MSSNY eNews: July 17, 2020 – Legislators Are Back! MSSNY Issues at Stake!

.

Dear Colleagues:

Legislators Are Back! MSSNY Issues at Stake!
The pandemic caused all of us to have our years unfold in ways far different than we thought it was going to be.

The New York State Legislature is no exception.

With several state legislators contracting the virus in mid-March and most of the state smartly following instructions to stay “socially distant” the State Legislature essentially suspended proceedings in early April after enactment of the State Budget (with limited returns for focused agendas in late May and mid-June).

Now with our low infection rates having made New York a model for the country, the Legislature is returning to Session next week, mostly virtually, to take up a “robust agenda” (as one legislator described it) of items that had been put on hold due to the pandemic response.  While many of the items under consideration are local issues important for the constituents of a particular Assembly or Senate district, there are also numerous health care items that could be brought up for discussion and have a significant impact on physicians and their patients.

One of these items is legislation (A.10427/S.8497) strongly opposed by MSSNY that would repeal the liability protections for physicians and other health care providers enacted in the State Budget for patient care provided as part of the Covid-19 response effort. These protections were not only for direct care provided to Covid-19 patients but also for the extremely difficult triaging decisions made when hospitals particularly downstate were being overwhelmed with patients.  These protections are also absolutely essential for physicians who were required by state government to postpone so-called elective procedures to prioritize health care resources for Covid-19 patients.

MSSNY worked together with the specialty societies to send a letter to the Legislature expressing its strong objections to this proposal.  I also had a letter to the editor of the Albany Times-Union published this week objecting to this short-sighted legislation.

While the bill’s proponents have focused on nursing home issues as the basis for repealing these liability protections, the impact of the legislation goes far beyond nursing homes.  In both our letter to the Legislature and to the Albany T-U, we noted our strong concerns that this legislation will not only prevent hospitals and other health care facilities from re-developing capacity in case of a second “surge” but also would unfairly retroactively remove the liability protection that healthcare professionals and facilities believed they had in responding to the crisis of patient load exceeding capacity.

As you know, we found ourselves making extraordinary medical decisions in confronting a new deadly disease with an unprecedented volume of patients. At the same time were asked to provide health care services that were not within our usual scope of services, and often without adequate protective equipment, threatening our health and our families’ health.

Certainly, it is important to assess our pandemic response for the purposes of improving how we can respond if there is a “second surge” in New York, or for future pandemics.  But undoing protections to our healthcare heroes who bravely treated patients on the frontlines would be extremely unfair and counterproductive for future response efforts.

Please remain alert for further updates.  We are continuing to work closely with our allies across healthcare sectors to advocate for the protection of this important law.

Bonnie Litvack, MD
MSSNY President

MSSNY Continues to Oppose Numerous Legislative Mandate Bills
With the Legislature set to return to Session next week, MSSNY continues to oppose countless well-intended but problematic bills under active consideration that would add significant new mandates on medical care delivery.

Taken together, these proposals would add significant new record keeping responsibilities that would also impose civil sanctions and/or disciplinary action for failing even in one instance to properly follow the mandate.  These proposals include:

• Mandated posting of how parents can obtain updates from the Consumer Product Safety Commission (A.2631/S.3583)
• Mandated conspicuous posting in a physician’s office of a patient’s ability to file a complaint with the Office of Professional Conduct (A.7991-A/S.6678-A)
• Mandated notification to epileptic patients of the risk of sudden death due to epilepsy (S.5397-A/A.7807-A)
• Mandated co-prescribing of naloxone (S.5150-B/A.5603-B)

Urge Your Legislator to Oppose Massive Liability Expansion Bill
With the State Legislature to return to Session next week to take up many items that had been set aside due to the pandemic, all physicians are urged to contact their legislators to have them oppose legislation (A.5612/S.4006) that has advanced that would greatly expand the possible damages awardable in a wrongful death action, and have the effect of greatly expanding our already outrageously high liability insurance premiums.  

You can send a letter here.

One recent actuarial estimate indicated that passage of this legislation could require a liability premium increase of nearly 50%.  

These kinds of increases are untenable particularly at a time when physician practices have been struggling to stay afloat due to the enormous drop in patient visits arising from the pandemic.

Please urge your legislators to oppose this legislation today!

MSSNY Working with NYSOS Urges Legislature to Keep Patient Safety Standards for Ophthalmological Care
Proposed legislation (A.1193-C/S.4035-A) to permit optometrists to prescribe certain oral medications has been amended, over the objection of ophthalmologists, to weaken optometrist training requirements designed to ensure patient safety. The bill was advanced by the Assembly Higher Education and Codes Committees this week.

To send a letter in opposition, click here: https://p2a.co/HsyXbSp

The bill had been negotiated between the NYS ophthalmological society and NYS Optometry Association but has been amended as follows:

• Significantly reducing the training required of optometrists to prescribe these oral medications;
• Removing the requirement that optometrists taking the required certification course and final examination retake the course if they have failed the final examination three times; and
• Eliminating a proposed requirement that optometrists to furnish evidence that they have completed required continuing education courses when they submit an application for license renewal;

To read MSSNY’s memo in opposition to this legislation, click here.

Members of New York’s Congressional Delegation Team Up in Bipartisan Push for Additional Funding for Community Physicians in CARES Act
Representatives Anthony Brindisi (D-Utica) and Elise Stefanik (R-Plattsburgh) teamed up this week to send a letter to the Secretary of Health & Human Services (HHS), Alex Azar, urging support for additional funding in the federal CARES Act, to help community physicians across New York State as they work to recover from the economic impact of the COVID19 crisis.

Specifically, the letter notes that, “Like many businesses, community physicians in New York have experienced a devastating impact on their practices because of the COVID-19 crisis, with patients having to appropriately limit their trips out of the house, including to their doctor’s office, along with the suspension of all elective procedures for months during lockdowns. The impact has devastated practices and jeopardized jobs for millions across the state.”

The letter also quotes a MSSNY survey this spring that found that 79% of physicians had seen a reduction of more than 50% in the volume of patients visiting their practices. Nearly 3/4 of physicians had a greater than 50% drop in practice revenue; and 40% had to lay off, or furlough, at least 25% of their staff. A recent Fair Health report indicating that patient visits to physician practices were down by nearly 80% in the Northeast.[1]

MSSNY’s Division of Governmental Affairs will continue to engage on this important issue and provide updates to members. CARY, AUSTER

Quality Health Plans of NY (QHPNY) No Longer Contracted with Medicare
Please be aware, QHPNY no longer has a contract with Medicare effective February 29, 2020.  QHPNY is responsible for all payment of claims for its (prior) members. CMS understands that QHPNY is in the process of being liquidated by the New York State Department of Insurance.  Once that happens, that State will pay the remaining claims.  CMS heard from physicians regarding outstanding claims. CMS has advised them to file a complaint for unpaid claims with the New York State Department of Financial Services.  Complaints can be made by submitting to www.dfs.ny.gov/consumer/filecomplaint.htm  After which, calls can be made to 212 480 6400. (Regina McNally, VP Socio-Med Div.)

New York’s Health Premiums Remain Among the Highest in the U.S.
The average cost of New Yorkers’ health benefits increased by less than the national average in 2019 but remained among the highest in the U.S., according to recently published federal data.

The average cost for family coverage rose 4 percent to $22,874, which was 12 percent above the national average and second only to Alaska, according to an annual survey of private-sector employers by the U.S. Agency for Healthcare Research and Quality (see first chart). The average cost of single coverage rose 2 percent to $7,890, which was 13 percent above the national average and third behind Alaska and Delaware.

Those increases were a bit lower than the nationwide jumps of 5 percent for family coverage and 4 percent for single coverage.

Still, all those figures were two or three times the general inflation rate – continuing a long-term pattern for New York and the U.S.

New York’s insurance has traditionally been more expensive than national norms, but the gap has been getting wider in recent decades (see second chart).

The state’s high cost of living is likely a factor, especially in the New York City area. State policy also drives up premiums by heavily taxing health insurance and continually adding to a long list of coverage mandates. (empire Center, July 17)

Missed Childhood Vaccines Could Be Bigger Threat than COVID-19, WHO says
The COVID-19 pandemic has spurred a major decline in childhood immunization rates worldwide, the consequences of which could be more severe than the pandemic, the World Health Organization warned.

“The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a statement cited by The Hill.

The WHO, CDC and other health partners polled 82 countries June 5-20. Sixty-nine percent of countries reporting on their vaccine programs said efforts were disrupted or suspended due to the pandemic. The most common reasons for disrupted vaccine programs were shortages of personal protective equipment, travel restrictions and a lack of available health workers.

Preliminary data for January through April also shows a “substantial drop” in the number of children receiving three doses of the vaccine against diphtheria, tetanus and pertussis, the WHO said. This could be the first time the world sees a drop in immunization coverage for these diseases in 28 years.

The WHO and UNICEF said they are providing resources and services to help countries make up lost ground on childhood vaccinations.

To learn more, click here.

HHS Telemedicine Hack on Telemedicine (One Hour per Week) Begins on July 22
This course is a free10-week learning community to accelerate telemedicine implementation for ambulatory providers. It is a learning collaborative from the US Department of Health and Human Services and others addressing telemedicine. Questions should be directed to: c19ECHO@salud.unm.edu

Managing Your Social Media Presence Webinar on August 12
On August 12, at 12 noon, MLMIC and HANYS will present a one-hour webinar designed to help healthcare providers optimize their social media strategy and minimize risks associated with its use. Read more at MLMIC.com

Please Take the AMA Survey on Telehealth Impact (on) Physicians
The American Medical Association has been working on a Telehealth Impact Physician survey in collaboration with MITRE, Mayo and others as part of an effort of the COVID-19 Healthcare Coalition.

You are invited to complete the Telehealth Impact Study Provider Questionnaire by clicking on the link below.  The study has been approved by the Mayo Clinic IRB and is part of our efforts in the COVID-19 Healthcare Coalition to address the pandemic. Since COVID-19 started, we have experienced a significant shift towards telehealth.  The goal of this project is to learn more about your experience with telehealth to identify the challenges and barriers, as well as the benefits. 

Building on existing research, your response will help inform additional resources needed across the industry and health care community, provide insights to federal and state policymakers, and identify gaps in current research. Respondent and organization information will remain confidential and will only be reported in aggregate. The findings will be shared and made available to all on the COVID-19 Healthcare Coalition website, as well as shared by the various organizations participating in the Coalition Telehealth Workgroup*. 

The COVID-19 Healthcare Coalition is focused on understanding your experience of telehealth as an individual physician, nurse practitioner, or physician assistant. Please click here to start the survey https://src.co1.qualtrics.com/jfe/form/SV_6KAkyEVfhtGj3vL. The survey is expected to take up to 15-20 minutes and we ask that you complete the survey by August 13^th, 2020.  Please remember to press submit when you get to the end of the survey. 

We want to hear from as many clinicians as possible to inform our work. If you have colleagues who use telehealth, please consider forwarding this invitation to them. 

Thank you in advance for your consideration and valuable insights. 

Best Regards,
Steve R. Ommen, MD
Medical Director, Center for Connected Care, Mayo Clinic
Francis X. Campion, MD, FACP
Principal Lead, Digital Health
MITRE Corporation 

*COVID-19 Healthcare Coalition Telehealth Workgroup: American Medical Association (AMA), American Telemedicine Association (ATA), Digital Medical Society (DiMe), MassChallenge Health Tech, Mayo Clinic and MITRE Corporation. The AMA, while a part of the Coalition Telehealth Workgroup, is not a formal member of the COVID-19 Healthcare Coalition.

MSSNY’s Weekly Podcast

What is the Cost of COVID-19 Hospitalization?
The median in-network commercial charge for COVID-19 hospitalizations ranged from $34,662 for the 23 to 30 age group to $4

5,683 for the 51 to 60 age group, new data show.

The 51 to 60 age group was the most expensive to treat as well as the most common to be hospitalized for COVID-19, accounting for nearly 30% of related hospitalizations, according to an analysis of commercial claims from January through May by not-for-profit research firm Fair Health. Although, the age distribution may be in flux, researchers said, pointing to recent reports indicating that the average age of new COVID-19 cases dropped by about 15 years.

In the South, Midwest and West, individuals aged 19 to 40 accounted for larger shares of COVID-19 claims than in the Northeast and the nation as a whole.

The study mirrored Medicare claims data showing that chronic kidney disease and kidney failure were the most common comorbidities of hospitalized COVID-19 patients.

Many Medicare beneficiaries, which Fair Health’s analysis excludes, end up under the Medicare severity-diagnosis related group of respiratory system diagnosis with ventilator support, which yields more than $42,000, said Glenn Melnick, a healthcare economist at the University of Southern California who has been studying COVID-19-related utilization and reimbursement trends. That may explain why the commercial claims for those 61 and older are relatively lower, he said, noting that it could also be related to claims lag since a lot of older patients are staying in the hospital longer. Still, the charges and payments for the upper age groups seem low, especially since commercial insurers typically pay more than Medicare, Melnick said.

The total charges to treat COVID-19 within hospital settings are projected to range from at least $362 billion to as high as $1.45 trillion, Fair Health estimates.

The Fair Health analysis revealed that males were associated with a larger share (54%) of COVID-19 commercial claims, according to Fair Health data. The office setting was the most common venue for initial diagnoses, except for patients aged 61 and older, who were most commonly diagnosed initially in an inpatient setting.

Notably, the Northeast had the highest percentage of COVID-19 patients first diagnosed via telehealth, which was typically the least-common medium.

Physicians and data experts at Santa Clara (Calif.) Valley Medical Center developed a COVID-19 risk score that aims to maximize resources and direct treatment. If they are male, over the age of 60, have a body-mass index of at least 30 and have comorbidities like diabetes or heart conditions, they are more likely to get sick, Santa Clara Valley Medical Center experts’ analysis of nearly 7,000 emergency department visits revealed. Patients who have fewer than three of those characteristics are extremely unlikely to require hospitalization. And 1 in 8 patients who meet at least three of the criteria will likely get very sick.