Nov. 2, 2018 – Leading & Learning

PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President MSSNY eNews November 2, 2018 Volume 20  Number 41

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Colleagues:

Meeting the Presidents

I experienced a fortuitous concatenation of meetings recently.   The common theme- Current and Former Presidents of the AMA and State Medical Societies.

Last Thursday evening I had dinner with AMA Past President Nancy Nielsen (and MSSNY Past Speaker) and two other friends at my home.  Friday afternoon, I saw my good friend and AMA Past President Andy Gurman.  Saturday morning, Dr. Barbara McAneny, current AMA President, treated me to breakfast while we were attending the Pennsylvania Medical Society House of Delegates Annual Meeting.  My wife Sandra and I were there to represent New York at the meeting.

Attending other states’ HODs allows me to see different approaches to problems, brainstorm with other leaders of the House of Medicine, and share our successes and challenges with colleagues from other states.  Pennsylvania is fortunate to have a number of great leaders at the local and national level.  Incoming president Danae Powers shared with me some of the opportunities and potential problems for physicians in the PAMED society. We have similar challenges and I was pleased to see that they have begun a successful marketing campaign and had substantial membership growth last year, particularly in some under-represented demographic groups.

Some of this was due to the activity and leadership of their outgoing President, Ted Christopher.  He has been a tireless advocate for patients and physicians this last year, crisscrossing the state and engaging with members and non-members.  Ted also focused on bringing to light issues with social determinants of health.  He transformed his personal experience as an emergency room physician into policy and advocacy that will improve the health and lives of his patients, and the joy of medicine for his colleagues.  I was also fortunate to meet new Indiana Medical Society President, Dr. Stacie Wenk, and Massachusetts President Alain Chaoui.

Listening, Learning, Leading

Dr. Christopher’s farewell address to the Pennsylvania House of Delegates emphasized his goals of listening, learning and leading.  That is a common theme of this group.  Dr. Nielsen had periods during which her family was uninsured and struggled with healthcare and economic insecurity.  Dr. McAneny continues to fight against consolidation of insurers and healthcare institutions and their unfair business practices that harm physicians and make care more expensive for her patients.  Dr. Chaoui is fighting the same battle with his practice against health systems and insurers in Massachusetts.

Their personal experiences and challenges are the crucible that helped to form these leaders.  They channeled their passion with the help of likeminded physicians, local medical students from their state, specialty or national medical societies to focus their energies for the good of their patients and our profession.  I’m grateful to them for sharing their time, talent, treasure and passion. I’m hopeful they inspire all of us to stand firm with our loins girt with truth, staff in hand, ready to battle for the health of our patients and improving the practice of medicine.

MSSNY, the AMA, and our County and Specialty Societies are the forge that created these great leaders.  Your involvement in creating policy and advocating for it is essential for your patients and your ability to care for them properly.  MSSNY has a strong focus on developing leaders (Physician Leadership Program on November 30-Dec.1 in Syracuse).

Let MSSNY help you forge your leadership skills.  Contact me at comments@mssny.org.

Ductus exemplo!

Thomas J. Madejski, MD
MSSNY President

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MSSNY Seeking Info: Have You Received Letter from Walmart Re Prescribing Practices?
The Medical Society of the State of New York and the American Medical Association Task Force on Opioids is interested in hearing from physicians who may have received a letter from Walmart in regards to the prescribing practices for controlled substances.  Walmart, Walgreens, and CVS pharmacies has implemented the CDC Guidelines for Prescribing Opioids for Chronic Pain as corporate policy.  MSSNY and the AMA learned that Walmart has sent letters to physicians throughout the country about their prescribing practices.

In the letters, Walmart indicated that it will no longer be accepting physicians’ prescriptions for Controlled Substances II-V where it believes it is warranted based upon Walmart’s review of a physician’s prescribing practice. MSSNY and the AMA Task Force on Opioids are extremely concerned about corporate policies that could result in refusal to fill prescriptions above certain doses and to refuse to fill prescriptions from certain physicians based on the corporation’s arbitrary definitions of questionable prescribing patterns.

MSSNY is aware nationally there have been physicians who have received this letter; an example of the letters can be found here. MSSNY will meet with state officials from the NYS Bureau of Narcotic Enforcement within the next few weeks to discuss this corporate policy and its impact on NYS physicians and patients.  Any physician who may have received this letter, please contact Pat Clancy, Sr. Vice President, Public Health and Education/Managing Director, at pclancy@mssny.org or by phone at 518-465-8085.

Physicians may also ask the NYS Office of Professional Discipline (OPD) to review this matter. To file a complaint, please complete the OPD complaint form and list the contact information for the New York pharmacy(s) that is involved along with the details of the complaint. This completed form along with any additional information may be emailed to the OPD directly at conduct@nysed.gov   Please copy Pat Clancy when filing the complaint.

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Contraction of Medicare E&M Payments Will Not Be Implemented in 2019
Among the many highlights of the final 2019 Medicare physician payment rule released this week is that CMS will not be implementing a proposal that had been opposed by MSSNY, the AMA and many other state and specialty medical associations to condense E&M payments for Level 2-5 visits.

According to an initial summary from the AMA of the 2,300 page payment rule, it noted that CMS will be implementing new documentation policies for E&M claims which will significantly reduce administrative burden.  Importantly, however, the CMS has acknowledged the work of the AMA’s CPT/RUC Workgroup on E/M by postponing any coding and payment-related changes for E/M office visit services until CY2021.  

The changes to E/M documentation guidelines for 2019 which were strongly supported by the AMA and other members of the Federation include:

• The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.

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• Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated.

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• Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.

It was also noted that the following policies opposed by the AMA and will not be implemented by CMS:

• Payment reductions by 50% for office visits that occur on the same date as procedures (or a physician in the same group practice). The AMA brought attention to the fact that duplicative resources have already been removed from the underlying procedure through the current valuation process; and

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• Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty’s indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (such as a greater than 10% payment reduction for chemotherapy services).

However, of concern, the final Medicare payment rule did include a reduction of the “add-on” amount for the wholesale acquisition cost (WAC)-based payment for Part B drugs.  Effective January 1, 2019, WAC-based payments for Part B drugs – during the first quarter of sales when ASP is unavailable – will be “subject to a 3 percent add-on in place of the 6 percent add-on that is currently being used.”  CMS stated that this “change in policy will help curb excessive spending, especially for new drugs with high launch prices, and will also decrease beneficiary cost sharing.”

Review of the final payment rule is ongoing and further updates will be provided.  To read the CMS press discussing highlights of the final 2019 Medicare payment rule, click here.

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November Council Meeting Voted on 2019 Legislative Program
At the meeting on November 1, Council approved the following:

• MSSNY will support and co-sponsor the Gay and Lesbian Medical Association (GLMA) resolution regarding an amendment to the AMA policy on Medical Spectrum of Gender. The resolution calls for the AMA to work with appropriate medical organizations and community based organizations to inform and educate the medical community and public on the medical spectrum of gender identity; educate state and federal legislators on the medical spectrum of gender identity to ensure access to quality health care; and affirm that gender is not fixed and may differ from the sex assigned at birth.

• MSSNY’s 2019 Legislative Program

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• MSSNY will advocate for legislation, regulation or other appropriate means to assure that needle electromyography and nerve conduction studies are performed by licensed physicians only, or those who are directly supervised by a physician.

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• MSSNY will work with the NYS Society of Orthopedic Surgeons to educate physicians regarding existing clinical data registries that collect data regarding poorly performing cobalt/chromium metal-on-hip implants to better assure physicians have necessary information to inform their patients. MSSNY will urge the AMA to work with the American Academy of Orthopedic Surgeons (AAOS) to increase the adoption of musculoskeletal registries so as to aid early detection capabilities of poorly performing implants and report to the public on clinical statistics, and inform quality improvement and educational activities.

Speaker of the House Dr. Kira Geraci announced the following important dates regarding the 2019 House of Delegates at the Tarrytown Marriot:

• April 11-CMS Programs

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• April 12-14-House of Delegates

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• Resolution submissions: February 8-March 8 @ 5 pm

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Mark your Calendars! The 3^rd and 4^th District Retreat will be held on January 26, 2019 at the Mirror Lake Inn in Lake Placid.

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Extortion Scam Targeting DEA Registrants
DEA is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel.  The criminals have masked their telephone number on caller id by showing the DEA Registration Support 800 number.  Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website, www.DEADiversion.usdoj.gov.

For more information contact:
Locate DEA Field Office for your area – https://apps.deadiversion.usdoj.gov/contactDea/spring/fullSearch
Registration Service Center – 1-800-882-9539
Email – DEA.Registration.Help@usdoj.gov

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Three-Year-Old State Billing Law Leads to Fewer Surprises for New Yorkers
Three years after New York implemented a landmark law to prevent patients from getting surprise bills, many consumers have been shielded from disputes between doctors and insurers. The out-of-network consumer protection law holds patients harmless in emergency cases when they are treated by out-of-network physicians, except for any in-network payment responsibility. It also removes patient liability in cases when a person attempts to use an in network provider but still receives an out-of-network bill from an anesthesiologist or pathologist, for example.

The New York State Health Foundation hosted a panel Monday to review the law’s successes and shortcomings. Troy Oechsner, deputy superintendent for health at the state Department of Financial Services, shared data about outcomes in the independent dispute-resolution process. In emergency cases, health plans were more likely to prevail than providers by a margin of 534 to 289. Plastic surgeons represented about one-quarter of the 2,104 cases that have gone through the resolution process, followed by emergency medicine physicians and orthopedic surgeons. Meanwhile, in cases of non-emergency, surprise bills, providers won the disputes more often, by a margin of 272 to 84, in cases where decisions were rendered. Those disputes most often involved neurosurgeons and anesthesiologists.

The law does have limitations, though. About half of New York’s commercially insured population is covered by self-insured employer health plans regulated by federal law, Oechsner said. “As a result, all these great protections that we’re working on for the state don’t apply to nearly half the commercial market,” he said. “That’s a huge problem.” He said the state is working to improve its enforcement of standards around the type and quantity of providers insurers must include in their networks. (Crains NY Business Oct 3).

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Urge Gov. to Sign Legislation to Expand Access to Prostate Cancer Screening
Physicians are urged to contact Governor Cuomo to encourage him to sign into law legislation (S.6882/A.8683­) that would ensure that health insurers provide coverage for diagnostic testing for prostate cancer without such care being subject to annual deductibles or coinsurance. In particular, men over 40 with family history and men over 50 who are asymptomatic would be enabled to receive this care without being subject to annual deductibles or coinsurance. Additionally, the bill would require the information regarding the availability of insurance coverage for prostate cancer screenings without cost sharing, to also be included in the standardized written summary prepared by the Commissioner of Health. New York has for many years required insurance coverage for these tests, but were subject to cost-sharing. This undoubtedly will encourage even more men to have this often life-saving test. You can send a letter in support here.

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Life Expectancy in New York Lowered: Obesity and Opioids Are Factors
Life expectancy in New York State is going in the wrong direction, an alarming reversal after years of steady increases. A report produced by the NYS Health Foundation’s internal policy and research department shows that, after peaking in 2014 at 80.7 years, life expectancy decreased in both 2015 and 2016 https://bit.ly/2Jz8bjf. The report found that a combination of factors–including the growing obesity epidemic and the opioid crisis–is likely contributing to declining life expectancy.

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Rockland County: 33 Cases of Measles; Five More Suspected
Rockland County officials confirmed that 33 people have measles and five more suspected cases are under investigation. More than 2,000 people in the county have gotten the measles, mumps, 

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Nassau County DOH Named Local Health Department of the Year
The Nassau County Department of Health (NCDOH) has been named “Local Health Department of the Year” for 2018 by the National Association of City and County Health Officials. The NACCHO represents the nation’s nearly 3,000 local governmental health departments.

The announcement was made at the NACCHO Annual Conference. NCDOH earned the tile by successfully bringing together providers, hospitals, and community-based organizations to evaluate the needs of residents, and together created a county-wide Community Health Assessment and Community Health Improvement Plan. NCDOH is a founding member of the Long Island Health Collaborative, which has grown from a three-agency online database to a grant-funded health initiative with almost 100 agencies.

In recent years, the County Health Department has created initiatives such as an Office of Minority Health Affairs, participation in the “Cribs for Kids” program, programs that screen infants for developmental delays, sending “Newborn Welcome Mailings” with pertinent newborn health information to the families of all 14,000 babies born in the county each year and serving as the grantee for the Long Island Ryan White HIV Service grant.

The Department’s Public Health Emergency Preparedness unit leads a troop of almost 1,000 volunteer medical professionals in a Medical Reserve Corps who train for emergencies and provide on-site medical coverage for the Games for the Physically Challenged and the Long Island Marathon.

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Flu Vaccine: One Year Doesn’t Reduce Effectiveness the Next Year
Getting the flu vaccine every year doesn’t reduce its effectiveness — and might even boost its performance — suggests a study in JAMA Network Open. Researchers examined the vaccination status of nearly 3400 children who presented with acute febrile respiratory illness during one of three successive flu seasons between 2013 and 2016. About one-fourth had flu confirmed on reverse-transcription polymerase chain reaction testing; the rest were considered negative for flu.

The researchers found that while vaccine effectiveness varied by vaccine type (e.g., live attenuated influenza vaccine [LAIV) or inactivated influenza vaccine) and flu virus strain, past-season vaccination did not reduce vaccine effectiveness. In fact, in some cases — for example, the effectiveness of LAIV against influenza A (H3N2) — previous vaccination appeared to improve the vaccine’s effectiveness.

Of note, residual protection from past-season flu vaccine alone was observed only for influenza B.

A commentator writes, “The results thus suggest additional support for the current Advisory Committee on Immunization Practices’ recommendation that children be vaccinated annually against influenza.” article; JAMA (Free)

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“Cybersecurity: A Daily Threat for Healthcare” CME Webinar
November 14 @7:30am_ Registration Now Open

Do you know how best to protect your office against a cyberattack?  Are you aware of your vulnerabilities?  Learn how to protect yourself, your patients and your workplace on November 14 at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

• Describe vulnerabilities within medical practices, hospitals and daily life
• Identify methods to increase protection from cyberattacks
• Review methods for reporting and responding to a cybersecurity incident

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. 

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Be Sure to Check Out All of MSSNY’s Podcasts and CME Programs
Did you know that MSSNY has created several podcasts and CME programs on current topics such as influenza and measles to name just two?  Click here for MSSNY’s podcast on Measles, Mumps and Rubella and click here to listen to a podcast on Influenza Vaccines.  And you can listen to all of our podcasts here.

MSSNY also has several free CME programs at https://cme.mssny.org concerning influenza, including our most recent Medical Matters: Influenza 2018-19.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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The Quality Payment Program Resource Library is Back on QPP.CMS.GOV
CMS has moved Quality Payment Program (QPP) resources from CMS.gov to the newly redesigned Quality Payment Program Resource Library on qpp.cms.gov. Following feedback from clinicians and others in the health care community, we wanted to make Quality Payment Program information and resources available in one place. We’ve also made it easier for you to find the resources you’re looking for by including a search function that allows you to search for resources by year, reporting track, performance category, and by document type (e.g., fact sheet, user guide, measure specifications).

Additional resources including materials from educational webinars will be added to the new Quality Payment Program Resource Library soon. Stay tuned for more information!

For More Information:

• Go to the Quality Payment Program Resource Library to review Quality Payment Program resources.
• Visit the Quality Payment Program website to check your participation status, explore measures, and to review guidance on MIPS, APMs, what to report, and more.

Questions? Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292.

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