I hear empty trains a’comin
They’re rollin round the bend
And I ain’t seen a steakhouse
Since I don’t know when.
I’m stuck in COVID prison
And time keeps draggin’ on
But the news scroll keeps a rollin’
On and on and on.
(Apologies to Johnny Cash)
John Donne famously wrote “No man is an island unto himself.” Mr. Donne clearly had not experienced social distancing. Humans are by nature social beings. This trait enabled our distant ancestors to obtain food while avoid being food. We enjoy going to parties, to shows, to restaurants, to sporting events, and yes, even to Grand Rounds. The current pandemic has stolen that all from us. We can no longer attend weddings. We cannot hold funerals for our dead. We can no longer congregate in parks nor play pick-up basketball. Tech can provide some relief, some illusion of sociability but that small comfort is both illusory and fleeting.
In the days when medicine was far more art than science, the most powerful weapon in that black bag was the therapeutic touch. Attending at the bedside to comfort the sick and dying was integral to the calling. Without curative therapies, all physicians really had to offer were moments of humanity. The virus has even deprived us of these moments. Surviving the virus, we have lost much of our humanity.
Now, we may be over the worst. Some curves have flattened. Others are on the downslope. Early reports of treatments are lighting up the financial markets. Our leaders are talking about and planning the recovery phase – society’s parole. This too will no doubt have its glitches, but we should be optimistic and begin to plan. We should realize that nothing will go back to the way things were and, in fact, many should never go back to the way things were. Hearings will be held. Books will be written. Talking heads will drone on.
Let me suggest one principle to help us find our way. We have flattened the curve. We must work to flatten the bureaucracy. Let’s do it together.
Let’s all find those Blue Skies.
Visit covid19tracker.health.ny.gov to See the Latest NY Data
New York reported 12,822 statewide deaths as of Friday morning, including 630 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Thursday, the state reported 8,893 deaths of New York City residents. As of Thursday, 17,035 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here.
Gov. Cuomo: What You Need to Know
- “New York on PAUSE” will be extended until May 15th. This action is taken in consultation with other regional states. Non-essential workers must continue to stay home and social distancing rules remain in place. We will re-evaluate after this additional closure period. I know this is hard, but we must stay the course.
- Cuomo outlined a blueprint to get New Yorkers back to work and ease social isolation without triggering a renewed spread of the virus.The blueprint operates under one overarching principle — do no harm. As part of the strategy to reopen, we will strengthen the healthcare system; use diagnostic testing, antibody testing and contact tracing to limit the spread of the virus; and implement a phased return to a “new normal” — which will include evaluating risk by industry, starting with the most essential businesses that present the lowest risk, rethinking the workplace to make it safer, and implementing protocols for response if a worker develops COVID-19 symptoms. Real the full plan here.
- New Yorkers MUST wear masks or face coverings on public transportation systems and while taking private transportation or riding in for-hire vehicles.Additionally, all operators of public systems, private carriers and for-hire vehicles must always wear a mask or face covering while working. These directives expand on the Executive Order announced yesterday requiring everyone in New York to wear a mask or a face covering when out in public and in situations where social distancing cannot be maintained. The order will go into effect on TODAY at 8 PM.
- The number of hospitalizations continue to fall but we are not out of the woods yet. Yesterday, total hospitalizations fell to 17,735, the third straight day of declines. However, infections remain high and the virus is still spreading. Visit health.ny.gov to see the latest data.
For more information, click here.
Urge the NY Congressional Delegation to Support Additional Stimulus to Assist Physician Practices
All physicians are urged to contact Senators Schumer and Gillibrand, as well as their respective US Representative, to urge that they fight for needed funding to assist physician practices across the state of New York to be able to keep their doors for their patients, as Congress discusses the creation of a fourth stimulus bill. A letter can be sent from here.
MSSNY Survey Results re COVID-19 Impact on Their Practices
This week, MSSNY issued a press release announcing the results of a physician survey that showed that, like many businesses across the state, New York physicians have faced a devastating impact on their practices as a result of the coronavirus outbreak. The survey results were reported in several media outlets including the Syracuse Post-Standard , Buffalo News and Crain’s Health Pulse.
The survey results make clear that while the CARES Act funding pools (including the SBA funding and other health care distribution pools) provided some funding to make up these enormous deficits, it is not nearly enough to ensure the survival of many physician practices across the State of New York. MSSNY President Dr. Art Fougner thanked the New York Congressional delegation for their efforts to fight for relief funds for New Yorkers, but also noted how is imperative they fight in the next relief package to preserve the viability of New York’s health care system, including physician practices. This is not only critically important for doctors and their patients, but also for their hundreds of thousands of dedicated employees—many of whom have been laid off or furloughed during this crisis.
Among the key findings of the MSSNY survey were that: 83% of respondents have had a reduction of more than 50% in the volume of patients visiting their practices; 80% have suffered a loss of revenue of more than 50% since the outbreak of COVID19; and more than a quarter have had to layoff, or furlough, more than 50% of their staff.
In addition to fighting for an expansion of the small business loan/grant funding pool, the grassroots letter also urges funding for tuition relief and loan forgiveness for physicians, residents and medical students treating patients on the front lines.
DHHS Stimulus Payment
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process: https://covid19.linkhealth.com/#/step/1
Please Continue to Let MSSNY Know if Your Hospital or Office Cannot Receive Adequate PPE
Pursuant to Executive Order 202.16 issued this past Monday, all businesses must provide face coverings, at their expense, for all their employees who are in direct contact with the public. However, we continue to hear concerns from physicians that, in some hospitals, physicians and other health care staff are not receiving the personal protective equipment (PPE) they need when delivering patient care.
MSSNY has been sharing these reports with the New York State Department of Health for further investigation. It is our hope that with the new Executive Order, and a briefing notice from the Greater New York Hospital Association and the Healthcare Association of New York State to their members calling for compliance with this requirement, that these concerns will be addressed. However, please let us know (email@example.com) if these concerns continue, and we will continue to bring them to the attention of the NYSDOH.
New Clarifications on Emergency Funds
As you know, concerns were raised Friday when the initial HHS Emergency Fund grants were released that, in agreeing to the terms and conditions of the grants, physicians were being required to attest that they diagnose, treat, or test patients for COVID-19. The AMA brought these concerns to the Secretary’s office and HHS committed to posting some clarifying language. HHS has now modified some of the language to make its meaning clearer, as follows, stating that every patient is a possible case of COVID-19.
The website now includes the following statement:
If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.
Also, the second provision of the Terms and Conditions has been changed to no longer say providers attest to “currently” taking care of patients, just that they did so after 1/31/2020:
The Recipient certifies that it billed Medicare in 2019; provides or provided after January 31, 2020 diagnoses, testing, or care for individuals with possible or actual cases of COVID-19; is not currently terminated from participation in Medicare; is not currently excluded from participation in Medicare, Medicaid, and other Federal health care programs; and does not currently have Medicare billing privileges revoked.
NEJM: Clinical Characteristics of COVID-19 in New York City
NYC physicians published a paper today in NEJM.
Garfunkel Wild Webinar: Employer’s Practical Guide to Facing Day-To-Day Coronavirus Challenges on April 20, 2020 | 12:00 pm – 1:00 pm
In the last several weeks, myriad laws and protocols have been issued by Federal and local governments in response to the outbreak of the global COVID-19 virus and to dissipate the profound economic and health and safety impacts of the virus. Examples of this are the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, which are part of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security Act (CARES Act).
At this juncture, while most employers are familiar with the eligibility requirements and magnitude of the leave benefits under these new statutes, they are lacking practical information and guidance on how to implement these requirements. The webinar will address such issues as:
- How to deal with COVID-related health issues in the workplace
- What measures can employers take to determine if employees coming into the workplace have COVID-19 or related symptoms?
- Can employers tell their employees if a co-worker contracts COVID-19?
- What types of accommodations must an employer consider related to COVID-19?
Planning for your PPP Loan
- Can employers furlough employees until the PPP loan comes in?
- How can employers apply for a PPP loan?
- How can employers deal with reductions in force and salary reductions in light of a PPP Loan?
Addressing Unemployment Insurance Issues
- How do the new federal unemployment provisions work?
- What is the interplay between State and Federal Standards?
- What are the rates of unemployment under the new rules?
- What to do with employees who don’t want to return to work?
COVID-19 & Healthcare Professionals: What the Latest CDC Data Shows
Federal data released this week showed that healthcare professionals account for 9,282 of the 315,531 COVID-19 cases nationwide, their median age is 42, and 73 percent of them are female. The tally came from the CDC April 14 and was representative of laboratory-confirmed COVID-19 cases voluntarily reported to the agency from 50 states, four U.S. territories and affiliated islands and the District of Columbia, from Feb. 12 to April 9.
Dr. Erick Eiting’s Video Diary from the ED Featured on ABCNY7
Dr. Erick Eiting, an Emergency Room physician at Mt. Sinai Beth Israel, is featured in a short film about last Friday’s night shift at the hospital treating COVID-19 patients.
Dr. Eiting, a MSSNY member since he left medical school, is currently Vice Chair of Preventive Medicine Family Health Committee, a Member of Task Force on End of Life Care, and Co-Vice Chair of Committee to Eliminate Health Disparities.
Staten Island Launched 10,000 Calls’ to Help Curb Spread of Coronavirus
Borough President James Oddo announced that his office has teamed up with several healthcare organizations on Staten Island, including Richmond County Medical Society (RCMS), Community Health Action of Staten Island (CHASI) and New York Chapter of the American College of Physicians (NY ACP) to launch “10,000 Calls.”
The initiative is meant to tackle the coronavirus pandemic through local physicians conducting outreach to patients, or their caregivers in order to provide a quick “wellbeing/social check-in” phone call. Patients who are 65 years old or older, who are more susceptible to the coronavirus, will be prioritized by physicians.
The Initiative gives physician offices and their staff questions to ask patients, and/or their caregivers, that are related to critical areas of the coronavirus outbreak.
Physician staff members will ask patients questions about their overall health and whether they have any pressing health concerns. Staff members will also ask patients about whether they need medication assistance, have concerns related to the pandemic and will offer concrete help related to social support during the pandemic.
COVID-19 Resources and Free CME Available from MSSNY
The MSSNY website has myriad resources available in response to the current pandemic. Go to www.mssny.org and click on the COVID-19 Update link or the banner with COVID-19 Resources for Physicians to find out more.
You can also go to https://cme.mssny.org and get free CME credits for the Medical Matters and Emergency Preparedness courses posted there. Courses of relevance to the current pandemic include, but are not limited to:
Medical Matters Courses:
- Psychosocial Dimensions of Infectious Outbreaks
- Coronaviruses 2020: COVID-19 An Evolving Story
- Disaster Medicine Every Physician’s Second Specialty
- Doctor Are You Ready?
- The Importance of Resilience After a Disaster
- Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
- Public Health Preparedness 101
- Virtual Drill: Incident Command System & Crisis Communications
- Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)
- Psychological Impact of Disaster and Terrorism Reference Card
Please note, if you do not already have an account there, you will need to create one, this is separate from MSSNY’s home page.
You are also encouraged to listen to the podcasts MSSNY has produced about COVID-19 by clicking on the links below:
- The Psychosocial Impact of COVID-9
- Physician Information on COVID-19
- Patient Information on COVID-19
April 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
“COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid”
Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am. Faculty for this program is William Valenti, MD and Craig Katz, MD.
Registration is now open for this webinar!
Educational objectives are:
- Explore the role of office-based physicians during the COVID-19 pandemic
- Describe surge preparedness procedures for infectious disease outbreaks
- Identify wellness and resiliency strategies to use during infectious outbreaks
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 and Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at firstname.lastname@example.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.
Pain Management, Palliative Care and Addiction Online Programs Now Available at MSSNY CME Website
The Medical Society of the State of New York updated 2020 Pain Management, Palliative Care and Addiction modules are now available on-line here.
These modules are being offered free of charge to all MSSNY members. Physicians who are new users to the MSSNY CME site will be required to register as a new user.
These online programs cover all eight topics required in the New York State statute:
- New York State and federal requirements for prescribing controlled substances
- Pain management
- Appropriate prescribing
- Managing acute pain
- Palliative medicine
- Prevention, screening and signs of addiction
- Responses to abuse and addiction
- End of life care
MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS). MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement.
These courses are entitled:
- PM, PC & A 2020: Understanding the Current Legal Landscape in New York State
- PM, PC & A 2020: When to Consider Opioid Therapy for Chronic Non-Cancer Pain and in Palliative Care
- PM, PC & A 2020: Patients with Opioid Use Disorders
Additional information or technical support may be obtained by contacting email@example.com
Attestation Process for Mandatory Prescribers
Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics.
A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application. Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):
- Log into the HCS at https://commerce.health.state.ny.us
- . Under “My Content” click on “All Applications”
- Click on “N”
- Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.
Complete the steps to ATTEST to the completion of the education requirement.
Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form.
Further information may be obtained by contacting BNE at 1-866-811-7957 or firstname.lastname@example.org