COVID-19 Update April 17, 2019

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.

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

Arthur Fougner, MD
MSSNY President


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 (mauster@mssny.org) 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?

REGISTER NOW


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.


 

MLMIC COVID Banner


CME COURSES

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

Emergency Preparedness:

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

Resources:

  • 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:


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 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.


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 cme@mssny.org

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):

  1. Log into the HCS at https://commerce.health.state.ny.us
  2. . Under “My Content” click on “All Applications”
  3. Click on “N”
  4. 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 narcotic@health.ny.gov

Or at https://www.health.ny.gov/professionals/narcotic/mandatory_prescriber_education/


This Week’s Legislative Podcast


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MSSNYeNews: April 3, 2020 – Sense and Sensibility

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
April 3, 2020

Vol. 23  Number 14



MSSNYPAC Seal

 


Colleagues:

How sad a sight it is to see the streets so empty of people.”
  Samuel Pepys 1666

I thought of Pepys’ diary of the great London plague as I saw the images of Times Square this week. The City that Never Sleeps now lies behind closed doors. Every morning, when I open my door, I half expect to see a candlestick outside. For all our technology, we are struggling to maintain some semblance of equilibrium. Emergency departments are struggling to stay afloat amidst the sea of patients afflicted by the SARS CoV2 virus. Our Healthcare Heroes are long on talent but short on PPE. Entire hospital units are being reconfigured to handle the increasing volume of patients. Ventilators are now more valuable than a Ferengi’s Gold-Pressed Latinum.

Our country has seen this before, one hundred years ago. Hard-learned lessons of the past can and should provide some guidance for today. Phyl Rubenstein, local Breckenridge CO historian, noted parallels between the current pandemic and the 1918 Spanish Flu. “The closing of businesses and distancing of people seem to be the most effective means of bringing this crisis to an end,” Rubenstein noted. However, reopening businesses too quickly could risk the virus’ resurgence.

Without technology, ventilators, antivirals the US survived the 1918 pandemic by attention to sanitation, hand-washing and social distancing. Already, in NY, the pace of hospitalization and death is slowing. A once two-day interval for deaths to double is now six days. While it may not seem like it, we are making progress. Make no mistake, we will overcome this as we have always overcome.

And we will do it together.

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

Arthur Fougner, MD
MSSNY President


MLMIC COVID Banner


 



MSSNY President Press Statement: NY Physicians Need Adequate Tools to Fight War on COVID-19
As New York physicians continue to fight on the front lines of the COVID-19 pandemic, our first priority is—and always has been—the health and well-being of our patients. But we can’t be thrown into this war zone without adequate tools. It is imperative that we are provided with the best available defense, including Personal Protection Equipment (PPE) and workplace practices and policies to reduce disease transmission.

“Unfortunately, despite everyone’s best efforts to facilitate the availability, we continue to hear far too many disturbing reports from physicians about inadequate PPE availability in the hospitals and office settings where they are delivering patient care.  This is shameful and must be addressed.

“In addition, physicians must retain the right to speak out about conditions that we perceive as endangering ourselves, our patients, and our colleagues’ well-being without fear of repercussion. Our patients’ welfare is our priority and we must retain our freedom to advocate for them, including expressing concerns regarding conditions and safety.” (See story below)

Interviews:

    • Politico – 03/26/20
       New York’s health care workforce braces for influx of retirees, inexperienced staffers (MSSNY President Dr. Arthur Fougner quoted)

 •  Crain’s Health Pulse – 03/3/20
       Stakeholders on budget watch after Medicaid redesign proposals
(MSSNY President Dr. Arthur Fougner quoted)

    • Fox News – 04/01/20
      Coronavirus first responders desperately need more safety equipment, 9/11              firefighter says (MSSNY President Dr. Arthur Fougner quoted)

    • Politico -04/02/20
       Statement from MSSNY President Dr. Arthur Fougner

    • NBC News 4 – 04/02/20
    Cuomo Orders National Guard to Take Ventilators as New York Deaths Near 3,000
(MSSNY President Dr. Arthur Fougner quoted)

   •  NPR – 04/03/20
    Ventilator Shortages Loom As States Ponder Rules For Rationing
(MSSNY President Dr. Arthur Fougner quoted)


City Council Members to Protect Hospital Whistleblowers
Nurses and doctors stationed in New York City’s overrun hospitals have spoken out about equipment shortages and increasingly dire workplace conditions — all while risking their jobs to do so.  A group of legislators is planning to introduce a bill to ensure whistleblower protections for hospital workers.

The bill — which has the support of four other Council members, medical personnel and union leaders — would prevent doctors and nurses from losing their jobs if they speak publicly about conditions in their hospitals. It was inspired during the outbreak of the coronavirus, which has stretched resources thin at public and private facilities throughout the city and is based on similar legislative protections for fast-food workers.

Several prominent hospitals have warned staff about disclosing the nightmarish scenarios playing out in their emergency rooms, either in interviews or on Twitter, Facebook and other social media platforms. (Politico, 4/3 2pm)


CORONAVIRUS UPDATE
By the numbers:

The state reported 102,863 confirmed cases and 2,935 deaths as of Friday morning, including 57,159 cases in New York City, 12,351 in Westchester County, 12,024 in Nassau County, 10,154 in Suffolk County, 4,289 in Rockland County, 2,397 in Orange County, 809 in Dutchess County, 720 in Erie County, 464 in Monroe County and 267 in Albany County.

NYS COVID-19 Tracker
NYT Coronavirus Stats as of 8AM 4/3


Latest News from DrHoward Zucker Commissioner of Health for New York State

GENERAL COVID-19:
– No data to suggest that a wide-spread face mask policy is
Gov: Fair to say that masks couldn’t hurt, unless they give a false sense of security.
– Governor describing new Exec. Order as sharing resources as a rebuttal
to use of the word “seizure.”
– Will not leave hospitals without essential equipment, but utilizing their stockpile, and will reimburse facilities.
– Gov says there could be several hundred ventilators that could be redeployed to areas of need.
– Paraphrase: If they want to sue me for borrowing their excess supplies to save lives, so be it – 4th Amendment concerns.
– High rate of illness in NYPD, FDNY, Transit Workers, Healthcare Workers: state will look to be of assistance, but has no plan to “take-over” any organization.
– State transferred several dozen COVID patients upstate.
– USNS Comfort is under-utilized . Ship is needed is for the COVID patients,

Notes from the On-going Governor’s Briefing:
– State now tracking “hotspots”, facilities with greatest total hospitalizations.
– Concerned about increase in Long Island
– Governor reiterated the state’s need for PPE supplies, and frustration
with interstate competition.  Reiterating desire for companies to help produce masks, gowns, face shields and other PPE.
– “We do not have enough ventilators, period.”
– Contingency plans: Splitting, Fed Stockpile, BiPaPP, Anesthesia
machines, redeployment of unused ventilators.
– Working with Alibaba as well.
– Javits is now COVID-19 only facility; “We don’t have any non-COVID-19
to any great degree.”  Federal agencies were not eager to approve the conversion.
– Governor noted a reduction in non-COVID cases due to the decrease in social activity: fewer car crashes, less trauma
– To sign Executive Order allowing state to assume control ventilators and
PPE from institutions for redeployment.  They will be returned or reimbursed. The National Guard will deploy to acquire the equipment.
– Not a question of state’s rights vs. federal interference.  It is a national disaster emergency.  State’s welcoming federal help.
– No state can get the supplies they need, explaining a National supply deployment strategy to meet the needs of the emergent hotspots. “What is the alternative” to the looming crisis.
– The Federal Government does not have enough supply to tell each state
that it can supply their need.
– Governor asking to systematize the medical professional volunteer effort to utilize across the country.


Members: Did you pay your dues? 


Legislature Works Toward Final Budget Passage
Today, the New York State Legislature is giving final passage to an extraordinarily difficult State Budget for the 2020-21 Fiscal Year that seeks to close what could be upwards of a $15 Billion Budget deficit.  With a Budget consideration process that was very different than previous years due to the managing of the coronavirus pandemic, MSSNY staff continues to go through the thousands of pages of Budget bills, but some of the top line highlights include:

  • Continuation of the Excess Medical Malpractice Insurance Program for another year, and rejecting proposals from the Medicaid Redesign Team to foist a 50% cost-share on the physician insureds, which could have been imposed thousands of dollars in new costs on the nearly 17,0000 physicians enrolled in the program.
  • Rejecting the Governor’s Budget proposal that would have severely curtailed important due process rights for physicians when a complaint has been filed against them to OPMC.
  • A 2-year extension of the existing physician-pharmacist collaborative drug program, and rejection of a proposal that would have greatly expanded the powers of pharmacists, and permitting nurse practitioners to also enter such protocols
  • Ending the sale of flavored e-cigarettes and flavored vaping products.
  • Targeted health insurance reforms including creation of an administrative simplification workgroup, a required reporting to DFS of health insurer denial statistics and hastening the timeframe for payment of claims when there has been a request for more information and that information has been provided.
  • Gives the NY Department of Financial Services power to investigate when a prescription drug price has gone up by over 50% in less than a year
  • Expansion of New York’s “surprise bill” law to include inpatient services that follow an emergency room visit, which will permit an out of network physician to bring these claims to the Independent Dispute Resolution process if they get an Assignment of Benefits from the patient.
  • Limits patient insulin co-payments to no more than $100 per 30-day supply.
  • Carving the Medicaid prescription drug benefit back into management by New York State, instead of by Medicaid Managed Care companies.
  • Continued funding of MSSNY’s Committee for Physician’s Health at its historical level.

Importantly, the Budget would also put into statute liability protections that had been set forth in a recent Governor’s Executive Order to provide qualified liability immunity to a physician or health care facility  (a) that is arranging for or providing health care services pursuant to a COVID-19 emergency rule;  (b) the act or omission occurs in the course of arranging for or providing health care services and the treatment of the individual is impacted by the health care facility’s or health care professional’s decisions or activities in response to or as a result of the COVID-19 outbreak and in support of the state’s directives; and (c) the health care facility or health care professional is arranging for or providing health care services in good faith.

Of significant note is a provision that will give the Governor significant discretion to adjust Medicaid payments across the Board throughout the fiscal year based upon the significant variability of revenue coming into New York State.  At the beginning of the year, the Governor implemented an across the Board 1% Medicaid cut, and the MRT2 recommended an across the board 1.875% cut.  This provision has the potential to bring about significant Medicaid cuts through the fiscal year based upon how quickly New York’s economy can recover.

MSSNY thanks the countless physicians for their grassroots advocacy on these key issues, as well as the great partnership with county medical and specialty society leaders in advocating for the many successful outcomes in this Budget, particularly during this extraordinarily difficult time.

We will follow up with a more in-depth report on the litany of health provisions in the State Budget that impact physicians and their patients.

Moe Auster, Pat Clancy, Zina Cary and Raza Ali


Legislature and Governor Agree to State Budget that Rejects Several Problematic Initiatives; Provides Qualified Immunity for COVID-19 Response
The New York State Legislature has given final passage to an extraordinarily difficult State Budget for the 2020-21 Fiscal Year that seeks to close what could be upwards of a $15 Billion Budget deficit.  With a Budget consideration process that was very different than previous years due to the managing of the coronavirus pandemic, MSSNY staff continues to go through the thousands of pages of Budget bills, but some of the top line highlights include:

  • Continuation of the Excess Medical Malpractice Insurance Program for another year, and rejecting proposals from the Medicaid Redesign Team to foist a 50% cost-share on the physician insureds, which could have been imposed thousands of dollars in new costs on the nearly 17,0000 physicians enrolled in the program.
  • Rejecting the Governor’s Budget proposal that would have severely curtailed important due process rights for physicians when a complaint has been filed against them to OPMC;
  • A 2-year extension of the existing physician-pharmacist collaborative drug program, and rejection of a proposal that would have greatly expanded the powers of pharmacists, and permitting nurse practitioners to also enter such protocols
  • Ending the sale of flavored e-cigarettes and flavored vaping products.
  • Targeted health insurance reforms including creation of an administrative simplification workgroup, a required reporting to DFS of health insurer denial statistics and hastening the timeframe for payment of claims when there has been a request for more information and that information has been provided.
  • Gives the NY Department of Financial Services power to investigate when a prescription drug price has gone up by over 50% in less than a year
  • Expansion of New York’s “surprise bill” law to include inpatient services that follow an emergency room visit, which will permit an out of network physician to bring these claims to the Independent Dispute Resolution process if they get an Assignment of Benefits from the patient.
  • Limits patient insulin co-payments to no more than $100 per 30-day supply.
  • Carving the Medicaid prescription drug benefit back into management by New York State, instead of by Medicaid Managed Care companies.
  • Continued funding of MSSNY’s Committee for Physician’s Health at its historical level.

Importantly, the Budget would also put into statute liability protections that had been set forth in a recent Governor’s Executive Order to provide qualified liability immunity to a physician or health care facility  (a) that is arranging for or providing health care services pursuant to a COVID-19 emergency rule;  (b) the act or omission occurs in the course of arranging for or providing health care services and the treatment of the individual is impacted by the health care facility’s or health care professional’s decisions or activities in response to or as a result of the COVID-19 outbreak and in support of the state’s directives; and (c) the health care facility or health care professional is arranging for or providing health care services in good faith.

Of significant note is a provision that will give the Governor significant discretion to adjust Medicaid payments across the Board throughout the fiscal year based upon the significant variability of revenue coming into New York State.  At the beginning of the year, the Governor implemented an across the Board 1% Medicaid cut, and the MRT2 recommended an across the board 1.875% cut.  This provision has the potential to bring about significant Medicaid cuts through the fiscal year based upon how quickly New York’s economy can recover.

MSSNY thanks the countless physicians for their grassroots advocacy on these key issues, as well as the great partnership with county medical and specialty society leaders in advocating for the many successful outcomes in this Budget, particularly during this extraordinarily difficult time.

We will follow up with a more in-depth report on the litany of health provisions in the State Budget that impact physicians and their patients.


Gov. Cuomo Shifting Resources Where Needed
“Right now, the numbers in upstate New York are lighter than the numbers in downstate New York but that is going to change,” Gov. Cuomo said. “You’re going to see that wave move through the state. … We’re going to shift resources all across the state to whatever place has that need at that time.” The state has estimated it has only a six-day supply of ventilators left based on the current need in the New York City area. There are about 102,800 confirmed coronavirus cases in New York state, with 57,000 in New York City.

More than 14,800 people are hospitalized and 3,700 are in intensive care. There have been 2,935 deaths from the pandemic as of Friday morning.

“Hospitals who are not dealing with COVID are seeing very low activity and it’s not that we’re going to leave any health care facility without adequate equipment, but they don’t need excess equipment,” the governor said. The governor’s plan drew concern from some upstate Congressional lawmakers.

Cuomo said it’s not yet clear how many ventilators might be found at upstate institutions but estimated there may be “several hundred excess.”

“Several hundred could represent several hundred lives so am I willing to deploy the National Guard and inconvenience people for several hundred lives, you’re damn right I am,” the governor said. (Politico 4/3)


Temporary Hospital Facility at Javits Center Will Now Treat COVID-19 Patients
The growing number of Coronavirus cases are threatening the capacity of our hospital system. The original plan for the Javits Center was to use it for non-COVID patients in order to free up beds at other hospitals. However, the number of COVID patients has increased to the point that it is prudent for Javits to support and care for COVID patients. I asked President Trump this morning to consider this request and stressed the urgent need and he agreed to it.


Health Advisory: Guidance: NYS DOH Advisory on PPE Shortage Options
Options when Personal Protective Equipment (PPE) is in Short Supply or Not Available


New DEA Buprenorphine Guidance from US Department of Justice
The U.S. Drug Enforcement Administration (DEA) recently issued guidance to DEA-registered physicians providing new flexibility for physicians managing patients with opioid use disorder. The new guidance permits physicians and other health professionals with a waiver allowing them to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31 for the duration of the COVID-19 emergency. More info


Pursuant to section 1135(b)(1)(B) of the Social Security Act, the Centers for Medicare and Medicaid Services New York State is offering Provisional Temporary Enrollment for the duration of the public health emergency. For ease of enrollment, we are offering multiple options for enrollment. New York’s goal is to quickly enroll Providers into New York State Medicaid so that they can react to the emerging health crisis.

This new provisional enrollment applies to providers in the following Categories of Service (COS):

  • Nurse LPN – 0521
  • Nurse RN – 0522
  • Nurse Practitioner – 0469
  • Physician – 0460
  • Physician Assistant (Registered) – 0462

To enroll using the Online Web Form, do the following:

  1. Use your web browser to access the form at: emedny.org/COVID19/
  2. Complete the form following instructions found below under Useful Links.
  3. When complete, click “Submit” to send the form to NYS for processing.

To enroll using email, do the following:

  1. The hard copy paper form can be found here.
  2. Complete the form, email it to this address for processing: emednycovid19PE@gdit.com
  3. Complete the form following instructions found below under Useful Links.

To enroll an individual provider or if you need support, please contact the eMedNY Call Center at 800-343-9000. If enrolling by phone, please be sure to have the following information available:

  • Email address
  • Category of Service (COS)
  • Identifying Information
  • Contact Information
  • Home address, work address, and service address.

To enroll a large number of providers, please contact the eMeNY Call Center Center at 800-343-9000.

Processing and Approval
When your application is approved, you will receive a Medicaid Provider ID number (MMIS) and will be able to submit


Advance Medicare Payments to Help Physicians Through this Period
Moreover, CMS announced over the weekend a process for physicians to receive 100% of predicted Medicare payments for a 3-month period ( Fact Sheet: Advanced Payment Program During COVID-19 Emergency).  Here is a recommended process for applying for these advanced payments shared with MSSNY by a medical practice, as well as some of the particulars of this program:
Process:

1. Go to your National Government Services (NGS) website and fill in, sign, and submit an Accelerated / Advance Payment request form for your practice.

2. Can request up to 100% of Medicare payment for a 3-month period.

3. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

3. State that the request is for an accelerated/advance payment due to the COVID-19 pandemic

4. Will receive payment within 7 calendar days from the request.

5. Recoupment will begin 120 days after payment issuance date.

Eligibility:

Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,

Not be in bankruptcy,

Not be under active medical review or program integrity investigation, and

Not have any outstanding delinquent Medicare overpayments.

For further information, contact Regina McNally, VP of MSSNY’s Socio-Economic

Division at 516-488-6100 ext.332 or email rmcnally@mssny.org.


Telehealth for Beginners on MSSNY Website
Not sure how to practice telehealth? Go here for a short primer.


Backline from Dr. First is a MSSNY- Approved Telehealth Product
DrFirst, a pioneer in healthcare technology offers HIPAA-compliant telehealth and video conferencing as part of its award-winning care collaboration and secure messaging platform, Backline. Backline is quick to set up and easy to use by both physicians and patients.

Initiate a video session without requiring a patient to download an app, complete a cumbersome registration process, or pay upfront before speaking with their physician. Physicians can use their PC or smartphone to engage with patients. Plus, Backline’s HIPAA security and extensive use cases make it a must-have even after the coronavirus crisis ends. Sign up here: https://drfir.st/blt-mssny


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

• The loan proceeds are used to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8-week period after the loan is made; and

• Employee and compensation levels are maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for 6 months.

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

Click here for the application.


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

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

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


CMS to Apply MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19, Reopens Application
CMS is offering multiple flexibilities to provide relief to clinicians responding to the 2019 Novel Coronavirus (COVID-19) pandemic. In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30, 2020 at 8 PM ET, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

If you are a MIPS eligible clinician and do not submit any MIPS data by April 30, 2020, you won’t need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. You will be automatically identified and will receive a neutral payment adjustment for the 2021 MIPS payment year. Please note, CMS has updated the QPP Participation Status Tool so eligible clinicians can see if the policy has been automatically applied.

Additional 2019 Relief Measure

We are also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups.

Who should submit an application?

·       Individual clinicians who started, but are unable to complete, their data submission.

·       Groups that started, but are unable to complete, their data submission; and

·       Virtual groups that are unable to start or complete their data submission.

An application submitted between April 3 and April 30, 2020, citing COVID-19, will override any previous data submission. For more information, please see the Quality Payment Program COVID-19 Response Fact Sheet.

You can contact the Quality Payment program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.


This Week’s Legislative Podcast


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

MSSNY Grassroots Banner

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

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

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

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

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


 

MSSNYeNews: April 10, 2020 – The Angel of Death and the Resurrection

Arthur Fougner MSSNY Presiident

 

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
April 10, 2020

Vol. 23  Number 15



MSSNYPAC Seal


Colleagues:

This year the religious holidays of Passover and Easter fall under the shadow of the COVID19 pandemic. Somehow, I find this eerily apropos. The Israelite slaves, by smearing the blood of the lamb on their doors, hunkered down as the Angel of Death passed. Trusting in the Lord, they readied themselves for the terror of that night while preparing for the promised land. Today we are hunkering down as today’s Angel of Death – the SARS-CoV2 virus – is upon us. Trusting in our guidance, we are awaiting the journey back to the new promised land.

The Feast of the Resurrection is a metaphor for our recovery. The trials and tribulations of this vale of tears will give way as we all will rise again. We will always remember the effort of society’s Healthcare Heroes who facilitated the rebirth from social distancing to social activity and who helped all of us out of the darkness and into the light.

We should never forget those who gave their all, sacrificing themselves in the struggle against the virus. One of our colleagues, Dr. Michael Goldstein, has prepared a Petition to form the COVID-19 First Responders Fund for all first responders, including physicians, nurses, technicians, therapists, nursing aides, paramedics, housekeeping and all of the other members of the healthcare team treating Coronavirus patients in Emergency Departments, Inpatient Hospital beds and Intensive Care Units. 

As Sir Winston Churchill famously exclaimed: “Never was so much owed by so many to so few.” I urge everyone to sign – to get family and friends to sign.

It’s the least we can do.

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

Arthur Fougner, MD
MSSNY President


MLMIC COVID Banner


COVID-19 Statistics 


CMS Now Distributing First 30 Billion of CARES Provider Pool
CMS announced its methodology for distributing the first $30 billion of the $100 billion CARES health care provider pool as set forth in the recent stimulus bill.

The Florida Medical Association has estimated through a “back of the envelope” calculation that, based on the allocation method in the press release, physicians should expect to receive $61,983 for every $1 million in Medicare payments to the physician or physician group’s Tax ID in 2019. (Moe Auster)

This allocation method is similar to the recommendation from organized medicine because we recommended that the distribution be tied to physicians’ Medicare FFS spending from a portion of 2019, pre-COVID-19.

It differs from our recommendation in several respects: instead of using a one-month average of three months of Medicare spending, it uses spending for the entire year 2019; and it does not multiply that amount by three to average all-payor revenue for a month. Also, it does not employ any methodology to pay physicians who may have no or few Medicare claims but rely significantly on Medicaid funding; but, at a White House Coronavirus Task Force briefing earlier this week, Administrator Verma indicated that a subsequent distribution from the Emergency Fund will be directed to pediatricians, children’s hospitals, and others who rely on Medicaid.

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. Note that the funds will go to each organization’s TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with “HHSPAYMENT” as the payment description.

The portal attest for this payment will open the week of April 13th. 

Additional details about the allocation are available here.

According to the press release, HHS has partnered with United to provide rapid payment for the distribution of the initial $30 billion in funds.  Eligible providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). The automatic payments will come to providers via Optum Bank with “HHSPAYMENT” as the payment description.  Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020.  Of particular note is the statement in the press release that one of the conditions of this distributions is that “providers are obligated to abstain from “balance billing.”


Using CS Modifier When Cost-Sharing is Waived
This clarifies a prior message that appeared in our April 7, 2020 Special Edition.
CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services.  Previously, CMS made available the CS modifier for the gulf oil spill in 2010; however, CMS recently repurposed the CS modifier for COVID-19 purposes.

Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount.  Additionally, they should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.


IMGs Can Enter US to Begin Residency Programs
The U.S. State Department responded to an AMA request and agreed to resume processing visa applications at U.S. embassies and consulates to ensure that non-U.S. citizen international medical graduates (IMGs) can enter the country to begin their residency training programs this summer and bolster the health care workforce fighting the COVID-19 pandemic.

“We encourage medical professionals with an approved U.S. non-immigrant or immigrant visa petition (I-129 or I-140 with a current priority date, or similar) or a certificate of eligibility in an approved exchange visitor program (DS-2019), particularly those working to treat or mitigate the effects of COVID-19, to review the website of their nearest embassy or consulate for procedures to request a visa appointment,” the department’s announcement states.

“For those foreign medical professionals already in the United States: J-1 Alien Physicians (medical residents) may consult with their program sponsor, ECFMG [the Educational Commission for Foreign Medical Graduates], to extend their programs in the United States,” the State Department adds. “Generally, a J-1 program for a foreign medical resident can be extended one year at a time for up to seven years.”

Additionally, the AMA is advocating on behalf of non-citizen IMGs who are severely restricted as to where they can practice under the terms of their H-1B visas—this includes some physicians who now cannot work as a result of being furloughed after the facilities they were working at closed.


NY: Fewer New Hospitalizations; Patients Being Treated Doubled
The coronavirus has killed more than 16,600 people in the United States — second only to Italy. The state of New York has recorded more than 7,000 deaths, though Gov. Andrew Cuomo says there continue to be encouraging signs that the rate may be leveling off, including fewer new hospitalizations. However, the number of patients being treated at overflow hospitals in New York City has more than doubled in the last two days, according to the Department of Defense. (NPR, April 9)


Gov. Cuomo Calls for Congressional Funding Aid
Gov. Andrew Cuomo renewed his call for federal action to help New York during the coronavirus pandemic on Thursday, arguing that congressional aid, including enhanced Medicaid funding, has fallen woefully short.

Hours after a partisan stalemate sidelined new coronavirus relief in the U.S. Senate, Cuomo urged Congress to approve federal legislation that stabilizes state and local governments.

“To our federal representatives … this is no time for politics. This is a time to enact the legislation that actually addresses the need,” he said at a morning news conference. “I was in Washington for eight years; I get how the political process works in Washington. Not here and not now, my friends.”

Cuomo said, however, that he’s “not that confident” the federal government will take such action.

Legislation offered by Senate Democrats on Thursday would have given New York state government as much as $16 billion in new federal aid. The bill was blocked as chamber Republicans and Democrats rejected each others’ coronavirus aid proposals.

He took particular issue with enhanced Federal Medicaid Assistance Percentage, or FMAP, dollars approved last month — funding which the governor repeatedly criticized while finalizing his fiscal year 2021 budget.

“They passed legislation that was enacted, we were told would bring $6 billion to health care. When we did our state budget a couple of weeks ago, we believed what they said, and thought we were looking at $6 billion in health care funding,” he said. “Turns out when we actually read the language it was actually about $1.3 billion for the state of New York … and the funding disqualified one-third of New York’s Medicaid recipients, which nobody said.”

The New York State Association of Counties, which previously urged the governor to use the eFMAP funds, joined Cuomo in urging the state’s congressional lawmakers to pass a new stimulus bill that increases federal Medicaid assistance and provides unrestricted funding for lost revenue.


WEBINAR

“COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid” 

CME Webinar on April 29th
Registration Now Open

MSSNY announces a new 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 a flyer for this program, please click here.

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 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. 

AMA

AMA Offers New Financial and Employment Resources for Physicians
 The AMA announced two new resources for physicians in response to the unique financial and employment challenges posed by the COVID-19 pandemic. The Know Your Rights: Navigating Physician Employment During COVID-19 Guide and Physician Practice Financial Relief Guide build on the AMA’s continued efforts to equip physicians and their practices with the latest, up-to-date information and resources necessary to navigate the changing landscape of COVID-19.

“From protecting fair and just working conditions to helping offset financial hardship, the AMA is working to help all physicians who are facing remarkable, unforeseen challenges due to COVID-19,” said AMA President Patrice A. Harris, M.D., M.A. “These timely and topical resources were designed to help physicians focus on what they do best: treat patients and save lives.”


Know Your Rights: Navigating Employment during COVID-19  
The Know Your Rights: Navigating Employment During COVID-19 guide helps physician employees and contractors of hospitals, health systems and other entities navigate the challenges and unique circumstances presented by COVID-19. It includes strategic, legal, and contractual considerations for physicians dealing with issues such as the financial distress of their employer, changes in clinical service demand, and growing anxiety related to caring for patients diagnosed with COVID-19.

Other topics covered in the guide include:

  • An overview of employment law applicable to changes of compensation and services, ranging from information on the application of contract law to employment relationships.
  • What to consider when negotiating compensation and other details in connection with continued employment/retention strategies, including attention to what is feasible under new blanket waivers under the Stark law, hazard pay opportunities and others.
  • Key issues in connection with exit strategies and packages, including severance/transitional support, waivers of non-compete provisions, non-solicit provisions, divestiture or retention of personal investments (e.g. enterprises / ASCs), and access to resources (EHR, personnel, telehealth technology, etc.).

AMA Physician Practice Financial Relief Guide
The AMA’s new Physician Practice Financial Relief Guide highlights the various options established by the federal government to help physician practices offset the financial impact of COVID-19, including:

Many of these programs were enacted into law after significant AMA COVID-19 advocacy with the U.S. Congress and Administration as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act and are now being implemented by federal agencies.

Additional information and resources to help physicians navigate the COVID-19 pandemic can be found on the AMA’s COVID-19 Resource Center.

CDC

COVID-19 Update: Guidance on Exposed, Asymptomatic Workers; CPR Recommendations; Case for Face Masks / Convalescent Plasma Guidance
The CDC says that critical infrastructure workers who have been exposed to SARS-CoV-2 but are not symptomatic can continue to work under certain conditions:

·     Employees’ temperatures should be taken, and symptoms assessed before work resumes, and they should regularly self-monitor. If employees develop symptoms, they should not work.

·     A face mask should be worn for 14 days since the last exposure.

·     Employees should maintain a 6-foot separation from one another if possible.

·     Workspaces should be regularly cleaned and disinfected, particularly areas that are commonly touched.

This guidance applies to workers in 16 sectors, including healthcare, law enforcement, agriculture, and transportation.

In other novel coronavirus disease (COVID-19) news:

Several medical groups have compiled recommendations for helping patients in cardiac arrest who have confirmed or suspected COVID-19. For instance, lay rescuers and the patient can wear face masks to help reduce the risk for viral transmission. The recommendations appear in Circulation.

  • An analysis in The BMJ makes a case for the public wearing face masks, even when the evidence doesn’t overwhelmingly support their use. The authors write: “As with parachutes for jumping out of aeroplanes, it is time to act without waiting for randomised controlled trial evidence… Masks are simple, cheap, and potentially effective. We believe that, worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life.”
  • The FDA has published guidance on collection and use of convalescent plasma as a potential treatment for COVID-19.

LINK(S):

CDC interim guidance (Free)
Cybersecurity and Infrastructure Security Agency memo on critical infrastructure workforce (Free)
CDC guidance on disinfecting surfaces (Free)
Circulation article on CPR guidance (Free PDF)
The BMJ analysis (Free)
FDA guidance on convalescent plasma (Free PDF)
NEJM Journal Watch COVID-19 page (Free)
NEJM COVID-19 page (Free)


Members: Did you pay your dues? 


This Week’s Legislative Podcast


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

MSSNY Grassroots Banner

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

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

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

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

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


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

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TITLE Community Health Program Manager 3 – 32201
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TRANSFER: Current NYS employee with one year or more of contingent-permanent or permanent competitive service in a title at or above Grade 29/M-3 and eligible for transfer under Section 52.6 of the Civil Service Law.
PROVISIONAL*: a bachelor’s degree AND seven years professional public health experience in a governmental public health agency or public health program* that receives funding from a public health governmental agency. Of the seven years required experience, three years must include supervision of professional staff and the following management responsibilities: program planning and implementation, AND program evaluation and monitoring, AND development and implementation of policies and procedures.
The required professional experience must include either:

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

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

Read More Here


98point6 is Looking for Part-time, Per Diem Physicians to help Address COVID-19 Volumes
Virtual care can play a pivotal role in keeping our communities safe and will be an increasingly important part of the fight to mitigate COVID-19. As an on-demand, text-based virtual care service, 98point6 is now hiring part-time physicians to expand our reach of care as clinic volumes continue to grow. We are deeply committed to delivering an incredible patient experience. Through an expedited credentialing and training process, we will be able to add physicians to our pool within one week of hire date. If you are interested in joining the 98point6 team apply here today.


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

MSSNYeNews: What Matters – March 27, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 27, 2020

Vol. 23  Number 13



MSSNYPAC Seal

 


Colleagues:

In the midst of pandemics, budget battles, regulations, legislation, resolutions, reality has the nasty habit of jumping into the mix like a collection notice from a bill long since forgotten. Never easy, certainly never pleasant, but there it is. Life told me to pass on its very hard lesson so here goes. Don’t worry, I will keep it short.

We are all here for a blink of the cosmic eye. We live, we laugh, we cry, we dance and then we are gone.

Embrace those around you. Friends and enemies are but two sides of the same coin. What’s important are family, colleagues, and yes, our patients. Everything else is just so much of life’s gift-wrapping – pretty but soon discarded. Embrace those around you – albeit virtually in the Age of Coronavirus – but embrace nonetheless. Remember that it’s what matters that truly matters.

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

Arthur Fougner, MD
MSSNY President



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CORONAVIRUS UPDATE

The state reports 44,635 confirmed cases and 519 deaths statewide, as of Friday morning, including 25,398 cases in New York City, 7,187 in Westchester County, 4,657 in Nassau County, 3,385 in Suffolk County, 1,457 in Rockland County, 910 in Orange County, 225 in Dutchess County, 219 in Erie County, 187 in Albany County, and 160 in Monroe County.
Coronavirus COVID-19 Global Cases by Center for Systems Science & Engineering at Johns Hopkins University


Main Points from Governor Cuomo’s On-going Announcements:

  • Extending the school closures until April 15th, as well as the 180-day mandate waiver.
    – Continuation of distance learning.
  • Additional bed sites / requesting temp hospital from FEMA, 4,000 more over 4 sites:
    – Bronx: NY Expo Center
    – Queens: Aqueduct
    – Brooklyn: Brooklyn Cruise Terminal
    – Staten Island: College of Staten Island
  • Looking at CUNY City College and CUNY Queens College as additional site
  • Looking at Marriott Brooklyn Bridge and Brooklyn Center Nursing Home as additional sites.
  • For a 60-day period, consumers and small businesses experiencing financial hardship due to COVID-19 may defer paying premiums for property and casualty insurance, including auto, homeowners, renters, workers comp, medical malpractice, livery and taxi. No late fees will be assessed and no negative data will be reported to credit bureaus during this time, and late payments will be payable over a one-year period.

NYS Asks Physicians to Volunteer During COVID-19 Pandemic
Governor Andrew Cuomo and the New York State Department of Health is requesting that physicians and other health care providers volunteer during the COVID-19 pandemic. Many MSSNY physicians have inquired about the process and the NYS Department of Health is coordinating volunteers for this effort.  All physicians, even retired physicians, must go through this portal.

There are a series of questions that are asked regarding name, specialties and certification, age, county of residency.  By completing the form, DOH and SED will check that your credentials are up to date and, if needed, recertify the physician.  Out of state physicians and health care providers should also use this portal.  Earlier this week the governor announced civil liability immunity protections for physicians and other health care practitioners in responding to the state’s COVID-19 outbreak.

According to officials from the NYS Department of Health, retired physicians and other health care providers will most likely be redirected to care for patients that are not afflicted with COVID-19.  Activation will be from either the New York State Health Department or the local county health department.

The Department of Health developed the ServNY volunteer registry in partnership with county health departments, the New York City Department of Health and Mental Hygiene, the Medical Society of the State of New York, hospital associations, and other medical professional organizations. Physicians can volunteer through their Health Commerce System Account by going to the ServNY portal at: go to www.health.ny.gov/ServNY

The registry, established in the aftermath of the 9/11 terrorist attacks, is currently used by all local health departments and Medical Reserve Corps for management of volunteer programs.

As New York state climbs the steep face of its COVID-19 curve, Gov. Andrew Cuomo (D) issued an executive order vastly widening the scope of practice for some healthcare providers and absolving physicians of certain risks and responsibilities.

Among the order’s provisions:

  • Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
  • Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
  • Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
  • Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
  • Granting providers immunity from civil liability for injury or death
  • Suspending usual record-keeping requirements
  • Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
  • Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries

The order, which remains in place through at least April 22, was met mostly with applause, though with some hesitation around work-hour limits. (MedPage, March 27)


What’s in Stimulus Package: Provisions of Interest to Physicians
Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. House passage is expected on Friday and the President is expected to sign the bill into law.

Provisions of particular interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
  • Suspension of the 2% Medicare sequester in May through December 2020.
  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.
  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
  • Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

Also of interest, the “health extenders” package that was set to expire on May 22 has now been extended to Nov. 30. For a complete summary once the bill is signed into law, visit the AMA COVID-19 website.


WEBINARS

Registration Now Open “Psychosocial Dimensions of Infectious Outbreaks” WEBINAR

April 1st @ 7:30am
REGISTRATION NOW OPEN HERE 

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

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

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

This program is a companion piece to the March 18th coronavirus webinar, Coronaviruses 2020: COVID-19 An Evolving Story.  You can go to the MSSNY CME website https://cme.mssny.org to view this and many other free CME webinars that are particularly relevant to the current pandemic situation. 

Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

You can also 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

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.


Navigating A Murky Landscape: An Employer’s Guide to Responding To Challenges of COVID-19

Monday, March 30, 2020
2:30 PM – 3:30 PM EDT

The outbreak of the global COVID-19 virus has confronted employers with unprecedented challenges in maintaining their workplaces and operational viability. With ever-increasing speed, new laws are being enacted by the Federal and local governments that are designed to soften the economic and health and safety impacts posed by the COVID-19 virus, but which also, no matter how well intentioned the legislatures, create confusion about available feasible options for employers on how to move forward in sensible, compliant and practicable fashion.

Garfunkel Wild PC will be presenting a webinar designed to assist employers in tackling these steep challenges. The webinar will address such issues as:

  • Highlights of the updated Federal leave laws.
  • Highlights of the updated New York State leave laws.
  • What is the type of “order” that triggers an employee’s entitlement to leave under the new statutes?
  • Who is a healthcare provider?
  • Staff reductions, reduction in hours and terminations.
  • An employer’s obligations under the WARN Act.
  • Practical considerations on dealing with the challenges.

Pain Management, Palliative Care and Addiction Online Program Now Available
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here.

The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

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

These 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.   Non-MSSNY members will be charged $50 per module.

Series programs include:

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

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

Educational Objectives:

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

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

Faculty: Charles Argoff, MD
Educational Objectives:

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

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

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

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

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

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

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

REGISTER NOW


CMS

Medicaid Allowing Phone Visits Only for Telemedicine
Medicaid is allowing phone, only for telemedicine, during the pandemic.  WC is following Medicaid rules listing the codes as 99441, 99442 and 99443.  I don’t think these codes will result in PAYMENT parity.

But, most plans, including Medicare and Medicaid, are accepting 99211 – 99215, with the GT modifier, which should result in payment parity.  If there is a medical condition, psychiatrists and ophthalmologists should also be able to use these codes, as well.

In addition, with the rules being relaxed including HIPAA rules, use of an iphone or similar equipment with audio/video for telemedicine is being accepted during this pandemic. (Regina McNally, VP MSSNY Socio-Medical Economics Div.)


CMS Call: Lessons from the Front Lines-Saturday, March 28 12noon-2:00 PM
On behalf of CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force, I am writing to invite the physician membership of your organization to the next call in our new series for physicians: Lessons from The Front Lines: COVID-19.

The call will take place on Saturday, March 28th from 12:00 PM – 2:00 PM EST, and the topic of discussion is: COVID-19 Therapeutics. We invite you to join us to share your ideas, strategies, and insights with one another.Please see dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

Participant Dial In: 877-251-0301
Conference ID: 9409959
Audio Webcast https://protect2.fireeye.com/url?k=0d59a9bc-510ca0af-0d599883-0cc47adb5650-9ac2bdf1f2555d1a&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1738

If you have specific best practices related to COVID-19 therapeutics you are interested in sharing with your peers, please respond to me by 5 PM today and we would be glad to add you to our agenda. 

As always, we appreciate your feedback and collaboration as we address this important issue together.


US Has Fewer Physicians and Hospital Beds Per Capita than Italy and Others
A new analysis and chart collection finds that the U.S. has fewer hospital beds and practicing physicians per capita than many similarly large and wealthy countries with health care systems already strained by the ongoing COVID-19 pandemic.

Compared to Italy and Spain, two countries in which hospitals have already been overwhelmed by an influx of COVID-19 patients, the U.S. has fewer practicing physicians per capita – 2.6 per 1,000 people, compared to 4.0 in Italy and 3.9 in Spain – but more licensed nurses. While the U.S. has a higher number of total hospital employees than most comparable countries, nearly half of that workforce is comprised of non-clinical staff who are not directly involved in delivering care. (KFF-Petersen March 27)


Upstaters Want Downstaters to Stay Away
In an attempt to slow the spread of the novel coronavirus, Upstate counties are warning anyone traveling from New York City to self-quarantine for two weeks or stay away entirely. The requests have no legal backing as only Gov. Andrew Cuomo could give such an order, but they come as the number of cases in New York City continue to grow and upstate health departments predict that they could soon see a similar surge, possibly overwhelming their capabilities. Governors in at least two states have also mandated that anyone who travels from the New York metro area must self-quarantine for two weeks after arriving.

Wednesday evening, county leaders in Rensselaer and Saratoga counties asked Cuomo order that anyone who travels from Westchester or New York City to self-quarantine, following a recommendation from Deborah Birx, the White House coronavirus response coordinator. On Thursday, Rensselaer County Executive Steve McLaughlin asked Cuomo to ban non-essential travel from the same areas. McLaughlin said five Troy residents who tested positive for COVID-19 had recently re-located from New York City. (Times Union, March 27)


Army Field Hospitals to Start Taking Non-COVID-19 Patients in NY on Monday
Three Army field hospitals have begun to deploy to New York and Washington state, the regions hit hardest by the coronavirus, and the facility in New York will start taking non-COVID-19 patients on Monday, according to Army officials.

  • The Army field hospitals will provide 284 beds in New York and 248 in Seattle to relieve stress on hospitals treating patients stricken with the coronavirus, Army Chief of Staff Gen. James McConville told reporters today.
  • The advanced party from the Army’s 531st Hospital Center from Fort Campbell, Ky., and the 9th Hospital Center from Fort Hood, Texas, are already on the ground in New York, McConville said. The main party will arrive at Joint Base McGuire-Dix-Lakehurst, N.J., Friday, and will set up at the Javits Center in Manhattan this weekend, McConville said.
  • The New York National Guard, the Army Corps of Engineers and Javits employees are hard at work converting the Javits Center into a makeshift disaster hospital with 1,000 beds to help with the city’s coronavirus response.
  • In total, roughly 650 personnel are heading to New York and a little over 600 to Seattle to help with the crisis, Army officials said. (Politico Pro 03/26/2020 02:50 PM EDT)

Do Not Bill for Telemedicine Until Further Instruction
I just was on a call with NGS MEDICARE.  They state they have not received direction from CMS on how to process claims for telemedicine.  Therefore, NGS MEDICARE is asking that telemedicine claims NOT BE SUBMITTED until CMS provides NGS with clear instructions regarding telemedicine claims processing procedures.  This is in an effort to avoid unnecessary claim denials.

As soon as NGS MEDICARE hears from CMS, they will advise us.

–From Regina McNally, VP MSSNY’s Socio-Med Economics Div.


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

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


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

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

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

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

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


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

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

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

 

This Week’s Legislative Podcast


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

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

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

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

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

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


 

MSSNYeNews: Trying Times – March 20, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 20, 2020

Vol. 23  Number 12


MSSNYPAC Seal

 


Colleagues:

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

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

Please share.

Tommy D.

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

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

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

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

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

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

Arthur Fougner, MD
MSSNY President




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

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

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

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

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

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

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

A copy of the press release is here.

A copy of the guidance is here.


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

Others:


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

Please see this video for more information.


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

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


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


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


Recently Released Guidance Documents Related to Home Care

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

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

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

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

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

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

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

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

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

About Backline

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

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

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


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


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


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

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

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

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

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

For more information, contact: Melissa Hoffman at mhoffman@mssny.org or call (518) 465-8085
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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

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


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



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

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

Educational objectives:

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

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

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

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


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

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

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


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

• We now have 46 deaths

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

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

o   4,408 NYC (695 new)

o   1,091 Westchester (158 new)

o   754 Nassau (52 new)

o   371 Suffolk (32 new)

o   61 Albany (13 new)

o   84 Orange (17 new)

o   101 Rockland (8 new)

o   36 Dutchess (4 new)

o   32 Monroe (4 new)

o   24 Saratoga (5 new)

o   21 Schenectady (9 new)

o   12 Ulster (1 new)

o   31 Erie (same)

o   8 Rensselaer (3 new)

o   7 Tompkins (1 new)

o   7 Putnam (same)

o   2 Allegany (same)

o   2 Greene (same)

o   2 Montgomery (1 new)

o   2 Onondaga (same)

o   2 Broome (same)

o   1 Delaware (same)

o   2 Herkimer (same)

o   1 Tioga (same)

o   3 Ontario (same)

o   2 Wyoming (same)

o   2 Clinton (same)

o   8 Sullivan (same)

o   2 Chenango (1 new)

o   1 Essex (1 new)

o   2 Hamilton (1 new)

o   1 Warren (1 new)

o   1 Washington (1 new)

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

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

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

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

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

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

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

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

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


TODAY’S ANNOUNCEMENT

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

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

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

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

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

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

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

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

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

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

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

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

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

o   1- Flatten Curve thru Density Reduction

o   2-Increase Current Hospital Capacity

o   3-Identify New Hospital Beds

o   And do all three simultaneously

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

o   Waive DOH regulations related to hospital beds

o   Discuss ways to add more staff, including reserve staff

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

o   Convert available facilities into extra hospital space.

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

o   VOLUNTARY: work from home

o   MANDATORY: closed schools statewide

o   MANDATORY: reduce state and local workforce

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

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

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

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

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


YESTERDAY’S ANNOUNCEMENTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


ADDITIONAL INFORMATION / PREVIOUS ANNOUNCEMENTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

o   All staff are required to wear masks.

o   All staff will be monitored for symptoms.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

o   The soldiers come from units located across New York.

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

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


RESOURCES

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

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


CDC WEEKLY Key Messages


This Week’s Legislative Podcast


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

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

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

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

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

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


 

MSSNYeNews: March 13, 2020 – Triskaidekacovid Phobia

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 13, 2020

Vol. 23  Number 11


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Colleagues:

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

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

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

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

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

All information can be found in the various articles below.

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

Arthur Fougner, MD
MSSNY President


Capital Update


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

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

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

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

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

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

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

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

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


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



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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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

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

Two Remaining Webinars will be held on:

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

Faculty: Charles Argoff, MD
Educational Objectives:

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

Register for this webinar here 

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

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

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

Register for this webinar here. 

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

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

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

(HOFFMAN)


This Week’s Legislative Podcast


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

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

Educational objectives are:

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

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

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

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

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


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

Where:
Nove Restaurant
707 Saratoga Road
Wilton, NY  12831

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

Educational Objectives:

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

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

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

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


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

 

eNews

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

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

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

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

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

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

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

Information Centers for Physicians

Current CDC Info for Professionals:

CMS News

CMS Emergency Info

CDC Travel Info


 


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


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


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

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


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


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

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


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


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


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

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

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

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


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

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

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

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

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

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


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

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

 

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

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
March 6, 2020

Vol. 23  Number 10


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Colleagues:

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

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

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

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

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

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

I’m out.

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

Arthur Fougner, MD
MSSNY President


Coronavirus Update with Anthony Fauci, MD – March 2020


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

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Capital Update

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This Week’s Legislative Podcast


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

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

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


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

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

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

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



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

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

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

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


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

Educational objectives are:

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

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

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

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

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


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

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

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

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

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


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

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

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


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

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

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


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

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


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

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

            (DIVISION OF GOVERNMENTAL AFFAIRS)


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

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

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

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


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

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

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

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

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

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

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

Register for this webinar here.

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

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

Register for this webinar here

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

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

Register for this webinar here.

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

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

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


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

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

Registration details coming soon!    (SHERPA)


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

Where:
Nove Restaurant
707 Saratoga Road
Wilton, NY  12831

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

Educational Objectives:

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

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

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

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

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

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

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

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

 

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

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

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

eNews

NY Coronavirus Statistics:

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


Information Sources:

NYS DOH
CDC
Johns Hopkins Global Interactive Map


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

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

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

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

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

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

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

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

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


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

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

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

This transcript has been edited for length and clarity.

What type of impact are you seeing on kids?

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

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

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

What about for middle and high school students?

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

What if students start asking more detailed questions?

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

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

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

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

Question: Will I get sick?

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

Question: What will happen if I get sick?

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

Statement: I am scared of coronavirus!

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

Question: Why is everyone talking so much about coronavirus?

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

Question: Will I die?

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


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

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

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

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

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


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

 


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

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

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

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

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

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


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


Dr. Fougner and Dr. Choi

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

Medical Students

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

 


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START SEEING PATIENTS IMMEDIATELY!!!
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ANNOUNCEMENT OF ANTICIPATED JOB OPPORTUNITY
Open to the Public

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

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

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

Read More Here


 

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

 

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

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
February 28, 2020

Vol. 23  Number 9


MSSNYPAC Seal

 


Colleagues:

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

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

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

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

We will all go down together.

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

Arthur Fougner, MD
MSSNY President



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Capital Update

This Week’s Legislative Podcast


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

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

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

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


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

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

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

NYC physicians should click here.

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

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

(CLANCY)


 

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

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

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

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

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


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

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


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

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

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


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

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

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


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

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

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

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

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


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

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


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

Educational objectives are:

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

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

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

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


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

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

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

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

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

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

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

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

Educational Objectives:

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

Register for this webinar.

Tuesday March 17, 2020—7:30-8:30am

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

Faculty: Charles Argoff, MD

Educational Objectives:

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

Register for this webinar.

Tuesday March 24, 2020—7:30-8:30am

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

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

Educational Objectives:

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

Register for this webinar.

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

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

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


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

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

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

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

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

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


 

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

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

Thursday April 23, 2020

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

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

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

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

Friday April 24, 2020

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

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


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

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

Registration details coming soon!              (HOFFMAN)

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Novel Coronavirus Information

NYS DOH

CDCEvaluating and Reporting Persons Under Investigation (PUI)

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

INFO BY NY COUNTY

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


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

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

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

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

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

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


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

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


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

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

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

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


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


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

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


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

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

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


Medicaid

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


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

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

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

To express online condolences visit www.sbfuneralhome.com.


 


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

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

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

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

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

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


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

 

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

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
February 21, 2020

Vol. 23  Number 8


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Colleagues:

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

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

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

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

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

Arthur Fougner, MD
MSSNY President


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eNews

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

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

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

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


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

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

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

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


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

Educational objectives are:

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

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

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

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


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

Educational Objectives are:

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

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

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

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

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

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


 

Dr. Pinto

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


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


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


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


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


Just One Dose of HPV Vaccine May Help Prevent Cervical Disease

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

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

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

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

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


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

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

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

Additional details below

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

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


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

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

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


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

Additional resources:

·       Telehealth Services (PDF) Medicare Learning Network Booklet

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

·       Medicare Telehealth Payment Eligibility Analyzer

·       List of Covered Telehealth Services webpage

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


 


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

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

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

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

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

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


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


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

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

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

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



 

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

 

MSSNYeNews: Presidents Day – February 14, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
February 14, 2020

Vol. 23  Number 7


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National Advocacy Conference in Washington DC
National Advocacy Conference in Washington DC Feb. 10-12
MSSNY members in Washington, DC advocating for legislation that puts patients before profits (left to right) Jerome Cohen, MD; MSSNY President-Elect Bonnie Litvack, MD; Purvi Parikh, MD; Jeff Morgan, Legislative Director to NY Rep. Paul Tonko; MSSNY Immediate Past President Tom Madejski, MD; MSSNY President Art Fougner, MD; Daniel Choi, MD; MSSNY Executive VP Phil Schuh; Pratisthe Kiorala, MD


Colleagues:

This Monday, we celebrate Presidents Day. The holiday could not come at a better time. While we agonize over Congress’ inching closer toward awarding insurers the upper hand on surprise bills and, at the same time, worry about Albany’s empowering OPMC, it would be wise to reflect on the lives and examples of America’s Romulus and Remus – George Washington and Abraham Lincoln.

George Washington truly led by example. He took command of a group of rag-tag patriots and led them with spirit, guile and whatever he found at his disposal to victory over the world’s mightiest power. At the height of his military career, he resigned his commission. When offered the scepter of King, he became instead President. After two terms, he retired to private life and left the office to others. George Washington observed that “happiness and moral duty are inseparably connected.” As historian Forest McDonald observed, Washington was “the instrument by which an inconsequential people took the first steps toward becoming a great nation.”

Abraham Lincoln was not a military man yet became the Commander in Chief during the second most important conflict in our history. Lincoln did not attend Harvard or Yale, yet he became arguably the most famous lawyer in our history. Federal judge Herbert George would ask a rhetorical question:

“Would you rather have the edge in the facts of a case, the law of a case or Abraham Lincoln as your lawyer?” Lincoln advised us that a “house divided against itself cannot stand.” We would be wise to heed his counsel.

So, this weekend, take a few moments away from prior authorizations and mouse clicks to reflect on how we got here and, more importantly, where we are going. Remember that another, more recent president pointed the way to that “Shining City on a Hill.”

Remember our patients. Do not despair. We will get there.

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

Arthur Fougner, MD
MSSNY President


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Capital Update

MSSNY Legislative Podcasts


Please Plan To Be in Albany for MSSNY‘s Annual “Physician Advocacy Day” March 4th
With State Budget discussions beginning to heat up the need for physician advocacy and grassroots involvement is greater than ever. With the Governor’s Budget Proposal teeing up items for potential concern such as Medicaid cuts, cuts to the Excess Medical Liability Insurance Program, and changes to the physician disciplinary process, but also supported reforms such as regulating PBMs and a flavored tobacco ban, it is imperative that physicians be in contact with their local legislators to ensure the physician community’s message is well-represented.One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click here to register!

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

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

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


MSSNY Leaders & Staff Hold Key Meetings in DC to Discuss “Surprise Billing” & Other Pressing Issues
On February 10 – 12, MSSNY member leaders, and staff, attended the American Medical Association’s (AMA) National advocacy conference, in Washington, DC., and held meetings with New York’s Congressional delegation. Attendees included the following:

  1. Art Fougner (Current MSSNY President)
  2. Bonnie Litvack-Penn (Incoming MSSNY President)
  3. Jerome Cohen
  4. Dan Choi
  5. Jacqueline Bello
  6. Thomas Madejski (MSSNY Immediate Past-President)
  7. Willie Underwood
  8. Yetunde Olowe
  9. Purvi Parikh

The group discussed several of MSSNY’s most pressing legislative priorities, with a heavy focus on the issue of Surprise Billing, which has multiple bills moving through Congress to try and resolve this issue in a way that serves the needs of both physicians and patients. Among the lawmakers’ offices that MSSNY met with were Senator Chuck Schumer, Senator Kirsten Gillibrand, Representative Paul Tonko (D- Schenectady), Representative Brian Higgins (D- Buffalo), Representative Eliott Engel (D-Westchester/Bronx), Dr. Tom Reed (R-Southern Tier), and Representative Joe Morelle (D-Rochester).

In addition to the “Surprise Billing” issue, MSSNY members discussed the need for federal legislation to reign in the number of services that are subject to prior authorization and a study of the potential public health impact of marijuana for recreational purposes.   (CARY)


 

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

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

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

Therefore, this proposal remains highly problematic, and MSSNY President Dr. Art Fougner offered the following comments in response:

“New York’s dedicated physicians remain anxious to work with all parties to ensure a fair federal legislative solution to protect patients from surprise out of network bills.  However, far more balance is needed in what has been put forward so far.  The proposal released Friday by the US House Ways & Means provides a few marginal steps forward but would still hand an enormous gift to already market dominant health insurance companies by tilting the factors in its dispute resolution mechanism towards the insurance industry.  Even worse, it fails to provide meaningful steps to make sure health insurance physician networks are adequate, to help protect patients from finding themselves in the position in a hospital where they are treated by an out of network physician.

These new proposals remain far different than the comprehensive and balanced measure that was enacted in New York, which not only put in place a balanced dispute resolution system to protect patients, but also put in place new measures to better ensure that health plan networks and out of network coverage was comprehensive.  We urge Congress to revise their proposals to more closely resemble New York’s acclaimed approach, which has had zero adverse premium impact and has saved consumers hundreds of millions of dollars.” (AUSTER, CARY)


Initial Meeting of the MRT 2
This week brought the initial meeting of the second iteration of the Governor’s Medicaid Redesign Team (MRT), charged with recommending $2.5 billion in Medicaid savings as part of an effort to enact a State Budget by April 1.  The meeting generally covered a review of the successes of the previous MRT, a statement of the general charge and activities for the MRT 2, and identifying the highest cost drivers in the Medicaid program that will be under the microscope for revisions.

There will be 3 meetings of the MRT 2, including this week’s, March 2 in NYC and a third meeting to be announced for mid-March.  There will also be a Long Term Care advisory group established.  They will be soliciting public input online as well as through 3 upcoming public forums/evening webinars. The next one will be place on Tuesday February 18th from noon – 3pm, at the Monroe County Community College, High Falls Auditorium, 321 State St., Rochester, NY

In looking at the services for 6.2 million Medicaid enrollees, among the highest cost drivers identified included:

  • LTC and Consumer Directed Personal Care Program (800% growth from 2016 to 2021)
  • Prescription Drugs (36% growth from 2011 to 2019, exceeding 25% medical CPI)
  • Transportation (up 131% from 2011 to 2019)
  • Case management including Health homes
  • Program Integrity (reducing fraud and abuse, and ensuring cost-efficient delivery of care for Medicaid recipients)
  • Distressed Hospitals (160% increase)

It was also noted that, among the 770,000 “dual eligibles” in New York, only 3% are enrolled in managed care programs.

The only area where physician care under Medicaid appeared to be directly implicated was the stated 344% increase in the Patient Centered Medical Home program from 2011 to 2019, which pays physicians a PMPM bonus to help manage the care of certain Medicaid patients.  However, DOH also noted that patients enrolled in PCMH also had significantly lower health costs overall than non-PCMH enrollees.  MSSNY has repeatedly argued to legislators that Medicaid payments to physicians are already among the lowest in the country, represent a good investment in care delivery, and therefore should be spared from future cuts.  MSSNY also continues to raise strong concerns about the lack of a community based physician on the MRT 2.

It was also noted that the public could submit recommendation to the MRT 2 for Medicaid cost-saving suggestions from here: Please click here  (AUSTER, ALI)                                                       


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

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

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

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


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

  • Mandated conspicuous posting in a physician’s office of a patient’s ability to file a complaint with the Office of Professional Conduct (A.7991-A/S.6678-A). Assembly Floor/Senate Health Committee
  • Mandated notification to epileptic patients of the risk of sudden death due to epilepsy (S.5397-A/A.7807-A). On Assembly Floor/On Senate Floor
  • Mandated co-prescribing of naloxone for patients: a) taking 50 mmg per day b) with a history of substance use disorder or c) concurrent use of opioids and benzodiazepine or nonbenzodiazepine sedative hypnotics (S.5150-B/A.5603-B). Passed Senate.  In Assembly Ways & Means
  • Mandated reporting of rescue inhaler prescriptions to the statewide immunization system (S.7337). On Senate floor
  • Mandated dissemination of a pamphlet prior to performance of a pelvic exam (S.7544/A.9600). On Senate floor/In Assembly Health
  • Mandated proof of completion of CME on cultural competency, including paying for an additional fee to SED on top of the bi-ennial $600 registration fee (S.2406-A). Passed Senate/In Assembly Higher Education Committee
  • Mandated seeking of a detailed patient/family member consent for a nursing home resident prior to the receipt of a psychotropic medication, or detailed documentation of the need to provide such medication without consent (A.1033/S.5441). On Assembly Floor/Senate Health Committee.
    (AUSTER, CLANCY

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Rear Seat Belt Measure Passes NYS Assembly; On Senate Calendar for Vote
A measure that would require safety belts for persons 16 years and younger in are back seat passengers in a motor vehicle has passed the New York State Assembly and is pending on the Senate Calendar for a vote.   This measure, Assembly Bill 6163/ S. 4336, is sponsored by Assemblymember Walter Mosely and Senator David Carlucci and the Medical Society of the State of New York supports this measure.

The MSSNY House of Delegates unanimously adopted policy urging that seat belts be required in both front and rear seats.  One of the safest choices drivers and passengers can make is to buckle up and 89.6% of drivers and passengers buckled up in 2018, saving 14,955 lives.   According to the 2015 data from the National Highway Traffic Safety Committee, 4.3% of 22,441 fatalities — or 966 deaths — involved unrestrained people in rear seats.  Research also found that unbuckled rear-seat travelers are eight times as likely as buckled rear-seat passengers to be injured or killed in a crash.

Thirty-eight states have laws that allow police officers to ticket a driver if the driver or the front-seat passenger is not wearing a seat belt, while only 18 states have the same laws for rear-seat riders. Those laws, along with police checks, public education campaigns, and seat-belt reminder systems, have helped increase use of seat belts in all seats.

Rear seating passengers who are older are less likely than front-seat passengers to wear a seat belt, making them more likely to injure themselves and drivers or other passengers in a crash.  Adult rear-row occupants were less likely to use seat belts, with just 70 percent of those ages 20 to 54, and 86 percent of those 55 and older using restraints, according to the Insurance Institute for Highway Safety. According to the Institute for Highway Safety (IHS), adult rear seat passengers are at greater risk for chest injuries and traumatic brain injuries than front seat passengers.                                          (CLANCY)


Register Now for CME Courses at MSSNY House of Delegates April 23 & 24
MSSNY will be offering multiple CME courses on Thursday April 23rd and Friday April 24th at the 2020 House of Delegates in Tarrytown.  Click Please click here to register for as many or few of these offerings as you can.

Thursday April 23, 2020

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

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

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

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

Friday April 24, 2020

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

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


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

Educational Objectives are:

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

Register by clicking here.

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.
(CLANCY, HOFFMAN, ALI)


Registration Now Open for Medical Matters: Virtual Drill: Incident Command System & Crisis Communications
MSSNY’s next Medical Matters will feature a Virtual Drill on the Incident Command System and Crisis Communications on February 19th from 6:00-8:00pm. Faculty for this program are: Arthur Cooper, MD; Pat Anders, MS, MEP; William Valenti, MD and Lorraine Giordano, MD.

With the outbreak of the Wuhan Coronavirus (COVID-19) it is doubly important for physicians to learn about the incident command system and crisis communications from the NYS Department of Health’s perspective.  This program provides physicians with vital information that would be needed to combat a public health emergency.  Be sure to note the format of this webinar includes extended time and takes place in the evening.

Educational Objectives are:

  • Obtain information about local, state and national chain of command in a public health emergency and learn how to access resources
  • Understand the importance of planning for medical surge and triage of patients, as well as staff and family considerations, in the office-based practice setting during a health emergency
  • Develop an understanding that all public health emergencies can potentially have mental health implications for survivors and others connected with the event
  • Acquire skills for the management of patients in a public health emergency

Please note that there are recommended pre-course materials to be viewed prior to this virtual drill. You will be sent a link with your registration confirmation. We encourage all participants to examine these prior to the Virtual Drill.  Register by clicking here:  Please click here.

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

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

The Medical Society of the State of New York designates this live activity for a maximum of 2.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. (CLANCY, HOFFMAN)


Veterans Matters: PTSD in Returning Veterans Live Seminar at Our Lady of Lourdes Memorial Hospital
The Medical Society of the State of New York is hosting a CME live seminar entitled Veterans Matters: PTSD in Returning Veterans on Thursday, February 27, 2020 at 12:00 pm at Our Lady of Lourdes Memorial Hospital, 169 Riverside Drive, Binghamton, NY 13905.

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

Reservations can be made by contacting Jean Jenkins at jjenkins@ascension.org or (607) 798-5290.

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.
(CLANCY, HOFFMAN)          


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


eNews

Physicians Are Fighting BCBS Plan Requiring Use of Mail-Order Pharmacies
A group of eight medical societies are pushing back against a proposal from BlueCross BlueShield of Tennessee that the groups fear will hurt patient access to critical drugs. (American Academy of Ophthalmology; American Academy of Dermatology; American College of Rheumatology; American Gastroenterological Association; American Urological Association; Coalition of State Rheumatology Organizations; Alabama Society for Rheumatic Diseases; Tennessee Rheumatology Society)

The proposed policy change would require physicians to use mail-order pharmacies to order drugs that have to be administered in-office, instead of allowing physician offices to bulk-order the drugs and keep them in-house. It would apply to drugs such as those given to rheumatoid arthritis patients that have to be administered by physicians in their offices.

BCBS said the policy changes are designed to save money for Tennessee-based employers and the people covered by their healthcare plans. The medical groups argue that the policy, which would mean physicians can only order the drugs on an as-needed basis for each patient, would delay patient care, reduce access to much-needed drugs, inflate out-of-pocket costs and increase drug waste.

Under the proposal, physicians would have to obtain the drugs from BCBS’ preferred pharmacies and then wait for that pharmacy to ship them, which the groups argue is just a way for BCBS to get rebates from its pharmacy benefit managers.

The groups are also concerned that they won’t be able to ensure the drugs are safe and haven’t been exposed to high temperatures. Additionally, extra doses would be required to be thrown away, increasing drug waste. The new policy could also mean patients have to go to a more expensive hospital outpatient setting if their physician can’t afford to obtain the drugs from the preferred pharmacies, which could be a significant barrier to access for some patients.

“We’re not asking members to see a different doctor or receive care at a different facility,” BCBS said on its website. The company added that the changes apply to only 5,500 of its 3.5 million members.  In a letter to BCBS, Ellen Gravallesse, MD, said: “We have had an alarming number of practices reporting they have been denied the ability to use therapies currently available in their offices to administer patient care quickly.” (Becker’s Healthcare Feb. 13)


If You’re a Physician under 40, Don’t Miss Feb. 28 Meeting in Manhattan!
For all medical students, residents, fellows, and new attendings starting practice in the last 8 years in the NY Metro Area and Long Island, don’t miss the upcoming Medical Society of the State of New York Joint Section Annual Meeting on February 28th from 8:30am-12:30pm at the New York Academy of Medicine, 1216 5th Avenue. New York, NY. More information and registration available at: www.mssnyconference.org Earn CME and learn from experts on how to succeed when starting practice and how to best advocate for your patients outside of the hospital and clinic. Limited space available. 3.0 AMA PRA Category I CME Credits available.

Program:

1.     Keynote speaker: The Evolving Healthcare Landscape: Challenges and Opportunities for Young Physicians by Jesse Ehrenfeld, Current AMA Board of Trustees Chair.

2.      “How to Avoid Malpractice Lawsuits in the First 5 Years of Practice” by William Hassett, Esq. from Fager, Amsler, Keller & Schoppmann, LLP.

3.      Millennials in Private Practice: Is It Even Possible? A Panel Discussion by Millennial Independent Physicians with Sonia Bahlani; Dhaval Bhanusali, MD, FAAD; Purvi Parikh, MD; Saya Nagori, MD. Moderated by: Daniel E. Choi, MD #doctor #medicalstudent #SoMeDocs



CDC Confirms 15th Case of Coronavirus Disease (COVID-19)
Yesterday, CDC confirmed another infection with Coronavirus Disease (COVID-19) in the United States. The patient is among a group of people under a federal quarantine order at JBSA-Lackland in Texas because of their recent return to the U.S. on a State Department-chartered flight that arrived on February 7, 2020.

All people who lived or traveled in Hubei Province, China, are considered at high risk of having been exposed to this virus and are subject to a temporary 14-day quarantine upon entry into the United States. This is the first person under quarantine at JBSA-Lackland who had symptoms and tested positive for COVID-19. The individual is currently isolated and receiving medical care at a designated hospital nearby.

This brings the total number of COVID-19 cases in the United States to 15. There will likely be additional cases in the coming days and weeks, including among other people recently returned from Wuhan. While 195 people were discharged from quarantine on Tuesday, more than 600 people who returned on chartered flights from Wuhan remain under federal quarantine and are being closely monitored to contain the spread of the virus.

For the latest information on the outbreak, visit CDC’s Novel Coronavirus 2019 website(Thursday, February 13, 2020 CDC release)


Yale New Haven Hospital Sued Over Exam Policy for Employees 70+ Years
The U.S. Equal Employment Opportunity Commission is suing Yale New Haven Hospital, alleging its policy mandating eye and neuropsychological exams for employees age 70 or older who seek medical privileges violates two federal antidiscrimination laws.

Yale New Haven implemented its late career practitioner policy about four years ago. The policy requires employees 70 and older who apply for or seek to renew staff privileges to take both medical exams. Employees under the age of 70 are not required to take the exam.

In the lawsuit, filed Feb. 11, EEOC claims that the individuals required to be tested are singled out solely because of their age, instead of a suspicion that their cognitive abilities may have declined.

As a result, Yale New Haven’s policy violates the Age Discrimination in Employment Act, the lawsuit says. “While Yale New Haven Hospital may claim its policy is well-intentioned, it violates antidiscrimination laws,” said Jeffrey Burstein, a regional attorney for the EEOC’s New York District office. “There are many other nondiscriminatory methods already in place to ensure the competence of all of its physicians and other healthcare providers, regardless of age.”

In addition, the EEOC charges that the policy also violates the Americans with Disabilities Act because it subjects employees to medical examinations that are not job-related. (Becker’s Hospital Review Feb 12)



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Lawsuit: Juul Bought Ad Space on Kids’ Websites Including Cartoon Network
E-cigarette maker Juul Labs Inc bought online advertisements on teen-focused websites for Nickelodeon, Cartoon Network and Seventeen magazine after it launched its product in 2015, according to a lawsuit filed on Wednesday by the Massachusetts attorney general’s office.

The allegations in the lawsuit, stemming from a more than year-long investigation, contradict repeated claims by Juul executives that the company never intentionally targeted teenagers, even as its products became enormously popular among high-school and middle-school students in recent years. (Reuters Business News 2/12)


Two States Have Each Reported 200+ Vaping-Related Illnesses
As of Feb. 4, a total of 2,758 hospitalized EVALI cases have been reported to CDC, an increase of 47 since the last CDC update Jan. 21.

Four updates:

  1. Sixty-four EVALI deaths have been confirmed in 28 states and the District of Columbia, up from 60 reported Jan. 21.
  2. The most EVALI cases have been in Texas and Illinois, with each state reporting between 200 and 249 illnesses as of Feb. 4.
  3. Vitamin E acetate, an additive in some THC-containing e-cigarette or vaping products, has been strongly linked to the outbreak.
  4. The recent decline in EVALI cases is due in part to a reporting lag. More deaths are currently under investigation, according to the CDC. Beckers Hospital Review, Feb 12

The outbreak of lung injury associated with vaping has slowed but it has not stopped. CDC data released Tuesday show 2,758 hospitalized individuals (three new) and 64 deaths.


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Would You Like to Be a Judge?
If you’re coming to the House of Delegates meeting – or just live in the neighborhood – please consider participating as a poster judge at this year’s Symposium. The event will take place in Tarrytown on Friday, April 24, 2020. Judging occurs between 1:30 and 3:30 pm. Each judge evaluates approximately 8 – 10 posters and is generally done in an hour. Contact sbennett@mssny.org


Register Now!  Young Physicians/Resident Fellow/Medical Students Meeting

When: Saturday, February 29, 2020
Time: 8:30 am – 12:30 pm
Where: New York Academy of Medicine, 1216 Fifth Avenue, Manhattan.
Why: Guest speakers, panel program “Is Private Practice Even Possible?”, important updates on how to avoid malpractice lawsuits in early practice. Webinar available.

Click here for required preregistration and details.


 


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

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

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

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

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

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


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RENTAL/LEASING SPACE


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


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


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

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

JOB OPPORTUNITIES

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

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

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

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

NYS Corrections Personnel Ad

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



 

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

 

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