Health of the Public
COVID-19 Pandemic: Resources and Links
WAFP maintains a webpage with a list of resources for clinicians amid the COVID-19 pandemic: http://wafp.net/resources/covid-19
The webpage includes resources from Gov. Jay Inslee, the Washington State Department of Health, other state resources, Seattle—King County Public Health, the Centers for Disease Control and Prevention, the AAFP, and regional and international resources.
2020 Annual Meeting to Go Online
Because of the COVID-19 pandemic, WAFP’s 2020 House of Delegates and Annual Scientific Assembly will be held virtually. The two meetings of the WAFP Board of Directors that shoulder the House of Delegates will also move online, as will the WAFP Foundation’s Board of Directors meeting.
The details are still being worked out, and the structure of the HOD and ASA is expected to be considerably different than in years past.
We still need delegates to serve during the House of Delegates; the time commitment is expected to be significantly less compared to the in-person meetings. The only qualification to be a delegate is to be a WAFP member in good standing! Register here. (Members who have previously registered or whose names have been submitted by their local chapters do not need to register again.)
Additional details will be available in the coming weeks.
WAFP Continues to Advocate on Behalf of Family Medicine, Patients
As Washington charted its own course as first-in-the-nation to confront the COVID-19 epidemic, WAFP leadership has maintained communications with elected officials and colleagues across the house of medicine.
Among those communications:
- In a letter to Gov. Jay Inslee on March 23, WAFP advocated for a shelter-in-place order. “As Governor, we know you take your duty to protect Washingtonians seriously as well and, when necessary, use whatever is in your power to honor that duty. Your strong encouragement to Washingtonians to stay home and practice social distancing is not having the desired effect,” WAFP President Russell Maier, MD, FAAFP, wrote.
- In a March 13 letter to Inslee, WAFP, WSMA and 21 other statewide health care associations asked the governor to consider a ban of gatherings of more than 50 people; increasing usage of telehealth services; and directing the Office of the Insurance Commissioner to apply flexibility to telehealth regulations and payments.
- In a March 23 statement, WAFP joined WSMA and 11 other statewide health care associations urged health care providers across the state to postpone or cancel elective surgeries if those procedures would not cause harm.
WAFP continues to distribute critical guidance at the request of the Washington State Department of Health. We also strive to strike a balance between distributing that important information and not overwhelming members’ inboxes. Rest assured that, behind the scenes, work within the WAFP has accelerated to advocate on behalf of family medicine and the health of all Washingtonians.
Mark Your Calendar: Next WAFP “Coffee with WAFP” to Take Place on April 11
WAFP’s president, Russell Maier, MD, FAAFP, and president-elect, Lillian Wu, MD, FAAFP, will host a second “Coffee with WAFP” on Saturday, April 11. The first was held Saturday, March 28, and highlighted three perspectives on the COVID-19 outbreak (see speakers below), followed by open discussion.
- Lillian Wu, MD, FAAFP, and WAFP President-Elect, with a clinical perspective
- Rachel Wood, MD, MPH, FAAFP, and Health Officer for Lewis County, with a public health perspective
- Russell Maier, MD, FAAFP, and WAFP President, with the WAFP and medical school perspective
We will start at 9:30 a.m. and, as before, keep it to an hour.
Additional information, including speakers and login information, will be available closer to the event.
Inslee Institutes Telemedicine Parity, Relaxed CME Requirements, Changes for Residents and Fellows
In late March, Gov. Jay Inslee issued two separate proclamations to ease the burden of physicians and other health care providers during the COVID-19 pandemic: one on telemedicine and one on licensure.
On March 25, Inslee issued a proclamation prohibiting insurers from billing medically necessary covered services at a rate lower than traditional, in-person methods. The proclamation also severely limited denials of telemedicine payments and banned the introduction of requirements that would circumvent the proclamation.
A day later, another proclamation relaxed CME requirements for fully licensed MDs and DOs in the state. According to the Washington Medical Commission, the effect of the proclamation is to waive requirements for:
- Seven hours of HIV/AIDS education
- Maintenance of licensure requirement options, including:
- 200 hours of CME every four years;
- Becoming board certified in the past four years;
- Obtaining an AMA PRA certificate in the two of the past four years;
- And satisfying ABMS maintenance of certification requirements.
- Suicide prevention training
- Compensation limitations for retired active physicians
That proclamation also eases geographic and employment limitations on residents, fellows and others with limited licenses. According to WMC, physicians with these licenses may be utilized in any setting of medicine in which they are competent and safe to practice as agreed to by the physician and their employer.
Legislature Passes Supplemental Budget to Close Session; Primary Care Collaborative Included
The Washington State Legislature closed the 2020 short session by passing its supplemental appropriations bill. That bill included language to form a primary care collaborative, which had been championed by WAFP.
The legislation did not direct specific funding to the effort. Instead, the legislature instructed the Washington State Health Care Authority to use its current funding to stand up the collaborative. Given the ongoing COVID-19 pandemic, it is unclear how feasible it will be for HCA to undertake such an effort.
Another WAFP priority was passed by the legislature: the creation of a statewide office of gun violence prevention. After passing the Senate by a single vote, the bill was delivered to Gov. Jay Inslee on March 12. He has until the end of this week to sign it.
Amid Epidemic, CMS Increases Payments for Medicare Participants
The Centers for Medicare & Medicaid Services will expand its program to help Medicare providers fight COVID-19. According to AAFP News, the program will provide for emergency funding and address cash-flow issues during emergencies by delivering payments based on historic performance, to be offset by future claims.
Qualifying practices must have billed Medicare for claims within 180 days immediately before the request was submitted; not be in bankruptcy; not be under active medical review or program integrity investigation; and not have any outstanding delinquent Medicare overpayments.
Two days before the announcement, the AAFP and eight other groups asked for relief in a letter to CMS.
DOH: Flu Activity is Decreasing in Washington
The Washington State Department of Health indicates influenza activity in the state remains elevated but is decreasing. Eighty-nine people have died from the flu this year, the state found, the lowest total since the 2015-16 flu season.
King, Pierce and Spokane counties have had at least 10 deaths.
Data from the Centers for Disease Control and Surveillance found that Washington maintained high ILI activity for the past three months. Even as other states in the Northwest and more broadly in the West saw their rates fluctuate, Washington’s rate was the highest on the CDC scale week after week.
Rule Change Will Allow Children Catching Up on Vaccines to Remain in School
The Washington State Board of Health has announced clarification on rules concerning school and child care immunization policy. Specifically, it clarified how to manage children who are conditional status – i.e., those catching up on vaccinations – to remain in school.
According to the Department of Health, in previous years, schools and child care facilities would assign conditional status to students in their first 30 days of school if they did not have current immunization paperwork. The rule change clarifies that all students must have immunization paperwork turned in to the school on or before the first day of school or child care attendance.
The rule change takes effect on Aug. 1, 2020. More information is available on the DOH’s webpage dedicated to the rule change.
Additionally, DOH will hold a webinar on April 16 at noon. It will cover the 2020 immunization schedule and updates to vaccine recommendations.
Cancer Death Rates Continue Long Decline
In its Annual Report to the National on the Status of Cancer just published in March 2020, the Centers for Disease Control and Prevention has reported cancer rates continued to decline through 2017 after peaking in 2001.
Decreases were noted in all major racial and ethnic groups, as well as in men, women, adolescents, young adults and children. Rates of cancer incidence for all cancers were level for men and increased slightly for women from 2012 to 2016.
In a companion report, researchers revealed that the goals set out in Healthy People 2020 were met for all cancers combined, as well as for lung, prostate, female breast and colorectal cancers (though not in all socioeconomic groups). Targets were not met for adults to decrease cigarette smoking; to increase smoking cessation success; and to reduce obesity prevalence.
Overdose Death Rates Drop by Four Percent from 2017 to 2018
The Centers for Disease Control and Prevention found a significant drop in overdose death rates from 2017 to 2018. Decreases ranged from four percent overall to four percent for heroin and 13.5 percent for prescription opioid-involved deaths.
One exception to the otherwise good news: death rates from synthetic opioids, not including methadone, increased by 10 percent. Of states with increases in deaths from synthetic opioids, Washington was among the highest.
CDC Finds Increase in Autism Prevalence
In surveillance data from 11 communities across the US, the Centers for Disease Control and Prevention found that the rate of autism in 8-year olds decreased from one in 59 (in 2014) to one in 54 (in 2016). The study further found that children are being evaluated and identified with autism at younger ages.
“Some of the increase in autism prevalence might be due to the way children are identified, diagnosed, and receiving services in their communities,” said the CDC’s Stuart Shapira, MD, PhD, in a news release. “The increase may also reflect reductions in racial differences in identification of autism, as this is the first [Autism and Developmental Disabilities Monitoring] Network report to identify black 8-year-olds with autism as having the same rates as white children.”
Hispanic children were identified as having autism at lower rates than black or white children. Also, black and Hispanic children were evaluated for autism at older ages than white children.
Higher Step Counts Leads to Lower Mortality Risk
Researchers from the National Institutes of Health and the Centers for Disease Control and Prevention have found that higher daily step counts were associated with lower mortality risk from all causes.
Further, the number of steps – as opposed to the intensity of those steps – had a strong association with mortality risk.
While other studied have produced similar findings, this study examined a representative sample of U.S. adults aged 40 and higher.
Taking 8,000 steps per day was associated with a 51 percent lower risk for all-cause mortality compared to taking only 4,000 steps per day. At 12,000 steps per day, the risk dropped by 65 percent.
Muted Match Day Doesn’t Diminish Records for Family Medicine
On a Match Day unlike any other, family medicine still had reason to celebrate: a record 4,335 medical students matching into family medicine, continuing an 11-year positive trend.
Match Day 2020 was notable for its lack of pomp, owing to the COVID-19 pandemic. 2020 was also the first year consolidation of the allopathic and osteopathic Match.
Breaking down the more than 4,000 soon-to-be family medicine interns, according to AAFP: 1,557 were US allopathic medical school seniors; 1,399 were US osteopathic medical school seniors; 788 were US international graduates; 405 were foreign IMGs; 120 were previous graduates of US allopathic medical schools; 65 were previous graduates of US osteopathic medical schools; and one was from another pathway altogether.
At the University of Washington School of Medicine, 38 of the 258 students (14.7 percent) matched into family medicine, more than 1.5 times the national average among US medical schools. Of those 38, 13 have matched into a Washington residency program.
Results from PNWU were not immediately available.
Update on WAFP Summer Socials
WAFP’s summer social events, intended to bring together medical students and family medicine residents, are still being planned.
The event that had been scheduled for Everett in late May will now be held later in 2020. Additional details will be available in the coming months.
The King County Academy of Family Physicians is co-sponsoring the King County event with WAFP; it will be held at The Garage (1130 Broadway in Seattle) on June 11 from 6 to 8:30 p.m.
An event in Pierce County is tentatively scheduled for July 18, and WAFP is planning a September event in Spokane. Stay tuned for more information on both events.
There are currently no changes for the August event at Hop Capital in Yakima.
If you have questions, contact Alyssa McEachran, WAFP’s director of pipeline and practice enhancement, at email@example.com.
ABFM Modifies Board Certification Criteria for Graduating Residents
Because of the stresses placed upon the health care system by the COVID-19 pandemic, the American Board of Family Medicine will alter some of its criteria to accommodate graduating residents.
Among the changes:
- Residency program directors must attest that a resident has met minimum training requirements as delineated by the Accreditation Council of Graduate Medical Education.
- Precepted televisits and other visits in novel settings (such as drive-through COVID-19 test centers) will count toward the 1,650-visit minimum. ABFM asks that those visits be documented as would be normally done for in-person continuity visits.
- Residents will be approved for board eligibility with changes in rotations necessitated by the COVID-19 crisis.
Medical Commission Issues Statement on ‘Pandemic Regulatory Intent’
The Washington Medical Commission is seeking to reassure health care providers that it understands the difficulty of providing care amid the COVID-19 pandemic. In a statement issued March 25, WMC said that “practitioners need support, not fear of regulatory action.”
As a result, the commission is working with other state agencies to lower barriers to patient care and licensing.
The commission also issued a clarification around Gov. Jay Inslee’s proclamation concerning non-urgent medical procedures. If surgery would positively impact a patient’s quality of life or would prevent worsening of a condition, health care providers “should not fear disciplinary action for performing the surgery.”
“When assessing complaints related to practitioner’s work we will consider the difficult circumstances and choices they are facing,” the commission wrote. “The WMC wants you to focus on treating the patient in front of you to the best of your ability.”
Premera Awards Grant to UW School of Nursing for Care in Rural Areas
Premera Blue Cross has awarded $4.7 million to the University of Washington School of Nursing to help establish its Rural Nursing Health Initiative.
The program would support 20 ARPN students over a four-year period, developing enhanced clinical placements throughout Washington’s rural areas.
In addition to UW students, students from Gonzaga University, Pacific Lutheran University, Seattle University, Seattle Pacific University and Washington State University can apply for the placements. Upon graduation, they may also apply for the Rural Health Nurse Practitioner Fellowship.
Female Physicians Have Higher Suicide Rate, Research Finds
In research published in JAMA Psychiatry, female physicians were found to have a higher rate of suicide than their male colleagues and women in general.
The research finds the significant jump in female US medical school graduates from 1980 to 2015, far ahead of that of the overall labor force. But that alone fails to account for the higher suicide rate.
“This implies that gender dynamics in medicine changed much more rapidly than in the general population during this period, which may have affected female and male physicians’ SMRs [standardized mortality ratios]”, the authors wrote. “However, many additional cultural, socioeconomic and political changes influenced health care during this period, reinforcing the need for action regarding physician suicides.”
CMS Allows Patients to Store EHR Data on Their Smartphones
The Department of Health and Human Services, along with the Centers for Medicare and Medicaid Services, released rules to allow patients to keep their health information on their smartphones.
While the rules would grant new freedom to patients, Kaiser Health News noted that some corners – notably EHR vendor Epic – raised concerns about technology security with companies such as Google, Apple, Microsoft and Amazon. Those companies would likely be at the forefront of developing apps to handle that information.
“We’re not afraid to take on special interests to do what’s right for patients,” CMS Administrator Seema Verma, MPH, told KHN. “Some people disagree because they want to keep the data. The reality is that patient data belongs to patients. It doesn’t belong to EHR companies.”