Aug. 7, 2015: Other payers position’s on CMS’ relaxed ICD-10-CM rules


drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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August 7, 2015
Volume 15, Number 30

Dear Colleagues:

Earlier this year, the Commonwealth Fund reported the findings of its 2014 Biennial Health Insurance Survey. It subsequently published a brief on the growing trend of Americans purchasing inadequate insurance coverage. The brief notes that the “share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014”.   It further reports that 23 percent of 19-to-64 year-old adults (31 million) had high out-of-pocket costs or deductibles and were as such, underinsured.  This stands in contrast to the 17 million that were previously uninsured who now have insurance (regardless of its adequacy).  The Commonwealth Fund sounds the alarm calling attention to the problem of the underinsured.

This comes as no surprise to New York’s physicians. Many of MSSNY’s members have been sounding this alarm for several years. The numbers of individuals who, prior to the ACA, had no health insurance has decreased.  But the number of those previously insured with higher deductible plans has increased.  This poses a tremendous burden on both patients and physicians.  The Commonwealth Fund brief notes that more such patients are seeing their credit ratings drop, experiencing bankruptcy and incurring credit card debt to pay their deductibles.

Physicians are required by law to make a reasonable effort to collect payment from patients.  We cannot simply write off the physician charges as bad debt.  For the patient who does not meet their high deductible, failure to meet their deductible obligation to their physician threatens future access to care (57% of patients with a high deductible plan reported at least one cost-related access problem).  Many physicians complain to me about their dilemma in trying to render necessary care–despite the patient’s inabilities to meet their deductible–while maintaining viable practices.  For many, opting out of high-deductible plans or opting out of a particular carrier is the only option for their financial viability.

If we truly want to improve access to care for all Americans, we must design health policies that ensure that ALL Americans have access to care.  This means designing and promoting healthcare insurance products with affordable deductibles that encourage patients to seek care and ensure a full cadre of participating physicians to meet their needs.

Failure to address this problem will destroy America’s middle class and shift the demographics of poor health outcomes from America’s poor to America’s middle class.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


SIM/SHIP Listening Tour Sessions in NYC, LI and Albany Next Week: This is Your Opportunity to Participate!
The Department of Health is conducting a Listening Tour to receive input on its design and rollout of the State Innovation Model/State Health Innovation Plan (SIM/SHIP) which will facilitate accelerated delivery system transformation to provide better care at lower cost. Several of MSSNY leaders participated in the SIM listening Tour sessions held last month in Buffalo, Rochester and Syracuse. The SIM/SHIP Tour will hold sessions for physician leaders in NYC, LI and Albany next week! This is your opportunity to participate!

This is a very important opportunity for physicians to provide feedback to the Department of Health on the State Innovation Model (SIM) and the various aspects of the Advanced Primary Care Model. In order to ensure that there is input from our members, you are being invited to participate.

The meeting locations are listed below.  If you are interested in participating, please contact Liz Dears at ldears@mssny.org. Due to space limitations registration is required.

NYC Provider Listening Session:

Date:     8/10/15

Time:    10:00 am – noon

Venue:  United Hospital Fund

1411 Broadway, 12th Floor
New York, NY 10018

Long Island Provider Listening Session:

Date:     8/11/15

Time:    10:00 am – noon

Venue: Medical Liability Mutual Insurance Company (MLMIC)

90 Merrick Avenue – 7th Floor
East Meadow, New York 11554

 Albany Provider Listening Session:

Date:    8/12/15

Time:    10 am – noon

Venue:  MSSNY

99 Washington Avenue, Ste 408

Albany, NY 12210 


MSSNY Survey on EHR Usage and Functionality Shows Continued Level of Frustration with EHR technology- Physicians Who Haven’t Yet Done So, Urged to Complete Survey
Preliminary response to MSSNY’s survey on EHR usage and functionality are consistent with results of other surveys which show a level of dissatisfaction with regard to EHR systems.

While 78% of respondents to MSSNY’s survey are using or plan within two years to use EHRs in their practice or at their hospital, 53% stated that they are either disappointed or very disappointed with their EHR. Notably, 38% of the respondents stated that their EHRs cannot generate routine reports to help manage their patient population, like diabetics, hypertension or ad hoc reports like finding patients due for a flu shot and 29% replied that their EHRs do not support meaningful use 2 or provide guidance on how to achieve MU-2. 56% responded that their EHR did not have prompts to notify them of gaps in patient care. Of the 45% of physicians who stated that they were currently participating in pay for performance (P4P) programs that require reporting from their EHRs, 32% stated that their EHR did not give adequate support to collect data to support their P4P program.

Many stated that they or their staff either manually aggregated the data or purchased additional software to do so. 75% of the respondents did indicate that they were e-prescribing either non-controlled substances only (46%) or both non-controlled and controlled substances (29%). Of those who were not e-scribing, a majority (66%) indicated that the delay in the implementation of the law was the primary reason why they were not yet e-scribing. With regard to educational programming, 46% of respondents stated that they would like more information on three topics: the Delivery System Reform Incentive Program (DSRIP) and how it will affect my practice;  the State Health Innovations Plan and how will it affect my practice; and how to get the most out of the data in your EHR. Other educational programs thought to be of value to respondents included: Value Based Purchasing; What is It and how can physicians position themselves to maximize payment (40%) and Practice transformation; what does this accomplish for the typical physician practice (33%).

Physicians are encouraged, if they haven’t yet done so, to complete the survey by clicking here.


Contact Governor Cuomo to Help Assure “Prescriber Prevails” Protections
Physicians are urged to contact the Governor’s office in support of legislation (A.7208, Gottfried/S.4893, Hannon) that would strengthen “prescriber prevails” protections in Medicaid managed care.  The bill passed the Assembly and Senate before the end of Session, and was just sent to the Governor.

The bill would reduce the hassles physicians are experiencing in trying to assure their patients insured by MMC plans can receive necessary anti-depressant, anti-psychotic, anti-rejection, epilepsy, seizure, endocrine, hematologist and immunologic medications.  In 2012, the Legislature passed a law to assure “prescriber prevails” protection for these drug classes similar to the Medicaid fee for service program, but a quirk in the law has given MMC plans the ability to unfairly delay approval, undermining the intent of the law.  This legislation would help to assure patients can receive these medications with a minimum of hassles.

The Governor has until next Friday, August 14, to act on the bill, so contacts must be made in the next week. A letter can be sent from the MSSNY Grassroots site here or a call can be made to 518-362-8946.


Legionnaires’ Outbreak Has Infected 100, Killed 10
As of Thursday, the Legionnaires’ disease outbreak in New York City has sickened at least 100 individuals. Ninety-two people have been hospitalized and 48 have been treated for the disease and discharged, according to the city’s Department of Health and Mental Hygiene. New York City Health Commissioner Dr. Mary T. Bassett issued a directive Thursday calling for all New York City buildings with water-cooling towers to be accessed and disinfected within the next two weeks. Today, Mayor Bill de Blasio is expected to provide details of a legislative plan he announced this week that is meant to tighten regulation of the cooling towers.


CMS Revised Guidelines Regarding ICD-10 Flexibilities
CMS has revised their FAQs on ICD 10 coding, which are consistent with the original announcement regarding flexibility when the right “family of codes” are submitted. Revisions were made to questions 3 and 5. We are also working with CMS to develop a version of the FAQs that is specifically geared for physicians (attached document is aimed at multiple audiences—Medicare contractors, CMS regional offices) and to be sure that a teleconference planned for late August reflects the initial joint announcement issued on July 6.


ICD-10 News from Non-Medicare Payers
Regina McNally, VP of Socio-Med, has asked non-Medicare payers their view of the AMA’s and CMS’ “relaxed rules” regarding the one-year grace period while physicians transition to full ICD-10 implementation. The following are the non-Medicare payers responses received to date:

  • Aetna: here for Aetna guidelines
  • Cigna: Click here for Cigna guidelines
  • Excellus: “There has been no official decision or discussion on this matter to date.  I suspect we will be following CMS.”
  • HealthPlus/Amerigroup: HealthPlus is evaluating CMS’s guidance for Medicare Part B and its applicability/impact to Medicaid. Consequently, we are awaiting additional guidance from CMS, as to how the agency defines “family” of codes and any guidance specific to Medicaid and Medicare Advantage.  CMS indicated additional guidance is to be forthcoming.
  • Magna Care: http://www.magnacare.com/icd/icd.aspx
  • Medicaid: We are working with CMS and are being advised that they will be issuing guidance to state Medicaid agencies sometime next week.  If you have received or seen anything from CMS it would be great if you could share.  I’ll continue to monitor from our end.
  • MVP: posts its approach and guidelines towards the ICD-10 transition online.  Here is the link. https://www.mvphealthcare.com/provider/ICD-10_updates_and_faqs.html
  • Oscar: We are fairly confident that we will go by this policy for ICD-10: Claims with date of service after 10/1 must have ICD-10 or they will be  Claims received after 10/1 but with date of service before 10/1 can be in ICD-9. For your questions related to a grace period for mis-coded claims, this isn’t a decision that’s been finalized. My sense is that giving providers 365 days to correct a claim is probably too long. We’ll likely stick with our current policy which allows providers to submit an adjusted claim in X number of days after getting a claim decision. X being the number of days a provider has to submit an initial claim. So if a provider has 120 days to submit an initial claim, they’ll have 120 days after getting a claim decision from us to submit an adjusted claim if they feel they made a mistake.
  • SEIU 1199: “For outpatient claims, the 1199SEIU Benefit Funds will deny claims with dates of service on or after October 1, 2015 that is billed with ICD-9 codes.   We will not deny claims if they are submitted with a valid ICD-10 CM and will not deny claims for proper or specificity coding.  Providers can submit corrected claims within 180 days of denials/payment if needed.  For Inpatient Hospital Claims, 1199SEIU Benefit Funds will expect that hospitals apply specificity coding to assign the appropriate DRGs.  Inpatient claims are subjected to reviews to validate this.”
  • UHC: At this point UnitedHealthcare does not believe that any change in our plans is required. The CMS-AMA guidance is specific to Medicare Part B and to medical record reviews / reporting penalties. Actual claim submission (valid ICD-10 code is required for submission) and claim processing should not change (either with CMS or elsewhere). Also, CMS has not issued any additional or modified requirement to health plans regarding ICD-10 claim processing.

Subsequently, when UHC was asked: if Medicare is primary and the physician used an unspecified code within the Family of ICD-10 and Medicare extended their primary benefit, will UHC extend its secondary benefit involving the Medicare deductible and/or coinsurance?  UHC’s replied as follows:

It would still have to be a valid code—not the family code—for CMS submission.  The code submitted can be unspecified, as unspecified codes are valid codes (it should be said that UnitedHealthcare is aligned with the CMS guidance from a specificity perspective in the sense that we do not have a new edit related to ICD-10 specificity) but again it has to be a valid ICD-10 code.  Below is what CMS states about valid codes:

What is a valid ICD-10 code? (Revised 7/31/15)

Answer 3:

All claims with dates of service of October 1, 2015 or later must be submitted with a valid ICD-10 code; ICD-9 codes will no longer be accepted for these dates of service. ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD-10 code from the right family (see question 5) is submitted, Medicare will process and not audit valid ICD-10 codes unless such codes fall into the circumstances described in more detail in Questions 6 & 7.

Question 5:

What is meant by a family of codes? (Revised 7/31/15)

Answer 5:

“Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

Question 6:

Does the recent Guidance mean that no claims will be denied if they are submitted with an ICD-10 code that is not at the maximum level of specificity?

Answer 6:

In certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an applicable policy, such as Local Coverage Determinations or National Coverage Determinations. (See Question 7 for more information about this). This reflects the fact that current automated claims processing edits are not being modified as a result of the guidance.

In addition, the ICD-10 code on a claim must be a valid ICD-10 code. If the submitted code is not recognized as a valid code, the claim will be rejected. The physician can resubmit the claims with a valid code.


Emblem Health Response to 7/31 Enews Article: Pulmonary Function Tests and E&M Visits on the Same Day
From Regina McNally, VP, Socio-Med
We [Emblem Health] convened a meeting (in follow-up to my forwarding your email) with representation from our Recovery Unit, Medical Directors and Legal department to ensure that all understand that CMS rescinded the MLN SE 1315 document and that it can no longer be used as grounds for recoveries. (We also confirmed that all of the requests that had been made were within the correct look back periods.) A new communication is being prepared to the providers who received the notices.

Regarding the larger issue of the use of Modifier 25, the joint understanding of the group is that it is necessary as the way for providers to let us know that a separate and distinct Evaluation and Management (E&M) service took place in addition to the diagnostic test or procedure. We agree that both events can take place on the same day and that both events can be payable, but they need to be communicated to us in a way that we can distinguish situations where the test or procedure was the sole reason for the visit from those situations where the test or procedure was performed in addition to a discrete E&M service.  According to our Medical Director, visits for “tests only” take place all the time and use of Modifier 25 is a matter of correct coding, not how medicine is practiced.

Emblem Health is planning an education campaign to let providers know that they need to distinguish stand-alone E&M services by using Modifier 25.

For Nassau and Suffolk Physicians


Adelphi University Accelerated MBA Program for Physicians
The Suffolk County Medical Society (SCMS) has formed a partnership with Adelphi University to offer its physician members (and prospective members) an opportunity to obtain an MBA degree from the Robert B. Willumstad School of Business. All classes will be held at SCMS headquarters.

All coursework is related to healthcare and will help you to run a more cost-effective practice as well as become proficient in business strategies. You’ll also gain the necessary skills to be an effective leader, critical thinker, negotiator and problem solver should you choose to be part of the decision-making process in the future of the healthcare system.

Classes will meet on Thursday evenings at SCMS, 1767 Veterans Memorial Highway in Islandia. The program will consist of 42 credits (14 courses) and is AACSB Accredited. For more information about the program, please contact Maureen Leslie, Assistant Director, at 516-237-8607 or leslie@adelphi.edu.



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July 31, 2015 – Facts v. Perceptions in JAMA’s ACA Study


drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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July 31, 2015
Volume 15, Number 29


Dear Colleagues:

This week, the Journal of the American Medical Association published the findings of a survey which, among other goals, sought to ascertain the nature of changes in access to care, and the health of patients during the first two enrollment periods of the ACA. In addition, the survey wanted to identify differences for low-income individuals in states that expanded Medicaid versus those that did not.  The authors point out the importance of the survey findings for development of future health policy. Sadly, the survey merely serves to highlight the dangers in failing to follow fundamental evidence-based research principles.  If the results are used as intended by the authors, the astute clinician with good critical appraisal skills will understand how flawed research design leads to flawed health policies.

Flawed Core Design

The development of a clear and answerable question is at the core of study design.  Moreover, the findings must be relevant and applicable to the research subjects and/or to the beneficiaries of the study findings.  The study’s questions, methods and findings all fail the relevancy test. A critical appraiser should reject the conclusions of the authors, especially as they are unsuitable for policy development.  “Perceived” patient access to care does NOT equate to access to care.  The ACA may have given more Americans the ability to purchase health insurance. However, having an insurance card, especially a Medicaid product, does not translate to being able to find a doctor to treat you.

“Insurance card access” says nothing about actual access. Will a newly acquired Medicaid card be equal to, better or worse than the care they may have received without insurance or with a non-Medicaid insurance product?  Are these patients actually accessing doctors?  Does the patient’s perception of the quality of care meet the perceptions of other patients with non-Medicaid insurance products? Questions based on patient perception of these matters are important but they should not be the central drivers of health policy.

Evidence of Access Problems

Policy needs to be grounded in more scientifically valid observations— not patient bias.  However, if the goal is to pander to public perceptions to promote health policy that has other agendas as their drivers, then “perceived” improvements in healthcare or access will suffice.  There is growing evidence that access to care is a problem for patients who have signed onto ACA health insurance products.

We now have the data to study access to care based on claims.  Insurance carriers can certainly provide deep data on complication rates, readmissions, and other outcomes.  If we want to develop sound health policy while assessing the current outcomes of patient care under the ACA, let’s do so based on evidence extracted from well-designed studies that are truly relevant to meaningful health policy development.

Perception of care is not delivered medical care. Let’s begin the future with the facts.

JAMA study

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


Please Take Just a Few Minutes to Complete our Health Insurance Hassles Survey
If you have not already, we urge you to take the opportunity to complete our latest health insurance hassles survey.  To complete the survey, click here.   It should take no more than just a few minutes.  Some of the initial findings of our survey include:

  • Many physicians see patient access to Out of Network coverage shrinking. 33% of the respondents indicated that they treat far fewer patients with out of network coverage than they did 3 years ago, and over 40% indicated that their patients’ OON insurance cover far less of a patients’ medical costs than it did 3 years ago
  • Health plan online participating provider lists are often inaccurate. 45% of the respondents indicated that they were erroneously listed as a participating provider on a health insurer’s website
  • Payments by Exchange plans are poor. Over 75% of the respondents indicated that Exchange plans paid them less than other commercial insurance products, with over 50% noting that the payments were “significantly lower” than payments for other plans offered by that insurer.
  • Health plans are shrinking their networks. Over ¼ of the respondents noted that there were not asked to participate in a new health insurance products offered by a plan with which they participated, with the overwhelming number of respondents noting that the reason was because the plan wanted to offer a “narrow network”.
  • Significant numbers of patients now have hefty deductibles. Nearly 20% of the respondents noted that patients with deductibles of $5,000 or greater comprised 10-25% of their practice, while 32% noted patients with deductibles between $2,500 and $5,000 comprised another 10-25% of their practice; and nearly 40% noted that patients with deductibles between $1,000 and $2,500 comprised another 10-25% of their practice.

These surveys help us to fully understand physician concerns with the contracting process between physicians and these health insurers. The findings also assist MSSNY’s advocacy efforts in the media and with policymakers to support fair contracting, comprehensive health insurer networks and comprehensive out of network coverage.

However, we need a representative cohort of physicians to respond to this survey is we are to be successful in advocating on yours and your patients’ behalf.  Please take just a few minutes to share your perspective.


United Healthcare and In-Network Labs
Effective September 1, 2015, UHC will require its network physicians and other qualified healthcare professionals in NYS to refer to or use network laboratories and pathologists for UHC Oxford NY members.  Any questions? Call United Healthcare Oxford network Laboratory Services Manager, Catherine Schaal at 631-584-0152.


55 Million Enrolled in Medicare; 3.3 Million in New York
55 million Americans are now covered by Medicare, according to a press release issued by CMS this week recognizing the 50th anniversary of Medicare and Medicaid.   The press release noted that there are over 3.3 million New Yorkers enrolled in Medicare, with over 2 million enrolled in traditional Medicare, and 1.25 million enrolled in Medicare Advantage plan.  Moreover, over 2.5 million New Yorkers have prescription drug coverage through Medicare, broken down between nearly 1.4 million enrolled in a Part D plan, and over 1.1 million enrolled in a Medicare Advantage plan with drug coverage. 


Over 2 million New Yorkers Enroll in Exchange; Nearly 75% is Medicaid
2.1 million New Yorkers enrolled in a health plan via the New York State Health Insurance Exchange, according to data released this week by the New York State of Health..  The data indicated that nearly ¾ of that 2.1 million, 1,568,345, were enrolled in Medicaid, with 159,716 enrolled in Child Health Plus, and 415,352 enrolled in commercial health insurance coverage.

The data also showed 9 health insurers enrolled 5% or more of total statewide commercial health insurance enrollees, led by Fidelis Care (20%), Health Republic (19%), Healthfirst (10%) and Empire Blue Cross Blue Shield (10%).  Of great concern, out of network coverage benefits were only available in 11 counties, with 21% of the enrollees in those counties selecting this coverage.   This lack of out of network coverage is exacerbated by the problem many consumers and physicians have reported regarding Exchange plans having inadequate physician networks to meet patient care needs.  Therefore, MSSNY continues to seek legislation (S.1846, Hannon/A.3734, Rosenthal) to require health insurers to offer out of network coverage in New York’s Exchange.

The overwhelming majority (58%) of those who received coverage in the Individual market were enrolled in Silver plans, while 18% enrolled in Bronze plans, 12% enrolled in Platinum plans, 10%  enrolled in Gold plans, and 2% enrolled in Catastrophic plans.  The State also reported that 55% percent of enrollees in the Individual market are in health plans with no annual deductible or deductibles of $600 or less.

While the overwhelming percentage of commercial health insurance coverage enrollment was in the individual market, the data indicated that 3,700 small businesses across New York State had procured coverage through the State Business Marketplace (SBM), providing coverage to nearly 15,000 employees and dependents.   Platinum plans were the most popular plan selected in the SBM representing over one-third of total enrollment. Gold and silver plans had enrollment at 27% and 26%, respectively, and only 13 % of SBM enrollees chose Bronze plans. 


Funding Opportunities Date Extended for Doctors Across New York
The New York State Department of Health, Office of Primary Care and Health Systems Management has made revisions to the Cycle IV Doctors Across New York (DANY) Physician Practice Support and Physician Loan Repayment Programs Funding Opportunity. The DANY application submission deadline has been extended to Monday, August 31, 2015. Applicants can, and are encouraged to, submit prior to the August 31st deadline.

For other revisions, please refer to the New Program Changes (Supersedes all other document references) bullet on the website.


Legionnaires Disease Outbreak in South Bronx
NYCDOHMH is reporting an outbreak of Legionnaires’ disease in the South Bronx, resulting in two deaths. There have been 31 reported cases since July 10, compared with five confirmed cases during the same period in 2013 and 2014, combined. The rate of Legionnaires’ disease in the Bronx during 2015 has been 3.9 per 100,000 residents, more than twice the rate of the rest of the city. In High Bridge-Morrisania and Hunts Point-Mott Haven, the rate is 8.8 per 100,000. Dr. Jay Varma, New York City’s Department of Health and Mental Hygiene Deputy Commissioner for Disease Control, said what is “unique and important” about the recent outbreak is the “dramatic increase in one specific area.” Officials had noticed an initial uptick in cases last week followed by a large increase over the weekend.


Legislation Introduced in Congress to Address Burdensome Meaningful Use Requirements
This week U.S. Representative Renee Elmers (R-NC) introduced legislation (H.R. 3309, the Further Flexibility in HIT Reporting and Advancing Interoperability Act, or Flex-IT 2 Act) to reduce the overwhelming burdens physicians are facing with complying with federal EHR meaningful use requirements.   A press release by Rep. Ellmers noted that the bill would accomplish the following:

  • Delay Stage 3 Rulemaking until at least 2017, or MIPS final rules or at least 75 percent of doctors and hospitals are successful in meeting Stage 2 requirements.
  • Harmonize reporting requirements (MU, PQRS, IQR) to remove duplicative measurement and streamline requirements from CMS.
  • Institutes a 90-day reporting period for each year, regardless of stage or program experience
  • Encourages interoperability among EHR systems
  • Expands hardship exemptions, as they are very narrowly defined under current regulations

In the press release, Rep. Ellmers made the following statement:

Today’s legislation is key to supplying healthcare providers with flexibility and certainty, as they struggle yet again to meet the Centers for Medicare & Medicaid Services’ (CMS) stringent requirements pertaining to Meaningful Use. This legislation supplies relief by delaying Stage 3 rulemaking until at least 2017 in order to give providers time to breathe and a reprieve from the unfair penalties.”

“Only 19 percent of providers have met Stage 2 attestation requirements—a clear sign that physicians, hospitals and healthcare providers are challenged in meeting CMS’ onerous requirements. Given this basic fact, I’m uncertain why CMS would continue to push forward with a Stage 3 rule. From my conversations with doctors back home, it is clear they are eager for relief.”

“As a nurse, I can speak to the fact that a patients’ health and safety must be put first. This legislation will ensure that hospitals and providers can effectively share information so they can continue to focus their time and attention to caring for patients.”            


Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation. Please note: As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.

Sessions are available on:


Pulmonary Function Tests and E&M Visits on the Same Day
From Regina McNally, VP, Socio-Med
Back in February 2015, it was brought to the attention of SME that NGS Medicare was seeking recovery action and offset for pulmonary function test done on the same day as an office visit.  In researching this matter, we found that CMS issued a MedLearn article, SE 1315.  This MLN article has no dates.

This old claims examiner (I) believed that the article is not appropriate for standard medical practice.  A Modifier 25 should not be needed to claim ANY diagnostic test (not a procedure) on the same day as a visit.  I asked CMS if they thought it necessary to use a Modifier 25 on the E&M code when an EKG or a lab test is also billed on the same day as a visit.  The author finds the position outlined in the article unnecessary. In addition, just because the RACs do not understand standard medical practice, is no reason for CMS to change the rule regarding a standard medical practice.

Therefore, I alerted CMS Central Office staff and asked that recovery actions for lack of a modifier 25 should be stopped and the article be rescinded.  As of today, July 28, 2015 we have been informed of the following:

Rescinded

SE1315 – Pulmonary Procedures and Evaluation & Management (E&M) Services

If any physician has been the subject of a recovery action on the basis of SE1315, the practice should file an appeal as soon as possible to get their money back if it was refunded or offset. 

Physician Groups Band Together to Address America’s Opioid Crisis
AMA convened task force engages physicians to curb opioid abuse

The AMA Task Force to Reduce Opioid Abuse announced the first of several national recommendations to address this growing epidemic.

The AMA Task Force to Reduce Opioid Abuse  is comprised of 27 physician organizations including the AMA, MSSNY, American Osteopathic Association, 17 specialty and six other state medical societies  as well as the American Dental Association that are committed to identifying the best practices to combat this public health crisis and move swiftly to implement those practices across the country.

“We have joined together as part of this special Task Force because we collectively believe that it is our responsibility to work together to provide a clear road map that will help bring an end to this public health epidemic,” said AMA Board Chair-Elect Patrice A. Harris, M.D., MA. “We are committed to working long-term on a multi-pronged, comprehensive public health approach to end opioid abuse in America.”

Medical Society of the State of New York President Joseph Maldonado, MD, said, “In an effort to reduce prescription diversion and abuse, New York has already taken the lead on this issue. New York’s physicians play a critical role in the effectiveness of the toughest opioid abuse program in the nation since August of 2013.  We are honored to become part of the AMA Task Force to address this epidemic.”

The AMA has long advocated in support of important initiatives aimed at addressing prescription drug abuse and diversion. This includes continued work with the administration and Congress toward developing balanced approaches to end prescription opioid misuse, as well as supporting congressional and state efforts to modernize and fully fund PDMPs.

The new initiative will seek to significantly enhance physicians’ education on safe, effective and evidence-based prescribing. This includes a new resource web page that houses vital information on PDMPs and their effectiveness for physician practices, as well as, a robust national marketing, social and communications campaign to significantly raise awareness of the steps that physicians can take to combat this epidemic and ensure they are aware of all options available to them for appropriate prescribing.


Diagnosing TBI in Your Office
Hospital data reveal that within New York State, over 550 persons per day sustain a brain injury caused by stroke, a Traumatic Brain Injury (TBI) or other factor(s). Actual incidence is higher as the prior numbers reflect only hospital based data; excluded are persons with brain injuries who seek treatment in a clinic, urgent care, or physician’s office, and those with the injury who are not aware of it.  Even a “mild” brain injury can result in lifelong disability, especially if proper treatment is not received.

To promote recognition and treatment of brain injury, the State University of New York at Albany’s School of Public Health produced a webcast, “Recognizing and Treating Mild Brain Injury” for health practitioners, in collaboration with a Federal grant awarded to the New York State Department of Health. The webcast, via “Public Health Live” received rave reviews from the physician, nurse, and nurse practitioner audience.  The program features the one page, evidenced based TBI diagnostic tool, “Acute Concussion Evaluation” (ACE) available free of charge from the Centers for Disease Control and Injury Prevention (CDC) website.

The goal of the program is to increase the number of practitioners able to recognize even the subtle signs of brain injury which may not surface until weeks even months after the initial trauma. That diagnostic ability can save lives and ameliorate the suffering caused by brain injury. The program is easy to access, and lists brain injury related information and materials, including the link to the ACE, all available free of charge. Continuing Medical Education Credits are available as listed below. Practitioners are encouraged to log on to the training at: http://www.albany.edu/sph/cphce/phl_0415.shtml

Continuing Medical Education Contact Hours: The School of Public Health, University at Albany is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. The School of Public Health, University at Albany designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits TM. Physicians should claim credit commensurate with the extent of their participation in the activity. Continuing education credits will be available until February 2016.

The training was paid in part by a grant from the Health and Human Resources and Services Administration to the NYS Department of Health Grant # H21MC26921.  For more information about the TBI Grant contact, helen.hines@health.ny.gov.



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When you understand your practice is an online business, tell us where it hurts.   Whether your website needs a simple refresh or serious surgery, our digital doctors heal what hurts. Doctors Digital Agency will improve your site’s front-end user experience and back-end functionality.  That means more patients, more phone calls, more patient time, more profitability. We use responsive design to build mobile and search-engine friendly custom websites. Leverage electrons!  Visit http://www.doctorsdigital.agency Email: hello@doctorsdigital.agency, or call 786-529-2025. Doctors Digital Agency, Inc. Since 1996.

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

July 24, 2014 – All in the Family??


drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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July 24, 2015
Volume 15, Number 28


Dear Colleagues:

Editor’s note: MSSNY President Dr. Maldonado is on vacation. This week’s Enews introduction is written by Michelle A. Leppert, CPC, a senior managing editor for JustCoding.com. And an editor for HCPro publication, Briefings on Coding Compliance Strategies.

Remember those friends and family cell phone plans where you didn’t use minutes if you called people in your circle? You had to pick who you wanted in your group and they had to pick you. It was very confusing trying to figure out who was in the family and who wasn’t.

CMS created the same kind of confusion last week when it basically cut a deal with the American Medical Association (AMA). The AMA, you may recall, has been very vocally opposed to ICD-10 being implemented in any way, shape, or form. To get AMA to cease and desist its defiance, CMS gave AMA something it wanted: no penalties for some coding errors and advanced payments if the technology goes kerflooey.

I can totally understand advancing payments if the system doesn’t work. That’s pretty straightforward. The physician gets paid on time and doesn’t have to worry about going under because of something he or she can’t control. The physicians will have to repay the advanced payment once the system is running smoothly, so they aren’t getting extra money. They just get a hedge against a Y2K meltdown. 

Coding from the Right Family?

The confusing part of the pact is the hold harmless for miscoding. AMA initially wanted physicians to get a pass on coding errors for two years. I’m pretty sure AMA knew that wasn’t going to fly, but when you negotiate, you always start high. In the final deal, CMS stated auditors will not deny a claim “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”

CMS does not, however, define a family of codes. Is it a category of codes, such as S00, superficial injury of head? That could be interesting. S00 has nine subcategories of codes, each with their own subcategories. Or does CMS mean those subcategories, say S00.4, superficial injury of ear? Again, S00.4 includes eight subcategories with their own subcategories.

Maybe CMS considers a family to be the smallest group of subcategories. So under S00, we could go all the way down to S00.46-, insect bite (nonvenomous) of ear as a family. That would give us three codes in the family:

  • 461, insect bite (nonvenomous) of right ear
  • 462, insect bite (nonvenomous) of left ear
  • 469, insect bite (nonvenomous) of unspecified ear

That seems reasonable. The only missing information is the laterality. Not a huge deal, but really the physician should be documenting it. Maybe the coder just couldn’t find it or was in a hurry and defaulted to unspecified.

Let’s consider open wounds of the eyelid and periocular area (S01.1). This is a subcategory under open wound of the head (S01). We’ve already narrowed it down to a specific area. The question becomes, is everything under S01.1- a family? I hope not. Here’s why. The first subcategory under S01.1- is S01.10- (unspecified open wound of eyelid and periocular area). S01.10- further specifies laterality:

  • 101-, unspecified open wound of right eyelid and periocular area
  • 102-, unspecified open wound of left eyelid and periocular area
  • 109-, unspecified open wound of unspecified eyelid and periocular area

That last one’s a killer because it tells you nothing. No wound type, no laterality.

Subsequent Encounters

Additional subcategories under S01.1- specify the type of wound:

  • Laceration with (S01.12-) and without foreign body (S01.111)
  • Puncture wound with (S01.14-) and without (S01.131) foreign body
  • Open bite (S01.15)

I can see not penalizing someone for failing to reporting the “without foreign body” code instead of requiring coders to query if the physician doesn’t document that no foreign body remained in the wound. The question of with or without foreign body becomes tricky when you start looking at subsequent encounters.

If S01.1- is a family, claims won’t be denied if you report S01.109- instead of S01.132- (puncture wound without foreign body of left eyelid and periocular area). Fractures will be even more confusing, largely because ICD-10 includes so many variations of fracture codes. What about specificity for diseases, such as diabetes? Where do you draw the family line? Is it the type of diabetes? So all codes under E11 (Type 2 diabetes mellitus) are one family?

Or do you go to the first subcategory and say all codes under E11.3- (Type 2 diabetes mellitus with ophthalmic complications) are the same family and therefore we won’t deny the claim if you have any E11.3- code. Maybe CMS goes one step further and really narrows down the family to E11.31- (Type 2 diabetes mellitus with unspecified diabetic retinopathy), which includes two codes:

  • 311, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
  • 319, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macularedema

We don’t know. I’m not convinced CMS knows at this point.

Something else we don’t know—how does this deal with AMA affect hospitals? CMS and AMA both only reference Part B physician fee schedule claims. What about Part A claims? Is CMS going to extend the same breaks to hospitals? Again, we don’t know.

CMS may have finally gotten the AMA on board with ICD-10, but it sure created a lot of additional confusion along the way.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



Reminder: MSSNY General Counsel Develops Template Forms for Physicians To Comply With Out of Network Law Required Disclosures
As a reminder, MSSNY’s General Counsel Donald Moy, Esq. has developed model template disclosure forms that physicians can use in their practices to comply with the new “surprise medical bill” law which took effect on April 1, available from the MSSNY website (Members Only) here. These new requirements include:

                             Network and Hospital Affiliations

All physicians must provide to patients or prospective patients in writing or on the physicians’ website prior to the provision of non-emergency services:

  • The health care plans with which the provider participates; and
  • The hospitals with which the health care professional is affiliated

For the model form physicians can use in their practice, click here.

Model Form #1

In addition, this participation/affiliation information must be provided verbally at the time an appointment is scheduled.

                                               Fee Disclosure

Physicians who do not participate in the network of a patient’s or prospective patient’s health care plan must:

  • Prior to the provision of non-emergency services, inform the patient or prospective patient that the amount or estimated amount the patient will be billed for health care services is available upon request;
  • Upon receipt of a patient or prospective patient’s request, the amount or the estimated amount (in writing) the patient will be billed for health care services, absent unforeseen medical circumstances that may arise when the health care services are provided

For the model forms physicians can use in their practice, click here, Model Forms #2-A, 2-B and 3

Other Health Care Providers Involved in Providing Patient Care

Allphysicians who refer or coordinate services for patients with another provider must provide to their patients the name, practice name, mailing address, and telephone number of any health care provider scheduled to perform anesthesiology, laboratory, pathology; radiology; or assistant surgeon services, in connection with care to be provided

  • in the physician’s office;
  • as coordinated by the physician; or
  • as referred by the physician.

For the model forms physicians can use in their practice, click here, Model Form, #4

Other Physicians Involved in Hospital Care

At the time of a patient’s pre-admission testing, registration or admission for scheduled hospital admission or outpatient hospital services, all physicians must provide their patients with the name, practice name, mailing address and telephone number of any other physician whose services will be arranged by the physician and are scheduled at the time non-emergency services are scheduled.

For the model forms physicians can use in their practice, click here, Model Form #5.

There are also numerous other provisions incorporated into this new law which took effect this past April 1.  For a summary click here.


Residents Salary & Debt Report 2015: Are Residents Happy?
Medscape surveyed more than 1700 residents in 24 specialties to take part in an online survey from May 14, 2015, through June 22, 2015. All participants were enrolled in a US medical resident program. In 2015, the average resident salary—$55,400—was a slight increase over that reported in Medscape’s 2014 Residents Salary & Debt Report ($55,300). The figure averages higher earnings in such specialties as critical care and oncology and lower earnings in other specialties, such as primary care. Some 68% of residents have a considerable amount of medical school debt (exclusive of any other debt): $50,000 or more. Well over one third (37%) of residents have over $200,000 in debt, and over one fifth (22%) have $100,000-$200,000. Another 9% have $50,000-$99,999, and 10% have less than $50,000. A fortunate 22% of residents have no debt.

Nearly two thirds (62%) of the residents we surveyed reported that they considered their compensation fair. This is higher than what was reported by practicing physicians; almost one half (47%) of primary care physicians feel fairly compensated, and 50% of specialists feel fairly compensated. Medscape surveyed more than 1700 residents in 24 specialties to take part in an online survey from May 14, 2015, through June 22, 2015. All participants were enrolled in a US medical resident program.


Missed the Meaningful Use Town Hall Meeting? Watch a Re-Broadcast
This week the AMA hosted a special national “town hall” meeting in Atlanta to highlight physician concerns with electronic health record systems (EHRs).  The forum gave physicians an opportunity, both in person and via Twitter, to express concerns with their efforts, often futile, to achieve meaningful use of EHR systems in order to avoid Medicare payment penalties.  In many cases, physician speakers noted that they had been “early adopters of EHR technology, yet still could not achieve meaningful use Stage 2, and had simply chosen to accept penalties in lieu of the interference they were facing in trying to provide needed patient care.  Moreover, physicians shared frustrations about the failure of EHR companies to assure that medical record systems become interoperable to better enable the sharing of treatment information when physicians treat the same patient.  To watch a re-broadcast of the “Town Hall” event, click here: http://live.breaktheredtape.org/.  To read more about this event, click here.


Your New Video – Countdown to ICD-10: 10 Facts about ICD-10
The Centers for Medicare & Medicaid Services (CMS) has released an exciting new video to help ease your transition as we count down to ICD-10 implementation. This animated video highlights ten facts of what to expect during the ICD-10 transition.

The following videos are currently available for viewing on CMS’s YouTube channel:

The 10/1/2015 implementation date is fast approaching and these videos will provide an overview of ICD-10 as well as explain the benefits of the new code set. It will also provide implementation guidance and coding examples. We hope you find these videos to be a valuable asset as we count down to ICD-10.


National Government Services Needs YOUR Help! Take Their Survey!
We know how busy you are but we urgently need our customers’ perspective. We are counting on you and your staff to complete the Medicare Satisfaction Indicator (MSI) and website ForeSee surveys. It takes time, but the benefit of taking these two surveys will help you as a Medicare Provider and us as a Medicare Contractor determine how we are performing.  Are you happy with us?  We hope you are, but if not, we need to know that too!  Good, bad, or indifferent, your feedback is a necessity!

Both surveys are available on their website at www.NGSMedicare.com.  The MSI survey banner is displayed on the home page.  For the website ForeSee survey, you are randomly chosen to take it, so whenever you do get that option, please click “yes, I’ll give feedback.”  As we work with your suggestions, you will be glad you took the 5-10 minutes to complete the survey.

This link will take you to the MSI survey for Part A and Part B providers.

Link to CMS MAC MSI Survey


What You Should Know about MEDICARE/MEDICAID Dual Eligibles
The following is provided as an informational reminder from Socio-Med VP Regina McNally:

As you should know, effective July 1, 2015 NYS Medicaid is no longer paying the 20% of the 20% coinsurance from the Medicare claim for Medicare/Medicaid dual eligible patients.  The NYS budget did not include funding to maintain this benefit from the NYS Medicaid Program. The final budget, accepts in part, the Executive’s proposal to limit Medicaid payments for dual eligibles’ Medicare Part B coinsurance amounts so that the total Medicare/Medicaid payment to the provider does not exceed the amount that the provider would have received for a Medicaid-only patient. The final budget accepts this cut with respect to dual eligibles in fee-for-service Medicare, but rejects it for dual eligible beneficiaries who are enrolled in Medicare Advantage plans. This cut took effect on July 1, 2015.

The June 2015 Medicaid Update on this matter reads as follows:

Effective July 1, 2015 a change to New York State Social Services Law adjusts Medicare Part B coinsurances reimbursement methodology for practitioner claims: Medicaid presently pays practitioners the full Medicare Part B annual deductible and partial Medicare Part B coinsurance amounts (20 percent of the Part B coinsurance) for Medicaid covered services provided to Medicare/Medicaid dually eligible recipients. Pursuant to recent changes to Social Services Law, New York State Medicaid has revised the reimbursement methodology for practitioner claims effective July 1, 2015. 

Beginning July 1, 2015, Medicaid is no longer reimbursing partial Medicare Part B coinsurance amounts. The total Medicare/Medicaid payment to the provider will not exceed the amount that the provider would have received for a Medicaid-only patient. If the Medicare payment is greater than the Medicaid fee, no additional payment will be made.

Note: The Medicare and Medicaid payment (if any) must be accepted as payment in full. Per State regulation 18 NYCRR Section 360- 7.7, a provider of a Medicare Part B benefit cannot seek to recover any Medicare Part B deductible or coinsurance amounts from Medicare/Medicaid Dually Eligible Individuals.

There is no change to the current reimbursement methodology of Medicare Part B coinsurance for the following: Ambulance providers; Psychologists; Article 16 clinics; Article 31 clinics; and Article 32 clinics. Medicaid will continue to reimburse these providers the full Medicare Part B coinsurance.

Reminder: If a patient is dually eligible, private practitioners must bill Medicare prior to billing Medicaid for the Part B co-insurance. Most claims are submitted to Medicare and are automatically crossed over to Medicaid for processing.

If a medical practice is enrolled with a Medicare Managed Care (MMC) (Medicare Part C), when the MMC pays the practice the payment is expected to be considered as payment in full.  The medical practice should review its MMC contract.

Regrettably, this goes back to the federal Balanced Budget Act of 1997.  The BBA included a clause that stated the states no longer had to pay the coinsurance amounts for “dual eligible.”  The BBA was passed at the time when MSSNY had just won the Medicare/Medicare Crossover lawsuit.  Therefore, NYS had decided to continue paying a small portion of the Medicare Coinsurance amount.  However, it just so happens that this year, the state decided to no longer include payment for this in the state budget.  The state will still cover the Medicare Part B deductible, though.

The statute  §1902(n)(3) of the Social Security Act) says that, where the State Medicaid program limits the amount it will pay for deductibles and coinsurance for QMBs, “for the purposes of applying any limitation under title XVIII [Medicare] on the amount that the beneficiary may be billed or charged for the service, the amount of payment made under title XVIII [Medicare] plus the amount of payment (if any) under the State plan [Medicaid] shall be considered to be payment in full for the service…”

Therefore, under Medicare rules, the provider has been paid in full if it receives the normal Medicare payment amount for the service plus any amount that Medicaid pays, even if Medicaid pays nothing.  It doesn’t matter that the provider is not enrolled in Medicaid, billing beyond what Medicare and Medicaid pays would be a violation of Medicare rules.

When treating a dual eligible, there is mandatory assignment for the Medicare claim.  This is not a new rule.

Can a physician who is not enrolled in Medicaid bill a Medicaid recipient for the Medicare deductible?

The answer is no. Under no circumstance can a provider balance bill dual eligible.  The provider needs to enroll in the Medicaid program as a non-participating provider for Medicaid to cover the Medicare deductible. Being enrolled in Medicare, you need to be cautious about not treating dual eligibles in your medical practice. Any patient should not be discriminated against because of the health insurance they have or don’t have.

Since a medical practice should not discriminate against any patient based on the type of payer/insurance/plan by which the patient is covered, a practice can make a business decision to limit the amount of patients it can handle from a particular plan.  So, the practice can say it can’t take any more patients from “X” plan.

Questions Regarding Out of Network Telephone Audits

Question: I am an out of network physician, but a health plan wants to audit me. What are my obligations?

Being out of network, physicians would be non-participating and therefore have NO contract with a health plan. To par or not to par with a health plan must be an individual business decision by any physician/practice.

A physician without a contract with a health plan who is asked to go through an audit process, should tell the health plan that a patient authorization is required before an audit can be conducted.  Without a contract, physicians have no obligation to a health plan but do have a privacy obligation to their patient. If the patient is covered by a health plan, the link is between the health plan and the patient. If the health plan wants the patient’s medical record, the health plan needs to obtain the patient’s authorization for disclosure of his/her medical information by the physician.

Physicians without contract with a health plan have no obligation to the plan.  The physician’s only obligation is to the patient.  Physicians should not leave themselves open to violations of their patients’ privacy.  Without the patient’s authorization to disclose their medical record, the physician has no authority to disclose the information.

Question: What if I have a contract with the plan?

If the health plan takes a negative position and wants the call to proceed without the benefit of recording and the physician has a contract, then the physician would need to make a business decision about the possibility of putting his/her contract at risk of termination.

Question: I am out of network. What if I receive a check from the plan?

When a physician has no contract with a health plan and the health plan inadvertently sends the physician a check, if the physician cashes the check, there could be an implied assignment of benefit whereby the physician is expected to “stand in the shoes of the patient.” If the physician does not want an implied assignment of benefits, the word “VOID” should be written across the face of the check and the check should be returned to the health plan with the instruction to reissue the check to the health plan’s insured/patient.

Question: Can I record a telephone audit?

It would be a good idea and a professional courtesy to inform the auditor that the telephone call will be recorded.  If the health plan representative chooses not to be recorded, then the audit would not need to proceed for a physician who has no contract. 

In reference to recording a telephone audit, the law on this is as follows:

NYS Penal § 250.00 Eavesdropping; definitions of terms.

    The following definitions are applicable to this article:

  1. “Wiretapping” means…   
  2. “Mechanical overhearing of a conversation” means the intentional overhearing or recording of a conversation or discussion, without the consent of at least one party thereto, by a person not present  there at, by means of any instrument, device or equipment…..

                                                                                   –From Regina McNally


Comprehensive Care for Joint Replacement (CCJR) Model Webinar Materials Posted
In follow-up to the July 9, 2015 announcement of the Comprehensive Care for Joint Replacement (CCJR) Model, the CMS Innovation Center hosted two webinars on July 15 and July 16, 2015. These webinars focused on providing an overview of the Model and provided an opportunity for attendees to ask questions.

The materials from these overview webinars are now available on the CCJR Overview webinar page. To access the audio recordings of both webinars, an email address is required. If already registered, please use the same email address used at the time of registration. Additional information on the CCJR Model can be accessed through the CCJR Model web page 


Calling All Amateur Photogs for MSSNY’s Social Media Feeds
We’d like to include more happenings from around the state in our Twitter, Facebook and Instagram feeds. If you’re at an event that you think might be of interest to our followers, please snap a picture with your phone and send to jvecchione@mssny.org with your name.  Be sure to include a caption or some identifying words. If you’re traveling around our beautiful state this summer, send us a photo!



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Doctors Digital Agency
When you understand your practice is an online business, tell us where it hurts.   Whether your website needs a simple refresh or serious surgery, our digital doctors heal what hurts. Doctors Digital Agency will improve your site’s front-end user experience and back-end functionality.  That means more patients, more phone calls, more patient time, more profitability. We use responsive design to build mobile and search-engine friendly custom websites. Leverage electrons!  Visit http://www.doctorsdigital.agency Email: hello@doctorsdigital.agency, or call 786-529-2025. Doctors Digital Agency, Inc. Since 1996.

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

eNews July 17, 2015 – Physicians and “Freebies”


drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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July 17, 2015
Volume 15, Number 27

Dear Colleagues:

This past week, Joe Queenan wrote a column in the Wall Street Journal entitled “Is There a Doctor in the House?”  Mr. Queenan suggests that physicians ought to behave like many other business owners who throw a patient/customer/client a “freebie” once in a while.  He proposes that procedures that an individual undergoes on a regular basis should form the basis for the occasional freebie.  Mr. Queenan initially rejects the notion that major surgical procedures, imaging studies and other infrequent procedures should not be the subject of the freebie but then gives as freebie examples—  nasal endoscopies, acupuncture and physical therapy.  Mr. Queenan’s column is perhaps part tongue-in-cheek humor, but it reflects quite accurately the ignorance of many Americans regarding how much free work physicians do. Perhaps the ignorance is predicated on how he has constructed his view of what constitutes a “freebie.”  This is suggested by a question he raises—“But when you see a physician several times a year, shouldn’t you feel entitled to a freebie every once in a while?”

Americans, both rich and poor, have developed a sense of entitlement.  Programs such as Medicare, Medicaid and now, the ACA, have promoted a sense of entitlement for many Americans regarding healthcare.  They are not just entitled to care.  They are entitled to FREE care.  What Mr. Queenan fails to recognize is that we DO provide free care.  We do so, consciously and unconsciously. After going the extra mile, we often fail to bill for a service.  We merely decided that providing the service was “doing the right thing” and we fail to bill the patient.  Sometimes we are aware of the personal cost to a patient for a co-pay or deductible and we simply fail to bill the service altogether for fear that forgiving the co-pay or deductible will lead to criminal and professional charges.

In my experience, doctors never brag or advertise that they’ve done a good deed.   They just do their mitzvahs— no need to announce it.  In doing so, they risk engendering ingratitude from folks with a sense of entitlement who then expect freebies at every visit rather than every fourth visit.  Most of the time, these “entitled” folks are unaware of the charity work or medical missions their doctors have taken in lieu of a vacation – at personal cost of family time, resources and compensation.

Should we highlight more of our own freebies to our “entitled” patients?  I don’t think so.  We didn’t give the freebie to garner their loyalty or adulation.  We gave them for altruistic reasons, knowing many would not appreciate them but feel they “earned” those freebies.  In fact, I would suggest that some may feel that they are doing us a favor by coming to us and allowing us to bill for the other services which should have been freebies, too.  When Mr. Queenan realized his dry cleaner never threw him a bone, he stopped taking his business to that cleaner, even though, in his own words, “they were consummate professionals.”  Most of us would still remain available to ungrateful and entitled patients.  Others, having provided innumerable silent freebies to countless patients would be happy to simply say to those who feel entitled to another freebie and opt to leave us for greener pastures elsewhere—   “Don’t let the door hit your backside on the way out.”

Mr. Queenan, may I open the door for you as you leave?

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


 

MLMIC



NYSIF Announces Launch of Online Medical Provider Portal
The New York State Insurance Fund recently announced the launch of its new online Medical Provider Portal at www.nysif.com. The new portal will allow registered providers and third party billers to retrieve claims payment information regarding their workers’ compensation patients.

Once a provider registers at nysif.com, he or she will be able to self-serve and obtain access to an explanation of benefits (EOB), bill payment status (with amount paid), claims covered on an issued check and claim-by-claim pricing and payment accounting.

To register for a medical provider user account, go to www.nysif.com and follow the instructions for registration. Providers will need a copy of their latest check from NYSIF to complete registration.  To safeguard the privileged information of both the medical provider and the claimant, obtaining EOB and bill payment information will now require a log-on before accessing that data.

If a provider uses a third-party billing company, the biller must also register for an account to obtain access to the provider’s information.  Once the vendor completes the registration, NYSIF will send the vendor a unique identifier code that they must share with the provider. Once a medical provider has designated the vendor as an approved third party biller, the biller will have online access to that provider’s medical bill payment information and explanation of benefits. Please note only the medical provider can approve access to the portal for the third party billing company.

Please take a moment to visit nysif.com today and register! 


Fed Up with EHRs? Share Concerns during AMA Town Hall Meeting
This Monday night, July 20, from 7 to 8:30 p.m., the AMA, in conjunction with the Medical Association of Georgia, will be hosting a special town hall meeting in Atlanta to discuss concerns with electronic health record systems (EHRs). The event will be live-streamed so physicians can participate at home and via Twitter with #FixEHR.

Among the national and local leaders who will be a part of the conversation will be Rep. Tom Price, MD, a Republican from Georgia’s 6th District, and AMA President Steven J. Stack, MD.

According to the AMA, physician participation in Stage 2 of meaningful use is less than 10 percent, even though 80 percent of physicians have adopted EHRs. Moving forward with Stage 3 could mean less time with patients, hindrances to practice innovation and costly penalties. Many physicians have complained that government requirements have affected EHR technology so it does not productively synch with physician workflow, such as interfering with face-to-face discussions with patients, requiring physicians to spend too much time performing clerical work and creating new costs that divert resources away from patient care improvements. Meanwhile, the much anticipated benefits of being able to share important patient health care information electronically among providers in different settings have gone unfulfilled.


CCNY Medical School to Welcome First Class in 2016
The City College of New York announced the establishment of the CUNY School of Medicine at City College in partnership with Bronx-based St. Barnabas Hospital, which is part of the SBH Health System. The new Harlem-based medical school, whose first class is scheduled to begin fall 2016, will be an expansion of City College’s Sophie Davis School of Biomedical Education. Established in 1973 on the City College campus, the Sophie Davis School currently offers a unique seven-year BS/MD program that integrates an undergraduate education with the first two years of medical school.

The new medical school on the City College campus builds on the strong record of achievement of the Sophie Davis School of Biomedical Education, whose mission is recruiting underrepresented minorities into medicine, increasing medical care in historically underserved communities and boosting the number of primary care physicians.

City College President Lisa S. Coico said the newly established school would nurture young students to embrace a career focused on caring for their fellow citizens with passion, empathy and respect. “The need for more physicians in many communities in our city, particularly in the communities surrounding City College, remains dire,” she said. “By establishing this resource, City College is both helping to address this critical need and fulfilling a vital community service.” 


CMS Releases Proposed Medicare Payment Rule for 2016
CMS recently released its proposed Medicare Part B payment rule for 2016.  To read the CMS press release highlighting some of most notable aspects of the proposal, click here.  The proposal begins to implement aspects of the Merit-Based Incentive Payment System (MIPS) enacted as part of the SGR repeal legislation as well as making changes to several of the quality reporting initiatives that will in 2019 be consolidated into the MIPS program, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Meaningful Use Program.   The SGR repeal proposal also provided for a 0.5% increase in the conversion factor July 1, as well as another 0.5% increase on January 1, 2016.

Among the issues items brought up in the proposal:

  • Establish Medicare fees for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners. (as referenced in last week’s MSSNY’s e-news);
  • Bringing up to 300 the number of measure reportable under the PQRS program. If an individual practitioner or group practice does not satisfactorily on PQRS quality measures, a 2% negative payment adjustment would apply in 2018;
  • Proposing a methodology to impose a 0.25% reduction in Medicare spending due to reductions in certain misvalued codes, as required by provisions incorporated in prior year’s legislation (the “ABLE” Act enacted in 2014).  CMS noted that it could make further misvalued code changes in the final rule to move closer to the statutory goal of 1% based on public comment.
  • With regard to 2018 Value-Based Modifier payments (which will be based upon 2016 performance), to set the maximum upward adjustment of +4.0 times the adjustment factor (to be determined after the conclusion of the performance period), for groups with ten or more EPs; +2.0 times the adjustment factor, for groups with less than 10 EPs;  as well as to set the potential penalty in 2018 to -4% for groups with ten or more EPs, and -2% for groups with less than 10 EPs.
  • Updating self-referral limitation provisions to establish a new exception to permit payment to physicians for the purpose of employing non-physician practitioners.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components.  Here is a link to the entire 2016 proposed Medicare payment rule.


Telemedicine Companies Popping Up in New York
Pager — a New York-based service that’s looking to revive the practice of house calls by doctors — just raised $14 million in a funding round co-led by Aston Kutcher’s firm Sound Ventures, valuing the company at around $75 million. “Telemedicine” services, in which doctors diagnose and treat patients on the phone and online, have been multiplying lately—like Doctor On Demand, Teladoc, MDLive and HealthTap.

But Pager has spent the past year building a network of physicians and nurses in New York City who, in addition to telemedicine services, can visit your home to treat everything from minor injuries to the flu.

Rates are $25 for telemedicine and $50 for an initial doctor’s visit. Subsequent visits are $200 and reimbursable as out-of-network by some plans. Pager expects to be in-network with several major insurers later this year.  


CMS Proposes Part A/Part B Medicare Bundle for Lower Joint Replacement
CMS has proposed to implement a new Medicare Part A and B virtual bundled payment model –  the “Comprehensive Care for Joint Replacement (CCJR)” model – under which acute care hospitals in certain selected geographic areas will receive retrospective reward payments or face financial liability relating to episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity.   The initiative is designed to test “whether bundled payments to acute care hospitals for LEJR episodes of care will reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.”

Under the proposal, the program would be implemented in 75 MSAs across the country, including the New York City and Buffalo areas.  There would be a 5 year performance period, beginning January 1, 2016, and ending December 31, 2020.

Under the model, an episode of care would begin upon admission to a hospital for an LEJR procedure and would end 90 days after the date of discharge.  The episode would include the LEJR procedure, inpatient stay, and all related care covered under Medicare Parts A and B within the 90 days after discharge, including hospital care, post-acute care, and physician services.  While spending under Part A and Part B would continue to be made on a fee for service basis, the acute care hospital that is the site of surgery would be held accountable for spending during the episode of care.  Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs.  Penalties would not be imposed the first year of the program, and be phased in beginning Year 2.

According to a CMS webinar describing this proposal this week, only the acute care hospitals where the surgery is performed would be ultimately liable for making repayment in certain circumstances where spending exceeds a certain threshold.  However, of significant concern, the hospital could require others who provide care within this “virtual bundle” to be responsible for up to 50% of full the repayment amount, including up to 25% for any one “collaborator”.

CMS states that this payment structure is designed to “give hospitals an incentive to work with physicians, home health agencies, and nursing facilities” to reduce avoidable hospitalizations and complications.  CMS also states that participants would gain access to data and educational resources to better understand post-acute care and associated spending.”

MSSNY will be working with effected specialty societies and the AMA to respond to this proposal.  Comments are due by September 8.  For more comprehensive information from CMS regarding this proposal, click here.


Is Your Infection Control Certification Up-to-Date?
New York State law requires that all health care providers—including physicians, medical residents and medical students—receive training on infection control and barrier precautions every four years upon renewal of their license.  The Medical Society of the State of New York is approved by the New York State Department of Health to provide Infection Control and Barrier Precautions to all healthcare professionals.  Additionally, MSSNY is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Measures to prevent the transmission of disease in health care settings have evolved over the years and, as such, this state-mandated course, with six elements total, includes the most updated information from the New York Department of Health.  The cost of the course is $50, payable online by credit card.  Upon successful completion of the course work, you will be able to print out your Infection Control Certificate of Completion.  Click here to take the course.


Analysis: ACA Plan Networks Offer Fewer Physicians
Health plans sold through the Affordable Care Act’s exchanges offered consumers access to 34% fewer health care providers than employer-based coverage, according to a new Avalere Health report. Avalere examined the largest rating region in the top five states by 2015 exchange effectuated enrollment: Florida, California, Texas, Georgia, and North Carolina. Compared with employer-sponsored coverage, exchange plans on average had networks with 42% fewer cancer and cardiac specialists, 32% fewer mental health and primary care physicians and 24% fewer hospitals. The study noted that the narrow networks can keep premiums low but often leave consumers with higher out-of-pocket costs. (The Hill)


PV-PQRS Users: Set up Your EIDM Account
CMS transitioned Individuals Authorized Access to CMS Computer Services (IACS) accounts to the Enterprise Identity Management System (EIDM). As of July 13, 2015, an IACS account can no longer be used to access a group or solo practitioner’s Quality and Resource Use Reports (QRURs); instead, an EIDM account will be required to access QRURs at https://portal.cms.gov. Below please find the action you should take as soon as possible in order to set up your EIDM account:

  • If you do not have an IACS or EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role.
  • If you have an IACS account that you previously used to access QRURs, then follow the instructions provided here to sign up for an EIDM account. You will be allowed to perform the same tasks using your EIDM account that you were able to perform with your IACS account.
  • If you already have an EIDM account, then follow the instructions provided here to sign up for the correct role in EIDM.

For questions about setting up an EIDM account, please contact the QualityNet Help Desk at:

  • Monday – Friday: 8:00 am – 8:00 pm EST
  • Phone: 1 (866) 288-8912 (TTY 1-877-715-6222)
  • Fax: (888) 329-7377
  • Email: qnetsupport@hcqis.org

Additional information on accessing QRURs is available on the CMS website.

 



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Doctors Digital Agency
When you understand your practice is an online business, tell us where it hurts.   Whether your website needs a simple refresh or serious surgery, our digital doctors heal what hurts. Doctors Digital Agency will improve your site’s front-end user experience and back-end functionality.  That means more patients, more phone calls, more patient time, more profitability. We use responsive design to build mobile and search-engine friendly custom websites. Leverage electrons!  Visit http://www.doctorsdigital.agency Email: hello@doctorsdigital.agency, or call 786-529-2025. Doctors Digital Agency, Inc. Since 1996.

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

ICD10: One Year Fiscal Reprieve!!!!! – July 10, 2015


drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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July 10, 2015
Volume 15, Number 26

Dear Colleagues:

This week, we received news that our efforts to get some relief from the onerous outcomes for implementation of ICD-10 in October had met with positive action.  Officials at the CMS announced that for a period of one year, physicians would not incur any penalties or delays in payment as a result of incorrect use of the ICD-10 codes.

Thanks to all of you that assisted us with the efforts advanced by the Big Four (California, Florida, New York and Texas) and the AMA.  After sending the Big Four letter, we had a conference call with CMS representatives who listened to the Presidents of the four state societies as well as others.  We relayed our concerns regarding the onerous nature of implementation at a time when physicians are trying to grapple with other reform efforts.  We explained our reasoning for a two-year grace period during which physicians would have to utilize the ICD-10 codes for billing but would not be penalized for errors in the use of ICD-10 codes.  The rationale and justification seemed to resonate with CMS as we have received a grace period– albeit of one year.

The specifics of the announcement are:

  • For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.  In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes.  This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
  • To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
  • CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
  • CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation. 

The granting of this one-year grace period does not mean our advocacy efforts are completed.  Congress is still in session and it is important we continue advocacy efforts to insure the proposed changes are implemented as regulation.  In addition, efforts are needed to attain relief from commercial payers.  .

With less than 100 days to go until the go-live date of October 1, physicians should be testing ICD-10. If not, you need to get going now. Please make the most of CMS’ one-year grace period and tap the additional resources now offered by AMA and CMS. Also, our MSSNY website offers additional resources on our home page to bring your office up to date.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


 

 

MLMIC



No Change in MLMIC Rates for 2015-2016; 5% Dividend Will Apply to Renewals
MLMIC has just been informed by DFS that they have approved MLMIC’s physician rate request for no base rate change effective July 1, 2015. There were no requested specialty or territory rate changes.  The 5% dividend can now be applied to the July 1, 2015 renewals to provide financial relief to renewing policyholders. If you have any questions please contact MLMIC at 1-888-793-0393.


CMS Proposes End-Of-Life Counseling Payment
On Wednesday, July 8, CMS stated that Medicare plans to reimburse physicians for having discussions with patients about advance care planning. The proposal, which was included in the agency’s 2016 physician payment rule, was praised by advocates and medical groups.

Dr. Patrick Conway, chief medical officer for CMS, said, “We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team.” According to the article, the plan would allow “qualified professionals like nurse practitioners and physician assistants,” as well as physicians, to be reimbursed for face-to-face consultations with a patient and any relatives or caregivers the patient chooses to include. Dr. Conway said a final decision on the proposal will be made by Nov. 1.


CMS is seeking public comment on the proposal until Sept. 8 at rule. In particular, CMS is asking for feedback on whether the payment for end-of-life conversations should be part of annual wellness exams. You may submit electronic comments on this regulation to www.regulations.gov. Follow the instructions for “submitting a comment.”


Urologist Calls for Personalized PSA Screenings for Prostate Cancer
In the New York Times (7/6, Kapoor), urologist Deepak A. Kapoor writes an op-ed calling for changes to guidelines in prostate cancer screening, which have been discouraged since 2012 for patients without symptoms of the disease. Dr. Kapoor cites improvements in screening techniques that can better predict prostate cancer risk and the need for further testing. Kapoor explains that the 2012 guidelines stemmed from the fact that prostate-specific antigen testing may lead to unnecessary surgery among patients who did not have prostate cancer or whose cancer was likely to remain dormant. He warns that an increase in prostate cancer mortality, though not yet identified, “may be a matter of time,” as “one study concluded that annual prostate cancer deaths may increase as much as 5 percent, for the first time in more than 20 years.” Finally, Dr. Kapoor recommends that men over 40 continue to pursue PSA testing and develop a personalized screening plan, rather than avoid the test altogether.

Dr. Kapoor is Chairman and CEO of Integrated Medical Professionals, a multi-specialty group of 100 physicians in the greater New York Metropolitan. IMP is one of a growing number of physician groups that have adopted a policy of 100% membership in MSSNY and their county medical societies. 


Applications Due July 31 for Physician Practice and Repayment Programs
The NYS DOH, Office of Primary Care and Health Systems Management is pleased to announce that applications for Cycle IV of the Doctors Across New York (DANY) Physician Practice Support and Physician Loan Repayment Programs will be accepted beginning July 8 through July 31, 2015.

Physician Practice Support (PPS) provides up to $100,000 in funding to support for new practices, improvements, loan repayment or other support to physicians in exchange for a two year service commitment to provide health care in an underserved region within New York State.

Physician Loan Repayment (PLR) provides up to $150,000 in loan repayment funding in exchange for a five year service commitment to provide health care in an underserved region within New York State.

Application materials can be found on the Department of Health website here.

All applications must be submitted electronically (in PDF) to gme@health.ny.gov

Questions should be directed to: Physician Practice Support-Lianne Ramos at 518-473-3513 or gme@health.ny.gov or Physician Loan Repayment: Amy Harp at 518-473-7019 or gme@health.ny.gov


Update to Physicians Advocacy Program from KACS Law Firm
Kern Augustine Conroy & Schoppmann, P.C. is proud to announce that the Physician Advocacy Program® has expanded to include the new Premier Partner Program.

The Premier Partner Program, as a stand-alone program, or an addition to your current Physician Advocacy Program® membership, will provide members with immediate access to their own expert health law defense team, in case of a legal investigation, as well as trusted advisors to build proactive solutions regarding Asset Protection, Estate Planning, HIPAA Compliance as well as Billing and Coding Documentation for reimbursement. Premier Partner Program.


CMS Proposes Revisions to Two Midnight Rule to Give Physicians More Discretion
To respond to physician and hospital concerns regarding the “two midnight rule”, CMS has proposed to allow hospitals on a case-by-case basis to receive Part A reimbursement for patients whose stay is expected to last less than two midnights.  To read the CMS release, click here.  According to the release, for stays expected to last less than two midnights – CMS proposes the following:

  • For stays for which the physician expects the patient to need less than two midnights of hospital care (and the procedure is not on the inpatient only list or otherwise listed as a national exception), an inpatient admission would be payable under Medicare Part A on a case-by-case basis based on the judgment of the admitting physician.  The documentation in the medical record must support that an inpatient admission is necessary, and is subject to medical review.
  • CMS is reiterating the expectation that it would be rare and unusual for a beneficiary to require inpatient hospital admission for a minor surgical procedure or other treatment in the hospital that is expected to keep him or her in the hospital for a period of time that is only for a few hours and does not span at least overnight.  CMS will monitor the number of these types of admissions and plans to prioritize these types of cases for medical review.

Under the current two-midnight rule, a physician can treat Medicare beneficiaries as inpatients only when the hospital stay is expected to span two nights — from one midnight to the next — or longer.  Implementation of the rule has been delayed multiple times by Congress, including through September 30 as part of the MACRA legislation enacted this past spring.


Medicare Physician Fee Schedule on Line
Effective July 1, 2015, please be aware that the new Medicare Physician Fee Schedule is up on-line at www.NGSMedicare.com Although the increase is only 0.5%, it is an increase.  Please be sure to have your staff review the appropriate fee schedule for your locality at your earliest possible convenience.  Again, there is a 0.5% increase that became effective July 1, 2015.


Study: Medicaid Recipients Using Multiple Pharmacies Made Up Nearly Half of All Deaths Resulting From Narcotic Pain Medicine Overdose
Nearly half of all deaths resulting from an overdose of narcotic painkillers involved Medicaid recipients who used multiple pharmacies to fill their prescriptions, according to a study published in the Journal of Pain and conducted by CDC researchers. After examining “the records of more than 90,000 Medicaid recipients aged 18 to 64, who were long-term users of narcotic painkillers,” researchers found that “patients who used four pharmacies within 90 days…had the highest odds of overdosing.” http://www.jpain.org/article/S1526-5900(15)00530-1/abstract


Calling All Amateur Photogs for MSSNY’s Social Media Feeds
We’d like to include more happenings from around the state in our Twitter, Facebook and Instagram feeds. If you’re at an event that you think might be of interest to our followers, please snap a picture with your phone and send to jvecchione@mssny.org.  Be sure to include a caption or some identifying words. We’re open to any and all ideas and hope to hear from you!

 



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

Successful Legislative Year Concludes – June 26, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado  
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Dear Colleagues:

This week has seen a significant share of federal and state legislative news.  The Supreme Court of the United States has ruled in King vs. Burwell by a vote of 6-3, that individuals in states that did not set up exchanges are eligible to receive tax subsidies.  Various folks have asked us to weigh in on the decision.  While enticing, dwelling on a discussion of the decision is purely a venting experience as it will contribute nothing other than creating greater divides.  Instead, we should accept closure on this matter and focus our energies on fixing the flaws of the ACA.  What good is a subsidized health plan that has a $6,000 deductible that encourages a patient to delay accessing care because of the out-of-pocket expense?

At the state level, we are pleased to announce that MSSNY has won two major victories—defeat of the mandated CME on pain management and change in commencement of the statute of limitations to the date of discovery.  We thank the many of you who took the time to contact their legislators to express their concerns with these bills. These are victories only in so much as we were able to stop governmentally proscribed redress of these issues.  We will NOT be able to walk away without addressing the core legitimate concerns raised by proponents of these now defunct pieces of legislation.  Instead, we will need to work with our specialty societies to devise an appropriate way to address the need for better medical education on pain management as well as responsible tort reform which includes not only redress for those harmed in the course of care but other reforms that will reduce our premium burden.

RED ALERT!!! Girding Our Loins this Summer

As we approach the 4th of July week, I draw on an archaic term to draw attention to a need to be prepared for the threat of danger.  This week, Rep. Devin Nunes, Chairman of the House Intelligence Committee stated that “the level of threat for a potential terrorist attack in the United States is at its highest.”  It has been 14 years since 9/11 and two years since the Boston bombing.  Within the past year, we dealt with an Ebola epidemic that reached our country and threatened our nation.  Presently, we face a new danger with avian flu and MERS.  MSSNY has a 50+ credit hour curriculum for Preparedness Planning which has been widely acclaimed.  It is critical that we voluntarily prepare to meet the needs of our patients PRIOR to the next potential crisis or terror event.  If we don’t volunteer, the next crisis will potentially bring a new mandate.  More importantly, it may bring casualties as a result of an unprepared medical community.  When was the last time you honed your preparedness skills and knowledge?   I would highly encourage you to use the CME link on the MSSNY website to access the curriculum. New users will need to register with an email and password. Why not use the curriculum as part of your summer reading?  It’s free to MSSNY members.  The knowledge you gain may save your family, friends, neighbors and community.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



Capital_Update_Banner

Dear MSSNY and Alliance Members: 

The 2015 legislative session conclude early this morning. Through your efforts guided by MSSNY leadership and the collective efforts of MSSNY staff, MSSNY has had a very successful legislative year. 

As part of the budget, we: (1) secured $127.4M in funding for the Excess Medical Liability program; (2) defeated accreditation and onerous new regulatory requirements for urgent care practices and practices which offer after-hour care; (3) defeated the retail clinic bill; (4) defeated proposals which would have imposed additional registration and reporting requirements on physician OBS practices; and (5) secured the elimination of fees physicians currently have to pay to initiate a Workers Compensation arbitration proceeding. 

As the session concluded, we have secured many more victories which demonstrate the tangible value of MSSNY to its physician members.  These victories are discussed in further detail below but can be quickly listed: we (1) defeated the date-of-discovery statute of limitationss; (2) defeated a CME mandate for pain management, addiction and end- of-life care; (3) defeated scope-of-practice expansion by the podiatrists, dentists, optometrists and many other non-physician practitioners; (4) participated in a coalition which secured passage of legislation requiring school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade; and (5) again defeated a last ditch effort by CVS Health to secure enactment of legislation to secure approval to establish corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law. 

As we did when the budget negotiations concluded, your lobby team would again like to acknowledge each and every County and Specialty Medical Society, MSSNY leadership, and the many rank-and-file physicians who answered the call for grassroots action and met locally with their representatives or wrote a letter and/or took a day away from their practice to travel to Albany to personally meet with their elected representatives on issues of importance to all of medicine. 

Sustained physician involvement can make a difference.  Because of your efforts, we list the many successes that together we have achieved. It is our hope that you will share this newsletter with your colleagues so that we may continue to build membership in MSSNY to support even greater legislative accomplishments in the future. 

                                                                                  Your Lobby Team,
                                                                                  Liz, Moe, Pat, and Barb 

STATE SENATE LEAVES ALBANY WITHOUT PASSING UNSUSTAINABLE MALPRACTICE “DATE OF DISCOVERY” LEGISLATION
Despite a huge push from some media outlets and the trial lawyers, the State Legislature finished its 2015 session without enacting legislation to change the statute of limitations in medical liability actions.  We thank the very significant number of physicians who weighed in with their local legislators to highlight the serious adverse consequences to our health care system that would ensue if this legislation were to have been passed without any corresponding provisions to bring down New York’s already exorbitant medical liability insurance costs that for many are among the highest in the nation.  As previously reported, legislation (A.285, Weinstein) to change New York’s 2.5 year medical liability statute of limitation to a “date of discovery” rule had passed the Assembly two weeks ago.  Substantially similar legislation (S.911-A, Libous) advanced to the Senate floor on the last day of Session, but the Senate did not bring it up for a vote.  MLMIC estimates of similar legislation were that enactment of this legislation could trigger premium increases of 15%.

Conversations on this issue will continue however.  During a press conference with the Governor and Assembly Speaker discussing end of Session agreements, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that immediately following the conclusion of Session a series of roundtables with parties on both sides of this issue will be convened so that the issues can be addressed “sooner rather than later”.   This should present an opportunity for MSSNY and other allied hospital and health provider associations to raise issues with New York’s dysfunctional medical liability adjudication system with the goal of bringing down the cost of medical liability insurance.

MSSNY worked closely with many other provider associations also impacted by this legislation, including the Greater New York Hospital Association, Healthcare Association of NYS, the Health Care Facilities Association, other specialty medical societies, and the Lawsuit Reform Alliance of New York, in an effort to defeat this legislation.   There were print ads in several newspapers across New York State, and in the Legislative Gazette, as well as radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.
(AUSTER, DEARS)


PHYSICIAN ACTION CREDITED WITH THE NYS ASSEMBLY TAKING NO ACTION ON CME MANDATE REQUIRMENT
The New York State Assembly did not vote on legislation requiring physicians to take three house of continuing medical education every two years.  Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would have required physicians to take three hours of continuing education on the following topics: I-STOP and drug enforcement administration 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; and end-of-life care.  The measure had passed in the NY Senate.  Thousands of physicians called or sent their legislators a letter through the Grassroots Action Center (GAC) about this legislation and urged its defeat.   MSSNY staff would like to thank all who weighed in on this issue.  Your grassroots advocacy made a real difference.  We also thank the many members of the Assembly who expressed their concern about this legislation, as well as the AMA Advocacy Resource Center staff who provided us with critically important information regarding the significant drop in opioid use in New York State compared to other states in recent years.
(CLANCY, DEARS)


CVS HEALTH’s RETAIL CLINIC BILL FAILS
As reported last week, CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, attempted to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) which would allow the establishment of corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.

The Senate bill passed the Senate and was placed on a Committee agenda in the Assembly where it failed to garner the necessary votes. Later in the week additional efforts were advanced to have the bill placed back on the Committee agenda. MSSNY working closely with the Nurses Association and other specialty medical societies succeeded in beating back this effort defeating the bill for the second time this year.

‘Convenience care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or CVS retail pharmacies. They are a growing phenomenon across the nation, particularly among upper class young adults who live within a one mile radius of the clinic. These clinics are usually staffed by nurse practitioners and focus on providing episodic treatment for uncomplicated illnesses such as sore throat, skin infections, bladder infections and flu.  Physicians feel strongly that retail based clinics pose a threat to the quality of patient care and to the ability of physician practices to sustain financially and should not be allowed to propagate in New York.                                                        

Another significant concern is the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner or physicians’ assistant in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. The same self-referral prohibitions and anti-kickback protections which apply to physicians are not applicable to retail clinics, raising the concern for significant additional cost to the health care system. Rather than bend the cost continuum, we are concerned that costs will increase and   quality of care will be negatively impacted.
(DEARS, AUSTER, CLANCY, ELLMAN)


LEGISLATURE PASSES BILL TO BETTER ASSURE AVAILABILITY OF PAIN MEDICATIONS  THAT REDUCE RISK OF INAPPROPRIATE USE
The Senate and Assembly passed legislation (A.7427-A, Cusick/S.5170-A, Hannon) prior to the end of the Session to reduce barriers to patients receiving opioid medications containing abuse-dererrent technologies.  The legislation would (1) prohibit the substitution of an opioid analgesic drug product, brand or generic, with abuse-deterrent technologies with an opioid analgesic drug product lacking abuse-deterrent technologies without obtaining a new prescription from the prescriber and (2) ensure that abuse-deterrent opioid products are covered by health insurance plans in New York at least the same prescription coverage tier as non-abuse-deterrent opioid products and ensure that a patient is not required to take a non-abuse-deterrent opioid before an abuse-deterrent version.                                                                                             (AUSTER, CLANCY)

LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans was passed by the Senate and Assembly towards the end of the Session.   MSSNY articulated its strong support for this legislation, and will urge the Governor to sign this legislation into law. 

For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff.  After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral,  anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections.  This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
 (AUSTER, DEARS)


AS SESSION ENDS MSSNY IS SUCCESSFUL IN PREVENTING PASSAGE OF SCOPE OF PRACTICE BILLS
The following are among many scope-of-practice bills that MSSNY defeated this year as the Legislative Session for 2015 concludes:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  2. 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand the scope of practice of podiatrists to diagnos, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  3. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers and call themselves naturopathic doctors. Despite claims that they cannot do invasive procedures, it would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  4. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  5. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  6. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill remains in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.

The outcome of all of these bills is a resounding victory for TEAM MSSNY and all of our physicians who reached out to their Legislators to oppose them.                                                                                                                            (ELLMAN, DEARS)


COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.

Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings passed during the final days of session and will soon be sent to the Governor for his consideration.  The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.

MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.

The bill extended the collaborative drug therapy demonstration with this parameter for three ore years.

MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.                     
(DEARS, ELLMAN)
 


NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that passed the New York State Legislature.  A. 123B, Paulin/S. 4739A,Hannon would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action.    The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home.
(CLANCY, DEARS, ELLMAN) 


HOUSE PASSES IPAB REPEAL LEGISLATION
This week the US House of Representatives passed legislation (HR 1190) to repeal the Independent Payment Advisory Board (IPAB) by a vote of 244-154 (Roll call here).  Eleven Democrats, including New York Representative Sean Patrick Maloney, joined 233 Republicans in voting in favor of passage (including New York Representatives Chris Collins, Dan Donovan, Chris Gibson, Richard Hanna, John Katko, Peter King, Elise Stefanik and Lee Zeldin).  As H.R. 1190 was offset with funding from the ACA’s Public Health and Prevention Fund, several lawmakers commented that the number of Democrats voting for IPAB repeal would have increased had the bill been offset differently.

The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress.  MSSNY recently signed on to a patient and provider advocacy letter in support of repeal of the IPAB.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”    
(AUSTER)


MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY continued working with the medical associations of California, Florida and Texas, as well as with the AMA, in support of activities to assure a more fair transition to the ICD-10 coding set.  This week the CMA, FMA and TMA together with MSSNY wrote to the US Senate and House of Representatives leadership to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015.   MSSNY also joined a similar federation sign-on letter initiated by the AMA.   Moreover, MSSNY President Dr. Joseph Maldonado and Vice-President Dr. Charles Rothberg joined physician leaders and staff from the four state medical associations in a conference call meeting with CMS staff as a follow-up to a similar letter sent to Acting CMS Administrator Andy Slavitt last week.   While the “Big 4” letter to Congress notes that the groups’ first request is to pass legislation such as HR 2126 (Poe), to stop the implementation of ICD-10 altogether, it also urges that “for those physicians who have adopted ICD-10, we ask that the payers allow a dual coding system where physicians can bill using either ICD-9 or ICD-10… If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (AL-06) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period…We believe that two years of transition time, on-the-job learning by physicians — plus our continued ICD-10 educational activities — will result in a much less disastrous transition to this overwhelmingly complicated new coding system.”

Our group efforts have been noted in multiple media outlets, including here and here.
(AUSTER)


SENATE FAILS TO ACT ON INCLUING E-CIGARETTES UNDER CLEAN INDOOR AIR ACT
The NY Senate failed to act on in waning hours of the legislative session to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act.  A.5595B/S.2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon, passed in the NY State Assembly.  In recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air.    This will continue to be one of MSSNY’s public health legislative priorities.
(CLANCY, ELLMAN)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:       

pschuh@mssny.org ldears@mssny.org   mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    

 

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Changes to the Medicare Opt-Out Law for Physicians and Practitioners
Prior to enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physician/practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. If physicians and practitioners that file affidavits effective on or after June 16, 2015 do not want their opt-out to automatically renew at the end of a two year opt-out period, they may cancel the renewal by notifying all Medicare Administrative Contractors with which they filed an affidavit in writing at least 30 days prior to the start of the next opt-out period. Valid opt-out affidavits signed before June 16, 2015, will expire two years after the effective date of the opt out. If physicians and practitioners that filed affidavits effective before June 16, 2015 want to extend their opt out, they must submit a renewal affidavit within 30 days after the current opt-out period expires to all Medicare Administrative Contractors with which they would have filed claims absent the opt-out.(Updated on 06/18/2015) 

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Please note: The application includes specific instructions for documentation requirements for each category, please check the instructions and form carefully for the documentation for the category for which you are applying. While supporting documentation must be provided for certain hardship exception categories, CMS does not require additional documentation for 2014 Edition certified EHR technology issues. You should, however, retain documentation for your own records. CMS will independently review each application and any supporting documentation.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.


Need Guidance for ICD-10? Come to MSSNY Website!
Most physicians won’t need to know ALL the new ICD-10 CM diagnosis codes. However,

if you haven’t done so already, you should pick your top 10 or 20 ICD-9 Codes for your practice/specialty and “crosswalk” them to the new ICD-10 CM codes.

Please visit the following websites, for assistance:

www.roadto10.org

http://www.icd10data.com/Convert

http://www.icd10data.com/ICD10CM/Codes

http://www.icd10charts.com/

Reminder: Medicare Does Not Preauthorize Coverage for Items or Services
National Government Services has seen an increase in calls to their Provider Contact Center (PCC), asking if Medicare preauthorizes coverage for provided items and services. As a reminder, Medicare does not preauthorize coverage for items or services that will receive payment under Part A or Part B, except for custom wheelchairs.

Additional information is available in the MLN Matters article SE0916 Revised, “Medicare Parts A and B Coverage and Prior Authorization.” Refer to this MLN and update any applicable internal procedures and policies with this information and share with internal staff.
Related Content
SE0916 Revised: Medicare Parts A and B Coverage and Prior Authorization

NY Medicaid Management Information System (NYMMIS) Project Website

The New York State Department of Health and Xerox State Healthcare, LLC are working diligently on the design and development of the new Medicaid Management Information System, called NYMMIS.

NYMMIS has an interim website online that was created to serve as an ‘information billboard.’ It will be used as a main source for communicating information by providing updates and email bulletins regarding the implementation of the new system.  Updates will be provided on a regular basis in an effort to share relevant NYMMIS information that may potentially impact providers’ business processes. The interim website hosts a ListServ signup section.  Those who sign up to the ListServ are able to receive timely emails that contain any updates on the project that might affect them.

The interim NYMMIS website will have no impact on eMedNY nor will it be used for provider billing or other transactions. Please visit: www.interimnymmis.com

Skinny Jeans Have Their Down Side
A  report in the Journal of Neurology, Neurosurgery and Psychiatry, that tells of a case “of a 35-year-old woman who wound up lying prone on the pavement, unable to get up, after spending the day in skinny jeans while helping a relative move. By the time the doctors saw the patient, both her legs were so swollen below the knee that the medical team had to cut the jeans off her. She also had severe weakness in her feet and ankles and was not able to walk.”


Doctors without Borders Reception in Woodbury L.I.
On August 12 at 6:00pm at the Liquid Outdoor Lounge @ the Woodbury Country Club, 884 Jericho Turnpike, Woodbury NY 11797, Nikhil G. Jaiswal, age 13, is hosting a charity reception featuring hors d’oeuvres and raffles for Doctors without Borders. (Nikhil is the son of Arun Jaiswal, a member of Suffolk County Medical Society.) Tesla Motors will be showcasing their award-winning car, the Model S. All donations are tax deductible. If you would like to donate by check, please make it out to Doctors Without Borders and bring it to the event. To attend the event, the minimum donation is $75 per person. For more information contact Nikhil G. Jaiswal here.


Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position
Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

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

Legislature Not Going Home Yet – June 19, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado  
asset.find.us.on.facebook.lg    Twitter_logo_blue1

Dear Colleagues:

It had been my hope that this week’s post would relay good news regarding our efforts in Albany.  Alas, the legislative session has gone into overtime and will be going into next week.  Thanks to all of you who have reached out to your Assemblyperson and Senator asking for their support of MSSNY’s position against the mandated pain management CME and extending the Statute of Limitations for filing a malpractice claim to run from the date of discovery.  Please keep an eye on your emails from MSSNY during the next five days as unexpected surprises may require us to issue an ALERT asking you to contact your state legislators once again.

At the federal level, we continue our joint efforts with other state and specialty societies in seeking assistance for physicians as we transition to ICD-10 on October 1, 2015. While MSSNY and many other physician associations strongly support and have advocated for postponing ICD-10, the efforts to delay its implementation or to completely bypass ICD-10 have been unsuccessful.  At this time, many of us in leadership at the state and specialty society level believe our efforts to assist physicians with the challenges of ICD-10 implementation should be directed towards establishing a grace period.  Such a grace period would allow for physicians to begin compliance with the requirement to use ICD-10. However, during said period, physicians would not be penalized for errors made in coding using the ICD-10 codes.   Data would be collected and physicians would be notified concerning errors in coding so that they can make appropriate changes in future coding.  However, payment for services would not be delayed because of errors.

This week, the four states with the largest numbers of physicians signed a joint letter to CMS’ Acting Administrator Mr. Andy Slavitt asking him to implement a two-year grace period.  This period is consistent with the recent vote of the House of Delegates of the AMA.  I would encourage you to review the attached letter and write to your Congressperson and our U.S. Senators asking for their support of this request.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



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LEGISLATIVE SESSION CONTINUES INTO NEXT WEEK- DEAL ON RENT CONTROL REMAINS ELUSIVE
A deal on rent control has not yet been reached. Late last evening the Senate and Assembly passed a five day extender of the rent control laws until Tuesday, June 23rd. The Senate then left town. The Assembly remained in Session on Friday. Physicians must remain vigilant on two issues discussed in greater detail in separate articles below: (1) the Date of Discovery state of limitations bill (A.285, Weinstein and similar proposal S.911A, Libous) which has passed the Assembly and (2) the CME mandate on pain management, addiction and end of life care which has passed the Senate and is on the floor of the Assembly. Over the weekend we urge physicians to continue their grassroots efforts by sending letters to their legislators urging defeat of each of these bills.

Link to Date of Discovery Statute of Limitations Letter in Opposition.

Link to CME Mandate Letter in Opposition. 


PHYSICIANS MUST CONTINUE TO CONTACT THEIR SENATORS TO OPPOSE HUGE MEDICAL LIABILITY EXPANSION LEGISLATION
With the Legislature continuing its Session beyond its scheduled end date, all physicians must continue to contact their Senators to urge that they oppose legislation (S.911-A, Libous) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.   Last week, the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).

MLMIC’s estimate based upon similar legislation is that could single bill could increase physician liability premiums by an untenable 15%!    While many other states do have some exceptions to their statutes of limitation for “discovery” of alleged negligent acts, the vast majority of these states also place strict limitations on non-economic damages.  As New York physicians continue to pay liability premiums that are among the very highest in the country and face dwindling payments from Medicare and commercial insurers, any changes to permit more lawsuits must be considered only as part of a comprehensive package that seeks to bring down these exorbitant costs.

MSSNY is working with many other provider associations also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.  This past week, there were print ads in several newspapers across New York State, and radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.    To view the print ad, click here.
(AUSTER, DEARS)


NYS SENATE PASSES CME MANDATE BILL; BILL STILL ON ASSEMBLY DEBATE LIST —URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION
Legislation requiring physicians to take three house of continuing medical education on pain management, palliative care, addiction and ISTOP, has passed the NY Senate and is on the Assembly debate list and could be voted on at any time.   Physicians are urged to contact their assembly members and urge them to reject this legislation.  Physicians are urged to send a letter urging defeat of this measure.  Or they can call their member at the generic Assembly phone number (518)455-4100 and ask to speak with him/her.

Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would require physicians to take three hours of continuing education on the following topics: I-STOP and drug enforcement administration 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; and end-of-life care.  When speaking to their Assembly members, physician can speak about how the mandate to check the Prescription Monitoring Program (PMP) has change behavior.   Notably, New York State now ranks 50th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014.  This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry.  It is the largest vendor of U.S. physician prescribing data in the nation.  It was provided to MSSNY from the American Medical Association.   Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing.   All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products).    New York State was 46th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization.  New York State also ranked 45th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions.  According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization.  Overall utilization of Controlled Substance III, New York State is ranked 27th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50th in growth of utilization with all CME states above New York.

This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances.   There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion.   According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States—  since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time.   It would appear from the data noted above the PMP has changed behavior more significantly than would  continuing medical education coursework and training  in the area of  pain management and opioid use as noted by the data by the IMS Health, Inc.  MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances.
(CLANCY, DEARS)


NYS ASSEMBLY PASSES BILL TO INCLUDE E-CIGARETTES UNDER CLEAN INDOOR AIR ACT; ACTION IS NEED IN NYS SENATE

The NY State Assembly passed legislature to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act.  The measure is pending in the NY State Senate.  A. 5595B/Senate Bill 2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon and must see action in the Senate before it can become law.   Physicians are urged to contact their senators in support of this measure by sending a letter.

Patients can also send a letter through MSSNY Grassroots Action Center.

In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke.  Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates.  However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air.
(CLANCY, ELLMAN)


LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans passed the Senate and Assembly this week.   MSSNY articulated its strong support for this legislation, along with many other patient advocacy organizations, and will urge the Governor to sign this legislation into law. 

For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff.  After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral, anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections.  This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
(AUSTER, DEARS) 


SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION PASSES NYS LEGISLATURE; WILL NOW GO TO GOVERNOR
A.791C/S. 4324A, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon, has passed the NYS Legislature.   The bill will now go to Governor Andrew Cuomo for his consideration.   The bill will require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade.  The Medical Society of the State of New York is part of a coalition of organizations supporting this legislation.  This bill is consistent with the Advisory Committee on Immunization Practices.   Organizations in support of the measure included the GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.
(CLANCY)


CVS HEALTH MAKES ADDITIONAL EFFORT AT THE END OF SESSION FOR AUTHORITY TO ESTABLISH RETAIL CLINICS- MASSNY WORKING WITH NURSES ASSOCIATION AGAINST THIS EFFORT
CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, made another effort during the waning days of the legislative session to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) to secure approval to establish retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.

The Senate bill passed the Senate earlier this week. MSSNY working closely with the Nurses Association and other medical specialties sought to defeat the Assembly proposal when considered by the Assembly Codes Committee earlier this week. The bill was defeated in Committee. Later in the week, however, additional efforts were advanced to have the bill placed back on the Committee agenda. Again, MSSNY and Nurses Association lobbyists worked together to assure that the bill remained in Committee.

Earlier this year MSSNY successfully advocated to the legislature to reject a similar initiative advanced as part of the proposed state budget.  ‘Convenience care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or CVS retail pharmacies. They are a growing phenomenon across the nation, particularly among upper class young adults who live within a one mile radius of the clinic. These clinics are usually staffed by nurse practitioners and focus on providing episodic treatment for uncomplicated illnesses such as sore throat, skin infections, bladder infections and flu.  Physicians feel strongly that retail based clinics pose a threat to the quality of patient care and to the ability of physician practices to sustain financially and should not be allowed to propagate in New York.

Another significant concern is the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner or physicians’ assistant in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. The same self-referral prohibitions and anti-kickback protections which apply to physicians are not applicable to retail clinics, raising the concern for significant additional cost to the health care system. Rather than bend the cost continuum, we are concerned that costs will increase and   quality of care will be negatively impacted.

MSSNY will remain vigilant against any further efforts to advance this measure before the end of session.
(DEARS, AUSTER)


COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.
Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) has passed both houses of the Legislature which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings.  The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.

MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.

The bill extended the collaborative drug therapy demonstration with this parameter for three more years.

MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.     
(DEARS, ELLMAN)


NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that has passed the New York State Legislature.  A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action.    The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home.      (CLANCY, DEARS, ELLMAN)


AS SESSION WINDS DOWN SCOPE OF PRACTICE BILLS STATUS UNCHANGED WITH TWO EXCEPTIONS
The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains in the Higher Education Committee in both the Senate and Assembly.
  2. 719-A (Pretlow)/ S.4600-A (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to diagnose, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee. It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and also would allow them to basically train themselves.  This bill is in the Higher Education Committee in the Senate and Assembly.
  3. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, call themselves naturopathic doctors, claims that they cannot do invasive procedures, yet allows them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  4. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  5. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  6. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.

The bills that have passed both Houses were vigorously negotiated by MSSNY to make them more acceptable to medicine.  
(ELLMAN, DEARS)


BILL REQUIRING EDUCATION OF ATHLETES REGARDING SUDDEN CARDIAC ARREST PASSES NYS ASSEMBLY; PENDING IN SENATE RULES COMMITTEE
Assembly Bill 8107/Senate Bill 5984, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza, has passed the NYS Assembly.  Its companion measure is pending in the Senate Rules Committee.   The legislation would require that the New York State Department of Health to develop an educational brochure on preventing sudden cardiac arrest among student athletes.  Under the bill’s provisions, the NYS Commissioner of Health shall provide educational materials for students and their parents and guardians regarding sudden cardiac arrest.  The Medical Society of the State of New York supports this measure and worked with the sponsors to help develop this legislation. The bill also calls for this material to be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association. The brochure would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are privately available for screening. The State of New Jersey currently has a program where brochures are sent home to parents and guardians. This legislation would establish a similar program by developing brochures that could be given to parents as well as pediatricians to distribute.

Sudden cardiac death is the result of an unexpected failure of proper heart function, usually (about 60% of the time) during or immediately after exercise without trauma. Since the heart stops pumping adequately, the athlete quickly collapses, loses consciousness, and ultimately dies unless normal heart rhythm is restored using an automated external defibrillator (AED). About 100 such deaths are reported in the United States per year. According to the American College of Cardiology, the chance of sudden death occurring to any individual high school athlete is about one in 200,000 per year. Sudden cardiac death is more common: in males than in females; in football and basketball than in other sports; and in African-Americans than in other races and ethnic groups. It remains important that athletes, parents, coaches and the health care community are educated about the issue of sudden cardiac arrest and the importance of recognizing the early warning signs and be provided with information about available screening options.   Additionally, it is important that all school officials and coaches are trained in the use of AEDs and having them available on the athletic field.
(CLANCY, AUSTER)


HEALTHCARE PROFESSIONAL TRANSPARENCY ACT HITS SNAGS DURING LAST WEEK OF SESSION- COMMITTEE CHAIRS AND SPONSORS COMMIT TO WORKING TO RESOLVE ISSUES DURING THE OFF SESSION
Throughout the Session MSSNY has worked closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, in pursuing legislation (S.4651-C, Griffo/A.7129-D, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public. Specifically, the bill would require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would have also required health care practitioners to wear an identification name tag during all patient encounters that includes the type of license held by the practitioner.

While the bill advanced to the floor of the Senate and was placed on an Assembly Committee agenda, changes were proposed to the Assembly bill which could not be embraced. Of concern is the issue of whether practitioners should be subject to professional misconduct in all instances where they fail to wear the identification badges. The Chair of the Assembly Higher Education Committee and the sponsors of the legislation have agreed to work with the physician community to address these concerns.
 (DEARS, ELLMAN) 


US HOUSE TO CONSIDER IPAB REPEAL LEGISLATION NEXT WEEK
Legislation is expected to be voted on next week by the U.S. House of Representatives to repeal the Independent Payment Advisory Board (HR 1190, Roe) enacted as part of the ACA.   Among the 235 co-sponsors of the IPAB repeal legislation are New York Congressional delegation members Chris Collins, Peter King, Sean Patrick Maloney, Chris Gibson, Tom Reed, Elise Stefanik, Richard Hanna and John Katko.  Physicians are urged to contact their Respective member of the US House of Representatives in support of this legislation.  To find contact information for your respective House member, please go to MSSNY’s Physician Action Center here.

The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress.  MSSNY recently signed on to a patient and provider advocacy letter  in support of repeal of the IPAB.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decision making responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”
(AUSTER)           


MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY joined the medical associations of California, Florida and Texas in writing to CMS Acting Director Andy Slavitt to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015.   At its recent meeting, physician delegates to the AMA House of Delegates overwhelmingly called upon the AMA to seek such 2-year “grace period”.  The letter notes that “the Oct. 1 mandatory implementation of the ICD-10-CM coding system is a looming disaster. The results of the recent end-to-end tests give us little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we “throw the switch” to ICD-10.”

Specifically, the letter asks that CMS implement the following steps with regard to ICD-10 implementation:

  • A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system;
  • A two-year period in which physicians will not be subject to RAC audits related to ICD-10 coding mistakes;
  • A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and
  • Advanced payments in the event that claims are delayed.
    (AUSTER)


CME WEBINARS ON PTSD AND TBI IN RETURNING VETERANS

MSSNY will be offering two CME webinars on the topic of “PTSD and TBI In Returning Veterans:  Identification and Treatment.”

June 24, 2015, 7:00 – 8:00 AM

Faculty:  Frank Dowling, MD

Registration:

June 30, 2015, 6:00 – 7:00 PM

Faculty:  Joshua Cohen, MD

Registration:

Course Objectives:

  • Explain the two most common disorders facing returning veterans today, their prevalence, risks, costs, and comorbidities.
  • Identify common symptoms and causes of PTSD and Traumatic Brain Injury (TBI), especially those that affect returning veterans most.
  • Outline proven treatment options in psychotherapy and pharmacotherapy, from concept to implementation.
  • Outline the process of recovery and post-traumatic growth.
  • Discuss barriers to treatment, including those unique to military culture, and how to overcome them.

The sessions are sponsored by MSSNY through a grant offered by the NYS Office of Mental Hygiene.

Program flyer can be accessed here:

For more information, contact Greg Elperin at gelperin@mssny.org or (518) 465-8085.

(DEARS, ELPERIN, HARDIN) 


FINAL “ADVOCACY MATTERS” SESSION ON SHIN-NY PATIENT LOOK-UP
The final “Advocacy Matters” CME webinar on the topic “SHIN-NY Statewide Patient Record Look-Up,” co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC), will be held on June 24, 2015, from 6-7 PM.  The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO,   Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

Registration link is below:

June 24, 2015 (6-7 PM):   Register here

Flyer is available here:

Information sheet on the Data Exchange Incentive Program is available here:

For more information, contact Miriam Hardin at mhardin@mssny.org  or (518) 465-8085.                                                                                                          (DEARS, HARDIN)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:       

pschuh@mssny.org ldears@mssny.org   mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    

 

enews_738px
Council Notes from June 18 Meeting

  • Dr. Thomas Madejski was elected to the AMA’s Council on Medical Service at the June AMA Meeting in Chicago.
  • Dr. John Kennedy has been named Chair of the AMA Delegation with Dr. Charles Rothberg as Vice-Chair.
  • Dr. Sellers presented the MSSNYPAC report, which included information about the possibility of procuring data to enrich the PAC database.  The data would be used as a tool for increased contributions. MSSNYPAC has a mobile donate site at www.mssny.org/mobile and active Facebook and Twitter accounts.
  • The Medical, Educational, and Scientific Foundation of New York (MESF) reported the following:
    • MESF has completed The Essentials of Leadership: What They Didn’t Teach You in Medical School program, which was presented by Rick Popovic to 13 county medical societies and other organizations. The total attendee count was nearly 400.
    • As a follow-up to the basic Leadership Training Program, MESF has responded to an RFP from the Physicians Foundation and has submitted an application for funding for additional leadership training programs. The grant application is for $150,000 for a two year program.
    • MESF has held discussions with Johns Hopkins in Baltimore for the development of a series of two year online programs on various Internal Medicine topics. The approach will permit efficient use of Johns Hopkins faculty time while taking advantage of readily available medical writers in India.


NY Workers Comp Business Re-Engineering Project (BPR) Roadshow Series
The BPR team has scheduled its next series of roadshows. The roadshow sessions will provide an update on current BPR initiatives and talk about what is planned for Phase 2. Here is the agenda: Programmatic Updates; Medical Authorization Portal; Payor Compliance; and BPR Phase 2: New Initiatives to Come

The full schedule is listed below.

District Office
Brooklyn 111 Livingston Street
19th Floor, Room 1917
Brooklyn, NY 11201
6/23/15 12:00 pm
4:00 pm
Manhattan 215 West 125th Street
Room 509-511
New York, NY 10027
6/24/15 12:00 pm
4:00 pm
White Plains 75 South Broadway
White Plains, NY 10601
6/30/15 12:00 pm
Queens 168-46 91st Avenue
3rd Floor, Room 325
Jamaica, NY 11432
7/1/15 12:00 pm
4:00 pm
Hauppauge 220 East Rabro Drive
Board Room 116-H
Hauppauge, NY 11788
7/2/15 12:00 pm
4:00 pm
Buffalo Ellicott Square Building
295 Main Street
Suite 400, Room 438
Buffalo, NY 14203
7/7/15 12:00 pm
4:00 pm
Rochester 130 Main Street West
Basement Conference Room
Rochester, NY 14614
7/8/15 12:00 pm
4:00 pm

These sessions offer an opportunity for stakeholders to learn about what is happening on the BPR project directly from the BPR team leaders. They also have become an important means of direct communication with their stakeholders. The team looks forward to addressing questions and exchanging ideas. Please email bpr@wcb.ny.gov with any questions.


Many Seniors Treated in ED after Car Crash on Pain Meds Six Months Later
Many seniors injured in motor vehicle crashes remain in pain for months afterwards, negatively affecting their quality of life and ability to live independently, according to a study published in Annals of Emergency Medicine available here.

The study looked at patients aged 65 and older who visited one of eight emergency departments after a motor vehicle crash between June 2011 and 2014 and were discharged home after evaluation. More than half of the patients were still taking some type of pain reliever after six months and about 10% had become daily users of opioid pain relievers, the study found. Of patients with persistent moderate to severe pain, 73% had experienced a decline in their physical function and 23% had experienced a change in living situation to obtain additional help. “The types of injuries that younger people recover from relatively quickly seem to put many seniors into a negative spiral of pain and disability,” said lead author Timothy Platts-Mills, M.D. “Older adults are an important subgroup of individuals injured by motor vehicle crashes and their numbers are expected to double over the next two decades.”


OPRA Prescription Reminders for Unlicensed/Foreign Residents and Interns
In December 2013, New York State (NYS) Medicaid issued a Special Edition (Vol.29, No.13) of the Medicaid Update to provide enrollment requirements and guidance for all Ordering, Prescribing, Referring, and Attending (OPRA) servicing/billing providers.

The purpose of this article is to provide a reminder regarding OPRA prescription requirements for unlicensed residents, interns and foreign physicians in training.

  • NYS Medicaid recognizes prescriptions written by providers legally authorized to prescribe per NYS Education Law Article 131 Section 6526 and 10NYCRR 80.75(e). This includes unlicensed residents, interns and foreign physicians in training programs, under the supervision of a NY State Medicaid enrolled physician.
  • In accordance with NYS Education Law, NYS Medicaid does NOT require the name and signature of the supervising physician to be included on the prescription. However, in order to enable billing by the dispensing pharmacy, prescriptions written by unlicensed residents must include the NPI of the supervising/ attending physician who is enrolled in Medicaid (see last bullet point below regarding billing requirements).
  • NYS Medicaid only enrolls licensed providers. As a result, unlicensed residents, interns or foreign physicians in training programs are not eligible for enrollment as NYS Medicaid providers.
  • Effective January 2014, NYS Fee-For-Service (FFS) Medicaid implemented claims editing that enforced the OPRA requirement for healthcare professionals, practice managers, facility administrators, and servicing/billing providers. Therefore, pharmacy claims for services ordered by unlicensed residents, interns and foreign physicians in training programs reject when initially submitted for payment. The following two (2) options continue to be available to pharmacies, to enable payment:
    1. Resubmit the claim, using the National Provider Identifier (NPI) of the enrolled NYS Medicaid provider (the intern or resident’s supervising physician).
    2. In the event the NPI number of the supervising physician cannot be obtained – or – the pharmacy’s billing system is limited to submitting only one prescriber NPI number then use the urgent/emergency override option (outlined below).


Ask the HPV Experts: CDC Experts Answer Your Questions
The questions and answers in this edition of IAC Express, all related to human papillomavirus (HPV) vaccination, first appeared in the May 2015 issue of Needle Tips.
The questions are answered by experts, medical officer Andrew T. Kroger, MD, MPH; and nurse educator Donna L. Weaver, RN, MN. Both are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).


Narcotic Addicts Can Sue Doctors and Pharmacies for “Enabling” Them
In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions. A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justice’s explanation: “A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others.”

The court recognized that most of the plaintiffs “admitted their abuse of controlled substances occurred before they sought help “at the pain clinic. In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: “It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court.”

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling “because they were aware of the ‘pill mill’ activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled ‘synergistic’ controlled substances.”



Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position

Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

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

Reform Needed Before Date of Discovery Change – June 12, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado
 

 


Dear Colleagues:

This week, the NYS Assembly passed “Lavern’s Law,” legislation that extends the statute of limitations (SOL) on medical malpractice cases. If passed, the SOL begins to run from the date of discovery of the alleged harm rather than from the date of “injury” as is currently the law.  It remains to be seen if next week, the Senate takes up the bill in the remaining days of the current legislative session.  On the surface, it seems impossible to raise any valid ethical arguments against the right of an injured patient to be legitimately compensated for harm caused.  It seems logical that a wronged patient should be able to file a lawsuit within a period of time that commences the running of the statute of limitation from the time they became aware of the injury.  Is it really fair that the timeline for seeking redress begins from the time of injury when one is not aware that injury has occurred?  This is the argument raised by those advancing Lavern’s Law.  Raising any objection or any argument against this framing or analysis seems repugnant and places those advancing a different view in a seemingly untenable position.  And yet, I argue that we must advance a different view to afford ALL New Yorkers the justice they deserve.

Consequences of Lavern’s Law

The framing of justice for injured parties must be placed in a wider framework that includes consideration for all parties in a claim concerning injury as well as the consequences to society at large in regards to access to healthcare.  First, one needs to ask the question why are there two time standards concerning the SOL for the Lavern case?  The time frame for filing a lawsuit alleging harm in the case of municipal hospitals such as in the Lavern case is 15 months.  However, in most other cases, the SOL runs 2 ½ years.  Shouldn’t the standards be the same?  Second, should any consideration be given to the consequences on premium rates and ability to retain physicians in NYS if the SOL is amended?  Are the residents of the State of New York benefitted by a law that may drive physicians to insurance companies in precarious financial positions or may not even be chartered in New York, thus making recovery for damages more difficult for legitimately injured parties?  Will New Yorkers benefit from a seemingly just law that drives more Obstetricians and Neurosurgeons out of this state? Third, Lavern’s Law fails to grant justice to defendants where a statute of limitations is drawn out longer possibly blurring the memories of both the plaintiff and defendant.  What can an injured party recall about a conversation with a physician nine years after a patient-doctor encounter?  What can a physician recall about his/her cognitive thinking on a finding in question where the standard of care has changed over that period of time?

Big Picture Required for Real Solutions

On the surface, Lavern’s Law seems just.  And yet, on further analysis, one realizes it is a disservice to ALL New Yorkers.  Concerns for injured parties who are unaware of injury and later cannot obtain justice within the current legal framework deserve justice.  However, solutions for how justice should prevail MUST be carried out within a more comprehensive discussion on tort reform.  Other states that have addressed justice for the concerns in Lavern’s Law have done addressed other “big picture” concerns such as caps on non-economic damages.  It’s time New York did the same:  REFORM OUR TORT SYSTEM!

Please have your medical staff and family weigh in on this issue affecting  ALL NEW YORKERS by using our grassroots advocacy website.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



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ASSEMBLY PASSES DISASTROUS LIABILITY EXPANSION BILL; PHYSICIANS MUST CONTACT THEIR SENATORS TO OPPOSE NOW!

All physicians must continue to contact their senators immediately to urge that they oppose legislation (S.911, Libous) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.  This week the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).

MLMIC’s estimate based upon similar legislation is that this could single bill could increase physician liability premiums by an untenable 15%!    As New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.

MSSNY is working with many other provider associations also impacted by this legislation, including HANYS, GNYHA, nursing homes associations, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.  As reported in today’s Crains’ Health Pulse, ads will be running in several newspapers across New York State urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.   For example, the ad notes that while many other states have adopted “date of discovery” exceptions to their statutes of limitations, the vast majority of these states have also enacted limitations on non-economic damages.  To view the ad, click here.                                               (DIVISION OF GOVERNMENTAL AFFAIRS)

NYS SENATE PASSES CME MANDATE BILL; BILL ON DEBATE LIST IN THE ASSEMBLY—URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION

The New York State Senate on Tuesday, June 9, 2015 passed Senate Bill 4348 (Hannon), which would require physicians to take three hours of continuing education on pain management, palliative care, and addiction.  Its companion measure, Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, is on the Assembly Debate list and can be voted at any time.  While several legislators have urged that this bill be defeated, we need more given the significant recent media attention to this issue.  Physicians are urged to send a letter urging defeat of this measure.

Additionally, the Governor has submitted to the NYS Legislature, language in his heroin legislative package that would require a four hour course work in pain management and addiction as part of registration renewal for all prescribers in New York State.   This language also provides an exemption from the requirement to anyone who requests the exemption and can clearly demonstrate that there would be no need for him/her to complete such course work because of the nature of his/her practice or can demonstrate that he/she has completed course work deemed by the department or the professional’s certifying or accrediting body to be equivalent to the course work approved by the department.

Assembly Bill 355/Senate Bill 4348 would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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; and end-of-life care.

New York legislators have already taken aggressive and far-reaching actions to reduce the inappropriate prescribing of diverting of pain medications and the action taken has worked.   In particular, New York State now ranks 50th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014.  This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry.  It is the largest vendor of U.S. physician prescribing data in the nation.  It was provided to MSSNY from the American Medical Association.   Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing.   All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products).    New York State was 46th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization.  New York State also ranked 45th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions.  According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization.  Overall utilization of Controlled Substance III, New York State is ranked 27th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50th in growth of utilization with all CME states above New York.

This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances.   There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion.   According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States—  since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time.   It would appear from the data noted above the PMP has changed behavior more significantly than would  continuing medical education coursework and training  in the area of  pain management and opioid use as noted by the data by the IMS Health, Inc.  MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances.          (CLANCY, DEARS)

HEALTHCARE PROFESSIONAL TRANSPARENCY BILL ON SENATE FLOOR

PLEASE CONTACT YOUR ELECTED REPRESENTATIVES.

MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-C, Griffo/A.7129-C, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public.  Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner.  The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.

Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.
(DEARS, ELLMAN) 

LEGISLATION EXPANDS LIST OF IMMUNIZATIONS THAT PHARMACISTS CAN ADMINISTER TO ADULTS

Legislation that would expand the list of immunizations that pharmacists can provide to adults appears headed for passage in the New York State Legislature.  A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis to the list of vaccines that can be administered by pharmacists.   The bill also allows physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill  requires the pharmacist to report  the administration of the vaccine to  the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The New York City Department of Health has made passage of this bill a priority; pharmacists and the pharmaceutical industry is also lobbying in support of the bill’s passage.   The Medical Society of the State of New York remains opposed as it believes that this policy would further fracture the concept of the “medical home”.   The bill is pending in the Higher Education Committee of both houses, but it is expected to be placed on the agenda and moved to the floor for passage next week.
(CLANCY, DEARS, ELLMAN)

HEALTH GROUPS URGE PASSAGE OF BILL TO INCLUDE E-CIGARETTES UNDER CLEAN INDOOR AIR ACT

Senate Bill 2202B/A. 5595B, sponsored by Senator Kemp Hannon and Assemblywoman Linda Rosenthal, is pending in the New York State Legislature.   The bill would prohibit e-cigarette use in all public places in accordance to the NYS Clean Indoor Air Act.  The bill is on Senate floor and is in the Assembly Codes Committee.  Physicians are urged to contact their legislators in support of this measure.   In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke.  Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates.  However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air Act.                                                             (CLANCY, ELLMAN) 

SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION PENDING IN ASSEMBLY CODES COMMITTEE AND ON SENATE FLOOR

Assembly Bill 791C, sponsored by Assemblywoman Aileen Gunther, is pending in the Assembly Codes Committee and its companion measure, Senate Bill 4324A, sponsored by and Senator Kemp Hannon,  is on the floor of the Senate for a vote.   This bill would require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade. The Medical Society of the State of New York has been part of a coalition of organizations supporting this legislation and is urging physicians and their patients to advocate in legislation. Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill.  MSSNY has also developed a patient-support letter that patients can use to urge support of this legislation.

This bill is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.  Organizations in support of this measure include GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.                            (CLANCY)

CDC ISSUES ADVISORY ON MERS-CoV; PHYSICIANS ENCOURAGED TO TAKE MSSNY’S FREE CME PROGRAM ON CORONAVIRUS

The Centers for Disease Control and Prevention (CDC) continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East Respiratory Syndrome Coronavirus (MERS-CoV) globally, including the cases of MERS-CoV infection recently reported by China and the Republic of Korea. The CDC has issued an advisory to provide updated guidance to state health departments and healthcare providers in the evaluation of patients for MERS-CoV infection, which have been revised in light of the current situation in the Republic of Korea.

The Medical Society of the State of New York has a free online program on “Coronavirus” on its website http://cme.mssny.org/.   New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the various courses.  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 Credit.    Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Healthcare providers and public health officials should maintain awareness of the need to consider MERS-CoV infection in ill persons who have recently traveled from countries in or near the Arabian Peninsula or in the Republic of Korea as outlined in the guidance. Since May 2015, the Republic of Korea has been investigating an outbreak of MERS.  It is the largest known outbreak of MERS outside the Arabian Peninsula.  Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV).  MERS affects the respiratory system (lungs and breathing tubes).  Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died.   The CDC is “sounding the alarm for American doctors now,” as more than 1,200 people have been infected around the world and the death toll is “approaching 500.”   Further information on MSSNY CME online programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)

SCOPE-OF-PRACTICE BILLS STATUS AT END OF SESSION

The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  2. 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  3. 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would  allow podiatrists to care for up to the knee.  This would include diagnosing, treating, operating or prescribing for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves. This bill is in the Higher Education Committee in the Senate and Assembly.
  4. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, and call themselves naturopathic doctors.  While they  claim the bill would not permit them to perform invasive procedures, it would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  5. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  6. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  7. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.      (ELLMAN)

WORKERS COMPENSATION BOARD TO HOST REGIONAL FORUMS ON PROGRAMMATIC INIATIVES

The New York Workers Compensation Board (WCB) will be hosting regional programs across New York State to update physicians, their staff and other WC stakeholders regarding the status of its Business Process Re-Engineering (BPR) to improve  the WC program in New York State.  The programs will be held in each District Office beginning next Tuesday in Albany and running through the first week of July.  The discussion will include updates on the Board’s proposal to establish a Medical Authorization Portal and assure greater payor compliance.  The release by the WCB also notes that the program will discussing upcoming initiatives.  The schedule is listed below.  Physicians and/or their staff are encouraged to attend. 

District Office Address Date Times
Menands/Albany 100 BroadwayCR 518A & 518BMenands, NY 12241 6/16/15 12:00 pm4:00 pm
Syracuse 935 James StreetSyracuse, NY 13203 6/17/15 12:00 pm4:00 pm
Binghamton State Office Building44 Hawley Street, 18th FloorWarren Anderson Community RoomBinghamton, NY 13901 6/18/15 12:00 pm4:00 pm
Brooklyn 111 Livingston Street19th Floor, Room 1917Brooklyn, NY 11201 6/23/15 12:00 pm4:00 pm
Manhattan 215 West 125th StreetRoom 509-511New York, NY 10027 6/24/15 12:00 pm4:00 pm
White Plains 75 South BroadwayWhite Plains, NY 10601 6/30/15 12:00 pm
Queens 168-46 91st Avenue3rd Floor, Room 325Jamaica, NY 11432 7/1/15 12:00 pm4:00 pm
Hauppauge 220 East Rabro DriveBoard Room 116-HHauppauge, NY 11788 7/2/15 12:00 pm4:00 pm
Buffalo Ellicott Square Building295 Main StreetSuite 400, Room 438Buffalo, NY 14203 7/7/15 12:00 pm4:00 pm
Rochester 130 Main Street WestBasement Conference RoomRochester, NY 14614 7/8/15 12:00 pm4:00 pm

 (AUSTER)

PHYSICIANS, HOSPITALS AND NURSING HOMES JOINTLY ADVOCATE TO PREVENT FURTHER EXTENSION OF MEDICARE SEQUESTRATION CUTS

MSSNY joined with the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA) and other provider associations in urging the New York House Congressional delegation to reject a Medicare sequestration cut extension (in 2024) included in the Trade Act of 2015 that was passed by the US Senate.  To read the letter, click here.  As of this writing, it appeared as if the US House of Representatives would remove the sequestration extension provision in a separate piece of legislation also to be passed by both Houses.  The letter notes that: “Extending Medicare sequestration reductions to pay for non-Medicare programs reinforces a dangerous precedent set last year of syphoning funds from the Medicare Trust Fund for non-Medicare purposes.  Such action will most certainly undermine the strength of the Trust Fund and the ability of hospitals, health systems, physicians, home care providers, nursing homes, and other providers to deliver the care our communities need and deserve.”  Earlier this year, the American Medical Association joined the American Hospital Association in a similar letter to Congress expressing concern with extending Medicare sequestration to pay for non-health care programs.
(AUSTER, DEARS) 

ADDITIONAL “ADVOCACY MATTERS” SESSIONS ON SHIN-NY PATIENT LOOK-UP

The June 9, 2015 “Advocacy Matters” CME webinar was on the topic “SHIN-NY Statewide Patient Record Look-Up.” There will be three more sessions offered on the same topic, co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC).  The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO,   Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

Dates, times, and registration links are as follows:

June 16, 2015 (8-9 AM):   Register Here

June 18, 2015 (6-7 PM):   Register Here

June 24, 2015 (6-7 PM):   Register Here

For more information on the June 16 or June 18 program, contact Karen Tucker at ktucker@nyacp.org   or (518) 427-0366.  For more information on the June 24 program, contact Miriam Hardin at mhardin@mssny.org  or (518) 465-8085.

Program flyer is available here.
(DEARS, HARDIN) 

pschuh@mssny.org ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

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New York County Medical Society Honors Anthony A. Clemendor, MD
At its annual meeting on June 2, New York County Medical Society President Joshua M. Cohen, MD, MPH presented the Society’s Nicholas Romayne, MD Lifetime Achievement Award to Anthony A. Clemendor, MD.

“Dr. Clemendor has worked tirelessly on behalf of physicians and patients throughout his career,” said Dr. Cohen. “He embodies the finest attributes represented by this award and its namesake, Dr. Romayne.”

The award is named for Dr. Nicholas Romayne, who in addition to serving as the Society’s first president in 1806, was also a founder of the New York College of Physicians and Surgeons.  It was said of Dr. Romayne that “he was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.”   In recognition of the caliber of physician this award honors, this year the Society presents it to a physician of equally impressive stature.

A graduate of the Howard University College of Medicine, Dr. Clemendor is board certified in obstetrics and gynecology. He is Clinical Professor of Obstetrics and Gynecology at New York Medical College, where he served as a dean for 23 years.

As a member of both New York County Medical Society and the Medical Society of the State of New York, Dr. Clemendor has served in a number of capacities: he chaired the MSSNY Task Force to Eliminate Ethnic and Racial Disparities in Health Care, and served on the AMA Commission to End Disparities in Health Care.  He served on the New York State Board for Professional Medical Conduct; as treasurer of the Empire State Medical Scientific and Educational Foundation; and on the New York State Council on Graduate Medical Education. In addition, he served on the Executive Committee of the Medical Society of the State for New York as Treasurer and as Councilor representing Manhattan and the Bronx.

Dr. Clemendor is a fellow of the New York Academy of Medicine. He continues to serve as vice chair of the Society’s delegation to the Medical Society of the State of New York. 

New York State Smoking Levels Reach “Historic Lows”

Smoking levels in New York State have reached a “historic low.” According to data released Monday by the state, smoking among high school students has dropped 42% over the past four years, with the rate now at 7.2%. Similarly, the adult smoking rate of 14.5% is below the national average of 17.8%. The statewide drop comes “even as smoking has been on the rise in the city after years of decline,” reaching 16% in 2013 after achieving a low of 14% in 2010. Experts cited New York’s “nation-high tobacco taxes as a reason,” alongside anti-smoking ads, laws and programs. Gov. Cuomo said, “With the lowest smoking rate in recorded history, it’s clear that New York State is becoming healthier than ever.”

Harlan Juster, director of the state’s Bureau of Tobacco Control, stated that the data is part of an annual survey that will be released in a full report later this year. He said the state has been collecting data on smoking since 1985, “when smoking rates were 31 percent among adults.” The data shows that 17.1% of men versus 12.1% of women smoke. Furthermore, “blacks have the highest percentage of smokers: 16.1 percent, compared with 15.1 percent of whites and 14.1 percent of Hispanics.” 

Study: Stroke Ages Patients by 7.9 Years

A study conducted by researchers at the University of Michigan and published in Stroke, based on data from over “4,900 black and white Americans aged 65 and older who underwent tests of memory and thinking speed between 1998 and 2012,” found that a stroke had the effect on the test results equivalent to aging 7.9 years. The effect of the stroke was “similar” for black and white patients.

AMA Delegates Ask CMS to Wave ICD-10 Penalties for Two Years

Physicians at the 2015 AMA Annual Meeting passed policy requesting that CMS wave penalties for errors, mistakes or malfunctions in the system for two years directly following implementation. The policy stipulates that CMS should not withhold physician payments based on coding mistakes, “providing for a true transition, where physicians and their offices can work with ICD-10.” With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period for physicians to avoid financial penalties to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients without undue disruption.

Related policy pushes the AMA to advocate for physician voices to be part of the group that manages the International Classification of Diseases (ICD). Currently, the four cooperating parties that manage ICD code sets are the Centers for Disease Control National Centers for Health Statistics, CMS, the American Hospital Association and the American Health Information Management Association. A physician group is necessary in these conversations because none of the current groups “represent providers who have licensed authority to define, diagnose, describe and document patient conditions and treatments.”

The new policy also directs the AMA to seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement or moving to all-cash practices.

CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes. The agency estimates that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association.

A 2014 AMA study (log in) conducted by Nachisom Advisors on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $22,579 to $100,349 during the first year of ICD-10 implementation. The study also estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.

While the AMA continues to urge regulators to ease the burden of ICD-10 implementation on physicians, physicians should act now to make sure your practice is prepared.

Parents’ Age May Play Role in Children’s Autism Risk
A study found increased autism rates among children born to teen moms and among kids whose parents have large gaps between their ages. The research, published in Molecular Psychiatry, indicated that “autism rates were 66 percent higher among children born to dads over 50 years old, as compared to dads in their 20s.” Meanwhile, “autism rates were 15 percent higher when moms had children in their 40s and 18 percent higher for children of teen moms, when compared to those born to women in their 20s.”

The risk also went up even more if the parents’ ages differed by at least 10 years. The researchers found that “the age gap risk showed up especially among fathers between 35 and 44 with a partner more than 10 years younger, and among mothers in their 30s with a partner at least 10 years younger.” The investigators came to these conclusions after looking at nearly “31,000 children with autism to nearly 6 million without autism in five countries.” These findings were reported online June 9 in the journal Molecular Psychiatry. The study authors compared almost 31,000 children with autism to nearly 6 million without autism in five countries. Those countries included Australia, Denmark, Israel, Norway and Sweden.

The CDC estimates that one in 68 children has an autism spectrum disorder.

Physician Burnout Scores at 40%–10% Higher than General Population

Physician burnout is largely attributed to the increasing administrative burden of modern medicine, according to a study from the AMA and RAND Corporation, a nonprofit, nonpartisan research organization that helps improve policy and decision-making.

The initiative, called AMA STEPS Forward, is comprised of interactive, online “physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.”

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent, more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their day-to-day concerns through a new online practice transformation series called AMA STEPS Forward,” said James L. Madara, MD, AMA Executive Vice President and CEO, in a press release.

Many physicians say factors such as bureaucratic obstacles, administrative rules and paperwork have negatively impacted their job satisfaction—taking time away from patients and affecting their ability to provide high-quality, the report found. The initiative provides strategies to help physicians refocus their practices so they and their staff can “thrive in the evolving health care environment by working smarter, not harder.”

There are currently 16 modules available at www.STEPSforward.org. They focus on practice efficiency and patient care, patient health, physician health and technology and innovation. More than 25 modules are expected to be available by the end of the year, according the AMA. The modules can be used to earn continuing medical education credit.

New AMA Policy Aims to Reduce Risk of Concussion in Youth Sports

With growing concerns about the negative health effects of sports-related concussions in recent years, the American Medical Association (AMA) voted today to adopt policies aimed at reducing the risk of concussions in young athletes.

The AMA’s newly adopted policy supports requiring youth athletes who are suspected of having sustained a concussion to be removed immediately from the activity and allowed only to return with a physician’s written consent. The new policy also encourages the adoption of evidence-based, age-specific guidelines for physicians, other health care professionals and athletic organizations to use in evaluating and managing concussion in all athletes as well as the development and evaluation of effective risk reduction measures to prevent or reduce sports-related injuries and concussions.

According to the Centers for Disease Control and Prevention, between 1.6 million and 3.8 million sports- and recreation-related traumatic brain injuries, including concussions and other head injuries, occur in the U.S. every year. A recent study shows that 59 percent of middle school female soccer players reported playing with concussion symptoms, with less than half having been evaluated by a physician or other qualified health professional. A study of high school athletes with concussions also found that 15 percent returned to play prematurely, and nearly 16 percent of football players who sustained a concussion that resulted in loss-of-consciousness returned to play in less than one day.

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation.
As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.

Date: Tuesday, 6/16/2015
Time: 12:00-1:30 p.m.

Register for session


Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position
Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

Act Now: Date of Discovery – June 5, 2015

drmaldonado PRESIDENT’S MESSAGE

Dr. Joseph R.Maldonado, President

Dear Colleagues:

We are nearing the end of the 2015 legislative session.  This session has seen recurring as well as new legislative efforts to change the practice of medicine in the State of New York.  This has occurred under new leadership in both the Assembly and Senate.  Last week, we saw the Assembly support a single payer effort in the State of New York.  This week, we have seen a strong push to have Date of Discovery Statute of Limitations and CME Mandate legislation voted on in the state legislature.  When examined in a vacuum, both of these issues appear to garner sympathy.  After all, who wouldn’t want their physician to have an up-to-date understanding of the pharmaceutical management of pain?  And yet, these issues cannot be considered purely in their ideological vacuum state.  Other considerations must be weighed into this discussion.

For example, what is the financial and workforce cost of enacting the Date of Discovery legislation?  What is the purpose of mandating CME on everything from I-STOP and drug enforcement administration 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 and end-of-life care? Any one of these subjects could be the focus of a three hour course. Simple solutions complicate already complicated issues.  Our solutions for complex problems must take into consideration a nuanced understanding of the etiology and nature of the problem.  It must consider the potential consequences of the solution.  The trial attorneys argue that the change in the statute of limitations concerning date of discovery affects a very small number of potential plaintiffs.  If so, why are the medical liability insurers concluding that this measure threatens to raise malpractice premium rates by at least 15%?  Why must we worsen the work environment for all physicians in a state that ranks lowest in WalletHub’s recent survey?  Why must we mandate all physicians to take a three -hour course every two years? Does a three-hour course even suffice for the physician who does pain management for a living?  Shouldn’t the professional specialty societies be the better judges of what is appropriate for their specialty society members?

Let’s take a moment this weekend to contact our state legislators.  Sign on to the letter we have drafted or draft your own expressing a reasoned, evidence based argument for a pragmatic approach to these problems.  Urge them not to support the current bills. Instead, urge them to study these issues more thoroughly and draft legislation that does justice for all New Yorkers

Physicians opposed to mandatory prescribing CME are urged to send a letter urging defeat of this measure.  Or physicians may call 518-455-4100 and ask for their assembly member office.

To defeat Day of Discovery, please click here.

Its companion measure, Senate Bill 4348 is also on the Senate floor and can be acted on at any time.  Physicians are urged to send the above letter or call the NYS Senate at 518-455-2800 and ask for their senator’s office.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC 

MSSNY President

Please send your comments to comments@mssny.org


MLMIC


Capital_Update_Banner 

PHYSICIAN ACTION URGED TO DEFEAT DISASTROUS LIABILITY EXPANSION BILL
All physicians must contact their legislators to urge that they oppose legislation (A.285, Weinstein/S.911, Libous) that would drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

Physicians are also urged to call their assemblymembers and senators.   Talking points are available here.

This week the bill was reported from the Assembly Codes Committee to the Assembly Rules Committee, where it could be reported to full Assembly and voted on as soon as Monday.   As many New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.  MSSNY is working with many other provider associations also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.                                    (DIVISION OF GOVERNMENTAL AFFAIRS)

NYS SENATE TO VOTE ON MONDAY FOR THE CME MANDATE BILL; BILL ON DEBATE LIST IN THE ASSEMBLY—URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION
On Monday afternoon, June 8, the New York State Senate is expected to vote upon Senate Bill 4348 (Hannon), which would require physicians to take three hours of continuing education on pain management, palliative care, and addiction.  Its companion measure, Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, is on the Assembly Debate list and can be voted on as early as Monday.  While several legislators have urged that this bill be defeated, we need more.  Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355/Senate Bill 4348 would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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; and end-of-life care.                                                                      (CLANCY, DEARS) 

HEALTHCARE PROFESSIONAL TRANSPARENCY BILL ON SENATE FLOOR
PLEASE CONTACT YOUR ELECTED REPRESENTATIVES. 

MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-A, Griffo/A.7129-A, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public.  Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner.  The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.

Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.                                                  (DEARS, ELLMAN)

SCHOOL-BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION MOVES FORWARD IN BOTH HOUSES
Assembly Bill 791C/Senate Bill 4324, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon,  is moving forward in the legislative process, and physicians are urged to send a letter to their legislators urging support. Assembly Bill 791C  is in the Assembly Codes Committee, and Senate Bill 4324A is now on the Senate floor for a vote.  The Medical Society of the State of New York has been part of a coalition of organizations supporting this legislation and is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.   Assembly Bill 791C/Senate Bill 4324 would require that every person entering seventh grade and 12th  grade shall have been immunized against meningococcal disease.  Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill.

MSSNY has also developed a patient-support letter that patients can use to urge support of this legislation.                                                                                                              (CLANCY)

SCOPE-OF-PRACTICE BILLS STATUS AT END OF SESSION
The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  • S.816 (Libous)/A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area.  This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  • A.5805 (McDonald)/S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states.  It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • A.123 (Paulin)/S.4739 (Hannon) – a bill that would authorize pharmacists to, in addition to those immunizations currently allowed to be administered by pharmacists, administer immunizations to prevent tetanus, diphtheria, pertussis, acute herpes zoster, and meningococcal pursuant to a patient specific or non-patient specific order, and would remove the sunset provisions currently in the law.   Pharmacists are currently allowed to administer influenza, pneumococcal, acute herpes zoster and meningococcal pursuant to a patient specific order from a physician.   This bill remains in the Higher Education Committee in both the Senate and Assembly.
  • A.719 (Pretlow)/S.4600 (Libous) –  a bill that would expand on a bill enacted in 2012, and would  allow podiatrists to provide care for up to the knee.  This would include diagnosing, treating, operating or prescribing for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.

This bill is in the Higher Education Committee in the Senate and Assembly.

  • A.7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice.  It would allow them to practice as primary care providers, and call themselves naturopathic doctors.   Despite claims that the bill would not enable them to perform invasive procedures, this bill would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  • S.2063 (Libous)/A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with.  Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • S.215-A (Martins)/A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners.  This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.   Physicians are urged to send a letter to their legislators.  (ELLMAN) 

LEGISLATION TO ENABLE PATIENTS TO END LIFE IS INTRODUCED IN NYS LEGISLATURE
There have been various bills introduced in the New York State Legislature that would enable patients to request assistance from their physician to end their life.  Senate Bill 5814, introduced by Senator John Bonacic, and Assembly Bill 5261A, introduced by Assemblywoman Amy Paulin, would amend the public health law and allow a patient to self-determine the end of life and would allow a physician to prescribe a lethal dose of drugs after they have received a written request from a patient who is terminally ill.  This bill is called the “Patient Self-Determination Act.”   Earlier in the year, Senator Diane Savino introduced Senate Bill 3685, the “New York End of Life Options Act,” which would allow physicians to assist and provide aid-in-dying medication to terminally ill patients.  Assemblywoman Linda Rosenthal has introduced Assembly Bill 2129, which would establish the “Death with Dignity Act” and would allow patients who have a terminal disease to voluntary self-administer a lethal dose of medications that have be prescribed by a physician for that purpose.  All of these bills are in the Assembly or Senate Health Committee.  There is also court action in the Supreme Court, County of New York, that has been filed by End of Life Choices New York and several physicians against New York State based on New York State assisted-suicide statute claiming that the provisions should not be interpreted to prohibit a physician’s prescription of lethal medications to a terminally ill patient who wished to end his/her life.  The introduction of these bills stem, in part, from the case  of Brittany Maynard, who took her own life after she was diagnosed with a terminal illness.  She lived in Oregon, where physicians can dispense lethal doses of drugs to terminally ill patients. The Medical Society of the State of New York’s House of Delegates in May 2015 adopted a revised policy on assisted suicide, MSSNY Policy 95.989 Physician Assisted Suicide and Euthanasia:

Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing.  Despite shifts in favor of physician-assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine. Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a fundamental duty in medical practice, relief of suffering through shortening of life has not. Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated.  MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases. Physicians should not perform euthanasia or participate in assisted suicide.                    (CLANCY)

HEALTH SYSTEMS TRANSFORMATION REGIONAL MEETING TO BE HELD JUNE 18TH
NYSDOH Commissioner Howard Zucker, MD, JD will be among the speakers at a  Health Systems Transformation Regional meeting to be held on Thursday, June 18, 2015 at the Albany School of Public Health, George Education Center Auditorium, One University Place Rensselaer, NY 12144.   This event is co-sponsored by American College of Preventive Medicine and the University of Albany.  The half-day conference will feature state officials representing New York, Vermont, and Massachusetts who will present their experiences, insights and lessons learned related to CMS’s State Innovation Model Initiative.   Representatives from organizations such as the New York Academy of Medicine, The Commonwealth Fund, Xerox, the Finger Lakes Health Systems Agency, and Maine Health Management Coalition will present on private-sector collaborations and involvement in fostering health systems transformation.   The intended audience is physicians, public health officials, students and residents, payers, and anyone with an interest in this important topic.  Registration for the Northeast Regional Meeting is open until Wednesday, June 10th.
The $30 registration includes lunch and up to four CME credits. To register, please click here.                                                                                                                       (CLANCY)

CMS RELEASES 2013 MEDICARE PAYMENT DATA; AMA RELEASES GUIDE TO PROVIDE CONTEXT
This week CMS released new data related to Medicare payments to hospitals and physicians for services provided during calendar year 2013.  The Medicare Part B data includes information on 950,000 distinct health care providers including physicians, and allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The Medicare hospital utilization and payment data includes information for services provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at over 3,000 hospitals in 2013.  To view the report, click here.

Recognizing the potential inaccurate conclusions that could be drawn based upon media reports of this data, the American Medical Association released a media guide to help provide necessary context for this data release.  To read the media guide, click here.  The media guide notes that the AMA “is committed to transparency and supports the release of data that can help improve quality of care. For that reason, the AMA believes that certain safeguards are needed to ensure accurate information is presented to the public. Given that CMS has once again released Medicare claims data without pre-verification by physicians to ensure accuracy and with little context, members of the media will be integral to ensuring that the public gets clear, accurate information.”                                                                                 (AUSTER) 

CMS RELEASES NEW ACO PARTICIPATION RULES
This week CMS adopted new rules for the Medicare Shared Savings Program (MSSP), including provisions relating to the payment of Accountable Care Organizations (ACOs) participating in the MSSP.   To read more, click here.

According to a summary provided by federal legislative counsel to the Physicians Advocacy Institute, among the significant revisions to the existing ACO program:

  • Adding a process for an ACO to renew its 3-year participation agreement for an additional agreement period, including factors (such as historical program compliance) that CMS will use to make a determination on the ACO’s renewal;
  • Finalizing a policy that permits ACOs to participate in an additional agreement period under one-sided risk with the same sharing rate as was available to them under the first agreement period and offering an alternative performance-based risk model (creating a new “Track 3” for ACOs);
  • Streamlining the data sharing between CMS and ACOs;
  • Establishing a streamlined process to allow prior Pioneer ACOs to apply for participation in the Shared Savings Program

CMS also states that it “intends to address other modifications to program rules in future rulemaking in the near term to improve ACO willingness to take on performance-based risk,” including waiving the geographic requirement for use of telehealth services.

CMS estimates that “at least 90 percent of eligible ACOs” will renew their participation in the MSSP when given the new options outlined in the final rule.                                              (AUSTER) 

HOUSE WAYS &MEANS COMMITTEE ADVANCES IPAB REPEAL LEGISLATION
This week the U.S. House Ways & Means Committee advanced to the full House of Representatives legislation to repeal the Independent Payment Advisory Board (HR 1190) and repeal the medical device tax (HR 160), provisions enacted as part of the ACA.   Among the 235 co-sponsors of the IPAB repeal legislation are New York Congressional delegation members Chris Collins, Peter King, Sean Patrick Maloney, Chris Gibson, Tom Reed, Elise Stefanik, Richard Hanna and John Katko.  The IPAB is a board charged with making cuts to Medicare payments if expenditures reach a certain level, with limited ability of Congress to reverse such cuts.

MSSNY recently signed on to a patient and provider association advocacy letter in support of repeal of the IPAB.  The letter contains over 500 signatories.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decision making responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”  The AMA also released a statement in support of the legislation, noting that: “IPAB is a flawed policy and the AMA has been advocating for the repeal of it since the ACA was passed. It would put significant health care payment and policy decisions in the hands of an independent body of individuals with far too little accountability. Additionally, IPAB’s arbitrary, annual cost cutting targets would lead to short term strategies that would threaten access to care for millions of Medicare patients across the country.”                                                                     (AUSTER)

HOUSE WAYS & MEANS COMMITTEE REQUESTS CMS DEVELOP ICD-10 CONTINGENCY PLANS
This week US House Ways & Means Health Subcommittee Chair Kevin Brady (R-TX) and 12 members of the Committee sent a letter to Acting CMS Administrator Andy Slavitt urging that CMS take steps to instill confidence among physicians that the October 1, 2015 implementation deadline for the required use of the ICD-10 coding system “will not cause widespread disruption.”  To read the letter, click here.

Among the recommendations in the letter were:

  • Make public any contingency plan for how Medicare will process claims in the event that CMS is unable to process claims with ICD-10 codes on October 1;
  • Make public a description how ICD-10 codes will be applied to current Medicare incentive programs for reporting on quality care and other metrics;
  • Expand “end to end” testing beyond the current 2,500 providers; and
  • Educate providers on resources in the event that CMS can accept ICD-10 codes but providers are unable to submit ICD-10 codes

In a press release accompanying the letter, Chair Brady stated, “Our local health-care providers have already taken on the financial and administrative burden of transitioning from ICD-9 to ICD-10.  Unlike the disastrous rollout of healthcare.gov in the Affordable Care Act, this Administration owes it to our local doctors to ensure a smooth transition to ICD-10.”

MSSNY also continues to support legislation (HR. 2126, Poe) that would postpone ICD-10 implementation, and physicians can send a letter in support of this legislation here.

(AUSTER) 

AMA URGES CHANGES BEFORE IMPLEMENTING MEANINGFUL USE STAGE 3
The American Medical Association recently wrote to CMS Acting Administrator Andy Slavitt to urge that CMS hold off on implementing Meaningful Use Stage 3 given the number of challenges facing physicians with implementing existing Meaningful Use standards.  Despite the fact that a large number of physicians are now using electronic health records (EHRs), less than 10 % of eligible professionals were able to attest for Stage 2 Meaningful Use in 2014.  The AMA letter highlights the following concerns that must be addressed before MU Stage 3 is implemented:

  • Patient Safety: There remains no thorough evaluation of how implementing EHRs and meeting complex MU requirements impact patient safety;
  • Modifications Rule Impact: Sufficient time is needed to ascertain physicians’ ability to meet the modified versions of Stages 1-2 now that some needed changes have been made;
  • Privacy and Security: There remain huge gaps in how to protect patient data, which must be addressed before expanding the program to include additional technology and other requirements;
  • Focus on Interoperability: More time is needed to prioritize interoperability, reduce barriers to data exchange, and promote the use of innovative technologies through pilot projects;
  • Quality Measures: The technology and infrastructure are still lacking to handle the next generation of quality measures and electronic reporting; and
  • Merit-Based Incentive Payment System (MIPS): The structure and requirements of the MIPS value-based payment program included as part of the recently enacted SGR Repeal legislation have yet to be outlined to ensure physicians have the appropriate tools to improve health care.                                                                (AUSTER, DEARS) 

ADVOCACY MATTERS CME WEBINAR JUNE 9, 2015
The next “Advocacy Matters” CME webinar will be held on Tuesday, June 9, 2015, from 12:30 to 1:30 PM.  The faculty will include David Whitlinger, CEO of NYeC, New York e-Health Collaborative (NYeC), Inez Sieben, COO, and Lisa Halperin Fleischer, NYeC CMO,, New York e-Health Collaborative (NYeC), presenting on the topic “SHIN-NY Statewide Patient Record Look-Up.”

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access. 

To register for this webinar, click here and fill out registration form.

The flyer for the program may be accessed here.                                          (DEARS, HARDIN) 

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER
The Medical Society’s final “Medical Matters” webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikungunya.”  Physicians are encouraged to register by clicking on https://mssny.webex.com.  Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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 Credit.    Physicians should claim only the credit commensurate with the extent of their participation in the activity. It is anticipated that Medical Matters programing for fall/spring 2015-2016 will be announced shortly.                               (CLANCY)

pschuh@mssny.org ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

enews_738px

Some Upstate NY Cities Have Some the U.S.’s Most Affordable Healthcare
Upstate New York cities have some of the most affordable health care in the country.

A report by the Niagara Quality Health Coalition found that three upstate cities rank among the cheapest places in the nation for the amount that health insurers pay hospitals, doctors and other care providers in their network.

Buffalo was the second most affordable city of 274 regions studied. Rochester ranked fourth and Syracuse was 19. The most affordable city in the United States was Honolulu. The Bronx ranked third. Albany ranked 83 rd.

The most expensive cities in the country were Santa Cruz, California followed by Huntington and Charleston in West Virginia.

Here is the report by the nonprofit coalition. The report analyzed data insurers submitted to the Institute of Medicine.

ACPM Meeting in Albany on June 18
The American College of Preventive Medicine is proud to be hosting a series of three Health Systems Transformation Regional Meetings across the United States in May and June 2015.  The northeastern regional event will be co-sponsored by ACPM and the University of Albany. A copy of the agenda is attached for your perusal.

Register here: Northeastern Regional Meeting

Where: University at Albany School of Public Health, Renselaer, New York
When:  Thursday, June 18, 2015

This half-day conference will feature state officials representing New York, Vermont, and Massachusetts who will present their experiences, insights and lessons learned related to CMS’s State Innovation Model Initiative.  Representatives from organizations such as the New York Academy of Medicine, The Commonwealth Fund, Xerox, the Finger Lakes Health Systems Agency, and Maine Health Management Coalition will present on private sector collaborations and involvement in fostering health systems transformation.   For physicians, public health officials, students and residents, payers, and anyone with an interest in this most important of topics, this promises to be a fascinating event. Registration for the Northeast Regional Meeting is open until Friday, June 12th.  The $30 registration includes breakfast, coffee/tea, and snacks. Attendees have an opportunity to register for up to 4 CME/MOC credits. 

NYU Langone Makes Deal with 42-Physicians L.I. Practice
NYU Langone completed a deal with the Huntington Medical Group, a 42-physician Long Island practice that has been renamed NYU Langone Huntington Medical Group. The group has a total staff of 288 at two locations, in Huntington Station and Commack, and leases both those sites. The hospital did not disclose the details of the transaction. NYU Langone said in a statement that it plans to add cardiothoracic surgery, electrophysiology and cancer treatment services to the sites. The multispecialty practice already offers most specialties and primary care. The practice will be moved to NYU Langone’s billing platform and to its EPIC electronic health record system. (Crains, 6/5) 

Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation.

As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.

Registration is open for the following dates:

Provider and Supplier Participation Requested for the 2015 MAC Satisfaction Indicator; Attention NGS providers and suppliers: Your feedback matters!
Your opinion is important to NGS. Please help them by participating in the 2015 MAC Satisfaction Indicator (MSI) survey. Please watch for their Email Updates with the survey link specific to providers and suppliers in the NGS jurisdiction. The survey will be available beginning June 15, 2015.

Complete the quick 10-minute survey to share your experience with the services we provide. The CFI Group is conducting this survey on behalf of the CMS. We appreciate your willingness to participate and assure you your responses will be kept completely confidential.

Roughly 150 People Being Monitored for Lassa fever After N.J. Man’s Death
At least 150 people may have had contact with a New Jersey man who died from Lassa fever after returning from Liberia. All are being monitored for symptoms, the Associated Press reports. Six of the contacts are at high risk of exposure, and 33 are at low risk. The virus, which can cause hemorrhagic fever, is not as lethal as the Ebola virus; but like Ebola, it is spread through contact with bodily fluids. CDC Lassa website: http://www.cdc.gov/vhf/lassa/

New York Blue Light Symposium
June 26-27, 2015 (Fri-Sat), Marriott Marquis, New York

With the explosion of blue light-emitting LEDs in homes, illuminated screens in personal devices, and increase in time-shift working hours, humans today are exposed to more light than they have ever been before. Recent studies have demonstrated the adverse effects of blue light on human health, including susceptibility to metabolism disorders and cancer.

To highlight this issue, the International Blue Light Society was founded in 2013 with 21 charter members from five countries. The 1st International Blue Light Symposium was held in Tokyo that same year, attracting 300 attendees from all over the world.

The New York Blue Light Symposium is a venue to discuss and heighten awareness in light studies. Basic scientists, clinicians, students, and other professionals are welcome to attend. Register early to avail of discounted rates.

For more information, visit http://blue-light.biz/2isbls/ 

New York County Medical Society Honors Anthony A. Clemendor, MD
At its annual meeting on June 2, New York County Medical Society President Joshua M. Cohen, MD, MPH presented the Society’s Nicholas Romaine, MD Lifetime Achievement Award to Anthony A. Clemendor, MD.

“Dr. Clemendor has worked tirelessly on behalf of physicians and patients throughout his career,” said Dr. Cohen. “He embodies the finest attributes represented by this award and its namesake, Dr. Romaine.”

The award is named for Doctor Nicholas Romaine, who in addition to serving as the Society’s first president in 1806, was also a founder of the New York College of Physicians and Surgeons.  It was said of Doctor Romaine that “he was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.”   In recognition of the caliber of physician this award honors, this year the Society presents it to a physician of equally impressive stature.

A graduate of the Howard University College of Medicine, Dr. Clemendor is board certified in obstetrics and gynecology. He is Clinical Professor of Obstetrics and Gynecology at New York Medical College, where he served as a dean for 23 years.

As a member of both New York County Medical Society and the Medical Society of the State of New York, Dr. Clemendor has served in a number of capacities: he chaired the MSSNY Task Force to Eliminate Ethnic and Racial Disparities in Health Care, and served on the AMA Commission to End Disparities in Health Care.  He served on the New York State Board for Professional Medical Conduct; as treasurer of the Empire State Medical Scientific and Educational Foundation; and on the New York State Council on Graduate Medical Education. In addition, he served on the Executive Committee of the Medical Society of the State for New York as Treasurer and as Councilor representing Manhattan and the Bronx.

Dr. Clemendor is a fellow of the New York Academy of Medicine. He continues to serve as vice chair of the Society’s delegation to the Medical Society of the State of New York.

Debate Begins on Single Payer

 drmaldonado PRESIDENT’S MESSAGE

Dr. Joseph R.Maldonado, President

Dear Colleagues:

In the coming weeks, you will be reading more about MSSNY’s progress in moving or stalling numerous legislative bills pertaining to healthcare delivery in New York State.  We anticipate Assemblyman Richard Gottfried’s bill on the New York Health Plan (a single payer plan initiative) will move to the floor of the Assembly for debate next week.

Our country and state are both divided on how best to remedy the complex problems associated with our present multi-payer healthcare system.  These problems are so wicked that many have looked to other countries for alternative models of healthcare delivery.  The vision of a single payer that can obviate the problems inherent in a multi-payer system is enticing.  The ease of access and the administrative attraction of dealing with one payer is appealing.  However, in studying many of these single payer systems, it is clear that physicians are unhappy and frustrated in these systems—albeit for different reasons.

A single payer system may not be the panacea some think it to be.

Several weeks ago, MSSNY’s House of Delegates expressed its views when it declined to support the concept of a single payer system.  As New Yorkers, we find ourselves in tremendous turmoil as our state leadership advances healthcare reform initiatives that will fundamentally change how we practice medicine in New York State.  MSSNY has been engaged in these efforts at the level of DSRIP, SHIP, PHIP and the SHIN-NY.  We are proud of our work in collaborating with the state to implement changes in a manner that will advance healthcare delivery improvements for decades to come.  The disruption of these efforts with the addition of another payment methodology threatens to undermine the physician workforce environment and the state’s efforts in healthcare delivery improvement.  Accordingly, the Society is opposing the New York Health Plan bill currently in the Assembly.

I will continue to support the dialogue within our profession and this state that explores improvements to our healthcare delivery system.  However, at this time, support for a single payer system threatens the viability of thousands of small practices throughout the state that are focused on preparing for ICD-10, e-prescribing, SHIP, SHIN-NY and DSRIP.  Let’s give the profession the opportunity to meet the immediate challenges facing our profession in the coming year before embarking on another megaproject such as transforming NY into a single payer state.

We will continue to work with Governor Cuomo, Assemblyman Richard Gottfried and Senator Kemp Hannon to better define the legislative and regulatory environment in which physicians operate in NY, thus improving the health of our state’s residents.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC 

MSSNY President

Please send your comments to comments@mssny.org

CapitalUpdate

ASSEMBLY WILL VOTE ON SINGLE PAYER BILL
Despite significant opposition from Republican and Democratic Assemblymembers, the Assembly Codes and Ways & Means Committees reported Assemblyman Gottfried’s single payer bill (A.5062/S.3525) to the floor of the Assembly. It can be voted on as early as Wednesday of next week.

Many physicians support this bill as a means to create health system efficiencies while reducing insurer control and influence over the practice of medicine. A significant number of physicians, however, feel that they will lose clinical autonomy under a single payer system. Moreover, based upon their experience with the Medicare and Medicaid systems, they are also concerned that a single payer system will result in a significant and unwarranted reduction in payment for the services they render.

At MSSNY’s most recent House of Delegates held earlier this month, a resolution which called upon MSSNY to support legislation to implement a single payer system was passionately debated by the physician delegates. While there was significant support among the physician delegates there was also overwhelming opposition. The Resolution was not adopted.

All physicians are encouraged to let your perspective be known to your Assembly representative by calling 1-518-455-4100, and asking to speak to your Assemblymember.  (DEARS, AUSTER)

PLEASE CONTACT YOUR LEGISLATORS IN SUPPORT OF HEALTH INSURANCE REFORM LEGISLATION
With just a few weeks left to go in the New York State legislative session, MSSNY continues to strenuously advocate for a number of critically needed health insurer reforms to better assure patients can receive coverage for the care they need from the physician of their
choice, and to reduce the extraordinary administrative burden imposed on physicians and their staff to assure patients can receive the care and medications they need.   Next week, Thursday, May 28, MSSNY President Dr. Joseph Maldonado will participate in a press conference with a number of patient advocacy groups, Assembly Health Committee Chair Richard Gottfried and Assemblymember Matthew Titone to urge the passage of legislation (A.2834-A, Titone/S.3419-A, Young) that would provide physicians with an expeditious method to override a health insurer step therapy/Fail-first protocol when prescribing needed medications for their patients.   To send a letter, click here.

In addition, physicians are urged to send letters to their legislators in support of these bills:

  • A.336 (Gottfried)/S.1157 (Hannon) – permits independently practicing physicians to collectively negotiate patient care contract terms with health insurers under close state supervision.  In the Senate Finance and Assembly Ways & Means Committees.  To send a letter in support, click here.
  • A.3734 (Rosenthal)/S.1846 (Hannon) – requires health insurers to offer Out of network coverage in New York’s Health Insurance Exchange.  In Assembly and Senate Insurance Committees.  To send a letter in support, click here(AUSTER, DEARS)

CME MANDATE BILL ON PAIN MANAGEMENT ON THE FLOOR OF BOTH HOUSES; CAN BE VOTED ON AT ANY TIME
Legislation that would require physicians to take three hours of continuing education on pain management, palliative care, and addiction is now on the floor of both houses in the New York State Legislature and can be voted on at any time.

Senate Bill 4348 passed out of the Senate Health Committee and has gone to the Senate floor.  Its companion measure, Assembly Bill 355 is also pending on the Assembly floor.   Immediate physician action is needed to stop this measure from passing.   Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, and Senate Bill 4348, sponsored by Senator Kemp Hannon would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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; and end-of-life care.  Given the success of New York’s I-Stop law and the wide variety of educational tools that prescribers are already using to educate themselves regarding the risks and benefits of various controlled medications, MSSNY remains opposed to the measure.        (CLANCY, DEARS)

SCOPE OF PRACTICE BILLS STATUS AT END OF SESSION
The following are among many scope of practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  • 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 123 (Paulin)/ S.4739 (Hannnon) – a bill that would authorize pharmacists to, in addition to those immunizations currently allowed to be administered by pharmacists, administer immunizations to prevent tetanus, diphtheria, pertussis, acute herpes zoster, and meningococcal pursuant to a patient specific or non-patient specific order, and would remove the sunset provisions currently in the law. Pharmacists are currently allowed to administer influenza, pneumococcal, acute herpes zoster and meningococcal pursuant to a patient specific order from a physician.   This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to care for up to the knee. This would include diagnosing, treating, operating or prescribing for cutaneousconditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.

This bill is in the Higher Education Committee in the Senate and Assembly.

  • 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, call themselves naturopathic doctors, claims that they cannot do invasive procedures, yet allows them to immunize and perform cryotherapy.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill is on 3rd reading in the Senate, and is in the Higher Education Committee in the Assembly. (ELLMAN)

HEARING AID ACCESS BILL GAINS MOMENTUM IN ASSEMBLY
A.127 (Buchwald)/ S.4080 (Murphy) is gaining momentum in the Assembly, with twenty-five co-sponsors and signing on to the bill, and many memos in support being sent to Legislators from physicians and groups.  The bill is in the Consumer Affairs and Protection Committee in the Assembly and in the Consumer Protection Committee in the Senate.  Physicians are urged to contact their Assembly Member and Senator to support the bill, which would allow an audiologist or hearing aid dispenser, employed in an ENTs office, to sell hearing aids at fair market prices, and calls for a report after two years to show the impact of the bill.  This can be done by clicking on the following link.

New York is currently one of only two states in which physicians are not allowed to sell hearing aids for profit.  (ELLMAN)

MSSNY URGES PHYSICIANS AND PATIENTS TO ADVOCATE IN SUPPORT OF SCHOOL BASED MENINGOCOCCAL IMMUNIZATION
The Medical Society of the State of New York is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.  Assembly Bill 791/Senate Bill 4324, sponsored by Assemblywoman Aileen

Gunther and Senator Kemp Hannon, would require that every person entering 6th grade and 11th grade shall have been immunized against meningococcal disease.   This recommendation is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.  Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill:

MSSNY has also developed a patient support letter that patients can use to urge support of this legislation:

The bills are in the respective health committees in each house of the legislature.  (CLANCY)

CADILLAC TAX REPEAL LEGISLATION INTRODUCED IN CONGRESS
Legislation (HR 2050) to repeal the so-called “Cadillac Tax” on comprehensive health insurance coverage contained in the Affordable Care Act was recently introduced by Rep. Joe Courtney (D-CT).  Eight members of New York’s Congressional delegation representing many regions of New York State have joined as co-sponsors, including Representatives
Chris Gibson, Brian Higgins, Hakeem Jeffries, Nita Lowey, Sean Patrick Maloney, Jerrold Nadler, Jose Serrano, and Paul Tonko.  The “Cadillac tax” refers to an excise tax on high-premium health insurance plans that will be implemented in 2018.  It will be a 40% tax on health premiums above a threshold of $10,200 a year for individuals and $27,500 for families.

At its 2013 House of Delegates, MSSNY adopted a policy calling for to repeal of this tax, which will particularly hurt high cost states like New York and dis-incentivize employers from offering their employees comprehensive health insurance benefits.  The negative impact of this tax on patient care access in New York State was recently the subject of a forum where Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Kemp Hannon each expressed their concerns with this tax. For more information about this forum, please see the linked article from Capital New York (AUSTER)                                                                                                    

BILL TO DELAY ICD-10 IMPLEMENTATION INTRODUCED
The AMA recently sent a letter to Rep. Ted Poe (R-TX) in support of his legislation, HR 2126, introduced in the US Congress to postpone the ICD-10 code sets required to be used by physicians in claim submissions as of October 1, 2015.  MSSNY has urged support for a
further delay of the ICD-10 mandate, though prospects for the bill’s passage remain unclear given the commitment of the leaders of the House Energy & Commerce Committee to permitting ICD-10 to be implemented as planned given the support of many healthcare stakeholders including health plans and hospitals.  The letter notes that “the differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to ICD-10. ICD-10 includes 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-9. Implementation will not only affect physician claims submission; it will impact most business processes within a physician’s practice, including verifying patient eligibility, obtaining pre-authorization for services, documentation of the patient’s visit, research activities, public health reporting, and quality reporting. This will require education, software, coder training, and testing with payers.”

Physicians can send a letter in support of this legislation here. (AUSTER)                                                                                                                         

MSSNY OFFERS FREE PATIENT BROCHURE ON DIABETES FOR USE WITHIN PHYSICIANS OFFICE
The Medical Society of the State of New York Committee’s on Preventive Medicine and Family Health and the Committee to Eliminate Health Care Disparities, has developed a patient brochure that physicians can offer within their office.  The patient brochure discusses risks associated with pre-diabetes and diabetes and is available in English and Spanish.  If you would like copies of this brochure, please contact the Medical Society of the State of New York at (518) 465-8085 or email Terri Holmes at tholmes@mssny.org and request copies of the Diabetes brochure.  The development of the brochure was made possible from a grant from AstraZeneca.  (CLANCY, ELLMAN)

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER
The Medical Society’s final webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikunguya”. Physicians are encouraged to register by clicking on https://mssny.webex.com . Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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

It is anticipated that Medical Matters programming for fall/spring 2015-2016 will be announced shortly.  (CLANCY)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:          

pschuh@mssny.org ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

Enews May 2015 550x150

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception. The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. 

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

CDC Report Shows Most Distinct Causes Of Death In Each State
The CDC published a report this week in the journal Preventing Chronic Disease: Public Health Research, Practice and Policy that showed the most distinct causes of death in each state from 2001 to 2010. The report labels each state with a cause of death higher on
average than the rest of the country. Pelvic inflammatory disease (PID) is the number 1 unusual cause of death in New York State. The lead author, Francis Boscoe, a research scientist at the New York State Health Department, told ABC News that “they looked for outliers in each state to determine the most distinctive cause of death.”

YouTube Video: What Medicare Professionals Need to Know in 2015
A video recording of the “PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015” presentation has been posted to the CMS MLN Connects® page on YouTube.  This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015.  A link to the video can be found here.

Last Call for GME Task Force Members|
The GME task force will be charged with making recommendations to MSSNY as to how best address the growing shortage of residency training positions. It will make recommendations to the Council regarding how to advance solutions that address the problem while minimizing the onerous consequences of one-sided solutions.

MSSNY welcomes inquiries from those interested in serving on the taskforce; please contact Eunice Skelly at eskelly@mssny.org 516-488-6100 ext.389.

Take a CME Cruise to Everywhere!
New York physicians are again being offered the chance to sail the Mediterranean while updating their practice skills through a series of onboard CME programs offered through Continuing Education, Inc. Based in Tampa, Florida the organization had just announced
15 cruises with CME programs focused on such topics as cardiology, family medicine, pulmonology, palliative medicine, pediatrics, gastroenterology and a host of other clinical topics. In addition, the company has a variety of other CME cruises available to Alaska, Northern Europe, Hawaii and the Caribbean. Working in concert with major cruise lines, each onboard program is scheduled while the individual ship is at sea to enable physicians and families to enjoy the ports on the ship’s itinerary. For further information, click here.

 

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