April 20, 2018 – Medical & Non-Medical Marijuana?
PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President April 20, 2018 Volume 18 Number 15 |
Dear Colleagues:
The use of marijuana to treat medical conditions is a very complicated topic that merits further in-depth study.
While MSSNY has policy (MSSNY Policy 65.985 MSSNY Opposes Recreational Marijuana Legalization) that opposes legalization of marijuana, I salute Governor Cuomo’s efforts to ensure that the health, criminal justice, and economic impacts of marijuana be fully examined should New York State move to a regulated marijuana program in the state. Our Governor understands fully that there could be public health and economic impacts as more and more of New York’s surrounding states move to legalize marijuana. The governor also acknowledges and recognizes recent action by the United States Attorney General Jeff Sessions to rescind the Obama Administration guidelines that allowed states that had authorized the use of marijuana under state law to operate without fear of federal prosecution.
Governor Cuomo has charged the New York State Department of Health with the formation of an interagency task force to consider the health, criminal justice, public safety, economic and education effects of non-medicinal use of marijuana. His newly developed website indicates the task force will look at:
- the benefits and consequences of a regulated marijuana program
- Public Health Impact on individual populations from a social justice perspective
The task force will also look at the impact on public safety; the overall financial impact, economic development and revenue, and education of the public with public health and public safety messaging.
Increased availability of marijuana has contributed to marijuana becoming the number one illicit substance detected in motor vehicle accidents.
One of MSSNY’s top concerns with New York’s medical marijuana law has been with the possibility of federal prosecution for physicians who are participating in New York’s marijuana program for medicinal use. With the US Attorney General’s action increasing the possibility of such prosecution, New York must gain a greater understanding of how this could affect prescribers.
There is still a relative dearth of knowledge about the usefulness and potential harm associated with medicinal and recreational use of marijuana. At MSSNY’s recent House of Delegates, we reaffirmed our call for moving marijuana from Schedule I to Schedule II. Reclassification to Schedule II will remove major barriers to research on marijuana and whether marijuana is a safe and effective treatment for pain and other medical conditions. Due to a lack of evidence based medicine and studies, particularly longitudinal studies that can evaluate the long term consequences of marijuana use, we don’t know the long term impact upon adults and children from continued use of marijuana.
Most importantly, New York State does not want to create a new type of industry, similar to the tobacco industry that addicted millions of adults and children. We have spent a lifetime trying to combat the scourge of tobacco. Our current opioid crisis was fueled in part by poor data, misguided regulatory advice to treat pain more aggressively, and perhaps overly aggressive marketing efforts by some opioid drug manufacturers.
Certainly, a “go slow approach” is the correct way to approach any type of legalization of marijuana and I applaud Governor Cuomo efforts on this.
Those who cannot recall history often re-experience it.
I’d appreciate hearing your thoughts at comments@mssny.org
Thomas J. Madejski, MD
MSSNY President
Please Urge Your Legislators to Enact Legislation to Address Prior Authorization Hassles and Expand Patient Choice of Physicians
Physicians are urged to express their support for several health insurance reform bills strongly supported by MSSNY that would reduce administrative barriers imposed by health insurance companies that interfere with patient care, and expand patient choice by limiting the ability of health insurers to narrow their networks. These bills include:
Last week, MSSNY shared with the entire State Legislature the results of a recent AMA survey (please click here.) that showed that a staggering 92% of physicians believe that prior authorization programs have a negative impact on patient clinical outcomes. Moreover, the survey also showed that 84% of responding physicians said that burdens associated with prior authorization were high or extremely high; and that 86% reported that these PA requirements had increased in the last 5 years. Moreover, every week a medical practice completes an average of 29 PA requirements per physician, which take an average 14.6 hours to process. WCB Announces Efforts to Expand Care Availability for Injured Workers by Addressing Physician Concerns with WC System Specifically, she noted that the WCB will be advancing a regulation to increase medical care delivery fees and enable use of the universal CMS-1500 form in lieu of existing board forms to reduce administrative burden. According to the written announcement, these proposals are being advanced to respond to “claimants’ challenges in finding treating providers, and concerns from health care providers around low fees and complexity that keep some from participating.” With regard to the proposed fee increase, the WCB will advance a regulation in June to increase medical fees for services provided after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. The announcement noted that “these new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.” However it is not clear yet the manner by which these fees will be raised. The announcement also noted that Board will propose replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. The Board will be working towards a January 1, 2019, implementation date. The announcement also noted other efforts the Board is pursuing including:
Please remain alert for further updates on this issue. (AUSTER, BELMONT) Opioid Prescribing By Physicians Decreases 20% in New York State Between 2013-2017 This reflects a nationwide trend — 22.2% fewer opioid prescriptions were filled in 2017 than had been filled in 2013. Every state in the nation has shown a significant reduction in opioid analgesic prescriptions since 2013, and every state showed a decline in the last year. Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force said that the fact that physicians and other health care professionals are increasingly judicious when prescribing opioids is “tempered by the fact that deaths related to heroin and illicit fentanyl are increasing at a staggering rate, and deaths related to prescription opioids also continue to rise. These statistics again prove that simply decreasing prescription opioid supplies will not end the epidemic. We need well-designed initiatives that bring together public and private insurers, policymakers, public health infrastructure, and communities with the shared goal to improve access and coverage for comprehensive pain management and treatment for substance use disorders.” MSSNY’s is one of seven state medical societies that are on the AMA’s Opioid Task Force. A copy of the IQVIA report and its analysis can be found here: (CLANCY) MSSNY Urges for Extension of Committee for Physicians Health Program As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees. The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013. The recently enacted State Budget included a provision to create another “demonstration program” until 2023. However, it omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken. These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed in the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform. These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances. (DIVISION OF GOVERNMENTAL AFFAIRS) MSSNY Participates in Interagency Workgroup on Organ and Tissue Donation Currently, there are over 10,000 New Yorkers waiting for a transplant, however only 32% of the eligible population is registered to be a donor. This means 1 person dies while waiting for a transplant every 19 hours. To learn more about organ donation, please click here: (CLANCY, HARRING) Register now for the Medical Society of the State of New York’s May 2018 Medical Matters CME Webinar Program May 16 at 7:30am – Medical Matters: Physically and Biologically Derived Chemical Agents: An Overview Register for this webinar here: Educational Objectives:
To view all of MSSNY’s scheduled programs, click here: and select “Upcoming”. 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 each of these live activities 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. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. (HOFFMAN) For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
Five Million Organ Donors Enrolled in NYS Donate Life Registry An executive order issued last year by Cuomo has also helped increase donors by allowing state agencies to provide opportunities for people to enroll in the registry when applying for government benefits, services and licenses. Insurer–PBM Mergers to Lower Medical Costs, Says Moody’s The recently announced Aetna–CVS Health and Cigna–Express Scripts mergers are likely to be credit-positive in the long term because of their ability to lower health care costs, Moody’s said. Cigna is likely to benefit incrementally from its purchase of Express Scripts by integrating Express Scripts’ ability to manage pharmacy costs, although Express Scripts does not have the benefit of CVS’ retail presence, Moody’s noted. MSSNY has expressed concern that the CVS–Aetna deal will drive patients away from doctors’ offices and into the company’s local retail clinics. Researchers Find Antibiotic-Resistant Bacteria and New Viruses in NYC Mice In one study, published in mBio, the researchers found that the mice carried dangerous bacteria, including antibiotic-resistant bacteria. In the other study, also published in mBio, the researchers identified 36 types of viruses. The study’s authors collaborated with researchers at the Centers for Disease Control and Prevention who “matched the strains of C. difficile from these mice to types known to cause infections in humans.” The researchers also identified six new viruses. The researchers found that 14 percent of the mice carried Shigella, 12 percent carried Clostridium perfringens, 4 percent carried C. difficile, 4 percent carried E. coli, and 3 percent carried salmonella. Advocates Want NY to Take Action to Reduce Black Women’s Maternal Mortality MSSNY Is Accepting Nominations for the 2017 Albion O. Bernstein, MD Award Researchers Find High Rates of T1D Near “Food Swamps” Ambulatory BP Monitoring May Be a Superior Predictor of Mortality
Visit the JIRA Website to Submit Official Comments by May 9, 2018 How to Submit Comments Log in to your JIRA account here. A JIRA account is required to submit a comment. If you are new to JIRA and do not have an account, sign up here. Comments will be accepted until 11:59 p.m. ET on May 9, 2018 Apply to Participate in the 2018 CMS Study on Burdens Associated with Reporting Quality Measures to Receive Improvement Activity Credit for 2018 CMS is conducting this study to:
Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities performance category. Applications for this study will be accepted through April 30, 2018 and will be notified in spring of 2018 if selected. Who Should Apply MIPS-eligible clinicians participating in MIPS as an individuals or as part of a group. Clinicians do not need any outside knowledge of MIPS to participate in the study; rather the study team is interested in learning more about clinicians’ experience participating in MIPS. A limited number of clinicians who are not eligible for MIPS in 2018 will also be included in the study. To check you participation status please see the QPP Website. Study Requirements The study runs from April 2018 to March 2019. Study participants will have to meet the following requirements in order to complete the study and receive full Improvement Activity credit. For participants reporting as a group, their entire group will receive credit. For participants reporting as individuals, only the participating clinician will receive credit. To Apply Click here to begin your application. Applicants will be notified by email of their status in spring of 2018. For more information about the study, please visit the CMS website or email MIPS_Study@abtassoc.com. Upcoming Webinar: APG Educational Series 2018, MIPS APMs to Advanced APMs: How to Make the Valuable Transition APG designed the series to provide physicians and physician organizations the “how-to” for APM implementation. Given America’s Physician Groups’ leadership with advanced payment models, we are well positioned to share best practices and lessons learned in this area. Each session will include Q&A time with the presenters. We hope the webinars will be a valuable resource to help you successfully participate in APMs in 2018 and beyond. Our next session in the series will focus on: Title: MIPS APMs to Advanced APMs: How to Make the Valuable Transition Date: April 30, 2018 Time: 9:00am -10:30am PT / 12:00pm – 1:30pm ET Register: http://eventcenter.commpartners.com/se/Rd/Rg.aspx?516875 Subject matter experts from CMS will review the MIPS APM model and requirements for qualifying to become an advanced APM. Additionally, CMS will answer specific audience questions on the final rule for 2018 and provide information and resources relevant to the transition from MIPS APM to advanced APMs. For more information, please contact Dr. Amy Nguyen, anguyen@capg.org or 213.239.5051.
|