U.S. Declares Monkeypox a Public Health Emergency

via MedPage Today

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

VDH Monkeypox Treatment Webpage is Live

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

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

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

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

Last chance to apply: Health Systems Science Scholars Program

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

Apply now!

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

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

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

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

Click here to apply.

New Resources from the AMA

Private Practice Playbook

This new, free the AMA STEPS Forward® resource is full of information to help physicians determine if opening a private practice is the right move for them, including guidelines for running a private practice and strategies to help grow a practice into a successful healthcare facility. LEARN MORE and then DOWNLOAD THE PLAYBOOK.

Accelerating and Enhancing Behavioral Health Integration through Digitally Enabled Care

Tuesday, August 2 | 12:00 pm CT

This live webinar co-hosted by the AMA and Manatt Health shares examples from innovators and researchers applying practical solutions for supporting the widespread adoption of sustainable behavioral health integration. REGISTER HERE.

Social Determinants of Health

Tuesday, August 9 | 12:00 pm CT

Join us for this live AMA STEPS Forward® webinar and hear panelists from Rush University Health System present on how to engage your practice in addressing Social Determinants of Health. REGISTER HERE.

Mind the Gaps: Digital Health Issues and Opportunities

Wednesday, August 30 | 11:00 am CT

In this Telehealth Immersion Program virtual event, Mayo Clinic leaders showcase efforts to advance digital health across three functional teams – strategy, research, and clinical informatics. REGISTER HERE.

AMA Private Practice Simple Solutions

This series of rapid learning cycles designed to increase efficiency in your private practice is free and open to all. Each 8-week learning session focuses on one topic area, and busy physicians can access pre-recorded content at a pace that works best for them. LEARN MORE.

BHI Immersion Program

The BHI Collaborative is launching a free initiative where selected practices will participate in a 12-month curriculum designed and taught by industry experts on how to effectively implement behavioral health integration. Applications accepted through Aug. 5. APPLY NOW.

International Conference on Physician Health

Oct. 13-15 | Orlando, Fla.

Join us at this year’s International Conference on Physician Health and connect with physicians from all over the world about how to engage organizations to achieve cultural change. REGISTER HERE.

Documenting time for each task during outpatient visits

The most recently published myth in the AMA’s Debunking Regulatory Myths Series tackles whether or not physicians and other qualified health professionals are required to document the time spent on each specific task associated with an outpatient visit. LEARN MORE HERE.

COVID-19: FDA Authorizes Pharmacists to Prescribe PAXLOVID with Certain Limits

The FDA issued an emergency use authorization (EUA) for PAXLOVID (nirmatrelvir co-packaged with ritonavir) for the treatment of mild-to-moderate COVID-19 in certain adults and pediatric patients at high risk for progression to severe COVID-19, including hospitalization or death. On July 6, the FDA revised the EUA to let pharmacists prescribe and dispense PAXLOVID to eligible patients without seeing a doctor or other clinician.

More Information:

Read the full news update from CMS here.

AMA Update: Department of Health and Human Services (HHS) Enforcement of the Emergency Medical Treatment and Active Labor Act (EMTALA)

This week Secretary Becerra sent a letter to all hospitals and healthcare providers reminding them of their obligation to comply with EMTALA.  The Secretary’s letter clarifies that EMTALA requirements preempt any state laws that restrict access to stabilizing medical treatment, including abortion procedures and other treatments that may result in the termination of a pregnancy.

Read the letter here.

CMS also released an updated guidance to hospitals reinforcing that EMTALA requirements apply to all hospitals in all states regardless of the state law to the contrary.

Yesterday, CMS held a conference call with stakeholders on these communications.  There were a number of questions about preemption.  CMS officials repeatedly stated that EMTALA would preempt state law and would be a defense for criminal prosecutions.  The American Medical Association (AMA) staff fully anticipate that this issue will end up in the courts.

The AMA has been and will remain in touch with the Federation about EMTALA and other emerging issues as a result of Dobbs. 

Physician Shortage: Solutions to Protect Physicians, Patients, and Healthcare Delivery

Within 12 years, the U.S. faces a physician shortage of between 37,800 and 124,000 physicians — which balloons to between 102,400 and 180,400 if underserved populations had healthcare-use patterns similar to those with fewer access barriers.

These shortage projections by the Association of American Medical Colleges include between 17,800 and 48,000 primary care physicians, and between 21,000 and 77,100 non-primary care physicians.

Unfortunately, the shortage is already very apparent. Despite the fact that the number of U.S. physicians is on the rise, there aren’t enough physicians today to meet needs. Physician numbers just aren’t growing fast enough to keep up with population growth and the healthcare demands of an aging population — the top two factors driving the physician shortage. The U.S. Health Resources and Services Administration specifically reports significant shortages in both primary care and psychiatry today, as well as general surgeons in rural communities.

The COVID pandemic and physician burnout has only exacerbated this shortage. According to the AMA, one in five physicians say it is likely they will leave their current practice within two years. Also, about one in three doctors and other health professionals say they intend to reduce work hours in the next 12 months

Unless results-focused solutions are put in place to address this crisis, these shortages will drastically change the face of healthcare in our country. One thing is clear: It’s more important than ever before to support solutions to protect physicians and healthcare delivery in all communities in our nation, large and small, urban and rural, and everything in between.

Impact of the Physician Shortage

For patients, the primary impacts of a physician shortage are access to and quality of care. The consequences of a physician shortage for patients include:

  • Reduced routine care visits
  • Reduced continuity of care
  • Reduced doctor-patient interaction time
  • Reduced doctor-patient relationships
  • Reduced preventative care and screenings
  • Increased wait times before consultations
  • Increased consultation prices
  • Increased frustration and dissatisfaction

In addition, because the supply of primary care physicians is linked to better health outcomes, a shortage in this particular specialty puts the health of our communities at risk, affecting overall health, life expectancy, and mortality from all causes.

There is also a toll for physicians. Patient care and access issues contribute to increasing the stress levels of physicians, who are focused on providing the best care possible for their patients and their communities. In addition to these critical care and access concerns, physicians also face increased workloads in a shortage — further exacerbating their stress levels.

A final issue that doesn’t often get the spotlight: economic impact. Physicians not only contribute to the health of their communities by caring for patients, but they also contribute to their community’s economic health. Physicians rent and buy office space. They create jobs by hiring roles within their practices. They support job creation in the community by directly buying goods and services. And they keep the community healthier, so more people are able to participate in the workforce. When physician practices disappear, so do their economic value and contributions.

Solutions for the Physician Shortage

There is no single solution for the physician shortage. Addressing the shortage will require a multi-faceted approach. Let’s highlight a few key solutions here.

In line behind the top two factors driving the physician shortage, population growth and an aging population, is the aging physician population. In the next five years, 35 percent of our physician workforce will be of retirement age. Burnout is also prompting many to consider early retirement, which would further amplify the shortage.

Addressing physician burnout is an issue of high importance, not just because of the shortage, but because of protecting physicians’ well-being. Luckily more attention is now being paid to physician burnout and mental health. As it relates to the shortage, however, addressing burnout will prevent more physicians from leaving their practices or reducing their hours — two repercussions of burnout that have a direct impact on patient access to care.

Healthcare reform is another focus area to address the physician shortage. One example on the table is improving the prior authorization process to both reduce administrative burden and improve the continuity and timeliness of patient care. Another example is permanently updating telehealth regulations to increase access and reimbursement options beyond temporary adjustments that were made during the pandemic. Both of these items are something the Medical Society of Virginia is continuously advocating and working on to support physicians and patients.

Technology is another piece of the solution puzzle, including improving access to and use of telehealth, electronic referrals and consults, and asynchronous patient care and monitoring. On the physician side of the technology solution, training for new and current physicians is essential to adopting and adapting to increased use of technology in daily practice. Current physicians would need to embrace and be supported in adjusting to changes in patient interaction and care delivery. The short-term training and implementation cycle would have a direct impact on improving long-term patient access to care and potentially addressing burnout factors as well.

There are many additional options being discussed and evaluated to address the shortage, including among them: reducing costs of medical education and related financial burdens, initiating Medicaid reform, improving distribution of physicians to rural communities via incentives and other strategies, increasing physician recruitment, reducing immigration barriers for foreign-born physicians, and encouraging more medical students to consider primary care.

To address and resolve the physician shortage, it’s imperative to support solutions to protect physicians and healthcare delivery in our communities. The need is urgent, the solutions are many, and the timing is now.

How are you contributing to being part of the solution, and in what ways can the Medical Society of Virginia support you in your efforts? Let us know by emailing me at [email protected].

Jenny Young
Associate VP of Membership and Engagement
The Medical Society of Virginia

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

Proposed Physician Payment Schedule Rule

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2023 Medicare physician payment schedule. While American Medical Association (AMA) staff will analyze and develop a summary of the 2,000+ page proposal, they wanted to make physicians aware of three key issues. Notably, the 2023 Medicare conversion factor would be reduced by about 4.5% from $34.6062 to $33.0775. This is largely a result of the expiration of a 3% increase to the conversion factor at the end of calendar year 2022 as required by law. The AMA will strongly advocate that Congress avert this significant cut and extend the 3% increase for 2023. Please note that the impact table in the proposed rule does not seem to include the 3% reduction in the conversion factor.

CMS would adopt changes to several evaluation and management (E/M) code families, including hospital, emergency medicine, nursing facility and home visits, as recommended by the CPT Editorial Panel and AMA/Specialty Society RVS Update Committee (RUC). These changes are estimated to require an additional reduction of about 1.5% to the 2023 Medicare conversion factor due to statutory budget neutrality requirements. In addition, under the Medicare Access and CHIP Reauthorization Act (MACRA), the final performance year that physicians are eligible to earn the 5% Advanced Alternative Payment Model (APM) incentive payment and $500 million Merit-based Incentive Payment System (MIPS) exceptional performance bonus is 2022, which will affect payment adjustments made in 2024. Therefore, the proposed rule does not contain any estimates of MIPS participants exceeding the exceptional performance threshold in 2023 or Advanced APM participants earning 5% incentive payments.

The confluence of these cuts, coupled with the 0% payment update that fails to account for significant inflation in practice costs, is creating long-term financial instability in the Medicare physician payment system and threatening patient access to Medicare-participating physicians. The AMA and our partners in organized medicine have developed a set of principles to guide advocacy efforts on Medicare physician payment reform. This is part of the AMA’s Recovery Plan for America’s Physicians and represents our ongoing work to establish a rational Medicare physician payment system that provides financial stability through positive annual payment updates, improves the financial viability of physician practices, and eases administrative burdens.

Finally, services that were going to be covered via telehealth only through the end of the COVID PHE would now be covered for an additional five months after the PHE ends, including the CPT codes for telephone visits.

Read the full text of the proposed rule here. 

Additional resources:

Monkeypox Outbreak Update

The Virginia Department of Health (VDH) needs your help to contain the current monkeypox outbreak that is growing rapidly in the United States and across the globe. To date, Virginia has three reported monkeypox cases. Other suspected cases have been reported, investigated, and ruled out with testing conducted at Virginia’s Division of Consolidated Laboratory Services (DCLS).

Healthcare providers working in outpatient clinics are at the front lines of this response and may be the first to suspect monkeypox. These include providers working in primary care, urgent care, emergency medicine, sexually transmitted infection clinics, dermatology, gynecology, and oral health. Here are key points to be aware of:

  • Many patients have mild symptoms that might be confused with sexually transmitted infections or varicella zoster virus. Rash lesions can begin on the genitals, perianal region, or oral cavity and might be the first or only sign of illness.
  • Co-infection with sexually transmitted infections have been reported.

To contain this outbreak, it is critical that providers recognize and report suspected cases immediately to their local health department (LHD).

  • With timely reporting, LHD staff can facilitate monkeypox testing, which is currently only available at certain public health laboratories, but likely to expand soon to certain commercial laboratories.
  • LHD staff can also ensure that people with monkeypox isolate safely and have access to treatment if they have or are at high risk for severe illness; monitor their close contacts; and offer post exposure prophylaxis to close contacts with high-risk and intermediate-risk exposures.
  • Review VDH’s Monkeypox Infection Prevention and Control Recommendations for Healthcare Settings to prepare your facility for potential cases.

Resources from CDC and VDH are available to help providers recognize and report suspected cases:

Time is of the essence to control this outbreak. Please share this information broadly both within your healthcare network and with any colleagues or facilities where frontline healthcare is provided.

Thank you for all your efforts to identify, report, and prevent monkeypox in Virginia.