National Preparedness Month: Prepare Your Practice for Emergencies

The best time to prepare for a disaster is before it hits — well before it hits. This seems obvious, but National Preparedness Month is here to remind us to take action and plan. Physician practices may lack comprehensive planning that protects the business and outlines “What to do when…” The consequences can be disastrous to your patients if they can’t count on you for care, as well as disastrous to your practice’s staff, operations, and financial well-being.

Most recently, the pandemic has been an extended exercise in disaster management, considering how quickly and completely it turned the medical world upside-down, and how long its impacts have continued. If you haven’t already, be intentional about thinking through and documenting what you learned throughout your pandemic experience and consider how you can apply those lessons to other possible disaster situations.

Since it is National Preparedness Month, it’s also a great time to build or update your plans to prepare your practice for disasters and emergencies. When you and your team know “What to do when…” you can ensure you’re ready to respond in ways that are helpful to the situation and your patients while also protecting the health of your practice.

A Physician’s Responsibility

When talking about disaster preparedness for your practice it’s a must to start with ethics. Disasters of many kinds require a medical response to which physicians are often urgently called. Clearly how you respond to a disaster, and how you balance your response with the needs of your patients, is an individual decision.

To help, look to the American Medical Association’s code of ethics and an opinion on disaster response which discusses that, although a physician’s obligation is to respond, you also have an obligation to consider risks and their impact on your ability to provide future care.

You may consider doing scenario planning around specific disaster situations to frame where and how you could best provide effective medical services. Examine how your response would potentially impact your everyday patients and design detailed alternative plans to ensure continuity of care for patients who may need it. When there is a future call to action, you’ll already have planned how you’ll respond and what needs to happen next.

National Preparedness Month: Helping You Make a Disaster Plan

If you need to make disaster plans for your business, or want to ensure they’re updated, where do you start? We have three suggestions.

The U.S. Department of Homeland Security created its Ready campaign to provide information to help Americans prepare for natural, health, and man-made disasters. The Ready Business website offers businesses detailed hazard-specific toolkits with information about identifying risk, developing a plan, and taking action. The Ready toolkits include hurricane, earthquake, inland flooding, power outage, and severe wind/tornado. The site also features information about important response elements like risk assessment, employee assistance, and protective actions like evacuation. You could build on these guides by applying their framework to other disasters and emergencies your practice may face, which could include things like snowstorms, extreme heat or cold waves, structure collapses, infectious disease outbreaks, and community violence.

The U.S. Small Business Administration also provides preparedness checklists and safety tips on its website for specific disasters, including hurricanes, winter weather, earthquakes, tornadoes, wildfires, floods, and cyber security.

Finally, the American Society for Health Care Risk Management created a brief guide for physicians to use to create an emergency plan. It steps you through recommendations for analyzing vulnerabilities, plan components, training, and developing policies and procedures for staff, communications, patient care, and more.

Protecting Your Practice

Of course, protecting your practice in a disaster is critical for you, your staff, and your patients.  Did you know MSV offers insurance through its insurance agency? The MSV Insurance Agency (MSVIA) can help you prepare your practice for disasters and emergencies with Business Insurance as well as provide Professional Liability Insurance and Group and Individual Health Insurance.

Specifically related to disasters, the Business Owners Policy (BOP) for small- and medium-sized practices combines business property insurance with coverage for the building (if your practice owns the building), crime, business interruption and lost income, and general liability. Additional optional coverages can add non-owned vehicles, computer and data coverage, equipment breakdown, and more. BOP can cover repair or replacement costs for physical damage and can provide continued cash flow if your practice must close temporarily.

Contact MSVIA through our website form today to learn how to prepare your practice for disasters and emergencies with insurance coverage, which is a critical piece of today’s disaster preparedness puzzle.

2022 Nominating Committee Report

The Nominating Committee met on August 16, 2022 to consider all eligible candidates for the upcoming term of office. The committee recommends the following slate for consideration by the society membership.

MSV Board of Directors
Term 2022-2023/2024

Officers (Elected for 1-year term)

President-Elect | Alice Coombs, MD

Speaker | Alan Wynn, MD

Vice Speaker | Michele Nedelka, MD

 

Directors (Elected for 2-year term)

District 2 | Lee Ouyang, MD

District 2 | Sharon Sheffield, MD

District 6 | Mark Kleiner, MD

District 8 | Atul Marathe, MD

District 10 | Tarek Abou-Ghazala

District 10 | Andrea Giacometti, MD

Academic | Karen Rheuban, MD (UVA)

 

Directors (Elected for 1-year term)

Resident | Lindsay Gould, MD (EVMS OBGYN)

Medical Student | Salimah Navaz Gangji (VCOM)

 

Associate Directors (Elected for 2-year term)

District 2 | John Sweeney, MD

District 6 | Joe Hutchison, MD

District 8 | Marc Alembik, MD

District 10 | Soheila Rostami, MD

Academic | Lindsay Robbins, MD (EVMS)

 

Associate Directors (Elected for 1-year term)

Resident | Pooja Gajulapalli, MD (VCU Peds)

Medical Student | Shreya Mandava (UVA)

Virginia Delegation to the American Medical Association
Term 2023-2024
Elected for 2-year calendar year term

Delegates

Thomas Eppes, MD

Michele Nedelka, MD

 

Alternate Delegates

Lee Ouyang, MD

Josephine Nguyen, MD

Josh Lesko, MD

Mohit Nanda, MD

2022-2023 Nominating Committee

 

District 1 Sterling Ransone, MD

District 2 Stuart Mackler, MD

District 3 Hazle Konerding, MD

District 5 Bushan Pandya, MD

District 7 Claudette Dalton, MD

District 8 Carol Shapiro, MD

District 10 Edward Koch, MD

Academic  Cyn Romero, MD

AMA Advisor (Chair of the Virginia Delegation) Tom Eppes, MD

2020-2021 Former President Advisor | Art Vayer, MD

2021-2022 Former President Advisor | Mohit Nanda, MD

Get Waivered: A Free Evidence-Based Training to Treat Opioid Use Disorder

Opioid use disorders (OUD) affect over 2.1 million people in the United States. Sentara, in partnership with Get Waivered is pleased to offer two free facilitated opportunities for this virtual evidence-based training:

Wednesday, September 21, 2022
4:30 p.m. – 5:30 p.m.

Saturday, September 24, 2022
10:00 a.m. – 11:00 a.m.

Because the path to recovery depends on a collaborative approach, we encourage you to share this information with other providers/colleagues who may be interested in our upcoming virtual training next month.

Qualified practitioners who undertake required training can treat up to 100 patients using buprenorphine for the treatment of OUD.

Eligibility:

  • Physicians (MD/DO)
  • Nurse Practitioners (NPs)
  • Physician Assistants (PAs)
  • Clinical Nurse Specialists (CNSs)
  • Certified Registered Nurse Anesthetist (CRNAs)
  • Certified Nurse-Midwifes (CNMs)

View the Event Flyer for additional information.

AMA Report: Disturbing Trends on Overdose Deaths Requires Specific Actions, All-Hands Approach

CHICAGO—With a report issued today detailing the horrific toll of the nation’s overdose and death epidemic, the American Medical Association (AMA) calls for an all-hands approach — policymakers, public health experts, educators, faith leaders, and employers – to help save lives.

While physicians and other health care professionals have reduced opioid prescribing in every state—by nearly 50% nationally – that by itself cannot reverse the trend of drug-related overdose deaths. In fact, for the first time, in 2021 drug-related overdose deaths exceeded 100,000—primarily due to illicitly manufactured fentanyl, methamphetamine and cocaine. Overdose deaths are amplified by underlying social needs including housing and transportation.

“No community has been – or will be – spared the pain of this epidemic. The spiking mortality numbers – with young people and Black and Brown Americans dying at the fastest growing rates – add yet another urgent call to remove health inequities from the nation’s health care system. We know policymakers have not exhausted all remedies. Until we have, we must keep advocating for humane, evidence-based responses,” said Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force.

The report calls for a campaign to include:

  • Policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and remove barriers – such as prior authorization — to evidence-based care. States should require health insurance companies and other payers to make non-opioid pain care alternatives more accessible and affordable.
  • Medical and other health care professional licensing boards to help patients with pain by reviewing and rescinding arbitrary restrictions on opioid therapy—as now recommended by the Centers for Disease Control and Prevention.
  • State officials to remove punitive policies against pregnant individuals and parents who have a substance use disorder. State departments of corrections and private jails and prisons need to ensure that all individuals with an opioid use disorder or mental illness receive evidence-based care while incarcerated — and are linked to care upon release. This includes ensuring access to medications for opioid use disorder (MOUD).
  • Employers to review their health insurance and benefits plans to ensure employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide MOUD, and psychiatrists who are in the employer’s network.
  • Public health officials to help control infectious disease spread through supporting comprehensive syringe services programs, reduce overdose through widespread, community-level distribution of naloxone and fentanyl test strips and pilot projects in support of overdose prevention centers.
  • Faith leaders to help destigmatize substance used disorders and harm reduction by educating their members and holding overdose awareness events.

“What is becoming painfully evident is that there are limits to what physicians can do. We have dramatically increased training and changed our prescribing habits, reducing the number of opioids prescribed while increasing access to naloxone, buprenorphine and methadone. But illicitly manufactured fentanyl is supercharging this epidemic. We need help from leaders across sectors to combat this public health crisis,” said Dr. Mukkamala.

The use of prescription drug monitoring programs (PDMPs) also continued its upward trajectory with physicians and other health care professions surpassing the 1 billion mark for the first time. PDMPs are electronic databases that track controlled substance prescriptions and help identify patients with uncoordinated care who might be receiving multiple prescriptions from multiple prescribers.

Read the report here, including state-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use.

Year Drug-related overdose deaths Opioid prescriptions dispensed from retail pharmacies Prescription drug monitoring program queries
2012 41,502 260,464,735  
2013 43,982 251,770,763  
2014 47,055 244,484,091 61,462,376
2015 52,404 227,807,356 86,096,259
2016 63,632 215,998,653 136,643,036
2017 70,237 192,696,190 295,347,288
2018 67,367 168,858,135 449,497,610
2019 70,630 153,966,961 744,943,531
2020 91,799 143,389,354 908,269,727
2021 107,270 139,617,469 1,131,828,211

New Webinar: Tecovirimat (“TPOXX”) for Treatment of Monkeypox

September 13th, 2022 | 11 a.m. CT/12:00 noon ET
Hosted by Sandra Fryhofer, MD, Chair, AMA Board of Trustees
Register Now

Guests:

  • Adam Sherwat, MD, Deputy Director, Office of Infectious Disease at FDA’s Center for Drug Evaluation and Research
  • Brett W. Petersen, MD, MPH, Deputy Chief, Poxvirus and Rabies Branch, CDC’s Division of High-Consequence Pathogens and Pathology

Join experts from the AMA, FDA, and CDC for a discussion about tecovirimat, or TPOXX, for the treatment of monkeypox in infected individuals. The discussion will provide background on tecovirimat, including its current status, availability and access while the drug is under an investigational new drug application. A moderated question and answer session will be held at the end of the discussion to help address any confusion or misinformation about patient access to TPOXX.

Register and Submit Your Questions

VDH Webinar: What Healthcare Professionals need to know about Monkeypox

These webinars will cover an overview of the current monkeypox situation, epidemiology of the virus, risk assessment/communication, infection prevention and control, testing, collaboration with public health officials, and medical countermeasure strategies, including an in depth overview of the JYNNOES vaccine and TPOXX therapeutic. There will also be an allotted time for questions.

Note: both sessions will present the same information/content.

Session 1 
Friday September 9th at 12pm (noon)

Session 2 
Tuesday, September 13th at 7pm

Solving Physician Burnout

Excerpt via Medical Economics

…In Virginia, physicians have a new level of confidentiality set in law. The Medical Society of Virginia (MSV) advocated for creation of the SafeHaven program, which has a partnership with a physician-focused national behavior health consulting practice.

Melina Davis, MSV executive vice president and CEO, agrees physicians are reluctant to seek counseling because if they must reveal it, they fear they could lose licenses, have referral networks dry up, or get fired. But physicians enrolling in SafeHaven gain legal privilege that forbids release of any records, reports or communications originating in the program — even in malpractice lawsuits, barring a court order that meets a high standard of proof, according to MSV.

State lawmakers unanimously approved the program in March 2020. It was coincidental timing with the spread of COVID-19, but the pandemic spurred the program’s beginning and physician enrollment started in July 2020. State lawmakers were unanimous a year later in expanding SafeHaven for physician assistants, nurses, pharmacists and students of those protected professions.

Now SafeHaven has 4,400 members, with 48% using the program and 17% in coaching and counseling. Davis argues that rate is unprecedented for physician usage of employer-sponsored wellness programs in the United States. “It’s unprecedented because they feel safe,” she says.

SafeHaven will expand into Michigan and MSV wants to serve as a consultant to take the program across the country. Primary care physicians can do their part by advocating for the same legal protection in every state, Davis says.

“More people need to be asking for this,” Davis says. “More people need to be advocating that it be a normal part of your legal system and your service system for health care workers. They need it, they deserve and it’s here. It makes a big difference.”

Read the Full Article

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