COVID-19 Update – April 2, 2020


New York State Statistics April 2
By the numbers: The state reported 92,381 confirmed cases and 2,373 deaths as of Thursday morning, including 51,809 cases in New York City,  11,567 in Westchester County, 10,587 in Nassau County, 8,746 in Suffolk County, 3,751 in Rockland County, 1,993 in Orange County, 667 in Dutchess County, 617 in Erie County, 420 in Monroe County and 253 in Albany County.

As of Wednesday night, New York City reported 1,374 deaths (deaths by borough) and 15,217 confirmed cases in Queens, 12,274 in Brooklyn, 8,607 cases in the Bronx, 7,022 in Manhattan, and 2,552 in Staten Island. More numbers here.


MSSNY President Dr. Fougner’s Press Statement re Ventilator Shortage
Based on information from Governor Cuomo’s press briefings, along with communications from our member physicians, hospitals in New York are getting to the point where ventilators as lifeboats are reaching capacity. At this point, the most difficult decisions facing physicians will have to be made. Already, some emergency physicians are reporting being told the equivalent of ‘Use your best judgement. You’re on your own.’ For sure, we will be seeing increasing depression and PTSD that will eclipse today’s physician burnout.

In 2015, NY State DOH’s Task Force on Life and Health published Guidelines on Ventilator Allocation. While DOH is reviewing the situation in light of COVID19, we suggest that our medical centers and health systems use this document as a framework to inform policy decisions. Additionally, each institution should empower its ethics committee to have in place a system to respond urgently to requests for guidance when the need arises so that no physician need bear this terrible burden alone.


Eight Things to Know About Drugs Touted as Coronavirus Game Changers
Two decades-old drugs designed to treat malaria, called chloroquine and hydroxychloroquine, have been touted by the Trump administration as “game changers” in the U.S. response to the coronavirus pandemic.

Eight things to know about them:

  1. Chloroquine and hydroxychloroquine were approved in 1949 to treat malaria, but today are used commonly to treat autoimmune diseases such as lupus and rheumatoid arthritis.
  2. Hydroxychloroquine is a safer, more commonly used version of chloroquine.
  3. Both drugs have shown to be somewhat effective in treating COVID-19 in preliminary trials, but there is no peer-reviewed clinical data showing this.
  4. The FDA granted emergency use authorization for both drugs March 28 to allow COVID-19 patients to be treated with them.
  5. The FDA has warned against taking chloroquine products without a prescription. A man died after taking chloroquine meant for his pet fish.
  6. Several state pharmacy boards have passed emergency rules restricting prescription of chloroquine and hydroxychloroquine in response to reports that some physicians and pharmacists were stockpiling the drugs for themselves and their families.
  7. Blue Cross Blue Shield of North Carolina said it would cover both chloroquine and hydroxychloroquine for use in treating COVID-19.
  8. Sandoz has donated 30 million doses of hydroxychloroquine to the strategic national stockpile, and Bayer has donated 1 million doses of chloroquine.
    (Becker’s Hosp Review, April 2)

Justice Department Will Send Seized Medical Supplies to New York, New Jersey
Hundreds of thousands of hoarded medical supplies, including 192,000 n95 respirator masks, are being sent to coronavirus hot spots New York and New Jersey, the Department of Justice and Department of Human and Health Services announced today.

The FBI located the supplies on March 30, as part of its work under the department’s Covid-19 Hoarding and Price Gouging Task Force announced last week. HHS was then alerted and activated the Defense Production Act to seize the supplies and put them under U.S. government control.

Along with the n95 respirator masks, the FBI also discovered 598,000 medical gloves, 130,000 surgical masks and other supplies like gowns, disinfectant towels, hand sanitizers and disinfectant sprays, materials the Justice Department said are being distributed to states.

“If you are amassing critical medical equipment for the purpose of selling it at exorbitant prices, you can expect a knock at your door,” Attorney General William Barr said in a statement. “The Department of Justice’s COVID-19 Hoarding and Price Gouging Task Force is working tirelessly around the clock with all our law enforcement partners to ensure that bad actors cannot illicitly profit from the COVID-19 pandemic facing our nation.” (Politico, April 2, 12:37)


Paycheck Protection Program (PPP) Information Sheet: Borrowers
The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. The loan amounts will be forgiven as long as:

  • The loan proceeds are used to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8-week period after the loan is made; and
  • Employee and compensation levels are maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for 6 months

What do I need to apply? You will need to complete the Paycheck Protection Program loan application and submit the application with the required documentation to an approved lender that is available to process your application by June 30, 2020.

Click HERE for the application.


10 K Disaster Grant: Does Not Impact Qualification for Forgivable Loan) 75% Reserved; File Now! Do NOT Wait
Apply for a COVID-19 Economic Injury Disaster Loan NOW! https://covid19relief.sba.gov/#/

In response to the Coronavirus (COVID-19) pandemic, small business owners in all U.S. states, Washington D.C., and territories are eligible to apply for an Economic Injury Disaster Loan advance of up to $10,000. To apply for a COVID-19 Economic Injury Disaster Loan, https://covid19relief.sba.gov/#/

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. The loan advance will provide economic relief to businesses that are currently experiencing a temporary loss of revenue. Funds will be made available within three days of a successful application, and this loan advance will not have to be repaid.  DO NOT WAIT!


White House Expected to Recommend All Wear Cloth Masks
The White House is expected to announce a new policy, based on guidance from the Centers for Disease Control and Prevention, that would urge Americans to wear cloth masks in an effort to prevent coronavirus spread, according to a federal official familiar with the policy.


Lessons from The Front Lines: COVID-19
CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force, invites MSSNY members to the next call in the new CMS series for physicians: Lessons from The Front Lines: COVID-19. The call will take place on Friday, April 3rd from 12:30 – 2 PM EST and the topic of discussion is: COVID-19 Flexibilities. Please join us to share your ideas, strategies, and insights with one another. Please see dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

Participant Dial-In: (877) 251-0301

Access Code: 2674453

Webcast Streaming: https://protect2.fireeye.com/url?k=4be5adfc-17b0a42c-4be59cc3-0cc47a6a52de-f8b939daf2762cc0&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1794


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

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

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

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

FOR MONETARY DONATIONS:

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

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

FOR PROTECTIVE SUPPLIES:

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

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

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


 

 

COVID-19 eNews March 25, 2020

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


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

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


TRACKING COVID-19

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

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


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

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

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

Art Fougner, MD
MSSNY President


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

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

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

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

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

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


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

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

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

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

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

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

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

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

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


Emergency Medical Aid and Telemedicine


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

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


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


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

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

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


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


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

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


CDC: Clinician Outreach and Communication Activity (COCA)

Emergency Preparedness and Response

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

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


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

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

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

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

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

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

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

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

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

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


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

CMS Outlines New Flexibilities Available to People with Medicare

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

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

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

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


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


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

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


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

 

 

COVID-19 eNews Update – March 18

As of March 18 Statistics:

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

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

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

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


Emergency Medical Aid and Telemedicine

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


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

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


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


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

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

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

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


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


Additional COVID-19 Information

COVID-19 Update March 22, 2020

How to Set Up Telehealth for Free

Doctor on Videoconference

Dr. Tom Madejski and Dr. Danial Choi have easy to follow directions on how to set up telemedicine in your office.

Since HIPAA has removed its requirement that all telehealth programs be HIPAA qualified, this do-it-yourself system is free. All you need is your cellphone or tablet.

Please see this video for more information.


Information for Insurers and Providers on Coverage for Telehealth Services click here.


Some points From the On-Going Governor’s Announcement:

– Calling on feds to nationalize medical supply acquisition. States unable to manage procurement, and costs, and are competing against other states.

– Governor thinks use of Defense Production Act at the federal level is appropriate for producing PPE and ventilators.  Use would resolve competitive price gouging, and interstate competition.

– Urges federal money be disbursed directly to individuals, then governments and both before corporate subsidies.  Referred to stock buy-backs with federal bailout money in 2008, and seeks to avoid it.

– Requesting temp hospitals from Army Corps of Engineers:

– Stony Brook
– Westbury
– Westchester
– Javits Center
– Temp hospitals are helpful, but they don’t come with supplies, nor staff – problematic

– Governor given approvals at state level, construction can start tomorrow.

– Asking FEMA to erect 4 federal hospitals at Javits Center – they come with staff and supplies

– Still requesting the federal government waive the 25% share of FEMA disaster money – wont be able to pay it.  Governor also asking on behalf of all states.

– State implementing trial (on Tuesday) of Hydroxychloroquine (70k), Zithromax (10k), Chloroquine (750k).

– Requesting serological testing for Coronavirus antibodies ASAP.  Possibly get people back to work quicker (especially medical staff).

– Requesting hospitals double their existing capacity. Waiving applicable regulations.
– Hospitals must provide plan to increase beds by at least 50%, this will be a mandate, DOH emergency order.

– Elective, non-critical surgeries cancelled on Wednesday.  Should provide 25-30% more beds.

– Repurposing existing health care facilities to provide more beds. 

 

MSSNYeNews: Trying Times – March 20, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 20, 2020

Vol. 23  Number 12


MSSNYPAC Seal

 


Colleagues:

The other night, after finally catching up with email, hospital alerts, and various text messages, I fell asleep during a story about physicians’ reporting shortages of Personal Protective Equipment (PPE)

While dreaming about life during wartime, who should show up but Rudyard Kipling. Kipling was sharing a few beers with some British soldiers, having a grand old time. He turned to me and whispered, “You docs have quite a bit in common with our unsung heroes here, you know.” At that, I awoke with a start and found a copy of his poem Tommy on my desk. I knew what I had to do. The result, you see below.

Please share.

Tommy D.

Went to the local grocery to fetch a loaf of bread
Counterman yelled “Stand far away, I’m ‘fraid of being dead.”
Customers talked among themselves, seeing only an empty shelf
I turned around, went outside and mumbled to myself.
It’s greedy this, rent seeker that, old one percenter guy
But it’s thank you Dr Thomson when the baby’s fever’s high

Mocking folks in white coats who treat you when you’re ill
Is cheaper than those white coats, cheaper than that pill.
And calling out tired doctors when they can hardly stand
Seems better for campaigning than giving them a hand.
So it’s greedy this, rent seeker that, old one percenter guy
But it’s savior of the country when pandemic time is nigh.

We don’t feel we’re heroes and not your villains to fear.
We’re merely human beings, just like your neighbors here.
If something that we do rubs folks the wrong way
Remember fellow humans, this isn’t All Saints Day.

So it’s greedy this, rent seeker that, old one percenter guy
But it’s savior of the country when the body count is high.
It’s greedy this, rent seeker that, say anything you please
Your doctor’s not a bloody fool, you bet your doctor sees.

Please make no mistake. We will continue answering the call. It’s what we do. Like the FDNY on September 11, we run into the burning buildings. The difference is that we are fighting fires often without respirators, without hoses and without water. We don’t ask for praise. That’s not why we’re here. We do ask for society’s support without having to keep one eye elsewhere. If we all pull together, I’ve no doubt we’ll pull through. We have no choice. All our lives depend on it.

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

Arthur Fougner, MD
MSSNY President




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Details from Governor Cuomo’s Announcement
Summary of Governor’s Press Conference today, including cancelation of non-critical elective surgeries next week and 100% work at home requirement for businesses that are not essential.

When out in public, New Yorkers will be required to “practice social distancing of at least six feet from others. This is the most drastic action we can take,” Cuomo said today.

  • Planning to cancel all elective, non-critical surgeries. Setting date next week.
  • Hospitals instructed to double room capacity (current capacity is 50k).
  • NYS will pay a premium for Personal Protective Equipment (PPE). Governor asking companies to get creative on production in order to meet PPE needs.  Governor is looking at state production as well.  Governor cannot mandate but will offer financial incentives – Companies to contact NYS.
  • For Funding to start up PPE Production – 212-803-3100
  • For Sales – 646-522-8477
  • Expansion of hand sanitizer production.
  • Asking closed medical offices to offer their PPE to needed areas.
  • Regulated health facility ordered by DOH to make ventilators. Will purchase, but asking for donations call DOH
  • NYS On Pause – Executive Order will be issued today. Only essential business will be functioning with in-person staff.  100% of the workforce must stay home.
  • Remain inside. “This is the most drastic action we can take.”
  • Specific Rules for personal conduct of vulnerable people:

-Remain indoors
-Go outside for solitary exercise
-Pre-screen visitors by taking temperature
-Don’t visit households with multiple people
-All vulnerable people should wear masks when in company of others
-Everyone in presence of vulnerable people should wear mask
-Stay six feet away from others
-Do not take public transport unless necessary

  • These provisions are legal and will be enforced. Civil fines and mandatory closure for businesses not in compliance

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 Elective Surgeries and Non-Essential Procedures Recommendations
Earlier today at the White House Task Force Press Briefing, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

A copy of the press release is here.

A copy of the guidance is here.


Check COVID-9 Websites Regularly for Updates
This is a rapidly changing situation. Please regularly check the NYSDOH COVID-19 website and the CDC COVID-19 website for updates.

Others:


How to Set Up Telehealth for Free
Dr. Tom Madejski and Dr. Danial Choi have easy to follow directions on how to set up telemedicine in your office. Since HIPAA has removed its requirement that all telehealth programs be HIPAA qualified, this do it yourself system is free. All you need is your cellphone or tablet.

Please see this video for more information.


NYSDOH Seeking Retired Physicians if Crisis Worsens
In the event that the novel coronavirus crisis worsens, we need the help of qualified retired health professionals and related professionals to supplement our hospital capacity on a temporary basis to treat seriously ill coronavirus patients including those that may need to be intubated. The NYS Dept. of Health will recertify you for the purpose.  The forms are available here.

MEDICAL CORPS: One thousand retired doctors and nurses signed up to join the city’s medical reserve corps, joining 9,000 existing members, as part of preparation for a wave of Covid-19 hospitalizations, the New York Post reported.


Researchers Say Digestive Symptoms Are Common in Patients with Coronavirus
Researchers from the Wuhan Medical Treatment Expert Group for COVID-19 say that digestive symptoms, including diarrhea, are common in patients infected with coronavirus, according to a study in the American Journal of Gastoenterology. The researchers also found that “patients without digestive symptoms were more likely to be cured and discharged than those with digestive symptoms (60% versus 34%).”


People May Hesitate to Seek Treatment for Coronavirus Due to Cost
The New York Times (3/19) reports that the federal government has passed legislation that would eliminate out-of-pocket costs for patients seeking coronavirus testing, and many states, insurers, and employers are also taking action to limit patients’ costs for testing or treatment for coronavirus. However, even if the cost of testing is covered for everyone, experts say people may be reluctant to seek treatment if they are concerned that treatment may be costly.


Recently Released Guidance Documents Related to Home Care

Dear Prevention Partners: Home Care Guidance Documents
Please see several recently released guidance documents related to home care. 

  1. Dear Administrator Letter (DAL): DHCBS 20-08, COVID-19 Guidance for Home Health Care Agencies and Hospice Providers – March 14, 2020

The purpose of this letter is to provide guidance from the New York State Department of Health (NYSDOH) to certified home health agencies, long term home health care programs, hospices, and licensed home care services agencies pertaining to the current novel coronavirus (COVID-19) outbreak.

  1. Interim Guidance for Home Care Services Regarding COVID-19 – March 16, 2020

This document provides agencies and organizations with information about home and community-based services as it relates to the 2019 novel coronavirus disease (COVID-19). Includes an Appendix for Recommended Screening Questions.

  1. Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19

MSSNY: How Telehealth Helps Prevent the Spread of COVID-19
The time for telehealth is now. Healthcare and government leaders have both advocated for the use of telehealth in the fight against the coronavirus.

Through virtual visits, clinicians can remotely screen those who may be infected with COVID-19 without the risk of exposing other patients and providers.

MSSNY endorses the use of telehealth and secure messaging technologies to assess and treat patients remotely, including Backline by DrFirst. Use Association Code MSSNY when registering for Backline Telehealth.

About Backline

Backline makes telehealth and care collaboration easy. A simple text from the provider using Backline goes straight to the patient’s mobile phone to initiate a secure, HIPAA-compliant virtual visit. There’s no patient registration process or app for patients to download. There are no limits on usage or per-session fees.  Plus, Backline gives you communication features you won’t find in other telemedicine offerings.

Please join us in combatting the spread of the coronavirus.  Switch to virtual visits powered by Backline.

Register for Backline Today
Use Association Code MSSNY when registering for Backline Telehealth. 


URGENT TELEMEDICINE UPDATE: Able to Conduct Tele-Visits Now
The CMS has announced that additional emergency measures have been put into place to temporarily expand the use of telemedicine. These measures will include allowing providers to conduct telemedicine visits with patients who are located in their homes. The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site (i.e., physician’s office or other location) and the patient at home. “SEE MSSNY WEBSITE FOR EASY DO-IT-YOURSELF INSTRUCTIONS or SIGN UP WITH BACKLINE ABOVE AT $300 PER USER. (See article above)


Small Business Loans Available in Five Counties
There are Small Business Administration loans available for the counties of Bronx, New York, Orange, Rockland, Westchester. Other counties may also qualify as the disease progresses. The loans are available for businesses impacted by COVID-19. The loan is called Economic Injury Disaster Loan Assistance.  Loans have an interest rate of 2.75% with long term repayments in order to keep payments affordable, terms are determined on a case by case basis.  Additional SBA disaster assistance customer service is: 1-800-659-2955 or email at disastercustomerservice@sba.gov or by going to https://disasterloan.sba.gov/ela


“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.


MSSNY COVID-19 Podcast by Dr. Valenti, Chair of Infectious Disease Committee
Dr. William Valenti, Clinical Associate Professor of Medicine (Infectious Diseases)
University of Rochester School of Medicine Senior Vice-President Chair of MSSNY’s Infectious Diseases Committee, discusses the current coronavirus outbreak.



“Coronaviruses 2020: COVID-19 An Evolving Story” CME Webinar Recorded on March 18th Now Available Online
Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18th is now available at https://cme.mssny.org .  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee along with Elizabeth DuFort, MD, Medical Director in the Division of Epidemiology at the New York State Department of Health served as faculty for this program. And Marcus Freidrich, MD, MBA, Chief Medical Officer – Office of Quality of Patient Safety – New York State Department of Health offered additional information.

If you do not already have an account at the MSSSNY CME website, you will need to create one.

Educational objectives:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role int eh public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

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. 

* Please note that while the recording time of this webinar is approximately two hours, there is only one credit available.  The second hour is an extra question and answer period.


Use the Right Codes for Telemedicine
Billing for telemedicine can be somewhat confusing due to the vast variety of codes.  For simplicity, please be aware that most plans, including Medicare and Medicaid, will accept the normal E&M AMA-CPT codes (99201-99215) with the GT modifier to reflect telemedicine.  Keep it simple. (Be sure to get your patient’s consent to provide your service in this way and note their agreement in their medical record.

Note, during this national state of emergency/pandemic, CMS has expanded telemedicine rules to allow the use of non-public face-to-face technology such as an iPhone or similar equipment.  Additionally, the Office of Civil Rights has relaxed the HIPAA regulations during this event.

If more information is required, email Regina McNally at rmcnally@mssny.org.


UPDATED CASE NUMBERS
TODAY, Governor Cuomo confirmed 1,008 new cases of coronavirus in New York State, bringing the statewide total to 2,382 positive cases.

• We now have 46 deaths

• Today, the Governor announced new cases in Chenango, Essex, Hamilton, Warren and Washington

• Here is the geographic breakdown in NYC and 32 counties:

o   4,408 NYC (695 new)

o   1,091 Westchester (158 new)

o   754 Nassau (52 new)

o   371 Suffolk (32 new)

o   61 Albany (13 new)

o   84 Orange (17 new)

o   101 Rockland (8 new)

o   36 Dutchess (4 new)

o   32 Monroe (4 new)

o   24 Saratoga (5 new)

o   21 Schenectady (9 new)

o   12 Ulster (1 new)

o   31 Erie (same)

o   8 Rensselaer (3 new)

o   7 Tompkins (1 new)

o   7 Putnam (same)

o   2 Allegany (same)

o   2 Greene (same)

o   2 Montgomery (1 new)

o   2 Onondaga (same)

o   2 Broome (same)

o   1 Delaware (same)

o   2 Herkimer (same)

o   1 Tioga (same)

o   3 Ontario (same)

o   2 Wyoming (same)

o   2 Clinton (same)

o   8 Sullivan (same)

o   2 Chenango (1 new)

o   1 Essex (1 new)

o   2 Hamilton (1 new)

o   1 Warren (1 new)

o   1 Washington (1 new)

• New York is still the most impacted state in the nation with 34% of all cases in the U.S. There are 201 deaths in the U.S.

• To date, there are 272,367 positive cases around the world and 11,375 deaths. So far, there are 87,966 total recoveries and 113,913 pending cases worldwide.

• Current Hospitalization Count: 549 out of 2,382 positive cases are currently hospitalized (23% of cases).

• Recovered: 108 people with coronavirus have been discharged from the hospital.

• Testing: 14,597 people have been tested statewide.

• Governor Cuomo’s messages to all New Yorker’s today:

o   “We are fighting a war against this pandemic and we know that two of the most effective ways to stop it is by reducing density and increasing our hospital capacity, so our healthcare system is not overwhelmed.” 

o   “The deployment of the USNS Comfort to New York is an extraordinary but necessary step to help ensure our state has the capacity to handle an influx of patients with COVID-19 and continue our efforts to contain the virus.”

o   Partnering with the private sector to require nonessential employees to work from home will also go a long way toward bending the curve. My number one priority is protecting the public health so that a wave of new cases doesn’t crash our hospital system, and we will continue taking any action necessary to achieve that goal.”


TODAY’S ANNOUNCEMENT

NAVY HOSPITAL SHIP: Today Governor Cuomo announced the Navy hospital ship USNS Comfort will be deployed to New York harbor and is expected to arrive in April.

o   The 1,000-bed hospital ship has 12 fully-equipped operating rooms and will significantly increase New York’s hospital surge capacity.

EXECUTIVE ORDER FOR BUSINESSES: The Governor also announced he will issue an executive order directing non-essential businesses to implement work-from-home policies effective Friday, March 20.

o   Businesses that rely on in-office personnel must decrease in-office workforce by 50 percent.

o   The executive order exempts essential service industries, including shipping, media, warehousing, grocery and food production, pharmacies, healthcare providers, utilities, banks and related financial institutions, and other industries critical to the supply chain. 

o   The Governor also recognized the following partners in this effort:

    • The Business Council of NY
    • Retail Council of NYS
    • ABNY
    • Partnership for New York City

REGIONAL APPROACH: Today the Governor announced that Pennsylvania has joined New York, New Jersey and Connecticut in a regional approach to the combating COVID-19.

o   Governor Cuomo, Governor Murphy, Governor Lamont and Governor Wolf directed temporary closure of all indoor portions of retail shopping malls, amusement parks & bowling alleys – effective by 8 PM Thursday.

STATE GOVERNMENT EMPLOYEES: On Monday, Governor Cuomo directed nonessential state employees statewide to work from home.

o   The Governor also directed local governments to reduce their overall workforce by 50 percent and allow nonessential employees to work from home.

ARMY CORPS OF ENGINEERS: The Governor is meeting with leadership of the Army Corp of Engineers today to discuss ways to increase hospital capacity in New York. 

ACTION PLAN: Today the Governor outlined the State’s ACTION PLAN components:

o   1- Flatten Curve thru Density Reduction

o   2-Increase Current Hospital Capacity

o   3-Identify New Hospital Beds

o   And do all three simultaneously

ID NEW HOSPITAL BEDS: Governor met yesterday with hospital administrators to increase bed capacity and…

o   Waive DOH regulations related to hospital beds

o   Discuss ways to add more staff, including reserve staff

o   And bring in staff from nursing schools, medical schools, retired healthcare workers; and,

o   Convert available facilities into extra hospital space.

DENSITY REDUCTION: Gov. Cuomo reiterated the following density reduction actions:

o   VOLUNTARY: work from home

o   MANDATORY: closed schools statewide

o   MANDATORY: reduce state and local workforce

o   MANDATORY: new 4-state regional agreement to close bars, restaurants and gyms

ESTIMATED VIRUS PEAK: Experts estimate the coronavirus will peak in about 45 days. 

DRIVE-THROUGH TESTING: continues in locations including New Rochelle in Westchester County, Jones Beach in Nassau County…Staten Island and Rockland County.

o   Drive-through mobile testing facilities help keep people who are sick or at risk of having contracted coronavirus out of healthcare facilities where they could infect other people.

o   These facilities are a critical part of the Governor’s nation-leading program to test thousands of people per day for COVID-19 by this week.


YESTERDAY’S ANNOUNCEMENTS

• THREE-WAY AGREEMENT / PAID SICK LEAVE: Governor Cuomo announced a three-way agreement with the Legislature on a bill guaranteeing job protection and pay for New Yorkers who have been quarantined as a result of novel coronavirus, or COVID-19.

o   The program bill also includes the permanent comprehensive paid sick leave policy first advanced in the Governor’s FY 2021 Executive Budget proposal.

o   This follows the Governor’s announcement last week that the state will guarantee two full weeks of paid leave for all state workers who are subject to a mandatory or precautionary order of quarantine as a result of the novel coronavirus.

• SUPPLEMENT HEALTHCARE PERSONNEL: The state is reaching out to qualified former doctors, nurses and other healthcare professionals to supplement the personnel at hospitals.

o   The State Department of Health and the State Education Department have sent letters to retired health care professionals and all schools of nursing, public health and medicine encouraging qualified health care personnel to sign up for on-call work during the COVID-19 crisis.

o   Healthcare professionals who wish to volunteer can contact the State Department of Health at health.ny.gov/assistance.

• CHILD CARE: Governor Cuomo also directed the Greater New York Hospital Association and the Healthcare Association of New York State to work with 1199 SEIU to develop a plan to create drop-in childcare opportunities and expand childcare facilities at their hospitals to ensure childcare for hospital workforce. They will submit a joint plan to the state by Friday.

• EMPLOYEE PROTECTIONS: To address the immediate need of employees affected by COVID-19 who are subject to mandatory or precautionary orders of quarantine or isolation, the Governor’s legislation will provide the following:

o   Employers with 10 or fewer employees and a net income less than $1 million will provide job protection for the duration of the quarantine order and guarantee their workers access to Paid Family Leave and disability benefits (short-term disability) for the period of quarantine including wage replacement for their salaries up to $150,000.

o   Employers with 11-99 employees and employers with 10 or fewer employees and a net income greater than $1 million will provide at least 5 days of paid sick leave, job protection for the duration of the quarantine order, and guarantee their workers access to Paid Family Leave and disability benefits (short-term disability) for the period of quarantine including wage replacement for their salaries up to $150,000.

o   Employers with 100 or more employees, as well as all public employers (regardless of number of employees), will provide at least 14 days of paid sick leave and guarantee job protection for the duration of the quarantine order.

• TIMING OF PROVISIONS: The provisions of the quarantine legislation are set to take effect immediately upon passage, ensuring that New York workers will be able to take advantage of these benefits.

• MORE ON PAID SICK LEAVE: The legislation also includes the comprehensive paid sick leave proposal that was advanced by the Governor as part of his State of the State and FY 2021 Executive Budget, which will be effective 180 days after enactment. Specifically, the legislation provides:

o   Employers with 4 or fewer employees and a net income less than $1 million will provide at least 5 days of unpaid sick leave each year.

o   Employers with 5-99 employees and employers with 4 or fewer employees and a net income greater than $1 million will provide at least 5 days of paid sick leave each year.

o   Employers with 100 or more employees will provide at least 7 days of paid sick leave each year.

• HALT ON STUDENT DEBT: Governor Cuomo and Attorney General Letitia James announced that — effective immediately — the state will temporarily halt the collection of medical and student debt owed to the State of New York and referred to the Office of the Attorney General for collection, for at least a 30-day period, in response to growing financial impairments resulting from the spread of 2019 novel coronavirus, or COVID-19.

o   In an effort to support these workers and families and ease their financial burdens, the OAG will halt the collection of medical and student debt owed to the State of New York and referred to the OAG for collection from March 16, 2020 through April 15, 2020.

o   After this 30-day period, the OAG will reassess the needs of state residents for a possible extension.

o   Additionally, the OAG will accept applications for suspension of all other types of debt owed to the State of New York and referred to the OAG for collection.


ADDITIONAL INFORMATION / PREVIOUS ANNOUNCEMENTS

• HOSPITAL CAPACITY: Governor Cuomo issued an Executive Order allowing the state to increase hospital capacity to prepare the state’s healthcare system to handle the potential influx of patients suffering from COVID-19.

o   The State will organize the National Guard and work with building unions and private developers to find existing facilities — such as dormitories and former nursing homes — that can most easily be converted to medical facilities, with the goal of creating an additional 9,000 beds.

o   The Governor also asked local governments, especially those in the most impacted areas, to help identify available facilities for this purpose.

o   The State Department of Health is also suspending regulations to allow existing hospitals to increase space and capacity.

• HOSPITAL SURGE CAPACITY COUNCIL: The Governor has asked the Greater New York Hospital Association President Ken Raske and Northwell Health President Michael Dowling to lead a council to develop hospital surge capacity.

• ELECTIONS DELAYED: Governor Cuomo issued an executive order delaying village elections statewide until the April 28 primary election.

o   Delaying village elections will help ensure poll workers and voters are not potentially exposed to the virus and at the same time maintain integrity in our election system.

• SCHOOL CLOSINGS UPDATE: Governor Cuomo signed an executive order directing all schools in New York to close by Wednesday, March 18 for two weeks ending April 1.

o   At that time, the state will reassess whether to extend the school closures further and continue to suspend the 180-day instructional requirement. Schools that exceed the closure period without state authorization will not be exempted from the 180-day rule.

o   About 86% of all schools in the state have closed already.

• LOCAL GOVTS: The Governor also directed local governments to reduce their overall workforce by 50 percent and allow nonessential employees to work from home. But local governments must keep a minimum 50 percent capacity to deal with community response efforts.

• PARK FEES WAIVED: The Governor also announced New York State will waive all fees for state, local and county parks.

• SUPPORTING CHILDREN and PARENTS:  The Governor also called on 1199 SEIU, NYSNA, Greater New York Hospitals Association and United Federation of Teachers to work together to ensure children who rely on school breakfast and lunch programs will continue to receive that support.

• DMV: The Governor also directed DMV to move to appointment only to limit person to person contact and revert to regular hours rather than the extended hours the state implemented in recent weeks to help reduce lines.

• WORKING WITH COUNTIES: The Governor also tasked SUNY Empire State College President Jim Malatras with working with counties to develop contingency plans in preparation for school closings, including how to provide meals to food insecure children and ensuring families have adequate access to childcare.

• NYS COURT SYSTEM:  Governor Cuomo asked Chief Judge Janet DiFiore to develop a plan to reduce density in the court system, including limiting nonessential proceedings, without disrupting criminal justice system.

• ELECTION PETITIONS: In an effort to keep New Yorkers safe during the COVID-19 pandemic, Governor Andrew M. Cuomo today signed an executive order temporarily modifying election procedures to help reduce the spread of the novel coronavirus.

o   Governor Cuomo said: “This executive order modifies the election process in a way that both protects public health and ensures the democratic process remains healthy and strong regardless of the ongoing pandemic.”

o   The executive order suspends the candidate petitioning process — effective 5PM on Tuesday — for the June primaries for Congressional, State Senate, State Assembly and Judicial races.

o   The executive order also modifies the signature requirements for ballot access; candidates will only need to collect 30 percent of the statutory threshold.

o   For Congress, candidates would need 375 signatures rather than 1,250.

o   For State Senate, candidates would need 300 signatures rather than 1,000.

o   For State Assembly, candidates would only need 150 signatures rather than 500.

o   The executive order also modifies deadlines and procedures to better allow New Yorkers to vote absentee for the Queens Borough President special election on March 24. It extends the current deadline to register to vote absentee to March 23, the day before the special election. Absentee votes must be postmarked or delivered in person up until the day of the election on March 24.

• TELEMEDICINE: Governor Cuomo today announced the State Department of Financial Services will require insurance companies to waive co-pays for telehealth visits.

o   This action will encourage New Yorkers to seek medical attention from their homes rather than visit a hospital or doctor’s office — ultimately reducing strain on the healthcare system and preventing further spread of the virus.

• INCREASING TESTING CAPACITY: The addition of a mobile testing facility on Long Island is part of the State’s initiative to replicate the New Rochelle Mobile Testing Center model at other locations, helping the state to run at least 6,000 tests per day starting next week — six times the state’s target goal when this outbreak first came to New York.

o   This is on top of the testing that will be conducted at the 28 public and private labs across the state and the out of state labs that New York is already contracting with.

o   All of this is a result of the proactive steps taken by Governor Cuomo and the Department of Health to get as many New Yorkers tested as possible.

• TESTING GUIDANCE: We have received lots of questions around testing guidance and who can or should get tested now. Here’s an excerpt from the current guidance.

• Testing for COVID-19 shall be authorized by a health care provider when:

o   An individual has come within proximate contact (same classroom, office, or gatherings) of another person known to be positive; or

o   An individual has traveled to a country that the CDC has issued a Level 2 or Level 3 Travel Health Notice, and shows symptoms of illness; or

o   An individual is quarantined (mandatory or precautionary) and has shown symptoms of COVID-19 illness; or

o   An individual is symptomatic and has not tested positive for any other infection; or

o   Other cases where the facts and circumstances warrant as determined by the treating clinician in consultation with state and local department of health officials.

• NURSING HOMES: There are new limits on visitations to nursing homes – Only Medically Necessary Visits Will Be Allowed to Protect Most Vulnerable.

o   All staff are required to wear masks.

o   All staff will be monitored for symptoms.

o   No non-medical/staff personnel may enter unless there’s an exigent circumstance. In such a case, visitors must then wear protective clothing including masks.

o   NYS DOH sent updated guidance to all nursing home administrators around the state. That guidance is posted on the State Department of Health’s COVID-19 website.

• UNEMPLOYMENT ASSISTANCE: As part of the Governor’s Executive Order, the state will waive the 7-day waiting period for workers in shared work programs to claim unemployment insurance for those that have been put out of work by COVID-19

• SUPPLIES: Local governments seeking to obtain additional stocks of hand sanitizer or other supplies should work with their County’s emergency Manager and local Health Department to submit requests directly into NY RESPONDS, the state’s web-based system which enables both local governments and state agencies to submit and share vital emergency-related information and resource requests.

• STATE GUIDANCE: We are continually updating guidance for our communities, local governments, schools, health care providers, businesses, other institutions, and the public at large.

o   In the last few days, we have provided – and posted to our websites – updated guidance for schools, nursing homes, home care agencies, hospice and more.

o   We have also posted guidance on testing, cleaning & disinfecting, large gatherings and public spaces, and for employees with exposure concerns.

• NEW MASS GATHERING REGULATIONS: Public health experts agree mass gatherings with people making sustained close contact are a place where the novel coronavirus can easily infect many people quickly and continue its spread.

o   So in response, events with 500 or more individuals in attendance will be cancelled or postponed.

o   From zero to 500, we’re reducing the occupancy by 50%. So 50% of your seated capacity is the new capacity for a facility.

o   Those new rules will go into effect five o’clock on Friday, except for the Broadway theaters in Manhattan, which closed as of five o’clock yesterday.

o   Large gatherings and public spaces within the scope of this guidance include, but are not limited to: • Theaters, • Auditoriums, • Concerts, • Conferences, • Worship services, • Sporting events, • Restaurants, • Bars, • Gaming establishments, and • Physical fitness centers.

o   This guidance is not intended for governmental, medical, educational, retail spaces, or mass transportation facilities, including but not limited to: • Schools, • Libraries, • Government Buildings, • Hospitals, • Residential Health Care Facilities, • Retail Establishments, including: o Grocery Stores, o Pharmacies, • Public Transit Facilities: o Trains/Railway Stations, o Subway Terminals, and o Buses and Bus Terminals.

• PUBLIC UTILITIES: The Governor also directed the New York State Department of Public Service to suspend public utilities from cutting off service – including power and heat – to customers affected by COVID-19. The State’s major utilities will take immediate action to suspend service shutoffs to households during the COVID-19 outbreak and will continue to offer deferred payment plans for customers struggling financially due to the outbreak.

• NATIONAL GUARD: At the direction of Governor Cuomo, the New York National Guard has mobilized Army and Air National Guard members in State active duty status to assist in New York State’s efforts to contain the spread of the COVID-19 virus.

o   The soldiers come from units located across New York.

o   The soldiers will be on duty as long as required and are assisting in the distribution of food supplies and state-provided hand sanitizer, aiding with the cleaning and disinfecting of public spaces, and helping with transportation and logistical needs.

• DOCCS: The New York State Department of Corrections and Community Supervision has suspended visitation at facilities statewide.


RESOURCES

• WEBPAGE: That NYS DOH dedicated coronavirus webpage is: (https://www.health.ny.gov/diseases/communicable/coronavirus/). That’s the best place for updated case numbers, guidance, press releases, and additional information.

• HOTLINE: NYS DOH maintains a Coronavirus Hotline (1-888-364-3065) where New Yorkers with questions about the coronavirus can speak with public health experts in their preferred language.


CDC WEEKLY Key Messages


This Week’s Legislative Podcast


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

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

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

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

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

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


 

MSSNYeNews: March 13, 2020 – Triskaidekacovid Phobia

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 13, 2020

Vol. 23  Number 11


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Colleagues:

Our Kevin Bacon Strategy is not working. While it’s probably too late for containment to hold off the spread of COVID-19, the goal shifts to mitigation – sufficient social distancing to slow down the virus and prevent overwhelming our medical resources. Testing, while not sufficiently scaled, is becoming increasingly available via health systems throughout the state. Some states, CT, CO, and WA are setting up “Drive Thru” testing facility, similar to New York State which initiates its first driving facility in New Rochelle. The Gates Foundation is funding a home test kit delivered by Amazon that could be mailed in. This is currently a pilot in the Seattle area but could be widely available soon. More information on SARS CoV2 and COVID-19 can be found here.

Every day, more cases are being found, especially now that testing is increasingly available. Our local health systems realized the importance of social distancing a while ago as medical staff meetings are now choosing Facetime over face time. As more large scientific meetings are canceled, our own House of Delegates has come under increasing scrutiny.  While further discussion and final decision is planned for early next week, it is far more likely than not that the House as we know it will not be held. The business of the House, however, will not be ended. It is the business model that will change. MSSNY’s Long Term Planning Committee has been working on a trial of virtual reference committees. What was once long-term planning may quickly become short term planning.

I’ve found humor to be a great salve for the worried brow. So, in that vein, on this Friday the 13th, take a few deep breaths and be of good cheer. We will get through this. This is a virus, not Ragnarok. We must be the adults in the room. While this is only Round 3 in a 12-round fight, we can do this. We have no choice. Our families, our colleagues and our patients are counting on us.  Fear is the mind killer. As former NY governor Franklin Roosevelt observed, “The only thing we have to fear is fear itself.”

Your Medical Society of the State of New York has taken the following steps to provide you with information:

  • Create a COVID-19 section on the MSSNY website
  • Participate in weekly conference calls with the New York State                    Department of Health
  • Create a physician resource page of valuable links to get information
  • Has created two podcasts on COVID 19 for physicians and patients—          both of which can be found on our website
  • Will conduct a COVID-19 webinar on March 18, 2020 for physicians.

All information can be found in the various articles below.

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

Arthur Fougner, MD
MSSNY President


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WHO Declares COVID-19 Pandemic; Important Information Physicians Need to Know
The World Health Organization (WHO) has declared COVID-19 as a pandemic.  There are 421 cases of confirmed COVID-19 in New York State as of March 13, 2020.  According to Governor Andrew Cuomo, 50 patients have been hospitalized which is about a 12% hospitalization rate.  He also announced the approval of the federal government for New York labs to conduct up to 6,000 COVID-19 tests per day.  The governor on Thursday also banned gatherings of 500 or more in the state and any gathering under 500 individuals in attendance will be required to cut capacity by 50%.  There are also new limits on visitations to nursing homes – Only medically necessary visits will be allowed to protect the most vulnerable.  

The Medical Society of the State of New York has gathered information to aid physicians and has also developed communication tools for your patients on COVID-19.  MSSNY strongly recommends that physicians utilize the New York State Department of Health which has up-to-date information on COVID-19 and includes and includes information on known cases of COVID-19, cleaning and disinfection guidance, help for childcare providers and schools, and guidelines for individuals who have recently traveled internationally.

Since COVID-19 is a reportable disease, please ensure that you and your staff have the number of your local department of health.  Contact information can be found here.

MSSNY now has a Physician Resource Page on its website of important links and it can be accessed here.

Additionally, MSSNY has put together a physicians’ podcast on COVID-19 accessible here.

MSSNY has also provided for patients a podcast on COVID-19 here.

MSSNY has also developed patient specific information page that you can provide to patients and it can be accessed here.

Physicians are also encouraged to go to the MSSNY CME website and take the Physicians’ Emergency Tool Kit modules which contain educational programs on Office Surge, Crisis Communication and responding to public health emergencies.

The Governor has also indicated his hope to find retired physicians and other healthcare personnel to help at their former hospitals in the event they are needed to help with exceeded capacity at the facility.   (CLANCY, HOFFMAN)


State Agencies Sent Out Reminder that New York Law Covers Telemedicine
Both the New York State Department of Financial Services (DFS) and Department of Health (DOH) have sent out notifications relating to the Covid-19 outbreak reminding health insurers, physicians and hospitals that New York law requires coverage for telemedicine in the same manner as if care had been provided in an office setting.  To read the DFS circular letter, click here  () and to read the Medicaid guidance click here.  Moreover, Congress passed a law last week that reduces current restrictions on Medicare coverage for telemedicine but we are awaiting guidance from CMS as to how it will be implemented.                                            (AUSTER)



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DFS Announces Emergency Regulation to Prevent Insurer Cost-Sharing for Covid-19 Testing
The New York Department of Financial Services (DFS) today announced an emergency regulation that prohibits New York health insurers from imposing cost-sharing on emergency room visits, in-network outpatient physician office visits, in-network urgent care center visits, in-network telehealth visits, and in-network laboratory tests when the purpose of the visit or test is to diagnose novel coronavirus (COVID-19).   To read the regulation click here.

This emergency regulation also requires that insurers notify their in-network health care providers not to collect any deductible, copayment, or coinsurance for diagnostic testing for COVID-19.

This regulation follows guidance issued on March 2nd, 2020 that outlined a series of other actions that New York health insurers are required or advised to take, including keeping New Yorkers informed regarding available benefits; offering, where possible, telehealth medical advice and treatment; preparing insurers to cover the costs of a COVID-19 immunization should one become available; and guaranteeing access to out-of-network providers at the in-network cost-sharing when no in-network provider can treat the insured.

The DFS Press release noted that Copayments, coinsurance, or annual deductibles may be imposed in accordance with the applicable policy for any follow-up care or treatment for the novel coronavirus (COVID-19), including an inpatient hospital admission, as otherwise permitted by law.         (AUSTER) 


MSSNY Governmental Affairs Team Prepares for Phase 2 in Budget Process
Since Governor Cuomo released his proposed budget for FY 2020 on January 21st, the MSSNY Governmental Affairs team has been working hard to build support in the legislature for the organization’s position on proposals that will have the greatest impact on physicians and public health. Included among these are:

  1. A ban on vaping products like flavored liquids used with e-cigarettes.
  1. Regulation of Pharmacy Benefit Managers (PBMs).
  1. Protecting funding for the state Excess Medical Malpractice Insurance Program.
  1. Opposing unnecessary, proposed changes to the physician disciplinary process administered by the Office of Professional Medical Conduct (OPMC), which could significantly curtail physician due process rights.
  1. Rejecting a steep across the board cut in reimbursements for physicians participating in the state Medicaid program.

As is traditionally done, the Assembly and Senate are expected to pass their own one house resolutions on March 18th, which will outline their budget priorities for FY 2020, followed by three-way negotiations between the Governor and leaders in the Assembly and Senate. The statutory deadline for lawmakers to have final agreement on a new budget is April 1st. However, it is possible this deadline could be delayed due to the COVID19 outbreak, which has hit New York state particularly hard, which may prevent the Legislature from meeting this deadline.

The Division of Governmental Affairs team will continue to push MSSNY’s budget priorities and monitor discussions between the Governor and legislative leaders in the coming weeks.                                                            (CARY, AUSTER)


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Medicaid Redesign Team II (MRT II) Discusses Possible Reform Proposals Including Several of Concern
The MRT II held its second public meeting this past week where it discussed the over 2,200 proposals that were submitted to the group, and which could be part of its final list of recommendations next week, March 19.   The MRTII is charged with finding $2.5 billion in savings to the Medicaid program as part of the State Budget that is scheduled to be finalized by April 1, just a few weeks away.

MSSNY continues to be concerned by a range of the MRT II proposals under consideration, chief among them:

  1. Eliminating or reducing funding for the Excess Medical Malpractice Insurance Program. Please send a letter to your legislators to oppose this cut here.
  1. Permitting nurse-anesthetists to deliver anesthesia care without adequate anesthesiologist supervision. Please send a letter to your legislators to oppose this policy change.
  1. A further Medicaid cut in addition to the 1% across-the-board cut to achieve desired Budget savings and what that means for physician reimbursements. Please send a letter to your legislators to oppose further Medicaid cuts here.
  1. Elimination of “Prescriber Prevails” policy in the Medicaid pharmacy benefit.
  1. Changes to the Patient Centered Medical Home (PCMH) program that may further tie payments to certain quality performance metrics. The Department of Health (DOH) has stated that patients enrolled in PCMH had significantly lower health costs overall than non-PCMH enrollees.

MSSNY’s Governmental Affairs team will continue to share our concerns with policymakers behind the scenes and will provide an update as new details become available. (CARY, AUSTER)


Registration Now Open for CME Series on Pain Management, Palliative Care & Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2020
The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

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

These webinars are being offered FREE OF CHARGE to MSSNY members. A discount code was emailed to members on February 24, 2020. Please contact Melissa Hoffman at mhoffman@mssny.org if you did not receive this discount code.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services (OASAS) in the development of these programs.  Following the webinars, the courses will be offered on-line on the MSSNY CME site.   The programs will be offered to MSSNY members free of charge and there is a non-member fee of $50 per session.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Two Remaining Webinars will be held on:

Tuesday March 17, 2020—7:30-8:30am
When to Consider Opioid Therapy for Chronic Non-Cancer Pain & in Palliative Care

Faculty: Charles Argoff, MD
Educational Objectives:

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

Register for this webinar here 

Tuesday March 24, 2020—7:30-8:30am
Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

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

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

Register for this webinar here. 

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

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

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

(HOFFMAN)


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“Coronaviruses 2020: COVID-19 An Evolving Story” CME Webinar on March 18th Registration Now Open
Included in MSSNY’s response to the COVID-19 outbreak is Matters: Coronaviruses 2020: COVID-19 An Evolving Story on March 18th at 7:30am.  Faculty for this program are William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee along with Elizabeth DuFort, MD, Medical Director in the Division of Epidemiology at the New York State Department of Health will serve as faculty for this program. And Marcus Freidrich, MD, MBA, Chief Medical Officer – Office of Quality of Patient Safety – New York State Department of Health will be present to answer questions.

Registration is now open for this webinar. Click here to register

Educational objectives are:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role int eh public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

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

For more information prior to this webinar, be sure to go to https://cme.mssny.org and view Principles of Isolation and Quarantine: Epidemiology as a Decision Maker for more information on the public health response to infectious diseases.

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. (HOFFMAN)


Veterans Matters: The Special Mental Health Needs of Women Veterans Live Seminar in Saratoga
The Medical Society of the State of New York and the Saratoga County Medical Society are hosting a CME live seminar entitled Veterans Matters: The Special Mental Health Needs of Women Veterans on Wednesday, March 18, 2020 at 6:45 pm.

Where:
Nove Restaurant
707 Saratoga Road
Wilton, NY  12831

When:                  Sign-in/Reception at 6:00pm – Program begins at 6:45pm
Faculty:                Malene Ingram, MD & Colonel, U.S. Army Reserves

Educational Objectives:

  • Review how the increased role of women in the military has impacted their mental health
  • Describe mental health concerns unique to women veterans and how to identify them
  • Identify the barriers that women veterans face in getting the specific care they need

Reservations can be made by contacting Gregory Pinto, MD at gregory685@aol.com or (518) 587-0772. Dinner charge for non-MSSNY member is $35.00 and no charge for MSSNY members and their spouses.

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.      (SHERPA)     


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pschuh@mssny.org mauster@mssny.org pclancy@mssny.org zcary@mssny.org rali@mssny.org

 

eNews

Gov. Andrew Cuomo is banning all gatherings of 500 people or more as of 5 p.m yesterday.  All businesses or facilities with capacities up to 500 — including restaurants and bars — must also reduce their occupancy by 50 percent. The state is also allowing schools that close to provide up to two meals per day to low-income students. The Trump administration also announced this morning that the FDA will allow New York state to authorize public and private labs to begin testing.

Today, Gov. Andrew Cuomo said New York state could be dealing with virus response for six months or more, during the opening of a New Rochelle drive-thru facility that will test for Covid-19. He said that could mean six, seven, eight or nine months that the state will be responding to the outbreak.

The governor said the facility, operated by Northwell Health, will have six lanes and will be able to process 200 people today with plans to increase its capacity to 500 in the next few days.

The state is working with BioReference Laboratories with the aim of processing 5,000 tests per day by next week. It has contracted with 28 public and private labs in New York as well as out-of-state labs to increase the number of samples it can process. Some are still waiting on federal approval to begin testing.

Testing will be done by appointment-only, with priority given to people in New Rochelle and to vulnerable populations, such as those with underlying illnesses, particularly respiratory diseases. Appointments can be made by calling 888-364-3065. The governor said the logjam in testing is not related to a lack of test kits but limited approvals for labs conducting testing. The state Health Commissioner said Thursday afternoon that about 2,300 people had been tested in the state.

There had been 328 people diagnosed with Covid-19 in New York as of Thursday afternoon, with 95 of those individuals living in New York City.

New Rochelle has been a focal point for the outbreak, with more than 100 people testing positive there.

Information Centers for Physicians

Current CDC Info for Professionals:

CMS News

CMS Emergency Info

CDC Travel Info


 


COVID-19 MAC Test Pricing
Today, CMS is posting a fact sheet to the CMS.gov website to aid Medicare providers with information relating to the pricing of both the CDC and non-CDC tests.  You can find the fact sheet here.


Clinical: Dr. Anthony Fauci on Talking with Patients About COVID-19
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, talks with Clinical Conversations about novel coronavirus disease (COVID-19). Listen in here.


EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2

http://www.mssnyenews.org/wp-content/uploads/2020/03/EPAs-list-products-for-use-against-COVID-19-031320.pdf


NYSDOH Issues Special Edition of Medicaid Update Re Corona Virus
The New York State Department of Health issued a special edition of the Medicaid Update on March 10 featuring New York State Medicaid Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID–19).  This Medicaid Update can be found here.


FDA Approves Generic Version of Asthma Inhaler
The FDA has approved a generic version of albuterol sulfate inhalation aerosol, the asthma inhaler marketed as ProAir HFA. The drug is indicated to treat reversible obstructive airway disease and prevent exercise-induced bronchospasm in both adults and children aged 4 years and older.

This is the first generic metered-dose inhaler to be approved in almost two decades and should be available in late 2020. FDA news release


Ways to Deal With Sleep Deprivation in Residents and Early-Career Clinicians
Endocrine News examined “ways to help” medical residents and early-career clinicians “cope with sleep deprivation so” they can give their “patients the best care possible, as well as take care of” their own personal health. The article interviewed Fariha Abbasi-Feinberg, MD, FAASM, FAAN, “board member of the American Academy of Sleep Medicine (AASM) and a practicing sleep medicine physician and medical director of Sleep Medicine with Millennium Physician Group, and board certified in sleep medicine and neurology, in Fort Meyers,” FL, and Timothy P. Brigham, MDiv, PhD, “the chief of staff and chief education and organizational development officer for the” Accreditation Council for Graduate Medical Education.


Q4 2019: 50% Increase in Ransomware Attacks Against Healthcare Providers
HealthIT Security (3/9) reports “ransomware attacks against healthcare providers increased a whopping 350 percent during the last quarter of 2019 with the rapid pace of attacks already continuing throughout 2020, according to a new report from Corvus.” The “findings mirror similar reports, which also noted that these numbers are likely lower than the actual number of attacks – as some ransomware victims do not report the incidents to the public.” The research found “one of the most common exposure types is through the remote desktop protocol, which is associated with a 37 percent greater likelihood of a successful ransomware attack.


HHS: In 2022, Patients Can Download Electronic Health Records
On March 9, Federal officials released groundbreaking rules that will let patients download their electronic health records and other health care data onto their smartphones. “Patients should have control of their records, period. Now that’s becoming a reality,” said Health and Human Services Secretary Alex Azar. “These rules are the start of a new chapter in how patients experience American health care.”

Many of the provisions are set to take effect in 2022.

“The days of patients being kept in the dark are over,” said Centers for Medicare & Medicaid Services Administrator Seema Verma. “In today’s digital age, our health system’s data-sharing capacity shouldn’t be mired in the Stone Age.” Yet the new rules also have raised concerns about privacy as technology companies, such as Google, Microsoft, Apple and Amazon, open up new markets for providing medical records through mobile apps. Major EHR vendor Epic, for instance, has warned that freer flow of medical records could spur the unwanted sale of data or other unauthorized uses.

Verma said the nation’s health care system remains “hugely expensive and inefficient as repeat tests drive up costs and, perhaps most importantly, doctors are forced to provide care with an incomplete clinical picture, especially at a time when the health care systems could be under stress…With the handling of the COVID virus, the urgent need for coordinated integrated care could not be clearer,” she said. (March 10, KHN)


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

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

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

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

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

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


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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

MSSNYeNews: Lobby Day in the Time of Coronavirus – March 6, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 6, 2020

Vol. 23  Number 10


MSSNYPAC Seal

 


Colleagues:

As I arrived in Albany, the city was abuzz with Coronavirus talk. Representatives of HANYS were preparing to leave. They had just canceled their lobby activity, needing to get back to their respective hospitals. At an event that night, I greeted State Senate Health Committee Chair Sen. Gustavo Rivera with a forearm bump and soon he had the whole room fist bumping, forearm bumping and air high fiving as he pointed me out and laughed. The message, however, was clear. MSSNY was in the house.

The following day 200 physicians – attendings, staff and yes, medical students filed into the auditorium in “The Egg” for the morning program, packed with COVID19 updates and a review of our legislative agenda. I cannot thank NY Society of Addiction Medicine, NY Osteopathic Medical Society, NY Society of Plastic Surgeons and ACOG enough for their participation. Appearances by Senate Minority Leader John Flanagan and DFS’ outgoing chief Troy “Surprise Bills” Oeschner (who received an award) and panel discussion followed, featuring Assembly Insurance Chair Kevin Cahill, Senate Insurance Chair Neil Breslin, and Assembly Health Committee Chair Richard “The Dean” Gottfried who all answered questions about our legislative concerns. Finally, outgoing Sen. James Seward received our commendation for years of service.

During the lunch that followed, we all agreed this was the most cordial session we had ever witnessed. Whether it was Coronavirus or a moment of clarity, our doctors went off for appointments with legislators on a real high note to deliver our message that our Medical Society stands ready to work with our state government to insure the health of all New Yorkers.

By the way, keep your fingers crossed— the news was encouraging on the OPMC issue.

As I write this, I’m struck by the dedication of NY physicians who heard the call, left their practices, and traveled to Albany to deliver our message. You all have my thanks and gratitude.

Oh, and the title above? Well, I riffed on Gabriel Garcia Marquez’ Love in the Time of Cholera.

I’m out.

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

Arthur Fougner, MD
MSSNY President


Coronavirus Update with Anthony Fauci, MD – March 2020


There is an order of priority for testing, defined below (1 through 5):

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This Week’s Legislative Podcast


Physician Advocacy Day – A Great Success!
Thank you to the hundreds of physicians, medical students and other physician advocates who took the time to come to Albany this week to participate in MSSNY’s Physician Advocacy Day at the State Capitol.    We would also like to give a special thanks to Assemblymember Kevin Cahill, Assemblymember Richard Gottfried, Senator Neil Breslin and Senate Minority Leader John Flanagan for educating the physicians in attendance about the health Budgetary issues that are being faced in Albany, and for responding to the many questions posed by physicians regarding various legislative proposals.

Physicians from across the State met with many of the members of the Assembly and Senate that represent the regions where they practice, and MSSNY physician leaders met with (or the top staff to) Senate Majority Leader Andrea Stewart-Cousins, Assembly Speaker Carl Heastie, Senate Deputy Majority Leader Michael Gianaris and Assembly Minority Leader Will Barclay as well as key health staff to the Governor.

They emphasized the physician community’s strong concerns with proposed Medicaid cuts, proposed elimination of the Excess Medical Liability Insurance Program, and seriously problematic changes to the physician disciplinary process, while also urging support for items such as regulating PBMs and a flavored tobacco/vaping ban.  Direct physician advocacy is an essential component of legislative success and helped in great part by your contributions on days like this.  We look forward to continuing to work with you on the many legislative issues that impact physicians and healthcare in general. (DIVISION OF GOVERNMENTAL AFFAIRS)


COVID-19 Cases Continue to Rise in NYS
New York State has 22 confirmed cases of COVID-19 with 122 cases under investigation as of March 6th.  Coronavirus is now a reportable disease and physicians are required to report suspected cases to their local department of health. There are 2,733 under quarantine in New York City.  Physicians are urged to stay informed by going to the New York State Department of Health website for healthcare providers here or the New York State Department of Health NYC physicians here.

NYS also has a coronavirus hotline at 1-888-364-3065.  The latest guidance from the NYS Department of Health can be found here.

MSSNY also has the latest updates from the state on its website at www.mssny.org   Please see information located in the blue boxes labeled COVID-19.

MSSNY will also conduct a webinar on COVID-19 at March 18, 2020 at 7:30 a.m.   Registration is now available here.    (CLANCY)



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Governor, DFS Announce Steps to Ensure Coverage for COVID-19 Testing and Treatment
As one of the many steps being taken to respond to the coronavirus outbreak, Governor Andrew Cuomo announced this week a new directive by the NYS Department of Financial Services requiring New York health insurers to waive cost sharing associated with testing for coronavirus including emergency room, urgent care and office visits, and ensuring health insurers cover care related to the testing and treatment for coronavirus.

In addition to prohibiting the imposition of patient cost-sharing, the guidance issued by DFS to health insurers regarding actions they should take in relation to the potential impact of COVID-19 on New York includes:

  • Directing insurers to develop robust telehealth programs with their participating providers where appropriate, particularly for individuals who may have difficulty making an office visit and where a phone call with a medical professional can alleviate the need for a hospital visit.
  • Directing insurers to verify that their provider networks are adequately prepared to handle a potential increase in the need for health care services, including offering access to out-of-network services where appropriate and required, in the event more COVID-19 cases are diagnosed in New York. In addition, DFS is reminding insurers that lifetime or annual limits cannot be placed on in-patient care.
  • In the event an immunization becomes available for COVID-19, DFS is reminding insurers that they must cover the cost of vaccination for children under 19. For adults, DFS’s guidance states that all insurers should be prepared to cover the immunization immediately at no cost-sharing.
  • Directing insurers to provide insurance coverage for off-formulary prescription drugs if there is not a formulary drug available to treat the insured, through a formulary exceptions process.
  • Reminding insurers that coverage for emergency services in hospital facilities is required at the in-network cost-sharing even if the hospital is out-of-network or overseas, and that no insurer may require a patient to seek preauthorization prior to seeking emergency care, including for ambulance service.

Directing insurers that they are required to hold harmless insureds who receive surprise medical bills for health care services, including those related to testing and treatment of COVID-19.                                                                   (AUSTER)


“Coronaviruses 2020” CME Webinar on March 18th Registration Now Open
With the number of Covid-19 cases and quarantines growing significantly this week, please sign up for MSSNY’s Medical Matters: Coronaviruses 2020 scheduled for March 18th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar: please click here   

Educational objectives are:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role in the public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

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

For more information prior to this webinar, be sure to go to https://cme.mssny.org and view Principles of Isolation and Quarantine: Epidemiology as a Decision Maker for more information on the public health response to infectious diseases.

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.      (HOFFMAN)


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Please Continue to Urge Your Legislators to Protect Physician Due Process
With Part L of Governor’s proposed Health/Mental Hygiene Budget bill containing extremely troubling measures to bypass important due process protections for physicians when a complaint has been filed against them with the OPMC, all physicians are urged to continue to contact their legislators contact here to urge that the Legislature reject this unfair proposal.

The proposal would, among many other provisions, make it far easier for the Commissioner of Health to disclose to the public that a physician is under disciplinary investigation.  It would also permit the OPMC to summarily suspend a physician without the typical due process requirements with only a minimal finding of “risk to the public”, as opposed to the much stronger “imminent danger” standard now required for bypassing these essential due process protections.  It would also give the OPMC much greater powers to seize physician records and record systems, even that which is necessary for physicians to deliver care to their patients.

That is particularly troubling given that only a small percentage of complaints to OPMC result in a disciplinary sanction.  MSSNY has indicated that we agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career. 

MSSNY has joined with 18 state specialty societies and the NYS Society of Physician Assistants in a communication to the Legislature setting forth our concerns in greater detail. Memo   Moreover, thousands of physicians from across the State have contacted their local legislators to express their severe concerns with this grossly unfair proposal.  Have you?

Please urge your legislators to reject this proposal from the Budget. (AUSTER)


Legislators Urged to Preserve Excess Liability Program
Physicians are urged to contact their legislators to request that the Excess Medical Malpractice Insurance Program be extended.  Unfortunately, the Excess program has become a “political pawn” in discussions regarding ways to address the State’s huge budget deficit.   A letter to your legislators can be sent here.

This program, which provides nearly 17,000 physicians across the State with an additional $1 million/$3 million of liability coverage above the primary $1.3M/$3.9M layer, is being proposed to be eliminated after June 30.  This is despite the fact that this coverage is needed more than ever due to New York’s excessive and growing liability costs that far exceed all other states.  Without this protection, many physicians will be unable to continue to practice. Indeed, those who would be dropped would be personally exposed to financial ruin in the event that a judgment or award exceeded the limits of the primary layer.  If anything, the program actually needs to be expanded, not diminished.

Let your legislator know that, in the absence of comprehensive medical liability reform, physicians need this secondary layer of liability insurance to protect against New York’s excessive verdicts and settlements.  please click here (AUSTER)


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Physicians Meet With Legislators to Discuss Flavored Vaping Ban
Physicians, parents and members of other health care organizations were in Albany on Tuesday to discuss with legislators the need to prohibit flavored nicotine products for use in e-cigarette or vaping products.  Participating from the Medical Society were Gregory Threatte, MD, president of the Albany County Medical Society and Roy Korn, MD, president of the Schoharie County Medical Society and members of MSSNY governmental affairs staff.  Along with meeting with members and staff of the NYS Legislature, the physicians also joined with Lt. Governor Kathy Hochul and Health Commissioner Howard Zucker, MD at an early morning strategy session on vaping and at a press conference with Lt. Governor Hochul in the afternoon.

MSSNY supports the proposal put forth by Governor Andrew Cuomo to prohibit the sale of flavored nicotine devices within the context of his 20-21 New York State Budget.  MSSNY also supports legislative efforts in the New York State Legislature.  Statistics show that youth vaping using flavored e-cigarettes has increase in NYS from seven percent to 27% percent over the last five years and 40% of all NYS high school seniors “vape” every day.

Please assist us in the efforts by sending a letter to legislators here.
(CLANCY, AUSTER, CARY, ALI)


MSSNY Testifies at NYC MRT2 Forum
MSSNY President Dr. Art Fougner delivered comments to the New York City meeting of the Medicaid Redesign Committee this week.  You can see his comments here: please click here (at the 11 minute mark).  The MRT2 is charged with arriving at recommendations to achieve $2.5 billion in State Budget savings for the State Budget due April 1.

Similar to MSSNY Vice President Dr. Joseph Sellers’ comments at the Albany MRT forum and Monroe County Medical Society Executive Director Chris Bell’s comments at the Rochester MRT forum, his recommendations included: expansion of Medicaid coverage for in-home physician care visits and telemedicine to help reduce rising transportation costs, expansion of the Patient-Centered Medical Home program (which according to DOH has demonstrated itself to reduce patient medical costs), and long overdue liability medical liability reform (since the State must subsidize the excessive liability costs in New York that are much less in other states).        (AUSTER)


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Care Delivery Mandate Bills Begin to Pile Up in Albany
MSSNY continues to raise serious concerns with the numerous bills advancing in Albany that, while well-intended, would place substantial new mandates on patient care delivery at a time when physicians are already drowning in administrative tasks diverting time away from treating patients.  A recent Annals of Internal Medicine study concluded that physicians already spend 2 hours on administrative tasks for every hour they spend actually delivering patient care.  These bills unfairly place the physician at risk of financial penalty by DOH or even license sanction by the OPMC if the physician fails to document even one time that they performed the mandated task.  These proposals include:

  • Mandated conspicuous posting in a physician’s office of a patient’s ability to file a complaint with the Office of Professional Conduct (A.7991-A/S.6678-A). Assembly Floor/Senate Floor
  • Mandated notification to epileptic patients of the risk of sudden death due to epilepsy (S.5397-A/A.7807-A). On Assembly Floor/On Senate Floor
  • Mandated co-prescribing of naloxone for patients: a) taking 50 mmg per day b) with a history of substance use disorder or c) concurrent use of opioids and benzodiazepine or nonbenzodiazepine sedative hypnotics (S.5150-B/A.5603-B). Passed Senate.  In Assembly Ways & Means
  • Mandated reporting of rescue inhaler prescriptions to the statewide immunization system (S.7337). On Senate floor
  • Mandated dissemination of a pamphlet prior to performance of a pelvic exam (S.7544/A.9600). On Senate floor/In Assembly Health
  • Mandated procedure for a maternal health care provider to provide written notification to patients regarding the risks of a C-section (A.318-A/S.2888-A). Passed Assembly/In Senate Women’s Issue Committee
  • Mandated proof of completion of CME on cultural competency, including paying for an additional fee to SED on top of the biennial $600 registration fee (S.2406-A). Passed Senate/In Assembly Higher Education Committee
  • Mandated seeking of a detailed patient/family member consent for a nursing home resident prior to the receipt of a psychotropic medication, or detailed documentation of the need to provide such medication without consent (A.1033/S.5441). Passed Assembly/In Senate Health Committee
  • Mandated completion of additional questions for the NYS Physician Profile including office hours, whether accepting new patients and an unknown number of practice demographic questions. Contained in Part K of the Governor’s proposed Health/Mental Hygiene Budget bill.

            (DIVISION OF GOVERNMENTAL AFFAIRS)


One-Sided Surprise Bill Proposals Advance in Congress
Contact Your Representatives Today
All physicians are urged to continue to contact New York’s Senators Schumer and Gillibrand, as well as their respective Representative to express strong concerns with the various proposals before Congress that would substantially limit insurer responsibility for coverage of out of network emergency and surprise medical bills.  A letter can be sent here: please click here

While MSSNY supports the goals of legislation to prevent surprise medical bills, most proposals advanced so far are steered heavily to the benefit of insurance companies, and do not have the balance of New York’s law.  Recently the House Ways & Means Committee and Education & Labor Committee advanced separate proposals.  While the Ed & Labor proposal was very similar to Energy & Commerce proposal advanced last year strongly opposed by MSSNY and many other physician organizations, the W&M proposal did make some modest improvements including rejecting a benchmark payment and permitting the consideration of many factors.

However, the IDR mechanism identified in the legislation would also prohibit the consideration of physician charge data and require the consideration of median in-network data, which in all certainty will skew the results towards the insurance companies.  In fact, when the proposal was scored by the Congressional Budget Office (CBO), it was noted that “in facilities where surprise bills are likely, average payment rates for both in- and out-of-network care would move toward the median in-network rate.  Moreover, the proposal only provides for a minimal review of insurer networks, which is the major contributing factor to the problem of surprise bills.

Please take the opportunity to contact your federal legislators today, urging a fair solution to this issue similar to New York’s law. Please click here            (AUSTER, CARY)


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Registration Now Open for CME Series on Pain Management, Palliative Care & Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2020
The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

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

These webinars are being offered FREE OF CHARGE to MSSNY members. A discount code was emailed to members on February 24, 2020.  Please contact Melissa Hoffman at mhoffman@mssny.org if you did not receive this discount code.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services (OASAS) in the development of this program.  Following the webinars, the course will be offered on-line on the MSSNY CME site.  The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.
Webinars will be held on:

Tuesday March 10, 2020—7:30-8:30am
Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances
Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Robert Kent, Esq., NYS OASAS General Counsel
Educational Objectives:

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

Register for this webinar here.

Tuesday March 17, 2020—7:30-8:30am
When to Consider Opioid Therapy for Chronic Non-Cancer Pain & in
Palliative Care
Faculty: Charles Argoff, MD
Educational Objectives:

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

Register for this webinar here

Tuesday March 24, 2020—7:30-8:30am
Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain
Faculty: Jeffrey Selzer, MD, Marc Manseau, MD, MPH, NYS OASAS Medical Director
Educational Objectives:

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

Register for this webinar here.

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

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

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


Veterans Mental Health Training Initiative – Save the Date!
The Medical Society of the State of New York, along with the New York Psychiatric Association and the National Association of Social Workers-NYS will hold a two-day Veterans Healthcare Training Initiative with interactive seminars and panel discussions on the health and mental health care needs of veterans. Continuing Medical Education (CME) credits will be offered for various programs.

The event will be held on Friday, May 1st and Saturday, May 2nd at the HNA Palisades Premier Conference Center, 334 Route 9W, Palisades, NY 10964.

Registration details coming soon!    (SHERPA)


Veterans Matters: The Special Mental Health Needs of Women Veterans Live Seminar in Saratoga
The Medical Society of the State of New York and the Saratoga County Medical Society are hosting a CME live seminar entitled Veterans Matters: The Special Mental Health Needs of Women Veterans on Wednesday, March 18, 2020 at 6:45 pm.

Where:
Nove Restaurant
707 Saratoga Road
Wilton, NY  12831

When:     Sign-in/Reception at 6:00pm – Program begins at 6:45pm
Faculty:   Malene Ingram, MD & Colonel, U.S. Army Reserves

Educational Objectives:

  • Review how the increased role of women in the military has impacted their mental health
  • Describe mental health concerns unique to women veterans and how to identify them
  • Identify the barriers that women veterans face in getting the specific care they need

Reservations can be made by contacting Gregory Pinto, MD at gregory685@aol.com or (518) 587-0772. Dinner charge for non-MSSNY member is $35.00 and no charge for MSSNY members and their spouses.

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          (SHERPA) 

pschuh@mssny.org mauster@mssny.org pclancy@mssny.org zcary@mssny.org rali@mssny.org

MSSNY ADVOCACY DAY WAS A GREAT SUCCESS WITH OVER 200 PHYSICIANS COMING TO ALBANY ON WEDNESDAY, MARCH 4

MSSNY President Art Fougner, President Elect Bonnie Litvack and Vice
President Joseph Sellers discuss New York’s malpractice problems and
New York’s highest per capita payment.

Dr. Daniel Choi (Suffolk), MSSNY EVP Phil Schuh, Dr. Thomas Lee (Westchester)
and Suffolk County Executive Director Dr. Aaron Kumar.

 

DFS Deputy Superintendent Troy Oeschner was honored for his many years
of assisting MSSNY in resolving several physician payment issues was presented
a plaque by Dr. Andrew Kleinman, who spearheaded the solutions to these
major issues for over a decade.

MSSNY Vice President Joseph Sellers awarded a commemorative
plaque to retiring State Senator James Seward. Dr. Sellers recalled
that he was impressed by Sen. Seward when he visited
one of Dr. Seller’s patients who was hospitalized.

Students representing their medical schools made the trip to
Albany to discuss their issues with their local representatives.

eNews

NY Coronavirus Statistics:

  • NEW YORK #Covid19 numbers
    4,000 people under cautionary quarantine
  • 44 people under mandatory quarantine
  • number of people who’ve tested positive is now 33, with all 11 new cases linked to the New Rochelle lawyer who works in Manhattan.
  • Total infected people hospitalized: 5


Information Sources:

NYS DOH
CDC
Johns Hopkins Global Interactive Map


CMS Issues Guidance on Coronavirus Coverage
WASHINGTON — CMS released information detailing how government health programs and certain plans will cover coronavirus-related services.

The agency also developed an additional code that labs can use to bill for coronavirus diagnostic tests not made by CDC, which CMS says will help boost testing and tracking of new cases. Medicare will cover diagnostic tests on or after Feb. 4 for the coronavirus test, and the health program for the elderly also covers medically necessary hospitalizations, virtual “check-ins” and more.

Children can receive all medically necessary testing and diagnostic services and recommended vaccines are covered without cost-sharing, CMS said.

In the new guidance, CMS reiterates that Obamacare plans will generally have to cover lab tests — with the caveat that states don’t all require the same standard of benefits and some people may see cost-sharing if the insurers haven’t waived co-pays for the tests.

Some insurers have already said they would waive cost-sharing or the tests. However, CMS notes that large employer plans don’t have to follow Obamacare’s rules — so patients with those plans may not be covered or may be on the hook for a co-pay.

The agency hasn’t decided whether a vaccine would be free under Obamacare’s rules for covering preventive treatment but said officials would offer new guidance when a vaccine hits the market.

Hospital costs associated with coronavirus treatment will also vary by state and by plan, CMS said, even though emergency care and hospitalization fall under the ACA’s essential health benefits.

On telehealth, Medicare pays for “virtual check-ins” for patients consulting practitioners they already know, given certain restrictions on time and content, CMS said. It also pays for communication through patient portals.

Medicare patients treated at rural health facilities may be covered for full virtual visits. Medicaid and CHIP telehealth coverage is determined by states.


How to talk to K-12 Children about Coronavirus
School psychologists are worried about coronavirus anxiety among kids in K-12 schools.

The National Association of School Psychologists is offering guidance to school mental health professionals, administrators, school crisis response teams and parents on how to help staff and students cope with the virus, called COVID-19.

Brock, a past president of NASP who wrote some of the guidance, said educators and psychologists can expect questions, and how they respond should depend on the developmental level of the students. In an interview with POLITICO, he offered some advice on how to talk with students about coronavirus.

This transcript has been edited for length and clarity.

What type of impact are you seeing on kids?

What is being reported to us is consistent with kids asking questions and being somewhat anxious, nervous, worried about the extent to which this could affect them. It’s too soon to be really specific regarding the extent to which this is impacting students. Young children are going to be more likely impacted and affected by adult reactions. Older students, conversely, are going to be in a position to more accurately gauge independently the threat presented by COVID-19.

How should school administrators, teachers and psychologists talk to students about this virus? Should they talk about it at all?

It’s going to vary depending upon developmental level. I would suggest that especially for the younger kids, we want their questions to be our guide. So beyond making sure my younger kids are engaging in behaviors that are going to keep them healthy and safe, I’m not going to give them a lot of unasked-for information about things like mortality statistics. … The other thing that I’ll be careful about with younger kids is screening media. There is an appropriate degree of attention to this being given by the media, but younger children may not be able to accurately interpret that. 

What about for middle and high school students?

For older kids, actually, I like to make available well-crafted media reports to help them understand the objective threat that’s being presented to them. 

What if students start asking more detailed questions?

The answer that I’m going to give for ‘What is COVID-19?’ is going to be different for a second-grader than it is going to be for a high school science class. In high school science class, we’re probably going to talk about viruses. Maybe a good teacher might even use this as a teachable moment, work it into the curriculum. For the younger child, it’s more like, ‘Yeah, there’s this flu that’s going around, and it’s a new flu, so we’re kind of worried about it. Do you have any questions about the new flu? 

Are there any concerns about this virus creating stigmas in a school setting?

We have seen that kind of thing in the past where people try to find someone or something to blame. Sometimes that is associated with behaviors that could be labeled bullying. And we do our best to try to mitigate that because it’s just not helpful. For the kid that’s bullied, now they’re stressed about being sick and they’re being bullied on top of it. For the bully, it’s just not an adaptive behavior. 

Brock provided some questions he expects from young children and how he would respond:

Question: Will I get sick?

Answer: We don’t know. I can’t promise you that you will not get sick, but there are some very important things you can do to help keep yourself and others healthy [and then list guidance offered by the CDC.

Question: What will happen if I get sick?

Answer: When people get this virus, they will have a temperature, a cough, and it might be difficult for them to catch their breath. Very few children are getting sick, but when they do, parents, doctors and other adults are able to help them feel better [CDC].

Statement: I am scared of coronavirus!

Response: During cold and flu season people do get sick, and sometimes so sick they need to see a doctor. It is a very good idea to do what we can to stay healthy. In our community … [and then offer any specific guidance from local health officials regarding whether or not a given community is at risk]. Here are things you can to do to keep from getting sick [and then list guidance offered by the CDC].

Question: Why is everyone talking so much about coronavirus?

Answer: Because it is new and for some people who are very old and not in good health it might cause them to see a doctor and go to the hospital.

Question: Will I die?

Answer: So far very few children are getting sick, and no young children have died. [If you are talking to a child 9 years of age or younger you could say: “So far no child your age has died.” (References have been made to World Meter and JAMA)


Low Back, Neck Pain Costs Are the Most Expensive Health Conditions

The total U.S. health bill for 2016 — excluding over-the-counter drugs, home health care, and spending on research and infrastructure — came to some $3.1 trillion, researchers estimate in JAMA. That represents over a doubling in spending since 1996.Payment came from private health insurers (48%), government health insurance (43%), and out-of-pocket payments (9%). Low back and neck pain constituted the top two spending spots. These two, combined with other musculoskeletal disorders, consumed over a quarter of a trillion dollars in 2016.

A commentator notes encouraging declines in spending for ischemic heart disease, heart failure, colorectal cancer, and lower-respiratory-tract infections, which “likely reflect population-wide improvements in primary and secondary prevention.”

What weren’t encouraging were findings for rheumatoid arthritis and multiple sclerosis, where expensive specialty drugs are commonly used. For such drugs, he advocates negotiations with drug makers based on “rigorous cost-effectiveness analysis.”

Regular Use of Fish Oil Linked to Lower Risk for Premature Death
Research links “regular use of fish oil supplements to a lower risk of premature death and cardiovascular disease (CVD).” Investigators “kept track of participants over a nine-year period on average, and found that fish oil supplements were associated with a 13% lower risk of death, a 16% lower risk of dying from cardiovascular disease, and a 7% lower risk of cardiovascular disease events such as stroke or heart attack.” The findings were published in the BMJ.


Smartphone Users More Likely to Use Pain-Relieving Medication for Headaches
Researchers investigating the association between smartphone use and new headaches “found that smartphone users were more likely to use more pain medication but find less relief compared to those who didn’t use smartphones,” according to a new study published in Neurology Clinical Practice. Specifically, “96% of smartphone users were more likely to take pain-relieving drugs compared to 81% of non-smartphone users.” Moreover, “smartphone users also reported less relief from headaches after taking medication, with 84% finding moderate or complete relief from headache pain compared to 94% of non-users.”

 


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

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

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

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

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

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


Dr. Michael Goldstein Running for Congress in Connecticut
New York County Medical Society Trustee and Past President Michael T. Goldstein, MD, JD, is running for office.   He is running in the Connecticut  Fourth Congressional District  —  information about his platform, which  has a strong health care component, naturally  —   is available at Goldstein for Congress.


Dr. Fougner and Dr. Choi

MSSNY President Dr. Art Fougner and Young Physicians
Chair Dr. Daniel Choi at the NY Academy of Medicine
last Saturday, March 1.

Medical Students

YPS Meeting in Manhattan. From left. Dr. Purvi Parikh
who was a panelist for Milennials in Private Practice;
Is It Even Possible?”: Dr. Erik Eiting; Dr. Carlos Zapata;
and Moderator Dr. Daniel Choi.

 


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TITLE Community Health Program Manager 3 – 32201
SALARY/GRADE $109,956 – $138,763 / M-4
NEGOTIATING UNIT Management Confidential (06)
LOCATION
Division of Family Health
Corning Tower, Empire State Plaza
Albany, NY 12237
MINIMUM QUALIFICATIONS
TRANSFER: Current NYS employee with one year or more of contingent-permanent or permanent competitive service in a title at or above Grade 29/M-3 and eligible for transfer under Section 52.6 of the Civil Service Law.
PROVISIONAL*: a bachelor’s degree AND seven years professional public health experience in a governmental public health agency or public health program* that receives funding from a public health governmental agency. Of the seven years required experience, three years must include supervision of professional staff and the following management responsibilities: program planning and implementation, AND program evaluation and monitoring, AND development and implementation of policies and procedures.
The required professional experience must include either:

1. Designing or implementing a public health outreach, promotion, or disease prevention program; OR
2. Conducting disease surveillance or a disease control program.

For the purposes of this recruitment, a public health program focuses primarily on the prevention of disease through outreach and public health education or health promotion, including population-based plans of care, not just plans of care for individual patients, or the study of the prevalence or causes of disease through population-based studies.
Examples of non-qualifying experience include, but are not limited to: providing clinical care in therapeutic health care facilities including public hospitals, physician’s offices, supervised community-based settings or home care settings; discharge planning or utilization review; developing treatment plans for patients in community settings; regulatory oversight of health care providers to determine compliance with laws, rules or regulations; reviewing appropriateness of services for insurance companies, Medicare, Medicaid, governmental agencies or other third-party payors; or other experience limited to administrative support of public health programs such as operations management, personnel, staff development, fiscal administration, contract/grant management, budgeting or health care finance is not considered qualifying, nor is the provision of medical services to a fixed population.

Read More Here


 

CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

MSSNYeNews: A Colleague in Need Is a Colleague Indeed – February 28, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
February 28, 2020

Vol. 23  Number 9


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Colleagues:

You can’t live a perfect day without doing something for someone who can never repay you.”
–John Wooden

I had just finished dinner when I got the call. A physician, whom many of you reading this may know, was calling, mainly out of desperation, seeking a sympathetic ear. Embroiled in a horrific family court battle over an adopted special needs child and the family may be at the end of the line. Quite frankly, this was a cry for help. I listened, made a few suggestions and agreed to cross our fingers, make a plan and hope for the best. This struggle has not been without cost, not only emotional but financial as well.

The word colleague is derived from two Latin words – college (one chosen along with another) and legare (to send or choose as a deputy.) But these are often merely words describing associates. For physicians, a colleague is more than that – we are all members of a fellowship. We took an oath. Part of that oath conveys a duty to each other. If one of us is in trouble, we all are in trouble. We should be the embodiment of Dumas’ “All for one and one for all.” If you are so inclined, there’s a Go Fund Me page.

Oh yes, one more thing – See You In Albany!

We will all go down together.

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

Arthur Fougner, MD
MSSNY President



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Capital Update

This Week’s Legislative Podcast


Please Plan to Be in Albany for MSSNY‘s Annual “Physician Advocacy Day” Wednesday March 4th
Are you planning to join us this Wednesday in Albany? With the Governor’s Budget Proposal teeing up items for serious concern such as Medicaid cuts, legalized marijuana and changes to the physician disciplinary process, but also supported reforms such as regulating PBMs and a flavored tobacco ban, it is imperative that physicians participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click here to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.  Please work with your County Medical Societies to schedule appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Raza Ali at rali@mssny.org.       (ALI)


Governor Cuomo Announces Emergency Appropriation to Combat Coronavirus
Gov. Andrew Cuomo announced this week $40 million emergency appropriation to assist state and local governments to hire staff and procure equipment necessary to combat the coronavirus.   Additionally, the governor will seek legislation that would grant authority to NYS Health Commissioner Howard Zucker, MD, to ensure that health department and hospitals to take certain actions in response to the outbreak.

DOH will also convene local health departments and hospitals to ensure that appropriate protocols are in place for responding to the virus.  Gov. Cuomo has also called upon the federal government to authorize the Wadsworth Lab and NYC Public Health Lab to test for the virus, which would allow expanded capacity within the northeast.  Gov. Cuomo indicated that the state has worked to develop and validate a test that complies with protocol.

New York State has had 26 patients that have tested negative for the virus as of Feb. 26th.   Coronavirus is now a reportable disease and physicians are required to report suspect cases to their local department of health.  NYS also has a coronavirus hotline at 1-888-364-3065.  Physicians can find further information by going to the New York State Department of Health website for healthcare providers here.

NYC physicians should click here.

DOH has also issued a Feb. 11th letter to physicians about patients who presented with respiratory symptoms.

Evaluating and Reporting Persons Under Investigation (PUI) – Click here.

(CLANCY)


 

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Please Urge Your Legislators to Reject Unfair Disregarding of Physician Due Process
With Part L of Governor’s proposed Health/Mental Hygiene Budget bill containing extremely troubling measures to bypass important due process protections for physicians during disciplinary proceedings, all physicians are urged to continue to contact their legislators to urge that the Legislature reject this unfair proposal, and plan to be in Albany this Wednesday, March 4 for Physician Advocacy Day.

The proposal would, among many other provisions, make it far easier for the Commissioner of Health to disclose to the public that a physician is under disciplinary investigation or summarily suspend a physician with only a minimal finding of risk to the public, as opposed to the much stronger “imminent danger” standard now required for bypassing existing due process protections.

That is particularly troubling given that only a small percentage of complaints to OPMC result in a disciplinary sanction.  MSSNY has indicated that we agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career.   

MSSNY has joined with 18 state specialty societies and the NYS Society of Physician Assistants in a communication to the Legislature setting forth our concerns in greater detail.  Moreover, thousands of physicians from across the State have contacted their local legislators to express their severe concerns with this grossly unfair proposal.  Have you?

Please urge your legislators to reject this proposal from the Budget.   (AUSTER)


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MSSNY and Public Health Organizations Advocate for Ban on Flavored Vaping and Tobacco Products
This week, MSSNY joined with over 50 other public health organizations in urging the New York State Legislature enact legislation that would ban flavored vaping and tobacco products. S.428B/A.47A sponsored by Senator Brad Hoylman and Assemblywoman Linda Rosenthal, would ban flavored vaping products, including menthol.  The bill is currently on the floor in the state senate and in the Assembly Codes Committee.

A. 8808/S. 6808, sponsored by Assemblywoman Rodneyse Bichottee and Senator Hoylman, would ban flavored tobacco products such as cigarillos and chewing tobacco.  Gov. Andrew Cuomo has also proposed in his New York State budget that the Legislature implement a ban on flavored vaping products.  MSSNY is working with groups such as NYS Association of County Health Officials, the American Heart Association, the American Cancer Society, the NYS PTA, Campaign for Tobacco Free Kids, the NYS Chapter of the AAP and Roswell Park to enact these provisions.
(DIVISION OF GOVERNMENTAL AFFAIRS)


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MSSNY to State Legislature – Elimination of Excess Liability Program Will Diminsh Patient Access to Specialized Care
Physicians are urged to contact their legislators to request that the Excess Medical Malpractice Insurance Program be extended.  This program, which provides nearly 17,000 physicians across the State with an additional $1 million/$3 million of liability coverage above the primary $1.3M/$3.9M layer, is being proposed to be eliminated after June 30.  This is despite the fact that this coverage is needed more than ever due to New York’s excessive and growing liability costs that far exceed all other states.  A letter to your legislators can be sent here.

Unfortunately, the Excess program has become a “political pawn” in discussions regarding ways to address the State’s huge budget deficit.    The liability exposure level of physicians makes it clear that this Excess protection is more essential than ever.   Without this protection, many physicians will face difficulties continuing to practice. Indeed, those who would be dropped would be personally exposed to financial ruin in the event that a judgment or award exceeded the limits of the primary layer.  If anything, the program actually needs to be expanded, not diminished.

Let your legislator know that, in the absence of comprehensive medical liability reform, physicians need this secondary layer of liability insurance to protect against New York’s excessive verdicts and settlements. (AUSTER)


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Physicians Urged to Contact Their Legislators to Oppose Massive Liability Premium Increasing Legislation
All physicians are urged to contact their Senators and Assemblymembers to urge that they oppose harmful legislation (S.4006/A.5612) that would enormously expand the damages awardable in a wrongful death legal action.  One recent actuarial study concluded that, if this legislation were to be enacted, it would require medical liability premiums increase to increase 47%!!  A letter to your local legislators can be sent from here.

This week the legislation was reported from the Senate Judiciary Committee to the Senate Finance Committee by an 8-1 vote.  However, the vote did receive some pushback as Senator Diane Savino (D-Staten Island) voted against the legislation and Senators Neil Breslin (D-Albany County), AndrewGournades (D-Brooklyn), Ken LaValle (R-Suffolk County), Tom O’Mara (R-Southern Tier) and Kevin Thomas (D-Nassau County) voted “without recommendation”.

Legislators need to understand the downstream impact of these measures.  At a time when New York physicians and hospitals already incur the highest liability costs in the country by far, legislation that requires any increase in premiums, let alone at the level this legislation would require, cannot be incurred without creating a serious adverse impact in patient access to needed care across New York State.  (AUSTER)


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MSSNY, County Medical Societies Testify to Provide Medicaid Cost-Savings Recommendations
As the newly configured Medicaid Redesign Team (MRT2) continues its work to arrive at recommendations to achieve $2.5 billion in savings for inclusion in the April 1 State Budget deadline, physician leaders and physician advocates promoted its’ recommendations at Rochester and Albany MRT2 public forums.

Their recommendations included: expansion of Medicaid coverage for in-home physician care visits and telemedicine to help reduce rising transportation costs, expansion of the Patient-Centered Medical Home program (which according to DOH has demonstrated itself to reduce patient medical costs), and long overdue liability medical liability reform (since the State must subsidize the excessive liability costs in New York that are much less in other states).

Here is the link to the Albany forum with testimony at the 1:12 mark by MSSNY Vice-President and Cobleskill pediatrician Dr. Joe Sellers.

Here is a the link to the Rochester forum at 2:00 mark by Monroe County Medical Society Executive Director Chris Bell.

MSSNY President and Queens OB-GYN Dr. Art Fougner is slated to speak at the Monday forum in New York City.   (AUSTER)


Physician Mandate Bills Begin to Pile Up in Albany
As if physicians needed one more reason to be in Albany on March 4, the State Legislature has been advancing numerous bills through its Committee process that, while well-intended, would place substantial new mandates on physician care delivery at a time when physicians are already drowning in administrative tasks that take time away from patient care delivery.  They also unfairly place the physician at risk of financial penalty by DOH or even license sanction by the OPMC if the physician fails to document even one time that they performed the mandated task. These proposals include:

  • Mandated conspicuous posting in a physician’s office of a patient’s ability to file a complaint with the Office of Professional Conduct (A.7991-A/S.6678-A). Assembly Floor/Senate Floor
  • Mandated notification to epileptic patients of the risk of sudden death due to epilepsy (S.5397-A/A.7807-A). On Assembly Floor/On Senate Floor
  • Mandated co-prescribing of naloxone for patients: a) taking 50 mmg per day b) with a history of substance use disorder or c) concurrent use of opioids and benzodiazepine or nonbenzodiazepine sedative hypnotics (S.5150-B/A.5603-B). Passed Senate.  In Assembly Ways & Means
  • Mandated reporting of rescue inhaler prescriptions to the statewide immunization system (S.7337). On Senate floor
  • Mandated dissemination of a pamphlet prior to performance of a pelvic exam (S.7544/A.9600). On Senate floor/In Assembly Health
  • Mandated procedure for a maternal health care provider to provide written notification to patients regarding the risks of a C-section (A.318-A/S.2888-A). Passed Assembly/In Senate Women’s Issue Committee
  • Mandated proof of completion of CME on cultural competency, including paying for an additional fee to SED on top of the biennial $600 registration fee (S.2406-A). Passed Senate/In Assembly Higher Education Committee
  • Mandated seeking of a detailed patient/family member consent for a nursing home resident prior to the receipt of a psychotropic medication, or detailed documentation of the need to provide such medication without consent (A.1033/S.5441). Passed Assembly/In Senate Health Committee
  • Mandated completion of additional questions for the NYS Physician Profile including office hours, whether accepting new patients and an unknown number of practice demographic questions. Contained in Part K of the Governor’s proposed Health/Mental Hygiene Budget bill. (DIVISION OF GOVERNMENTAL AFFAIRS)


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“Coronaviruses 2020” CME Webinar on March 18th Registration Now Open
The first suspected case of locally acquired COVID-19 in the United State was announced on February 27, 2020.  Learn more about this and other coronaviruses by signing up for Medical Matters: Coronaviruses 2020 on March 18th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar.   

Educational objectives are:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role in the public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

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

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

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


Registration Now Open for CME Series on Pain Management, Palliative Care & Addiction; NYS Requires Every Prescriber to Take 3 Hour Course by July 1, 2020
The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

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

These webinars are being offered FREE OF CHARGE to MSSNY members. A discount code was emailed to members on February 24, 2020.  Please contact Melissa Hoffman at mhoffman@mssny.org if you did not receive this discount code.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services (OASAS) in the development of this program.  Following the webinars, the course will be offered on-line on the MSSNY CME site.   The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on: Tuesday March 10, 2020—7:30-8:30am

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

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

Educational Objectives:

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

Register for this webinar.

Tuesday March 17, 2020—7:30-8:30am

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

Faculty: Charles Argoff, MD

Educational Objectives:

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

Register for this webinar.

Tuesday March 24, 2020—7:30-8:30am

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

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

Educational Objectives:

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

Register for this webinar.

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

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

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


Veterans Matters: The Special Mental Health Needs of Women Veterans Live Seminar in Saratoga
The Medical Society of the State of New York is hosting a CME live seminar entitled Veterans Matters: The Special Mental Health Needs of Women Veterans on Wednesday, March 18, 2020 at 6:45 pm at Nove Restaurant, 707 Saratoga Road, Wilton, NY 12831.

Malene Ingram, MD & Colonel, U.S. Army Reserves, will serve as faculty for this program. The educational objectives are:

  • Review how the increased role of women in the military has impacted their mental health
  • Describe mental health concerns unique to women veterans and how to identify them
  • Identify barriers that women veterans face in getting the specific care they need

Reservations can be made by contacting Gregory Pinto, MD at gregory685@aol.com or (518) 587-0772. Dinner charge for non-MSSNY member is $35.00 and no charge for MSSNY members and their spouses.

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.                      (HOFFMAN)


 

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Register now for CME Course at MSSNY House of Delegates April 23 & 24
MSSNY will be offering multiple CME courses on Thursday April 23rd and Friday April 24th at the 2020 House of Delegates in Tarrytown.

Click here to register for as many or few of these offerings as you can. 

Thursday April 23, 2020

1:00-2:00pm       Medical Matters: Triage in a Disaster Event

2:00-3:00pm       Veterans Matters: TBI in Returning Veterans

3:00-4:00pm       Steps to Physician Wellness and Resiliency

4:00-5:00pm       The Health of Sexual and Gender Minorities

Friday April 24, 2020

1:00-4:00pm       Pain Management, Palliative Care & Addiction

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


Veterans Mental Health Training Initiative – Save the Date!
The Medical Society of the State of New York, along with the New York Psychiatric Association and the National Association of Social Workers-NYS will hold a two-day Veterans Healthcare Training Initiative with interactive seminars and panel discussions on the health and mental health care needs of veterans. Continuing Medical Education (CME) credits will be offered for various programs.

The event will be held on Friday, May 1st and Saturday, May 2nd at the HNA Palisades Premier Conference Center, 334 Route 9W, Palisades, NY 10964.

Registration details coming soon!              (HOFFMAN)

eNews

Novel Coronavirus Information

NYS DOH

CDCEvaluating and Reporting Persons Under Investigation (PUI)

CDC – Public Health Response to the Coronavirus Disease 2019 Outbreak — United States, February 24, 2020

INFO BY NY COUNTY

JOHNS HOPKINS CENTER FOR SCIENCE AND ENGINEERING INTERACTIVE INTERNATIONAL MAP IN REAL TIME


New US Coronavirus Cases: Human Testing for Drug Begins
Fifty-seven COVID-19 cases have been reported in the U.S. as of 9 a.m., Feb. 26. This is an increase from 53 cases reported by the CDC Feb. 24. The source of exposure for the new cases is currently unknown.    

U.S. Residents Should Expect Community Spread of Novel Coronavirus

A top CDC official warned Feb. 25,  “It’s not so much a question of if this will happen anymore, but when and how many people in this country will have severe illness,” said Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases. https://www.cdc.gov/media/releases/2020/a0225-cdc-telebriefing-covid-19.html

The CDC on Tuesday warned that it expects the novel coronavirus that has sparked outbreaks around the world to begin spreading at a community level in the United States, as a top official said that disruptions to daily life could be “severe.”

“As we’ve seen from recent countries with community spread, when it has hit those countries, it has moved quite rapidly. We want to make sure the American public is prepared…As more and more countries experience community spread, successful containment at our borders becomes harder and harder,” she said.

There have been 14 cases of the virus diagnosed in the U.S., all in people who traveled recently to China or their close contacts. Another 39 U.S. residents have been infected in other parts of the world before being repatriated and quarantined. But CDC officials say the country could soon see more cases as the virus starts to spread through communities in areas outside China, including Iran, South Korea, and Italy. (Feb. 25)


Majority of Current/Former Smokers Don’t Get Recommended Cancer Screenings
The majority of those who ought to be getting annual lung cancer screenings aren’t getting them, according to a new CDC analysis. Among those ages 55-80, the U.S. Preventive Services Task Force recommends annual screenings for current smokers or those who quit in the past 15 years and who have a history of smoking at least 30 packs of cigarettes a year.

But according to data on screening collected by 10 states in 2017, around 12% of adults met the USPTF criteria, but only a small fraction of those individuals actually got a CT scan in the previous year to screen for cancer. Of the 10 states that reported the data, Florida had the highest rate of lung cancer screenings, with 16% reporting having had CT scans. The data is only from a minority of states but indicate a need for better public health initiatives to educate people about screening, according to the report.


AMA Statement on Ninth Circuit Title X Decision
 “The American Medical Association (AMA) is disappointed by – and strongly disagrees with – the reasoning behind a federal appeals court’s decision to allow the Trump administration to enforce a gag rule on physicians.

“The judges failed to properly take into consideration the AMA’s legal arguments or the decision’s impact on either health care or the patient-physician relationship. This government overreach and interference demands that physicians violate their ethical obligations – prohibiting open, frank conversations with patients about all their health care options – if they want to continue treating patients under the Title X program. It is unconscionable that the government is telling physicians that they can treat this underserved population only if they promise not to discuss or make referrals for all treatment options.

“As this case moves to the next stage, we’ll continue to fight for open conversations between patients and physicians – the cornerstone of quality health care.”

Statement Attributable to:
Patrice A. Harris M.D., M.A.
President, American Medical Association


Lung Cancer More Prevalent Among Young Women Than Young Men in US
Cancer Therapy Advisor (2/19) reports researchers found that “the incidence of lung cancer appears to be higher among young women compared with young men in the United States as well as 5 other countries.” The findings were published in the International Journal of Cancer.


Physicians Seeing Increasing Number of Young Adults with Symptoms of Alcohol Consumption-Related Acute Liver Disease
Last month, “the National Institute on Alcohol Abuse and Alcoholism published a study” indicating that “from 1999 to 2017 the number of alcohol-related deaths per year doubled, rising from 35,914 to 72,558,” with “just under a third of those” resulting “from liver disease.”

This “trend is particularly pronounced in middle-aged women, where studies suggest that high-risk drinking is the highest it has ever been.” Physicians are seeing an increasing number of “people in their 20s and 30s with symptoms of acute liver disease related to alcohol consumption.”


FDA Approves New Cholesterol-Lowering Drug
The FDA has approved bempedoic acid (marketed as Nexletol) to help lower LDL cholesterol in adults with heterozygous familial hypercholesterolemia or established atherosclerotic cardiovascular disease for whom statins are deemed insufficient. The oral ATP citrate lyase inhibitor, the first approved in its class, acts by decreasing cholesterol biosynthesis and upregulating LDL receptors, the manufacturer says.

It’s indicated as an adjunct to diet and maximally tolerated statin therapy. In phase 3 studies comprising over 3000 patients, once daily bempedoic acid was superior to placebo (a mean 18% placebo-corrected LDL reduction) in patients also taking moderate- or high-intensity statins. The manufacturer notes that uric acid levels should be monitored in those taking bempedoic acid, as it may increase risk for gout. Additionally, the drug has been associated with tendon rupture and should not be used in patients with prior tendon disorders.

Bempedoic acid’s effects on cardiovascular morbidity or mortality are unknown, the manufacturer says.
Background: NEJM Journal Watch Cardiology coverage of phase 3 s


Medicaid

Across the Board (ATB) Medicaid Payment Reductions
Effective for dates of service on or after January 1, 2020, through March 31, 2020, and each State Fiscal Year thereafter, all non-exempt Department of Health state funds Medicaid payments will be uniformly reduced by 1%. For services subject to the 1% reduction, all fee-for service payments will receive a decrease to Medicaid checks and/or Electronic Funds Transfers for dates of services on or after January 1, 2020. Conversely, managed care payments to health plans will be reduced through a 1% reduction to premium rates effective January 1, 2020. Remittances will reflect the 1% reduction (appearing as an “FC2” recoupment) starting in cycle 2219, which has a check release date of 3/18/2020.
Please Click Here to read the full physician notice; or call 1-800-343-9000
emednyalert@csra.com


MSSNY Past President Dan O’Keeffe Dies at 98
MSSNY President Dr. Dan O’Keeffe died Sunday, Feb. 23, 2020. He was 98½ years old and leaves his legacy. Raised in his beloved North Creek, he was a star basketball player at Johnsburg Central School, ski champion, and avid hunter. He attended Holy Cross College and did his medical education and training at the Albany Medical Center. After serving in the Air Force, he settled in Glens Falls and touched many lives as a physician practicing obstetrics and gynecology.

In 1951, he started the practice that became Women’s Care in Glens Falls. Over 40 years, he delivered more than 10,000 babies. He served as president of the Warren County Medical Society, St. Luke Physician’s Guild, Warren County Chapter of the American Cancer Society, Medical Staff of the Glens Falls Hospital, and the New York State Medical Society.

He was the chief gynecologist at the 1980 Winter Olympics in Lake Placid. At age 65, he decided to take up tennis and went on to become the Senior Olympic US National Champion in his 80s. Dr. Dan also wrote and published four books: One Heartbeat From Heaven (The Story of the O’Keeffe Hunting Camp 1915-1965); Halfway To Heaven (Livin’ in the “Crick”); Ride Up – Slide Down (A History of Skiing at Gore Mountain); You Really Made Housecalls? (The Practice and Politics of Medicine). He was very proud that all three of his children followed his footsteps, each becoming an OB/Gyn physician, Jim O’Keeffe, MD, Dan O’Keeffe III, MD, and Kate O’Keeffe, MD. He is survived by nine grandchildren, and five great-grandchildren.

To express online condolences visit www.sbfuneralhome.com.


 


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

MSSNY Grassroots Banner

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

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

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

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

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.org if you have questions or comments.  Thank you.
(WILKS)


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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

MSSNYeNews: Stupid Insurance Tricks, Continued – February 21, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
February 21, 2020

Vol. 23  Number 8


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Colleagues:

Apparently, Meyer Lansky chose the wrong racket. Case in point – Advanced Gynecology and Laparoscopy of North Jersey, et al v CIGNA Health and Life Insurance.

In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed amount and requests the same amount from the self-insured health plan. However, instead of paying the medical provider or member, CIGNA hires a Repricing Company to try and negotiate a reduction. If the provider refuses to negotiate, CIGNA pays the claim at an exorbitantly low level but appears to keep the difference between what was removed from the self-insured health plan and what was paid to the medical providers. In an attempt to conceal this from the patient and self-insured health plan, CIGNA issued Electronic Remittance Advice or paper Explanation of Benefits forms (collectively, the “EOB”) misrepresent the balance as “Discount” to the members, certifying the member is not responsible for the balance, while simultaneously representing the balance to the Plaintiffs as member liability or “Amount Not Covered”.

Curiously, CIGNA has been actively suing out-of-network physicians for not collecting patient liabilities in full. Moreover, the complaint includes allegations of RICO violations as well. You can read the whole thing at the above link.

Yes, as through this world I’ve wandered
I’ve seen lots of funny men;
Some will rob you with a six gun.
And some with a fountain pen.
–Woody Guthrie, Pretty Boy Floyd

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

Arthur Fougner, MD
MSSNY President


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eNews

Urge Your Legislators to Reject Undermining Physician Due Process
With Part L of Governor’s proposed Health/Mental Hygiene Budget bill containing extremely troubling measures to bypass important due process protections for physicians during disciplinary proceedings, all physicians are urged to continue to contact their legislators to urge that the Legislature reject this unfair proposal, and plan to be in Albany on March 4 for Physician Advocacy Day.

The proposal would, among many other provisions, make it far easier for the Commissioner of Health to disclose to the public that a physician is under disciplinary investigation or summarily suspend a physician with only a minimal finding of risk to the public, as opposed to the much stronger “imminent danger” standard now required for bypassing existing due process protections.  That is particularly troubling given that only a small percentage of complaints to OPMC result in a disciplinary sanction.  MSSNY has indicated that we agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career.   

MSSNY has joined with 16 state specialty societies in a communication to the Legislature setting forth our concerns in greater detail. Moreover, MSSNY President Dr. Art Fougner recently appeared on the WCNY “Capitol Pressroom” radio program to discuss MSSNY’s concerns with this proposal.

Please urge your legislators to reject this proposal from the Budget.


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One-Sided Surprise Bill Proposals Advance in Congress – Contact Your Representatives Today
All physicians are urged to continue to contact New York’s Senators Schumer and Gillibrand, as well as their respective Representative to express strong concerns with the various proposals before Congress that would substantially limit insurer responsibility for coverage of out of network emergency and surprise medical bills.  A letter can be sent here.

While MSSNY supports the goals of legislation to prevent surprise medical bills, most proposals advanced so far are steered heavily to the benefit of insurance companies, and do not have the balance of New York’s law.  Last week the House Ways & Means Committee and Education & Labor Committee advanced separate proposals.  While the Ed & Labor proposal was very similar to Energy & Commerce proposal advanced last year strongly opposed by MSSNY and many other physician organizations, the W&M proposal did make a few marginal improvements including rejecting a benchmark payment and permitting the consideration of many factors.

However, the IDR mechanism identified in the legislation would also prohibit the consideration of physician charge data and require the consideration of median in-network data, which in all certainty will skew the results towards the insurance companies.  In fact, when the proposal was scored by the Congressional Budget Office (CBO), it was noted that “in facilities where surprise bills are likely, average payment rates for both in- and out-of-network care would move toward the median in-network rate.  Moreover, the proposal only provides for a minimal review of insurer networks, which is the major contributing factor to the problem of surprise bills.

Therefore, this proposal remains highly problematic, and MSSNY President Dr. Art Fougner offered this statement supporting efforts to “ensure a fair federal legislative solution to protect patients from surprise out of network bills”, but that “far more balance is needed in what has been put forward so far”, and that the proposal released Friday by the US House Ways & Means “provides a few marginal steps forward but would still hand an enormous gift to already market dominant health insurance companies by tilting the factors in its dispute resolution mechanism towards the insurance industry.”


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“Coronaviruses 2020” CME Webinar on March 18th Registration Now Open
There have been 29 confirmed cases of COVID-19 in the United State as of February 20, 2020.  Learn more about this and other coronaviruses by signing up for Medical Matters: Coronaviruses 2020 on March 18th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role int eh public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

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

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

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


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Registration Now Open for Steps to Physician Wellness and Resiliency
MSSNY’s Committee on Physician Wellness and Resiliency will hold its first webinar, entitled Steps to Physician Wellness and Resiliency on February 25th from 7:30-8:30am. Jeffrey Selzer, MD will serve as faculty for this webinar.

Educational Objectives are:

  • Review the warning signs that stress, depression, anxiety or substance use may impact work or personal life
  • Identify strategies to increase personal empowerment toward making positive change, including self-assessment tools
  • Recognize self-monitoring strategies for stress related problems and know when to seek professional assistance

Register by clicking here.  Please click here to view the flyer for this program.

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.

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Several NY Counties Pushing Back Against Gov.’s Medicaid Cost-Shifting Plan
The Buffalo (NY) News (2/14) reported, “Officials from Erie County, New York City and elsewhere are pushing back on an additional Medicaid cost-shifting plan that they say could be even worse than what Gov. Andrew M. Cuomo recently proposed in his new budget.” This “latest fight is over millions of dollars counties receive each year from the federal government for additional Medicaid services and costs under the Affordable Care Act.”


 

Dr. Pinto

Saratoga County President Greg Pinto, MD with Assemblywoman Carrie Woerner, Assembly District 113 (Saratoga) at 2-19-2020 Legislative Update meeting of the Saratoga County Medical Society.


NYS DOH Flu Tracker
https://nyshc.health.ny.gov/web/nyapd/new-york-state-flu-tracker


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Unregulated/Deeply Discounted Insulin Sales Common on Craigslist
Reuters (2/17) reports, “Unregulated and deeply discounted sales of insulin are common on Craigslist,” research indicated. Over the course of “a two-week period, researchers turned up 327 ads from private parties selling insulin at a fraction of the retail price,” investigators found. The study’s co-author said, “The take home message from this study is that patients (with diabetes) should not have to go to Craigslist to find affordable insulin.” She added, “There has to be a better way than patients going out on their own and seeking out potentially harmful products.” The findings were published online in a research letter in JAMA Internal Medicine (subscription required).


Grandparents May Be Bad Influence on Children’s Weight
Grandparents can be a bad influence on kids’ weight,” investigators concluded after analyzing data from “23 studies conducted in the United States and eight other countries.” That analysis revealed that children “who were cared for by grandparents had nearly 30% higher odds for being overweight or obese.” The findings of the systematic review and meta-analysis were published online in the journal Childhood Obesity.


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MSSNY Young Physicians, Resident Fellow, Med Student Social
Friday, 2/28/2020, 6pm-9pm
Sessions 73 – 73rd St. and 1st Ave. New York, NY
RSVP for social here


Just One Dose of HPV Vaccine May Help Prevent Cervical Disease

A single dose of human papillomavirus (HPV) vaccine is associated with a significant reduction in cervical disease, according to a retrospective study in Cancer. The CDC generally recommends two doses for those vaccinated between ages 9 and 14, and three doses for those vaccinated later.

Using a U.S. insurance claims database, researchers matched nearly 67,000 females aged 9 to 26 who received at least one dose of the quadrivalent HPV vaccine with 67,000 unvaccinated controls.

The estimated rate of preinvasive cervical disease at 5 years was 2.65% in the unvaccinated group, versus 1.62%, 1.99%, and 1.86% among those who received one, two, and three vaccine doses, respectively, between ages 15 and 19. After multivariable adjustment, one vaccine dose was associated with a 36% risk reduction; two doses, a 28% reduction; and three doses, a 34% reduction.

Editorialists say the findings “add to the growing evidence suggesting that there may truly be no major difference in protection against cervical preinvasive lesions … conferred by 1, 2, or 3 doses of HPV vaccination.”

Cancer article
Background: Prior Physician’s First Watch coverage of single-dose HPV vaccination


Considering a Run for Office for Yourself?
AMPAC Candidate Workshop February 28 – March 1, 2020

Ever wonder how Doctors get elected to Congress or your state legislature? The AMPAC Candidate Workshop will teach you how to run a winning political campaign, just like we taught many of your AMA colleagues over the years.

The Candidate Workshop is designed to help you make the leap from the exam room to the campaign trail and give you the skills and strategic approach you will need to make a run for public office.

Additional details below

This one-and-a-half-day workshop is designed to provide you with the skills and strategic approach you will need to make a run for public office. Some of the topics include: how and when to make the decision to run; the importance of a disciplined campaign plan and message; the secrets of effective fundraising; what kinds of media advertising are right for your campaign; how to handle the inevitable crises that emerge for every campaign; the role of your spouse and your family; and how to become a better public speaker.

Registration is now open. There are still a few spots remaining but don’t delay. The registration fee is $250 for AMA members ($1,000 non-members), spouses and state medical society staff. The fee is waived for students/residents, however, there are limited slots and the AMPAC Board will review and select from the pool of qualified applicants. For more information visit AMPAC online. To apply, simply fill out the online registration form or email your questions to: politicaleducation@ama-assn.org.


Med Schools Recruit LGBTQ Students to Improve Care for LGBTQ Patients
The AP (2/19) reports on efforts to increase the number of LGBTQ physicians, which LGBTQ advocates say should improve the quality of care received by LGBTQ patients. The article says that “when being heterosexual is presumed even in doctors’ offices, those who identify otherwise can feel marginalized and less likely to seek medical care, contributing to health problems” such as mental health issues, alcohol and drug use, and forgone preventive care, according to LGBTQ advocates.

The article adds that some medical schools are pushing to recruit more LGBTQ students citing “research showing that patients often get better care when treated by doctors more like them.” Exact numbers of LGBTQ medical students and doctors are unknown. In 2018, the AMA added sexual orientation and gender identity as an option for members to include in demographic profiles the group compiles.

Of the 15,000 doctors and students who have volunteered that information so far, about 4% identify as LGBTQ. That is similar to Gallup estimates for the general U.S. population, although LGBTQ advocates believe the numbers are higher and rising as more people are willing to “out” themselves. This past fall, Harvard’s entering class of medical students was 15% LGBTQ, a milestone that is no accident.


Bill Correctly for Medicare Telehealth Services
In a recent report, the Office of Inspector General (OIG) determined that the CMS improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.

Additional resources:

·       Telehealth Services (PDF) Medicare Learning Network Booklet

·       Medicare Claims Processing Manual, Chapter 12 (PDF), Section 190

·       Medicare Telehealth Payment Eligibility Analyzer

·       List of Covered Telehealth Services webpage

·       CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report


 


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

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

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

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

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

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.org if you have questions or comments.  Thank you.
(WILKS)


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RENTAL/LEASING SPACE


Office Rental 30 Central Park South
Three exam rooms, consultation, reception and secretarial rooms. Ground floor next to Plaza Hotel.
Elegantly decorated and fully equipped with operating suite on site. Part or full time. $1280/month for each exam plus consultation room.213.371.0468 www.drcenedese.com


Midtown Medical Office for Rent
Beautiful office for rent in midtown Manhattan located opposite Grand Central Station on 42nd Street and Madison avenue. ideal for medical and surgical specialists as there are five spacious exam rooms with an accredited quad a certified operating room with anesthesia services. You can perform procedures and see patients. Rent for three days a week is $3,200 and 4 days a week is $4,100 Interested physicians please email cpmgman@gmail.com or call 914-582-0749.


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We improve the employee and patient experience to help you achieve your goals and grow your practice. How? With strategic processes that support you, your staff, and your patients! We integrate your values into all areas of your practice including hiring, training, communication and operational strategies. Whether you’re independent or part of a group, we have an approach that will work for you. If you’re ready to strengthen your practice, we can help. 

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Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties. Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032

JOB OPPORTUNITIES

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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.



 

CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

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