Society action regarding COVID-19

Conditions are changing by the moment regarding COVID-19. The Wisconsin Medical Society (Society) is taking action to help protect and support physicians and their patients to address this public health crisis and flatten the curve.

Telehealth

To help protect physicians and serve patients, the Society is exploring ways to allow physicians to utilize telehealth to expand and improve access and minimize exposure.

Last week the Department of Health Services (DHS) issued its first telehealth guidance for BadgerCare in response to both the COVID-19 crisis and recently passed legislation (Act 56). This guidance opens up coverage for telehealth services at all originating sites, allows for new codes to be billed and allows services to be provided via telephone. DHS issued additional guidance on temporary telehealth policies for mental and behavioral health visits, comprehensive community services and community support programs. This includes phone-only communication for behavioral services.

The federal Office of Civil Rights (under the Department of Health and Human Services) has temporarily loosened its HIPAA guidelines for telehealth, allowing telehealth consults and services to be provided via Skype, Zoom, Google Hangouts and other specified video conference services. Centers for Medicare and Medicaid Services is also temporarily expanding access for telehealth services under its 1135 waiver, and has issued a new series of FAQs describing what will and will not be covered under the temporary guidelines. Under the waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country, including in patient’s places of residence which began March 6. Additional guidance on telehealth will be released in the coming days.

In addition, the Society is working to increase the availability and flexibility of telehealth coverage provided through both public and private means.

Expanding the physician workforce

The Society has been working with the Evers Administration to try and find a means to allow physicians to work across state lines. This includes leveraging Wisconsin’s participation in the Interstate Medical Licensure Compact, examining existing authority under the Governor’s public health emergency declaration and examining if new legislation may be required.

The Society is also exploring options for how retired physicians may be utilized to fill gaps in access and care.

Safer at home order

The Society and other key health care organizations supported the Evers Administration’s decision to employ a temporary “safer at home” order. The goal of the order is to slow the spread of COVID-19, flatten the curve and protect both patients and clinicians.

Personal Protective Equipment (PPE)

The Society has been in contact with the Evers Administration to acquire more PPE for health care professionals on the front lines of the COVID-19 crisis. On March 22, Governor Evers asked FEMA to help Wisconsin obtain 50,000 non-surgical masks, 10,000 face shields, 11,000 coveralls, 3,000 N95 face masks and 35,000 pairs of protective gloves from the strategic national stockpile.

The Trump Administration is also asking various manufacturers to begin switching their production capabilities to produce needed items such as ventilators and face masks, though they have yet to order such production as would be allowed under the Defense Production Act.

The Society will continue to advocate for more PPE as existing supplies are insufficient and current stockpiles inadequate to address the ongoing crisis.

Collaboration and sharing of best practices

During this crisis it is imperative that physicians share their experiences with each other so best practices can be shared for the benefit and safety of patients and all health care practitioners. The Society will be hosting a call with CMOs from across the state to hear about what they are experiencing in their locations, what is working and what needs to be done. The Society is also providing members with a host of tools for them to communicate with each other and share ideas and best practices via its WisMed Community site, WisMed Voice text alerts and social media platforms.

Check out the Society’s COVID-19 resources page for up to date information for you, your patients and your families.

Contact HJ Waukau with questions.

Back to top

Eileen Wilson retiring; Marje Murray to take the helm as Foundation director

After almost 20 years with the Foundation, serving the last seven years as executive director, Eileen Wilson will be retiring in April. She shared her intent to retire almost a year ago and the Foundation Board has completed a search and named her replacement.

During Eileen’s tenure, the Foundation’s support for medical students has risen significantly with $207,500 in scholarships and awards and $560,000 in student loans awarded for the 2019-2020 school year. She has also worked diligently over the years to establish and strengthen policies and procedures to keep the Foundation strong and secure for the future.

“Assisting students with the daunting task of paying for their medical education and seeing the difference that the Foundation’s support for public health programs and research can make has been incredibly rewarding,” said Eileen. “I will miss working with our small, but dedicated staff, our partners and the physician and community leaders whose selflessness I greatly admire. I’m confident in passing the torch to Marje and look forward to great things to come from the Foundation, its programs and the generous people who make it all possible.”

Marje Murray, MBA, BSN, will join the Foundation as executive director on March 30. She comes to us with a resume of many professional accomplishments in health care and beyond. Marje is trained as a registered nurse and spent a short time working in the pharmaceutical industry.

She gained fundraising expertise while at the UW Foundation. She raised money for the School of Medicine and Public Health and launched the first mini-med school program, attracting good attendance and donor support over seven years. After that she worked for UW Health as the Director of Geriatric Services, looking for innovative ways to improve the care of patients over 65.

Since 2018, she has served as the UW director of a National Institutes of Health “All of Us” Research Program, as part of a consortium with the Medical College of Wisconsin, Marshfield Clinic Health System and the Gunderson Health System. The goal of the program is to build a large database of populations, including those underrepresented by research, allowing researchers access to the information needed to better understand health and disease for generations to come.

This is an opportunity to step back and consider what better health means for the state and how the Foundation can be a part of improving it. When I accepted this offer just a month ago the world was such a different place. I look forward to working with members and supporters across the state to make a difference as we enter this uncharted territory. My deepest gratitude to all of you on the front lines in health care right now.

WisMed Foundation incoming Director Marje Murray

“I have a passion for population health and reducing disparities in health care and I’m very excited to help advance the Foundation’s mission to improve health for the people of Wisconsin,” said Marje. "Eileen and her team have done so much for the Foundation and I am proud to continue their work. At the same time, this is also an opportunity to step back and consider what better health means for the state and how the Foundation can be a part of improving it. When I accepted this offer just a month ago the world was such a different place. I look forward to working with members and supporters across the state to make a difference as we enter this uncharted territory. My deepest gratitude to all of you on the front lines in health care right now."

Marje obtained her Bachelor of Science in Nursing from the University of Iowa and her MBA from University of Wisconsin-Madison. She is a longtime Madison-area (Sun Prairie) resident with three daughters and a husband who are all Badger grads. 

Help us welcome Marje by reaching out to her at [email protected].

Back to top

Senate passes Phase 3 of COVID-19 relief

On Wednesday, the Senate passed the Coronavirus Aid, Relief, and Economic Security Act, otherwise known as “Phase 3,” of Congress’s efforts to provide relief for families, health care practitioners and businesses impacted by the COVID-19 crisis. The bill passed the Senate 96-0 and the House will take up the bill tomorrow.

Phase 3 will be a $2 trillion package making it the largest rescue package in U.S. history. Large portions of the bill are devoted to checks for individuals, loans for small businesses and large corporations, state and local relief funds and funds for hospitals and health care practitioners to help them deal with the COVID-19 crisis. The Wisconsin Medical Society signed on with many leading health organizations to urge Congress to include provisions for physicians and their practices and ensure access to personal protection equipment (PPE). Overall, the bill is 880 pages and Society staff will be reviewing the bill in detail.

Title III of the bill deals explicitly with health care parameters.

• $100 billion to hospitals and health care practitioners to deal with the crisis as well as to help offset the cost of delaying elective surgeries and other procedures
• 20 percent Medicare bump for treating patients with COVID-19
• Aims to address shortages in medical supplies such as PPE and ventilators
• Provisions to mitigate drug shortages and expedite reviews of drug applications
• Coverage for testing
• Supplemental awards for community health centers, rural health services and telehealth
• Additional funding for training health care professionals, developing new models of care and workforce development
• Multiple provisions related to telehealth including temporary exemptions for insurance coverage, increasing flexibility of telehealth services and incentives for telehealth

Phase 3 also includes multiple provisions for Medicare and Medicaid. The Medicaid provisions address reimbursement increases for treatment of COVID-19 and clarifications of coverage. It also extends the geographic price cost index floor through the end of the year. On the Medicaid side, it delays some hospital reductions and expands mental health services demonstration programs. It also extends graduate medical education funding for teaching health centers.

Phase 1 of the broader COVID-19 package provided $8.3 billion to states to help prevent, prepare and respond to the initial COVID-19 outbreak (including vaccine research and development). It also allowed the Department of Health and Human Services to broaden existing telehealth authority. Phase 2 provided $3.4 billion and focused on boosting funding and mitigating disruptions in services for vulnerable populations. This included programs such as the Supplemental Nutrition Assistance Program (SNAP) and school lunch programs for children, meal programs for the disabled and elderly and expansion of medical leave policies related to sickness, caring for someone who is sick or childcare. It also essentially provided for across-the-board coverage of testing for COVID-19.

Please contact HJ Waukau with questions.

Back to top

Mile Bluff Medical Center shares their COVID-19 response

Mile Bluff Medical Center (MBMC) kindly shared their COVID-19 response plan that was sent to their staff on Monday, March 23. Their team, like all health care teams, is adapting and updating the plan as needed. Please share your insights and successes in treating COVID-19 via WisMed Community or at [email protected]. The following is from Jim O’Keefe, President & CEO of Mile Bluff.

As the COVID-19 pandemic grows, I want to update you on MBMC’s response. Last week a special meeting of the MBMC Medical Staff Executive Committee was convened to provide leadership and input. The Physicians Operations Committee also met and was asked to provide leadership and input. While Juneau County to date has not had a positive COVID-19 patient, the reality is it is only a matter of time. Therefore, the following plan for clinic services is being developed and implemented as quickly as is reasonably possible.

Effective Monday, March 23 a COVID-19 phone triage process will be implemented. Any calls to MBMC related to respiratory illnesses will be forwarded to a COVID-19 hotline for triage staffed by MBMC nurses. Patients who are sick with a mild illness or otherwise low risk will be instructed on home cares. Patients who meet criteria for outpatient visit will be scheduled for an afternoon respiratory illness spot (by transferring that call to the appropriate clinic scheduler). Patients who meet criteria for emergency level care will be sent to the ED with consultation with the ED to prepare for arrival.

Effective as soon as possible, outpatient primary care clinics will be restructured to see essential non-respiratory illness visits in the morning till 1 p.m.  Beginning at 2 p.m. patients triaged by the COVID-19 hotline as appropriate for an outpatient appointment (versus appropriate for home care or in distress and needing emergency level care) will be seen.  The time from 1 p.m. to 2 p.m. will be used to clean and prepare for the respiratory ill patients. Moving the respiratory ill patients to the afternoon will allow for a thorough cleaning of facilities overnight to protect non-respiratory ill patients from contamination. Non-essential patient visits will be rescheduled for no sooner than April 30.

The restructuring of outpatient primary care clinics will require all currently scheduled patients to be evaluated for essential non-respiratory, essential respiratory and non-essential and rescheduled as appropriate. Beginning Monday, providers are asked to work with their PCS staff to evaluate their currently scheduled patients for rescheduling.

The following guidelines have been established to assist with the identification of essential non-respiratory illness visits.

• Acute non-respiratory illnesses such as UTIs, cellulitis. Acute abdominal pain, acute musculoskeletal pain
• Acute GI illnesses. GI bleeding
• Headache
• Asthma/COPD exacerbation, would need to be triaged and if concern for viral respiratory needs to be an afternoon appointment
• Medication assisted treatment appointments
• LARC placement/initiation of contraception
• Hospital follow ups. Essential ED follow ups
• Unstable chronic medical conditions (decompensated CHF, uncontrolled hypertension)
• Unstable mood disorders
• Post-op checks
• Well child checks where vaccines are indicated
• Prenatal visits
• Case by case basis:  derm procedures (skin cancers)

Guidelines for what qualifies as non-essential visits are as follows.

• Annual physicals, routine chronic medical condition appointments if patients have not had a status change (if medical condition is worsening such as a hemoglobin A1c too high, consider a phone call for medication adjustment)
• ADHD follow up/mood disorder follow ups if stable
• Well child checks where vaccines are not needed
• Smoking cessation

Efforts are underway to facilitate telehealth/telemedicine visits, where appropriate

Beginning Monday, March 23 at 1 p.m. all patients and visitors will be screened at the door for fever and respiratory symptoms. If the screen is negative, patients will be allowed to proceed to registration. If the screen is positive, they will be given a mask and taken directly to a designated clinic room for further care.

Other screening tests like routine mammograms, screening for lung cancer, and pulmonary function testing are under consideration for inclusion in the delay of non-essential services. And, plans are underway for MBMC’s response to the expected surge of inpatients resulting from COVID-19. Information will be forwarded as more details are available.

Thank you for all you do for our patients and communities.

Back to top

Board of Pharmacy and other COVID-19 prescribing-related actions

Physicians and pharmacists always work to provide care and medications for their patients, especially during a pandemic or other disaster. This requires coordination with the entire health care team to help ensure patients receive the necessary testing, treatments, follow-up care and medications. This is why the American Medical Association (AMA), American Pharmacists Association and American Society of Health-System Pharmacists issued a joint statement yesterday on inappropriate ordering, prescribing or dispensing of medications to treat COVID-19. 

The AMA also shared an initial state chart  providing nine examples of state actions. They include common restrictive elements, and also some states that support the professional judgment of physicians and pharmacists.

The efforts of clinicians and pharmacists to be just stewards of health care resources during this public health crisis is just one example of the countless selfless acts by health care professionals across the nation to provide care for their patients.

Back to top

Small Business 20/20 grants to help with impacts of COVID-19

Wisconsin Economic Development Corporation (WEDC) created the Small Business 20/20 Program to provide grants to help mitigate the impact of the COVID-19 pandemic. The program is designed to assist Wisconsin’s small businesses and micro-enterprises with short-term cash flow challenges and, in conjunction with other programs, protect jobs and public health. 

Small business owners are encouraged to work with their lenders, as approved financial institutions will be making grants available to their business clients with 20 or fewer employees and less than $2 million annual revenues. 

WEDC CEO Missy Hughes said they hope to provide additional resources. “We’re starting to look to the long-term,” she said. “Whether or not the recovery is two weeks or two months or three months, we will have a recovery. We will be working through that. And as a state, we’ll come together and work together.” 

In addition to the grants, long-term loans are available. They usually are $2 million or less, have low interest and are available to employers of 500 workers or fewer. She expects the federal agency to be “inundated” with applications.

Back to top

Trials begin for COVID-19 treatment

Last week the University of Minnesota began a clinical trial for post-exposure treatment for COVID-19 using hydroxychloroquine. Hydroxychloroquine is a known treatment for malaria, and it has been suggested in multiple outlets as a potential method for treating patients suffering from the COVID-19 virus. The trial is national in scope and seeks to enroll up to 1,500 people who have had household contact or are health care workers who have been exposed to someone with known COVID-19 disease within the past three days and presently are not ill. For additional information please click on the link above.

Other COVID-19 related trials are also underway. Earlier this week the Department of Health and Human Services announced it is funding a Phase 2/3 clinical trial for Kevzara as a potential COVID-19 treatment. In addition, the National Institutes for Health began a Phase 1 clinical trial for a potential COVID-19 vaccine at Kaiser Permanente Washington Health Research Institute in Seattle, called mRNA-1273. These trials are a part of over 100 treatments and vaccines that are currently being tested. Other trials include remdesivir, INO-4800 and avigan.

If you have questions, please contact HJ Waukau.

Back to top

Young Physician Section election results

The Young Physician Section (YPS) results from the election are included below. Congratulations to the new leaders!

YPS representative to the Society’s Board of Directors  (one position, three-year term)

• Erica Larson, DO

Chair-elect (one-year term, ascends to Chair in second year)

• Roger Kapoor, MD

AMA YPS Alternate Delegate (two positions each with a two-year term)

• Erica Larson, DO

YPS Alternate Delegate to the Society's House of Delegates (one position, two-year term)

• Erica Larson, DO

At-large YPS Governing Council Representative (unexpired 1-year term)

• Matthew Ferroni, MD

Please email the Society's Membership Department or call 800.762.8975 if you have any questions.

Back to top