WVOS "No Bones About It" Summer 2020

Volume 10 • Issue 3 • Summer 2020

No Bones About it

New Ways of Teaching

President Felix Cheung, MD Doctor means “Teacher” in Latin. I know not all of us have chosen academic medicine as a career, but every day we are teachers, to our staff and to our patients. Showing our patients their conditions and giving them an understanding of how we can work together to improve their function is the heart of what we do.

One way I have seen our Society teach this summer is through our new CME Journal Clubs. I am particularly proud of this idea from our VP Shafic Sraj to help replace the CME credits we lost this spring. He has done a great job organizing them and we have taught and learned from each other during the spirited discussions.

I encourage all of you to

In This Issue:

participate. Perhaps I can plug the Tumor one in February, lol!

We had another opportunity to teach this summer. The National Orthopaedic Leadership Conference is a great meeting in DC, usually held in June. It is a chance for us to visit with our Senators and Representatives, and show our appreciation for how they support us in Congress and ask them for their help in legislation. Usually the actual elected officials are busy with meetings or votes so we end up talking with their legislative assistants who pass the message on.

This summer, however, was different. Because of the pandemic, we held our meetings virtually over Zoom during the August recess. And because we could schedule them throughout the week or day, we had a chance to meet with the actual Senator or Representative. I have been attending this conference as part of the WVOS for several years, and this was the first time I had actually gotten to

New teaching

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• President’s notes: New Ways of Teaching • The New Look of WVOS CME Events • WVOS Takes DC...

by Zoom • Medical Insurance Covid-19 Impact • Endorsements Announced for November • Marshall Review of 2019-2020 • WVU Review of 2019-2020 • OrthoEvidence Usage by WVOS • Join Us for Journal Club

By WVOS Vice President Shafic Sraj, MD

The New Look of WVOS CME Events

“Journal Club gives members new information, free CME and a chance to ‘see’ colleagues. It’s been a great addition to our member services.”

- Shafic Sraj, MD WVU

At the end of April 2020, I emailed my Hand surgery colleagues telling them that “it is possible that social distancing will remain in effect till ... May.” Oh, how wrong was I! That email was the invitation to our monthly Hand Surgery Journal Club. In that same email, I copied our West Virginia Orthopaedic Society (WVOS) President Felix Cheung, sharing with him our experience running a journal club and converting it to a virtual platform. We explored the virtues of developing a WVOS statewide Journal Club. It did not take much to get Felix on board and we immediately included our Executive Director Diane Slaughter and started planning. All we needed was to select a good format that would appeal and be of value to our WVOS members, obtain CME accreditation (to replace those lost due to the cancellation of our Annual meeting), and secure sponsorship to cover costs.

For the Journal Club to be valuable, we had to cover a variety of topics that are focused enough to add knowledge but general enough to be relevant to a majority of our members. After considering different schedules, we settled on a monthly theme, championed by an expert host from our orthopaedic community. The host would invite colleagues of similar interests and cover recent and relevant advances in the 2

selected theme. Diane secured CME accreditation as well as sponsorship from Professional Risk Associates for 12 months very quickly and emailed us back: “We have a Journal Club!”

Following this, you know the rest of the story: The first three themes, Hand, Hips/ Knees and Trauma were a huge success. Participation was excellent and speaker ratings were high.

We currently have a running list of themes and corresponding hosts that goes as far as March 2021, and we will definitely need some more. The themes do not have to follow traditionally defined specialties. If you have an interest in a particular aspect of orthopaedic or musculoskeletal care and are willing to be our host, we would love to have you. Telehealth in Orthopaedics? Sure thing!

Biologics? Bring it on!

We are currently scheduled on the second Thursday of each month at 7:00 pm for a one hour discussion of 4-5 articles. This will give each of us one hour of CME per month at no cost! Moving forward, we may invite national experts and share experience and perspective with them.

The one thing that I learned from this quick shift from inperson to virtual platforms is, and I quote Diane, “ We can do this!!!

If you would like to be a host one month, please reach out to Diane or me!

By WVOS Executive Director Diane Slaughter, CAE, APR, Fellow PRSA

WVOS Takes DC...by Zoom

The 2020 National Orthopaedic Leadership Conference (NOLC) Capitol Hill Day, originally scheduled in June, was another victim of COVID-19. However, this change in venue, from Washington, DC, to Zoom, actually offered additional opportunities for the West Virginia Orthopaedic Society.

During the last two weeks of August, we were able to meet with all five members of the West Virginia Congressional delegation; we rarely see all five elected members in DC in any given year, rather meeting with their staff. In addition, our meeting generally lasted twice as long as our typical in-person meetings.

WVOS participants included President Felix Cheung, Vice President Shafic Sraj, SecretaryTreasurer Manny Molina, Director Karim Boukhemis, Resident Board Member Galen Burdis and AAOS Councilor Joe Prud’homme, as well as Executive Director Diane Slaughter and West Virginia State University intern Jordan Bonnett. We discussed House bills and urged support of Senate companion bills.

Specifically, we urged our delegation to waive Medicare’s budget neutrality requirements for the finalized evaluation and management (E/M) code policies, including the E/M adjustment to 10- and 90-day global code values, which go into effect on January 1, 2021.

Congress should also ask CMS to maintain the current value of

total knee and hip arthroplasty codes at work RVU of 20.72.

Congressman McKinley sent a letter to Reg. Roger Marshall’s office supporting our budget neutrality request.

We asked their support of H.R. 7059, the “Coronavirus Provider Protection Act,” that would provide health care professionals and the facilities in which they work with narrowly-crafted liability protections from COVID-19related lawsuits. Congressman Mooney said he would cosponsor this legislation.

Representatives McKinley, Miller and Mooney are all cosponsors of H.R. 3107, the “Improving Seniors’ Timely Access to Care Act,” which would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the MA program, while also providing additional oversight and DC by Zoom

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WVOS WVAOE leaders is made honoring the most Joshua of Zoom Tuck’s meetings legacy with with a scholarship.

Members of Congress You can contribute in August.to keep this going for the future!

By Gregg Moore, Professional Risk Associates

Medical Insurance Covid Impact

“This isn’t a place where anyone would want to live -however, it is my home.”

- Juliana Summers

Understanding the Lasting Impact of COVID-19 on Medical Professional Liability Insurance Since the arrival of coronavirus disease 2019 (COVID-19) in the United States in January 2020, few industries have been hit harder than the healthcare sector. Working the front lines of this pandemic has irrevocably altered the way clinicians administer care, which may impact liability exposures. As life crawls back towards some semblance of normalcy, healthcare providers will be forced to reckon with the rapid changes instituted during these unprecedented times and the sometimesunexpected consequences.

Here we will examine how the pandemic could give rise to more malpractice claims.

According to some insurance industry leaders, COVID19 will “potentially be a major influence on MPL claims and litigation, underwriting strategy, rates and carrier finances” (Greve, P., Henderson, R., Semlies, L., 2020). More specific to healthcare providers, we believe medical professional liability claims filed in the wake of the pandemic could be divided into two key categories, COVID-19 related claims and a second wave of delayed healthcare claims.

COVID-19 Treatment Related Claims At the onslaught of the crisis, hospitals were 4

unprepared for a pandemic; there was a shortage of personal protective equipment, inadequate training for staff in infection control practices, and a lack of accommodations for patients(Greve, P., Henderson, R., Semlies, L., 2020). These factors could lead to allegations of negligence for claims related to COVID-19. However, claims related directly to the treatment of COVID-19 will be inhibited by regulations passed during the pandemic.

The first line of defense for healthcare professionals was the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed March 27th, 2020.

The CARES Act provides some federal liability protections to healthcare workers and volunteer aids thanks to its broad Good Samaritan language. Additionally, the Facilitating Innovation to Fight COVID-19 Act is a pending bill that- if passed- will expand immunity from civil liability to healthcare providers for actions taken during the health crisis. It will specifically protect providers from, “(1) using or modifying a medical device for an unapproved use or indication; (2) practicing without a license or outside of an area of specialty, if instructed to do so by an individual with such a license or within such an area of specialty; or (3) conducting the testing of, or providing treatment to, Insurance More on page 11

By WESPAC Chairman Joe Prud’homme, MD

Endorsements Announced for Nov. WESPAC is a voluntary, bi-partisan, unincorporated organization and is a separate segregated fund established by the WVSMA. The goals of WESPAC are to: work with elected officials to make sure they understand the many facets of our healthcare system; organize the physician community into a powerful

voice for quality healthcare in West Virginia; and preserve the vital relationship between you and your patients by educating legislators on healthcare issues.

WESPAC Chairman and WVOS’ AAOS Councilor Joe Prud’homme, MD, has announced the organization’s endorsements for the Nov. 3 election:

Governor Recommendation Jim Justice WV Senate District Recommendation 1 Ryan Weld 2 Mike Maroney 3 Donna Boley 4 Amy Grady 5 Robert Plymale 7 Ralph Rodigherio 8 Glenn Jeffries 10 William Laird 11 Denise Campbell 13 Mike Caputo 15 Craig Blair 16 Pete Dougherty 17 Eric Nelson WV House of Delegates District Recommendation 1 Mark Zatezalo 3 Erikka Storch 5 Dave Pethel 10 Vernon Criss 12 Steve Westfall 13 Joshua Higganbotham 16 Anna Lewis 16 Dakota Nelson 17 Chad Lovejoy 18 Evan Worrell 19 Ric Griffith 22 Zach Maynard 23 Rodney Miller

24 Susan Perry 26 Ed Evans 27 Joe Ellington 30 Mick Bates 32 Kayla Kessinger 32 Margaret Staggers 32 Austin Haynes 33 Roger Hanshaw 34 Brent Boggs 35 Moore Capito 35 Doug Skaff 35 Larry Pack 35 Chris Stansbury 36 Jim Barach 36 Amanda Estep-Burton 36 Chris Walters 37 Mike Pushkin 39 Dana Ferrell 42 Cindy Lavendar-Bowe 43 Bill Hartman 43 Cody Thompson 46 Bob Stultz 48 Danny Hamrick 48 Ben Queen 50 Mike Angelucci 50 Joey Garcia 51 Rodney Pyles 51 Joe Statler 51 Danielle Walker 51 Justin White 53 Cory Chase 65 Sammi Brown 66 Paul Espinosa 67 John Doyle 5

“Please study the candidates and VOTE on Nov. 3!”

- Dr. Joe Prud’homme

By Ali Oliashirazi, MD, Chairman, Marshall University Dept. of Orthopaedics

Marshall Univ. Review of 2019-2020

“41% of residents have elected to come back and join the mothership, even though none were picked for regional ties.”

- Dr. Ali Oliashirazi

Marshall Orthopaedics has grown in revenue 10 to 15%, year over year. In 2020, the department was annualized to grow by 17%; however, because of Covid, we showed only a 1% increase.

Clinical quality continues to be one of the top in the nation.

The department has been recognized by HealthGrades as being in America’s Top 100 best hospitals for joint replacement, America’s Top 100 best hospitals for orthopedics, overall excellence in joint replacement, overall excellence in orthopedics, 5/5 stars for total knee replacement and 5/5 stars for total hip replacement.

We also continue to have the advanced certification by the joint commission for joint replacement surgery.

Marshall Orthopaedics’ residency program continues to be strong. We have funding to increase our complement from three to four residents per year and are debating on the exact timing of this increase. 100% of our residents have passed their board part one and boards part two. 41% have elected to come back and join the mothership or one of Marshall Orthopaedics’ eleven affiliated institutions in Ohio, Kentucky or West Virginia. This is amazing in that none of the residents are picked because they have ties to our state or neighboring states.

This year, the program’s rank is 97th percentile in the 6

country for the in-training exam. Two of our residents scored 100%, two 99% and one 98% on the OITE. The research arm is doing phenomenal work. We had 32 publications last year, 25 poster presentations and 20 podium presentations. Cutting edge technologies include Dr. Chad Lavender‘s “Fertilized ACL” as well as his work with the “nanoscope” that has been nationally and internationally recognized.

Our annual fundraising “Joints Jog” was canceled due to Covid and we hope to revisit this event next year, as it provides philanthropic aid to our community.

As a department, through our clinical, education, research and philanthropic arms, Marshall Orthopaedics continues to strive to bring the most positive light on our region and state.

By Sanford Emery, MD, MBA, Chairman, WVU Dept. of Orthopaedics

WVU Review of 2019-2020 West Virginia University Department of Orthopaedics has had a strong year despite the trials and tribulations of the virus! We have continued to grow, though more slowly than in the last several years.

Currently, we have 34 clinical faculty, 4 PhDs, and 26 advanced practice providers.

We continue to build a PM&R Division, which at some point will become a full-fledged department of its own. We said goodbye last June to three of our chief residents who will be doing fellowships in Cincinnati, Indianapolis and Albuquerque, NM. With many of our surgical subspecialties at a satisfactory level from a capacity standpoint, we have had some success in planting our future

graduates in communities around the state. Dr. Mark Plumby will begin practice after his fellowship in Marietta, OH. Dr. Lunden Ryan and Dr. Alex Conti are currently chief residents here at WVU and after completion of their trauma fellowships, they will be joining Drs. Jeff McElroy and George Harriot at Camden Clark Memorial Hospital in Parkersburg. As most of you know, many communities and smaller hospitals in our state could benefit tremendously from orthopaedic surgery care.

We hope to be able to provide our graduates with good job opportunities around the state and region to provide this musculoskeletal care. For a training program, this is indeed very satisfying.

“We have had some success in planting our future graduates in communities around the state.�

-Dr. Sanford Emery

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By OrthoEvidence Managing Editor Christopher Smith, MSc

OrthoEvidence Usage by WVOS

OrthoEvidence is proving to be a popular WVOS member benefit.

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New teaching More from page 1 talk some of them. It was great!

We introduced the topics we wanted to discuss, ranging from telemedicine to COVID liability reform, from Medicare reimbursements to preauthorization requirements.

Some of the topics were fairly technical, and some of the Congressional delegation really pressed us on the facts and kept us on our toes. We welcomed the opportunity to share our knowledge and experience as orthopaedic surgeons with them. This was our “teaching moment.” I know their legislative assistants will do the fact checking,

and analyze the political ramifications of our “asks.” But the personal appeals from real physicians treating real COVID patients had a true impact on them, and made the visit special.

Never underestimate your influence as a doctor in your community. You are well educated, well trained and well respected. You are a teacher, whether you think you are or not. Your words and actions have impact, affecting attitudes, actions, and votes. You should be proud and humbled by this.

Please don’t be afraid to teach and to fight for what is best for our patients.

Join Us for Monthly Journal Club

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Never underestimate your influence.

We appreciate the time of both the Members of Congress

DC by Zoom More from page 3 transparency. Senators Capito and Manchin said they would watch for a Senate companion to this legislation.

We discussed telemedicine and its somewhat surprising usefulness during the pandemic. Dr. Prud’homme specifically shared his positive experiences, and those of his patients, using this technology.

This conversation led all five Members of Congress to address the need for broadband services in West Virginia.

We also thanked them for supporting the PPP and other financial programs, sharing stories of several physicians

whose offices could stay open and employees stay employed through this difficult time.

The AAOS was also advocating for H.R. 7168 and S. 3547 relating to physicianowned hospitals. We did not address these bills, since West Virginia’s certificate of need laws prohibit these entities.

We presented each Congressional office with a link to the spring 2020 “No Bones About It” opioid issue featuring 10 student essays.

We appreciate the time of both the Members of Congress and the West Virginia Orthopaedic Society for making time for these Zoom meetings.

In-District Advocacy Event

and the WVOS

During August 2020, AAOS members across the U.S. advocated for access to the very best orthopaedic care on behalf of their patients and the profession.

leadership for making time for these Zoom

Surgeon 1,400 Orthopaedic Advocates

4,200 Letters to Policymakers

meetings.

150 Meetings with Legislators

ISSUES RAISED WITH POLICYMAKERS Payment policy changes Preserving the value of musculoskeletal care services

Physician-owned hospital expansion Lifting restrictions on high-quality, low cost facilities

Medical liability reform Protecting pandemic healthcare workers from the threat of lawsuits

Prior authorization reform Removing regulatory barriers to timely access to care

@AAOSAdvocacy #OrthoAdvocacyinAction aaos.org/indistrictevent

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ORTHOPAEDIC PAC 26 Fundraising events $147,099 Dollars raised 638 OrthoPAC Contributors

Insurance More from page 4 a patient outside of the premises of standard healthcare facilities�

(Congressional Research Services, 2020). The CARES Act in conjunction with the Facilitating Innovation to Fight COVID-19 Act should provide broad protections for providers and safeguard them from litigation for care rendered while treating COVID patients.

Delayed Healthcare Claims Second wave delayed healthcare claims are likely the greater financial threat.

Due to the massive influx of critical patients, social distancing guidelines, and the discontinuation of nonessential procedures, many patients elected to delay care or did not have the option to seek treatment. These postponements could severely affect the longterm health of patients.

Providers could expect an increase in malpractice claims alleging failure to diagnose or treat. It is still too early to know exactly how impactful these claims could be, but it is important to be aware of the exposure.

Medical professional liability carriers will be pricing future premiums with these provisions in mind.

Although some of the circumstances leading to potential second wave claims were out of the

clinician’s control, providers fortunately still have factors working in their favor.

First, the incorporation of telemedicine has allowed patients to make virtual appointments. These remote visits are not a perfect replacement for face-to-face care, but they have fostered more communication in the patientprovider relationship in a time when conventional appointments are not an option.

Furthermore, as telemedicine increased in popularity and demand, many states added legislation to protect clinicians from telemedicine related claims. Couple this new-age medicine with the fact that public perception for healthcare workers is at an all-time high, litigation may be less likely.

Patients may be less litigious, and plaintiff attorneys will likely be less aggressive about pursuing these claims apart from cases that involve gross negligence.

Greve, P., Henderson, R., Semlies, L. (2020). COVID19 and its Impact on Medical Professional Liability: First Impressions. PLUS Journal, Second Quarter 2020, 28-36.

Congressional Research Services (2020). Summary: S.3630-116th Congress Facilitating Innovation to Fight Coronavirus Act. Retrieved from https://www. congress.gov/bill/116th-congress/senate-bill/3630

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These postponements could severely affect the long-term health of patients.

President

Felix Cheung, MD Huntington, WV 304.691.1262 cheungf@marshall.edu

Consider contributing to Ortho PAC to help make your voice heard on issues of importance to orthopaedic medicine and your patients!

Vice President

Shafic Sraj, MD Morgantown, WV shaficsrajmd@gmail.com

Secretary-Treasurer Manuel Molina, MD Charleston, WV manmo99@aol.com

Immediate Past President Stanley Tao, MD Huntington, WV totalsportscare@comcast.net

At-large Members

Karim Boukhemis, MD Huntington, WV 25702 kboukhemis@scottorthopedic.com Christopher Courtney, DO Bridgeport, WV ccourtney48@hotmail.com Ryan Murphy, MD Morgantown, WV tmurphy@hsc.wvu.edu Vivek Neginhal, MD Huntington, WV 304.525.6905 vneginhal@hotmail.com Rajesh Patel, MD Beckley, WV RajeshVPatel@yahoo.com

AAOS Councilor

Joseph Prud’homme, MD Morgantown, WV 304.293.2779

Advocacy Chairman Joseph Prud’homme, MD Morgantown, WV 304.293.2779

Legislative Chairman Richard (Ret) Topping, MD Elkins, WV 304.637.4509

Membership Chairman Tony Majestro, MD Charleston, WV 304.343.4691

No Bones About It is published four times a year by the West Virginia Orthopaedic Society (WVOS).

Felix Cheung, MD, President Diane Slaughter CAE, APR, Executive Director

Program Chairman Jack Steel, MD Huntington, WV 304.525.6905

Ex Officio Members

Sanford Emery, MD, MBA Morgantown, WV 304.293.1210 Ali Oliashirazi, MD Huntington, WV 304.697.7114 Lunden Ryan, MD Morgantown, WV 304.293.1168 LeeAnne Torres, MD Huntington, WV 304.631.1262

WVOS reserves the right to determine suitability of advertisements and content. Correspondence regarding subscriptions and changes of address should be sent to: WVOS • PO Box 13604 • Charleston, WV 25360 (304) 984-0308 • wvos@frontier.com No Bones About It is a member service of the WVOS and may not be reproduced without permission. WVOS © 2020.

Executive Director

Diane Slaughter, CAE, APR, Fellow PRSA PO Box 13604 Charleston, WV 25360 304.984.0308 wvos@frontier.com

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