Avian Influenza Update for Virginia

via VDH

Dear Colleague:

This letter provides updates on influenza testing guidance and avian influenza A(H5) (bird flu) activity in Virginia birds.

Avian influenza A(H5) has not been detected in people or dairy cattle in Virginia. It has recently been detected in Virginia in wild birds, commercial poultry, and in birds housed in a zoo collection. These detections are not unexpected, as avian influenza A(H5) virus is currently widely circulating in the environment. The risk from avian influenza viruses to the public remains low. People with job-related or recreational exposure to birds or other avian influenza virus-infected animals are at greater risk of infection.

Avian influenza A(H5) Virus Interim Recommendations for Clinicians

Clinicians should consider the possibility of avian influenza virus infection in persons showing signs or symptoms of acute respiratory illness or conjunctivitis who have a relevant exposure history. This includes people who have had contact with potentially infected sick or dead birds, livestock, or other animals or animal products within 10 days before their symptom onset.

If avian influenza virus infection is suspected or confirmed in any patient:

  • Ask about exposures to:
    • Wild and domestic animals, including birds, poultry, and dairy cattle.
    • Raw animal products, such as raw cow milk and raw cow milk products, or raw meat-based pet food.
    • Recent close contact with a symptomatic person with probable or confirmed avian influenza A(H5) infection.
  • Isolate the patient and follow infection control recommendations, including the use of PPE.
  • Initiate antiviral treatment with oseltamivir as soon as possible without waiting for the results of influenza testing.
  • Immediately notify your local health department to coordinate testing with the Division of Consolidated Laboratory Services (DCLS), if needed. Specimen collection guidance is available on the DCLS website.

Recommendations for Influenza Testing of Hospitalized Patients

On January 16, 2025, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to clinicians and laboratories recommending expedited subtyping of influenza A positive respiratory specimens from hospitalized patients, especially those in intensive care units (ICU). This request for expedited subtyping is in response to continued sporadic human infections with avian influenza A(H5N1) viruses in the U.S. during high levels of seasonal influenza activity. These recommendations will enhance patient care and infection prevention and control measures and will help facilitate timely public health investigation and action, such as contact tracing.

Clinicians should test for seasonal influenza A in hospitalized patients suspected of having influenza, especially ICU patients, within 24 hours of admission using a diagnostic test capable of providing seasonal influenza subtyping [i.e., A(H1) and A(H3)]. When possible, when ordering these tests, please include clinical information from the patient to help ensure specimens from hospitalized and severely ill patients are prioritized.

Recommendations for Hospital and Commercial Clinical Laboratories

  • Subtype respiratory specimens (for seasonal influenza subtypes) from hospitalized patients that are positive for influenza A.
  • If specimens from these patients are positive for influenza A but negative for seasonal influenza A virus subtypes [i.e., negative for A(H1) and A(H3)] please forward the specimens to DCLS as soon as possible and within 24 hours of obtaining the results.
  • If the hospital does not have access to seasonal influenza A subtyping in-house or at a commercial laboratory, forward influenza A positive samples from hospitalized patients to DCLS. DCLS-specific guidance for submitting specimens for influenza A subtyping are available on the DCLS website.
  • Immediately notify your local health department and the infection control program of your facility if subtyping yields a positive result for influenza A(H5) virus.

Notably, if results are “Influenza A positive with no subtype identified/obtained” or “Flu A-unsubtypeable” AND a clinician suspects avian influenza A(H5) or another novel influenza A infection, contact DCLS (804-335-4617) immediately for specific consultation regarding shipment of specimens to DCLS for testing. Specimens should not be submitted until consultation has occurred. You should also immediately notify your local health department.

Thank you again for your continued partnership in keeping Virginians safe from respiratory illnesses. To learn more about influenza viruses, please visit the following websites:

Sincerely,

Karen Shelton, MD
State Health Commissioner

Executive Order 43: Governor Youngkin’s Reclaiming Childhood Effort

via VDH

Dear Colleague:

Today, adolescent use of the internet, social media, and smartphones is almost universal, with 95% of teenagers ages 13 to 17 reporting that they use some form of social media; 97% reporting they use the internet daily; and 95% reporting access to smartphones. Recent studies have revealed that teenagers spend on average nearly 5 hours a day on social media.

According to the Office of the U.S. Surgeon General, “children and adolescents are affected by social media in different ways based on their individual strengths and vulnerabilities and based on cultural, historical, and socio-economic factors.” Social media can provide benefits for isolated youth and for youth with disabilities, by providing them with connections and helping them feel accepted.

At the same time, emerging research has demonstrated that adolescents who are exposed to extreme, inappropriate, or harmful content on social media are at risk of developing mental health issues. Negative effects can specifically include concerns about body image, thoughts or acts of self-harm, and issues with self-esteem. There is evidence to suggest that youth who spend more than three hours a day on social media have double the risk of poor mental health, including experiencing symptoms of depression and anxiety. Additionally, research links prolonged screen time to obesity, sleep problems, and poor academic performance.

Parents, educators, and clinicians in Virginia all have important roles to play in monitoring social media and internet use for its impacts on mental health. Clinicians are uniquely positioned to talk with patients and families about social media use, screen for cell phone and social media usage along with mental health issues, connect families to resources, and promote healthy behaviors.

On November 21, 2024, Governor Glenn Youngkin issued Executive Order 43 (2024) to promote education and collaboration among parents, medical professionals, and educators in Virginia to improve mental health, academic development, and chronic health conditions among adolescents who regularly use cell phones and social media.

The following resources are recommended for clinicians related to youth mental health and social media:

  1. Governor Youngkin’s Reclaiming Childhood effort is aimed at improving youth mental health outcomes by increasing awareness about the dangers of addictive social media and creating opportunities for cultural change. If you have any questions or concerns, please contact us at [email protected].
  2. The National Center of Excellence on Social Media and Youth Mental Health serves as a centralized source for evidence-based education and technical assistance to support the mental health of children and adolescents as they navigate social media. It includes various resources for education, screening and assessment, including:
  3. The Virginia Mental Health Access Program (VMAP), promotes the integration of mental and behavioral health services into pediatric primary care through training, technical assistance, and teleconsultation. To engage in services with VMAP, please call 1-888-371-8627 x 2.
  4. The Virginia Chapter of the American Academy of Pediatrics (AAP) has developed school health resources for healthcare providers and the Cell Phone Exemption Consensus statement to help navigate questions about medical requirements for cell phone use in schools.
  5. Keeping teens safe on social media: What parents should know to protect their kids (American Psychological Association, 2024)
  6. Screen Time & Technology: Learn how to help kids use screens in a healthy way. (Child Mind Institute)
  7. Cellphones and Devices: A Guide for Parents and Caregivers (Common Sense Media)
  8. 4 Conversations to Have with Older Kids and Teens About Their Screen Time Habits (Common Sense Media)
  9. National Scientific Council on Adolescents – Council Report No. 2
  10. Hear from Jonathan Haidt, social psychologist and author of the book, The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness at Commonwealth Conversation on Restoring Childhood Through Common Sense Approaches to Social Media and Cell Phones

Thank you for your continued partnership and commitment to improving and prioritizing the well-being of adolescents in the Commonwealth.

Sincerely,

Karen Shelton, MD
State Health Commissioner

2024 Virginia Medical News MSV Member Magazine

The 2024 issue of the Virginia Medical News MSV Member Magazine is available here.

2024 Virginia Medical News magazine cover

Articles cover topics such as:

  • child mental health care in Virginia
  • medical students and mentorship
  • what to expect during the 2025 Virginia General Assembly session
  • physician and PA advocacy efforts

 

 

 

 

 

Alliance for Innovation Partners with the Medical Society of Virginia to Explore Mental Health Solutions in Norfolk

Richmond, VA – The Alliance for Innovation (AFI) has joined forces with the Medical Society of Virginia (MSV) to address pressing mental health challenges by sharing and adapting programs proven effective in Virginia. Leaders from both organizations convened in Norfolk, Virginia, to discuss mental health programs, including innovative approaches and strategies to address and support post-traumatic stress disorder (PTSD) and other behavioral health concerns. This partnership aims to bring impactful initiatives to Poland, adapting Virginia programs to local needs and fostering international collaboration on mental health. 

“This collaboration represents a critical step forward in addressing mental health challenges on both sides of the Atlantic. Our joint efforts will focus on delivering immediate, practical solutions for PTSD, provider burnout, and patient stress, and we are committed to ensuring that these initiatives create tangible improvements in mental health treatment for both Poland and the United States,” said Marcin Hańczaruk, Co-Chairman of AFI Poland. 

The Virginia Mental Health Access Program (VMAP), the HealthHaven programs and SafeHaven have been recognized as transformative resources for mental health support. VMAP connects primary care providers with mental health specialists, ensuring timely and effective care for patients. HealthHaven programs include solutions targeted toward chronic health issues, substance use disorders and more. SafeHaven focuses on combating provider burnout by offering greater confidentiality for healthcare professionals seeking mental health support. 

These initiatives, combined with MSV’s dedication to improving mental health for healthcare providers and patients, serve as a model for addressing similar challenges in Poland. 

“We are thrilled to collaborate with the Alliance for Innovation on this vital mission. The mental health crisis knows no borders, and by sharing knowledge and resources, we can make a meaningful difference in the lives of patients and providers alike. Programs like these have the potential to provide much-needed relief and inspire innovative approaches internationally,” said Melina Davis, CEO and EVP of the Medical Society of Virginia. 

The partnership between AFI and MSV underscores a shared commitment to improving mental health outcomes through collaboration, innovation, and cultural exchange. By bringing these types of efforts to Poland, both organizations aim to address the unique challenges faced by healthcare providers and patients in their communities.

About the Medical Society of Virginia

The Medical Society of Virginia is a professional association with 10,000 members. The MSV is the only association representing all medical doctors, doctors of osteopathy and PAs, regardless of specialty or type of practice setting, in Virginia. Dedicated to Virginia’s physicians, PAs, and their patients, the MSV provides administrative, membership, and legislative services to its members, as well as serving as the liaison between local, national, and specialty medical organizations.

US Senate Letter on Addressing Medicare Payment Cuts

As physicians face another year of cuts stemming from the Medicare Physician Fee Schedule, 41 Senators cosigned a letter urging the Senate to address cuts before end of year. Text of the letter below. View full PDF with signatures.

Dear Majority Leader Schumer and Minority Leader McConnell:

We write to request that you urgently address the 2.8 percent cut to Medicare payments that will go into effect on January 1, 2025. Failure to address these cuts will threaten the continued ability of physicians and other healthcare providers to care for their patients.

On November 1, 2024, the U.S. Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2025 Medicare Physician Fee Schedule (MPFS) Final Rule, which includes provisions subjecting all physicians and other clinicians treating Medicare patients in the outpatient setting to a 2.8 percent payment cut. The scheduled cut represents the fifth consecutive year that CMS has issued a fee schedule lowering payments to physicians and other clinicians.

Persistent instability in the health care sector- due, in part, to consistent payment cuts —impacts the ability of physicians and clinicians to provide the highest quality of care. These continued payment cuts undermine the ability of independent clinical practices especially in rural and underserved areas to care for their communities. Some practices have limited the number of Medicare patients they see, or the types of services offered.

In addition to addressing the looming 2.8 percent payment cut, Congress must develop long-term legislative solutions to reform the Medicare Access and CHIP Reauthorization Act (MACRA), such as enacting targeted reforms to statutory budget neutrality requirements and payment updates reflective of inflationary pressures. These efforts are critical to supporting patient access to high-quality Medicare-covered services and bolstering our healthcare workforce.

On behalf of patients and healthcare providers, we look forward to working together to address the 2.8 percent payment cut and create stability in the Medicare program for our nation’s seniors.

We appreciate your attention to this critical matter.

Increase in Pneumonia and Pertussis Infections

via VDH

Dear Colleague:

This letter provides updates on increases in pneumonia and pertussis in Virginia.

Increase in Pneumonia Among Children

Since September 2024, the Virginia Department of Health (VDH) has observed a significant rise in emergency department and urgent care visits involving diagnosed pneumonia. During the week of November 10-16, 2024, there were 2,029 emergency department and urgent care visits with diagnosed pneumonia among children aged 0-17 years. This is more than triple the weekly peak observed in the past two years. There are also increases in visits among adults aged 18-64 years. In addition to this upward trend, numerous K-12 schools have reported clusters of students with pneumonia and unspecified respiratory illness. Laboratory testing has identified a variety of pathogens, primarily rhinoviruses/enteroviruses as well as Mycoplasma pneumoniae.

Rhinovirus infections are the most frequent cause of the common cold. Rhinovirus infections can exacerbate chronic respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). Enteroviruses have a broad spectrum of clinical presentations that can range from mild upper respiratory symptoms to more severe. It is uncommon for these viruses to cause pneumonia, so additional testing is being performed to type and analyze infecting viruses.

M. pneumoniae infections are generally mild and mostly present as a chest cold but may also present as pneumonia. Symptom onset is typically gradual and can include fever, cough, and sore throat. The Centers for Disease Control and Prevention (CDC) recently released a bulletin about a national increase in M. pneumoniae infections, especially in children 2-4 years of age. This differs from previous years in which most infections were observed among school-aged children and adolescents.

Providers are encouraged to:

  • Promote routine and seasonal immunizations and other healthy respiratory habits (e.g., staying home when sick, covering coughs and sneezes, frequently washing hands) to help prevent respiratory infections that can lead to pneumonia.
  • Consider enterovirus, rhinovirus, and pneumoniae as possible causes of infection among children with community-acquired pneumonia.
  • When possible, perform full respiratory panel testing if pneumonia is suspected, especially among hospitalized children, to ensure appropriate treatment is administered.
  • Consider swabbing both the throat and nasopharynx to improve the likelihood of pathogen detection in respiratory swab specimens.
  • Be aware of treatment recommendations for pneumoniae infections and promote the judicious use of antibiotics by prescribing only when indicated by clinical and/or laboratory evidence.

For more information, please see CDC’s Pneumonia and M. pneumoniae webpages.

Increase in Pertussis

VDH continues to respond to an increase in cases of pertussis (whooping cough). This trend was first reported in August and is linked to outbreaks in group settings, including universities, schools, religious communities, and childcare settings.

Providers are encouraged to:

  • Ensure all patients are up to date on DTaP and Tdap vaccination.
  • Maintain a heightened index of suspicion for pertussis in patients presenting with respiratory illness, especially with prolonged cough.
  • Obtain a nasopharyngeal (NP) swab or aspirate for testing of suspected cases. Contact your local health department to request pertussis testing at Virginia’s state public health laboratory.
  • Ensure appropriate antibiotic treatment (e.g., azithromycin, erythromycin) for pertussis patients. Please note that ciprofloxacin and doxycycline are not recommended for pertussis treatment.
  • Ensure timely receipt of post-exposure prophylaxis (PEP) antibiotics for contacts meeting high-risk criteria. People who refuse PEP should be excluded from high-risk settings for 21 days.

Thank you again for your continued partnership in keeping Virginians safe from respiratory illnesses. Although influenza, COVID-19 and RSV activity is currently stable in Virginia, we expect these trends to increase in the coming weeks. Please visit the VDH website for current public health guidance on respiratory diseases in Virginia and other information.   

Sincerely,

Karen Shelton, MD
State Health Commissioner

SafeHaven Launches Podcast for Healthcare Professionals Focused on Solving Practice Challenges

RICHMOND, VA – SafeHaven®, a program of the Medical Society of Virginia (MSV), announce the launch of a podcast for clinicians focused on solving the challenges of today’s medical practice environment. Titled “JoyMed,” and hosted by MSV CEO and Executive Vice President Melina Davis, the podcast is intended to help medical leaders share experiences and solutions while exploring ways to bring joy back into everyday life and the practice of medicine.

“In today’s environment, stress and burnout are very real issues for healthcare professionals of all kinds — from physicians and nurses to pharmacists and even students,” says Davis. “This podcast is an extension of our SafeHaven program, which provides confidential support to healthcare professionals, addressing career fatigue and other mental health challenges. It’s critical that we encourage healthcare professionals at all levels to seek the help they need, and provide the tools and resources to create a culture of care and support, so they can reclaim their work-life balance and joy at home and in the work they do.” 

“It’s important for medical professionals to take be cared for so they can care for others”

Davis continues. “By bringing important issues to light, and encouraging honest and meaningful dialogue that focuses on solutions, the JoyMed podcast is one more way we’re helping healthcare professionals reinforce and rediscover their purposeand joy, and ensuring those who care for us are cared for as well.” 

The JoyMed podcast will delve deeper into the unique challenges faced by healthcare professionals, explore strategies for resilience, and highlight the support systems available to them. Each podcast episode will feature expert insights, personal narratives, and practical tools to help foster a healthier and more supportive environment for our healthcare heroes.

The podcast’s first three episodes were released on Spotify and Apple Podcasts on October 17. Episode 1 highlights MSV’s SafeHaven program and its origin. Episode 2 features a PA’s experience with burnout. Episode 3 takes a look at the future of medicine from the perspective of both a medical and physician assistant student.  

Additional JoyMed episodes will release on a monthly schedule.  

About SafeHaven

SafeHaven was founded by the Medical Society of Virginia (MSV) after recognizing a greater need to provide clinicians the support to stay well and prevent burnout. SafeHaven ensures clinicians can seek support for burnout, career fatigue, and mental health reasons without the fear of undue repercussions to their medical license. Protections vary by state. 

About the Medical Society of Virginia

The Medical Society of Virginia is a professional association with 10,000 members. The MSV is the only association representing all medical doctors, doctors of osteopathy and PAs, regardless of specialty or type of practice setting, in Virginia. Dedicated to Virginia’s physicians, PAs, and their patients, the MSV provides administrative, membership, and legislative services to its members, as well as serving as the liaison between local, national, and specialty medical organizations. 

The 2025 Medicare Physician Payment Schedule Final Rule

On Nov. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies under the Medicare Physician Payment Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies final rule. The rule includes proposals related to Medicare physician payment and the Quality Payment Program (QPP).

These policies will take effect on January 1, 2025, unless otherwise noted.

The AMA Final Rule Summary detailing the payment updates and proposals is available here.

Are Physician Loan Repayment Programs Good for Primary Care?

Physician pay is decreasing while the cost of a medical education continues to increase. What’s to be done? Can physician loan repayment programs make a difference? Specifically, are physician loan repayment programs good for primary care? Considering there is a projected shortage of 68,020 full-time primary care physicians by 2036, improvements to the primary care workforce are critical to our nation’s healthcare delivery. 

Let’s take a closer look. 

Medical Education Costs 

Becoming a doctor is an investment, and 70 percent of medical students borrow money to attend medical school. According to the Association of American Medical Colleges (AAMC), in 2023 the average medical school debt was more than $200,000 — which with interest can balloon to $300,000 over the life of the loan. 

Four years of medical school costs between $268,476 for public medical school and $363,836 for private medical schools, according to the AAMC. And that doesn’t include costs like living expenses, textbooks, or supplies. It also doesn’t include the cost of an undergraduate education.  

Undergraduate tuition is going up, and has been for the last two decades. In 2023-24, the average cost of attending a 4-year, in-state public college was $28,840, compared to $60,420 at a private institution, with out-of-state public colleges costing 62 percent to more than 100 percent more than in-state. The average cost of an undergraduate education increased for 2024-25 academic year for both public and private schools, according to a new report from U.S. News. Once again, that cost doesn’t factor in room, board, and textbooks, which can add thousands more to the bill. It’s worth noting that grants and other aid can reduce the costs of an undergraduate education. 

Bottom line: Despite incurring substantial costs — and debt — to become a physician, the upward trajectory for education costs unfortunately isn’t matched by physician pay. 

Physician Pay

After several years of modest or declining growth, average pay for physicians increased by 5.9 percent in 2023, according to Doximity’s “2024 Physician Compensation Report” published this past May. At first glance this appears to be positive step forward, especially considering 2022 saw a drop of 2.4 percent. 

Unfortunately inflationary pressures continue to negatively impact physicians’ real income. Plus Medicare physician payment has decreased 22 percent since 2001. And in addition to the Centers for Medicare and Medicaid Services (CMS) cutting overall physician pay 1.25 percent in 2024, a proposed new CMS payment rule could see Medicare reimbursement fall by an average of 2.9 percent next year. 

Bottom line: Inflation plus declining reimbursements combine to create contracting physician pay, with primary care physicians already making significantly less than specialists — and nearly $100,000 less per year than the average for all physicians. 

Physician Loan Repayment Programs

Increasing debt and declining physician pay combine to create and exacerbate risks — like the physician shortage, specialty gaps, and physician stress and burnout, which comes from overwork, among other factors. The ultimate loser is patient care. 

Can physician loan repayment programs make a difference? Specifically, are physician loan repayment programs good for primary care? The answer to both is “yes.” They can certainly make an impact on a physician’s debt — which then has an impact on decisions like specialty as well as where a physician decides to practice. 

Offered as a recruiting incentive, educational loan repayment is an attractive benefit. In exchange for an employment commitment, a recruiting hospital or other facility will pay a physician’s medical loans. An April article by the American Medical Association (AMA) cites 2023 stats from recruiting firm AMN Healthcare’s Physician Solutions division indicating 18 percent of searches included loan repayment benefits. The average amount in 2022-23 was $98,665, and most applicants were required to stay in their position for 3 years or more. The range of incentive amounts offered varied from $10,000 to $400,000. 

Other opportunities for physician loan repayment also are available — and specifically for primary care. Due to the exceptional need for primary care physicians, loan forgiveness programs are more widely available for these fields than other specialties. 

Through the Health Resources & Services Administration (HRSA), the National Health Service Corps (NHSC) offers loan repayment to licensed primary care physicians in exchange for serving at least 2 years at an NHSC-approved site in a Health Professional Shortage Area (HPSA). HPSAs can be defined by geography, population, or facility type, like private medical facilities, correctional facilities, or Federally Qualified Health Centers (FQHCs). In fact, this April the HRSA increased loan repayment amounts by 50 percent for primary care providers who commit to practicing in high-need and rural areas. 

Public Service Loan Forgiveness (PSLF) programs are also an option. Physicians must complete full-time public service employment by a 501(c)3 tax-exempt nonprofit or public institution, and includes working in areas that are underserved or have a high need for medical professionals. In this program, borrowers must make monthly payments for 10 years during PSLF-qualified work, after which the federal government will forgive their remaining debt. 

Military programs are another option. Military branches offer tuition assistance for students who are service members, but even doctors who have already graduated and are practicing can enroll in military service to get student loan assistance. Programs vary by branch. 

For state programs, the Association of American Medical Colleges (AAMC) maintains a searchable database of loan repayment and other programs for students and residents. 

Although loan repayment programs are obviously a benefit more geared toward younger physicians, as established physicians have a higher likelihood of having paid off their debt and have already selected their area of specialty, they can be a terrific way to reduce large portions of debt early in a physician’s career. They can also encourage physicians to specialize in high-need areas, as well as serve high-need populations — specifically in primary care. 

2024 SafeHaven Impact Report

SafeHaven is growing and expanding – and our providers report that they’re seeing the benefits.

Get the 2024 SafeHaven Impact Report to learn more about the SafeHaven Movement and history, the program’s expansion, and the latest data on participant engagement and outcomes.