“Divide et impera.” Julius Caesar
CMS has proposed a new fee schedule. True to form, some physicians will see an increase in Medicare payments. However, some will see a pay cut. Not unexpectedly, I received a call from an ophthalmologist about his 10% pay cut. He also noted that his colleagues in Endocrinology would receive a 10% increase and wondered if the Diabetologists would be splitting the difference for those patients with cataracts and retinal disease caused by their diabetes.
No matter where in this equation your particular practice is located, whether a “winner” or a “loser,” realize that in truth we are all losers. Echoing my comments from last week, when others are able to pit physician against physician, colleague against colleague, physicians lose. For many years now, this trend has made the practice of medicine less about profitability and more about viability. Rather than grumbling about whose slice of the pie is larger, we should be demanding (yes, demanding) a bigger pie.
For over a decade, Medicare payments have not kept up with inflation. It appears that Medicine has the dubious distinction of being an American endeavor which annually is treated to a cost of living decrease.
We need to stop being Only a Pawn In Their Game.
What say you? Please feel free to address your comments to: firstname.lastname@example.org.
And do follow me on Twitter: @sonodoc99
Arthur Fougner, MD
New York Approves Increased Rate for Individual Insurance Market
Crain’s New York Business (8/9) reported that New York’s “state Department of Financial Services said Friday it would allow insurers selling health plans to individuals to raise their rates by 6.8% on average for 2020, a reduction of about one-quarter from the 9.2% insurers requested from the state in May.”
The proposed reduction “represented a less drastic cut than the state levied last year, when it cut insurers’ requests by about two-thirds and granted an average increase of 8.6% in the individual insurance market.” The article added, “The 6.8% increase for 2020 will be the lowest since 2015.”
Nursing Home Associations Call for State Payment Reforms
New York’s nonprofit nursing homes say action from state lawmakers is needed to slow the transfer of facilities to for-profit chains. An analysis Crain’s last week showed 48 nonprofit nursing homes were sold to for-profit operators between 2014 and 2018. It noted that the attorney general’s office was increasing its scrutiny of such sales in light of the trend.
Leaders of two of the largest nonprofit nursing home associations, the Continuing Care Leadership Coalition and LeadingAge New York, told Crain’s they believe the state must go further. “The attorney general’s laudable efforts must be part of a multipronged approach involving the highest levels of New York state leadership to prevent further sales and closures of mission-driven, not-for-profit nursing homes,” wrote Scott Amrhein, president of CCLC, and James Clyne Jr., president and CEO of LeadingAge.
Amrhein and Clyne recommended increasing Medicaid payments to nursing homes, noting that a study commissioned last year found payment rates resulted in a $64 per-patient shortfall.
They also said Medicaid nursing home payments should return to a fee-for-service model administered by the state rather than the managed-care approach that has been adopted. Similarly, the restoration of a $246 million cut in the state budget, which lowered Medicaid rate adjustments based on residents’ acuity, also could boost nonprofits. (Crain’s Health Pulse, Aug 8)
USPSTF Proposes Screening All Adults for Illicit Drug Use
On August 13, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation that providers screen all adult patients for illicit drug use, marking the first time the task force has proposed such a recommendation. According to STAT News, the draft recommendation is intended to help combat the U.S. opioid epidemic. A federal survey in 2017 found one in 10 U.S. residents older than age 18 reported using drugs or prescription drugs illicitly, and other research has shown more than 70,000 U.S. residents in 2017 died from a drug overdose, STAT News reports. USPSTF in 2008 had concluded that there was insufficient evidence to recommend that providers screen all adult patients for illicit drug use.
However, based on new evidence, USPSTF on August 13 proposed that providers screen all patients ages 18 and older for illicit drug use if the providers can offer or refer patients to services to accurately diagnose and effectively treat substance use disorders. USPSTF in the draft recommendation defined illicit drug use as the use of illicit drugs or prescription drugs in amounts and for durations or frequencies other than prescribed.
Recommend Questions Not Drug Tests
According to the draft recommendation, USPSTF found new evidence showing screening tools can allow providers to detect whether a patient is using drugs illicitly and whether a patient might need to be assessed further. However, Karina Davidson, co-chair of USPSTF, noted that the task force is not recommending providers use drug tests to screen their patients. Instead, USPTF said providers could ask their patients a series of questions to determine whether they are using drugs illicitly.
Based on the evidence, USPSTF concluded “with moderate certainty” that screening adult patients for illicit drug use has a moderate net benefit when providers can offer or refer patients to services to diagnose and treat substance use disorders. USPSTF did not endorse a particular screening tool or treatment, which means providers who follow the recommendations can decide how they will screen and treat their patients.
USPSTF gave a “B” grade to the draft recommendation. Under the Affordable Care Act, insurers are required to cover preventive services that receive a “B” grade or higher from USPSTF without cost sharing.
USPSTF Draft Did Not Extend to Adolescent Patients between the of 12 and 17
The task force said there was insufficient evidence to determine whether screening tools and treatments are safe and effective for adolescents. According to STAT News, the long-term effects of certain treatments on the developing brains of adolescents are unknown, which is why treatments such as buprenorphine are approved only for use among patients 16 and older. USPSTF in the draft recommendation called for additional research on screening tools and treatments for adolescents who use drugs illicitly.
AMA Speaks Against Pres. Trump’s Proposal to End Sexual Orientation Protections
On Monday, August 12, the American Medical Association (AMA) spoke out against the Trump administration’s misguided proposal to remove anti-discrimination protections related to sexual orientation, gender identity, and the termination of pregnancy across a wide variety of health care programs and insurance plans.
The AMA noted that the proposal perverts the nondiscrimination provisions included in the Affordable Care Act by drastically limiting coverage protections despite decades of case law recognizing these protections. The letter said: “This proposal marks the rare occasion in which a federal agency seeks to remove civil rights protections. It legitimizes unequal treatment of patients by not only providers, health care organizations, and insurers, but also by the government itself—and it will harm patients. Such policy should not be permitted by the U.S. government, let alone proposed by it.” The letter concludes: “HHS should not finalize the proposed rule, but rather should redirect their efforts toward advancing health care access and equity for all. The AMA remains ready to assist with such efforts.”
The full text of the letter can be downloaded here.
Garfunkel Wild Offers Discount to MSSNY Members for Nov. Symposium in NYC
Garfunkel Wild is pleased to offer a discount to members of the Medical Society of the State of New York to attend Garfunkel Wild’s 6th Annual ASC and Healthcare Management Symposium on November 1, 2019 in NYC. This has been a highly successful program and over the years it has grown in content, attendees and sponsors. The agenda includes speakers from New York, Connecticut and New Jersey who will present timely and important topics that should be of great interest to your members.
Please see the attached flyer which we hope you can market to your members. Please note this discount (off the normal $350 registration fee) is only effective until September 15, 2019.
Medical Groups Raise Outcry Over New Immigration Rule
The Trump Administration’s new “public charge” rule released Monday could keep noncitizen immigrants from seeking necessary medical care, according to healthcare experts.
Under the rule (clocking in at 837 pages), immigrants’ financial status and past use of public assistance programs will be taken into account in deciding whether to approve applications for permanent residency (“green cards”) and visa renewals. Those with low incomes or little education, and who have used benefits such as Medicaid, food stamps, and housing vouchers, may be turned down because they’d be seen as more likely to need future government assistance.
The rule quickly came under attack.
“Today’s changes to how ‘public charges’ are classified will discourage noncitizen immigrants from seeking the care and other services they need and to which they are legally entitled,” said David Skorton, MD, president and CEO of the Association of American Medical Colleges.
The administration’s actions could worsen health disparities, Skorton said: “The consequences of this action will be to potentially exacerbate illnesses and increase the costs of care when their condition becomes too severe to ignore.”
The final rule expands the definition of “public charge” to include the use of non-cash programs that previously had been excluded, according to Samantha Artiga, director of the Disparities Policy Project for the Kaiser Family Foundation. Even before the rule was finalized, Artiga said anecdotal reports came from providers that immigrant families were not enrolling in certain public programs, despite being eligible. Providers said they also noticed women dropping out from the Women Infants and Children (WIC) supplemental nutrition program, even though that program isn’t included under the rule, she noted.
According to Ken Cuccinelli, acting director of the U.S. Citizenship and Immigration Services (USCIS), during a press briefing Monday, Cuccinelli said “self-reliance” has been a “core principle” of America for decades. He said his family came to the U.S. from Italy and “worked together to ensure that they could provide for their own needs and they never expected the government to do it for them.”
Public benefits that are part of the rule would include “general assistance,” such as supplemental security income, Supplemental Nutrition Assistance Program (SNAP, a.k.a. food stamps), most forms of Medicaid, and certain subsidized housing programs…The rule will apply prospectively to applications and petitions received starting on Oct. 15, 2019 of this year, Cuccinelli noted.
“Make no mistake — this rule is a threat to the health of immigrant children and families,” said Mark Del Monte, JD, CEO and interim executive vice president for the American Academy of Pediatrics. “The rule considers the use of public programs like Medicaid, SNAP, and housing assistance in this definition, forcing immigrant families into an impossible choice: keep your family healthy but risk being separated, or forgo vital services so your family can remain together in this country. This is really not a choice at all,” Del Monte said.
“The public charge rule further intimidates these families and expands on the chilling effects pediatricians have seen across the country ever since the proposed rule was issued, with families disenrolling from or avoiding critical health programs and services they are eligible for,” Del Monte added. (Medpage, August 12)
How Anthem, UnitedHealth + 4 Other Payers Fared in Q2
Anthem, Centene, Cigna, Humana and UnitedHealth Group all reported higher profits in the second quarter of fiscal year 2019, while Molina Healthcare saw profits decline.
Here’s how the six payers fared in the three-month period ended June 30:
- Anthem reported total revenues of $25.5 billion, up 11 percent from $22.9 billion recorded in the same period a year prior. Anthem ended the second quarter with a $1.1 billion profit, up 8.1 percent year over year.
- Centene posted total revenues of $18.4 billion in the second quarter of this year, up 29.4 percent from $14.2 billion reported in the same period last year. Centene ended the quarter with a $495 million profit, up 65 percent from $300 million reported in the same period in 2018.
- Cigna saw its total revenues climb 238 percent year over year to $38.8 billion, compared to $11.5 billion in the year prior. Cigna ended the second quarter with net income of $1.4 billion, compared to $808 million reported in the same period a year prior.
- Humana saw its total revenues climb to $16.2 billion, up 13.9 percent from $14.3 billion recorded in the same period a year prior. The payer boosted its net income 387 percent in the second quarter of this year to $940 million, up from $193 million in the same period a year prior.
- Molina Healthcare‘s total revenue fell 14.1 percent to $4.2 billion, compared to $4.9 billion in the same quarter a year prior. Molina ended the quarter with net income of $196 million, down 3 percent from $202 million reported in the same period a year prior.
6. UnitedHealth Group recorded total revenues of $60.6 billion, up 8 percent from $56.1 billion in the same quarter a year prior. After accounting for expenses, UnitedHealth ended the second quarter with net income of $3.3 billion, up 12.7 percent from $2.9 billion recorded in the same quarter of 2018. (Becker’s Payer Issues, Aug. 13)
21 companies affected by AMCA breach
Three more health care companies have notified patients that their personal information might have been exposed in a data breach at the American Medical Collection Agency. The companies’ announcements bring the total number of health care companies known to have been affected by the data breach to 21, and the total number of patients potentially affected by the breach to at least 24.4 million. (HIPAA Journal, 8/8)
Physicians Invited to DoctHERS 4th Annual Symposium in Buffalo on 9/21
The Jacobs School of Medicine and Biomedical Sciences’ Medical Alumni Association is proud to present the 4th Annual DoctHERS Symposium.
When; Saturday, September 21, 2019
What time? 8:00 a.m. – 12:00 p.m.
Where? The Westin Buffalo, 250 Delaware Avenue, Buffalo, NY 14202
Cost: $25 general admissions; students and residents are free
Join us for a morning of networking, information, enrichment and resources for pay, promotions and equity in the workplace and support for females in the healthcare profession.
Dr. Rose Berkun, Co-Chair of MSSNYPAC, is the Chair of DoctHERS and is a Clinical Assistant Professor of Anesthesiology Jacobs School of Medicine and Biomedical Sciences.
2019 Symposium Registration
Registration is now open or the 2019 DoctHERS Symposium!
Susan R. Bailey, MD
President-Elect, American Medical Association
Allergist in private practice, Fort Worth, TX
Distinguished Fellow of the American College of
Allergy, Asthma, and Immunology
Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
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Rental includes: two consultation rooms, private office, private bathroom. Common waiting room, back office filing space and reception desks included. Affordable rent. Location East 60s between Park and Lexington. Easy distance to Lenox Hill Hospital and New York Cornell. Subway access within 1 block. Immediate occupancy available. Call James: 917-710-7643
Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter. Four new exam rooms and dictation room. New stainless and granite kitchenette. State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards. Digital X-ray room with PACS in each exam room available as an option. Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855; Please see our listing: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/
Office Rental 30 Central Park South
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Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.
Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.
We have openings in the following counties offering a choice of urban, suburban or rural living:
Clinton* Clinton Correctional Facility (sporting and recreational outlets)
Dutchess Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin* Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene* Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca* Five Points Correctional Facility (heart of wine country)
St. Lawrence Riverview Correctional Facility (hiking, boating and museums)
Washington Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.
Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review. We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: firstname.lastname@example.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355