MSSNY COVID-19 Update – March 29, 2020

Physicians are required to report suspect cases to their local department of health.

Microscopic view of COVID-19

March 29 Statistics

New York State: 44,635 confirmed cases, 285 deaths. New York City: 29,766 confirmed cases; 672 deaths, 5,537 Nassau; 4,138 Suffolk; 7,875 Westchester, 1,986 Rockland; 195 Albany.

United States: 124,686; deaths: 2,191; 2,612 recovered. World Count: 716,701 confirmed; 31,882 deaths. 

For a complete NYS county list, click here.



March 28

· Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

· Executive Order of Suspension of Non-Essential Elective Surgeries

· Operationalizing State-Wide Ban on Elective Surgery

· List N: Disinfectants for Use Against SARS-CoV-2

· Psychosocial Impact of COVID-19 (podcast)


Telehealth

· Humana Telehealth Update

· How to Set Up Free Telemedicine for Your Patients – Part I

· Telemedicine in Practice – Part 2

· Emergency Medical Aid and Telemedicine

· Comprehensive Guidance Regarding Use of Telehealth 

· Expansion of Medicare coverage for telehealth (so it is no longer limited to rural areas)

· Assuring physicians can use Facetime and Skype for telehealth without worrying about HIPA

· COVID-19 Physical, Occupational and Speech Therapy Telehealth

· Telehealth Insurance Circular Letter No. 6 (2020)
Reminder that private insurers must cover telehealth services for patients (including those provided through a smartphone) and without patient cost-sharing.

· COVID-19 Telephonic Communication Services
Since Medicare still requires telemedicine to be provided only to patients in a rural setting, you should look at “virtual check in” services under codes  G2010, G2012, 99421, 99422 and 99423.

· State regulated insurers re: required telehealth coverage for all health care services without patient cost-sharing “including technology commonly available on smartphones and other devices”.

· Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus


Patients

• Precautions Physicians Should Take (from NYSDOH)

• Evaluating and Reporting Persons Under Investigation (PUI)

• Patient Information on COVID-19 (Podcast)

• Patient precautionary Flyer


Financial

· Trump Administration Approves 34th State Request for Medicaid Emergency Waivers

· Small Business Provisions in Coronavirus Aid, Relief, and Economic Security (CARES) Act

· Tax Day now July 15: Treasury, IRS extends filing deadline and federal tax payments regardless of amount owed


• AMA Letter Urging Federal Assistance for personal protection equipment (PPE) for Physicians

• Medicare Administrative Contractor (MAC) COVID-19 Test Pricing

• FAQs on Essential Health Benefits Coverage and COVID-19

• WC: Laws, Regulations and Decisions

For Medicare fees, go to ngsmedicare.com and do a fee schedule look up for your specific locality (01, 02, 03, 04, or 99).

• Infection Prevention for Self Quarantine

Questions:

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

COVID-19 Update March 26, 2020

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

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


Governor Cuomo’s Daily Press Conference

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

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


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


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

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

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

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


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

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

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

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

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

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

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

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


Tail Coverage for Physicians Who Come out of Retirement

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

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

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

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

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

Physicians can register for this program at the link below! 

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

REGISTRATION NOW OPEN HERE.

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

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

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

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

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

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

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

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

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

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

Medical Matters Courses:

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

Emergency Preparedness:

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

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

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


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

Outbreak updates:

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

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


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

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

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


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

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

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

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

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


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

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

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

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


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

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

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

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

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


Notes from Gov. Cuomo’s Press Conference

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

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

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

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

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

He argued business would welcome such an order.

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

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

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

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

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

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


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

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


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

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

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

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


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


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

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

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

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

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

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

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

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

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

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

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


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

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

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


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

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

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

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

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


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

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

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

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

Modern Healthcare Mar 23


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

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

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


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

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

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

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

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


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

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

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


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

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

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

 

 

COVID-19 eNews – March 24, 2020

Podcast:

Psychosocial Impact of COVID-19


Webinar:

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

REGISTRATION NOW OPEN HERE 

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

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

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

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

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

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

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

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

COVID-19 eNews March 19, 2020


Summary of Medicare Telemedicine Services

Summary of Medicare Telemedicine Services

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Wednesday in New York: 2382 COVID-19 Cases; 23% Hospitalization Rate
New York state reported 2,382 cases Wednesday morning, with a 23 percent hospitalization rate — its highest yet. It is likely that New York City will experience a similar or higher rate as more people begin experiencing COVID-19 symptoms that require hospitalization, though the surge has not hit health systems yet.

President Donald Trump announced Wednesday he was dispatching the Navy hospital ship USNS Comfort to New York Harbor to support the response. The Pentagon is preparing the ships, which are equipped with 1,000 hospital beds each. Defense officials noted that the hospital ships aren’t conducive to containing infectious disease outbreaks, but can be used to treat non-coronavirus patients while existing medical facilities focus on disease treatment.


MSSNY Contracted with DrFirst to Offer a Telehealth Product for $300 Per User
We would like to make members aware that MSSNY has contracted with DrFirst to offer Backline, a HIPAA compliant telemedicine product and care collaboration secure messaging tool that may be of assistance to private practitioners. Backline is available at a $300/user annual subscription. For more information, please go here. To register today to begin to use Backline -Telehealth, go here.


Clinicians Petitioning US to Produce/Distribute Personal Protective Equipment
Clinicians across the United States are petitioning the federal government to follow the lead of South Korea, China, and other nations by imposing an immediate nationwide quarantine to slow the inevitable spread of COVID-19.

Without federal action, the creators say, their lives and the lives of their colleagues, patients, and families are being put at increased risk. In addition to the quarantine, the petition, posted on the website Change.org, calls on US leaders to institute emergency production and distribution of personal protective equipment for healthcare workers and to rapidly increase access to testing.

The petition, which garnered more than 40,000 signatures in just 12 hours and as of this writing was approaching 94,000, was started by an apolitical Facebook group to focus attention on what members see as the most critical issues for clinicians: slowing the spread of the virus through a coast-to-coast quarantine; protection of medical personnel with adequate supplies of essential equipment; and widespread testing.


State and Federal Agencies Take Steps to Strongly Encourage Patients to Receive Treatment Via Telehealth
There have been a number of important steps taken over the last week to better enable physicians to treat their patients via telemedicine.

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

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

Governor Cuomo has signed an Executive Order permitting out of state physicians and other health care personnel to practice in New York State as if they had a license in New York. Governor Cuomo has also been urging retired physicians and other health care personnel to volunteer to help their former hospitals during this emergency. Physicians can sign up here.


AMA: Government’s Move on Elective Surgery Guidelines Will Give Flexibility to Physicians Awaiting Surge in Patients
“The guidance from Centers for Medicare & Medicaid Services (CMS) on adult elective surgery is a vital step is allocating resources during the pandemic. As hospitals and physician practices plan for anticipated surges of patients needing care for COVID-19 infections, health professionals must use their expertise to develop allocation policies that are fair and safeguard the welfare of patients.

The CMS guidance offers needed flexibility to physicians by allowing them to consider the imperative of resource conservation, especially personal protective equipment. “The nation’s physicians know challenging days are coming. We are preparing for it and are grateful that the federal government understands that physicians need to have flexibility when responding to this threat.” The AMA Code of Medical Ethics offers detailed advice to physicians on how to approach the allocation of limited health care resources. Among other things, it covers which criteria to consider, setting care priorities and the importance of transparency. Statement Attributable to: Patrice A. Harris M.D., M.A. President, American Medical Association.


President Trump Invokes Defense Production Act
The Trump administration on Wednesday said it would invoke the Defense Production Act to increase the domestic production of medical supplies necessary for fighting the coronavirus pandemic. The Defense Production Act gives the executive branch a wide range of powers to influence the nation’s industrial base for national defense, including warning the administration for weeks that there’s a critical lack of ventilators and other devices and supplies to address COVID-19. The coronavirus outbreak has strained medical supply chains because many devices and supplies are made in China or by a small number of firms.

The administration will likely use its ability to steer private businesses to increase U.S. production of N95 masks and other critical medical supplies and devices. Hospitals, experts and policymakers asked the administration to invoke the Defense Production Act earlier.


Psychosocial Dimensions of Infectious Outbreaks” WEBINAR April 1st @ 7:30am
REGISTRATION NOW OPEN HERE

MSSNY’s has expedited the presentation of the next Medical Matters webinar “Psychosocial Dimensions of Infectious Outbreaks” on Wednesday April 1st at 7:30am.  This program is a companion piece to the March 18th coronavirus webinar.  This program provides physicians with vital information to care for patients, staff, family and themselves during this unprecedented pandemic.

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

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

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

For more information, contact: Melissa Hoffman at mhoffman@mssny.org or call (518) 465-8085

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

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

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


Jones Beach, Stonybrook, Staten Island and Rockland Set Test Sites
A steady stream of people in cars pulled up to the Jones Beach site Tuesday afternoon and were waved into an area with three large white tents as state troopers stood by. The site will operate from 8 a.m. to 8 p.m., by appointment only, though no doctor referral is needed. Cuomo said another site will open in Suffolk County, at Stony Brook University.

Other drive-thru sites opened Tuesday on Staten Island and in Rockland County. In New Rochelle, where a similar site was recently set up, on Sunday 1,882 people showed up, state officials said. There have been more than 1,800 people using that drive-thru each of the first four days.

In Nassau County, the tents were set up in the parking lot of the Theodore Roosevelt Nature Center across the road from the New York State Park Police headquarters. Unlike in New Rochelle, people will not need a referral from a doctor to get tested at the Jones Beach location, officials said. The number to call for an appointment is 888-364-3065.

When people call in, they will be prioritized for testing based on factors such as age, health condition, and other risk factors, Cuomo’s office said. Call 888-364-3065.


Gov. Cuomo: Must Halve Number of Employees
Businesses across New York must half the number of employees that show up to the workplace, Governor Cuomo announced Wednesday.

The governor will sign an executive order enacting the new mandatory requirement, which exempts essential services including food, pharmacies, healthcare, and shipping. Cuomo said he could increase the fraction of people required to work remotely if the 50% rule does not slow the spread of COVID-19New York is the most affected state in the country and the Governor reported 1,008 new cases of the virus on Wednesday—Cuomo is pursuing increasingly aggressive actions to slow its spread.  He said, “I understand this is a burden to business. I understand the impact on the economy,” Cuomo said. “Let’s maintain the public health, we’ll figure out the economy afterwards.”