Councl January 14, 2021

MSSNY COUNCIL AGENDA
Thursday, January 14, 2021 at 9:00 a.m. (Virtual)

                                                                       

A. Call to Order and Roll Call

B. APPROVAL of the November 5, 2020 Council Minutes 

C. New Business
1. President’s Report
 a. MSSNY CME Action Item (For Council Approval)
 MSSNY Policy 1999.2 – Procedure for Processing Complaints/Inquiries 
 Concerning MSSNY Accredited CME Providers

 b. Legislative & Physician Advocacy Committee Resolutions
 Paul Pipia, MD Chair
 Action Items (For Council Approval) 
 Resolution 63  – Recommendations for Lowering Health Care Costs
 Resolution 69 – Office of Professional Medical Conduct Reform
 Resolution 106 – Piloting Use of Financial Incentives to Reduce
Unnecessary Emergency Room Visits
 Resolution 111 – Physician Assistance Parity With Lawyers
.
.2 Board of Trustees Report – Dr. Andrew Kleinman will present the report
         (For Council Approval) Report will be posted prior to the Council meeting
.
 3. Secretary’s Report – Dr.  Frank Dowling will present the report
         (For Council Approval)
.
 4. MLMIC Update – Dr. John Lombardo will present a verbal report
.
 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

8. Telemedicine Presentation (10:00 am)
    Shahin John Korangy, MD, Founder & CEO of CareClix


ADJOURNMENT OF COUNCIL

Action Item- For Council Approval

Approval of the Empire State Medical, Scientific & Educational Foundation, Inc. Election of Directors

RECONVENE OF COUNCIL


D. Reports of Officers

  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 1/1/20 – 12/31/20 (For Council Approval
    6. Office of the Speaker – William R. Latreille, Jr., MD

E. Reports of Councilors (Informational)

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

F. Commissioners (Informational Items)
  1. Commissioner of Communications, Maria A. Basile, MD, MBA
     Report from the Division of Communications

  1. Commissioner of Continuing Medical Education, Mark J. Adams, MD
        Report from the Division of CME
  1. Commissioner of Governmental Relations, Gregory L. Pinto, MD
    Report from the Division of Governmental Affairs
  1. Commissioner of Membership, David M. Jakubowicz, MD
        Report from the Division of Membership
    .
  2. Commissioner of Science & Public Health, Joshua M. Cohen, MD
    a. Preventive Medicine and Family Health Committee- Action Item
        Final Climate Change Paper (For Council Approval)

    (To be presented by Dr. Emily Senay & Dr. Moshe Bressler)
    b. Preventive Medicine and Family Health Minutes, October 29, 2020
    c. Bioethics Minutes, October 23, 2020
  1. Commissioner of Socio Medical Economics, Brian P. Murray, MD
        (no report submitted)

G. Report of the Executive Vice President, Philip Schuh, CPA, MS

  1. Membership Dues Revenue Schedule
  2. Group Institutional Dues Report

H. Report of the General Counsel, Garfunkel Wild, Barry Cepelewicz, MD, Esq
    Approval of the Erie County Medical Society Bylaws

I. Report of the Alliance, Barbara Ellman
   (no report submitted)

J. Other Information/Announcements 
 1. A letter from the Big Four re 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule:  Request for Delay of Implementation
 2. Status of 2020 AMAF Excellence in Medicine Awards
 3. Sign On VA Letter – Authority of VA Professionals to Practice Health Care

K. Adjournment

       

 

 

 

 

MSSNYeNews: January 8, 2021 – 2021: Ready for a New Chapter


.MSSNY’s Partnership with Premier Group Purchasing

Colleagues:

Happy New Year to all.  I think we are all relieved that 2020 and all its bad karma is behind us.  The New Year is starting with some positive updates about expansion of vaccine eligibility and a new money-saving MSSNY benefit.

COVID-19 Vaccine Updates

The New Year started off with the right sentiment in this regard when on 1/4/2021 all community physicians and their patient facing office staff were added to the 1a list of those authorized to receive the COVID-19 vaccine. View information on how to get the COVID-19 vaccine.

We share the goal of the Governor and the DOH of getting as many vaccines into arms as quickly as possible. We need to reach herd immunity to get back to some semblance of normal—and that requires 70-90% of the population to be vaccinated. Time wasted = lives lost.  Hospitalization rates are increasing, the UK strain that spreads more quickly is in NY, staff shortages are appearing, and we want to avoid another shutdown of elective surgery and a shutdown of our economy. Time is of the essence!

We are aware that implementation of the vaccine roll-out has been bumpy, and we have been in constant communication and partnership with DOH to right the ship.   MSSNY has made DOH aware of the IT website issues, communication problems concerning pop-up sites and issues identifying locations with availability—and DOH has responded.  Please make sure you are checking your MSSNY communications frequently as MSSNY is sharing all communications concerning vaccine and availability with our county societies, sending direct email communication to our physicians, and is posting the information on our website and on social media in an effort to get the information to physicians in real time.

Currently we are still in the 1a phase of vaccination and after 3 weeks of vaccinations, 1 million New Yorkers in the 1a category have yet to be offered their first dose.  The speed of vaccination must increase.  The next category 1b (Those >75yo and essential workers) includes 3 million New Yorkers.  To speed up vaccination we need to add significant additional capacity – our Community Physician Practice Distributors who are ready, willing, and able experienced vaccinators!

Volunteers Needed 

We will also need all hands-on deck and to that end MSSNY is encouraging all physicians, residents, students, and retired physicians to volunteer to provide COVID-19 immunizations through ServNY.  ServNY is a volunteer management system, administered by the department’s Office of Health Emergency Preparedness (OHEP) that was established after 9/11.  It is a web-based registry of individuals willing to assist on behalf of New York State during an emergency. When volunteers are needed, they are automatically notified via phone or e-mail with the information necessary for a volunteer to determine if they are ready and available for the assignment.  Physicians would most likely be contacted by their local Department of Health, the regional hospital hub, or by the county’s Medical Reserve Corp.  Sign–up through ServNY provides liability protections for physicians and other health care providers during their service to the NYS.  The sign-up is through the NYS health Commerce site.

NYS Department of Health has two numbers for assistance:

  • 1-866-529-1890, option 1 to assist with the Heath Commerce System
  • ServNY at 1-518-408-5163

Savings for Your Practice And/Or Yourself: Group Purchasing

MSSNY is now offering a GPO benefit for MSSNY members through Premier Inc., one of the largest group purchasing companies. There are no fees and no minimums, just savings for you and your practice, which in most cases will more than cover the cost of MSSNY membership. Premier offers a portfolio featuring over 900 suppliers and 2,000 products and services, including numerous PPE products! See our website www.mssny.org, contact MSSNY-Premier@premierinc.com or call (888) 258-3273.

I am hopeful that the challenges of 2020 will give way to a stronger, more cohesive profession and a new chapter of engagement in organized medicine leading to a healthier New York and a stronger profession.

Bonnie Litvack, MD
MSSNY President


Capital Update

MSSNY Weekly Podcast


Notes from Governor Cuomo’s Briefing:
COVID:
– Day 314
– Statewide positivity rate without micro-clusters: 7.49%
– Statewide rate with micro-clusters: 7.7%
– Micro-cluster rate: 8.3%
– 243,0000 tests conducted
– 161 deaths
– 8,561 hospitalizations, up 13
– 1,475 ICU patients, up 51
– 912 intubations, up 53

Hospitalizations by Region:
– Finger Lakes: 905 (0.08%)
– Western NY: 530 (0.04%)
– Southern Tier: 212 (0.03%)
– Mid Hudson: 980 (0.04%)
– NYC: 3,066 (0.04%)
– Long Island: 1,552 (0.05%)
– Central NY: 374 (0.05%)
– Mohawk Valley: 321 (0.07%)
– Capital Region: 515 (0.05%)
– North Country: 106 (0.03%)

Positivity by Region:
– Finger Lakes: 10.22%
– Western NY: 8.61%
– Southern Tier: 5.30%
– Mid Hudson: 8.12%
– NYC: 6.42%
– Long Island: 9.68%
– Central NY: 8.57%
– Mohawk Valley: 10.80%
– Capital Region: 10.16%
– North Country: 8.45%
– Manhattan: 4.45%
– Staten Island: 7.84%
– Brooklyn: 6.70%
– Queens: 7.49%
– Bronx: 8.21%

Vaccine:
– Gov. cautioned “frightening infection rate” of new strain, combined with
low supply of the vaccine can still cause stress on the hospital system
– State is concerned about low vaccination rate for healthcare workers,
particularly in New York City, which is currently at 13%
Private providers, ambulatory centers, pharmacies, county health departments
will begin being utilized next week

– On Monday, reservations for vaccinations will be accepted, the state will have a
website to sign up
– Healthcare workers must continue to be prioritized, but the next tier (1b)
will be eligible as well
– NYSDOH will hold a webinar on Monday for new providers, county DOHs
– State will allocate to distribution network proportionately by population
of each group and region
– State will be mandating social equity distribution by local health departments
Gov. signing an EO making additional staff eligible to administer vaccinations
DOH is setting up 20 “mass distribution sites” in the coming weeks: Javits Center
will be open next Wednesday

– Gov. noted at the current rate, the first two tiers (1a) and (1b) will not be
completed until mid-April

Federal:
– Gov. further condemned the events at the U.S. Capitol, and
President Trump’s actions; Gov. questioned the lack of security at the Capitol

State of the State:
– Will be on Monday, will be focused on specific initiatives, post-COVID issues
– Gov. proposing legislation to process absentee ballots as soon as they’re received
and begin being counted on election day
– Also to extend early voting hours, and extend timeframe to request absentee ballot
to 45 days before an election
– Gov. will propose legislation to create an Office to End Domestic and Gender-Based
Violence, and to authorize courts to force abusers to pay damages, including housing
and moving costs
– Legislation will also create new misdemeanor for those convicted of domestic violence
attempting to purchase guns, closing a loophole in existing law
– Also proposing legislation for a statewide eviction moratorium on commercial evictions
to be extended until May 1
– Also, penalties for late residential rent payments will be prohibited through May 1
– Gov. also announced the creation of a new public space at Pier 76 on the west side of
Manhattan, where a tow pound currently exists
– By law, NYPD had to vacate this space by January 1, it will be transferred to
Hudson River Park Trust, which will be accepting proposals for design this month

On when vaccinations will start for second (1b) tier:
– Appointments can be scheduled on Monday, some pharmacies will begin
administering Monday, others will take longer
– Gov. said website will be available Monday, listing available sites and accepting
reservations
– Gov. added the Biden administration is currently working on increasing the
supply available to states

On any updates on reallocation of vaccine from low-performing hospitals:
– Gov. responded that performance from hospitals has increased over the
last week, but low-performing hospitals will not receive additional allocations
– Gov. said this issue is expected to be solved by the new distribution
network being introduced next week

On current vaccination number:
– 479,000 vaccines done so far in the state
– Nursing home residents, staff will be completed by the end of next week

On how the state will ensure healthcare workers will continue to be prioritized:
– Providers must continue to give priority to healthcare workers when
scheduling appointments
– New providers in the distribution network are required to vaccinate their
own workers prior to administering the vaccine


Vaccine Availability by Counties That Have Submitted Schedules

View a list of Counties that have submitted vaccine schedules.

  • Saratoga County
  • Westchester County
  • Nassau County
  • Suffolk County
  • Essex, Warren, Wash, Clinton, Franklin Counties

Governor’s State of the State Message This Monday
With the State Legislature initiating the 2021 Legislative Session earlier week, this upcoming Monday the Governor will unveil his State of State message, followed by his release of the proposed State Budget for the 2021-22 Fiscal Year the following week (likely 1/19).

With the State looking to close a historic $65 billion multi-year deficit, there is likely to be many concerning provisions impacting the state’s health care system, even as physicians and other care providers struggle to manage historic drops in patient visits and revenue.  Please remain alert for comprehensive summaries and follow up action steps as these documents are released next week and the following week.                                     (AUSTER)


Join Us for MSSNY’s Virtual Lobby Day on March 2
Please plan to put aside Tuesday, March 2 for MSSNY’s Annual Physician Advocacy Day – this time Virtual!  To register, click here: Webinar Registration – Zoom

The format will follow previous years formats, where assembled physicians and allies will hear from legislative leaders in the morning (this year via Zoom), and then have virtual visits with their respective legislators in the afternoon.

With the Governor and the State Legislature needing to create tens of billions of savings to the State Budget, any number of healthcare programs of interest to physicians could be on the table, not to mention concerns with the numerous proposals to inappropriately expand the scope of practice for various non-physicians as well as numerous proposals to mandate how physicians provide care to their patients.

Please plan to join hundreds of colleagues from around the State on March 2! (ALI)


MSSNY Prioritizes Key Telehealth Policies Department of Financial Services (DFS) Extends COVID19 Telehealth Policy
One of the key items MSSNY will be working on for the 2021 legislative session, is to advocate for policies to help maintain expanded health insurance coverage for telemedicine services and to advocate for parity in payment for health care services delivered via video, as well as required insurer coverage for delivering care for audio-only visits with patients. A central part of this work will include advocating for passage of legislation to require health insurers to provide “payment parity” between telemedicine visits and in-office visits. MSSNY is teaming up in this effort with a range of provider organizations including many specialty societies, the Healthcare Association of New York State (HANYS), communication centers, among others. To read the letter: click here.

Prior to the onset of the COVID19 crisis, some physicians across the state had integrated Telemedicine into their practices, but the pandemic forced physicians, and other health care providers, to quickly increase their capacity to provide care remotely. A May 2020 MSSNY survey showed that 83% of the physician respondents indicated they had incorporated telemedicine into their practice, with nearly half the respondents noting that they were treating at least 25% of their patients remotely. Moreover, a spring 2020 Fair Health study showed that, for the northeastern part of the country, use of Telehealth went from 0.08% of claim submissions in May 2019, to 12.5% in the span of a month. (report.

Additionally, the New York Department of Financial Services (DFS) extended for additional 60 days (until March 5) its emergency rules supported by MSSNY requiring New York State health insurance plans to cover Telehealth services without patient cost-sharing.

In early 2020, the DFS issued a circular letter detailing its requirements for insurers to a) waive cost-sharing requirements for services delivered via telemedicine b) permit coverage for health care services delivered via audio-only mechanisms and c) enabling delivery of telemedicine services through basic smartphone and video technologies. To read the letter: (circular letter)

Even though states have started administering Covid vaccines, public health experts anticipate that COVID-19 will remain a public health threat for the foreseeable future, making it reasonably likely that this expanded Telehealth coverage policy will need to be extended well beyond March. (CARY, AUSTER)


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Governor Announces Proposal to Legalize Adult Use Recreational Marijuana
Governor Andrew Cuomo this week announced a proposal to create an Office of Cannabis Management to regulate both the medical and adult-use of marijuana.   The governor’s proposal will be part of his State of State and his 2021-22 New York State budget.  The governor estimated that this proposal would generate more than $300 million in tax revenue—however, that revenue is not anticipated to be generated for several years.

The Medical Society of the State of New York is opposed to the legalization of recreational marijuana and continues to oppose this measure along with the New York State Association of County Health Officials (NYSACHO), the Mental Health Association of New York State, the NYS PTA, and Smart Approaches to Marijuana (SAM).  MSSNY believes that with the COVID-19 pandemic, this measure, if enacted would create an even greater stress on New York State’s public health system.  The National Institute of Drug Abuse (NIDA) reports that COVID-19 is a respiratory illness that attacks the lungs, and is a serious threat to anyone who smokes or vapes tobacco or marijuana products.

MSSNY has also been working with various states in expressing opposition to the legalization of recreational marijuana. MSSNY also joined with the state medical societies of Delaware, New Jersey, New York, Ohio, and Pennsylvania to express mutually shared concerns about state governments’ efforts to legalize marijuana for recreational use. Legalization continues to present serious public health concerns.  A copy of the press release can be found here.                                 (CLANCY, AUSTER)


 

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MSSNY Partners With “Let’s Get Immunized NY”
The Medical Society of the State of New York has partnered with “Let’s Get Immunized NY”  a campaign that strives to provide all New Yorkers reliable and trustworthy information on immunization and encourage New Yorkers to get recommended vaccines.  The campaign will also support policies that protect and improve access to immunization, increase awareness of the public health benefits of vaccination, and address health disparities with vaccine access, especially in medically underserved areas and communities with low immunization rates.

MSSNY is also on the steering committee for Let’s Get Immunized NY.   Some of the organizations that are part of this campaign are:  The NYS Chapter of the Academy of Family Physicians; the NYS American Academy of Pediatrics, NYS Chapters 1, 2, & 3; the NYS Association of County Health Officials (NYSACHO); the March of Dimes; the NYS Public Health Association; The Business Council and the NYS Farm Bureau.  Further information may be obtained at the website: http://www.letsgetimmunizedny.org (CLANCY)           


Assemblyman Gottfried Reintroduces Physician-Friendly Legislation
Assemblyman Richard N, Gottfried (D-Manhattan), Chair of the New York State Assembly Committee on Health, has reintroduced three pieces of legislation that MSSNY has supported for several past legislative cycles. They are:

1. A.832, which would prohibit or restrict a number of practices between HMOs and health care providers that negatively impact physicians’ ability to provide the highest quality of care. 2. A.951, which would permit some collective negotiations between physicians and health insurance plans under close supervision by the state. 3. A.879, which ensures that health plans can only deny payment for covered benefits after review by a physician, or other health care professional, licensed in New York State and when the provider is board certified in the same, or similar, specialty as the treatment under review.

MSSNY thanks Chairman Gottfried for his continued leadership on these important bills and will update its membership as they advance this session.   (CARY)


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Registration Now Open: Veterans Matters: PTSD in Returning Veterans Webinar
Tuesday, January 26th @ 7:30 am 

The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: PTSD in Returning Veterans live webinar on Tuesday, January 26, 2020 at 7:30 am.

Click HERE to register for the program! View the program flyer HERE

When:                 January 26, 2020 at 7:30 am
Faculty:               Frank Dowling, MD

Educational Objectives:

Identify diagnostic criteria for PTSD
Discuss medical and psychiatric comorbidities of military related PSTD
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 this live activity for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


COVID-19 & Mental Health: Registration Now Open for Two CME Webinars
January 20, 2021 @ 7:30am Medical Matters: COVID-19 & Mental Health of Patients Click here to register

February 5, 2021 @ 7:30am Physician Wellness/Medical Matters COVID-19 & Mental Health of Physicians and Other Healthcare Providers Click here to register

The COVID-19 pandemic has contributed to countless health problems over the past year.  Not the least of which are mental health related.  Learn more about how the COVID-19 pandemic has affected the mental health of patients on January 20th at 7:30am and how it has affected physicians and other healthcare workers on February 5th at 7:30am.

Dr. Craig Katz will serve as faculty for both webinars. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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

The Medical Society of the State of New York designates each live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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Vaccine Availability by Counties That Have Submitted Schedules
View a list of Counties that have submitted vaccine schedules.

  • Saratoga County
  • Westchester County
  • Nassau County
  • Suffolk County
  • Essex, Warren, Wash, Clinton, Franklin Counties

MSSNY Information for Physicians: How to Get the COVID-19 Vaccine
Community-based physicians and their  staff are now eligible to receive the COVID-19 vaccine.  Below is information on how physicians and staff, including NY City based physicians, can make an appointment to receive the vaccine.

To better ensure expeditious distribution of the COVID-19 vaccine, this week the Governor announced additional possible enforcement actions against hospitals that do not distribute their supply within the week they receive it.

COVID-19 Vaccine Process for NY State Physicians and Staff
The web page will ask for information for your name, where you live, and what you do for a living.  If you are in a priority group currently getting the vaccine, the site will show you the location of health care providers who can give you the vaccine near you.  Just choose the one you prefer, and schedule the appointment.

COVID-19 Vaccine Process for NYC Physicians and Staff
The New York City Department of Health and Mental Hygiene updated their COVID-19 vaccination page with information for non-hospital providers, including vaccination locations and related scheduling.

The NYC Department of Health and Mental Hygiene indicated that vaccine locations and supply are limited, and they are working very hard to ensure that providers and their staff across New York City are vaccinated as quickly as possible. The City plans to ramp up capacity at these sites and add sites over the coming weeks. MSSNY encourages physicians to check the NYC vaccination page regularly, as this is where the most up-to-date information will be posted.

Community-based physicians and staff eligibility information can be found here.

Physicians, Residents, Students and Retired Physicians Who Would Like to Volunteer to Provide COVID-19 Immunizations
The Medical Society of the State of New York encourages the physician community to volunteer to provide COVID-19 Immunizations to residents of New York State. The first step in this process is by signing up for ServNY. .


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Congressional Package Includes Expansion of Paycheck Protection Program (PPP)
As was recently reported, the Congressional year end package included an additional $284 billion for the Paycheck Protection Program (PPP).  Importantly, it would enable a second PPP forgivable loan for the hardest-hit small businesses (including physician practices) with 300 or fewer employees which can demonstrate a loss of 25% of gross receipts in any quarter during 2020 when compared to the same quarter in 2019.

Moreover, it would also provide that loans will not be included in taxable income, and clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the CARES Act and applicable to subsequent PPP loans.  MSSNY had heard from several physicians concerned that receipt of a PPP loan/grant was going to cause them to not be able to deduct business expenses due to a recent IRS interpretation.

Please read here for a comprehensive AMA summary of this and many other provisions in the Congressional Covid relief package.


Congress Passes Measure to Address Surprise Medical Bills
As was widely reported, among the provisions contained in the year-end Congressional Covid relief package was a comprehensive measure to establish a federal standard for addressing surprise out-of-network medical bills.

The new federal surprise bill provisions will apply to patients insured by ERISA plans, and New York’s approach would continue to be followed for out of network claims from patients insured in state-regulated plans.  There are similarities in this federal standard to New York’s well-regarded approach, but also significant differences for which MSSNY expressed serious concerns.

Here is a comprehensive summary of these provisions from the AMA: http://www.mssnyenews.org/wp-content/uploads/2020/12/Summary-of-Surprise-Billing-Language-12-21-20.pdf

The measure, to take effect January 1, 2022, would ensure that patients are “held harmless” from surprise out-of-network medical bills. Like New York’s law, patients would only be required to pay the in-network cost-sharing, (i.e., copayment, coinsurance, and deductibles) amount for out-of-network emergency care, for certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent.

However, unlike New York’s law, the federal provision calls for a 30-day open negotiation period for out of network physicians and payers to settle out-of-network claims, and if the 30 day negotiation period is unsuccessful, requires either the physician or the health plan to initiate an independent dispute resolution (IDR) process within 4 days of the end of the 30-day period.

The federal IDR process is similar to New York’s mechanism in that the IDR entity would select which side – the physician’s or the insurer’s suggested payment – will prevail.  Physicians may batch similar services in one proceeding when claims are from the same payer, but the bill permits only 30 days of batching.  The IDR entity would consider numerous sources of information brought by either party, such as the provider’s training and experience, patient acuity, and the complexity of furnishing the item or service.   However, in a significant departure from New York, neither provider charges nor usual and customary charges may be considered by the IDR entity, and the IDR entity is required to consider the market-based median in-network rate.  This a major deficiency that MSSNY has highlighted in its advocacy efforts over the last year on this issue, and was noted by MSSNY President Dr. Bonnie Litvack in MSSNY’s press release.

The Congressional provisions also address “voluntary” out of network services by providing that non-participating providers at participating facilities may not bill a patient more than the cost-sharing requirements or balance bill the patient unless the notice and consent requirements are met. These consent requirements include providing the patient with written notice and consent 72 hours in advance of appointment; providing a good faith estimate of the costs of the services; and providing the patient with a list of in-network providers at the facility and information regarding medical care management, such as prior authorization.

At participating facilities, the notice and consent exception does not apply to out-of-network providers of radiology, pathology, emergency, anesthesiology, diagnostic, and neonatal services; assistant surgeons, hospitalists, intensivists, and providers offering services when no other in-network provider is available.

Further analysis of this far-reaching legislation is ongoing, so please remain alert for further updates.


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Congressional Package Helps to Prevent or Reduce Medicare Cuts
As a result of an advocacy effort across medicine including from the AMA and MSSNY, the year-end Congressional package included a number of steps that helped to prevent and/or reduce what would have been enormous cuts to Medicare payments to many physician specialties.  Specifically, the bill:

  • Provides for a one-time, one-year increase in the Medicare physician fee schedule of 3.75%, to support physicians and other professionals in adjusting to changes in the Medicare physician fee schedule during 2021, and to provide relief during the COVID-19 public health emergency.
  • Delays for 3 years the Secretary’s implementation of Code G2211 which reportedly will increase the MPFS by approximately 3%.
  • Delays the -2% sequestration cuts for 3 months.

As noted in this chart developed by the AMA analyzing the specialty by specialty impact of these Congressional actions, an example of the impact:

  • Under the original CMS Medicare 2021 payment rule, ophthalmologists were expected to see a 6% cut, but now will face likely no cut.
  • Under the original CMS Medicare 2021 payment rule, general surgeons were expected to see a 6% cut, but now will face likely no cut.
  • Under the original CMS Medicare 2021 payment rule, neurosurgeons were expected to see a 6% cut, but now likely will face no cut.
  • Under the original CMS Medicare 2021 payment rule, interventional radiologists were expected to see an 8% cut, but now it will be a likely 2% cut.
  • Under the original CMS Medicare 2021 payment rule, internal medicine was expected to see a 4% increase, but now likely a 6% increase.
  • Under the original CMS Medicare 2021 payment rule, anesthesiology was expected to see an 8% cut, but now likely a 2% cut.
  • Under the original CMS Medicare 2021 payment rule, PM&R was expected to see a 3% cut, but now likely will have a 3% increase.

Importantly, as well, the long overdue E&M increases set forth in the CMS 2021 Medicare payment rule will go forward.

We thank all the physicians who took the time to respond to our call for grassroots action on this and the litany of other “year-end” issues before Congress.  We anticipate that CMS will soon issue an update announcing these changes arising from Congressional action.


2021 E & M Coding Changes Webinar on Friday, Jan. 22 from 12-2 PM
On January 22 from 12 noon to 2PM,  MSSNY will be hosting a webinar for our Members regarding the 2021 E & M coding changes.  NGS Medicare staff will be making the presentation. NGS will be sending a registration URL to MSSNY shortly that we will then send on to the membership.


Five States with Highest Confirmed Cases
The 5 states with the highest total confirmed cases are:

  1. California: 2.536,832
  2. Texas: 1,885, 609
    3. Florida:1,409, 906
    4. New York: 1,064, 297
    5. Illinois: 999, 288

Deaths: New York has the most deaths due to COVID-19 with 38,912 reported fatalities, followed by Texas with 29,123 deaths, and California with 28,081.

Tests administered: California leads in number of persons tested with 34,548,621 people tested, followed by New York with 26,333,682 people tested, and Florida with 16,310,438 people tested.


How NY Hospitals Are Using Their Allocated Their Allocated Vaccine
Gov. Andrew Cuomo in his Jan.6 briefing provided an updated list of the top and bottom 10 hospitals that have used their allocated vaccines. The previous list was of health systems. In the city, NYU Langone’s Tisch Hospital in Kips Bay (100%), Richmond University Medical Center on Staten Island (100%), SUNY Downstate in East Flatbush (100%), New York-Presbyterian on the Upper East Side (99%) and Northwell Health’s Lenox Hill Hospital (87%) were top performers. Montefiore Mount Vernon (11%) and Montefiore New Rochelle (23%) in Westchester County, Brookdale Hospital Medical Center in Brownsville (24%), NYC Health + Hospitals—Queens in Jamaica (29%) and NYC Health + wHospitals—Coney Island (34%) were the lowest performing.


FDA Warns Against Changes to Authorized Dosing Schedules of COVID-19 Vaccines
FDA officials recommend all health care professionals should continue to administer 2 full doses of the 2 COVID-19 vaccines currently available.

In a new statement, the US Food and Drug Administration (FDA) recommended all health care professionals should continue to administer 2 full doses of the 2 vaccines currently available against the coronavirus disease 2019 (COVID-19).

The statement comes after discussions, including reports in the media, about altering the dosing schedule in order to immunize more individuals against COVID-19. Proposed alternatives include reducing the number of doses, extending the length of time between doses, changing the dose, or mixing and matching vaccines, according to the FDA.

The FDA has granted emergency use authorization for vaccines produced by Pfizer-BioNTech and Moderna. “At this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19,” said FDA Commissioner Stephen M. Hahn, MD, and Peter Marks, MD, PhD, director, Center for Biologics Evaluation and Research, FDA, in the statement.

Hahn and Marks noted that administering rating a single-dose regimen and/or administering less than the dose studied in clinical trials is concerning, “as there is some indication that the depth of the immune response is associated with the duration of protection provided.”

Although data from the phase 3 trials of both the Pfizer-BioNTech and Moderna COVID-19 vaccine suggested some protection following the first dose, the FDA cautioned that the participants who did not receive 2 vaccine doses at either a 3- or 4-week intervals were only followed for a short period of time.

“We cannot conclude anything definitive about the depth or duration of protection after a single dose of vaccine from the single dose percentages reported by the companies,” said Hahn and Marks.

The current available data continues to support the use of the 2 vaccines. For the Pfizer-BioNTech COVID-19 vaccine, the interval is 21 days between the first and second dose and 28 days between doses for the Moderna vaccine.

“We know that some of these discussions about changing the dosing schedule or dose are based on a belief that changing the dose or dosing schedule can help get more vaccine to the public faster,” concluded Hahn and Marks. “However, making such changes that are not supported by adequate scientific evidence may ultimately be counterproductive to public whealth.” (Patient Care. Jan 7).


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COVID-19 ‘Long Haulers’ Identify 205 Virus Symptoms
Researchers have identified more than 200 long-term symptoms that can affect COVID-19 “long haulers,” or people who experience prolonged effects from the virus, according to a survey published Dec. 24 in the medical preprint server medRxiv.

Researchers polled 3,762 adults from 56 countries with confirmed or suspected COVID-19 cases. Respondents developed symptoms before June 2020 and experienced them for a minimum of 28 days.

Four survey findings:

  1. In total, respondents identified 205 symptoms in 10 organs linked to the virus, including 66 symptoms traced over seven months.
  2. The most commonly reported symptoms after six months were fatigue (77.7 percent), post-exertional malaise (72.2 percent) and cognitive dysfunction (55.4 percent).
  3. Respondents who were sick six months after symptom onset experienced an average of 13.8 symptoms.
  4. Most respondents had not returned to full-time work due to their health issues.

The survey has not been peer-reviewed. (Jan. 4 Becker’s Hospital)


States Ranked by Percentage of COVID-19 Vaccines Administered: Jan. 7
The CDC’s data tracker compiles data from healthcare facilities and public health authorities. It updates daily to report the total number of COVID-19 vaccines that have been distributed to each state and thew total number each state has administered.


Shortened Quarantine May Pose Transmission Risk, CDC Finds
About 19 percent of people who were exposed to COVID-19 and remained negative or asymptomatic through the first week developed an infection by the end of the 14-day quarantine period, according to the CDC’s Jan. 1 Morbidity and Mortality Weekly Report. 

Using interim data from an ongoing study, CDC researchers identified 185 household contacts who were exposed to COVID-19. A total of 109 household contacts had detectable SARS-CoV-2 at any point during the 14-day quarantine period after exposure. Among the close contacts infected, 76 percent (83) of test results were positive within seven days after the index patient’s illness onset, while 86 percent (94) of infections were detected within 10 days.

About 81 percent of household contacts who remained negative or asymptomatic through the first week after exposure did not develop COVID-19 through day 14. This increased to 93 percent for those who remained asymptomatic or negative through day 10.

In an effort to get more people to comply, the CDC trimmed its quarantine recommendations in December to 10 days without symptoms or seven days without symptoms and a negative test result.

In this latest report, researchers concluded the original 14-day quarantine period is the most effective way to minimize the spread of COVID-19.

“Although persons might be more adherent to a shorter quarantine period, such a policy is not without risk for further spread,” the report said. “Persons released from quarantine before 14 days should continue to avoid close contact and wear masks when around others until 14 days after their last exposure.”


 

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Unique Rheumatology Practice Opportunity – Great Neck, NY
Partnership opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join our practice or merge practices. Contact 516-972-2986 / susanrita1@msn.com for more info.

 

 

 

 

 

 

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