January 25, 2019
Vol. 26, No. 2
DC Council Taking Hard Look at Economies and Efficiencies
This week, the District Council released its schedule for oversight hearings and the 2020 budget process . Of particular note to the medical community, the weeks of February 4 and 11 will see much action as the Committee on Health holds hearings on United Medical Center/Department of Health Care Finance (February 6), DC Health (February 8), and Department of Behavioral Health (February 12). MSDC will be closely following these oversight proceedings and weighing in where appropriate.
In terms of legislating, the Council made news recently with its focus on helping federal workers with their bills as the partial federal shutdown drags into a second month. However, of note is the reintroduction of the School Sunscreen Safety Act ( B23-0084 ), legislation supported by MSDC in the last session. In addition, on January 28 MSDC will be submitting written testimony for the joint Health/Judiciary hearing on opioid policy in the District. In it, MSDC will urge the Council to eliminate the barriers to accessing medication assisted treatments, especially prior authorization and step therapy. This idea is included in the Mayor’s LIVE.LONG.DC . opioid plan .
Welcome New Members!
We are pleased to welcome the following physicians from Reiter, Hill, Johnson & Nevin , MSDC's newest group member.

Mary Melody Abraham, MD 
Rebecca J. Busch, MD
Sheetal J. Dedania, MD
Travis J. De Mik, MD
Andrew I. Engel, MD
Neil J. Horlick, MD
Jo'Ann A.Jackson, MD
Heather L. Johnson, MD
Charles L. Katz, MD
Tsion A. Ketema, MD
Ekaterina A. Kolmogorova, MD 
Lauren S. Muagnman, MD 
Paula J. McKrisky, MD
Matthew S. Peterson, MD
Shiva Sedghi, MD
Ashley N. Smith, MD 
Kelsey R. Thrush, DO

We also welcome Reiter, Hill, Johnson, & Nevin's CEO Jason Miller and practice staff: Kathryn A. Blanchette, Jesscia L. Campbell, Angelica P. Fernandez Dizon, Margaret M.King, Nidhi Reva, Laura D. Shernit, Michele L. Tabaie
MSDC Past President Dr. Daniel Perlin Takes Over Facebook Page
This week, MSDC Past President Daniel Perlin, MD, has been in charge of the MSDC Facebook page . He's shared his passion for fighting the stigma of addiction, his love for his family and friends, and his daily workouts. Dr. Perlin is a dynamic physician leader, who will soon be leaving the Washington, DC area, and we are thankful that he has shared a "week in his life" which you can see on Facebook . In addition to being a P ast President, Dr. Perlin is MSDC's Physician Health Committee Chair and recipient of the 2018 Dr. Charles H. Epps, III Community Service Award for outstanding public service to the community.
National Policy
Number of Uninsured Americans Reached Four-year High in 2018, Poll Indicates
The New York Times reports that the number of uninsured Americans “plunged” after the ACA took effect, but that figure “inched up throughout last year,” according to a new Gallup poll. Data indicate “the uninsured rate for adults increased by 1.3 percentage points,” which means there was “an increase of more than three million people without insurance between the first quarter of 2018 and the end of the year.” 

New Moves by FDA Could Increase Naloxone Access
The FDA has developed a label for naloxone that can be easily understood by consumers, clearing one of the major hurdles in making it available for over-the-counter use. Read more.

AMA Comments on Medicaid and CHIP Managed Care
The AMA submitted  comments  on a proposed rule from the Centers for Medicare & Medicaid Services (CMS) on managed care in Medicaid and the Children's Health Insurance Program (CHIP). The AMA's comments focused on concerns that several significant provisions in the proposed rule could result in inadequate payments to physicians and other providers, weaken access protections for beneficiaries, especially through changes to network adequacy, and decrease information transparency. For more information on the AMA's comments, see the linked  letter .
MSDC eNewsline
Pia R. Duryea
202-355-9414 (direct)
202-466-1800 (main)
For previous editions, visit eNews Archives

MSDC Media
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2018-2019 Board of Directors
Susanne Bathgate, MD
Chair of the Board, At-large

Raymond Tu, MD, MS
President, AMA Alternate Delegate

J. Desiree Pineda, MD
President-elect, AMA Alternate Delegate

Barry L. Lewis, MD, MBA
Immediate Past President

Joseph E. Gutierrez, MD
Treasurer, AMA Delegation Chair

Peter E. Lavine, MD
AMA Delegate

Laurie Duncan, MBBS, MS

E.W. Emanuel, MD

Alice Fuisz, MD
At-large, Secretary

Daniel I. Perlin, MD

Marc Rankin, MD

Carla C. Sandy, MD

Robert Hay Jr., CAE
Executive Vice President
Poll: Public On Next Steps for ACA proposal to Expand Coverage
A recent Kaiser Family FOundation poll examines Americans’ early opinion on a national Medicare-for-all plan and other approaches to expanding coverage through public programs. The poll finds majority support for four different approaches, but views shift significantly when people hear arguments for and against Medicare-for-all. See Poll Findings .
Practice Management
Attention Practice Managers!
Would you like to connect with others?MSDC is forming a Practice Management Group for managers to socialize with their colleagues, share practice tips and resources. If interested, please contact Pia Duryea ( duryea@msdc.org )
Are You Frustrated By Prior Authorization?
Is prior authorization a burden on you or your patients? Do you want an innovative solution to prior authorization challenges? MSDC leadership is working to develop new solutions and is seeking a select group of volunteers to share their experience, time and insights. Contact Robert Hay, Jr. at hay@msdc.org .
Open Payments Data Updated
On January 18, CMS updated the Open Payments dataset to reflect changes to the data that took place since the last publication in June 2018. Use the Open Payments Search Tool to view the data. The refreshed dataset includes:

- Record updates: Changes to non-disputed records made on or before November 15
- Disputed records: Updated information for dispute resolutions completed on or before December 31
- Record deletions: Removed records deleted before December 31

The Search Tool is updated with a Query Builder (to conduct payment searches not tied to an entity) and Entity Profile Updates (Payment types are converted to tabs to make data easier to access and navigate. The summary table is consolidated with the top summary section and accessible by a “table” toggle button.)

For More Information:

New Medicare Part D Opioid Management Policies Went Into Effect January 1. Here’s What Prescribers Should Know  
As the nation’s opioid crisis continues, a new rule from the Centers for Medicare and Medicaid Services (CMS) effective January 1 seeks to reduce potential instances of opioid overutilization. Be aware of following new pharmacy dispensing guidelines:

·    Pharmacies may not dispense more than a seven-day supply for an initial opioid prescription without an override or Medicare Part D plan authorization. If a patient needs more than a seven-day supply, a prescriber will need to contact the Medicare Part D plan and attest that the supply is medically necessary. NOTE: Subsequent prescriptions aren’t subject to these limits.
·    Pharmacies will be alerted when a patient’s cumulative dosage of morphine milligram equivalents  ( MME) across all prescriptions, prescribers and pharmacies exceeds 90 MME. The pharmacist will contact the prescriber whose prescription triggered the alert to review and approve the order. 
·    Pharmacies will be alerted when a patient has concurrent prescriptions for opioids and benzodiazepines. The pharmacist is expected to do additional safety reviews and may contact the prescriber(s) to determine the appropriateness of the concurrent medications.

Additional information about these and other Medicare Part D opioid management policies is available from CMS .
The Do’s and Don'ts of Calling out a Patient's Bad Behavior  
It’s a clinical curveball, though in this case a physician in training can’t turn to science for help. What does a doctor do when a patient’s biased, disrespectful or hateful language threatens to get in the way of necessary treatment?  Read more from the AMA
MSDC Community
National Women Physicians Day Distillery Tour and Tasting: February 3
In celebration of National Women Physicians Day, MSDC Women in Medicine is organizing a distillery tour and tasting on Sunday, February 3 at 3:00 pm at Republic Restoratives, a woman-owned distillery located at 1369 New York Avenue NE, Washington DC. The tour and tasting last one hour and tasting is $12/person. Register on the  distillery's website  and reply to duryea@msdc.org . For more details, click here.
Community Connections
MSDC continues to connect with medical societies, practices and medical staff of all specialties in all eight wards. This week, MSDC met with the leadership of the Medico-Chirurgical Society of the District of Columbia, to discuss urgent healthcare issues. MSDC also attended the DC Metropolitan Radiological Society, which launched its Women in Radiology group, including MSDC member Dr. Anjali Malik.

Follow MSDC on Twitter as we work to make the District the best place to practice medicine. If your practice or group would like to meet with MSDC, please contact Robert Hay Jr.
Top: DCMRS members and guests
Bottom: Dr. Melvin Williams, President Med Chi of DC, and Dr. Raymond Tu, President, MSDC
Upcoming Board Meeting
MSDC's next board meeting will be Monday, February 25 at 6:30 PM at MSDC headquarters (1250 23rd Street, NW). MSDC members in good standing who are interested in attending may contact Robert Hay Jr for an invitation.
MSDC Staff To Speak on Physician Employment
MSDC's Director of Membership and Communications, Pia Duryea, will be co-presenting a panel at the 2019 Annual Conference of the American Association of Medical Society Executives in Pittsburgh, PA on July 24-26, 2019. The panel will explore evolving trends in physician employment, a topic that impacts many physicians, especially those here in the District.
Thank You To Our Corporate Supporters
MSDC 1817 Society
Public Health
CDC: Third Case of Rifampin/Penicillin-Resistant Strain of RB51 Brucella from Consuming Raw Milk 
The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, PA. Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, and potentially more serious complications (e.g., endocarditis, hepatomegaly, splenomegaly, and neurologic symptoms). In pregnant patients, Brucella infections can be associated with miscarriage. Symptom onset can occur anywhere from five days to six months following exposure.

As of January 22, 2019, exposures have been identified in 19 states: Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia. 

People who consumed raw milk or raw milk products from this dairy since January 2016 may have been exposed.
• Patients who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and appropriate post-exposure prophylaxis (PEP) is recommended, along with six months of symptom monitoring. Please see diagram below.
• If patients are outside of the six-month window following their last consumption of the raw milk and have or develop an illness consistent with brucellosis, a blood culture should be obtained prior to starting any treatment, preferably while the patient is symptomatic.

For additional background and recommendations, read HAN Advisory 417.
Corporate Partners
End the Epidemic: Opioid-related Resources and News
CDC Opioids Training Modules
Help stop the growing  number of drug overdose deaths  in the United States. Take the final three modules in a training series from the Centers for Disease Control and Prevention (CDC):  Applying CDC’s Guideline for Prescribing Opioids . Each module includes clinical scenarios, knowledge feedback prompts, and a resource library to help enhance learning:
View additional modules on the  Interactive Training Series  webpage. The modules offer free continuing education.
DC Prescription Drug Monitoring Program
D C Health encourages its licensed physicians to enroll and participate in the PDMP . To make the process easier, physicians may also register at the same time that they renew their license, or go to https://dchealth.dc.gov/service/prescription-drug-monitoring-program .
AMA "End the Epidemic" Website
See the AMA's End the Epidemic website , with resources and recommendations from the AMA Opioid Task Force
Public Charge: What is it and How it Affects Families in DC
January 31, 2019
7:00 PM
CentroNia (1420 Columbia Road, NW, Washington, DC 20009)
The D.C. Chapter of the American Academy of Pediatrics (DC AAP) invites you to a community dinner and conversation on Thursday, January 31, at 7:00 PM.
On October 10, 2018, the Department of Homeland Security (DHS) published a proposed rule related to public charge in the Federal Register. Although many steps away from a final rule and its implementation, the chilling effect this news creates has already impacted immigrant families in the DMV. Anecdotal stories abound of immigrant families declining to enroll in or renew needed health care services, WIC, SNAP and other public assistance programs. Come learn about the proposed public charge ruling and help clarify some of the confusion and misinformation that is creating significant consequences for our immigrant neighbor families.
4th Annual Healthcare Law & Compliance Bootcamp
Saturday, February 23, 2019
8:00 AM - Noon
Lisner Hall (2023 G Street NW, Room 201, Washington, DC)
G2Z Law Group, PLLC and GW Law are pleased to invite you to the 4th Annual Healthcare Law & Compliance Boot CampTM of the greater Washington metropolitan area. Healthcare providers face a myriad of legal and regulatory issues on a daily basis. Awareness of and compliance with healthcare laws and regulations not only enhance patient quality of care but also promote healthy and efficient healthcare practices. At the 4th Annual Healthcare Law & Compliance Boot CampTM learners will analyze and debate challenging issues routinely is seen by healthcare professionals. The event is complementary for providers and GWU students. RSVP to Rghafoorian@g2zlaw.com by February 19, 2019. Read the flyer for more information on the program, speakers, and CME accreditation. 
Loss Prevention Seminars
Out-of-Bounds: Previous Claims Under Further Review
April 9, 2019
American College of Cardiology (2400 N Street, NW, Washington, DC 20037)
This year, ProAssurance, MSDC's 1817 Society Member and partner for medical professional liability insurance, will offer a sports-themed loss prevention seminars titled, Out-of-Bounds: Previous Claims Under Further Review.  Participation in this seminar will better enable participants to:
·    Explain the relationship between physician-patient boundaries and professional liability risks
·     Identify a previous encounter where expectations were not met
·     Recognize the need to apply an internal or external boundary in a patient scenario
Whether you are competing for a championship sports title or practicing medicine, there are consequences for crossing the line. In this course, physicians and other healthcare professionals will hear the professional liability considerations associated with personally and professionally stepping out of bounds. The information and examples will help you stay in the game. 

Mark your calendar for the first s eminar on Tuesday evening, April 9, 2019 . Additional details and dates coming soon!
Abdominal Wall Reconstruction 2019
June 6-8, 2019
Grand Hyatt Washington (1001 H Street NW, Washington, DC 20001)
MedStar Georgetown University Hospital is pleased to announce Abdominal Wall Reconstruction (AWR) Conference taking place on June 6 to 8, 2019. This comprehensive conference will offer evidence-based discussion on all aspects of AWR through lectures and case presentations to address the growing rate of hernia repairs and updates in technology and procedures. We will also cover the high overall complication rate as well as the association of ventral hernia repair as the cause of the second highest postoperative readmission rate. The agenda is constructed to provide an in-depth understanding of the complexity of AWR. 

To register please visit AWRConference.com
Medical Real Estate Listings
Brought to you by MSDC Corporate Partner GZ Medical Realty. Contact Pete Papantoniou for your real estate needs.
Office Sublet Available
600 square foot sublet available on 19th Street NW between Farragut North and Dupont Circle Metro. Brand new build out with separate suite number, entrance, waiting area. One office and one exam room with large window. One smaller office without windows. Sublet space is connected to an established private internal medicine practice. Price negotiable . Contact Dr. Alice Fuisz if interested. alicefuiszacp@gmail.com .

2440 M Street NW
2440 M Street NW
Washington, DC 20037
2440 M Street is a Class A 110,000 SF medical office building with a three-level parking garage in northwest Washington, DC. The building has abundant patient and physician parking. Please contact Peter Papantoniou at 301-961-1941 or see the online listing for more information. 

Part Time/Full Time Office Space Available
3 Washington Circle
Washington, DC 20037
Part time/full time office space available immediately at 3 Washington Circle. This includes a large consultation room, fully equipped examination room, lab drawing facility onsite, EKG machine, space for receptionist, space for medical records, shared use of copier, telephone system, wireless internet and waiting room. Ideal for general internist, medical subspecialist or surgeon. If interested, please call Mark Sklar, MD. 202-887-4769 or email mmsklar@gmail.com .
Boutique Townhouse Medical Office for Rent Across From GWU Hospital/ Medical School
900 New Hampshire Ave., NW
Washington, DC 20037
Boutique townhouse medical office for rent across from G.W.U. Hospital & School of Medicine. Very close to Foggy Bottom Metro. Three rooms, one on entry level with powered table/chair & overhead surgical light. Consultation room, reception/waiting room, & possibility of 2 additional rooms. Two-car driveway. Call/text Sheldon K. Gottlieb, MD, 301-509-3319, or email skgottliebmd@comcast.net .
Woodburn Medical Park
3229 Woodburn Road  
Merrifield, VA 22003
Woodburn Medical Park is located within walking distance of INOVA hospital directly off Capital Beltway. Common area was recently upgraded. Contact Peter Papantoniou at 301­-961­-1941 or see the online listing for more information.
Full Time/ Part Time Office Space Available
Well-designed and attractively decorated office of three general internists has additional consulting room/exam room suite available. Looking for another general internist to share space and overhead in fully staffed and equipped internal medicine office. Shared call coverage is possible. Contact Alan Stone, MD, 202-466-8118 or aws.md@verizon.net
Medical Resources and Announcements
Healthcare Job Opening
DC Health Seeks Senior Deputy Director, Health Emergency Preparedness and Response Administration (HEPRA)
 DC Health invites qualified applicants to visit DCHR careers site to complete your application.
1. Select the  link to access the careers site
2. Sign In to access your account, or if you are not an existing user, select the New User link to create one. 
3. Review the job description and select the Apply button to begin your application.

GENERAL JOB INFORMATION : Bring your professional career to Washington, D.C., the most dynamic and diverse city in the country. With its proximity to major museums, world class parks, entertainment and restaurants, increasing job opportunities and the seat of the federal government, the District of Columbia continues to be ranked in the top 10 of thriving city indicators where you can live, work and play. Contribute to and work for a nationally accredited Health Department. The District of Columbia Department of Health (DOH) earned national accreditation by the Public Health Accreditation Board (PHAB) and is an early adopter in attaining the designation. Come see where your skills are appreciated and rewarded by applying for the following public health opportunity. 

JOB SUMMARY : This position is located in the District of Columbia’s DC Health, Health Emergency Preparedness and Response Administration. The Senior Deputy Director directs activities of the DC Health relating to protecting the District population from acts of bio-terrorism and other public emergencies through effective planning and timely operational response. The Senior Deputy Director for HEPRA oversees DC Health’s efforts to prepare for and protect against, respond to, and recover from all acts of bio-terrorism and other public health emergencies, including but not limited to; Prevention/Deterrence/Protection, Emergency Assessment/Diagnosis, Emergency Management Response, Incident/Hazard Mitigation, Public Protection, Investigations, Recovery and Remediation.
 The DC Medical Reserve Corp (MRC) is actively recruiting for medical and public health professionals. The MRC is a network of local medical volunteers who are willing to donate their time during emergencies and other times of community need like parades or inaugurations. All volunteers receive comprehensive instruction in areas of emergency response. Learn more here .
Online Vaccine Resources for Providers and Patients
From MSDC partner, Atlantic Health Partners
From the annual influenza season and the beginning of the school year, to the threat of vaccine-preventable disease that travelers may face while abroad, there are many reasons for healthcare providers to be knowledgeable about immunization and be prepared to inform their patients.
There are credible, scientifically-backed resources that providers and patients alike can use to be informed and protected. We rounded up some of the best online resources to help providers and patients with all kinds of vaccine-related issues and questions.

Medical Society of the District of Columbia
1250 23rd Street NW, Ste 270
Washington, DC 20037