MSSNY eNews – April 19, 2019 – Empowering Physicians Once Again

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews April 19, 2019 Vol. 22  Number 15

 

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Colleagues:

When Gerald Ford took the oath of office, he offered that he was a Ford not a Lincoln. Heck, I’m a Fougner, not a Madejski.

I just hope I’m not an Edsel!

In the early 1980s while a young attending at North Central Bronx Hospital, Dr. George Kleiner decided they needed someone with ultrasound skills for his department and was kind enough to get me going. Fast forward to 1986 and I was now offering my services to private patients in the community, including many patients from other OB-GYNs. One physician then told me that the reason that he did not refer was that he somehow felt his patients would be so impressed that they’d leave his practice for mine. Ridiculous right? But I thought about it long and hard and decided to get a life and no longer respond to the 3AM hospital calls. I delivered my last baby in 1992 and consider myself ahead of the unfortunate trend of OB’s abandoning obstetrics for “gynecology only” practice which is collateral damage on the med-mal front.

Forces Against Us

And the front it is. For many years, there has been a War on Doctors. While there have been few pitched battles, there has been the daily toll of minor skirmishes. About ten years ago, I likened the forces confronting medicine to Cerberus, the Hound of Hades, who stood guard over the Greek Underworld. As often is the case, I was wrong. Today, that beast has morphed into an ugly, multi-headed Hydra. Yes, we still battle Trial Lawyers, Government Regulators and Insurers, but there are also Health Policy Wonks, Administrators of all sorts, Pharma and PBMs, EHRs, and— yes— even our own Boards confront us over Certification.

In Christopher Nolan’s 2005 movie “Batman Begins,” the martial arts expert who schools Bruce Wayne and remarks that “Criminals thrive on the indulgence of society’s goodwill.” Folks, today EVERYONE thrives on the indulgence of Doctors’ goodwill. Medicine is known as a learned profession yet its practitioners have so little say in the manner in which they practice their profession. We’re a Doctors’ Organization. Without doctors, what will our patients do? 

On every flight, the attendant runs a drill. The rule is that the fit place their oxygen masks on first before attending to others. Otherwise, no one is fit. Physicians, we need to learn to care for ourselves first. If something is not good for doctors, how can it be good for patients?

Our largesse is killing us. And it shows. Whatever you choose to name it, Burnout, Abuse, Moral Injury, Disillusionment, it’s real and it is killing doctors. Suicide among physicians is double that of the general public.

Fourth Pillar

Two years ago, Dr. Charles Rothberg introduced Three Pillars – Wellness, Diversity, and Engagement.

This year, I propose a fourth – EMPOWERMENT!

The good book tells us that the Father’s House has many mansions. Well, the House of Medicine has many silos. We have specialty societies, ethnic societies, alumni societies, staff societies. We have employed physicians and independent physicians. All too easily, our differences morph into opposition. Others see this … and they use it against us. Divide and conquer – Specialty vs. Specialty, Specialty vs Primary Care, Ethnic vs Ethnic, Upstate vs Downstate, Independent vs Employed, Health System vs Health System. Our differences ultimately lead to division, disillusionment and defeat.

The good book tells us that the Father’s House has many mansions. Well, the House of Medicine has many silos. We have specialty societies, ethnic societies, alumni societies, staff societies. We have employed physicians and independent physicians. All too easily, our differences morph into opposition. Others see this … and they use it against us. Divide and conquer – Specialty vs. Specialty, Specialty vs Primary Care, Ethnic vs Ethnic, Upstate vs Downstate, Independent vs Employed, Health System vs Health System. Our differences ultimately lead to division, disillusionment and defeat.

Solidarity is the key to Empowerment. Doctors everywhere, tear down these silos!

Physician Wellness is today’s buzzword. And kudos to the Northwell Health System for showing a private screening of the film “Do No Harm,” a powerful expose on the forces that can drive intelligent, talented physicians to despair—sometimes— even suicide. In fact, Dr. Ira Nash, head of Northwell’s Physician Partners, was able to intervene in a physician’s cry for help in response to the email announcing the film. Many resources are available for doctors in need. But in NY State, a physician’s plaintive cry can lead to an OPMC investigation! Our Society is negotiating with OPMC to institute a system similar to the POPPA program available for police officers in need. If all NY’s physicians to cry out in unison, this would certainly happen.

Make it so! The path to wellness runs through empowerment!

Getting Onboard

We need all physicians to get onboard. So what’s holding up engagement? The inertia of past frustrations stands in the way of the enthusiasm of winning. The silos remain intact. I get this all the time: “But what have you done for ME lately?”

Engagement without a sense of Empowerment is an exercise in futility. Defeatism is a tough nut to crack. While there are articles bemoaning the End of the Doctors’ Lounge, know that there are new Doctors’ Lounges every day called Social Media. Here our younger colleagues can show us the way because we need all the help we can get!  If the truth is out there, then let’s mobilize our younger physicians to spread the word.

Start small. Pick issues where most agree and roll with it! When folks get in the habit of working together successfully, the feeling perpetuates itself, making the harder stuff easier.

We’re the ones who managed to pass Gross Anatomy.

We can do this! This is not about me, it’s about everyone. E pluribus unum!

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

Arthur Fougner, MD
MSSNY President

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eNews

Resolution Highlights: MSSNY’s 2019 House of Delegates
Nuisance Prior Authorizations
Medication prior authorizations must have a sound clinical justification, including, but not limited to, promotion of adherence to guidelines, promotion of generic alternatives, prevention of adverse reactions, and be available upon request from the Pharmacy Benefit Manager. MSSNY will advocate with the NYS Department of Health and NYS Department of Financial Services to prevent health insurers from imposing prior authorizations without appropriate clinical justification. MSSNY will advocate to the NYSDOH to instruct Medicaid managed care contractors to approve prior authorizations for a minimum of one year. 

Single Payer
MSSNY reaffirmed its opposition to the concept of single payer. MSSNY will continue to consider the feasibility of other payment methodologies including single payer and will also continue to work collaboratively with physicians who both support and oppose such proposals in order to assess the strengths and weaknesses of such proposals. MSSNY will continue to advocate that physicians are ensured direct input and ongoing involvement on all aspects of any single payer system or other system that may be considered by the New York State Legislature or United States Congress. 

Mental Health Services for Medical Students
MSSNY will encourage Medical Schools in New York State to provide confidential in-house mental health services at no cost to students, without billing health insurance, and set up programs to educate both students and staff about burnout, depression and suicide and bring this resolution to the AMA. MSSNY will encourage Medical Schools in New York State to offer, affordable, confidential off-site counseling. 

Continuing Certification of Medical Competence
MSSNY will adopt the position that verifiable demonstration of currency and competence in medical practice should include as an acceptable alternative to continuing board certification by the appropriate medical specialty board(s) the following: written attestation of good professional standing in the appropriate community(s) of practice by a minimum of two peers also in good standing in the same community; satisfactory completion of a minimum of 50 hours every two years of CME experiences related to the specialty(s) of medicine in which one currently practices, in accordance with the current practices of the appropriate medical specialty(s); and validated self-assessment of current cognitive knowledge following no fewer than 20 hours every two years from the above cited CME experiences. 

Advancing Gender Equity in Medicine
MSSNY will promote pay structures based on objective, gender-neutral criteria; promote educational programs to empower physicians of all genders to negotiate equitable compensation; advocate for training to identify and mitigate implicit bias in compensation decision making for those in positions to determine salary and bonuses; collect and analyze comprehensive demographic data and produce a report on gender equity within MSSNY with recommendations to support ongoing gender equity efforts. 

MSSNY Policy on Gender Equity in Medicine
MSSNY will support institutional, departmental and practice policies that promote transparency in defining the criteria for initial and subsequent physician compensation; advocate for pay structures based on objective, gender-neutral criteria; encourage a specified approach, sufficient to identify gender disparity to oversight of compensation models and create an awareness campaign to inform physicians about their rights under the Lilly Ledbetter Fair Pay Act and Equal Pay Act.

Right for Gamete Preservation Therapies
MSSNY will officially recognize fertility preservation services as an option for the members of the New York transgender and non-binary community who wish to preserve future fertility through gamete preservation prior to undergoing gender affirming medical or surgical therapies and will officially support the right of transgender or non-binary individuals to seek gamete preservation therapies. 

Increased Accessibility of Emergency Epinephrine for Anaphylactic Response
MSSNY will support legislative action to bring about training on and accessibility to emergency epinephrine in areas deemed to be high risk, including but not limited to those focused on children and food service, such as childcare facilities, schools, school buses, food-service areas and restaurants. 

Physician Credentialing Improvement
MSSNY will advocate for regulation or legislation asserting that a physician who has submitted a completed application for credentialing, until which time that application is accepted or rejected, may bill for services under the general supervision of a physician who is already credentialed by that plan. This shall be applied to all insurance plans, including state sponsored plans such as worker’s compensation. 

Reducing Physician Barriers to Mental Health Care
MSSNY will promote the work of its Physician Wellness and Resilience Committee and the survey on physicians’ stressors that are faced on a daily basis.  MSSNY will design educational resources and continuing medical educational programs on physician wellness and resiliency and will explore the possibility of establishing a physician, resident and medical student wellness program. 

Laser Hair Removal
MSSNY will advocate that laser hair removal only be performed by an appropriately trained and educated individual under physician supervision and will encourage provision of public education regarding the risks of laser use for aesthetic services. 

Financial Penalties and Clinical Decision-Making
MSSNY opposes the practice of a payer utilizing statistical targets to determine the cost-effectiveness of a therapeutic choice and opposes the practice of a payer imposing financial penalties upon individual imposing financial penalties upon individual physicians and/or associated physicians based upon use of statistical targets without fist considering the clinical factors unique to each patient’s claim. 

Benzodiazepine and Opioid Warning
MSSNY will raise the awareness of its members of the increased use of illicit sedative/opioid combinations leading to addiction and overdose death and will bring this resolution to the AMA so that it may warn members and patients about this public health problem. 

Promoting Addiction Medicine during a Time of Crisis
MSSNY will endorse and support the incorporation of addiction medicine science to medical student education and residency training and will send the resolution to AMA, Liaison Committee on Medical Education, Commission on Osteopathic College Accreditation, American Osteopathic Association, and Accreditation Council of Graduate Medical Education.

The following two resolutions were referred to Council for further study:

• Urgent Care in the Doctor’s Office
  This resolution asks that MSSNY seek payment reform to ensure site neutrality such that urgent, same-day services provided outside of usual business hours or for emergency care are paid equivalently regardless of the site of service.
• Shortage of Specialists in Workers’ Compensation System
  This resolution asks that MSSNY work with the Workers’ Comp Board, and, if necessary, the legislature to promulgate new regulations or laws that are necessary to increase voluntary participation of necessary specialists and subspecialists in locations and in specialties where there is a shortage of qualified providers and work with specialty societies that represent the specialties that are in short supply in the Workers’ Comp system to develop a joint strategy, including review of the current inadequate payment structure, to resolve this public health problem.

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Office-Based Surgery Mandated Reporting Update
The NYS Department of Health has sent Office-based Surgery (OBS) practices a letter indicating that it was not moving forward in 2019 with a proposed requirement for OBS practices to report information to DOH regarding the numbers of each type of procedure performed in their OBS practices.

MSSNY, working together with the NYS Society of Plastic Surgeons and NY Chapter of the American College of Physicians, had indicated its support for the goals of the proposed reporting requirements to provide necessary context to assess the frequency/lack of frequency of certain adverse events reported to DOH.  However, given the potential complexity this presented for some practices, MSSNY, NYSSPS and ACP also suggested alternatives to this reporting requirement such as having DOH request such cumulative procedural information from the accrediting entities from which OBS practices are required to receive accreditation.

Instead, the DOH will be placing additional efforts to ensure all OBS physician practices are complying with the New York law that requires all adverse events arising in an OBS setting to be reported to the DOH patient safety center within three business days of the adverse event.  NYS Public Health Law Section 230-d defines an “Adverse event” as a “(i) patient death within 30 days;  (ii) unplanned  transfer  to  a hospital or emergency department visit within 72 hours of office-based surgery for  reasons  related  to  the   office-based  surgery encounter; (iii) unscheduled hospital admission or assignment to observation services,  within 72 hours of the office-based surgery, for longer than 24 hours; or (iv) any other serious or life-threatening event”.

MSSNY looks forward to partnering with the DOH to educate and ensure physicians in complete compliance with these adverse event reporting requirements.

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MSSNYPAC Congratulates and Thanks Joseph R. Sellers, Md for His Leadership
We would like to thank Dr. Joseph R. Sellers, MD of Schoharie County for his dedicated and steadfast leadership of MSSNYPAC from April 2010 until April 2019. He has skillfully steered MSSNYPAC through challenging changes in the medical practice landscape and we are confident he will do the same as he continues to progress through MSSNY leadership. Dr. Sellers has been elected to serve as Vice President of MSSNY and is on track to become President of MSSNY in 2021.

On behalf of the MSSNYPAC members and Executive Committee, we thank you for your many years of selfless service to the profession of medicine. Your professionalism in advocacy on behalf of the patients, physicians and medical community as a whole, both in New York State and nationally, has been exemplary. We extend our sincere and heartfelt gratitude and honor your service. We appreciate the foundation that you have laid for our future success and the example that you have set for our future PAC leaders and members. We wish you the best of luck in your endeavors and look forward to your continued service to MSSNY.

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Mount Sinai Medical School to Cap Debt at $75K for Students with Financial Need
The Icahn School of Medicine at Mount Sinai will begin capping debt at $75,000 for students with a demonstrated financial need during the next academic year, making it the latest institution to address the massive debt burden that often accompanies medical education.

Students who qualify will take out no more than $18,750 per year in loans to cover costs such as tuition, housing, food and books.

The initiative follows NYU School of Medicine’s decision to offer free tuition for all medical students and a move by Columbia University’s Vagelos College of Physician and Surgeons in 2017 to offer scholarships that cover 100% of students’ financial needs.

Mount Sinai’s strategy is unique in that it applies not just to tuition but to living expenses. Tuition for the current academic year is nearly $53,000, but the school estimates the cost of attendance, which includes expenses such as rent and health insurance, will run students an additional $25,000 to $35,000 a year. Three-quarters of medical students nationwide finance their education with some debt, and the median amount for the class of 2018 was $194,000, according to the Association of American Medical Colleges.

“The program won’t benefit all students. It will award money based on a student’s expected family contribution, which is determined through federal and private financial aid applications. A first-year student with an expected family contribution of $79,000, which is above the cost of attendance, wouldn’t receive any aid, for example.

The news was shared with students via email Wednesday and wasn’t met with unanimous praise. One student, who doesn’t expect to qualify but will graduate with about $200,000 in debt, said it was “honestly a little bit of a disappointment” because many middle-class students won’t be eligible.

The program does not, as some do, compel students to enter specialties such as family medicine and pediatrics or to work in underserved areas. Crains Health Plus Ap 11.

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New York Leads All States in Malpractice Payouts
Medical malpractice claims against New York health care
professionals paid out $685.3 million last year, over $300 million more than in the second-highest state, Pennsylvania.

New York’s cases paid $35.07 in malpractice payouts per capita, which was also the highest nationwide, according to data from online insurance broker LeverageRx. The payments were 11% higher than during the previous year.

New York’s medical community has for years pointed to the high rate of malpractice claims as creating a hostile environment for doctors here. Consumer-finance website WalletHub named New York the worst state to practice in as a physician, which has led the Medical Society of the State of New York to call for tort reform.

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Northwell Enters Management Agreement with Nassau County Med Center
Northwell Health has received state approval to form a management services agreement with Nassau University Medical Center and create a five-year strategic plan for the hospital.

Winnie Mack, Northwell’s senior vice president of operations, will run the hospital as president and chief executive of NuHealth, the public corporation that operates the facility. She will be working on behalf of True North Healthcare Consulting but will report to NuHealth’s board.

The board has agreed to a three-year strategic advisory services agreement with Northwell, which will have its leaders assess the hospital’s needs and make recommendations.

Nassau University Medical Center is a safety-net provider for the county, and more than half of its patients either are uninsured or pay through Medicaid, which provides lower reimbursement than other forms of insurance. Northwell said the deal would be similar to its work advising One Brooklyn Health System, the three-hospital network that enlisted Northwell’s consulting arm to produce a strategic plan. That comparison is notable in that Northwell has acted as an adviser, not an acquirer, for the Brooklyn facilities, which rely on significant state subsidies. The announcement said NuHealth and Northwell will keep separate governance structures. Crains Health Plus Ap11.

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Physicians Day at the Races 2019 – Secure Your Tickets Today!
Join your colleagues for MSSNYPAC’s Physicians Day at the Races on Saturday, July 27, 2019 at Saratoga Race Track in Saratoga Springs, NY. All physicians, including non-members of MSSNY are welcome to support this state-wide fellowship event for MSSNYPAC while supporting a great cause that strengthens our profession. Tickets are $500/physician and $300/guest. Visit www.mssnypac.org/events for details or to download an invitation. Ticket or sponsorship inquiries can be directed to Jennifer Wilks at 518-465-8085.

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Measles Update: Recent Measles Outbreak in Brooklyn and Queens
As of April 15, 2019, there have been 329 confirmed cases of measles in Brooklyn and Queens since October. Most of these cases have involved members of the Orthodox Jewish community.

The initial child with measles was unvaccinated and acquired measles on a visit to Israel, where a large outbreak of the disease is occurring. Since then, there have been additional people from Brooklyn and Queens who were unvaccinated and acquired measles while in Israel. People who did not travel were also infected in Brooklyn or Rockland County.

Vaccination Requirement in Brooklyn

On April 9, the Health Commissioner ordered (PDF) every adult and child who lives, works or resides in the following ZIP codes and has not received the measles, mumps and rubella (MMR) vaccine to be vaccinated:

• 11205
• 11206
• 11211
• 11249

People who demonstrate they are immune from measles have a medical condition that prevents them from receiving the vaccine will not need to get vaccinated.

If the Health Department identifies a person with measles or an unvaccinated child exposed to measles in one of the above ZIP codes, that individual or their parent or guardian could be fined $1,000. (NYCDOHMH)

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Potential Risks of Direct-to-Consumer Pediatric Telemedicine Visits
Children were more likely to receive antibiotics for acute respiratory infections via DTC telemedicine visit versus in-person urgent care or primary care visit.

Commercial companies now offer acute pediatric care via direct-to-consumer (DTC) telemedicine visits with physicians who are outside of the child’s medical home. The American Academy of Pediatrics and American Telemedicine Association have cautioned that because such care lacks continuity and access to the child’s past medical history, it could lead to lower quality of care, especially in nonverbal children.

To test this hypothesis, researchers used commercial health plan claims data to compare children’s receipt of antibiotics for acute respiratory infection from 4600 DTC telemedicine visits, 38,400 urgent care visits, and 485,200 primary care pediatrician (PCP) visits. Patients were newborn to age 17 years. Children with chronic conditions that could affect antibiotic management decisions were excluded. Groups were matched on patient demographics, insurance, medical complexity, and diagnosis category.

Children seen via DTC telemedicine visit were more likely to receive antibiotics (52%) compared with those seen in urgent care (42%) or by PCPs (31%) and less likely to receive guideline-concordant care regarding antibiotic management (59% vs. 67% for urgent care and 78% for PCP; P<0.001 for both comparisons). Lower guideline concordance in DTC telemedicine was primarily attributable to inappropriate antibiotic prescribing for viral infections. (Pediatrics 2019 Apr 8 Gerber JS).

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SED Grants Extension on Use of School Health Forms
The State Education Department (SED) has notified school districts that it has again delayed implementation of a new NYS School Health Examination Form. In an April 16, 2019 letter to school superintendents and principals, SED instructed that school accept any physician examination form from students for the 2019-2020 school year, regardless of the form used. MSSNY and the American Academy of Pediatrics, Chapters I, II, III, have been working with the SED and health officials on revisions to the school health form. The new form was required by Commissioner’s Regulation 136.3 which became effective on July 1, 2018. Physicians throughout the state have indicated that the new form was not compatible to electronic health record. MSSNY, AAP and SED have been working collaboratively to make the form compatible to EHR. A copy of SED’s letter to the school superintendents and principals can be found here.

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UnitedHealth posts $3.5B profit in Q1
UnitedHealth Group recorded strong financial results in the first quarter of fiscal year 2019, ending the period with a $3.5 billion profit. The company recorded revenues of $60.3 billion for the three months ended March 31, up 9.3 percent from $55.2 billion reported in the same period a year earlier. Revenue gains were led by growth across its UnitedHealthcare Medicare and Retirement, OptumRx, and OptumHealth lines. The company’s health insurance arm, UnitedHealthcare, added 880,000 members in the past year.

This helped increase the unit’s first-quarter revenues by $3.4 billion to $48.9 billion.
UnitedHealth’s Optum unit continued to be a significant source of revenue growth for the company. Optum’s revenue climbed by 11.7 percent year over year to $26.4 billion in the first quarter of this year, up from $23.6 billion recorded in the same quarter a year prior.
Overall, UnitedHealth saw its operating expenses increase year over year to $55.5 billion in the first quarter of this year, up 8.5 percent year over year from $51.1 billion.
UnitedHealth ended the first quarter with net earnings attributable to shareholders of $3.5 billion, up 22 percent from a profit of $2.8 billion reported in the first quarter of 2018. (Beckers Hospital Review)

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CMS

Physicians Advocacy Institute Comments on CMS Releases QPP Year 1 Report
On March 20, CMS released the 2017 QPP Reporting Experience Report with an appendix providing an overview of the participation results from the first year of the QPP. PAI does not believe the report comprehensively reflects the experience of QPP participation, which is of great concern. For example, the report does not reflect the disproportionate number of small and rural practices who received a penalty under MIPS (details below), which underscores PAI’s ongoing concern about the burden placed on these practices that often results in a shift into employed status. In response, PAI is working to develop a thoughtful response to policymakers highlighting our concerns and providing recommendations to improve the report to accurately and fully capture the 2017 QPP experience. Additionally, PAI wants to ensure a report portraying an incomplete picture of QPP participation is not utilized to make adjustments to the program in future rulemaking. A few of CMS’ key findings are shared below in addition to initial observations from PAI.

CMS’ Key Findings

• Ninety-five percent of all eligible clinicians participated in MIPS and avoided a negative payment adjustment
• Ninety-three percent of those who participated in MIPS earned a positive payment adjustment
• Fifty-four percent of eligible clinicians participated as a group, 12 percent as individuals, and 34 percent through MIPS APMs
• A majority of eligible clinicians opted to report data for 90 days or longer
• MIPS eligible clinicians who were in small or rural practices had participation rates of 81 and 94 percent, respectively

PAI’s Observations

• Ninety-nine percent of individual participants submitted their quality measures data using claims emphasizing the importance of retaining this submission mechanism for small practices
• Seventy-one percent of eligible clinicians received a positive adjustment with the additional adjustment for exceptional performance; however, the range for the overall payment adjustment for this group was low at 0.28-1.88 percent, indicating the marginal reward for participation in the program
• It appears that the participation rate includes eligible clinicians who actively participated as well as those who did not submit any data but were deemed as meeting the minimum threshold for avoiding a negative payment adjustment (i.e. automatically received three points as their final score) due to the 2017 Extreme and Uncontrollable Circumstances Policy
• About 83 percent of negative payment adjustments were collected from individual and small practices (15 or fewer eligible clinicians), indicating how the positive payment adjustments are mostly being funded off the backs of those in individual and small practices who may be disadvantaged and face barriers to successful participation in MIPS

Only 37 percent of eligible clinicians participated in the Promoting Interoperability (formerly ACI) category which requires use of Certified Electronic Health Records (CEHRT), indicating the continued challenges and barriers with CEHRT requirements.

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CMS New Report: 94% Overall Physician Participation in Medicare MIPS/APM
In late March, the Center for Medicare and Medicaid Services (CMS) released a report (https://qpp-cm-prod-content.s3.amazonaws.com/uploads/491/2017%20QPP%20Experience%20Report.pdf) summarizing the results of physician and other care provider participation in the Medicare Quality Payment Program for 2017, effecting 2019 Medicare payments.  Among the highlights of the report:

• According to the report, a total of 1,057,824 “clinicians” were eligible for MIPS in 2017, of which 95% participated in the program and avoided a negative payment adjustment by receiving at least 3 points as their MIPS final score. This exceeded the CMS established goal of having 90% of MIPS eligible clinicians participate during the 2017 performance year. Physicians had a 94.2% participation rate, and non-physician clinicians had a 97.5% participation rate.

• Of the over 1,000,000 clinicians that participated in QPP, 54% received their final score based on participation as part of a group; 12% of received their final score based on individual participation; and 34% received final scores based on participating in the QPP through an Advanced Payment Model (APM).

• Bonuses: 71% overall received positive adjustments ranging from +0.28% to +1.88%; 22% received bonuses of up to +0.2%; and 2% received no positive or negative adjustment.

• 81% of clinicians practicing in small practices participated with MIPS, and 94% of those practicing in a rural area participated with MIPS.

• Of the over 340,000 clinicians who participated in the APM track, the overwhelming majority participated via the Medicare Shared Savings Program (as an Accountable Care Organization).

• Of those who successfully participated, 74.3% reported data for a full 12 months, and another 24.9% reported data for 90 days to 12 months. With regard to small practices, 44.5% reported for the full 12 months, and 53.9% reported data for 90 days to 12 months.

• The most frequent quality measures reported were: 1) controlling high blood pressure 2) screening for tobacco use and cessation 3) Breast Cancer screening 4) pneumococcal vaccine and 5) encouraging use of aspirin or other anti-platelet

• The most frequent Quality Improvement measures reported were 1) Having 24/7 access to a patient’s medical record 2) Use of decision support and standardized treatment protocols 3) Patient Centered Medical Home attestation 4) Engaging with patients through patient portal and 5) Collection of data and follow up regarding patient experience.

Here is a chart detailing specialty by specialty participation in the QPP program in New York:

MIPS/APM PARTICIPATION LEVELS – NEW YORK – 2017

Specialty	MIPS/APM Participation
Addiction Medicine	87.5%
Allergy/Immunology	91.28%
Anesthesiology	93.14%
Cardiac Surgery	93.65%
Cardiology	91.91%
Colorectal Surgery	93.57%
Critical Care Intensivists	97.37%
Dermatology	85.73%
Diagnostic Radiology	94.45%
Emergency Medicine	97.83%
Endocrinology	93.78%
Family Practice	93.91%
Gastroenterology	92.6%
General Surgery	94.32%
Geriatric Medicine	96.23%
Gynecology/Oncology	96.43%
Hand Surgery	92.68%
Hematology	97.06%
Hematology/Oncology	95.05%
Hospitalist	100%
Infectious Disease	92.6%
Internal Medicine	92.63%
Interventional Cardiology	95.51%
Interventional Pain Management	83.16%
Interventional Radiology	95.21%
Medical Oncology	96.42%
Nephrology	91.87%
Neurology	91.95%
Neurosurgery	94.66%
Nuclear Medicine	94.92%
OB-GYN	96.41%
Ophthalmology	91.14%
Orthopedic surgery	92.46%
Otolaryngology	92.43%
Pain Management	83.78%
Pathology	93.16%
Pediatric Medicine	99.32%
Physical Medicine and Rehabilitation	87.26%
Plastic and Reconstructive Surgery	90.26%
Psychiatry	93.7%
Pulmonary Disease	91.54%
Radiation Oncology	97.37%
Rheumatology	95.03%
Surgical Oncology	95.56%
Thoracic Surgery	96.37%
Urology	91.6%
Vascular Surgery	94.21%

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Webinars

MSSNY CME Webinar Health Matters for Women Registration Now Open
The Medical Society of the State of New York is proud to announce a live continuing medical education (CME) webinar on a women’s health topic entitled “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. Registration for the webinar is now open.

Health Matters for Women: Endometriosis.  Register here.

When:  Tuesday, April 23^rd at 7:30am
Faculty: Lisa Eng, DO

Educational Objectives:

Review potential causes of pelvic pain and discuss how to identify endometriosis

Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis

Discuss implementation of individualized endometriosis treatment plans and options

The Medical Society for 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 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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