Enews: July 1, 2020


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Burnout at Record High for Many Primary Care Clinicians, Survey Finds
Nearly half of primary care clinicians reported that their burnout is at an all-time high, largely due to financial pressures caused by the covid-19 pandemic, a new survey found. The Larry A. Green center and primary care collaborative surveyed 763 practicing clinicians in 49 states from June 12-15. Respondents represented a broad range of primary care specialties, practice settings and types.

Five Survey Findings:

  1. 44% of respondents reported high levels of personal burnout, and 48 percent reported high levels of office burnout.
  2. 36% said their physical well-being has suffered, while 45 percent said their psychological state has declined.
  3. 63% of respondents said they have had “severe” or “near severe” stress levels the last four weeks.
  4. 39% said they have had to lay off or furlough staff members in the last month.
  5. 25% of respondents said they have skipped or deferred their salaries.

To view the full survey, Click Here.
(Editor’s Note: This article was updated June 30 at 11:00 A.M. CDT. Becker’s Hospital Review)


California Among 8 States Added to Gov. Cuomo’s Quarantine Order
Travelers from eight additional states, including California, will be subjected to a mandatory two-week quarantine upon entering New York, Gov. Andrew Cuomo announced on Tuesday.

The other states are Georgia, Iowa, Idaho, Louisiana, Mississippi, Nevada, and Tennessee.

Key context: Since Texas and Florida were among the eight states already on the quarantine list, now travelers from the country’s three most-populous states will be restricted in their ability to travel to the fourth-most populous state.

What comes next: Cuomo’s order applies to any state where more than 1 out of every 10,000 residents has tested positive on a seven-day rolling average or more than 10 percent of the tests come back positive. New Jersey and Connecticut joined New York in issuing the same restrictions and thresholds last week. (Politico, 6/30)


Dr. Fauci Predicts COVID-19 Cases Could Top 100K Cases A Day
“We can’t just focus on the areas that are having the surge. It puts the entire country at risk,” Dr. Fauci told the Senate Health, Education, Labor and Pensions Committee on a hearing focused on whether schools could reopen. “We are now having 40-plus thousand new cases a day. I would not be surprised if we go up to 100K a day if this does not turn around so I’m very concerned … I think it’s important to tell you and the American public that I’m very concerned because it could get very bad.”

He suggested that people who ignored social distancing and didn’t wear face coverings have contributed to community spread, even in states that have closely followed reopening guidelines laid out by the Centers for Disease Control. “I think we need to emphasize the responsibility we have as individuals and as part of a societal effort to end the epidemic and that we all have to play a part in that,” Dr. Fauci said. (Politico 6/30)

“It is critical that we all take the personal responsibility to slow the transmission of COVID-19, and embrace the universal use of face coverings,” Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said during his testimony Tuesday. “Specifically, I’m addressing the younger members of our society, the millennials and Generation Zs,” Redfield said. (KHN, 6/30)


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AHA Says: Hospitals Will Take $320B Hit This Year
Hospitals and health systems will lose over $320 billion in 2020 due to the COVID-19 pandemic, according to an American Hospital Association report Tuesday. More than $200 billion in financial losses occurred from March to June. But the AHA expects hospitals to lose another $120 billion—about $20 billion per month—through year-end, mostly driven by lower patient volumes. (Modern Healthcare, 6/30)

Local and state public health departments across the country work to ensure that people in their communities have healthy water to drink, their restaurants do not serve contaminated food and outbreaks of infectious diseases don’t spread. Those departments now find themselves at the forefront of fighting the coronavirus pandemic.

But years of budget and staffing cuts have left them unprepared to face the worst health crisis in a century.

KHN and The Associated Press sought to understand the scale of the cuts and how the decades-long starvation of public health departments by federal, state, and local governments has affected the system meant to protect the nation’s health. (Modern Healthcare)


Six Takeaways of KHN-AP Investigation into the Erosion of Public Health
Here are six key takeaways from the KHN-AP investigation:

  • Since 2010, spending for state public health departments has dropped by 16% per capita, and for local health departments by 18%. Local public health spending varies widely by county or town, even within the same state.
  • At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce in what was once viewed as one of the world’s top public health systems.
  • Nearly two-thirds of Americans live in counties that spend more than twice as much on policing as they spend on non-hospital health care, which includes public health.
  • More than three-quarters of Americans live in states that spend less than $100 per person annually on public health. Spending ranges from $32 in Louisiana to $263 in Delaware.
  • Some public health workers earn so little that they qualify for government assistance. During the pandemic, many have found themselves disrespected, ignored or even vilified. At least 34 state and local public health leaders have announced their resignations, retired, or been fired in 17 states since April.
  • States, cities, and counties whose tax revenues have declined during the current recession have begun laying off and furloughing public health staffers. At least 14 states have cut health department budgets or positions, or were actively considering such cuts in June, even as coronavirus cases surged in several states.

Dr. Richard Izquierdo, 2019 AMA Nathan Davis Awardee, Dies at Age 90
The American Medical Association (AMA) presented Richard “Doc” Izquierdo, M.D., with the Dr. Nathan Davis Award for Outstanding Public Service. Dr. Izquierdo has served his Bronx community for nearly six decades as a physician, health care innovator, community leader and Medical Society advocate. He was chosen for the AMA’s top public service award for his lifetime of work, serving generations of Bronx residents.

Dr. Izquierdo has dedicated his entire career to furthering health and opportunity in his Bronx community. With a $3,000 down payment, he founded the San Juan Health Center, which in 1974 became Urban Health plan, Inc., and today is one of the largest health centers in New York State. Dr. Izquierdo also served as the first chairman of the Community Planning Board and as Chairman of the 41st Precinct Community Council for 14 years.

In 2010 Dr. Izquierdo fulfilled a lifelong dream when he opened the Dr. Richard Izquierdo Health and Science Charter School. The first school of its kind, it provides technical education geared specifically toward preparing students for jobs in the health care sector, including Emergency Medical Technician (EMT) certification.

“Dr. Izquierdo put down roots for good nearly 60 years ago when he opened his first practice two blocks from where he grew up in the Bronx,” said AMA Board Chair Jack Resneck, Jr., M.D. “Not only has he treated generations of patients from his community, but he has built, in his charter school and health center, a legacy that will serve the Bronx for years to come.”

Dr. Richard Izquierdo was one of eight honorees chosen this year to receive the Dr. Nathan Davis Award for Outstanding Public Service. The award, named for Dr. Nathan Davis, a member of the Medical Society for the State of New York, and the founding father of the AMA, recognizes those in service whose outstanding contributions have promoted the art and science of medicine and the betterment of public health.

Dr. Izquierdo attended University of Lausanne Medical School and completed his internship and residency at Fordham Hospital in New York. The AMA presented Dr. Izquierdo with the Dr. Nathan Davis Award last night at a ceremony in Washington, D.C. as part of the AMA’s National Advocacy Conference.

Dr. Izquierdo (known as “The People’s Doctor of the Bronx and Founder of the Urban Plan, Dead at 90)”) was also featured in the Bronx Journal.


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Dr. Fauci: Contact-Tracing ‘Not Going Well;’ Other Updates

  • National contact-tracing efforts are “not going well,”Anthony Fauci, MD, told CNBC.. Instead of creating a national contract-tracing strategy, the White House instructed states to develop infrastructure for broad COVID-19 testing and contact-tracing before reopening. Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said some states have been slow to ramp up this capacity, which will be crucial before a potential second wave of coronavirus cases this fall. 
  • Federal officials are warning of fake mask exemption cards that say their owners are exempt from ordinances requiring masks in public due to a health condition, according to The New York Times. Some versions of the card feature a fake U.S. Justice Department logo and list a phone number to report violations of the Americans with Disabilities Act. A group called the Freedom to Breathe Agency was selling 500-count boxes of the fake cards online for $49.99, officials said.

US Warns that 2nd COVID-19 Wave Could Worsen Generic Drug Shortages
A federal intelligence report found that the U.S. is likely to see a worsening shortage of generic drugs if another round of shutdowns occurs due to the COVID-19 pandemic, according to ABC News. The federal report, created by the Department of Homeland Security and distributed to government agencies last week, found that the U.S. already is seeing shortages of more than 200 drugs and supplies due to international shutdowns. The report is warning that another round of shutdowns could further strain the system in a way that many U.S.-based drugmakers would be “unable to quickly offset,” according to ABC. 

“Chinese factories that produce raw ingredients for common antibiotics closed for weeks as of March, and India’s lockdown extended until the end of May,” the report said, according to ABC. “France, Germany, and China have also considered reimposing lockdown measures as COVID-19 cases have begun to reemerge.”


NEJM Study: 300 Cases Rare Inflammatory Disorder in COVID-19 Children
U.S. researchers have found nearly 300 cases of a rare inflammatory disorder linked to COVID-19 in children, according to two new studies cited by STAT. In the first study, researchers from Boston Children’s Hospital identified 186 children with the condition in 26 states. Eighty percent required intensive care, 20 percent were put on a ventilator, and 2 percent (four children) died. In a second study examining 99 cases in New York state, 63 percent needed mechanical ventilation, and two children died. Both studies were published in The New England Journal of Medicine.


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AMA Statement on U.S. Supreme Court Ruling in Louisiana Abortion Access Case

Statement Attributable to:
Susan R. Bailey, M.D.
President, American Medical Association

“Today’s decision is a victory for patients and a strike against government interference in the patient-physician relationship. There is no evidence that Louisiana’s admitting privileges requirement improves patients’ safety, and we are pleased by the U.S. Supreme Court’s finding that such regulations are constitutionally invalid.

“The AMA joined other leading national health organizations in an amicus brief to the Supreme Court, urging it to strike down a Louisiana law that interferes with clinical judgment and obstructs women’s access to abortion services in the state. We will always fight government intrusion that compromises access to safe clinical care.


Gilead Sets Remdesivir Price, Allocation Plan
Gilead Sciences will charge the U.S. government and other developed countries $2,340 for a five-day course of remdesivir. Commercial insurers in the U.S. will pay 33 percent more, or $3,120 for a five-day course, the drugmaker said June 29.

Most patients treated with remdesivir receive a five-day treatment course using six vials of remdesivir. The cost breaks down to $390 per vial for government insurers like Medicaid and $520 per vial for private insurers.

Gilead said while deciding on a pricing strategy for remdesivir, it wanted to create a one-price model to curb the need for country-by-country negotiations on price. While there are still no COVID-19 treatments approved by the FDA, remdesivir has been shown to shorten recovery time of hospitalized patients by about four days. Due to its potential to save lives and cut hospital spending, Gilead said its pricing is well below value. Gilead said due to the earlier hospital discharge, hospitals could save about $12,000 per patient.

“As with many other aspects of this pandemic, we are in uncharted territory in pricing remdesivir,” Daniel O’Day, chair and CEO of Gilead, wrote in a statement on the pricing decision. “Ultimately, we were guided by the need to do things differently. As the world continues to reel from the human, social and economic impact of this pandemic, we believe that pricing remdesivir well below value is the right and responsible thing to do.”

Gilead also said July 29 that HHS will continue to manage the allocation of remdesivir to U.S. hospitals through September. After that period, HHS will no longer manage allocation. (Open letter from Gilead CEO Daniel O’Day)


MSSNY Helpline for Physicians Experiencing COVID-19 Related Stress 518-292-0140


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Classifieds

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.


For Sale:  715 Park Avenue
Medical office, 1,800 sq. ft. Rectangular, 11 1/2 ft ceilings, street level access. Private entrance on 70th Street, side of the building.  Windows on Park Avenue and 70th Street.  Excellent office space for plastic surgeon, dermatologist or dental practice. Central air conditioning, high voltage electric service, two bathrooms. *Sale could include active Cardiac / Medical Practice. Please contact Janet @ 212-288-5468.


Office Space and Quad-A Certified O.R. for Rent
Plastic surgery office and/or quad A – certified operating room available for rent. We welcome you to tour our facility, where safety and luxury are combined in the most prime location on the upper east side. We assure you will be delighted by what you discover. We take pride in our facility, where your patients’ safety and satisfaction are our number one priority.
  • Fully equipped operating room perfect for a board-certified plastic surgeon
  • Pre-op and recovery areas
  • A bright and modern waiting area
  • 3 consultation rooms, administrative room, kitchenette, and 2 bathrooms
  • Full day office rental per week / O.R. rental per case

For inquiries please call 212.737.8700, email polina@specialtyaestheticsurgery.com
Office Space and Quad-A Certified O.R. for Rent


 

 

 

 

 

 

eNews: June 24, 2020


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NYSDOH June 24 Updates


Tri-State Govs Impose 14-Day Quarantine for Visitors from High Infection Rate States
The governors of New York, New Jersey and Connecticut announced on Wednesday that they would impose a 14-day quarantine on visitors from states with high coronavirus infection rates.

“We worked very hard to get the viral transmission down. We don’t want to see it go up,” said Governor Andrew Cuomo during a joint press conference with his fellow tri-state governors.

The order in New York, which will take the form of a travel advisory, will take effect at midnight. The standard for measuring states considered a risk will be those with more than 10 coronavirus cases per 100,000 people or whose infection rate is above 10 percent based on a seven-day rolling average.

As of today, Cuomo said there are nine states that fit that criteria: Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Washington, Utah, and Texas. But more than two dozen states are seeing surges in cases.

The advisory not only applies to out-of-state residents. Any New Yorker that leaves to visit those states would be subject to quarantine upon their return, Cuomo said. The infection rate in New York state is now 1.1 percent, while the number of total hospitalizations is now at 1,071, the lowest since March 19th.

Although it was not clear how the three states would enforce the quarantine, Cuomo denied that the measure was simply symbolic. “You violate the quarantine, you will have to do mandatory quarantine and you will be fined,” he said.

Violators may be asked to pay a minimum fine of $2,000 and up to $10,000 if they cause harm, according to the governor.


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Younger Adults Testing Positive for Coronavirus in More States
In several U.S. states, including Florida, Texas, Washington, California and Colorado, there are reports of a demographic shift in coronavirus case trends, with younger adults increasingly making up a greater share of cases, according to NPR.

There are many possible reasons for this shift, including the fact that more people are getting tested for the new virus, public health experts told NPR. But some experts attribute the rise in cases among adults in their 20s and 30s to their possible belief that they are at lower risk of contracting the virus and return to social gathering settings sooner than older adults.

In Washington, an analysis of state data showed that nearly half of new COVID-19 cases in Seattle were among people in their 20s and 30s. State data in California shows that adults younger than 35 years make up about 44 percent of new coronavirus cases, NPR reports.

“If you see these types of trends occurring in a state as large as California, it’s probably a very strong harbinger that this is actually happening nationally, too,” George Lemp, DrPH, an infectious disease epidemiologist and former director of the University of California’s HIV/AIDS Research Program, told NPR.

Many governors have blamed the uptick in cases on young adults, including Texas Gov. Greg Abbott, who tied the rise in new virus cases to reports of packed bars and young adults failing to socially distance.

Some local governments are trying to create public awareness campaigns aimed at young adults. Ken Welch, a county commissioner in Pinellas County, said the county thought about getting local athletes to talk about the importance of wearing a mask.

Wafaa El-Sadr, MD, a professor of epidemiology and medicine at New York City-based Columbia University, told NPR that identifying “trusted spokespeople” to create awareness among younger adults is key.

“I think young people can potentially have a very, very valuable role if we can harness their energy and attention,” she said. (Becker’s Hospital Review June 22)


Resistant Meningococcal Strain Circulating US, CDC Warns
The CDC is warning healthcare providers about a new resistant strain of Neisseria meningitidis, which causes meningococcal disease.

Meningococcal disease is a life-threatening infection of the brain and spinal cord or bloodstream. The infection is usually treated with penicillin or ciprofloxacin. The antibiotics are also used for prophylaxis in people who have had close contact with the infected patient.

However, the CDC has detected 11 meningococcal cases that occurred in nine states between 2019 and 2020 in which isolates contained a gene and mutations associated with resistance to these antibiotics. Another 22 cases reported from 2013 -20 contained the gene associated with penicillin resistance, but did not have mutations associated with ciprofloxacin resistance, according to the CDC’s Morbidity and Mortality Weekly Report published June 19.

The agency is urging clinicians to conduct antibiotic susceptibility testing before switching from empirical treatment to penicillin or ampicillin for patients with meningococcal disease.

To learn more, click here.


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AHA Urging HHS To Extend Health Emergency Declaration: Set to Expire July 25
The declaration grants healthcare providers certain resources and flexibilities to care for COVID-19 patients, which will be needed past July, AHA President and CEO Richard Pollack said in a letter to HHS Secretary Alex Azar. Mr. Pollack asked HHS to extend the declaration until various criteria are met related to supply chain, testing volume, intensive care unit capacity and death figures.


WEBINARS

June 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open Questions & Answers Surrounding the COVID-19 Pandemic 

Register now for MSSNY’s next webinar related to the COVID-19 pandemic on June 29th at 7:30am, Medical Matters: Questions & Answers Surrounding the COVID-19 Pandemic. The COVID-19 pandemic has generated myriad questions for health professionals.

This webinar will explore some of the most frequently asked of these questions and provide answers where they are available Faculty for this program is William Valenti, MD, Arthur Cooper, MD, Marcus Friedrich, MD and Elizabeth Dufort, MD.

Educational objectives:

  • Identify frequently asked questions surrounding the COVID-19 pandemic
  • Examine the dynamic circumstances encompassing COVID-19

Registration is now open for this webinar

To view the companion pieces to this webinar, be sure to go to cme.mssny.org or go to the MSSNY podcast site and listen to the COVID-19 related podcasts available here.

Additional information can be found here and 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.


IPRO QIN-QIO Community of Care Coalitions: Working Together to Improve Care and Reduce Burden Wednesday July 8, 2020 | 12PM – 1PM EDT

Register Here!

Join us for a presentation of the Community of Care Coalition program and the ways our work at the IPRO QIN-QIO aligns with multiple initiatives including the Merit Based Incentive Payment System (MIPS) and the Shared Savings Program (SSP).
Our presentation will include a short overview of the program, a panel discussion of experts describing how the IPRO QIN-QIO programs can help your practice, and an open Q and A.

Participating organizations in our Community of Care Coalition program will have access to:

Educational resources and tools: guide and support quality improvement processes.

·       Health information technology support: access clinical decision support tools; innovations in HIT to reduce opioid-related harm, improve opioid prescribing and pain management; and track and report adverse events.

·       Data analysis and reporting: enhance identification, tracking, and reporting opportunities for improvement; receive timely data on quality measure performance.

·       Peer to peer collaboration: learn about best practices from peers.

·       Person and family engagement: gain insight on how best to involve patients, residents and their family members and care partners in their care.

·       Online learning: join virtual collaborative and take advantage of online, self-paced educational programs.

Find out more about the IPRO QIN QIO program here.


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CMS

CMS Opens Office to Cut Red Tape for Providers
To determine where to trim red tape, CMS relied on input from 10 Requests for Information, along with listening sessions, site visits, feedback from more than 2,500 stakeholders.

CMS says it has already removed unnecessary and burdensome regulations that have saved providers 4.4 million paperwork hours and $800 million. The Centers for Medicare & Medicaid Services on Tuesday announced the creation of a new office designed to cut red tape for providers.

The regulatory reductions are expected to save providers $6.6 billion and 42 million unnecessary burden hours through 2021, CMS said. “The work of this new office will be targeted to help reduce unnecessary burden, increase efficiencies, continue administrative simplification, increase the use of health informatics, and improve the beneficiary experience,” CMS Administrator Seema Verma said.

To determine where to trim red tape, CMS relied on input from 10 Requests for Information, along with listening sessions, site visits, feedback from more than 2,500 providers, clinicians, administrative staff, and beneficiaries, and 15,000 comments from various stakeholders.

So far, CMS said, the red tape reductions have:

·       Removed unnecessary, obsolete, or excessively burdensome conditions of participation for providers saving 4.4 million paperwork hours and total projected savings to providers of $800 million annually.

·       Removed 235 data elements from 33 items on the Outcomes and Assessment Information Set assessment instrument for home health.

·       Established within the Quality Payment Program consolidated data submission for the Merit-based Incentive Payment System, removing a requirement that clinicians submit data in multiple systems.

·       Eliminated 79 measures under the Meaningful Measures Initiative, resulting in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours through 2020.

·       Accelerated processing state requests to make program or benefit changes to their Medicaid programs through the state plan amendment and section 1915 waiver. (Health Leaders, June 23)


Physician Compare Preview Period is Now Open
The Physician Compare 60-day Preview Period is officially open as of June 22, 2020 at 10 a.m. ET (7 a.m. PT). You can now preview your 2018 Quality Payment Program performance information before it will appear on Physician Compare profile pages and in the Downloadable Database. You can access the secured Preview through the Quality Payment Program website.

Access the resource below on how to preview your data:

·        Physician Compare Preview Period User Guide

For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov.

To learn more about the 2018 Quality Payment Program performance information that is available for preview as well as the 2017 clinician utilization data that will be added to the Downloadable Database, download these documents from the Physician Compare Initiative page:

·        Clinician Performance Information on Physician Compare: Performance Year 2018 Preview Period

·        Group Performance Information on Physician Compare: Performance Year 2018 Preview Period

The 60-day Preview Period will close on August 20, 2020 at 8 p.m. ET (5 p.m. PT).


MSSNY Helpline for Physicians Experiencing COVID-19 Related Stress 518-292-0140


Classifieds

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.

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MSSNY Tough in Tough Times


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MSSNY in Action:  The Cliff Note Version
This week brings some good news in New York as our infection rates, hospitalization rates and death rates and from COVID-19 continue to decline amidst reopening the state. As we, as a profession, settle into new practice paradigms, I know that our email inboxes have often suffered from neglect. With that in mind, this week’s column aims to provide a quick update on society activities.  Throughout the crisis MSSNY has been in daily contact with the Governor’s office, the DOH and our state legislature providing input, seeking help, and getting the changes necessary for physician practices to see patients. We were successful in getting rapid changes to payment for telehealth, immunity for COVID treatment, pushing to get elective surgery and care reinstituted throughout the state, practical changes to everything from COVID testing requirements to changes in the date for completion of the mandated pain management course and innumerable other needed small and large flexibilities.

Your MSSNY has written articles, emails, done press releases, given testimony, written letters to our Governor, our congressional delegation, and other national leaders.  We have also given print and TV interviews on the plight of our physicians that have aired locally and nationally. We have done 2 polls on the economic impact of COVID-19 on physician practices in NY that have garnered significant press and our data was corroborated by a Fair Health report released this week. MSSNY has also given testimony to our NY State Senate and Assembly, most recently on Wednesday, on the economic impact on physician practices and the need for additional funds to be made available to sustain them.

Throughout the crisis and now during re-opening, we have reiterated to our State Government the very important roles that our physicians and our medical society have played.  MSSNY has repeatedly stressed that all state task forces dealing with healthcare must include practicing community physicians and that not doing so is to the detriment of the health and wellbeing of NYS residents.

Our May member email on physician PPE needs resulted in over 700 responses. MSSNY has taken this issue extremely seriously and continues to pursue every angle to get NY physicians the needed, affordable, reliable supplies necessary to take care of their patients and keep their offices open. National shortages persist, there are significant delivery delays and the major manufacturers will not sell directly to the society. We have been in contact with the Governor’s office, our NYS legislature, the major manufacturers, distributors, Vice President Pence, Congress, and the AMA.  We have made our members aware of the many counterfeit products on the market and have been sending out information on availability of legitimate sources as we hear of them; all while directly trying to procure PPE. Within the past week alone we have spoken with the NYS legislature about mandating insurers to cover the increased cost of PPE, done an interview that will air nationally, spoke with numerous distributors and sent letters to the AMA Chief Executive, Dr. Madara, our NYS health commissioner, Howard Zucker, and to our congressional delegation.

Through everything, the health and wellbeing of our physicians is of paramount importance. We have all been through a lot personally and professionally and many of us need an ear to listen and a colleague to lean on. MSSNY is here for you. Our helpline is up and running at 518-292-0140 and our first class of Peer to Peer supporters has been trained.

While these are the Cliff Notes, MSSNY has outsized, ongoing efforts on a multitude of fronts to help sustain you and your practice and to move our society forward.

Bonnie Litvack, MD
MSSNY President


MSSNYs Weekly Podcast


Notes from Governor Cuomo’s COVID-19 Final Daily Address

DATA:

– 1,284 total hospitalizations.

– The state conducted 79,000 tests yesterday.

– We continue to have the lowest infection rate since the beginning of the outbreak.

– 25 lives lost yesterday. 

GOV PERSPECTIVE:

– Gov thanked all those involved in COVID-19 mitigation efforts.

– Gov shared a story about his daughter missing her graduation ceremony, and how he similarly regrets not celebrating the unveiling of the new state seal.

– “Why did it take a crisis to bring us together?”


MSSNY Statement on U.S. Supreme Court’s DACA Ruling
Statement Attributable to:
Bonnie Litvack, MD
President, Medical Society of the State of New York

“Yesterday’s US Supreme Court decision will allow medical students and medical residents with Deferred Action for Childhood Arrivals (DACA) status to continue their education and training in the United States.

“The Medical Society of the State of New York (MSSNY) believes that this action by the Supreme Court will help medical schools and teaching hospitals to produce a diverse and culturally responsive health care workforce to meet the needs of underserved populations, improve cultural awareness, and promote health equity.

“As this nation’s population grows and becomes much more diverse, it is crucial that the physician workforce reflect the changing demographics of the country to mitigate racial, ethnic, and socioeconomic health disparities.

“The Medical Society of the State of New York urges that Congress work towards a permanent resolution for the individuals here in this country under DACA.”


MSSNY Chairman of the Board and Past President Dr. Kleinman in JAMA on Crushing Effects of COVID-19 on Medical Practices
In a JAMA article about the crushing effects of COVID-19 on medical practices across the country, Andrew Kleinman, MD, a past president of MSSNY, said “Unfortunately, I think this [pandemic] is going to accelerate the closure of the smaller practices. With a lot of practices, 40% or more of their revenue goes just to overhead.”

In a survey of 558 US primary care physicians fielded May 29 through June 1—nearly 3 months into the pandemic—6% of respondents said their practices were closed, perhaps temporarily, and 35% said they’ve furloughed staff, according to the nonprofit Primary Care Collaborative (PCC) and the Larry A. Green Center.

Dr. Kleinman, a past president of the Medical Society of the State of New York, said he reduced his malpractice coverage to half-time, but he still had to pay two-thirds of his prepandemic premium. “For a plastic surgeon, it’s still expensive when there’s no income.” And he still had to pay other overhead costs—phones and electronic medical records, to name 2—for his temporarily closed practice.

“If this happened to me 20 years ago, I would be bankrupt,” said Dr. Kleinman, who, at age 66 years, was able to draw on savings to help his practice survive. “When this whole thing started, I strongly considered just retiring now.” While he’s heard of physicians retiring early rather than waiting out the pandemic, Kleinman said, he decided he’s not yet ready to follow suit.


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Have You Used Your MSSNY Member Benefits Lately?


HHS Portal Now Open for Eligible Physician to Apply for CARES Act Grant funds
As noted in the MSSNY e-news a few days ago, the US Department of Health and Human Services (HHS) announced it will distribute approximately $15 billion to eligible physicians and organizations that a)  participate in state Medicaid and CHIP programs and b) have not received a payment from the Provider Relief Fund General Allocation established in the CARES Act.  Last evening, HHS opened the portal that will allow these eligible physicians to report their annual patient revenue data and other necessary information to receive a payment equal to at least 2% of reported gross revenues from patient care.

To apply, click here.

For an HHS FAQ regarding who may be eligible for this distribution, click here.


PAI Releases Independent Physician Survey on High-Deductible Health Plans
A survey of independent physicians from the Physicians Advocacy Institute (PAI), conducted by NORC at the University of Chicago, shows the challenges in patient care caused by high-deductible health plans.

Before the COVID-19 pandemic hit the United States, patients’ large and growing share of out-of-pocket healthcare costs posed challenges for individuals, families, and independent physicians. When the epidemic became a pandemic, the federal government and certain insurance companies acted quickly to make coronavirus-related care widely accessible by ensuring it was affordable to everyone who needed it.

Key findings include:

  • 79 percent of physicians believe that high health insurance deductibles are a key driver of patients’ cost concerns.
  • 80 percent of physicians believe their patients often or sometimes refuse or delay care due to cost concerns.
  • More than half of physicians report that patient delay of care caused capacity or schedule issues for their practice.
  • 77 percent of providers say it takes more than a month to receive any payment.
  • Three out of four physicians say they do not have most of the information they need in order to have cost of care discussions with patients
  • Most physicians say their office staff spends more than 300 hours per year educating patients on their coverage.

More information on the study is available on PAI’s website.


Veterans Matters Podcasts
Check out MSSNY’s Veterans Matters podcast series on Veterans’ healthcare topics including PTSD in Returning Veterans, TBI in Returning Veterans, Substance Use in Veterans, Suicide in Veterans, The Special Mental Health Needs of Women Veterans and Military Culture: Everything Physicians Need to Know about Veterans as Patients.

Click here to listen to Part 1 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to Part 2 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to TBI in Returning Veterans with Dr. David Podwall.

Click here to listen to Substance Use Disorders with Dr. Thomas Madejski.

Click here to listen to Suicide in Veterans podcast with Dr. Jack McIntyre.

Click here to listen to The Special Mental Health Needs of Women Veterans with Dr. Malene Ingram, Colonel, U.S. Army Reserves and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.

Click here to listen to Military Culture: Everything Physicians Need to Know about Veterans as Patients with Retired Lieutenant Colonel, U.S. Army, Lance Allen Wang and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.


Third COVID-19 Study Released by FAIR Health
In April 2020, in the midst of the COVID-19 pandemic, healthcare professional services declined 68 percent in utilization and 48 percent in revenue based on total estimated in-network amounts compared to April 2019 nationally.

In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80 percent) and revenue (79 percent) in April 2020. These are among the findings of FAIR Health’s third COVID-19 study, Healthcare Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization



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June 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open Questions & Answers Surrounding the COVID-19 Pandemic
Registration is now open for MSSNY’s next webinar related to the COVID-19 pandemic.  Medical Matters: Questions & Answers Surrounding the COVID-19 Pandemic on Monday June 29th at 7:30am.  Faculty for this program is William Valenti, MD, Arthur Cooper, MD, Marcus Friedrich, MD and Elizabeth Dufort, MD.

Educational objectives:

  • Identify frequently asked questions surrounding the COVID-19 pandemic
  • Examine the dynamic circumstances encompassing COVID-19

Click here to register

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org or go to the MSSNY podcast site and listen to the COVID-19 related podcasts available at https://www.buzzsprout.com/51522.

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 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.


SBA Revised Paycheck Protection
This week, the U.S. Small Business Administration, in consultation with the U.S. Department of the Treasury, posted a revised, user-friendly Paycheck Protection Program loan forgiveness application implementing the PPP Flexibility Act of 2020. In addition to revising the full forgiveness application, the SBA also published a new “EZ” version of the forgiveness application applying to borrowers who:

  • Are self-employed and have no employees; OR
  • Did not reduce the salaries or wages of their employees by more than 25%, and did not reduce the number or hours of their employees; OR
  • Experienced reductions in business activity as a result of health directives related to COVID-19 and did not reduce the salaries or wages of their employees by more than 25%

“This is great news for small businesses,” said SBA Regional Administrator Steve Bulger, who oversees agency operations in the Atlantic and Mid-Atlantic regions. “The EZ application requires fewer calculations and less documentation, which makes the process much less intimidating. I’m sure this will go a long way toward improving access and helping us distribute the remaining PPP appropriations to support small business owners and their employees.”

Details regarding the applicability of these provisions are available in the instructions to the new EZ application form.  Both applications give borrowers the option of using the original 8-week covered period (if their loan was made before June 5, 2020) or an extended 24-week covered period.  These changes will result in a more efficient process and make it easier for businesses to realize full forgiveness of their PPP loan.

Click here to view the EZ Forgiveness Application.

Click here to view the Full Forgiveness Application.


MSSNY Helpline for Physicians Experiencing COVID-19 Related Stress 518-292-0140


Classifieds

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.

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MSSNY Statement on U.S. Supreme Court’s DACA Ruling

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For Immediate Release
June 19, 2020 

MSSNY Statement on U.S. Supreme Court’s DACA Ruling

Statement Attributable to:
Bonnie Litvack, MD
President, Medical Society of the State of New York

“Yesterday’s US Supreme Court decision will allow medical students and medical residents with Deferred Action for Childhood Arrivals (DACA) status to continue their education and training in the United States.

“The Medical Society of the State of New York (MSSNY) believes that this action by the Supreme Court will help medical schools and teaching hospitals to produce a diverse and culturally responsive health care workforce to meet the needs of under served populations, improve cultural awareness, and promote health equity.

“As this nation’s population grows and becomes much more diverse, it is crucial that the physician workforce reflect the changing demographics of the country to mitigate racial, ethnic, and socioeconomic health disparities.

“The Medical Society of the State of New York urges that Congress work towards a permanent resolution for the individuals here in this country under DACA.”

# # #

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


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

 

COVID-19 Update May 26, 2020

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


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

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

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

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


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

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

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

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


 


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


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

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

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

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

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

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

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

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

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

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

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

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

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


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

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


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

Four things to know:

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

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

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

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

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

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

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


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

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

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

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

COVID-19 Update May 22, 2020



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

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

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

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

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

The Helpline number is: 518-292-0140

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

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

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


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


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


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

The article’s authors are:

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

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

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

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


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

Five study findings:

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

(Becker’s Hospital Review May 20)


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

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


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

What you need to consider before re-opening?

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

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

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


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

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


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


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 21, 2020

 

Notes from Governor Cuomo’s COVID-19 Briefing

· Hospitalizations are down to 5,187

· Net change in hospitalizations and intubations are down.

· Amount of new hospitalizations: 246

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

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

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

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

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


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

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

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


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

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

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


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


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

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

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

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

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


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

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


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


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

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

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

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

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

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


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

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


Registration Now Open for Veterans Matters CME Webinar

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

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

Click here to register for the webinar

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

· Identify diagnostic criteria for PTSD

· Discuss medical and psychiatric comorbidities of military related PTSD

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

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

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

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

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


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

Frank Dowling, MD Re-elected Secretary of the Medical Society of the State of New York


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

 

For Immediate Release

Frank Dowling, MD Re-elected Secretary
of the Medical Society of the State of New York

MSSNY is the State’s Primary Professional Organization for Physicians

Westbury, NY—May 8, 2020— Frank Dowling, MD was re-elected Secretary of the Medical Society of the State of New York (MSSNY) on May 7.

A graduate of Harvard College, Dr. Dowling received both their medical degree and their residency training from SUNY at Stony Brook School of Medicine.  Since 2004, they have served as Clinical Associate Professor of Psychiatry at SUNY Stony Brook School of Medicine. Prior to that appointment, they were Clinical Assistant Professor from 1993-2004.

Board certified in both Psychiatry and Addiction Medicine, Dr. Dowling has an outpatient private practice in Garden City and Islandia that focuses on treating victims of trauma and disaster, emergency responders and healthcare professionals and their families. They also treat patients with co-occurring substance use and psychiatric disorders. In addition to their private practice, Dr. Dowling serves as Medical Advisor to the Police Organization Providing Peer Assistance (POPPA), an independent, confidential, non-departmental voluntary assistance program for the NYPD.

An active member of MSSNY, Dr. Dowling has served as Commissioner for Science and Public Health, co-chair of the Addiction and Psychiatric Medicine Committee, chair of the Task Force on Alcohol and Health and vice chair of the Committee on Bioterror and Emergency Preparedness. In addition, they serve on the Advisory Committee and as faculty for the Veteran’s Mental Health Training Initiative, a collaborative effort by MSSNY, NYSPA and NASW-NY to train NY practitioners to assist warriors and veterans with post-traumatic stress and TBI.  

When the ISTOP law was under consideration in Albany, Dr. Dowling—working with MSSNY staff—was instrumental in helping a MSSNY led coalition obtain the right for a designee to assist a physician with mandated PMP lookups.  They currently serve on the AMA’s LGBTQ Advisory Committee and Opioid Task Force and on MSSNY’s Committee on Physician Wellness and Resilience. They previously worked with the MSSNY/OASAS Planning Committee that developed a 3 hour CME program on pain management and opioid abuse, which is available free to MSSNY members to meet the New York State mandated CME requirement.

As a member of the New York Delegation to the American Medical Association (AMA), Dr. Dowling has collaborated with others to update AMA policies in several public health areas, including psychiatric and substance use disorders, access to care issues, preservation pf medically necessary care for patients with chronic pain, LGBTQ health issues and societal and healthcare inequities.

Dr. Dowling received the American Psychiatric Association’s Bruno Limo Award in 2003 for “outstanding contributions to the care and understanding of victims of disaster” for their work with emergency services personnel after the World Trade Center attacks in 2001. In addition, Dr. Dowling received a Long Island Healthcare Heroes Award from Long Island Business News for their work in support of veterans and others with chronic psychiatric illnesses. In 2015, they were awarded MSSNY’s Charles D. Sherman Award for their support of medical students.  They are a co-author of Disaster Psychiatry: Readiness, Evaluation, and Treatment, a textbook intended to prepare psychiatrists and other mental health professionals to respond to disasters and mass casualty events.

Dr. Dowling lives in Oakdale, NY with their spouse Theresa, children Frank, Finn and Charlie Robin.

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

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

 

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COVID-19 Update May 8, 2020


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Colleagues:

After literal and figurative March and April showers, we are ready for those May flowers! We have been living in what should be the realm of science fiction. This global pandemic has hit our house of medicine hard physically, emotionally, and financially. My thoughts and prayers are with all of you. I wish those that are sick a speedy recovery and those that have suffered the loss of a loved one my heartfelt sympathy.

During these trying times the ethics, courage, strength, ingenuity, and resilience of the physicians of New York have not waivered nor have the efforts of our medical society. We have spoken out about everything from needed equipment, needed protections both physical and legal to needed funding.  We have come together as a profession and rapidly mobilized, disseminated needed information, and helped our practices adapt to the current reality.  This has been in no small part due to the strong leadership and tireless efforts on the part of Dr. Art Fougner whose inspiring quotes and stories have been a light in the darkness.

As I humbly take the torch from Art, the seeds of change are beginning to take hold.  The talk is of re-imagining healthcare in our state. It is time to change– medical malpractice reform, an end to bureaucratic paperwork and hassles and a time for collective negotiation for physicians.  As we start this new decade it is time to end to health disparities and prioritize healthy equity. Let us imagine New York with a new distinction as the healthiest place to live and to practice medicine.

May the roses bloom in our gardens this year!  Happy Mother’s Day to all.

Bonnie Litvack, MD
MSSNY President


Governor Cuomo’s COVID-19 Briefing Notes for Today

GENERAL:
-Hospitalizations down to 8,196.
– Intubations down (-330).
– New hospitalizations flat (604), have been flat for a few days.
– IHME Projection model show cases decreasing over time, but still expects a
few hundred in June.
– Deaths since May 7: 216. 171 in hospitals, 45 in nursing homes

AIRPORTS:
– 3 Million Europeans flew into NY from December to March, none were screened
for the virus.
– Reiterated argument that an outbreak in one nation can be assumed to exist
in other regions as well.

UPDATES ON COVID-19:
– There are doubts of immunity despite the existence of antibodies, though
information continues to be updated.
– 73 reported cases of children with symptoms similar to Kawasaki disease.
– On Thursday, a 5-year old boy passed away from COVID-related
complications and other cases are being investigated as well.
– Gov urged parents to seek care if their child has a prolonged fever,
difficulty feeding, severe abdominal pain/diarrhea/vomiting, change in skin
color (pale, patchy, or blue), trouble breathing, chest pain, decreased amount
or frequency of urine, lethargy, irritability, or confusion.
– Infection rate is higher in minorities, affecting Hispanic/Latinos and
African-Americans the most.
– Have asked hospitals to provide information on new cases as a way
to better target state efforts.
– Majority of new cases are coming from minority communities. Gov says
this inequity will be addressed immediately, with new information to be
released in a couple of days.

CHILD VICTIMS ACT:
– Because of reduction in court services, window will be extended an additional
five months (Jan. 14).

PERSONAL OPINION:
– Gov feels we are ahead of the virus and “in control of our own destiny.”
Attributes success to distancing protocols. Again, urged for responsible
reopenings to ensure numbers continue to go down.

Q&A:

REOPENING:
– Gov says “nicest surprise” when reopening would be acting responsibly.
Reiterated a focus on factual data to best determine reopening and the actions
to be taken. Doesn’t believe downstate numbers will change enough in the next
few days to reopen.
– Gov wants to avoid any potential deaths from “responding to politics.”

UNEMPLOYMENT:
– On a remark that many jobs were lost, Gov, claimed to understand the
struggles many New Yorkers are facing now. “We have to get through,” he said. Gov
reiterated previous statement that health is most important.
– Said we will “figure out” the economics once the situation becomes more
manageable.
– DeRosa urged applicants to take matters online and only use the phone system
if there is a lack of access to internet. Granted $6.8 billion to 1.6 million
people in the last seven weeks.
– DeRosa reiterated that upgrades to the system were not necessary prior to
the outbreak, as well as the point that NYS has done more than other states to
help the unemployed.
– “Unemployment forfeit” days: DeRosa said this has come to their attention in
the last week and the state is working to fix the issue.

TESTING:

– Antibody testing is used as an indicator of infection rates. No action is
being taken after testing, Gov says data is used for statistical purposes.
– DOH Commissioner Zucker: Working with hospitals to develop tests and confirm quality of tests. Also added that NYS’s antibody test stands six standard deviations out, making it more accurate.


SMALL BUSINESS LOANS FOR PHYSICIANS

PLEASE TAKE THE NEW SURVEY!

In late April, Congress approved an additional $310 billion dollars for the Paycheck Protection forgivable loan Program (PPP) to assist small businesses, including physician practices. To date, the program has approved assistance to nearly 250,000 New York businesses in two different rounds of application periods.

The Congressional package also provided $75 billion more for the CARES Act Health Provider Relief Pool, to assist hospitals and physicians. This is in addition to $30 billion dedicated to physicians and hospitals, in early April, based on 2019 Medicare payments, and $20 billion was just made available to physicians and hospitals based on 2018 total patient revenue.

As with our first survey, MSSNY wants to gather data to determine how much New York physicians are benefiting from these new resources, to better guide our advocacy for further stimulus bills. Please help us evaluate this by taking a few minutes to fill out and submit the following Survey Monkey questionnaire.

Please take the survey here


COVID-19 Map – Johns Hopkins Coronavirus Resource Center


HHS Extends Attestation Time Period for CARES Act Relief Pool
The US Department of Health and Human Services (HHS) has extended the deadline for physicians and other healthcare providers to attest to receipt of payments from the CARES Act Provider Relief Fund and accept the Terms and Conditions. Physicians will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. The AMA gives the example that, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions. For physicians, this is referring to payments from the $30 billion in Round 1 from this fund and $20 billion in Round 2 from this CARES Act relief fund (not the PPP).


More Details Regarding Empire BCBS Advance Physician Payment Program
As reported in the MSSNY e-news and Crain’s Health Pulse earlier this week, Empire BCBS (Anthem) is initiating a program to provide advance care payments to many of its network independent primary care and specialty care physician practices in New York State and across the country.  The goal of the program is to help these practices through this difficult period to remain available for patient care as we begin to transition back to a more regular schedule of patient care visits.  Advance payments would be paid back over a period of time.  Empire has begun outreach to physician groups that meet the criteria to be eligible for this program.  Further questions can be directed to Empire’s provider relations department (https://www.empireblue.com/provider/)


Malaria Drug Shows No Benefit in New Coronavirus Study
A new study finds no evidence of benefit from a malaria drug widely promoted as a treatment for coronavirus infection. Hydroxychloroquine did not lower the risk of dying or needing a breathing tube in a comparison that involved nearly 1,400 patients treated at Columbia University in New York, researchers reported Thursday in the New England Journal of Medicine.

Although the study is observational rather than a rigorous experiment, it gives valuable information for a decision that hundreds of thousands of COVID-19 patients have already had to make without clear evidence about the drug’s risks and benefits, some journal editors and other doctors wrote in an editorial. “It is disappointing that several months into the pandemic, we do not yet have results” from any strict tests of the drug, they wrote. Still, the new study “suggests that this treatment is not a panacea.”

President Donald Trump repeatedly urged the use of hydroxychloroquine, which is used now for lupus and rheumatoid arthritis. It has potentially serious side effects, including altering the heartbeat in a way that could lead to sudden death.

The U.S. Food and Drug Administration has warned against its use for coronavirus infections except in formal studies. Doctors at Columbia tracked how 565 patients who did not get the drug fared compared to 811 others who received hydroxychloroquine with or without the antibiotic azithromycin, a combo Trump also has touted.

In all, 180 patients required breathing tubes and 232 died, and the drug did not seem to affect the odds of either. Patients given hydroxychloroquine were generally sicker than the others, but widely accepted methods were used to take that into account and still no benefit was seen for the drug.

Its use started within two days of admission for nearly all who received it. Some critics of earlier studies have said treatment may have started too late to do any good.

The study was funded by the National Institutes of Health, which has launched two of its own trials comparing hydroxychloroquine to placebo — the gold standard for establishing safety and effectiveness.

One study involves COVID-19 patients, and the other aims to see whether the drug can help prevent infections in health care workers exposed to the virus. Both got started in April. (Modern Healthcare, May 8)


This Week’s Legislative Podcast


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Hospitals and Doctors: Need $60 Billion in Direct Funding
New York state said Thursday that it needs at least an additional $60 billion in direct federal funding along with millions of dollars more from Medicaid and FEMA formula changes in the next coronavirus aid package being crafted in Congress.

New York’s massive request, which is part of the National Governors Association’s bid for $500 billion for all states and territories, would be spread over three fiscal years, unrestricted and could be used for revenue shortfalls, according to the association.

New York hospitals need additional direct federal funding, targeted to “hot spots” such as New York state, to meet the high cost of treating patients with COVID-19 amid huge revenue losses, the Healthcare Association of New York State said.

A top priority is to bolster New York State’s finances so that it does not have to cut state Medicaid funding by as much as 20% to 30%.The association seeks changes in formulas used to distribute health care funding, including tweaks to Medicare and Medicaid payment systems, that could be worth billions of dollars.

Meanwhile, doctors with private practices need greater access to small business loans and medical school loan debts should be forgiven for young physicians and residents, especially for those who have pitched in to treat the infected patients, said the Medical Society of the State of New York. (Newsday, Updated May 7)


Symptomatic Spread of SARS-CoV-2 in a Nursing Home
Neil M. Ampel, MD reviewing Arons MM et al. N Engl J Med 2020 Apr 24 Gandhi M et al. N Engl J Med 2020 Apr 24

More than half the residents who tested positive were asymptomatic at testing.

Nursing homes are now recognized as niduses of infection with SARS-CoV-2. On February 29, 2020, because of known COVID-19 in their area, a nursing home in King County, Washington, instituted enhanced infection control measures and soon identified a resident and staff member who were infected. This prompted a larger study culminating in two point-prevalence surveys of the residents. Full-time staff were also tested.

On the initial screen of 76 residents, 23 (30%) were positive on nasopharyngeal swab for SARS-CoV-2. Among those testing positive, 12 (52%) were asymptomatic. One week later, 49 who were initially negative were retested. Of these, 24 (49%) were positive and 15 (63%) were without symptoms. Of the 27 residents testing positive without symptoms, 24 (89%) later developed symptoms. Among 138 full-time staff, 26 (19%) tested positive. The doubling time of infection was 3.5 days. Fifteen residents (26%) died. There was no difference in the viral load of SARS-CoV-2 in samples from those with symptoms and those without symptoms. Viable virus was isolated from 6 days before to 9 days after symptoms developed.

COMMENT

This paper has multiple important takeaways. First, infection can spread rapidly and efficiently in a nursing home environment. Second, infection control methods that focus only on those with symptoms are inadequate, since there is likely ongoing transmission from patients without symptoms as well as from staff. As the editorialists point out, this asymptomatic transmission distinguishes SARS-CoV-2 from the related SARS-CoV-1. Last, early and repeated viral testing of residents and staff, particularly those without symptoms, is the key to control. CITATION(S):

Arons MM et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med 2020 Apr 24; [e-pub]. (https://doi.org/10.1056/NEJMoa2008457)

Gandhi M et al. Asymptomatic transmission, the Achilles’ heel of current strategies to control Covid-19. N Engl J Med 2020 Apr 24; [e-pub].

 (https://doi.org/10.1056/NEJMe2009758)


May 20, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open Mental Health and COVID-19 for Health Professionals

Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals.  Just like we need to take extra precautions to protect ourselves from the risk of being infected by COVID-19, we also need to be concerned about psychological risks for health professionals.  Faculty for this program is Craig Katz, MD.

Registration is now open for this webinar

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.

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.


Health Care Workers Dealing With ‘Medical Burnout’ Amid Exhausting Pandemic
The pandemic has taken its toll on health care workers, leading many to experience medical burnout. Northwell cardiologist Dr. Evelina Grayver, who works in a COVID-19 ICU, says the trauma and stress can take a toll on medical staff. She says burnout has always- been a bullet to dodge, but the coronavirus has made it even tougher.

“At a certain point, we allow ourselves to be human and allow ourselves to feel the fear and the helplessness and the sense of desperation,” says Grayver. “Because if we don’t deal with it head-on, we are going into an era of anxiety depression, insomnia, post-traumatic stress disorder.”

Northwell Health has set up several resources for its medical providers who are feeling burned out, including outreach programs, counseling and setting up tranquility spaces where staff can take a few moments to regroup.

“We have ramped up our support services because everybody knows that people are under an enormous amount of stress and anxiety,” says Northwell Health Senior Vice President Dr. David Battinelli.

Along With support from clinicians, Northwell Health psychiatrist and Director of CPH, Dr. Jeff Selzer. says the signs of support from the community and sense of teamwork is keeping health care professionals emotionally strong.

“Strong teams, the sense of peer support, the sense of mission and how important it is for all of us to express gratitude to health care workers,” says Selzer.


Veterans Matters: Substance Use Disorder in Veterans Podcast
Check out MSSNY’s Veterans Matters newest podcast entitled Substance Use Disorders (SUDs) in Veterans. Dr. Thomas Madejski, Immediate Past President of MSSNY, discusses how to identify and diagnose substance use in veterans. Click here to listen.


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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.orgThank you. (WILKS)

Contact Tracing Opportunities in NYS

Contact Tracing Opportunities in NYS

The aim of this initiative will be to call every person diagnosed with COVID-19, establish all contacts of this person, and proceed to call and maintain ongoing communication with every contact. In addition, the team will support the isolation and quarantine of individuals, as appropriate in cooperation with the Local Health Department. This includes virtual needs checks and referral to community resources as needed. This contact tracing initiative is in tandem with statewide-wide efforts to increase testing, improve communication and knowledge of effective strategies to reduce transmission, and implementation of isolation and quarantine. This will fortify efforts to control the pandemic in NYS.

New York State plans to hire a team of 6,400 to 17,000 staff statewide, depending on the projected number of COVID-19 cases, to support the NYS Department of Health (NYSDOH) and Local Health Departments (LHDs) to perform contact tracing in communities across NYS. To meet the scale and scope of this nation-leading program, Bloomberg Philanthropies, Vital Strategies: Resolve to Save Lives and the Johns Hopkins Bloomberg School of Public Health will support building the team through a three-step process: recruitment, interviewing and training.

Our first goal is to help the state identify and recruit a robust Contact Tracing team to be a part of this ambitious and urgent effort. To be considered, candidates must be a New York State resident 18 years of age or older; meet the position description requirement; go through an interview process; and complete a training and certification program.

New York State is looking to immediately fill the following roles:

  • Contact Tracers: reach out to the contacts of anyone diagnosed with COVID-19 to assess symptoms, ensure compliance with quarantine and determine social support needs.
  • Team Supervisors:  lead a team of 20 Contact Tracers, and one Community Support Specialist who are working remotely using digital tools.
  • Community Support Specialists: work with the team and the local health departments to address the physical/mental health, and social/human service needs of those contacted, especially those who are under isolation or quarantine.

Click here if you or someone you know in New York State is interested in applying to be a part of the Contact Tracing team.

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