MSSNYeNews: A Hard Rain’s A ‘Gonna Fall – January 10, 2020

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews January 10, 2020 Vol. 23  Number 2

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Colleagues:

As I wing my way toward the AMA’s State Legislation Advocacy Meeting in Florida, I keep thinking about Governor Cuomo’s State of the State speech. While there are things we most certainly can support, when he got to healthcare, the tone shifted. As I wrote previously, Medicaid is the largest item responsible for NY’s $6B budget deficit. The Governor had already cut payments 1%, but he went further. He blamed local spending for much of the problem and offered that his initial Medicaid Redesign would need Redesign.

We also learned that he would propose legislation to boost OPMC and physician discipline. As it so happens, on Monday, MSSNY will be meeting with DOH and OPMC and will learn more about specifics.

All too often, we hear about physician burnout, physician suicide and how physician wellness is on the DOH agenda. It appears ironic to talk about burnout and wellness when the state is cutting payments and talking about streamlining physician discipline. If physicians feel that someone has stuck a “Kick Me” sign on their backs, it is understandable. Medicine has become a profession of Rodney Dangerfields. I can hear him now – “When I see patients, I get no respect. After Press Ganey gets me, the Insurers, Trial Lawyers and Government get their licks in, too.”

Getting physicians to join together has been likened to herding cats. However, in the coming weeks and days, we all really do need to band together. Stay tuned to MSSNY updates as many devilish details remain to be hashed out. Trust me, this is serious. If we don’t work collegially and collectively, we are sunk. The 1% Medicaid Cut was but a test of our resolve. Far worse may be coming down I-87.  Please consider this year’s March 4th Lobby Day in Albany, our day to make them hear all of us. I call on all NY’s physicians, Medical Staff Societies, Specialty Societies, Ethnic Societies to text MSSNY to 52886 to get our Grassroots alerts and updates. Also, please contribute to our MSSNY-PAC as well. No contribution is too small. We need all the help we can get. Quoting David Byrne as I have previously: “This ain’t no party. This ain’t no disco. This ain’t no foolin’ around.”

And it’s a hard, it’s a hard
It’s a hard, it’s a hard
It’s a hard rain’s a gonna fall.
Bob Dylan, A Hard Rain’s A Gonna Fall

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

Arthur Fougner, MD
MSSNY President

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Capital Update

Governor Cuomo Proposes Changes to OPMC Processes; MSSNY Expresses Strong Objections
Governor Cuomo released his 36^th proposal as part of a package of policy changes in 2020. The plan calls for changes in the way that DOH investigates, disciplines and monitor physicians, physician assistants and specialist assistants licensed in New York. Details of the proposed changes include:

• Making investigations public “when the Commissioner of Health deems it warranted”, as well as, making administrative warning actions public.
• Eliminating lifetime licensure to ensure out of state physicians with a NY license periodically renew.
• Amend the Public Health law to allow the State Health Commissioner to suspend a physician’s license, at the start of an investigation, if the commissioner deems that physician to be a risk to the public. This would be a lessened standard from the current “imminent danger” standard currently required for a summary suspension.

In response, MSSNY released the following statement:  “New York’s Physicians have a great interest in working with the State Health Department to ensure that New York’s disciplinary process moves swiftly when necessary to remove those from practice that present a threat to the public. To that end, we have worked proactively with the administration and legislature on laws to enhance the ability of OPMC to “summarily suspend” physicians in certain instances where it would be imprudent to wait for a final action. And it is imperative that we work for improvements to this system as issues arise that interfere with its mission to protect the public.

At the same time, an appropriate balance is needed. Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct. Indeed, most complaints of alleged misconduct do not become actual findings of misconduct. Yet with Google and Yahoo search functions, an unproven allegation could linger forever in cyberspace, and permanently and unfairly scar a reputation. We look forward to reviewing the text of this proposal as it becomes available and working with the Legislature and Governor to ensure we maintain the critical balance of protecting the Public while also protecting against the consequences of unfounded allegations.”

MSSNY Division of Governmental Affairs Staff will keep our members updated as discussions move forward, in the coming months, in Albany.                               (DIVISION OF GOVERNMENTAL AFFAIRS)             

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Governor Cuomo Outlines 2020 Health Priorities at State-of-the-State
On Wednesday, January 8^th, members of the New York State Senate, Assembly, and other governmental dignitaries, gathered in the Convention Center for Governor Cuomo’s State-of-the-State speech, where he outlined his 2020 agenda, including his health priorities. MSSNY will likely support many of these initiatives, while other items raise serious concerns, at first glance, and require close monitoring, this session. The following is the full list of issues MSSNY Staff will closely follow, and potentially take action if necessary, in the coming months:

• Proposal for legislation to address the OPMC disciplinary process that would enact periodic renewal requirements for New York physicians, physician assistants and specialist assistants to maintain their licenses and ability to practice in the state if they practice out of state. He will also seek to update the public health law to strengthen disciplinary oversight and allow for quick removal of providers who present a risk to patients; ensure the public can access up-to-date information about physicians and any professional conduct concerns; and give the Office of Professional Medical Conduct authority to increase patient safety and physician accountability.
• Reducing the small business tax from 6.5% to 4%.
• Expands Access to Buprenorphine, an important advance in Medication Assisted Treatment, which, like methadone and injectable naltrexone, is used in combination with counseling, to help people reach and sustain recovery from Opioid Use Disorder.
• Governor Cuomo will direct the Department of Health (DOH), to require all hospitals statewide to develop protocols for their emergency departments to address Opioid Use Disorder based on the standard of care for treatment or referral for treatment. The Enacted Budget also prohibits health plans from requiring prior authorization for Medication Assisted Treatment.
• Legalizing Gestational Surrogacy Current state law creates legal uncertainty for parents of children conceived by reproductive technology. The governor’s proposal establishes criteria for surrogacy contracts, providing for the nation’s strongest protections for parents and surrogates. His proposal will also streamline the “second parent” adoption process, removing outdated barriers and extending common-sense protections for New York families.
• A proposal to legalize recreational marijuana.
• Proposal to ban all flavored nicotine vaping product, including menthol flavors. The governor has also proposed banning vaping advertisements aimed and youth and to authorize the NYS Department of Health to regulate the sale of chemicals used in vaping-related products and ban the sale of vaping product carrier oils deemed a hazard to public health. His proposal also includes legislation that would prohibit the online, phone and mail order sale of e-cigarettes and would require that only registered retailers be allowed to purchase e-cigarettes using these methods.
• Legislation to crack down on retailers that illegally sell untaxed cigarettes and other tobacco products in New York State. Under the Governor’s proposal, retailers who acquire untaxed cigarettes from other states or other sources and sell them illegally in New York would face possible closure. The Governor is also proposing strengthening penalties and fines for retailers that sell tobacco products to people under 21 years of age.
• A proposal for the Department of Health, the Department of Financial Services, and the New York State Digital and Media Services Center- a joint enterprise of the Office of Information Technology Services and Office of General Services – to create a consumer-friendly website, called NYHealthcareCompare, where New Yorkers can easily compare the cost and quality of healthcare procedures at hospitals around the state. The platform will also provide consumers with educational resources designed to help consumers know their rights including financial assistance options, what to do about a surprise bill and more.
• Require the registration of all PBMs and oversight by DFS.
• Proposal to develop a three part plan to lower prescription drug costs for all New Yorkers. The Governor’s proposal would cap insulin co-payments at $100 per month for insured patients to help address the rising cost of insulin that has resulted in diabetes patients rationing, skipping doses and not filling prescriptions.
• A call for legislation banning fentanyl analogs — a deadly synthetic opioid that is 50 to 100 times more potent than morphine — by making them subject to the same criminal sale or possession penalties as other controlled substances. The legislation will also empower the New York State Health Commissioner to ban any new fentanyl analogs that have been added to the federal schedule of controlled substances, allowing the State to deal with these deadly substances in real time rather than play catch up.
• A proposal calling for legislation to prevent individuals from receiving New York State gun licenses if they commit a crime in another state that is similar to a crime that would disqualify them from owning a gun in New York State. New York law currently prohibits individuals from obtaining a gun license if they commit certain New York misdemeanors that are deemed “serious offenses.” However, the law does not prohibit individuals from obtaining a New York gun license after committing comparable misdemeanors in another state.
• Expanding the surprise bill law to: prohibit billing of patients by out of network physicians and hospitals for emergency care for amounts above the applicable cost-sharing amounts; and to require disclosure of facility fees to patients in Article 28 and Office-Based surgery settings.

Proposed Cuts to Medicaid
On January 1, 2020, Governor Cuomo implemented a 1% across-the-board cut to the state’s Medicaid program & we anticipate additional proposed reductions to the program when his budget is released. The Governor did not provide more details about his plans to address the $6 Billion Budget deficit, except for his goal to convene a new Medicaid Redesign Team (MRT). More details will come when Governor Cuomo releases in his New York State Budget on this cut and the other proposals contained in his State of the State. MSSNY Division of Governmental Affairs staff will follow with more information as it becomes available. At this time, it is unclear whether each of these initiatives will be pursued in the State Budget or through stand alone “program” legislation.
(DIVISION OF GOVERNMENTAL AFFAIRS)        

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MSSNY Calls for a Reversal of Medicaid Cut; Please Join Our Efforts
MSSNY joined several other specialty societies and health care provider associations in a letter to Governor Cuomo this week urging that the recently enacted 1% cut to Medicaid physician payments be reversed.  The letter noted that “The State’s Medicaid program has not adequately reimbursed for increased costs and critical policy initiatives since the Medicaid Redesign Team (MRT) changes began to take effect” and that “In spite of these cost increases in the past decade, providers have not had a trend factor to recognize the basic expenses of providing care to the poor, elderly and disabled in our State.”

In MSSNY’s own statement on this cut (click here for MSSNY statement), MSSNY President Dr. Art Fougner noted that physicians are “confounded by the announced cuts”, given that “Medicaid physician payment remains a very small part of New York’s overall Medicaid Budget” and that “New York has one of the lowest Medicaid to Medicare physician payment ratios in the country”. With New York State facing a $6 Billion Budget deficit for the 2020-21 fiscal year, further steep cuts could be proposed in the soon-to-be released Governor’s Executive Budget.  Physicians are urged to contact their legislators to act to reverse these cuts, and prevent further cuts. click here.                                                                        (AUSTER)

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Senate Health Committee To Act on Package of Bills Regarding E-Cigarettes
On Monday, January 13^th, the Senate Health Committee will take action on several legislative e-cigarette proposals.  S. 428B, sponsored by Senator Brad Hoylman, which would prohibit the sale and distribution for use in e-cigarettes.  S. 3905A, sponsored by Senator Gustav Rivera, which would regulate electronic cigarettes in the same way as tobacco products to prevent access to products by persons younger than 21 years.  S. 4249A, sponsored by the Senator Monica Martinez, which would create restrictions for the locations of tobacco stores and electronic cigarette stores to be at least 200 feet away from a school or place of worship.

The Medical Society of the State of New York supports banning all flavored e-cigarettes, including menthol and supports legislation that would also ban all flavored tobacco products, such as chewing tobacco and cigarillos.  On January 13^th, MSSNY President Arthur Fougner, MD, and Gregory Threatte, MD, President of the Albany County Medical Society will participate in an Albany press conference on e-cigarettes with members of the Legislature and will join with other public health groups, in advocating for measures that would prohibit the sale of flavored tobacco products and e-cigarettes, including menthol.   

In December,  MSSNY has joined with other public health organizations that called upon the Governor, the Senate and Assembly leaders, and members to pass legislation that would prohibiting the sale of flavored nicotine and tobacco products which will protect our young people from the scourge of the myriad health problems and addictions caused by flavored tobacco products and e-cigarettes. Physicians are encouraged to send a letter through MSSNY Grassroots Action Center (GAC)  here.>
(CLANCY)

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Legislation to Expand Mandate For Pain Management for All DEA Prescribers
A measure that would expand the coursework under the pain management requirement will be acted upon by the Senate Health Committee next week.  S. 7102, sponsored by Senator Brian Benjamin, would include requirements that would reduce the likelihood of overdose and spread of blood-borne diseases by those who use drugs; medications used for the treatment of addiction and information about becoming a buprenorphine prescriber.  Additionally, the bill requires prescribers to update standards and approvals as necessary according to best practices for providing patient centered care with the consideration of social determinants of health and co-occurring disorders.

The Medical Society of the State of New York is opposed to this measure.  Physicians and other health care providers who have a DEA license were required to take a three hour course on pain management, palliative care, addiction that included the state and federal requirement for prescribing controlled substances, appropriate prescribing, managing acute pain, palliative medicine, prevention, screening and signs of addiction, responses to abuse and addiction and end of life care.

This requirement passed the Legislature in 2016 and physicians were required to have taken this program by July 1, 2017.  The law also requires that DEA prescribers take the course every three years—2020 is the start of a new cycle and physicians are again required to take this course.  MSSNY is in the process of updating its current pain management program and it will be available by spring. (CLANCY)

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MSSNY Opposes Legislation to Allow Estheticians & Others to Perform Laser Hair Removal
A bill that would allow estheticians, and others, to perform laser hair removal with only minimal physician oversight, was reintroduced in 2019 and is on the agenda for next week’s Senate Committee on Consumer Protection. MSSNY has long opposed this legislation as it legitimizes in statute a currently unregulated practice to perform a procedure that should only be done by an appropriately trained and educated individual, under physician supervision. Procedures involving lasers have the potential to cause painful burns and permanent scarring if not used properly.

A 2013 article in the Journal of the American Medical Association (JAMA) reported on a study that showed that, despite the fact that approximately only 1/3 of laser hair removal procedures are performed by non-physicians, 75.5% of hair removal lawsuits from 2004 to 2012 were performed by non-physicians, and that from 2008 to 2012, this percentage increased to 85.7%. MSSNY appreciates the efforts of the sponsors to provide greater regulation of a currently unregulated practice, but in its current form, MSSNY opposes this legislation. We will continue to work with the sponsors to ensure the bill is amended to establish necessary oversight of this practice and to ensure patients’ safety.                      (CARY)

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Barclay Elected as New Assembly Minority Leader
Assemblymember Will Barclay (R-Pulaski) has been elected by the Assembly Republican Conference as the new Minority Leader of the New York State Assembly.  Assemblyman Barclay previously served as Ranking Member of Assembly Ways & Means Committee and, prior to that, as Ranking Member of the Assembly Insurance Committee.  He replaces Assemblymember Brian Kolb in this post.  MSSNY congratulates Assemblymember Barclay on this new position, and looks forward to working with him.                                          (AUSTER)

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AG James Stops Public Charge Rule From Taking Effect
The United States Court of Appeals for the Second Circuit denied the Trump Administration’s efforts to immediately reverse preliminary injunction on the president’s Public Charge Rule. In September 2019, Attorney General James filed a motion to seek a preliminary injunction to stop the Trump Administration’s public charge rule from going into effect. In August 2019, Attorney General James and a coalition that included the attorney general of Connecticut and Vermont, as well as the City of New York filed a lawsuit challenging the Trump Administration’s Public Charge rule which aimed to deny green cards and visas to immigrants who use government assistance programs.

The preliminary injunction seeks to stop the public charge rule from taking effect arguing that it would harm millions of non-citizens and their family members by deterring them from accessing public benefits that they are lawfully entitled to receive. As New York braces to confront the $6 billion dollar budget gap with DOH’s decision to cut Medicaid payments by 1% in 2020 as well as overall Medicaid enrollment decline, individuals who would have otherwise had access to healthcare are at risk of living with undiagnosed and untreated conditions.                                                                              (ALI)

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SAVE THE DATE: MSSNY‘s Annual “Physician Advocacy Day” (3/4)
On January 8^th the New York State Legislature welcomed back returning members to Albany! As the new session begins, the need for physician advocacy and grassroots involvement is greater than ever.  Physicians can sign up to participate in MSSNY’s “Physician Advocacy Day” which will be held on Wednesday, March 4^th in the Lewis Swyer Theatre in the Egg, Empire State Plaza, Albany NY. Click here to register!

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

A brief luncheon to which members of the NYS Legislature are invited to speak with their constituents will follow the morning program. County medical societies will also be scheduling appointments for physicians to meet with their elected representatives.

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

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“Doctor Are You Ready?” CME Webinar on January 15; Registration Now Open
Disasters big and small happen every day.  Be sure to find out how best to be prepared at MSSNY’s next Medical Matters webinar: Doctor Are You Ready? on January 15^th at 7:30am.  Kira Geraci-Ciardullo, MD, MPH immediate past speaker of the house and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here. 

Educational objectives are:

• Explore core preparedness competencies every physician should possess
• Describe emergency situations that arise on a regular basis
• Identify resources to acquire preparedness training

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

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

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

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MSSNY & St. Peter’s Health Partners to Host Four Grand Rounds Seminars
The Medical Society of the State of New York and St. Peter’s Health Partners are providing four CME live seminars for the Veterans Matters programs. The following seminars will take place at St. Peter’s Hospital in Mercy Conference Rooms 1 – 4, 315 S Manning Blvd, Albany, NY 12208.

• The Special Mental Health Needs of Women Veterans
      When: January 15, 2020 at 7:00 am
  Faculty: Malene Ingram, MD (Col., US Army Reserves)

• Substance Use Disorders (SUDs) in Veterans
      When: January 22, 2020 at 7:00 am
  Faculty: Thomas Madejski, MD

• PTSD in Returning Veterans
      When: January 29, 2020 at 7:00 am
  Faculty: Adolph Meyer, MD

• Military Culture: Everything Physicians Need to Know about Veterans as Patients
      When: February 5, 2020 at 7:00 am
  Faculty: Lt. Cl. Lance Allen Wang

Reservations can be made by contacting Lori Weaver at Lori.Weaver@sphp.com or (518) 874-6914. Please click here to view the flyer.

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

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

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eNews

TODAY!
MSSNY Responds To Gov.’s Statement on Physician Discipline Proposal
“New York’s Physicians have a great interest in working with the State Health Department to ensure that New York’s disciplinary process moves swiftly when necessary to remove those from practice that present a threat to the public.  To that end, we have worked proactively with the Administration and Legislature on laws to enhance the ability of OPMC to “summarily suspend” physicians in certain instances where it would be imprudent to wait for a final action. And it is imperative that we work for improvements to this system as issues arise that interfere with its mission to protect the public.

At the same time, an appropriate balance is needed. Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct.  Indeed, most complaints of alleged misconduct do not become actual findings of misconduct. Yet with Google and Yahoo search functions, an unproven allegation could linger forever in cyberspace, and permanently and unfairly scar a reputation.  We look forward to reviewing the text of this proposal as it becomes available and working with the Legislature and Governor to ensure we maintain the critical balance of protecting the Public while also protecting against the consequences of unfounded allegations.”

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MSSNY President Criticizes Governor Cuomo’s Medicaid Cuts
Politico Pro (1/6) reports that healthcare providers, insurers, and others are pushing back against “the state’s new 1 percent across-the-board reduction in Medicaid spending” calling for Gov. Cuomo “to take a more targeted approach as it looks to close a $4 billion budget gap in the coming months.”

Dr. Art Fougner, the president of the Medical Society of the State of New York (MSSNY), said, “Physicians are confounded by the announced cuts to their payments for care delivered to Medicaid beneficiaries… This is particularly difficult to accept given that they were not the beneficiaries of increases to Medicaid payments recently granted to other parts of the health care system. In fact, Medicaid physician payment remains a very small part of New York’s overall Medicaid Budget.”

WSJ: Former MSSNY President Warns Risks of Expanding Marijuana Industry
In a letter for the Wall Street Journal (1/6) former President of the Medical Society of the State of New York Dr. Thomas J. Madejski, wrote:

“Regarding your editorial “The Vaping-Marijuana Nexus” (Dec. 26): Tobacco, marijuana and vaping companies mislead the public on the clear harms associated with wider use of today’s higher-THC-content marijuana and inhaling substances other than clean air. Opponents of expansion of marijuana availability acknowledge concerns about disparate enforcement of drug laws. But the costs to society from legitimizing the addiction industry far outweigh the benefits. Meanwhile, proponents of recreational marijuana push the false narrative of a tax windfall for governments and improved safety for users while ignoring the harms: mental-health issues, addiction, acute and chronic lung disease, domestic violence and more.”

Thomas J. Madejski, M.D.
Albion, N.Y.
Jan. 7, 2020
Dr. Madejski Is the Immediate Past President of MSSNY.

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Staten Island Hospital Opens Opioid Treatment Center for Teens, Young Adults
Richmond University Medical Center in Staten Island has opened a medication-assisted treatment center for people ages 16 to 24 who are struggling with opioid-use disorder.

The center, funded by a Statewide Health Care Facility Transformation Program grant, is in the Center for Integrative Behavioral Medicine, also known as the Silberstein Clinic, at 1130 South Ave.

The opening comes about a year after the Staten Island Mental Health Society became a division of the medical center in a merger.

A substance-use program has existed for adolescents ages 11 and older and their families, said Dr. Joel Idowu, chairman of psychiatry and behavioral health sciences at the medical center. However, he said, older people with opioid-use disorder also can benefit from medication-assisted treatment.

The treatment “offers something that frees you to be able to go to work and live your life like any other person,” Idowu said. “The medication is effective and helps people to stay sober, and it reduces the risk of overdose.”

An injectable form of one such medication, buprenorphine, is available through the new program, he said, adding that it comes in convenient monthly doses.

For most patients, insurance covers the treatment.

The medical center noted in a filing with the state that opioid misuse, including heroin misuse, among adolescents and young adults has “risen dramatically in the past two decades.” However, it said, treatment capacity for the population remains “extremely low,” and Staten Island has the highest incidence of opioid use and related deaths in the city.

The new program is aimed at addressing those gaps in care and aligning with the state’s Medicaid reform priority of integrating medication-assisted treatment into primary-care settings. (Crains’ Health Plus) Jan 6

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NYS Flu Statistics for Week of January 4
During the week ending January 4, 2020

• Influenza activity level was categorized as geographically widespread. This is the sixth consecutive week that widespread activity has been reported.
• There were 10,085 laboratory-confirmed influenza reports, a 9% increase over last week.
• The number of patients hospitalized with laboratory-confirmed influenza was 1,964, a 34% increase over last week.
• There were no influenza-associated pediatric deaths reported this week. There has been one influenza-associated pediatric death reported this season.
https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2019-2020/flu_report_current_week.pdf

Widespread Flu Activity Reported in 46 States

As of the last week of December, “widespread” flu activity was reported by health departments in 46 states. More ominously, a second measure — the percentage of patients with flu symptoms visiting medical clinics — shot up almost to the peak reached at the height of the 2017-18 flu season, which was the most severe in a decade. About 61,000 Americans died of flu that season, the CDC said. (The original estimate of 79,000 was revised downward last year; the agency said the number changed as more death certificate information became available.)

This year’s flu vaccine may not be particularly effective against the strain of the virus now widespread in the United States, experts said. According to the CDC, it is worth getting the shot because people who are vaccinated fare better if struck by the flu than those who are not.

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CDC Updates Guidelines for Discharging Vaping Patients
After a new study found at least one quarter of vaping-related rehospitalizations and deaths occurred within two days of discharge, the CDC now recommends outpatient follow-up within 48 hours, according to the CDC’s Morbidity and Mortality Weekly Report published Jan. 2.

A recent analysis of previously hospitalized EVALI patients found common comorbidities among patients who were readmitted or died after discharge. The findings prompted the CDC, in consultation with the Lung Injury Response Clinical Working Group, to revise EVALI patient guidelines, which previously recommended outpatient visits within two weeks of discharge.

Guideline updates for providers include:

1. Confirming that vital signs have not significantly changed for at least 24 to 48 hours before discharge.
2. Ensuring outpatient primary care or pulmonary specialist follow-up, ideally within 48 hours of discharge.
3. Planning discharge care, early follow-up and management of any comorbidities.
4. Following best practices for medication adherence.
5. Ensuring access to mental health and substance use disorder services.

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US Cancer Death Rates See Largest Single-Year Drop on Record
Overall cancer death rates in the U.S. fell by 2.2 percent from 2016 to 2017, the largest single‐year drop ever recorded, according to a report from the American Cancer Society. The annual report estimates the numbers of new cancer cases and deaths expected this year. It also compiles the most recent data on cancer occurrence from the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries and the North American Association of Central Cancer Registries.

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CMS

CMS Releases MIPS Results for 2018: 5 Things to Know
CMS published 2018 results for the Merit-Based Incentive Payments System program Jan. 6.

Five things to know about the results:
1. CMS Administrator Seema Verma said 2018 participation in MIPS, created under the 2015 Medicare Access and CHIP Reauthorization Act, exceeded participation rates in 2017.
2. More clinicians will receive a positive payment adjustment compared to the 2017 performance year, with nearly all eligible clinicians participating in MIPS getting a payment boost in 2020.
3. In total, 889,995 clinicians saw a MIPS payment adjustment, whether negative, neutral or positive. Ninety-eight percent of those clinicians will receive a neutral or positive payment adjustment.
4. Additionally, more rural and small practices will see positive payment adjustments compared to the 2017 performance year.
5. More clinicians are earning Qualifying Alternative Payment Model Participant status under the Advanced APM path than in the previous reporting year.

“Positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral,” Ms. Verma said. “This means that the funds available for positive payment adjustments are limited to the estimated decrease in payments resulting from the negative payment adjustments. However, because the thresholds have been lower, many providers have qualified. As the program matures, we expect that the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries and positive adjustments will increase.”

To view the full results, click here.

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MSSNY Benefit – Protect your hearing with American Hearing Benefits

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Deadline to Submit 2019 Registration and Attestation Info for MIPS Is March 2
The deadline to submit 2019 data for (CMS) Medicare Promoting Interoperability Program is March 2, 2020. 

As a reminder, in 2018, CMS transitioned to the QualityNet System (also known as CMS’s Hospital Quality Reporting [HQR] system) for hospitals that attest to CMS for the Medicare Promoting Interoperability Program. By transitioning to one system, CMS continues in their effort to streamline data submission methods.

Specific submission details for each program are listed below.

• Medicare Eligible Hospitals and Critical Access Hospitals (CAHs) – These participants must attest to CMS through the QualityNet Secure Portal.
• Medicaid Eligible Professionals (EPs), Eligible Hospitals, CAHs – These participants should follow the requirements of their State Medicaid agencies to submit their meaningful use attestation.
• Dual-Eligible Hospitals and CAHs – Those who qualify for both the Medicare and Medicaid Promoting Interoperability Programs are required to demonstrate meaningful use to CMS through the QualityNet Secure Portal (not their State Medicaid agency).

Registering on Behalf of a Medicaid EP?
An EP can designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System (I&A) web user account (User ID/Password) and be associated with the EP’s National Provider Identifier (NPI). If you are working on behalf of one or more EPs and do not have an I&A web user account, please visit I&A Security Check to create one.

Note: States and territories will not necessarily offer the same functionality for registration and attestation in the Medicaid Promoting Interoperability Program. Check with your state or territory’s Promoting Interoperability Program to see what functionality is offered.

Additional Resources

• QualityNet Secure Portal
• Eligible Hospital Information Webpage
• QualityNet Secure Portal Enrollment and Login User Guide

For More Information

Visit the Registration and Attestation page on the CMS Promoting Interoperability Programs website.

Medicare & dual-eligible hospitals participating in the Medicare & Medicaid Promoting Interoperability Programs may contact the QualityNet help desk for assistance at 1 (866) 288-8912 or qnetsupport@hcqis.org.

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PAI Comments on Stark Law and Anti-Kickback Proposed Rules
On December 31, PAI submitted comment letters in response to two proposed rules proposing modifications to the Anti-Kickback (AKS) Statute and the Physician Self-Referral (Stark) Law. The letters are attached and summarized below. Please share widely with your medical association staff and physician members.

PAI was generally supportive of both the Centers for Medicare and Medicaid Services’ (CMS’s) and the HHS Office of the Inspector General’s (OIG’s) efforts to remove regulatory barriers and create alignment between the Stark Law and AKS exceptions and safe harbors to encourage participation in APMs and innovative payment arrangements. We were also supportive of the new definitions related to value-based arrangements, including Value-Based Enterprise (VBE), VBE Participant, Value-Based Activity, Value-Based Purpose, etc., bought sought additional clarification on what would/would not satisfy these definitions and whether existing arrangements could be used to satisfy these definitions for the safe harbors and exclusions. PAI’s specific comments in response to each proposed rule are summarized below.

Anti-Kickback Statute Proposed Rule
PAI was supportive of the following proposed new safe harbors and updates to existing safe harbors, and made additional recommendations in response to each:

• Care Coordination Arrangements (CCAs) – PAI sought additional clarification on the “commercially reasonable” standard under AKS
• VBAs with Substantial Downside Risk – PAI recommended a more flexible definition for “risk-sharing”
• VBAs with Full Financial Risk – PAI expressed concerns that the VBAs with Full Financial Risk safe harbor would only be made available to larger, more integrated systems, and that smaller and rural practices may not be able to enter traditionally defined “full risk” models even though they are embracing downside risk
• Patient Engagement and Support Arrangements – PAI strongly supported focusing on improving access to items, services, and supports that address social determinants of health (SDOH)
• Blanket Safe Harbor for CMMI Model Participants
• Donation of Certain Cybersecurity Technology and Related Services – PAI urged the OIG to ensure that the donors must donate the technology with “no strings attached” tied to future upgrades, maintenance costs, etc.
• Outcomes-Based Payment Arrangements – PAI encouraged the OIG to also include full and partial capitation payments
• Updates to the EHR Safe Harbor – PAI opposed proposals that would allow the safe harbor exception to apply if the items or services were “deemed” to be interoperable, and urged how important it is for the OIG to continue focusing on how the data and systems are actually being used and information is being shared to ensure that information blocking is not occurring.
• Updates to the Warranties Safe Harbor
• Updates to the Local Transportation Safe Harbor – PAI supported expansion of this safe harbor to include ride-sharing services and urged the OIG to further expand the safe harbor to be inclusive of urban areas as well as “provide a ride” and telephonic-related programs and services
• Updates to the ACO Beneficiary Incentive Program – PAI codifying protections for beneficiaries but requested additional guidance on what is required for such protected beneficiary remunerations
• Exceptions for Telehealth Technology Definitions for In-Home Dialysis – PAI did not support the requirement that donations of such technology must be made available to all eligible Part B beneficiaries, as this may restrict small and rural providers from offering such donations entirely 

Stark Law Proposed Rule
PAI was supportive of the following proposed exceptions and made additional recommendations in response to each:

• Exceptions for Full-Risk Models – PAI commented that full-risk should be more inclusive of other types of arrangements in addition to capitated payments, including bundled and episodic payments, and that additional flexibility should be considered for demonstrating “full-risk” arrangements
• Exceptions for VBAs with Meaningful Downside Financial Risk to the Physician – PAI expressed concerns with defining “meaningful downside risk” and believed that the 25% threshold is too high and should be decreased to 5%
• Exceptions for General VBAs – PAI supported general exceptions for VBAs, regardless of risk, as we believe this exception will be most applicable for independent, small, and rural practices. However, PAI did support the contribution requirement of 15% for VBAs under such exceptions as it could adversely impact the same group of physicians and practices.
• Price Transparency – PAI believes that any information to be made public should first be shared with physicians and others to ensure that it is accurate, and that physicians have appropriate time to review and correct the information.

In addition to the above, PAI also provided comments on additional technical changes proposed in the rule.

http://www.mssnyenews.org/wp-content/uploads/2020/01/PAI-2019-AKS-Proposed-Rule-Comment-Letter.pdf

http://www.mssnyenews.org/wp-content/uploads/2020/01/PAI-2019-AKS-Proposed-Rule-Comment-Letter.pdf

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