Thomas J. Madejski, MD
April 6, 2018
Nearly 75 percent of practices do not like the technology they use for the most part. This is according the 2017 Annual Physicians Practice Technology Survey, which looks at the usage of technology at the practice level from more than 500 (mostly independent) practices across the country.
According to the survey, only 12.6 percent of practices have used telemedicine. About six years ago, one of the physician executives of United Healthcare gave a presentation regarding telemedicine to the MSSNY Council. When the Power Point concluded the Councilors were silent. Then, the outrage flowed freely with several physicians commenting that telemedicine violated every code of ethics including the Hippocratic Oath.
Well, telemedicine is here to stay and many physicians are interested in integrating it into their practices as a patient convenience, especially in rural areas. MSSNY has been working with telemedicine expert Peter Caplan for two years as a source for our physicians who are interested in adopting this technology into their practice.
Mr. Caplan’s Telemedicine Resource Guide was created to assist MSSNY members in navigating the telemedicine service industry. Its purpose is to provide physicians with information about companies that either:
- Recruit physicians to be part of a regional/national provider network offering direct-to-consumer tele-consults (a monthly subscription vs. fee-per-call or a hybrid of both models) that are available as part of an employer health plan or as an independent, standalone service paid by the individual employee
- Sell practice-based turnkey solutions (hardware, software, network connectivity, videoconferencing services, peripheral devices and vital sign monitors) used by physicians offering a customized and branded telemedicine program to their own patients. Click here for the Telemedicine Resource Guide (Excel)
If we can better understand and integrate the use of telemedicine as part of a patient management strategy to improve care, increase access to treatment, reduce transportation costs, and more effectively engage patients who are not able to get to a physician’s practice location, we will have created real value for patients and their physicians.
MSSNY’s Telemedicine Task Force continues to review options for our members to consider for the addition of telemedicine into their practices to enhance patient care. I think it is critical we continue to review the evolving landscape of telemedicine options to the benefit of our patients. We also need to review what type of care is not appropriate for a telemedicine program and ensure the safety of patients.
Proper integration of telemedicine will enhance the care of our patients and limit the intrusion of non-physician retailers like CVS and WalMart and their potential interference in the physician patient relationship.
I’d appreciate your thoughts. Send your comments to firstname.lastname@example.org
Thomas J. Madejski, MD
State Legislature Completes Passage of Difficult Budget that Rejects Several Items Opposed by MSSNY
As reported last week, the New York State Legislature recently completed passage of a $168 Billion State Budget that closed a $4.4 Billion Budget deficit. Importantly, the final adopted State Budget rejected numerous proposals of great concern that MSSNY together with specialty societies and other allies had been advocating against, including:
- Independent practice authority for CRNAs
- Authorization for corporate-owned retail clinics;
- Steep Medicaid cuts to the Patient-Centered Medical Home program;
- Elimination of “Prescriber prevails” protections for prescriptions for patients covered by Medicaid;
- Overbroad state powers to penalize physicians and other health care providers for Medicaid billing errors
- Authorization for patient drug management protocols between Nurse Practitioners and pharmacists. Instead, there was a 2-year extension of the current Collaborative Drug Therapy pilot program (between physicians and pharmacists) that MSSNY supports;
- Authorizations for EMTs to provide non-emergency care in patient homes without any express coordination requirement with that patient’s treating physician;
- Provisions which would have reduced from 7 days to 3 days the length of an initial prescription for acute pain. The final bill did include a requirement, consistent with CDC Chronic pain guidelines, for a prescriber to have a written treatment plan that follows generally accepted professional or government guidelines for a patient on opioid medications longer than 90 days or past the time of normal tissue healing;
- Significant expansion of the DOH’s Commissioner’s power to investigate physician misconduct, including provisions that would have a) greatly reduced the time to respond to document requests and b) expanded the power to search and seize records and equipment. The final bill did include a provision to permit the Commissioner to summarily suspend a physician who is both been charged with a felony crime and believed to be an imminent danger to the public as determined by the Commissioner;
At the same time, the final Budget included the following items supported by MSSNY:
- Continued funding for the Excess Medical Malpractice Insurance Program at the historical level.
- A new $150,000 allocation for the MSSNY’s Veterans Mental Health Initiative;
- Reducing some of the insurance barriers to substance abuse treatment
- Consistent with policy recently adopted at the MSSNY Council, prohibiting PBMs from disclosing to patients drug cost options that may be less than what is specified in their insurance
- Continued historical funding and a 5-year extension of the MSSNY Committee for Physicians Health until 2023.
Thank you to all the physicians who took the time to make phone calls, send letters, or meet with their local legislators over the last few months to advocate on all these issues. Certainly, our success on these fronts is in large part due to these extensive grassroots efforts. However, we can’t exhale just yet – many of these proposals will continue to be raised during the remainder of the legislative session.
DEA Warns Public of Extortion Scam by DEA Special Agent Impersonators
The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme.
The criminals call the victims (who in most cases previously purchased drugs over the internet or by telephone) and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas. If victims refuse to send money, the impersonators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.
Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.
The DEA reminds the public to use caution when purchasing controlled substance pharmaceuticals by telephone or through the Internet. It is illegal to purchase controlled substance pharmaceuticals online or by telephone unless very stringent requirements are met. And, all pharmacies that dispense controlled substance pharmaceuticals by means of the internet must be registered with DEA. By ordering any pharmaceutical medications online or by telephone from unknown entities, members of the public risk receiving unsafe, counterfeit, and/or ineffective drugs from criminals who operate outside the law. In addition, personal and financial information could be compromised.
Anyone receiving a telephone call from a person purporting to be a DEA special agent or other law enforcement official seeking money should refuse the demand and report the threat using the online form below. Please include all fields, including, most importantly, a call back number so that a DEA investigator can contact you for additional information. Online reporting will greatly assist DEA in investigating and stopping this criminal activity.
Complimentary Webinar by MSSNY Counsel Garfunkel Wild: How to Handle Medicare and Medicaid Overpayments
Friday, April 20, 201812:00 PM – 1:00 PM EST
Providers who identify Medicaid or Medicare overpayments have a legal obligation to timely report, return and explain the overpayments. Knowing how to appropriately handle Medicare and Medicaid overpayments is both necessary and an essential part of an effective compliance program.
This complimentary webinar will:
- Educate providers on the applicable laws
- Discuss the various mechanisms that exist for returning overpayments to the government
- Provide practical ideas for how best to report, return and explain identified overpayments
After registering, you will receive a confirmation email containing information about joining the webinar.
Register Now For 2018 NY HIT Symposium on Sat. April 28 in Brooklyn
When: Saturday, April 28, 2018 8:30 a.m. – 3:00 p.m.
Where: Brooklyn Borough Hall
209 Joralemon St.
Brooklyn, NY 11201
Please join us as we examine potential risk management issues with EHR technology.
- Liability pitfalls in EHR documentation
- Fraud risks in documenting encounters
- Privacy, security, and confidentiality in EHR technology
The HIT Symposium is designed for physicians in all specialties.
Click here to register.
Supported by MLMIC and MSSNY
“Current Concepts in Concussion for Pediatric and Adult Patients” CME Webinar on April 12, 2018, Registration Now Open
The Medical Society of the State of New York will hold a free Continuing Medical Education (CME) webinar on the “Current Concepts in Concussion for Pediatric & Adult Patients” on Thursday, April 12th at 12:30pm.
Register for this webinar here.
Faculty: Deborah Light, MD & John Pugh, MD, PhD
- Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology;
- Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol;
- Describe methods for the primary and secondary prevention of concussion;
- Identify patients who would benefit from referral to a concussion specialist
“Plague & Q Fever” CME Webinar on April 18, 2018; Registration Now Open
Upcoming in MSSNY’s Medical Matters continuing medical education (CME) webinar series is: “Plague & Q Fever”. This webinar will take place on Wednesday, April 18, 2018 at 7:30 a.m. Faculty for this program is Kira Geraci-Ciardullo, MD, MPH.
Register for this webinar here.
Educational objectives are:
- Describe the epidemiology of Plague and Q Fever
- Describe the transmission of Plague and Q Fever
- Describe the diagnosis and treatment of Plague and Q Fever
- Explain the use of Yersinia pestis and Coxiella burnetii as a biologic weapons(s)
- Identify infection control procedures
- Identify resources for reporting
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Bolstering Small-Practice “Medical Home” Capabilities
Small independent primary care providers are a vital lifeline for New Yorkers, providing services to many diverse and often disadvantaged communities. While they make up approximately 40 percent of all primary care providers in New York City and State, these practices are at risk of falling behind in the race toward medical home recognition and value-based purchasing.
Understanding that challenge, UHF brought together more than 30 experts last year to discuss the potential for shared services among small practices-a way to pool resources for practice transformation and eventual value-based purchasing (VBP). The results of that convening and subsequent efforts are now being finalized, with an anticipated release this spring.
Part of UHF’s partnership with the New York City Department of Health and Mental Hygiene and the New York City Population Health Improvement Program, the roundtable discussion solicited expert feedback on a white paper entitled New York City Population Health Improvement Program (PHIP) Small Primary Care Practice Project, Draft Interim Report, which was provided to participants in advance for their review and comment.
That report reviewed:
- Findings from a series of focus groups of small-practice providers in New York City, describing a specific set of capacities the practices felt they needed to operate as medical homes and participate in VBP contracts, but could not afford on their own. Providers reported willingness to consider sharing services with other small practices if those services were affordable and provided by a trusted organization with a track record of competence;
- Findings from a series of interviews with organizations in New York State that are providing a range of services to small practices, describing the types of services offered and how they are organized, deployed, and supported.
The conversation reinforced the findings of this qualitative research, particularly related to the core competencies of medical homes and preparation for value based payment. Of particular value were discussions on the scope of the shared service “bundle” that was envisioned, with discussants recommending that it include support in two priority areas with which many small practices often struggle:
- The adoption and best use of electronic medical records, and
- Practice management consultation and support on operational issues and on compliance with complex and changing requirements related to billing and coding.
The Draft Interim Report and roundtable findings served as the foundation for subsequent quantitative work describing the legal and regulatory issues involved in establishing a shared service program, and modeling the economics of such a venture.
The final report will bring together both the qualitative and quantitative reports findings of the project.
Crain’s Reports MSSNY’s HOD Gun Safety Resolution
New York Business (3/28, Lewis) reports, “The Medical Society of the State of New York is endorsing a set of proposed gun-control measures through a resolution that was passed at its annual House of Delegates meeting over the weekend.” MSSNY supports “bans on high-capacity magazines and bump stocks, legislation requiring a background check and waiting period before someone can purchase a gun, and the ability of the Centers for Disease Control and Prevention to conduct public health research on gun violence.” Dr. Thomas Madejski, the president of MSSNY, said that MSSNY members disagree about how restricted gun ownership should be. Madejski also said that there have been difficulties implementing the New York SAFE Act, which “requires mental health practitioners to report when a patient is likely to harm himself or others.”
Correction re Third Party Payers Being Billed
On March 30, it was reported that Resolution 261, which required that all 3rd party payers be billed before any patient is billed, was adopted. This was incorrect. The House voted NOT adopt this resolution. We apologize for any confusion.
CVS Health Sued for Revealing HIV Status of 6000 Patients in Ohio
CVS Health is being sued for allegedly revealing the HIV status of 6,000 patients in Ohio.
A federal lawsuit claims CVS mailed letters last year that showed the status of participants in the state’s HIV drug assistance program through the envelopes’ glassine window.
The complaint, which was filed March 21 in federal court in Ohio, also names Fiserv, the company that CVS hired to mail the letters. On the envelopes used by Fiserv, the patients’ HIV status could be seen through the clear window, just above their name and address, the documents states. The letters included the patients’ new benefits cards and information about a mail prescription program.
The attorneys claim that CVS failed to announce the breach of privacy data and did not contact all the patients whose status was revealed. In a statement to CNN, CVS Health said the envelope window was intended to show a reference code for the assistance program and not the recipient’s health status. “CVS Health places the highest priority on protecting the privacy of those we serve, and we take our responsibility to safeguard confidential information very seriously,” the statement said. “As soon as we learned of this incident, we immediately took steps to eliminate the reference code to the plan name in any future mailings.”
Surgeon General Releases Advisory on Naloxone
Naloxone is already carried by many first responders, such as EMTs and police officers. The Surgeon General is now recommending that more individuals, including family, friends and those who are personally at risk for an opioid overdose, also keep the drug on hand.MSSNY endorses the surgeon general’s call for more availability/use of naloxone. MSSNY quickly endorsed the bill/law that passed a few years ago calling for more widespread availability of Naloxone including without a patient specific script. Naloxone is available in pharmacies throughout NY State. With endorsement by MSSNY and other groups, the bill passed quickly and as a result, thousands of lives have been saved in NY by overdose reversals. MSSNY appreciates and supports the Surgeon General’s call for more widespread availability and use.
FDA Orders Recall of Powdered Kratom Products Due To Salmonella
The Food and Drug Administration “ordered a mandatory recall of” Triangle Pharmanaturals’ “powdered kratom products because salmonella was found in the herbal supplement.” The agency “said the company did not cooperate with the agency’s request for a voluntary recall.” The Wall Street Journal (4/3) reported that FDA said that the recall was the first of its kind under the Food Safety Modernization Act of 2011.
Physician Medicine and Drug Procedure Codes and Fee Schedule Updated
The Physician Medicine and Drugs Procedure Codes and Fee Schedule have been updated for 2018. For details, click here.
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