MSSNYeNews: What Matters – March 27, 2020

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

March 27, 2020

Vol. 23  Number 13




In the midst of pandemics, budget battles, regulations, legislation, resolutions, reality has the nasty habit of jumping into the mix like a collection notice from a bill long since forgotten. Never easy, certainly never pleasant, but there it is. Life told me to pass on its very hard lesson so here goes. Don’t worry, I will keep it short.

We are all here for a blink of the cosmic eye. We live, we laugh, we cry, we dance and then we are gone.

Embrace those around you. Friends and enemies are but two sides of the same coin. What’s important are family, colleagues, and yes, our patients. Everything else is just so much of life’s gift-wrapping – pretty but soon discarded. Embrace those around you – albeit virtually in the Age of Coronavirus – but embrace nonetheless. Remember that it’s what matters that truly matters.

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

MLMIC Insurance Banner Ad


The state reports 44,635 confirmed cases and 519 deaths statewide, as of Friday morning, including 25,398 cases in New York City, 7,187 in Westchester County, 4,657 in Nassau County, 3,385 in Suffolk County, 1,457 in Rockland County, 910 in Orange County, 225 in Dutchess County, 219 in Erie County, 187 in Albany County, and 160 in Monroe County.
Coronavirus COVID-19 Global Cases by Center for Systems Science & Engineering at Johns Hopkins University

Main Points from Governor Cuomo’s On-going Announcements:

  • Extending the school closures until April 15th, as well as the 180-day mandate waiver.
    – Continuation of distance learning.
  • Additional bed sites / requesting temp hospital from FEMA, 4,000 more over 4 sites:
    – Bronx: NY Expo Center
    – Queens: Aqueduct
    – Brooklyn: Brooklyn Cruise Terminal
    – Staten Island: College of Staten Island
  • Looking at CUNY City College and CUNY Queens College as additional site
  • Looking at Marriott Brooklyn Bridge and Brooklyn Center Nursing Home as additional sites.
  • For a 60-day period, consumers and small businesses experiencing financial hardship due to COVID-19 may defer paying premiums for property and casualty insurance, including auto, homeowners, renters, workers comp, medical malpractice, livery and taxi. No late fees will be assessed and no negative data will be reported to credit bureaus during this time, and late payments will be payable over a one-year period.

NYS Asks Physicians to Volunteer During COVID-19 Pandemic
Governor Andrew Cuomo and the New York State Department of Health is requesting that physicians and other health care providers volunteer during the COVID-19 pandemic. Many MSSNY physicians have inquired about the process and the NYS Department of Health is coordinating volunteers for this effort.  All physicians, even retired physicians, must go through this portal.

There are a series of questions that are asked regarding name, specialties and certification, age, county of residency.  By completing the form, DOH and SED will check that your credentials are up to date and, if needed, recertify the physician.  Out of state physicians and health care providers should also use this portal.  Earlier this week the governor announced civil liability immunity protections for physicians and other health care practitioners in responding to the state’s COVID-19 outbreak.

According to officials from the NYS Department of Health, retired physicians and other health care providers will most likely be redirected to care for patients that are not afflicted with COVID-19.  Activation will be from either the New York State Health Department or the local county health department.

The Department of Health developed the ServNY volunteer registry in partnership with county health departments, the New York City Department of Health and Mental Hygiene, the Medical Society of the State of New York, hospital associations, and other medical professional organizations. Physicians can volunteer through their Health Commerce System Account by going to the ServNY portal at: go to

The registry, established in the aftermath of the 9/11 terrorist attacks, is currently used by all local health departments and Medical Reserve Corps for management of volunteer programs.

As New York state climbs the steep face of its COVID-19 curve, Gov. Andrew Cuomo (D) issued an executive order vastly widening the scope of practice for some healthcare providers and absolving physicians of certain risks and responsibilities.

Among the order’s provisions:

  • Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
  • Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
  • Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
  • Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
  • Granting providers immunity from civil liability for injury or death
  • Suspending usual record-keeping requirements
  • Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
  • Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries

The order, which remains in place through at least April 22, was met mostly with applause, though with some hesitation around work-hour limits. (MedPage, March 27)

What’s in Stimulus Package: Provisions of Interest to Physicians
Late Wednesday night the Senate approved a massive $2 trillion stimulus and COVID-19 relief package. House passage is expected on Friday and the President is expected to sign the bill into law.

Provisions of particular interest to physicians and their practices include the following:

  • Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
  • $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
  • Suspension of the 2% Medicare sequester in May through December 2020.
  • Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
  • A temporary waiver of the face-to-face visit requirement with home dialysis patients.
  • Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
  • Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

Also of interest, the “health extenders” package that was set to expire on May 22 has now been extended to Nov. 30. For a complete summary once the bill is signed into law, visit the AMA COVID-19 website.


Registration Now Open “Psychosocial Dimensions of Infectious Outbreaks” WEBINAR

April 1st @ 7:30am

MSSNY’s has expedited the presentation of the next Medical Matters webinar “Psychosocial Dimensions of Infectious Outbreaks” on Wednesday April 1st at 7:30am.  This program provides physicians with vital information to care for patients, staff, family and themselves during this unprecedented pandemic. 

Faculty for this program is Craig Katz, MD.

Educational Objectives are:

  • Understand common human reactions to infectious outbreaks
  •  Explore factors that influence how people react
  • Describe how to apply historical lessons to your own medical practice

This program is a companion piece to the March 18th coronavirus webinar, Coronaviruses 2020: COVID-19 An Evolving Story.  You can go to the MSSNY CME website to view this and many other free CME webinars that are particularly relevant to the current pandemic situation. 

Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

You can also listen to the podcasts MSSNY has produced about COVID-19 by clicking on the links below:

The Psychosocial Impact of COVID-9
Physician Information on COVID-19
Patient Information on COVID-19

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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.

Navigating A Murky Landscape: An Employer’s Guide to Responding To Challenges of COVID-19

Monday, March 30, 2020
2:30 PM – 3:30 PM EDT

The outbreak of the global COVID-19 virus has confronted employers with unprecedented challenges in maintaining their workplaces and operational viability. With ever-increasing speed, new laws are being enacted by the Federal and local governments that are designed to soften the economic and health and safety impacts posed by the COVID-19 virus, but which also, no matter how well intentioned the legislatures, create confusion about available feasible options for employers on how to move forward in sensible, compliant and practicable fashion.

Garfunkel Wild PC will be presenting a webinar designed to assist employers in tackling these steep challenges. The webinar will address such issues as:

  • Highlights of the updated Federal leave laws.
  • Highlights of the updated New York State leave laws.
  • What is the type of “order” that triggers an employee’s entitlement to leave under the new statutes?
  • Who is a healthcare provider?
  • Staff reductions, reduction in hours and terminations.
  • An employer’s obligations under the WARN Act.
  • Practical considerations on dealing with the challenges.

Pain Management, Palliative Care and Addiction Online Program Now Available
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here.

The Medical Society of the State of New York announces an updated series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers, holding a DEA license, to complete three hours of coursework every three years.  Coursework must include the following:

  • New York State and federal requirements for prescribing controlled substances
  • Pain management
  • Appropriate prescribing
  • Managing acute pain
  • Palliative medicine
  • Prevention, screening and signs of addiction
  • Responses to abuse and addiction
  • End of life care

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.   Non-MSSNY members will be charged $50 per module.

Series programs include:

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Robert Kent, Esq., NYS OASAS General Counsel

Educational Objectives:

  • Understand New York State and Federal Requirements for Prescribing Controlled Substances
  • Discuss Guidelines for Chronic Pain

When to Consider Opioid Therapy for Chronic Non-Cancer Pain & in Palliative Care

Faculty: Charles Argoff, MD
Educational Objectives:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation
  • Describe palliative medical care and end-of-life care

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Marc Manseau, MD, MPH, NYS OASAS Medical Director
Educational Objectives:

  • Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral
  • Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed
  • Describe Strategies for Treating Pain in Patients with Substance Use Disorders

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.

Additional information or assistance may be obtained by contacting Melissa Hoffman at or 518-465-8085



Medicaid Allowing Phone Visits Only for Telemedicine
Medicaid is allowing phone, only for telemedicine, during the pandemic.  WC is following Medicaid rules listing the codes as 99441, 99442 and 99443.  I don’t think these codes will result in PAYMENT parity.

But, most plans, including Medicare and Medicaid, are accepting 99211 – 99215, with the GT modifier, which should result in payment parity.  If there is a medical condition, psychiatrists and ophthalmologists should also be able to use these codes, as well.

In addition, with the rules being relaxed including HIPAA rules, use of an iphone or similar equipment with audio/video for telemedicine is being accepted during this pandemic. (Regina McNally, VP MSSNY Socio-Medical Economics Div.)

CMS Call: Lessons from the Front Lines-Saturday, March 28 12noon-2:00 PM
On behalf of CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force, I am writing to invite the physician membership of your organization to the next call in our new series for physicians: Lessons from The Front Lines: COVID-19.

The call will take place on Saturday, March 28th from 12:00 PM – 2:00 PM EST, and the topic of discussion is: COVID-19 Therapeutics. We invite you to join us to share your ideas, strategies, and insights with one another.Please see dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

Participant Dial In: 877-251-0301
Conference ID: 9409959
Audio Webcast

If you have specific best practices related to COVID-19 therapeutics you are interested in sharing with your peers, please respond to me by 5 PM today and we would be glad to add you to our agenda. 

As always, we appreciate your feedback and collaboration as we address this important issue together.

US Has Fewer Physicians and Hospital Beds Per Capita than Italy and Others
A new analysis and chart collection finds that the U.S. has fewer hospital beds and practicing physicians per capita than many similarly large and wealthy countries with health care systems already strained by the ongoing COVID-19 pandemic.

Compared to Italy and Spain, two countries in which hospitals have already been overwhelmed by an influx of COVID-19 patients, the U.S. has fewer practicing physicians per capita – 2.6 per 1,000 people, compared to 4.0 in Italy and 3.9 in Spain – but more licensed nurses. While the U.S. has a higher number of total hospital employees than most comparable countries, nearly half of that workforce is comprised of non-clinical staff who are not directly involved in delivering care. (KFF-Petersen March 27)

Upstaters Want Downstaters to Stay Away
In an attempt to slow the spread of the novel coronavirus, Upstate counties are warning anyone traveling from New York City to self-quarantine for two weeks or stay away entirely. The requests have no legal backing as only Gov. Andrew Cuomo could give such an order, but they come as the number of cases in New York City continue to grow and upstate health departments predict that they could soon see a similar surge, possibly overwhelming their capabilities. Governors in at least two states have also mandated that anyone who travels from the New York metro area must self-quarantine for two weeks after arriving.

Wednesday evening, county leaders in Rensselaer and Saratoga counties asked Cuomo order that anyone who travels from Westchester or New York City to self-quarantine, following a recommendation from Deborah Birx, the White House coronavirus response coordinator. On Thursday, Rensselaer County Executive Steve McLaughlin asked Cuomo to ban non-essential travel from the same areas. McLaughlin said five Troy residents who tested positive for COVID-19 had recently re-located from New York City. (Times Union, March 27)

Army Field Hospitals to Start Taking Non-COVID-19 Patients in NY on Monday
Three Army field hospitals have begun to deploy to New York and Washington state, the regions hit hardest by the coronavirus, and the facility in New York will start taking non-COVID-19 patients on Monday, according to Army officials.

  • The Army field hospitals will provide 284 beds in New York and 248 in Seattle to relieve stress on hospitals treating patients stricken with the coronavirus, Army Chief of Staff Gen. James McConville told reporters today.
  • The advanced party from the Army’s 531st Hospital Center from Fort Campbell, Ky., and the 9th Hospital Center from Fort Hood, Texas, are already on the ground in New York, McConville said. The main party will arrive at Joint Base McGuire-Dix-Lakehurst, N.J., Friday, and will set up at the Javits Center in Manhattan this weekend, McConville said.
  • The New York National Guard, the Army Corps of Engineers and Javits employees are hard at work converting the Javits Center into a makeshift disaster hospital with 1,000 beds to help with the city’s coronavirus response.
  • In total, roughly 650 personnel are heading to New York and a little over 600 to Seattle to help with the crisis, Army officials said. (Politico Pro 03/26/2020 02:50 PM EDT)

Do Not Bill for Telemedicine Until Further Instruction
I just was on a call with NGS MEDICARE.  They state they have not received direction from CMS on how to process claims for telemedicine.  Therefore, NGS MEDICARE is asking that telemedicine claims NOT BE SUBMITTED until CMS provides NGS with clear instructions regarding telemedicine claims processing procedures.  This is in an effort to avoid unnecessary claim denials.

As soon as NGS MEDICARE hears from CMS, they will advise us.

–From Regina McNally, VP MSSNY’s Socio-Med Economics Div.

Medicaid Guide re Use of Telehealth
An updated version of the Medicaid Update Special Edition – Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency, which now includes clarifications for FQHC billing as well as billing for home care providers, has been posted. This guidance was originally issued on March 21, 2020. The Department will be scheduling a webinar shortly to walk through this guidance and a set of FAQs for Medicaid telehealth are under development.

This document will be updated frequently so please continue to check the COVID-19 Guidance for Medicaid Providers webpage and the Medicaid Update webpage  for updates and amendments.

AMA: Ethical Challenges in a Pandemic
The COVID-19 pandemic poses ethical challenges and exceptional demands for physicians in the United States.

While caring for the anticipated surge of seriously ill COVID-19 patients, physicians are very likely to encounter heart-wrenching decisions. Meanwhile, physicians face having to balance the obligation to provide urgent medical care during emergencies, with risks to their own safety, health or life. The current pandemic offers each member of the medical profession a unique opportunity to reflect anew on medical ethical dilemmas that arise in the face of adversity.

During the COVID-19 pandemic, some of these ethical challenges will include:

  • Allocation of limited resource
  • Caring for patients in the face of personal risk
  • Use of quarantine and restrictions of personal liberty

The Code of Medical Ethics offers detailed ethical guidance to physicians on these issues that will help physicians approach the difficult decisions in the days ahead.
For more information, please see the AMA’s list of newly released resources on ethical challenges that arise during pandemics

MLMIC: Staff Ready to Answer Questions 24/7
Due to the minute by minute changes regarding COVID-19, MLMIC is keeping our insureds informed via email blasts, our website, blog, as well as through our social media accounts via Twitter and Linked In.

For those insureds who face challenges to their practice due to COVID-19, MLMIC is offering the following:

  • MLMIC’s toll free 24/7 Legal Hotline – (855) FAKS-LAW (1-855-325-7529) can help address many questions or concerns that may arise.
  • Our staff remains directly available via phone (800) ASK-MLMIC(1-800-275-6564) and every effort will be made to handle inquiries and answer questions regarding claims, coverages and policies on an immediate basis.
  • Blog:  Guidance on Using Telemedicine for Coronavirus – click here


This Week’s Legislative Podcast

Garfunkel Wild Ad


MSSNY Grassroots Banner

When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.orgThank you. (WILKS)