CVMS Bulletin

October 2023
Volume 1, Issue 10

“Wherever the art of Medicine is loved, there is also a love of Humanity." - Hippocrates

Healthier 757

CVMS has recently partnered with EdLogics, a company founded by Tom Chamberlain, dedicated to improving health literacy for the public in our area. Health literacy means the more patients know about their health, the healthier they are. Healthier 757 is the online program produced by EdLogics to accomplish this. It is presented as a game platform that is a fun way to learn about better health and at the same time offers real monetary rewards for answering questions correctly. Physicians can now offer this program to their patients for free due to multiple funding sources. Doctors can write specific prescriptions on what topics their patients should review, or just let them know about the program in general so they can browse through it.

This program is nothing less than revolutionary in educating the public about health-related matters. Take a look at Healthier 757 here...

Snapshots

Biomarkers identified in long COVID syndrome:

Biomarkers have been identified in patients with Long COVID (Post-acute-COVID-19 syndrome) suggesting its presence as a real disease entity according to a study published recently in Nature. High Fibrinogen and and high D-Dimer levels along with low CRP levels during acute COVID infection have been found to be associated with the development of long COVID, specifically the subjective cognitive deficits and occupational outcomes.

Learn more here...

Medical Treatment for Appendicitis?

Most patients with acute appendicitis can be successfully treated with antibiotics rather than surgery, even though some may require surgery up to 20 years later. 

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Price Transparency

Price Transparency is required by Federal Law, but only one in five hospitals make this information available.

Learn more...

How Much Do You Know about Type 2 Diabetes and Peripheral Artery Disease?

Here is a test quiz for you...

Virginia Total Care

Virginia Total Care is a subsidiary of Centene, a health management company for Medicare and Medicaid, similar to Humana only much better. They have partnered with our neighbor, the Medical Society of Northern Virginia and will be in our area soon. CVMS has already been in discussions with them. We are looking forward to their presence in our community as a benefit to our patients and our physicians.

Learn more about Virginia Total Care here...

Committee to Protect Healthcare

Jodi Helsel, a local representative of the Committee to Protect Healthcare, has reached out to CVMS with an opportunity to participate in a press conference regarding Site Neutral Payments. We are excited to get the word out about this since many people still have no idea about the large price discrepancies for procedures when done in the hospital versus when done in physicians' offices and outpatient facilities.

Read more about the Committee to Protect Healthcare here...

Community Pharmacists Cheer Class Action Lawsuit Against PBMs to Recoup DIR Fees

[Excerpt from Dr. Harry Gewanter's article on the MSV General Community Page.]

NCPA September 27, 2023

ALEXANDRIA, Va. (Sept. 27, 2023) – "The National Community Pharmacists Association loudly applauded a class action lawsuit filed against vertically consolidated CVS Health, Caremark, and Aetna that aims to recoup for independent pharmacies millions of dollars in what the lawyers say are wrongful back-end penalties for Medicare Part D prescriptions, otherwise known as pharmacy direct and indirect remuneration fees.

"It's payback time," said NCPA CEO B. Douglas Hoey. "Finally, community pharmacies have a chance to recover DIR fees that were unfairly taken. PBMs have been gaming the system for a long time, and it's time to turn the tables."

The lawsuit, announced today by the law firms Berger Montague PC and Cohen & Gresser LLP, claims that Caremark – the largest pharmacy benefit manager in the country and a subsidiary of Fortune 6 corporation CVS Health – has been assessing pharmacy DIR fees in violation of federal antitrust laws and state laws governing contracts. The lawsuit also challenges Caremark's agreements to arbitrate claims as being unfair and unenforceable."

Read more...

What Do You Tell Your Patients When COVID Rebounds?

As Covid cases are rapidly creeping up, and new variants are emerging with as many as 30 new mutations what do you do when your patient has completed Paxlovid only to test positive five to ten days later again?

According to the Centers for Disease Control and Prevention Paxlovid therapy was designed for people at high risk for severe disease yet with demand has expanded to a broader area. Now this category includes people with mood disorders, like depression, current and former smokers, those with obesity, the autoimmune, and an effective tool to keep people out of the hospital. But, now it's getting bad press from high-profile instances of "Paxlovid Rebound, " or testing positive days after recovering from the virus, " said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California San Francisco.

Although Paxlovid rebound is well charted in the literature, it's also possible to get rebound without ever having taken the drug. A representative of Pfizer wrote in an email to The New York Times, that "rebound is uncommon and not uniquely  associated with any specific treatment." 

So rebound is tricky stuff. You can look at it in two ways, says NYTs Dani Blum, looking at whether someone tested positive again a few days after testing negative, or by looking at whether symptoms have returned after someone seemingly recovered, or whether a new symptom appears as a secondary illness." Jay Pandit, the Director of Digital Medicine at Scripps Translational Institute believes it's hard to quantify how often rebound occurs.

In a clinical trial, Pfizer researchers estimated that 2.3 percent of people who took Paxlovid and 1.7 percent of the control group experienced rebound. Yet, estimates are 14 percent who took drug, and 9 percent for those who did not. As with everything Covid it's difficult to get real world data and those who experience rebound are unlikely to tell their doctors.

"The numbers are definitely higher than what has been reported, " said Dr. Michael Mina, a former Harvard epidemiologist, who is now chief science officer for eMed, a telehealth company, and who has studied rebound. "The theory behind Paxlovid rebound is that the treatment is so effective it's like allowing the medication to take the steering wheel from your immune system. Your immune system was going to take a back seat for a while, then you're asking it to kick back up after five days after you complete the treatment. Then the virus can replicate in your nose with a vengeance.

It's also not clear how contagious people are when they rebound. But according to the CDC if your patients test positive again on a rapid test, assume they are contagious, take precautions, isolate from other people, and if you go out in public, wear a mask. Rebound can last from two to ten days before testing negative again. Drink fluids. Report breathing poblems.

Excerpts from "What To Do When Covid Rebounds," by Dani Blum. New York Times, Oct. 2, 2023. Under WELL. Dr. Alexandria Peck Berger, Director of Public Health. CVMS.

Using Artificial Intelligence in Healthcare

Artificial Intelligence (AI) is revolutionizing healthcare in numerous ways, improving patient outcomes, reducing costs, and enhancing overall efficiency. Here are some key applications of AI in healthcare:

1. Disease Diagnosis and Detection: Medical Imaging: AI algorithms can analyze medical images (e.g., X-rays, MRIs, CT scans) with high accuracy to detect and diagnose conditions such as cancer, fractures, and neurological disorders.Pathology: AI can assist pathologists in analyzing tissue samples for cancer or other diseases.Radiology: AI-powered tools can help radiologists identify abnormalities and prioritize critical cases.
2. Personalized Treatment Plans: Genomic Analysis: AI can analyze a patient's genetic data to determine their susceptibility to certain diseases and tailor treatment plans accordingly. Drug Discovery: AI accelerates drug discovery by predicting potential drug candidates, optimizing molecular structures, and identifying existing drugs for new uses.
3. Electronic Health Records (EHRs) Management: Natural Language Processing (NLP): NLP algorithms extract valuable information from unstructured clinical notes, making it easier for healthcare providers to access patient data and make informed decisions.Predictive Analytics: AI can predict patient outcomes, readmission risks, and disease progression using EHR data, helping healthcare providers intervene early.
4. Virtual Health Assistants: Chatbots and Virtual Nurses: AI-powered chatbots and virtual assistants can provide patients with information, schedule appointments, and monitor their health, enhancing patient engagement.Telemedicine: AI can facilitate remote consultations by connecting patients and healthcare providers, offering diagnostic support and monitoring vital signs.
5. Predictive Analytics and Early Warning Systems: AI can analyze patient data to predict deteriorating health conditions, enabling early intervention and reducing hospital readmissions. Remote Patient Monitoring: Wearable devices and sensors connected to AI systems can continuously monitor patients' vital signs and send alerts if anomalies are detected.
6. Drug Dosage Optimization: AI algorithms can determine the optimal dosage for medications, reducing the risk of adverse reactions and improving treatment efficacy.
7. Fraud Detection and Billing: AI can identify fraudulent claims and billing errors, saving healthcare organizations money and ensuring accurate billing practices.
8. Research and Clinical Trials: AI can analyze vast datasets to identify potential research opportunities and match eligible patients with clinical trials more efficiently.
9. Administrative Tasks: AI-powered chatbots and virtual assistants can handle administrative tasks, such as appointment scheduling, freeing up healthcare staff for more critical duties.
10. Population Health Management: AI can analyze population data to identify trends, allocate resources effectively, and develop preventive healthcare strategies.
11. Robotics in Surgery: Surgical robots, guided by AI, enhance the precision and dexterity of surgeons, leading to less invasive procedures and faster recovery times.

Overall, AI is helping healthcare providers deliver more accurate diagnoses, individualized treatment plans, and improved patient care while reducing costs and administrative burdens. However, it is essential to ensure privacy, security, and ethical considerations when implementing AI in healthcare.

Learn more...

AI in Healthcare: Online Short Course by MIT

Free Digital Newsletter

Stay up to date on issues and news you need to know. The CVMS Bulletin is published monthly and will list concerns that local physicians have expressed about healthcare in Coastal Virginia and how we can make it better. We will provide potential solutions and let you know what is happening behind the scenes to help solve these problems.

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