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Colleagues:

Here’s to 2021!

Never before have I so looked forward to New Year’s Eve.  Closing the chapter on 2020 will be a huge relief.   The drop of the ball in Times Square will signify the end of a year of darkness and the beginning of a New Year where we will cherish the family gathering, the coffee with colleagues and the dinners with friends that we once took for granted.

But before we get there, these last few weeks of 2020 have been quite busy so here is the update:

COVID-19 Vaccine Information:
Some of you have been lucky enough to be in the first group vaccinated within NYS (approximately 40,000 people as of yesterday.) However, most of you are still awaiting vaccination.  Those of you providing in person care to patients are in the first vaccination group (1a) and will get vaccinated as soon as the supply is available.

NYS is expecting approximately 500,000 – 600,000 doses of vaccine in the next couple of weeks. Sit tight, you have not been overlooked but remember there are about 2 million people in the 1a category.

Many of you have contacted the society with questions about where, when, and how you and your office staff get vaccinated. For doctors that are on a medical staff, employed or not, you will receive your vaccination from the hospital.  Priority is to be given based on exposure risk and personal health risk factors, NOT based on employment status. 

MSSNY has communicated with top officials at the DOH and the Governor’s office in charge of vaccine distribution concerning the questions that we do not yet have answers for:  Where do doctors not affiliated with a medical staff get vaccinated? How, when, and where do the office staff of community doctors get vaccinated?  If a community-based physician practice has applied to be a vaccine distributor, will they be getting vaccine now for themselves and their other 1a staff? 

We hope to have answers to these questions shortly and when we do, we will post them to our website, email them and post them on social media so stay tuned and know that we care and are listening.

The Year End Federal Spending Package
As noted in several articles below, late Monday, Congress passed a comprehensive spending package that would fund the federal government through 2021. The end-of-year package contains some positive measures for physicians, including a new round of funding for the Paycheck Protection Program and provisions to ensure the continued ability to deduct certain essential business expenses for those who receive these loans, and important provisions to help reduce the very steep impending 2021 Medicare cuts.

However, the congressional bill also included a surprise medical billing dispute resolution component. MSSNY has long supported efforts to add federal protections to help prevent patients from receiving unexpected bills. However, despite the valiant efforts by the collective house of medicine (with a substantial New York component) the final federal version is greatly tilted in favor of health insurance companies and is inconsistent with New York’s far more balanced approach to addressing surprise medical bills for patients insured under state-regulated plans.

MSSNY has communicated to our NYS Congressional delegation our concerns that health insurers will take advantage to dramatically cut payments for their network participating physicians at a time when community physician practices are already at the edge of extinction due to a variety of factors and in a year when physicians have put their health and their families’ health at risk to ensure their patients receive the care they need.

Further complicating the picture is the President now threatening to veto the entire package because he believes the $600 direct payments to most Americans called for in the COVID-19 relief package is insufficient.  As if 2020 was not already enough of a roller coaster. Stay tuned for further details.

A very Merry Christmas to all that celebrate.  May your stocking be filled with vaccine dates for you and your staff.   Here’s to a joyful, healthy, and happy 2021!

Bonnie Litvack, MD
MSSNY President

Year End COVID-19 Package: Congressional Hits and Misses
“The end-of-year package agreed to by Congress contains some positive measures, including a new round of funding for the Paycheck Protection Program that assisted many community-based physician practices on the verge of closure earlier this year due to historic drops in patient visits.

Also important are provisions to ensure the continued ability to deduct certain essential business expenses for those who receive these loans, and provisions to help reduce though not eliminate the very steep Medicare cuts countless physicians will face for delivering health care services to their patients in 2021.

“Regarding the surprise medical billing dispute resolution component of this package, we have long supported efforts to add additional federal protections to help prevent patients from receiving these unexpected bills.  However, while the final version contains slight improvements from earlier versions, it does not address our fundamental concern we have repeatedly raised that the dispute resolution mechanism to resolve insurer-physician differences is greatly tilted in favor of health insurance companies.  Health insurers will be permitted to present data as to the appropriate cost of the health care services while physicians for all practical purposes will not be permitted to offer their own data.

“This is grossly unfair, and inconsistent with New York’s far more balanced approach to addressing surprise medical bills for patients insured under state-regulated plans. With this new, even greater leverage, we are very concerned that health insurers will take advantage to dramatically cut payments for their network participating physicians at a time when community physician practices are already at the edge of extinction due to a variety of factors.  More forced employment arrangements are inevitable, furthering reducing competition in health care delivery and driving up costs.

“We thank the efforts of the many members of the New York Congressional Delegation who have worked diligently to improve many of these provisions from earlier versions. However, the bottom line remains that this year-end Congressional package does as much harm as good to our front-line physicians who have put their health and their families’ health at risk this year to ensure their patients receive the care they need.”

Congressional Package Helps to Prevent or Reduce Medicare Cuts
As a result of an advocacy effort across medicine including from the AMA and MSSNY, the year-end Congressional package – if signed into law – would take a number of steps to help prevent and/or reduce what would have been enormous cuts to Medicare payments to many physician specialties.  Specifically, it would:

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

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

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

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

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

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

It would also provide for an additional $20 billion for EIDL Advance Grants. Small businesses and nonprofits in low-income communities are eligible to receive $10,000 grants, previous recipients are also eligible to receive the full $10,000 if their award was less in the first round of grants.

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

Congress Passes Measure to Address Surprise Medical Bills – Improvements Over Earlier Version but Still Titled in Favor of Insurance Companies
As has been widely reported, among the provisions contained in the year-end Congressional COVID relief package is a comprehensive measure to establish a federal standard for addressing surprise out-of-network medical bills.

If signed into law, based upon initial review and conversations with Congressional staff and the AMA, the new federal surprise bill provisions will apply to patients insured by ERISA plans, and New York’s approach would continue to be followed for out of network claims from patients insured in state-regulated plans.  There are similarities in this federal standard to New York’s well-regarded approach, but also significant differences for which MSSNY expressed serious concerns.

Here is a comprehensive summary of these provisions from the AMA:

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

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

The federal IDR process is similar to New York’s mechanism in that the IDR entity would select which side – the physician’s or the insurer’s suggested payment – will prevail.  Physicians may batch similar services in one proceeding when claims are from the same payer, but the bill permits only 30 days of batching.  The IDR entity would consider numerous sources of information brought by either party, such as the provider’s training and experience, patient acuity, and the complexity of furnishing the item or service.

However, in a significant departure from New York, neither provider charges nor usual and customary charges may be considered by the IDR entity, and the IDR entity is required to consider the market-based median in-network rate.  This a major deficiency that MSSNY has highlighted in its advocacy efforts over the last year on this issue, and was noted by MSSNY President Dr. Bonnie Litvack in MSSNY’s press release:

“it does not address our fundamental concern we have repeatedly raised that the dispute resolution mechanism to resolve insurer-physician differences is greatly tilted in favor of health insurance companies.  Health insurers will be permitted to present data as to the appropriate cost of the health care services while physicians for all practical purposes will not be permitted to offer their own data.”

There were improvements in this version over a version announced a week ago including a prohibition of the consideration of Medicare or Medicaid data by the IDR, as well as elimination of provisions that would have set up cumbersome processes to require patients to receive a detailed description of services rendered within 15 days of the date of service and required a patient to be billed within 90 days of the date of service even if the claims had not been fully adjudicated by the health insurer.

The Congressional provisions also address “voluntary” out of network services by providing that non-participating providers at participating facilities may not bill a patient more than the cost-sharing requirements or balance bill the patient unless the notice and consent requirements are met. These consent requirements include providing the patient with written notice and consent 72 hours in advance of appointment; providing a good faith estimate of the costs of the services; and providing the patient with a list of in-network providers at the facility and information regarding medical care management, such as prior authorization.  At participating facilities, the notice and consent exception does not apply to out-of-network providers of radiology, pathology, emergency, anesthesiology, diagnostic and neonatal services; assistant surgeons, hospitalists, intensivists, and providers offering services when no other in-network provider is available.

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

Tribute to MSSNY’s Long Time Tech Genius, Brian Petrucco
Our MSSNY family was very saddened by the unexpected passing of our long-time technical support staffer Brian Petrucco on December 13.  Brian was an unsung hero to our collective MSSNY efforts – anyone who has run or worked in an office can appreciate the absolutely indispensable role that a technical support person plays in our day to day lives.

Brian not only provided this support for the MSSNY Albany office, but he regularly traveled to the various MSSNY offices across the State to ensure our systems were working properly so we could better carry out our mission to provide needed services to our member physicians.

Brian genuinely loved what he did and was always happy to provide needed answers to various technical questions that the staff posed to him, and like an accomplished chef (Brian was also a very good cook!), he enjoyed providing the fine details of how he fixed a particular technical glitch.

Like many MSSNY staffers, his contributions grew significantly over the years, and he was often in the office over many hours over a weekend to ensure that our interconnected computer systems were functioning properly.  As the pandemic forced much of MSSNY’s staff to work remotely, he ably helped to ensure that our transition from in-person to virtual was seamless, and unnoticeable to our physician members.

Brian and his wife Tanya had a great love of exotic travel, including getting married on a glacier in Alaska.

Brian leaves a legacy of a tremendous amount of “behind the scenes” work to assist the physicians of New York and is someone that will be extremely hard to replace.

Rest in peace, Brian.

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

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

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

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

Pfizer to Deliver 70 Million Doses by June 30
The Trump administration has reached a deal with Pfizer to buy an additional 100 million doses of the company’s COVID-19 vaccine, effectively doubling the federal government’s supply from Pfizer.

The pharmaceutical giant is to deliver 70 million doses by June 30, 2021 and complete the rest of the order by the end of the following month, according to a statement released today by the Department of Health and Human Services. Pfizer said the U.S. government has agreed to pay $1.95 billion for the additional doses of its vaccine, which was developed jointly with BioNTech. (NPR, Dec 23)

MSSNY President Interviewed Re COVID-19 Impact on Healthcare Workers
USA Today (12/22) Network New York interviewed MSSNY President Dr. Bonnie Litvack, a Westchester County radiologist, about the COVID-19 pandemic and the impact on healthcare workers. Dr. Litvack said, “A lot of physicians and other health care workers have sort of borne the brunt of the pandemic. … It’s something that has affected physicians like it has most New Yorkers, in many ways, in terms of physical pain and mentally and the stress of increased patient caseloads and in terms of financial stress to keep their doors open.”

Summary: Physicians Foundation 2020 Survey of America’s Physicians
I want to start by thanking you for your support and participation in The Physicians Foundation Three-Part 2020 Survey of America’s Physicians. Throughout 2020, we have had multiple touch points with physicians regarding their perspective on the current state of the medical profession; how practice patterns, career plans and attitudes are evolving; their attitudes on navigating the current political landscape; and how COVID-19 is impacting their practices, patients, and their own wellbeing.

As the health care landscape evolves amid COVID-19, America’s physicians are faced with countless obstacles when it comes to delivering high-quality, cost-efficient care. As the foundation of our health care system, physicians’ voices must be heard.

For ease, I have attached in this email and linked here, an executive summary of all three surveys. We hope that you will share these to ensure physician insights are being included in all conversations about health care reform in America.

Robert Seligson
Chief Executive Officer
The Physicians Foundation

Note: MSSNY is a charter member of The Physician Foundation.

Dr. Fauci: Fast-Spreading COVID-19 Variant in U.K. Is Probably Already in U.S.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told CNN fast-spreading COVID-19 variant in U.K. is probably already in the U.S.

(12/22). Dr. Fauci said imposing a U.K. travel ban would be a “rather dramatic step” for the U.S., though more than 40 other countries have already closed their doors to Britain, reports The New York Times. Pfizer and Moderna are both testing their vaccines against the new variant, according to CNN. Pfizer and Moderna are testing their COVID-19 vaccines against a mutated strain of the coronavirus that first appeared in England, CNN reported.

Moderna said: “We expect that the Moderna vaccine-induced immunity would be protective against the variants recently described in the U.K.; we will be performing additional tests in the coming weeks.”

Pfizer said it is generating data on how well blood samples from immunized people are able to neutralize the new strain, CNN reported.

The strain hasn’t been identified in the U.S., but the CDC said Dec. 22 that “given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected.”

COVID-19 Patients with Neurological Problems Have A Higher Mortality Risk Individuals hospitalized with Covid-19 and neurological problems, including stroke and confusion, have a higher risk of dying than other COVID patients, according to a new study by researchers at Montefiore Health System and Albert Einstein College of Medicine. Montefiore and Einstein said in announcing the study that its findings have the potential to identify and focus treatment efforts on the individuals most at risk. The study was published Friday afternoon in Neurology, the medical journal of the American Academy of Neurology.

The study examined data from 4,711 COVID-19 patients who were admitted to Montefiore during the six-week period between March 1 and April 16. Of those patients, 581—or 12%—had neurological problems serious enough to warrant brain imaging.

Among patients who underwent brain imaging, 55 were diagnosed with stroke and 258 exhibited confusion or altered thinking ability, Montefiore and Einstein said. Individuals with stroke were twice as likely to die—the group had 49% mortality compared with a matched control group, which had 24% mortality. More than half of the stroke patients in the study did not have hypertension or other underlying risk factors for stroke.

People with confusion had a 40% mortality rate compared with 33% for their matched control, which was also statistically significant, the researchers found. “This study is the first to show that the presence of neurological symptoms, particularly stroke and confused or altered thinking, may indicate a more serious course of illness, even when pulmonary problems aren’t severe,” said Dr. David Altschul, chief of the division of neurovascular surgery at Einstein and Montefiore, and associate professor in the Department of Neurological Surgery and of radiology at Einstein, in a statement.

“Hospitals can use this knowledge to prioritize treatment and, hopefully, save more lives during this pandemic,” Altschul, who is also surgical director of the Montefiore Comprehensive Center for Stroke Care and the study’s co-author, added. Montefiore and Einstein said there were no funding sources for the study. (Crain’s Pulse, Dec. 20)

CDC: Next Priorities for Vaccine: Ages 75+, Front-Line Essential Workers
People age 75 and older and front-line essential workers should be the next priority groups to receive COVID-19 vaccines, the CDC’s Advisory Committee on Immunization Practices put forth Dec. 20.

The committee vote establishes their recommendation for vaccine distribution in the remainder of phase 1 — phases 1b and 1c.

• Healthcare personnel and long-term care facility residents made up phase 1a.
• Phase 1b applies to adults age 75 and older and front-line workers essential to societal functions, such as teachers, firefighters, prison officers and police.
• Phase 1c expands access to adults 65 and older, people with underlying medical conditions that put them at higher risk of severe illness from COVID-19, and other essential workers including those in food service, construction, waste, and trucking.

The next step is for CDC Director Robert Redfield, MD, to accept the committee’s recommendations. They would then be published in the CDC’s “Morbidity and Mortality Weekly” later this week and shared as official CDC guidance.

Stanford Medicine residents protested after they were not included in the vaccine distribution plan. (Photo: Becker’s Hospital Review, Dec. 22)

Stanford Medicine Residents Protest Being Left Out of The Vaccine Allocation
“We take complete responsibility for the errors in the execution of our vaccine distribution plan,” said Lisa Kim, a Stanford Medicine spokesperson. “Our intent was to develop an ethical and equitable process for distribution of the vaccine.

We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine.”

An algorithm chose who would be the first 5,000 in line. The residents said they were told they were at a disadvantage because they did not have an assigned “location” to plug into the calculation and because they are young, according to an email sent by a chief resident to his peers. Stanford Medicine has about 1,300 across all disciplines.

Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases. The algorithm has been corrected. The university quickly revised its vaccine distribution plan to prioritize health workers including residents and fellows. Stanford also created a new committee that would consider the interests of all stakeholders.

New Member Benefit: MSSNY’s Partner with Premier Group (Essensa) Purchasing
We are excited to announce registration information for our new group purchasing partnership between MSSNY and Premier.

We expect this new partnership to result in lower operating costs and improved access to supplies and products for MSSNY members who sign on to purchase through Premier negotiated agreements.

Sign up today and begin taking advantage of the value and savings Premier brings to the table for MSSNY members:  

• A leading healthcare improvement company dedicated to better care and outcomes at lower costs
• Nearly 30 years of experience in the alternate site group purchasing organization space
• A portfolio featuring more than 900 suppliers and 2,000 products and services ranging from pharmaceuticals to medical/surgical supplies to business solutions and more (including numerous PPE solutions!)
• A distributor neutral approach, meaning MSSNY members can continue using existing distributors while accessing Premier-negotiated pricing
• A commitment to hands-on service to ensure MSSNY members are receiving the best value for all their purchasing needs

Click the links below to access specifics on the program:

• Continuum of Care Overview: High level overview of the Premier program and the value it provides
• GPO FAQ: Questions and answers to further introduce Premier and explain the program
• Physician Practices information sheet: Provides value proposition of the Premier program, followed by specific suppliers and contracts members will be able to access, broken down by category
• What to Expect: Step by step onboarding guide for members

Questions? Email MSSNY-Premier@premierinc.com or call (888) 258-3273.

Register now!

JAMA Original Investigation Dec 22, 2020: Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic

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

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

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

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

Educational Objectives:

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

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

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

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