Medical Staff Voice

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

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

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

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

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. 

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

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

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

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 https://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

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

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:

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

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

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

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