CVMS Bulletin

“They’ve told us they’re suffering because of a lack of access to timely, effective care, confused by a system that is limited in the services it provides, that is cumbersome and almost too complex to navigate, and angered by a system that fails to put their needs first or even engage them about their health issues.”
– Dr. Jeffrey Turnbull

Welcome to the eighth edition of the CVMS Bulletin bringing you updates on the status of healthcare in Eastern Virginia. We hope you find it interesting, informative and enjoyable. Please let us know if there is anything we can do to make it better: admin@cvmedicalsociety.org.

To all physicians and medical students who care about improving patient care, the healthcare system, and their own personal and professional welfare:

The Coastal Virginia Medical Society (CVMS) is a new non-profit organization built from the ground up for two purposes: (1.) To provide meaningful representation and advocacy at the state and local levels for the physicians, medical residents and students of Norfolk, Chesapeake, and Virginia Beach, and (2.) To enhance professional collegiality, communication, networking, health, and well-being for our members. The previous medical societies for each of those cities have dissolved and are now merged into this new Society which is recognized as a 501(c)6 tax exempt legal entity by the State Corporation Commission and the IRS. Consider the following benefits of being part of this professional society:

·       CVMS will serve as your voice in matters relating to healthcare in eastern Virginia. We will actively be involved in making proposals, recommendations, resolutions, and voting on your behalf at the Medical Society of Virginia and the state legislature to improve healthcare for your patients and to advocate for your own welfare. (You currently have no voice.)

·       We will provide educational venues for MOC, CME credits, as well as courses related to business, leadership, and other non-medical interests.

·       Multiple benefits will be offered to help improve your practice and your personal life.

·       Get to know your colleagues at professional and social gatherings.

·       Join various groups of professionals to explore common interests: photography, nature, stocks, business, sports, journal clubs, etc.

·       Learn how to balance your professional life with your personal life.

·       Learn ways to improve your practice and professional life that you don’t even know about yet.

·       You CAN make things better. Joining CVMS will give you some control over your life, your practice, and your career.

·       Receive recognition for your hard work, your contributions, and your dedication to medicine and to the community.

Sign up for our free monthly newsletter at https://www.cvmedicalsociety.org/CVMS-Bulletin.html to follow our progress and stay informed on a variety of medical and policy issues. While you’re there, review the website and see what we are about. There are lots of links to places you might find interesting and educational.

“Making a Difference”

Access to Care

One of our major concerns about healthcare in this area is that patients often have a difficult time getting the care they need in a timely manner. Some things can be done fairly quickly like labs and routine x-rays, but many studies like MRI scans and Echocardiograms have long waiting times. Getting in to doctors' offices is also a major challenge.The wait time in emergency rooms all over Tidewater creates a huge amount of stress and suffering for patients and providers alike. 

Over the past several months as COVID cases began to wane, the healthcare community noticed this phenomenon that heretofore had not existed. Patients couldn’t get appointments to physicians in some instances for more than a year. By the same token, primary care physicians who wished to refer patients to specialists could not get them in for many months even for urgent situations. Sometimes PCPs could get around that by calling specialists directly and sometimes offices would have a cancellation list that would allow a patient to get in earlier than they would by waiting for the next available slot. But many times, PCPs are left trying to take care of things that are beyond their expertise and just doing the best they can under the circumstances.

During the same time, scheduling tests to be done in a timely manner has become a nightmare. There are just not enough testing facilities available for the demand. Diagnostic efforts are slowing down to a crawl. Patients are suffering while providers are waiting a week or more for diagnostic information before treatment can be provided.

These events are seriously impacting patient care and adding to the emergency room overcrowding. No longer can America brag about its healthcare system while criticizing other countries who have similar problems, whether or not they have public or private systems. Addition of midlevel staff doesn’t seem to have helped the situation much. We need a LOT more providers and a LOT more testing facilities to handle this load. Corporate America is not helping partly due to the restrictive CON laws. It will be years before the planned EVMS-ODU merger will begin to produce more providers.  Requiring providers to see more patients in less time puts an undue burden on already overworked physicians and just leaves patients unsatisfied and searching for other options, which in turn just overcrowds the system even further. Neither does telemedicine seem to be the answer, which for many patients, is impersonal, but perhaps, “better than nothing.”

Do you have any comments or cases regarding access to care that you would like to share? Are you getting frustrated by not being able to schedule referrals, tests, or procedures in a timely manner? Are your patients frustrated and unhappy with this? Do you have any ideas or solutions that you think might help? Would keeping at least one slot open in your schedule every day for urgent situations allow you to improve access for your own patients or for urgent consultations and referrals? Please write your comments in the box below.

CVMS Status Update

Our second official Board meeting was held on August 2, 2023 at the Westin in Towne Center. It was well attended. Several new guests were present including Dr. Juan Montero II, founder of Montero Medical Missions, Dr. David Archer from the Jones Institute, and James Beckner, Executive Director of the Richmond Academy of Medicine. 

Dr. Montero was added to our Advisory Board, Dr. Archer was introduced and participated in the discussions, and Jim Beckner was approved as our Business Manager. Dr. Archer graciously agreed to accept our invitation to take the position of Director-at-Large.

You will be receiving a letter by email in the near future asking you to join CVMS. Please consider doing so. Every person we add makes our organization that much stronger, not to mention the benefits that will be available to you.

We have selected five delegates to attend the August 9th Caucus in Norfolk and to the Medical Society of Virginia Annual Meeting in October. They will be your representatives to MSV and ultimately to the state legislature. We have until August 29th to submit proposals, so please let us know right away what problems you are facing relating to inefficiencies in the healthcare system, restrictions and barriers to care. We want to be there as your advocate and fight for what you believe in.

We will be making several proposals this year as follows:

• Removal of CON laws in Virginia - This has already been proven in other states  to improve competition, improve patient care, lower healthcare prices, increase the number of hospital beds available, and decrease the serious overcrowding in emergency rooms.
• Removal of the requirement for prior authorizations which serve only to burden physician workloads. It is not fair that physicians have to take on the unpaid work that saves money for insurance companies.
• Require price transparency so that larger healthcare organizations have to show openly and upfront how much procedures cost when done in the hospital - the same procedures that can be done in outpatient clinics and doctors' offices for much less. (This is supposed to be happening now, but patients have to ask for it. We will observe for accountability.)
• Establishment of state owned and operated Opiate Control, Treatment and Prescription Pain Management Clinics. The current number of privately operated prescription pain management practices are woefully inadequate and patient access is very restricted. The burden of pain management currently lies on primary care physicians who have no resources to help with these patients. 
• Reduce medical record requirements that create an undue burden on physicians, or allow physicians to charge a fee for maintenance of records for each patient seen.
• Improve insurance coverage for mental health to incentivize an increase in psychiatrists and mental health care. 
• Remove any insurance penalties for procedure-oriented physicians who do patient visits and procedures in the same setting.
• Provide tax benefits for any physician who volunteers to work in a free clinic (already being done).
• Allow a surcharge for doctors who agree to add-on urgent referrals from other physicians. This will incentivize better access to care for patients with urgent problems.
• State financial support for physician burnout treatment. (Safe Haven has been initiated by MSV and is currently providing this support!)
• Change requirement for 3-day hospital stay to 1-day hospital stay (either inpatient or observation status) for Medicare patients before going to Medicare-covered SNF Rehab.
• If a physician has to see a patient twice a day for a new problem or persistence of a prior problem, whether in the hospital or in the clinic, the physician should receive compensation for it.
• If a physician is required to do a discharge summary and a separate admission H&P on the same day (for patients being discharged from the hospital and being admitted to an SNF, the physician should be compensated for both.
• If a patient requests a physician to see them after a Nurse Practitioner or Physician’s Assistant has seen them, they should have that right to see the physician. The physician should be compensated for that visit.

The Medical Society of Virginia has been working on many of these same goals for some time. They welcome the support that the physicians in CVMS can provide. The more members we have in supporting these issues, the greater our ability to make changes.

As you may know, the Beach Clinic closed several months ago. We want to get this operating again and will work tirelessly to make that happen. 

We are also planning to develop a charitable fundraising foundation for the purpose of providing better healthcare to our less privileged communities. We can then potentially provide funds that would allow under insured patients to get testing and/or treatments that they would otherwise not be able to afford. The prior Virginia Beach Foundation run by the VBMS Auxilliary was quite effective in this regard. We hope to re-establish these efforts.

We will work to provide help for the homeless, the mentally ill, and for patients with substance abuse disorders.

Educational courses, seminars and webinars will become available for you soon to learn more about leadership, setting up and maintaining a practice, business courses, hobbies, gardening, photography, along with medical CMEs.

Our first quarterly membership meeting is planned for late September. Details will be posted on the website by the end of August. We also plan to have monthly happy hours just to get together for the fun of it. Attending social events like these are critical to help control and prevent burnout and depression. So, even if it's not for you, please attend for the benefit of your colleagues. We need socialization to prevent isolation. It's therapeutic for all of us.

How to Write a Proposal

Would you like to create a proposal for CVMS to bring to the MSV table?

Here's how to do it...

Montero Medical Missions

If you have never heard of Montero Medical Missions, you will be delighted to know there is good will in the world after all. From humble beginnings, Dr. Juan Montero founded this amazing non-profit organization to help people all over the world who lack medical supplies and have poor access to medical care. The website best explains it as follows: MMM "combines foreign and domestic talents in medicine, healing, humanitarianism, operations and logistics to create sustainable projects around the world as well as within the US." They are unique in that they allow volunteers and donors to join missions in order to experience the joy of serving others who are in need and who are forever grateful for their care.

The idea behind this is that all people should have the benefit of health and healing when they need it. Lack of supplies and healthcare workers should not be a deterrent to this basic human right. 

Dr. Montero is a retired general surgeon who practiced in Virginia Beach for 37 years, partnering with the late Dr. William Hotchkiss, former president of the AMA. Retirement, however, did not stop him from continuing his never-ending desire to help people. Now in his 80s, his energy abounds. He continues to travel on multiple missions every year, and when he is not traveling, he is fund raising. A significant part of his mission is also committed to helping Veterans.

His world-wide missions include establishing clinics for eyesight, dental work, feeding and educating children, technology donations for schools, mental health, women's health, prosthetics, and others.

We are honored and delighted to have Dr. Montero on our Advisory Board.

Related Links

Association of American Physicians and Surgeons

Virginia Department of Health Professions

Virginia General Assembly

Medical Society of Virginia

Virginia Health Department

Virginia Beach Health Department

Chesapeake Health Department

Chesapeake Care Clinic

Norfolk Health Department

Center for Disease Control

CDC Stats for Virginia

COVID-19 in Virginia

NIH - Pub Med

American College of Physicians/Advocacy

American College of Surgeons/Advocacy

AMA HealthCare 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

Mercatus Center: CON Laws

Fierce HealthCare

Educational Sites

Eastern Virginia Medical School

Business Courses

MedScape CME

Virginia CME Packages

MedScape References

Medical Legal Partnerships

Medical Ethics

JAMA Network

Vu-Medi

Snapshots

Snapshots:

• The new national number for mental health emergencies is - -988 - -. Pass this on to your patients! Virginia has been expanding its services to take these calls.

• Alpha-gal syndrome, a meat allergy linked to the Lone Star tick bite across southern, mid-Atlantic and midwestern states is an emerging immunoglobulin E (IgE)-mediated allergic condition characterized by a reaction to the oligosaccharide galactose-alpha-1,3- galactose (alpha-gal). Found in meat, milk, dairy and some pharmaceutical products, symptoms range from mild ( e.g. rash or gastrointestinal upset) to anaphylaxis. Thousands have contracted this.

•H.R.35661: Patient Act of 2023, a bill supporting complete transparency in healthcare billing, needs your voice! Promote passage. Write your representative. To Read the full bill go to: https://www.govinfo.gov/content/pkg/BILLS-118hr3561ih/pdf/BILLS-118hr3561ih.pdf

• Patients with cancer currently have the lowest risk of severe Covid-19 outcomes since the start of the pandemic according to a paper published in Scientific Reports.

• A new analysis of data from a large clinical trial of healthy older adults found higher rates of brain bleeding among those who took daily low-dose aspirin and no significant protection against stroke.The findings published in JAMA Network Open, involved 9,525 people who took 100mg. daily aspirin doses and 9,589 people taking a placebo.

• Federal health officials have identified a number of mental health conditions associated with long Covid, and have issued an advisory to help doctors treating patients. Conditions include depression, anxiety, compulsive-obsessive disorder, and post-traumatic stress disorder. Other long Covid symptoms include fatigue, trouble sleeping, and cognitive impairment.

•The Food and Drug Administration (FDA) has approved Zurzuvae (Zuranolone), the first oral medication to treat postpartum depression. The pill takes effect in as little as two weeks.

• Approved January 19, 2023, now available Brukinsa (Zanubrutinib) improves targeted treatment for Chronic lymphocytic leukemia (CLL ), and small lymphocytic lymphoma (SLL) with fewer side effects.

• A new study presented at the 12th International AIDS Society (IAS) Conference on HIV Science reported that (Sunlenca) Lenacapavir showed long-term favorable quality-of-life outcomes for patients treated twice-yearly with the subcutaneous injections.

Questions or Comments: Send an email to cvmedsoc@gmail.com.

CME Videos on Opioid Management

Dispelling Old Myths about Obesity

Hint: It's not about
Calories in = Calories out

Are your patients having trouble losing weight? Would you like to lose a few pounds yourself? There are so many different diets, and pills out there, most of which don't help, that the prospect of seriously losing weight becomes overwhelming. There are too many misconceptions about it. Here are some common myths:

Overweight people are weakly disciplined. If they would just decrease their calories and exercise more, they would lose the weight. Not true. Some of the most disciplined people in the world still can't lose weight. 

Calories In = Calories Out: Not true. Many studies over the past few decades have proven this to be oversimplified and inaccurate. It's more about what and when you eat.

What causes weight gain? Calories? Lack of exercise? Neither one. The correct answer is INSULIN. 

Every time we eat, Insulin levels go up. If you're a grazer and eat small amounts six times a day, insulin levels will be high. If those little meals have a lot of carbs, insulin will be even higher. On the other hand, if you eat only one or two low carb meals a day, insulin levels will remain low, you will reset your body's metabolic balance and you will lose weight.

Exercise, although it is good for you in terms of maintaining strength and muscle tone, has almost nothing to do with your weight.

If you want to know more about this, read the book entitled Obesity Code by Jason Fung, MD. Everything you thought you knew about obesity will be blown out the window.

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Things You Need to Know

News Releases
from the
Virginia Beach Health Department
Norfolk Public Health Department
Chesapeake Health Department

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.

Medical Society of Virginia Updates

Upcoming Virtual CME Activities from MSV

COVID-19 Vaccine Information

Pfizer COVID-19 Training Sessions and Additional Vaccine Information

Includes a section on what to tell your patients

VDH Clinician Letters - COVID-19 updated from the Virginia State Health Commissioner

COVID Trends in Virginia

Coastal Virginia Medical Society

Mission Statement

The mission of the Coastal Virginia Medical Society is (1) to provide professional advocacy and representation for its members regarding their ability to provide for and promote better healthcare in the Coastal Virginia area, specifically for the cities of Norfolk, Chesapeake, and Virginia Beach, and (2) to facilitate and/or promote communication, education, fellowship, scholarship, and other lawful benefits for its membership as determined to be reasonable by the Board of Directors, and (3) to assist in and/or promote the physical health and mental wellness of its members through the use of local resources, again as determined to be reasonable by the Board of Directors.

What's New?
(Blog Posts)

Recent Articles

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• 
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1. Quick-Survey

   Dec 18, 24 05:11 AM

   Let us know what's on your mind.

   Read More

2. CVMS Medical Webinars

   Dec 17, 24 02:38 PM

   
   CVMS Medical Webinars

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3. People Solutions Digest

   Nov 13, 24 05:55 AM

   Here is the latest edition of the monthly "People Solutions Digest" from Lockton that you might find interesting.

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Helpful Links

Earn MOC Points

Physicians Grassroots Network

Continuing Education Requirements from the Board of Medicine

Informed CMEs for Virginia Physicians (including the mandatory opioid credits)

Stroke Smart Materials

Severn Leadership Group Fellows Program 

List of Concerns Requiring Study, Advocacy and Action  

This is a list of concerns and recommendations from the Board of Directors that require focus, advocacy, and action as we move along in our mission to improve the lives of our physicians and patients in coastal Virginia. Please feel free to comment on or add to this list using the Comment Box at the bottom.

* Highest Priority

      a.    Certificate of Need*

      b.    Price Transparency*

      c.     Prior Authorizations*

      d.    “Peer to Peer” reviews with insurance companies

      e.    Reducing physician workload/paperwork/computer work, or get paid for it.

      f.      Easier communication with patients and colleagues- encrypted.

      g.    Physician burnout and depression issues – moral dilemma*

      h.    Office scheduling and practice management seminars to improve patient access and patient-centric routines.

      i.      Better Patient Care / Access to care /Eliminate barriers*

      j.      Public/patient mental health issues.*

      k.     Firearm concerns

      l.      Connect with American College of Physicians Advocacy Program

      m.  Selection of Delegate(s) to attend MSV Annual Meeting in October. Will need delegates on standby for the August 9th 2nd district caucus. 

      n.    Working with external forces – hospital policies, pharmacies, allied professionals

      o.    Poor Medicare reimbursement for this area.

      p.    Staff shortages physicians and nurses.

      q.    “Scapegoats” for opioid crisis – lack of specialists and community resources.

      r.     Pain management.*

      s.     Fact checking service. Dispelling myths and medical misinformation.

      t.     Inpatient vs observation – incentivizes longer hospital stays.

      u.    3-day stay for patients who require rehab.

      v.     Requirement for us to discharge patient when the hospital wants to discharge them.

       x.   Need to regain respect as leaders in the healthcare system*

Board of Directors

Our current Board of Directors is as follows:

Greg Warth, MD,  President, Communications Director, Newsletter Editor, MSV Delegate

Keith Berger, MD, Vice President and Advocacy Director, MSV Delegate

Jerome Blackman, MD, Secretary, Director of Mental Health, MSV Delegate

Lisa Barr, MD, Director of Membership, MSV Delegate

Dr. Alexandria Peck Berger, Director of Public Health and Research

David Archer, MD, Director-at-Large

Cynthia Romero, MD, Director of Education, Liaison to EVMS and ODU

Joel Bundy, MD, Director-Liaison to Sentara, MSV Delegate

Duane Lawrence, MSV Delegate

Brenda Musto, Executive Director, non-voting

Advisory Board (non-voting):

• Karen Greenhalgh, State Delegate
• Charlotte Dunn, Professional Risk
• Juan Montero, II, MD, FACS
• James Beckner, Business Manager

Please note there are two important vacancies on the Board - one for Secretary-Treasurer, which actually could be two positions on its own, and one for Director of Marketing, Benefits and Services. Here is your opportunity to become a leader in the community, to actually make a difference in improving healthcare in eastern Virginia. If you are at all interested in either of these positions, please let us know.

Contact us:

Email:admin@cvmedicalsociety.org

Phone: 757-816-8399

FAX: 757-486-2208

Contact Us

Here is your chance to let us know what is on your mind. What problems with healthcare in this area are you most concerned about? What benefit or service can we provide to help you the most with regard to your well being or that of your patients?

Just send an email to admin@cvmedicalsociety.org.