Medical Staff Voice

JW Moore- Tuesday, Noon, CME Conference “Altered Mental Status in Alcohol Use Disorder”

Christopher Kerrigan, M.D., Internal Medicine & Addiction Medicine Specialist, CMHS, will present a lecture on “Altered Mental Status in Alcohol Use Disorder.”

At the end of the conference, the learner should be able to: 1) Identify differential diagnosis in altered mental status, 2) Discuss treatment options for alcohol withdrawal, and 3) Improve staff safety and prevent admissions to ICU.

The conference will take place on January 18, 2022, at noon, via ZOOM. 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 will be emailed to you.

———————————————————————————————————-

Special Presentation “Outpatient COVID-19 Treatment Options for Practicing Physicians: Best Practices and Prioritization Guidelines During the Omicron Outbreak.” – Thursday, January 20, 2022,

Tara Vijayan, M.D., MPH, Clinical Associate Professor of Medicine & ID, UCLA and Neil Wenger, M.D., MPH, Professor of Medicine, General Internal Medicine, UCLA, Director of UCLA Healthcare Ethics Center, will present a lecture on “Outpatient COVID-19 Treatment Options for Practicing Physicians: Best Practices and Prioritization Guidelines During the Omicron Outbreak.”

At the end of the conference, the learner should be able to: 1) Review the currently available outpatient COVID-19 treatments, 2) Review when to use outpatient COVID-19 treatments, 3) Discuss the need to prioritize patients during times of scarcity, and 4) Review the current recommendations to triage high-risk patients.

The conference will take place on January 20, 2022, 5:30 pm – 6:30 pm, via ZOOM. 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 will be emailed to you.

The Special Presentation has been organized by Dr. James Hornstein and endorsed by the Departments of Family Medicine, Internal Medicine,  Ambulatory Medicine, and the Ethics Committee.

Critical Staffing Guidelines at Community Memorial Health System
– sent by Gary Wilde, CEO

CMHS Drug Shortages (click on image to enlarge)

A reminder of the Electronic Only Prescribing Law January 1, 2022

Beginning January 1, 2022, most prescriptions issued by a licensed healthcare practitioner to a California pharmacy must be submitted electronically. This includes prescriptions issued by out-of-state health care practitioners to be filled in a California pharmacy.

Many of the state’s healthcare practitioners already utilize e-prescribing technology, but those who fail to meet the requirements after January 1 will be in violation of the law, which may subject their license to disciplinary action.

The law provides certain exemptions, including if transmission of the prescription is temporarily unavailable because of technological or electrical failure. In addition to the electronic transmission requirements for most prescriptions, there are additional new requirements for controlled substance prescriptions.

Practitioners can find a full accounting of the requirements and exemptions in the AB 2789 bulletin, available on the California Department of Consumer Affairs website, www.dca.ca.gov, or the website of their licensing board.

Interesting exception for Pharmacists:

A pharmacist who receives a written, oral, or faxed prescription shall not be required to verify that the prescription properly falls under one of the exceptions. Pharmacists may continue to dispense medications from legally valid written, oral, or fax prescriptions pursuant to this division.

The US outlier status for its rise in hospitalizations: 

• vs European countries now starting the descent from Omicron
• in the US, the Omicron wave was superimposed on a 2nd Delta surge
• the US very low 62% vaxx and 23% booster rate is contributing to this

Attention: COVID Updates: MSV Special Edition with substantial updates later this week (too many to include in this info packed edition)

CMHS Weekly Medical Staff Calendar – January 17 – 21

Final Thoughts

“An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.”
– Martin Luther King, Jr.

Keep the faith,

Hospital Staff – Return to Work – Critical Staffing Needs

This memo is in response to the California Hospital Department of Health, All Facilities Letter (AFL) on January 8, 2022. Click on the link for the full AFL: AFL link

Last Friday we had to implement critical staffing, which allows asymptomatic or minimally symptomatic COVID positive employees to report to work. There are currently 40 of these employees throughout the hospital. They are required to wear an N95 at all times.
We are currently doing team nursing which allows one nurse to care for more than the usual amount of patients being assisted by medical assistance from the centers for family health.
PPE and testing supplies remain in good stead.
Any symptomatic medical staff should contact infection control at 5004 for guidance Regarding testing and returning to work.
Surgical cases are being evaluated on a day-to-day basis, depending upon OR staffing and bed availability.

COVID Update Details

1. Both Pfizer and Moderna vaccines are now eligible to be given 5 months after the initial series.
2. All health care providers, including physicians, by CDPH mandate, must be COVID boosted by February 1, 2022, or by 6 months after the last Pfizer or Moderna vaccines, or 2 months after the J&J vaccine.
3. New CMHS Visitation Guidelines (Purple) as of January 9, 2022
   1. All patients without COVID-19 may have one healthy visitor per day. Exception: patients with suspected COVID-19 will not be permitted visitors until a negative test is received.
   2. All visitors must show proof of being fully vaccinated or have proof of a negative PCR test within 48 hours. A negative antigen test is acceptable within 24 hours.
   3. Fully vaccinated is defined as having received the 1st and 2nd doses of the Moderna or Pfizer BioNTech AND the booster dose 6 months after the second dose. Johnson and Johnson recipients are considered fully vaccinated after an initial dose AND a booster two months later.
   4. Visitors will be allowed entry between the hours of 8 a.m. and 6 p.m. daily. Visiting hours end at 8 p.m.
      Link to CMHS Visitor Policy

JW Moore Tuesday, Noon, CME Conference canceled for the following event:

Annual Three-Minute Scholarly Summary – GME Residents

Come support our Residents as they compete with 3- Minute Scholarly Summaries from each specialty: Internal Medicine, Family Medicine, General Surgery, Orthopedic Surgery, and Psychiatry.

Contact Erin Parker at eparker@cmhshealth.org or 805-948-5638 if you would like to attend this event & you will be emailed a meeting invite.

Medical Staff Meetings Go Pure Virtual During Covid Surge

In an effort to keep our staff and physicians safe during this COVID surge, the MEC  announced that there will be no in-person or hybrid Medical Staff meetings until the surge is over. 

ATTENTION ALL MEDICAL PRACTICES from Ventura County Medical Association

The County of Ventura Emergency Medical Services Agency (EMSA) is distributing antigen test kits to medical providers who request through the www.VCEM.org  website. They may not be able to fill all requests, but that is where requests should start.

From the EMSA:

“For the Therapeutics, the attached memos provide some clarification on the situation. The extremely small allocations we are currently getting do not allow for referrals, as the current eligible patients in the hospital setting already exceed the weekly allocation. For transparency, Ventura County only received an allocation for 60 doses of Sotrovimab this week for the entire county and sometimes the allocation is less than that. The other sites, Primary Medical Group, and 1st Stop Urgent Care are/were administering Bam/Ete and Regen Cov, however, we removed the referral info for these two sites because they were getting 400+ calls per day to schedule, and most requests did not meet the treatment criteria (attached). Additionally, those medications are both expected to have a limited response to Omicron, so they are likely not going to be continued to a large degree in the future. As the supply increases and additional medications become available, we will try to add more options and we will let you know.”

More than 19% of US hospitals are critically understaffed: Numbers by state

List of pharmacy sites in Ventura that will get the first allocations of the oral Merck and Pfizer (Paxlovid) drugs (not readily available yet)

The value of the COVID Booster

America’s Omicron Wave Already Looks More Severe Than Europe’s

There is a national decoupling, yes, in the sense that cases are shooting up much higher than hospital admissions and ICU patients. But each of those levels is already approaching the worst heights of the pandemic, and Omicron is just now starting to roll through the hospital system. Burn-Murdoch estimates that in “in wealthy, well-boosted countries like the U.K., deaths may peak at 10–15 percent of the previous record. In others, they may hit 50 percent.” Those are encouraging estimates, especially given how large the case growth has been. But the U.S. began the Omicron wave at close to 50 percent of its previous peak, and those lines on the right are all pointing pretty sharply up. The ultimate outcome is not yet clear, but if the early course of Omicron through Europe suggested a decoupling of cases from hospitalizations and deaths, the early course of the variant through the U.S. suggests a decoupling from that encouraging European path.

PDF of Article: America’s Omicron Wave Now Looks More Severe Than Europe’s

US Hospitalizations set New Record

CMHS Weekly Medical Staff Calendar – January 10 – 14

Final Thoughts

“The universe seems neither benign nor hostile, merely indifferent.”
– Carl Sagan

Keep the faith,

JW Moore- Tuesday, Noon, CME Conference “Care of the Combative Patient”

Matthew DeLaney, M.D., University of Alabama at Birmingham School of Medicine will present a lecture on “Care of the Combative Patient.” At the end of the conference, the learner should be able to: 1) Develop a plan to evaluate a combative patient, 2) Evaluate a tiered response when managing an agitated patient, and 3) Avoid common errors involved when patients are restrained.

The conference will take place on January 04, 2022, at noon, via ZOOM. 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 will be emailed to you.

COVID Booster Vaccines for CMHS Medical Staff

CMH COVID-19 Booster Clinic (Pfizer BioNTech):

Who: CMHS employees and medical staff only
Where: Ocean Tower 6th floor waiting room
When: Thursday, January 6th, 2022, 7:00 am – 10:00 am, 4:00 pm – 7:00 pm
Eligibility: 6 months from last Pfizer or Moderna vaccine dose, 2 months from the last Johnson & Johnson dose

COVID positive individuals may get their booster dose after they meet the eligibility timeframe above and have recovered from COVID-19 (at least 10 days have passed if mild-moderate symptoms; isolation removal criteria met: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html)

How to sign up: use the QR code below or go to the following link:
https://myturn.ca.gov?config=6a4e9d8c-6692-41be-9ba1-50707fd280f0

OVCH COVID-19 Booster Clinic (Pfizer BioNTech):
Who: CMHS employees and medical staff only
Where: 117 Pirie Road, Suite E; Ojai CA
When: Friday, January 7th, 2022, 7:00 am – 4:00 pm
Eligibility: 6 months from last Pfizer or Moderna vaccine dose, 2 months from the last Johnson & Johnson dose

COVID positive individuals may get their booster dose after they meet the eligibility timeframe above and have recovered from COVID-19 (at least 10 days have passed if mild-moderate symptoms; isolation removal criteria met: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html)

How to sign up: use the QR code below or go to the following link:
https://myturn.ca.gov?config=89fbb338-bcc1-4ef2-9b4a-384e2b6f2ac5

Midtown Medical Group – Only Available For CMHS Employees, Medical Staff and Auxiliary”

Please bring CMHS Badge with you for ID verification
COVID-19 First Dose, Second Dose, and Booster vaccines for all Community Memorial Health System Staff and Immunocompromised Only. Not for dependents, spouses, or the general public at this time.

Midtown Medical Group is offering Moderna and Pfizer vaccine by appointment.
Please call to schedule your appointment: 805-667-2841

Location:

Midtown Medical Group
2721 E Main St
Ventura, CA, 9300

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

Remdesivir improves clinical outcomes in patients hospitalized with moderate-to-severe coronavirus disease 2019 (Covid-19). Whether the use of remdesivir in symptomatic, nonhospitalized patients with Covid-19 who are at high risk for disease progression prevents hospitalization is uncertain.
PDF to full NEJM article:
Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients

PDF of NEJM Editorial on current Remdesivir use:  The Goldilocks Time for Remdesivir — Is Any Indication Just Right_

Current and Pending Therapeutics for Covid-19 in the United States

Clinical strategies to reduce morbidity and mortality from coronavirus disease 2019 (Covid-19) are designed according to infection status and the stage of disease. First, for uninfected persons, one of three Covid-19 vaccinations is the most appropriate intervention to prevent development of Covid-19. Second, for those who have a high risk of progression to a more severe case of Covid-19, postexposure prophylaxis with combination neutralizing monoclonal antibodies can be used to preemptively abort development of infection. Third, for those who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are now multiple approaches to prevent hospitalization. These include neutralizing monoclonal antibodies against the SARS-CoV-2 spike protein and antivirals that block viral replication. This is a critical need that will have a great effect on our ability to curtail this pandemic. Finally, for hospitalized patients, there are antiviral options (remdesivir) and immunomodulator therapies that have been shown to reduce in-hospital mortality. Baricitinib and tocilizumab are indicated for patients with severe-to-critical Covid-19 and elevated markers of inflammation. Tofacitinib can be used instead of baricitinib, and sarilumab can be used instead of tocilizumab.

California Mandatory E-Prescriptions – January 1, 2022

Beginning January 1, 2022, most prescriptions issued by a licensed healthcare prescriber will need to be done electronically pursuant to Assembly Bill (AB) 2789, including prescriptions issued by out-of-state practitioners to be filled in a California pharmacy
Click on PDF for full CMA article and description:
Mandatory E-Prescriptions – January 1, 2022

COVID by the Numbers (Click on the image to enlarge)

Today hospitalizations rose steeply again, >6,000 to ~105,000. It has become clear that we’ll exceed the previous peak of 130,000 a year ago when there were no vaccines.

CMHS Weekly Medical Staff Calendar – December 27 – 31

Final Thoughts

“We are all born for love. It is the principle of existence and its only end.”
– Benjamin Disraeli

Keep the faith,

JW Moore- Tuesday, Noon, CME Conference – Cancelled for the remainder of 2021

COVID-19 Boosters Required for All Health Care Workers – State Public Health Officer Order of December 22, 2021

1. All workers who provide services or work in facilities described in subdivision (a) have their first dose of a one-dose regimen or their second dose of a two-dose regimen by September 30, 2021:

a. Health Care Facilities:

i. General Acute Care Hospitals
ii. Skilled Nursing Facilities (including Subacute Facilities)
vii. Ambulatory Surgery Centers
ix. Clinics & Doctor Offices (including behavioral health, surgical)

b. Two-dose vaccines include: Pfizer-BioNTech or Moderna or vaccines authorized by the World Health Organization. The one-dose vaccine is: Johnson and Johnson [J&J]/Janssen.

c. “Worker” refers to all paid and unpaid individuals who work in indoor settings where (1) care is provided to patients, or (2) patients have access for any purpose. This includes workers serving in health care or other health care settings who have the potential for direct or indirect exposure to patients or SARS-CoV-2 airborne aerosols. Workers include, but are not limited to, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the health care facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).

2. All workers currently eligible for boosters, who provide services or work in facilities described in subdivision 1(a) must be “fully vaccinated and boosted” for COVID-19 receiving all recommended doses of the primary series of vaccines and a vaccine booster dose pursuant to Table A below.

California Immunization Requirements for Covered Workers 

 a. Those workers currently eligible for booster doses per the Table above must receive their booster dose by no later than February 1, 2022. Workers not yet eligible for boosters must be in compliance no later than 15 days after the recommended timeframe above for receiving the booster dose.

3. Workers may be exempt from the vaccination requirements under sections (1) and (2) only upon providing the operator of the facility a declination form, signed by the individual, stating either of the following: (1) the worker is declining vaccination based on Religious Beliefs, or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons.

a. To be eligible for a Qualified Medical Reasons exemption the worker must also provide to their employer a written statement signed by a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician stating that the individual qualifies for the exemption (but the statement should not describe the underlying medical condition or disability) and indicating the probable duration of the worker’s inability to receive the vaccine (or if the duration is unknown or permanent, so indicate).

4. If an operator of a facility listed above under section (1) deems a worker to have met the requirements of an exemption pursuant to section (3) OR deems a booster-eligible worker to have not yet received their booster dose pursuant to section (2), the worker must meet the following requirements when entering or working in such facility:

a. Test for COVID-19 with either PCR or antigen test that either has Emergency Use Authorization by the U.S. Food and Drug Administration or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services. Testing must occur at least twice weekly for unvaccinated exempt workers and booster-eligible workers who have not yet received their booster in acute health care and long-term care settings, and at least once weekly for such workers in other health care settings. Facilities must begin testing of all booster-eligible workers who have not yet received their booster by December 27, 2021. CDPH strongly recommends that all workers in Skilled Nursing Facilities (including those that are fully vaccinated and boosted) undergo at least twice weekly screening testing.

b. Wear a surgical mask or higher-level respirator approved by the National Institute of Occupational Safety and Health (NIOSH), such as an N95 filtering facepiece respirator, at all times while in the facility.

6. Nothing in this Order limits otherwise applicable requirements related to Personal Protective Equipment, personnel training, and infection control policies and practices.

7. Facilities covered by this Order are encouraged to provide onsite vaccinations, easy access to nearby vaccinations, use of work time to get vaccinated, and education and outreach on vaccinations, including:

a. access to epidemiologists, physicians, and other counselors who can answer questions or concerns related to vaccinations and provide culturally sensitive advice; andb. access to online resources providing up to date information on COVID-19 science and research.

8. The July 26 Public Health Order will continue to apply.

9. This Order shall take effect on December 22, 2021, and facilities must be in full compliance with the Order by February 1, 2022.

10. The terms of this Order supersede the August 5, 2021 State Health Officer Health Care Worker Vaccine Requirement Order.

COVID UPDATE:  

Monoclonal Antibodies & Antiviral medications

Initial data shows that Bamlanivimab and Etesevimab administered together and REGEN-COV are UNLIKELY to retain activity against new viral variants, including Omicron.  Based on similar cell culture data, Sotrovimab appears to retain effectiveness.  

Shipments of Bam+Ete and REGEN-COV have been paused awaiting updates from the CDC.

 PMG will not be offering REGEN-COV in the near future.

A limited stock of Evusheld, the only antibody authorized for pre-exposure prophylaxis, has been received and is expected to be available to our patients soon.

Limited doses of Sotrovimab are in stock and are expected to be available in January.

Also, this week the FDA authorized Paxlovid and Molnupiravir, two oral antivirals for the treatment of COVID-19.

Currently, in Ventura County, a limited number of courses of both antiviral medications have been allocated to some CVS and Rite-Aid locations.  However, we are not at a point where we can start directing patients to the pharmacies yet.  Once allocations are finalized and more direction from CDPH is received, updates will be forthcoming.

Below is the link to the press release published by the FDA.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-december-23-2021

Doctors sue Envision Healthcare, say private equity-backed firm shouldn’t run ERs in California

An emergency medicine physicians group has sued Envision Healthcare, the giant health care services company, alleging that it violated California laws barring corporations from practicing medicine when it took over staffing of the emergency department at Placentia-Linda Hospital in Placentia, California, in August. The lawsuit was filed by the American Academy of Emergency Medicine Physician Group, a unit of AAEM, a nonprofit professional medical association that provides administrative services to physician groups.
Link to the full article

Thank you, Vicki

As 2021 comes to a close, I want to take this opportunity to thank Vicki van der Toorn, Director of the Medical Staff Office, for the substantial and consistent guidance, editing and support in producing the Medical Staff Voice every Monday.  On the rare occasion that she does not provide editing because she’s off on a Monday or because it’s a holiday, I shudder to think of the inadvertent errors in grammar or facts that I might produce without her support. So, Vicki, thank you for your most gracious support.

CMHS Weekly Medical Staff Calendar – December 27 – 31

“Know all the theories, master all the techniques, but as you touch a human soul be just another human soul.”
– Carl Jung

Keep the faith,

JW Moore- Tuesday, Noon, CME Conference – Cancelled for the remainder of 2021

CMHS Medication Shortages for December 2021 (click on image to enlarge)

CMHS Dysphagia Diets and Order

Food & Nutrition Services and Speech-Language Pathology departments are announcing a major change coming to CMH in regards to DYSPHAGIA DIETS AND ORDERS. Our current National Dysphagia Diet (NDD) is now outdated and early next year we will be transitioning to the International Dysphagia Diet Standardization Initiative also known as “IDDSI.” IDDSI is an internationally recognized and standardized framework for terminology and preparation of texture-modified foods and thickened liquids for individuals with dysphagia of all ages in all care settings and for all cultures which will in turn greatly improve the safety and continuity of care for our patients with dysphagia. While it is not mandatory, it is the only professionally- supported and evidence-based standard of practice.

The CMH IDDSI task force is currently working hard on developing new order sets, policy updates, menus, nursing education/training, etc. Medical Staff education on these changes is being planned. Please see below for a more detailed PDF on these changes.

PDF: Detailed Dysphagia Diet Classification Chart

United States: Daily number of confirmed COVID cases

It is natural to feel COVID fatigue.  Despite the fatigue, it is time to double our efforts in proper masking and practice well-learned COVID precautions, particularly with the Omicron surge.

CMHS Weekly Medical Staff Calendar – December 20 – 24

“In life, as in chess, forethought wins.”
– Charles Buxton

Keep the faith,

JW Moore- Tuesday, Noon, CME Conference – Cancelled for the remainder of the Year

Medical Staff Voice – LIVE! Season 2, Episode 15 – Dr. John Van Houten | Neonatology

In the final episode of Season 2 of Medical Staff Voice LIVE, Dr. Stan sits down with Dr. John Van Houten, Neonatologist with Community Memorial Hospital’s NICU Department. Dr. Van Houten joined Community Memorial Health System after he received a call from Dr. Reisman about an opening in the new NICU at Community Memorial Hospital. Over the course of his time with CMHS, he has watched the CMH NICU grow from 7 beds to currently offering 23 beds and 24/7 access to visitors. He says the NICU is special because of the team effort that it takes to care for the infants. Outside of work, Dr. Van Houten likes to ride his bike, paint, and spend time raising his family. Link to YouTube video interview

E-Prescribing Training – Coffee Event held in the Ocean Tower Physicians Cafeteria Dining Room Lounge

Meet with an IT representative to assist with E-Prescribing sign up and enjoy a complimentary coffee drink from The Cappuccino Express! This is a great opportunity for you to be trained on PatientKeeper E-prescribe and to be validated for Electronic Prescribing for Controlled Substances. 

December 14, 2021 6:00am- 10:00 am

December 16, 2021  12:00 pm-4:00 pm

The Cappuccino Express will be offering Full Service, Espresso, Café Americano, Cappuccino, Café Latte, Café Mocha, Chai Tea Latte, and Hot Chocolate (both regular and decaf espresso included).

EMPOWER Invitation to Medical Staff

Location: Soule Park Golf Course

1033 East Ojai Avenue
Ojai, CA 93023

Date: Thursday, December 16, 2021, at 8:00 am first tee time

# of Players: 20

Format: Consecutive tee times in 9-minute intervals

*carts and range balls will be provided

There will be an area set aside for lunch after the round. Participants will be responsible for paying for their lunch, however. SPACE IS LIMITED*

Please RSVP to Kannie Valdovinos at kvaldovinos@cmhshealth.org or by phone at (805) 948-5413

Surprise Billing Litigation – Important for Physicians

The American Medical Association and American Hospital Association filed a complaint and motion to stay against the federal government today over the misguided implementation of the federal surprise billing law.  What follows is the press release.

Hospital and physician groups file lawsuit over No Surprises Act final rules that jeopardize patient access to care

December 9, 2021

WASHINGTON —The American Hospital Association (AHA) and American Medical Association (AMA), representing hospitals, health systems, and physicians, sued the federal government today over the misguided implementation of the federal surprise billing law. The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health, and two physicians based in North Carolina.

The lawsuit challenges a narrow but critical provision of a rule issued on Sept. 30, 2021, by the U.S. Department of Health and Human Services (HHS) and other agencies. The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect on Jan. 1, 2022.

The AHA and AMA strongly support protecting patients from unanticipated medical bills and were instrumental in passing the landmark No Surprises Act to protect patients from billing disputes between providers and commercial health insurers.

The legal challenge became necessary because the federal regulators’ interpretation upends the careful compromise Congress deliberately chose for resolving billing disputes. According to the lawsuit, the new rule places a heavy thumb on the scale of an independent dispute resolution process, unfairly benefiting commercial health insurance companies. The skewed process will ultimately reduce access to care by discouraging meaningful contracting negotiations, reducing provider networks, and encouraging unsustainable compensation for teaching hospitals, physician practices, and other providers that significantly benefit patients and communities.

Congress created an independent dispute resolution process that is required when providers and insurers are unable to reach an agreement on payment for out-of-network services from providers who are not under contract with the insurer. However, federal regulators have directed arbiters under independent dispute resolution to presume that the median in-network rate is the appropriate out-of-network rate and limit when and how other factors come into play. The suit argues that the regulations are a clear deviation from the law as written and all but ensure that hospitals, physicians, and other providers will routinely be under-compensated by commercial insurers and patients will have fewer choices for access to in-network services.

Importantly, today’s challenge does not prevent the law’s core patient protections from moving forward and will not increase out-of-pocket costs to patients. It seeks only to force the Administration to bring the regulations in line with the law before the dispute negotiations begin.

“No patient should fear receiving a surprise medical bill,” said Rick Pollack, AHA president, and CEO. “That is why hospitals and health systems supported the No Surprises Act to protect patients and keep them out of the middle of disputes between providers and insurers. Congress carefully crafted the law with a balanced, patient-friendly approach and it should be implemented as intended.”

“Congress established important patient protections against unanticipated medical bills in the No Surprises Act, and physicians were a critical part of the legislative solution,” said AMA President Gerald E. Harmon, M.D. “But if regulators don’t follow the letter of the law, patient access to care could be jeopardized as ongoing health plan manipulation creates an unsustainable situation for physicians. Our legal challenge urges regulators to ensure there is a fair and meaningful process to resolve disputes between health care providers and insurance companies.”

Last month, a bipartisan group of 152 lawmakers urged the Administration to fix the independent dispute resolution provisions, noting the rule’s approach “is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law.”

The AHA, AMA, and their co-plaintiffs filed their lawsuit against the departments of HHS, Labor, and Treasury, along with the Office of Personnel Management in the U.S. District Court for the District of Columbia.

For additional information, please see copies of the filed complaint and motion to stay.

Neuroradiology Conference on December 23^rd

Please join us for Neuroradiology Conference on December 23^rd from 8:00 am – 9:30 am in the 8^th Floor Board Room, Mountain Tower, hosted by Dr. Nicholas Bates, CMH’s newest neuroradiologist.

Alternatively, you may join us via Zoom, however, the Zoom time is limited to 40 minutes, if your meeting closes, you may rejoin using the same link…..

CME Credits Available

Join Zoom Meeting
https://us04web.zoom.us/j/73340765462?pwd=YXgrSENiTXQ3NXpDNGZseE04emJ6Zz09

Meeting ID: 733 4076 5462
Passcode: stroke

PLEASE RSVP

Nicholas E. Tarlov, MD
Director of Stroke and Interventional Neurology
Community Memorial Hospital, Ventura CA

Stephanie M. Lara, RN, MS-HCA, SCRN
Stroke Program Coordinator
147 No. Brent Street, Ventura, CA 93003
805.948.5832 (O)  I  805.443.6434 (C)

Monoclonal Antibody (mAb) Therapeutics webinar with a focus on early treatment in high-risk populations

The Ventura County Public Health, Emergency Medical Services Agency, and Health Care Coalition will be hosting an anti-SARS-CoV-2 Monoclonal Antibody (mAb) Therapeutics webinar with a focus on early treatment in high-risk populations. The webinar will address the benefits of anti-SARS-CoV-2 mAbs, how to access mAbs locally in Ventura County, and how to implement administration of anti-SARS-CoV-2 mAbs in your practice.

Attendees will have a unique opportunity to have their questions answered by the California Department of Public Health Science Branch Clinical Lead, Dr. John Openshaw.

Learn how you can help decrease hospitalizations and disease progression through early treatment!

Date: Wednesday, December 15th
Time: 1:00 pm – 2:30 pm
Registration: https://bit.ly/covid-19mabs

Questions? Email VCHCC@ventura.org

CMHS Weekly Medical Staff Calendar – December 13 – 17

“Wisdom outweighs any wealth.”
– Sophocles

Keep the faith,

“A pessimist is simply an optimist with experience.”
– Scott Goodfriend, M.D.

JW Moore- Tuesday, Noon, CME Conference “Increased Risk of Mental Health Issues & Suicide Among Clinicians Treating COVID-19 Patients.”

John Tsuang, M.D., Clinical Professor, Dept. of Psychiatry, UCLA School of Medicine & Director of Dual Diagnosis Treatment Program at Harbor-UCLA Medical Center will present a lecture on “Increased Risk of Mental Health Issues & Suicide among Clinicians Treating COVID-19 Patients.” At the end of the conference, the learner should be able to: 1) Recognize mental health symptoms associated with the treatment of COVID-19 patients, 2) Recognize factors associated with increased suicidal risks, 3) Formulate plans for self-care, and 4) Apply skills to reduce the risk of suicide.

The conference will take place on December 07, 2021, at noon, via ZOOM. 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 will be emailed to you.

Medical Staff Voice LIVE! Season 2, Episode 14 – Dr. Heidi Henson | Internal Medicine

In the latest episode of Medical Staff Voice LIVE, we are joined by Dr. Heidi Henson, Internal Medicine Specialist with Midtown Medical Group.   Dr. Henson attended undergrad at the University of Arizona, where she majored in Physiology and minored in Psychology, Religious Studies, and Chemistry. Dr. Henson was also a member of U of A’s ballet school—a longtime passion of hers.  She joined CMHS as a resident in our Internal Medicine program.  Now, she spends her time at Midtown Medical Group’s Internal & Geriatric Medicine Clinic in Ojai. In her free time, she enjoys gardening, spending time with her two Siberian Huskies, traveling, and cake decorating! Link to YouTube video interview

EMPOWER Invitation to Medical Staff

Location: Soule Park Golf Course

1033 East Ojai Avenue
Ojai, CA 93023

Date: Thursday, December 16, 2021, at 8:00 am first tee time

# of Players: 20

Format: Consecutive tee times in 9-minute intervals

*carts and range balls will be provided

There will be an area set aside for lunch after the round. Participants will be responsible for paying for their lunch however. SPACE IS LIMITED*

Please RSVP to Kannie Valdovinos at kvaldovinos@cmhshealth.org or by phone at (805) 948-5413

Mandatory E-Prescribing Begins January 1, 2022, for California

The new E-Prescribing requires us to be an active participant in the process. Please review the following:

Beginning January 1, 2022, all prescriptions issued for controlled and non-controlled substances in California by a licensed prescriber will need to be done electronically pursuant to Assembly Bill (AB) 2789. This is in an effort to reduce medication errors, fraud, and forgery of prescription medications. In response to stakeholder feedback, the Centers for Medicare and Medicaid Services (CMS) is proposing to extend the start date for E-prescribing compliance actions to January 1, 2023. However, California is not considering such extensions at this time.

Complimentary Coffee Event held in the Ocean Tower Physicians Cafeteria Dining Room Lounge.

Meet with an IT representative to assist with E-Prescribing sign up and enjoy a complimentary coffee drink from The Cappuccino Express!

December 8, 2021  6:00am- 10:00 am

December 14, 2021 6:00am- 10:00 am

December 16, 2021  12:00 pm-4:00 pm

The Cappuccino Express will be offering Full Service, Espresso, Café Americano, Cappuccino, Café Latte, Café Mocha, Chai Tea Latte, and Hot Chocolate (both regular and decaf espresso included).

COVID Monoclonal Antibody MAb therapy Sites

There are now multiple resources providing COVID Monoclonal Antibody MAb therapy (subQ), in Ventura County through physician referral or patient (after positive test) self-referral. For more information, or if you are interested in scheduling treatment, email Primary Medical Group at: covidresponse@primarymedical.net or call: 805-702-8339

1st Stop Urgent Care is also offering the treatment. They are located at 2275 Las Posas Road, Camarillo, CA 93010. Website: 1ststopurgentcare.com. Phone: 805-388-3732.

Mobile Wellness Clinic, 818-232-5788; Dr. Mohammed Rezai will administer MAb in homes throughout Ventura County. For more information: https://www.venturacountyrecovers.org/monoclonal-antibody-treatment-information/

Quarterly and Annual Fire Alarm and Fire Sprinkler Component Testing- CMH Mountain & Ocean Towers – Week of Dec 6-10, 2021

We are notifying you of the Quarterly and Annual Fire Alarm and Fire Sprinkler System Testing in the CMH Mountain Tower December 6 & 7, 2021, and the Ocean Tower December 8-10, 2021.  This work will be conducted by our contracted vendor, TRL.  All TRL technicians working on site have been fully vaccinated and will go through COVID screening before starting work. 

While the entire Mountain and Ocean Tower buildings may hear the alarms, chimes, and tones, and the emergency partitions and doors may be activated, there is no action required on the part of the staff during testing.  We will coordinate with PBX to make appropriate announcements and will do our best to minimize interruption during the testing times. 

New SARS-CoV-2 Variant of Concern Identified: Omicron (B.1.1.529) Variant – CDC Health Alert

Omicron, a new SARS-CoV-2 variant, has been identified in many countries and categorized as a Variant of Concern by the U.S. government and the World Health Organization (WHO). Because little is known about Omicron currently, it is important for the public health and medical communities as well as the general public to remain vigilant to reduce potential exposure. This Health Alert Network (HAN) Health Advisory summarizes current knowledge about Omicron and provides recommendations on how to detect the Omicron variant within the United States as soon as possible to mitigate its spread. Full Announcement pdf

US COVID Death by Vaccination Status

CMHS Weekly Medical Staff Calendar – December 6 – 10

“The secret of genius is to carry the spirit of the child into old age, which means never losing your enthusiasm.”
– Aldous Huxley

Keep the faith,

JW Moore Tuesday, Noon, CME Conference “Laughter (and Chocolate) is the Best Medicine!”

Joseph Weiss, M.D., Clinical Professor of Medicine, Division of Gastroenterology, UCSD School of Medicine will present a lecture on “Laughter (and Chocolate) is the Best Medicine!” At the end of the conference, the learner should be able to: 1) Recognize the value of humor and laughter in human health and well-being, 2) Apply tasteful humor with discretion and only in appropriate situations where it will be well received, 3) Recognize the dietary and physiological benefits of chocolate, 4) Describe the effect of humor and laughter on cytokines and their impact on the immune response, and 5) Describe the neuroendocrine basis of the physiological consequences and benefits of humor and laughter.

The conference will take place on November 30, 2021, at noon, via ZOOM. 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 will be emailed to you.

MSV – LIVE! Season 2, Episode 13 – Dr. Michelle Takase-Sanchez – Urogynecology

In today’s episode of Medical Staff Voice Live, Dr. Stan is joined by Dr. Michelle Takase-Sanchez, Urogynecologist at San Buenaventura Urology Center. Urogynecology, or Female Pelvic Medicine, focuses on diagnosis and treatment related to female urinary incontinence, prolapse, and pelvic floor disorders.
These days, Dr. Takase-Sanchez spends her free time snowboarding with her husband, spending time with her family, and enjoying the beach in Ventura! Did you know? Dr. Takase-Sanchez took part in motorcycle road racing in college! Link to YouTube video interview– (15 minute viewing time)

Mandatory E-Prescribing Begins January 1, 2022, for California

The new E-Prescribing requires us to be an active participant in the process. Please review the following:

Beginning January 1, 2022, all prescriptions issued for controlled and non-controlled substances in California by a licensed prescriber will need to be done electronically pursuant to Assembly Bill (AB) 2789. This is in an effort to reduce medication errors, fraud, and forgery of prescription medications. In response to stakeholder feedback, the Centers for Medicare and Medicaid Services (CMS) is proposing to extend the start date for E-prescribing compliance actions to January 1, 2023. However, California is not considering such extensions at this time.

The U.S. Drug Enforcement Administration (DEA) and Title 21 of the Code of Federal Regulations previously established the Electronic Prescriptions for Controlled Substances (EPCS) procedures, including third-party certification that prescription software applications meet DEA requirements, identify-proofing of prescribers, two-factor authentication when signing prescriptions, and access controls established by software users.

AB 2789 does provide certain exemptions for E-prescribing found in Business and Professions Code (BPC) section 688. They are:

• Prescriptions for terminally ill patients are issued pursuant to section 11159.2 of the Health and Safety Code. The prescriber must certify that the patient is terminally ill by the words “11159.2 exemption.”
• An electronic data transmission prescription is not available due to a temporary technological or electrical failure – meaning failure of a computer system, application, or device; the loss of electrical power to that system, application, or device; or any other service interruption affecting the certified electronic data transmission prescription application used to transmit the prescription.
• The prescribing health care practitioner is issuing a prescription to be dispensed by a pharmacy located outside California.
• The prescribing health care practitioner reasonably determines it would be impractical for the patient to obtain the prescribed substances in a timely manner, and the delay would adversely impact the patient’s medical condition.
• A prescription issued in a hospital emergency department or urgent care clinic when at least one of the following conditions is present:
  1. The patient resides outside California.
  2. The patient resides outside the geographic area of the hospital.
  3. The patient is homeless or indigent and does not have a preferred pharmacy.
  4. The prescription is issued at a time when a patient’s regular or preferred pharmacy is likely to be closed.
• Under any of conditions a, b, c, or d above, a prescription shall be electronically issued but does not require electronic transmission and may be provided directly to the patient.

A healthcare practitioner who does not use an e-prescription to issue a controlled substance prescription shall document in the patient’s medical record the reason as soon as practicable, and within 72 hours of the end of the technological or electrical failure.

BCP 688 (i) specifically states that a pharmacist who receives a written, oral, or faxed prescription is not required to verify that the physician met the requirements of the E-prescribing laws or exemptions. Pharmacists may continue to dispense medications from legally valid written, oral, or fax prescriptions pursuant to this division. Therefore, this law will not require a pharmacist to reject a prescription that is not submitted electronically. But the licensed provider would be out of compliance with the law. Healthcare practitioners who fail to meet the requirements of AB 2789, may be referred to the appropriate state professional licensing board solely for administrative sanctions, as deemed appropriate by that board.

To maintain compliance and patient care, CMHS will be hosting three EPCS registration events to ensure licensed prescribers have two-factor authentication access and are providing instructions to assist with self-registration.

Option 1: Self-Registration

• Download the Symantec VIP Access application to your smartphone from your app store

• Open the app, phone the HelpDesk at 805-948-5090 (24/7) and provide the Credential ID from the app. The HelpDesk will open a ticket and assign it to the appropriate analyst group.

• Once you have been set up for e-prescribing controlled substances you will be contacted with instructions for doing so.

Option 2:  Complimentary Coffee Event held in the Ocean Tower Physicians Cafeteria Dining Room Lounge.

Meet with an IT representative to assist with E-Prescribing sign up and enjoy a complimentary coffee drink from The Cappuccino Express!

December 8, 2021  6:00am- 10:00 am

December 14, 2021 6:00am- 10:00 am

December 16, 2021  12:00 pm-4:00 pm

The Cappuccino Express will be offering Full Service, Espresso, Café Americano, Cappuccino, Café Latte, Café Mocha, Chai Tea Latte, and Hot Chocolate (both regular and decaf espresso included).

Hackers using Holidays to their advantage – Be Aware & Vigilant

Sent on behalf of Keith McWilliams, VP/Chief Information Officer

Each year, hackers use holidays to their advantage. Please be extra vigilant through this holiday season. Phishing campaigns are being orchestrated to spread ransomware, and fraudulent financial activity, including fake invoices.

Follow these guidelines to minimize the impact of phishing attempts:

• Please verify that external emails are valid before opening.
• Report any suspicious emails to CMHS IT immediately.
• Do not open emails from senders you do not know.
• Do not forward suspicious emails, use the report function below

Significant Upcoming Dates:

• United States  – Cyber Monday – November 29, 2021
• International –   Christmas Eve/Day – December 24-25, 2021
• International –   New Year’s Eve – December 31, 2021

CMHS Weekly Medical Staff Calendar – November 29 – December 3

“In three words I can sum up everything I have learned about life: it goes on.”
– Robert Frost

Keep the faith,

JW Moore Conference – Tuesday Noon Lecture – Cancelled for Thanksgiving

MSV – LIVE! Season 2, Episode 12, Dr. Jamil Muasher | Diagnostic & Interventional Radiology

In the 12th episode of Season 2 of Medical Staff Voice LIVE, Dr. Stan sits down with Dr. Jamil Muasher. Originally from the east coast, Dr. Muasher attended Virginia Commonwealth University’s School of Medicine, where he was a resident in the Diagnostic Radiology program. He completed his fellowship in Interventional Radiology at the University of Virginia. Dr. Muasher is board certified in Diagnostic Radiology by the American Board of Radiology. After completing his fellowship, Dr. Muasher and his wife moved to the west coast, where he’s been since 2012. His hobbies and interests outside of work include anything that pertains to his children, from soccer games to birthday parties! Interventional Radiology is a diverse practice, according to Dr. Muasher. He performs various minimally-invasive procedures using medical imaging. He splits his time between Vein Specialists of Santa Barbara & CMHS’ Prostate Institute of America, where he helps patients navigate prostate disease diagnosis and treatment options. Link to YouTube video interview

Become a Buprenorphine Waivered Practitioner

Qualified practitioners can offer buprenorphine, a medication approved by the Food and Drug Administration (FDA), for the treatment of opioid use disorders (OUD).

To receive a practitioner waiver to administer, dispense, and prescribe buprenorphine practitioners must notify SAMHSA’s Center for Substance Abuse Treatment (CSAT), Division of Pharmacologic Therapies (DPT) of their intent to practice this form of medication-assisted treatment (MAT). The notification of intent (NOI), or buprenorphine waiver application, must be submitted to SAMHSA before the initial dispensing or prescribing of OUD treatment medication.

Qualified practitioners include physicians, Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwives (CNMs). Apply for a buprenorphine waiver.

Recent Practice Guidelines have allowed for an alternative NOI for those seeking to treat up to 30 patients: The customary NOI requires eligible providers to undertake required training activities prior to their application to prescribe buprenorphine; the alternative type of NOI allows those providers who wish to treat up to 30 patients to forego the training requirement, as well as certification to counseling and other ancillary services (i.e., psychosocial services). Practitioners utilizing this training exemption are limited to treating no more than 30 patients at any one time (time spent practicing under this exemption will not qualify the practitioner for a higher patient limit). This exemption applies only to the prescription of Schedule III, IV, and V drugs or combinations of such drugs, covered under the CSA, such as buprenorphine.

The following link for the waiver apparently only takes a few minutes to complete:

Link for a buprenorphine waiver application

The United States is entering its 5th major Surge

In November, new cases have increased 30% starting from the high level of 70,000/day. With that hospitalizations and deaths are increasing again.

CMHS Weekly Medical Staff Calendar – November 22 – 26

“Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.”
– Oprah Winfrey

Keep the faith,