MSSNYeNews: April 10, 2020 – The Angel of Death and the Resurrection

Arthur Fougner MSSNY Presiident


Arthur Fougner, MD
MSSNY President

April 10, 2020

Vol. 23  Number 15



This year the religious holidays of Passover and Easter fall under the shadow of the COVID19 pandemic. Somehow, I find this eerily apropos. The Israelite slaves, by smearing the blood of the lamb on their doors, hunkered down as the Angel of Death passed. Trusting in the Lord, they readied themselves for the terror of that night while preparing for the promised land. Today we are hunkering down as today’s Angel of Death – the SARS-CoV2 virus – is upon us. Trusting in our guidance, we are awaiting the journey back to the new promised land.

The Feast of the Resurrection is a metaphor for our recovery. The trials and tribulations of this vale of tears will give way as we all will rise again. We will always remember the effort of society’s Healthcare Heroes who facilitated the rebirth from social distancing to social activity and who helped all of us out of the darkness and into the light.

We should never forget those who gave their all, sacrificing themselves in the struggle against the virus. One of our colleagues, Dr. Michael Goldstein, has prepared a Petition to form the COVID-19 First Responders Fund for all first responders, including physicians, nurses, technicians, therapists, nursing aides, paramedics, housekeeping and all of the other members of the healthcare team treating Coronavirus patients in Emergency Departments, Inpatient Hospital beds and Intensive Care Units. 

As Sir Winston Churchill famously exclaimed: “Never was so much owed by so many to so few.” I urge everyone to sign – to get family and friends to sign.

It’s the least we can do.

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President


COVID-19 Statistics 

CMS Now Distributing First 30 Billion of CARES Provider Pool
CMS announced its methodology for distributing the first $30 billion of the $100 billion CARES health care provider pool as set forth in the recent stimulus bill.

The Florida Medical Association has estimated through a “back of the envelope” calculation that, based on the allocation method in the press release, physicians should expect to receive $61,983 for every $1 million in Medicare payments to the physician or physician group’s Tax ID in 2019. (Moe Auster)

This allocation method is similar to the recommendation from organized medicine because we recommended that the distribution be tied to physicians’ Medicare FFS spending from a portion of 2019, pre-COVID-19.

It differs from our recommendation in several respects: instead of using a one-month average of three months of Medicare spending, it uses spending for the entire year 2019; and it does not multiply that amount by three to average all-payor revenue for a month. Also, it does not employ any methodology to pay physicians who may have no or few Medicare claims but rely significantly on Medicaid funding; but, at a White House Coronavirus Task Force briefing earlier this week, Administrator Verma indicated that a subsequent distribution from the Emergency Fund will be directed to pediatricians, children’s hospitals, and others who rely on Medicaid.

All facilities and health professionals that billed Medicare FFS in 2019 are eligible for the funds. These are grants, not loans, and do not have to be repaid. Note that the funds will go to each organization’s TIN which normally receives Medicare payments, not to each individual physician. The automatic payments will come to the organizations via Optum Bank with “HHSPAYMENT” as the payment description.

The portal attest for this payment will open the week of April 13th. 

Additional details about the allocation are available here.

According to the press release, HHS has partnered with United to provide rapid payment for the distribution of the initial $30 billion in funds.  Eligible providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS). The automatic payments will come to providers via Optum Bank with “HHSPAYMENT” as the payment description.  Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.

Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020.  Of particular note is the statement in the press release that one of the conditions of this distributions is that “providers are obligated to abstain from “balance billing.”

Using CS Modifier When Cost-Sharing is Waived
This clarifies a prior message that appeared in our April 7, 2020 Special Edition.
CMS now waives cost-sharing (coinsurance and deductible amounts) under Medicare Part B for Medicare patients for certain COVID-19 testing-related services.  Previously, CMS made available the CS modifier for the gulf oil spill in 2010; however, CMS recently repurposed the CS modifier for COVID-19 purposes.

Now, for services furnished on March 18, 2020, and through the end of the Public Health Emergency, outpatient providers, physicians, and other providers and suppliers that bill Medicare for Part B services under specific payment systems outlined in the April 7 message should use the CS modifier on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services and to get 100% of the Medicare-approved amount.  Additionally, they should NOT charge Medicare patients any co-insurance and/or deductible amounts for those services.

IMGs Can Enter US to Begin Residency Programs
The U.S. State Department responded to an AMA request and agreed to resume processing visa applications at U.S. embassies and consulates to ensure that non-U.S. citizen international medical graduates (IMGs) can enter the country to begin their residency training programs this summer and bolster the health care workforce fighting the COVID-19 pandemic.

“We encourage medical professionals with an approved U.S. non-immigrant or immigrant visa petition (I-129 or I-140 with a current priority date, or similar) or a certificate of eligibility in an approved exchange visitor program (DS-2019), particularly those working to treat or mitigate the effects of COVID-19, to review the website of their nearest embassy or consulate for procedures to request a visa appointment,” the department’s announcement states.

“For those foreign medical professionals already in the United States: J-1 Alien Physicians (medical residents) may consult with their program sponsor, ECFMG [the Educational Commission for Foreign Medical Graduates], to extend their programs in the United States,” the State Department adds. “Generally, a J-1 program for a foreign medical resident can be extended one year at a time for up to seven years.”

Additionally, the AMA is advocating on behalf of non-citizen IMGs who are severely restricted as to where they can practice under the terms of their H-1B visas—this includes some physicians who now cannot work as a result of being furloughed after the facilities they were working at closed.

NY: Fewer New Hospitalizations; Patients Being Treated Doubled
The coronavirus has killed more than 16,600 people in the United States — second only to Italy. The state of New York has recorded more than 7,000 deaths, though Gov. Andrew Cuomo says there continue to be encouraging signs that the rate may be leveling off, including fewer new hospitalizations. However, the number of patients being treated at overflow hospitals in New York City has more than doubled in the last two days, according to the Department of Defense. (NPR, April 9)

Gov. Cuomo Calls for Congressional Funding Aid
Gov. Andrew Cuomo renewed his call for federal action to help New York during the coronavirus pandemic on Thursday, arguing that congressional aid, including enhanced Medicaid funding, has fallen woefully short.

Hours after a partisan stalemate sidelined new coronavirus relief in the U.S. Senate, Cuomo urged Congress to approve federal legislation that stabilizes state and local governments.

“To our federal representatives … this is no time for politics. This is a time to enact the legislation that actually addresses the need,” he said at a morning news conference. “I was in Washington for eight years; I get how the political process works in Washington. Not here and not now, my friends.”

Cuomo said, however, that he’s “not that confident” the federal government will take such action.

Legislation offered by Senate Democrats on Thursday would have given New York state government as much as $16 billion in new federal aid. The bill was blocked as chamber Republicans and Democrats rejected each others’ coronavirus aid proposals.

He took particular issue with enhanced Federal Medicaid Assistance Percentage, or FMAP, dollars approved last month — funding which the governor repeatedly criticized while finalizing his fiscal year 2021 budget.

“They passed legislation that was enacted, we were told would bring $6 billion to health care. When we did our state budget a couple of weeks ago, we believed what they said, and thought we were looking at $6 billion in health care funding,” he said. “Turns out when we actually read the language it was actually about $1.3 billion for the state of New York … and the funding disqualified one-third of New York’s Medicaid recipients, which nobody said.”

The New York State Association of Counties, which previously urged the governor to use the eFMAP funds, joined Cuomo in urging the state’s congressional lawmakers to pass a new stimulus bill that increases federal Medicaid assistance and provides unrestricted funding for lost revenue.


“COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid” 

CME Webinar on April 29th
Registration Now Open

MSSNY announces a new webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am.  Faculty for this program is William Valenti, MD and Craig Katz, MD.

Registration is now open for this webinar.   

Educational objectives are:

  • Explore the role of office-based physicians during the COVID-19 pandemic
  • Describe surge preparedness procedures for infectious disease outbreaks
  • Identify wellness and resiliency strategies to use during infectious outbreaks

To view a flyer for this program, please click here.

To view the companion pieces to this webinar, be sure to go to and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020 and Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020.

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. 


AMA Offers New Financial and Employment Resources for Physicians
 The AMA announced two new resources for physicians in response to the unique financial and employment challenges posed by the COVID-19 pandemic. The Know Your Rights: Navigating Physician Employment During COVID-19 Guide and Physician Practice Financial Relief Guide build on the AMA’s continued efforts to equip physicians and their practices with the latest, up-to-date information and resources necessary to navigate the changing landscape of COVID-19.

“From protecting fair and just working conditions to helping offset financial hardship, the AMA is working to help all physicians who are facing remarkable, unforeseen challenges due to COVID-19,” said AMA President Patrice A. Harris, M.D., M.A. “These timely and topical resources were designed to help physicians focus on what they do best: treat patients and save lives.”

Know Your Rights: Navigating Employment during COVID-19  
The Know Your Rights: Navigating Employment During COVID-19 guide helps physician employees and contractors of hospitals, health systems and other entities navigate the challenges and unique circumstances presented by COVID-19. It includes strategic, legal, and contractual considerations for physicians dealing with issues such as the financial distress of their employer, changes in clinical service demand, and growing anxiety related to caring for patients diagnosed with COVID-19.

Other topics covered in the guide include:

  • An overview of employment law applicable to changes of compensation and services, ranging from information on the application of contract law to employment relationships.
  • What to consider when negotiating compensation and other details in connection with continued employment/retention strategies, including attention to what is feasible under new blanket waivers under the Stark law, hazard pay opportunities and others.
  • Key issues in connection with exit strategies and packages, including severance/transitional support, waivers of non-compete provisions, non-solicit provisions, divestiture or retention of personal investments (e.g. enterprises / ASCs), and access to resources (EHR, personnel, telehealth technology, etc.).

AMA Physician Practice Financial Relief Guide
The AMA’s new Physician Practice Financial Relief Guide highlights the various options established by the federal government to help physician practices offset the financial impact of COVID-19, including:

Many of these programs were enacted into law after significant AMA COVID-19 advocacy with the U.S. Congress and Administration as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act and are now being implemented by federal agencies.

Additional information and resources to help physicians navigate the COVID-19 pandemic can be found on the AMA’s COVID-19 Resource Center.


COVID-19 Update: Guidance on Exposed, Asymptomatic Workers; CPR Recommendations; Case for Face Masks / Convalescent Plasma Guidance
The CDC says that critical infrastructure workers who have been exposed to SARS-CoV-2 but are not symptomatic can continue to work under certain conditions:

·     Employees’ temperatures should be taken, and symptoms assessed before work resumes, and they should regularly self-monitor. If employees develop symptoms, they should not work.

·     A face mask should be worn for 14 days since the last exposure.

·     Employees should maintain a 6-foot separation from one another if possible.

·     Workspaces should be regularly cleaned and disinfected, particularly areas that are commonly touched.

This guidance applies to workers in 16 sectors, including healthcare, law enforcement, agriculture, and transportation.

In other novel coronavirus disease (COVID-19) news:

Several medical groups have compiled recommendations for helping patients in cardiac arrest who have confirmed or suspected COVID-19. For instance, lay rescuers and the patient can wear face masks to help reduce the risk for viral transmission. The recommendations appear in Circulation.

  • An analysis in The BMJ makes a case for the public wearing face masks, even when the evidence doesn’t overwhelmingly support their use. The authors write: “As with parachutes for jumping out of aeroplanes, it is time to act without waiting for randomised controlled trial evidence… Masks are simple, cheap, and potentially effective. We believe that, worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life.”
  • The FDA has published guidance on collection and use of convalescent plasma as a potential treatment for COVID-19.


CDC interim guidance (Free)
Cybersecurity and Infrastructure Security Agency memo on critical infrastructure workforce (Free)
CDC guidance on disinfecting surfaces (Free)
Circulation article on CPR guidance (Free PDF)
The BMJ analysis (Free)
FDA guidance on convalescent plasma (Free PDF)
NEJM Journal Watch COVID-19 page (Free)
NEJM COVID-19 page (Free)

Members: Did you pay your dues? 

This Week’s Legislative Podcast

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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.

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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)

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98point6 is Looking for Part-time, Per Diem Physicians to help Address COVID-19 Volumes
Virtual care can play a pivotal role in keeping our communities safe and will be an increasingly important part of the fight to mitigate COVID-19. As an on-demand, text-based virtual care service, 98point6 is now hiring part-time physicians to expand our reach of care as clinic volumes continue to grow. We are deeply committed to delivering an incredible patient experience. Through an expedited credentialing and training process, we will be able to add physicians to our pool within one week of hire date. If you are interested in joining the 98point6 team apply here today.