Table of Contents

Focus of the Week - Clinical

Announcements

Presentations/Publications

Department Member Recognition

Frankly Speaking Podcast

Clinical Services Spotlight

Massachusetts law requires health insurers to pay for behavioral health services delivered via telehealth on par with in-person services in perpetuity. The requirement for pay parity for primary care and chronic disease management services delivered via telehealth expires at the end of this calendar year.

Thanks to BCBS!

AMA Advocacy

If Congress fails to act by the end of the year, physician Medicare payments are planned to be cut by 4.5% in 2023. Please take a moment and contact your Senators and Representatives to tell them to cancel the cuts to protect physician practices and preserve patient access to care.

The AMA is pleased that CMS finalized its proposal to use the hospital market basket in 2023 to update ASC payment rates, making the update factor 3.8%, as ASC rates have fallen further below outpatient hospital rates due to lower updates in the past. CMS also finalized policies establishing Rural Emergency Hospitals, a new type of Medicare provider that Congress created in the Consolidated Appropriations Act of 2021.

Rural Emergency Hospitals will receive additional Medicare payments to help maintain access to a wide array of services in rural areas. CMS finalized its proposal to add Facet Joint Interventions to the list of services that require prior authorization but delayed the implementation date from March 1, 2023, to July 1, 2023.

Tips for Improving Patient Flow in the Ambulatory Setting

• Communicate to the team that our goal is to improve patient flow in the clinic.
• Create a patient flow team.
• Focus on improving both patient care related activities and activities that are not direct patient care. 
• Define measures and document time at each stage of waiting.
• Allow innovation. 
• Use technology to track time and transitions.

Palliative Medicine Fellowship Match

We are thrilled to announce that Dr. Mark Skiba, MD, PhD, has matched into our Palliative Medicine fellowship program! Dr. Skiba earned his Bachelors of Science degree from Western New England College with a Major in Biology. He went on to obtain a PhD at Clark University in the field of Mammalian Genetics. Dr. Skiba then conducted five years of postdoctoral research in the field of Molecular Genetics in the laboratory of Dr. Kendall Knight at the University of Massachusetts Medical Center. He then obtained his MD at the University of Massachusetts Medical School and went through Medical Residency at UMASS/Memorial Health Care where he trained in Internal Medicine. Dr. Skiba has been practicing hospital-based medicine at Milford Regional Medical Center for the last twenty years. Congratulations to Sunita Puri, Fellowship Director and the Palliative Medicine team for a great match!

Erika Zimmons, program director of the Geriatrics Fellowship, has announced the new fellows for 2023-2024. Dr. Hawa Abu is completing her residency in Internal Medicine at St. Vincent’s Hospital and Dr. Sher Bano is completing her nephrology fellowship at Boston Medical Center and previously completed her Internal Medicine residency at UMass Chan Medical School. 

Suturing skills instructors needed! Please volunteer December 12^th at 6pm in the Albert Sherman Center with students from FMIG, MassAHEC Rural and Urban Health Scholars and Primary Care Principles OEE.  We want to show students that Family Medicine ROCKS with different skills sessions over the year. This is the ONLY suturing session for AY22-23.  If available, please contact [email protected]

Advanced MA LTBI ECHO - Open to Massachusetts primary care team members including clinicians, nurses, care managers, community health workers, peer navigators, pharmacists, social workers! Course starts January 5, 2023!!

Interested in being able to test and treat your patients for latent TB infection within primary care and manage some of the more nuanced scenarios? Beginners and more advanced participants welcome! All participants will receive introductory material prior to the start of the seven session virtual and interactive course. You can receive up to 7 CME credits and the course is free. Find the details in the attached brochure. Register here.

The new VISTA curriculum will have 8 Pathways. All students need to choose a Pathway. Pathways include the following themes:

• Inequity/Advocacy/social justice ​
• Entrepreneurship/biomedical innovation​
• Clinical care​
• Research​
• Population/global/community health​
• Health systems science ​
• Education​
• PURCH - Springfield students

Students will be required to work on a project over 3.5 years. This will replace Capstone projects. They can be very diverse in nature. Faculty who mentor students on their project will meet with them initially and then periodically.

There are 3 ways to get onto a list for potential students to work with:

1. Put your name out there with an area that you are interested in (e.g. substance use disorder or women's health) and which Pathway or Pathways appeal to you and you will be put on a list for students to look at
2. Have an idea for a project and forward that project and students can look at your idea
3. Already have a project you are working on and list that and a student can join your project with you.

If you have an idea, please reach out to Hugh Silk at [email protected].

Presentations/Publications

Ekaterina Pivovarova, Ph.D, presented at the Association for Medical Education and Research in Substance Abuse (AMERSA) national conference held in Boston.

• Barriers and facilitators to collaboration between community-based medication for opioid use disorder providers and drug treatment courts.

Ekaterina Pivovarova, Ph.D, and Warren Ferguson, MD, presented the following 3 talks at the AMERSA conference as co-authors.

• Stopka, T., Rottapel, R., Ferguson, W., Pivovarova, E., Del Toro-Mejias, L., Friedmann, P., & Evans, E.A. Treatment continuity of medications for opioid use disorder after incarceration: A qualitative study with community-based treatment organizations.
• Friedmann, P.D., Dunn, D., Pryce, M., Bernson, D., Stopka, T. J., Pivovarova, E., Ferguson, W.J., Rottaperl, R., Hoskinson, R., Wilson, D., & Evans, E. A. Covid-19 Impact on Opioid Overdose After Jail Releases in Massachusetts.
• Friedmann, P.D., Matsumoto, A., Santelices, C., Stopka, T., Pivovarova, E., Ferguson, W.J., & Evans, E.A. (2022). Medications for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers.

Department Member Recognition

Congratulations to Dr. Liam Burke who will serve as the next Medical Director of Benedict Family Medicine. Dr. Burke will take over the role of Medical Director on January 1, 2023. In this vital position, Dr. Burke will oversee family medicine care that meets the chronic and acute medical needs of a complex population of patients from newborns to geriatrics. Dr. Burke will focus on cultivating teams to deliver compassionate, coordinated patient care. This succession allows Dr. Mary Lindholm to increase her time committed to directing the Family Medicine Clerkship and prepare for changes to the clerkship resulting from the transition to the VISTA curriculum at UMass Chan. We thank her for her many years of outstanding leadership as Medical Director. 

Frankly Speaking Podcast

A weekly Podcast series covering newsworthy topics in primary care medicine.

Listen on Apple Podcasts: https://podcasts.apple.com/us/podcast/frankly-speaking-about-family-medicine/id1194659367.

Please join us for an overview: We will review the general treatment approach to gastroesophageal reflux disease (GERD) and the risks of using proton pump inhibitors (PPI) for long durations. In particular, we will examine a new study that links PPI use, in comparison with H2 receptor antagonist (H2RA) use, with a significant increase in the risk of gastric cancer. This episode will highlight the importance of looking at PPIs on a medication review and evaluating whether patients are taking them for longer than needed. Guest: Jillian Joseph, MPAS, PA-C, presents: "Risks of Long-Term Use of PPIs". - Frankly Speaking Ep 305.

COVID-19 UPDATES

COVID in MA

• Nationally, COVID, flu, and RSV are stilling filling hospital beds.
• There were 5,068 new cases of COVID reported in the last 7 days. 
• The 7-day average of percent positivity is 7.14%.
• There were 63 new confirmed deaths in the last 7 days. 
• There have been 20,896 confirmed deaths due to COVID in MA.

COVID-19 UMMMC

• Cumulative COVID confirmed patient deaths vs Discharged Alive

 COVID Related deaths                            Discharged Alive

     ED               8                                                    8,616

     INPT            658                                                5,818

• The current 7-day positivity rate is 20.3%.
• In-house patients, the current 7-day average of COVID positive is 47. This is up 41%.
• Of the 47, 70% are fully vaccinated. Of the 47, 7 are in the ICU.
• Of the 7 in ICU, 5 are fully vaccinated.
• From March 15, 2020 to December 5, 2022, there have been 61,275 cases of COVID at UMMMC.
• During the past 7-days there were 2,389 COVID cases at UMMMC.

Worcester County COVID Data

• COVID 19 community level is medium.
• Case rate per 100,000 is 65.85.
• The new COVID admissions per 100,000 is 10.2.
• The level of coronavirus in the water has increased. 
• Hospitalization for children less than 6 months is increasing.
• BQ.1 and BQ 1.1 are the cause of a large number of cases in MA.

Sources: https://www.mass.gov/info-details/Covid-19-response-reporting#Covid-19-interactive-data-dashboard-

Flu in MA

• The flu in MA has been rated as high during the last week.
• Lab confirmed cases was 2,781.
• Hospitalizations related to the flu were 1.22%.

Wellness Resources

The Caring for the Caregiver Program provides resources such as the Caregiver Support Line (508-334-HELP) and The Employee Assistance Program (EAP) which offers a variety of services and supports (including virtual peer support and wellness tips. EAP can be accessed at 866-263-3525, or www.LiveandWorkWell.com, [company code UmassMemorial]. More information is available on the Caring for the Caregiver page.