In the News
Dr. Amar Duggirala featured as AAFP’s Boundary Breaker
History of Medicine CME Podcasts
The Medical Alumni Association is delighted to offer medical school faculty the Medical History CME Podcasts at a discounted price of $100. The Medical History CME Podcasts has been approved 14.75 AMA PRA Category 1 CreditsTM
Please click the link below to review the brochure and register:
LINK TO MAA WEBSITE AND HISTORICAL MEDICAL CME
These one-of-a-kind offerings were created by Philip Mackowiak, ’70, our Carolyn Frenkil and Selvin Passen Scholar in the History of Medicine and include a number of guest lecturers, many of whom are Maryland faculty members. We trust you will enjoy them.
of the planners, speakers, and others in control of this content for
this educational activity have relevant financial relationship(s) to
disclose with ineligible companies whose primary business is producing,
marketing, selling, re-selling, or distributing healthcare products used
by or on patients.
The University of Maryland School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Maryland School of Medicine designates this Live activity for a maximum of 14.75 AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity
Credits AMA PRA Category 1 Credits™ (14.75 hours), Non-Physician Attendance (14.75 hours) – Wednesday, September 1, 2021, 12:00 AM – Thursday, September 1, 2022, 12:00 PM
Vaccinations are Essential to Protect Young Lives
July 26, 2021 – COVID-19 did not make the other vaccine preventable illnesses go away. Vaccines help provide immunity to children before they are exposed to potentially harmful diseases, including the COVID vaccination if they are eligible, and is part of how the whole community stays protected. All vaccines are extensively tested for safety and efficacy before approved for use by the CDC. Please get your children vaccinated now before school begins.
Jocelyn Hines, MD, MBA
How to Fight Imposter Syndrome Physician Wellbeing CME
July 22, 2021 – What is imposter syndrome, and what can family physicians do to overcome it? MDAFP members can get the answers to those questions, and more, when you enroll in the latest activity in the Academy’s Physician Wellbeing CME series. Enroll Today
Now Available On-Demand | COVID-19 Community Forum
June 23, 2021 – Did you miss our COVID-19 Community Forum on June 22 where Family physicians and community leaders addressed COVID-19 vaccine concerns and the importance of adolescent vaccination? The forum recording is now available on-demand for MDAFP members! View Webinar
Now Available On-Demand | Monoclonal Antibody Therapy for COVID-19 Webinar
June 21, 2021 – Did you miss our Monoclonal Antibody Therapy for COVID-19 webinar on June 17 with the Federal COVID-19 Response Team? The webinar recording is now available on-demand for MDAFP members! View Webinar
Fighting for Family Medicine
May 28, 2021 – Last month, Dr. Kisha Davis, Dr. Amar Duggirala, Dr. Ariel Warden-Jarrett and Brian Lin, third-year medical student, represented the MDAFP for the virtual Family Medicine Advocacy Summit (FMAS). They had an opportunity to meet with staff members from Representative David Trone, United States Representative Maryland’s 6th Congressional District and Representative John Sarbanes, United States Representative Maryland’s 3rd Congressional District.
During the meetings, they discussed the importance of Medicaid pay parity, the need for telehealth flexibility for primary care and improved primary care access for patients enrolled in high-deductible health plans. The FMAS is a nationwide conference sponsored by the AAFP dedicated to advocacy. Each AAFP state chapter sends members to meet with their individual state representatives, and united, we fight for family medicine to address the AAFP’s top legislative concerns. Plan now to attend next year’s FMAS, hopefully live in Washington, D.C. Kudos to those who represented us in 2021!
Ariel J. Warden-Jarrett, MD, FAAFP is MDAFP’s Vice President and Co-Chair of the Governmental Advocacy Committee.
MDH, MDAAP and MDAFP Team Up to Address Pediatric COVID-19 Vaccine Distribution
May 27, 2021 – The Maryland Department of Health along with a representation of the MDAAP and the MDAFP have been meeting weekly for the past month to work on state wide pediatric COVID vaccine rollout.
Due to Pfizer’s distribution restrictions related to the ultra cold refrigeration criteria and the unique needs of the different counties, the hub and spoke model seemed to meet most of the needs.
Hub can be your local hospital or health department where the vaccine can be safely stored and the spokes are the outpatient primary care offices, all working together to coordinate the transfer process if VFC/COVID PIN number holders.
So far, eight practices have been confirmed ready to give vaccine to their patients.
The change in dose configuration from 1170 to 450 and the change in refrigeration criteria will ultimately help the distribution and the vaccination clinic set up, although small practices might still find challenging to balance dosages with wastage, if not able to reach the right number of people per clinic schedule.
The 450 dosage configuration is only 30 percent of the Pfizer vaccine stock.
Local health department and practices have been doing community outreach to address vaccine hesitancy via social media, radio, TV broadcast and local libraries.
Vaccine distribution via mass vaccination sites, pharmacies, counties school is ongoing.
Mobile clinics are being considered to reach the more rural part of Maryland.
MDPCP is planning to start webinars and training next week for further information.
Stay tuned for more information and reach out to your association, health department or local hospital for further updates.
Novella Papino, MD, FAAFP is a MDAFP Director and Family Physician at Calvert Health Primary Care in Solomons, Maryland.
MDAFP Chapter AAFP Delegate, Dr. Kisha Davis, Testifies before the Senate Finance Committee
May 26, 2021 – On May 19, I had the honor and privilege of testifying before the Senate Finance Committee on COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned. The committee convened to discuss the Medicare flexibilities that have been instituted during the COVID-19 pandemic. The hearing focused mostly on telehealth, whether it should be continued and how it should continue to be reimbursed. The core tenets of my testimony were:
1. Congress should remove geographic and originating site restrictions which would allow Medicare beneficiaries to conduct a telehealth visit from any location.
2. Congress should cover audio-only E&M services beyond the public health emergency.
3. Congress should ensure permanent equitable coverage and payment of services provided by community health centers and modify existing payment methodologies to provide timely, appropriate payment for telehealth.
4. Policymakers should monitor the impact of telehealth on access and equity and invest in infrastructure to promote digital health equity.
Additionally, I stressed the important distinction between vendor provided telehealth and telehealth conducted by a patient’s PCP as part of their medical home. As Congress looks to expand telehealth it should be done with ongoing monitoring of patient satisfaction, health outcomes, and ensure the collection and reporting of data stratified by race, ethnicity, gender, language, and other key factors.
Beyond telehealth, I advocated for the coverage of all vaccines, the ability to provide direct supervision and teaching services via audio-video to increase training opportunities in underserved areas; and removing prior authorization for most DME regardless of whether it is ordered via telehealth or in person.
Kisha Davis, MD, MPH, FAAFP is an AAFP Alternate Delegate and past president of MDAFP.
Dr. Amar Duggirala Speaks Out as COVID-19 Vaccinations Slow and FPs Begin Delivering More Doses
May 21, 2021 – At the start of the year, herd immunity against COVID-19 was a blank canvas, and family physicians were eager to pick up the paintbrush.
A remarkable area of that space has been covered: As of May 20, some 160 million Americans had received at least one dose of a COVID-19 vaccine, and nearly 129 million were fully vaccinated.
But the pace has slackened, and more than half of the country’s population remains unvaccinated as summer approaches and many retailers and communities have halted mask requirements.
Now, family physicians — largely left out of the initial vaccine rollout — are busy painting in the corners. They’re also visible, vocal advocates working against the vaccine hesitancy that’s contributing to the slowed immunization rate.
One example: Amar Duggirala, D.O., M.P.H., of Poolesville, Md. His Poolesville Family Practice was one of 17 primary care clinics selected for a pilot program in that state to test family medicine’s vaccine reach.
From its March launch, it was an instant hit, he told AAFP News.
“They basically said, ‘Here are 100 doses to see if you guys can do this,’” said Duggirala, who, with the Maryland AFP, had advocated for such a program. “Every practice I know of finished the 100 doses easily. “The first week, we individually called our high-risk patients we knew hadn’t been vaccinated. Maryland has a great database that updates daily, so we knew who didn’t have it already. An immunocompromised patient cried after the first dose, out of sheer relief.” Read More
Amar Duggirala, DO, MPH, FAAFP is MDAFP’s Treasurer and Co-Chair of the Governmental Advocacy Committee.
Dr. Amar Duggirala Discusses Alternative Payment Models with the US Government Accountability Office
May 20, 2021 – I had the opportunity through an invitation from the AAFP to meet with several representatives of the Governmental Accountability Office (GAO) to discuss my experiences with Medicare Alternative Payment Models and Quality Based Programs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), included a provision for GAO to report on transitions to alternative payment models (APM) for health care providers in rural areas, health professional shortage areas (HPSA), or medically underserved areas (MUA), including small practices with 15 or fewer providers, and any administrative burdens these providers may face in transitioning to APMs. To this end, the GAO has been speaking to providers in these types of practices to discuss their administrative burdens.
Small and rural practices are a vital lynchpin in our healthcare system. They tend to exist in areas that other healthcare entities have overlooked or found not to be financially profitable. Without small and rural practices, a significant portion of underserved Americans would not have a primary healthcare provider. This is from my experience as a family physician providing care in a rural community, for the past 15 years, that has no primary care providers.
I discussed with the GAO about my extensive experience in transitioning to and being a part of quality-based programs and alternative payment models over the past 8 years. Some of the burdens that small and rural practices face include a lack of clarity and transparency in the programs, a lack of administrative and IT support, as well significant impacts in cost and uncertainty of revenue in these programs.
There are multiple alternative payment models, and it is unclear to practices which ones they qualify for, and which ones would best suite them. I encouraged the GAO to pursue efforts to offer support to small practices to help them pick the most appropriate model for them.
Preparing for and joining an alternative payment model is very daunting for a small practice that may not have the administrative or IT support necessary. I discussed with the GAO the need to offer administrative support help practices transition to an alternative payment model. The Maryland Primary Care Program (a Medicare Alternative Payment Model), has practice coaches that support practices in their administrative requirements and deadlines. This type of practice coach would be a great model for other programs and should be offered to practices even as they are starting the process of transitioning.
Small and rural practices also have difficulty in obtaining IT support for the significant data requirements of alternative payment models. These models require a considerable IT infrastructure, including running quality and demographic reports, database management, and interfacing with other IT systems. Small practices may not have the staff to develop reports and manage databases. Also interfacing with other IT systems often cost several thousand dollars per interface and the practice may need several interfaces. This cost can be easily handled by large practices and hospital systems as they can spread that cost over tens, if not, hundreds of providers, but in small practices that cost is a significant hardship.
Along with IT support, many rural areas have a lack of reliable broadband internet which can significantly affect their efforts in managing their patients through cloud based EMRs and other IT systems.
Though alternative payment models may offer possible higher revenue for small and rural practices that perform well, the risk and potential revenue or cost of these models is not clear. There is very little guidance on how a practice can budget or plan financially for these payment models that could cost tens of thousands of dollars in investment with very little guarantee on revenue generation, even if the practices perform well.
Finally, the frequently changing requirements and quality metrics of alternative payment models do not give small and rural practices much certainty on what they would need to do perform well in these programs. Having stable, long-term requirements and quality metrics would help practices plan accordingly.
Amar Duggirala, DO, MPH, FAAFP is MDAFP’s Treasurer and Co-Chair of the Governmental Advocacy Committee.
Vaccines.gov Website Is Now Live
May 10, 2021 – CMS would like to make you aware that the federally supported website that makes it easier for individuals to access COVID-19 vaccines is now live. Vaccines.gov – powered by the trusted VaccineFinder brand – is available in English and Spanish, with high accessibility standard, and will help connect Americans with locations offering vaccines near them. In addition to the website, people in the U.S. are also now able to utilize a text message service, available in both English and Spanish. People can text their ZIP code to 438829 (GETVAX) and 822862 (VACUNA) to find three locations nearby that have vaccines available.
Vaccines.gov is meant to complement the number of state and pharmacy websites that have been successfully connecting many Americans with vaccinations, by providing a unified federal resource for Americans to use no matter where they are.
In addition to the website and text messaging service, the National COVID-19 Vaccination Assistance Hotline is now available to help those who prefer to get information by phone on where to get a vaccine. Call 1-800-232-0233 to find a location near you.
CareFirst Downstream Legislation Takes a Pause
By Ariel J. Warden-Jarrett, MD, FAAFP
April 29, 2021 – CareFirst introduced controversial state legislation during the 2021 session that would have given them the authority to enter into “downstream risk arrangements” with health care providers. This can be viewed as a raw attempt to shift the risk from the insurer to the provider of medical services. This legislation was met with strong resistance from physicians, and the bill was subsequently withdrawn before a formal hearing. However, the CareFirst Legislative Task Force was formed to work on the verbiage within the proposed legislation with a goal to have recommendations completed by August 31, 2021. The task force is sponsored by MedChi and has primary care and specialty representation.
Important Information Regarding Medicaid Fee-for-Service Opioid Naive Participants
April 20, 2021 – In order to comply with federal regulations (Ref. # CMS-2482-F, 12/31/2020), effective March 1, 2021, Opioid Naive Patients, identified as those who have not received an opioid, either short or long acting, within the last 90 days, will be limited to seven (7) day supply on the initial fill for both short acting and long acting opioids.
The Office of Pharmacy Services (OPS) will implement a “soothing period” from April 1, 2021 through May 31, 2021. During the “soothing period,” opioid claims for Opioid Naive Patients that exceed the day supply limits referenced above, will continue to pay and pharmacy providers will receive the following message: “Effective June 1 st Opioid naive, defined as no paid opiate claim in last 90 days, will be limited to a 7 day supply initial prescription for Medicaid participants”. At the end of the soothing period, opioid claims for Opioid Naive Patients that exceed the day supply limits referenced above, will be denied at the Point of Sale and require a prior authorization by the prescriber.
These day supply limits would not apply to Medicaid participants who are currently receiving an opioid, as well as any participant who has a diagnosis of Hospice Care, Palliative Care, Cancer or Sickle Cell Disease.
If you have questions regarding this letter, please contact 1-800-492-5231, option # 3.
In an effort to give timely notice to the pharmacy community concerning important pharmacy topics, the Maryland Department of Health (MDH)
Office of Pharmacy Services (OPS) has developed the Maryland Medicaid Pharmacy Program Advisory.
To expedite information timely to the pharmacy and prescriber communities, an email network has been established which incorporates the email lists of the Maryland Pharmacists Association, EPIC, CARE, Long Term Care Consultants, headquarters of all chain drugstores and prescriber associations and organizations.
It is our hope that the information is disseminated to all interested parties. If you have not received this email through any of the previously noted parties or via MDH, please contact the OPS representative at 410-767-1455.
Jack of All Trades Event Recap
April 16, 2021 – The Task Force on Health Equity and Racism Pipeline Subcommittee hosted a virtual panel discussion, “Jack of All Trades: The Versatility of a Family Medicine Physician” on Wednesday, April 14. MDAFP Board Members Corey Boggs, M4 and Dr. Kathryn Hart moderated. Twenty-four participants joined the conversation including 18 medical students and seven MDAFP student members. Panelists, Dr. Amar Duggirala and Dr. Kwame Akoto discussed what inspired them to pursue family medicine, what a typical day looks like in their practice and ways students can gain exposure to the specialty.
Of the students who completed evaluations after the event, 100 percent agreed or strongly agreed the webinar increased their interest in family medicine and opened their eyes to the breadth of the specialty. Other characteristics about family medicine students learned included its holistic approach, continuity of care, variety of patients and organization of care. All the respondents expressed interest in future webinars and being paired with a family physician mentor.
The Pipeline Subcommittee looks forward to hosting future webinars on a quarterly basis, developing a formal mentorship program, and strategizing ways to reach additional students, including those at universities and community colleges across Maryland.
MDAFP FP of the Year Featured in Baltimore Sun
March 29, 2021 – Dr. Njdeka Udochi, 53, is a health care provider who strives to treat all of her patients as if they were her family, caring for many, including immigrants and people who are experiencing homelessness.
“I do everything I can to provide the best care for my patients, regardless of their insurance,” Udochi said. “I don’t walk through the doors without knowing who they are and why they are here.” Read More
COVID-19 Vaccine Provider Update
Thursday, March 25, 2021 – The Maryland Department of Health recently shared updated information regarding provider registration and guidelines for distributing the COVID-19 vaccines. Please review the Clinician Letter, ImmuNet COVID-19 Vaccine Quick Reference Guide and the COVID-19 ImmuNet Registration Instructions linked below for the latest guidance.
Power to Heal Medicare and the Civil Rights Revolution
View full documentary now through March 17
The award-winning documentary, Power to Heal, tells how civil rights activists, the federal government, and medical professionals leveraged Medicare funding to bring down segregation, opening the door to hospitals, doctors and medical schools for Black Americans and other minorities in both the North and South. The film begins by revealing the culture of segregated health care and the real perils it unleashed in black communities. It follows a chronological arc, beginning with federal legislation (the Hill–Burton Act of 1946) that facilitated the spread of segregated hospitals following World War II just as black doctors intensified their efforts to end racial discrimination.
- Limited free access
- View full 60-minute documentary now thru March 17
March 4, 2021 – By J. Steven Wise of Schwartz, Metz & Wise, P.A.
In addition to the other great resources that the Maryland Academy of Family Physicians provides for its members, our firm is retained to keep members apprised of important legislative issues and to communicate with legislators about the impact of those issues on family physician practices. This is done in coordination with the Government Affairs Committee and the Board, which direct our work.
The 2021 General Assembly Session, which got underway on January 13th and runs for 90 consecutive days, is anything but normal with procedures altered to limit the spread of COVID-19. Bill hearings are all virtual, a marked change from sitting at the witness table in well-adorned hearing rooms before committees of Senators and Delegates. The House and Senate chambers are outfitted in plexiglass, and the House is literally a house divided, with half of the 141 members seated in an annex. The work of governing goes on, however, and that includes considering legislation that MDAFP has identified as priorities this year.
2021 Priority Issues
House Bill 28/Senate Bill 5-Public Health-Implicit Bias Training would address implicit bias and health disparities by, among other things, requiring all licensed health care professionals to complete an implicit bias training course recognized by their health occupations board. This would be done upon the next license renewal after April 1, 2022. MDAFP has devoted a substantial amount of time toward addressing these important issues and sees this legislation as a critical step toward educating health care providers on these matters.
Senate Bill 3/House Bill 123-Preserve Telehealth Act of 2021 addresses telehealth, but two issues are of particular importance:
- Retaining audio-only as an authorized modality of telehealth coverage. This is very important in areas of the State where internet coverage is weak, for the elderly or disabled persons who may not be able to easily access telehealth services through visual means; and for low-income residents who may not be able to afford internet access; and
- Requiring insurers to reimburse the same for a telehealth service as an in-person visit.
Medicaid Funding (Budget Bill)–Medicaid payment rates to physicians have historically been too low to ensure an adequate network for enrollees, negatively affecting access to medically necessary services. Maryland has done an excellent job of bringing Medicaid rates for E&M Codes up closer to Medicare rates, and currently stands at 94% of Medicare in 2021 Budget. The goal is to maintain these rates in the upcoming fiscal year.
Virtual Advocacy Day
Given the prohibition on members of the public entering the House and Senate buildings, as well as on receptions and other gatherings, MDAFP pivoted to virtual meetings with key legislators for its Advocacy Day this year. We conducted meetings with the following legislators, and appreciated their time during a busy Session to hear our concerns on the above issues:
- Delegate Ariana Kelly (Dist 16-Montgomery) Chair, Health Occupations Subcommittee of HGO Committee
- Delegate Kirill Reznick (Dist 39-Montgomery) Chair, Health & Human Services Subcommittee of APP Committee
- Delegate Nic Kipke (Dist. 31B-Anne Arundel), Minority Leader, Ranking Member, HGO
- Senator Brian Feldman (Dist 15-Mongtomery) Vice Chair, Finance Committee
- Senator Melony Griffith (Dist.25-Prince George’s) Health Subcommittee Chair, Budget & Tax Committee
MDAFP members who participated in these meetings were: GAC Co-Chairs Dr. Amar Duggirala and Dr. Ariel Warden-Jarrett, Dr. Cynthia Calixte, Dr. Robin Motter-Maste, Dr. Kisha Davis, Corey Boggs, Dr. Olufunto Campbell, and Dr. Mozella Williams. Their input was extremely valuable in conveying the real-world impact of these proposals. While Advocacy Day took a different form this year, it was equally effective as in prior years.
Maryland Department of Health: COVID-19 Vaccine Provider Updates
March 1, 2021, — The Maryland Department of Health Center for Immunization recently released further information on how providers can register to become COVID-19 vaccines providers. Please review the clinician letter and registration guide linked below to learn the latest on the vaccine distribution process for providers in Maryland.
MDAFP Recognizes All Members As Family Physician of the Year
February 27, 2021 – Each year, the Maryland Academy of Family Physicians is honored to recognize a Family Physician member who has displayed exceptional leadership, compassion for their patients and dedication to advocacy efforts for primary care across Maryland.
With the many obstacles and challenges that this past year presented, we decided recognizing just a singular member did not seem justified with the commitment you continue showing to your patients and communities through the COVID-19 pandemic.
You, our Family Physicians, sacrificed so much these last 11 months working tirelessly on the front lines to save lives while grieving loses of your own and trying to maintain your personal health and wellbeing.
Thus, in lieu of selecting one member this year to receive the Family Physician of the Year award, MDAFP has decided to recognize and honor all of our Maryland Family Physicians as 2020 Family Physician of the Year. We are incredibly grateful for your continued drive, loyalty and commitment to your practices and patients.
Thank you for sharing your time, money and voice in support of Family Medicine and working to enhance healthcare across the state. We look forward to furthering our mission with you this year.
MDAFP Student Director Corey Boggs interviewed in AAFP News
January 27, 2021, 8:42 am David Mitchell — Last year was a tough one for everyone, and although family physicians were often in the news for stepping up and saving the day, there were also stories of hardship that rose to the level of national news. But here at the start of 2021, students are showing hope about the future of medicine — especially family medicine. We asked some of the AAFP’s student leaders what they are excited about, and here is what they shared. Read More
Recording: MD CRC Webinar
January 20, 2021 – Missed Maryland CRC Task Force’s recent webinar, Adopting Quality Improvement Methods to Maximize CRC Screening Outcomes in Maryland held on January 14, 2021? You’re in luck! Click the button below for the recording. This webinar offered enduring CMEs.Recording Here
The AAFP has reviewed Adopting Quality Improvement Methods to Maximize CRC Screening Outcomes in Maryland and deemed it acceptable for up to 1.00 Online Only, Live AAFP Prescribed credit. Term of Approval is from 01/14/2021 to 01/14/2021. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Important Message from MDAFP President & Executive Director (January 8, 2021)
Our Dear Members and Allies,
As we draw to the end of this week, entirely aware of the indelible mark it has made in the history of our country and on the precious lives that reside therein, we reach out to you with words of support and comfort, for we have survived an attempted insurrection of our democracy during a time at our lowest collective physical, emotional, and mental health. Most of us are coming out of shock, having a mixture of emotions that are hard to reconcile and name.
To our MDAFP members who live or work in and around D.C, the images most of us witnessed through our screens may be especially vivid to you, your secure and healing spaces tainted with the stench of violence and fear. We extend care and solidarity to you.
In ten days our nation celebrates Martin Luther King, Jr’s birthday, to both honor the remarkable man and the promise of peace that comes with open discourse, humility, honestly, accountability, and reconciliation. May it be so in our time and for our future generations.
The leadership and staff of the MDAFP stand for respect and dignity to all persons and believe that the collective and powerful impact of Family Physicians can change our society for good. Thank you for continuing to join us in this good work.
In utmost sincerity,
Mozella Williams, MD MBA FAAFP Becky Wimmer
President Executive Director
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