Why medical students should be next up for debt relief

By Sterling N. Ransone

As a new academic year for medical students begins, I’m excited for the next generation of physicians to start their careers in medicine. However, like many of these students, I’m also nervous: The increase in student debt has created significant roadblocks to physicians who want to enter the primary care profession and practice in underserved communities.

While the administration’s recent actions to cancel some debt for eligible borrowers and extend the student loan pause through the end of the year are welcomed as positive steps forward, Congress must enact permanent solutions to address medical student debt and our shrinking primary care workforce…

Read the Full Article at The Hill

COVID-19 and Monkeypox Updates for Virginia

Letter from Virginia State Health Commissioner Dr. Colin Greene

Dear Colleague:

I am writing to provide you brief updates on COVID-19 and monkeypox.

CDC Updates COVID-19 Recommendations

  • On August 11, the Centers for Disease Control and Prevention (CDC) made substantial COVID-19 guidance updates and recommends that in light of high population levels of anti–SARS-CoV-2 seroprevalence, and to limit social and economic impacts, quarantine of exposed persons is no longer recommended, regardless of vaccination status.
  • CDC recommends that people who have had recent confirmed or suspected exposure to an infected person should wear a mask for 10 days around others when indoors in public and should receive testing ≥ 5 days after exposure (or sooner, if they are symptomatic), irrespective of their vaccination status.
  • CDC recommends case investigation and contact tracing only in health care settings and certain high-risk congregate settings. In all other circumstances, public health efforts can focus on case notification and provision of information and resources to exposed persons about access to testing.
  • Everyone is encouraged to stay up-to-date on their COVID-19 vaccinations and use the COVID-19 Community Levels to guide additional prevention efforts for themselves, based on their own personal risk.
  • CDC continues to recommend masking at all times in healthcare settings, regardless of the current COVID-19 Community Level.
  • The elimination of most quarantine for COVID is in concurrence with VDH policy.  VDH policy leaves masking as a personal choice in most circumstances; exceptions are high-risk settings including healthcare delivery, and as part of an isolation protocol, where masking is still recommended.

COVID-19 Vaccine Update: Novavax and Bivalent Boosters

  • FDA recently authorized and CDC recommended Novavax’s COVID-19 vaccine as another primary series option for adolescents aged 12 through 17 years.  Previously, this vaccine had been recommended for adults aged 18 years and older.
  • To reflect the expanded age eligibility, FDA updated their fact sheets for healthcare providers and for patients and caregivers, and CDC updated its Interim Clinical Considerations for the Use of COVID-19 Vaccines in the United States.
  • Providers in Virginia may immediately begin using this 2-dose primary series vaccine for these adolescents.  As a reminder, Novavax’s COVID-19 vaccine cannot be used for a booster dose or for third doses for immunocompromised persons.
  • In the near future, FDA and CDC might provide information about new bivalent COVID-19 vaccine boosters that cover an Omicron BA.4/5 spike protein, and that might be available in the 2022 fall and winter.

COVID-19 Therapeutic Update: Bebtelovimab is Available for Purchase Commercially

  • As of August 15, 2022, bebtelovimab has become commercially available for purchase. Orders can be placed directly through AmerisourceBergen.
  • The federal government will allocate its remaining supply of bebtelovimab to jurisdictions. Providers should not bill patients or insurance for any product procured from the federal government.
  • VDH places a high priority on equitable availability of bebtelovimab. If a facility does not serve the under and/or uninsured, VDH encourages these locations to utilize the redistribution process to reallocate bebtelovimab procured from the federal government for this vulnerable population.

Monkeypox Clinical Evaluation and Management

  • CDC recently published a report describing the clinical and epidemiologic features of U.S. monkeypox cases.
  • Coinfections with sexually transmitted infections (STIs), like HIV, have been reported. To date, there have been no reported U.S.deaths.  Lesions, however, can be painful or pruritic as they progress.  Some patients require hospitalization.
  • As a reminder, all healthcare staff should implement standard and transmission-based precautions when providing care to a patient with suspected or confirmed monkeypox. VDH has received reports of healthcare staff not using appropriate PPE when performing initial triage or collecting vital information, which puts those individuals at risk.
  • For patients with monkeypox, supportive care should be assessed and provided for management of pain, skin and oral lesions, proctitis, and gastrointestinal symptoms.  This treatment might include over-the-counter or prescription medication for acute pain management, baths or topical gels for painful or itchy lesions, oral histamines for pruritus, and rehydration for fluid losses.  Providers can refer to New York City Department of Health & Mental Hygiene’s guidance on supportive care.
  • Antiviral treatment using tecovirimat (TPOXX) is available through an Expanded Access – Investigational New Drug (EA-IND) protocol authorized by the CDC for patients with severe illness or those at high risk of severe illness.

JYNNEOS Vaccine for People at High Risk of Exposure to the Monkeypox Virus

  • On August 9, FDA issued an emergency use authorization (EUA) for the JYNNEOS vaccine, which will allow for an expanded U.S. supply.  The standard vaccine dosing regimen is to administer 0.5ml of the vaccine subcutaneously.  Under the EUA, an alternative regimen of 0.1ml administered intradermally is available for people aged 18 years or older.
    • Adults who received their first dose subcutaneously may receive their second dose intradermally or subcutaneously.
    • The EUA also expanded vaccine eligibility to people younger than 18 years of age using the standard vaccine dosing regimen.
    • At this time all JYNNEOS vaccines are administered by local health departments and a small number of select community providers.
    • If you are a provider caring for a person who is eligible for JYNNEOS, including children, please contact your local health department for information on how to access the vaccine for your patients.
  • Effective today (August 25), the following groups of people are now eligible to receive Expanded Postexposure Prophylaxis (PEP) in Virginia:
  • All people, of any sexual orientation or gender, who have had anonymous or multiple (more than 1) sexual partners in the last 2 weeks; or
  • Sex workers (of any sexual orientation or gender); or
  • Staff (of any sexual orientation or gender) at establishments where sexual activity occurs (e.g. bathhouses, saunas, sex clubs).
  • Please familiarize yourself with eligibility criteria for JYNNEOS vaccine in Virginia, and visit the VDH website regularly to obtain the most current information.

Thank you again for your continued partnership.  Please visit the VDH website for current clinical and public health guidance on COVID-19 and monkeypox.       

Sincerely,

Colin M. Greene, MD, MPH
State Health Commissioner

The Dobbs Decision: Two Months Later

Two months ago today, the Supreme Court issued its decision in Dobbs v. Jackson Women’s Health. As previously described, this opinion held that abortion is not a constitutional right, leaving abortion regulation to the states. Since the issuance of this opinion, we have seen a flurry of activity at both the state and federal levels with some states moving to protect, and even expand, access to abortions, while in other states abortion bans continue to go into effect. At the same time, the federal government has both instigated and been the subject of lawsuits surrounding abortion regulation.

Read More at Hancock Daniel

Online Reviews: Should you Respond, Even When They’re Negative?

Written By Tracey Cumberland
Project Director, Client Operations for Curi Advisory, Curi’s business unit dedicated to helping practice leaders protect, optimize, and grow their businesses with confidence

Medical practices are no exception to the rule that a strong online presence is essential to maintaining a thriving business. How and when you respond to online reviews is a key element of that presence—what’s often called online reputation management, or ORM.

Online reviews are used extensively by consumers to pick everything from mouthwash to medical care. A 2020 survey by Software Advice found that 90% of people use online reviews to evaluate physicians, and more than 70% of surveyed patients use online reviews as the first step to finding a new doctor. While most patients are pleased with the care that they receive, unfortunately, it’s the unhappy ones who are most likely to leave a review. How you choose to respond to these reviews can make or break a practice’s reputation, and it’s important to proceed with extreme caution to ensure compliance with any applicable privacy laws.

Responding to Online Reviews

Leaving negative or false reviews unaddressed can hurt your practice, your reputation, and even your career. So what do you do when a review is inflammatory or false? How do you avoid violating confidentiality? And should you even bother responding to positive reviews?

Many healthcare providers believe that HIPAA prevents them from responding to online patient reviews—and while it’s certainly a major concern, this is not entirely true. Privacy laws do restrict specific information from being noted on a public forum (such as acknowledgment of a doctor-patient relationship), but it’s important to note that these privacy laws do not outright prohibit responses to online commenters.

Understanding how to appropriately respond within these parameters can be nuanced, and we recommend that practices engage the help of experts to manage their online presence to avoid potential liability. At the very least, practices should appoint a designated individual to respond to all online reviews using only templates for responses. For example:

  • Related to positive reviews: “Thank you for taking the time to leave us a review!”
  • Related to negative reviews: “At our medical practice, we strive to provide the highest levels of patient satisfaction. However, we cannot discuss specific situations due to patient privacy regulations. If you are a patient and have questions or concerns, please contact us directly at [phone number].”

Top Dos and Don’ts of Online Reputation Management

Do:

  • Appoint a designated individual to respond to online reviews
  • Respond as soon as possible
  • Investigate negative feedback
  • Follow up—negative reviews should trigger a prompt and direct phone call, but never back-and-forth on the online review platform
  • Contact external experts before posting any response deviating from the language used in the above templates

Don’t:

  • Be defensive—don’t let emotion play a part in responses
  • Respond to specifics
    • Do not mention the practice or the patient’s name
    • Do not even remotely infer or confirm that the review relates to a patient of the practice
    • Do not mention details that could identify the patient
    • Do not acknowledge that the practice was involved in the treatment that is the subject of the review
  • Pay for positive reviews
    • Do not engage with any services that offer paid reviews or practice review “gating” (soliciting feedback and only directing those who had positive experiences to leave a public review). These practices are not advisable and could have negative consequences, including, but not limited to, removal of your business from online searches such as Google.

To learn more about online reputation management and the ways that Curi Advisory can help you protect and enhance your online presence using our Arrowlytics platform, click here or reach out to one of our experts at by calling 800.662.7917.

The opinions expressed herein are not intended as legal advice. We have found that the use of such information reduces the risks associated with ORM, but we cannot guarantee that following this advice will prevent an adverse action, claim, investigation, enforcement action or fine/penalty.

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

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

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

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

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

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

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.