Visions, Myopia, or Delusions?
Thomas J. Madejski, MD
January 4, 2019
Volume 22 Number 1
I hope you, your families, friends, and patients have a happy and healthy New Year. I want to bring to your attention recent developments in the current controversy of Maintenance of Certification (MOC).
The ABMS Visions for the Future Commission released its report on principles for continuous professional development and MOC in December. The period for public comment closes January 15.
One of the principle duties of a learned profession is self-regulation of professional duties and standards. The nature of that regulation has evolved over the years from the profession itself to a more complicated structure to provide regulation with input from multiple stakeholders outside the profession to ensure service to the public. Part of that evolution resulted in the establishment of Certification Boards as professional knowledge and practice became more and more specialized.
Medicine continues to debate and discuss how to best maintain and improve practice standards and the Specialty Boards have been important advocates for higher practice standards. The dilemma for the boards and the profession is how best to move continuing professional development forward, while minimizing the burden to the profession. Clearly, one size does not fit all, and there has been variable acceptance of maintenance of certification requirements across the specialties within the ABMS. I was able to provide some testimony to the Visions Commission this past March, and MSSNY is reviewing the report and preparing comments. I encourage you to review the report and send us your thoughts for inclusion in our response here.
I think most of us agree that competition is good, and can help to improve performance and satisfaction when applied to many different situations. To that end, a group led by Dr. Paul Tierstein, a cardiologist from the Scripps Clinic in California, created the National Board of Physicians and Surgeons as an alternative for MOC, in response to some of the criticisms of the present ABMS sponsored program with regards to cost, relevance and burden of participation both in time and on physician wellness. There have also been some concerns regarding the actions of some of specific specialty boards’ activities. Those concerns have resulted in at least one class action lawsuit against one of the constituent specialties within the ABMS.
MSSNY is committed to advocating for our patients, the betterment of public health, maintaining high standards of practice, and the well-being of the physicians of New York State.
Finding the balance that maintains and raises practice standards and patient care, while not paradoxically worsening care and reducing time spent with patients due to overly burdensome requirements is the key. Please send me your additional thoughts at firstname.lastname@example.org.
Quod oculus non videre mente id quod non habet
Thomas J. Madejski, MD
SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
On January 9, the New York State Legislature will welcome nearly 40 new members in Albany – the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.
One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!
Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.
Join us to urge your legislators to:
- Reduce excessive health insurer prior authorization hassles that delay patient care
- Reduce the high cost of medical liability insurance through comprehensive reforms
- Reject burdensome mandates that interfere with patient care delivery
- Preserve opportunities for medical students and residents to become New York’s future health care leaders
- Reject inappropriate scope of practice expansions of non-physician practitioners
- Prevent big-box, store-owned medical clinics that will negatively impact community primary care delivery
- Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.
A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.
If you have any questions/comments, please contact Carrie Harring at email@example.com. (HARRING)
MSSNY President Urges Caution on Single Payor Proposals
With the discussion of single payor legislation heating up in Albany, MSSNY President Dr. Thomas Madejski’s op-ed on the topic appeared in the January 1, 2019 edition of the Albany Times-Union.
Dr. Madejski noted that “One of the most appealing aspects of the NYHA is the potential to reduce administrative burdens associated with delivering patient care. Physicians increasingly report difficulties with challenging insurer-imposed prior authorizations that lead to unnecessary delays in patients receiving needed care. And physician burnout arising from these administrative burdens is a very real and pervasive issue. However, there is concern among many physicians that budget pressures could force state bureaucrats implementing a single-payer system to impose even more burdensome prior authorization requirements. Furthermore, many physicians are concerned that these same budget pressures could create enormous pressure to constrain payments for care at a time when physicians already face immense overhead costs that exceed those in any other state.”
He went on to note that “Failure to adequately address the many questions with transitioning to a single-payer system may not be in the best interest of New Yorkers. We must make sure that, in our efforts to address the current barriers patients face in receiving care, we do not impose new ones.” (AUSTER)
President Approves Bill to Provide Funding for States to Prevent Maternal Deaths
President Donald Trump has signed into law legislation, the “Preventing Maternal Deaths Act”, to provide millions of dollars in funding to states to establish maternal mortality committees. The bill had been passed by the US Congress in early December. The purpose of such committees are to investigate pregnancy-related deaths and use the findings to prevent others.
In the United States, the maternal mortality rate is 26.4 deaths per 100,000 (about 700 per year). That rate increased 250% between 1987 and 2014, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that 60% of the deaths are preventable. The maternal death rate is more than three times higher for African American women than white women in the United States, according to the CDC.
MSSNY working together with the American College of Obstetricians & Gynecologists – District II have supported legislation in the 2018 Legislative Session to establish a Maternal Mortality Review Board in New York. The MMRB would be comprised of a multidisciplinary team of medical experts tasked with reviewing data on maternal deaths, identifying the root causes of the these events, and disseminating evidence-based best practices to prevent them in the future. The board’s primary focus will be on quality improvement rather than punishment, reviewing outcomes of care, conducting peer reviews, and collaborating on process improvements. As a necessary component to achieving this mission, the bill contains broad confidentiality protections to the board’s proceedings to allow for open and honest dialogue and review. However, some are advocating that the confidentiality provisions be minimized, which could seriously undermine the quality improvement goals of the MMRB. MSSNY will again work with ACOG in 2019 to achieve passage of a MMRB in New York.
Gov. Signs Measure to Increase Transparency of Mental Health Parity Compliance
Just before the close of 2018, Governor Cuomo signed into law legislation establishing the Mental Health and Substance Use Parity Report Act, a measure that MSSNY strongly supported in conjunction with the New York State Psychiatric Association and other patient advocacy groups. With its adoption, the NY Department of Financial Services (DFS) will be required to collect key data points and elements from health insurers in order to analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.
We thank the hundreds of physicians who took the time to contact the Governor to urge that he sign the bill into law. MSSNY’s letter to the Governor noted that “In light of the growing opioid epidemic, it is vitally important that the state and various public stakeholders have a resource that would help those individuals make informed choices with respect to the choice of health plan. Moreover, the responsibility to provide such information will incentivize insurers to follow the laws that are intended to assure that patients have coverage for the care they need.”
Timothy’s Law, which works to ensure New Yorkers have access to care and treatment for mental illness and substance abuse disorders, was passed in 2006 and made permanent in 2009. This law mandated a number of provisions aimed at improving access to mental health and substance abuse care, including coverage of a variety of relevant services for children and employees of large employers and premiums and cost sharing for mental health services that are equivalent to those for physical health services. However, investigations by the New York Attorney General’s office have identified numerous instances of noncompliance, including evidence of elevated levels of denials for mental health services. This necessitated proactive evaluation of insurers and health plans to ensure compliance and provide New Yorkers with the information they need to get the best possible care.
The data collected this law will be used by the DFS to ensure compliance with Timothy’s Law and to prepare an annual Mental Health Parity report as part of the annual comprehensive DFS Consumer Guide to Health Insurance. In a letter of support to Governor Cuomo, the American Medical Association noted that the bill “will provide important data to better compare requirements for accessing benefits that are applied to mental health and substance use disorder treatment and coverage as compared with those applied to medical/surgical benefits. The compliance report, particularly if made available to key stakeholders and open for public inspection to patient advocates, will help regulators and others identify where appropriate oversight and enforcement are necessary.” (AVELLA, AUSTER, CLANCY)
Workers Comp Board Finalizes Fee Schedule Increases to Take Effect April 1
The New York Workers Compensation Board finalized regulations providing an overall 5% increase in the medical fee schedule for care to injured workers that will be applicable April 1, 2019. For more information, click here.
Moreover, the WCB finalized regulations to increase the physician deposition and hearing testimony fee from $400 to $450, also effective April 1. The WCB also clarified that payment of such witness fees shall be paid by the carrier within 10 days of the testimony, and suggest physicians who have not been paid within that time frame contact the WCB for enforcement.
There are concerns with some aspects of the changes. For example, the WCB decided to implement changes in reimbursement for electro-diagnostic testing that had been opposed by MSSNY, certain specialty societies and many physicians. As is noted in the WCB Summary of Public Comment:
“The Board received comments objecting to the change in CPT codes resulting in reductions in reimbursement for EMG studies and EDX testing. Needle EMG tests have received proportionate increases. Surface EMGs are not recommended under the Medical Treatment Guidelines and therefore have no fee associated. Fees for NCV reflect changes to the CPT codes themselves, as created by the American Medical Association, and the method for billing, and will be reimbursed at 200% of the Medicare level, so no change has been made.”
It should also be noted that with regard to the proposed changes to physical medicine Ground Rule 2, the Summary of Public Comment stated:
“The Board received many comments disagreeing with physical medicine Ground Rule 2 – specifically, the 12 sessions/180-day limitation. In response, the Board has decided not to implement this change, so Ground Rule 2 will read as it did previously: “Physical medicine services in excess of 12 treatments or after 45 days from the first treatment, require documentation that includes physician certification of medical necessity for continued treatment, progress notes, and treatment plans. This documentation should be submitted to the insurance carrier as part of the claim.”
MSSNY will continue to push for further increases in the WC fee schedule. While the changes are a positive step forward to better assure access to care for injured workers, these modest increases are the first positive updates in over 2 decades. During this same time, the costs of running a medical practice increased well over 30% (as measured by the Medicare Economic Index). (AUSTER)
Six Cases of Acute Flaccid Myelitis Confirmed in New York
The Albany (NY) Times Union (12/28) reported CDC officials have confirmed six cases of acute flaccid myelitis in New York, three of which were “in New York City and three more outside the five boroughs.” Nationwide, the CDC received 336 reports of suspected AFM this year and confirmed 182 of them in 39 states as of Dec. 21. As in previous years, an uptick in cases was observed around August and peaked in September.
Lake Erie College of Osteopathic Medicine Expands to Elmira
Buffalo (NY) Business First (1/3) reports hospitals in western New York are hoping that the new Lake Erie College of Osteopathic Medicine (LECOM) campus in Elmira may bring more physicians to the area. The article explains that LECOM is based in Erie, Pennsylvania with other locations in that state as well as Florida, but LECOM is now “investing nearly $20 million in a new facility on the Elmira College campus for a medical school program.” The new location in Elmira is scheduled to open in 2020 and “will start with 120 osteopathic medical students annually, growing to 480 after four years.”
JAMA Oncology: Over 7% of Cancers in US Attributable To Excess Body Weight
The findings were published in JAMA Oncology report that a study indicates “more than seven percent of cancer cases in the United States are attributable to excess body weight.” Investigators “found that from 2011 to 2015, among people 30 and older, 4.7 percent of cancers in men and 9.6 percent of those in women were attributable to excess weight – some 37,670 cancers in men, and 74,690 in women every year.”
Study: Casts Doubt on Omega-3 for Primary Cardiovascular Disease
Many people without known cardiovascular (CV) disease take omega-3 (ω-3) fatty acid supplements (“fish oil”) to prevent adverse CV events. However, recent studies cast doubt on this practice.
In the VITAL study, about 26,000 people (mean age, 67) without CV disease were randomized to 1-g capsules of fish oil (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 5.3 years, risks for the primary endpoint (nonfatal myocardial infarction [MI], stroke, or CV-related death) and all-cause death were similar in the two groups. Although the incidence of MI was significantly lower in the ω-3 group than in the placebo group, the absolute difference was small: 1.1% vs. 1.5% during 5 years of treatment and N Engl J Med 2018 Nov 10; [e-pub]).
In the ASCEND trial, more than 15,000 people (mean age, 63) with diabetes but without CV disease were randomized to 1-g fish-oil capsules (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 7.4 years, risks for the primary endpoint (nonfatal MI, stroke, transient ischemic attack, or CV-related death) or all-cause death were similar in the two groups (NEJM JW Gen Med Oct 1 2018 and N Engl J Med 2018; 379:1540).
A meta-analysis of 10 randomized trials (78,000 total patients) showed no significant differences between ω-3 recipients and controls in risks for coronary heart disease–related death, nonfatal MI, any coronary heart disease event, or major adverse CV events overall. Subgroup analyses among participants with known coronary heart disease or diabetes yielded similar findings (JAMA Cardiol 2018; 3:225).
The two new randomized trials do not support the use of ω-3 fatty acid supplements for preventing adverse CV events in patients with no history of CV disease. Although the meta-analysis showed no evidence of benefit for secondary prevention, a recently published trial (REDUCE-IT) showed that a different ω-3, icosapent ethyl, lowered risk for adverse CV events in patients with established CV disease and elevated triglycerides; those results are summarized elsewhere.
|FREE CME PROGRAMS|
Be sure to check out all of MSSNY’s Medical Matters and Emergency Preparedness FREE CME Programs
An individual in New York was recently diagnosed with Brucellosis from raw milk. Did you know that MSSNY offers an Emergency Preparedness CME program on Brucellosis, Glanders, Melioidosis and Tularemia? Additionally, MSSNY has posted the recent Medical Matters webinar on Measles which continues to spread throughout the state.
All of MSSNY’s timely and relevant CME programs are available at https://cme.mssny.org. Please note that you will need to create an account there if you haven’t already.
Additional information or assistance with the website may be obtained by contacting Melissa Hoffman at firstname.lastname@example.org.
“Public Health Preparedness 101” CME webinar January 16, 2019 at 7:30am – Registration now open
The American Medical Association Code of Medical Ethics opinion 8.3 states that: “With respect to disaster, whether natural or manmade, individual physicians should take appropriate advance measures, including acquiring and maintaining appropriate knowledge and skills to ensure they are able to provide medical services when needed.”
Are you prepared for a public health emergency? And are you ready for one as well? MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am. Registration is now open for this program here. Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.
- Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
- Describe the importance of readiness in addition to preparedness
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc
Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to email@example.com
Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355