MSSNY eNews: Talking Marijuana/Single Payor
Thomas J. Madejski, MD
September 7, 2018
Volume 20 Number 33
Being MSSNY President is a new adventure every day. Your leadership and staff have been active this week on many fronts. Many of you are aware that the Governor and Health Department are considering legalization of marijuana for recreational use. MSSNY and the AMA have extensive policy on a scientific approach to evaluating marijuana as a therapeutic agent, as well as for recreational use. Just before the Labor Day Holiday, Governor Cuomo announced a series of public comment opportunities throughout the state.
Pundits often joke about public policy— “you can lead the train, be on the train, or be under the train.” I’m concerned that further expansion of non-medicinal marijuana usage in New York State may lead to a train wreck. We have some data with regards to increased use of marijuana that is troubling. The AMA Council on Science and Public Health recently reviewed Clinical Implications and Policy Considerations of Cannabis Use (read here, beginning on page 25) in response to the request of AMA and MSSNY members last fall. I encourage you to read it. After discussion with our leadership team, MSSNY in conjunction with some of our specialty and County Society leaders will provide comment to hopefully keep the train on track. We want our patients to arrive safely at their destination, prevent the inappropriate expansion of drug use, misuse, and abuse, and avoid the development of a ‘new tobacco’ industry that exploits our most vulnerable citizens.
Thanks to Dr. Joe Sellers, our MSSNY Treasurer who was able to pinch hit for me in Albany on Wednesday, where he represented MSSNY at the Governor’s listening session on medical marijuana. Read the full statement here.
While Dr. Sellers was covering for me in Albany, I was in New York at the MLMIC Executive Committee meeting. MSSNY provided testimony at the recent public hearing with regards to the proposed sale of MLMIC to Berkshire Hathaway.
Later in the day, President Elect Dr. Arthur Fougner and I along with colleagues from New York County, spent a couple of hours with Assemblyman Richard Gottfried—who has been a great advocate for patients and physicians. He provided insight into his proposed single payer legislation. We came away with a better understanding of the general workings of the plan and how it could affect your practice. We agreed to continue dialogue on the evolution of the plan. You can find our policy with regards to single payer here. I will keep you updated periodically on those discussions.
Your membership and personal contributions allow us to be effective advocates on behalf of our patients and our profession. Click here to join or contribute to MSSNYPAC.
Please share your thoughts and comments with me at email@example.com.
DOH HIV Prevention and Partner Service to Aid “End the Epidemic”
The NYS Department of Health’s HIV Prevention and Partner Service programming is highlighted in the attached document. NYS and County health department staff can assist in locating and re-engaging individuals with diagnosed HIV infection into HIV-related medical care. Staff also actively refer HIV status unknown or negative persons with syphilis or other STDs to clinicians offering PrEP and facilitate access to these services.
A new HIV/STI prevention approach works with individuals in rapidly growing transmission clusters to ensure their partners are linked to HIV and STI testing, medical care, PrEP and other prevention services. Finally, electronic clinician reporting is included in the document to improve efforts for expedited partner services to aid in the efforts to End the Epidemic.
Please take the three-question survey on your use/non-use of MIPS! https://www.surveymonkey.com/r/MIPS_Survey
Governor Announces Series of Listening Tour for Regulated Marijuana
Governor Andrew Cuomo has announced a series of listening sessions on regulated marijuana slated for September and October. The purpose of these sessions is to garner input from community members and key stakeholders on the implementation of a regulated marijuana program in New York State. This input will assist the regulated marijuana workgroup in drafting legislation for an adult-use marijuana program for the legislature to consider in the upcoming session. A copy of the governor’s press announcement is available here.
MSSNY will have representation at each listening session. NOTE: Although the dates are finalized, several of the venues have not been finalized.
The listening dates and registration is required for the sessions:
– Monday, September 17 – Bronx
– Thursday, September 20 – Manhattan
– Monday, September 24 – Queens
– Tuesday, September 25 – Brooklyn
– Wednesday, Sept. 26 – Staten Island
– Thursday, September 27 Long Island
– Monday, October 1 – Newburgh
– Tuesday, October 2 – Binghamton
– Wednesday, October 3 – Buffalo
– Thursday, October 4 – Rochester
– Tuesday, October 9 – Syracuse
– Wednesday, Oct. 10 – Utica
– Thursday, October 11 – Watertown
Registration for individual listening sessions: https://tinyurl.com/y9sh5j9k
DFS’ Report Ranking Health Insurers Based Upon Complaints and Care Access
This week, the NY Department of Financial Services released it 2018 Consumer’s Guide to Health Insurers, which provide consumers information regarding the complaints, appeals and grievances filed against insurance companies during 2017, as well as out of network independent dispute resolution (IDR) statistics for 2017.
For 2017, the insurers with the highest overall ranking based on the lowest number of complaints were:
- MVP Health Services Corp.
- Independent Health
- Genworth Life Insurance Company
- Community Blue (Health Now)
Some of the most noteworthy findings of the report:
- For Prompt Payment complaints, CDPHP had the best ranking among HMO plans and MVP the best among EPO/PPO plans. Empire had the worst ranking among HMO plans, and GHI the worst among EPO/PPO plans.
- For Overall complaints, Independent Health had the best ranking among HMO plans and MVP the best among EPO/PPO plans. Empire had the worst ranking among HMO plans, and GHI had the worst among EPO/PPO plans.
- There were 1,512 external appeals of health insurer denials of care, of which approximately 38% where reversed entirely or in part.
- For “Access and Service”, CDPHP had the highest ranking among HMOs and Empire had the highest among PPOs. However, Empire had the lowest ranking among HMOs and MVP had the lowest among PPOs.
- Regarding IDR for “surprise” medical bills, of the 332 resolutions reached, the provider’s charge was found more reasonable in 141 claims, the plan’s payment more reasonable in 49 claims, a “split decision” in 75 claims, and a settlement in 67 claims.
- Regarding IDR for out of network emergency care bill, of the 475 resolutions reached, the provider’s charge was found more reasonable in 61 claims, the plan’s payment more reasonable in 2013 claims, a “split decision” in 102 claims, and a settlement in 109 claims.
MSSNY Joins Patient Advocacy Organizations to Protest CMS Authorization of Step Therapy for Part B Medications
MSSNY this week joined nearly 200 patient and physician advocacy association in a letter to US House and Senate leaders expressing strong concerns about the Center for Medicare and Medicaid Services’ (CMS) recent notification to Medicare Advantage plans that they will no longer be prohibited from utilizing step therapy protocols for physician administered drugs covered under Medicare Part B beginning in 2019. It would in effect overturn a 2012 CMS policy that had prohibited the use of step therapy for Part B covered medications.
Last week, MSSNY also joined many other national specialty and state medical societies in a similar letter initiated by the American Medical Association to CMS.
Numerous states across the country, including New York, fought for the enactment of strong patient protection laws that put strict guardrails around the insurer/PBM use of “step therapy” for needed medications. However, this policy would go in the opposite direction. In particular, the group letter expressed concerns that “CMS’ sudden and disruptive decision to allow the inappropriate use of step therapy policies is inconsistent with the requirement that MA plans provide coverage consistent with Original Medicare and threatens to restrict access and decrease therapy choices for patients. This could put patients’ health at risk and potentially creates long-term health care issues in the process.”
4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC
Healing “Unexplainable” Pain: Advances in Multidisciplinary Integrated Psychosomatic Care”
Columbia University Medical Center & Office of Mental Health of the State of New York present: 4th Columbia Psychosomatics Conference.
Healing “Unexplainable” Pain: Advances in Multidisciplinary Integrated Psychosomatic Care Lectures and workshops by multidisciplinary world experts in research and treatment of psychosomatic disorders. Conference Chairs: Alla Landa, PhD, Harald Gündel, MD, Brian A. Fallon, MD, Philip R. Muskin, MD
When: Sat-Sun, October 20 – October 21, 2018
Where: New York State Psychiatric Institute at Columbia University Medical Center, 1051 Riverside Drive, NY, NY
Advanced registration is encouraged at the number of seats is limited!
For information on CME, complete program, and to register please visit conference website here.
FREE BUPRENORPHINE WAIVER TRAINING: Sept. 22, 2018 in White Plains
Saturday, September 22nd, 2018 9:00AM – 2:00PM
The NYSDOH AIDS Institute in partnership with Westchester Medical Center (WMC) Health Network Performing Provider System (PPS), Westchester County Department of Health and Hudson Valley Community Services is sponsoring a free Buprenorphine Waiver Eligibility Training for Clinical Providers at Westchester County Center, 198 Central Ave, 2nd Floor, Room E, White Plains, NY 10606. Parking: available on the street and in a paid parking lot across the street. Light refreshments will be provided. Directions. Online Registration.
Under current regulations, authorized practitioners (MDs, DOs, NPs, and PAs) are required to obtain a ‘waiver’ to prescribe buprenorphine. To acquire this waiver, physicians are required to complete a standardized buprenorphine waiver 8-hour training. Nurse Practitioners (NPs) and Physician Assistants (PAs) are required to complete the standardized buprenorphine waiver 8-hour training as well as an additional 16 hours of online training as established by the Comprehensive Addiction and Recovery Act (CARA). Residents may also take the course and apply for their waiver once they receive their DEA license. The buprenorphine waiver 8-hour training is offered in a ‘half and-half’ format [4.5 hours of in-person training followed up by 3.5 hours of online training]. Upon completion of the required training, providers will meet the requirement of the DATA 2000 to apply for a waiver to prescribe buprenorphine for opioid-dependent patients. Please contact us for further information.
Questions: NYSDOH, AIDS Institute, Office of Drug User Health
Stephen Crowe, 212-417-4558, firstname.lastname@example.org Belinda Duncan, 212-417-4553, email@example.com
ACCREDITATION: This activity has been planned and implemented by NYSDOH, AIDS Institute in accordance with the accreditation requirements and policies of the American Academy of Addiction Psychiatry (AAAP) and in partnership with Westchester Medical Center (WMC) Health Network Performing Provider System (PPS), Westchester County Department of Health and Hudson Valley Community Services.
“Influenza 2018-19” CME Webinar on October 17; Registration Now Open
The first of MSSNY’s 2019 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2018-19” on Wednesday, October 17, 2018 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at firstname.lastname@example.org.
Educational objectives are:
- Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
- Describe clinical and laboratory diagnostic features and treatment specific to each flu season
- Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated
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.
2018 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers, and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS. This conference will inspire participants to explore new developments in continuing medical education, including compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.
Conference will take place on Friday, September 21, 2018, at the Courtyard Westbury Long Island (adjacent to the MSSNY Westbury Office). Registration links and more information are available here. Graham McMahon, MD, President and CEO of the Accreditation Council for Continuing Medical Education (ACCME) will deliver the keynote speech, as well as leading an educational session on “Better Methods” for planning and implementing CME activities. MSSNY President Thomas Madejski, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at email@example.com.
Two Studies Doubt Benefits of Commercialized Probiotic Products
Two studies published Thursday in the journal Cell “cast further doubt on the benefits of the highly-commercialized probiotic products.” Because they are “marketed as dietary supplements, not drugs,” probiotics do not need to be approved by the FDA for claims that they prevent or treat any health conditions, such as “preventing the common cold to treating allergic disorders.”
In the first study, “25 healthy volunteers ate a generic probiotic with 11 strains of ‘good’ bacteria,” and while each had “probiotic bacteria in their stool,” when physicians “did the endoscopy to evaluate their intestines, they found that probiotics had only actually ‘stuck’ and grown in a few people.” In the second study, the researchers tested what happens when a patient takes probiotics after a course of antibiotics and discovered the probiotics colonized their gastrointestinal tracts “at the expense of the normal gut microbiome, delaying the return to its normal, pre-antibiotic state by several months.”
MSSNY Joins House of Medicine to Urge CMS to Reject Proposal to Collapse E&M Payments
MSSNY has joined on to multiple letters to the Center for Medicare & Medicaid Services (CMS) to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019. Both letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments. Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).
Register for September 12 All-Payer Combination Option Overview Webinar
Join CMS for 9/12 Webinar on All-Payer Combination Option Overview on Wednesday, September 12, 2018 at 2:00 PM ET to provide an overview of the All-Payer Combination Option, which allows clinicians to become a Qualifying APM Participant (QP), and therefore eligible for the 5% APM Incentive payment, through participation in a combination of Medicare Advanced Alternative Payment Models (APMs) and Other-Payer Advanced APMs, including Medicaid, Medicare Advantage and commercial payers.
During the webinar, CMS will discuss:
- Overview of APMs and Advanced APMs
- All-Payer Combination Option Basics
- Determinations of Other Payer Advanced APMs (Payer and Eligible Clinician Initiated Processes)
- Determinations for QPs under the All-Payer Combination Option
- Frequently Asked Questions
- Additional Resources
CMS will address questions from participants at the end of the webinar, as time allows.
- Title: All-Payer Combination Option Overview Webinar
- Date: Wednesday, September 12, 2018
- Time: 2:00 – 3:00 p.m. ET
- Registration Link: https://engage.vevent.com/rt/cms/index.jsp?seid=1193
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.
- Register for September 12 All-Payer Combination Option Overview Webinar
- Register Now for the 2019 MIPS Performance Period Self-Nomination Virtual Office Hours Session
More on Medicare Revalidation
Previously, MSSNY has reminded physicians of the requirement to revalidate their enrollment with the Medicare program. Once a timeframe is established for the physician or group, revalidation will occur every 5 years. Physicians need to know that CMS/NGS Medicare reserves the right to perform off cycle revalidations in addition to the regular 5–year revalidations and may request that a provider or supplier recertify the accuracy of the enrollment information when warranted to assess and confirm the validity of the enrollment information maintained by CMS. Off cycle revalidations may be triggered as a result of random checks, information indicating local health care fraud problems, national initiatives, complaints, or other reasons that cause CMS to question the compliance of the provider or supplier with Medicare enrollment requirements. Off cycle revalidations may be accompanied by site visits.
In addition, physicians, non-physician practitioners, and physician and non-physician practitioner organizations must report the following reportable events to their Medicare contractor within the specified timeframes:
(1) Within 30 days—
(i) A change of ownership;
(ii) Any adverse legal action; or
(iii) A change in practice location.
(2) All other changes in enrollment must be reported within 90 days.
The law further provides that no payment will be made (by the program or the Medicare beneficiary) for an otherwise Medicare covered item or service during the period of deactivation of billing privileges.
Physician Fee Schedule Year 3 Proposed Rule: Comments Due September 10
On July 12, CMS released proposed changes to the Physician Fee Schedule and Quality Payment Program. CMS seeks comment on various proposals by 5 pm ET on September 10. See the proposed rule for information on how to submit your comments. If you haven’t yet done so but would like to, you can submit your comments on the CMS Proposed Rule electronically here – look for the green box, see below: This document has a comment period that ends (09/10/2018) SUBMIT A FORMAL COMMENT
NOTE: Personalized comments have the highest impact on CMS’ decision making process, so the public is encouraged to submit separate comments and add information about how this rule will uniquely impact the medical practice and patients.
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Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated. The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services. The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee. The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review. The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff. The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.
Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012,
or by email to firstname.lastname@example.org with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.
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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355