Enjoy Tuesday’s NCMS Morning Rounds.

Dec. 22, 2020

Sticking With the COVID-19 Vaccine Plan

The NCMS has been in contact with the NC Department of Health and Human Services (NCDHHS) on behalf of members who contacted us regarding access to the COVID-19 vaccine. Some of these members have been notified they are eligible to be vaccinated in the first round of COVID-19 immunizations but are having difficulty getting the vaccination. Some believe they qualify as front-line outpatient clinicians but have not received proper clearance to be immunized. Here is what we can advise you:

• The NCMS cannot register or authorize anyone to get the vaccine. That authority lies with the hospitals/health systems and/or your local county health department. Please contact the health system you are associated with if you are on the medical staff at the hospital or an employed physician or PA with that system.

• If you are not affiliated with a health system, but feel you qualify under phase 1A, please reach out to your local health department.

• We have encouraged NCDHHS to clarify the guidelines outlined in the vaccination plan and to ensure health systems and health departments are sticking with that plan. Here is the graphic showing who is eligible to receive the vaccine at each phase.

• Keep in mind that supplies of the vaccine are limited at this point, so NCDHHS is urging patience as shipments arrive and they are distributed. This week, the state expects to receive 175,900 doses of the Moderna vaccine, which received emergency use authorization from the Food and Drug Administration (FDA) on Friday. Between 70,000 and 80,000 of those will go to local health departments and the 63 hospitals that did not receive any of the Pfizer vaccine last week, according to NCDHHS Secretary Mandy Cohen, MD, MPH.

• As outlined on NCDHHS’ COVID-19 vaccine website, outpatient providers who have an increased risk of exposure beyond that of a typical general outpatient setting could be included in the first phase (1A). This could include outpatient providers who are focused on COVID patient evaluation, respiratory care such as respiratory diagnostic testing centers, members of a dedicated respiratory care team, or frequently involved in COVID testing sites.

According to NCDHHS, Health care employers (e.g., health systems, medical practices, hospice providers, EMS) should:
• Determine who meets the criteria of being high risk for exposure to COVID-19 as defined above because they interact and care for patients with COVID-19.
• Work with local hospitals or local health departments to coordinate access to vaccination.

NCDHHS also states that “if a hospital is providing hospital-based outpatient/primary care, they should do the same for outpatient and community providers to provide equitable access to vaccine. They also should ensure that they are including the entire care team, not just the physicians.”

For more information visit the NCDHHS COVID-19 vaccine webpage here.

Surprise Billing Legislation Close

As of yesterday evening, the US Congress was set to pass a massive government funding bill, which not only includes $900 billion in new COVID-19 relief, but also a provision on surprise medical bills.

The NCMS has long advocated for reforms to protect patients from surprise bills, and in November 2019, the NCMS Board of Directors adopted a policy framework to guide our advocacy on this issue. We have long sought a solution that addresses the issue proactively by shifting the focus from reacting to the surprise bill after the fact, to preventing it in the first place. This could be accomplished by identifying the areas where surprise billing is most likely to occur and negotiating charges before they are billed, perhaps by requiring them to be arbitrated in advance of services being rendered. Learn more about the NCMS’ proactive approach to this issue.

Preliminary reports on the legislation under consideration revealed that the latest version called for health insurers and providers to negotiate most billing disputes or bring them to a mediator.

While final language in the surprise billing provision was not available, the proposed legislation doesn’t seem to fulfill the NCMS’ goals and objectives. Once the final language is clear, the NCMS will analyze the legislation’s impact and how it will shape decisions going forward. Watch upcoming issues of your NCMS Morning Rounds for details.

Here is a media report with more information on the proposal: Surprise Medical Bill Prevention Included in Year-End Legislative Package, The Hill, 12-20-20

Guidance for Children with MIS-C Associated with COVID-19

Earlier this month, the NC Department of Health and Human Services (NCDHHS) issued updated clinical guidance on identification and reporting of Multisystem Inflammatory Syndrome in Children (MIS-C) potentially linked to COVID-19.

A possible link between COVID-19 and a serious inflammatory disease in children and teenagers has been reported in multiple countries and in the United States. While the specific features and range of disease manifestations are still being determined, most children and adolescents with this syndrome have gastrointestinal, dermatologic, and/or cardiovascular involvement including significantly elevated markers of inflammation and cardiac damage. Because the case definition is non-specific and clinical manifestations may overlap with acute COVID-19, Kawasaki disease or toxic shock syndrome, it may be difficult to distinguish MIS-C from these other conditions.

According to the Centers for Disease Control and Prevention (CDC), 1,163 cases of MIS-C and 20 deaths had been reported in the US as of Oct. 30, 2020. The mean age of cases was 8 years (range 0 – 20 years) and the majority of cases have occurred in children who are Hispanic or Latino (35.4 percent) or non-Hispanic black (31.7 percent).

In a more detailed report in August 2020, the most common signs and symptoms reported were abdominal pain, vomiting, skin rash, diarrhea, hypotension and conjunctival injection. The majority of patients did not have an underlying medical condition.

Read the NCDHHS memo here for more information.

As a reminder, DHHS has requested voluntary reporting of cases of this syndrome to the Communicable Disease Branch at this link. If you have questions, please contact the Communicable Disease Branch epidemiologist on call at 919-733-3419.

In the News

Police, Firefighters, Teachers Will Be Next in Line for COVID-19 Vaccine, USA Today, 12-20-20

Learning Opportunity

Mark your calendar for these upcoming NCMS-managed specialty society meetings:

The NC Eye Physicians and Surgeon’s Annual CodeQuest meeting will be a one-day virtual training with Sue Vicchrilli, COT, OCS, OCSR on Jan. 23. Watch the NCMS Morning Rounds for details and updates on registration.

The NC Dermatology Association’s Annual Meeting will be held Jan. 30-31. This first-ever virtual annual meeting features an impressive list of outstanding faculty addressing the latest dermatological topics in online sessions that offer up to 7.75 hours of CME credit. Click here to register for the meeting or get more information.

If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!