Washtenaw County Epi Update: Ebola 10/30/14

Washtenaw County Public Health (WCPH) is working with Michigan Dept of Community Health (MDCH) and Centers for Disease Control and Prevention (CDC) to actively monitor individuals with recent travel from Ebola-affected countries. Currently, these counties include Liberia, Guinea and Sierra Leone. Public Health will actively monitor the recent traveler for the 21 days after departure from the affected country. As of today, WCPH is actively monitoring one low risk traveler who is asymptomatic.

WCPH is following the Traveler Evaluation and Monitoring (TEAM) protocol recently developed for MDCH and Local Health Departments to conduct active monitoring and follow-up for travelers returning from Ebola-affected countries. Stated in this protocol, Michigan state and local authorities will require travelers to report the following information twice daily:

· Temperature

· Presence or absence of other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding

· If they intend to move during the monitoring period

In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a twice daily basis.

Actions for clinicians:

· Assess all clients for recent travel (within 21 days) from the affected countries.

· If they have a positive travel history, assess for symptoms. If they have symptoms, isolate patient and call MDCH at (517) 335-8165 regarding next steps.

· If asymptomatic with a positive travel history, ask the individual if they are being monitored by the Health Department. If yes, no further action needed. If they are not being monitored, please call MDCH at (517) 335-8165.

Feel free to call us here at WCPH at (734) 544-6700 if you have questions.

CDC guidance for active monitoring of travelers and individuals exposed to Ebola:


MDCH guidance and resources on Ebola: http://www.michigan.gov/ebola

Washtenaw County Medical Society Holds First Ebola Preparedness Meeting

Ann Arbor – The Washtenaw County Medical Society held its first Ebola Preparedness meeting for health and medical leaders within Washtenaw County. Representatives from Washtenaw County Public Health, University of Michigan Health System, Saint Joseph Mercy Health System, Michigan Department of Community Health, and independent physician association Integrated Healthcare Associates (IHA) were present to discuss Ebola preparedness at all levels. Over 40 health care professionals were present at the meeting. The group discussed the personal protective equipment (PPE) that will be used by healthcare workers caring for possible patients with the Ebola virus, including rigorous and repeated training of donning and doffing of PPE, the newly introduced CDC guidelines stressing no skin exposure when PPE is worn, and the use of a trained observer to monitor PPE use and safe removal. The group also discussed the screening and management of possible Ebola patients; including quarantine guidelines and proper procedures when a healthcare worker may become exposed to the Ebola virus. “These meetings will help us all be on the same page regarding what we’ll do when, and if, a confirmed case of Ebola appears in Washtenaw County,” said Charles Koopmann, Jr., MD, Washtenaw County Medical Society President. The group will meet again in several weeks to further discuss these issues as well as bring additional stakeholders to the table.

WCMS Survey – Take the Survey and Win a New iPad

We would like to have a better understanding of the concerns and interests of physicians in Washtenaw County, in order to provide you with more relevant and useful services.

This survey will take you less than 10 minutes to complete. Your survey responses are completely anonymous. Upon completion, you may choose to enter a drawing for a new iPad Mini with retina display.

Your opinions are important, and your participation would be very much appreciated. To start the survey, click this link: https://www.surveymonkey.com/s/9GJVWFG

CDC Releases New Guidelines for Personal Protective Wear for Healthcare Workers Treating Patients with the Ebola Virus

Yesterday, the CDC released new detailed guidance on the types of personal protective equipment (PPE) to be used and on the processes for donning and doffing (i.e., putting on and removing) PPE for all healthcare workers entering the room of a patient hospitalized with Ebola virus disease (Ebola). For that information, and to read the CDC’s other recommendations, please click on the following link:


Washtenaw Medical Beat Episode on Depression Available For Viewing

The latest Washtenaw Medical Beat discussing depression can be seen thru the following link:

The program previously aired in March 2014 on the Community Television Network, Cable Channel 17.

2014 MSMS Foundation Annual Scientific Meeting

Washtenaw County Medical Society and its membership are cordially invited to attend the 149th Michigan State Medical Society (MSMS) Foundation Annual Scientific Meeting to be held October 22-25, 2014, at the Somerset Inn, Troy.

ASM 2014 will offer WCMS members over 40 three-hour sessions, two one-hour plenary sessions, and the one-hour William Beaumont Lecture over the four-day conference. Physicians can earn up to 28.5 AMA PRA Category 1 Credit(s)TM.

Conference highlights include:

ü Free Plenary Sessions offered at 7:00 a.m.

· Thursday – Delivering High Value Care in 2014

· Friday – Sew Up the Safety Net for Women and Children: Reducing Infant Mortality in Southeast Michigan through Equitable Care

ü Discounted Rates for Members, YPS, Retirees, Students and Residents.

ü Earn CME at Night. Courses with complimentary dinner offered Wednesday and

Thursday evenings.

ü Saturday CME. Three sessions on Saturday, from 8:30 a.m. to 12:00 p.m. covering

Otolaryngology, Back Pain, and Interventional Radiology.

Space is limited, so please register early. For questions, please contact Marianne Ben-Hamza at (517) 336-7581 or mbenhamza@msms.org. We look forward to seeing you at this year’s ASM.

Registration form:
ASM Mailer_2014_print

CMS to Reopen Meaningful Use Hardship Exemption

Due to significant pressure from the AMA, the Centers for Medicare & Medicaid Services (CMS) has announced the reopening of its Meaningful Use (MU) hardship exception application for physicians and hospitals to avoid the 2015 penalty. The new deadline will be November 30, 2014. Previously, the hardship exception application deadline was April 1, 2014 for hospitals and July 1, 2014 for physicians.

While all Medicare physicians have until February 28, 2015 to attest to any 90-day reporting period in 2014 to obtain an MU incentive, Medicare physicians who started the program this year were required to attest by October 1, 2014 to avoid a penalty of up to 2 percent in 2015. Those new to the MU program can now apply for a hardship exception to avoid this penalty if they missed the October 1 deadline. In addition, even if you are prepared to attest by February 28, 2015, you can still apply for a hardship exception as a fallback precaution to avoid the penalty. The AMA believes this hardship exemption will be interpreted broadly by CMS and therefore encourages all physicians who meet the following criteria to apply by the November deadline.

The hardship exception, however, only provides relief from the MU penalty and will not earn you an incentive. Meaningful Use incentives are still available for those who are able to meet and attest to the Stage 1 or Stage 2 measures by the February deadline.

This reopened hardship exception period is for Medicare physicians and hospitals that:

· Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability; and

· Physicians who were unable to attest by October 1, 2014 and hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

The CMS 2014 CEHRT Flexibility Rule allows physicians to use older certified EHR technology (Version 2011), a combination of old and new technology (Version 2011 and Version 2014), or just new technology (Version 2014) to attest for their 2014 reporting period. A more in-depth review of the rule can be found on the AMA website under “Avoiding meaningful use penalties / Hardship Exceptions.” Unfortunately, the CMS system was not ready to accept attestations by the October 1, the last date Medicare physicians new to MU could attest to avoid a penalty. This is part of the reason why CMS elected to re-open the hardship filing period, ensuring more doctors avoid a 2015 penalty.

For more information, and for a link to the hardship exemption application, visit the CMS website.

FREE CME if You Renew Your Membership by November 15

MSMS/WCMS membership renewals are in the process of being mailed, and as a thank you for your loyalty as a member and for paying early, all physicians who pay their 2015 dues by November 15 will receive a coupon for a free CME course at a MSMS educational training.

MSMS/WCMS values you as a member and this is just a small token of our appreciation for your continued support of organized medicine.

For questions about membership, please contact Joshua C. Richmond, Director, Membership & Political Fundraising, at 517-336-5788 or jrichmond@msms.org.

Washtenaw County Flu Update

First flu hospitalization of the season as of 10/1/14

Washtenaw County Public Health received a report of a Washtenaw adult hospitalized with lab-confirmed influenza B (via PCR testing). The individual is an older adult with underlying high risk health conditions who had not been vaccinated against flu. An additional case of influenza B, also in an Ypsilanti-area adult, was reported two weeks ago.

Influenza testing:

It is important for clinicians to order confirmatory lab testing on suspected influenza cases, especially when we are early in the season. Rapid flu tests are not reliable when low levels of influenza are circulating. Influenza PCR and culture isolates are an essential part of ongoing public health surveillance throughout the season.


Providers should vaccinate throughout the influenza season (see below for a summary of vaccine coverage for last flu season). Provider recommendation for vaccination is critical. Public Health has flu vaccine available for everyone 6 months and older; call 734-544-6700 to schedule an appointment.

Please see the Washtenaw County Public Health web site for ongoing local flu surveillance information:


Influenza vaccination coverage in Washtenaw County during 2013-14 season

Washtenaw County children had the top rate of flu vaccine coverage in Michigan last year (per MCIR). Among Washtenaw children ages 6 months through 4 years, 70% received at least one dose of flu vaccine; the state average was 49.6%. In the 5 to 12 year-old age group, 50.1% in Washtenaw were vaccinated compared to 31.6% statewide. Rates in adults are lower but this is partly due to lack of consistent entry of adult vaccines into the MCIR.

Public Health wants to thank all of our providers for helping to protect our community against flu. Flu vaccine rates in Washtenaw kids are particularly impressive and reflect the efforts of staff across the health care system. We are getting closer to our community goal of 90% coverage for everyone 6 months and older.

2013-14 Flu-associated hospitalizations and deaths in Washtenaw residents

2013-14 was a moderately severe flu season which was dominated by influenza A/H1N1; B viruses were circulating as well. An intense wave of A/H1N1 hit the community in late December and January causing numerous hospitalizations. The hospitalizations were fairly evenly distributed among younger (18 – 49 yrs), middle-aged (50 – 64 yrs) and older adults (65+ yrs). Few hospitalizations (5% of total) were seen in children 17 years and younger. Almost all hospitalized individuals had an underlying high-risk condition. Residents of the Ypsilanti area and African-American adults had higher rates of hospitalization than expected.

The low hospitalization rate in Washtenaw children last season is notable. The flu-related hospitalization rate among Washtenaw 0 – 4 year olds was 10.4/100,000 compared to a national rate of 46.7/100,000 (CDC). During the 2009 H1N1 pandemic, 27% of local hospitalizations were in children 17 years and younger, compared to 5% in 2013-14.

Some key findings of Washtenaw flu-related hospitalizations in 2013-14:

· Total hospitalizations = 116

· ICU Admissions = 20%

· Adult flu-related deaths = 4

· Child flu-related deaths = 0

· Underlying high-risk condition = 94%

Please see the full summary of hospitalizations for more details: http://www.ewashtenaw.org/government/departments/public_health/disease_control/2013-14-flu-hospitalization-summary