Chopin live at the event bringing new dimension and depth to experience the elegance of space and music.

The need to connect and experience the full range of senses and emotions was the driving force for a breathtaking initiative Chopin. The Space Concert. The music of Frédéric Chopin first reached space thanks to an American astronaut of Polish origin – Colonel George D. Zamka who was one of the members of the STS-130 mission. In February 2010 he took a CD with the music of the great Polish composer on board of the Space Shuttle Endeavour.

Colonel Zamka said: “I am one of several million Americans with Polish roots. The music {of Chopin} would be a way to celebrate the friendship and heritage between two great countries, the United States and Poland.”

This year’s concert expands the theme of human imagination, brotherhood, and freedom with the goal of helping the people of Ukraine. Through Chopin. The Space Concert, AFI and the MSV are raising awareness and funds to establish a Center of Excellence to train and support Polish and Ukrainian medical specialists in Polytrauma (Traumatic Brain Injury, PTSD, Acute Stress Disorder) in Poland. The Center of Excellence is being developed in collaboration with the Medical Society of Virginia and the National Center for PTSD, a program of the U.S. Department of Veterans Affairs.

Ticket information and sponsorship opportunities will be available soon.

Patients are Already Flooding into Doctors’ Offices, Hospital Emergency Departments, and Pediatric ICUs During Early Days of Flu and Respiratory Illness Season; Taking Precautions such as Getting a Flu Shot, the COVID-19 Vaccine, and Practicing Basic Health and Safety Behaviors Helps Reduce the Risk of Illness

via VDH

The Virginia healthcare community is encouraging Virginians who haven’t done so to get vaccinated against flu, get vaccinated or boosted against COVID-19, and to take personal prevention steps as we enter the flu and respiratory illness season. This year’s flu season is already showing early, concerning signs that it may be worse than in recent years. There are also increasing numbers of Respiratory Syncytial Virus (RSV) cases, which may cause serious illness and hospitalization in children and older adults. If these trends continue, this could strain healthcare systems in some communities.

Some Virginia doctors, hospitals, and other healthcare providers are already seeing very high volumes of patients with respiratory illnesses seeking care, filling hospital beds, and in many cases requiring longer hospital stays. Emergency department and urgent care clinic visits involving patient diagnoses of RSV have quadrupled since early September and remain significantly elevated. Visits for flu-like illness are also rising – for the week ending November 5, such visits are at least four times as high than in the same week for each of the past four years. Virginia Immunization Information System data from July 1-November 9, 2022 indicates that flu vaccine uptake in children under 12 years old is lower this year as compared to the same time period during the previous three years.

These conditions are occurring even as COVID-19 remains a significant concern – Virginia hospitals continue to treat an average of 486 hospital inpatients each day. The continued presence of COVID-19 combined with the rapid spread of flu and other respiratory illness poses a heightened risk of developing medical complications from COVID-19 or the flu among older Virginians, individuals with weakened immune systems or other medical conditions, and younger children.

The holiday season is just around the corner. To protect yourself and your family against flu,  RSV, and other respiratory illnesses, the healthcare community recommends taking the following steps:

• Make an appointment to get a flu vaccine as soon as possible. The U.S. Centers for Disease Control and Prevention (CDC) advise that “everyone 6 months and older, including pregnant women, should get a flu vaccine every season with rare exceptions.” Flu vaccines are available at many doctor’s offices, pharmacies, local health departments, and community health clinics, among other locations. Contact your healthcare provider, local health department or find out where you can get a flu vaccine in your community here.
• Get vaccinated against COVID-19 if you have not done so already. Get boosted if you have been vaccinated but it has been at least 2 months since your last vaccine dose. Bivalent booster doses are available for vaccinated individuals five years and older. VDH advises parents to discuss this option with their child’s healthcare provider. Find out where you can get a COVID-19 vaccine or booster in your community by visiting vaccinate.virginia.gov or call (877) VAX-IN-VA or (877) 829-4682.
• Parents of sick children are encouraged to keep them home from school and other activities to help limit the spread of infection. Parents with sick children are also advised to initially contact a pediatrician or family physician for medical guidance unless your child is in medical distress, in which case seeking hospital care may be warranted. Taking this approach helps ensure that hospital beds and emergency departments are open and available to patients with critical medical needs.
• Adults who become ill are also encouraged to stay home to limit the risk of spreading illness and to contact their healthcare provider for evaluation, testing and/or guidance on the appropriate course of treatment depending on the severity of symptoms and other risk factors. There are some treatment options for both COVID19 and influenza; people are encouraged to seek care quickly and talk to their health care provider about the right treatment options for them.
• People are also encouraged to take simple but powerful prevention steps- wash their hands regularly,  avoid touching their faces with unwashed hands,  cover their mouths when they cough or sneeze, and  limit the time children spend in large group settings with other contagious individuals when possible.
• Individuals with symptoms, or those who test positive, are encouraged to contact their healthcare providers to determine the treatment option that is right for them. This is especially true for high-risk individuals. Because treatment is often most effective when taken within five days of the onset of symptoms, people are advised not to delay seeking medical advice and starting prescribed treatment. It is also important to remember that prescriptions such as antibiotics used to treat bacterial infections are typically not appropriate or indicated for treating viral infections like flu and RSV.

Increases in respiratory illnesses and related hospitalizations are a good reminder to Virginians to get vaccinated, take simple prevention steps, and seek appropriate medical care and guidance if you become sick. These actions can help you and your family stay safe and healthy this holiday season.

In addition to the Virginia Department of Health and the Virginia Hospital & Healthcare Association, the following organizations and institutions endorse this statement: Access Now, the American Academy of Pediatrics – Virginia Chapter, Ballad Health, Bon Secours Richmond and Hampton Roads, Carilion Clinic, Centra Health System, Chesapeake Regional Healthcare, Children’s Hospital of the King’s Daughters, Children’s Hospital of Richmond at VCU, HCA Virginia, LewisGale Hospital – Alleghany, LewisGale Medical Center, LewisGale Hospital – Montgomery, LewisGale Hospital – Pulaski, Mary Washington Healthcare, the Medical Society of Virginia, the Richmond Academy of Medicine, the Richmond Ambulance Authority, Riverside Health System, Sentara Healthcare, UVA Health, Valley Health System, the Virginia Academy of Physician Assistants, the Virginia Association of Clinical Nurse Specialists, the Virginia Association of Community-Based Providers, the Virginia Association of Nurse Anesthetists, the Virginia Chapter of the National Association of Social Workers, the Virginia College of Emergency Physicians, the Virginia Council of Nurse Practitioners, VCU Health, the Virginia Health Care Association-Virginia Center for Assisted Living, the Virginia Health Care Foundation, VHC Health, the Virginia Network of Private Providers, the Virginia Nurses Association, the Virginia Orthopaedic Society, the Virginia Pharmacists Association, the Virginia Podiatric Medical Association, the Virginia Public Health Association, Virginia Rural Health Association, and the Virginia Section of the American Congress of Obstetricians and Gynecologists.

The Medical Society of Virginia (MSV) Foundation announced the winners of their annual Salute to Service Awards. Seven Virginia physicians are being recognized from across the Commonwealth for their outstanding service in six categories: Service to — the Profession, the Uninsured and Underinsured, the International Community, Advancing Patient Safety and Quality Improvement, service by a Medical Student or Resident – and a special category, Service to Healthcare During COVID-19.

The premiere award, Service to the Profession, has been given to William L. Harp, MD of Midlothian, Virginia. Dr. Harp is the Executive Director of the Virginia Board of Medicine.

The 2022 Winners of the MSV Foundation’s Salute to Service Awards include:

• Edgar B. Rodas, MD of Glen Allen, Service to the International Community
• William L. Harp, MD of Midlothian, Service to the Profession
• Mary Suzanne Kraemer, MD of Roanoke, Service for Advancing Patient Safety and Quality Improvement
• Lauren Canary of Roanoke, Service by a Medical Student or Resident
• Catherine Casey, MD of Charlottesville, Service to the Uninsured and Underserved
• Charles R. Joseph, MD of Lynchburg, Service to the Uninsured and Underserved
• Michael Dacey, MD of Newport News, Service to Healthcare During COVID-19

The MSV Foundation created the annual Salute to Service Awards in 2004 to recognize outstanding efforts of physicians, residents, and medical students who are dedicated to creating and nurturing a caring health promotion and disease prevention environment by providing service on behalf of patients everywhere.

The Medical Society of Virginia Foundation presented the 2022 Salute to Service Awards at their annual Physicians Gala on October 29, 2022, at the Omni Homestead Resort in Hot Springs, Virginia.

About the Medical Society of Virginia Foundation

The MSV Foundation (MSVF) advances opportunities for physicians to participate in health improvement efforts in Virginia by supporting programs and initiatives that equip physicians to best serve themselves, their patients and their communities. For more information, visit www.msv.org/foundation.