Maine Medicine Weekly Update - Maine Medicine Weekly Update
August 20, 2021
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Important Status Update on Maine Medical Associationís 168th Annual Session

MMA President, Karen Saylor, MD & MMA CEO, Andy MacLean

Because of the uncertainty of the COVID-19 pandemic, the Maine Medical Association has planned a “hybrid model” for its 168th Annual Session scheduled for September 10-12, 2021 at the Jordan Grand Hotel at the Sunday River Resort in Newry, Maine. Our “hybrid model” was designed to accommodate the preferences of those members and guests who want a traditional in-person meeting experience and those who wish to participate in the key governance and CME activities without attending in person.

Because of the uncertainty of the COVID-19 pandemic, the Maine Medical Association has planned a “hybrid model” for its 168th Annual Session scheduled for September 10-12, 2021 at the Jordan Grand Hotel at the Sunday River Resort in Newry, Maine. Our “hybrid model” was designed to accommodate the preferences of those members and guests who want a traditional in-person meeting experience and those who wish to participate in the key governance and CME activities without attending in person.

Based upon recent trends in the pandemic as a result of the “Delta variant,” MMA has reviewed its protocols for this “hybrid model” and believe we can still offer a safe in-person meeting experience as well as an excellent remote participation option. We thank those who have registered to date and encourage all members to consider the option that best meets their needs and expectations.

We have recently reviewed with the resort staff, the protocols for the Annual Session and draw your attention to the following points:

·      The Sunday River Resort’s safety protocols have met U.S. and Maine C.D.C. guidelines throughout the pandemic and the COVID-19 experience has been minimal.

·      Weather permitting, we will hold as many of the meeting activities outside.

  • The Jordan Hotel’s conference rooms provide adequate space for social distancing.
  • In keeping with current pandemic guidance, masks will be required for all attendees at public indoor activities, except while eating.
  • ALL MEETING ATTENDEES MUST BE FULLY VACCINATED AGAINST COVID-19 (all those who are eligible under current guidelines)
  • We will continue to monitor the pandemic developments and adjust plans for the Annual Session as appropriate.

We look forward to seeing many of you in person at Sunday River and understand that some of you will be more comfortable participating remotely.

Register for the 168th MMA Annual Session here.

If you have any questions about the safety protocols or registration for the 168th MMA Annual Session, please contact Diane McMahon at dmcmahon@mainemed.com or 207-480-4188.

Maine Chapter American Academy of Pediatrics to Hold Back to School Town Hall

Please join the Maine AAP and Maine DHHS on Tuesday, August 31 from 7:00 p.m. to 8:00 p.m. for an online town hall forum to discuss safely getting our youth back to school, complying with the new vaccine law and how to best stay safe while in the classroom, gym, cafeteria, school yard, sports fields and buses!

Please join the Maine AAP and Maine DHHS on Tuesday, August 31 from 7:00 p.m. to 8:00 p.m. for an online town hall forum to discuss safely getting our youth back to school, complying with the new vaccine law and how to best stay safe while in the classroom, gym, cafeteria, school yard, sports fields and buses!

Click here to register.

Contact Executive Director, Dee Kerry at Maine AAP for more information at 207-622-3374 x219 or dee.kerry@maineaap.org

New Maine Immunization Law for Schools Takes Effect Sep 1

This is a reminder that a new law removing religious and philosophical exemptions for childhood immunizations to attend school in Maine is set to be implemented this school year, on September 1, 2021.

  • Overview of the New Law
  • Maine DHHS Memo: Preparing Students for the 2021-2022 School Year
  • Vax To School Maine Resources
  • ACIP & AAP Childhood Immunization Links and Resources

This is a reminder that a new law removing religious and philosophical exemptions for childhood immunizations to attend school in Maine is set to be implemented this school year, on September 1, 2021.

Students enrolled in grades PreK through 12 are required to be immunized against:

  • Diphtheria
  • Tetanus
  • Pertussis
  • Measles
  • Mumps
  • Rubella
  • Polio
  • Varicella

* Immunization requirements for preschool students: 4 DTap, 3 Polio, 1 MMR, 1 Varicella

All students enrolled in grades 7-12 also must be immunized against meningococcal disease.

Beginning September 1, 2021, philosophical exemptions and religious exemptions will no longer be allowed as exceptions from immunization requirements.

Medical exemptions are still allowed and are to be provided by the parent/student and in the form of a written statement from a licensed physician, nurse practitioner or physician assistant.

Those with an IEP who elected a philosophical or religious exemption prior to Sept 01, 2021, may continue to attend school under an existing exemption with a statement from a licensed physician, nurse practitioner or physician assistant confirming consultation that the parent or guardian has been made aware of the risks and benefits associated with the choice to immunize.

Individualized Education Plans (IEP)

Individualized Education Plans are covered by the Individuals with Disabilities Education Act (IDEA). Federal laws take priority over any conflicting rules of state law.

Students’ rights under IDEA supersede state law, local school board and school district policies. States cannot enact laws that provide less protection than guaranteed by federal law. Federal IDEA, the Office of Administrative Hearings (OAH or special education court) and the 9th District Circuit Court explicitly provide for children with IEP’s to be excluded from school immunization requirements.

***Important Note: 504 plans are not covered by IDEA and are therefore not exempt.

According to a Maine DOE sample letter to parents/guardians, “Beginning September 1, 2021 no child will be permitted to attend school without evidence of immunization or proof of immunity against disease.”

However, the Maine Department of Health and Human Services and Maine Centers for Disease Control and Prevention released the following memo this week.

Preparing Students for 2021-2022 School Year (PDF)

The document lists the various circumstances where exceptions apply, including a one-time written assurance from a parent or guardian that the child will be immunized by private effort within 90 days of enrollment (officially registering) in school or of the child first attending, whichever date is the earliest.

Vax to School Maine

Vax to School Maine is a partnership between the Maine Chapter of the American Academy of Pediatrics, the Maine Immunization Coalition, and Maine Families for Vaccines. The website includes public service announcements on the new law and the following information to help Mainers learn more.

  • Required Vaccines
  • Immunization Schedules for Providers
  • Immunization Schedules for Parents
  • A link to read the new law
  • An FAQ page

More Helpful Links

ME DHHS COVID-19 Vaccines - Special Clinician Info Session - Tues, Aug 24, 7:30AM

To: Maine Clinicians

Given the rapidly evolving changes and issues involving COVID-19 vaccinations, Maine DHHS & ME CDC will be holding an additional COVID-19 Vaccines Clinician Info Session on Tues, Aug 24 at 7:30AM.  Recognizing that there are a number of issues for discussion, we’ll plan to hold this as a 1hr call (vs. the usual 30 minutes).  We will continue to otherwise hold these 30-minute calls monthly on the 2nd Tuesday of each month (next on Tues, Sept 14). Please share with colleagues.

To: Maine Clinicians

Given the rapidly evolving changes and issues involving COVID-19 vaccinations, Maine DHHS & ME CDC will be holding an additional COVID-19 Vaccines Clinician Info Session on Tues, Aug 24 at 7:30AM.  Recognizing that there are a number of issues for discussion, we’ll plan to hold this as a 1hr call (vs. the usual 30 minutes).  We will continue to otherwise hold these 30-minute calls monthly on the 2nd Tuesday of each month (next on Tues, Sept 14). Please share with colleagues.

Join Zoom Meeting
https://zoom.us/j/6218434986?pwd=dEJoNEVRSkVSN2dwZlJ5WEl3WjJsZz09

Meeting ID: 621 843 4986
Passcode: 338847
One tap mobile: +13017158592,,6218434986#,,,,,,0#,,338847#

Top National Pandemic Actions & News This Week

  • Moderna & Pfizer Booster Shots Will Be Available in September
  • U.S. Will Require Nursing Home Employees To Get COVID-19 Vaccine(s)
  • More Than One Million Doses Were Administered Over One 24-hour Period This Week

  • Moderna & Pfizer Booster Shots Will Be Available in September
  • U.S. Will Require Nursing Home Employees To Get COVID-19 Vaccine(s)
  • More Than One Million Doses Were Administered Over One 24-hour Period This Week

Moderna & Pfizer Booster Shots Will Be Available in September

The Biden Administration announced a nationwide booster shot plan this week which will start the week of September 20th. US Surgeon General, Dr. Vivek Murthy announced during a White House briefing that the first phase of boosters will commence for “our most vulnerable populations, like our health care providers, nursing home residents and other seniors. We will also begin delivering booster shots directly to residents of long-term care facilities."

People 18 years and older who received the Pfizer or Moderna vaccines will be eligible for a booster dose eight months after their second dose. The booster shots will not be extended as of yet to those who received Johnson & Johnson’s one-dose vaccine because public health officials await trial results using two doses.

Although the initiative will still need to be authorized by the FDA and US CDC, the announcement comes afterthree new studies outlined in US CDC Morbidity & Mortality Reports appear to show the vaccines still appear to remain effective at preventing severe illness and hospitalization for most people.

However, Céline Gounder, MD, ScM, FIDSA, an infectious disease specialist at NYU and a former member of the Biden-Harris Transition COVID-19 Advisory Board, questions such a broad plan for boosters stating, “I do not understand the urgency of giving the general population additional doses of COVID vaccine at this time,” and said boosters could be limited to vulnerable groups like people over 80. “[The vaccines] remain highly protective vs hospitalization & death.”

 

U.S. Will Require Nursing Home Employees To Get COVID-19 Vaccine(s)

President Joe Biden this week stated his administration will require employees at nursing homes to be vaccinated against COVID-19 as a condition of the facilities participating in the Medicare and Medicaid government health care programs. Governor Mills announced a statewide mandate for all health care workers last week.

The President and CEO of the American Health Care Association and National Center for Assisted Living responded by saying that focusing on nursing homes "will cause vaccine hesitant workers to flee to other healthcare providers" and "make an already difficult workforce shortage even worse."

The announcement came Wednesday, August 18, after a US CDC Morbidity & Mortality Weekly Report (MMWR) presented a new study comparing weekly data from over 3,800 nursing homes and long-term care facilities spanning March 1 to May 9, before Delta became widespread, to data from nearly 15,000 facilities covering June 21 to Aug. 9, when the variant was responsible for the majority of new infections.

Researchers found that efficacy of the two-dose vaccines from Pfizer/BioNTech and Moderna for preventing any coronavirus infection — mild or severe — dropped from 74.7% to 53.1%. Effectiveness estimates were similar for the Pfizer-BioNTech and Moderna vaccines, they said.

US CDC August 18, 2021 MMWR: Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant — National Healthcare Safety Network, March 1–August 1, 2021

More COVID Nursing Home News:

The Bangor Daily News reported this week that “Maine’s delta variant surge has largely spared nursing homes.”

 

More Than One Million Doses Were Administered Over One 24-hour Period This Week

According to White House figures, more than one million doses were administered in the past 24 hours, including half a million people with a first dose. It was also a 31 percent week-over week increase in the daily average of people completing their vaccine series.

Thursday’s announcement marks the first time there have been at least 1 million doses administered in close to seven weeks. Vaccinations had slowed down after hitting a peak in mid-April of about 3.3 million doses per day.

Full story from The Hill can be found here.

FDA COVID-19 Updates & Info

  • FDA—August 13, 2021: COVID-19 Update including a new FDA Consumer Update highlighting 5 Things to Know about COVID-19 Vaccination for Adolescents

FDA—August 13, 2021: COVID-19 Update including a new FDA Consumer Update highlighting 5 Things to Know about COVID-19 Vaccination for Adolescents

FDA—August 13, 2021: Preparing for the School Year: Younger Children & Adolescent Vaccine Updates - 45-minute recording of a stakeholder call with HHS Assistant Secretary for Health Rachel L. Levine, MD, and FDA Center for Biologics Evaluation and Research Director Peter Marks, MD, PhD

FDA—August 12, 2021: FDA Authorizes Additional Vaccine Dose for Immunocompromised People

Bangor Daily News: What You Can Do If You Lost Your COVID-19 Vaccination Card In Maine

  • Patients can contact the organization that ran the clinic where they received doses
  • Patients can also fill out an authorization for release of information form from the Maine Department of Health and Human Services
  • People can also call 1 (800) 821-5821 to request a replacement from the Maine Immunization Program.

  • Patients can contact the organization that ran the clinic where they received doses
  • Patients can also fill out an authorization for release of information form from the Maine Department of Health and Human Services
  • People can also call 1 (800) 821-5821 to request a replacement from the Maine Immunization Program.

Read the full Bangor Daily News story here. (Subscriber content with a limited amount of free articles)

Nurse Anesthetists Announce Name Change; ASA Responds

The American Association of Nurse Anesthetists announced this week that it will now be known as the American Association of Nurse Anesthesiology (AANA) going forward. The American Society of Anesthesiologists (ASA) quickly called it “medical title misappropriation” that confuses patients and creates discord in the care setting, ultimately risking patient safety.

The American Association of Nurse Anesthetists announced this week that it will now be known as the American Association of Nurse Anesthesiology (AANA) going forward. The American Society of Anesthesiologists (ASA) quickly called it “medical title misappropriation” that confuses patients and creates discord in the care setting, ultimately risking patient safety.

The AANA statement included the quote, “Nurse anesthesiology is the first profession to own the responsibility of anesthesia delivery,” according to AANA President Steven M. Sertich, CRNA, MAE, JD, Esquire. “Today, nurse anesthesiology remains one of the nation’s most innovative fields of science.” He added, “Our new name tells the story of who we are, what we do, and what we stand for,” said President Sertich. “We have now unified this understanding behind a clear, revitalized brand.”

The ASA’s response countered:

“The term “anesthesiologist” has always been used to differentiate physicians trained in the science and study of anesthesiology from non-physicians, including nurse anesthetists.

Additionally, it is an unchallenged ethical principle that every patient must have full knowledge and understanding of the education, training, skills, and experience of the health care professionals providing their care. ASA will continue to protect patients by aggressively challenging AANA’s attempts to threaten clear identification of roles and advance nurse-only care.”

Weekly Update readers may recall a story in late May how the American Academy of Physician Assistants (AAPA) House of Delegates voted to change their title to Physician Associate and the subsequent responses from the AOA and the AMA respectively.

FDA: Stop Using All Eco-Med Ultrasound Gels and Lotions Due to Risk of Bacterial Contamination

The FDA has issued a Letter to Health Care Providers to inform health care providers, health care facility risk managers, and procurement staff to immediately stop use of and discard all ultrasound gels and lotions manufactured by Eco-Med Pharmaceutical, Inc., due to risk of bacterial contamination with Burkholderia cepacia complex (Bcc).

The FDA has issued a Letter to Health Care Providers to inform health care providers, health care facility risk managers, and procurement staff to immediately stop use of and discard all ultrasound gels and lotions manufactured by Eco-Med Pharmaceutical, Inc., due to risk of bacterial contamination with Burkholderia cepacia complex (Bcc).

EcoGel ultrasound gel products and lotions manufactured by Eco-Med are distributed by a number of companies under various product names, including MediChoice Ultrasound Gel distributed by both Owens & Minor and Mac Medical Supply Co., Inc.

The Letter to Health Care Providers includes important information about Eco-Med ultrasound gels and lotions, including:

  • The specific names of affected products
  • Details on Eco-Med ultrasound gel and lotion contamination.
  • Recommendations for health care providers and facilities.
  • Actions the FDA is taking to address the issue.
  • Instructions for reporting problems with Eco-Med ultrasound gel and lotion products.

Read the full FDA letter here.

Maine CDC Makes New Vaccine Products Available Through Maine Immunization Program (MIP)

The Maine Vaccine Board voted to include two new vaccine products to the approved list of

available vaccines supplied through the Maine Immunization Program (MIP).

 

The newly approved vaccines are:

  • The meningococcal quadrivalent conjugate vaccine (MenACWY) vaccine formulation, MenQuadfi™ (Sanofi).
  • VAXELIS™ (Sanofi and Merck), the new hexavalent vaccine indicated for protection against diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae type B (Hib)

The Maine Vaccine Board voted to include two new vaccine products to the approved list of available vaccines supplied through the Maine Immunization Program (MIP).

The newly approved vaccines are:

  • The meningococcal quadrivalent conjugate vaccine (MenACWY) vaccine formulation, MenQuadfi™ (Sanofi).
  • VAXELIS™ (Sanofi and Merck), the new hexavalent vaccine indicated for protection against diphtheria, tetanus, pertussis, polio, hepatitis B, and Haemophilus influenzae type B (Hib)

Both vaccines are now available to order to all enrolled VFC Providers. Click here for more information on the vaccines.

For questions on any immunization-related issue, please call (207) 287-3746 or email

ImmunizeME.DHHS@maine.gov. Thank you for all that you do to keep Maine children safe from vaccine-preventable diseases

Maine CDC Vaccine Provider Training

The Maine Immunization Program isbe hosting twice weekly trainings for all VFC provider sites. These trainings will serve as a refresher of VFC requirements and will continue each Tuesday and Wednesday throughout the months of August and September. Maine CDC will re-evaluate the need to continue trainings for October at the end of September.

 

All provider staff are welcome and encouraged to join.

The Maine Immunization Program isbe hosting twice weekly trainings for all VFC provider sites. These trainings will serve as a refresher of VFC requirements and will continue each Tuesday and Wednesday throughout the months of August and September. Maine CDC will re-evaluate the need to continue trainings for October at the end of September.

All provider staff are welcome and encouraged to join.

Where: Zoom Meeting https://zoom.us/j/92080721290?

When: Tuesdays and Wednesdays at 12:00 PM

Meeting ID: 920 8072 1290

Passcode: cMnCc6

ACIP General Best Practice Guidelines for Immunization Updates - 8/17/2021

Revisions have been made to the ACIP General Best Practice Guidelines for Immunization.

To see the revisions, please go to ACIP List of Errata/Updates for Guidelines for Immunization | CDC

Revisions have been made to the ACIP General Best Practice Guidelines for Immunization.

To see the revisions, please go to ACIP List of Errata/Updates for Guidelines for Immunization | CDC

Changes have also been made to:

2020-2021 Seasonal Influenza Recommendations

https://www.cdc.gov/vaccines/acip/index.html

Bookmark the following pages for future use

General Best Practice Guidelines for Immunization

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

Preparing Your Practice for COVID Vaccination: Recommendations, Schedules, Storage/Handling, Administration, Clinical Resources

https://www.cdc.gov/vaccines/hcp/index.html

Update: 2020 MIPS Performance Feedback, Final Score, and 2022 MIPS Payment Adjustment Information

Earlier this week, CMS made the AMA aware that certain MIPS participant scores for 2020 were inadvertently miscalculated due to a technical issue. CMS is recalculating all scores to ensure their accuracy and plans to update both the 2020 scores and related 2022 payment adjustment information in the next few weeks. During our conversation, CMS also informed the AMA that the deadline to submit an appeal, or targeted review request, would also be extended. Please see the note below for more information. 

Update: 2020 MIPS Performance Feedback, Final Score, and 2022 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) will be updating the Merit-based Incentive Payment System (MIPS) performance feedback and final scores for some clinicians for performance year 2020 and the associated MIPS payment adjustment information for payment year 2022.

We are committed to ensuring transparency in our program and alerting clinicians as soon as possible when issues are discovered. Our intention is to provide clinicians advanced notice that they may see some change to their current final scores and payment adjustment information. Additionally, because of these expected changes we will also be extending the targeted review period. More details about what will change from the initial release, who is impacted and how this will affect MIPS payment adjustments, as well as the new targeted review period deadline are coming soon. We appreciate your patience as we work to confirm the information we’re providing you is accurate.


 Additional Resources:

You can view your current MIPS performance feedback, final score, and payment adjustment on the Quality Payment Program website.  Please note the information you see now may be changing.

You can access your 2020 MIPS performance feedback, 2020 final score, and 2022 payment adjustment information by:

  • Going to cms.gov/login
  • Logging in using your HCQIS Access Roles and Profile (HARP) system credentials; these are the same credentials that allowed you to submit your 2020 MIPS data

If you don’t have a HARP account, please refer to the Register for a HARP Account and Connect to an Organization documents in the QPP Access User Guide and start the process now.

For Shared Savings Program ACOs, please note that beginning August 5, 2021, you will be able to create a HARP account and manage your account in the ACO Management System (ACO-MS). Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1).

To learn more about the information in your performance feedback, review the following 2020 MIPS Performance Feedback Resources:  

NEW! 2020 Performance Period Benchmarks (ZIP) – Identifies the performance period benchmark results (as available) for measures without a historical benchmark and provides general information about performance period benchmarks.

2020 MIPS Performance Feedback FAQs (PDF) – Highlights what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.

2022 MIPS Payment Year Payment Adjustment User Guide (PDF) – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.

MIPS Eligible Clinicians Participating in MIPS Alternative Payment Model (APM) Entities

Individual clinicians and representatives of APM Entities will also be able to access performance feedback directly on the Quality Payment Program website using their HARP account. Note: Performance feedback is not related to model-specific requirements and assessments outside of the Quality Payment Program.  

Questions?

Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

Healthcare Dive: Biden administration invests $19M to bolster rural telehealth

Key Points:

  • The Biden administration has benchmarked more than $19 million in grants to expand telehealth in rural and underserved communities, which have continued to lack access to care during the COVID-19 pandemic.