COVID-19 Update June 1, 2020

The unofficial U.S. tally as of 8:00 a.m. ET Monday was 1,790,191 cases and 104,383 deaths, up about 4% and 3%, respectively, since Friday morning.


HEALTH SPENDING: There was an unprecedented 38% drop in spending on health services in the U.S. in April compared with the same month in 2019, according to the Peterson-KFF Health System Tracker.


Acute Kidney Injury Seen in Most Severe COVID-19 Cases
New data from two health systems in New York City — where hospitals

struggled to keep up with dialysis demands as they were flooded with COVID-19 patients — detailed a high rate of acute kidney injury among infected patients.

In the first 1,000 patients with COVID-19 at New York-Presbyterian/Columbia University Irving Medical Center, 33.9% developed acute kidney injury.

Of the 236 who ended up in the ICU, 78% developed AKI, Ruijun Chen, MD, and colleagues reported in The BMJ.

A separate analysis of nearly 5,500 patients with COVID-19 treated by April 5 in the 13 hospitals of the Northwell Health system, the AKI rate was a similar 36.6%.

The rate was 89.7% among those on mechanical ventilation, Kenar Jhaveri, MD, of Northwell Health in Great Neck, New York, and colleagues reported in Kidney International.

New York City hospitals had described precarious situations with dialysis supply and machine shortages, with at least one death reportedly due to lack of capacity to cope with the surge of acute kidney injury during the peak of COVID-19 cases in the city.

The new data have implications for hospital preparedness as the pandemic continues, commented National Kidney Foundation President-elect Paul Palevsky, MD, of the University of Pittsburgh School of Medicine, who was not involved in the studies.

“What it does tell us is acute kidney injury is an important component of the disease process in patients who have COVID-19, particularly severe COVID-19,” he told MedPage Today. “Hospitals need to have surge capacity in providing dialysis to provide services. If we see a surge as social distancing is relaxed, as I’ve seen in reports from Alabama and Texas, they’re going to need to be prepared to increase acute dialysis services in hospitals.”

The rates were higher than expected from the initial reports from China and Italy, which suggested 0.5% to 29% overall AKI, “with most estimates on the lower end,” and the 19% reported initially from a Seattle ICU, Jhaveri’s group noted.

The variation in rates may have a number of components.

Age and number of comorbidities of the studied population matter, as does severity of illness, commented Ladan Golestaneh MD, of Montefiore Medical Center in New York City.

“It seems to me as if clinicians caring for these patients will be looking at comorbidity burden and need for ICU stay as strong indicators of AKI development, in which case they may need to prepare for provision of renal replacement therapy,” Golestaneh said.

“Our patients had a higher average body mass index, greater prevalence of hypertension, diabetes, and chronic pulmonary disease than those characterized in Italian and Chinese cohorts,” noted Chen’s group.

How AKI is identified is also a factor, Palevsky noted.

Jhaveri’s study of 5,449 patients admitted with COVID-19 used medical chart review with the KDIGO criteria to define AKI.

While about half of patients only reached stage 1 AKI, stage 2 developed in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy, and 96.8% of the 285 who did need dialysis were on ventilators.

Prognosis of those who developed AKI was poor as 35% died. It was “bleaker” with requirement for dialysis: 157 of the 285 such patients died and “only 9 were discharged from the hospital at the time of analysis.”

Chen’s group examined records for the first 1,000 patients with positive PCR tests for SARS-CoV-2 who were seen in the emergency department or hospitalized at their center, although testing criteria shifted during March and April.

In this cohort, 13.8% required inpatient dialysis overall, a rate which rose to 35.2% in the ICU.

The high rate of renal complications might have been in part due to limiting use of IV fluids when treating patients with acute respiratory distress syndrome as a lung protective fluid management strategy, Chen’s group noted.

“Alternatively, there might be inherent renal toxicity associated with the pathophysiology of COVID-19,” they wrote, “given that the rates of acute kidney injury are high even in patients not receiving intensive care or in those without acute respiratory distress syndrome.” (MedPage Today, May 29)


Primary Care Practices Fear They May Not Survive the Pandemic
Primary care practices focus on the preventive care that keeps patients healthy. Many of them are small but punch above their weight in providing access to services in underserved communities

A series of new surveys by researchers at NYU have found that the city’s primary care practices have been particularly hard hit by the pandemic. Many of them worry they may not come out on the other side.

Initial survey results collected in mid-April yielded responses from nearly 500 primary care practices across the city and revealed that the Covid-19 crisis was having a severe impact on 85% of them, NYU said. The most common sources of stress included shortages of personal protective equipment, which 53% of respondents reported. Nearly half noted strain from large volumes of patient calls, and 42% reported struggles with staff illness. For practices that remained open, more than half of patient visits were completed via video or telephone, the researchers found. However, some providers were unsure whether they would be reimbursed for them.

In the most recent iteration of surveys completed May 21, more than 120 practices responded, and 72% said that they were detrimentally affected by the crisis. More than 60% of respondents cited decreases in revenue as a severe source of stress.

“It is frustrating because small community clinics are completely forgotten,” one practice from Brooklyn responded. “We don’t get funds, and insurance carriers pay peanuts for televisits—that is, if they choose to pay.”

Though many primary care practices have applied for varying loan and grant programs to help ease some of the financial strain, there is concern they haven’t been a priority for federal relief.

“We all understand that the crisis is at the hospital level, but what’s remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other frontline health care workers, and they’re called primary care doctors and nurses,” said Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research.

The Medical Society of the State of New York also noted that more federal funding is needed to support physician practices during the pandemic following its own survey. And even large practices have noted the high costs of obtaining PPE.

Shelley and her colleagues are working with NYU Langone Health as well as the city Health Department on the research. She collectively calls the primary care practices the “silent safety net.”

“If 50% shut their doors, they worry that their patients would have nowhere to go,” Shelley said. One practice responded that members of its staff can speak four African languages, an essential part of providing quality care to the patients it serves.

“Primary care is the foundation of our health care system,” Shelley said. “We have underinvested in it for decades.” — (Crain’s Pulse June 1)


If You Practice in Times Union Reach Area, Tell Patients You Are Open
We just launched a free Open for Business directory on TimesUnion.com so that you can let the Capital Region know you are open. They can also purchase gift cards to use at a later date if you include the link for that listing too. I attached the flyer for the instructions on how to post your business and it only takes 5-minutes. There are also upgraded package options if you choose to do that one instead, with other added features. Questions? Contact Cristi.Lalli@timesunion.com

Or call 518-454-5368  Cell:518-728-6453.


MSSNY Provides Access to PPE Supply Chain in Collaborative Effort with American Society of Plastic Surgeons 
The Medical Society of the State of New York (MSSNY) is pleased to offer members access to purchase PPE supplies through the American Society of Plastic Surgeons (ASPS) PPE supply chain program. ASPS established the program earlier this month to help practices acquire difficult-to-access PPE and other needed supplies as states begin to lift restrictions on elective surgery and office-based procedures.

Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked. Please note that shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times.

To see the available supplies and create an account to purchase items, visit this website

MSSNY is proud to offer this benefit to our members and grateful to ASPS for extending this opportunity to help medical practices and patients in our state resume p ractice swiftly and safely. Join MSSNY at www.mssny.org.


Gilead: Short Course Remdesivir Tops Standard COVID-19 Tx
Hospitalized patients with moderate COVID-19 pneumonia treated with antiviral remdesivir plus standard of care were modestly more likely to show clinical improvement in a specified period than patients treated with standard of care alone, topline results from a randomized phase III open-label trial found.

In COVID-19 patients receiving treatment with intravenous remdesivir for 5 days in addition to standard treatment, odds of showing clinical improvement at day 11 were 65% higher (95% CI 9%-148%, P=0.017) versus those receiving standard of care, reported manufacturer Gilead Sciences in a press release on Monday.

This difference in improvement was only significant in the group receiving 5 days of remdesivir, with a non-significant difference among patients receiving 10 days of the drug (OR 1.31, 95% CI 0.88-1.95, P=0.18).

On day 11, a significantly higher proportion of patients in the 5-day group achieved at least a 1-point improvement in the ordinal scale (76% vs 66%). In the 10-day group, 70% achieved this endpoint.

Two-point improvements were achieved by 70% and 65% of the 5- and 10-day remdesivir groups, respectively, compared with 61% with standard care.

Rates of clinical worsening or death trended higher in controls (11%) versus both remdesivir groups (3% and 6% for 5 and 10 days, respectively).

Remdesivir is currently approved for emergency use authorization by the FDA to treat hospitalized patients with severe COVID-19. Recently, data from the ACTT-1 trial, which was sponsored by the National Institute of Allergy and Infectious Diseases, also found the drug was associated with shorter time to recovery compared to standard of care.

In the SIMPLE Moderate trial, 584 patients were randomized 1:1:1 into three groups: remdesivir for either 5 or 10 days, or standard of care alone. Primary endpoint was clinical status, which was assessed on a 7-point ordinal scale on day 11.

Similar to prior trials, remdesivir was well-tolerated, with nausea being the most common side effect, followed by diarrhea and headache, all of which occurred in more than 5% of patients in both treatment groups.

Gilead says they plan to submit these results to a peer-reviewed journal in the upcoming weeks. (Medpage)

Last Updated June 01, 2020


NYSNA LAWSUIT v. NYSDOH for Failure to Enforce Regs re PPE Dismissed
A New York Supreme Court justice has dismissed a lawsuit against the state health department by New York’s largest nurses’ union seeking several workplace protections, saying the group’s allegations are beyond judicial review.

The New York State Nurses Association accused the state health department of failing to enforce regulations around the safe use of personal protective equipment, arguing it led to hundreds of NYSNA members testing positive for the coronavirus, and pressed for new work attendance policies. “While the Court is most sympathetic to the position of petitioner’s members and other healthcare workers, the law does not permit the Court to substitute its judgment for that of an administrative agency, such as respondent DOH,” New York State Supreme Court Justice Frank Nervo wrote in a Thursday decision. (Politico June 1)


 

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Free Webinar

Beyond COVID-19: 3 Financial Opportunities for Physicians

As the world emerges from quarantine, health, safety and financial concerns remain paramount.

As MSSNY’s preferred wealth manager for members, Altfest is offering a complimentary webinar, Beyond COVID-19: 3 Financial Opportunities for Physicians, which will address topics for physicians’ consideration during this time, including:

  • Tax options to take advantage of in a potentially lower-income year
  • Refinancing your mortgage
  • Identifying investment opportunities in a volatile market

Date: Wednesday, June 3rd at 11:00am ET

Speakers:

Steven Novack, CPA, CFP®, Senior Financial Advisor, Altfest Personal Wealth Management

Benjamin Lake, CFA, CFP®, Senior Financial Advisor, Altfest Personal Wealth Management

REGISTER AT THIS LINK

There is no fee to attend this webinar. Enrollment is limited. You may submit questions in advance by emailing webinar@altfest.com by noon on Tuesday, June 2nd.

Want to speak with someone now about a personal financial concern? Through MSSNY, you are welcome to contact Altfest Personal Wealth Management for a complimentary personal financial planning review by calling (212) 406-0850, emailing inquiry@altfest.com or visiting altfest.com/physicians.


 

 

 

 

 

 

 

 

COVID-19 Update May 29, 2020


Grow Through What You Go Through: Telehealth Coverage MUST Be Permanent
Finally, the re-opening phase has begun for most of New York. However, for history not to repeat itself with we must reflect on those things that helped New York to get to this position. Toward the top of the list would be the swift adoption by New York physicians of telehealth models.

In mid-March through strong advocacy, the barriers to telehealth in federal, commercial, and state-sponsored insurance programs were knocked down.  With persistence, even coverage for 20th century telehealth, the telephone conversation, was accomplished.

As we enter a new phase in confronting the pandemic, and preventing against a second surge, this expanded coverage for telehealth must be continued across the health insurance coverage spectrum.  This is a needed tool to care for those that are ill without putting staff and other patients at risk and to see and connect with those that cannot, will not or are afraid to come out of their homes and into our offices or hospitals.

This week, the NYS legislature took a step in a positive direction and passed A.10404-A/S.8416) which expands Medicaid and CHIP coverage for telehealth to include “audio-only” services. However, much work remains.  We are urging DFS to continue to require coverage by state-regulated commercial health insurance plans.  Nationally, we are working with the AMA to urge CMS to make telehealth “flexibilities” permanent and to curtail commercial insurance companies from cutting telehealth coverage or subjecting it to cost sharing.

Rolling back telehealth coverage will be detrimental to patient care. We must hold our state and our nation leaders to the goal of building back smarter and growing through this experience.  Permanent expansion of telehealth coverage fits that bill.

Bonnie Litvack, MD
MSSNY President


NY State DOH Pain/Opioid Course Deadline Extended Until Oct
Due to the impact of Novel Coronavirus – COVID-19 in NYS, prescribers who were due to attest or re-attest between June 30, 2020 and September 30, 2020, now have until October 1, 2020 to complete the required coursework or training and attest or re-attest. 

Course is free to all MSSNY members and is available here.


The News of New York Wants Your Submissions for How You Are Faring During Quarantine!

Hello, ALL MSSNY Physicians:

Do you have a COVID-19 story to tell? This question is directed at all physicians, not just physicians who work in hospitals. Many physicians were furloughed because their patients were quarantined or afraid to go out of their homes. Many physicians have not had this much free time since college.

Did you do find interesting diversions? Were you preoccupied with worry about the future of your practice? Did you sign up for telehealth—if yes, how is the learning curve?

If possible, send photos. If you submit and do not want your name printed, tell us.

Submissions will be published in the News of New York.

Christina Southard
csouthard@mssny.org
Editor


Notes from Governor Cuomo’s COVID-19 Daily Briefing:

 Data:

– Hospitalizations and intubations are down

– 152 new COVID cases as of yesterday

– 67 deaths yesterday (46 in hospitals, 21 in nursing homes)

Reopening:

– NY was hit the hardest, but we’re reopening smarter

– We test more than other states and must continue to test and trace

– A new dashboard is available showing the severity of the virus, measures

being taken in each region, and other information

– 5 regions will now begin entering Phase 2

– All office-based jobs:

– Professional services

– Administrative support

– Information Technology

– Retail:

– In-store shopping

– Rental, repair, and cleaning

– Barbershops and hair salons (limited services)

– Motor vehicle leasing, rental, and sales

– Real estate services

– Building and property management

– Leasing, rental, and sales services

NYC is on track to meet reopening metrics by June 8

– Must work on the following:

– Hospital capacity remains below 70% and establishing PPE stockpile

– Testing/contact tracing being

– MTA preparing for reopening

400K workers will be returning to work in Phase 1

Virtual Appearance from Mayor de Blasio:

– De Blasio noted that NYC aims to be below 15% of positive COVID tests, only 5%

tested positive

– A hotline will be utilized for business owners to have questions answered

Q&A

Travel:

– In response to a question regarding public transit, the Governor stated that the

public transportation system will be operating and would not be open if it was

not safe

– Mujica reiterated the executive order requiring masks on public transportation and

CDC information on the COVID illness not being highly transmissible via surfaces


NY Businesses Can Refuse Entry to People Not Wearing a Face Covering
Under a New Executive Order, Gov. Andrew Cuomo said May 29. “People Have A Right To Jeopardize Their Own Health (I Don’t Recommend It),” Mr. Cuomo Tweeted May 29. “People Don’t Have A Right to Jeopardize Other People’s Health.” Another Tweet From The Day Before Reads, “No Mask – No Entry.”


This Week’s MSSNY Podcast


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Only 49% Of Americans Would Get COVID-19 Vaccine, Survey Shows
Only about half of Americans say that if a vaccine against the new coronavirus becomes available, they would get vaccinated, a new poll shows.

The survey was conducted May 14-18 by the Associated Press and NORC Center for Public Affairs Research at the University of Chicago, and it includes responses from 1,056 adults nationwide. Twenty percent of Americans anticipate that a COVID-19 vaccine will become available to the public before the end of the year, but if it does, only 49 percent say they plan to get it, while 20 percent say they do not plan to get vaccinated. About 31 percent said they are unsure.

Of the 20 percent of Americans who said they will not get the vaccine, most (70 percent) cited concern about its potential side effects. Another 42 percent cited concern about getting infected with the coronavirus from the vaccine. Among the 49 percent who said they will get vaccinated, wanting to protect themselves (93 percent) and their families (88 percent) were the top reasons for wanting to get vaccinated.


Clinical Leaders Most Concerned about Second Wave of COVID-19
Clinical leaders are most concerned about the possibility of a COVID-19 outbreak or second wave when it comes to resuming deferred procedures, according to a survey released by Deloitte May 27.

The Deloitte Center for Health Solutions asked 50 clinical leaders at health systems, hospitals and ambulatory surgery centers about their biggest concerns around COVID-19’s effect on deferred services. The survey was conducted during the first two weeks of May.

Deloitte found clinical leaders estimated that their elective procedure volume in April represented only 16 percent of what they normally see and returning to pre-COVID-19 volumes could take between two and six months.

While 82 percent of respondents said the possibility of an outbreak or second wave topped their list of worries around resuming elective procedures, 54 percent said low patient demand also was a big concern. Half were worried about medications, equipment, or testing.

Read the full survey results here. (Becker’s Hospital Review Leadership & Management May 28)


Blood Oxygen Levels, Inflammation Make Covid-19 Turn Critical: NYU Study Researchers at NYU Langone Health have found a pair of factors more strongly associated with critical illness from Covid-19 than the commonly cited risks of advanced age and comorbidities. Patients with inflammation and low levels of blood oxygen were most likely to have the worst outcomes, the researchers found.

The study, published in the medical journal BMJ, followed more than 5,200 patients in the city who tested positive for Covid-19 between March 1 and April 8. Slightly more than half of the patients were hospitalized. Nearly 70% of hospitalized patients were discharged, and more than 24% died or were discharged to hospice.

Risk factors for developing critical illness—besides age—include heart failure, chronic kidney disease, a body mass index greater than 40 and being male.

However, a blood oxygen level below 88% upon admission and markers of inflammation in the body were more strongly associated with critical illness than age and comorbidities, NYU said. One such marker included a substance produced by the liver in response to inflammation.

Some 53% of hospitalized patients were younger than 65.

Other findings included that the risk of critical illness and death among hospitalized patients decreased over the study period, NYU Langone said.

The findings show that physicians’ increasing familiarity with the disease might improve outcomes, even without a vaccine or proven drugs for treatment, the researchers wrote. (May 27 Crain’s Health Pulse)


House Passes Small Business Loan Tweaks That Would Help Healthcare Providers
The House legislation’s payroll tax deferral would also be a help to providers that employ highly compensated physicians, Willey said. Proskauer Rose partner Rick Zall said the extension of the time frame from eight to 24 weeks to spend PPP funds would be especially useful to physician practices that had to nearly or completely shut down due to the pandemic. “They are looking at the PPP as a bridge to be able to maintain staff and reopen promptly,” Zall said. (Modern Healthcare, 5/28)


 

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COVID-19 Patients with Cancer: 13% of 928 Died
The AP (5/28) reports on two studies that concluded people with cancer who developed COVID-19 were more likely to die than people without cancer who developed COVID-19. Researchers found in one study published in The Lancet and which will be presented at the American Society of Clinical Oncology online conference that “half of 928 current and former cancer patients with COVID-19 were hospitalized and 13% died.” In the other study, which was also published in The Lancet, researchers in the UK found that a 28 percent mortality rate out “of 800 patients with various types of cancer and COVID-19.”


U.S. Adults Still Afraid to Go to A Hospital Over Covid-19 Fears
A new survey reinforces the fact that many Americans’ fears of contracting Covid-19 at a hospital are keeping them from seeking essential care. The new survey, conducted by the Society for Cardiovascular Angiography & Intervention, included responses from around 1,000 U.S. adults over the age of 30.

It found that 36% of respondents view going to the hospital as risky behavior, which is higher than the number who view going to a salon as risky (27%) and those who would reconsider going to the beach (16%). Asked further about going to a hospital, 61% said they felt they were somewhat or very likely to acquire Covid-19 there. Half of respondents said they were more afraid of contracting the infection than they were of experiencing a heart attack or stroke, while nearly 60% said the same about a family member.


Asymptomatic Patients With SARS-CoV-2 Shed Virus for About Eight Days, Compared With 19 Days for Those Who Have Symptoms, Study Shows
NBC News (5/27) reports, “New estimates of the number of asymptomatic people with the coronavirus suggest that ‘silent’ COVID-19 is much more prevalent than once thought – but these individuals may not spread the virus for as long as symptomatic patients do, a study from China suggests.” The report published in JAMA Network Open found “the asymptomatic patients were more likely to be women, and more likely to be younger, in their 20s, 30s and early 40s.” Furthermore, “the researchers found the asymptomatic individuals shed the virus for about eight days, compared with 19 days among those who did have symptoms.”


Support Health Equity Initiatives Through The David and Donna Marie Meza Health Equity Fund
The David and Donna Marie Meza Health Equity Fundwas established by Thomas Madejski, MD and Sandra Madejski to support health equity initiatives through the AMA Foundation. Support from this fund is focused on the AMA’s Center for Health Equity and the Foundation’s Community Health Program. 

Eligible initiatives must demonstrate a commitment to addressing health disparities and promoting health equity in diverse, economically disadvantaged environments. Preference shall be given to initiatives that support health literacy and self-management.

You can make a tax-deductible donation in direct support of this fund using the form here


 

 

 

 

 

 

 

 

MSSNY Applauds Legislation to Expand Medicaid and CHIP Coverage for Telehealth to Include “Audio-Only” Services


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
May 28, 2020

MSSNY Applauds Legislation to Expand Medicaid and CHIP Coverage for Telehealth to Include “Audio-Only” Services

Statement Attributable to:
Bonnie Litvack, M.D.
President, Medical Society of the State of New York

“We applaud Senator Metzger and Assemblymember Rosenthal for advancing their legislation (A.10404-A/S.8416) to expand Medicaid and CHIP coverage for telehealth to include “audio-only” services.  During this pandemic, telemedicine availability has been an absolutely essential modality for our patients to continue to receive needed medical services from their physicians.

“The Cuomo Administration, through the New York State Department of Health (DOH) and Department of Financial Services (DFS), took critically important steps in mid-March to remove barriers to telehealth coverage for commercial and state-sponsored insurance programs, including ensuring that telephone conversations between patients and their physicians were covered.  This is particularly important for many of our patients who do not possess adequate video-enabled technology to conduct audio-visual telehealth visits with their physicians.  Recognizing this concern, CMS also took the step of expanding audio-only telehealth coverage for our senior patients covered by Medicare.

“As we enter a new phase in confronting the pandemic, and preventing against a second “surge”, MSSNY has been urging that this expanded coverage for telehealth be continued across the health insurance coverage spectrum.  This legislation would ensure that this expanded coverage continues for the Medicaid and CHIP programs, a standard which we would also urge DFS to continue to require of state-regulated commercial health insurance plans.”

# # #

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 Update May 28, 2020

.

Gov. Cuomo’s Daily Press Conference Highlights

-Total hospitalizations and intubations is down
– 163 new COVD cases as of yesterday
– 74 lives lost yesterday (52 in hospitals, 22 in nursing homes)

Governor’s Opinion:
– I understand what states and Governors must do, but what is Washington going
to do?
– Analysis from May 4 shows that NYS only received about $24K per positive
COVID case, compared to Kentucky who received about $338K per positive case
– – Governor reiterated that corporations that accept federal aid, must rehire
the same amount employees that were fired

Reopening NYC:
– Contact Tracing needs to be worked on before reopening
– Focus on troubled areas
– More cases are coming from outer-borough, minority, lower income
communities with people who are currently unemployed

– NYS is partnering with Northwell Health to bring more healthcare
services to impacted communities
– There are more than 225 testing sites in NYC, but many are being underused
– 1M masks will be delivered to hard hit communities
– Executive order will be signed today authorizing businesses to deny entry to those
who do not wear face mask or coverings

Q&A:
Federal Aid:
– According to DeRosa, the state will realize a savings through a hiring freeze,
a voluntary pay increase deferment from unionized labor as well as from
management confidential employees

Testing & PPE:
– Perez commended today’s executive order stating that it will help decrease
instances in which conflict/anxiety occurs due to some customers not wearing masks
– According to DeRosa, only 10 states are currently providing probable and confirmed
death data


There Were 364,965 Confirmed COVID-19 Cases in New York as of Wednesday.


MSSNY President Voices Support for Bill to Curb Price Gouging of Essential Medical Supplies
MSSNY President, Dr. Bonnie Litvack, MD, voiced support for the passage of A.10270 (Rozic)/S.8189 (Hoylman), which would expand New York’s anti-“price gouging” statute to include “unconscionably excessive” prices charged by vendors for essential medical supplies used by physicians every day in their practices, such as PPE and hand sanitizer.  The bill passed the Senate and Assembly during its legislative session this week. “Even though the COVID19 acute crisis has begun to subside around the state, New York physicians still face enormous challenges as they work to fully reopen their practices to treat their patients,” said Dr. Bonnie Litvack, MD, President of the Medical Society of the State of New York (MSSNY).

“Chief among those challenges is the dangerous shortage of Personal Protective Equipment (PPE) due to a variety of factors including refusal by some suppliers to sell to smaller physician practices and/or charging enormously marked-up prices. This legislation sets forth important steps to better ensure that PPE sellers will deal more fairly with community physicians and other care providers to enable them to get the critical supplies they need to get back to treating their patients and serving the communities where they live.” (CARY, AUSTER)


Legislature Passes Measure to Expand Whistleblower Protections for Healthcare Workers
The Senate and Assembly passed a measure this week (S.8397-A, Savino/A.10326-A. Reyes), which would provide New York healthcare workers with greater “whistleblower” protections to reduce the risk of employers penalizing employees for filing complaints against them.

New York’s Labor Law provides healthcare workers with some whistleblower protections but does not specifically address disclosures to the public made via new platforms like social media. This legislation would provide medical professionals with greater legal protections against employer retaliation regarding public reports raising concerns with workplace safety conditions.   The sponsor’s memo in support of this legislation notes that the legislation is in response to concerns raised by many healthcare professionals during the pandemic that the institution where they practiced did not provide them sufficient PPE.

If signed into law by the Governor, the law would take effect immediately.
(CARY, AUSTER)


Legislature Passes Measure to Expand Medicaid Coverage for Audio-Only Telehealth
The Senate and Assembly passed a measure this week (A.10404-A, Rosenthal/S.8416) that permanently expands coverage for telemedicine in Medicaid and the Child Health Plus Insurance program to include “audio-only” services. Given the importance of making sure patients with limited access to video technological services could maintain continuity of care with their physician, Medicaid has been covering audio-only telehealth services since mid-March.  MSSNY President Dr. Bonnie Litvack issued a statement praising the legislation and urging that it be continued as well for all forms of insurance coverage.

“We applaud Senator Metzger and Assemblymember Rosenthal for advancing their legislation (A.10404-A/S.8416) to expand Medicaid and CHIP coverage for telehealth to include “audio-only” services.  During this pandemic, telemedicine availability has been an absolutely essential modality for our patients to continue to receive needed medical services from their physicians.

The Cuomo Administration, through the New York State Department of Health (DOH) and Department of Financial Services (DFS), took critically important steps in mid-March to remove barriers to telehealth coverage for commercial and state-sponsored insurance programs, including ensuring that telephone conversations between patients and their physicians were covered.

This is particularly important for many of our patients who do not possess adequate video-enabled technology to conduct audio-visual telehealth visits with their physicians.  Recognizing this concern, CMS also took the step of expanding audio-only telehealth coverage for our senior patients covered by Medicare.

As we enter a new phase in confronting the pandemic, and preventing against a second “surge”, MSSNY has been urging that this expanded coverage for telehealth be continued across the health insurance coverage spectrum.  This legislation would ensure that this expanded coverage continues for the Medicaid and CHIP programs, a standard which we would also urge DFS to continue to require of state-regulated commercial health insurance plans.” (AUSTER)


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Research Indicates Five-Day Course of Remdesivir Works as Well As 10-Day Course for Patients with Severe COVID-19
Reuters reports that “Gilead Sciences Inc, which has suggested that a shorter treatment duration could extend limited supplies of its drug remdesivir,” has “published results of a study showing no significant difference in outcomes between 5-and 10-day courses of the drug for patients with severe COVID-19.” The findings were published in the New England Journal of Medicine.


“2nd Wave ‘Is Not Inevitable,” Dr. Fauci Says; CDC Clarifies Message on Virus Transmission — 5 Covid-19 Updates
Reported U.S. deaths related to COVID-19 have surpassed 100,000, with 100,442 deaths and 1,699,933 COVID-19 cases reported as of 7:45 a.m. CDT May 28. Globally, there have been 5,716,570 reported cases and 356,131 deaths, while 2,367,292 have recovered.


Five Updates:

  1. The coronavirus can spread by touching a contaminated surface and then touching the mouth, nose or eyes, though this isn’t thought to be the main form of transmission, according to the CDC. The clarification comes after the agency updated its website last week to say that the virus doesn’t spread easily via surface transmission. The update was “to make it easier to read, and was not a result of any new science,” according to the CDC. The primary and most significant mode of transmission is close contact with others, the agency reiterated.
  2. A second wave “could happen but is not inevitable,” Anthony Fauci, MD, said during a May 27 interview on CNN‘s “Newsroom.” The nation’s top infectious disease physician said broad efforts to identify and isolate COVID-19 patients through contact tracing could help prevent the virus’s resurgence this fall. Dr. Fauci also commented on the use of the antimalarial drug hydroxychloroquine as a potential COVID-19 treatment during the interview. “The scientific data is really quite evident now about the lack of efficacy for it,” he told CNN.
  3. The WHO Foundation was created to broaden the World Health Organization’s donor base and achieve ‘sustainable and predictable’ funding, according to a May 27 announcement. The entity is legally separate from WHO and will facilitate contributions from the public, individual major donors, and corporate partners. After President Donald Trump said May 18 that he may pull all WHO funding from the U.S., agency officials voiced concern regarding emergency programs. The WHO Foundation will initially focus on emergencies and response to the pandemic.
  4. “The jury is still very much out” on whether COVID-19 antibodies provide immunity against reinfection, Mike Ryan, MD, executive director of the WHO’s emergencies program, said. May 26. Scientists are still learning about the virus SARS-CoV-2 and the disease COVID-19, including how immune systems respond once a person is exposed to the virus, according to WHO officials.
  5. More than 2.1 million Americans filed for unemployment last week, according to new data from the U.S. Department of Labor. This marks the eighth consecutive week of decline in unemployment figures, although the number of people seeking financial assistance is still about 10 times higher than before lockdowns started in March, according to The Wall Street Journal (Becker’s Hospital Review May 28)

Cuomo to Sign Executive Order Allowing Businesses to Deny Entry to Customers Without Masks
New York Gov. Andrew Cuomo said today he will sign an executive order allowing private businesses to deny entry to customers who are not wearing face coverings.

“We made them mandatory in public settings, public transportation etc., but when we’re talking about reopening stores and places of business, we’re giving the store owners the right to say, ‘if you’re not wearing a mask, you can’t come in,” Cuomo said during his daily press briefing.

Store owners have a right to protect themselves and other patrons, he said.

“You don’t want to wear a mask? Fine, but you don’t have a right to then go into that store if that store owner doesn’t want you to,” the governor added.


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COVID-19 Update May 27, 2020


Please Join NYSDOH Update for Physicians Tomorrow 1-2 PM 

For audio only, please dial in: 844-512-2950
Please share with your healthcare provider members- 

Please join the NYS Department of Health 

Thursday May 28th at 1-2PM forCOVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

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


48% of Americans Delayed Care in Pandemic; Tests May Be Wrong Half the Time
The U.S. has reported 1,681,418 COVID-19 cases and 98,929 related deaths as of 7:45 a.m. CDT May 27. Globally, there have been 5,614,458 reported cases and 350,958 deaths, while 2,307,510 have recovered.


Five COVID-19 Updates:

1. COVID-19 antibody tests are wrong nearly half the time, according to the CDC. Serologic tests meant to measure past COVID-19 exposure or infection are not accurate enough to use to make policy decisions, the CDC said. Healthcare providers should use the most accurate antibody test available and may need to test people twice. If only a small percent of people being tested have been exposed to the virus, even a small margin of error can be significant — if 5 percent of the population tested has the virus, a test with more than 90 percent accuracy could still fail to detect half the cases.

2. Forty-eight percent of Americans said they or someone in their household have postponed or skipped medical care due to the pandemic, according to a poll by Kaiser Family Foundation. The phone survey was conducted May 13-18 among 1,189 U.S. adults. As restrictions ease, many (68 percent of those who delayed care; 32 percent of all adults) expect to receive the care they delayed over the next three months.

3. New cases are increasing in about a dozen states, according to The New York Times, at least half of these states — including Alabama, Florida, Georgia, South Carolina, and Tennessee — started reopening in late April and early May. NYT said the new cases could reflect increased testing capacity in some areas. Former FDA Commissioner Scott Gottlieb noted during an interview with CNBC‘s “Squawk Box” there is also “a small uptick” in hospitalizations that “is probably the result of reopening.”

“I’m concerned that there are people who think that this is the all-clear,” he said.

4. One-third of Americans show signs of clinical anxiety or depression, according to a U.S. Census Bureau survey cited by The Washington Post.The agency polled adults from more than 42,000 households between May 7-12. Twenty-four percent of Americans showed clinically significant symptoms of major depressive disorder and 30 percent had symptoms of generalized anxiety disorder. These figures demonstrate a large jump from depression and anxiety rates seen before the pandemic.

5. The CDC shared a new guidance on when confirmed or suspected COVID-19 patients can end self-isolation practices. Patients can be around others if they have gone three days with no fever, their symptoms have improved, and it has been 10 days since symptoms first appeared. Asymptomatic patients who tested positive for COVID-19 can be around others after 10 days. (Becker’s Hospital Review, May 27)


WHO Warns Of ‘Second Peak’ Before Second Wave
The world could see a “second peak” of COVID-19 cases before a presumed second wave comes this fall, Dr. Mike Ryan, executive director of the World Health Organization’s emergencies program, said during a May 25 media briefing.

Dr. Ryan said the world is still in the middle of the first wave, citing areas like Africa and South Asia where cases are steadily rising. He warned against making any assumptions about the pandemic’s trajectory just because cases are falling in some areas. Countries cannot assume they will have a few months to get ready for a second wave, Dr. Ryan said.

“We need to be cognizant of the fact that the disease can jump up at any time,” he said. “We may get a second peak in this wave… It is crucial for countries to implement a comprehensive strategy involving testing, surveillance, and other public health measures to “ensure we continue to have an immediate downward trajectory” in cases, Dr. Ryan concluded.

To view the full media briefing, click here. (Becker’s Hospital Review, May 26)


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Webinar: Re-Opening Your Medical Practice in COVID-19 Era
On June 4, MLMIC and HANYS will host “Emerging From COVID-19: Guidelines for Re-opening Healthcare.” This webinar will provide a strategic roadmap to help medical practices safely and efficiently return to normal operations. Read more at MLMIC.com


Zocdoc Concerns MSSNY Physicians, Again
Recently, the MSSNY leadership had a few meetings; whereby, many physician members expressed much dismay seeing their names on Zocdoc’s website/database.  MSSNY addressed a similar problem last year.  Many physicians who have no agreement with Zocdoc do NOT want to be listed on the Zocdoc website.

It is considered by many physicians to be inappropriate and misleading to the patient community.  MSSNY contacted Zocdoc to urge correction of this misleading information.  Physicians without a Zocdoc agreement should be removed from the website/database.  The statement that the physician has no online appointments available is misleading since the statement is used when a physician does not participate with Zocdoc.  Patients have no idea if a doctor has appointments outside of Zocdoc and may not take further steps to contact the physician.

Zocdoc has advised that they would remove individual pages at the applicable physician’s request.  Any physician who would prefer their page removed from Zocdoc’s website can contact Zocdoc, directly at service@zocdoc.com

Zocdoc will work directly with the physician to remove the physician’s page.

On a related note, MSSNY’s Task Force on Telemedicine is currently in the process of vetting vendors to partner with to offer a statewide telemedicine platform for our members.


Physicians, Do You Use Telemedicine?
CMS has asked MSSNY for a listing of physicians who do Telemedicine. They have heard from a numbers of community health care groups for seniors that some patients are hesitant about calling their physicians about needed appointments since they are fearful of having to go to the doctor’s office.

CMS is asking for MSSNY’s assistance for two reasons:

The first is to alert patients in communities which physicians can provide virtual care during this pandemic.

Second, regarding forward thinking, it would be helpful for CMS to know which and how many physicians can provide telemedicine. This information would be useful in making the argument of continuing the expanded telemedicine coverage in a post pandemic future.

If you are capable of providing telemedicine, please provide MSSNY with your name, address, specialty, phone and NPI number. This information will be added to MSSNY’s website and shared with your county societies.  CMS would also help in disseminating the information to the patient community.


New York Pharmacist Arrested in N95 Profiteering Scheme
Richard Schirripa, a licensed pharmacist in New York City, was charged May 26 with violating the Defense Production Act by allegedly hoarding and hiking the price of thousands of N95 masks.  Mr. Schirripa allegedly bought $200,000 worth of N95 masks from the black market between February and April and sold thousands of them at severely inflated prices.

He often sold them out of his car and charged up to $25 for a mask that cost about $1.27, the U.S. Justice Department alleged. When the Defense Production Act was invoked March 25, it made it a crime to hoard or price gouge N95 masks. In a separate charge, Mr. Schirripa was also accused of falsely billing Medicare and Medicaid for thousands of doses of controlled substances that he kept for himself before closing his pharmacy in New York City earlier this year.

Mr. Schirripa is charged with violating the Defense Production Act, committing healthcare fraud, aggravated identity theft and exploiting the personal information of his pharmacy’s customers to fill prescriptions. Read the Justice Department’s full news release here.


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COVID-19 IN CHILDREN:  They Have Lower Levels of ACE2 Gene Expression
Mount Sinai Health System said Friday that a group of its researchers have found that children have lower levels of ACE2 gene expression than adults, which may explain children’s lower risk of Covid-19 infection and mortality. The virus that causes Covid-19 uses ACE2, which is found on the surface of certain cells in the body, to enter victims, Mount Sinai said. A new study on the findings was published in JAMA. (Crain’s Pulse, May 27)


 

 

 

 

 

 

Council June 4, 2020

MSSNY COUNCIL AGENDA
Thursday, June 4, 2020, 4:00 p.m. (Virtual)

A. Call to Order and Roll Call

B. APPROVAL of the March 5, 2020 & May 7, 2020 Council Minutes

C. New Business (Informational/Action Items)

Introduction of AMA President, Patrice A. Harris, MD, MA by MSSNY President, Bonnie L. Litvack, MD 

1. President’s Report:

         Announcement – Certificate of Recognition

a. APPROVAL 2020/2021 Meeting Schedule
b. APPROVAL 2020/2021 Committee Selections

      (to reflect changes only)

c. APPROVAL – 2020/2021 At Large Members to MSSNY’s Executive Committee:

• Maria A. Basile, MD
• Brian P. Murray. MD

d. APPROVAL2020 HOD Resolutions referred to Council  

e. AMA Article -Police Brutality Must Stop

2. Board of Trustees Report – Dr. Kleinman will present the report

3. Secretary’s Report – Dr. Frank Dowling will present the report

4. MLMIC Update – Dr. John Lombardo will present the report (verbal)

5. AMA Delegation Report – Dr. John Kennedy will present the report

6. MSSNYPAC Report – Dr. Thomas Lee will present the report

7. County Federation Report – Dr. Aaron Kumar will present the report

D. Reports of Officers (Verbal)

  1. Office of the President – – Bonnie L. Litvack, MD
  2. Office of the President-Elect – Joseph R. Sellers, MD
  3. Office of the Vice President – Parag H. Mehta, MD
  4. Office of the Immediate Past President – Arthur C. Fougner, MD
  5. Office of the Treasurer – Mark J. Adams, MD, Financial Statement for the period January 1, 2020 to April 30, 2020
  6. Office of the Speaker – William R. Latreille, Jr., MD

E. Reports of Councilors  (Informational Items)

  1. Kings & Richmond Report – Adolph B. Meyer, MD (received)
  2. Manhattan & Bronx Report – David M. Jakubowicz, MD (received)
  3. Nassau County Report – Paul A. Pipia, MD (received)
  4. Queens County Report – Saulius J. Skeivys, MD (received)
  5. Suffolk County Report – Linda S. Efferen, MD (received)
  6. Third District Branch Report – Brian P. Murray, MD (received)
  7. Fourth District Branch Report – Gregory L. Pinto, MD(no report submitted)
  8. Fifth District Branch Report – Barry Rabin, MD (received)
  9. Sixth District Branch Report – Robert A. Hesson, MD (received)
  10. Seventh District Branch Report – Janine L. Fogarty, MD (received)
  11. Eighth District Branch Report – Mark R. Jajkowski MD (received)
  12. Ninth District Branch Report – Thomas T. Lee, MD (received)
  13. Medical Student Section Report –  Shireen Saxena (received)
  14. Organized Medical Staff Section Report – Stephen F. Coccaro, MD
    (no report submitted)
  15. Resident & Fellow Section Report – Raymond Lorenzoni, MD
    (no report submitted)
  16. Young Physician Section Report – L. Carlos Zapata, MD
             (no report submitted)

F. Commissioners (Informational Items)

1.  Commissioner of Continuing Medical Education, Mark J. Adams, MD
    a. Report from the Office of CME

2.  Commissioner of Communications, Maria A. Basile, MD, MBA
  a. Report from the Division of Communications

3.  Commissioner of Governmental Relations, Gregory L. Pinto, MD
  a. HIT Committee Minutes, May 8, 2020 & March 12, 2020
b. Budget Passes – Physician Advocacy Made MAJOR Impact On Outcome
c. MSSNY Press Releases

4. Commissioner of Membership, David M. Jakubowicz, MD
(no written report submitted)

5. Commissioner of Science & Public Health, Joshua M. Cohen, MD
(no written report submitted)

6. Commissioner of Socio Medical Economics, Brian P. Murray, MD
       (no written report submitted)

G. Report of the Executive Vice President, Philip Schuh, CPA, MS
1. Group Institutional Dues Comparison Report
2. Membership Dues Revenue Schedule

H.  Report of the General Counsel, Garfunkel Wild, P.C. Barry Cepelewicz, MD, Esq. (no written report submitted)

I. Other Information/Announcements

  1. AMA Letters – The Health Care at Home Act
  2. AMA Letter to US Dept. of Health & Human Services regarding federal funding to native populations
  3. Sign-On Letter – CARES Act
  4. USMLE Suspending Step 2 Clinical Skills Examination
  5. CDC Guidelines for COVID-19 Antibody Testing
  6. MSSNY Letter to Dr. Zucker – Peer to Peer Program
  7. MSSNY Letter to Governor Cuomo – COVID 19
  8. Scope of Practice Committee Minutes

J. Adjournment

 

 

 

 

COVID-19 Update May 26, 2020

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CORONAVIRUS COUNT — There were 362,764 confirmed cases in New York as of Monday. (NYSDOH MAP)


Notes from Governor Cuomo’s COVID-19 Briefing TODAY
– Hospitalizations down, net change down, intubations down. New COVID
cases in hospitals down.

Lives lost on May 26th: 73 – 52 in hospitals, 21 in nursing homes

Monitor the Re-openings
– Mid-Hudson Region opens today
– Long Island opens tomorrow
– Regional Control Groups monitor and respond to the numbers
– NYC is not ready to reopen
– Focus on data to get NYC reopened
– Focus on neighborhoods within NYC that are suffering the most

Supercharge Reopening
– Gov believes the economy bounces back differently
– Top end will be fine
– American workers and small businesses will be hurt
– Government can stimulate the economy
– Provides examples
– Hoover Damn
– Lincoln Tunnel
– Overseas Highway
– Have major infrastructure work to do that is long overdue
– NOW IS THE TIME TO BUILD
– Gov will travel to DC tomorrow to meet with President
Q&A:
Financial Situation for State and NYC:
– Asked about legislation allowing NYC to borrow $7 billion and
whether raising taxes on the wealthy was an option
– Reiterates without funding from feds the state will have a financial
problem
– Gov says Borrowing for operating expenses “fiscally questionable”


New York Forward Loan Fund Supports NYS Small Businesses
New York Forward Loan Fund (NYFLF) is a new economic recovery loan program aimed at supporting New York State small businesses, nonprofits and small landlords as they reopen after the COVID-19 outbreak and NYS on PAUSE.

NYFLF targets the state’s small businesses with 20 or fewer full-time equivalent (FTE) employees (90% of all businesses), nonprofits and small landlords that have seen a loss of rental income.

NYFLF is providing working capital loans so that small businesses, nonprofits and small landlords have access to credit as they reopen. These loans are available to small businesses, nonprofits, and small landlords that did not receive a loan from either the U.S. Small Business Administration (SBA) Paycheck Protection Program (PPP) or SBA Economic Injury Disaster Loans (EIDL) for COVID-19 in 2020.  The loans are not forgivable in part or whole.  The loans will need to be paid back over a 5-year term with interest.

The working capital loans are timed to support businesses and organizations as they proceed to reopen and have upfront expenses to comply with guidelines (e.g., inventory, marketing, refitting for new social distancing guidelines) under the New York Forward Plan.


 


NY1: Why Independent Physician Practices are Devastated by COVID-19 Pandemic


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Trump Administration Announces Changes to Medicare Advantage and Part D to Provide Better Coverage and Increase Access for Medicare Beneficiaries

Final Rule continues to strengthen the popular private Medicare health and drug plans

CMS today finalized requirements that will increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases, provide support for more MA options for beneficiaries in rural communities, and expand access to MA for patients with End Stage Renal Disease (ESRD). Together, the changes advance President Trump’s Executive Orders on Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health as well as several of the CMS strategic initiatives.

Due to the upcoming June 1, 2020, MA and Part D bid deadlines for the 2021 plan year, CMS is finalizing a subset of the proposed policies before the MA and Part D plans’ bids are due. CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year.

We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to coronavirus disease 2019 (COVID-19), and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries.

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

Building on actions that the Trump Administration has taken to expand access to telehealth so beneficiaries can get care at home instead of traveling to a healthcare facility, today’s rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas.

CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology, and Infectious Diseases) towards meeting CMS network adequacy standards. This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas.

Today’s rule gives beneficiaries with ESRD more coverage choices in the Medicare program. Previously, beneficiaries with ESRD were only allowed to enroll in MA plans in limited circumstances. The rule implements the changes made by the 21st Century Cures Act to give all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021. This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare Fee-For-Service.

CMS is also finalizing proposals to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall Star Rating. The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered.

One of the best indicators of a plan’s quality is how its enrollees feel about their coverage experience. This decision reflects CMS’s commitment to put patients first and improves incentives for plans to focus on what patients value and feel is important. Additionally, CMS adopted a series of changes in the March 31, 2020, Interim Final Rule with Comment Period (CMS-1744-IFC) for the 2021 and 2022 Star Ratings to accommodate challenges arising from the COVID-19 public health emergency.

For a fact sheet on the Contract Year 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), please click here.

The final rule can be downloaded from the Federal Register here.


About 35 Percent of COVID-19 Patients Do Not Show Symptoms, the CDC Estimates
In a new guidance that outlines five pandemic planning scenarios, according to CNN. The scenarios are designed to inform decisions by mathematical modelers and public health officials.

In its “best estimate” the CDC states 40 percent of coronavirus transmission is happening before people start to feel sick, and 0.4 percent of those who contract COVID-19 and show symptoms will die. (Becker’s Hospital Report)


Flu, Pneumonia, COVID-19 Deaths Drop and other CDC Updates
Deaths attributed to pneumonia, influenza or COVID-19 dropped by about 6 percentage points for the week ending May 16 compared to the week prior, but were still high compared to previous flu seasons, according to the CDC’s weekly COVID View report.

Four things to know:

  1. The percentage of respiratory specimens testing positive for the new coronavirus decreased at public, commercial and clinical laboratories for the week ending May 16. Public labs reported the biggest drop — from 10.7 percent during the week ending May 9 to 8.5 percent during the week ending May 16.
  2. About 12 percent of deaths across the country were attributed to pneumonia, flu or COVID-19 in the week ending May 16, down from 18.5 percent the week before. The percentage remains high compared with any flu season before the pandemic and may change as additional death certificates are processed, the CDC said.
  3. The cumulative COVID-19-associated hospitalization rate for all age groups is 67.9 hospitalizations per 100,000 population, with the highest rates in people ages 65 years and older (214.4 hospitalizations per 100,000 population).
  4. Visits to outpatient providers and emergency departments for symptoms linked to COVID-19 continue to decline, and outpatient visit for flu-like illness was 1.1 percent the week ending May 16, below the national baseline of 2.4 percent. (CDC)

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Gilead Releases Full Results of Remdesivir Trial
Remdesivir quickened the recovery time for COVID-19 patients but did little to benefit patients on ventilators, according to study results from Gilead’s clinical trial of the drug, the first given emergency approval to treat COVID-19, STAT reports.

The full data from Gilead’s clinical trial, being run by the National Institute of Allergy and Infectious Diseases, was released May 22 in the New England Journal of Medicine

The trial included 1,063 patients, with 538 receiving remdesivir and 521 being given a placebo. The patients given remdesivir recovered in a median of 11 days, compared to 15 days for the placebo group, STAT reported. Mortality in the remdesivir group was 7.1 percent, compared to 11.9 percent for the placebo group, slightly better than previous results.

“It’s a very safe and effective drug,” Eric Topol, MD, founder, and director of the Scripps Research Translational Institute, told STAT. “We now have a definite first efficacious drug for COVID-19, which is a major step forward and will be built upon with other drugs [and drug] combinations.”

There was no sign of benefit for patients who began taking remdesivir while on ventilators or who were receiving extracorporeal membrane oxygenation, a treatment in which oxygen is added to the blood outside the body, according to STAT. Knowing which patients benefit from remdesivir the most could be important for deciding who gets the drug, as it has been in short supplySTAT reports. In the full study results, the benefit of remdesivir appeared to be much larger for patients who were less sick.

The study was stopped after a data safety and monitoring board told NIAID that there was a statistically significant benefit of remdesivir, and critics have said the study should have continued to better discern if remdesivir reduces the death rate, STAT reports. (May 26)


Survey: Consumers Still Feel Comfortable Picking Up Scripts at Pharmacies
The pandemic has not significantly shaped Americans’ feelings about in-person pharmacy visits, according to survey responses released May 21 by the Alliance of Community Health Plans.

The survey, which involved 1,263 adults from ages 18 to 74, found that 41 percent of respondents had delayed nonemergency healthcare appointments and 42 percent felt uncomfortable visiting the hospital for treatment.

However, the survey also revealed the following insights about respondents’ attitudes toward pharmacies during the pandemic:

  • Forty-nine percent reported feeling “very comfortable” picking up prescriptions at their pharmacy and speaking with their pharmacists.
  • Forty-seven percent received a new prescription in the last 90 days.
  • Ninety percent of respondents who received a new prescription in the last 90 days did so at a local retail pharmacy.
  • Thirty-nine percent of respondents reported feeling comfortable undergoing COVID-19 testing at a pharmacy.
  • Twenty-four percent used a mail-order pharmacy service in the last 90 days.
  • Nine percent used their local pharmacy’s home delivery service in the last 90 days.

COVID-19 Update May 22, 2020



Lean on Me: MSSNY Launches COVID Helpline and Recruits Peer Supporters

You just call on me brother, when you need a hand 
We all need somebody to lean on
 
I just might have a problem that you’ll understand
 
We all need somebody to lean on”
  … written and recorded by American singer-songwriter Bill Withers, released in April 1972

Hit songs typically come and go but this song has had enduring longevity.  The lyrics speak to us now touching our soul, expressing exactly how we feel. The music resonates in our heart, mind, and spirit lifting us to another dimension.

Physician stress and moral injury have been plaguing our profession for years and solutions have been a top MSSNY priority.  Our MSSNY committee on Physician Wellness and Resiliency has been working with the AMA and local medical groups and hospital medical staffs on solutions and implementation of a peer to peer support program. The COVID-19 pandemic has added previously unimaginable stressors exacerbating the problem and threatening a professional crisis.  In response, our MSSNY committee jumped into action to accelerate timelines to get needed help to our colleagues.

Last Friday, MSSNY launched the 24/7 Physician COVID Helpline for NYS physicians experiencing COVID 19 related stress.

The Helpline number is: 518-292-0140

Phase Two of the MSSNY Physician Wellness and Resiliency Committee response is the MSSNY Peer to Peer (P2P) support program intended to provide an opportunity for physicians, residents and medical students to talk with a peer about life stressors both work and family related. MSSNY is currently seeking volunteer peer supporters at all career stages who will be trained to listen without judgment, validate feelings and provide support, empathy, and perspective. When needed, peers may also provide a confidential referral for treatment.

Consider volunteering yourself or nominating a colleague. Nominations can be sent to pclancy@mssny.org. More information here.

As we lean on each other, may we all find comfort and peace this Memorial Day Weekend.


HEALTH ADVISORY: Ensuring Access to Health Care Services During COVID-19
Please distribute to the Chief Medical Officer, Family Medicine and Pediatric Departments, Director of Medicine,Director of Nursing and all primary care clinics.


Health Advisory: COVID-19 Updated Guidance for Hospital Operators Regarding Visitation


8 COVID-19-Related Diagnostic Errors to Know
The COVID-19 pandemic could increase the risk of diagnostic errors due to staffing shortages, chaotic work environments and high levels of clinician stress and fatigue, two healthcare quality experts wrote in an article published in the Journal of Hospital Medicine.

The article’s authors are:

  • Tejal Gandhi, MD, chief safety and transformation officer at Press Ganey
  • Hardeep Singh, MD, chief of health policy, quality, and informatics at the Michael E. DeBakey VA Medical Center in Houston.

Drs. Gandhi and Singh identified eight diagnostic errors that may occur in the COVID-19 era based on emerging research and discussions with experts worldwide. The errors are defined below.

  1. Classic: Missed or delayed COVID-19 diagnosis in patients with respiratory symptoms.
  2. Anomalous: Missed or delayed COVID-19 diagnosis in patients who do not have respiratory symptoms.
  3. Anchor: Missed or delayed diagnosis of a different condition because clinicians assume the patient has COVID-19.
  4. Secondary: Missed or delayed diagnosis of a secondary condition in a patient being treated for COVID-19.
  5. Acute collateral: Delayed diagnosis of an acute condition because patients are not seeking care due to fear of contracting COVID-19 in a hospital or emergency department.
  6. Chronic collateral: Delayed diagnosis of ambulatory conditions due to canceled appointments or elective procedures.
  7. Strain: Missed or delayed diagnosis of a different condition because hospitals are overwhelmed, potentially limiting the time and attention clinicians spend on non-COVID-19 patients.
  8. Unintended: Missed or delayed diagnosis because clinicians are using telemedicine more instead of interacting with patients in person.

To view the full article, click here. (Becker’s Hospital May 20)


1 in 5 COVID-19 patients in NYC hospitals were Critically Ill: 5 Things About Them
About 22 percent of COVID-19 patients admitted to two New York City hospitals were critically ill, and nearly all had at least one chronic illness, a new study shows. The study, published in The Lancet, examined the clinical characteristics of critically ill COVID-19 patients admitted to two New York-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in New York City from March 2 to April 1. Of the 1,150 COVID-19 patients admitted to both hospitals, 257 (22 percent) were critically ill.

Five study findings:

  1. The median age of the critically ill patients was 62 years.
  2. Sixty-seven percent were men.
  3. Eighty-two percent of the patients had at least one chronic illness — most commonly hypertension (63 percent) and diabetes (36 percent).
  4. About 46 percent were obese.
  5. Seventy-nine percent of the patients received invasive mechanical ventilation for a median of 18 days.
  6. The researchers conducted a follow-up April 28 and found 39 percent of the patients had died and 37 percent remained hospitalized.

(Becker’s Hospital Review May 20)


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Endocrinologists Share Perspective on Pandemic as Patients with Diabetes Who Contract The Virus Can Face Higher Risk For Hospitalization And Mortality
Endocrine News (5/21) reports, “As the COVID-19 pandemic continues to roil the world’s healthcare systems, endocrinologists may have unique insights that could save lives and improve outcomes in these patients who present with elevated glucose levels and other underlying comorbidities such as obesity and diabetes.”

Endocrine News adds, “Patients with diabetes who contract COVID-19 are at a higher risk for hospitalization and even mortality.” Endocrine News highlights a paper published in Endocrine Reviews last month that examined “how the pathophysiology of diabetes and obesity might intersect with COVID-19 biology and found key shared pathways and mechanisms linked to the development and treatment of” T2D.


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Re-Opening Your Medical Practice in COVID-19 Era; Tuesday, May 26, 12 Noon-1 PM
As physicians are now considering re-opening their practices, they need to appreciate that they cannot simply “go back to normal”.  With furloughs, layoffs, severe limitations of medical services, decreased revenues and office closures, physicians need to consider strategies to maximize the success of their practices going forward.  These include financial analysis and planning, how to best protect and treat patients and employees, and what needs to be done to ensure that their practices operate efficiently, safely, and profitably.  Topics addressed will include:

What you need to consider before re-opening?

  • What financial issues must be considered to better prepare your practice to move forward?
  • How can you ensure your practice operates appropriately as it relates to patients?
  • Is there a continued role for telehealth?
  • What will the new practice culture look like going forward?
  • What reasonable accommodations and workplace safety precautions should be made for employees?
  • What are potential discrimination issues that can arise, including, for example, from a phased re-opening, or gradual return of employees from furlough?
  • Given that employees have had a furlough period, and there may be a backlog of work, can/should employers make changes to or limit their PTO policies for the remainder of the year?
  • How do we handle/resolve employment contract breach issues?

Presented by:
Barry B. Cepelewicz, M.D., Esq.
Partner/Director
Garfunkel Wild, P.C. 

Roy W. Breitenbach, Esq.
Partner/Director
Garfunkel Wild, P.C.


CDC Estimates About One-Third of Coronavirus Patients Don’t Have Symptoms
In new guidance for mathematical modelers and public health officials, the US Centers for Disease Control and Prevention is estimating that about a third of coronavirus infections are asymptomatic. CNN (5/22, Azad) reports that in its “new guidance for mathematical modelers and public health officials,” the CDC “is estimating that about a third of coronavirus infections are asymptomatic.”

The agency also “says its ‘best estimate’ is that 0.4% of people who show symptoms and have Covid-19 will die, and the agency estimates that 40% of coronavirus transmission is occurring before people feel sick.” The CDC “cautions that those numbers are subject to change as more is learned about Covid-19, and it warns that the information is intended for planning purposes.”


Veterans Matters: TBI in Returning Veterans Podcast
Check out MSSNY’s Veterans Matters newest podcast entitled TBI in Returning Veterans.  Dr. David Podwall discusses how to identify and diagnose mild TBI in veterans, along with a discussion on prevention and treatment options. Click here to listen.


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 21, 2020

 

Notes from Governor Cuomo’s COVID-19 Briefing

· Hospitalizations are down to 5,187

· Net change in hospitalizations and intubations are down.

· Amount of new hospitalizations: 246

· 105 lives lost yesterday: 78 in hospitals, 27 in nursing homes.

REOPENING: – Rockland County is eligible for elective surgery and ambulatory care.

-NY Coronavirus Hotline: 1-888-364-3065 -Report employers if they are not following proper reopening procedures. – State beaches open tomorrow. – Beaches are limited to 50% capacity. – Social distancing must be followed. – Concessions will remain closed. – No contact sports are allowed. TRACING: – NYS tracers will call infected people. -Caller-ID will read: “NYS Contact Tracing” CHILDREN: – NYSDOH is now investigating 157 cases of COVID-related illness in children. -Today, 13 countries and 25 states and Washington D.C. have reported cases. – Gov reiterated that it is still too early to decide if schools will open in the Fall. -The state will issues guidelines to schools in June. -Schools will submit plans to the state in July. – Summer school will be conducted via distance learning. Q&A: CAMPS:

– Gov: until we have more information on COVID-related illness, it might be a bad idea to send children to camps. REOPENING:

– Reporter said NYC Mayor de Blasio says NYC has to reopen by early to mid- June. – There are metrics that will guide reopening for NYC just like every other region.


Some N.Y. Hospitals Will Allow Visitors as Part of State Pilot
COVID-19 patients will be allowed visitors in some New York hospitals and small Memorial Day ceremonies will be allowed, Gov. Andrew Cuomo said. Sixteen hospitals in New York state will allow visitors as part of a pilot program addressing the heartbreak of COVID-19 patients suffering while isolated from their families and friends.

Cuomo said visits under the two-week pilot program will be time limited. Visitors will need to wear protective equipment and will be subject to temperature and symptom checks. Strict visitation rules were adopted to check the spread of the virus, but they have resulted in painful scenes of patients relying on phones or tablets for emotional conversations with loved ones.

“It is terrible to have someone in the hospital and then that person is isolated, not being able to see their family and friends,” Cuomo said. Nine of the hospitals participating are in New York City, with the rest spread out around the state. Cuomo made the announcement as COVID-19-related hospitalizations and deaths continue to decline. There is an average of 335 new hospitals admissions a day. (Modern Healthcare 5/21)


Strokes May Be Less Frequent, More Deadly Than Previously Thought
Fewer than 1% of hospitalized patients who tested positive for COVID-19 also suffered a stroke, a rate much lower than the 2% to 5% reported in China and Italy, said a news release on a study led by the NYU Grossman School of Medicine.

But the people who had a stroke and the virus were younger, had worse symptoms and were seven times more likely to die, according to the release.

“Our study suggests that stroke is an uncommon yet important complication of coronavirus given that these strokes are more severe when compared with strokes occurring in patients who tested negative for the virus,” says study lead author Dr. Shadi Yaghi, an assistant professor in the Department of Neurology at NYU Langone Health, in the release. Modern Healthcare (5/21)


Mount Sinai Uses AI to Analyze COVID-19 Patients
Mount Sinai researchers have created an algorithm that can detect COVID-19 based on how lungs look in CT scans combined with patient information like age, symptoms, bloodwork, and possible contact with others infected with the coronavirus. “Imaging can help give a rapid and accurate diagnosis—lab tests can take up to two days, and there is the possibility of false negatives—meaning imaging can help isolate patients immediately if needed and manage hospital resources effectively. The high sensitivity of our AI model can provide a ‘second opinion’ to physicians in cases where CT is either negative (in the early course of infection) or shows nonspecific findings, which can be common,” said Zahi Fayad, director of the BioMedical Engineering and Imaging Institute at the Icahn School of Medicine at Mount Sinai. (Modern Healthcare, 5/20)


Brooklyn Clinic to Provide Follow-up Care for Discharged Covid-19 Patients
SUNY Downstate Health Sciences University in East Flatbush has established a dedicated outpatient clinic that is providing ongoing care for discharged Covid-19 patients. The clinic opened May 7 at University Hospital of Brooklyn. Follow-up care is especially important given that nearly 90% of Covid-19 patients treated at SUNY Downstate have had at least two comorbidities, and 30% have had three. The vast majority of patients have been people of color, and many don’t have an established relationship with a primary care physician, said Dr. Mafuzur Rahman, vice chair of medicine at SUNY Downstate. “These patients are dischargeable because they don’t have to be in the hospital, but they’re in no condition to resume normal life,” Rahman said.

There is constantly changing information about how Covid-19 affects different parts of the body beyond the lungs, Rahman said. That has included gastrointestinal symptoms, headaches, stroke like symptoms, heart attacks, nerve damage and multisystem inflammatory syndrome in children.

The clinic plans to follow up with patients on symptoms that may develop once they have left the hospital, Rahman said. And because Covid-19 has no standard of care, the clinic will monitor patients for any serious side effects from medications used to treat the disease while they were in the hospital. SUNY Downstate is in the process of contacting more than 1,000 discharged Covid-19 patients for an initial telehealth appointment. Those who need to come in for an in-person assessment will have priority access to primary and specialty care.

SUNY Downstate has reallocated existing resources to get the clinic up and running, including designating several physicians from each subspecialty—such as pulmonologists and heart and kidney specialists—to provide care as needed. The clinic will care for patients for a month or more following discharge. It will continue operation should there be additional waves of Covid-19 patients, Rahman said. Aside from follow-up care, the clinic will focus on tracking the incidence of post-Covid-19 health impacts over time as well as the success of various therapeutic treatments during recovery, SUNY Downstate said.

The mental health of patients also will be a focus, Rahman said. Rahman and a team of leaders from SUNY Downstate already have been working to help address the mental health needs of frontline health care workers. Dr. Ayman Fanous, chairman of psychiatry, recently told Crain’s that isolating patients from their loved ones has taken an emotional toll on doctors and nurses. The solitude is also affecting patients. Many have been isolated and even intubated for weeks on end, Rahman said. And they may struggle to get back to their everyday activities due to the long-term physical effects of the disease.” (Crain’s 10/20)


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Patients with Obesity May Be At Least Three Times More Likely to Have SevereCOVID-19 Symptoms Than Those with Normal Weight, Studies Indicate

Healio (5/20) reports, “In two cohorts of Chinese adults with COVID-19, those with obesity were at least three times more likely to have a severe case of the disease than those with normal weight, according to two studies published in Diabetes Care.” Furthermore, “increasing obesity was associated with increasing odds of severe COVID-19, and the association between obesity and symptom severity was stronger for men than for women.” In one study, the researchers found “median hospital stay was 23 days for patients with obesity vs. 18 days for those with normal weight.” In a second study, the results indicate “men with obesity were more than five times as likely to develop severe symptoms vs. men with normal weight.”


Speeding in New York City? Yes, Really!
In New York City, cameras captured 296,000 speeders during a five-week stretch beginning in mid-March, an 81% increase from the same period in 2019, according to data collected by the city’s speed-camera vendor. The city says traffic deaths are sharply lower.…Roads in the 10 biggest US metro areas have emptied, with volume down 63% in the New York City region. Meanwhile, cars are going faster during morning and evening rush hours, Inrix found in comparing April 13-17 with the first two weeks of March. (WSJ, May 21)


May 28 Webinar: Leading Causes of Million-Dollar Claims in NYS!
On Thursday, May 28, at 7:30 a.m., MLMIC will host “Million Dollar Claims: A Closer Look,” a complimentary webinar examining major causes of million-dollar claims in New York State. As the State’s leading medical professional liability carrier, MLMIC is well-positioned to provide guidance to medical organizations on reducing the risk of high-exposure claims. These recommendations and strategies are informed by an analysis of factors contributing to $1,000,000 claims over a five-year period.

Presenters Joyce McCormack, a MLMIC risk management consultant and registered professional nurse, and Danielle Mikalajunas Fogel, a medical malpractice litigation expert with Fager Amsler Keller & Schoppmann, will educate participants on:

  • identifying the leading causes of loss in million-dollar claims;
  • analyzing the key factors leading to significant payments in these claims;
  • recognizing the chief medical factors identified in these files; and
  • implementing risk management strategies to lessen the risks of high-exposure professional liability claims within your organization.

Policyholders can sign up for this event via the webinar registration form.

This webinar is designed to offer risk management perspectives to physicians and other healthcare providers, risk managers, quality improvement managers, medical directors, office practice administrators/managers, office practice staff, nurse administrators, patient safety officers and healthcare counsel.

MLMIC is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians and designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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Veterans Matters: PTSD in Returning Veterans Podcast
Check out MSSNY’s Veterans Matters newest two-part podcast entitled PTSD in Returning Veterans. In Part One, Dr. Frank Dowling, Secretary of MSSNY discusses how to identify PTSD in veterans, leading causes of PTSD and common comorbidities. Click here to listen to Part One.

In Part Two, Dr. Dowling discusses treatment options along with how PTSD affects family members and provides advice to physicians on providing better care for veteran patients with PTSD. Click here to listen to Part Two.


Registration Now Open for Veterans Matters CME Webinar

PTSD in Returning Veterans on June 3, 2020 @ 8:30 am

The Medical Society of the State of New York, along with Cobleskill Regional Hospital are hosting a CME live webinar entitled Veterans Matters: PTSD in Returning Veterans on Wednesday, June 3, 2020.

Click here to register for the webinar

Adolph Meyer, MD will serve as faculty for this program and the educational objectives are:

· Identify diagnostic criteria for PTSD

· Discuss medical and psychiatric comorbidities of military related PTSD

· Discuss evidence based treatment modalities for PTSD including medications and psychotherapy

· Discuss strategies to help veterans overcome stigma to seek and accept treatment for military related trauma

For more information, contact Jangmu Sherpa at jsherpa@mssny.org or call (518) 465-8085

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 each of these live activities 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 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 20, 2020


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Please Join NYS DOH’s Webinar Update on COVID-19 Tomorrow!
Please join the NYS Department of Health Thursday May 21st at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

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


PPE Source for MSSNY Members Only!
MSSNY is now able to provide members with access to a PPE supply chain, in a collaborative effort with the American Society of Plastic Surgeons.

Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked.  Shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times.

MSSNY members have been sent details on linking to the ASPS, where they can see available supplies and create an account to purchase items.  If you are not currently a MSSNY member you can renew for 2020 or apply online here.

MSSNY is proud to offer this benefit to our members and grateful to ASPS for extending this opportunity to help medical practices and patients in our state resume practice swiftly and safely.


NYSDOH Reducing Medicaid by 1.5% Effective for Service after April 2
As a practical matter, with a 1% cut having already been imposed for claims with dates of service between January 1, 2020 and April 1, 2020, physicians can expect that their payments will be 0.5% less for claims with dates of service 4/2/20 and after, when compared to claims with dates of service between 1/1/20-4/1/20.

The announcement from DOH notes the cuts are not applicable to physician administered drugs. These cuts are one way New York State is seeking to address its enormous revenue shortfall as a result of the Covid-19 pandemic.   MSSNY has been working together with the federation of medicine in support of legislation before Congress that would, among many other provisions, provide additional Medicaid funding to states to prevent against further Medicaid cuts.


HEALTH ADVISORY: Ensuring Access to Health Care Services During COVID-19
It is critical to maintain access to health care services during the COVID-19 public health emergency, including routine preventive care and follow-up services. • Healthcare providers should continue to ensure infection prevention and control measures are in place to prevent the spread of COVID-19. Healthcare providers should contact patients who may have missed routine preventive care or follow-up appointments during the COVID-19 public health emergency, including ensuring children, adolescents, and adults receive doses of recommended vaccines they may have otherwise missed.


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Re-Opening Your Medical Practice in the COVID-19 Era on May 26 12 Noon – 1 PM
As physicians are now considering re-opening their practices, they need to appreciate that they cannot simply “go back to normal”.  With furloughs, layoffs, severe limitations of medical services, decreased revenues and office closures, physicians need to consider strategies to maximize the success of their practices going forward.  These include financial analysis and planning, how to best protect and treat patients and employees, and what needs to be done to ensure that their practices operate efficiently, safely, and profitably.  Topics addressed will include:

What you need to consider before re-opening?

  • What financial issues must be considered to better prepare your practice to move forward?
  • How can you ensure your practice operates appropriately as it relates to patients?
  • Is there a continued role for telehealth?
  • What will the new practice culture look like going forward?
  • What reasonable accommodations and workplace safety precautions should be made for employees?
  • What are potential discrimination issues that can arise, including, for example, from a phased re-opening, or gradual return of employees from furlough?

Given that employees have had a furlough period, and there may be a backlog of work, can/should employers make changes to or limit their PTO policies for the remainder of the year?

  • How do we handle/resolve employment contract breach issues?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Register in advance for this webinar: https://mssny.zoom.us/webinar/register/WN_8YjCTCssTq6fVgwn404Bw

Presented by:
Barry B. Cepelewicz, M.D., Esq.
Partner/Director
Garfunkel Wild, P.C. 

Roy W. Breitenbach, Esq.
Partner/Director
Garfunkel Wild, P.C.


Tomorrow, Thursday, May 21 Nassau County Medical Society Webinar @ 7PM

DATE: May 21, 2020
Time:   7pm

Zoom Webinar Link https://us02web.zoom.us/webinar/register/WN_sPTtUWRVSxqJrZqKWBumFA

Guest Speaker: Dr. David A. Hirschwerk
                          Attending-Infectious Diseases
                          Executive Vice Chair-Dept. of Medicine
                         North Shore University Hospital/LIJ Medical Center


May 28 Webinar: Leading Causes of Million-Dollar Claims in NYS!
On Thursday, May 28, at 7:30 a.m., MLMIC will host “Million Dollar Claims: A Closer Look,” a complimentary webinar examining major causes of million-dollar claims in New York State. As the State’s leading medical professional liability carrier, MLMIC is well-positioned to provide guidance to medical organizations on reducing the risk of high-exposure claims. These recommendations and strategies are informed by an analysis of factors contributing to $1,000,000 claims over a five-year period.

Presenters Joyce McCormack, a MLMIC risk management consultant and registered professional nurse, and Danielle Mikalajunas Fogel, a medical malpractice litigation expert with Fager Amsler Keller & Schoppmann, will educate participants on:

  • identifying the leading causes of loss in million-dollar claims;
  • analyzing the key factors leading to significant payments in these claims;
  • recognizing the chief medical factors identified in these files; and
  • implementing risk management strategies to lessen the risks of high-exposure professional liability claims within your organization.

Policyholders can sign up for this event via the webinar registration form.

This webinar is designed to offer risk management perspectives to physicians and other healthcare providers, risk managers, quality improvement managers, medical directors, office practice administrators/managers, office practice staff, nurse administrators, patient safety officers and healthcare counsel.

MLMIC is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians and designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Registration Now Open for Veterans Matters CME Webinar PTSD in Returning
Veterans on June 3, 2020 @ 8:30 am

The Medical Society of the State of New York, along with Cobleskill Regional Hospital are hosting a CME live webinar entitled Veterans Matters: PTSD in Returning Veterans on Wednesday, June 3, 2020.

Click here to register for the webinar

Adolph Meyer, MD will serve as faculty for this program and the educational objectives are:

  • Identify diagnostic criteria for PTSD
  • Discuss medical and psychiatric comorbidities of military related PTSD
  • Discuss evidence based treatment modalities for PTSD including medications and psychotherapy
  • Discuss strategies to help veterans overcome stigma to seek and accept treatment for military related trauma

For more information, contact Jangmu Sherpa at jsherpa@mssny.org  or call (518) 465-8085.

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 each of these live activities 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.


Garfunkel Wild Ad


Surgeon/Colleagues Make N95 Mask Disinfection Facility for Under $15,000
VCU Health shares step-by-step instructions, quality controls, and blueprints for an innovation it created to disinfect and reuse up to 12,000 masks a day.

DOCTORS CREATE

KEY TAKEAWAYS

  • A VCU Health orthopaedic surgeon and his colleagues created this innovation.
  • The rack system enables the high throughput necessary to disinfect thousands of masks daily
  • Other health systems can replicate this initiative for about $15,000. While other methods exist to sterilize the masks, VCU Health chose UV-C light because it relies on electricity rather than supplies that might run short during the pandemic.

The COVID-19 crisis has spawned a new era of innovation at hospitals and health systems to adapt to changing demands. Inspiration comes from many sources.

In Richmond, Virginia, an anticipated N95 mask shortage at VCU health sent orthopaedic surgeon Stephen Kates, MD, into his personal machine shop, where he has fabricated items for the operating room, his car, and even parts for a friend’s old Ford tractor. This time, working with an anesthesiologist, two residents, and two PhDs from Virginia Commonwealth University, the professor and chairman of orthopaedic surgery produced a trellis rack to hang and sterilize masks with UV-C light. The design amplifies an already proven sterilization process, enabling high throughput. The health system is now using the system to decontaminate and reuse up to 12,000 N95 masks a day.

The process is based on a concept from the University of Nebraska and adheres to Centers for Disease Control and Prevention guidelines. It involves a commonly used UV-C light robot that VCU already had on hand to decontaminate hospital rooms and employs materials which the VCU team sourced from The Home Depot, Lowe’s, and a tractor supply store.

To help other health systems replicate this initiative, Richmond, Virginia–based VCU Health, which includes an academic medical center and is affiliated with Virginia Commonwealth University, offers a free 28-page downloadable instruction manual. The booklet outlines each step in the process, including quality controls with pictures and a video link providing added details. Kates estimates a similar system can be fabricated for as little as $15,000, provided a facility already has a proper UV-C light source that can be redeployed for this purpose.

Kates was called into action by a group from the university, which had produced a white paper on the topic of disinfecting N95 masks. While other methods exist to sterilize the masks, including hydrogen peroxide vapor, VCU Health chose UV-C light because it relies on electricity rather than supplies that might run short during the pandemic. In addition, exposure to the light source does not structurally degrade the mask as quickly as other methods, Kates says.

“The concept of sterilizing things with UV lights is not new; we didn’t come up with that,” says Kates. “The question was, ‘How to you actualize it and make it work?’ ” he says. “How do we have a high throughput process that can deal with a surge of patients that otherwise is overwhelming health systems across the country?”

“Making stuff out of metal is a hobby of mine, so I went to work on it that day and made a sample,” he says. “Everyone liked the appearance of it, so the next day we made seven more. Once we found a good design, we had local welders and machinists fabricate the rest of them.”

RAMPING UP PRODUCTION

N95 Masks

Photo Courtesy of VCU Health

VCU created a mask decontamination facility in a building adjacent to the hospital and painted the treatment room with reflective white paint at the recommendation of its UV-C robot manufacturer to facilitate light measurement.

The final design includes six racks on wheels, each containing 42 masks. The racks are arranged in a hexagonal pattern around the robot.

 

 

 


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

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