MSSNYeNews: August 23, 2019 – Death Be Not Proud

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews August 23, 2019 Vol. 22  Number 32

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Colleagues:

I think suicide is sort of like cancer was 50 years ago. People don’t want to talk about it, they don’t want to know about it. People are frightened of it, and they don’t understand, when actually these issues are medically treatable. – Judy Collins

NYPD suicides have dominated the news cycle. This from the NY Post:

… The recent spate of suicides is devastating, but not shocking. Whereas 13 out of every 100,000 people will die by suicide in the general population, that number climbs to 17 in 100,000 for police officers, according to a 2018 report by the Ruderman Family Foundation, a disability advocacy nonprofit. Furthermore, the report found, officers are more likely to kill themselves than to be killed on the job — a result, experts believe, of high stress and traumatic encounters in their line of work.

“… Even when cops do seek therapy, they’ll often go to great lengths to make sure it’s off the books,” says Petrullo, an NYPD retiree. His volunteer group of retired cops man a 24-7 hotline (800-599-1085) and can confidentially refer police officers to professional psychologists or psychiatrists.

“… Some of them are so concerned, they’ll self-pay [instead of going through their insurance],” says Petrullo. “And then there are some people who think no matter who they go to, someone is going to find out.”

Do you know who else has a suicide problem? Well, there’s this: One doctor commits suicide in the U.S. every day — the highest suicide rate of any profession. And the number of doctor suicides — 28 to 40 per 100,000 — is more than twice that of the general population, new research shows. The rate in the general population is 12.3 per 100,000.

You could rewrite the Post story, substituting “Doctor” for “Police Officer” and it would be eerily similar. Your Medical Society is working on a Peer to Peer Program to try to head some of these off at the pass, so to speak.

Fingers crossed and stay tuned.

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

Arthur Fougner, MD
MSSNY President 

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Urgent Activism Requested on Federal Surprise Billing Legislation
Physicians are urged to continue advocating for a fair and common sense solution to the surprise billing issue. With federal legislators on summer recess, the time is now to set up meetings to discuss how the current bills winding through Congress (S1895/HR3630) will hurt access to care for our patients through narrower insurer networks and exacerbating shortages in needed specialty care in our hospital emergency departments.

Instead of these well-meaning but seriously misguided proposals, Congress should advance legislation that addresses out of network “surprise” bills through a balanced dispute resolution system like HR3502. This bill is similar to New York’s law which has proven to be cost-effective, fair and successful at reducing the burden of surprise bills on patients.

To understand why this legislation would be so harmful, please visit one of these articles which explains the issue in detail Congress, Don’t Harm Patients With The Wrong Surprise Medical Bills Solution & Congress Is About to Give Health Insurance Companies the Nuclear Weapon. While S1895 and HR 3630 would not immediately impact state-regulated plans in New York (it would only apply to ERISA-regulated plans), employer-sponsored plans make up a relatively large percentage of plans in NY. Further, it represents a startling precedent that the insurance lobby in New York would certainly attempt to capitalize upon. As such, it is extremely vital that physicians advocate for legislation that uses IDR instead of a benchmark that would create a downward spiral of fees for doctors and narrower networks for patients.

While they are on break from Washington, D.C., please reach out to your member of Congress’s (and any others that you may be acquainted with) district office to sit down and discuss this issue. You may also take direct action by utilizing the following tool that allows you to take quick action a variety of ways, including social media and phone calls https://www.freeroots.com/campaign/mssny-end-surprise-billing.

Additionally, physicians are requested to retweet MSSNY President Dr. Art Fougner’s message to members of Congress in NY and in leadership positions relevant to this issue. Please take a moment to retweet all 6 of these so that we can have our message heard en masse (links below).

http://tiny.cc/Tweet1  http://tiny.cc/Tweet2  http://tiny.cc/Tweet3

http://tiny.cc/Tweet4  http://tiny.cc/Tweet5  http://tiny.cc/Tweet6

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Now Is the Time to Urge Your Members of Congress to Support Medicare Payment Increases
The American Medical Association has sent out a grassroots alert to physicians urging them to write your members of Congress today and support improvements to the Medicare Access and CHIP Reauthorization Act (MACRA), noting that when Congress returns to DC in September one item on their plate will be improving the MACRA.

After a 15 year fight to replace the flawed Sustainable Growth Rate (SGR) update system for Medicare reimbursement rates, Congress finally acted, and passed the MACRA law in 2015. Since its enactment, physician organizations have worked closely with both Congress and CMS to promote a smooth implementation of key components of the law.

Unfortunately, it has become clear that further refinements are needed to improve the program and ensure physicians can be successful moving forward. During the first five years, the law had provided for modest payment increases, but payment rates still have not kept up with inflation. To make matters worse, the statute calls for a 0% per year payment update for years 2020-2025.  Among the improvements being fought for by organized medicine:

• Implementing positive payment adjustments for physicians in lieu of a payment freeze over the next six years;
• Extending the Advanced Alternative Payment Models (APM) bonus payments for an additional six years, and;
• Implementing additional technical improvements to MACRA

This problem is real and if Congress doesn’t act when they return, many physicians who see Medicare patients will be negatively affected.  This is even more important this year, given the significant shifts in Medicare physician payment (up and down) being proposed by CMS.

Please contact your members of Congress here.

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DOH Issues Emergency Regulations for Granting Medical Exemptions from Immunizations
Last Friday, the New York State Department of Health issued emergency regulations to strengthen and clarify the process by which physicians can grant medical exemptions under the new state law which repealed non-medical exemptions for children attending school or daycare.

The new regulations are effective immediately and provide clear, evidenced based guidance to physicians on appropriate issuance of medical exemptions.  The Department, in collaboration with the Office of Children and Family Services and the State Education Department, has issued a series of Frequently Asked Questions (FAQ) on the new law FAQ issue August 16, 2019.

Effective immediately, physicians who issue medical exemptions will be required to complete the applicable medical exemption form approved by the New York State Department of Health or New York City Department of Education, which specifically outlines the medical reason(s) that prevent a child from being vaccinated. Additionally, the regulations require physicians to outline specific justifications for each required vaccine in order to be able to grant an exemption.

Previously, regulations allowed for a physician to submit a signed statement to schools without having to document on an approved form stating why immunization may be detrimental to the child’s health. The emergency regulations apply to all children statewide, and they continue to require that medical exemptions must be reissued annually. By providing clear, evidence-based guidance to physicians regarding when immunization may be detrimental to a child’s health, this emergency regulation will help prevent medical exemptions from being issued for inappropriate reasons.

Public Health Law §2164, as amended by Chapter 35 of the Laws of 2019, applies to students attending all schools as defined in Public Health Law §2164 to include any public, private or parochial child-caring center, day nursery, day care agency, nursery school, kindergarten, elementary, intermediate, or secondary school. The NYS Department of Health encourages parents and guardians of all children who do not have their required immunizations to receive the first dose in each immunization series as soon as possible.

The deadline for obtaining first dose vaccinations in each immunization series for children attending school in the fall is 14 days from the first day of school or enrollment in child day care. Within 30 days of the first day of school, parents and guardians of such children must show that they have scheduled appointments for all required follow-up doses.

As of August 16, 2019, there were 1,044 cases of measles in New York State.   Measles is a reportable disease and physicians are encouraged to seek further information on the New York City Department of Health/Mental Hygiene website here or at the New York State Department of Health website here.

MSSNY has a free CME program on measles is available here.  Users new to the site will have to establish an account; all others will need to just log into the website and access the program entitled: The Continued Public Health Threat of Measles 2018.

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Med Students: Learn How to be a Physician Advocate at AIM Conference in NYC
The second annual Advocacy in Medicine (AIM) Conference will bring
together healthcare advocates and trainees from various academic institutions interested in health advocacy for a full day of talks, interactive panels, breakout sessions and networking. The conference opens with keynote speakers addressing the role of physician advocacy followed by an interactive Q&A panel discussion with physicians on advocacy, activism, and their personal career trajectories. The afternoon will be dedicated to small workgroups with the opportunity to focus on skill-building and topic-focused content.

The conference will be held on Sunday, September 22, 2019 from 8:30 am-4:00 pm at The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029. For more information and a full list of speakers, click here. Admission is free for medical students and health professionals with a current ID.

Our State Fair Is a Great State Fair!
Once again, the Onondaga County Medical Society is staffing the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the state fair with volunteer Medical Society physician members. The state fair runs through September 2.

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New Study Finds that Levels of Marijuana Use Disorder Continue to Rise
This week, the Substance Abuse and Mental Health Services Administration released the 2018 Annual National Survey on Drug Use and Health (NSDUH). According to the survey, 45,000 more teenagers are regularly using pot, marijuana users are more likely to abuse opioids than non-users, and levels of marijuana use disorder continue to rise.
The study found that an average of 8,400 Americans aged 12 or older tried marijuana for the first time each day in 2018. This is an increase of 100 users per day from last year’s study. Furthermore, the majority of people in 2018 who reported first time marijuana use were between the ages of 12-25.

Approximately 4.4 million people aged 12 and older had a marijuana use disorder in the last year. Breaking this out further, 2.1 percent of youths aged 12-17, 5.9 percent of young adults aged 18-25, and 0.9 percent of adults 26 and older suffered from a marijuana use disorder. The percentage of young adults with a marijuana use disorder is significantly higher than last year and is the highest it has been since 2004. Read more here.

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Have You Visited MSSNY’s Podcast Site Yet?
MSSNY proudly announces the addition of two new podcasts to our podcast site here.  You will find podcasts on a variety of timely and relevant topics from the current measles outbreak to emergency preparedness to veteran’s matters and adult immunizations.  Our latest podcast productions include The Mental Health Needs of Women in the Military and Health Matters for Women: Endometriosis.  Go here and check out all of the podcast MSSNY has on offer.

WCB – New Injured Worker Prescriptions Must Be Consistent with Formulary by December 5
The NYS Workers Compensation Board recently issued a Bulletin reminding physicians and other care providers that, pursuant to the recently-adopted WCB Drug Formulary, as of December 5, 2019, any newly prescribed medication to their injured worker patient must be for a medication listed on the Drug Formulary, unless the physician obtains prior authorization for the non-formulary medication.

On or after June 5, 2020, all refills or renewals of prescriptions must use a Drug Formulary medication unless prior authorization has been obtained before the date of the refill or renewal.

• A refill means any subsequent fill of a prescription when the number of refills is explicitly included in the original prescription.
• A renewal means a prescription that the injured worker has been taking but for which there are no available refills.

Insurers, self-insured employers and third-party administrators must notify medical providers and injured workers by December 5, 2019, that a currently prescribed drug is not included on the Drug Formulary.

With regard to opioid medications, the bulletin also notes that the Drug Formulary does not include narcotics/opioids after the first 30 days following an injury (except in the immediate pre- and post-operative period).  It also notes the following:

• On or after December 5, 2019, during the 30 days following an injury, narcotics/opioids may not exceed a single seven-day supply; and,
• Prior to June 5, 2020, medical providers and injured workers must plan for a transition to a Drug Formulary medication. If such a transition is not medically appropriate, the medical provider must obtain prior authorization for a refill or renewal of a non-formulary narcotic/opioid well in advance of June 5, 2020.

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Some Hospitals Use Text Messaging For Communication With Patients
Modern Healthcare reports on the use of text messaging for clinicians to communicate with patients. The article highlights the experience at Goshen Health in Indiana where clinicians use secure messaging apps to communicate with patients. The article quotes clinicians from Goshen offering advice for hospitals considering similar moves.

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New DOH Report on Cigarette Smoking Among Adults in New York State
The New York State Department of Health announced this week the release of a new report on Cigarette Smoking among adults in New York State. The report is based on data from New York’s Behavioral Risk Factor Surveillance System and found that an estimated 2 million adults, or 14.1% of the state’s adult population aged 18 years and older, are current smokers. Between 2011 and 2017 the prevalence of adult smoking decreased 22%. Since 2014, however, the prevalence of adult smoking has remained relatively unchanged.

Rates of smoking remain highest among adults reporting frequent mental distress, defined as adults who report problems with stress, depression, or emotions on at least 14 of the previous 30 days (formerly referred to as poor mental health) (25.5%); adults enrolled in Medicaid (22.1%); adults who are unemployed (22.0%); adults living with disability (21.6%); adults with less than a high school education (20.0%); and adults with an annual household income of less than $25,000 (19.7%). The full report can be accessed here.

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