Alex Macia represents WV State Medical.

Sent from my iPad

On Mar 31, 2020, at 1:30 PM, Barbara Zektick <bzektick@alexander-cleaver.com> wrote:


Hi Tom – I have shared with the MD Medical Society (MedChi)’s lobbyist. They may reach out directly, but I’ll let you know if I hear from them.

From: state_law@lists.statelaw.org <state_law@lists.statelaw.org> On Behalf Of Jason Larrabee
Sent: Tuesday, March 31, 2020 12:49 PM
To: 'state_law@lists.statelaw.org' <state_law@lists.statelaw.org>
Cc: 'Erin Murphy' <emurphy@statelaw.org>
Subject: RE: Cutbacks for some doctors and nurses as they battle on the front line

Tom,
We represent a host of health care related companies, but not the specialty docs. I’m sure you’re talking with the American Academy of Family Physicians, but if not let me know and I can connect you with their lobbying team.
It’s been a fast a furious couple of weeks in DC, and with both chambers out until at least April 20th, the work has shifted to agencies.  There’s lots of debate about what to do next, but the response is very fluid.
Here’s a link to our firms work tracking everything on COVID from D.C.  https://www.vnf.com/covid-19-resource-center<https://www.vnf.com/covid-19-resource-center>
Happy to assist as needed.
Stay safe, be well and stay home.
Jason

Jason Larrabee | Senior Policy Advisor

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1050 Thomas Jefferson Street, NW
Washington, DC 20007
Direct – (202) 298-1877
Cell – (530) 570-1620
jlarrabee@vnf.com<mailto:jlarrabee@vnf.com> | vnf.com<http://www.vnf.com/>

From: state_law@lists.statelaw.org<mailto:state_law@lists.statelaw.org> [mailto:state_law@lists.statelaw.org] On Behalf Of Hoffman, A. Kimberly
Sent: Tuesday, March 31, 2020 8:55 AM
To: Susan Fisher
Cc: Erin Murphy; state_law@lists.statelaw.org<mailto:state_law@lists.statelaw.org>; Lindsay Knox
Subject: Re: Cutbacks for some doctors and nurses as they battle on the front line

Caution: External Email.

I’ve reached out to the Medical Society of Delaware. We represent them.

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A. Kimberly Hoffman
Partner
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<http://www.morrisjames.com/>
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On Mar 31, 2020, at 8:21 AM, Susan Fisher <sfisher@mcdonaldcarano.com<mailto:sfisher@mcdonaldcarano.com>> wrote:


Tom – we represent the NV Orthorpaedic Society, the NV State Society of Anesthesiologists, and Board of Osteopathic Medicine. As such, we do work very closely with the NV State Medical Association (NSMA).

I would be more than happy to make an intro to NSMA. We also have a state senator and an assemblywoman who are family practice docs.

Susan Fisher | Senior Vice President

McDONALD CARANO
Government Affairs & Advocacy Group

D: 775.326.4385 | E: sfisher@mcdonaldcarano.com<mailto:sfisher@mcdonaldcarano.com>

From: state_law@lists.statelaw.org<mailto:state_law@lists.statelaw.org> <state_law@lists.statelaw.org<mailto:state_law@lists.statelaw.org>> On Behalf Of Erin Murphy
Sent: Monday, March 30, 2020 11:37 AM
To: state_law@lists.statelaw.org<mailto:state_law@lists.statelaw.org>
Subject: SLR: Cutbacks for some doctors and nurses as they battle on the front line

Dear SLR Members,

Please see below email from Tom Forbes (TX):

From: Tom Forbes <Tom.Forbes@butlersnow.com<mailto:Tom.Forbes@butlersnow.com<mailto:Tom.Forbes@butlersnow.com%3cmailto:Tom.Forbes@butlersnow.com>>>
Sent: Monday, March 30, 2020 12:15 PM
To: Erin Murphy <emurphy@statelaw.org<mailto:emurphy@statelaw.org<mailto:emurphy@statelaw.org%3cmailto:emurphy@statelaw.org>>>; Moira Skelley <mskelley@statelaw.org<mailto:mskelley@statelaw.org<mailto:mskelley@statelaw.org%3cmailto:mskelley@statelaw.org>>>
Cc: 'Tom Banning' <tbanning@tafp.org<mailto:tbanning@tafp.org<mailto:tbanning@tafp.org%3cmailto:tbanning@tafp.org>>>
Subject: Fw: Cutbacks for some doctors and nurses as they battle on the front line

Dear Friends:
I represent the Texas Academy of Family Physicians (TAFP) which is the voice of the primary care physicians here in Texas. The CARE Act, just passed by Congress, doesn't address the dire financial straights physicians and other primary care providers are in. And the CARE Act doesn't address this while other small businesses are a focus in the Act. The article below describes the issue.

The Texas Academy is leading an effort to deal with this on a national level. So....my request : do any of you represent your state medical association or a primary care specialty society (e.g. Family practice or internal medicine). If not , do you have contacts within the medical association community, and would you be willing to provide an introduction? The Texas Academy is working to galvanize support for addressing this and needs all the support it can get.
Many thanks,
Tom
________________________________
From: Tom Banning <tbanning@tafp.org<mailto:tbanning@tafp.org<mailto:tbanning@tafp.org%3cmailto:tbanning@tafp.org>>>
Sent: Sunday, March 29, 2020 9:43:03 AM
To: Kim Ross (kim@rosskimble.com<mailto:kim@rosskimble.com<mailto:kim@rosskimble.com%3cmailto:kim@rosskimble.com>>); George Shipley; Marshall Kenderdine (marshall@lobbytx.com<mailto:marshall@lobbytx.com<mailto:marshall@lobbytx.com%3cmailto:marshall@lobbytx.com>>); Jerry Philips (jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com%3cmailto:jerry@philipsmeachum.com>>); Kurt Meachum (kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com%3cmailto:kurt@philipsmeachum.com>>); Tom Forbes; Thomas Forbes; dan hinkle; davidhreynolds.atx@gmail.com<mailto:davidhreynolds.atx@gmail.com<mailto:davidhreynolds.atx@gmail.com%3cmailto:davidhreynolds.atx@gmail.com>>; Jonathan Nelson; Steve Levine; Michael Darrouzet; Helen Kent Davis (helen.davis@texmed.org<mailto:helen.davis@texmed.org<mailto:helen.davis@texmed.org%3cmailto:helen.davis@texmed.org>>)
Subject: Cutbacks for some doctors and nurses as they battle on the front line

Cutbacks for some doctors and nurses as they battle on the front line

Hospitals and medical practices are deferring pay and raises as they get hit with sudden shortfalls
By Rebecca Ostriker
Boston Globe
March 27, 2020

Emergency room doctors at Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back. More than 1,100 Atrius Health physicians and staffers are facing reduced paychecks or unpaid furloughs, while pay raises for medical staff at South Shore Health, set for April, are being delayed.

These financial cutbacks, coming in response to sudden shortfalls during the coronavirus outbreak, have triggered an outcry from doctors and nurses who are already working grueling shifts in demanding working conditions, including the risk of infection from patients who are critically ill with COVID-19.

“This is at a time when many of us have moved out to live like lepers separate from family to prevent spreading infection, and have already been working huge extra hours trying to scrape together [personal protective equipment] and otherwise brace for COVID-19,” said Dr. Matt Bivens, an ER doctor at Beth Israel Deaconess Medical Center and St. Luke’s Hospital in New Bedford.

The burdens of the current health care crisis have fallen especially hard on front-line medical workers. Widespread shortages of protective masks, gloves, and other gear have put not only them at risk of infection, but their family members as well. An alarming rise in the number of hospital workers who have tested positive for COVID-19 is depleting institutions of much-needed personnel, forcing both those staff and often their co-workers into quarantine.

Top executives at hospitals and medical practices defend the financial cutbacks, saying their institutions are not immune to the loss of revenue being felt everywhere in the country during the pandemic. To make way for critically ill patients and comply with new state directives stopping “nonessential” procedures, they have canceled elective surgeries, an important source of revenue. Other sources of revenue, including physician visits, are also being canceled as patients stay away during this time.

“Like many other health care and physician organizations, the economics of the care we provide has changed quickly and dramatically,” wrote Dr. Alexa B. Kimball, chief executive of the Harvard Medical Faculty Physicians group practice at Beth Israel Deaconess Medical Center, in an e-mail Thursday to doctors that was obtained by the Globe. “I wish I had better news to convey as I know all of you are making sacrifices every day in all sorts of ways.”

In that e-mail, the physicians group announced that effective April 1, it is suspending employer contributions to the retirement plan for doctors in the group, as well as at an affiliated group that staffs many other hospitals in the state, Associated Physicians of Harvard Medical Faculty Physicians at BIDMC. There are 1,600 doctors in both groups, and the majority of them are affected by the cutback, according to a company spokesperson.

The physicians group also told ER doctors this week that it is withholding and deferring half of their quarterly “bonuses” scheduled for March 30, according to another e-mail shared with the Globe. Those payments, which can reach tens of thousands of dollars per quarter, are based on extra shifts or additional patients the ER doctors took on months earlier, according to the doctors.

“The bonus is just pay we’ve earned,” Bivens explained. “It’s analogous to re-branding ‘overtime pay’ as ‘your bonus.’" Meanwhile physicians in other specialties in the group will not be receiving bonuses at all on March 30, according to the e-mail.

When asked about the deferments, Kimball said in a statement: “Like hospitals, physicians are battling on two fronts — facing severe financial issues and a public health crisis on the front lines. Like many others, we need relief from federal and state sources to support our doctors who selflessly take care of our patients.”

The financial cutbacks come as Congress has authorized close to $200 billion in support for health care institutions as part of the $2 trillion coronavirus stimulus bill that President Trump signed on Friday.

Even so, the Massachusetts Medical Society on Friday sent a letter to Governor Charlie Baker urging him, in part, to consider “direct financial support, grants, no-interest or forgivable small business loans for physician practices, deferment of medical student loan payments, and other health care business grants to assist practices.”

A spokesman for the Massachusetts Nurses Association called for direct federal and state funding to support the health care industry. “No doctor, no nurse, and no hospital cleaning person should lose their job or should lose their pay,” he told the Globe.

Massachusetts General Hospital and Brigham and Women’s Hospital are not currently contemplating financial cutbacks for health care providers, according to a spokesman for their parent company, Partners HealthCare. Tufts Medical Center says it has not taken such steps. And at UMass Memorial Health Care, where many departments are closed, downsized, or operating remotely, staff can be redeployed to areas where the need is greatest, or take paid time off or accrued earned time off, according to a spokesman.

Atrius Health, a network of more than 1,100 physicians, primary care providers, and clinicians in Eastern Massachusetts that includes Harvard Vanguard Medical Associates, announced extensive cutbacks this week. Some nonphysicians whose work is in less demand will take a one-month unpaid furlough, with health benefits, according to an internal e-mail sent by its CEO, Dr. Steven Strongwater, and shared with the Globe.

The remaining staff still working, Strongwater said in his e-mail, will have anywhere from 10 percent to 25 percent of their pay withheld through early May, with the understanding that Atrius anticipates paying them back later. Strongwater added that employees with salaries below $55,000 would be exempted from this measure and that all merit increases would also be delayed.

“Like every healthcare organization here and across the country, we are operating in uncharted waters,” said Marci Sindell, Atrius senior vice president of external affairs, in a statement to the Globe. “In light of the realities we face as a result of the drop in routine patient visits and cancellation of elective surgeries, our practice must adapt quickly and decisively to protect our patients and to preserve our mission.”

Meanwhile, South Shore Health, the largest independent health system in Southeastern Massachusetts, told doctors, nurses, and other staff last week that it is deferring all scheduled pay increases indefinitely, starting the first week of April.

“Factors contributing to this include: cancellation of elective surgeries, closure of many outpatient programs, and a significant decrease in overall patient volume in every area of our health system,” according to a statement from South Shore Health.

A nurse at South Shore Health who requested anonymity because of career concerns decried the move: “Health care workers at South Shore Health are working hard to keep the community safe and deserve what they were promised,” the nurse said.

Some health care providers who spoke to the Globe wondered whether company financial reserves could be used to help weather the crisis, instead of dipping into their paychecks.

Several ER doctors from the BIDMC-affiliated physicians groups, who requested anonymity out of concern for potential career consequences, spoke vividly about how the financial hit was one more strain as they step up to combat the pandemic at work, all while trying to keep their families safe.

“It’s a privilege and an honor to have this job,” said one ER doctor. “It seems crazy that we’ll be compensated less as we work more and put ourselves in harm’s way.”

“We’re human, too,” another ER doctor said simply. “It’s just blow after blow after blow, on top of showing up for work and feeling potentially like I could not come home, too.”

From: Tom Banning
Sent: Sunday, March 29, 2020 7:38 AM
To: Kim Ross (kim@rosskimble.com<mailto:kim@rosskimble.com<mailto:kim@rosskimble.com%3cmailto:kim@rosskimble.com>>) <kim@rosskimble.com<mailto:kim@rosskimble.com<mailto:kim@rosskimble.com%3cmailto:kim@rosskimble.com>>>; George Shipley <george@shipleyassociates.com<mailto:george@shipleyassociates.com<mailto:george@shipleyassociates.com%3cmailto:george@shipleyassociates.com>>>; Marshall Kenderdine (marshall@lobbytx.com<mailto:marshall@lobbytx.com<mailto:marshall@lobbytx.com%3cmailto:marshall@lobbytx.com>>) <marshall@lobbytx.com<mailto:marshall@lobbytx.com<mailto:marshall@lobbytx.com%3cmailto:marshall@lobbytx.com>>>; Jerry Philips (jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com%3cmailto:jerry@philipsmeachum.com>>) <jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com<mailto:jerry@philipsmeachum.com%3cmailto:jerry@philipsmeachum.com>>>; Kurt Meachum (kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com%3cmailto:kurt@philipsmeachum.com>>) <kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com<mailto:kurt@philipsmeachum.com%3cmailto:kurt@philipsmeachum.com>>>; Tom Forbes <Tom.Forbes@butlersnow.com<mailto:Tom.Forbes@butlersnow.com<mailto:Tom.Forbes@butlersnow.com%3cmailto:Tom.Forbes@butlersnow.com>>>; Thomas Forbes <tomforbestx@gmail.com<mailto:tomforbestx@gmail.com<mailto:tomforbestx@gmail.com%3cmailto:tomforbestx@gmail.com>>>; dan hinkle <kdan@kdanhinkle.com<mailto:kdan@kdanhinkle.com<mailto:kdan@kdanhinkle.com%3cmailto:kdan@kdanhinkle.com>>>; davidhreynolds.atx@gmail.com<mailto:davidhreynolds.atx@gmail.com<mailto:davidhreynolds.atx@gmail.com%3cmailto:davidhreynolds.atx@gmail.com>>; jnelson@tafp.org<mailto:jnelson@tafp.org<mailto:jnelson@tafp.org%3cmailto:jnelson@tafp.org>>; Steve Levine <Steve.Levine@texmed.org<mailto:Steve.Levine@texmed.org<mailto:Steve.Levine@texmed.org%3cmailto:Steve.Levine@texmed.org>>>; Michael Darrouzet <michael.darrouzet@texmed.org<mailto:michael.darrouzet@texmed.org<mailto:michael.darrouzet@texmed.org%3cmailto:michael.darrouzet@texmed.org>>>; Helen Kent Davis (helen.davis@texmed.org<mailto:helen.davis@texmed.org<mailto:helen.davis@texmed.org%3cmailto:helen.davis@texmed.org>>) <helen.davis@texmed.org<mailto:helen.davis@texmed.org<mailto:helen.davis@texmed.org%3cmailto:helen.davis@texmed.org>>>
Subject: FW: Masks from Mexico

https://www.kvue.com/article/news/health/coronavirus-ceo-delivers-masks-ppe-mexico-protective-equipment/269-a237bd49-d6ef-49e4-888e-88205d108cf9<https://www.kvue.com/article/news/health/coronavirus-ceo-delivers-masks-ppe-mexico-protective-equipment/269-a237bd49-d6ef-49e4-888e-88205d108cf9><https://www.kvue.com/article/news/health/coronavirus-ceo-delivers-masks-ppe-mexico-protective-equipment/269-a237bd49-d6ef-49e4-888e-88205d108cf9<https://www.kvue.com/article/news/health/coronavirus-ceo-delivers-masks-ppe-mexico-protective-equipment/269-a237bd49-d6ef-49e4-888e-88205d108cf9>>

Austin CEO delivers thousands of masks from Mexico to Texas doctors in need of protective equipment

AUSTIN, Texas — On Tuesday, Tom Banning got a call that a U-Haul truck full of personal protective equipment masks arrived in Austin. A golf friend asked if he knew anyone who needed them.

“Without hesitating, I picked up the phone, called some practices in Dallas, in Houston and in Austin, in San Antonio, and the need was, ‘Please bring whatever you can,’” Banning said.

According to Banning, his friend had shipped about 525,000 masks from Mexico to deliver them across Texas. His friend had connections to facilities in the oil and gas industry that recently transitioned from "producing materials for oil and gas field workers" to masks.

"They had a product that, frankly, did not exist in Texas," Banning said.

The masks came in cardboard boxes of 1,500. Around 350 boxes filled the back of the U-Haul when Banning arrived at a warehouse in Austin.

Banning said a Dallas practice had sent a driver to pick up boxes of the masks. He sent another driver down to San Antonio with masks. Others came from across the state to pick up what they could.

“Texas Organization of Rural and Community Hospitals took 40 cases," Banning said. "There are hospitals in rural areas across Texas that are in pretty desperate straits. They actually had a hospital in Hereford, Texas, which is up near Amarillo, fly a plane down to pick up some supplies.”

TAFP sent an email out to physicians and doctors in the Austin area, saying in part that Banning had access to 1,500, asking how many they would they need. In the email, Banning warned these masks were not FDA-certified, but met the specifications the FDA called for.

For weeks, Austin-based doctors have called for more PPE, citing a soon-desperate need to protect healthcare workers on the front lines of the COVID-19 pandemic. Banning, who delivered 1,500 masks to 37 Austin-based practices, wants to see more done to help small, family practices.

"These physicians are not only putting their lives on the line, but their financial wellbeing on the line," Banning said. "They’re sort of in the back of the bus in terms of getting access to these PPE even though they’re the ones on the front lines seeing patients. We’re trying to keep people away from the emergency room; we’re trying to keep people away from the hospital."

One doctor in North Austin responded to Banning's email asking for 30 masks. Dr. Erica Swegler runs Beacon Family Health Care on Steck Avenue. She normally does not have masks or any other PPE on-hand.

Up until last week, she had gloves and three protective gowns in her practice. The gowns, she said, came from somebody who had them left over and did not need them.

"We would have no reason to keep those in stock until all this happened," Swegler said. "We’ve had to totally improvise. I mean, what I usually have on hand are gloves."

Swegler's practice diagnosed a COVID-19 positive patient about 10 days ago, but she's confident she had come into contact with patients showing mild coronavirus symptoms.

"Before that positive, we were only wearing masks when we felt somebody might be a risk," Swgler said. "Now, our policy is we’re wearing masks – two masks a day, one in the morning throughout the morning and one in the afternoon that I expect the staff to have on 100% of the time."

Swegler only asked for 30 masks. She has four members in her office that she expects to wear two a day. That means those masks will only last her office about 10 days, and she has no idea where the next masks will come from, assuming she is able to get any.

"The N95 masks that I got Wednesday for the first time is the first time in this entire time that I’ve had a mask that would protect me from the virus," Swegler said.

Gov. Greg Abbott announced on Tuesday the state-created Supply Chain Strike Force will spend more than $80 million on getting masks and other PPE for doctors across the state. Abbott said to expect as many as 200,000 masks per day coming into Texas.

It's doctors like Swegler that Banning is most worried about.

"The system should not be treating them this way," Banning said. "It's going to have long-term ramifications on physician morale, on burnout, on their ability to practice and maintain a practice going forward. That’s what’s keeping me up at night is how are we treating a profession that we are so desperately reliant on like this?"

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