MSSNY eNews: July 26, 2019 – Turn Complaints into Action

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews July 26, 2019 Vol. 22  Number 28

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Colleagues:

One of the most, if not THE most, aggravating issues plaguing physicians is the process of obtaining prior authorization for medically necessary drugs, procedures or tests. In fact, Medical Economics has cited the all too often arduous process of obtaining authorizations as one major factor associated with physician burnout. In 2016, this video, illustrating the absurdity of the process, went viral. Yet, like a stubborn cold, the problem remains.

Finally, it appears someone with sufficient juice may be paying attention. Yesterday, your Medical Society’s Regina McNally received an email from CMS’ NY Division of Financial Management and Fee for Service Operations, urging comments on this process as part of the “Patients over Paperwork Initiative designed to find opportunities to modernize or eliminate rules and requirements that are outdated, duplicative, or getting in the way of quality patient care.”

Simply register here and fire away. Here’s our chance to turn complaints into action. But we need to move on this one as there is an August 12^th deadline.

Although personally, I find the Murphy-Reinhold Maneuver attractive, I’d make our comments more substantive. So as Larry the Cable Guy would put it, let’s “Git ‘Er Done.” (See further info below).

Arthur Fougner, MD
MSSNY President 

CMS Regional Offices are contacting provider organizations to make a special request for comments on prior authorization procedures under Medicare FFS, as well as those of Medicare Advantage, Medicaid Advantage and Health Insurance Marketplace Plans. Physicians are invited to send their experiences and comments concerning preauthorization to PatientsoverPaperwork@cms.hhs.gov. CMS anonymizes the comments, stories, experiences, and recommendations you share, with the exception of your ‘role’ e.g., clinician, ‘location’ e.g., state, or ‘facility type’ e.g., hospital.

The team uses the information to inform policy and operational staff, as well as for internal presentations. The early goal of this Prior Authorization Engagement is to create a strategy that will become the foundation for improving the prior authorization process. This is part of CMS’ ongoing “Patients over Paperwork” initiative designed to find opportunities to modernize or eliminate rules and requirements that are outdated, duplicative, or getting in the way of quality patient care.  In that regard, I should remind you that CMS recently published a Request for Information (RFI) in the Federal Register: “Reducing Administrative Burden to Put Patients over Paperwork”, a broad request for public comments on ways to improve CMS programs. You can submit formal comments on the RFI by August 12, 2019, and we hope that you do.  

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

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With Congressmembers Back in Districts, Now is the Time to Meet with Them to Raise Concerns with Surprise Billing Proposals
A recently published article, “Congress is About to Give Health Insurance Companies the Nuclear Weapon” noted that elected officials at the federal level continue to move well-intended, but seriously misguided legislation that would address surprise bills for out of network care delivered to a patient covered by an ERISA-regulated health plan. 

Specifically, they are referring to legislation that has advanced from the Senate HELP (S.1895) and House Energy & Commerce Committees (HR 3630) that would limit payments to out of network physicians for “surprise” hospital bills to an insurer determined “median contracted” rate.

These bills are clearly slanted toward benefiting insurance company interests.  MSSNY and many other physician groups agree with the goal to assure patients are protected from surprise bills, but disagree with the approach of these bills.  These bills are far different than New York’s balanced approach to this issue, which includes regionally adjusted charges (as reported by Fair Health) for services as a major consideration for determining fair reimbursement by an independent dispute resolution entity.  As has happened in California, permitting insurers to pay an in-network rate in these instances would give already fat-cat insurance companies the incentive to further narrow their networks, and impact the ability of ALL physicians to fairly negotiate with these corporate behemoths.

However, physicians still have the opportunity to shape the outcome as negotiations continue to occur.  We still have a chance to impact the ongoing dialogue as the bill continues to move through the legislative process.  MSSNY and many other physician organizations have noted their support for HR 3502 (Ruiz/Roe/Morelle), which largely mirrors New York’s approach to surprise medical bills.

As members of Congress are back in New York for the “August recess,” please seek to call and meet with them to let them know that HR 3630 and S.1895 would be an unmitigated disaster, resulting in narrower networks and potentially making it much harder for hospitals to have needed on-call specialty care in their emergency departments.  Instead, urge them to support the Ruiz-Roe HR 3502 approach to this issue.

Notably, an AMA press release this week raised strong concerns with the “clear mischaracterization” of the impact of an independent arbitration process by America’s Health Insurance Plans (AHIP). 

Please also take a moment to send a letter to your members of Congress by going to http://tiny.cc/SurpriseBIlling. The letter is pre-populated and allows you to get the message to the right individuals in just a few short minutes.

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Gov.: New Action Ensuring Insurers Give Expanded Coverage for HIV-Prevention
This week, Gov. Cuomo issued a statement that requires additional co-pay assistance for coverage of HIV prevention drug PrEP in a proposed regulation to require more information on patients’ health insurance ID cards. 

Responders Continue to Suffer from World Trade Center-Related Illnesses
The Centers of Disease Control and Prevention “notes that thousands of responders and survivors of the 9/11 attack continue to suffer adverse health effects from toxic contaminants, risks of traumatic injury, and physically and emotionally stressful conditions.” New York City Fire Commissioner Daniel Nigro said, “It is almost incomprehensible that after losing 343 members on September 11, we have now had 200 more FDNY members die due to World Trade Center illness.” The recent deaths “come as legislation remains stalled in Congress to extend the 9/11 Victim Compensation Fund that provides financial help to victims of the attack in exchange for their agreement not to sue the airline corporations involved.”

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Study Finds Google Search More Accurate Than Medicare Advantage Directories
Compared to Google, Medicare Advantage provider directories contained less accurate information, according to a study published in the American Journal of Managed Care. Austin Frakt, PhD, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System and a co-author of the study, wrote in a column for The New York Times that even for researchers, “figuring out which doctors are available (and where) can be exceedingly difficult, if not impossible” for Medicare Advantage plans.

While Medicare Advantage has been promoted by the Trump administration as an alternative to Medicare that offers more coverage for a lower price tag, Dr. Frakt writes that often a limitation of the plans — that physician networks may be narrower — is omitted from this discourse. In addition, directories for the plans are often riddled with errors. CMS found nearly half of provider entries had either address errors, incorrect phone numbers or physicians who weren’t accepting new patients, according to Dr. Frakt, who cited government audits of Medicare Advantage plans.

“Still, because there is no way for Medicare beneficiaries to compare plan networks, people could easily stumble into a narrow network plan without knowing it,” Dr. Frakt wrote. “As with many things in healthcare, it’s hard to make an informed decision.”

Anthem’s New App Can Schedule and Pay for Care Via Smartphone
Anthem will roll out a new app this month that will give members and nonmembers the ability to schedule and pay for medical care through their smartphones. The app, right now called CareSpree, will be tested in Indiana during the last week of July. Anthem plans to expand the app to people across its 14 main states. The app will include an artificial intelligence-powered chat function to predict diagnoses for consumers after they enter their symptoms and other health information. The app then allows users to connect with a physician through text for follow-up.

Video physician visits will also be a feature of the app. The app will allow Anthem and non-Anthem users to schedule in-person physician visits, MRIs and X-rays, and pay a pre-negotiated rate through their smartphones. Anthem has made deals with 10 healthcare providers for the app, according to The Wall Street Journal.

Users not covered by Anthem will be charged to text and video message with physicians. Anthem members will be able to tie the app with their health history and health plan, allowing them to pay any out-of-pocket charges with their smartphone. Additionally, Anthem will offer a new digital personal health record for its members later this year.
(Becker’s Hospital July 22)

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Death Rates Rising for Young and Middle-Aged Adults
Death rates are on the rise for young and middle-aged American adults, according to a study published July 23 by the CDC.  Among younger adults ages 25-44, the death rate rose 21 percent for whites and blacks and 13 percent for Hispanics between 2012 and 2017. Most died of injuries such as drug overdoses, suicides, homicides and heavy use of alcohol.

Among middle-aged adults ages 45-64, death rates rose by 6.9 percent for whites and 4.2 percent for blacks. The Hispanic death rate in this cohort did not change significantly.

The analysis further examines negative health trends across the U.S., where the opioid epidemic and heart disease are decreasing life expectancy.

Death rates have declined overall for the general population, but the decline is slowing. Hispanics have typically had lower death rates than blacks and whites in the U.S., but the opioid epidemic is curbing that trend among younger Hispanics. In contrast, older Hispanics, many of whom are foreign-born, have remained healthier.

More Than 25% of Early-Middle-Aged Adults Have Osteopenia in Their Neck
Healio (7/19) reported, “More than 25% of early-middle-aged adults had osteopenia in their neck,” researchers concluded after “173 questionnaires from men and women aged 35 to 50 years that determined calcium intake, weekly exercise and other risk factors associated with osteoporosis and osteopenia.” The findings were published in the Journal of the American Osteopathic Association.

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Study: Colorectal Cancer Rates Among Adults Under 50 Are Increasing
An observational study indicates “more adults below the age of 50 are being diagnosed with colorectal cancer compared with five decades ago.” The study, published in the journal Cancer, showed “under 50s made up 12 percent of colorectal patients, spiking to 13.9 percent among African Americans and 18.9 percent among Hispanic populations.”

Furthermore, “when younger patients are diagnosed, the disease is more likely to be picked up in the advanced three or four stages, at 51.6 percent versus 40 percent of those above 50.” HemOnc Today (7/22)reports that “overall incidence of colorectal cancer incidence has decreased in the United States over the past several decades,” but “the percentage of colorectal cancer cases diagnosed among adults aged younger than 50 years increased from 10% in 2004 to 12.2% in 2015.”

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USPSTF Reaffirms Recommendation to Screen All Pregnant Women for Hepatitis B
The U.S. Preventive Services Task Force is again recommending that all pregnant women be screened for hepatitis B infection. The grade A recommendation, published in JAMA, reaffirms the group’s 2009 guidance and aligns with recommendations from the CDC and American College of Obstetricians and Gynecologists.

The task force specifies that a hepatitis B surface antigen test should be ordered at the first prenatal visit. Women who continue to have hepatitis B risk factors during pregnancy (for example, use of injection drugs) should be screened again at admission for delivery.

All women should be screened in each pregnancy, even if they have tested negative in a prior pregnancy or have been vaccinated against hepatitis B.

The USPSTF notes that since 1998, rates of maternal hepatitis B infection have increased 5.5% per year. Screening accurately identifies such infection, and treatment can prevent perinatal transmission.

USPSTF recommendation statement in JAMA;JAMA editorial

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