COVID-19 Update – March 31


MSSNY Urges NY State Legislature to Reject Problematic Proposals Advanced by the Medicaid Redesign Team

Statement attributable to:
Art Fougner, MD

President, Medical Society of the State of New York

“As the Legislature and Governor work to finalize a State Budget in the next 2 days amid the extraordinary crisis we are facing in our health care system right now due to the coronavirus outbreak, we strongly urge the State Legislature to reject problematic proposals that had been advanced by the Medicaid Redesign Team.

“These problematic proposals include imposing enormous new costs on the nearly 17,000 physicians participating in the Excess Medical Malpractice Insurance Program, and changes to scope of practice for numerous health care practitioners including nurse anesthetists, pharmacists and nurse practitioners.  The Excess program provides a critical additional layer of malpractice insurance for New York physicians who already incur the highest liability costs in the country.

“While we realize that the COVID-19 pandemic requires an ‘all hands-on deck’ approach, we would also urge that the temporary changes to the scopes of practices of numerous health care practitioners revert to the previous status as soon as possible. It is imperative to maintain stability as well as patient safety in our health care system as we manage this current crisis and its aftermath.”


Gov. Asking Hospitals to Adopt “Statewide “Approach” to Optimize Capacity
New York is asking hospitals to adopt a statewide approach to the coronavirus pandemic to prevent overcrowding, staffing strains and equipment shortages seen at New York City facilities in recent days. Gov. Andrew Cuomo, who previewed the coordinated approach on Monday, said he has asked private and public hospitals across New York to share staff, patient loads and medical equipment so the state can optimize its capacity to respond to the virus before it reaches its apex in the coming weeks.

The coordinated effort will initially send nurses, doctors and other medical professionals from upstate facilities to New York City, which has become the new epicenter for Covid-19, Cuomo said. It will also allow for transfers of patients, staff and supplies among all hospitals in the state, as well as new temporary federal health facilities. The governor said the state Department of Health will lead a central coordinating team with Westchester, New York City and Long Island hospitals, as well as the Greater New York Hospital Association and Healthcare Association of New York State.


Gov. Announces 60-Day Deferment for Malpractice Payments
Governor Cuomo announced on Friday that, for a 60-day period, consumers and small businesses experiencing financial hardship due to COVID-19 may defer paying premiums for property and casualty insurance, including medical malpractice, auto, homeowners, renters and workers compensation. No late fees will be assessed and no negative data will be reported to credit bureaus during this time, and late payments will be payable over a one-year period. https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-completion-first-1000-bed-temporary


13 NY Medical Schools Allow Early Graduation during Pandemic
Thirteen medical schools in New York state intend to allow students to graduate early to join the fight against COVID-19, the disease caused by the novel coronavirus, Associated Medical Schools of New York President and CEO Jo Wiederhorn told The Wall Street Journal.

The medical schools in New York City, Long Island and Westchester County include New York University’s medical school, which is allowing students to graduate a few months early to begin working in NYU’s internal medicine or emergency medicine departments amid the pandemic.

They also include Valhalla-based New York Medical College, one of the nation’s largest private health sciences colleges. For the past month, Chancellor and CEO Edward Halperin, MD, has been in contact with hospital and health officials, and more than 400 New York Medical College students have been placed at local facilities, such as Westchester Medical Center, the Journal reported.

“Any good doctor learns really fast when you get thrown into a situation,” Dr. Halperin told the newspaper. “Would it have been better if they had more time? Yes. But extraordinary times call for extraordinary solutions.” (Becker’s Hospital, March 31)


NYS DOH: Physicians, Take these Precautions
Based on the NYS Department of Health webinar on March 13, 2020 physicians should take the following precautions:

  • Triage patients over the phone or via telehealth so that your office can be prepared and avoid exposure to other patients, it is also recommended that you suspend walk-ins. Please be aware, as noted below, that the NYS DFS and DOH have taken a number of steps to ensure that physicians will be paid for telehealth and telephone visits with patients.
  • Advise any patient to self-quarantine/self-isolate until COVID-19 is ruled out. Patients who have been exposed to the virus or traveled to affected international locations must continue quarantine for 14 days even if their test is negative.
  • Notify the county health Department of any patient you advise to self-quarantine, even if the patient is considered low risk. A list of county health departments can be found at: https://www.health.ny.gov/contact/contact_information/ For location of testing sites, please contact the county department of health.
  • Keep plenty of ear-loop face masks on hand for physicians and staff. If you need more masks or other PPE equipment in response to COVID-19, please contact your county Emergency Management Office (EMO) and indicate that you are having difficulty obtaining PPE and request their assistance in acquiring these items.

CMS Adds 85 More Medicare Services Covered under Telehealth
CMS on March 30 issued various regulatory changes to further support hospitals’, physicians’ and other healthcare organizations’ capabilities during the COVID-19 pandemic, including expanding Medicare coverage of telehealth visits.

On March 17, the Trump administration announced CMS will temporarily pay clinicians to provide telehealth services for beneficiaries during the pandemic. CMS is now expanding Medicare coverage of 85 additional services provided via telehealth, including emergency department visits and initial nursing facility and discharge visits.

Here are the 85 additional services, and their respective codes, that CMS will cover when provided via telehealth through the duration of the pandemic:

  1. 77427: radiation management
    2. 90853: group psychotherapy
    3. 90953: end stage renal disease, one visit per month, ages 2 and younger
    4. 90959: end stage renal disease, one visit per month, ages 12-19
    5. 90962: end stage renal disease, one visit per month, ages 20 and older
    6. 92057: speech/hearing therapy
    7. 92521: evaluation of speech fluency
    8. 92522: evaluation speech production
    9. 92523: speech sound language comprehension
    10. 92524: behavioral quality voice analysis
    11. 96130: psychological test evaluation phys/qhp 1st
    12. 96131: psychological test evaluation phys/qhp ea
    13. 96132: neuropsychological testing evaluation phys/qhp 1st
    14. 96133: neuropsychological testing evaluation phys/qhp ea
    15. 96136: psychological and neurological testing phy/qhp 1s
    16. 96137: psychological and neurological testing phy/qhp ea
    17. 96138: psychological and neurological tech phy/qhp ea
    18. 96139: psychological and neurological testing tech ea
    19. 97110: therapeutic exercises
    20. 97112: neuromuscular re-education
    21. 97116: gait training therapy
    22. 97161: physical therapy evaluation low complexity, 20 min
    23. 97162: physical therapy evaluation moderate complexity, 30 min
    24. 97163: physical therapy evaluation high complexity, 45 min
    25. 97164: physical therapy re-evaluation establish plan care
    26. 97165: occupational therapy evaluation low complexity, 30 min
    27. 97166: occupational therapy evaluation moderate complexity, 45 min
    28. 97167: occupational therapy evaluation high complexity, 60 min
    29. 97168: occupational therapy re-evaluation establish plan care
    30. 97535: self care management training
    31. 97750: physical performance test
    32. 97755: assistive technology assessment
    33. 97760: orthotic management and training 1st en
    34. 97761: prosthetic training 1st enc
    35. 99217: observation care discharge
    36. 99218: initial observation care
    37. 99219: initial observation care
    38. 99220: initial observation care
    39. 99221: initial hospital care
    40. 99222: initial hospital care
    41. 99223: initial hospital care
    42. 99234: observation/hospital same date
    43. 99235: observation/hospital same date
    44. 99236: observation/hospital same date
    45. 99238: hospital discharge day
    46. 99239: hospital discharge day
    47. 99281: emergency department visit
    48. 99282: emergency department visit
    49. 99283: emergency department visit
    50. 99284: emergency department visit
    51. 99285: emergency department visit
    52. 99291: critical care first hour
    53. 99292: critical care additional 30 mins
    54. 99304: nursing facility care initial
    55. 99305: nursing facility care initial
    56. 99306: nursing facility care initial
    57. 99315: nursing facility discharge day
    58. 99316: nursing facility discharge day
    59. 99327: domiciliary or rest home visit new patient
    60. 99328: domiciliary or rest home visit new patient
    61. 99334: domiciliary or rest home visit established patient
    62. 99335: domiciliary or rest home visit established patient
    63. 99336: domiciliary or rest home visit established patient
    64. 99337: domiciliary or rest home visit established patient
    65. 99341: home visit new patient
    66. 99342: home visit new patient
    67. 99343: home visit new patient
    68. 99344: home visit new patient
    69. 99345: home visit new patient
    70. 99347: home visit established patient
    71. 99348: home visit established patient
    72. 99349: home visit established patient
    73. 99350: home visit established patient
    74. 99468: neonatal critical care initial
    75. 99469: neonatal critical care subsequent
    76. 99471: pediatric critical care initial
    77. 99472: pediatric critical care subsequent
    78. 99473: self measurement of blood pressure at home education/training
    79. 99475: pediatric critical care ages 2-5 initial
    80. 99476: pediatric critical care ages 2-5 subsequent
    81. 99477: initial day of hospital care for neonatal care
    82. 99478: ic low-birthweight infant < 1500 gm subsequent
    83. 99479: ic low-birthweight infant < 1500-2500 g subsequent
    84. 99480: ic infant pbw 2501-5000 g subsequent
    85. 99483: assessment and care plan cognitive impairment

Click here to view the full list of services payable under Medicare when provided via telehealth. (Becker’s Hospital Review, March 31)


Stakeholders on Budget Watch After Medicaid Redesign Proposals
As health care providers, insurers and advocates await Gov. Andrew Cuomo’s budget, concerns over Medicaid redesign recommendations may be more heightened than ever.

Though long-term care is slated for the largest number of potential cuts—$715 million—physicians and community health centers are among the groups concerned.

Dr. Art Fougner, president of the Medical Society of the State of New York, said in a statement that, as the Legislature and the governor work to finalize a budget during the Covid-19 pandemic, the society urges them to “reject problematic proposals” advanced by the Medicaid redesign team. insurance for local physicians who incur high liability costs compared to the rest of the country.

“It is imperative to maintain stability as well as patient safety in our health care system as we manage this current crisis and its aftermath,” Fougner said.

Community health centers are also concerned. They say the Medicaid redesign recommendation—valued at $125 million in savings—that would shift the Medicaid pharmacy benefit from managed care to fee for service would result in a loss of 340b rebate revenue to community health centers and hospitals.

As for long-term care providers and advocates, their message has gotten even stronger during the coronavirus outbreak.

Bryan O’Malley, executive director of the Consumer Directed Personal Assistance Association of New York State, told Crain’s he thinks the cuts make even less sense now than they did just weeks ago.

The scope of the cuts—in combination with elderly and disabled enrollees facing long-term isolation due to Covid-19—is “appalling and devastating,” he said. (Crain’s Pulse 3/1)


Emergency Adoption of Amendment to 12 NYCRR 355.9 making a COVID-19 Diagnosis a Serious Health Condition
The Chair of NYS Workers Compensation Board announced the the board has adopted, on an emergency basis, an amendment to clarify that employees may take family leave to care for a family member diagnosed with the COVID-19 virus. The amendment is to section 355.9 of Title 12 NYCRR. A Notice of Emergency Adoption will be published in the April 15, 2020 edition of the State Register. This emergency rulemaking is effective for 90 days upon filing March 27, 2020. (March 31, 2020)


Small Business & Non-Profit Relief | Rep. Joseph Morelle
If you are a government contractor, there are a number of ways that Congress has provided relief and protection for your business. Agencies will be able to modify terms and conditions of a contract and to reimburse contractors at a billing rate of up to 40 hours per week of any paid leave, including sick leave. https://morelle.house.gov/coronavirus/smallbusiness


CAIPA Foundation “CAIPA Task Force on COVID-19” Donation and Supplies Drive
CAIPA, CAIPA MSO and CAIPAFoundation greatly appreciate your support and donations during this challenging time.

The Task Force Committee and Leadership sincerely ask for your continued support to this donation drive effort due to the increasing and pressing needs of our frontline healthcare providers.  For your information, in the past weeks, we have already delivered protective supplies to our partner hospitals, including NY Presbyterian-Queen, NYU Langone Brooklyn, Maimonides Medical Center, Northwell Health, Stony Brook University Hospital, NYP-Brooklyn Methodist Hospital, The Brooklyn Hospital Center and Interfaith Hospital to help ease the needs of our frontline heroes who are fighting COVID-19 for our communities.

We want to assure you that the monetary donations and protective suppliers received will be put to the best use for our partner hospitals in the communities throughout the city, which we jointly take good care of our patient population. The money and supplies will also be used to support CAIPA’s initiatives in assisting our staff and provider-members in our fight against COVID-19.

CAIPA has dedicated a webpage, “CAIPA Task Force on COVID-19”, on CAIPA.net , where you can see our weekly update, media activities, donation report, educational materials, and resources to keep you, our providers and community posted on the progress and milestones that we achieved so far on this campaign. 

FOR MONETARY DONATIONS:

Please kindly make check payable to:
CAIPA FOUNDATION, INC.
202 CANAL ST STE 500
NEW YORK, NY 10013

Or use PAYPAL and pay to acct@caipa.net.

FOR PROTECTIVE SUPPLIES:

Please kindly contact Task Force Project Lead Lisha Xiang at lxiang@caipa.net,  who will make arrangements to be delivered to the following locations:

·                Manhattan: 202 Canal St., Suite 500, New York, NY 10013 (entrance on Mulberry St.)
·                Brooklyn: 5721 6th Ave., Brooklyn, NY 11220
·                Queens: 136-33 37th Ave., Flushing, NY 11354

Thank you again for your support and commitment to this meaningful cause.


AMA summary of the CARES Act
Small businesses, including physician practices, with no more than 500 employees are eligible to apply for the Small Business Administration’s (SBA) section 7(a) Payroll Protection Program. The AMA is in the process of developing more in-depth resources for physicians on Medicare advance payments, SBA loans, and medical liability that will be available soon. The attached summary is available online at: https://www.ama-assn.org/system/files/2020-03/summary-H.R.%20748-cares-act.pdf.

Andrew Saul, Commissioner of Social Security, reminds the public that Social Security and Supplemental Security Income (SSI) benefit payments will continue to be paid on time during the COVID-19 pandemic.  The agency also reminds everyone to be aware of scammers who try to take advantage of the pandemic to trick people into providing personal information or payment via retail gift cards, wire transfers, internet currency, or by mailing cash, to maintain Social Security benefit payments or receive economic impact payments from the Department of the Treasury.

For more information, please visit https://www.ssa.gov/news/press/releases/.

MSSNY Urges NY State Legislature to Reject Problematic Proposals Advanced by the Medicaid Redesign Team


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

For Immediate Release
March 30, 2020

MSSNY Urges NY State Legislature to Reject Problematic Proposals Advanced by the Medicaid Redesign Team

Statement attributable to:
Art Fougner, MD
President, Medical Society of the State of New York

“As the Legislature and Governor work to finalize a State Budget in the next 2 days amid the extraordinary crisis we are facing in our health care system right now due to the coronavirus outbreak, we strongly urge the State Legislature to reject problematic proposals that had been advanced by the Medicaid Redesign Team.

“These problematic proposals include imposing enormous new costs on the nearly 17,000 physicians participating in the Excess Medical Malpractice Insurance Program, and changes to scope of practice for numerous health care practitioners including nurse anesthetists, pharmacists and nurse practitioners.  The Excess program provides a critical additional layer of malpractice insurance for New York physicians who already incur the highest liability costs in the country.

“While we realize that the COVID-19 pandemic requires an ‘all hands on deck approach’, we would also urge that the temporary changes to the scopes of practices of numerous health care practitioners revert to the previous status as soon as possible. It is imperative to maintain stability as well as patient safety in our health care system as we manage this current crisis and its aftermath.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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COVID-19 Economics

Emergency SBA Financing: CARES Act


With $349 Billion in Emergency Small Business Capital Cleared, SBA and Treasury Begin Unprecedented Public-Private Mobilization Effort to Distribute Funds


Social Security Benefits Will be Paid on Time and Other Updates Related to the COVID-19 Pandemic


Stimulus Package Passed by Congress Provided Several Programs to Aid Physicians Through this Crisis
As reported in an AMA summary of the $ 2 trillion stimulus package enacted into law last Friday, here are some of the key provisions to benefit physicians:

Small business loans. Small businesses, including physician practices, with no more than 500 employees are eligible to apply for the Small Business Administration’s (SBA) section 7(a) Payroll Protection Program. For more information how physicians can access this program, click here.

This allows a small business to apply to an SBA-approved lender for a loan of up to 250% of the business’ average monthly payroll costs to cover 8 weeks of payroll as well as help with other expenses like rent, mortgage payments, and utilities. The maximum loan amount is $10 million. Sole-proprietors, independent contractors, and other self-employed individuals are eligible.

A loan can be forgiven based on maintaining employee and salary levels. For any portion of the loan that is not forgiven, the terms include a maximum term of 10 years, a maximum interest rate of four percent. Small businesses and organizations will be able to apply if they were harmed by COVID-19 between February 15, 2020 and June 30, 2020. This program is retroactive to February 15, 2020andare available through June 30, 2020.

Emergency loans.  Moreover, there was also Authorization for $10 billion in “emergency” Economic Injury Disaster Loan (EIDL) to eligible entities with not more than 500 employees. Allows an eligible entity that has applied for an EIDL loan to request an advance on that loan, of not more than $10,000, which the SBA must distribute within 3 days. Advance payments may be used for providing paid sick leave to employees, maintaining payroll, meeting increased costs to obtain materials, making rent or mortgage payments, and repaying obligations that cannot be met due to revenue losses

Financial support for hospitals, physicians, and others. Provides $100 billion through the Public Health and Social Services Emergency Fund to provide immediate financial relief by covering non-reimbursable expenses attributable to COVID-19. Health care entities, including physician practices, that provide health care, diagnoses, or testing are eligible. Non-reimbursable expenses attributable to COVID-19 qualify for funding.

Examples include increased staffing or training, personal protective equipment, and lost revenue. HHS is instructed to review applications and make payments on a rolling basis to get money into the health system as quickly as possible. HHS is given significant flexibility in determining how the funds are allocated and is expected to release guidance on the application process shortly.


Business Loan Forgiveness Included in CARES Act
Within the Coronavirus Aid, Recovery and Economic Security (CARES) Act that President Trump signed yesterday is a $350 billion Paycheck Protection Program that will allow businesses and nonprofits with fewer than 500 employees to apply for loans up to $10 million each to cover losses caused by the COVID-19 pandemic. 

What makes this relief even more significant is the possibility for loan forgiveness, which is available to employers who retain their workforce levels through the crisis. If you follow the guidelines carefully, you can essentially convert your business loan to a grant – even if you’ve already laid off employees.

Loan Forgiveness Requirements

Loans may be forgiven if businesses use the money to pay for payroll costs, salaries, benefits, mortgage interest, rent and/or utilities.  The forgiven amount would be equal to the amount actually paid for these expenses during the eight weeks following disbursement of the loan. Additional wages paid to tipped employees under Section 3(m)(2)(A) of the Fair Labor Standard Acts may also be forgiven.

Forgiveness will be scaled back if the business has a reduction in employees, salaries or wages. Reductions in workforce, salaries and wages that occur from February 15, 2020 to April 26, 2020 will be disregarded for purposes of reducing the forgiveness amount, as long as the reductions are eliminated by June 30, 2020.

For purposes of the loan forgiveness, a reduction in workforce and salary or wages will be calculated as follows:

  • Workforce reductions will be calculated by the initial forgiven amount multiplied by the quotient of average full-time equivalents (FTEs) during the eight-week period, divided by the average FTEs for the period from February 15, 2019 through June 30, 2019 or January 1, 2020 through February 29, 2020, as determined by the loan recipient.
  • Salary or wage reductions will be determined by the amount of any salary or wage decrease in excess of 25 percent of the total salary or wages during the most recent full quarter such employee was employed before the eight-week period. Only employees who did not receive, during any single pay period during 2019, wages or salary at an annualized rate of pay in excess of $100,000 are included in this calculation.

Advance Medicare Payments to Help Physicians Through this Period
Moreover, CMS announced over the weekend a process for physicians to receive 100% of predicted Medicare payments for a 3-month period ( Fact Sheet: Advanced Payment Program During COVID-19 Emergency).  Here is a recommended process for applying for these advanced payments shared with MSSNY by a medical practice, as well as some of the particulars of this program:
Process:

1. Go to your National Government Services (NGS) website and fill in, sign, and submit an Accelerated / Advance Payment request form for your practice.

2. Can request up to 100% of Medicare payment for a 3-month period.

3. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

3. State that the request is for an accelerated/advance payment due to the COVID-19 pandemic

4. Will receive payment within 7 calendar days from the request.

5. Recoupment will begin 120 days after payment issuance date.

 Eligibility:

1.     Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,

2.     Not be in bankruptcy,

3.     Not be under active medical review or program integrity investigation, and

4.     Not have any outstanding delinquent Medicare overpayments.

For further information, contact Regina McNally, VP of MSSNY’s Socio-Economic

Division at 516-488-6100 ext.332 or email rmcnally@mssny.org.


Request for Accelerated/Advance Payment


 

 

 

 

 

 

 

 

 

 

 

 

 

COVID-19 Update March 30, 2020


.
March 30 is National Doctors Day: We Salute Our Physicians Today and Everyday

Thank You flyer to doctors

Today, National Doctors Day, we take a moment to salute our physician heroes for their tireless commitment to the health of all New Yorkers. We are especially proud of our physicians during this time of national crisis, but heroes–our physicians–need support.

From what we are hearing from the front, in order to do the job that they’re being called on to do, physicians require the necessary equipment, especially the recommended Personal Protective Equipment (PPE) to continue to serve our patients in need. Please take a moment to remember those who risk it all to take care of you.

New Yorkers are all stronger together.

Art Fougner, MD
MSSNY President


Latest New York Coronavirus Statistics

  • 59,513– People who have tested positive for coronavirus in New York, as of March 29.
  • 57% – The percentage of those positive tests – 33,768 – in New York City.
  • 143,532 – The number of positive tests for coronavirus across the United States, as of March 30. 42% of U.S. cases are in New York.
  • 965 – The number of people who have died of coronavirus in New York state, as of the morning of March 29. The New York Times, compiling city and state figures, reported that the death toll now exceeds 1,000 in New York state.
  • 50% – The percentage of victims, at least in New York City, who are 75 years old or older.
  • 6,481– The number of people hospitalized for COVID-19 in New York, as of March 27. 1,583 of them are in the intensive car unit.
  • 140,000 – The number of hospital beds Cuomo expects New York will need at the apex of COVID-19 in the state. As of March 27, the state had a capacity of just 53,000.
  • 50% – How much Cuomo is mandating hospitals to increase their capacity – and asking them to go further, increasing capacity by 100% and doubling the number of hospital beds available.
  • 30,000 – How many ventilators Cuomo says New York will need at the apex of COVID-19, with 15,000 just for New York City.
  • 400 – The amount of ventilators the federal government, through FEMA, sent to New York on March 24. After complaints, the government sent 4,000 more.
  • 76,000 – The number of health care workers – including retirees and students – who have signed up to volunteer as part of New York’s surge health care workforce, as of March 29.
  • $1 billion – How much the New York state government had spent fighting coronavirus, as of March 25, with Cuomo expecting to spend “several billion dollars when we’re done.”

Stimulus Package Passed by Congress Provided Several Programs to Aid Physicians Through this Crisis
As reported in an AMA summary of the $ 2 trillion stimulus package enacted into law last Friday, here are some of the key provisions to benefit physicians:

Small business loans. Small businesses, including physician practices, with no more than 500 employees are eligible to apply for the Small Business Administration’s (SBA) section 7(a) Payroll Protection Program. For more information how physicians can access this program, click here.

This allows a small business to apply to an SBA-approved lender for a loan of up to 250% of the business’ average monthly payroll costs to cover 8 weeks of payroll as well as help with other expenses like rent, mortgage payments, and utilities. The maximum loan amount is $10 million. Sole-proprietors, independent contractors, and other self-employed individuals are eligible.

A loan can be forgiven based on maintaining employee and salary levels. For any portion of the loan that is not forgiven, the terms include a maximum term of 10 years, a maximum interest rate of four percent. Small businesses and organizations will be able to apply if they were harmed by COVID-19 between February 15, 2020 and June 30, 2020. This program is retroactive to February 15, 2020andare available through June 30, 2020.

Emergency loans.  Moreover, there was also Authorization for $10 billion in “emergency” Economic Injury Disaster Loan (EIDL) to eligible entities with not more than 500 employees. Allows an eligible entity that has applied for an EIDL loan to request an advance on that loan, of not more than $10,000, which the SBA must distribute within 3 days. Advance payments may be used for providing paid sick leave to employees, maintaining payroll, meeting increased costs to obtain materials, making rent or mortgage payments, and repaying obligations that cannot be met due to revenue losses

Financial support for hospitals, physicians, and others. Provides $100 billion through the Public Health and Social Services Emergency Fund to provide immediate financial relief by covering non-reimbursable expenses attributable to COVID-19. Health care entities, including physician practices, that provide health care, diagnoses, or testing are eligible. Non-reimbursable expenses attributable to COVID-19 qualify for funding.

Examples include increased staffing or training, personal protective equipment, and lost revenue. HHS is instructed to review applications and make payments on a rolling basis to get money into the health system as quickly as possible. HHS is given significant flexibility in determining how the funds are allocated and is expected to release guidance on the application process shortly.


Advance Medicare Payments to Help Physicians Through this Period
Moreover, CMS announced over the weekend a process for physicians to receive 100% of predicted Medicare payments for a 3-month period (Fact Sheet: Advanced Payment Program During COVID-19 Emergency).  Here is a recommended process for applying for these advanced payments shared with MSSNY by a medical practice, as well as some of the particulars of this program:
Process:

1. Go to your National Government Services (NGS) website and fill in, sign, and submit an Accelerated / Advance Payment request form for your practice.

2. Can request up to 100% of Medicare payment for a 3-month period.

3. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

3. State that the request is for an accelerated/advance payment due to the COVID-19 pandemic

4. Will receive payment within 7 calendar days from the request.

5. Recoupment will begin 120 days after payment issuance date.

 Eligibility:

1.     Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,

2.     Not be in bankruptcy,

3.     Not be under active medical review or program integrity investigation, and

4.     Not have any outstanding delinquent Medicare overpayments.

For further information, contact Regina McNally, VP of MSSNY’s Socio-Economic

Division at 516-488-6100 ext.332 or email rmcnally@mssny.org.

 

MSSNYeNews: What Matters – March 27, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 27, 2020

Vol. 23  Number 13



MSSNYPAC Seal

 


Colleagues:

In the midst of pandemics, budget battles, regulations, legislation, resolutions, reality has the nasty habit of jumping into the mix like a collection notice from a bill long since forgotten. Never easy, certainly never pleasant, but there it is. Life told me to pass on its very hard lesson so here goes. Don’t worry, I will keep it short.

We are all here for a blink of the cosmic eye. We live, we laugh, we cry, we dance and then we are gone.

Embrace those around you. Friends and enemies are but two sides of the same coin. What’s important are family, colleagues, and yes, our patients. Everything else is just so much of life’s gift-wrapping – pretty but soon discarded. Embrace those around you – albeit virtually in the Age of Coronavirus – but embrace nonetheless. Remember that it’s what matters that truly matters.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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CORONAVIRUS UPDATE

The state reports 44,635 confirmed cases and 519 deaths statewide, as of Friday morning, including 25,398 cases in New York City, 7,187 in Westchester County, 4,657 in Nassau County, 3,385 in Suffolk County, 1,457 in Rockland County, 910 in Orange County, 225 in Dutchess County, 219 in Erie County, 187 in Albany County, and 160 in Monroe County.
Coronavirus COVID-19 Global Cases by Center for Systems Science & Engineering at Johns Hopkins University


Main Points from Governor Cuomo’s On-going Announcements:

  • Extending the school closures until April 15th, as well as the 180-day mandate waiver.
    – Continuation of distance learning.
  • Additional bed sites / requesting temp hospital from FEMA, 4,000 more over 4 sites:
    – Bronx: NY Expo Center
    – Queens: Aqueduct
    – Brooklyn: Brooklyn Cruise Terminal
    – Staten Island: College of Staten Island
  • Looking at CUNY City College and CUNY Queens College as additional site
  • Looking at Marriott Brooklyn Bridge and Brooklyn Center Nursing Home as additional sites.
  • For a 60-day period, consumers and small businesses experiencing financial hardship due to COVID-19 may defer paying premiums for property and casualty insurance, including auto, homeowners, renters, workers comp, medical malpractice, livery and taxi. No late fees will be assessed and no negative data will be reported to credit bureaus during this time, and late payments will be payable over a one-year period.

NYS Asks Physicians to Volunteer During COVID-19 Pandemic
Governor Andrew Cuomo and the New York State Department of Health is requesting that physicians and other health care providers volunteer during the COVID-19 pandemic. Many MSSNY physicians have inquired about the process and the NYS Department of Health is coordinating volunteers for this effort.  All physicians, even retired physicians, must go through this portal.

There are a series of questions that are asked regarding name, specialties and certification, age, county of residency.  By completing the form, DOH and SED will check that your credentials are up to date and, if needed, recertify the physician.  Out of state physicians and health care providers should also use this portal.  Earlier this week the governor announced civil liability immunity protections for physicians and other health care practitioners in responding to the state’s COVID-19 outbreak.

According to officials from the NYS Department of Health, retired physicians and other health care providers will most likely be redirected to care for patients that are not afflicted with COVID-19.  Activation will be from either the New York State Health Department or the local county health department.

The Department of Health developed the ServNY volunteer registry in partnership with county health departments, the New York City Department of Health and Mental Hygiene, the Medical Society of the State of New York, hospital associations, and other medical professional organizations. Physicians can volunteer through their Health Commerce System Account by going to the ServNY portal at: go to www.health.ny.gov/ServNY

The registry, established in the aftermath of the 9/11 terrorist attacks, is currently used by all local health departments and Medical Reserve Corps for management of volunteer programs.

As New York state climbs the steep face of its COVID-19 curve, Gov. Andrew Cuomo (D) issued an executive order vastly widening the scope of practice for some healthcare providers and absolving physicians of certain risks and responsibilities.

Among the order’s provisions:

  • Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
  • Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
  • Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
  • Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
  • Granting providers immunity from civil liability for injury or death
  • Suspending usual record-keeping requirements
  • Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
  • Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries

The order, which remains in place through at least April 22, was met mostly with applause, though with some hesitation around work-hour limits. (MedPage, March 27)


What’s in Stimulus Package: Provisions of Interest to Physicians
Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. House passage is expected on Friday and the President is expected to sign the bill into law.

Provisions of particular interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
  • Suspension of the 2% Medicare sequester in May through December 2020.
  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.
  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
  • Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

Also of interest, the “health extenders” package that was set to expire on May 22 has now been extended to Nov. 30. For a complete summary once the bill is signed into law, visit the AMA COVID-19 website.


WEBINARS

Registration Now Open “Psychosocial Dimensions of Infectious Outbreaks” WEBINAR

April 1st @ 7:30am
REGISTRATION NOW OPEN HERE 

MSSNY’s has expedited the presentation of the next Medical Matters webinar “Psychosocial Dimensions of Infectious Outbreaks” on Wednesday April 1st at 7:30am.  This program provides physicians with vital information to care for patients, staff, family and themselves during this unprecedented pandemic. 

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

  • Understand common human reactions to infectious outbreaks
  •  Explore factors that influence how people react
  • Describe how to apply historical lessons to your own medical practice

This program is a companion piece to the March 18th coronavirus webinar, Coronaviruses 2020: COVID-19 An Evolving Story.  You can go to the MSSNY CME website https://cme.mssny.org to view this and many other free CME webinars that are particularly relevant to the current pandemic situation. 

Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

You can also listen to the podcasts MSSNY has produced about COVID-19 by clicking on the links below:

The Psychosocial Impact of COVID-9
Physician Information on COVID-19
Patient Information on COVID-19

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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.


Navigating A Murky Landscape: An Employer’s Guide to Responding To Challenges of COVID-19

Monday, March 30, 2020
2:30 PM – 3:30 PM EDT

The outbreak of the global COVID-19 virus has confronted employers with unprecedented challenges in maintaining their workplaces and operational viability. With ever-increasing speed, new laws are being enacted by the Federal and local governments that are designed to soften the economic and health and safety impacts posed by the COVID-19 virus, but which also, no matter how well intentioned the legislatures, create confusion about available feasible options for employers on how to move forward in sensible, compliant and practicable fashion.

Garfunkel Wild PC will be presenting a webinar designed to assist employers in tackling these steep challenges. The webinar will address such issues as:

  • Highlights of the updated Federal leave laws.
  • Highlights of the updated New York State leave laws.
  • What is the type of “order” that triggers an employee’s entitlement to leave under the new statutes?
  • Who is a healthcare provider?
  • Staff reductions, reduction in hours and terminations.
  • An employer’s obligations under the WARN Act.
  • Practical considerations on dealing with the challenges.

Pain Management, Palliative Care and Addiction Online Program Now Available
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here.

The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

  • New York State and federal requirements for prescribing controlled substances
  • Pain management
  • Appropriate prescribing
  • Managing acute pain
  • Palliative medicine
  • Prevention, screening and signs of addiction
  • Responses to abuse and addiction
  • End of life care

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.   Non-MSSNY members will be charged $50 per module.

Series programs include:

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Robert Kent, Esq., NYS OASAS General Counsel

Educational Objectives:

  • Understand New York State and Federal Requirements for Prescribing Controlled Substances
  • Discuss Guidelines for Chronic Pain

When to Consider Opioid Therapy for Chronic Non-Cancer Pain & in Palliative Care

Faculty: Charles Argoff, MD
Educational Objectives:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation
  • Describe palliative medical care and end-of-life care

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Marc Manseau, MD, MPH, NYS OASAS Medical Director
Educational Objectives:

  • Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral
  • Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed
  • Describe Strategies for Treating Pain in Patients with Substance Use Disorders

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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.

Additional information or assistance may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org or 518-465-8085

REGISTER NOW


CMS

Medicaid Allowing Phone Visits Only for Telemedicine
Medicaid is allowing phone, only for telemedicine, during the pandemic.  WC is following Medicaid rules listing the codes as 99441, 99442 and 99443.  I don’t think these codes will result in PAYMENT parity.

But, most plans, including Medicare and Medicaid, are accepting 99211 – 99215, with the GT modifier, which should result in payment parity.  If there is a medical condition, psychiatrists and ophthalmologists should also be able to use these codes, as well.

In addition, with the rules being relaxed including HIPAA rules, use of an iphone or similar equipment with audio/video for telemedicine is being accepted during this pandemic. (Regina McNally, VP MSSNY Socio-Medical Economics Div.)


CMS Call: Lessons from the Front Lines-Saturday, March 28 12noon-2:00 PM
On behalf of CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force, I am writing to invite the physician membership of your organization to the next call in our new series for physicians: Lessons from The Front Lines: COVID-19.

The call will take place on Saturday, March 28th from 12:00 PM – 2:00 PM EST, and the topic of discussion is: COVID-19 Therapeutics. We invite you to join us to share your ideas, strategies, and insights with one another.Please see dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

Participant Dial In: 877-251-0301
Conference ID: 9409959
Audio Webcast https://protect2.fireeye.com/url?k=0d59a9bc-510ca0af-0d599883-0cc47adb5650-9ac2bdf1f2555d1a&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1738

If you have specific best practices related to COVID-19 therapeutics you are interested in sharing with your peers, please respond to me by 5 PM today and we would be glad to add you to our agenda. 

As always, we appreciate your feedback and collaboration as we address this important issue together.


US Has Fewer Physicians and Hospital Beds Per Capita than Italy and Others
A new analysis and chart collection finds that the U.S. has fewer hospital beds and practicing physicians per capita than many similarly large and wealthy countries with health care systems already strained by the ongoing COVID-19 pandemic.

Compared to Italy and Spain, two countries in which hospitals have already been overwhelmed by an influx of COVID-19 patients, the U.S. has fewer practicing physicians per capita – 2.6 per 1,000 people, compared to 4.0 in Italy and 3.9 in Spain – but more licensed nurses. While the U.S. has a higher number of total hospital employees than most comparable countries, nearly half of that workforce is comprised of non-clinical staff who are not directly involved in delivering care. (KFF-Petersen March 27)


Upstaters Want Downstaters to Stay Away
In an attempt to slow the spread of the novel coronavirus, Upstate counties are warning anyone traveling from New York City to self-quarantine for two weeks or stay away entirely. The requests have no legal backing as only Gov. Andrew Cuomo could give such an order, but they come as the number of cases in New York City continue to grow and upstate health departments predict that they could soon see a similar surge, possibly overwhelming their capabilities. Governors in at least two states have also mandated that anyone who travels from the New York metro area must self-quarantine for two weeks after arriving.

Wednesday evening, county leaders in Rensselaer and Saratoga counties asked Cuomo order that anyone who travels from Westchester or New York City to self-quarantine, following a recommendation from Deborah Birx, the White House coronavirus response coordinator. On Thursday, Rensselaer County Executive Steve McLaughlin asked Cuomo to ban non-essential travel from the same areas. McLaughlin said five Troy residents who tested positive for COVID-19 had recently re-located from New York City. (Times Union, March 27)


Army Field Hospitals to Start Taking Non-COVID-19 Patients in NY on Monday
Three Army field hospitals have begun to deploy to New York and Washington state, the regions hit hardest by the coronavirus, and the facility in New York will start taking non-COVID-19 patients on Monday, according to Army officials.

  • The Army field hospitals will provide 284 beds in New York and 248 in Seattle to relieve stress on hospitals treating patients stricken with the coronavirus, Army Chief of Staff Gen. James McConville told reporters today.
  • The advanced party from the Army’s 531st Hospital Center from Fort Campbell, Ky., and the 9th Hospital Center from Fort Hood, Texas, are already on the ground in New York, McConville said. The main party will arrive at Joint Base McGuire-Dix-Lakehurst, N.J., Friday, and will set up at the Javits Center in Manhattan this weekend, McConville said.
  • The New York National Guard, the Army Corps of Engineers and Javits employees are hard at work converting the Javits Center into a makeshift disaster hospital with 1,000 beds to help with the city’s coronavirus response.
  • In total, roughly 650 personnel are heading to New York and a little over 600 to Seattle to help with the crisis, Army officials said. (Politico Pro 03/26/2020 02:50 PM EDT)

Do Not Bill for Telemedicine Until Further Instruction
I just was on a call with NGS MEDICARE.  They state they have not received direction from CMS on how to process claims for telemedicine.  Therefore, NGS MEDICARE is asking that telemedicine claims NOT BE SUBMITTED until CMS provides NGS with clear instructions regarding telemedicine claims processing procedures.  This is in an effort to avoid unnecessary claim denials.

As soon as NGS MEDICARE hears from CMS, they will advise us.

–From Regina McNally, VP MSSNY’s Socio-Med Economics Div.


Medicaid Guide re Use of Telehealth
An updated version of the Medicaid Update Special Edition – Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency, which now includes clarifications for FQHC billing as well as billing for home care providers, has been posted. This guidance was originally issued on March 21, 2020. The Department will be scheduling a webinar shortly to walk through this guidance and a set of FAQs for Medicaid telehealth are under development.

This document will be updated frequently so please continue to check the COVID-19 Guidance for Medicaid Providers webpage and the Medicaid Update webpage  for updates and amendments.


AMA: Ethical Challenges in a Pandemic
The COVID-19 pandemic poses ethical challenges and exceptional demands for physicians in the United States.

While caring for the anticipated surge of seriously ill COVID-19 patients, physicians are very likely to encounter heart-wrenching decisions. Meanwhile, physicians face having to balance the obligation to provide urgent medical care during emergencies, with risks to their own safety, health or life. The current pandemic offers each member of the medical profession a unique opportunity to reflect anew on medical ethical dilemmas that arise in the face of adversity.

During the COVID-19 pandemic, some of these ethical challenges will include:

  • Allocation of limited resource
  • Caring for patients in the face of personal risk
  • Use of quarantine and restrictions of personal liberty

The Code of Medical Ethics offers detailed ethical guidance to physicians on these issues that will help physicians approach the difficult decisions in the days ahead.
For more information, please see the AMA’s list of newly released resources on ethical challenges that arise during pandemics


MLMIC: Staff Ready to Answer Questions 24/7
Due to the minute by minute changes regarding COVID-19, MLMIC is keeping our insureds informed via email blasts, our website, blog, as well as through our social media accounts via Twitter and Linked In.

For those insureds who face challenges to their practice due to COVID-19, MLMIC is offering the following:

  • MLMIC’s toll free 24/7 Legal Hotline – (855) FAKS-LAW (1-855-325-7529) can help address many questions or concerns that may arise.
  • Our staff remains directly available via phone (800) ASK-MLMIC(1-800-275-6564) and every effort will be made to handle inquiries and answer questions regarding claims, coverages and policies on an immediate basis.
  • Blog:  Guidance on Using Telemedicine for Coronavirus – click here

 

This Week’s Legislative Podcast


Garfunkel Wild Ad


SIGN UP TO RECEIVE ALERTS FROM MSSNY’S GRASSROOTS ACTION CENTER

MSSNY Grassroots Banner

When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.orgThank you. (WILKS)


 

COVID-19 Update March 26, 2020

CORONAVIRUS UPDATE
The state reports 37,258 confirmed cases and 385 deaths statewide, as of Thursday morning, including 21,393 cases in New York City, 5,944 in Westchester County, 3,914 in Nassau County, 2,735 in Suffolk County, 1,197 in Rockland County, 751 in Orange County, 190 in Dutchess County, 171 in Albany County, 139 in Monroe County, and 134 in Erie County. (City and State 3/26/2020)

The U.S. COVID-19 death toll surpassed 1,000, with 1,046 deaths as of 8 a.m. CDT March 26. Nationwide, 69,197 American cases have been reported. Worldwide, 487,648 COVID-19 cases and 22,030 deaths have been reported, while 117,749 people have recovered from the illness.


Governor Cuomo’s Daily Press Conference

  • Governor scouting additional sites for overflow, 1,000 plus overflow in each of the downstate counties, in addition to simultaneously increasing current facility capacity.
    – Queens, Brooklyn, Bronx, Manhattan, Staten Island, Nassau, Suffolk, Westchester, Rockland
  • Approved splitting of ventilators.
    – Converting anesthesia machines into ventilators.
  • Shifting load from downstate hospitals to upstate hospitals, and expanding upstate hospital capacity
  • Lost revenue estimated between $10B and $15B.
  • Fed Stimulus Bill:
    – Unemployment insurance, and small businesses addressed
    – Does not help governmental losses, Governor described this portion as a failure, and irresponsible.
    -NYS gets $5B, only for COVID-19 expenses.
    – Does not know how much revenues are down, do not know the forecast for economic activity, nor additional federal response.
    – State will adjust down revenue projections if needed.
    – Adjust the budget through the years to reflect the actual revenue, and adjust spending down accordingly to match the actual revenue. This will be on a yet-to-be determined schedule. (Moe Auster, Senior VP MSSNY Govt. Affairs)

Frontline Physicians: Are You Available for Media Interviews?
If you are a MSSNY member on the front lines of the COVID-19 pandemic (ideally in emergency or critical care) and are able to make yourself available to do press interviews, please contact Julie Vecchione at jvecchione@mssny.org or 516.488.6100 x340.


Are You a Retired Physician Who Has Signed Up to Serve? Call us!
Are you a retired MSSNY member that has heeded the call to come out of retirement to serve on the front lines of the COVID-19 pandemic? If so and you’re able to make yourself available to do press interviews, please contact Julie Vecchione at jvecchione@mssny.org or 516.488.6100 x340.


NGS Medicare Will Receive Claims for Telemedicine
NGS Medicare can receive claims for telemedicine now. CMS has provided instructions to the Medicare contractor. (Regina McNally (VP Socio-Medical Economics)

MSSNY Members’ Telemedicine Directory: Are You Interested?
As we continue to confront the challenges of the COVID-19 outbreak, and helped by laws ensuring health insurance coverage, a significant number of physicians have incorporated telehealth into their medical practices.

With this growth is a need for physicians to be able to refer their patients to different specialists who may also have incorporated telehealth into their practices. MSSNY is examining the logistical and legal challenges of creating a telehealth “referral” directory. If such a telehealth specialty directory were to be created, would you be interested in being part of such a directory?

If you would like to be part of this directory, please email Steve Sachs at ssachs@mssny.org. Please include your full name and email address.


Cuomo Blasts Federal Relief Package as ‘Terrible’ for New York
Gov. Andrew Cuomo says the emergency deal struck between the U.S. Senate and the Trump administration for coronavirus relief “would be really terrible” for his state, even as his fellow New Yorker, Minority Leader Chuck Schumer, called the package a negotiating victory.

Cuomo, who has consistently criticized New York’s allotments of federal aid during the pandemic, said during a press briefing on Wednesday that New York would get roughly $3.8 billion from the $2 trillion package, “a drop in the bucket as to need.”

Schumer’s office characterized the deal differently, saying New York would receive more than $40 billion when totaling unemployment insurance, hospitals and transportation funding. That includes $5.8 billion to local governments in the state — about $1.4 billion for New York City and about $500 million to Long Island.

“Like all compromise legislation, this bill is far from perfect — but it now does much more for this state, its people and its future than where we began,” Schumer said in a release.

It’s not entirely clear which portion the governor was criticizing, but Cuomo seemed to be focused on the expected state share of the expenditure relief. He said he told the state’s congressional delegation “this doesn’t do it.”

Cuomo said the state already has spent roughly $1 billion on its response and will probably spend several billion more by the time the pandemic is over. His budget office predicted on Tuesday that state revenue losses could be as high as $15 billion.

Cuomo said the previous House version of the bill would have given New York about $17 billion, and he is in conversations with representatives in the House about adjustments.

The House is expected to pass the legislation by the end of the week. (3/25 Politico)


Tail Coverage for Physicians Who Come out of Retirement

  1. Q. If I come out of retirement to assist during the COVID-19 pandemic, will it terminate my free tail coverage with MLMIC? Will I be covered for the work I am returning to do under my free tail coverage?
  2. A. If you come out of retirement to assist during the COVID-19 pandemic, it will not terminate your free tail coverage from MLMIC, nor will it alter your ability to report claims from your expired policy. However, you will need new coverage for the work you are returning to do. You can check to see if you have this coverage from your employer or hospital, or if you would like to speak with us about providing this coverage, please call or email us.
    (Regina McNally, VP Socio-Medical Economics)

MSSNY Offers CME Programs-Registration for April 1 Medical Matters
Now Available

The Medical Society of the State of New York is pleased to be able to offer physicians’ on-line programming for Continuing Medical Education (CME). A variety of programs, including a COVID-19 update with the New York State Department of Health and our updated pain management course (free to MSSNY members) are available here.

Physicians who are new to the site will need to establish an account; and physicians who have used the site need only to login in with their user name and password. The majority of courses on the website are free to physicians.

Additionally, MSSNY hosts many “live” webinars and the next one is on Wednesday, April 1, 2020.  

Physicians can register for this program at the link below! 

Psychosocial Dimensions of Infectious Outbreaks”
April 1st @ 7:30am

REGISTRATION NOW OPEN HERE.

MSSNY’s has expedited the presentation of the next Medical Matters webinar “Psychosocial Dimensions of Infectious Outbreaks” on Wednesday, April 1st at 7:30am. 

This program is a companion piece to the March 18th coronavirus webinar.  This program provides physicians with vital information to care for patients, staff, family and themselves during this unprecedented pandemic.

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

  • Understand common human reactions to infectious outbreaks
  • Explore factors that influence how people react
  • Describe how to apply historical lessons to your own medical practice

Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  A copy of the flyer for this program can be accessed here. 

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. or Pat Clancy at pclancy@mssny.org. 

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

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.

If you missed it last week, Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story is now available here.

The MSSNY CME website also has a number of free preparedness courses that are invaluable in this time of uncertainty and unprecedented need for preparedness.  Below is a list of just some of the courses that will assist physicians to better prepare:

Medical Matters Courses:

  • Coronaviruses 2020: COVID-19 An Evolving Story
  • Disaster Medicine Every Physician’s Second Specialty
  • Doctor Are You Ready?
  • The Importance of Resilience After a Disaster
  • Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
  • Public Health Preparedness 101
  • Virtual Drill: Incident Command System & Crisis Communications

Emergency Preparedness:

  • Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)

Please note, if you do not already have an account there, you will need to create one, this is separate from MSSNY’s home page.

For more information or assistance, please contact Melissa Hoffman at mhoffman@mssny.org or pclancy@mssny.org.


Dr. Fauci: We Should Prepare for “Inevitable” Cycle of Outbreaks
Americans should prepare for “inevitable” cyclic COVID-19 outbreaks, Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases, said during a March 25 White House briefing. Viral patterns in Southern Hemisphere countries suggest a cyclical nature to the illness, meaning it could be seasonal, Dr. Fauci said. (Modern Healthcare 3/26/2020)

Outbreak updates:

  • The Senate passed a $2 trillion relief package, the largest economic stimulus bill in U.S. history, in a unanimous 96-0 vote late March 25, CNBCThe 880-page bill, which now heads to the House, provides funding for hospitals, emergency loans for small businesses, enhanced unemployment insurance and direct checks to Americans.
  • The U.S. wants the United Nations Security Council to declare COVID-19 originated in China, while China seeks recognition in the U.N.’s statement for its response to the outbreak, stalling a global resolution, four U.N. diplomats told NBC News.China’s diplomats are enraged, the diplomats said, as President Donald Trump’s administration increasingly blamed China for the pandemic. However, after reports of racist attacks against Asian Americans, the president tweeted March 23 that it was “NOT their fault” and later said that he would stop calling COVID-19 “the Chinese virus.”
  • Some hospitals are considering do-not-resuscitate orders for all COVID-19 patients, citing the high exposure risk for staff as protective equipment supplies run low, The Washington Post (Becker’s Hospital Review, 3/26)

Regulatory Timeline of COVID-19
William Rinehart, senior research fellow at the Center for Growth and Opportunity at Utah State University, created a timeline to document the major regulatory actions in response to COVID-19.(Modern Healthcare, 3/26/2020.


MSSNY Contracts DrFirst’s “Backline” for Physicians’ Telehealth
DrFirst, a pioneer in healthcare technology offers HIPAA-compliant telehealth and video conferencing as part of its award-winning care collaboration and secure messaging platform, Backline.

Backline is quick to set up and easy to use by both physicians and patients.  Initiate a video session without requiring a patient to download an app, complete a cumbersome registration process, or pay upfront before speaking with their physician. Physicians can use their PC or smartphone to engage with patients. Plus, Backline’s HIPAA security and extensive use cases make it a must-have even after the coronavirus crisis ends.

Also, please remember to add the following link to your call to action https://drfir.st/blt-mssny so that we can track your member registrations and to also enter the Assn Code MSSNY in the Assn box on the registration page.


Cuomo: Social Density Controls May Be Slowing Hospitalization Rate
New York’s social distancing policies may be working to slow the rate of coronavirus-related hospitalizations in the state, Gov. Andrew Cuomo announced Wednesday, though he cautioned the numbers are preliminary.

The governor said new projections suggest that since new density controls enacted over the weekend, hospitalizations have gone from doubling every two days as of Sunday, to doubling every 3.4 days as of Monday, to doubling every 4.7 days as of Tuesday.

There were 30,811 confirmed cases of Covid-19 in New York as of Wednesday morning, Cuomo said. More than 3,800 people are currently hospitalized due to the virus, including 888 who are in intensive care unit beds. Cuomo said the state currently has 53,000 of the 140,000 beds needed to treat patients when the coronavirus reaches its apex in New York — something which is now projected to occur in 21 days. It has identified a total of 119,000 beds it can use through increased capacity at existing hospitals, temporary FEMA and Army Corps of Engineers medical facilities, a Navy hospital ship and dormitories.

The governor said New York will work with hotels and former nursing homes to identify additional beds it can use for coronavirus patients.

Cuomo, who exchanged barbs with President Donald Trump on Tuesday over New York’s access to the national ventilator stockpile, said he’s working with the federal government to procure the 30,000 ventilators the state will need to treat the expected surge in Covid-19 patients. New York has 4,000 of the devices in its current system, received 4,000 more from the federal government and purchased another 7,000, he said.  (Politico, 3/25).


Loss of Smell and Taste: A New COVID-19 Warning Sign?
A pair of ear, nose, and throat doctors (ENTs) in the United Kingdom on Friday published a statement warning doctors that anosmia, or loss of sense of smell, and ageusia, diminished sense of taste, could be symptoms of COVID-19, the disease caused by the new coronavirus. However, the researchers qualified their comments, noting the observations are preliminary. The statement was published by Claire Hopkins, president of the British Rhinological Society, and Nirmal Kumar, president of ENT UK.

In the statement, the authors cited reports from doctors around the world who observed that anosmia was commonly reported among patients who tested positive for the virus.

COVID-19 eNews March 25, 2020

CORONAVIRUS UPDATE:
The state reports 30,811 confirmed cases, and 285 deaths statewide, as of Wednesday morning, including 17,856 cases in New York City; 4,691 in Westchester County; 3,285 in Nassau County; 2,260 in Suffolk County; 968 in Rockland County; 638 in Orange County; 153 in Dutchess County; 152 in Albany County; 122 in Erie County; and 118 in Monroe County.


NYS DOH Update Tomorrow Thursday 1-2 PM
Please join the NYS Department of Health Thursday March 26th at 1-2PM for A COVID-19 Update for Healthcare Providers. To accommodate the large number of participants, our webinar will be streaming via YouTube Live:

For audio only, please dial in: 844-512-2950


TRACKING COVID-19

The CDC’s tracker of US COVID-19 cases. The CDC regularly updates their tracker with newly confirmed cases, including a state-by-state breakdown.

The WHO’s COVID-19 myth busters. This page clarifies common misconceptions about the virus and includes downloadable graphics staff can post on their units.


MSSNY President Dr. Art Fougner’s Editorial Appeared in Yesterday’s Empire Report
As I drove into the parking lot, I couldn’t help noticing the lack of cars. Thanks to the SARS CoV2 virus, hunkering down is now the new normal. Yet through it all, physicians are answering the call, adapting as only they can to the fluid situation. This is not without a cost. As in Italy, the healthcare workers casualties are mounting all too quickly. What hasn’t been emphasized enough is that those professionals are, much like the elderly and the immune-compromised, a very high-risk group for serious complications. And yet, as the FDNY and NYPD on September 11, your physicians, nurses and others are running to the fire while others are running away. Just the other day, one thousand retired medical personnel volunteered to back up beleaguered doctors and nurses on the front lines.

There’s a serious problem, however. We are all short of Personal Protective Equipment. We need this yesterday. Doctors seeing seriously ill patients without adequate protection and supplies is akin to firemen attempting to fight fire without hoses and water. And still, your doctors and nurses are hitting the ground running every day. This indomitable spirit should be an example to us all.

So, when you see a doctor or nurse, give them a hearty Thank You – an air high five or corona forearm bump will do. NY’s Healthcare Team is fighting the good fight for us all. In the words of Winston Churchill, “Never have so many owed so much to so few.” http://empirereportnewyork.com/arthur-fougner-doctor-new-york-our-finest-hour/

Art Fougner, MD
MSSNY President


High Points of Gov. Cuomo’s Announcement
Some points from the on-going Governor’s announcement.

  • NYC currently implementing social distancing plan:
    – closing streets to traffic for pedestrian use.
    – playground density reduction mandates.
    – no close contact sports, such as basketball.
    – if not followed, playgrounds will shut down.
  • Evidence is showing that the density control plan is working.  The doubling of hospitalization rates is spreading out across more days than earlier in the week.
  • As of today, PPE demand is satisfied for the next couple of weeks, but 3 weeks out there will again be a need.
    – Federal Government committed 4,000 ventilators (yesterday, the number was 400).
    – still working with feds for more ventilators, and still looking into splitting ventilators.
    – Governor states that they have purchased everything that can be purchased.
  • 40,000 responses from “Surge Healthcare Force”, the reserve healthcare workforce
    -6,175 mental health professionals signed up (hotline 1-844-863-9314) to provide services.
    – Working with feds to find vendors and using Defense Production Act to maximize production.
    – Working with feds on a rolling deployment plan (mentioned yesterday as a request) to meet needs of hot spots as they arise.  Redeployment of equipment, and personnel as state’s needs decline.
  • Governor described the $2 Trillion bill as “terrible” for NY. $3.8B for NYS, and $1.3B for NYC.

– Told the House to modify the bill.
(Moe Auster, Senior VP MSSNY Govt. Affairs)

Executive Order: Physicians Immune from Civil Liability for COVID-19 Services
As part of an Executive Order,  Governor Cuomo announced physicians and other health care practitioners would be “immune from civil liability for any injury or death alleged to have been sustained directly as a result of an act or omission by such medical professional in the course of providing medical services in support of the State’s response to the COVID-19 outbreak, unless it is established that such injury or death was caused by the gross negligence of such medical professional”.

While this is a very welcome development, at the same time, the Executive Order also contains several very concerning short -term waiving of laws, including physician supervision requirements for Certified nurse anesthetists, physician assistants and nurse practitioners.

The Executive Order also contains provisions that directs the Health Commissioner to cancel all elective surgeries and procedures, in “all general hospitals, ambulatory surgery centers, office-based surgery practices and diagnostic and treatment centers to increase the number of beds available to patients”.


State/Federal Agencies Encourage PTs to Receive Treatment Via Telehealth
There have been a number of important steps taken over the last week to better enable physicians to treat their patients via telemedicine. This week, CMS announced it was implementing rules to temporarily waive the limitations on providing telemedicine for their Medicare patients.

Also, very importantly, the federal Office of Civil Rights announced it was relaxing enforcement of HIPAA rules such that a physician “that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients”, and that OCR will “not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency.”

This follows important steps taken by the New York State Department of Financial Services reminding insurers to cover telehealth services for patients including basic smart phone technology and waiving patient cost-sharing.  They also noted they would be strongly encouraging self-insured plans operating in New York State not subject to state regulation to follow these coverage and cost-sharing rules.  Moreover, a similar announcement was made by the New York State Department of Health including ensuring there is Medicaid and Medicaid Managed Care coverage for telephone visits.

In light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). 

Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules. However, the announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.

For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.

Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules.

Physicians should not use Facebook Live, Twitch, TikTok or other public-facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA). HHS also noted that while it hasn’t confirmed such statements, Skype for Business, Updox, VSee, Zoom for Healthcare, Doxy.me, and Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.

Additional information can be found at this notice from Department of Health and Human Services (HHS).


Emergency Medical Aid and Telemedicine


Amendment to Allow Telemedicine for Social Distancing
New York State Workers’ Compensation Board sent this bulletin at 03/16/2020 03:00 PM EDT

Emergency Adoption of Amendments to 12 NYCRR 325-1.8, 329-1.3, 329-4.2, 333.2, and 348.2 (COVID-19 Telemedicine)


New Emergency Regulation Requiring Insurance Companies to Waive Cost-Sharing for In-Network Telehealth Visits
New Regulatory Actions State New Yorkers Do Not Have to Pay Copayments, Coinsurance, or Annual Deductibles for In-Network Telehealth Services


AMA: COVID-19 Physician Practice Resources
The COVID-19 physician and practice resources released by the AMA include:

  • A Physicians Guide to COVID-19, to help physicians prepare their practices, address patient concerns, and provide answers to physicians’ top questions;
  • An AMA COVID-19 online resource center, and a COVID-19 FAQ that are updated each day with the latest information on the COVID-19 epidemic;
  • A Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care which can help achieve a dramatic increase in the nation’s telemedicine capacity;
  • The AMA Journal of Medical Ethics published ethical guidance for physicians to help them in making determinations about how to combat COVID-19;
  • The JAMA Network COVID-19 Resource Center for evidence-based, actionable resources, plus videos of firsthand accounts from physicians on the front lines;
  • CME for physicians through the JAMA Network’s JN Learning website, including COVID-19 epidemiology, infection control and prevention recommendations

Executive Order of Suspension of Non-Essential Elective Surgeries
A directive was sent out by DOH to hospitals, ambulatory surgery centers, and office-based surgery centers to implement the Executive Order to suspend all non-essential elective surgeries.


Garfunkel Wild Webinar Operationalizing NYS Ban on Elective Surgery
New York State is banning elective procedures at hospitals and ASCs for the unforeseeable future. This webinar explored what the scope of these bans and some suggestion on how to operationalize.


AMA Releases Special Coding Advice Related to COVID-19
New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply the best coding practices. The scenarios include telehealth services for all patients.

Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19 and is directed to come to physician office or physician’s group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician office for testing; and more. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.


CDC: Clinician Outreach and Communication Activity (COCA)

Emergency Preparedness and Response

COCA prepares clinicians to respond to emerging health threats and public health emergencies by communicating relevant, timely information related to disease outbreaks, disasters, terrorism events, and other health alerts.

COCA Call: March 27, 2020 – Underlying Medical Conditions and People at Higher Risk for the Coronavirus Disease 2019 (COVID-19)


FDA Expedites Treatment of Seriously Ill COVID-19 PTs with Experimental Plasma
In an unusual move, the Food and Drug Administration today announced that is making it easier for doctors to try an experimental treatment for COVID-19 patients that uses plasma from people who had the disease and recovered. There is scant evidence it works in people infected with the coronavirus, but the approach has been tried for other illnesses.

The idea is that this so-called convalescent plasma will contain antibodies to the virus that allowed the donor to recover to disease, and therefore should help patients who are sick.

Convalescent plasma been used in the past to treat outbreaks polio, measles, and mumps before a vaccine was available. More recently it’s has been used with some effectiveness to treat patients with SARS and Ebola.

In guidance to doctors, the FDA stated, “Given the public health emergency that the expanding COVID-19 outbreak presents, while clinical trials are being conducted, FDA is facilitating access to COVID-19 convalescent plasma for use in patients with serious or immediately life-threatening COVID-19 infections.” Doctors will still have to get FDA approval for individual patients to use the treatment, but if doctors need an answer in less than four hours, they can call the FDA Office of Emergency Operations for a verbal authorization.

The idea for using convalescent serum to treat COVID-19 has been championed by Arturo Cassadeval of the Johns Hopkins Bloomberg School of Public Health and Liise-anne Pirofski from the Albert Einstein College of Medicine.

Cassadeval has been interested in the use of convalescent serum to treat outbreaks of viral diseases throughout his career. In February, he wrote an op-ed piece for The Wall Street Journal suggesting it be used in the current outbreak. He followed that up with a scientific paper and then started hearing from doctors all over the country asking if they could participate in a clinical trial of the approach.

Cassadevall was hoping to hear from the FDA that it would give him approval to start a trial. The broader usage granted by FDA was a surprise.

“The FDA just opened the floodgates,” wrote Jeffrey Henderson, associate Professor of Medicine and Molecular Microbiology at Washington University School of Medicine in St. Louis in an email to NPR. “Our institution is scrambling to be ready to use this, as are many others, I’m sure.”

As with any unproven therapy, there are risks with the approach. The worst is that it could actually make patients sicker, a response known as antibody-dependent enhancement where the virus is actually helped to proliferate by a patient’s own immune system.

“I think we need to be cautious about using convalescent serum,” says Martin Zand, professor in the department of medicine and co-director of the Clinical & Translational Science Institute at the University of Rochester Medical Center. (NPR Mar 24 5:35PM)


Update on President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

CMS Outlines New Flexibilities Available to People with Medicare

On March 17, 2020,  CMS announced that Fee For Service (FFS) Medicare is expanding coverage for Telehealth services, with an effective date of March 6, 2020. MLN Connects® Special Edition for Tuesday, March 17, 2020. Previously covered Telehealth services are now available to beneficiaries in their home environments, regardless of geographic location.

Our sole intent is to make the claim process as seamless as possible for the providers we serve. While we do not anticipate claim rejections and denials relative to these Telehealth claims, we urge providers to notify us immediately if any such problems are identified. We also advise providers that the NGS Provider Call Center does not have any further information on this issue at present.

NGS keenly recognizes the challenges providers are facing as the country deals with this current emergency and we assure you of our full support as we navigate through this time.

NGS remains fully committed to a prompt and successful implementation of the telehealth benefits as a result of these changes.  Please continue to monitor this website (www.ngsmedicare.com) for additional information from CMS or NGS as it becomes available.


OIG Warns of COVID-19 Fraud Schemes
The US Department of Health and Human Services Office of Inspector General (OIG) released a fraud alert warning Medicare beneficiaries of potentially fraudulent schemes that take advantage of the fears surrounding the COVID-19 public health emergency. The OIG warns that fraudsters are targeting Medicare beneficiaries through telemarketing, social media and even in-person, door-to-door contact. According to the OIG, the fraudulent schemes often involve an offer of a COVID-19 test in exchange for an individual providing personal information.  More on COVID-19 Fraud Schemes Here.


AMA Releases Special Coding Advice Related to COVID-19
New guidance from the AMA provides special coding advice during the COVID-19 public health emergency. One resource outlines coding scenarios designed to help health care professionals apply the best coding practices.

The scenarios include telehealth services for all patients. Examples specifically related to COVID-19 testing include coding for when a patient: comes to the office for E/M visit, and is tested for COVID-19 during the visit; receives a telehealth visit re: COVID-19 and is directed to come to physician office or physician’s group practice site for testing; receives a virtual check-in/online visit re: COVID-19 (not related to E/M visit), and is directed to come to physician office for testing; and more. There is also a quick-reference flowchart that outlines CPT reporting for COVID-19 testing. A new web page on the AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19. Check the AMA COVID-19 resource center to stay up to date and for additional resources.


CVS To Waive Co-Pays for Aetna Member Coronavirus Hospitalizations
CVS Health said it will waive co-payments and related out-of-pocket cost-sharing of commercially insured Aetna members’ inpatient admissions related to the Coronavirus strain COVID-19. The move is among the more significant thus far among health insurance companies that are expanding coverage and eliminating plan member cost-sharing for everything from doctor office visits for Coronavirus tests to telehealth consultations for screening of the disease. (Forbes, March 25)

 

 

COVID-19 eNews – March 24, 2020 5:30 PM

A List of all New York State resources for Physicians Has Been Compiled by MSSNY and is Available Here.


Gov. Cuomo Demands Supplies from President
Gov. Andrew Cuomo voiced alarm and frustration with the Trump administration’s response to the growing coronavirus crisis Tuesday, estimating that New York is just two weeks away from hitting the apex of its outbreak.  “The president said it’s a war … then act like it,” Cuomo said, raising his voice during a morning news conference at the Javits Center in Manhattan. “They’re doing the supplies? Here’s my question: Where are they?”

New York has procured just 7,000 of the 30,000 ventilators required to treat the expected surge in hospitalized Covid-19 patients. Cuomo repeated his call for the Trump administration to use the federal Defense Production Act to contract with American companies so more of the vital machines can be manufactured in the coming weeks. “There is no other way for us to get these ventilators, we’ve tried everything else,” he said. “The only way we can obtain these ventilators is from the federal government, period. … If we don’t have the ventilators in 14 days it does us no good.”

With nearly 26,000 confirmed cases of coronavirus, New York is the epicenter of the crisis, nationally. The governor said the state is now expected to need 140,000 hospital beds when the virus reaches its peak — which he estimates will occur in the next 14 to 21 days. Cuomo has ordered New York hospitals to increase their total capacity from 53,000 beds to at least 75,000 — with the goal of creating 110,000 beds.

The governor said he “will turn this state upside down to get the number of beds we need.” He said he’s in touch with hotel owners to take over their locations and has no problem turning dorms at state colleges into makeshift hospitals.

But, Cuomo argued, that means nothing if New York does not have the staff or equipment needed to treat those beds. (Politico 3/24)


Notes from Gov. Cuomo’s Press Conference

– Apex is forecasted for 5/1, but the curve is increasing, new apex is forecasted for 14 to 21 days.
– New projected needed beds are at 140k, with 40k ICU beds.
– NYC expected to have a density reduction plan in place by noon today.
– Hydroxychoroquine and Zithromax trials will start today.
– DOH still pursuing Plasma Injection as well as Antibody test.
– Cuomo will speak with all hospital administrators today on increasing capacity.
– Cuomo is speaking with hotel owners to discuss conversion of locations.  He will use SUNY and CUNY dorms, as well.
– Experimenting with splitting ventilators in order to cover two people simultaneously.
Still pushing feds to use of federal Defense Production Act.  Not using power is inexplicable to Cuomo.
– The Governor is urging HHS Secretary Azar to release 20,000 ventilators to the State.
– FEMA is reportedly sending 400 ventilators, but the need is projected to be 30,000.
– The Governor will take personal responsibility for transporting federal stockpile ventilators to the next region where needed, once state crests over apex.
– Governor discussing bringing lower risk people back into the workforce, and recovered people.
-Ramp up the economy with available workers.  Reiterates that the crisis facing the state today is hospital capacity.

FEMA has sent just 400 ventilators to New York — an amount which Cuomo said misses “the magnitude of the problem.”

The federal government could use its authority to provide businesses start-up capital and guaranteed contracts to build more ventilators in 14 days. Companies volunteering services — something the president has pointed to in recent days — is not enough, Cuomo said.

He compared the current push to World War II when the U.S. contracted directly for military supplies.

“When we went to war we didn’t say, ‘Any company out there want to build a battleship?'” he said, mocking the federal government’s current stance.

He argued business would welcome such an order.

“You know what business wants? They want to make money … let them open their factory and make money, help them do that by ordering the supplies you need,” Cuomo said. “That’s what the Defense [Production] Act was all about and at the rate they are going — it is not happening. FEMA says we’re sending 400 ventilators. Really? What am I going to do with 400 ventilators when I need 30,000?”

https://www.governor.ny.gov/news/no-20210-continuing-temporary-suspension-and-modification-laws-relating-disaster-emergency
No. 202.10: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency | Governor Andrew M. Cuomo

No. 202.10. EXECUTIVE ORDER. Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency. WHEREAS, on March 7, 2020, I issued Executive Order Number 202, declaring a State disaster emergency for the entire State of New York; WHEREAS, both travel-related cases and community contact transmission of COVID-19 have been documented in New York State and …

www.governor.ny.gov
https://www.governor.ny.gov/news/no-20210-continuing-temporary-suspension-and-modification-laws-relating-disaster-emergency

As part of an Executive Order Governor Cuomo announced physicians and other health care practitioners would be “immune from civil liability for any injury or death alleged to have been sustained directly as a result of an act or omission by such medical professional in the course of providing medical services in support of the State’s response to the COVID-19 outbreak, unless it is established that such injury or death was caused by the gross negligence of such medical professional”.  While this is a very welcome development, at the same time, the Executive Order also contains several very concerning short -term waiving of laws, including physician supervision requirements for Certified nurse anesthestists, physician assistants and nurse practitioners.

The Executive Order also contains provisions that directs the Health Commissioner to cancel all elective surgeries and procedures, in “all general hospitals, ambulatory surgery centers, office-based surgery practices and diagnostic and treatment centers to increase the number of beds available to patients”.


Medicaid Guide re Use of Telehealth
An updated version of the Medicaid Update Special Edition – Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency, which now includes clarifications for FQHC billing as well as billing for home care providers, has been posted. This guidance was originally issued on March 21, 2020. The Department will be scheduling a webinar shortly to walk through this guidance and a set of FAQs for Medicaid telehealth are under development.

This document will be updated frequently so please continue to check the COVID-19 Guidance for Medicaid Providers webpage and the Medicaid Update webpage for updates and amendments.


PODCAST ”The Psychosocial Impact of COVID-19″
Available at :https://www.buzzsprout.com/51522/3095743

The COVID-19 physician and practice resources released by the AMA include:

  • A Physicians Guide to COVID-19, to help physicians prepare their practices, address patient concerns, and provide answers to physicians’ top questions;
  • An AMA COVID-19 online resource center, and a COVID-19 FAQ that are updated each day with the latest information on the COVID-19 epidemic;
  • A Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care which can help achieve a dramatic increase in the nation’s telemedicine capacity;
  • The AMA Journal of Medical Ethics published ethical guidance for physicians to help them in making determinations about how to combat COVID-19;
  • The JAMA Network COVID-19 Resource Center for evidence-based, actionable resources, plus videos of firsthand accounts from physicians on the front lines;
  • CME for physicians through the JAMA Network’s JN Learning website, including COVID-19 epidemiology, infection control and prevention recommendations

Guidance on How to Protect Yourself and Your Family from COVID-19 When Enjoying the Outdoors


NYS has a Coronavirus Hotline at 1-888-364-3065.
The New York State Department of Health has established a provider email account for physicians to ask questions about COVID-19: Covidproviderinfo@health.ny.gov


Chloroquine in Short Supply As Hospitals Buy in Bulk
Providers have been purchasing significant amounts of chloroquine and hydroxychloroquine in anticipation that they will be used to treat COVID-19, drastically depleting available supply, according to a new report from Premier.

While the U.S. Food and Drug Administration is still investigating whether the inexpensive, old anti-malaria drugs can tame symptoms and limit the spread of the highly contagious virus, hospitals have responded to clinical trials in other countries that have shown promising results.

Orders of chloroquine spiked 3,000% in March, according to data from Premier, the group purchasing and consulting organization. From January 2019 through February 2020, hospitals ordered an average of 149 units a month. More than 2,300 units were ordered through March thus far.

Its variant hydroxychloroquine experienced a 260% surge in demand, Premier data show. Hospitals typically used about 8,800 units a month, jumping to 16,110 units ordered in March. Chloroquine phosphate tables and hydroxychloroquine sulfate tablets went into shortage on March 9 and March 19, respectively, according to the American Society of Health System Pharmacists.

All major wholesale distributors put hydroxychloroquine and chloroquine on allocation this week, which limits ordering to prevent hoarding, Premier said.

Chloroquine, which is also used to treat lupus and rheumatoid arthritis, isn’t typically well stocked by hospitals, if at all, said Erin Fox, a drug shortage expert and senior director of drug information and support services at University of Utah Health.

Some of the manufacturers of chloroquine and related products have lowered prices and donated millions of doses to the U.S. government.

Last month, the National Institutes of Health began a randomized controlled trial for the treatment of COVID-19 patients with Gilead Sciences’ antiviral drug remdesivir. It is one of several drugs that are being tested for COVID-19 treatment, but quality and pricing questions remain.

“We understand and recognize the urgency with which we are all seeking prevention and treatment options for COVID-19. FDA staff are working expeditiously on that front,” FDA Commissioner Dr. Stephen Hahn, said in prepared remarks. “We also must ensure these products are effective; otherwise we risk treating patients with a product that might not work when they could have pursued other, more appropriate, treatments.”

The drug supply chain is already working around restricted access to pharmaceutical ingredients. The Indian government is limiting the export of 26 ingredients, some of which are used in widely used antibiotics, to protect its domestic supply amid the pandemic.

Much of the world’s supply of generic drugs comes from India, which relies heavily on China for their active pharmaceutical ingredients. (Modern Healthcare Mar. 23)


Florida Governor Orders New York Travelers to Quarantine
Florida Gov. Ron DeSantis said Monday he is issuing an executive order mandating that anyone arriving on a flight from New York City and the surrounding area submit to self-quarantine for two weeks. DeSantis said in an address from his Tallahassee office that more than 100 such flights arrive daily in the state and he believes each contains at least one person infected with the new coronavirus.

He said he has been in contact with federal officials about curtailing such flights, but has not yet received a response. He said people will be screened when they arrived and told they must self-quarantine. He said those travelers will not be allowed to stay with family or friends, because that is one way the virus is spread.

He did not say specifically how the self-quarantine would be enforced, but said “it is actually a criminal offense if you violate the quarantine order.” Florida law says it is a second-degree misdemeanor to violate a quarantine order that could result in a 60-day jail sentence.


Update on President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak; CMS Outlines New Flexibilities Available to People with Medicare

On March 17, 2020,  CMS announced that Fee For Service (FFS) Medicare is expanding coverage for Telehealth services, with an effective date of March 6, 2020. MLN Connects® Special Edition for Tuesday, March 17, 2020. Previously covered Telehealth services are now available to beneficiaries in their home environments, regardless of geographic location.

Our sole intent is to make the claim process as seamless as possible for the providers we serve. While we do not anticipate claim rejections and denials relative to these Telehealth claims, we urge providers to notify us immediately if any such problems are identified. We also advise providers that the NGS Provider Call Center does not have any further information on this issue at present.

NGS keenly recognizes the challenges providers are facing as the country deals with this current emergency and we assure you of our full support as we navigate through this time.

NGS remains fully committed to a prompt and successful implementation of the telehealth benefits as a result of these changes.  Please continue to monitor this website (www.ngsmedicare.com) for additional information from CMS or NGS as it becomes available.


CMS Eliminated Reporting for Jan. to June of 2020
CMS eliminated much of the need for reporting in the first six months of 2020. For the Merit-based Incentive Payment System, eligible clinicians who have not submitted any MIPS data by April 30, 2020 will receive a neutral payment adjustment for the 2021 MIPS payment year, according to the press release.

For the Ambulatory Surgical Center Quality Reporting Program, any data from January 1, 2020 through March 31, 2020 submitted will be used for scoring in the program.

Programs with data submission deadlines in April and May 2020 will be given exemptions based on the facility’s choice to report.

The CMS stated in the press release that it “recognizes that quality measure data collection and reporting for services furnished during this time period may not be reflective of their true level of performance on measures such as cost, readmissions and patient experience during this time of emergency and seeks to hold organizations harmless for not submitting data during this period.”

Modern Healthcare Mar 23


University of Washington Doctors Share Findings of COVID-19 Cases
In a research letter published in JAMA on Thursday, doctors at the University of Washington revealed what they called “the first description of critically ill patients infected with COVID-19 in the U.S.,” describing them as having a high rate of acute respiratory distress syndrome and a high risk of death.

The research shows “poor short-term outcomes among patients requiring mechanical ventilation.”
A total of 21 cases, ranging in age from 43 to 92, with 52% of them male were admitted to the ICU at Evergreen Hospital between February 20, 2020, and March 5, 2020, were included. Evergreen Hospital is a 318-bed public hospital with a 20-bed ICU serving approximately 850 000 residents of King and Snohomish counties in Washington State.

Comorbidities were identified in 18 cases, with chronic kidney disease and congestive heart failure being the most common. (7:40 PM CT on 3/19/2020 Modern Healthcare 3/19)


AMA: Ethical Challenges in a Pandemic
The COVID-19 pandemic poses ethical challenges and exceptional demands for physicians in the United States.

While caring for the anticipated surge of seriously ill COVID-19 patients, physicians are very likely to encounter heart-wrenching decisions. Meanwhile, physicians face having to balance the obligation to provide urgent medical care during emergencies, with risks to their own safety, health or life. The current pandemic offers each member of the medical profession a unique opportunity to reflect anew on medical ethical dilemmas that arise in the face of adversity.

During the COVID-19 pandemic, some of these ethical challenges will include:

  • Allocation of limited resource
  • Caring for patients in the face of personal risk
  • Use of quarantine and restrictions of personal liberty

The Code of Medical Ethics offers detailed ethical guidance to physicians on these issues that will help physicians approach the difficult decisions in the days ahead.
For more information, please see the AMA’s list of newly released resources on ethical challenges that arise during pandemics


Scientists Warned re China as a “Time Bomb” for Viruses 13 years Ago
In a 2007 study published by Clinical Microbiology Reviews.scientists warned that a penchant for eating exotic mammals in southern China was a “time bomb” waiting to happen.

Lack of hygienic environments and crowded, wet markets selling wild game plus the common presence of coronaviruses in China was a “time bomb” for a dangerous virus outbreak.

“The small reemergence of SARS in late 2003 after the resumption of the wildlife market in southern China and the recent discovery of a very similar virus in horseshoe bats, bat SARS-CoV, suggested that SARS can return if conditions are fit for the introduction, mutation, amplification, and transmission of this dangerous virus,” the authors said. 6:09 PM CT on 3/23/2020 Modern Healthcare, 323


MLMIC: Offering 24/7 Legal Hotline for Insureds
Due to the minute by minute changes regarding COVID-19, MLMIC is keeping our insureds informed via email blasts, our website, blog, as well as through our social media accounts via Twitter and Linked In.

For those insureds who face challenges to their practice due to COVID-19, MLMIC is offering the following:

  • MLMIC’s toll free 24/7 Legal Hotline – (855) FAKS-LAW (1-855-325-7529) can help address many questions or concerns that may arise.
  • Our staff remains directly available via phone (800) ASK-MLMIC(1-800-275-6564) and every effort will be made to handle inquiries and answer questions regarding claims, coverages and policies on an immediate basis.
  • Blog:  Guidance on Using Telemedicine for Coronavirus – click here

 

 

COVID-19 eNews – March 24, 2020

Podcast:

Psychosocial Impact of COVID-19


Webinar:

“Psychosocial Dimensions of Infectious Outbreaks”
April 1st @ 7:30am

REGISTRATION NOW OPEN HERE 

MSSNY’s has expedited the presentation of the next Medical Matters webinar “Psychosocial Dimensions of Infectious Outbreaks” on Wednesday April 1st at 7:30am. 

This program is a companion piece to the March 18th coronavirus webinar.  This program provides physicians with vital information to care for patients, staff, family and themselves during this unprecedented pandemic.

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

  • Understand common human reactions to infectious outbreaks
  • Explore factors that influence how people react
  • Describe how to apply historical lessons to your own medical practice

Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  A copy of the flyer for this program can be accessed here

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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.

COVID-19 eNews Update – March 18

As of March 18 Statistics:

In light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). 

For example, a physician using their professional judgement may request to examine a patient exhibiting COVID-19 symptoms, using a video chat application connecting the physician’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation.

Likewise, a physician may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.

Additional information can be found at this notice from Department of Health and Human Services (HHS).


Emergency Medical Aid and Telemedicine

Importantly, yesterday Medicare announced that it has temporarily limited its limitations on telehealth coverage. And the New York Department of Financial Services put out another statement reminding state regulated insurers about required telehealth coverage for all health care services without patient cost-sharing “including technology commonly available on smartphones and other devices”


Navigating Telehealth Reimbursement; Garfunkel Wild Presents Tomorrow Noon
While telehealth has become an acceptable means of delivering health care, how third-party payers reimburse telehealth services vary depending on the payer. This one-hour webinar will explore the rules and regulations impacting telehealth reimbursement by the Medicare and Medicaid programs and highlight the reimbursement policies of national commercial health plans.

Click here to Register
Thursday, March 19, 2020
12:00 PM – 1:00 PM EDT


Join the New York State Department of Health and New York City Department of Health & Mental Hygiene for a call about COVID-19 – Tomorrow, March 19, 1:00 PM


19% of New York’s 1,374 Coronavirus Cases Required Hospitalization
New York has 53,000 hospital beds, including 3,000 beds in intensive care units which have ventilators and other equipment needed to treat the coronavirus, the governor said. That capacity, he said, is much lower than the 55,000 to 110,000 hospital beds, and 18,600 to 37,200 ICU beds public health and epidemiological experts estimate New York will need when the virus hits its peak in the state. Estimates suggest that will happen in about 45 days.

Gov. Cuomo said 264 of the state’s 1,374 coronavirus cases, about 19 percent, required hospitalizations as of Tuesday morning.

“The expected peak is somewhere between 55,000 and 110,000 positives — the low range, 55,000, is a problem because we have people now in 80 percent of the 53,000 hospital beds — it’s not like they’re vacant,” he said. “One hundred and ten thousand is a problem because it’s double your capacity, if every bed was empty. The real problem is the ICU beds because that’s what people are going to need.”

State Health Commissioner Howard Zucker added that New York has around 4,000 ventilators, and hundreds more in a stockpile, which can be deployed in response to the coronavirus outbreak. (Politico 3/17)


MSSNY’s HOD Meeting Scheduled for April 24-26 in Tarrytown Cancelled
The MSSNY HOD in Tarrytown has been canceled but will moved to an alternative format. When we have finalized the details, we will inform all attendees and members.


Additional COVID-19 Information

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