November 9, 2018 – Winners and Losers
Thomas J. Madejski, MD
November 9, 2018
Volume 20 Number 42
Apart from personal thoughts, beliefs and policy implications, I was fascinated and intrigued by the run up to the elections Tuesday night. I was encouraged, and my faith in our system was strengthened by the level of participation and engagement of all of us in the electoral process. Democracy is a terribly inefficient system of government, but there is none better.
Then national, and importantly for MSSNY and our members, New York State political landscapes have changed (See article below). Subsequent to this, I had an email chat with some of our members on the importance of political activity and participation in MSSNYPAC. (Please see my contribution to the discussion below.)
The President of MSSNY is responsible for executing the MSSNY agenda (which changes depending on our members’ thoughts and desires) and, with the direction of the HOD and Council, the operation of the organization to attempt to achieve that agenda. Part of that Presidential responsibility is to try and get us to all pull together and craft a team of physician leaders to have the best chance of achieving our goals.
PAC activity was created by our broader society as a mechanism for advocacy, and former wise leaders created MSSNYPAC to complete our advocacy efforts. It is a helpful tool; it would be more helpful if it was if better funded. When I came into the Presidency, one of my goals was to make us as effective as possible, building on the work of my predecessors. I asked staff to provide me data on PAC participation. We have excellent, but not uniform participation within leadership and committees. I also want to be sure that our committee members are committed to success for their efforts by participating personally and financially in our advocacy efforts. While everyone’s personal circumstances differ, it should be a rare exception to not participate at all. There are a few instances that I can contemplate for not participating. Having said that it does raise a question of cognitive dissonance for achieving our mission.
Part of leadership is to lead by doing. We will reach out to every member, especially our new members who are becoming engaged (For example, I spoke with a new member who is excited to join us and will participate on our Legislative and CME committees) and ask them to participate in MSSNYPAC and the MSSNY Physicians Advocacy Liaison (PAL) Network.
You look for inspiration when you participate in an organization. I think that is one of the hardest things for a President to do. I felt honored to be able to have my Presidential Reception at the Theodore Roosevelt inaugural site. TR spoke about the responsibilities of citizenship in Paris in 1910:
It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.
As physicians, we have a responsibility to the profession. I’d like all members to dare greatly, inspire other non-members to join us as we try and make the practice of medicine, and the arena we live in—a better place.
Join MSSNYPAC http://www.mssnypac.org/contribute.
Contact me at email@example.com.
Election Results Could Bring Major Change to Albany
This week’s election will bring many familiar faces back to Albany in 2019 but many new ones as well. Overall, there will be nearly 40 new state legislators come 2019.
Democratic Governor Andrew Cuomo, Lieutenant Governor Kathy Hochul and Comptroller Tom DiNapoli were all re-elected for new four year terms. In the race for Attorney General, Democrat Letitia James defeated Republican Keith Wofford, to succeed current interim AG Barbara Underwood.
Perhaps the most significant aspect of this week’s elections is that Democrats will now have control of the New York State Senate for the first time in a decade and for only the second time in the last 50 years. Democrats appear to have picked up 8 new seats in the State Senate that had previously been held by Republicans, though ballots from some of these races are still being counted. If the numbers hold as they are now, Democrats will outnumber Republicans 39-24. These potential pick-ups include:
- SD-3 (Suffolk): Monica Martinez (D) defeating Dean Murray (R) to replace Sen. Tom Croci (R)
- SD-5 (Nassau/Suffolk): James Gaughran defeating Sen. Carl Marcellino (R)
- SD-6 (Nassau): Kevin Thomas (D) defeating Senate Health Committee Chair Kemp Hannon (R)
- SD-7 (Nassau): Anna Kaplan (D) defeating Sen. Elaine Phillips (R)
- SD-22 (Kings): Andrew Gournardes (D) defeating Sen. Martin Golden (R)
- SD-39 (Orange/Ulster): James Skoufis (D) defeating Tom Basile to replace Sen. Bill Larkin (R)
- SD-40 (Putnam/Westchester): Peter Harckham (D) defeating Sen. Terence Murphy (R)
- SD-42 (Orange/Sullivan/Ulster): Jen Metzger (D) defeating Anne Rabbit (D) to replace Sen. John Bonancic (R)
For more information about the still contested races, click here.
In the State Assembly, Democrats held their wide majority, 106-44. Three incumbent Democrats (Pellegrino, Jenne, and Magee) lost their seats to Republican challengers (LiPetri, Walczyk, and Salka). Two Republican incumbents (Curran, Walter) were defeated by Democratic challengers (Griffin and McMahon).
With so many new Assemblymembers and Senators coming to Albany next year, the need for physician grassroots involvement is greater than ever.
With the Democrats taking control of both the New York Senate in addition to the Assembly, there could be significant change in the approach to health care legislation. For example, many Democrats in their campaigns pushed for many progressive changes, including single payer healthcare. While that bill has overwhelmingly passed the Assembly multiple times, those votes were taken when it was likely the legislation would not be approved by the Senate. Other health care issues likely to be acted upon include legalizing recreational marijuana, and expanding access to contraception.
There has never been a greater need for MSSNY members to become active both politically and at the grassroots level. It cannot just be left to a relative few individuals to participate and be active in MSSNYPAC and the MSSNYPAL. Many are part of our efforts but we need far more. We must broaden our network of active physicians. If you are not a member of MSSNYPAC, or would like to increase your contribution, you can do so at www.mssnypac.org/contribute.
Moreover, with some new faces in the Legislature, it is a perfect time to join MSSNY’s Physician Advocacy Liaison (PAL) program to commit to engaging with your local legislators on an ongoing basis to assure they are familiar with the concerns of physicians and their patients. For more information about the PAL, contact Carrie Harring at firstname.lastname@example.org, or join today at PAL Sign Up.
Federal Elections Bring Change to Washington for New York House Seats
At the federal level, party control of the U.S. House of Representatives switched from Republican to Democrat as Democrats across the country won at least 30 seats. However, the Republicans increased their majority in the U.S. Senate, defeating Democratic incumbents in Florida, Indiana and North Dakota.
In New York’s House races, 22 of its 27 incumbent Representatives won re-election. However, two incumbent Republican Congressmen, Dan Donovan and John Faso, lost their re-election bids to Democrat challengers Max Rose and Antonio Delgado, while a third, Democrat Anthony Brindisi, appeared to have defeated Republican incumbent Claudia Tenney with ballots still to be counted. Also of note, current Assembly Democratic Majority Leader Joe Morelle defeated Republican Dr. Jim Maxwell to become Representative for the 25th Congressional District which is presently vacant following the death of Congresswoman Louise Slaughter (D).
NYC Marathon Hero!
MSSNY Member and NYC Marathoner Theodore Strange MD, Stopped at Mile 16 to Save a Life
Dr. Theodore Strange, an IM from Richmond County (Staten Island), was running his 25th NYC Marathon last Sunday. At mile 16, Dr. Strange answered a call for help for a downed female runner. She was not breathing; he started performing CPR and called for an officer to bring him a defibrillator. On the fourth shock, the woman breathed and was finally taken to the hospital. “People have been calling me a hero, but I was doing what I was trained to do,” he said. Read the full story here.
Gov. Raises Medicaid Rates for Hospitals and Nursing Homes before Election
Gov. Andrew Cuomo “quietly increased Medicaid rates to hospitals and nursing homes” just a few days before the election. In the New York State Register, “the state Health Department notified the public of a two percent hike for hospitals and 1.5 percent nursing homes on page 90.”
Gov. Signs Measure to Eliminate Patient Cost-Sharing for Prostate Cancer Screening
Governor Cuomo signed into law this week legislation passed earlier in the year (S.6882-A, Tedisco/A.8683-A, Gottfried) and supported by MSSNY to ensure that health insurers provide coverage for diagnostic testing for prostate cancer for men 40 and over with a family history, and men 50 and over who are asymptomatic, without such care being subject to annual deductibles or coinsurance.
The bill would also require the inclusion of information regarding the availability of insurance coverage for prostate cancer screening without cost sharing 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 patient cost-sharing. The new law, effective for insurance policies initiated or modified after January 1, 2019, would provide coverage without patient cost-sharing to a greater cohort of men for necessary prostate cancer screening than what has been recommended by the US Preventative Services Task Force.
Would You Like to Share MSSNY’s The Daily with Other Professionals in your Practice?
MSSNY is ready to extend this popular member benefit to the PAs and NPs on your staff. If you’re interested, please send the email addresses of the appropriate professionals in your office to email@example.com so they can begin to enjoy this daily sweep of healthcare news.
The Best Test is the One That Gets Done: Colorectal Cancer Screening
“How to Save Lives and Resources by Matching the Test with the Patient,” featuring Dr. Dorado Brooks, VP Cancer Control Interventions, American Cancer Society; and Dr. Heather Dacus, Director, Bureau of Cancer Prevention and Control, NYS Department of Health.
WHEN: November 13th, 2018, from Noon to 1:00 pm. To register click or copy this link. Register today while lines are still available!
Nine Cases of Flaccid Myelitis Suspected in New York
New York health officials say there are now nine suspected cases of acute flaccid myelitis in the state, a mysterious condition that’s paralyzing children nationwide.
The last known report from state Department of Health officials put the number of suspected cases at five in late October. On Wednesday, they confirmed four additional cases are under investigation. They declined to say where the suspected cases originated, other than outside of New York City, citing patient confidentiality laws.
None of the nine cases have been confirmed yet, said spokesman Jeffrey Hammond. So far this year, the CDC has confirmed 80 out of 219 suspected cases of acute flaccid myelitis. The cases have been reported across 25 states, with an increase occurring in August and continuing through September and October — similar to other spike years.
Big Employers Will Use Online Startup To Save On Medicine Costs
A group of large employers plans to use a new online prescription-savings tool as they confront high drug costs and try to steer patients to the most cost-effective medicines. The Health Transformation Alliance, a coalition of more than 40 big companies that includes IBM Corp., Verizon Communications Inc. and American Express Co., has agreed to use a new online tool from startup Rx Savings Solutions to help the millions of people who work for the group’s members get better deals on their medications. (Bloomberg, 11/1)
CVS to Test Stores with More Health Services after Aetna Deal Closes
Consumers will soon start to see CVS Health’s vision for the future of health care. CVS expects its roughly $69 billion acquisition of health insurer Aetna to close before Thanksgiving, the company said Tuesday when announcing third-quarter financial results. The combined company has pledged to improve health services and outcomes and lower costs. CVS plans to open its first concept stores early next year, CEO Larry Merlo told Wall Street analysts Tuesday. (CNBC, 11/6)
As previously reported, MSSNY Past-President Dr. Charles Rothberg testified at a NY Department of Financial Services hearing expressing MSSNY’s opposition to this acquisition. NYDFS Superintendent Mario Vullo expressed many concerns about this transaction at the hearing.
Review Comprehensive 2019 Summary of Medicare/MIPS Physician Payment Rule
As reported last week, CMS finalized its Medicare physician payment rule for 2019. Please click here for a comprehensive summary of the rule by the American Medical Association.
According to the AMA summary, the 2019 PFS conversion factor will be $36.0391. The Anesthesia conversion factor is $22.2730. The 2019 conversion factors reflect a statutory update of .25%, (as required by MACRA), offset by a budget neutrality adjustment of -0.14%, resulting in a 0.11% update.
According to the summary, it was noted that CMS has postponed any coding and payment-related changes for E/M office visit services until CY2021. But CMS will be implementing new documentation policies for E&M claims which will significantly reduce administrative burden. These include:
- The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.
- 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.
- 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 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); and
- 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.
It was also noted that CMS is expanding access to medical care using telecommunications technology by finalizing coverage of several new services, including three new CMS-created HCPCS codes for: brief, non-face-to-face appointments via communications technology (virtual check-ins); evaluation of patient-submitted photos; and the foregoing codes bundled together for use by federally qualified health centers and rural health clinics.
It was also noted that CMS reduces reimbursements for new Part B drugs. Currently paid with an add-on payment of 6% (before sequester), CMS will reduce the add-on payment to 3% (before sequester) for all drugs with Wholesale Acquisition Cost (WAC)-based payment rates.
The AMA summary also includes an extensive summary of changes to the MIPS program for 2019, which will effect Medicare payment for 2021. The Quality category will now comprise 45% of the score. The promoting interoperability category (formerly Advancing Care Information) will now comprise 25%. The performance improvement category will now comprise 15%, as will the cost efficiency category. Performance on these measures will effect Medicare physician payment in 2021.
CMS projects that 97.8% of MIPS eligible clinicians will submit performance data in 2019. Of those submitting data, 91.2% are projected to receive a positive or neutral payment adjustment in 2021, with the remaining 8.8% receiving a penalty in 2021. Nearly two-thirds of those projected to receive a positive or neutral payment adjustment are projected to score high enough for an “exceptional” payment adjustment.
CMS: Most Physicians Will Receive Positive Medicare MIPS Payment Adjustment; Still Concerns for Smaller Practices
CMS Administrator Seema Verma announced this week that 93% of clinicians eligible for the Merit-based Incentive Payment System (MIPS) received a positive payment adjustment for their performance in 2017. Moreover, she announced that 95% overall avoided a negative payment adjustment while nearly 100,000 eligible clinicians earned Qualifying APM Participant status under the Advanced Alternative Payment Model track.
However, the press release also noted that only 73% of “small practices” received a positive payment adjustment, while 19% received a negative payment adjustment.
The 2017 performance will affect Medicare payments for 2019.
The press release further noted Administrator Verma acknowledged that the MIPS “positive payment adjustments are modest,” while noting that 2017 was a transition year. She indicated that CMS expects that gradual increases in performance thresholds in the future “will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.” She also pledged customized technical assistance, at no-cost, for clinicians who received a negative payment adjustment,” and to continue assistance to providers in solo, small and rural practices.
“Cybersecurity: A Daily Threat for Healthcare” CME Webinar
November 14 @7:30am_ Registration Now Open
It’s not too late to register! 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 firstname.lastname@example.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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Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and
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