Network Director

Dear APAMSA community:

Less than 24 hours after the release of our Anti-Asian Racism Toolkit, we were horrified by the news out of Atlanta: 8 people were murdered by a white terrorist who deliberately targeted Asian-owned massage parlors. 6 of the victims were Asian women. The names we know so far:

Xiaojie Tan, 49

Daoyou Feng, 44

Julie Park, 70s

Hyeon Jeong Park, 50s

Delaina Ashley Yaun, 33

Paul Andre Michels, 54

Two yet unreleased

Today, we mourn these women who could be our sisters, mothers, aunts. We mourn the communities they represent: femme, low income/working class, the elderly, immigrant — the most vulnerable in our communities. We grieve the loss of their lives individually – wishing them peace as they join our ancestors. We also grieve the loss of their lives as our collective loss, tear drops added to the expanding pool of lives claimed by White supremacy and anti-Asian hate.

That hate did not end after it took these women’s lives. It continues with the denial that this crime was racially motivated, that the murderer deliberately and methodically targeted Asian businesses and Asian workers. It continues with the narrative that minimizes his motive by claiming he had a “bad day,” a “sex addiction,” by taking him at face value when he says he “isn’t racist” instead of judging him by his actions. It continues with our erasure from American history, the silence of our medical education leaders, our exclusion from curricula that claims to teach us how to care for all patients and initiatives that proclaim to center equity.

In the face of this hatred, we send love to you all, our community grieving and in pain. It is absurd that we must bear these tragedies on top of the neverending parade of exams, clerkships, research applications, residency applications, and more. National APAMSA is here for you, and we want to emphasize that we will support you in asking your institutions for time off, for protection, for space to be human.

Sharing a post from @asiansformentalhealth on Instagram with the text:

“Dear AAPI family, As you hear the news of the attacks in Atlanta, please sit down. Please give your weary soul time to breathe and catch up. Please turn off your phones and turn inward toward those you love. Please grieve, cry, wail, and exhale. Give your body the space to acknowledge the pain that you have been carrying for so long.”

https://www.instagram.com/p/CMgTRVzDdU-/

In solidarity,

Your APAMSA family

On February 11th, 2021, Dr. Princess Dennar, the first Black female program director at Tulane University School of Medicine, was terminated from her position with Tulane’s Med-Peds residency without warning or clear cause. Since then, evidence has emerged that this termination may have been the culmination of years of racist and sexist mistreatment against Dr. Dennar and minoritized residents in the program; or, indeed, retaliation against Dr. Dennar for speaking out and filing complaints about this mistreatment.

National APAMSA stands in solidarity with Dr. Dennar, our Tulane chapter, the Tulane community, and our Black colleagues in medicine. Too often, healthcare is a hostile field for minoritized trainees and leaders – those who are best equipped to care for patients marginalized by that very same system. We cannot allow this insidious violence to continue.

We urge our members to educate themselves about what is happening in Tulane – a situation that could very well be happening in their home institutions – and to take the following actions in support of Dr. Dennar:

1. Sign and circulate Tulane’s letter to Tulane administration with specific demands for clarification, transparency, and accountability (signee identities remain private and protected);

2. Sign and circulate this national letter of support with specific demands for clarification, transparency, and accountability from Tulane and the ACGME (signatures displayed);

3. Customize and send this email to the ACGME (link automatically opens an email for you);

4. If in a position to do so, contribute to the GoFundMe for Dr. Dennar’s legal costs;

5. Follow @MedPeds21 and @TheTulane7 to stay updated

If you have questions or concerns, please contact the main organizers at Tulane University School of Medicine, the S.L.A.M Coalition (SNMA, LAMSA, APAMSA, MSPA) at slam.tusom@gmail.com.

In solidarity,

Your National APAMSA Board

February 19, 2021
Liz Richter
Acting Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Acting Administrator Richter:

As the Biden Administration begins to take aggressive steps to deploy the COVID-19 vaccine across the nation, we are writing to seek your assistance with urgent Medicare and Medicaid vaccine reimbursement concerns that could significantly impact the ability to reach the people most in need of the vaccine.

Federally Qualified Health Centers (FQHCs or “health centers”) work tirelessly to ensure access to timely, affordable care for all individuals, regardless of ability to pay. We appreciate the confidence the Biden Administration has placed in health centers to deliver the COVID-19 vaccine to the most vulnerable communities. However, it is critical that health centers have the tools and resources they need to do their part. To ensure their continued ability to fulfill this commitment, we are writing with an important request.

In recognition of the critical role FQHCs are playing on the front lines of the pandemic, we request that CMS establish FQHC-specific COVID-19 vaccine administration reimbursement policiesfor Medicare and Medicaid, ensuring that health centers have the resources they need to keep their doors open. Existing federal regulations, including the COVID-19 Interim Final Rule that went into effect on November 2, 2020,

and other guidance will leave health centers severely challenged at the worst possible time. It is imperative that health center reimbursement rates account for the increased costs associated with the COVID-19 vaccine. Such costs may include factors such as hiring additional or temporary staff; training; outreach and vaccine hesitancy related activities; storage capacity; altered, temporary, or rented facilities; PPE and other equipment; IT systems interfacing; outdoor and overnight capacities; security; cleaning and disposal; patient transportation; and lost revenues for redeploying staff. Furthermore, the vaccine’s short shelf life requires health centers to strategically schedule appointments, perform additional outreach for both doses, and dedicate staff for patient monitoring while complying with social distancing and occupancy guidelines.

Below you will find our specific policy recommendations:

Medicare

Serving over 2 million Medicare beneficiaries a year, health centers are positioned to meet the goal of vaccinating the 65 and older population as quickly as possible. Under current Medicare regulations, health centers are reimbursed for vaccine administration through their Medicare Cost Report, which takes 12 to 18 months for processing and payment. We request that the agency establish the following:

• An interim payment for COVID-19 vaccine administration based on the Medicare Part B Physician Fee Schedule to ensure they receive reimbursement in a timely manner — and before 2022. • A revised reimbursement rate for FQHCs at 100 percent of reasonable costs for the COVID-19 vaccine administration given the additional costs to administer the COVID-19 vaccine.

Medicaid

Health centers serve 1 in 5 Medicaid beneficiaries nationwide and need adequate compensation for the additional resources required to meet the demand for vaccinations. In recognition of the critical role health centers play for Medicaid patients, Congress established a specific payment methodology for health centers,

the FQHC Prospective Payment System (PPS). This payment system is central to the ability of health centers to provide a broad range of primary care services to Medicaid beneficiaries while serving other low income patients. Currently in some states, vaccine-only visits do not trigger a Medicaid billable visit for FQHCs, which means they do not receive the PPS reimbursement rate and, in some cases, receive a very low or no additional administration fee at all for administering the COVID-19 vaccine. As a result, we request that the agency do the following:

• Require states to cover COVID-19 vaccine administration and specimen collection as a mandatory service for FQHCs under Medicaid state plans. This would require a state to either: (a) increase the PPS rate to account for the “new” mandatory service or (b) create an alternative payment methodology (APM) to pay for vaccine administration outside of the PPS rate.

• Encourage states to propose APMs that provide additional payments for vaccine administration to compensate for the additional resources required to meet the demand for vaccinations related outreach and general administration.

• Provide flexibility for more health care professionals employed, or under contract, with health centers to trigger a “billable visit” for vaccine administration.

• Require states retroactively reimburse health centers for additional costs of COVID-19 vaccine administration should new payment policies be adopted.

We appreciate the administration’s attention to this important issue and look forward to working together to ensure our nation’s most vulnerable are able to access the COVID-19 vaccination.

Sincerely,

National Association of Community Health Centers(NACHC)

AIDS Foundation Chicago

The AIDS Institute

AIDS United

AMDA – The Society for Post-Acute and Long Term Care Medicine

American Academy of Family Physicians American Immunization Registry Association American Kidney Fund

American Muslim Health Professionals American Network of Community Options & Resources (ANCOR)

Asian & Pacific Islander American Health Forum

Asian Pacific American Medical Student Association (APAMSA)

Association of Asian Pacific Community Health Organizations

Association of Black Cardiologists

Association of Nurses in AIDS Care

Autistic Self Advocacy Network

Cascade AIDS Project

Casting for Recovery

Center for Disability Rights

The Center for Law and Social Policy (CLASP)

Christ Health Center

CommonSpirit Health

Disability Rights Education and Defense Fund (DREDF)

Empowering Pacific Islander Communities (EPIC)

Equality California

Familia Unida

Hep B United

Hepatitis B Foundation

Hispanic Federation

HIV Medicine Association

Howard Brown Health

Immunization Action Coalition

Immunize Nevada

Infectious Diseases Society of America International Association of Providers of AIDS Care (IAPAC)

International Community Health Services Justice in Aging

Los Angeles LGBT Center

Multi-State Partnership for Prevention National Alliance for Hispanic Health National Alliance of State and Territorial AIDS Directors

National Association of Pediatric Nurse Practitioners

National Association of Social Workers National Black Nurses Association

National Consumers League

National Council of Asian Pacific Americans (NCAPA)

National Council for Behavioral Health National Council of Jewish Women National Health Care for the Homeless Council National Organization of Black Elected Legislative Women

National Viral Hepatitis Roundtable

Nevada State Medical Association Nurses Who Vaccinate

Prism Health

RESULTS

Shriver Center on Poverty Law Sickweather

Silver State Equality-Nevada

South Dakota Public Health Association UnidosUS

Vaccinate Your Family

VaxCare

The Well Project

On January 28th, 84-year-old Vicha Ratanapakdee, a Thai American, was murdered while on his morning walk in the Anza Vista neighborhood of San Francisco. On February 3rd, a 64-year old Vietnamese grandmother was assaulted and robbed in San Jose in broad daylight. That same day, Noel Quintana, a Filipino-American, was slashed across the face on a subway in Manhattan.

These deliberate and targeted acts of violence against Asian/Pacific Islander Americans (APIA) are part of a long history of racism that threatens our communities. APIA elders are particularly vulnerable and are now being attacked, physically and verbally, more so than ever since the onset of the COVID-19 pandemic. According to the Stop AAPI Hate National Report, over 2,000 anti-APIA incidents have been reported since early 2020, which does not account for the number of unreported and ignored cases.

APIA communities such as those in Oakland, CA are expecting a rise of robberies and burglaries ahead of the Lunar New Year celebration. The silence of the mainstream media exacerbates the model minority myth–Asians are assumed to be a monolith, “well-behaved,” and generally wealthier, healthier, and more educated–erasing concerns that many of us face: economic suffering and disproportionate mortality from COVID; mental health crises and stigma; and racist violence and police brutality. In response to these acts of anti-Asian violence, there have been calls from within our community for increased policing and punitive measures. While we firmly advocate for the protection of our communities, we emphasize that increased policing is harmful both to our own communities (ie the recent murder of Christian Hall, post-9/11 policing of South Asians) and those of our Black and brown siblings. Instead, we must invest in community-based interventions.

APAMSA denounces these and all acts of violence against our community, and we oppose racism in all its forms. Additionally, APAMSA reaffirms our calls for better reporting of and prevention against anti-APIA hate incidents as part of any anti-racist policy. We urge our members to both amplify and condemn anti-Asian violence and interrupt and call out anti-Black and all forms of racism. In this time of crisis, we urge our allies to show solidarity with APIA communities by speaking out against all forms of anti-APIA aggression and demanding our policymakers to pass inclusive and comprehensive anti-racist policies that not only address the concerns of APIA communities but those of all marginalized peoples.

In solidarity,

Your APAMSA National Board

In April 2020, APAMSA condemned the rising tide of anti-Asian violence and offered tools for our members to support one another as we faced COVID in the hospitals and racism on the streets. Since then, our community has suffered nearly a year of racist verbal and physical abuse that was sometimes, unfortunately, stoked by the federal administration.

Today, we thank President Biden for taking the important step to denounce anti-Asian racism within his first 100 days in office. In addition, we welcome his memorandum’s guidance for the Justice Department on how to better collect data and assist with reporting and preventing anti-Asian hate incidents.

For resources on how to respond to such incidents or where to receive support, please see https://www.apamsa.org/advocacy/official-statements/42620-coronavirus-resources & https://stopaapihate.org/

In solidarity,

APAMSA National Board

Today, APAMSA celebrates a new chapter in the United States, including the swearing-in of our first Asian American and Black woman Vice President.

As future health professionals, we anticipate a number of policies from President Biden and Vice President Harris today that will support Asian American/Pacific Islander communities through the ongoing pandemic and beyond, including:

• Reinstating the Directorate for Global Health Security and Biodefense

• Rejoining the World Health Organization

• Counting undocumented Americans in the U.S. Census

• Ending the Muslim travel ban

Finally, as we continue to serve our patients through this difficult time, we would like to point our members to these words from National Youth Poet Laureate Amanda Gorman:

…the new dawn blooms as we free it

for there is always light if only we’re brave enough to see it

if only we’re brave enough to be it.

National APAMSA is proud to sign onto the following petition for racial justice in eGFR reporting. Race is a sociological construct, not a biological fact, and race-based tests and therapies should no longer be an unquestioned part of our medical practices. We are passing on the following request from the petition authors for individuals to sign on to the petition:

Since June, numerous institutions across the country, including UCSF, have successfully eliminated race-based eGFR reporting, but it needs to happen in ALL hospitals. So, with this new, national petition, we are taking our demands to the National Kidney Foundation-American Society of Nephrology (NKF-ASN) and beyond.

If you haven’t already, please sign on to the National Petition for Racial Justice in eGFR reporting. Link for sharing: https://tinyurl.com/change-egfr

This is not just about eGFR, and it’s not just about 1 or 2 individually isolated problematic race-based equations or guidelines. It’s a whole system’s problem of weaponizing race as biology. And it’s not just about our institution. It’s all of healthcare. Thank you for considering signing on!

In solidarity,
Drs. Monica Hahn, Stephen Richmond, Juliana Morris, Nathan Kim, and Vanessa Grubb

On September 25th 2020, the Department of Homeland Security released a proposal to limit foreign student visas to two years. According to the proposal, after two years, the students will have to reapply for an extension to stay in the country and complete their education. The supposed purpose is to allow for increased accountability, identification of security threats, and oversight regarding the foreign students, such as discontinuing education for students who are “more likely to fail”. The proposal specifically targets students from 59 countries – those designated as “state sponsors of terrorism” and those with a high rate of visa overstays. The majority of these students are from African nations, China, India, Brazil, and Canada.

This proposal is not the first time Trump has attempted to decrease the number of foreign students and workers in the U.S.; in July of 2020, the administration attempted to remove all foreign students studying through online programs. This proposal may appear reasonable on its surface, but the vague criteria for discontinuation – such as “suspicion for potentially applying for additional immigration benefits” – allows too much room for for immigration officers to act on racism and xenophobia rather than national interest, and leaves international students to face the burden of uncertainty regarding their status and safety, as well as long and arduous re-application processes. Additionally, this proposal could deprive the country of high levels of revenue as well as future members of the skilled workforce, posing real consequences for the U.S. economy.

Finally, we are concerned that this proposal would disproportionately impact Asian American and Pacific Islander healthcare students. Nursing, physician, and scientist training programs all take longer than 2 years to complete, and our community makes up over 10% of the healthcare workforce. We stand opposed to this potential policy and to the treatment of our international students as threats, rather than assets, to our country.

In Solidarity,

National APAMSA