MSSNYeNews: November 15, 2019 – Collateral Damage
This past week, I learned that pharmacies in the Bronx were either out of stock of opioids or on “back order.” This seemed hard to believe but one neurologist recounted his experience in trying to find a pharmacy carrying Percocet for his patient with severe paroxysms of sympathetic nerve pain. In exploring further, he had obtained a memo from a health organization suggesting that opioid manufacturers were loathe to ship supply to NY State because of the opioid excise tax recently enacted.
This particular organization suggested that the medications would be obtainable via a rather circuitous route via their own central distribution center.
This, of course, would be little help for this particular patient or for many who legitimately need narcotic analgesia. Despite the opioid crisis, pain relief is still a quality metric and pain is still the “fifth vital sign.” Measures in place, however well-intended, have put patients and physicians in a bind. Pain must be relieved but the relief is often difficult to obtain. And when the analgesics in question are out of reach, is it so hard to consider that patients might seek alternative means to relieve that pain?
Therefore never send to know for whom the bell tolls.
It tolls for thee.
Arthur Fougner, MD
We Need Your Data
At November’s MSSNY Council meeting, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain. He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain. Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery. Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.
To help us help you, please download the MSSNY Hassle Factor Form. Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for you patients.
In Section C of the form, please indicate the name of the pharmacy. If you have experienced problems with multiple pharmacies, please use multiple forms. In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc. The completed form can be emailed to RxHassles@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.
It’s Crunch Time – Please Make Sure Congress Adopts a Fair Solution to Surprise Medical Bills
With just 6 weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills. It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to already market dominant insurers. By clicking here, you can send a letter, and tweet at your legislators.
Please remind them of the successes of New York’s law. In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation. According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.
At the same time, please remind them of the grave concerns that have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”. When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.
United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery. Please do not give them any more power. Please contact your Senators and Representatives today!
Physician Action on Key Health Care Legislation Needed
As of today, there were still 375 bills that passed both houses in 2019 that were awaiting delivery to the Governor. But with just 6 weeks left in the year, the flurry of bill signings/vetoes has begun. This week, MSSNY sent letters to the Governor in support of legislation to extend for 2 years the “nursing home exception” to mandatory e-prescribing (A.1034-A/S.4183) and to permit ophthalmologists to delegate administration of eye drops to assistants (S.4469-B/A.3822-D).
Physicians can quickly and easily send a letter to the Governor here on the following bills:
- Protect Against Insurer Mid-year Formulary Changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law.
- Support Partial Prescription Fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
- Oppose Liability Expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills.
NYeC: Shin-NY Reduced Healthcare Costs by Over $160 Million Annually
According to a recent preliminary analysis conducted by New York eHealth Collaborative (NYeC) use of the Statewide Health Information Network for New York (SHIN-NY) is reducing unnecessary healthcare spending in New York by $160-$195 million annually, which includes significant savings to Medicaid and Medicare. To see NYEC’s white paper on this analysis click here.
The results of the analysis indicate that the savings are based on the current size and use of the network, using methodology developed by the Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for purposes with recent related federal proposals.
The report noted that, “The approximated savings and value are based and consistent with results of existing peer reviewed academic studies pointing to the value of using HIE generally. HIE has been associated with 50% reduction in rates of hospital readmission, 26% reduction in the rate of emergency department admissions, 35% reduction in the repeat of repeat imaging procedures and 10% lower 30-day readmission rate among Medicare fee-for-service beneficiaries”
The SHIN-NY is a statewide network that facilitates secure and confidential electronic sharing of patient data across the healthcare system to improve outcomes. It is comprised of and connects regional health information networks (RHIOs) that allow participating healthcare professionals, with patient consent, to quickly access and share comprehensive patient health information and medical records. Statewide, 100 percent of hospitals and over 100,000 healthcare professionals are connected to the SHIN-NY, which facilitates the exchange of health information (HIE) for patients across the state.
MSSNY representatives have been in regular communication with NYeC staff to work towards enhanced physician participation in their local RHIOs and the SHIN-NY. They have touted HIT as a fundamental tool in positively impacting patient care and outcomes, but also have raised concerns that this technology, for many physicians, is not easily compatible with patient care delivery. Physicians should be aware of programs such as the Data Exchange Incentive Program (DEIP) that helps subsidize the cost of connecting to your local RHIO.
New York Is 1st State to Publicize Hospitals with C. Auris Cases
New York health officials on Nov. 13 published a list of healthcare organizations that have treated patients for the deadly fungus Candida auris, making it the first state to share this information with the public, reports The New York Times.
The list includes 64 hospitals, 103 long-term care homes, three hospice units and one long-term care hospital. It does not detail how many cases occurred at each organization.
The New York State DOH released the list in response to a rapid increase in C. auris cases. Health officials said the information is intended to boost transparency for consumers and motivate hospitals to stop C. auris from spreading further, according to NYT. The CDC has reported 836 cases of C. auris nationwide as of Aug. 31. Of these, 388 have occurred in New York.
To view the state’s full list of healthcare organizations reporting C. auris cases, click here. (Becker’s Hospital Review, Nov. 14)
Vaping Illness Leads to Lung Transplant at Henry Ford Health System
Henry Ford Health System this week announced that it performed what the health system believes is the first ever double-lung transplant for a patient with a vaping-related illness. Hassan Nemeh, who led the surgical team at Henry Ford, said the patient’s lungs were unlike anything he had seen in his 20-year career, noting that the 17-year-old patient’s lungs were scarred, rigid, inflamed, marked with dead spots. (New York Times, 11/12)
Hospital Safety Grades
The Leapfrog Group last week released its Fall Leapfrog Hospital Safety Grades, giving about one-third of hospitals an “A,” but giving more than 40% of hospitals a “C” or lower. Leapfrog also published an infographic that looked at the rates of avoidable deaths at hospitals for each grade. (Source: HealthLeaders Media, 11/7)
CDC: Five Leading Causes of Death
U.S. residents living in rural areas of the country were more likely to die from preventable causes than those living in urban areas from 2010 to 2017, according to a CDC Morbidity and Mortality Weekly Report released last week. Overall, the researchers found heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke ranked as the five leading causes of death in the United States in 2017.
Survey Finds Many PCPs Don’t Discuss How Hair Care Can Be a Barrier to Exercise for Some Black Women
Findings published in the Journal of the American Board of Family Medicine suggests “primary care providers often don’t realize that hair care can be a barrier to regular exercise for some black women.” A survey of primary care physicians “found an overwhelming majority talk to their female African American patients about the importance of exercise. But three-quarters said they don’t talk with these patients about hair care, which can be a barrier to vigorous workouts.”
Families May Feel Better About End-Of-Life Care in ICU if Granted Simple Wishes
Researchers found in a small study that “families of dying patients may feel better about end-of-life care in the ICU if they are granted simple wishes, like letting the patient taste a favorite meal or use a blanket from home.” The findings were published in the Annals of Internal Medicine
Hospital Price Transparency Rule Could Come Before Year’s End
CMS could release a rule by the end of 2019 on a proposal that hospitals disclose payer-specific negotiated rates, a White House adviser said. CMS is delaying action on the price transparency proposal, excluding it from the 2020 Medicare Outpatient Prospective Payment System final rule released Nov. 2.
The proposal, which CMS released July 29, includes provisions in a price transparency executive order signed this year by President Donald Trump. It would require hospitals to publish all “standard charges,” including the hospital’s gross charges and negotiated rates with payers for an item or service, online in a machine-readable format.
Under the rule, hospitals also would be required to publish the rates they negotiate with insurers for 300 services consumers are likely to shop for in a searchable and consumer-friendly manner. Hospitals that do not comply would be penalized.
The proposal builds on a current federal rule that requires hospitals to publish a list of their standard charges on the internet, but excludes negotiated rates with payers.
The American Hospital Association has come out against the proposal, saying it is “the wrong approach” and “would introduce confusion and fuel anticompetitive behavior among commercial health insurers.” Federal contends the proposal could significantly reduce healthcare costs. (Becker’s Hospital CFO Report Nov.11)
(E/M) Visit Frequently Asked Questions (FAQs) Physician Fee Schedule (PFS)
This document addresses Frequently Asked Questions (FAQs) regarding documentation and payment for evaluation and management (E/M) visits under the Medicare Physician Fee Schedule (PFS).
- What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?
The CY 2019 PFS final rule expanded current policy for office/outpatient E/M visits starting January 1, 2019 to provide that any part of the chief complaint (CC) or history that is recorded in the medical record by ancillary staff or the beneficiary does not need to be re-documented by the billing practitioner. Instead, when the information is already documented, the billing practitioner can review the information, update or supplement it as necessary, and indicate in the medical record that she or she has done so.
This is an optional approach for the billing practitioner, and applies to the chief complaint (CC) and any other part of the history (History of Present Illness (HPI), Past Family Social History (PFSH), or Review of Systems (ROS)) for new and established office/outpatient E/M visits.
To clarify terminology, we are using the term “history” broadly in the same way that the 1995 and 1997 E/M documentation guidelines use this term in describing the CC, ROS and PFSH as “components of history that can be listed separately or included in the description of HPI.” This policy does not address (and we believe never has addressed) who can independently take/perform histories or what part(s) of history they can take, but rather addresses who can document information included in a history and what supplemental documentation should be provided by the billing practitioner if someone else has already recorded the information in the medical record.
Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line!
Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.
There are several ways to find your revalidation due date:
- Centers for Medicare & Medicaid Services (CMS) Revalidation List Tool
- Search by National Provider Identifier (NPI) or name.
- A due date of “TBD” (to be determined) means a revalidation due date has not been assigned by CMS.
- You can access the YouTube video, “How to use the CMS Medicare Revalidation Tool“
- Revalidation notice mailed by National Government Services
- Mailed in yellow envelope
- Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)
- Sign in with user ID and password.
Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.
NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.
Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.
- Provider Enrollment Revalidation Overview
- Getting Access to PECOS
- Submitting Revalidation via PECOS Application
- Submitting Revalidation via CMS-855A Paper Application for a Part A providers
- Submitting Revalidation via CMS-855B Paper Application for a Part B providers
- Submitting Revalidation via CMS-855I Paper Application for a Part B providers
- Let’s Chat about Provider Enrollment Revalidation
“When is the Flu not the Flu?” CME Webinar on November 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly. Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am. 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. Please click here to view the flyer for this program.
Educational objectives are:
- Recognize the distinction between types of influenza and other similarly presenting illnesses
- Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
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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Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : email@example.com
Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change? Tired of working long shifts with an overwhelming patient load? Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.
Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.
We have openings in the following counties offering a choice of urban, suburban or rural living:
Clinton* Clinton Correctional Facility (sporting and recreational outlets)
Chemung Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia* Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin* Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene* Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston* Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida Mohawk Correctional Facility (Cooperstown, breweries)
Orleans Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca* Five Points Correctional Facility (heart of wine country)
St. Lawrence Riverview Correctional Facility (hiking, boating and museums)
Ulster Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.
Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at: 98point6.com/pcc/
Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review. We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: firstname.lastname@example.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F
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