September 29, 2017 – Helping to Help Others

PRESIDENT’S MESSAGE Charles Rothberg, MD

September 29, 2017 Volume 17 Number 37

Dear Colleagues:

Over the past few weeks our mainland has been devastated by hurricanes. Most recently, and most tragically, Puerto Rico has been overcome with loss of life and lack of available medical services due to flooding, isolation and downed communication lines. Hospitals, clinics and nursing homes have been destroyed beyond repair. The entire Puerto Rican medical system has been critically damaged. Local officials have called conditions “a humanitarian crisis.”

The Medical Educational and Scientific Foundation (MESF) is MSSNY’s not-for-profit subsidiary. As they have in other times of need, MESF is collecting funds to assist in the recovery efforts. One hundred percent of the funds raised will support the physicians affected practices in Puerto Rico. After Hurricane Sandy, due to your generosity, MESF was able to help many New York physicians rebuild their practices.  The program will help cover expenses (not covered by insurance or other funding) for relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar needs all towards the goal of helping physicians once again treat patients.

I encourage you to join me in supporting the work of the Foundation with a generous contribution.

Donations can be made online here or by sending a check made payable to MESF with the designation “Hurricane Relief Fund” and mailed to MSSNY, 865 Merrick Avenue, Westbury NY 11590. All donations are tax deductible.

Thank you for helping us to help others.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Assembly Hearing: Labor Community Concern Re Impairment Guideline Proposed Changes
The New York State Assembly Labor Committee held a hearing this week to examine strong concerns expressed by organized labor, groups representing injured workers and trial attorneys with a proposal by the Workers Compensation Board to revise the permanency impairment guidelines.  To watch a re-broadcast of the hearing, click here.  The testimony and Q&A with the leadership of the New York Workers Compensation Board encompasses approximately the first 2 ½ hours of the hearing.

The labor community, including the NYS AFL-CIO, New York Committee on Occupational Health & Safety (NYCOSH) and the Injured Workers Bar Association expressed concerns with both the proposed changes to the impairment guidelines as well as the regulations implementing the use of these new guidelines.  They are very concerned that the schedule loss of use (SLU) awards will be reduced if the proposed guidelines are permitted to go into effect.  Moreover, they have strong concerns with proposals that would limit the ability of an injured worker to have an independent physician rather than the treating physician determine the degree of the injured worker’s impairment.  Moreover, there are concerns with provisions that would require injured workers to completely answer questionnaires and respond to written interrogatories from Independent medical examiners.

On the opposite side, the Business Council of New York State challenged the assertions that the regulations were unfair to injured workers.  However, they too raised concerns with the proposed guidelines due to “multiple instances where the guidelines fail to be reflective of advances in modern medicine in very key areas, are far too subjective in their determination processes and fail to give employers fair opportunities to cross-examine claimants.”

The proposed revised guidelines were originally drafted by the New York State Society of Orthopedic Surgeons (NYSSOS).  However, they were changed significantly following an August 15 meeting convened by the WCB that included representatives of the NYS AFL-CIO, the New York Business Council, the City of New York and several insurance companies, as well as physicians representing MSSNY and the New York State Osteopathic Medical Society.  NYSSOS President and MSSNY member Dr. John Olsewski as well as orthopedist Dr. Jeffrey Lozman testified at the Assembly hearing this week, expressing concerns with the significant changes to their original proposed guidelines.

To read the testimony of the New York Committee on Occupational Health & Safety, click here.

To read media coverage of the Assembly hearing, click here.

Governor Proposes Legislation to Combat Synthetic Fentanyl Use
Governor Andrew Cuomo announced this week a series of actions to combat the fentanyl crisis in communities across New York State. Specifically, the Governor is proposing legislation to add 11 fentanyl analogs to the state controlled substances schedule.  Moreover, the NY Department of Financial Services issued a circular letter to advise health insurers against placing arbitrary limits on the number of naloxone doses covered by an insurance plan.

The press release noted that, while overdose deaths involving opioids in New York increased nearly 35% between 2015 and 2016, fentanyl-related deaths increased nearly 160%   The release further noted that while Fentanyl proper is a Schedule II synthetic opiate, underground labs have tweaked the molecular structure of fentanyl to create new, unregulated chemicals referred to as fentanyl analogs. These deadly cousins are chemically similar to fentanyl—and often many times more potent—but are not listed on New York State’s schedule of controlled substances, and therefore not subject to the same criminal penalties.

In response,  the legislation proposes to add the following 11 fentanyl analogs to Schedule I of the controlled substance schedules of New York State Public Health Law §3306: AH-7921; Acetyl Fentanyl; Butyryl Fentanyl; Beta-Hydroxythiofentanyl; Furanyl Fentanyl; U-47700; and Acryl Fentanyl (or Acryloylfentanyl); N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide; Ortho-Fluorofentanyl; Tetrahydrofuranyl Fentanyl; Methoxyacetyl Fentanyl. The 11 substances are already listed on the federal schedule of controlled substances. The legislation will also give the New York State Health Commissioner the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule.

Moreover, the new DFS circular letter advised that health insurers “should provide coverage for naloxone on an outpatient basis when prescribed to an insured by an authorized provider, as they would for any other prescribed drug, subject to the terms and conditions of the health insurance policy or contract. In addition, naloxone should also be covered on an inpatient basis when medically necessary.”

Among the many public officials quoted in the press release is Suffolk County legislator and Past-President of the Suffolk County Medical Society Dr. William Spencer who stated:  “Fentanyl represents a dangerous new front in the devastating opioid crisis, and I am grateful that Governor Cuomo recognizes this challenge and is stepping up to address it head on. The Governor’s multi-pronged effort to stop the spread of fentanyl will literally save lives. So I want to thank Governor Cuomo for spearheading this effort and making a difference here and all across the state.”

Continue to Urge Gov. Cuomo to Veto One-Sided Medical Malpractice Expansion Legislation
Physicians are urged to continue to send letters and call Governor Cuomo’s office to request that he veto legislation (S.6800/A.8516) passed in the waning hours of the Legislative Session that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer”.   You can send a letter here and call 518-474-8390.

This week MSSNY President Dr. Charles Rothberg had a letter published in the Albany Times Union calling for comprehensive, not piecemeal, reform of NY’s dysfunctional medical malpractice adjudication system.  Dr. Rothberg’s letter recommends that, “Cuomo must veto this well-intentioned, but one-sided, destructive legislation. Instead, he should empanel a blue ribbon commission to develop legislation that both assures the rights of patients to bring actions for negligence while preserving the availability of timely and quality medical care.”  The article referenced by Dr. Rothberg’s letter can be found here.

Last week, Orange County Medical Society President Dr. Stephanie Zeszutek had a letter published in the Middletown Times-Herald urging the Governor to veto this bill.   Dr. Zeszutek’s letter noted that “The state has a dangerous doctor shortage and future doctors are already being deterred from certain specialties or medicine altogether due to malpractice liability concerns. This bill sets a dangerous precedent for liability across the country. We urge Gov. Cuomo to reject this bill in favor of more sensible legislation.”

Numerous other letters from regional physician leaders have appeared in papers across the State urging a veto including the following:  Buffalo News, Syracuse Post-Standard, Rochester Business Journal, Poughkeepsie Journal, Albany Times Union

While many physicians have weighed in, we need an overwhelming demonstration from physicians regarding how this bill will harm access to care in their communities if this bill is signed into law without also providing needed tort reforms to bring down the exorbitant costs of medical liability insurance in New York.

Promo Code: MSSNY

MSSNY’s 2017 Legislative Summary Now Available Online
Many of you are aware that a statute of limitations expansion bill (S.6800/A.8516) passed over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.  However, working together with specialty societies and other health care advocacy groups, MSSNY was successful in advocating for several public health bills passed both houses.

Moreover, MSSNY’s advocacy together with its allies resulted in scores of adverse bills being rejected by the New York State Legislature included those that would have expanded the scope of practice for various professions and those that would have imposed unworkable mandates on physician delivery of patient care.

Please click here to see our 2017 legislative summary.

Sign Up To Become a Physician Advocacy Liaison Today
Your participation is essential to continue a strong grassroots effort to address all of the issues facing physicians.  We encourage you to remain active and reach out to your elected officials to make sure our voices and health care expertise are heard.

PAL responsibilities include:

• • Educating other members on issues facing physicians, such as at local county medical society or medical staff meetings
  • Working as appropriate with your county medical society, be available to meet with your members of the legislature at least twice a year
  • Being responsible for calling or writing letters to members of the legislature on issues that impact physicians
  • Attend training programs in regard to legislative issues

• Enlisting other member to support our action plans and mobilize them to action
• Joining and recruiting others to join MSSNYPAC

Please join the many other physicians who have signed up to become a Physician Advocacy Liaison.

Michael Dowling: The Issue of Ill-Conceived Regulation and How it Led to CareConnect’s Demise
Becker’s Hospital Review/Written by Michael J. Dowling, President & CEO, Northwell Health 

One of the greatest frustrations among many healthcare leaders today is the federal government’s increasing addiction to micro-management. Whether it’s a soccer match, or a football, hockey or basketball game, the referees set the rules and then allow the players to compete, stopping the game only when the rules are broken. Rather than let the players play, today’s federal regulators have set the rules and often enter the game themselves. On occasion, they’re even changing the rules during the middle of the game.

To continue reading the article, click here.

US Senate Decides to Shelf Cassidy-Graham Legislation
This week the United States Senate failed to garner the necessary support to bring the “Cassidy-Graham” ACA repeal and replace legislation to a vote of the full US Senate.  As reported last week, MSSNY joined with numerous other New York healthcare provider associations in a letter to New York’s Congressional delegation expressing its strong objections to the Cassidy-Graham proposal because of its potentially significant adverse consequences to New Yorkers’ insurance coverage as well as to our State finances.

As reported in Politico-NY, after Senate Majority Leader Mitch McConnell announced that the bill would not be considered, MSSNY President Dr. Charles Rothberg stated: “Once again, another unworkable ACA repeal bill failed to secure a majority of Senate votes. Now is the time for Republicans and Democrats to work together to find common ground to address the many pressing health care issues of anxious patients and their physicians.

These include continuation of the Child Health Insurance Program, continuation of essential cost-sharing subsidies and yes, addressing fundamental flaws of the ACA such as inadequate physician networks and exorbitant deductibles.” 

Constitutional Convention Debate
Every 20 years, New Yorkers have the chance to vote whether they want to hold a constitutional convention to amend or change the New York State Constitution.  As reported last week, while some advocacy groups support a Constitutional Convention, many groups oppose it.  Professor Gerry Benjamin moderated a recent NYS Constitutional Convention forum with former counsel to former Governor Mario Cuomo, Evan Davis and Chris Ludlow, Hudson Valley Legislative and Political Action Coordinator for the Civil Service Employees Association.

Click here to listen to the pros and cons of holding a NYS Constitutional Convention.  Voters will decide on whether they want to hold a convention on Election Day, November 7, 2017.

USPSTF: Vitamin D Not Recommended Fall Prevention in Seniors
The U.S. Preventive Services Task Force is recommending against vitamin D supplementation to prevent falls in community-dwelling adults aged 65 and older (grade D recommendation). The draft statement is a change from its 2012 recommendation in favor of supplementation.

In a new analysis, the group found evidence that vitamin D supplementation did not reduce fall risk in patients who were not vitamin D deficient.

The USPSTF continues to recommend exercise to reduce the risk for falls in community-dwelling elders (grade B), and multifactorial interventions may be offered to high-risk seniors (grade C).

In a separate draft recommendation statement, the task force maintained its 2013 position on vitamin D and calcium supplementation to prevent fractures in men and premenopausal women. There is still not enough evidence to recommend for or against the practice (grade I).

The group again recommends against postmenopausal women taking 400 IU or less of vitamin D and 1000 mg or less of calcium daily because there’s no effect on fracture prevention (grade D). There was less certainty about higher doses (grade I).

USPSTF recommendations on fall prevention for seniors

USPSTF draft recommendations on Vitamin D, calcium supplementation for fracture prevention.

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

Register Now for the Veterans Mental Health Training Initiative Conference
The Medical Society of the State of New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two day conference on Friday, 10/13 Saturday,10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY. Registration is now open for this free two-day conference here.

Please note registration for the conference is separate from the registration for the educational programs.

The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans. MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are: Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues;  Recognition, Management and Prevention of Veteran Suicide; and Veterans Matters: Substance Use Disorders in Returning Veterans  (you can register for each seminar by clicking on the program title[s]).

“The Importance of Herd Immunity” CME Webinar October 18; Register Now!
MSSNY will begin its 2018 Medical Matters continuing medical education (CME) webinar series with “The Importance of Herd Immunity” on Wednesday, October 18, 2017 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 mhoffman@mssny.org.

Educational objectives are:
Review the epidemiology of vaccine-preventable infectious disease and role of herd immunity.
Describe how herd immunity protects vulnerable populations such as newborns, the elderly and those who are too sick to be vaccinated.
Discuss the percentage(s) of a population who need to be vaccinated to allow herd immunity to be effective.

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.

Are You Ready to Eliminate Hepatitis C?
Did you know that Hepatitis C is easy to treat and curable? Join us for an exciting free half day CME program that will review the recently released NYSDOH AI clinical guidelines on the treatment of chronic HCV! This program is sponsored by NYSDOH AI Clinical Education Initiative and Mount Sinai Institute for Advanced Medicine.

“From Screening to Treatment: The Clinician’s Role in Eliminating Hepatitis C in New York State”
Thursday, October 12, 2017
8:00am – 12:00pm
DoubleTree Syracuse
6301 State Rte. 298
East Syracuse, NY 13057

Space is limited, so register for this free training today – http://bit.ly/HCVSyracuse      

 Not near Syracuse? We’re coming to a city near you!

• Rochester, October 3^rd: http://bit.ly/HCVRochester  
• Buffalo, October 26^th: http://bit.ly/HCVBuffalo
• NYC, December 8^th: http://bit.ly/HCVNewYorkCity

Questions? Contact Jessica Steinke at jessica.steinke@mountsinai.org or 212-731-3789
View Flyer Here .

NYSDOH AIDS Institute Started Naloxone Co-payment Assistance Program (N-CAP) in August
For individuals with prescription coverage through their health insurance plans, this program will cover the cost of co-payments for naloxone up to $40 so there are no or lower out-of-pocket expenses when accessing naloxone at participating pharmacies.  All Medicaid Managed Care Plans cover at least one formulation of naloxone, and the vast majority of private insurance plans also cover naloxone.

Additional information as well as the ability to order promotional materials on N-CAP can be found at:  www.health.ny.gov/overdose. There are 2,000 pharmacies throughout the State who dispense naloxone with a physician standing order.  Individuals getting naloxone at these pharmacies do not need a prescription. They simply need to ask for it at the pharmacy counter and present their insurance information as they do for any other medicine.  They do not need to enroll in N-CAP.  Maximizing pharmacy distribution will allow individuals increased access to naloxone.

Pharmacies are open evening hours and weekends, and have multiple locations. Refills can also be obtained from any of the 2,000 participating pharmacies.  A directory of pharmacies with standing orders can be found here.

Individuals who cannot access naloxone from pharmacies will continue to access naloxone through registered opioid overdose prevention programs including individuals using naloxone in the line of duty and people who are uninsured.  If you have questions, please contact Lyla Hunt at:  lyla.hunt@health.ny.gov.

As you are aware, CMS has been working on our Handwritten Paper Claims Reduction Initiative since July.  As we move to the Downstate New York regions, I am once again asking if you can help us communicate this important update to your Members and colleagues.

Handwritten Paper Claims Reduction Initiative
On July 10, 2017, NGS began returning any paper claims that include handwriting in fields other than the allowed signature fields (Items 12, 13, or 31).

We are rolling this out on a State/Locality basis and by November, all handwritten claims will be returned to the provider.

The schedule is as follows:

November 13, 2017New York (Downstate: Localities 01, 02, and 04)New York Locality/Area and County Information

The CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30, “Printing Standards and Print File Specifications Form CMS-1500” (700 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims. Please use this CMS IOM reference to ensure you are completing paper claims correctly.

Alternatives to Handwritten Paper Claims
We understand this may require some substantial changes to your office practices and we at NGS have two alternatives to handwritten paper claims that would be of little cost to your practice.

1. NGSConnex is our web-based self-service portal, free of charge, and available through Internet access. You can login to NGSConnex and submit claims to us. In addition to claims submission, NGSConnex has other useful functions like verifying Medicare entitlement, submitting appeals on claims, and viewing and downloading your remittance advice. Take this opportunity to get started on NGSConnex today!

2. Electronic claim submission and other transactions submitted electronically process considerably faster than paper submission. The Electronic Data Interchange (EDI) page on our website, explains how to enroll and what capabilities your office needs to be able to submit electronic claims.  In addition, NGS can provide you with no cost claim submission software, PC-ACE.  Visit our web site at PC-ACE to learn more.

All providers with access to the Internet should have the capability to download this billing software free of charge. However, if that is not the case, this software will continue to be available on CD for a $25 nonrefundable fee.

To learn more about PC-ACE visit the Electronic Data Interchange software tab on our web site at www.NGSMedicare.com  and choose Claims & Appeals

For assistance, please contact the EDI Help Desk or submit an EDI E-mail Inquiry Form for assistance. If it is determined that you are not capable of downloading the software, you will be provided with the appropriate form to request the PC-ACE software on CD.

Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA, Medco Consultants, Inc. 

Due to HIPAA-HITECH requirements, please do not send any Protected Health Information (PHI) via email. Please contact Medco to obtain secure file transfer instructions.

Professional Healthcare Consulting Services that make a difference!

Certified Coding, Remote Coding, Coding education, Coding Certification Prep Course, and discounted coding products. If you have a coding or compliance question you would like to have answered please send your question to MSSNY at eskelly@mssny.org, and complete the subject line with Tip of the Week.

MIPS Milestone: Begin Data Collection by October 2nd for 90 Consecutive Days of Participation
It’s not too late to participate in the first year of the Merit-based Incentive Payment System (MIPS)—one of the two tracks in the Quality Payment Program. The transition year of MIPS has been underway since January 1, 2017 and runs until December 31, 2017.

Transition year (2017) Participation:

For 2017, you can participate in one of three ways:

• Submit data covering a full year, or
• Submit data covering at least a consecutive 90-day period, or
• Submit a minimum amount of data (<90 days)

Remember: You should begin data collection no later than October 2, 2017, to report 90 consecutive days of data for the transition year. For example: If you are planning to submit 90 days or more of your quality data via your claims, you would need to begin adding the applicable quality data codes to your claims no later than October 2nd. If you submit data for at least 90 days, you avoid the negative payment adjustment, and may be eligible for a positive payment adjustment.

Are you planning to submit less than 90 days of data? If so, you can begin data collection as late as Dec 31st and still avoid the negative payment adjustment. However, more data increases your likelihood of earning a positive payment adjustment.

When is data submission? This listerv is a reminder to begin data collection. You will begin submitting your 2017 MIPS performance data on January 2 through March 31, 2018.  If you are eligible to participate but choose not to submit data, you’ll get a negative 4% payment adjustment which will go into effect on January 1, 2019.

Need Help Participating?

• • Use the MIPS Look-Up Tool on the Quality Payment Program website to determine if you should participate in MIPS.
  • Review resources available in the Resource Library including A Quick Start Guide to Participating in MIPS.
  • Learn about the free Technical Assistance available to clinicians, especially those in small, underserved, and rural practices.

• Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292 (TTY: 1-877-715-6222).

Targeted Probe and Educate
Effective 10/1/2017, the CMS is expanding the existing Targeted Probe and Educate (TPE) pilot to include all MACs. TPE will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the ZPIC, UPIC, RAC, etc. The goal of TPE is to reduce/prevent improper payments. The purpose of this expansion is to reduce appeals, decrease provider burden, and improve the medical review and education process.

Key Elements of TPE

• All current NGS medical record reviews are replaced with three rounds of pre-payment or post-payment TPE. If the provider’s error rate remains high upon completion of the first round, then the provider is retained for the second and, potentially, a third round of review.
  • Automated reviews and prior authorization directed by CMS are outside of the TPE strategy.
  • Note that any reviews or pilots otherwise mandated by CMS are excluded from this change.
• Providers with a continued high error rate after three rounds of TPE will be referred to CMS for additional action
• NGS will select the topics for review based upon existing data analysis procedures.
• The claim sample size for each round of probe review is limited to a minimum of 20 and a maximum of 40 claims
  • Note that the sample is per provider, per topic, and per round.
• The TPE process includes provider specific education that will focus on improving specific issues without allowing other problems to develop along with an opportunity for the provider to ask questions. Education will be offered after each round of 20 to 40 claims reviewed.   We urge all to take advantage of the education.
  • In addition, there is an opportunity for intra-round education as well if the nurse reviewer identifies a common theme that can be easily corrected during the review phase.

Provider Tips

• Providers targeted for TPE will receive a notification letter about the upcoming review and ADRs will be used for the specific claims selected for review.
• Providers should ensure that medical records are submitted promptly upon request.
  • Reminder: ADRs must be responded to prior to the 45 day deadline (based on the date of the ADR) for each claim selected.
  • Providers are highly encouraged to respond to the ADR by sending all applicable medical records prior to day 45
• Provider nonresponse to medical records requests will count as an error.
• MACs may conduct a “related claim review” of services related to a denied claim and such reviews may be conducted outside of the TPE process.
• The TPE process does not replace or change appeal rights.
  • The educational sessions are not an appeals forum nor do the result letters and/or the educational sessions extend the appeal period.

Related Content

• • CMS Change Request 10249
  • CMS Targeted Probe and Educate (TPE) Information
  • CMS TPE Process Flow Chart

• Reducing Provider Burden