COVID-19 Task Force discusses Paxlovid issues

At its most recent meeting on July 28, the Wisconsin Medical Society’s COVID-19 Task Force discussed the latest developments regarding Paxlovid – Pfizer’s two-drug antiviral COVID-19 treatment. Following the U.S. Food and Drug Administration’s action in July authorizing pharmacists to prescribe Paxlovid (with various limitations), the task force invited the Pharmacy Society of Wisconsin (PSW) to the meeting to discuss what their profession is experiencing with this new “test and treat” initiative. (PSW has been a solid partner during the COVID-19 pandemic, including joining with WisMed on a COVID-19 vaccine awareness campaign to promote more rapid uptake of COVID-19 vaccines.)

PSW Vice President of Public Affairs Danielle Womack, MPH, shared that Paxlovid prescribing uptake has been slow among her members, and especially among community pharmacies, due to the amount of information a pharmacist must confirm before being allowed to prescribe Paxlovid under the latest Emergency Use Authorization coupled with dismal reimbursement rates for administering the treatment. Womack said that pharmacists readily refer patients to their physician if the EUA-required information is not known.   

The group also discussed how task force members and other physicians have had surprising difficulties getting Paxlovid prescribed and administered for vulnerable family members testing positive for COVID-19. Recent headlines focusing on so-called “rebound” cases (such as Dr. Anthony Fauci’s experience in late June and President Joe Biden’s ongoing situation) have only added to potential physician hesitancy. Research has shown that receiving Paxlovid greatly reduces COVID-19 hospitalization or death, especially in unvaccinated patients. "Rebound COVID-19” cases following Paxlovid treatment is under evaluation but likely related to many factors including being part of the natural history of the disease. Even when rebound has been described, symptoms have generally been mild, not requiring hospitalization. Read more about Paxlovid on the U.S. Dept. of Health and Human Services’ Paxlovid page.

“Paxlovid remains an important option in preventing progression to more severe COVID-19 in high-risk populations, especially the unvaccinated,” says Task Force Chair David Letzer, DO. “Physicians need to keep this option in their toolbox. Eligible patients should start Paxlovid as soon as possible upon a positive test and within five days of symptoms.”

The WisMed COVID-19 Task Force continues to meet regularly to discuss important COVID-19 topics and developments. If you would like to be part of the task force or want more information, please email WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD.

Back to top

Drug Testing in Clinical Practice: The Science and Art of Drug Monitoring webinar available on demand

Presented by David Galbis-Reig, MD, DFASAM, Medical Director of Addiction Services at Wheaton Franciscan Healthcare – All Saints, Drug Testing in Clinical Practice: The Science and Art of Drug Monitoring* will introduce prescribers to the art and science of drug testing including the use of different drug testing matrices and an explanation regarding the differences between screening immunoassay technology and confirmatory GC-MS or LC-MS testing.

The Wisconsin Medical Examining Board (MEB) approved a rule requiring physicians with a DEA number to complete two CME credits on its Opioid Prescribing Guideline biennially. To help physicians comply with this rule, the Wisconsin Medical Society developed a series of on-demand webinars. This course will need to be combined with additional education to meet the two-hour requirement.

Drug Testing in Clinical Practice: The Science and Art of Drug Monitoring learning objectives:

• Review the history of drug testing and its introduction into clinical practice.
• Describe the different drug testing matrices and the potential advantages and disadvantages of each in clinical practice.
• Identify the basics of drug testing: what to test, how to test and in what situations to perform a urine drug screen.
• List the limitations of urine drug testing.
• Interpret a positive urine immunoassay and identify when to obtain confirmatory tests.

Click here to register for Drug Testing in Clinical Practice: The Science and Art of Drug Monitoring or click here to learn about other courses that have been approved by the MEB. Please contact [email protected] with questions or for assistance logging in.

*Accreditation Statement
The Wisconsin Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

1 MOC Part II Credit
Application for MOC Part II credit has been filed with the American Board of Medical Specialties (ABMS) for approval by ABMS Member Boards. See course description for more information.

1 AMA PRA Category 1 Credit(s)™ (Enduring)
The Wisconsin Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Wisconsin Medical Society designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Back to top

A budget for physicians

Everyone needs to know their budget numbers. Budgeting gives you control and even the freedom to know when you can splurge. I firmly believe budgeting apps have made it much more complicated than it needs to be. In fact, you only need four numbers. They are fixed, future, philanthropy and fun. Know how much of your income should be going toward those four “fahs” and you’ll have a solid budget.

50% Fixed. These are your survival expenses and should be 50% or less of your income. Monthly averages are listed below.

• Housing should be 20-25%. If you own a home, stick with a fixed rate mortgage while low rates are still available. A 15-year fixed rate mortgage is preferred because the home will be paid off before the start of kids’ college expenses and retirement.
• Utilities like natural gas, electric, water and internet are approximately $300 for the average household.
• Cell phones cost $104 per person (while this is the national average, much less expensive plans are available).
• Transportation $130.
• Food $247 to $437 per person.
• Childcare $868 to $2,000+.
• Insurance costs vary.
• Minimum debt payments vary (don’t forget about federal student loans that restart August 31, 2022).

15-25% Future. This percentage is only for your retirement. Money you save to replace a car or for kids’ college is in addition to this.

• $1,708 for 401(k) or 403(b) ($20,500 per year max)
• $1,000 for backdoor Roth IRA ($6,000 per spouse per year max)
• $7,300 health savings account ($7,300 family max)
• Non-retirement investment amounts vary

10% Philanthropy. This is pretty self-explanatory; however, you can increase the tax deductibility of your gifts by:

• bunching charitable gifts using a donor advised fund if you are under age 70 ½ or
• utilizing a qualified charitable distribution over age 70 ½.

15-25% Fun.

• Vacations, monthly entertainment, etc.
• Recurring lifestyle expenses such as a TV package or streaming services go here, not in the fixed category.
• Debt snowball is a strategy to pay off consumer debts like credit cards and auto loans by paying extra on one debt at a time to eliminate them all. This is in the fun category because excess debt inhibits your ability to spend on other items. Paying off those debts gives you the freedom to spend more on actual fun.

Note, students and retirees can omit the Future category from their budget. Rather than saving for the future, it’s usually best for students to pay bills and avoid accumulating more debt.

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society.

Back to top

Reminder: behavioral health services for WisMed members

The Wisconsin Medical Society (WisMed) is proud to offer behavioral health services options for our members state-wide. WisMed has partnered with Marvin to provide confidential counseling and coaching services with flexible hours. Board certified psychiatrists and licensed psychologists are available via teletherapy when you need them.

WisMed members can register online to get started or call with questions. Members may choose to pay out of pocket at a special WisMed discounted rate or have the services billed to their insurance. Your initial appointment will be within 72 hours of your outreach. 

To reach Marvin, call 424.322.6881, visit meetmarvin.com/wisconsin or scan the QR code on the flier.

Additionally, members of Dane County and La Crosse County Medical Societies can access LifeBridge Physician Wellness Program. This completely confidential offering provides up to six free coaching/counselling sessions per year with a psychologist. Appointments are available via telemedicine and are scheduled within 72 hours.

Members of LCMS and DCMS can learn more and access this member benefit here. For information on how to launch Lifebridge Physician Wellness Program in your county, please contact Jim Lorence.

Back to top

DHS expands monkeypox vaccine eligibility

Last week, the Wisconsin Department Health Services (DHS) announced expanded eligibility requirements for JYNNEOS, the preferred vaccine for preventing monkeypox infection in the United States. DHS is allocating the vaccine to a small number of Wisconsin clinics. Due to the limited amount of vaccine available, DHS is following recommendations from the federal government to prioritize JYNNEOS for individuals at the highest risk of infection.

In Wisconsin, vaccination is now recommended for people who had known exposure to someone with monkeypox and people with certain risk factors who are more likely to be exposed to the virus. Criteria for vaccine eligibility include: 

• People who know that a sexual partner in the past 14 days was diagnosed with monkeypox, or
• People who attended an event or venue where there was known monkeypox exposure, or
• Gay, bisexual, trans, and any other men who have sex with men who have had multiple sexual partners in the past 14 days.

As allocations increase and the outbreak changes, the criteria of eligible individuals for vaccination will be updated. 

DHS will also be offering a communicable diseases webinar for health care professionals focusing on updates on Legionnaires’ disease and monkeypox on Friday, August 5 from 7:00 to 8:00 a.m.

Please contact [email protected] or the DPH Communicable Diseases on-call team at 608.258.0099 with questions.

Back to top

UW seeking physicians for end-of-life care surveys

An international collaboration of physician organizations and universities – including the University of Wisconsin School of Medicine and Public Health – needs input from specific specialties to help assess physician personal preferences on end-of-life care impacting clinical practice. The research study, “Physician Reported End-of-life Decision Preferences: a multinational cross-sectional survey study” (PROPEL), includes a qualitative interview and/or an online survey.   

The project seeks input from general practitioners as well as cardiologists, gastroenterologists, geriatricians, oncologists, nephrologists, neurologists, gynecologists, pulmonologists, intensive care and palliative care physicians. To participate in the qualitative interview (lasting 30-60 min), please contact lead researcher, Sarah Mroz, at [email protected] or 608.352.9055. The online survey (expect to spend 10-15 minutes) can be accessed here.

You can read more about the study specific to Wisconsin physicians in this flyer. If you have other questions, contact the UWSMPH’s local research partner, Toby Campbell, MD, MS, the UW Health Chief of Palliative Care, Professor Hematology/Oncology.

Back to top

AMA resources for WisMed members

The American Medical Association (AMA) provides a variety of resources that WisMed members can take advantage of, including webinars and podcasts. Two upcoming webinars will focus on mental health and suicide prevention. Details, including registration information, are listed below.

Addressing Adult Suicidal Ideation in the Primary Care Setting
Thursday, September 1 at 12 p.m. CT
September is Suicide Prevention Awareness Month. Building off the Practical Strategies for Managing Suicidal Ideation & Reducing Risk, this pre-recorded webinar focuses on how primary care practices can address suicidal ideation within their adult patient population. Click here to register.

Dismantling Stigma for All: Addressing Physician and Patient Mental Health and Suicide Risk
Monday, September 8 at 12 p.m. CT
As part of National Suicide Prevention Week, this live, interactive forum will connect attendees with industry experts on suicidal ideation and physicians with lived experience to discuss solutions for dismantling the stigma around seeking mental health treatment. Click here to register.

AMA STEPS Forward® Podcast Episode 29: Electronic Health Record Optimization
Daniel Dunham, MD, MPH, FACP, Chairman of Medicine at Lenox Hill Hospital, discusses how eliminating unnecessary clicks in the EHR ultimately decreases physician burnout and allows care teams to focus their time on what matters most—patient care.
Listen here: Apple Podcasts | Spotify

AMA STEPS Forward® Podcast Episode 30: Small Interventions Matter
Alfred Atanda, MD, a pediatric orthopedic surgeon and Director of Clinician Well-Being at Nemours Children’s Hospital, discusses how to minimize unnecessary patient transfers using digital technology and how small interventions can lead to big improvements.
Listen here: Apple Podcasts | Spotify

Back to top