October 16, 2015 – Are You Burnt Out? Help on the Way!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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October 16, 2015
Volume 15, Number 39

Dear Colleagues:

Over the past five years, there has been an acute growth in interest in the subject of physician stress and burnout.  This is in part the result of financial and economic crises as well as practice stresses including liabilities, regulatory and healthcare reform uncertainties.  Whereas in the past, physicians were by and large able to manage stress individually and use a day off and vacation to assist in this endeavor, the stresses facing physicians today have eroded those mechanisms and have rendered past approaches difficult or irrelevant.

The standardized questionnaire measuring these three scales of physician burnout is called the Maslach Burnout Inventory (MBI). The designers of the MBI described physician burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.” That vivid description really puts a deeper and more serious description to what some of us are feeling or observing on a daily basis.

While our profession in New York has very successfully created a mechanism for helping physicians who are failing to manage their stress in a manner which has threatened patient care (Committee for Physician Health), little attention has been paid to identifying and understanding the stressors which currently wear down physicians.  Many would agree that the uncertainty created by decreased reimbursement, narrowed networks, increased severity of malpractice awards and health care transformation cannot be addressed by taking an afternoon off or increasing vacation time.  Furthermore, these stressors creep into our lives such that the experience is similar to the parable of the frog in a slow boiling pot.  Thus, efforts need to be undertaken to better understand and identify the stressors and develop mechanisms for healthy coping with these so that we don’t drive physicians to burnout, impairment and perhaps even suicide. Signs of these issues in fellow physicians are sometimes subtle and usually masked, but even simple gestures in reaching out to a stressed colleague may make a world of difference.

This year, the House of Delegates passed Resolution 200 which called for the development of programs to help physicians 1) identify physician stress and burnout and 2) manage and treat these. Council has agreed to address the resolution passed earlier this year through a mechanism that is separate from CPH but which uses the knowledge of many of our physicians within that committee as well as our wider MSSNY community. In addition,the Medical Educational Scientific Foundation (MESF) will be developing programs to help address this issue.  If you have an interest in working on this project, please contact MESF Executive Director Tom Donoghue at tdonoghue@mssny.org or call 516-488-6100ext 350.

Yes, in so many ways we are our brother’s keeper.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


VA Program Presents an Opportunity for Community-Based Physicians
After asking for physicians’ help to enhance care for veterans last November, the U.S. Department of Veterans Affairs (VA) has released information for physicians interested in delivering care through the Veterans Choice Program.

A recently released VA fact sheet (log in) offers detailed guidance on how community-based physicians can partner with the VA to deliver care to our nation’s disabled veterans. Dubbed the Veterans Choice Program, this new benefit was authorized by Congress as a short-term solution to the VA’s workforce shortage and care delivery problems that were exposed last year.

AMA advocacy successfully influenced the legislative language to ensure that physicians in the private sector could provide care to veterans. Members of Health Net’s or TriWest’s PC3 provider networks are automatically eligible to deliver care through the Veterans Choice Program. More information about the Veterans Choice Program, including the eligibility criteria for veterans and how physicians can apply to deliver care, can be found on the AMA’s Supporting Veteran Health Web page.

In 2014, hundreds of MSSNY physicians signed onto a list affirming that they would be honored to treat veterans. Now, they can. 


From Workers Comp Board: Creating Web-Based Medical Authorization Portal
The New York State Workers’ Compensation Board is creating a web based Medical Authorization Portal. We would like for physicians associated with MSSNY to participate in a “User Acceptance Testing” of this system before it becomes available to all stakeholders in the Workers’ Compensation Claims process at the end of this year. Any physicians within your organization that would like to participate are welcome. The only criteria is that they have an authorization number to treat workers’ compensation claims patients.

To help facilitate this testing, we would also like for you to provide the top three carriers or third party administrators you send the highest volume to (ranked from highest to lowest) of the following Workers’ Compensation Board forms: MG-1, MG-2 and the C-4 Auth.

We thank you in advance of your anticipated agreement to participate in this new web based application that the Workers’ Compensation Board, as well as all of the other stakeholders in the claims system, have created to improve the way workers’ compensation claims are handled within the state.

Please contact me to indicate your willingness to participate in this user testing or if you have any additional questions regarding this subject. I may be reached by email at Anthony.Contento@wcb.ny.gov or by telephone at (518) 402-6186. 


Health Republic NY Won’t Honor Policy Renewals
Health Republic Insurance of New York sent brokers a notice on October 16 that it is not honoring small-group policy renewals for Nov. 1 and Dec. 1. That sudden action—even given the fact that the insurer is winding down its operations—will leave clients scrambling to find alternative insurers in about three weeks’ time for the earlier date, and just over seven weeks for the latter.

On Oct. 9, William Friedman, the insurer’s senior vice president of commercial sales, emailed brokers with the news that the Department of Financial Services told Health Republic “we cannot renew small-group policies with Nov. 1 and Dec. 1 renewal dates. This means that those groups’ current health insurance policy with Health Republic will not renew and will end at midnight the day before those groups’ scheduled renewal date (i.e. midnight on 10/31 for 11/1 renewal).”

The language for the termination letters is online here.

“We certainly understand that this provides relatively shorter notice for this particular segment of consumers, but we believe that given the company’s financial condition, allowing the company to write new business isn’t in the interest of consumers overall,” a DFS spokesman said. “That’s the broader public policy reason for this particular approach.”

According to state law, insurers must give small-group policy holders 30 days’ written notice for non-renewals. But the state’s insurance regulator may be invoking powers outside that notification law.

GNYHA said that DFS is conducting an “audit to determine whether the insurer has sufficient funds to operate and continue paying provider claims through the end of each employer’s contract period. DFS could require Health Republic to terminate all small-group enrollment on a certain date.” 


Many Faces of Flu CME Webinar on October 21st; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 at 7:30 a.m.  Registration is now open for this free webinar here.

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. Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment.

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.

A copy of the flyer can be accessed HERE.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  Additional programs are will be conducted in January-May 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly.


Exchange Announces 2016 Offerings; New Options for Low Income New Yorkers
New York Health Insurance Exchange officials this week announced the insurers offering health and dental plans to individuals and small business owners in 2016, as well as the insurers that will be offering the new Essential Plan to eligible, lower income New Yorkers.   The open enrollment period begins on November 1, and runs through January 31, 2016.

There are 16 insurers that will offer Qualified Health Plans on the Individual Exchange Marketplace in 2016, and 8 insurers that will be offering coverage on the Small Business Exchange Marketplace, or SHOP, in 2016, for businesses with 100 or fewer employees.    To view a county by county map of the plans being offered in each county, click here.

There are also 13 insurers that will be offering coverage for the New Essential plan which is available to single New Yorkers who make $23,540 or less; couples who make $31,860 or less; or a family of 4 that makes $48,500 or less; and who are not eligible for Medicaid.  The Essential Plan has no annual deductible and offers the same essential benefits as other health insurance plans. Consumers pay just $20 a month per adult or nothing at all depending on their income. Additional information on the Essential Plan can be found here. To view a county by county map of these plans being offered in each county, click here.

The New York State Department of Financial Services had previously announced the approved health insurance plan rates for insurers seeking to offer coverage in New York’s marketplace on July 31, 2015.

The New York State of Health website does not as of this moment contain a listing of the network participants for each plan for 2016.  However, this information will be added to the website shortly, as it was for 2015 plans.

As has been widely reported, the press release also noted that Health Republic will not be offered for 2016, and that persons enrolled in Health Republic will receive a renewal notice providing information about how to select another plan for 2016. NY State of Health and Department of Financial Services staff will be available to assist Health Republic consumers with this transition to new coverage.


Agreements with Urgent Care Centers to Improve Plan Participation Disclosure
New York Attorney General Eric Schneiderman announced agreements with four urgent care centers in New York City and Long Island to provide more detailed information to consumers about the centers’ participation with health plans, as required by New York’s recently enacted “surprise medical bill law.”  

In July, AG Schneiderman issued letters to 20 urgent care centers across New York State requesting information about the centers’ representations on websites that they participate in a certain health plan networks.  The AG raised concerns that these centers’ website disclosures might have inaccurately disclosed their health plan network participation status, confusing consumers into believing these centers were “in-network”.

The press release announcing the settlements noted that, after review of the disclosures and underlying contracts, the AG concluded that the information provided was at times unclear, incomplete, or not specific enough. The urgent centers that signed agreements were: 181st Street Urgent Care in Manhattan; Brookdale Urgent Care, affiliated with Brookdale Hospital; New York Doctor’s Urgent Care with two locations in Manhattan; and Cure Urgent Care, with three locations in Manhattan and Long Island.  Disclose to patients the availability of fee information, and, upon request, disclose to the patient the total cost for services that the center will bill the patient.


MSSNY Conducting E-Prescribing Webinars November and December
The Medical Society of the State of New York will host two free continuing medical education webinars on E-prescribing on November 9 and December 9 at 7:30 a.m Registration is now open to MSSNY physicians by clicking here. Select training session and the upcoming tab.   A copy of the flyer can be found here. 

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances 

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.


Why EHRs Get in the Way – and What You Can Do About It

Date: Wednesday, October 21, 2015 from 12:00 p.m. – 1:00 p.m. (EST)

50% of practices want to dump their EHR. 72% of physicians say that their EHR distracts them from face time with patients. And 59% of doctors wouldn’t recommend the field of medicine to their own children. Has our health information technology let us down? Join athenahealth for this free webinar, where they’ll discuss the biggest barriers to better, more focused patient care, and what you can do about them. See more details here.

Athenahealth is a vetted MSSNY member benefit. 


E-Prescribing Of All Substances Required by March 27, 2016
For physicians who prescribe controlled substances, there are steps to complete in order to electronically prescribe controlled substances.  These include the following:

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements. Third, you must obtain a two-factor authentication as defined in the federal requirements. Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system. ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

Under “My Content,” click on “All Applications” and then click on “R.” Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so before January 1. The waiver process will be electronic.   Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance. DOH has indicated that more information on the waiver process will be available shortly.

Information regarding e-prescribing may be accessed at the following links:

http://www.health.ny.gov/professionals/narcotic/electronic_prescribing

http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm


DOH Commissioner Grand Rounds Now Online: “Ending the HIV Epidemic”
The New York State Department of Health has placed the Commissioner Grand Rounds now online with the first program called Ending the HIV Epidemic.  This program will focus on the unique populations most at risk for HIV, increase clinician awareness of the new indications for HIV treatment and the new modalities for HIV prevention. To view this program click here. Further information on the program may be obtained here.


Attention Paper Claim Submitters: Changes due to the implementation of ICD-10
With the implementation of ICD 10 on October 1, 2015, it is important to use the appropriate ICD Indicators on claim submissions. 

The “ICD Indicator” identifies the ICD code set being reported. It is imperative that you enter the applicable ICD indicator according to the following:

Indicator Code Set
9 ICD-9-CM Diagnosis
0 ICD-10-CM Diagnosis

Dates of service October 1, 2015 and after, the ICD-10-CM indicator should be “0”

Dates of service September 30, 2015 and prior, the ICD-9-CM indicator should be “9” 

Line item 21 on the CMS 1500 claim form or the electronic equivalent shall be submitted with the appropriate indicator of “0” for ICD-10-CM or “9” for ICD-9-CM.

Item 21

Oct26a

Note: It is mandatory that you enter the indicator as a single digit between the vertical, dotted lines.

For additional information on ICD-10, visit our ICD-10-CM section of our website at www.ngsmedicare.com.



Helpful ICD-10 Reminders

Now that ICD-10 is a reality, below are a few reminders:

Always code each health care encounter to the level of certainty known for that encounter. All providers are expected to code correctly and have sufficient documentation to support the codes selected.

ICD-10-CM External Cause Codes
Medicare did not require external cause reporting in ICD-9-CM and does not require external cause reporting in ICD-10-CM. Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity.

Signs and Symptoms
In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses. While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined). In fact, you should report unspecified codes when such codes most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It is inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.
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