CVMS Bulletin
Making a Difference
in HealthCare for Eastern Virginia
December 2023
Volume 1, Issue 12
In This Issue...
- Current Status of CVMS
- Price Transparency Bill Passes
- Regulation of AI in Medicine
- Another Healthcare Giant Emerging
- Mental Health
- Physician Burdens
- Access to Care
- Biomarkers in Long Covid
- Interactive CT Case Studies
- Gender Disparities in Cardiogenic Shock
- Finding Joy in Medical Practice
- Free CMEs
- Event Board
- Newsletter Signup
Current Status of
Our New Society
The Board met again on December 7, 2023. The following is a summary of what was discussed. A full copy of the minutes is available on the website.
1. We discussed the establishment of an Affiliate Membership consisting of non-MD, and non-faculty members or organizations, who wish to maintain a partnership with CVMS. This will require a yearly membership fee depending on the size of the organization and the estimated value that these potential members can bring to CVMS. Also, we do not wish to provide exclusivity to any of these entities. For example, if one law firm joins, we will not exclude others from joining. In addition, these entities will be non-voting.
2. We have decided to establish a 501(c)3 charitable foundation as a related associate entity to be used as a tax deductible and tax exempt fund to support CVMS and also provide scholarships for selected EVMS students.
3. We will expand communication with our membership by providing useful medical news and updates with brief emails and/or short surveys once a week.
4. We will continue to focus on mental health in the community and among providers confidentially with videos and webinars.
5. Our membership is growing. Many have seen our article published in the Doctor to Doctor magazine and some have joined as a result of that. We will continue to advertise and publish articles in magazines and newsletters to make sure our message goes out to as many providers as possible and to the public so they can become educated about our healthcare system.
6. Our advocacy program will be in full force this coming year. We intend to make multiple proposals to the Virginia legislature to improve our healthcare and work toward reducing inefficiencies in our system. These will include mental health proposals, removing the prior authorization mandates, and removal of COPN laws.
We are serious about making changes as soon as possible. Our voices have been suppressed for way too long.
The Roman Fasces was a symbol of strength and power occurring as a result of many binding together. It was made of multiple elm or birchwood rods about 5 feet long tied together and sometimes including an axe. It was carried by attendants to soldiers or powerful figures in ancient Rome. For us, it symbolizes that we are stronger and more powerful if we bind together in supporting our goals.
Price Transparency Bill Passes
"The Lower Costs, More Transparency Act, which advances policies to force pharmacy benefit managers and hospitals to meet price transparency standards, passed on the House floor Monday by a vote of 320 to 71." However, fines for noncompliance were squashed due to lack of support from MSV and AMA, despite the support received from AAPS.
Regulation of AI is Ramping Up around the World
Artificial Intelligence (AI) is rapidly evolving. There are many concerns about its future and how it will affect ours and future generations. It can become a wonderful resource to make our lives better, but also has the potential to make things much worse.
A recent article published in the New England Journal of Medicine suggests that we take heed to our history of research related to new technology, some of which was not always ethical. This led to the passage of the National Research Act 50 years ago which regulated how human subjects were to be treated in medical research. The alarm has been raised again with AI. The lawmakers in the US and the European Union will likely be passing new legislation soon to regulate the research and use of AI in medicine.
This new legislation will need to answer the questions of (1) who should be making the rules, the government vs. scientists, (2) how strongly should we regulate (restrict) data collection and ownership, and (3) anticipating and planning how these regulations will be revised in the future of this rapidly moving science.
Read more here...
Laura Stark, PhD, "Medicine's Lessons for AI Regulation", NEJM, Dec. 9, 2023
Another Healthcare Giant in the Making
The potential merger of Cigna and Humana first reported by the Wall Street Journal would create yet another huge healthcare system about the size of CVS and could control a third of the market as another Pharmacy Benefit Manager (PBM) along with CVS Caremark, and Optum Rx. This would likely end up increasing costs to patients and taxpayers and result in more acquisitions of doctors' offices. It would further increase monopolization of healthcare, and stifle competition from smaller organizations. What's good for big business generally is not so good for patients, doctors and the healthcare system overall. The bigger the system, the greater the bureaucracy, the more healthcare dollars are siphoned away from patients to feed the administration, the longer the wait to access care, the less personalization of patient care, the greater the fragmentation of care, and the more loss of continuity of care. People get lost in the system and doctors become nothing more than worker bees to feed the hive, a dime a dozen. Do you think this will incentivize students to spend 11-12 years of additional training and student loans of up to $400,000 to become unidentified cogs in a system which no longer respects their abilities?
This potential merger is likely to face some anti-trust pushback. The DOJ has already blocked prior potential mergers of Aetna with Humana and Anthem with Cigna. Will see what happens with this one.
Mental Health
Mental Health will be a major focus of our efforts in 2024. These issues involve the following concerns:
- Civil commitment laws need to be liberalized to make it easier to commit violent, psychotic patients within the confines of civil rights. Civil rights are important, but so is public safety.
- We need more psychiatric hospital beds. Many of the homeless who are mentally ill should be hospitalized so they can be taken care of humanely, so they do not suffer, and so the public doesn't suffer either.
- Insurance coverage for psychiatric care is deplorable. Most insurance companies only pay for 3 days of inpatient care. Insurance coverage for 45 minute psychiatric outpatient visits is woefully inadequate to sustain a psychiatric practice.
- Malpractice liability: Psychiatrists are held liable if any of their patients kill themselves or other people. These actions are not predictable with any degree of certainty, and malpractice liability needs to be removed in these cases.
- Burnout and depression among physicians remains a major problem in our current healthcare systems stemming from lack of autonomy, barriers to patient care, inability to provide quality care due to time and financial constraints, inadequate compensation, EMR entry overload, too many mundane tasks that take up time and don't improve patient care, prior authorizations, peer to peer conversations for insurance coverage, lack of any control over their lives either professionally or otherwise.
What are the Main Burdens that Physicians Face in the Current Healthcare System?
Physicians in the current healthcare system face various challenges and burdens that can impact their ability to provide quality patient care. Some of the main burdens include:
- Administrative Burden: Physicians often spend a significant amount of time on administrative tasks, such as billing, coding, and dealing with insurance paperwork. This administrative burden can detract from the time they have available for patient care.
- Electronic Health Records (EHRs): While EHRs have the potential to improve patient care and information accessibility, the implementation and use of these systems have added to the administrative burden. Physicians may spend a substantial amount of time inputting data, navigating complex interfaces, and dealing with interoperability issues.
- Regulatory Compliance: Physicians must comply with a myriad of regulations, guidelines, and quality reporting requirements imposed by government agencies and insurance providers. Keeping up with these requirements can be time-consuming and may divert attention away from patient care.
- Workload and Burnout: Physicians often face heavy workloads and demanding schedules. The pressure to see a large number of patients, combined with the emotional toll of dealing with illness and challenging cases, contributes to high levels of burnout within the profession.
- Insurance and Reimbursement Issues: Physicians may encounter challenges related to insurance reimbursement, including delays, denials, and changes in reimbursement rates. Navigating the complexities of insurance can be frustrating and impact the financial viability of a medical practice.
- Lack of Autonomy: Some physicians feel that they have limited autonomy in decision-making due to external influences, such as insurance companies, hospital administrators, and government regulations. This can be frustrating for those who want more control over the care they provide.
- Rising Healthcare Costs: Physicians may face pressure to control costs while maintaining high-quality care. Balancing these competing priorities can be challenging, and cost-cutting measures may impact the resources available for patient care.
- Technology Challenges: While technological advancements have improved healthcare in many ways, adapting to new technologies and staying current with medical advancements can be a challenge for physicians. It requires continuous learning and adjustment to evolving tools and techniques.
- Provider Shortages: In some regions and specialties, there is a shortage of healthcare providers. This shortage can increase the workload on existing physicians, leading to burnout and reduced access to care for patients.
- Patient Expectations and Communication: Meeting the diverse expectations of patients, managing communication effectively, and addressing health literacy challenges can be demanding. Physicians often need to spend time educating and communicating with patients to ensure understanding and compliance with treatment plans.
Addressing these challenges requires a multifaceted approach, involving healthcare system reforms, improved technology solutions, and attention to physician well-being and work-life balance.
Access to Care
Access to care is a critical aspect of our healthcare system, and several problems can limit or hinder our patients' ability to obtain timely and appropriate medical services. Some of the key problems associated with access to care in healthcare systems include:
- Geographic Barriers: Rural and underserved areas often lack sufficient healthcare infrastructure and providers, making it challenging for residents in these regions to access necessary medical services. Limited availability of healthcare facilities and specialists can result in delayed or inadequate care.
- Financial Barriers: High healthcare costs, including out-of-pocket expenses, deductibles, and co-pays, can be significant barriers to accessing care. Individuals without health insurance or those with inadequate coverage may delay or forgo necessary medical treatments due to financial constraints. They ultimately end up in overcrowded emergency rooms with advanced diseases and poor outcomes.
- Health Insurance Coverage Gaps: Gaps in health insurance coverage, such as waiting periods, exclusions, or limitations on certain services, can prevent individuals from seeking timely and comprehensive care. This is particularly relevant for those transitioning between jobs or facing other life changes.
- Long Wait Times: Extended wait times for appointments, diagnostic tests, and specialist consultations can impede access to timely care. Delays in receiving necessary services may negatively impact health outcomes and exacerbate health conditions.
- Provider Shortages: Shortages of healthcare providers, particularly in certain specialties or geographic areas, can limit access to care. This shortage can lead to longer wait times for appointments and reduce the availability of primary care services. This is a major problem in our area.
- Cultural and Linguistic Barriers: Language and cultural differences can create barriers to effective communication and understanding between patients and healthcare providers. This can result in misunderstandings, misdiagnoses, and suboptimal care.
- Limited Telehealth Infrastructure: While telehealth has the potential to improve access to care, there are challenges related to limited access to high-speed internet, technology literacy, and regulatory barriers. Not everyone has the necessary resources or knowledge to engage in virtual healthcare visits.
- Transportation Challenges: Lack of reliable transportation can prevent individuals, particularly in rural or low-income areas, from reaching healthcare facilities. Transportation barriers can contribute to missed appointments and delays in seeking care.
- Stigma and Mental Health Barriers: Stigma associated with seeking mental health services can prevent individuals from accessing necessary mental health care. Additionally, shortages of mental health providers exacerbate difficulties in accessing timely mental health services.
- Fragmentation of Care: Fragmented healthcare delivery systems can result in disjointed and inefficient care, making it difficult for patients to navigate through the healthcare system and receive coordinated services.
Addressing these access-to-care challenges requires a comprehensive approach, involving policy changes, increased healthcare infrastructure, improved insurance coverage, and efforts to enhance healthcare delivery models. It also involves addressing social determinants of health, such as income, education, and housing, which can impact access to care. CVMS needs to address all of these issues by making proposals and resolutions, but even more important, get our legislators to act on them.
Snapshots
Biomarkers May help in Diagnosis of Long COVID
New research from Cardiff University in the UK has found certain biomarkers like C3, C4 and C5 and low serotonin levels seem to be associated with Long COVID about 80% of the time. The study was small, only involving about 166 patients, but may point to a dysregulation of the immune system perhaps caused by an inflammatory effect from the coronavirus. The question is whether these biomarker abnormalities were present before the infection started or whether they were caused by the infection. If they are caused by the infection, perhaps treatment with a C5 inhibitor may be helpful in treatment of Long COVID. If nothing else, they may provide a clue to the diagnosis.
Interactive CT Case Studies
Women's Health December 2023 - Gender disparities in Cardiovascular Outcomes
- Vascular complications are more frequent in women.
- Greater amounts of bleeding and limb ischemia in women.
- Women are less likely to receive invasive therapies.
- There is a need for better technology in accessing smaller vascular structures in women.
- There is a need for more women to specialize in the field of cardiovascular medicine
- There is a need for more women to become principal investigators in cardiovascular research.
Finding Joy in Medical Practice
Among all the troubles we face as physicians, would we do it again? The answer for most of us is probably yes. This video may help to put it all in perspective.
Easy, Free, Educational CMEs
The non-profit CME Outfitters provided by Alosa Health has developed an easy, online, free program for clinicians to not only satisfy your CME obligations, including the required opioid certification, but also to get other educational, practical CMEs that make a real difference in patient outcomes.
Click here...https://www.cmeoutfitters.com/transfers/cm/?ID=45805
CVMS Event Board
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Related Links
Association of American Physicians and Surgeons
Virginia Department of Health Professions
Virginia Beach Health Department
American College of Physicians/Advocacy
American College of Surgeons/Advocacy
Centers for Medicare and Medicaid Services
Virginia Legislative Agenda for 2023 Session
VDH Certificate of Public Need Program
AMA: Certificate of Need: Evidence for Repeal
Educational Sites
Letter to Physicians:
from CVMS
[This letter was sent separately from the Bulletin. It is reprinted here for those who didn't see it before. - Ed.]
As an independently thoughtful physician, you are well aware of the challenges of practicing medicine in our current healthcare environment. There is no need for me to enumerate these difficulties here (except I’m going to list a few of them anyway). Let me just say that you are courageous to survive as you are within a severely impaired, fragmented system, getting worse by the minute.
Whether you are totally independent, or practicing within a group framework, the difficulties you face every day can be extremely frustrating for you and your patients. What if you never had to do another prior authorization for writing a prescription? What if you actually got paid for all the extra time you have to put in at the end of every day to keep up your charts and make phone calls? What if you could directly admit someone to the hospital without your patient having to wait three days in the Emergency Room? What if your patient who needs a transfusion could actually get into an infusion center to have this done in less than 48 hours? What if you didn’t have to do a peer-to-peer conversation with an insurance clerk every time you order an imaging study? What if your patient with newly diagnosed cancer didn’t have to wait two months or more to have surgery or to see a specialist? What if insurance companies and government regulators actually trusted physicians to make complex decisions, rather than assume you are fraudulent or incompetent until proven otherwise? Why should patients be incentivized to have procedures done in the hospital when they could be easily and safely done in your office for half the cost?
Almost all of these challenges and barriers to care have developed over the past two decades. What will the next two decades bring?
My purpose for writing this is to offer you the benefit of joining a group of likeminded physicians who would like to re-establish the ability for more physicians to enjoy the practice of medicine, to be fairly compensated for what we do, to be acknowledged for our long years of expensive training. and to have a voice in how patients are treated, instead of being brushed aside as worker-bees by healthcare monopolies. We need to restore autonomy and respect to those who dedicate their lives to the care and healing of patients.
The Coastal Virginia Medical Society (CVMS) represents a merger of the Norfolk, Chesapeake, and Virginia Beach medical societies, but it bears no resemblance to these previous organizations. It has been built from the ground up to focus much more on advocating for the welfare of the healers and their patients by reducing paperwork, increasing efficiency, getting rid of the current barriers to patient care, improving access and delivery, and increasing reimbursement wherever possible. We stand strong in the face of these challenges. We need to reverse the current path and/or at least prevent it from getting worse. Our medical organizations such as CVMS are our only hope to do this.
Please note: We are not radicals. This is not a labor union. We are regular physicians who have lived through the history of this decline and are worried about the future of healthcare. We are not worried about technology or pharmacology. We are worried about healthcare access and delivery, about patients who need and deserve better care, and about those who provide that care. That is what we support – the humanitarian aspect of care, which cannot be ignored as it has been, but which must be integrated within the business and science of medicine. Without all three of these working harmoniously, our health systems will continue to fail.
If you are at all interested in these concepts or in being a part of a group that is willing to strive for improving them, please consider joining us for the very inexpensive fee of $20/month paid annually.
Thank you for your consideration.
Kind regards,
Greg Warth, MD
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The Roman Fasces was a symbol of strength and power occurring as a result of many binding together. It was made of multiple elm or birchwood rods about 5 feet long tied together and sometimes including an axe. It was carried by attendants to soldiers or powerful figures in ancient Rome. For us, it symbolizes that we are stronger and more powerful if we bind together in supporting our goals.
