Health Care Provider Community request for Governor Northam to issue an Executive Order on Liability Protections

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The Honorable Ralph S. Northam
Governor of Virginia
Re: Legal Protections for Healthcare Providers

Dear Governor Northam:

The undersigned organizations sincerely thank you for your unwavering support for our health care system and its physicians, nurses, physician assistants, nurse practitioners and other health care workers who are making tremendous sacrifices as part of the Commonwealth’s emergency response to the novel coronavirus (COVID-19) pandemic. The pandemic is certain to be a critical test of all of us, and your additional support during this great time of need is especially appreciated.  Accordingly, we are writing to request you issue an Executive Order to afford appropriate legal protections.

Under your leadership, the Commonwealth of Virginia has made great strides in its emergency response to COVID-19, including a series of Executive Orders and Orders of Public Health Emergency aimed at reducing community spread, conserving personal protective equipment (PPE), and building up our capacity to treat the large number of COVID-19 patients that are forecasted and are already beginning to be treated in hospitals, hospices and long term care facilities and residences across the Commonwealth. But the work has only just begun. COVID-19 presents an ongoing threat to our communities. Information from the Virginia Department of Health reveals occurrences of the virus in every region of the Commonwealth. Indeed, the data suggests that in several regions there may be community spread of the virus and the number of confirmed cases, hospitalizations, and persons under investigation (PUIs) in Virginia have increased substantially.

Health care providers are already experiencing critical shortages of PPE and other supplies and in some cases are being required to reuse PPE where appropriate and possible to conserve PPE.  This is exacerbated by a severe disruption in both the state, national, and international supply chains caused by the significant increased use of such equipment worldwide in response to COVID-19.

In order to meet the anticipated surge in demand for acute care and intensive care beds, hospitals are retrofitting care areas for use in treating COVID-19 patients. Transfer of patients with COVID-19 from hospitals to other sites of care such as assisted living facilities, hospices, and nursing homes is limited by the need to contain the spread of the virus.  Additionally, the state and public and private health care providers are establishing alternate care sites to meet the anticipated surge.  All of these measures are necessary in response to the public health emergency created by COVID-19; however, they present less than optimal conditions than those indicated by conventional standards of care, placing patients, the public, and health care workers at risk.

There are already reports of health care workers being infected with COVID-19 and the reality is these will continue as the spread of the disease is inevitable. As the number of health care workers infected increases, this will place an even greater strain on remaining trained staff. As a result, the ability of hospitals, long term care facilities, and other facilities to adequately staff operations will be limited, also placing patients and health care workers at risk.

Despite our collective good faith and exhaustive efforts and a number of environmental factors that are outside of our control, we have seen a marked increase among the legal community discussing and advertising the possibility of tort litigation for our response to the COVID-19 pandemic. We already face a critical shortage of funds within the health care system. Hospitals and other health care providers that have postponed non-essential health care services and have dedicated resources to COVID-19 emergency response are facing significant financial losses that place our health care system at risk. The threat of tort litigation would accelerate and exacerbate the financial strain placed on us and the care that we provide. However, health care providers may not be afforded the necessary limitations of liability without clarification of existing statutes and declarations from your Administration to allow them to focus on the prioritization of patient care.

Virginia law provides some immunity to health care providers and other persons responding to an emergency, but there is little case law interpreting them and clarification is needed to adequately provide the limitation of liability that is appropriate in response to the COVID-19 emergency. Existing statutes have several gaps that could open health care providers to lawsuits, despite performing in good faith. Examples of needed clarification include:

Whether COVID-19 is a “communicable disease of public health threat” as defined in § 44-146.16 that constitutes a “disaster” as defined in § 44-146.16.

Whether for the purpose of Va. Code § 8.01-225.01, Executive Order No. 51 is a state emergency that has been declared and for purposes of Va. Code § 8.01-225.02, Executive Order No. 51 is a state emergency that has been declared in response to a disaster.

Whether Va. Code § 8.01-225.01 and § 8.01-225.02 provide immunity to “health care providers” during declared state emergencies, such as the current COVID-19 pandemic.

To what extent facilities such as assisted living facilities, adult day centers, home care and hospice that are not included in the definition of  “health care provider” pursuant to the definition in § 8.01-581.1. Va. Code § 8.01-581.1 would have any protection under § 8.01-225.01 and § 8.01-225.02.

What activities are included in what it means to “respond to a disaster,” and what it means for a “lack of resources” under § 8.01-225.02.

These and other ambiguities open health care providers to lawsuits as the law currently exists in our Commonwealth. The changing dynamic and situation of this pandemic warrant grants of civil and criminal immunity where health care providers act in good faith. Other states have codified such “good faith” immunity by statute, such as Maryland which provides that healthcare providers, including assisted living programs, are “immune from civil or criminal liability if the health care provider acts in good faith and under a catastrophic health emergency proclamation.”[1]

Others have proclaimed civil or criminal immunity by way of executive orders such as New Jersey which declares that health care providers are afforded civil liability immunity “as a result of the individual’s acts or omissions undertaken in good faith, whether or not within the scope of the licensee’s practice, in the course of providing healthcare services in support of the State’s COVID-19 response, whether or not such immunity is otherwise available under current law.”[2] On March 29, 2020, Governor Gretchen Whitmer of Michigan issued Executive Order No. 2020-30 that provides immunity to “any licensed health care professional or designated health care facility that provides medical services in support of…the COVID-19 pandemic … regardless of how or under what circumstances or by what cause those injuries are sustained, unless … caused by … gross negligence.”[3] Such grants of immunity for acting in good faith are essential to recognizing the strain on health care provider resources and protecting them from the difficult decisions that may need to be made.

For the foregoing reasons, we respectfully request that you continue your support of health care providers by issuing an executive order that will afford our members with the legal protections necessary to fully focus on treating patients and containing this pandemic rather than focusing on lawsuit mitigation. Specifically, we request that you clarify that existing legal immunity protections include assisted living facilities, adult day centers, home care and hospice, and also declare civil and criminal immunity to health care providers that act in good faith. By doing so, you will enable health care providers to focus on the difficult task of combating the COVID-19 outbreak without fear of legal retribution that could lead to insolvency.

Your leadership and service to our Commonwealth during these difficult times are greatly appreciated.

Sincerely,

American College of Physicians – Virginia Chapter

American College of Radiology – Virginia Chapter

LeadingAge Virginia

Medical Society of Virginia

Richmond Academy of Medicine

Psychiatric Society of Virginia

The American College of Obstetricians and Gynecologists

Virginia Academy of Physician Assistants

Virginia Association for Home Care and Hospice

Virginia Association for Hospices & Palliative Care

Virginia College of Emergency Physicians

Virginia Council of Nurse Practitioners

Virginia Dental Association

Virginia’s Family Physicians

Virginia Health Care Association – Virginia Center for Assisted Living

Virginia Hospital and Healthcare Association

Virginia Nurses Association

Virginia Orthopaedic Society

Virginia Society of Anesthesiologists

Virginia Society of Eye Physicians and Surgeons

Virginia Society of Oral & Maxillofacial Surgeons

Virginia Society of Plastic Surgeons

 

Draft of Executive Order Submitted to Governor

PDF Version of this Letter

 

 

 

 

[1] Md. Code 14-3A-06

[2] State of New Jersey, Executive Order No. 112, available at https://nj.gov/infobank/eo/056murphy/pdf/EO-112.pdf.

[3] State of Michigan, Executive Order No. 2020-30, available at https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-523481–,00.html.

MSV Recommends All Physicians & Providers Follow Guidelines in Postponing Elective Procedures

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To all physicians and health care providers across the Commonwealth:

These are exceptional times. COVID-19 is a risk to the lives and well-being of nearly every American. Even if individuals and their loved ones avoid this virus, the ripple effects across our nation and our Commonwealth will be immeasurable. The Medical Society of Virginia (MSV) understands the immensity of the challenge before Virginia and all heath care professionals. Any successful effort to stop COVID-19 will require coordinated sacrifice and a deep community response.

The MSV serves as the voice of Virginia’s physicians, residents, medical students, physician assistants and physician assistant students, representing all medical specialties in all regions of the Commonwealth. Our membership is at the frontlines of responding to the COVID-19 crisis.

In order to lead the response to COVID-19, protect patients, and make best use of health providers’ training and expertise, the MSV recommends all physicians and providers follow the American College of Surgeons guidelines, CMS guidelines, and specialty society recommendations postponing elective procedures. Given the risk of COVID-19, there are several reasons elective procedures should be postponed:

  1. As stated by AMA President Patrice A. Harris, M.D., M.A., “there is nowhere near enough PPE in the fight against COVID-19–a shortage that endangers patients and jeopardizes the entire response to this virus.” Elective procedures that use PPE and other resources potentially jeopardize our national response to COVID-19.
  2. COVID-19 is spread through aerosolized droplets that are expelled during coughing, sneezing, or breathing. Performing elective procedures puts patients and providers in a position for infection by bringing them into the hospital and exposing them to multiple potential transfers. This violates the edict of social distancing. We need as many physicians, nurses and other health care workers as possible responding to this crisis—not endangering themselves for nonessential work.
  3. Accountability does not lessen during a crisis, it only heightens. Physicians live under a staff privileging regulatory framework that already accounts for unethical behavior and incorporates the individual needs of each region.
  4. Cancelling elective procedures is an ethical responsibility. This not an administrative decision, but a medical decision. The entire national health care community is asking people to stay home, miss work, and do what they can to mitigate the spread of COVID-19. Physicians owe it to our communities to make similar decisions. Under the current threat, performance of inappropriate procedures is unethical.

It is up to each physician to make the best recommendation for their patient given the risks, benefits, and alternatives. The MSV will update its recommendation as new information develops. The MSV is committed to providing our members and the broader health community with the most up to date COVID-19 information. Please visit MSV.org/COVID19 to get the latest information.

Sincerely,
Clifford L. Deal III, MD, FACS
President

Find a PDF copy of the letter here.

The Third Chair

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The Third Chair

Once upon a time, medicine and health care were solely focused on the patient. What does the patient need? How can we help them and make their lives better? Physicians had more time to talk with their patients and truly get to know and understand them. Physicians and health care teams were a source of comfort and healing. Our health care system is forgetting them.

The relationship between a physician and patient forms the backbone upon which diagnosis and treatment are based. In my experience, surgery is but a small part of helping a patient navigate the journey of breast cancer.  My patients, their families and I become a part of each other’s lives, and we both are forever changed.

We become physicians for patients. Patients rely on us. We need to be able to diagnose and treat them when they are sick, heal their broken bones, and educate them on maintaining and building a healthy lifestyle. Caring for patients IS the reason we practice medicine. Building a lifetime relationship with our patients is the goal.

The patient-physician relationship has been changing over the years, and it seems that we are drifting further apart. Patient data is collected and reviewed, diagnoses and plans are made, compliance is developed, and healing can be achieved. However, there is an extra, unnecessary chair in the exam room.  As insurance coverage and compliance for medical care become more administrative-based and complex, the need for a strong physician-patient bond is fading. Medical decisions are no longer being made by just the physician and the patient’s health care team. Insurance companies, government entities, and employers are inserting themselves into the sacred relationship of the physician and patient.

The third chair is another barrier to care. Physicians are trying to work through endless paperwork, denials from insurance companies, and so much more. Patients are having many of the same struggles. They get denied payment from their insurer, struggle with insurance price fixing (surprise billing), and as the need for physicians grows, the harder it is to get needed appointments.

We need to reinstate the patient and physician relationship as a key driver for health care system change. Perhaps someday, Dr. Google will be able to provide a technical answer to a technical question, but it will never truly care for you, or walk alongside you in your journey.  Patients come to us in their most vulnerable moments, and we need to be able to treat them without the influence of the third chair.

Clifford L. Deal III, MD, FACS
The Medical Society of Virginia President

Tackling Physician Burnout Requires Unprecedented Leadership

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By Robert D. Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company

The term “burnout” has been questioned as a labeling error—and rightfully so. Burnout implies victim shaming. What many healthcare professionals on the frontlines are experiencing is a normal response (symptoms) to an abnormal situation (cause), like sick fish in a tank of toxic water. A diagnosis of burnout suggests that the solution is to medicate the fish. A more holistic view is to say, “There’s really nothing wrong with you; let’s clean the tank.”

The World Health Organization (WHO) announced plans to include what it labels “burn-out” as an occupational phenomenon in the International Classification of Diseases (ICD-11). The syndrome, which results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy.[i]

The WHO’s actions seem to further legitimize what many are experiencing: an ever more exhausting, distancing, and chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging and contributes to burnout, healthcare professional distress, or to what some have even labeled moral injury or human rights violations.[ii][iii][iv]

Physician Burnout Thought Leaders Weigh In

Drs. Simon Talbot and Wendy Dean, who co-founded the nonprofit organization MoralInjury.healthcare, borrowed the expression “moral injury” from Jonathan Shay, MD, PhD, a clinical psychiatrist who coined the phrase. Briefly, it is (1) a betrayal of what’s right, (2) by someone who holds authority, (3) in a high-stakes situation.[v] Discussions of moral injury include the view that repeated daily betrayals by authorities within the system are manifest in healthcare every day in the form of mandates from leaders to see more patients with less time to care for them, forced use of dysfunctional electronic health record (EHR) systems, overburdens by payers, competing financial considerations, fear of litigation, and more. These types of betrayals run counter to patients’ best interests—which pains doctors, whose unifying creed is that patients come first.

While other physician thought leaders like Dr. Dike Drummond (thehappymd.com), Dr. Paul DeChant (author, Preventing Physician Burnout), Dr. Zubin Damania (aka ZDoggMD), and Dr. Pamela Wible (idealmedicalcare.org) may differ on the terminology, each makes a similar call for leadership and action equal to the severity and scope of the dilemma. They all call for partnering with enlightened leaders to change the systemic and institutional patterns that inflict betrayals on the practice of good medicine.

Dr. Wible calls these issues human rights violations that begin in medical education and training due to labor law abuses, sleep/food/water deprivation, discrimination, violence, understaffing, and more—driving up depression and suicide rates.[vi] Because of the profound impact on individuals, there is broad consensus about the immediate need to expand access to confidential, nonpunitive mental healthcare for doctors and nurses.

In response to systemic conditions, some doctors are quitting because having less time with patients has driven morale to rock bottom, and those who remain are warning of a mass exodus if things don’t improve.[vii] According to Paul DeChant, MD, MBA, a failure to step up and meet this challenge is a failure of leadership and constitutes management malpractice, with some administrators asserting that they are suffering from management burnout.[viii]

Dr. Howard Marcus, an internist in Austin, Texas, responded, “Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.”

An Annals of Internal Medicine cost-consequence analysis reported that physician burnout is costing $4.6 billion per year related to physician turnover and reduced clinical hours. The authors offer a prescription that burnout “can effectively be reduced with moderate levels of investment,” suggesting there is “substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.”[ix]

The National Academy of Medicine issued a report that offers a bold vision for systemic change—because “the system,” the amorphous healthcare-industrial complex, is designed, unwittingly or not, to produce the results it is producing. When you take what is at its core a moral and scientific enterprise, that is the practice of medicine, and relentlessly mess with it in an unscientific manner driven by economics and regulation, physician burnout is the expected outcome. The scope and breadth of the problem requires unprecedented leadership, shared “collective and coordinated action across all levels of the health care system—front line care delivery, the health care organization, and the external environment.”[x]

Leadership matters. The Mayo Clinic reported that a one-point increase in the leadership score of a physician’s immediate supervisor was associated with a 3.3 percent decrease in the likelihood of burnout.[xi] This and other reports support the often-quoted conclusion that your supervisor is more important to your health than your primary care doctor. If leadership will not make this issue a priority, lead as though no help is coming.

Executive leaders in some healthcare systems are beginning to require all executive staff to frequently round with or shadow physicians and to ask questions like “What isn’t working?” To be of value, executive leaders must be armed with the courage to lead and an organizational commitment to change. Some systems have appointed chief wellness officers and formed clinician wellness teams, giving them authority to create opportunities to support well-being and resiliency.

Steven Beeson, MD, founder of the Clinician Experience Project, urges “to advance care for patients and take on the healthcare imperatives in front of us, we have to care for those caring for others first. To care for the care team we must listen to clinicians, respond to the things they need, invest in burden reduction, support and develop them to be their best, empower them to lead the way, allow them to be the clinician they envisioned, and appreciate the impact they make when we do these things.” (Stephen Beeson, MD, email communication, July 17, 2019.)

Efforts to Improve EHR Usability

EHR rescue and optimization work is becoming more common to regain lost relationships with patients. Executive leaders who are desperate for help often contact firms like Medical Advantage Group (MAG), a subsidiary of The Doctors Company. MAG conducts system database audits, followed by workflow analysis, previsit planning, and redesign of work screens to make the EHR function better as a convenient, accessible clinical source of truth. Ironically, this improvement in EHR accessibility and usability makes the EHR function more like old paper charts when everything was at hand. Other benefits of this work include increases in quality-based payments, improved EHR user efficiency and experience, reduced time spent searching, and reduced or eliminated “pajama time” (charting at home).

On a smaller scale, Dr. Gabe Charbonneau (fightburnout.org), a family physician and EHR problem-solver who is on a mission to disrupt burnout, finds his greatest fulfillment in helping doctors one-on-one. Another example related to EHR usability is at Atrius Health, where a collaboration with its IT department reduced inefficiencies by cutting 1,500 clicks per day per physician.[xii] This sustained, resourced commitment to improvements resulted in less time spent in the EHR and improved professional satisfaction.

Like any meaningful change, improvements require leadership with a growth mindset that demonstrates a deep respect for people and for the nature of their work. This means exhibiting leadership behaviors such as deference to expertise and sensitivity to clinical operations—two characteristics of the continuous improvement mindset on the journey toward high reliability. Effective leaders meet physicians where they live—on the frontlines of care—and seek to understand what is getting in the way of connecting with patients and providing quality care. The best leaders then work tirelessly to remove the barriers.

Additional Resource

American Hospital Association and AHA Physician Alliance. Well-being playbook: a guide for hospital and health system leaders. https://www.aha.org/system/files/media/file/2019/05/plf-well-being-playbook.pdf. Published May 2019.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Reprinted with permission. ©2019 The Doctors Company (www.thedoctors.com).

[i] Burn-out an “occupational phenomenon”: International Classification of Diseases. World Health Organization. https://www.who.int/mental_health/evidence/burn-out/en/. May 28, 2019. Accessed June 12, 2019.

[ii] Swenson S. Esprit de corps: turning vicious cycle virtuous. Talk presented at: NEJM Catalyst event Essentials of High-Performing Organizations; July 25, 2018; Institute for Healthcare Policy and Innovation, University of Michigan. https://catalyst.nejm.org/videos/esprit-de-corps-vicious-virtuous-cycle/. Accessed March 4, 2019.

[iii] Talbot SG, Dean W. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. Stat website. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/. Published July 26, 2018. Accessed April 30, 2019.

[iv] Wible P. Not “burnout,” not moral injury—human rights violations. https://www.idealmedicalcare.org/not-burnout-not-moral-injury-human-rights-violations/. Posted March 18, 2019. Accessed May 10, 2019.

[v] Shay J. Moral injury. Psychoanal Psychol. 2014;31(2):182–191. https://www.law.upenn.edu/live/files/4602-moralinjuryshayexcerptpdf.

[vi] Wible P. Not “burnout,” not moral injury—human rights violations. https://www.idealmedicalcare.org/not-burnout-not-moral-injury-human-rights-violations/. Posted March 18, 2019. Accessed May 10, 2019.

[vii] Eichacker C. Doctors quit EMMC as changes leave less time with patients, push morale to ‘all-time low.’ Bangor Daily News. May 13, 2019. https://bangordailynews.com/2019/05/13/news/bangor/doctors-quit-emmc-as-changes-leave-less-time-with-patients-push-morale-to-all-time-low/. Accessed May 14, 2019.

[viii] DeChant P. Management burnout. www.pauldechantmd.com/management-burnout/. Posted April 26, 2019. Accessed April 29, 2019.

[ix] Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. [Epub ahead of print 28 May 2019] 170:784–790. https://annals.org/aim/article-abstract/2734784/estimating-attributable-cost-physician-burnout-united-states. Accessed June 12, 2019.

[x] Taking action against clinician burnout: A systems approach to professional well-being. Slide 19. National Academy of Medicine. https://nam.edu/wp-content/uploads/2019/10/Public-release-PPT-10-23-19.pdf. Published October 23, 2019. Accessed October 25, 2019.

[xi] Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146. https://www.mayoclinicproceedings.org/article/S0025-6196%2816%2930625-5/pdf.

[xii] Berg S. How collaboration with IT cut 1,500 clicks a day per physician. American Medical Association. https://www.ama-assn.org/practice-management/digital/how-collaboration-it-cut-1500-clicks-day-physician. Published March 7, 2019. Accessed May 1, 2019.

What Makes a Strong Healthcare Team?

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Today’s healthcare teams face a growing need for interprofessional collaboration, creative problem solving, and impactful leadership training to drive organizational performance.

The healthcare work environment is changing every day. Across the board, healthcare providers are expected to do more – more paperwork, more reporting, more meetings, see more patients. At the same time, providers are feeling further isolated and less supported. The House of Medicine needs strong, dedicated leaders and effective healthcare teams more than ever.

The SYNC program is an innovative, team-based learning experience that teaches collaboration and leadership through hands-on problem solving. SYNC helps develop your leadership and teamwork skills by having you work on a capstone project to be presented at the end of the session. As a hospitalist, we chose to focus our SYNC Capstone on patients in the acute care setting. Our project focused on educating patients at high risk for stroke, in hopes of reinforcing compliance and ultimately decreasing their risk for stroke. Our team included physicians and nurses, and we reached out to pharmacists, social workers, and hospital leadership throughout the project. We initially sought to identify patients with new onset atrial fibrillation, however, upon reviewing the data, we realized the population size was too small and we had to widen our focus. As our project evolved, we faced challenges that forced us to make other changes. We reviewed social determinants of health, looking for patterns and areas where we could help patients. It forced us to look outside the lens of the hospital setting and more at proactive prevention rather than reactive treatment.

SYNC is facilitated by successful leaders who understand the necessary qualities for the entire healthcare team – communication, collaboration, and flexibility.

Communication is a key component in healthcare. Patients are relying on you to help them through some of the toughest times of their lives. In order to best serve your patients, you must have an open line of communication with your coworkers. Be open and honest with your team members. Check in with each other. Be present in conversations. The SYNC Capstone project creates a line for open and necessary communication with other members of the healthcare team.

Collaboration is necessary for success. This is the keystone of SYNC. If your team is not on the same wavelength or encouraged to share ideas, they will be less motivated to succeed. Being in an environment that encourages professional growth and allows ideas to flow freely ensures positive outcomes for patients. During our project, we learned from each other, each bringing different skills to the table.

Flexibility is required of all members of the healthcare team. By signing up for SYNC, participants are taking their first step into accepting and participating in the unplanned. The leadership role in the team is dynamic and changes depending on the needs and each other’s expertise.

The SYNC program teaches the foundation of effective interprofessional collaboration. Participants leave with a different understanding of what it means to be a part of the healthcare team. While our project started out small, we are working on expanding it to include more patients and involving new team members.

Denise G. Alcantara, M.D.
Sentara Hospital Medicine Physicians
SYNC Cohort 5

Participants have used SYNC to develop or build on programs that are critical for patients. Some of these programs include-

  • Stroke Education in High Risk Populations for Primary Prevention – Sentara Princess Anne Hospital – Cohort 5
    Project Goal: Implement a program identifying non-stroke patients admitted to hospital who are at high risk for stroke. Once identified, the focus will be to complete targeted stroke reduction education and follow the patient post acute-care.
  • Barriers to Breast Cancer Screening – Valley Health – Winchester Medical Center – Cohort 2
    Project Goal: Improve access and streamline delivery of breast cancer screening, identify barriers that make access difficult, and eliminate travel and distance between service delivery settings and target populations.
  • Improving Communication & Handoffs During Transitions of Care for ICU Patients – Centra Health – Inpatient Team – Cohort 1
    Project Goal: Decrease the amount of time until a patient is seen by a receiving physician after an ICU transfer, decrease rate of “bounce back” to ICU and eliminate unnecessary medications upon transfer.
  • Diabetes Prevention – A Public Health Collaborative – Mason and Partners Clinic & Prince William Health District – Cohort 1
    Project Goal: Identify pre-diabetic patients in the Mason and Partners Clinic and refer them to the lifestyle change program to improve overall health.  The project involved utilizing Community Health Workers in patient care and connecting patients to a medical home.

The House of Medicine is critical to keeping patients and communities healthy. With the changing landscape of healthcare and the added pressures of healthcare professionals, there has never been better time to sign up and become a part of SYNC.

If you have questions about SYNC conact Amy Swierczewski, Assistant Director of Intrastate Accreditation and MSVF Programs, at [email protected]

MSV Foundation Becomes Program Administrator for VMAP

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RICHMOND, Va. (Feb 11, 2020) – The Medical Society of Virginia Foundation (MSVF) has been named the program administrator for the Virginia Mental Health Access Program (VMAP) by the Virginia Department of Behavioral Health and Developmental Services (DBHDS).  The Virginia Mental Health Access Program is a statewide program designed to provide access for children to mental health services including child psychiatrists, psychologists, social workers, and care coordination.  As program administrator, MSVF will coordinate among 23 other VMAP partners to expand the program statewide through the establishment of five regional hubs.

“We see the integration of behavioral health services into primary care settings as a needed step in the direction of reducing stigma and increasing access to needed mental health services,” said Alison Land, commissioner of the DBHDS. “This partnership with the Medical Society of Virginia Foundation will expand access to early screening and management of behavioral health needs through pediatric and psychiatric partnerships.”

Pediatricians, family physicians, and nurse practitioners across Virginia will have access to a phone number, website, and telephone or video consults with their regional VMAP psychiatrist and other team members. Care coordinators at each regional location will identify local, community mental health resources for children who need them.

“The Virginia Chapter of the American Academy of Pediatrics (AAP) is excited about the future collaboration with the Medical Society of Virginia Foundation.  VMAP is providing increased access to mental health services through primary care providers in our state.” Dr. Sandy Chung, President of Virginia Chapter of AAP and VMAP Medical Director, affirms, “With MSVF’s help, we can support all providers who take care of children and adolescents, including pediatricians, family physicians, nurse practitioners and physician assistants.”

According to the 2019 State of Mental Health in America report, Virginia currently ranks 41 out of 51 for mental health workforce availability.  This program will ensure more children have access to providers who are better able to screen, diagnose, manage and treat mental health.

“With this program, we will be better able to serve children and adolescents in their communities with their trusted providers and be able to more quickly identify emerging concerns and linkage to resources and services,” said Nina Marino, director of the DBHDS Office of Child & Family Services. “The Medical Society of Virginia’s capability to develop and sustain programs and health initiatives will be vital as we work to create a Mental Health Access Program across the Commonwealth.”

To learn more about VMAP visit https://www.vmapforkids.org/.

About the Medical Society of Virginia Foundation 

Placing an emphasis on the needs of the uninsured and underserved, the MSV Foundation advances opportunities for physicians to participate in health improvement efforts in Virginia including educational programs for physicians and health care providers across the Commonwealth. For more information, visit www.msvfoundation.org. 

Celebrating 200 Years of Impact

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For the past two centuries, MSV has represented the passion and power of Virginia’s physicians working together. MSV has defined Virginia medicine as we know it today, but most importantly, has championed physician-led patient care.

Physicians’ strength, innovation, and service to their profession has had a humanitarian impact on our history and is carving the path forward to making Virginia the best place to practice medicine and receive care.

The story of the Medical Society of Virginia is the story of anyone who has ever been a patient in Virginia, anyone who has had a friend that was a patient – a mother or father, son or daughter, wife or husband – and the care that made them well again.

MSV represents the passion and power of Virginia’s physicians working together. Their resilience, dedication, and leadership to their profession is creating a better place to practice and receive care in Virginia. That story holds a place in history and is carving the path forward for better well-being for all Virginians.

MSV and its members has a history of health care progress for the Commonwealth. Most recently, MSV has been leading the effort to curb the opioid crisis in Virginia and advocate for change. MSV partnered with other Virginia changemakers and developed innovative solutions to removing barriers to obtaining treatment to those in need, provide educational opportunities for physicians, and create prescribing regulations for pain management. MSV partnered with our hospital and patient communities this past legislative session to eliminate other barriers to receiving care with reform of prior authorization and step therapy – processes that delay or prevent necessary treatment. When physicians are involved in the legislative process, patients come first.

MSV recognized the exponential rise and damage of physician burnout by creating programs to bring back the joy in practicing medicine and empower our doctors. When physicians are treating patients at their healthiest, patients are healthier and happier, too.

Virginia’s physicians have had a pivotal role throughout the history of Virginia medicine, including support of medical education, development of codes of ethical behavior and the establishment of the Board of Health, the Board of Medical Examiners, and the Virginia Health Quality Center. These moments of history have defined Virginia medicine for how we know it today, but most importantly, they stand for physician-led patient care. This high level of care is dependent on the expertise gained through over a decade of medical training and the heart that inspires doctors to commit to the profession in the first place. Physicians deliver the humanity in health care that all sectors of influence on the system should strive to achieve. MSV will continue to champion the Virginia doctors who change our lives every day.

MSV 200th Anniversary Sponsors

Virginia Physicians’ 200 Years of Impact

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This year marks a significant milestone for the Medical Society of Virginia with the celebration of its 200th anniversary.

On December 15, 1820, 17 physicians from Richmond and Manchester met and created the Medical Society of Virginia. That story holds a place in history and is carving the path forward for well-being of all Virginians. Their resilience, dedication, and leadership to their profession continues to create a better place to practice medicine and receive care.

MSV represents the passion and power of Virginia’s physicians working together to drive progress in health care for the Commonwealth. Most recently, MSV has been leading the effort to curb the opioid crisis in Virginia and advocate for change. Partnering with other Virginia changemakers, we developed innovative solutions that removed barriers to obtaining treatment for those in need, provided educational opportunities for physicians, and created prescribing regulations for pain management. MSV worked with our hospital and patient communities this past legislative session to eliminate other barriers to receiving care with reform of prior authorization and step therapy – processes that delay or prevent necessary treatment. When physicians are involved in the legislative process, patients come first.

MSV recognized the exponential rise and damage of physician burnout by creating wellness programs to bring back the joy in practicing medicine and empower our physicians. When physicians are treating patients at their healthiest, patients are healthier and happier, too.

The Medical Society of Virginia would not be what it is today without our passionate members. Throughout our 200 years, members have dedicated their time to MSV, their patients, their communities, and bettering health care delivery in Virginia.

Expertise in the art and science of medicine and intrinsic desire to advocate for patients are powers only physicians have. Physicians are at their best when they are doing what they are trained to do – treat patients. For the past two centuries, MSV has represented the passion and power of Virginia’s physicians working together. MSV has defined Virginia medicine as we know it today, but most importantly, has championed physician-led patient care.

Physicians’ strength, innovation, and service to their profession has had a humanitarian impact on our history and is carving the path forward to making Virginia the best place to practice medicine and receive care.

Passion

Our physicians’ passion is the reason behind MSV – a passion for medicine, a passion for our profession, a passion for our patients.

Strength

The strength of physicians coming together has defined how medicine is practiced in Virginia.

Innovation

Health care continues to change at a constant pace. Physicians manage these changes and continuously work to improve the process of caring for patients.

Service

The physician community is dedicated to serving society through their expertise and commitment to humanity in health care.

We look forward to a year of celebration of our past 200 years and looking forward to our next 200!

AMA 2019 Interim Meeting Report

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By William C. Reha, MD, MBA
Vice Chair, Virginia Delegation to the AMA

Virginia was well represented at the AMA Interim Meeting held November 16-19, 2019 in San Diego, California. Over 100 Resolutions and Reports are typically handled at this meeting devoted exclusively to advocacy, ethics, and urgent matters affecting the practice of medicine. Virginia brought forward a resolution based on the successful legislation MSV helped pass recently regarding Co-Pay Accumulators. As you recall, Co-Pay Accumulators prevent patients from reaching their deductibles when using manufacturer’s coupons to lower their out of pocket costs.  The resolution as adopted states “That our American Medical Association develop model state legislation regarding Co-Pay Accumulators for all pharmaceuticals, biologics, medical devices, and medical equipment”.  Additionally, Virginia co-sponsored another resolution brought forward by the American Academy of Dermatology opposing Board Certification of Physician Assistants in that it would “mislead the public to believe such certification is equivalent to medical specialty board certification”.  This too was successfully adopted by the House of Delegates.

Pictured from left to right: Drs. Michele Nedelka, Clifford L. Deal III, Sterling Ransone, Joel Bundy, and Cynthia Romero smile for the camera before the start of a session at the AMA Interm meeting in San Diego, CA.

Our Delegation weighed in on all the resolutions submitted at the meeting.  Each reference committee was assigned a member of our delegation to study the resolutions and report the testimony at our caucus so that each member was informed of the pertinent discussion at each hearing for deliberation at the Full House of Delegates.

Virginia is fortunate to have Dr. Claudette Dalton serve as Chair of the Southeastern Delegation (SED) to the AMA.  States represented range from New Jersey to Florida and westward to Oklahoma and have significant policy influence at the AMA.  Additionally, Dr. Larry Monahan is a member-at-large of the AMA Organized Medical Staff Section (OMSS) Governing Council.  Dr. Joel Bundy served on the reference committee for Amendments to Constitution and Bylaws.  Drs. Cyn Romero and Sterling Ransone participated in SED leadership training and I represent Virginia as Co-Chair of the SED Resolutions Committee.

We had two retiring Delegates; Drs. David Ellington and Hazle Konerding. It is with mixed emotion to wish them farewell, they have contributed significantly and will be missed!

I would like to acknowledge other members of our Delegation who attended this meeting.   They are Drs. Randy Gould (Chair), Tom Eppes, Cliff Deal, and Michele Nedelka.  MSV staff included Kaycee Ensign, Lauren Bates-Rowe, and Jenny Young.  Medical Students and Residents were Jon Taylor-Fishwick (EVMS), Matt Van de Graaf (EVMS), Meeta Prakash (VTC), Vaish Sridhar (VTC), Zoe Moyer (VCU), Josh Lesko MD, and Tim Parker MD.

Finally, we look forward to welcoming Dr. Alice Coombs-Tolbert to our Delegation in 2020. She also serves on the AMA Council of Medical Service.

Medical Society’s New President Preps for Assembly Session

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via Virginia Lawyer’s Weekly
By Maura Mazurowski

The Medical Society of Virginia will focus on Medicaid expansion and the elimination of “surprise billing” during the 2020 General Assembly session, according to the group’s new president.

Clifford L. Deal III, chief of surgery at Henrico Doctors’ Hospital, was installed as the 199th president of the physician advocacy group last month.

“Physicians must be involved in the overall execution of the healthcare plan, not just care at the bedside,” Deal said in his inaugural speech. “There has never been a more important time to be involved in organized medicine.”

In an interview with Virginia Lawyers Weekly, Deal shared his priorities for the 2020 legislative session, the group’s role in state politics and the responsibility of medical professionals to fight for health care that upholds physician values. He said that in recent years, Medicaid has gotten by on paying “unreasonable rates” that have not kept up with inflation. As a result, groups of physicians are becoming so economically challenged that they are unable to provide patient care.

“Ask somebody on Medicaid how hard it is to find a pediatrician in Richmond,” Deal said. “The options are limited…[Pediatricians] cannot spend the time they need for a sick child.”

Richmond lawyer and lobbyist Scott Johnson, who has been the MSV’s general counsel since 2002, also emphasized the importance of increased reimbursement rates for Medicaid providers.

“Hospitals two years ago got a bump up in their reimbursement, and certainly physicians would like to see equal treatment,” Johnson said. “Just making a penny or two increase isn’t going to do it; it needs to be an epic change and a meaningful increase.”

Another continuing issue from last year’s session is balance billing, or “surprise” billing, in which an out-of-network medical provider bills a patient for costs that are not paid by their insurance company. In 2019, Sen. Glen Sturtevant, R-Midlothian, introduced Senate Bill 1763 that would have prohibited balance billing for emergency care and required physicians be paid the regional commercial average directly.

The bill was killed. However, Deal anticipates it will be another topic of discussion at next year’s session.

“The society, the hospitals and the patients were united on one side of the legislation… insurance companies were on the other,” Johnson said. “That spectrum, if you will, was very telling to a lot of the legislators.”

Johnson said that in an ideal world, Congress would pass a bill that would “take patients out of the middle” and allow out of network providers and insurance companies to voluntarily negotiate a fair payment amount.

“The second thing is, if you don’t work it out voluntarily, you’ve got to look to some independent decision maker to help say what should be a fair payment,” Johnson said.

Virginia Democrats won majorities in both the House of Delegates and the Senate last week, giving Democrats full control of state government for the first time since 1994. However, Johnson said the election results are unlikely to impact the medical society’s goals for the upcoming Assembly session one way or the other.

“We’ve got a very strong relationship with both sides of the aisle,” Johnson said. “The white coat that physicians wear has a commonality that brings [legislators] together to do what’s best for the patient, and we’re going to work with whoever is in control at the time to do that.”

Johnson added that MSV and the Virginia Trial Lawyers Association are adamant about working together to see legislation passed.

“Years ago, the General Assembly basically said that if doctors and trial lawyers cannot be in agreement on something, they’re not going to pass any bills or take action,” Johnson said. “We try to make sure that neither association has something unless there’s adequate support regardless of political control.”

Deal, a practicing surgeon with more than 15 years of experience, took office at the annual MSV meeting at The Homestead in late October. According to Deal, his path to medicine was “a little nontraditional.” After graduating from the first coed class of Washington & Lee University, Deal spent four years commissioned in the Army. He started medical school at Virginia Commonwealth University Medical College of Virginia when he was 29 years old.

“I wanted to serve first. Then I got out and went to medical school, and that took me in this direction,” Deal said. “It’s a dream come true. Really.”

Founded in 1820, the MSV celebrates its 200th anniversary next year. In honor of the organization’s history, the MSV foundation will take a traveling exhibit throughout the state that will feature photos and facts of the group’s history and medical history in Virginia.

“We’re looking at what type of organization we want to be for the next 200 years,” said Jenny Young, director of membership at MSV. “You think about the physicians that started this 200 years ago, that had this dream and vision, and how we can continue that.”

Deal said that his favorite part about being a surgeon is the unique opportunity to participate in his patients’ lives.

“You’re helping to make a difference in an individual person’s life,” Deal said. “And that is a gift to feel like you do that every day.”

MSV is the voice for more than 30,000 medical professionals and students across the commonwealth since 1820. Headquartered in Richmond, the organization falls at the intersection of medicine and law, working to represent the interests of more than 30,000 medical professionals and students throughout the state to ensure that their needs – and the needs of their patients – are properly considered when legislators make the rules.

Deal’s presidency will continue until the MSV meeting in October 2020, where the group will have a formal 200th anniversary celebration.”