via VDH

Dear Colleague:

Respiratory virus season has started and the Centers for Disease Control and Prevention (CDC) predicts we will see a similar number of hospitalizations due to respiratory illness as last season. Please read below for updates on how to prepare for the upcoming season to help keep you and your patients healthy and safe.

Immunizations Available to Protect Against Three Major Respiratory Illnesses

Fortunately, we now have immunizations to protect against three major respiratory illnesses: respiratory syncytial virus (RSV), COVID-19, and influenza (flu). Please see VDH’s summary table on fall and winter immunizations that you can share with your patients. The VDH Respiratory Diseases in Virginia website provides clinical and communication resources, including the VDH Respiratory Disease Toolkit.

Thank you for your partnership in ensuring all eligible Virginians have access to these important immunizations. VDH administers the Virginia Vaccines for Adults – Bridge (VVAB) Program and the Virginia Vaccines for Children (VVFC) Program. The VVAB program ensures access to COVID-19 vaccines for under and uninsured adults in Virginia. The VVFC program ensures access to the CDC Advisory Committee on Immunization Practices (ACIP) routinely recommended vaccines for uninsured and Medicaid-enrolled children in Virginia. I encourage you to offer these immunizations in your office and enroll in these programs if applicable. To learn more about these programs, you can contact our team via the VDH Immunization Webpage.

FDA Advises Health Care Providers to Ensure Correct Moderna Vaccine Dosing

On November 1, 2023, the U.S. Food and Drug Administration (FDA) issued a MedWatch alert regarding the Moderna COVID-19 Vaccine (2023-2024 Formula) for children aged 6 months to 11 years. The single dose vial of the Moderna COVID-19 Vaccine for this age group contains notably more than the actual dose (.25 mL), and there is concern that some providers may administer the entire contents of the vial. Please work with your staff to ensure the correct amount of vaccine is withdrawn from the vial to ensure patients receive the correct dose. For more information, visit the FDA webpage.

CDC Provides Options for Clinicians in Response to a Limited Supply of Nirsevimab

On October 23, 2023, CDC issued a Health Alert Network (HAN) Health Advisory in response to a limited supply of nirsevimab, a monoclonal antibody product to protect infants and young children from lower respiratory tract infection caused by RSV. For the 2023–2024 RSV season there are not sufficient 100mg dose prefilled syringes of nirsevimab to protect all eligible infants weighing ≥5 kg and supply of the 50mg dose prefilled syringes might also be limited. Below is a summary of the CDC recommendations to protect infants from RSV during the shortage; please refer to the CDC Health Alert for complete detail:

• Prioritize 100mg doses of nirsevimab for infants at the highest risk for severe RSV disease: young infants (age <6 months) and infants with underlying conditions that place them at highest risk for severe RSV disease.
• Avoid using two 50mg doses for infants weighing ≥5 kilograms (≥11 pounds) to preserve supply of 50mg doses for infants weighing <5 kilograms (<11 pounds). Please note that some insurers may not cover the cost of two 50mg doses for an individual infant.
• Suspend using nirsevimab in palivizumab-eligible children aged 8–19 months during the current RSV season. These children should receive palivizumab per American Academy of Pediatrics recommendations.
• Continue to offer nirsevimab to American Indian and Alaska Native children aged 8–19 months who are not palivizumab-eligible and who live in remote regions, where transporting children with severe RSV for medical care is more challenging, or in areas with known high rates of RSV among older infants and toddlers.
• Discuss nirsevimab supply issues when educating pregnant people about RSVpreF vaccine (Abrysvo) as RSV vaccination during pregnancy is safe and effective (when given at 32-36 weeks) and will reduce the number of infants needing nirsevimab during the RSV season.

VDH Releases New Respiratory Disease Vaccine Dashboard and Weekly Activity Report

On November 14, 2023, VDH updated its COVID-19 vaccination dashboards to add a respiratory disease vaccine dashboard that displays both COVID-19 and influenza (flu) vaccine data. These dashboard updates will help Virginians more effectively monitor COVID-19 and flu vaccine protection for 2023–2024.

• The COVID-19 Vaccine Summary Dashboard now shows the total doses of 2023–2024 COVID-19 vaccine administered and the percentage of people in Virginia who have received a 2023–2024 COVID-19 vaccine. It will also display the vaccination rate per 100,000 people and a map displaying percentage of the population who has received a 2023–2024 COVID-19 vaccine by locality.
  • Dashboards with previous COVID-19 vaccines and the percentage of people vaccinated with a primary series and who are up to date on COVID-19 vaccines have been retired.
• The Respiratory Disease Vaccine Dashboard displays the percentage of people vaccinated with a 2023–2024 COVID-19 and/or 2023–2024 flu vaccine.

VDH also began publishing a weekly Respiratory Disease Report to provide a summary of key viral respiratory illness activity for COVID-19, flu, and RSV in Virginia. This report will be published weekly on Fridays on the Respiratory Disease webpage.

Thank you again for your continued partnership. Please visit the VDH website for current clinical and public health guidance on respiratory diseases in Virginia and other information.   

Sincerely,

Karen Shelton, MD
State Health Commissioner

The stories are not new, but they become more frequent every year. Nurses assaulted in the emergency room by a patient being evaluated for treatment, surgeons shot to death in their clinics, dental staff threatened by patients over wait times, hospital employees shot to death by coworkers in hospital stairwell, and countless others. While possible everywhere, emergency departments and behavioral health facilities are at the most risk for an incident to occur. According to the World Health Organization, it is estimated that between 8% and 38% of healthcare workers suffer physical violence at some point in their careers. Additionally, per the US Bureau of Labor Statistics, healthcare and social service workers were victims of 76% of all nonfatal injuries from workplace violence in 2020.

What is Workplace Violence?

The Occupational Safety and Health Administration (OSHA) defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. Workplace violence ranges from threats and verbal abuse to physical assaults and even homicide. Patients are the largest, but not the only source of violence as family members, visitors, intruders, or even coworkers are also potential instigators. Most incidents are created by systemic factors such as overcrowded areas, staff shortages, long wait times, inflexible visiting hours, and differences of language and culture. When healthcare workers require treatment or miss work because of an injury, employers’ workers’ compensation insurance (whether private or self-insured) will typically bear the expense of continuing to compensate the injured provider while away from work. Non-economic costs include provider stress, fatigue, burnout, and turnover, all of which have been shown to relate to decreased patient satisfaction and an increased risk of error.

Workplace Violence Prevention for Healthcare and Social Service Workers Act

On April 18, 2023, both the Senate and the House reintroduced the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 2663 and S 1176) that was previously considered in 2021 and 2019. It has been sent by both houses for committee review. The new legislation would require the Secretary of Labor to issue a standard requiring healthcare providers to write and implement a workplace violence prevention plan. If it becomes law, it will apply to many healthcare settings, including hospitals, psychiatric treatment facilities, and substance use disorder treatment centers. The requirements include unit-specific assessments and implementations of prevention measures, including:

• physical changes to the environment
• staffing for patient care and security
• hands-on training
• robust record-keeping requirements
• protections for employees to report workplace violence to their employer and law enforcement

Additionally, the Safety from Violence for Healthcare Employees Act, introduced in September, would make assaulting healthcare workers in hospitals a federal crime with enhanced penalties for assaults resulting in serious bodily injury.

Many states are also passing legislation surrounding workplace violence prevention in healthcare, including Virginia, which recently required every hospital to implement a heightened security plan with staffing of at least one off-duty police officer at all times, absent a waiver. Additionally, The Joint Commission revised workplace violence prevention requirements effective January 1, 2022. The increase in legislation and attention around workplace violence in healthcare recognizes that identifying risk factors and providing education can help to prevent or minimize incidents from occurring.

Hancock Daniel’s Security, Workplace Violence, and Crisis Management Team provides assistance in assessing or creating a compliant program for your organization. Our team provides the full continuum of services from risk assessment to crisis management as well as handling the legal, regulatory, and operational aspects resulting from safety related events occurring in the healthcare setting.

via Hancock Daniel.  Click here for a full PDF version of the advisory.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson, P.C., is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson, P.C. be liable for any direct, indirect, or consequential damages resulting from the use of this material.

The fall season brings with it the potential for government shutdown on October 1. We are seeing this play out this week as Congress has yet to pass any of the 12 FY2024 appropriations bills or a short-term spending bill (i.e., Continuing Resolution, or CR) to keep the government funded while Congress continues to work on a broader spending package. The Senate is expected to vote by Saturday on a CR that would fund the government until November 17. There are two CR proposals in the House—one to fund the government for 30 days and the other until January 11—but a vote has not been scheduled and may not be by the October 1 deadline.

Below are some highlights of the impact on key health policy areas in the event Congress does not pass a CR by midnight Saturday, September 30, and there is a government shutdown.

Congress

1. Congressional offices will remain open.

Medicare and Medicaid

1. The Centers for Medicare & Medicaid Services (CMS) will continue to process claims.
2. Physicians would not have to hold claims until the CR passes, but there could be a delay in payment if the shutdown is prolonged and funding to Medicare Administrative Contractors is delayed.
3. If the shutdown is prolonged, it is possible that the release of the Medicare physician fee schedule final rule, outpatient prospective payment system final rule, and other major regulations could be delayed.
4. Medicare benefits will not be affected.
5. Medicaid has full funding for the next three months.
6. Approximately half of CMS employees would be deemed essential and continue to work, although many would be unpaid until the shutdown ends.
7. CMS staffing levels may not be sufficient to respond to physicians’ questions about Medicare policies or scores under the Merit-based Incentive Payment System (MIPS).
8. Center for Medicare and Medicaid Innovation (CMMI) staff may continue to develop new alternative payment models, but any new model that CMMI plans to formally announce would likely be delayed.

Department of Health and Human Services (HHS)

1. HHS will use its authority under the Antideficiency Act (ADA) to maintain existing HHS activities, including research and vaccine and therapeutic development.
2. CMS will maintain the staff necessary to make payments to eligible states for the Children’s Health Insurance Program (CHIP).
3. CMS will continue Federal Exchange activities, such as eligibility verification, using Federal Exchange user fee carryover.
4. The Substance Abuse and Mental Health Services Administration (SAMHSA) will continue substance abuse and mental health programs, including those that provide critical behavioral health resources in the event of a natural   or human-caused disaster such as Disaster Behavioral Health response teams, the 24/7 365 day-a-year Disaster Distress Helpline that provides crisis counseling to people experiencing emotional distress after a disaster, and the 988/Suicide Lifeline to connect people in crisis with life-saving resources.
5. The Administration for Strategic Preparedness and Response (ASPR) will maintain the minimal readiness for all hazards, including COVID-19, pandemic flu, and hurricane responses.
6. The National Institutes of Health (NIH) will continue research and clinical activities.
7. The Food and Drug Administration (FDA) will continue to support drug and medical device reviews, as well as emergency use authorizations and countermeasures to fight the COVID-19 pandemic. FDA will also continue core functions to handle and respond to emergencies, such as monitoring for and quickly responding to outbreaks related to foodborne illness and the flu, supporting food and medical product recalls when products endanger consumers and patients, pursuing criminal and certain civil investigations when the public health is at risk, and screening the food and medical products that are imported to the U.S.
8. HHS will continue to protect human life and property, such as monitoring for disease outbreaks conducted by the Centers for Disease Control and Prevention (CDC).
9. CMS regulations and guidance related to the No Surprises Act, including the Independent Dispute Resolution process, could be delayed.
10. The Health Resources and Services Administration (HRSA) will continue to oversee many direct health services and other activities funded through carryover balances, such as the Ryan White HIV/AIDS program – Parts A and B and Ending the HIV Epidemic.
11. The Agency for Healthcare Research and Quality (AHRQ) will continue activities funded through the Patient-Centered Outcomes Research Trust Fund (PCORTF).
12. Advanced Research Projects Agency for Health (ARPA-H) is under a three-year appropriation; all of ARPA-H activities would continue during a lapse of appropriation.
13. The Indian Health Service (IHS) is under advance appropriations for FY 2024; the majority of IHS-funded programs will remain funded and operational in the event of a lapse of appropriation.

Miscellaneous

1. Supplemental Nutrition Assistance Program (SNAP) will continue at least through October.
2. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) could begin an immediate reduction in benefits a few days after the shutdown starts, although some states may be able to use extra funding to maintain funding for a week or two.
3. Student loan payments: The beginning of a government shutdown could coincide with the restart of federal student loan payments in the U.S. on Oct. 1, but borrowers will still have to make payments to their loan service providers.

National Physician Suicide Awareness Day (NPSA)—on Sept. 17—is a sobering reminder for physicians and others to ensure that we advocate for programs and initiatives to support physician health and wellness. Supporting physician wellness and reducing physician burnout are key elements of the AMA Recovery Plan for America’s Physicians.

Physicians have higher rates of death by suicide than the general population, and medical residents and students also experience depression at rates greater than the general population, according to the American Foundation for Suicide Prevention.

“AMA advocacy is focused on eliminating barriers that prevent physicians and medical students from seeking care for their own mental health,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “National Physician Suicide Awareness Day is an important reminder of the tragedies in our profession—it is time, however, for licensing boards, health systems and credentialing organizations to take additional actions to ensure that we can support our physicians’ health and wellness and help prevent our colleagues from dying by suicide.”

Part of the AMA’s advocacy to support physician wellness has been direct engagement with state medical boards, hospitals and health systems to remove stigmatizing questions on applications related to mental health and substance use disorders. The AMA has worked with several dozen medical boards, hospitals and health systems alongside the Dr. Lorna Breen Heroes’ Foundation (PDF) and the Federation of State Medical Boards to urge boards and others to review, revise and/or remove all questions that may deter physicians from seeking treatment for mental illness or substance use disorder. In addition, the AMA has worked closely with the Medical Society of Virginia and Virginia Healthcare and Hospital Association to challenge all Virginia hospitals to ensure their credentialing applications are consistent with recommendations from the AMA, Federation of State Medical Boards and Dr. Lorna Breen Heroes’ Foundation…

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Quality Insights, a healthcare organization committed to improving healthcare and promoting health equity, recently celebrated its 50th anniversary by launching a grant program aimed at supporting innovative projects. After reviewing submissions, Quality Insights selected six winners who will collectively receive more than $100,000.

Quality Insights CEO, Sven T. Berg, M.D., expressed his gratitude to all applicants while congratulating the winners and looking forward to the successful implementation of their grants.

“We were impressed with the quality of all the applicants. These decisions were difficult to make, but we are thrilled to support these innovative programs that will make a significant difference in health and healthcare,” said Berg.

The winners of the grant program include:

• Lori’s Hands Charm City Scholars Initiative, Baltimore, MD, will create specialized, stipend internships for black, indigenous, people of color (BIPOC), low-income, and/or first-generation college students who are pursuing careers in healthcare. Interns will advance Lori’s Hands’ unique community health service learning model that provides instrumental and social support to community members.
• The Medical Society of Virginia Foundation, SafeHaven™ Coaching Network, Richmond, VA, will bolster the health and wellness coaching resources available to the healthcare community, building a foundation of peer health and wellness coaches for and increasing access to confidential and protected well-being coaching services.
• Literacy Delaware, Demystifying the Healthcare Journey, Wilmington, DE, will develop a health literacy education program for dialysis patients and their families to close the health equity gap.
• Think Kids, West Virginia Wraparound Intensive Support in Enrollment (WV WISE), Charleston, WV, will create a model of person-centered benefits enrollment assistance that overcomes stigma and galvanizes local programs to address health disparities.
• Grassroots Health, College Athlete Health Education Program for Middle School Students, Baltimore, MD/Philadelphia, PA, will recruit and train 100 college athletes to deliver weekly sports-based health education modules in under-resourced middle schools, an investment in both preventive health education for middle school youth and volunteer/peer training in a health-related field for college student volunteer program facilitators.
• West Virginia Osteopathic School of Medicine, Women Interested in Staying Healthy (WISH), Lewisburg, WV, will provide support, encouragement, nutrition education, and exercise opportunities for women in Greenbrier County, incorporating a professional dietician, a professional strength trainer/exercise physiologist, and physician counseling on weight loss and healthy lifestyle.

The grant program is part of Quality Insights’ commitment to improving healthcare and closing the health equity gap. The organization believes that by investing in innovative programs, it can make a significant impact in the lives of individuals and communities.

About Quality Insights

Founded in 1973, Quality Insights is celebrating 50 years of using quality improvement science, education and collaboration to develop and bring best practices to healthcare settings and communities. Learn more at www.qualityinsights.org.