CMS Prior Authorization Proposed Rule May Streamline PA Processes

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.

Research Agenda: Addressing Clinician Burnout in the Department of Veterans Affairs

AcademyHealth has just released their final report on research needed to address clinician burnout for the Department of Veterans Affairs: Research Agenda Outlines Next Steps in Addressing Clinician Burnout within the Department of Veterans Affairs (VA) | AcademyHealth

Key recommendations:

  1. Prioritize research on interventions to address burnout at the organization or system levels. The biggest gap in the existing evidence base on clinician burnout is not its drivers or causes, but how to effectively address it across teams, divisions, and whole systems.
  2. Capitalize on the variation between VAMCs to study the comparative effectiveness and costs of interventions to address burnout, specifically which approaches work for whom and under which circumstances. Also, there is the opportunity to learn from “positive deviants,” identifying VAMCs with low rates of clinician burnout, and leveraging their approaches at an organizational level.
  3. Leverage the VA’s ability to conduct large, controlled studies across sites and/or clinician types, particularly for “whole system interventions” with varying components. Findings should be widely disseminated and implemented across VA sites and share their learnings with health systems nationally and globally.
  4. Focus on the effectiveness of burnout interventions on clinicians of color and other dimensions of diversity and identity that affect the clinician’s interactions with healthcare staff and patients. This is a salient gap in the evidence.
  5. Include studies on the role of effective VA leadership (from senior leaders to supervisors of frontline staff), including strategies for leadership training and support, trust in leadership, and approaches for leaders to create and sustain a welcoming and supportive culture were all aspects of the priority questions.

Thank you to MSV leader Dr. Russell Libby for his part in this important work!

Chopin. The Space Concert | A Benefit to Celebrate Science and the Arts and Support Efforts in Ukraine

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.

Single-Dose Vial Presentation for Pfizer (12+) Updated COVID-19 Vaccine

On November 14, HHS will open ordering to jurisdictional and federal entity administration partners for a limited amount of the updated (bivalent) Pfizer-BioNTech COVID-19 vaccine for people 12 years of age or older in single-dose vials. Deliveries will begin several days later. This vial presentation is in response to widespread requests from our vaccine administration partners for the greater flexibility this presentation provides.

This limited introduction of single-dose vials is designed to allow partners to offer the updated COVID-19 vaccines in more places, such as physicians’ offices or mobile clinics that may not have the capacity or demand to keep multi-dose vials of COVID-19 vaccine on hand. It is the latest step in improving ease of access for COVID-19 vaccines and creates the potential for more equitable availability of this lifesaving product.

The U.S. government will continue distributing multi-dose vials of the updated Pfizer vaccine for people 12 years of age or older through our distribution network that reaches more than 70,000 vaccine administration sites.

Ordering and Distribution

The introduction of single-dose vials will provide administration partners with greater flexibility in their vaccine distribution strategy. This limited rollout is intended to expand the number of locations that offer the updated vaccine. Partners are encouraged to direct their orders of single-dose vials to sites
where they will most increase access and availability of the updated vaccine to people. For example, administration partners could use single-dose vials to expand access at doctors’ offices or community health centers that have consistently low or irregular patient traffic and/or might not otherwise offer the COVID-19 vaccine. Administration partners can also use this opportunity to engage providers who have never offered COVID-19 vaccines, and provide any support they need to enroll.

As always, partners are strongly encouraged to consider equity and consult resources, such as national data published by CDC on updated vaccine uptake by race and ethnicity, as well as maps of providers and high social vulnerability index (SVI) locations on the Tiberius platform. Single-dose vials will be available at a minimum order quantity of 50 doses. Awardees will be limited to not more than 150 single-dose vials per order.

No Kits with Single-Dose Vial Orders

Ancillary kits will not be distributed with orders of single-dose vials. Single-dose vials do not require the use of low-deadvolume (LDV) syringes. If supply concerns exist, it is recommended that providers use surplus appropriate onsite materials for vaccine administration.

Quick Facts

 

Single-Dose Vial Pfizer Bivalent Booster (Ages 12+)

  •  NDC: 59267-1404-02
  • Configuration: 10 single-dose vials/carton
  • Minimum quantity per order: 50 doses
  • Maximum quantity per order: 150 doses
  • Product dimensions: 1.457 in length × 1.535 in width × 3.504 in height
  • Storage and handling: Same as other Pfizer tris products (e.g., store at ultra-low temperature until expiry, may refrigerate up to 10 weeks within expiry period)
  • No ancillary kits included with single-dose vial orders

Strategy and Considerations when Placing Orders

  • Single-dose vials should be prioritized to expand site footprint and access to the bivalent booster
  • Single-dose vials are a one-for-one match for potential customers

Questions? Reach out to:

  • Pfizer: 1-800-666-7248, Option 8 | [email protected]
  • Your ISD Project Officer/CDC Vaccine Distribution Support Officer

Virginia Healthcare Community Offers Safety Tips Amid Surge in Flu, Respiratory Virus Cases and Hospitalizations

 

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 MSV Installs New President Harry L. Gewanter, MD, FAAP, MACR at 2022 Annual Meeting

Harry L. Gewanter, MD, FAAP, MACR of Richmond, Virginia was installed as president of the Medical Society of Virginia (MSV) at the organization’s Annual Meeting on October 29, 2022 at the Omni Homestead Resort in Hot Springs, Virginia. Dr. Gewanter is a board-certified pediatrician. He is a co-founder of Medical Home Plus, Inc, a nonprofit organization dedicated to connecting families of children with any chronic or disabling condition with appropriate information, services and support, and serves as its Medical Director.

In his inaugural speech, Dr. Gewanter spoke of his experiences as a parent, patient, and physician that drive him and his passion for medicine.

“My winding road has allowed me to see the world as a parent, a patient, a primary care physician, a subspecialist, a community physician, an academic and an administrator. Being within the nexus of pediatric, rheumatology and disability worlds has taught me to appreciate the many varied issues, but to focus on the common imperatives faced by all of us. Becoming a part of families through caring for their children over time impressed upon me the many roles we play, not just as a physician, but what it means to be a human being on this planet and a member of our larger community. How we influence what happens outside the examination room is at least, if not more, important than what we do inside it.”

His agenda for his presidency includes a focus on physician and PA mental health and wellness, developing and supporting new programs designed to better the lives of physicians and patients, and to uphold MSV’s overall goal to make Virginia the best place to practice medicine and receive care.

After graduating from Duke University and the Wayne State University School of Medicine, he completed his training at the University of Rochester/Strong Memorial Hospital where he remained until moving to Richmond. He has practiced in a variety of settings including private pediatric practices, public clinics as well as community, university, and pediatric specialty hospitals. He has been a member and held leadership positions in a variety of national, state, and local committees and organizations.

About the Medical Society of Virginia

The Medical Society of Virginia (MSV) serves as the voice for more than 30,000 physicians, residents, medical students, PAs and PA students, representing all medical specialties in all regions of the Commonwealth. The association was founded in 1820 and is headquartered in Richmond, Virginia. MSV strives to advance high-quality health care and make Virginia the best place to receive care and practice medicine.

The Medical Society of Virginia Foundation Recognizes Seven Outstanding Physicians

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.

Upcoming Webinar: Influenza Vaccination and Amelioration of Disease

Please join ImmunizeVA and the Virginia Public Health Association for the webinar Influenza Vaccination & Amelioration of Disease, presented by ImmunizeVA member Dr. Ferdaus Hassan.

When?
Thursday, October 27th from 3 – 4pm
Register now

Dr. Hassan has extensive professional experience in the areas of infectious disease and vaccines and has published 60 research articles in peer-reviewed journals. He is a strong advocate and passionate about vaccines and believes no one should suffer from vaccine-preventable diseases.

Register for the webinar here.

Cybersecurity: 10 Steps to Protect Your Patients’ Data and Privacy

As more and more of our everyday lives and information move online, cyber risks from hackers, malware, denial of service attacks, and ransomware attacks continue to increase. There are cybersecurity risks to everything from the nation’s energy infrastructure to personal health and financial data — with the latter putting physician practices squarely in the risk zone.

Generally speaking, what’s at stake? Breach of privacy. Loss of data. Loss of money. Service disruption. And even loss of trust — trust in technology, certainly, but people also lose trust in an organization responsible for a cyber breach. Especially for physicians, having and keeping your patients’ trust is critical.

Cybersecurity Awareness Month is a great time to evaluate your practice to ensure you’re doing everything you can to protect your patients’ data, privacy, and continuity of care.

Strengthen EMR and EHR Cybersecurity

The American Medical Association recently released detailed cybersecurity resources for physicians, including an updated 2022 guide on Electronic Medical Records in Healthcare from the U.S. Department of Health & Human Services (HHS). The guide details benefits and risks of using EMRs and EHRs, such as vulnerability to hacking. The guide also reviews specific threats to EMRs and EHRs, including ways to protect against each threat, as well as strategies to strengthen cybersecurity.

Email

Email is an “easy” way for hackers to get into your practice. Many phishing schemes and ransomware attacks target email systems — where staff who use email can inadvertently fall victim to these threats. Phishing attacks take the form of malicious emails that trick recipients into clicking a link or downloading a file that exposes their computer to malware, which can do everything from destroying files to releasing a virus. Ransomware, also shared via email, is software that can hold your systems or data hostage until a ransom is paid.

The HHS and the U.S. Cybersecurity & Infrastructure Security Agency (CISA) have detailed prevention resources for both: Counter-Phishing Recommendations for Non-Federal Organizations and Ransomware: What It Is and What To Do About It.

Take Action

Here are some helpful ways you can strengthen your cybersecurity and take action to protect your patients’ data, privacy, and continuity of care:

  • Training: Educate all staff on cybersecurity risks and responses as well as proper use of email and other systems to ensure security protocols are applied and followed.
  • Added protection: Supplement the cyber protections offered by 3rd party providers and vendors to address any gaps in systems and services.
  • System backups: Ensure all critical systems are regularly backed up and can be readily accessed as needed.
  • Planning: Develop detailed incident response plans, just like for disaster response, including the importance of contacting law enforcement as soon as possible.
  • Updates: Regularly perform system and network updates so their security protections are the most current.
  • Access review: Determine which staff, vendors, and other outside parties need to have access to your network and other systems and ensure those who don’t need the access don’t have it.
  • Passwords: Use strong passwords and change them frequently to maximize their effectiveness. Make sure all staff are protecting their confidential passwords.
  • Remote protection: Assess remote workers’ security to ensure it’s buttoned up, including systems access, password use and storage, personal computers and networks, and general cyber safety protocols staff should be following.
  • Mobile protection: Ensure staff who use mobile devices for email and network access have strong passwords, encrypted data, and updated security apps.
  • Insurance: Protect your practice with cyber-related coverage. The MSV Insurance Agency (MSVIA) specifically offers Cyber Liability Coverage that expands coverage beyond standard professional liability.

Cybersecurity is important for your practice every day. It’s not something to think about once in a while or even once a year, although Cybersecurity Awareness Month is a perfect time for a reminder. Make training, updates, reviews, and assessments part of your regular business operations to give you the peace of mind of knowing you’re doing everything you can to protect your patients’ data, privacy, and continuity of care.

COVID-19 and Monkeypox Updates for Virginia

Dear Colleague:

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

VDH Adopts CDC’s Revised COVID-19 Infection Prevention and Control Guidance

  • On September 23, 2022, the Centers for Disease Control and Prevention (CDC) released updated COVID-19 infection prevention and control (IPC) recommendations for healthcare personnel (HCP). Corresponding guidance for isolation and work restriction of HCP and strategies for mitigating staff shortages was also updated.
  • Healthcare facilities are encouraged to review the recommendations in detail and make updates to their policies and procedures as needed.
  • Community Transmission is currently the metric used to guide select IPC measures in healthcare settings. Healthcare facilities should review the Community Transmission levels weekly to determine if modifications to current IPC measures are needed.
    • When SARS-CoV-2 community transmission levels are high, source control (wearing a well-fitting facemask, cloth mask, or respirator) is recommended for everyone in a healthcare setting where patients could be encountered.  If community transmission is not high, healthcare facilities may opt not to recommend universal source control.
    • Source control is also recommended for people in healthcare settings who have suspected or confirmed SARS-CoV-2 infection or another respiratory infection, had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with COVID-19, for 10 days after exposure, or who reside or work in an area of the facility with a COVID-19 outbreak.
  • Asymptomatic patients with close contact with someone with COVID-19 should have a series of three viral tests for SARS-CoV-2. Testing is recommended to be done promptly, but no earlier than 24 hours after the exposure.  If the first test is negative, a second test should be done 48 hours later and, if negative, a third test should be done 48 hours later.
    • Testing is not generally recommended for asymptomatic people who are recovering from COVID-19 in the previous 30 days.
    • For those who have recovered in the prior 31–90 days, testing with a rapid antigen test, not a molecular test, can be considered.
  • COVID-19 vaccination status is no longer used to inform source control, screening testing, or post-exposure recommendations.
  • Performance of expanded screening testing of asymptomatic HCP with known COVID-19 exposures is at the discretion of the facility.

Monkeypox Updates

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

Sincerely,

Colin M. Greene, MD, MPH
State Health Commissioner

Published October 6, 2022 at VDH