MSSNY Testifies at Assembly Hearing Examining CVS-Aetna Merger
Immediate MSSNY Past President Dr. Charles Rothberg expressed the medical community’s opposition to the proposal of CVS Health to acquire Aetna during an Assembly Insurance-Health Committee hearing in Albany this week examining this proposed acquisition. Specifically, Dr. Rothberg noted MSSNY’s strong concerns regarding: the risk of reduced community pharmacy options for patients; the risk of even more burdensome prior authorization requirements for patient needed prescription medications; the potential impact on reduced health insurance competition, given that some smaller health plans may need to purchase drug management services from a PBM whose parent is a competitor; and the risk to medical home availability as a result of an increased push for the development of retail clinics. Also testifying at the hearing were representatives of pharmacists and consumer advocacy groups concerned with the merger, as well as representatives of CVS and Aetna.
Following the conclusion of the hearing, in a statement Assembly Insurance Committee Chair Kevin Cahill summarized, “Our hearing today helped shine light on the impact the proposed merger will have on health care delivery in New York State. New York has a long tradition of professional and non-profit healthcare and it is critical that regulators, both at the Federal and State level, ensure that any major changes, such as this one, have unimpeded objectives of improving access and quality of care…” He also noted that “our State must be proactive in responding to such drastic potential changes in our health care delivery systems. The past has taught us that reactive approaches to challenges in health care could have devastating effects on consumers and our health care system. This acquisition poses serious questions for the long-term stability of the State’s insurance markets and access to health care products”
Assembly Health Committee Chair Richard Gottfried added: “An acquisition like this would reshape health care delivery. Pharmacy benefit managers, like CVS’s CareMark, and health plans have leverage over pharmacies in ways that could favor CVS’s own stores at the expense of independents and other chains. It should be of great concern to have what economists call ‘vertical integration’ – in this case a major health care provider and a major health insurer sharing the same bottom line – with dramatic effect on consumers and others in the market. It’s critical that State and Federal regulators assess and understand the potential impact on patients, insurance networks, and drug purchasing and dispensing processes. Today’s hearing, including feedback from CVS, Aetna, other health care providers, and consumer advocates, was an important step in that process.”
To view the entire 4 hour hearing, Click Here: Dr. Rothberg’s comments begin at about the 2:20 mark.
Please Click Here to view a Capital Tonight interview with Assemblyman Cahill as he discusses his concerns with the merger proposal including the physician, pharmacy, and consumer concerns. (AUSTER)
5% Overall Increase to Workers Compensation Medical Fee Schedule Proposed
As a follow up to its announcement in April, the New York State Workers Compensation Board released a proposal this week to provide an “overall” 5% increase in the Workers Compensation medical fee schedule effective October 1, 2018. The statement accompanying the release of the proposed rule noted that “areas with shortages of medical providers authorized to treat injured workers may see further increases.”
To review how such increase is proposed to be implemented, Click Here: As comments are due to the WCB by August 5, MSSNY is reviewing the entire proposal, and has sought feedback from the members of its Workers Compensation and No-Fault committee. MSSNY has also sought input from societies representing affected medical specialties such as Orthopedics, Anesthesiology and Osteopathy.
The proposed regulation also notes that the cost of ordering a hard copy of the fee schedule will be $100, and an electronic copy will cost $400.
By separate regulation, the WCB also proposed to increase the WC testimony fee for physicians from $400 to $450.
These proposals are part of a multi-pronged effort by the WCB to increase care availability for injured workers. As reported last week, the WCB has also advanced legislation (S.8812 and A.8387-B) in the Assembly and Senate that would expand the list of eligible providers allowed to treat injured workers. The bill expands eligibility to include acupuncturists, chiropractors, nurse practitioners, physical therapists, physician’s assistants, podiatrists, psychologists and social workers.
MSSNY has expressed concern that the proposal would enable a nurse practitioner to assess an injured worker’s level of disability and determine causation of a patient’s injury without the involvement of a physician. MSSNY has also expressed concern over another component of the legislation that would modify the process of how county medical societies recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation. While the provision has been improved over earlier versions, MSSNY remains very concerned that the phrasing of the proposal could enable the WCB to bypass the county medical society in approving physicians to be authorized to treat or provide IMEs under Workers’ Compensation. (AUSTER, BELMONT)
MSSNY Opposes Requiring New Physician Mandates
MSSNY continues to advocate against various pieces of legislation that would impose more burdensome mandates on physicians. MSSNY remains opposed to a bill, S.2113-A (Felder) / A.352-A (Perry) that would require physicians and hospitals in New York City to inquire and document the name of the school attended by school-aged patients and to include this information in their admission registration forms. New York Public Health Law Section 2101 already requires physicians to report immediately to the local health officer regarding the presence of any communicable disease. The health officer is then charged with the responsibility to investigate cases of communicable disease, to ascertain sources of infection, to seek out contacts, and to take other steps to reduce the spread of the disease.
Increasing mandates take more and more time away from the ability to deliver the timely care patients expect to receive. This trend is well documented. A recent 2016 study reported in the Annals of Internal Medicine concluded, remarkably, that for every one hour of patient care delivered by a physician, two more must be spent on paperwork. (BELMONT)
Bill to Prohibit Flavored E-liquid in E-Cigarettes Moves in the NY Assembly; On Senate Calendar for Vote
Assembly Bill 8688/S. 8610, sponsored by Assembly member Linda Rosenthal and Senator Kemp Hannon, is moving in both houses of the legislature. This measure, if enacted, would prohibit the sale and distribution of flavored e-liquid for use in e-cigarettes. The measure moved to the Assembly Codes Committee by a vote of 14-12 and is on the Senate calendar for a vote. Throughout the country and New York State, the use of electronic cigarette is on the rise especially among adolescents and young adults.
E-cigarette use poses a significant health risk to young people in by increasing the possibility of addiction and long-term harm to brain development and respiratory health. E-cigarettes liquid is nicotine and most now have flavoring in them. E-cigarettes are considered tobacco products. According to a 2016 report by the U.S. Surgeon General, young adult users of e-cigarettes (ages 18 through 24) are much more likely to use flavored e-cigarettes than are users over the age of 25.
The Surgeon General also reported that the majority of youth who have tried e-cigarettes first used a flavored product. Youth are attracted to e-cigarettes due to the flavoring and a perceived lower risk than using traditional tobacco products. Electronic cigarette companies use colorful packaging and enticing flavors to lure young people when they are at the most common age to begin smoking. The Medical Society of the State of New York supports this measure. (CLANCY)
Bill to Include Lyme Long Term Therapy Prohibition in OPMC on Assembly Floor
Assembly Bill 10930, sponsored by Assemblywomen Didi Barrett, has moved to the Assembly floor for a vote. This legislation amends public health law to include diagnosis and long term antibiotic treatment of Lyme disease in existing standards that the Office of Professional Misconduct (OPMC) follows in relation to what a physician cannot be charged with misconduct for doing.
Under this measure, no health care professional shall be subject to professional discipline for prescribing long-term antibiotic therapy for a patient diagnosed with or treated for Lyme disease or other tick borne illness. In 2015, the New York State Legislature amended the statute by putting into place existing principles that were being followed by OPMC regarding the investigation of physicians, physician assistants and specialist assistants who use treatment modalities that are not universally accepted by the medical profession, such as the varying modalities used in the treatment of Lyme disease and other tick-borne diseases.
These principles had existed since 2005. When this law was enacted in 2015, according to officials from OPMC, there have only been one physician who has ever lost his or her license for misconduct related to the use of antibiotics, and that occurred in the mid- 1990s. To MSSNY’s knowledge, there has not been any other professional who has been reviewed on antibiotic use. The Medical Society of the State of New York has, for over last 20 years, worked with the Department of Health and the New York State Legislature to enhance due process protections for physicians under the OPMC statute. MSSNY believes that those protections already preserve the freedom of physicians to exercise their clinical judgment in the treatment of their patients. MSSNY is opposed to this measure. There is no companion measure, at this time, in the New York State Senate. (CLANCY)
MSSNY Joins Patient Groups to Advocate to Prevent Mid-Year Formulary Changes
With just 7 scheduled Session days left, all physicians are urged to contact their legislators to urge their support for legislation (A.2317-C, People-Stokes/S.5022-C, Serino) that would (in most cases) prohibit a health insurer from making a change to their prescription drug formulary or moving a prescription drug to a higher tier during a policy year. The legislation has passed the Assembly unanimously, and is before the Senate Insurance Committee. To send a letter in support, Click Here.
Earlier in the year MSSNY participated in a press conference in support of the legislation, together with the sponsors of the bill, as well as many of its supporters, including the Global Healthy Living Foundation, Lupus and Allied Diseases Association, NAACP, AARP, New Yorkers for Accessible Health Coverage, the Epilepsy Foundation, the Arthritis Foundation, the American Cancer Society, the National Association on Mental Illness-NY, the NY Chapter of the American College of Physicians, the NYS Osteopathic Medical Society, and the American College of Rheumatology.
MSSNY President Dr. Thomas Madejski stated the following for the press release: “Continuation of a medication regimen prescribed by a patient’s treating physician is critical to assuring a patient’s recovery from illness, maintaining their health, or preventing worsening of their condition. Unexpected changes to a medication formulary could result in significantly higher out-of-pocket costs for patients. This could seriously interfere with their continued ability to obtain these needed medications. Insurance company formulary changes are not made with the intimate knowledge of the patient’s personal physician. Additionally, this legislation would help to protect consumers from unforeseen higher cost-sharing requirements. (AUSTER)
Bill To Allow Superintendent of DFS to Evaluate Insurers & Health Plans Compliance with Mental Health & Substance Use Disorder Parity Laws; Physicians Urged to Contact Legislators
With only seven scheduled legislative session days left, physicians are urged to contact their legislators to urge passage S.1156-C/A.3694-C, which directs the Superintendent of the Department of Financial Services to collect certain key data points and elements from insurers and health plans in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws. The information collected would be analyzed and used for the preparation of a parity compliance report in the annual “Consumer Guide to Health Insurers” issued by Department of Financial Services.
Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, there still exists within the health insurance and health plan industry patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services, which is further evidence by the settlements/agreements the office of attorney general in New York State reached over the last several years with several major insurers, health plans and managers of behavioral health benefits regarding acts of non-compliance. This further demonstrates the need for an industry wide approach and annual evaluation of compliance. MSSNY along with NYSPA firmly believe this legislation is the next step for New York to take to assure compliance and full implementation of the federal and state MH/SUD parity laws, thereby for enhancing access to care for MH/SUD care and treatment. Physicians are urged to send a letter to please Click Here. (CLANCY)
MSSNY Committee for Physicians Health Bill Passes Senate
The New York State Senate this week passed legislation (S.8093-A, Hannon) supported by MSSNY that would extend for an additional 5 years the continued operations of the MSSNY Committee for Physicians Health (CPH) program. Authorization for several key components of the program expired on March 31, 2018. The identical Assembly bill (A.10221-A, Gottfried) advanced from the Assembly Ways & Means Committee to the Assembly Rules Committee this week, and could very well be voted on next week.
The CPH is a program designed to confront and assist physicians thought to be suffering from alcoholism, substance abuse or mental illness. Since the inception of this program, CPH has assisted thousands of physicians in returning healthy to medical practice. The work of the CPH program is an important public service both to our health care system as well as the general public. As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees.
The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013. The recently enacted State Budget included a provision to create another “demonstration program” until 2023. However, it omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken.
These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed in the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform. These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances. (DIVISION OF GOVERNMENTAL AFFAIRS)
MSSNY Supports Physician Protection Act
MSSNY participated in a press conference with Senator Funke, Assemblywoman Joyner, the New York State Academy of Family Physicians and the Albany County Medical Society to support legislation that would include assaults on physicians as an ‘assault in the second degree’, a class D felony charge in the state of New York. Currently it is a class A misdemeanor.
Physicians and other health care employees are exposed on a daily basis to the potential of assault or other violent situations in the course of their duties. Assaults on the job are one of the most frequent causes of serious injuries in health care. While current statute affords protections and increased penalties for assaults on nurses, EMTs, emergency department medical personnel, firefighters, police officers, school crossing guards, sanitation workers and other employees providing direct patient care, physicians are currently not afforded the same safeguards. Please call your legislators and tell them to support S.8055 (Funke) and A.10225 (Joyner). (BELMONT)
Measure to Require Co-prescribing on Naloxone By All Prescribers for All Opioid Prescriptions Held in Committee
Assembly Bill 10099/Senate Bill 7801, sponsored by Assembly member Daniel O’Donnell and Senator George Amedore, was held in the Assembly Health Committee. The measure is currently in the Senate Health Committee. This measure would authorize the New York State commissioner of health to develop guidelines to require that every time an opioid prescription is provided to a patient that co-prescribing of an opioid antagonist is required. Additionally, the bill would require that physicians and other health care providers identify patients at risk of an opioid-related drug overdose and prescribe an opioid antagonist to that person or to a person in a position to administer the opioid antagonist to the patient.
The Medical Society of the State of New York is opposed to this measure. The Medical Society, a member of the AMA’s Opioid Task Force, agrees with the task force that physicians be encouraged to consider co-prescribing naloxone when it is clinically appropriate to do so. New York State has enacted a non-patient specific script which allows for ease to do this. The Medical Society of the State also believes that this measure will create greater stigma toward patients with pain. (CLANCY)
Assembly Higher Education Committee Rejects Scope Expansion Bills
Over the last few weeks of Session, advocates for various non-physician health professions have been actively pushing their legislation to expand their scope of practice. While many of these bills remain pending in the remaining days of Session, the Assembly Higher Education Committee, chaired by Assemblywoman Deborah Glick, voted to “hold” in Committee the following bills that had been opposed by MSSNY:
- A.1880 (Pretlow) – Would have expanded the ability of podiatrists to provide wound care and reduced supervision requirements
- A.5913 (Ortiz) – Would have given statutory recognition to the practice of naturopathic medicine.
- A.5807 (O’Donnell) – would have permitted chiropractors to form professional partnerships with physicians. (DIVISION OF GOVERNMENTAL AFFAIRS)
DMV Reporting Legislation Update
With only two weeks left of the 2018 legislative session remaining, legislation, S. 3569 (Young) / A.10094 (Carroll) is still pending that would require a licensed physician, physician assistant or nurse practitioner to report patients that have a chronic condition which cause or may cause unconsciousness or unawareness to the Department of Motor Vehicles. MSSNY staff and activists have educated members of the legislature about the ambiguity of the bill language and the fact that it encompasses a number of medical conditions where there may only be a remote chance the unconsciousness and unawareness may occur. Such conditions may include a convulsive disorder, epilepsy, fainting, dizzy spells, coronary ailments or other health conditions that may impair the ability to operate a motor vehicle. The bill is also opposed by the Epilepsy Foundation & American Diabetes Association.
A new bill, A.11121 Rules (Carroll) was introduced this week. This bill would authorize the Department of Motor Vehicles (DMV) to require driver’s license holders to submit to a DMV reexamination of their fitness to drive if the licensee experienced a loss of consciousness and was involved in a reportable accident while driving and DMV receives evidence that the loss of consciousness caused or contributed to the accident. The bill would also direct the DMV, in consultation with the Department of Health and the Division of State Police to review its notification process by physicians and the methodologies by which the DMV receives information.
The bill would review the identification procedures of medical review programs and whether certain drivers should operate motor vehicles due to chronic, ongoing conditions that may cause loss of consciousness, loss of awareness or loss of body control. MSSNY will continue to work with both houses and the various state agencies to continue to advocate that the physician’s duty to report medical conditions that would impair safe driving should be voluntary and under the physician’s discretion. (BELMONT)
Health Insurer Premium Increase Requests Announced by DFS
The New York Department of Financial Services announced the proposed health insurance premium rates for the individual and small group markets for the 2019 policy year. To read the DFS press release, Click Here:. The chart in the press release highlights the additional premium increases insurers are seeking as a result of legislation recently enacted by Congress that repeals the previous ACA requirement for individuals to have health insurance coverage. For the individual market, the average rate increase was 24%, with a range of a 3.2% requested decrease from Health Now to a 38.6% requested increase from Fidelis. For the small group market, the average requested increase was 7.5%, with a range of a 0.1% requested decrease from Health Now to a 21% requested increase from Health First. Under New York, DFS must approve health insurers premium rates. (AUSTER)
NYS Program Helps to Subsidize Cost of Connecting to Regional Health Information Exchange
Did you know that New York State has a program to provide physicians with financial assistance to connect to your local Regional Health Information Exchange (RHIO)? The Data Exchange Incentive Program (DEIP) was established by the NYS Department of Health to provide physicians and other health care providers with up to $13,000 to help offset the costs of connecting to your local RHIO. It was established in response to the concerns expressed by many physicians – including most recently through a resolution adopted a the 2018 MSSNY House of Delegates – to reduce the sometimes exorbitant costs imposed by EHR vendors in connecting to their local RHIOs. For more information about eligibility requirements, Click Here: or send an e-mail to firstname.lastname@example.org. Last week, the MSSNY HIT Committee received a presentation from top staff to the New York eHealth Collaborative (NYeC) about this important program to reduce the financial burden to physicians in implementing EHR systems. (AUSTER)
Physicians Urged to Contact Senator On Legislation to Allow Enhanced Religious Exemptions for School Based Immunizations
Physicians are urged to contact their state senator regarding Senate Bill 6141D, sponsored by Senator Martin Golden, which would allow the admission of certain unvaccinated students to public schools. The bill is in the Senate Finance Committee. S. 6141-D amends the Education Law to provide the procedure for religious exemptions from vaccination requirements. Under the bill, a parent or guardian would complete a religious beliefs vaccination exemption form to ensure a public school district does not deny admission to their unvaccinated child.
A religious exemption is currently allowable under NY State law, but the exemption allows the school institution to make a decision on whether the student should be exempt from vaccination. This bill, if passed by the Legislature, would force schools to accept the form and allow unvaccinated students to enter the school. Its companion measure, A. 8123B, sponsored by Assemblymember Richard Gottfried, chair of the Assembly Health Committee, is also pending before the Assembly’s Education Committee. Physicians are urged to write to the members of the NYS Legislature and urge that this bill not be enacted. To write a letter go to the MSSNY Grassroots Action Center and click on the letter here. (CLANCY)
Medical Society of the State of New York Announces June Medical Matters CME Webinar Schedule
The Medical Society of the State of New York encourages you to register for its free Medical Matters Continuing Medical Education (CME) webinar on June 20th at 12:30pm. Participation in this webinar will earn physicians one CME credit free of charge.
June 20th at 12:30pm – Medical Matters: Children’s Mental Health After Disaster
Register for this webinar here.
Faculty: Linda Chokroverty, MD
- Enhance physician’s understanding of the impact of disaster on children’s and family mental health
- Improve physician skills to address potential psychiatric problems in children and families following a disaster
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com. (HOFFMAN)
MSSNY Announces Members of Task Force for End of Life Care
In May, the Medical Society of the State of New York Council created a Task Force on End of Life Care. The task force has been charged with developing a “white paper” on the physicians’ role in end of life and palliative care; and that the paper also discuss the impact of these issues on the disparate populations and the disabled community. Ideally, the task force will generate ideas that would be brought to the MSSNY House of Delegates, and if appropriate, the AMA House of Delegates to create policies that improve access, implementation, and general approach to care as our patients approach the end of their lives.
Dr. Thomas Madejski, MSSNY President, named Jeffrey T. Berger, MD and Dr. John Maese as co-chairs of the task force. Dr. Berger is chair of MSSNY Bioethics Committee and serves as Chief of the Division of Palliative Medicine and Director of Clinical Ethics at NYU Winthrop Hospital. He is board certified in both Internal Medicine and Hospice and Palliative Medicine; Dr. Maese, a member of the MSSNY Committee on Continuing Education, is board certified in Geriatric Medicine and Internal Medicine.
Additionally, Dr. Madejski appointed the following MSSNY members to serve on the task force: Bruce H. Berlin, MD; Patricia A. Bomba, MD; Clare B. Bradley, MD; Erick A. Eiting, MD, MPH; Steven M. Kaner, MD; Shail Maingi, MD; John “Jack” McIntyre, MD; Parah H. Mehta, MD; Nancy H. Nielsen, MD, PH. D. John A. Ostuni, MD; Malcolm D. Reid, MD, MPP; Myrna Sanchez, MD; M. Monica Sweeney, MD, MPH; Rishi Kamlesh Thaker, Medical Student; Joshua Cohen, MD, Commissioner of MSSNY’s Science and Public Health Division; and Janine L. Fogarty, MD, Assistant Commissioner for Science and Public Health.
New York Insurers in Seeking Double-Digit Premium Hikes for ACA Plans
The Hill (6/4) reports that insurers which sell ACA plans in New York are seeking double-digit premium hikes for 2019, “citing recent and upcoming changes to the law.” About 14 insurers in New York want an average increase of 24 percent, and 11 in Washington State are requesting an average hike of 19.08 percent. Insurer Fidelis wants “state regulators to approve a 38.6 percent rate hike, attributing 25.9 percent of that increase to the repeal of the mandate.” For its part, Emblem, which is seeking “a 31.5 percent increase,” attributed 12 percent of that figure to the repeal of the ACA’s individual mandate.
New York’s Department of Financial Services, “Insurers have attributed approximately half of their requested rate increases to the risks they see resulting from its repeal. … Without the federal action, the average requested rate increase would be 12.1 percent.”
AG Settles with Ageless Men’s Health for Misleading PTs with Low Testosterone
Chain of “Low T” Clinics Will Reform its Practices and Provide Key Info to Patients
New York’s AG, Barbara D. Underwood, announced an agreement with Ageless Men’s Health, P.C. (“Ageless”), requiring Ageless to make complete and accurate disclosures to its patients and prospective patients concerning the diagnosis of low testosterone and the risks associated with testosterone replacement therapy (“TRT”). TRT is an increasingly common treatment for men with low levels of testosterone, sometimes called hypogonadism or “Low T.”
Ageless and its affiliates provide TRT to men at 36 clinics across the United States, including three in New York City. Ageless failed to inform patients that in diagnosing low testosterone and addressing potential side effects of treatment, it was not following evidence-based practices recommended by leading medical organizations. Additionally, Ageless prominently featured a deceptive “Low T quiz” on its website that misled patients regarding the diagnosis of low testosterone.
Medical guidelines, such as the guidelines of the Endocrine Society and the American Urological Association, recommend that two morning blood tests, on different days, should be performed to confirm a diagnosis of low testosterone before starting TRT. Ageless’ practice has been to perform only a single diagnostic blood test, at any time during business hours — more often than not in the afternoon — without informing patients that diagnosing low testosterone in this manner is contrary to these guidelines.
Instead, without informing patients, Ageless relied on different guidelines that do not contain a recommendation one way or the other concerning the time of day of testing or the number of tests that should be performed. In so doing, Ageless led patients to believe that they require treatment when they may not.
Ageless offered TRT to men whose diagnostic testosterone levels are above the thresholds for treatment set out in medical guidelines, including those collected in its own Clinical Operations Manual, without informing patients of that fact. This also led patients to believe that they require treatment when they may not.
Under the agreement, Ageless has committed to (1) remove the misleading “Low T Quiz” from its website; (2) inform patients that according to medical guidelines, blood tests for purposes of diagnosing low testosterone should be performed in the morning, and two morning tests should be performed before starting TRT; (3) inform patients about the thresholds for treatment set out in the relevant medical guidelines; and (4) inform patients in writing about the fertility-related side effects of TRT.
Addressing MSSNY Concerns Regarding eMOLST Registry
By Patricia Bomba, MD, FACP ,Vice President and Medical Director, Geriatrics Chair, MOLST Statewide Implementation Team & eMOLST Program Director and a MSSNY member
- Doctors fear OPMC problems if they do not comply with the law.
Do you have evidence of OPMC problems with failure to follow Family Health Care Decisions Act (FHCDA) or the Palliative Care Information Act (PCIA)? Similarly, are their concerns with OPMC enforcement issues related to physicians reporting immunizations to the New York State Immunization Information System (NYSIIS)? The reporting requirement contained in this legislation was modeled on the 2008 requirement that all practitioners enter immunizations administered to children into the NYSIIS within 14 days of administration of the immunization. To date, we are unaware of any enforcement by OPMC related to reporting to this registry.This provision is also designed to encourage the use of eMOLST, rather than the paper version, which would eliminate any concerns related to reporting within 14 days as completion on eMOLST would automatically be submitted to the Registry, requiring no additional action by the physician.
- Doctors are concerned that the data may not be housed at the NYS DOH.
Concern about data not being housed by NYS DOH: Under the structure of the legislation, it is envisioned that the Department of Health would contract with an entity, presumably the MOLST Program, to operate the Registry. While not “housed” at the NYSDOH, the Registry operator would be under contract with the DOH for the operation of the Registry and would be subject to significant oversight by DOH. In addition, the current eMOLST system operated by the MOLST Program is not housed by the NYS DOH, but is housed in a separate secure server, electronically stores all MOLST forms completed through the eMOLST system. The data is encrypted and separate from the application.The Registry would be operated in the same manner as the current eMOLST application. Importantly, this means that access and information transmitted through the application complies with HIPAA, Department of Health privacy rules and New York State Public Health Law. In keeping with New York State’s vision for open-system solutions, the eMOLST application was developed following open architectural principles for the benefit of the community and other Regional Health Information Organizations (RHIOs) across the state, as well as serve as a data source for the Statewide Health Information Network for New York (SHIN-NY).
Lastly, the information contained on the MOLST is not intended to remain with the DOH, rather, it is meant to be accessed by all health care providers.
- Doctors are concerned about multiple different documents which may have conflicting data.
This legislation would assist in eliminating this concern by creating 2 Registries – an advance directive registry and MOLST Registry. The advance directive registry would assist in ensuring accurate documents, such as health care proxies. Patients who are appropriate for MOLST should have an up-to-date health care proxy in case MOLST orders need to be revised after the patient loses capacity. Similarly, the MOLST registry would only allow for the most recent valid MOLST to be accessible to health care providers, eliminating the concern that the form may be out of date or had been revoked.MOLST is a set of medical orders signed by the physician or nurse practitioner (as of May 28, 2018) that defines life-sustaining treatment the patient wants to receive or avoid now. Living wills are difficult for physicians to interpret and operationalize as irreversible and potentially reversible conditions coexist. A MOLST done reflecting a patient’s current health status, prognosis and goals for care is more valuable to the physician making decisions than a living will done 20 years ago, especially when the same physician is not seeing the patient in every care setting.
New Calculator for Prescribing Meds to Avoid Heart Attack, Stroke
STAT (6/4) reports that a team from Stanford University has developed a new calculator to be used to decide “whether patients might benefit from aspirin, statins, or blood pressure medications” which updates data sources, adds findings from the more recent Jackson Heart Study and Multi-Ethnic Study of Atherosclerosis, and applies newer statistical methods. The current calculator was derived in 2013 and was “endorsed by the American College of Cardiology and the American Heart Association.” The researchers claim their findings “improve the accuracy of risk estimates among multiple populations.” The results were published Monday in the Annals of Internal Medicine
Opioids Responsible for About 20 Percent of Deaths among Young Adults
A new study published in JAMA Network Open shows that in 2016, one in 65 deaths in the US involved opioids and that among younger adults, “that number skyrocketed to one in five.” The paper used data from the CDC’s WONDER database, which tracks mortality data and causes of death in the US. According to the study, in 2016, “opioids were involved in 28,496 deaths,” and “more than 8,400 of these occurred among adults between the ages of 25 and 34, a number high enough to mean that 20% of all deaths in this age group in 2016 involved opioids.”
Researchers Examine Motivating and Deterring Factors for Stool Donors
The New York Times (6/5) reports researchers examined motivating and deterring factors for stool donors and presented their findings at Digestive Disease Week. The investigators found that stool donors were motivated by altruism and financial compensation, but deterred “by the unpleasantness that would be involved in collecting stool samples,” as well as the time required. The Times points out that there is growing demand for stool donors as fecal transplants become a more common treatment for C. difficile infections.
Important Notice Regarding Handwriting on Face of Claims Submitted to Medicare
Beginning Monday, 7/10/2018, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that is not a signature field, (i.e., Items 12, 13, or 31). A notice will be attached to the front of the returned claim and you will need to submit a new claim. No more delays.
Register for Upcoming CMS Webinars
CMS has a number of upcoming webinars scheduled to help you understand MIPS and quality measures.
Title: MIPS Promoting Interoperability Performance Category Webinar
When: Tuesday, June 12, 2018, 1:00 – 2:00 p.m. ET
CMS is hosting a webinar on Tuesday, June 12 at 1:00 PM ET to provide information about the Promoting Interoperability (PI) performance category (formerly the Advancing Care Information performance category) of the Merit-based Incentive Payment System (MIPS).
- During the webinar, CMS subject matter experts will:
- Provide a brief overview of MIPS requirements in 2018
- Discuss the renaming of the PI performance category
- Explain the PI performance category requirements for 2018
- Review PI scoring
Address questions from participants at the end of the webinar, as time allows.
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion.
Title: CMS Quality Measures: Development, Implementation, and You Webinar (Part 2)
When: Wednesday, June 13, 2018; 12:00-1:00pm ET and Thursday, June 14, 2018; 4:00-5:00pm ET
Registration Links: June 13; 12:00-1:00pm, ET https://battellemacra.webex.com/battellemacra/onstage/g.php?MTID=ea6790ccacf388df754e44783d623fc7f
June 14th; 4:00-5:00pm, ET
On June 13, from 12:00-1:00pm, ET, CMS will host the second webinar, of a two-part series, that covers an introduction to quality measures, overview of the measure development process, and how providers, patients, and families can be involved. If you are unable to attend during this time, the same session will be offered again on June 14, from 4:00-5:00 pm, ET. CMS is looking for your feedback and participation in the quality measure community, so please join us during the webinar to hear updates and how you can be a part of the process!
Please note that the two opportunities listed are for the same session; we ask that you only register for one of the sessions.