S.1297 – Student Athletes Cardiac Arrest

May 23, 2017

Hon. Catherine T. Nolan
Chair, Assembly Education Committee
Room 836 Legislative Office Building
Albany, New York 12248

Dear Assemblywoman Nolan:

The Medical Society of the State of New York wishes to express its significant concerns regarding Assembly Bill 3452 which would require cardiac screening of student athletes and Assembly Bill 6050/S. 1297, which requires the development of regulations for the treatment and monitoring of students who exhibit signs of sudden cardiac arrest.  Both of these bills were on the Assembly Education Committee agenda for May 23.  While we of course agree with the goals of these bills to prevent sudden cardiac arrest in student athletes, these bills have some flaws which we are urging be addressed.

Sudden death in young athletes is a rare but tragic event which MSSNY wants to work with all interested parties to help to prevent.  The possibility that young, well-trained athletes at the high school, college, or professional level could die suddenly seems incomprehensible.  It is a dramatic and tragic event that devastates families and the community.  Physical exertion associated with competitive sports and other physical athletic activities can exacerbate a pre-existing condition and can result in an untimely death of a student.  However, experts have concluded that to require a cardiac screening for every individual who seeks to in any school sponsored athletic activity poses a potential unnecessary emotional toll on the student athlete and could also incur a significant financial burden on the family as cardiac screenings in young people, without a family history, may not be covered under insurance.

In this regard, the Medical Society of the State of New York supports Assembly Bill 6538, sponsored by Assemblymember Michael Cusick.   A. 6538 has already passed the New York State Assembly and is on its companion measure, S. 3149, sponsored by Senator Andrew J. Lanza, is advancing in the New York State Senate.  This measure adds to the existing Health Care and Wellness Education and Outreach Program within the New York State Department of Health. The bill would require DOH to provide educational materials for students and their parents and guardians regarding sudden cardiac arrest. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association.  The materials would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are presently available for screening.   The State of New Jersey currently has a similar program where brochures are sent home to parents and guardians.  We believe this is a positive legislative approach for addressing this difficult issue.

Regarding A.3452, we are concerned that experts have recommended against mandatory cardiac testing.  While competitive sports are associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with underlying cardiovascular disorders, the United States Preventive Services Task Force does not recommend universal screening with Electrocardiography for any individual, let alone children under the age of 18.  The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.  The USPSTF ranks this as D—which means that the USPSTF recommends against this service and that there is a moderate or high certainty that the service has no benefit or that the harms may outweigh the benefits.   Additionally, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.  The USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of the service.   Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Instead, the American Heart Association recommends that pre-participation screening of athletes include a history and physician exam and A complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available and most practical approach to screening populations of competitive sports participants, regardless of age.

Regarding A. 6050/S. 1297, we agree with the concept of requiring course instruction for coaches, physical education teachers, nurses and athletic trainers on the signs and symptoms of sudden cardiac arrest.  However, we are concerned that the bill”s language does not specifically include medical personnel, such as pediatric or family physicians, cardiologists, emergency department physicians or organizations representing these groups of individuals in the development of such educational program.   Additionally, it should be noted that the most important way to effectively treat sudden cardiac arrest with student athletes is for schools to have and to have individuals trained to use an automated external defibrillator (AED). An AED is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and pulseless ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.  Having individuals trained within the school systems to use AEDs would be a significant step forward.

We very much want to work with you to assure that individuals who work with student athletes are properly trained in recognizing the signs and symptoms of cardiac arrest.  However, at the same time, we do not want to subject patients to what often are unnecessary tests that have been recommended against by national experts.  Moreover, we believe it is very important that physician experts be involved in the development of educational materials for families and school personnel involved in overseeing student athletes.   Working together, we can all help to prevent these tragic incidents in the future.

Thank you for your consideration of our comments.   Please do not hesitate to contact us if there are any questions.

Sincerely,
Morris Auster, Esq.
Pat Clancy
Hon.  Kemp Hannon
Hon. Carl Marcellino
Hon.  Richard Gottfried
Hon.  Jeffrion L. Aubry
Members:  Assembly Education Committee

 

 

 

 

 

 

 

A.3079 – Prohibiting participation in torture and improper treatment of prisoners

May 12, 2017

To: Members of the NYS Assembly Codes Committee: 

RE: A.3079– AN ACT to amend the public health law, the education law and the labor law, in relation to prohibiting participation in torture and improper treatment of prisoners by health care professionals 

The Medical Society of the State of New York is writing to you relative to the above referenced legislation which would bar health care professionals from participating in torture or improper treatment of prisoners.  The bill also provides a means by which health care professionals responsible for the care of prisoners or detainees can refuse an order to directly or indirectly participate in torture and to insist on providing professional responsible care and treatment.

The Medical Society of the State of New York and the American Medical Association believe that any involvement by physicians in torture is incompatible with the physician’s role of healer.  There are core ethical principles under the Code of Medical Ethics that both organizations have adopted.   After almost 18 months of study of this issue by the BioEthics Committee, the Medical Society’s Council adopted on Nov. 19, 2009, MSSNY POLICY 95.973 Physician Involvement in Interrogation and in Torture. (copy attached) The statement, says in part, that:

“Physicians who engage in any activity that relies on their medical knowledge and skills, regardless of jurisdiction or location, must continue to uphold principles of medical ethics. Physicians must not engage, directly or indirectly, in torture or in interrogations. Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect the public interest, e.g. from terrorist attack. Precedent for this may be found in public health ethics in which physicians’ expertise inform guidelines, policies, and procedure that lead to the imposition of relatively minor hardships on individuals for public welfare. However, when a physician is directly and clinically involved with an individual, the physician’s obligations to the individual take precedence over public interests”.

The Medical Society of the State of New York at its 2015 House of Delegates unanimously reaffirmed MSSNY Policy 95.973 on this matter.

The Medical Society, supports the basic intent of the bill, i.e. that physicians should not conduct, support, aide, abet, or condone the torture of prisoners. However, we remain troubled by the issue of whether this legislation is necessary since torture is already a federal crime. Furthermore, current statements in the Geneva Convention, Military Manual of Conduct and from professional societies (e.g. AMA) already provide an explicit basis for refusal to participate in torture. It is not clear that a central purpose of the legislation – i.e., to provide physicians with an additional legal basis and therefore more powerful platform to refuse to participate in torture will in actuality have such an effect in circumstances in which a commanding officer directs a physician to participate in torture. The bill provides no practical recourse for physicians who are intimidated by military superiors into withholding reports of torture. There are inherent challenges and barriers to evidentiary discovery for accusations of torture in the military and prisons.  Physicians may be poorly positioned to defend themselves since, ostensibly, many of these incidents would occur overseas. Physicians would have to overcome claims of national security and national defense and would have to operate in domains in which civil authority will be limited.

At this time, the Medical Society of the State of New York and the American Medical Association is supportive of continued Congressional inquiries into interrogation techniques used by the military as well as the role of physician and non-physician health care providers.  We believe that this is the proper venue for this issue.

We will continue to work with you on this most important matter as it continues to be considered and examined.

Sincerely,

 

Morris Auster, Esq.

Pat Clancy, VP

 

 

A.2460 Amend the Public Health Law

Morris Auster, Esq.                           Division of Governmental Affairs             Senior Vice President /
Chief Legislative Counsel        

                                                                     MEMORANDUM  IN  SUPPORT 

ON ASSEMBLY HEALTH COMMITTEE              A.2460 (GOTTFRIED)
AGENDA

ON SENATE FLOOR (Cal. #717)                               S.3661 (HANNON)
 
AN ACT to amend the public health law and the education law, in relation to quality assurance and peer review activities 

This measure would extend the confidentiality provisions relating to discovery of testimony to apply to statements made by any person in attendance at peer-review committee that is a party to an action the subject matter of which was reviewed at such meeting. The Medical Society of the State of New York supports enactment of this measure.

The objective of the existing discovery exclusions under section 2805-m of the Public Health Law and section 6527 of the Education Law is to enhance the objectivity of the review process and to assure that medical peer review committees may frankly and objectively analyze the quality of health services rendered. This exclusion from discoverability, however, contains a narrow and yet potent exception that permits disclosure of statements given at an otherwise privileged peer-review meeting by a party (medical provider) to a lawsuit which involves the same underlying conduct that is the topic of discussion at the meeting.  As a result of this narrow exception, any statements or information volunteered as part of the peer-review process could be discovered and used against them in such proceedings.  It is believed that incidents involving medical errors can go undetected and are under-reported because physicians and other health care providers understand that they would potentially be exposed to future civil actions even though the particular event did not involve negligence.  Moreover, it should be noted that New York is one of only a small number of states that actually permits statements in peer-review proceedings to be disclosed.  Most other states do not permit such disclosure.

This legislation would improve the peer-review process and the clear benefits to be derived therefrom through the increased willingness of providers to submit information without fear of misuse in subsequent legal proceedings.

For the above stated reasons, the Medical Society supports enactment of this legislation.

Respectfully submitted,
MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

5/12/17
MMA – support

A.2460 – Amend the Public Health Law

Morris Auster, Esq.                             Division of Governmental Affairs           

Senior Vice President /                    MEMORANDUM  IN  SUPPORT
Chief Legislative Counsel

ON ASSEMBLY HEALTH COMMITTEE           A.2460 (GOTTFRIED)
AGENDA

ON SENATE FLOOR (Cal. #717)                               S.3661 (HANNON)

AN ACT to amend the public health law and the education law, in relation to quality assurance and peer review activities

This measure would extend the confidentiality provisions relating to discovery of testimony to apply to statements made by any person in attendance at peer-review committee that is a party to an action the subject matter of which was reviewed at such meeting. The Medical Society of the State of New York supports enactment of this measure.

The objective of the existing discovery exclusions under section 2805-m of the Public Health Law and section 6527 of the Education Law is to enhance the objectivity of the review process and to assure that medical peer review committees may frankly and objectively analyze the quality of health services rendered. This exclusion from discoverability, however, contains a narrow and yet potent exception that permits disclosure of statements given at an otherwise privileged peer-review meeting by a party (medical provider) to a lawsuit which involves the same underlying conduct that is the topic of discussion at the meeting.  As a result of this narrow exception, any statements or information volunteered as part of the peer-review process could be discovered and used against them in such proceedings.  It is believed that incidents involving medical errors can go undetected and are under-reported because physicians and other health care providers understand that they would potentially be exposed to future civil actions even though the particular event did not involve negligence.  Moreover, it should be noted that New York is one of only a small number of states that actually permits statements in peer-review proceedings to be disclosed.  Most other states do not permit such disclosure.

This legislation would improve the peer-review process and the clear benefits to be derived therefrom through the increased willingness of providers to submit information without fear of misuse in subsequent legal proceedings.

For the above stated reasons, the Medical Society supports enactment of this legislation.

Respectfully submitted,

MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

5/12/17
MMA – support

 

A.1404 Patient privacy protection act

Morris M. Auster, Esq.                   Division of Governmental Affairs
Senior Vice President/                  MEMORANDUM  IN  OPPOSITION
Chief Legislative Counsel

ON ASSEMBLY FLOOR                                        A.1404 (WEINSTEIN) 

IN SENATE JUDICIARY COMMITTEE       S.243 (DEFANCISCO)

AN ACT to amend the civil practice law and rules, in relation to enacting the “patient privacy protection act”

This bill would amend the civil practice law and rules to prohibit a physician’s defense counsel in a medical liability action from conducting an interview with the plaintiff’s treating physician.   The Medical Society of the State of New York opposes this legislation and urges that it be defeated. 

This legislation would overturn a very important New York State Court Appeals decision that was issued in 2007 that affirmed a long-standing principle in our legal system that no party has a proprietary interest in a particular witness in a civil liability action.  Were this decision to be overturned through legislation, it would present significant problems for a physician defendant in seeking to defend himself or herself in a medical liability action by limiting the opportunity to fully examine the plaintiff’s health condition to evaluate the merit of the plaintiff’s claim.     

New York’s dysfunctional liability adjudication system is in need of systemic reforms to reduce our huge liability insurance premiums, instead of provisions such as this proposed legislation which would undoubtedly increase them.  New York’s health care delivery system already faces severe financial strains due to a myriad of factors.  Therefore, it is imperative that the State Legislature take action to assure that physicians and hospitals remain available to deliver the care New Yorkers are expecting to receive, including acting to reduce the choking costs of medical liability insurance.

Given the extraordinary costs of medical liability insurance that many physicians must pay, combined with the enormous changes in health care delivery and payment that is placing huge new financial pressures on physician practices and hospitals, it is irresponsible to consider legislation at this time that might actually increase these costs.  Many New York physicians already pay liability premiums that far exceed $100,000 and some even exceed $300,000!

The timing of this legislation and other bills to expand tort liability could not be worse.  We now have multiple malpractice insurance companies operating in New York State that appear to be facing serious financial jeopardy which can ill-afford to absorb the substantial costs of a brand new cause of action.  Moreover, with the US House’s recent passage of the AHCA, there is enormous uncertainty in our health care system because of proposals in the AHCA that could profoundly restructure New York’s Medicaid system.

For many physicians currently struggling to keep their practices afloat due to the enormous changes taking place in health care delivery, this legislation could be the “final straw” to drive them out of practice and into other states. Many New York physicians pay liability premiums that far exceed $100,000 and some even exceed $300,000!  The cost of medical liability coverage for the 2015-16 year is:

  • $338,252 for a neurosurgeon in Nassau and Suffolk counties;
  • $186,630 for an obstetrician in Bronx and Richmond counties;
  • $141,534 for an orthopedic surgeon in Nassau and Suffolk Counties;
  • $132,704 for a general surgeon in Kings and Queens counties, and
  • $134,902 for a vascular surgeon or cardiac surgeon in Bronx and Richmond counties.

Furthermore, malpractice payouts in New York State continue to be far out of proportion to the rest of country.  For example, a recently released report by Diederich Healthcare showed that once again New York State had by far and away the highest number cumulative medical liability payouts ($711,718,250), nearly two times greater than the state with the next highest amounts, Pennsylvania ($374,018,550), and far exceeding states such as California ($263,874,600) and Florida ($248,911,150).    At the same time, New York had by far and away the highest per-capita medical liability payments in the country, far exceeding the second highest state Massachusetts by nearly 20%, the third highest state Pennsylvania by 23%, and the fourth highest state New Jersey by 26%.   Remarkably, it was more than 500% more than California!

It is little wonder that a recent analysis from the website WalletHub listed New York as the worst state in the country in which to practice medicine, in large part due to its overwhelming liability exposure as compared to other states in the country.  Legislation such as this will only make this embarrassment even worse!

At the same time physicians face these exorbitant costs, health plans continue to reduce payments to physicians by inappropriately denying, delaying and reducing payment for needed care.   Exacerbating these problems are the increasingly large patient balances that are accruing as a result of a significant increase in the use of high deductible health insurance plans.   At the same time, physicians face substantial new costs as a significant component of their revenue base will be conditioned on participation in often unwieldy value-based payment schemes both in Medicare and in Medicaid, including the need to invest tens of thousands of dollars to implement electronic medical record systems.    When factoring all these problems together, it is no surprise that regions all across New York State are beginning to see shortages in several specialties, according to reports issued by the Center for Health Workforce Studies.

With all these enormous changes occurring in patient care delivery, physicians need comprehensive reform of our flawed civil justice system and reduction in our medical liability costs, not legislation that increases costs and exacerbates existing problems.

This bill would do nothing to address the problems facing our health care system, and would instead make these problems worse.  Physicians need liability cost decreases, not increases!

For all of the reasons stated above, we urge that this measure be defeated. 

                                                                        Respectfully submitted,

MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

5/22/17
MMA – oppose                                              

August 18, 2017 – NYTimes Editorial WRONG!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
August 18, 2017
Volume 17
Number 32

Dear Colleagues:

Today’s New York Times editorial in support of legislation to expand malpractice lawsuits is an affront to every physician in New York State.  The editorial board members should be ashamed to look their doctors in the eye the next time they need their services, which they apparently must take for granted.

We have sent a response to the Times that highlights the threat to patient care this bill would undoubtedly bring about should it be signed into law.  Their editorial completely ignores this risk, despite the fact that we were recently named the worst state in the country to be a physician, and despite the fact that surveys of hospital Emergency Departments across the state have shown that many do not have sufficient on-call specialty care to meet expected patient demand.

They also repeat the tired line of New York being only one of a handful of states without such “date of discovery” exceptions to their statute of limitations law, without at all acknowledging that most other states with such laws have limitations on damages to balance these costs.

They also failed to acknowledge that the situation involving Lavern Wilkerson was the result of the application of the much shorter statute of limitations for municipal hospitals as compared to private hospitals.  As I have repeatedly stated, were the circumstances involving Lavern’s case to occur at a private hospital, she would have had ample time to sue her doctors and hospitals.

Rather than advancing legislation to correct that imbalance, trial lawyers have manipulated the issue to bring us to the verge of a huge explosion of lawsuits, at a time when physicians cannot take on any new costs.  And patient care in New York is bound to suffer.  In addition to more payouts, there will also be an explosion of meritless litigation given the drafting errors in this bill that may cause this legislation to apply to far more cases than simply alleged misdiagnoses of cancer.

Apparently, the New York Times does not care.

I am a regular reader of the Times.  I find it ironic that the Times will often warn their readers about the importance of understanding an issue comprehensively rather than simply reacting emotionally; yet when it comes to medical malpractice legislation they are clearly viewing this issue through one lens only.

We must continue to make the public aware of the damage this bill will cause to our healthcare system.  In this regard, I want to thank the many physicians across the State who have taken the time to send op-eds to their local papers warning of the consequences to care in their communities.  Some examples are here , here and here.  We anticipate that many more will be published in the near future.

I also want to thank the many physicians who have taken the time to contact the Governor.  Physicians should continue to do by calling his office at 518-474-8390 and sending a letter here.

Since this bill has not yet been officially delivered for his consideration, it is clear that the Governor and his staff are trying to be very thoughtful in their analysis of legislation.

With all the problems in our health care system, and still facing the possibility of huge cuts coming from Washington, we cannot tolerate any new costs.  We urge Governor Cuomo to veto this legislation and work to develop legislation that both addresses the Lavern situation and establishes needed systemic reforms to better assure timely patient access to care.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large

DFS Announces Insurance Premium Rates for 2018; Slight Decrease from Insurers Requests
Individual health insurance premium rates will increase 14.5%, and small group premiums will increase 9.3%, according to an announcement this week from New York Financial Services Superintendent Maria Vullo.  The DFS press release noted that it reduced the insurers’ requested 2018 rate increases by more than 3.8 % overall for the 300,000 enrolled in individual plans.  For small group plans, with more than 1 million insureds, DFS reduced insurers’ requested 2018 rate increases by 2.4%.

The press release noted that the premiums were set despite the uncertainty regarding the continued availability of the ACA’s Cost Sharing Reduction (CSR) subsidies for insurers. Specifically, it was noted that “ DFS will continue to fight for payment of the CSRs so that consumers are not further harmed by federal government actions. However, in light of the ongoing uncertainty regarding CSR payments by the federal government… DFS is granting an additional rate factor based on information that insurers had provided to DFS in May 2017 that estimated potential funding loss. The additional factor only applies to the individual rates of silver plans.”

The press release further noted that “Underlying medical costs continue to be the main drivers of premium rate increases, reflecting a nationwide trend. For the 2018 individual rates announced today, drug costs account for the largest share (26 percent) of all medical costs, with specialty drug costs increasing about 49 percent. Inpatient hospital costs account for the second largest share of medical expenses (19 percent), followed by physician specialty services (12 percent) and diagnostic testing/lab/x-ray (10 percent).”

For a full listing of the premium rates requested and approved on a company by company basis, please view the press release here.


AG Announces Joint State-Federal Settlement with Maker of Epipens
New York Attorney General Eric Schneiderman announced this week that New York State had agreed to join a state-federal $465 million settlement with drug maker Mylan to resolve allegations that Mylan knowingly underpaid rebates owed to Medicaid for EpiPens that were dispensed to Medicaid beneficiaries. Under the settlement, New York will receive $38.5 million.

To read the AG’s press release, click here.  The press release notes that the settlement resolves allegations that Mylan submitted false statements to the Centers for Medicare and Medicaid Services (CMS) and several states reliant on EpiPen rebates, and knowingly underpaid its obligations for Medicaid drug rebates to the State Medicaid Program for EpiPens.

DFS Issues Transgender Health Guidance to Health Plans
NYS DFS issued guidance on transgender health in a circular letter to health plans.  The letter advises plans to request additional information before denying benefits for procedures that are not routinely provided to a specific gender. Insurers may not discriminate against transgendered or gender non-conforming individuals who file health claims for conditions that are not normally associated with the gender with which they identify. The circular letter is here.


2017 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS. This conference will inspire participants to explore and interactively address challenges such as self-directed learning for physicians and compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

The conference will take place on Friday, September 15, 2017, at the Westbury Marriott.  The program is scheduled from 7:30 AM to 3:45 PM.  Registration links and more information are available here.  Featured speakers include Steve Singer, PhD; Vice President of Education and Outreach, Accreditation Council for Continuing Medical Education (ACCME) and Mary Kelly, Project Administrator, AMA PRA Standards and Policy.  MSSNY President Charles Rothberg, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at mhardin@mssny.org. Our flyer with information is here.

MSSNY Counsel Don Moy: Please Read the 2018 Family Leave Law
Virtually every employer in NYS must start preparing for phased in implementation of the NYS Paid Family Leave law, which begins in 2018.  The State of New York website gives detailed summaries regarding the law, and the obligations of employers and employees under the law.  Perhaps the attached information can be helpful in the event a medical practice or county medical society is not aware of this website.


FREE Drug Discount Card for Your Patients

Many of your most vulnerable patients have trouble affording medication. The New York Rx Card can help with those prescription costs and is a free program available to all New York residents. There are no eligibility requirements or forms to fill out. Tell your patients to simply take the card into the pharmacy to get savings of up to 75% on prescription medications for their whole family. New York Rx Card is a proud supporter of Children’s Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card. Your patients can find and print their FREE card here!



DOH Releases Children’s Medicaid Transformation Plan
The state released a draft plan on August 16 regarding how it will transform the children’s Medicaid program and transition children currently covered by fee-for-service Medicaid to managed care plans. The transformation of the children’s Medicaid system is intended to improve access to care for high-needs children, according to the document. One way the state aims to do that is by consolidating the six waivers currently authorizing home- and community-based services for children into a single waiver. It also aims to shift more children in need of care management for chronic conditions, including behavioral health issues, into health homes. Currently there are 16 health homes across the state that have been designated to serve children. (Crains 8/16)


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


CMS Announces End to Two Mandatory Bundled Payment Programs, and Proposes Rollback to Joint Replacement Program
CMS announced this week that it was intending to cancel two of its Medicare bundled payment demonstration programs and make substantial changes to a third program. Specifically, the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model announced last year would be cancelled, and the number of regions across the country required to participate in the Comprehensive Care for Joint Replacement (CJR) model adopted in 2015 would be cut in half.

To read the full press release, click here.

The EPM and Cardiac Rehabilitation Incentive Payment models were scheduled to begin in January 2018. CMS stated that it was proposing to eliminate these two models to give the agency “greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum.”  According to the press release, CMS expects in the future to “increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts.”

Moreover, the number of regions required to participate in the Joint Replacement bundled payment program was cut from 67 to 34.  Hospitals in the other 33 regions could continue to participate voluntarily. To read the entire proposed rule, click here.  Based upon an initial review of the rule, it appears the Buffalo metropolitan area has been removed entirely from mandatory participation in this program (p.26)   While the New York City metropolitan area will remain in the mandatory program, several hospitals in the MSA have been exempted from voluntary participation (p. 27).

MSSNY Travel Discount Program
MSSNY is pleased to offer an exclusive worldwide travel discount service to our members. Savings average 10-20% below-market on all hotels and car rental suppliers around the world.

Save time and money.  Let Local Hospitality negotiate the best deals and comparison price for you.  Any hotel, any car, anywhere, anytime. Click here to save on your next trip.

Survey: Medical Groups Find Complying with MIPS Extremely Burdensome
A recent survey by Medical Group Management Association (MGMA) has found that most physician practices are finding it challenging to comply with the Merit-Based Incentive Payment System (MIPS). Approximately 82% of medical practices identifies the system as “very” or “extremely” burdensome.  Responding medical groups also noted health information technology as a major inhibitor in their ability to provide quality patient care.  The survey includes responses from 750 group practices with the largest representation among independent medical practices and in groups with 6 to 20 physicians.

Reminder: Medicaid Billing for Prescription Drugs when Prescribed by Unlicensed Residents, Interns and Foreign Physicians in Training
The purpose of this article is to provide a reminder regarding NYS Medicaid’s billing requirements for drugs when prescribed by unlicensed residents, interns and foreign physicians in training only.

  • NYS Medicaid accepts prescriptions written by providers legally authorized to prescribe per NY Education Law, Article 131, Section 6526, and 10 NYCRR 80.75(e). This includes unlicensed residents, interns and foreign physicians in training programs, under the supervision of a NY State Medicaid enrolled physician.
  • In accordance with NY Education Law, NYS Medicaid does NOT require the name and signature of the supervising physician to be included on the prescription.
  • Effective January 2014, NYS fee-for-service Medicaid implemented claims editing that enforced the OPRA requirement for healthcare professionals, practice managers, facility administrators, and servicing/billing providers.
  • Because NYS Medicaid’s provider enrollment system can only accept licensed providers, pharmacy claims for services ordered by unlicensed residents, interns and foreign physicians in training programs reject when initially submitted for payment.

The following two (2) options continue to be available to pharmacies, to enable payment for prescription drug claims when prescribed by unlicensed residents, interns and foreign physicians in training only:

  1. Resubmit the claim using the National Provider Identifier (NPI) of the enrolled NYS Medicaid provider (the intern or resident’s supervising physician) as the secondary NPI.
  2. In the event the pharmacy’s billing system is limited to submitting only one prescriber NPI number, or the NPI number of the supervising physician cannot be obtained, then use the urgent/emergency override option (outlined below).

Directions for Urgent/Emergency Override

If you have a prescription written by an unlicensed resident, intern or foreign physician in a training program you will receive a reject code of “56” via NCPDP transaction stating the provider has a non-matched Prescriber ID listed in NCPDP field number 511-FB.

In the case of claims for items prescribed by unlicensed residents, interns or foreign physicians in training programs, pharmacies can provide the medication and receive reimbursement by resubmitting the claim using the following emergency override procedure:

In the Reason for Service Code Field (439-E4) also known as the Drug Utilization Conflict Field – enter “PN” (Prescriber Consultation) In the Result of Service Code Field (441-E6) – enter one of the following applicable values (1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1J, 1K, 2A, 2B, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3J, 3K, 3M, 3N, or 4A)

In the Submission Clarification Code Field (420-DK) also known as the Drug Prescription Override Field – enter “02” (Other Override).

Please note that the above override should NOT be used for a licensed prescriber who has not yet enrolled in NYS Medicaid. In the event of a prescription being sent by a non-enrolled licensed prescriber, the prescriber should be encouraged to enroll in the NYS Medicaid Program. Information regarding how to enroll can be found here.

Medicaid Fee-For-Service (FFS) to Systematically Enforce Legislation Limiting Initial Opioid Prescribing to a Seven Day Supply
In accordance with New York State Public Health Law, effective August 24th, 2017, the Medicaid FFS program will be implementing a seven (7) day supply limit on initial opioid prescribing for acute pain. This is a change from the current editing, implemented on December 5, 2013, which set the limit to a fifteen (15) day supply on initial opioid prescriptions. Information on this legislation can be found on page 6 of the July 2016 Medicaid Update.

Prior authorization (PA) will be required for claims that do not meet the above criteria.

To obtain a PA, please contact the clinical call center at 1-877-309-9493. The clinical call center is available 24 hours per day, 7 days per week with pharmacy technicians and pharmacists who will work with you, or your agent, to quickly obtain a PA.

The most up-to-date information on the Medicaid FFS Pharmacy Prior Authorization (PA) Programs and a full listing of drugs subject to the Medicaid FFS Pharmacy Programs can be found here and here.

Medicaid enrolled prescribers can also initiate PA requests using a web-based application. PAXpress® is a web based pharmacy PA request/response application accessible here.



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A.352 Oppose School Information

Morris Auster, Esq.                               Division of Governmental Affairs

Senior Vice President /                    MEMORANDUM  IN OPPOSITION
Chief Legislative Counsel

ON ASSEMBLY FLOOR                     A.352 (Perry) (Ca1. #3) 

IN SENATE HEALTH COMMITTEE                    S.2113 (Felder)

 AN ACT to amend the public health law, in relation requiring physicians and hospitals to obtain the name of the  school  attended  by school-aged  patients  and to include this information in their admission registration forms This legislation would amend the public health law to require physicians and hospitals to obtain the name of the school attended by school-aged patients and to include this information in their admission registration forms.  The Medical Society of the State of New York opposes this legislation. 

While the intent of this legislation is laudable, it would impose yet another unfunded mandate on already overstressed physician offices seeking to assure patients receive needed care amid the myriad of requirements already imposed by Medicare, Medicaid, private insurers, as well as other state mandates.  These increasing mandates take more and more time away from the ability to deliver the timely care patients expect to receive.  This trend is well documented.  Indeed, a recent 2016 study reported in the Annals of Internal Medicine concluded, remarkably, that for every one hour of patient care delivered by a physician, two more must be spent on paperwork.   Moreover, these overwhelming paperwork demands is one of the major factors that is causing physicians to feel compelled to leave private practice to become employed in a large health system, which can threaten the continuity of existing physician-patient relationships.  At a time when we are seeking to assure that the hundreds of thousands of patients who have newly received health insurance coverage through New York’s Exchange are truly able to receive needed care, imposing new paperwork requirements will only create further delays and roadblocks to patients receiving care.

Based on the foregoing, the Medical Society of the State of New York opposes this legislation and urges that it be defeated. 

Respectfully submitted,
MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

6/13/17MMA – oppose      

 

A.7218A – Tanning Salons

ON ASSEMBLY HEALTH AGENDA                                     A. 7218A (JAFFE)

IN SENATE HEALTH COMMITTEE                                    S. 5585A (BOYLE)

An act to amend the                                                                                                             public health law, in                                                                                                             relation to  tanning facilities

This bill would prohibit children age of 18 and under from using tanning facilities and it removes the procedures to grant 17 to 18 year olds access to tanning booths. Tanning devices are dangerous to health and well-being of children and should be banned from use by them. Consequently, the Medical Society of the State of New York supports this bill. 

The United States Department of Health and Human Services and the World Health Organization’s International Agency for Research on Cancer have classified UV radiation from tanning devices as carcinogenic to humans, in the same category as tobacco and tobacco smoking.  A review of seven studies found a seventy five percent increase in the risk of melanoma in those who had been exposed to UV radiation from indoor tanning before the age of 35.  With the rising incidence of melanoma and non-melanoma skin cancer in the United States, as well as increasing usage of tanning parlors for cosmetic purposes by the public, the medical community supports legislative and regulatory efforts to severely curb access to these devices.

Epidemiologic data suggest that most skin cancers can be prevented if children, adolescents, and adults are protected from UV radiation; however, melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.  Moreover not only is indoor tanning associated with melanoma, but new evidence demonstrates that ever-use of indoor tanning beds is associated with a 69% increased risk of early-onset basal cell carcinoma (BCC), the most common form of skin cancer. Risk of developing BCC was higher in those who begin indoor tanning at earlier ages (less than 16 years old).

The Medical Society of the State of New York has adopted policy to eliminate tanning salons in the State of New York and strongly supports this legislation.  According to the American Cancer Society, skin cancer is the most diagnosed cancer in the United States. About 95,400 invasive skin cancers will be diagnosed in the US, and more than 87,000 of these will be of melanoma, the most serious form. The American Cancer Society has noted that the highest risk for skin cancer lies in avoiding the use of indoor tanning facilities. Because the harmful effects of UV exposure accumulate over time, indoor tanning devices pose a greater risk for teens due to the misleading claims by the industry. This is one of the many reasons New York currently prohibits indoor tanning for children under the age of 17 (Chapter 105 of 2012).

Currently, The US Food and Drug Administration is reviewing federal regulations for indoor tanning devices for the first time since 1985.  New York has proven to be proactive in this regard and should, once again, take definitive steps to prevent this avoidable cancer that takes the lives of so many New Yorkers.

For all the reasons above, the Medical Society of the State of New York supports this measure and urges it passage.

PFC/support

6/5/17

A.2317 Higher-Cost Drugs

Morris Auster, Esq.                              Division of Governmental Affairs           Senior Vice President /                     MEMORANDUM  IN  SUPPORT
Chief Legislative Counsel

ON ASSEMBLY FLOOR                           A.2317 (PEOPLES-STOKES)

IN SENATE INSURANCE COMMITTEE                  S.5022 (SERINO)
 
AN ACT to amend the insurance law, in relation to prescription drug formulary changes during a contract year/ 

This bill would amend the Insurance Law to protect health insurance consumers by prohibiting healthcare plans from moving a drug to a higher-cost tier and not allow for the removal of a prescription drug from a formulary during the enrollment year. The Medical Society of the State of New York supports enactment of this measure.

Critical to assuring a patient’s recovery from illness or stabilizing a patient’s condition is through continuation of a medication regimen recommended by their physician.    As a result, a consumer’s choice of which insurance plan to enroll is often driven by which health insurance plan will cover their needed medication with the lowest possible out of pocket cost.  Under this bill, consumers would be assured that coverage for prescription drugs in the plan’s formulary will not change during the enrollment year.  Unexpected prescription drug changes in the formulary could result in higher out-of-pocket costs, which could seriously interfere with the continued medication therapy for patients with serious medical conditions such as epilepsy, cancer, asthma, and HIV/AIDS,  This legislation would help to protect consumers from unforeseen higher deductibles, copayments and coinsurance that would result from health care plans moving prescription drugs to a tier with higher patient cost sharing.

For the above stated reasons, the Medical Society supports enactment of this legislation.

Respectfully submitted,

5/17/17

MMA – support
MSSNY DIVISION OF GOVERNMENTAL AFFAIRS

Bill Memos

Bill Memos 2017

Memos in Support

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