Medical Staff Voice – September 21, 2020

CMHS Updates – Please remember that information changes daily in our dynamic environment

  1. New, faster App for Screening Process for entering the Hospital. Please see below for details.
  2. With COVID census coming down, 5 E will admit more Telemetry patients.  All rooms on 5E are negative pressure.
  3. The CDC has reversed their recommendation, now saying that anyone exposed to an infected person for more than 15 minutes needs a test. An earlier guideline said it might not be necessary.
  4. CMHS COVID Taskforce:
    1. Universal PCR reference lab testing initiated for all CMHS admissions.
    2. Remdesiver use will be extended to early inpatient COVID, in addition to moderate and severe. FDA Remdesivir Emergency Use Auth. link
  5. Dr. Jeff Brackett continues to update the Medical Staff at the weekly Monday, 7:30 am  COVID-19 briefings via Teams. To be added to the meeting contact Martina Longobardi in the Medical Staff Office at (805) 948-2201.
  6. Current COVID-19 PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to our reference lab. We are also using antigen and antibody testing when clinically indicated. The complex nature of which testing modality is used is dependent on test quantity availability, clinical context and indications as well as specialist review. Please continue to order Pre-op testing 4 days prior to surgery.
  7. Please send in-patients home with prescriptions generated electronically via PatientKeeper, rather than hand written.  We are currently at 25% electronic prescriptions and must achieve a much higher percentage in order to comply with meaningful use requirements to avoid monetary penalties.
  8. Cottage Health has opened two Urgent Care centers in Oxnard, one in Camarillo and opening one on Victoria at the Ralph’s shopping center in Ventura. If you desire referrals from the Urgent Care centers send me an email with the title: Urgent Care referrals.

JW Moore Tuesday, Noon, CME Conference – “Diets, Herbs, Supplements and Cardiovascular Disease: What Really Works?”

C. Noel Bairey Merz, M.D., Cedars-Sinai Smidt Heart Institute, will present a lecture on “Diets, Herbs, Supplements and Cardiovascular Disease: What Really Works?” At the end of the conference, the learner should be able to: 1) Review concepts including Diet and Nutrition, 2) Improve knowledge regarding the role of Diet and Nutrition in CVD, and 3) Review the evidence regarding the use of Diet and Nutrition to treat CVD.

The conference will take place on September 22, 2020, at noon, via Microsoft Teams. AMA PRA Category 1 Credit™ & AOA Category 1-A CME credit will be available. If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Electronic COVID Screening Day Pass to the Hospital

Beginning on Tuesday, September 15, 2020 we are introducing an electronic option for your daily COVID Screening Pass. This new option provides a faster way to complete the screening process and allows you to have your daily pass available on your mobile device.

Daily instructions for accessing the electronic screening pass:

  1. From your mobile device text the word “screen” to 80976.
  2. You will receive a text message with a link, click on the link.
  3. Enter your first and last name (as worded on your employee badge)
  4. Answer the two (2) screening questions regarding COVID-19 symptoms and exposure.
  5. Click the submit button.
  6. You will receive another text message with a second link.
  7. Click on the link to access your daily pass (Do not take a screenshot of your pass).

Key Points

  • Screening Day Pass is good for 24 hours.
  • You can complete the electronic screening before you arrive to work.
  • CMHS Screeners will verify your identity by reviewing your employee badge.
  • You will still have your temperature taken.
  • Screenshots of your Screening Day Pass will not be accepted.
  • Standard messaging and data rates may apply.
  • Traditional paper screening forms or wrist bands will still be available.

For any questions or concerns, please contact the Employee Occupational Health Department at (805) 948-2886. Thank you.

Medical Staff Flu Vaccine Policy and Free Clinics

It is the policy of Community Memorial Health System to require proof of Influenza Vaccine administration or a signed declination form of all physicians and Allied Health Professionals annually in accordance with the CA Department of Public Health’s recommendation.  All Medical Staff and Allied Health Professional Staff members will be required to submit proof of vaccination or a completed Influenza Vaccine declination form.  If you wish to decline the vaccine please complete, sign and return the attached declination form to the Medical Staff Office.

Influenza Vaccines are available through the hospital’s Occupational Health Department, or may be done at another healthcare facility.  Below is this week’s CMHS Flu Vaccination Clinic schedule.  If you have any questions regarding the clinics, the Occupational Health Department  can be reached at (805) 948-2886.  If you choose to have your flu vaccine administered at a non-CMHS clinic please provide a copy of your vaccination record to the Medical Staff Office and pick up the green hologram security sticker to affix to your badge.

You can fax your Influenza Vaccine record to fax number 805-648-4295 or e-mail CREDENTIALS@CMHSHEALTH.ORG

 It is important to note that Flu vaccine documentation or a signed declination must be received by October 31, 2020.
If you have any questions, please feel free to call us at (805) 948-5662.

CMHS Flu Vaccine Clinics for the Public

CMHS Weekly Medical Staff Calendar – September 21 – 25

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update
for Medical Staff - Teams
12:00 pm Cancer Cmte –
Teams
12:00 pm JWM Education Conf - Virtual
5:30 pm CMHS Credentials Cmte- BR &
Teams
5:30 pm Surgery Cmte – NA & Teams
12:00 pm General CA Conf – Teams
12:00 pm Bioethics Cmte – NA & Teams
6:30 am HIM Cmte -Teams
5:30 pm COVID19 Task Force Meeting - Teams

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“Some people are always grumbling because roses have thorns; I am thankful that thorns have roses.”
– Alphonse Karr

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – September 14, 2020 – corrected JW Moore CME lecture

CMHS Updates – Please remember that information changes daily in our dynamic environment

  1. CMHS COVID Taskforce:
    1. Universal PCR reference lab testing initiated for all CMHS admissions.
    2. Remdesiver use will be extended to early inpatient COVID, in addition to moderate and severe. FDA Remdesivir Emergency Use Auth. link
    3. Less use of Convalescent Plasma Transfusions based on recent data associated with lack of efficacy.
    4. Limiting use of COVID serology based on recent recommendations.
  2. Dr. Jeff Brackett continues to update the Medical Staff at the weekly Monday, 7:30 am  COVID-19 briefings via Teams. To be added to the meeting contact Martina Longobardi in the Medical Staff Office at (805) 948-2201.
  3. Current COVID-19 PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to our reference lab. We are also using antigen and antibody testing when clinically indicated. The complex nature of which testing modality is used is dependent on test quantity availability, clinical context and indications as well as specialist review. Please continue to order Pre-op testing 4 days prior to surgery.
  4. Please send in-patients home with prescriptions generated electronically via PatientKeeper, rather than hand written.  We are currently at 25% electronic prescriptions and must achieve a much higher percentage in order to comply with meaningful use requirements to avoid monetary penalties.
  5. CMH inpatient COVID census showing steady decrease in cases.
  6. Cottage Health has opened two Urgent Care centers in Oxnard, one in Camarillo and opening one on Victoria at the Ralph’s shopping center in Ventura.

CMHS Quarterly General Medical Staff Meeting

Join Microsoft Teams Meeting
+1 805-724-0209   United States, Santa Barbara (Toll
Conference ID: 444 737 741#
Local numbers | Reset PIN | Learn more about Teams | Meeting options
Call 805 948-5090, Helpdesk, for any issues achieving a connection to the meeting.

JW Moore Tuesday, Tuesday ,Noon, CME Conference “Stereotactic Ablative Radiotherapy: Techniques & Applications”

Steven Lau, M.D., Ph.D.; Coastal Radiation Oncology will present a lecture on “Stereotactic Ablative Radiotherapy: Techniques & Applications.” At the end of the conference, the learner should be able to: 1) Differentiate stereotactic ablative radiotherapy & conventional radiotherapy techniques, 2) Assess the role of SAbR in modern oncologic paradigms and 3) Interpret the advantages, disadvantages and outcomes of SAbR.
The conference will take place on September 15, 2020, at noon, via Microsoft Teams.
This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Mobile Heartbeat – Do Not Download Android Update

Android has released a new software update as of September 8, 2020. Please DO NOT  take this upgrade. This is not compatible with Mobile Heartbeat at this time. If there are any questions please call the HelpDesk (805 652-5090). The expectation is that compatibility will occur sometime over the next few weeks.

Hydralazine shortage

There is a new hydralazine injectable shortage. Currently, there are 325 hydralazine injection vials throughout the CMH Pyxis machines. The shortage is expected through mid-October. There is a chance our current supply could last us through the next 4-6 weeks with conservative use.
Review of injectable antihypertensive agents:

  • Evaluate if elevated BP needs urgent treatment.
  • Consider what department will be administering medications.
  • Enalaprilat injection is available, and this can be IVP’d on all floors.
  • Metoprolol injection use may increase, but please remember that this is not recommended as maintenance therapy for HTN and can only be IVP’d on Tele, PCU, and Critical Care areas.
  • Propranolol injection – minimal effect on BP, better as an antiarrythmic.
  • Diltiazem or verapamil inj – will decrease BP initially, possibly up to 3 hrs. But rhythm and conduction disturbances outweigh benefits. Reserve for situations where effects on SA or AV nodes are desired and ECG monitoring is available.
  • Nicardipine injection – may be used for postop HTN, severe HTN. Monitor BP before and after doses. ECG not required.
  • NTG, labetalol, nitroprusside  – common for HTN crisis or severe HTN.
  • Diuretics
  • Oral hydralazine is not a good alternative option for urgent scenarios due to the much longer initial response.

References:

  1. https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=431
  2. https://pubmed.ncbi.nlm.nih.gov/7552893/#:~:text=Little%20information%20on%20the%20comparative,medications%20for%20controlling%20chronic%20hypertension

A Special Shout Out to our Unsung Heroes – Environmental Services – CMHS

Suicide Prevention Month – Save This Number

New COVID Deaths – USA compared to European

CMHS Weekly Medical Staff Calendar – September 14 – 18

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update
for Medical Staff - Teams
12:00 pm JWM Education Conf - Virtual
4:30 pm Anesth Dept – BR & Teams
6:00 pm Quarterly General Staff Meeting.
- Teams
7:45 am- Pediatrics Dept.-NA & Teams
12:00 pm General CA Conf – Teams
12:00 pm UR Committee- NA & Teams
12:00 pm Radiation Safety/Radiology
Division – NA & Teams
5:30 pm COVID19 Task Force Meeting – Teams
5:30 pm Orthopedic Division – BR & Teams
Rosh Hashanah (sundown)

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“It is not in the stars to hold our destiny but in ourselves.”
William Shakespeare

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – Special Edition – September 10, 2020

This special edition of the Medical Staff Voice is published in response to a number of time sensitive announcements. You should be able to print the individual announcements from the Blog Site. The link to the blog site is found at the bottom of this newsletter.

Quarterly Medical Staff Meeting

Join Microsoft Teams Meeting
+1 805-724-0209   United States, Santa Barbara (Toll
Conference ID: 444 737 741#
Local numbers | Reset PIN | Learn more about Teams | Meeting options

 

Flu Vaccines for Medical Staff – September 2020

Code Stroke Protocol

COVID Admission Isolation Algorithm

Breast Center Awareness month

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – September 7, 2020

CMHS Updates – Please remember that information changes daily in our dynamic environment

  1. CMHS COVID Taskforce meeting consensus last week:
    1. Universal PCR reference lab testing initiated for all CMHS admissions.
    2. Remdesiver use will be extended to early inpatient COVID, in addition to moderate and severe. FDA Remdesivir Emergency Use Auth. link
    3. Less use of Convalescent Plasma Transfusions based on recent data associated with lack of efficacy.
    4. Limiting use of COVID serology based on recent recommendations.
  2. Dr. Jeff Brackett continues to update the Medical Staff at the weekly Monday, 7:30 am  COVID-19 briefings via Teams. To be added to the meeting contact Martina Longobardi in the Medical Staff Office at (805) 948-2201.
  3. Current COVID-19 PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to our reference lab. We are also using antigen and antibody testing when clinically indicated. The complex nature of which testing modality is used is dependent on test quantity availability, clinical context and indications as well as specialist review. Please continue to order Pre-op testing 4 days prior to surgery.
  4. Please send in-patients home with prescriptions generated electronically via PatientKeeper, rather than hand written.  We are currently at 25% electronic prescriptions and must achieve a much higher percentage in order to comply with meaningful use requirements to avoid monetary penalties.
  5. The anesthesiologists wish to remind physicians seeking intubation consultation or other anesthesia services to make every effort to communicate directly with the anesthesiologist.

JW Moore Tuesday, Tuesday ,Noon, CME Conference -“Relaxation on the Run for Doctors & Patients: Stress Reduction for Busy People”

Jay Winner, M.D.; Family Practitioner, Sansum Clinic, Santa Barbara, will present a lecture on -“Relaxation on the Run for Doctors & Patients: Stress Reduction for Busy People.” At the end of the conference, the learner should be able to: 1) Explain the impact physician stress has on medical practice, 2) Recognize the impact of patient distress on almost any medical problem, 3) Apply mindfulness techniques to reduce stress in practice, and 4) Reframe to reduce frustration.

The conference will take place on September 8, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit. If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Letter of Gratitude for One of our Physicians – Dr. Hebard (received this week)

Hello Ladies, hope all is well. I wanted to take a minute to express my profound gratitude for Dr. Hebard, Kaiser ENT. 

Last night Dr. Menz needed emergent assistance from ENT during a bed side procedure.  Given the nature of the emergency Dr. Hebard was called directly to his cell phone after his call hours and within minutes he was at the patients bedside in the OR. 
I want to bring this to light because this is not the first time Dr. Hebard comes in during an emergency after his call hours. He always answers his cellphone and without hesitation he asks to speak with the referring physician. In multiple occasions Dr. Hebard was at the patients bedside within minutes of reaching out to him for assistance after his call hours. 
He is a great asset not only to our hospital, but our community.  
– Yolanda G Alvarez

 

CMS Launches Consolidated Care Compare for Patients Making Health Care Decisions – September 3, 2020

Improved tool makes it easier for patients to find important information when shopping for health care services

The Centers for Medicare & Medicaid Services (CMS) launched Care Compare, a streamlined redesign of eight existing CMS healthcare compare tools available on Medicare.gov. Care Compare provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools.

This actually looks like a successful effort in helping patients and families with a friendlier user interface located in a single site rather than three separate prior sites.
– SF

CMS Updates Medicare COVID-19 Snapshot

The Centers for Medicare & Medicaid Services (CMS) released our August monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 773,000 COVID-19 cases among the Medicare population and nearly 215,000 COVID-19 hospitalizations.

Other key findings:

  • The rate of COVID-19 cases among Medicare beneficiaries grew 40% since the July release to 1,208 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 33% since the July release to 338 hospitalizations per 100,000 beneficiaries.
  • Weekly counts of COVID-19 cases and hospitalizations reached the lowest point to date in late June and began to increase in July.
  • The rate of COVID-19 cases and hospitalizations grew the most among disabled beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $3.5 billion or just over $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the July release. 29% of beneficiaries went home at the end of their hospital stay and 24% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.

The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to July 18, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by August 14, 2020.

For more information on the Medicare COVID-19 data, visit: https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

For an FAQ on this data release, visit: https://www.cms.gov/files/document/medicare-covid-19-data-snapshot-faqs.pdf

HIPAA in Jeopardy Survey

A new study suggests our medical confidentiality may not be as safe as we thought. Almost half of future healthcare employees said they would violate HIPAA if offered monetary incentives. Find out what kind of incentives would influence future healthcare employees to expose medical records to friends or the media. Click on link:
What HIPAA law? Study finds future healthcare employees would consider violating privacy laws for cash

A 3rd US Pandemic Surge, now in College counties

COVID-19 patients suffer long-term lung and heart damage but it can improve with time and prompt rehabilitation

Link to above study

Dr. Paul Garner on long haul COVID-19 – Don’t try to dominate this virus, accommodate it

“Has covid-19 gone?” My first thought every morning for six months. A few weeks ago, I was jubilant. The muscle aches had evaporated, my head was clear. I announced this to Rachael, a friend who knows chronic fatigue well. “Fantastic, Paul. You have found your baseline.” Crestfallen, I realised this was not the end; it was the end of the beginning.
Link to full BMJ article

Dear Commissioner Hahn: Tell the Truth or Resign

An Open Letter to Stephen Hahn, MD, From Eric Topol, MD

Dear Dr. Hahn,

I’m writing because I’m gravely concerned about your leadership of the Food and Drug Administration (FDA). The circumstances of your statements in recent days has led to a crisis in confidence. Not only has your credibility been diminished but so has that of the FDA, its 15,000-plus staff members, and, most importantly, your ability to oversee the health interests of the American people.
Link to full letter

CDC/FDA Declining Credibility tweet by Dr. Atul Gawande

Bit by bit, the FDA & CDC’s strengths have been pecked away to insure fealty to the President instead of the people. The damage will take years to undo. For those who devoted our lives to serving the health of those people, I cannot express how difficult seeing this is.
– @Atul_Gawande

FDA  Vaccine Fast-Track


The Onion

CMHS Weekly Medical Staff Calendar – September 7 – 11

MondayTuesdayWednesdayThursdayFriday
Labor Day12:00 pm JWM Education Conf -Virtual
5:00 pm Medicine Cmte – NA & Teams
12:00 pm General CA Conf – Teams
12:15 pm OB/GYN Cmte – NA & Teams
12:00 pm QA & Patient Safety Cmte– Teams
12:15 pm Cardiology Division – NA & Teams
5:30 pm COVID19 Task Force Meeting - Teams
7:30 am OVCH ED
Subcommittee - Teams

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“We cannot change anything until we accept it. Condemnation does not liberate, it oppresses.”
– 
Carl Jung

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – August 31, 2020

CMHS Updates – Please remember that information changes daily in our dynamic environment

  1. The anesthesiologists wish to remind physicians seeking intubation consultation or other anesthesia services to make every effort to communicate directly with the anesthesiologist.
  2. Starting Sept 17th – Postoperative TAVRs will be recovering in the PCU, instead of ICU. This change is being implemented by Dr. Omid Fatemi, our Structural Heart Medical Director, in collaboration with nursing leadership and staff.
  3. Avasure, 24/7 remote safety monitoring, was successfully piloted and implemented one month ago at CMH. These monitors allow for bidirectional audio communication with patients, and continuous visual observation by our telemetry staff.  This technology allows us to better care for our patients and conserve our patient sitters more effectively and comprehensively.
  4. Dr. Jeff Brackett continues to update the Medical Staff at the weekly Monday, 7:30 am COVID-19 briefings via Teams. To be added to the meeting contact Martina Longobardi in the Medical Staff Office at (805) 948-2201.
  5. Current COVID-19 PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to our reference lab and Ventura County. We are also using antigen and antibody testing as clinically indicated. The complex nature of how many testing modalities are used is dependent on test quantity availability, clinical context and indications as well as specialist review. Please continue to order Pre-op testing 4 days prior to surgery.
  6. Convalescent Plasma Transfusions – please refer to the two articles below from Vitalent and the FDA. If you have specific questions as to patient eligibility for Plasma transfusion, contact one of our ID specialists. 
  7. Please send in-patients home with prescriptions generated electronically via PatientKeeper, rather than hand written.  We are currently at 25% electronic prescriptions and must achieve a much higher percentage in order to comply with meaningful use requirements to avoid monetary penalties.

JW Moore Tuesday, Noon, CME Conference via Microsoft Teams – “COVID Concerns”

Diane Birnbaumer, M.D., Emeritus Professor of Medicine at the David Geffen School of Medicine at UCLA, will present a lecture on “COVID Concerns.” At the end of the conference, the learner should be able to: 1) Describe the range of clinical presentations for patients infected with SARS-CoV-2, 2) Discuss the issues related to viral and antibody testing of patients for SARS-CoV-2, and 3) Examine the available information on the course of patients recovering from COVID-19

The conference will take place on September 1, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit. If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Flu Season 2020/2021 Update

There is quite a bit of controversy surrounding the intensity of the expected flu season in the US. The thoughts range from severe combined respiratory infections, combining flu and COVID-19, to a very mild flu season, that the global southern hemisphere experienced with the winter season just now ending. Regardless of which scenario manifests, it is prudent to encourage and support flu vaccines for our patients and ourselves.

For 2020-2021, cell- or recombinant-based vaccines are recommended to contain:

  • A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/45/2019 (H3N2)-like virus (updated)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)
  • B/Phuket/3073/2013-like (Yamagata lineage) virus

Do we need to get a flu vaccine earlier this year (i.e. July/August)?

There is no change in CDC’s recommendation on timing of vaccination this flu season. Getting vaccinated in July or August is too early, especially for older people, because of the likelihood of reduced protection against flu infection later in the flu season. September and October are good times to get vaccinated. However, as long as flu viruses are circulating, vaccination should continue, even in January or later.

How many flu vaccines are expected to be available for the 2020-2021 flu season?

Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. For the 2020-2021 season, manufacturers have projected they will provide as many as 194-198 million doses of flu vaccine, which is more than the 175 million dose record set during the 2019-2020 flu season.
2020/2021 Flu Vaccine CDC Link

Mayo Clinic Expanded Access Program (EAP) for Plasma Transfusion Update:

On August 23, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for convalescent plasma for the treatment of hospitalized COVID-19 patients. Click here for more information regarding the Emergency Use Authorization (EUA) announcement.

The Emergency Use Authorization (EUA) is currently active and represents the preferred means of administering convalescent plasma.

For additional information, please consult the US FDA fact sheet for health care providers, available at: https://www.fda.gov/media/141478/download

New patient enrollment in the Mayo Clinic EAP is not authorized after August 28, 2020.

Order of convalescent plasma under the Mayo Clinic EAP is not authorized after August 31, 2020.

Participating sites are required to complete data follow-up forms for all patients enrolled in the Mayo Clinic Expanded Access Program (EAP).

Please visit this website for additional information: https://www.uscovidplasma.org/

Convalescent Plasma Donation

Link to Vitalent Convalescent Plasma Donation Web Site

Estimate of Cumulative American COVID-19 Infections

Best estimate of cumulative American covid-19 infections is ~14.3%, or ~47 million people, by covid19-projections.com. That is linked to over 182,000 deaths; nowhere near >70% for herd immunity. Deaths do not take into account the untold number of #LongCovid sufferers. – Eric Topol, M.D.
Science vs. Everything Else

CMHS Weekly Medical Staff Calendar – August 31 – September 4

MondayTuesdayWednesdayThursdayFriday
7:30am COVID19 Update for Medical Staff - TEAMS12:00 pm JWM Education Conf - Virtual
5:30 pm MEC – NA & Teams
8:00 pm Nominating Cmte – NA & Teams
12:00 pm General CA Conf – Teams
12:15 pm OB/GYN Cmte – NA & Teams
12:30 pm OVCH Campus Committee OVCH Conference Room - Teams
5:30 pm COVID19 Task Force Meeting - Teams

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“I think and think for months and years. Ninety-nine times, the conclusion is false. The hundredth time I am right.”
– Albert Einstein

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – August 24, 2020

COVID-19 Updates – Please remember that information changes daily in our dynamic environment

  1. Dr. Jeff Brackett conducts a weekly Monday, 7:30 am Medical Staff COVID-19 briefings via Teams. To be added to the meeting contact Martina Longobardi in the Medical Staff Office at (805) 948-2201.
  2. Over the past week our inpatient COVID cases have crept up, staying above 20/day. Our ED admit rate is also on the high side, above 30%.
  3. Current COVID-19 PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to our reference lab and Ventura County. We are also using antigen and antibody testing as clinically indicated. The complex nature of how many testing modalities are used is dependent on test quantity availability, clinical context and needs as well as specialist review.
  4. In light of recent changes affecting COVID-19 Convalescent Plasma Transfusions recommendations, the Medical Staff Inpatient COVID Taskforce with be meeting tonight to deliberate on our approach to the treatment.  I will address the decisions in next week’s MSV.
  5. Please send inpatients home with prescriptions generated electronically via PatientKeeper, rather than hand written.  We are currently at 25% electronic prescriptions and must achieve a much higher percentage in order to comply with meaningful use requirements so as to avoid monetary penalties.

JW Moore Tuesday, Noon CME Conference via Microsoft Teams – “The Use of Direct Oral Anticoagulants (DOAC) in Acute Cardiac Care.”

Bojan Cercek, M.D., Director of Cardiac Intensive Care Units, Cedars-Sinai, will present a lecture on “The Use of Direct Oral Anticoagulants (DOAC) in Acute Cardiac Care.” At the end of the conference, the learner should be able to: 1) Discuss the use of direct oral anticoagulants in acute cardiac care, 2) Review the use of direct oral anticoagulants for cardioversion, and 3) Review the use of direct oral anticoagulants after percutaneous coronary intervention.

The conference will take place on August 25th, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Allscripts EHR Scheduled Downtime Reminder:

Allscripts EHR is scheduled for downtime during its upgrade, from Friday, August 28th at 8:00 PM till Sunday, August 30th at 12:00 PM. Please follow your respective area downtime procedures during that time.
Thank you.
– CMHS IT

CMA Telehealth Series for Small & Medium Sized Practices, Pt. 2: Getting Started

AUGUST 27, 2020   |    12:15 PM – 1:15 PM

In this webinar, we will present an approach for implementing a telehealth solution that is tailored to small and medium sized practices. Participants will be provided with a telehealth self-assessment, a summary of available telehealth tools, things to consider when implementing telehealth technology, and plenty of telehealth phone and video best practices, tips, example workflows and telehealth policies. The presentation will also discuss how to prioritize in-person visits vs. telehealth phone or video visits. This webinar series is made possible through the support of the California Health Care Foundation and is open to all physician practices.

Presenters:

  • David Ford, CMA Vice President of Health Information Technology
  • Natalie Martin, MBA, SHRM-SCP, TCI-CF, President and CEO, Elevation Health Partners
  • Rachel Proud, MPH, Senior Managing Consultant, Elevation Health Partners

Dr. Nicholas Tarlov’s published piece in this month’s issue of JVIN

To read the full article, go about 3/4 down the table of contents page: Link to full Journal Article

Provider Relief Fund deadline extended for Medicaid providers, will reopen portal for Medicare providers

In an August 5, 2020, notice to providers, Blue Shield announced it would be temporarily increasing reimbursement rates for certain Evaluation and Management services to help reduce the negative impacts to practices as a result of the COVID-19 pandemic.

The increased reimbursement rates, which will reflect a flat 5% fee schedule increase, will apply to providers on the Blue Shield standard fee schedule and will be effective for dates of service from August 24 to December 31, 2020, for the following services:

CPT Code Description
99201 – 99205 Office visit – new patient
99211 – 99215 Office visit – existing patient
99241 – 99245 Office consultation
99381 – 99387 Initial preventive medicine visit – new patient
99391 – 99397 Periodic preventive medicine visit – established patient
99441 – 99443 Physician/qualified health professional telephone evaluation.
99421 – 99423 Online digital evaluation and management services for established patient
99446 – 99449 Interprofessional phone/internet assessment and management service

The new rates are available on the Blue Shield website (log in then select “Professional Fee Schedule” under the Claims section of the menu). You can search for the above listed temporary rates by CPT code with a date of service on or after August 24, 2020. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Information and Enrollment Department at (800) 258-3091.

The COVID-19 pandemic has created an unprecedented threat to the viability of physician practices. The California Medical Association (CMA) has called on state lawmakers to ensure that health plans and insurance companies do their part to maintain our health care infrastructure, and to ensure we emerge from the COVID-19 crisis with a health care system that can meet patients’ needs. CMA appreciates that Blue Shield is taking independent steps to assist primary care physicians during this difficult time.

Contact: CMA Reimbursement Helpline, (888) 401-5911 or economicservices@cmadocs.org.

County of Ventura COVID-19 Testing

Heard Immunity

CMHS Weekly Medical Staff Calendar – August 24 – 28

MondayTuesdayWednesdayThursdayFriday
7:30am COVID19 Update for Medical Staff - TEAMS8:30 am ED Division – TEAMS
12:00 pm JWM Education Conf –
Virtual TEAMS
5:30 pm CMHS Credentials Cmte- BR & TEAMS
5:30 pm Surgery Cmte – NA & TEAMS
12:00 pm General CA Conf – TEAMS5:30pm COVID19 Task Force Meeting TEAMS

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“Happiness is not a goal; it is a by-product.”
– Eleanor Roosevelt

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – August 17, 2020

Updates – Please remember that information changes daily in our dynamic environment

  1. Dr. Jeff Brackett weekly Monday, 7:30 am Medical Staff COVID-19 briefings via Teams
  2. Current PCR testing at CMHS – Panther, Cepheid, Biofire, as well as send outs to reference lab and Ventura County
  3. The scaffolding in the patient healing garden is being used to create negative pressure rooms in the Ocean Tower, in an effort to expand our ability to accommodate a possible surge of COVID-19 patients.
  4. Sofia COVID Testing – current state: Inpatient and Emergency Department PCR testing going to Public Health. CFH Urgent Care and MMG doing Sofia antigen testing.
  5. Convalescent COVID Plasma donations and transfusions are encouraged. Please contact CMHS Lab.

JW Moore Tuesday, Noon CME Conference via Microsoft Teams “Drug-Induced Movement Disorders.”

Leslie Lundt, M.D., Psychiatrist & Director of Medical Affairs at Neurocrine Biosciences, will present a lecture on “Drug-Induced Movement Disorders.” At the end of the conference, the learner should be able to: 1) Describe the four most common drug-induced movement disorders, 2) Review the risk factors for developing each drug-induced movement disorder, 3) Outline effective treatments for each drug-induced movement disorder, and 4) Be able to identify the most common movement disorders based on the video presentation.

The conference will take place on August 18th, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

PACS Downtime

PACS WILL BE DOWN FOR UPGRADE AND MAINTENANCE ON Saturday, August 22nd, 5:00 a.m. We will continue sending exams to ATR for the night. We estimate this downtime will be for 6 hours. ATR will be faxing the reports since the system will be down.

6 Medical Insurance Companies that made $1 Billion in 2nd Quarter 2020

The second quarter of this fiscal year proved lucrative for big for-profit health insurers, who saw significantly fewer medical claims than usual because of the COVID-19 pandemic.
Here are six payers that posted profits of at least $1 billion in the most recent quarter:

1. UnitedHealth: $6.6 billion
2. Kaiser $4.5 billion
3. Anthem: $2.3 billion
4. Cigna: $1.8 billion
5. Humana: $1.8 billion
6. Centene Corp. $1.2 billion

CMS pitches physician payment rule for 2021: 6 things to know

CMS released its annual proposed changes to the Physician Fee Schedule for 2021, which would update the payment rates for physician services and expand the list of telehealth services covered by Medicare.

Here are six takeaways from the proposed rule:

1. Payment update. With the budget neutrality adjustment to account for changes in relative value units, as required by law, the proposed Physician Fee Schedule conversion factor for 2021 is $32.26, down from $36.09 in 2020.

2. Telehealth. CMS proposed adding several services to the Medicare telehealth services list during the public health emergency for the COVID-19 pandemic, including home visits for established patients and psychological and neuropsychological testing. The department also proposed adding the following services to the list of Medicare telehealth services on a Category 1 basis, meaning the services are similar to those already on the list:

  • Visit complexity associated with certain office/outpatient evaluation and management
  • Prolonged services
  • Group psychotherapy
  • Neurobehavioral status exam
  • Care planning for patients with cognitive impairment
  • Domiciliary, rest home or custodial care services
  • Home visits

3. Direct supervision by interactive telecommunication technology. For the duration of the public health emergency CMS adopted a policy revising the definition of direct supervision to include virtual presence of the supervising physician or practitioner using real-time video communications technology. Under the proposed rule, direct supervision could be provided using real-time, interactive audio and video technology through Dec. 31, 2021.

4. Evaluation and management coding and payment. CMS proposed a refinement to clarify the times when prolonged office and outpatient evaluation and management visits can be reported. The department proposed revaluing eight code sets, including maternity services, therapy evaluation and transitional care services.

5. Medicare Shared Savings Program. CMS proposed changes to the Medicare Shared Savings Program quality performance standard and reporting requirements for the performance year beginning Jan. 1, 2021. The department is also seeking comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances for performance year 2020.

6. Comment period. Public comments on the proposed rule are due by Oct. 5.
Ayla Ellison (Twitter)

Medicare moving forward with planned E/M office visit changes

Specialties in line for increases under the 2021 draft rule include allergy/immunology (9%), endocrinology (17%), family practice (13%), general practice (8%), geriatrics (4%), hematology/oncology (14%), internal medicine (4%), nephrology (6%), physician assistants (8%), psychiatry (8%), rheumatology (16%), and urology (8%).

In line for cuts would be anesthesiology (–8%), cardiac surgery (–9%), emergency medicine (–6%), general surgery (–7%), infectious disease (–4%), neurosurgery (–7%), physical/occupational therapy (–9%), plastic surgery (–7%), radiology (–11%), and thoracic surgery (–8%).

Click on the AMA explanation and analysis of the new physician fee schedule: Link to article

CMA launches telehealth webinar series for small- and medium-sized practices

The California Medical Association (CMA) is launching a new 12-part webinar series – Telehealth for Small and Medium Sized Practices. The 12 presentations will take place over the next six months, and will cover all aspects of implementing telehealth in a medical practice – selecting a platform, reimbursement rules and patient interactions. The webinar series will have an emphasis on the use of telehealth in Medi-Cal.

The first webinar in the series is Thursday, August 13, and will provide a general overview of telehealth, including changes that have been implemented by federal and state regulators in response to the COVID-19 pandemic. The presentation will also cover proper documentation of telehealth visits.

This webinar series is made possible through the support of the California Health Care Foundation and is open to all physician practices.

If Karen was on the Titanic

CMHS Weekly Medical Staff Calendar – August 17 – 21

MondayTuesdayWednesdayThursdayFriday
7:30am COVID19 Update for Medical Staff - TEAMS10:00am CMHS Infection Control
Cmte –TEAMS

12:00 pm JWM Education Conf –
Virtual
7:45 am- Pediatrics
Cmte/Neonatal Cmte-NA (back)
TEAMS
12:00 pm General CA Conf –TEAMS
12:15 pm Inpatient Medicine Division – TEAMS
5:30 pm Orthopedic Division – BR &
TEAMS
5:30pm COVID19 Task Force Meeting -TEAMS

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“Things turn out best for the people who make the best of the way things turn out.”
– John Wooden

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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COVID-19 Update – Medical Staff Voice Special Edition – August 10, 2020

Updates – Please remember that information changes daily in our dynamic environment

  1. Outpatient turnaround for PCR testing sent to Quest can take as long as 10-14 days.
  2. COVID Testing – current state: Inpatient and Emergency Department PCR testing going to Public Health, with urgent cases being run in house. The ED is using antigen testing.
  3. CFH Urgent Care and MMG doing Sofia antigen testing only on symptomatic patients, with negative results being sent for PCR confirmation. Positive results are relatively accurate.
  4. The scaffolding in the patient healing garden is being used to create negative pressure rooms in the Ocean Tower. This is being done in an effort to expand our ability to accommodate a possible surge of COVID-19 patients.
  5. Please avoid entering empty patient rooms for charting/break purposes, as it can lead to contamination and compromised patient/staff safety.  To ensure terminally cleaned inpatient rooms remain clean, EVS will place a paper ‘seal’ on the door.  Note: OVCH will adopt this practice as soon as the magnetic seals are in stock.   

JW Moore Tuesday, Noon, CME Conference – “Hormones, Menopause & Heart Disease: What a Clinician Needs to Know”

Chrisandra Shufelt, M.D., Internist, Cedars-Sinai, will present a lecture on “Hormones, Menopause & Heart Disease.” At the end of the conference, the learner should be able to: 1) Discuss the role of age, time since menopause, and other cardiac risk factors that can be used to determine if hormone therapy is appropriate at the time of menopause, 2) Explain the timing hypothesis and role that estrogen plays on healthy blood vessels as compared to diseased blood vessels and, 3) Analyze non-hormonal treatment options to systemic hormone therapy for menopausal symptoms and how to counsel patients on usage.

The conference will take place on August 11th, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

COVID-19 Isolation Updated Definitions 

Expanded Precautions: used for COVID-19 rule-out or confirmed patients . 

Respiratory Illness Isolation is being removed since N95s are to be used for all COVID-19 positive patients and ruleouts.    

Non-Respiratory COVID-19: used for patients who do NOT have COVID-19 symptoms and are being tested for placement to a congregate living setting or for an upcoming procedure.  Modified standard precautions apply (respiratory protection, aseptic mask acceptable and eye protection at a minimum).  The name of this isolation type will likely change in the coming weeks to avoid confusion with COVID-19 patients with symptoms such as diarrhea/nausea/vomiting. 

Observation patient: used in SNF settings only at this time

These updates are reflected in similarly in modified PatientKeeper order sets.

CDC Clinician On-Call Center

A clinical update from the California Department of Public health call this week:  The CDC has partnered with the Infectious Diseases Society of America (IDSA) to offer a new service to clinicians treating COVID-19 patients. Clinicians who have questions about the clinical management of patients with COVID-19 can call the main CDC information line at 800-CDC-INFO (800-232-4636). Calls from clinicians will be triaged by CDC to a group of IDSA volunteer clinicians for peer-to-peer support.
Clinician On-Call Center:
Link to On-Call Center

New Physician Introduction Medical Staff Podcast

This has been a notable and unique year for many reasons.  Beyond the obvious Pandemic, and pertinent to our Medical Staff, is the record number of new Medical Staff applicants to CMHS. So far this year, we’ve on-boarded over 60 new Medical Staff members, as many as we on-boarded in all of 2019. The efforts and time devoted by our Medical Staff office, Tracey Shoop, Physician Liaison, and individual department managers has been remarkable. Although the effort seems daunting, I’m grateful for the opportunity to personally interview and orient the new clinicians to our Medical Staff culture, history, and obligations (including some of the rules & regs., bylaws and policies).

With so many physicians new to our Medical Staff, many of us are not familiar with what they actually do, their background, or their specialty interests, and in some cases, new service lines that they’re introducing.  Tracey came up with a innovative idea on how to introduce so many of these new members to the Medical Staff.  She and I will create, with the use of Microsoft Teams, an internal “Podcast” which will include a very brief COVID and CMHS update, followed by a live 5-10 minute interview of the new Medical Staff member.  Because the interview will be live and we want to engage as many of the Medical Staff as possible, it will be held during lunchtime and you will be invited and encouraged to submit questions real time using Teams. We anticipate launching within about a month and then provide the “Podcasts” on a 2-4 week interval.

I look to your input, guidance and recommendations on how to focus and improve the Podcasts. Let me know what you would like to hear about, who you would like me to interview and if there is a more preferred time for the broadcast.

USA seven-day rolling average of New COVID-19 Cases

CMHS Weekly Medical Staff Calendar – August 10 – 14

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update for Medical Staff - TEAMS
5:15 pm QA & Improvement Cmte – BR & TEAMS
12:00 pm JWM Education Conf – Virtual
5:00 pm Medicine Cmte – NA & TEAMS
12:00 pm General CA Conf – TEAMS12:15 pm Cardiac Division Cmte – NA Front
5:30 pm COVID19 Task Force Meeting - TEAMS
7:30 am CMHS Emergency Division - OVCH Subcommittee - TEAMS

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“Life consists not in holding good cards but in playing those you hold well.”
– Josh Billings

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Covid-19 Update – Medical Staff Voice Special Edition – August 3, 2020

Updates – Please remember that information changes daily in our dynamic environment

  1. CMHS COVID Testing:
    1. Inpatient and Emergency Department PCR testing going to Public Health.
    2. CFH Urgent Care and MMG doing Sofia antigen testing.
  2. Please avoid using “Cleaned” patient rooms for charting or relaxation purposes.
  3. For COVID intubations in the Critical Care units, anesthesia remains available. Always make every effort  to communicate physician to physician for the consult to intubate.
  4. 6th Floor, Mountain Tower (MT) – ready for patient COVID Surge overflow.
  5. 4th & 5th floors MT approved for and being prepared for additional Surge overflow.

JW Moore Tuesday, Noon, CME Conference – “Antimicrobial Stewardship.”

Kaitlyn Moorehead, PharmD; Pharmacy Clinical Coordinator, CMHS, will present a lecture on “Antimicrobial Stewardship.” At the end of the conference, the learner should be able to: 1) Describe the threat of antibiotic resistance, 2) List Antimicrobial Stewardship Goals, 3) Introduce CMHS’s Antimicrobial Stewardship Program, and 4) Incorporate the four moments of Antibiotic Decision making into practice

The conference will take place on August 4th, 2020, at noon, via Microsoft Teams. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

CMS to Pay Clinicians for Counseling Patients During COVID-19 Tests

The Centers for Medicare & Medicaid Services (CMS) said it will pay eligible clinicians for telling patients to isolate while awaiting results of a test for the novel coronavirus.
Under the just-announced policy, doctors and other healthcare providers will be able to bill CMS using existing evaluation and management (E/M) payment codes when they discuss with patients the immediate need for isolation, and the importance of informing their immediate household members that they should also be tested for COVID-19.
The agency has provided a checklist for clinicians to use.
Clinicians are also expected to review the signs and symptoms of the disease and discuss services available to patients to help them isolate at home.
Reimbursement is available regardless of where a test is administered, including doctor’s offices, urgent care clinics, hospitals, and community drive-thru or pharmacy testing sites.
– Click on the underlined links in the above article to see the full CMS announcement and a copy of the checklist.

Physician Forum – CMHS, COVID & Seaview Update

A total of 28 physicians attended the hour long Physician Forum last Friday.  Attendance was predominantly via Microsoft Teams with a handful of people attending in person, with distance and mask precautions exercised. Dr. Kooros Samadzadeh provided an update on the ongoing negotiations with Change Healthcare. I was able to provide an update on COVID testing at CMHS and the region, and additional topics dealing with Telehealth and Specialty referrals were discussed. Our next full meeting will be in 2 months, but we may have a brief virtual update in 4 weeks via Teams.

Comment  by Dr. Ben Lish (posted to last week’s MSV Blog site for those of you who may have missed it)

Quest Labs are now requiring an appointment for lab draw. As I understand, the only way to make an appointment is online or by using the Quest App. Many of our Gold Coast patients do not have access or knowledge on how to set up an appointment. Also it is 1-2 weeks out to get an appointment. I have also noticed that the results for routine lab tests (not including COVID testing) is taking about a week before I get the results back. I think this is affecting patient care. I have written an email to Gold Coast expressing my concerns. I think our Gold Coast patients were better served when we had the option to send patient to CMH or Quest for their lab draws.

Dr. Lish sent essentially this same comment to Steve Peiser, who is the Senior Director, Network Management at Gold Coast and he promptly responded that he would look into it. Let’s stay tuned to this and follow where it leads.

Prescribing Cytotoxic Drugs – Policy Update for Medical Staff

Physicians who are not oncologists may prescribe hazardous and/or cytotoxic drugs for non-cancerous diagnosis, within their scope of practice. This includes, but is not limited to: rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune conditions as identified in literature, certain dermatologic conditions, certain ophthalmologic procedures, ectopic pregnancies, certain nephrology conditions, and Wegener granulomatosis with polyangiitis. In such cases, practitioners may seek consultation with an oncology specialist for chemotherapeutic administration and side effect management.

Excellent article – COVID Testing Current and Future Options

Please click on this link for the COVID Testing article

Looks like coffee is good for us again – Enjoy your Coffee


Click on the NEJM Link to article

CMHS Weekly Medical Staff Calendar – August 3 – 7

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19
Update for Medical
Staff - TEAMS
12:00 pm JWM Education Conf – Virtual
12:30 pm – Interdisciplinary Practice Cmte – BR & TEAMS
5:30 pm MEC – NA & TEAMS
12:00 pm General CA Conf – TEAMS
12:15 pm OB/GYN Cmte – NA & TEAMS
5:30pm COVID19 Task Force Meeting - TEAMS

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“History is a vast early warning system.”
Norman Cousins

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Covid-19 Update – Medical Staff Voice Special Edition – July 27, 2020

Updates – Please remember that information changes daily in our dynamic environment

  • Elective surgery – COVID PCR testing is to be done 4 days before surgery (see below).
  • CFH Urgent Care Clinics & CMH ED have begun Antigen Testing (see below).
  • We are experiencing recent PCR testing limitations and results delays. Updates to follow.

JW Moore Tuesday, Noon, CME Conference – “Renal Denervation as a Non-Pharmacologic Approach to Blood Pressure Lowering” 

Florian Rader, M.D., Co-Director, Clinic for Hypertrophic Cardiomyopathy, Cedars-Sinai Smidt Heart Institute, will present a lecture on “Renal Denervation as a Non-Pharmacologic Approach to Blood Pressure Lowering.”
At the end of the conference, the learner should be able to: 1) Differentiate difficulties/barriers to hypertension control, 2) Evaluate the influence of the sympathetic nervous system on blood pressure, and 3) Recapitulate current evidence of renal denervation as a treatment for hypertension.
The conference will take place on July 28th, 2020, at noon, via Microsoft Teams.
This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.
If you would like to attend this meeting, please contact CME Coordinator, Erin Parker at eparker@cmhshealth.org or 805-948-5638 and an invite with a link to the meeting and instructions on how to join will be emailed to you.

CHANGES IN COVID PRE-OP/PRE-PROCEDURE TESTING

Please be aware that due to the critical shortage of COVID-19 PCR testing, CMH is no longer able to accommodate performing STAT testing as part of pre-op and pre-procedural evaluation. These cases may still proceed with appropriate precautions as if the patient had tested positive.

COVID 19 testing using the Panther Platform (24-hour turn around) is currently available for those cases that can be delayed for 24 hours.

We would appreciate if you would continue comply with our current policy for testing elective outpatient procedures according to the schedule below:

COVID testing Schedule: 4 Days before Procedure/Surgery

  • Monday Surgery—test Thursday the week before Date of Procedure/Surgery
  • Tuesday Surgery—test Friday the week before date of Procedure/Surgery
  • Wednesday Surgery—test Saturday week before date of Procedure/Surgery
  • Thursday Surgery—test Saturday week before date of Procedure/Surgery
  • Friday Surgery—test Monday
  • Saturday Surgery—test Tuesday

We will make every effort to keep the medical staff informed as the situation changes.
Thank you in advance for your cooperation.

New Allscripts Orderable Items

  • CT Virtual Colonoscopy (only available at RADNET and Grossman).
  • The Saliva Drug Screen, Expanded

Meditech (MT) Downtime – Thursday, July 30th – 9:00 pm

The downtime to migrate to new hardware for MT is scheduled for Thursday, 7/30/20,  beginning at 9:00 PM. We are planning for 12 hours of downtime, but will send an update if anything changes.

MT and PK CPOE will be completely unavailable during the downtime. PK will be available for documentation purposes. We will be putting out a broadcast on the day of 7/30 with a request to complete morning draws for Lab by 6pm, due to the duration of the downtime.
– CMHS I.T

Point of Care (POC) Antigen test for the SARS-CoV 2 virus

The CFH urgent care centers have a POC test for the SARS-CoV 2 virus.  It is an ANTIGEN test that detects viable and non-viable SARS-CoV 2.  It has received approval and is used with our current SOFIA machines. Similar to influenza, it is a nasal swab and takes 15 minutes to result.

The clinical performance was established with a study using 143 NP swabs. It demonstrated 80% sensitivity and 100% specificity.  There was no demonstrable cross-reactivity with 79 specimens containing seasonal coronaviruses.

The validation done by CMH used 75 samples showing a sensitivity of 54% and specificity of 98%. One false positive was resulted on a patient with severe staph aureus sepsis. 

Taking into consideration the above results and the significant backlog in testing that has come with the most recent surge, we recommend the POC antigen test be used for SYMPTOMATIC patients Only.  If the test is negative, a reflex NP PCR test should be sent.  We may also use it to retest prior COVID (+) patients and more information on that is to come.

If the testing volume continues to increase, we may allocate some additional SOFIA machines to the urgent care clinics. We will place a POC test into Allscripts and also inform you of the insurance and self-pay charge amounts.

Here are the final guidelines for use of the POC test:

SOFIA POC COVID TESTING GUIDELINES

  1. The POC test is to be used on SYMPTOMATIC patients ONLY.
  1. If the test is Positive, that patient is very likely infected with the virus and no further testing needs to be done.
  1. If the test is Negative, the result is considered inconclusive and a nasopharyngeal PCR swab should be sent to the lab for confirmation.
  1. It is NOT to be used to retest patients (For example; an employer is requiring 2 negative tests in a row in order for an employee to return to work).  If that is necessary, a nasopharyngeal PCR swab should be used and sent out to the lab.
  • After including more samples, our CMH lab validation showed an increase in sensitivity of 74%. A nasopharyngeal PCR swab is sent out on the negative tests because it includes amplification and can detect a much smaller viral load.
  • We will be keeping track and comparing the results of the SOFIA test and the PCR swab.  If that information correlates we will likely just be using the POC test, but more data is needed.

The cash price is $30. 

Physician Forum – Outpatient and  Inpatient Medical Staff & Residents Invited

Updated COVID-19 Testing Guidance

Doctors Dining Room & Cafe Safety Measures

PPE Reminders

  1. Extended Standard Precautions include patient mask use, universal staff mask usage and eye protection in patient rooms.  Refer to the April all-staff memo on the Intranet for details.
    1. Glasses DO NOT count as eye protection, since there are exposed areas above/below the eyes and on the sides of the face.
    2. Some staff have purchased plastic side pieces for their glasses.  Feel free to wear these, but they do not substitute goggles/face shield protection on their own.  Staff would need to wear a face shield over their glasses for PPE compliance.
  2. CMHS staff are not using cloth masks at this time.  Staff may feel free to wear a cloth masks on outside of the Hospital or Clinic environment.

New US Deaths attributed to COVID-19

CMHS Weekly Medical Staff Calendar – July 27 – 31

MondayTuesdayWednesdayThursdayFriday
7:00 am CMHS
Outpatient Division – NA
7:30 am COVID19
Update for Medical
Staff - TEAMS
8:30 am ED Division -TEAMS
12:00 pm JWM Education Conf – Virtual
12:00 pm Board of Trustees – BR
5:30 pm CMHS Credentials Cmte- BR & TEAMS
5:30 pm Surgery Committee – NA & TEAMS
12:00 pm General CA Conf – TEAMS5:30pm COVID19 Task Force Meeting - TEAMS

MSV Links

If at any time you are having difficulty connecting to a link in the MSV email, simply click on the Blog site link at the bottom of this email and you will find an active and functional link at the MSV CMHS Blog site.

Final Thoughts

“The unfed mind devours itself.”
– Gore Vidal

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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