The SCMA has continued to push for vaccination access to physicians and in physician offices.  Make no mistake - physicians want to be vaccinated and want to vaccinate their patients. 

The SCMA has continued to push for vaccination access to physicians and in physician offices.  Make no mistake - physicians want to be vaccinated and want to vaccinate their patients.  The narrative that the front line is not signing up for vaccination is simply not true when it comes to physicians. Physicians were not provided the opportunity to receive the vaccine initially unless they were affiliated with a hospital. Now, sending 70+ patients to websites and long phone ques, and then to a hospital for a vaccination, misses the available network of physicians across South Carolina with patient relationships. The SCMA is continuing to speak on behalf of physicians to improve the vaccine role out, meeting with the Governor and SC DHEC on these issues. Please see our latest correspondence regarding these issues. If you have missed where to sign up to get a vaccine as a Phase 1a worker, click here for the locations. 

A Message from SC DHEC on the COVID-19 Vaccine

The SCMA continues to work on providing access to the COVID-19 vaccine for non-affiliated physicians and staff. We have been working closely with the South Carolina Department of Health and Environmental Control (DHEC) over the past week to answer direct questions from physicians, and also to assist in staging access sites.  This evening DHEC provided the below message directly for SCMA physicians as an update on the process. We will continue to provide updates regularly in this fluid situation.  Copies of our 12/19 and 12/24 alerts are below DHEC's information brief for those who may have missed them. And, from the SCMA to you, have a Happy New Year!

Message from SC DHEC:

On behalf of the South Carolina Department of Health and Environmental Control (DHEC), we thank you for your continued service throughout this historic public health response. We recognize that many South Carolinians have questions about the COVID-19 vaccines, including when and where you will be able to get vaccinated. This afternoon, we provided a virtual media brief to share the latest information about the COVID-19 vaccine plan and roll out in South Carolina. 

Since receiving the first doses of the vaccine on Dec. 14, we remain encouraged by the dedication of South Carolinians in continuing to do their part in the fight against COVID-19 by getting vaccinated. Our ultimate goal is to save lives. DHEC is committed to working with our partners to ensure that everyone who wishes to be immunized against COVID-19 in South Carolina will be vaccinated, but it is going to take time. It’s important to recognize that this is a rapidly evolving event. This vaccine is unlike any vaccine that we have ever dealt with before. We must remain flexible in our response so we can continue to respond to global and local challenges as they arise, such as:
•    limited initial supplies of vaccine during the phased rollout, 
•    complex logistics, and
•    adapting to changes in federal guidance.

Together with our partners, we are confident that we will continue meet each new challenge head on. We encourage you to take a moment to click here to read and share an update that DHEC provided earlier today on the state’s phased vaccine roll out efforts. Summary highlights include overviews on:

•    Preparing for historic ultra-cold storage requirements 
•    Adjusting to rapidly changing federal guidance 
•    Progressing from the initial phase into widespread availability in summer
•    Understanding next steps in the phased vaccine roll out

For individuals in Phase 1a who have not been contacted regarding an opportunity for vaccination yet, DHEC is working with our partners at SCHA and SCMA as well as numerous independent providers and vaccination locations to onboard them and allocate and distribute vaccines in the coming weeks. As more locations for vaccination become available, we will be contacting healthcare workers via their employers, associations, or licensing entities to provide a way for them to sign up if they wish to be contacted when it is their turn to make an appointment for vaccination. It is going to take several weeks to a couple of months to vaccinate all members of Phase 1a, so please be patient as we go through this process. 

We will continue to keep you informed as we learn more about the vaccines and related requirements. For the latest on South Carolina’s COVID-19 vaccine plan and distribution efforts, please visit scdhec.gov/vaxfacts. You can also visit our FAQ page, here. 

Updates to Physician Questions on Receiving the COVID-19 Vaccine

Physicians have many questions on how to obtain the COVID-19 vaccine for themselves and staff. The SCMA is continuing to work with DHEC to obtain answers.  Below is a new series of questions and answers on the COVID-19 vaccine.  

1. Why did hospitals receive the COVID-19 vaccine first?

• Per federal requirements, DHEC had to submit a statewide vaccine plan to the federal government prior to the FDA approval of any vaccines.  DHEC submitted its plan on October 16,2020 based on the guidance at that time.
• At the time of DHEC's submission, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended that Phase 1a of the vaccine delivery be given priority to front line healthcare workers treating COVID patients and Long Term Care residents. 
• The federal government required states to place an order for the number of vaccinations in the first round, designate sites that could handle quick distribution, and preposition the sites to receive the first delivery of the vaccine.  
• On December 1, 2020, after DHEC was required to submit information, the ACIP broadened its guidance to include all healthcare workers in Phase 1a. DHEC was unable to increase its request or change its site plan for the initial vaccines provided to South Carolina. 
• Not even all hospitals received vaccines with the first shipment, only selected sites that were prepositioned and trained on CDC guidelines for distribution. 

2. Hospitals are reaching out to primary care doctors and providing the vaccine.  Why?

• Because the ACIP guidance has broadened, DHEC has encouraged and asked hospitals to reach out and vaccinate as many physicians as it can within the broader Phase 1a description. 
• There are still challenges in getting the vaccine to non-hospital sites due to limitations with storage and pre-set doses requiring facilities to accept large quantities of the vaccine. Hospitals can help distribute the vaccine quickly to all health care workers. 

3. Staff at hospitals are receiving the vaccine, not just physicians. Why?

• DHEC has encouraged hospitals to vaccinate physicians, other healthcare providers, and administrative staff that are crucial to running a hospital. A hospital may vaccinate staff members and is not required to only vaccinate physicians. 

4. Will independent physician facilities obtain the vaccine? 

• Yes. DHEC has registered and accepted 611 sites to receive the vaccine, which includes many independent practices.
• Currently only Pfizer COVID-19 vaccines are being distributed, meaning a facility must be able to accept and store 975 vials of the vaccine at sub-zero temperatures.  DHEC cannot change these requirements set forth by the CDC.  In other words, it cannot provide the vaccine in smaller doses.
• The Moderna vaccine, which will be available soon, will be provided in smaller quantities and does not need sub-zero temperatures.  However, the initial Moderna vaccines will be used to vaccinate long term care facility residents and staff. 
• As the Moderna vaccine production increases, a site may qualify later to receive the Moderna vaccine at its site. 

5. DHEC accepted my practice's registration to receive the vaccine.  What is next? 

• Receiving an acceptance email from DHEC is the first step in the registration process.  Next, your site must be activated.  Sites are being activated as vaccine supplies increase.
• Prior to activation, DHEC will email your accepted practice through the listed coordinator and coordinate the proper training as required by the CDC.  
• As more vaccine becomes available, the federal government will provide DHEC an ordering cadence.  This means that soon DHEC will know South Carolina's weekly allocation and can begin placing orders and activating additional sites more regularly. Right now DHEC does not know exactly how much vaccine will be provided and on what distribution dates.  
• Sites may prepare for activation in advance. Then, when DHEC reaches out to activate your practice, you will have completed the training and can be activated more quickly. To prepare in advance, click here and scroll to the bottom of the page where there are additional resources. The training modules for the CDC record keeping and the VAMS system are located there.

6. My practice was rejected when it tried to register to receive the vaccine.  Or, my practice cannot meet the criteria set forth in the registration required by DHEC. What should my practice do to receive the vaccine? 

• DHEC is working to provide the vaccine for everyone, but there are limited supplies.
• Also, the CDC will not allow vaccine to be sent to sites that do not meet all of the CDC requirements, which currently require subzero storage and accepting 975 vials of vaccine. 
• DHEC has already asked that hospitals work to get the vaccine out to physicians in the community.  DHEC is working on this and other distribution mechanisms for practices that cannot meet CDC requirements.
• Various locations that are accepted sites around the state will be made access points, and your practice and staff will be able to receive the vaccine through that access point. 
• As these locations are decided, DHEC and the SCMA will be providing additional information to physicians and their staff on how to get vaccinated at these access points.

7. We are not a vaccination site, but we see plenty of patients with COVID.  Can I just go to the hospital and ask for the vaccine? Who do I ask? 

• DHEC has already asked that hospitals work to get the vaccine out to physicians in the community.  DHEC is working on this and other distribution mechanisms for practices that cannot meet CDC requirements.
• Various locations that are accepted sites around the state will be made access points, and your practice and staff will be able to receive the vaccine through that access point. 
• As these locations are decided, DHEC and the SCMA will be providing additional information to physicians and their staff on how to get vaccinated at these access points.

8. Why are hospitals distributing the vaccine to everybody, not just high-risk physicians? 

• The SCMA has brought this concern to the forefront for DHEC.  Please let the SCMA know if you see issues with the distribution from the hospitals and we will continue to take your concerns to DHEC and the South Carolina Hospital Association (SCHA).
• However, note that with the broader ACIP guidance, hospital decisions still may be within the guidelines as their are multiple criteria for these decisions.  
• Also, hospitals have been encouraged to reach out to provide the vaccine to physicians it can connect or partner with. 
• Last, remember that this was the first vaccine delivery and that DHEC is coordinating additional distributions as the vaccine allotment increases. DHEC is diligently working to expand the distribution of the vaccine to healthcare workers. 

If you have additional questions that the SCMA can answer, please send them to info@scmedical.org by the end of the day Tuesday, December 29.  The SCMA will be working with DHEC to answer your questions and continue to update physicians on these topics. 

How Do Physicians Receive the COVID-19 Vaccine?

The SCMA has been sending out information on registering to receive the COVID-19 vaccine for several weeks. With the arrival of the vaccine, physicians have had many questions these last few days. Below is a list of the questions we are getting a lot of, along with the answers, in hopes of helping everyone through this process.  

1. Who is receiving the vaccine first? 

• The CDC is determining the vaccine allocations for each state.  Initial allocations in Phase 1a will be limited.
• In making the priority decisions, DHEC is utilizing recommendations from the CDC's Advisory Committee on Immunization Practices (ACIP).
• DHEC is providing the vaccine to facilities with healthcare workers that fall into high-risk settings, which includes physicians.
• Because each healthcare office is different, DHEC developed guidance explaining which healthcare workers will be vaccinated first. The guidance can be read here: Phase 1a Guidance for COVID-19 Vaccine Allocation.
• DHEC has also provided a letter explaining the prioritization within Phase 1a, noting that front line healthcare workers that are most at risk of exposure to COVID-19 will receive the vaccine first.   

2. It looks like only hospitals are receiving the vaccine.  Is this true? 

• Both hospitals and independent practices are in line to receive the vaccine in Phase 1a. Only 56 facilities have received the vaccine to-date.
• Your facility, if it qualifies as a Phase 1a facility, may still receive the vaccine. However, the state has not yet received enough of the vaccine to distribute to all qualified parties within Phase 1a.  
• It will take a while to obtain enough vaccine to distribute to the entire Phase 1a category; therefore, please do not be concerned if it is not at independent facilities yet.

3. How does my office receive the vaccine for our practice - physicians and staff?

• First and foremost, you cannot be in the pool to receive the vaccine if you do not enroll in the vaccine program.  To register you start by reviewing a presentation, and then you may enroll.  This is a federal process that DHEC is rolling out and is required. You can register with DHEC here. 
• Many physicians have said that the registration, which begins with a presentation, seems to be for vaccinating patient populations. It is not. It is to register to obtain the vaccine for your facility. 
• If you read that enrollment needed to be completed by November 23rd, do not worry. You can still register; you will just be added into the pool as DHEC moves forward. 
• If you would like to know what is required to register, you can access the CDC COVID-19 Vaccination Program Provider Agreement to view in advance.  The DHEC presentation defines several of the terms, such as who would qualify as the CMO signatory if you do not have this official title in your facility.  
• There are three official DHEC documents you will need to sign to complete enrollment. 
• If you are interested in receiving the vaccine for your staff but cannot meet the requirements of the enrollment process, such as not having ultra-cold storage or a CMO, physicians and physician offices are directed to reach out to DHEC here: ACC-Immunization@dhec.sc.gov.

4. Are all physicians going to be accepted into the vaccine roll out process for Phase 1a? 

• No. DHEC will reject applications that do not meet the Phase1a Guidance criteria. You should review the Phase 1a Guidance and information linked above in question one to see if your facility is likely to receive the vaccine.
• There is a Phase 1b and a Phase 1c that the CDC's ACIP is still determining regarding other critical need persons, such as those over 65 or with other illnesses that make them higher risk.
• Phase 2 will include broader provider networks, to include most doctor's offices and public health venues. 
• Physicians receive the vaccine before the general public but are tiered within the phases depending on the likelihood of exposure.

5. How will I know when Phase 1b begins or when physicians can receive the vaccine if they do not fall under Phase 1a? 

• DHEC has not provided information on Phase 1b populations as the federal ACIP is expected to provide this by the end of 2020. DHEC will not announce a plan until this information is provided. 
• The SCMA and DHEC will continue to put out information on their websites, social media, and elsewhere to inform physicians about the availability of the vaccine. There is no registration site for updates. 

6. I see on social media all types of physicians receiving the vaccine that are not working on a COVID-19 unit. 

• Once a shipment is provided to a hospital, DHEC recommends that the vaccines be given to the personnel with the highest exposure, co-morbid conditions (which includes being over 65), or due to the need for bench depth. 
• Physicians outside of the COVID-19 wing are eligible for the vaccine that fall into these categories.  
• Physicians in hospital settings treating COVID-19 are more likely to be exposed to COVID-19.  
• Physicians that are not in a hospital but fall into the high-risk categories in Phase 1a may receive the vaccine through their facility if it has completed the registration process. 
• No system is perfect, and certainly there may be a physician that receives the vaccine outside of these parameters. But please try to be understanding as there may be many factors for why a hospital chooses prioritization.

We will continue to work with DHEC and encourage an equitable distribution for all physicians in South Carolina as well as all providers and high risk patients. Please continue to let us know your concerns and questions and we will continue to try and find answers through DHEC. As you know, this is an ever-changing process that can create many logistical challenges, but we want to continue to work on behalf of the physicians in the state. 

Covid-19 Resources

The SCMA has compiled state and federal resources below to facilitate answers on COVID-19 for South Carolina physicians. Members receive weekly updates via email. If you are not receiving these updates, please email info@scmedical.org

The SCMA Works for Physicians

It is hard to believe that the first COVID-19 case in South Carolina occurred on March 7, 2020. The Governor closed schools on March 15, and on March 17 the Governor asked that over the next 72 hours hospitals stop non-urgent care to preserve protective gear and protect patients from infection.  As COVID-19 spread, the Governor closed non-essential businesses on March 31, 2020. A lot has changed in the course of a few weeks, and physicians have been at the forefront of these issues and changes.  Whether serving in the ER or weathering the slowdown in your practice, each physician has been impacted in some way. 

The SCMA is here for you and has worked to help South Carolina physicians with all sorts of issues.   Below we have captured some of the SCMA's work over the past two months so that you can see the SCMA's action at work.  And, the SCMA appreciates the physician support in each of these endeavors - the organization cannot do it without your support, your input, and your willingness to assist us by being the physician voice. Many of you have joined late night phone calls, responded to early emails, or simply answered questions on issues we are tackling.  To this we simply say thank you. Together we have done a lot:

• Opening Telehealth Codes: The SCMA urged private insurers to open telehealth codes for billing patient services as in-patient visits, meeting with the Governor's Office and the Department of Insurance (DOI) on this issue.  On March 17, the Governor called for private insurers to open telehealth lines with parity pay in his press conference, and by March 19 BlueCross BlueShield had done so. Other insurers quickly followed suit.  
• Working with the Governor: At the beginning of the COVID-19 crisis, the Governor's Office solicited input on how to handle patient surge. The SCMA Executive Committee joined with the South Carolina Hospital Association to encourage the Governor to allow physicians and healthcare facilities to make decisions on non-urgent surgeries, and to ask instead of mandating, so that it would be easier to both draw down patient census and bring it back up to normal.  The SCMA Executive Committee met and provided a list of items for the Governor to consider, such as waiving CON laws during the pandemic to create additional bed space.  The SCMA has been in regular contact with the Governor's office, and the Executive Committee has spoken with the Governor about many of the issues facing South Carolina physicians due to the virus. 
• Working with Congressional Leaders: The SCMA set up meetings with physicians and the offices of Senator Scott, Senator Graham, and Congressman Wilson.  The SCMA has also worked with those offices and other congressional offices to answer questions on specific legislation and ask for support on federal bills that support physicians during COVID-19. 
• Obtaining CMS Waivers: The SCMA worked to obtain Medicare and Medicaid waivers for telehealth and other requirements. The SCMA spoke to South Carolina federal delegation leaders and the South Carolina Department of Health and Human Services (DHHS) about needed waivers.  And, the SCMA joined with the South Carolina Hospital Association to ask for state-specific waivers. Examples of waivers requested include the need to waive limits on using telehealth for nursing home patients, as well as waiving the need for a fit test every six months for durable medical equipment.
• Board of Medical Examiners Hearings: The SCMA participated in Board of Medicine (BME) hearings and provided input on BME decisions related to COVID-19 issues.  In particular, the SCMA voiced its opinion in a letter to the Governor, the BME and the Board of Nursing (BON) on behalf of patient safety and the need to keep a physician-led team, while acknowledging the need to help hospitals quickly move around health care teams in the event of a patient surge. 
• Working with State Agencies: The SCMA worked with the Department of Health and Environmental Control (DHEC) on various issues, to include surveying members on additional ventilators that could be used in a patient surge.  The SCMA has been in close contact with the Department of Employment Workforce providing feedback on unemployment claims and how unemployment provides more than some jobs at physician practices. The SCMA worked with the Department of Labor, Licensing, and Regulation (LLR) on many issues outside of the BME, such as waiving OSHA fit testing requirements during COVID-19. 
• Governor's Emergency Management Division Work: The SCMA was part of the Governor's Emergency Management Division planning team to provide a plan to the Governor for staffing stand up hospitals if needed for expected patient surge. The SCMA represented the need to keep these physician-led for patient safety, as well as asking that physicians receive pay for staffing hospital-run overflow.
• Pandemic Healthcare Ethics Advisory Council: The SCMA co-chaired the Pandemic Healthcare Ethics Advisory Council and had several physician members participate. This Council dealt with scarce resource issues and provided guidance for hospitals and physicians in the event these decisions were necessary.
• COVID-19 Webinar: The SCMA hosted a free CME webinar, COVID-19 In the Storm with Dr. Helmut Albrecht, an Infectious Disease Specialist and Heyward Gibbes Distinguished Professor of Internal Medicine Chair, Department of Internal Medicine University of South Carolina Chair, Department of Internal Medicine Palmetto Health USC Medical Group and Society of America on coronavirus. This webinar can be found on the SCMA website.
• Gathering Information/Weekly Calls: The SCMA staff attended weekly AMA legislative calls, weekly Congressional leader calls, weekly Hospital Association calls, and other informational calls to gather information to pass to physicians in our SC MedNews COVID-19 letters.
• PPE Shortages: The SCMA sent out various ways to order PPE, make mask covers, and helped get the news out when the Charleston County Medical Society put together a group order form to help small practices order PPE. 
• Free Telehealth Programs: The SCMA help secure free telehealth programs for members to utilize during COVID-19.
• Billing Issues: The SCMA worked with practices to resolve billing issues with BCBS, getting many practices quick approval of telethealth usage.
• Funding: The SCMA worked on getting funding for physicians, asking federal congressional leaders to support various funding.  SCMA has also asked South Carolina leaders for additional funds to assist physicians and will continue to do so as federal funds come to the state and the state provides funding for various needs.

The SCMA is still working on issues, like asking for telehealth parity on audio visits only as many patients do not have video capability, and working with the Governor and the federal delegation to find help with PPE and reagents for testing in our State.  We are also asking the legislature to waive liability for physicians who treated COVID-19 patients and for situations where a physician could not see patients due to the COVID-19 restrictions. We know that we are not at the end of this.

COVID-19 Vaccination Sites

The South Carolina Medical Association supports all physicians getting vaccinated.  We are excited to help independent physicians and their medical staff gain access more quickly to the vaccine. 

 
The SCMA has worked around the clock during the holiday season to open the access sites for vaccinations, working with DHEC and the Governor’s office to ensure that all physicians have equal access to the vaccine.  The SCMA provided valuable information on how general practitioners, pediatricians, and others are still exposed to COVID-19, and why front line physicians are not just at hospitals. The SCMA also provide information on how all physicians are exposed through patient care and the need to keep our physician offices open through this crisis. Thanks to these efforts, DHEC updated its 1a Guidance on January 1st to tell hospitals to open vaccines to non-affiliated physicians, and then again on January 6th to clarify in the guidance that vaccinations should occur for all physicians and their medical staff, not just those treating COVID-19.  Please refer here for DHEC’s most recent 1a Guidance as the agency is updating it often.
 
Early this week SCMA Members received early lists of vaccination sites that could be utilized by non-affiliated hospitals.  We want to thank the SC Hospital Association who has worked to obtain contacts at each hospital for non-affiliated physicians and their medical staff to register.  The site is now public, and can be found here. You should also have received a message from LLR at the email you use for updating your license providing the same information.  For ease, the most current list of where to register for the vaccine below this message. 

We know that many of you have been frustrated as you could not register for the vaccine until this week.  However, many access sites are now open.  Please register your practice by January 15th. Registration includes signing up for a scheduled vaccination or getting on a hospital list so that the hospital can reach out as additional vaccine is available.  In speaking with DHEC today, many additional new sites that are not at hospitals will be opened on Monday and Tuesday next week, and these sites and how to register will be made available on DHEC's website.   

New FAQs:

• Must you be vaccinated in the county you work in? No. DHEC has told hospitals to vaccinate physicians and staff that encounter patients. The Agency will be re-messaging this today.  If a hospital asked you to go elsewhere, please try again and let them know you need the vaccination and have been told there are no geographic restrictions. 
• What does the January 15th date mean? Physicians and staff can still register for vaccinations after the 15th.  However, at that time DHEC will reassess when it should begin scheduling Phase 1b vaccinations in order to keep the roll out moving fast. 
• How many doses are the sites receiving and when? DHEC has a dashboard with this information that is updated daily.  
• Why are 60 and up getting vaccinated? DHEC has not changed its core 1a Guidance authorizing the vaccine to front line workers to allow persons at a set age to be vaccinated. However, DHEC has provided guidance to hospitals that with patients admitted to the hospital, it may be appropriate to vaccinate a vulnerable admission, depending on the care being received. You can read this guidance here. 
• Can I volunteer to give the vaccine? DHEC is in the process of setting up a volunteer sign up where physicians or others may sign up to help vaccinate South Carolina. 

Are hospitals vaccinating patients? SC DHEC has provided guidance on vaccinating patients who are admitted to a hospital, without COVID-19, above the age of 65.  DHEC provided this guidance today in response to requests to vaccinate our most vulnerable populations within hospital settings. 

Vaccination Sites and Contact Information Linked Here and Listed Below

Abbeville Area Medical Center covid19vac@abbevilleareamc.com 864-625-0582
Aiken Regional Medical Centers LLC Aikencovid@uhsinc.com
Allendale County Hospital beckyr@achospital.org 803-632-3311; ext 235
AnMed Health covidvaccine@anmedhealth.org
Beaufort Memorial Hospital healthupdates@bmhsc.org
Bon Secours St Francis Health System SCCovidVaccine@bshsi.org 864-351-9527
Carolina Pines Regional Medical Center covidvaccine@cprmc.com
Coastal Carolina Hospital HHRH_COVID_VACCINE_INFORMATION@tenethealth.com
Colleton Medical Center 843-782-2653
Conway Medical Center CMCCovidVaccineRequest@cmc-sc.com
East Cooper Medical Center 843-881-0100
Grand Strand Medical Center 843-692-1000
Hampton Regional Medical Center vaccinerequest@hamptonregional.org
Hilton Head Hospital HHRH_COVID_VACCINE_INFORMATION@tenethealth.com
Kershaw Hospital LLC covidvaccine@kershawhealth.org
Lake City Community Hospital (activated Pee Dee Family Practice) 843-394-5471
Lexington Medical Center covidvaccine@lexhealth.org, 803-739-3363
McLeod Health Lesli McGee, lkennedy@mcleodhealth.org, 843-777-8502
MUSC Health covidvaccinerequest@musc.edu
Newberry County Memorial Hospital (803) 405-7487
Prisma Health COVIDVaccine@Prismahealth.org
Providence Health 803-256-5866, Accepting calls Monday-Friday from 8am-2pm
Regional Medical Center Mickey Whisenhunt, mwhisenhunt@regmed.com, 803-707-6476
Spartanburg Regional Healthcare System signupcovidvaccine@srhs.com
Summerville Medical Center (843) 970-5000
Tidelands Health https://tidelandshealth.org/employerenrollment
Trident Medical Center (843) 797-7000