Maui Support Page Published to Keep Informed

Marc Alexander, Executive Director of the Hawaii Medical Association (HMA), based in Honolulu, thanks everyone for the emails and messages of concern about the Maui fire disaster. HMA President, Dr. Angela Pratt, and her team have been ensuring open communications with various entities. HMA's President-Elect, Dr. Elizabeth Ignacio, lives on Maui and is in the thick of things. HMA is in direct communication with the incident commander, as well as the Governor's office and Maui Mayor's office, ready to assist.

HMA has published a Maui Support Page that is being regularly updated, several times daily, as news and additional resources become available. Bookmark the Maui Support page to keep apprised of the disaster. Several news outlets are linked, as are donation pages.

At this time, HMA has been asked to gather names of additional physicians who may be able to assist, but there is a need to wait patiently for when that need arises. There is a need for coordination of individuals and organizations through the chain of command, including FEMA, the Red Cross, and Maui Strong. If you would like to be added to the volunteer list, please email Mark Conching at HMA. Include a contact phone number and email, along with your specialty. The list of volunteers will be forwarded to the Hawaii Emergency Management Agency and they will contact volunteers directly, if needed. Find more details about donating and/or volunteering on the Maui Support Page.

The road to recovery will be long. HMA has advised that the best supports currently are cash, patience, and yes, prayers. Mahalo for all your support. Photo credit to Hawaii News Now.

Supreme Court: Any New Restrictions On Hold While Litigation Continues

A federal appeals court on Wednesday upheld abortion pill restrictions indicating the US Food and Drug Administration (FDA) did not follow the proper process when it loosened regulations in 2016 to make the pill mifepristone more easily available. The FDA's decisions to allow the drug to be taken later in pregnancy, be mailed directly to patients, and be prescribed by a medical professional other than a physician were not lawful, according to a three-judge panel. Mifepristone is used in more than half of US abortions. For now, access to mifepristone will not change. The Supreme Court indicated that any new restrictions would be on hold while litigation continues. The FDA's 2019 approval of a generic version of mifepristone, made by GenBioPro, will be left in place and also be available under the same conditions. The main impact of the appeals court decision, if it is upheld by the Supreme Court, would be that the drug can be taken up to seven weeks into a pregnancy, rather than 10, and can only be prescribed by physicians. It must also be dispensed in person, instead of by mail or telemedicine. The Biden administration indicated it would appeal and major medical associations, such as the American Medical Association and the American College of Obstetricians and Gynecologists have stated that pulling mifepristone off the market would harm patients by forcing them to undergo more invasive surgical abortions.

Court Withdraws Price Increase

The U.S. District Court for the Eastern District of Texas issued an opinion and order in Texas Medical Association (TMA) v. United States Department of Health and Human Services that vacates the $350 administrative fee established by the Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process Under the No Surprises Act (NSA): Change in Administrative Fee issued on December 23, 2022. As a result of the TMA IV opinion and order striking down the administrative fee increase, the administrative fee reverts to the amount established, a $50 non-refundable administrative fee for initiating a payment dispute under the No Surprises Act. The amendment had increased the fee from $50 to $350 per party per dispute at the start of 2023.

Physician Practice Information (PPI) Survey Sent to Thousands of US Doctors

Thousands of U.S. physicians will be getting a short patient-care hours survey from either their practice directly or from Mathematica. The aim of the Physician Practice Information (PPI) Survey is to better understand the costs faced by today’s physician practices to support physician payment reform. Participation will ensure that practice expenses and patient-care hours are accurately reflected. Read more.

H.R. 5013 Helps Facilitate Greater Participation in APMs

The American Medical Association (AMA) continues to press Congress to make key legislative changes that will help facilitate greater physician participation in Alternative Payment Models (APMs), which reimburse providers based on quality and care coordination as opposed to the number of services delivered to patients. The Value in Health Care Act (H.R. 5013) is bipartisan legislation which would extend the 5% APM incentive payments for two years and freeze the 50% revenue threshold needed to qualify for the bonus. Read more.

H.R. 4968 Reintroduced

This important bipartisan legislation exempts physicians from Medicare Advantage plan prior authorization requirements so long as 90% of the physician's pre-certification requests were approved in the preceding twelve months. Read more.

H.R. 4942, the Conrad State 30 and Physician Access Reauthorization Act

Absent congressional activity, the Conrad 30 program expires on Oct. 1. With the United States facing an ongoing shortage of physicians, especially in rural and underserved areas, and an underlying need to diversify the workforce, the American Medical Association (AMA) is urging the House to pass this legislation. Read more.

Deadline for Submitting Update Billing Information is September 1st

The Centers for Medicare & Medicaid Services (CMS) is disbursing incentive payments to physicians and other health care professionals who qualified for them through their participation in Advanced Alternative Payment Models (APMs) during 2021. Updated billing information must be sent to CMS no later than Sept. 1, 2023, to receive the incentive payment. Read more.

To Support Research to Reduce Pregnancy-Related Complications, Deaths

The National Institutes of Health (NIH) announced it has awarded $24 million in first-year funding to establish Maternal Health Research Centers of Excellence. Part of NIH’s Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative, the centers will develop and evaluate innovative approaches to reduce pregnancy-related complications and deaths and promote maternal health equity. The grants are expected to last seven years and total an estimated $168 million, pending the availability of funds.

High Rates of Procedural-Based Terminations

According to Centers for Medicare and Medicaid Services (CMS) data, so far 2.2 million Medicaid/CHIP enrollees have gone through the renewal process in 18 states that completed renewals during the first month of the unwinding—April 2023. Just over one million (45.5%) had their coverage renewed while more than 700,000 (32.2%) had their coverage terminated. 22% of cases were still pending. Delaware disenrollments began in July. Read more.

Get the Most Current List of Codes, Payment Allowances, Effective Dates

The US Food and Drug Administration (FDA) announced more vaccines that are no longer authorized for use in the U.S. Medicare doesn’t pay for the following CPT codes effective:

• June 1, 2023, Janssen: 0031A, 0034A, and 91303

• April 18, 2023, Moderna: 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 91301, 91306, 91309, and 91311

• April 18, 2023, Pfizer: 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 91300, 91305, 91307, and 91308



Visit the COVID-19 Vaccine Provider Toolkit for more information, and get the most current list of billing codes, payment allowances, and effective dates. Note: You may need to refresh your browser if you recently visited these webpages.

Automatically Applies Coupons for Insulin and Diabetes Medicines

Amazon announced on Tuesday this week that its online pharmacy will automatically apply manufacturer-sponsored coupons to more than 15 insulin and diabetes medicines to help patients access discounts pledged by the drug industry. Amazon Pharmacy patients will no longer have to search for and manually enter coupons from the three largest insulin makers, Novo Nordisk, Eli Lilly, and Sanofi, to lower the cost of their insulin to as little as $35 for a month’s supply. Additionally, available discounts will automatically be applied to diabetes-related medical devices from manufacturers Dexcom and Insulet, including continuous glucose monitors and pumps, as well as to other cardiometabolic medicines such as Novo’s weight-loss drug Wegovy. 

Removing Cancer Treatment Misinformation

YouTube announced it will streamline dozens of its existing medical misinformation guidelines to fall under three categories – Prevention, Treatment, and Denial. These policies will apply to specific health conditions, treatments, and substances where content contradicts local health authorities or the World Health Organization (WHO). Also, starting this week and ramping up in the coming weeks, they will begin removing content that promotes cancer treatments proven to be harmful or ineffective, or content that discourages viewers from seeking professional medical treatment. This includes content that promotes unproven treatments in place of approved care or as a guaranteed cure, and treatments that have been specifically deemed harmful by health authorities.

Findings published in JAMA Network Open suggest that only a small percentage of practicing physicians actually disseminate misinformation about COVID-19 on social medial platforms. This information is primarily related to vaccine safety, efficacy, and unfounded treatments, with some promoting conspiracy theories about the virus' origin.

Bringing the Joy Back into Medicine

It’s easy for patients to come across bad information about vaccinations. Fortunately, a physician’s recommendation still carries more weight than something found on the internet or heard from a friend. Physicians should ensure their entire team is prepared to address common patient questions and concerns about vaccinations—and reinforce the message that vaccines are safe, necessary and effective. 



LEARN MORE:

• Toolkit: Adult Vaccinations
• Resource: CDC’s Frequently Asked Questions about COVID-19 Vaccination
• Webinar: Marie Brown, MD, Discusses Vaccination Hesitancy
• Success story: Student Health Ambassadors Help Overcome Vaccination Disparities

Updated FDA Safety Communication

Today, the U.S. Food and Drug Administration (FDA) provided an update to the list of ultraviolet (UV) wand products that may present a potential risk of injury. Do not use these UV wands because they may expose the user or any nearby person to unsafe levels of ultraviolet-C (UV-C) radiation and may cause injury to the skin, eyes, or both after a few seconds of use. 

Expanding Mental Health Benefits

In the past few years, many employers have expanded their company’s mental health benefits as a show of support for potential jobseekers, employees, and their families. The intention is to help promote employee wellbeing through better access and improved benefit levels for those feeling stressed about personal or work-life matters. By addressing issues like stress and anxiety in a more proactive fashion, employers can reduce or even eliminate costly treatment for conditions such as hypertension, diabetes, and cardiac problems. The small financial investment the employer makes now (by incorporating methods like telehealth, expanding access to in-network mental health professionals, reducing cost sharing for mental health services, adding/expanding employee assistance programs, and providing apps that support wellness) can often save substantial costs in the future. The Medical Society of Delaware Insurance Services offers its members access to My Benefit Advisor as a solution for employee benefits, including voluntary offerings. For more information about My Benefit Advisor, visit their website at www.mybenefitadvisor.com or contact Sharon Ruth at (302) 397-0173.

It Is Life Changing for Medical Students Donning Them for the First Time

A short white coat may not seem like a life-changing article of attire, but for medical students donning them for the first time as they begin their physician training, it is exactly that. The short white coat is a steppingstone to the longer white coat many students progress to at the completion of their degree. It also symbolizes professionalism, caring and trust, which medical students must earn from patients, according to an essay providing historical perspective on the doctor’s white coat that was published in the AMA Journal of Ethics. Read more.

Consider a Donation to DFMS or DMEF

The 2023 Annual MSD Mission Appeal is under way!  Your generous support allows MSD to provide advocacy, representation, public service, and education to equip doctors with the tools they need to keep our communities healthy. MSD has been working diligently this year on strategic legislation, critical resolutions with the AMA, targeted education, and improving the lives of those in the community. You should have received a letter from us detailing key highlights from 2023. The letter highlights the efforts across the organization to promote the practice and profession of medicine to enhance the health of our communities. Now is the time to support the Annual MSD Mission Appeal to ensure programmatic viability and sustainability. Please consider a donation to Delaware Foundation for Medical Services (DFMS) or Delaware Medical Education Foundation (DMEF). Thank you to all who have already supported the 2023 Mission Appeal. For questions, please contact Lisa Gruss, External Affairs and Development Officer at Lisa.Gruss@medsocdel.org or (302) 893-3907. 

Save on Your Yearly MSD Membership Renewal by Applying

Hospitals, physician practice groups, and affinity groups can take advantage of MSD's group membership renewal discount program and save money on the 2024 regular membership dues! Discounts are applied to those membership categories that are not already discounted. Solo practitioners - get creative and form your own network of physicians to qualify (such as your call group). All physicians within the group must be members of MSD to qualify. Eligibility for the group discount is contingent upon membership application approval for those who are not currently members. Groups must be enrolled in the program by 4pm on Friday October 13, 2023. Groups who participated in the program in previous years must re-enroll annually. If your group is interested, contact Michelle.Seymour@medsocdel.org or (302) 224-4905 for details and to start the enrollment process. Download the enrollment form for the 2024 membership cycle. (Note: one enrollment form is for Hospitals and one is for Private Practices.)

Beebe Healthcare

Robert H. Radnich, MD

MSD has learned that member Robert Hays Radnich MD, formerly of Dover, Delaware, passed away on April 5, 2023, at The Country House in Wilmington, Delaware. He was 81 years old. He attended Baylor College of Medicine in Houston, Texas where he earned his medical degree. He then began his US Naval career. Dr. Radnich completed his internship at the US Naval Hospital in Portsmouth, Virginia; followed by a tour of duty at The National Regional Medical Center in Bethesda, Maryland where he first started practicing as an OB-GYN. His next assignment was at the Regional Medical Center, in Jacksonville, Florida, where he resigned from the Navy in 1976 after attaining the rank of Commander. In 1980, Dr. Radnich and his family moved to Dover, Delaware, where he became a partner in the Dedicated to Women Group. He practiced OB-GYN at Bayhealth, Kent General Hospital for 31 years, retiring in 2011. Following his retirement, he enjoyed traveling with his spouse, Diane, both stateside and abroad, participating in many classes through OSHER Life Long Learning, reading history books and honing his culinary skills. Burial to take place at Arlington National Cemetery with military honors. Read obituary.

Bradlee J. Palmquist, DO

MSD spotlights members throughout the state, highlighting medical students, residents, and practicing colleagues, whether they are new to membership or have been a member over the years.

This week's spotlight is on Bradlee J. Palmquist, DO, Internal Medicine Resident at Bayhealth. Read more about Dr. Palmquist.

If you would like to be featured in a future Member Spotlight, please contact Michelle Seymour, Manager of Membership.

Monica Javadian, MD - Family Medicine Residency, Beebe Healthcare

Sofia F. Perez Delgado, DO - Family Medicine Residency, Beebe Healthcare

Catherine Zorc, MD - Nemours Children's Health, Saint Francis Healthcare

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Shazia Aziz, MD, Cardiovascular Disease Fellowship, ChristianaCare

Awele Maduka-Ezeh, MD, MPH, ID/IM, Delaware Department of Correction

Dakota M. Urban, MD, Plastic Surgery, Dakota M. Urban, MD, PA

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information.

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• 2nd bivalent COVID-19 Vaccine Booster: Who Should Receive It?
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)