MSSNYeNews: April 3, 2020 – Sense and Sensibility

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
April 3, 2020
Vol. 23  Number 14

MSSNYPAC Seal

 

Colleagues:

“How sad a sight it is to see the streets so empty of people.”
  Samuel Pepys 1666

I thought of Pepys’ diary of the great London plague as I saw the images of Times Square this week. The City that Never Sleeps now lies behind closed doors. Every morning, when I open my door, I half expect to see a candlestick outside. For all our technology, we are struggling to maintain some semblance of equilibrium. Emergency departments are struggling to stay afloat amidst the sea of patients afflicted by the SARS CoV2 virus. Our Healthcare Heroes are long on talent but short on PPE. Entire hospital units are being reconfigured to handle the increasing volume of patients. Ventilators are now more valuable than a Ferengi’s Gold-Pressed Latinum.

Our country has seen this before, one hundred years ago. Hard-learned lessons of the past can and should provide some guidance for today. Phyl Rubenstein, local Breckenridge CO historian, noted parallels between the current pandemic and the 1918 Spanish Flu. “The closing of businesses and distancing of people seem to be the most effective means of bringing this crisis to an end,” Rubenstein noted. However, reopening businesses too quickly could risk the virus’ resurgence.

Without technology, ventilators, antivirals the US survived the 1918 pandemic by attention to sanitation, hand-washing and social distancing. Already, in NY, the pace of hospitalization and death is slowing. A once two-day interval for deaths to double is now six days. While it may not seem like it, we are making progress. Make no mistake, we will overcome this as we have always overcome.

And we will do it together.

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

MLMIC COVID Banner

 


MSSNY President Press Statement: NY Physicians Need Adequate Tools to Fight War on COVID-19
“As New York physicians continue to fight on the front lines of the COVID-19 pandemic, our first priority is—and always has been—the health and well-being of our patients. But we can’t be thrown into this war zone without adequate tools. It is imperative that we are provided with the best available defense, including Personal Protection Equipment (PPE) and workplace practices and policies to reduce disease transmission.

“Unfortunately, despite everyone’s best efforts to facilitate the availability, we continue to hear far too many disturbing reports from physicians about inadequate PPE availability in the hospitals and office settings where they are delivering patient care.  This is shameful and must be addressed.

“In addition, physicians must retain the right to speak out about conditions that we perceive as endangering ourselves, our patients, and our colleagues’ well-being without fear of repercussion. Our patients’ welfare is our priority and we must retain our freedom to advocate for them, including expressing concerns regarding conditions and safety.” (See story below)

Interviews:

    • Politico – 03/26/20
       New York’s health care workforce braces for influx of retirees, inexperienced staffers (MSSNY President Dr. Arthur Fougner quoted)

 •  Crain’s Health Pulse – 03/3/20
       Stakeholders on budget watch after Medicaid redesign proposals
(MSSNY President Dr. Arthur Fougner quoted)

    • Fox News – 04/01/20
      Coronavirus first responders desperately need more safety equipment, 9/11              firefighter says (MSSNY President Dr. Arthur Fougner quoted)

    • Politico -04/02/20
       Statement from MSSNY President Dr. Arthur Fougner

    • NBC News 4 – 04/02/20
    Cuomo Orders National Guard to Take Ventilators as New York Deaths Near 3,000
(MSSNY President Dr. Arthur Fougner quoted)

   •  NPR – 04/03/20
    Ventilator Shortages Loom As States Ponder Rules For Rationing
(MSSNY President Dr. Arthur Fougner quoted)

City Council Members to Protect Hospital Whistleblowers
Nurses and doctors stationed in New York City’s overrun hospitals have spoken out about equipment shortages and increasingly dire workplace conditions — all while risking their jobs to do so.  A group of legislators is planning to introduce a bill to ensure whistleblower protections for hospital workers.

The bill — which has the support of four other Council members, medical personnel and union leaders — would prevent doctors and nurses from losing their jobs if they speak publicly about conditions in their hospitals. It was inspired during the outbreak of the coronavirus, which has stretched resources thin at public and private facilities throughout the city and is based on similar legislative protections for fast-food workers.

Several prominent hospitals have warned staff about disclosing the nightmarish scenarios playing out in their emergency rooms, either in interviews or on Twitter, Facebook and other social media platforms. (Politico, 4/3 2pm)

CORONAVIRUS UPDATE
By the numbers:

The state reported 102,863 confirmed cases and 2,935 deaths as of Friday morning, including 57,159 cases in New York City, 12,351 in Westchester County, 12,024 in Nassau County, 10,154 in Suffolk County, 4,289 in Rockland County, 2,397 in Orange County, 809 in Dutchess County, 720 in Erie County, 464 in Monroe County and 267 in Albany County.

NYS COVID-19 Tracker
NYT Coronavirus Stats as of 8AM 4/3

Latest News from Dr. Howard Zucker Commissioner of Health for New York State

GENERAL COVID-19:
– No data to suggest that a wide-spread face mask policy is
Gov: Fair to say that masks couldn’t hurt, unless they give a false sense of security.
– Governor describing new Exec. Order as sharing resources as a rebuttal
to use of the word “seizure.”
– Will not leave hospitals without essential equipment, but utilizing their stockpile, and will reimburse facilities.
– Gov says there could be several hundred ventilators that could be redeployed to areas of need.
– Paraphrase: If they want to sue me for borrowing their excess supplies to save lives, so be it – 4th Amendment concerns.
– High rate of illness in NYPD, FDNY, Transit Workers, Healthcare Workers: state will look to be of assistance, but has no plan to “take-over” any organization.
– State transferred several dozen COVID patients upstate.
– USNS Comfort is under-utilized . Ship is needed is for the COVID patients,

Notes from the On-going Governor’s Briefing:
– State now tracking “hotspots”, facilities with greatest total hospitalizations.
– Concerned about increase in Long Island
– Governor reiterated the state’s need for PPE supplies, and frustration
with interstate competition.  Reiterating desire for companies to help produce masks, gowns, face shields and other PPE.
– “We do not have enough ventilators, period.”
– Contingency plans: Splitting, Fed Stockpile, BiPaPP, Anesthesia
machines, redeployment of unused ventilators.
– Working with Alibaba as well.
– Javits is now COVID-19 only facility; “We don’t have any non-COVID-19
to any great degree.”  Federal agencies were not eager to approve the conversion.
– Governor noted a reduction in non-COVID cases due to the decrease in social activity: fewer car crashes, less trauma
– To sign Executive Order allowing state to assume control ventilators and
PPE from institutions for redeployment.  They will be returned or reimbursed. The National Guard will deploy to acquire the equipment.
– Not a question of state’s rights vs. federal interference.  It is a national disaster emergency.  State’s welcoming federal help.
– No state can get the supplies they need, explaining a National supply deployment strategy to meet the needs of the emergent hotspots. “What is the alternative” to the looming crisis.
– The Federal Government does not have enough supply to tell each state
that it can supply their need.
– Governor asking to systematize the medical professional volunteer effort to utilize across the country.

Members: Did you pay your dues? 

Legislature Works Toward Final Budget Passage
Today, the New York State Legislature is giving final passage to an extraordinarily difficult State Budget for the 2020-21 Fiscal Year that seeks to close what could be upwards of a $15 Billion Budget deficit.  With a Budget consideration process that was very different than previous years due to the managing of the coronavirus pandemic, MSSNY staff continues to go through the thousands of pages of Budget bills, but some of the top line highlights include:

  • Continuation of the Excess Medical Malpractice Insurance Program for another year, and rejecting proposals from the Medicaid Redesign Team to foist a 50% cost-share on the physician insureds, which could have been imposed thousands of dollars in new costs on the nearly 17,0000 physicians enrolled in the program.
  • Rejecting the Governor’s Budget proposal that would have severely curtailed important due process rights for physicians when a complaint has been filed against them to OPMC.
  • A 2-year extension of the existing physician-pharmacist collaborative drug program, and rejection of a proposal that would have greatly expanded the powers of pharmacists, and permitting nurse practitioners to also enter such protocols
  • Ending the sale of flavored e-cigarettes and flavored vaping products.
  • Targeted health insurance reforms including creation of an administrative simplification workgroup, a required reporting to DFS of health insurer denial statistics and hastening the timeframe for payment of claims when there has been a request for more information and that information has been provided.
  • Gives the NY Department of Financial Services power to investigate when a prescription drug price has gone up by over 50% in less than a year
  • Expansion of New York’s “surprise bill” law to include inpatient services that follow an emergency room visit, which will permit an out of network physician to bring these claims to the Independent Dispute Resolution process if they get an Assignment of Benefits from the patient.
  • Limits patient insulin co-payments to no more than $100 per 30-day supply.
  • Carving the Medicaid prescription drug benefit back into management by New York State, instead of by Medicaid Managed Care companies.
  • Continued funding of MSSNY’s Committee for Physician’s Health at its historical level.

Importantly, the Budget would also put into statute liability protections that had been set forth in a recent Governor’s Executive Order to provide qualified liability immunity to a physician or health care facility  (a) that is arranging for or providing health care services pursuant to a COVID-19 emergency rule;  (b) the act or omission occurs in the course of arranging for or providing health care services and the treatment of the individual is impacted by the health care facility’s or health care professional’s decisions or activities in response to or as a result of the COVID-19 outbreak and in support of the state’s directives; and (c) the health care facility or health care professional is arranging for or providing health care services in good faith.

Of significant note is a provision that will give the Governor significant discretion to adjust Medicaid payments across the Board throughout the fiscal year based upon the significant variability of revenue coming into New York State.  At the beginning of the year, the Governor implemented an across the Board 1% Medicaid cut, and the MRT2 recommended an across the board 1.875% cut.  This provision has the potential to bring about significant Medicaid cuts through the fiscal year based upon how quickly New York’s economy can recover.

MSSNY thanks the countless physicians for their grassroots advocacy on these key issues, as well as the great partnership with county medical and specialty society leaders in advocating for the many successful outcomes in this Budget, particularly during this extraordinarily difficult time.

We will follow up with a more in-depth report on the litany of health provisions in the State Budget that impact physicians and their patients.

Moe Auster, Pat Clancy, Zina Cary and Raza Ali

Legislature and Governor Agree to State Budget that Rejects Several Problematic Initiatives; Provides Qualified Immunity for COVID-19 Response
The New York State Legislature has given final passage to an extraordinarily difficult State Budget for the 2020-21 Fiscal Year that seeks to close what could be upwards of a $15 Billion Budget deficit.  With a Budget consideration process that was very different than previous years due to the managing of the coronavirus pandemic, MSSNY staff continues to go through the thousands of pages of Budget bills, but some of the top line highlights include:

  • Continuation of the Excess Medical Malpractice Insurance Program for another year, and rejecting proposals from the Medicaid Redesign Team to foist a 50% cost-share on the physician insureds, which could have been imposed thousands of dollars in new costs on the nearly 17,0000 physicians enrolled in the program.
  • Rejecting the Governor’s Budget proposal that would have severely curtailed important due process rights for physicians when a complaint has been filed against them to OPMC;
  • A 2-year extension of the existing physician-pharmacist collaborative drug program, and rejection of a proposal that would have greatly expanded the powers of pharmacists, and permitting nurse practitioners to also enter such protocols
  • Ending the sale of flavored e-cigarettes and flavored vaping products.
  • Targeted health insurance reforms including creation of an administrative simplification workgroup, a required reporting to DFS of health insurer denial statistics and hastening the timeframe for payment of claims when there has been a request for more information and that information has been provided.
  • Gives the NY Department of Financial Services power to investigate when a prescription drug price has gone up by over 50% in less than a year
  • Expansion of New York’s “surprise bill” law to include inpatient services that follow an emergency room visit, which will permit an out of network physician to bring these claims to the Independent Dispute Resolution process if they get an Assignment of Benefits from the patient.
  • Limits patient insulin co-payments to no more than $100 per 30-day supply.
  • Carving the Medicaid prescription drug benefit back into management by New York State, instead of by Medicaid Managed Care companies.
  • Continued funding of MSSNY’s Committee for Physician’s Health at its historical level.

Importantly, the Budget would also put into statute liability protections that had been set forth in a recent Governor’s Executive Order to provide qualified liability immunity to a physician or health care facility  (a) that is arranging for or providing health care services pursuant to a COVID-19 emergency rule;  (b) the act or omission occurs in the course of arranging for or providing health care services and the treatment of the individual is impacted by the health care facility’s or health care professional’s decisions or activities in response to or as a result of the COVID-19 outbreak and in support of the state’s directives; and (c) the health care facility or health care professional is arranging for or providing health care services in good faith.

Of significant note is a provision that will give the Governor significant discretion to adjust Medicaid payments across the Board throughout the fiscal year based upon the significant variability of revenue coming into New York State.  At the beginning of the year, the Governor implemented an across the Board 1% Medicaid cut, and the MRT2 recommended an across the board 1.875% cut.  This provision has the potential to bring about significant Medicaid cuts through the fiscal year based upon how quickly New York’s economy can recover.

MSSNY thanks the countless physicians for their grassroots advocacy on these key issues, as well as the great partnership with county medical and specialty society leaders in advocating for the many successful outcomes in this Budget, particularly during this extraordinarily difficult time.

We will follow up with a more in-depth report on the litany of health provisions in the State Budget that impact physicians and their patients.

Gov. Cuomo Shifting Resources Where Needed
“Right now, the numbers in upstate New York are lighter than the numbers in downstate New York but that is going to change,” Gov. Cuomo said. “You’re going to see that wave move through the state. … We’re going to shift resources all across the state to whatever place has that need at that time.” The state has estimated it has only a six-day supply of ventilators left based on the current need in the New York City area. There are about 102,800 confirmed coronavirus cases in New York state, with 57,000 in New York City.

More than 14,800 people are hospitalized and 3,700 are in intensive care. There have been 2,935 deaths from the pandemic as of Friday morning.

“Hospitals who are not dealing with COVID are seeing very low activity and it’s not that we’re going to leave any health care facility without adequate equipment, but they don’t need excess equipment,” the governor said. The governor’s plan drew concern from some upstate Congressional lawmakers.

Cuomo said it’s not yet clear how many ventilators might be found at upstate institutions but estimated there may be “several hundred excess.”

“Several hundred could represent several hundred lives so am I willing to deploy the National Guard and inconvenience people for several hundred lives, you’re damn right I am,” the governor said. (Politico 4/3)

Temporary Hospital Facility at Javits Center Will Now Treat COVID-19 Patients
The growing number of Coronavirus cases are threatening the capacity of our hospital system. The original plan for the Javits Center was to use it for non-COVID patients in order to free up beds at other hospitals. However, the number of COVID patients has increased to the point that it is prudent for Javits to support and care for COVID patients. I asked President Trump this morning to consider this request and stressed the urgent need and he agreed to it.

Health Advisory: Guidance: NYS DOH Advisory on PPE Shortage Options
Options when Personal Protective Equipment (PPE) is in Short Supply or Not Available

New DEA Buprenorphine Guidance from US Department of Justice
The U.S. Drug Enforcement Administration (DEA) recently issued guidance to DEA-registered physicians providing new flexibility for physicians managing patients with opioid use disorder. The new guidance permits physicians and other health professionals with a waiver allowing them to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31 for the duration of the COVID-19 emergency. More info

Pursuant to section 1135(b)(1)(B) of the Social Security Act, the Centers for Medicare and Medicaid Services New York State is offering Provisional Temporary Enrollment for the duration of the public health emergency. For ease of enrollment, we are offering multiple options for enrollment. New York’s goal is to quickly enroll Providers into New York State Medicaid so that they can react to the emerging health crisis.

This new provisional enrollment applies to providers in the following Categories of Service (COS):

  • Nurse LPN – 0521
  • Nurse RN – 0522
  • Nurse Practitioner – 0469
  • Physician – 0460
  • Physician Assistant (Registered) – 0462

To enroll using the Online Web Form, do the following:

  1. Use your web browser to access the form at: emedny.org/COVID19/
  2. Complete the form following instructions found below under Useful Links.
  3. When complete, click “Submit” to send the form to NYS for processing.

To enroll using email, do the following:

  1. The hard copy paper form can be found here.
  2. Complete the form, email it to this address for processing: emednycovid19PE@gdit.com
  3. Complete the form following instructions found below under Useful Links.

To enroll an individual provider or if you need support, please contact the eMedNY Call Center at 800-343-9000. If enrolling by phone, please be sure to have the following information available:

  • Email address
  • Category of Service (COS)
  • Identifying Information
  • Contact Information
  • Home address, work address, and service address.

To enroll a large number of providers, please contact the eMeNY Call Center Center at 800-343-9000.

Processing and Approval
When your application is approved, you will receive a Medicaid Provider ID number (MMIS) and will be able to submit

Advance Medicare Payments to Help Physicians Through this Period
Moreover, CMS announced over the weekend a process for physicians to receive 100% of predicted Medicare payments for a 3-month period ( Fact Sheet: Advanced Payment Program During COVID-19 Emergency).  Here is a recommended process for applying for these advanced payments shared with MSSNY by a medical practice, as well as some of the particulars of this program:
Process:

1. Go to your National Government Services (NGS) website and fill in, sign, and submit an Accelerated / Advance Payment request form for your practice.

2. Can request up to 100% of Medicare payment for a 3-month period.

3. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

3. State that the request is for an accelerated/advance payment due to the COVID-19 pandemic

4. Will receive payment within 7 calendar days from the request.

5. Recoupment will begin 120 days after payment issuance date.

Eligibility:

Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,

Not be in bankruptcy,

Not be under active medical review or program integrity investigation, and

Not have any outstanding delinquent Medicare overpayments.

For further information, contact Regina McNally, VP of MSSNY’s Socio-Economic

Division at 516-488-6100 ext.332 or email rmcnally@mssny.org.

Telehealth for Beginners on MSSNY Website
Not sure how to practice telehealth? Go here for a short primer.

Backline from Dr. First is a MSSNY- Approved Telehealth Product
DrFirst, a pioneer in healthcare technology offers HIPAA-compliant telehealth and video conferencing as part of its award-winning care collaboration and secure messaging platform, Backline. Backline is quick to set up and easy to use by both physicians and patients.

Initiate a video session without requiring a patient to download an app, complete a cumbersome registration process, or pay upfront before speaking with their physician. Physicians can use their PC or smartphone to engage with patients. Plus, Backline’s HIPAA security and extensive use cases make it a must-have even after the coronavirus crisis ends. Sign up here: https://drfir.st/blt-mssny

Paycheck Protection Program (PPP) Information Sheet: Borrowers
The Paycheck Protection Program (“PPP”) authorizes up to $349 billion in forgivable loans to small businesses to pay their employees during the COVID-19 crisis. All loan terms will be the same for everyone. The loan amounts will be forgiven as long as:

• The loan proceeds are used to cover payroll costs, and most mortgage interest, rent, and utility costs over the 8-week period after the loan is made; and

• Employee and compensation levels are maintained. Payroll costs are capped at $100,000 on an annualized basis for each employee. Due to likely high subscription, it is anticipated that not more than 25% of the forgiven amount may be for non-payroll costs. Loan payments will be deferred for 6 months.

What do I need to apply? You will need to complete the Paycheck Protection Program loan application and submit the application with the required documentation to an approved lender that is available to process your application by June 30, 2020.

Click here for the application.

10K Disaster Grant: Does Not Impact Qualification for Forgivable Loan 75% Reserved; File Now! Do NOT Wait
Apply for a COVID-19 Economic Injury Disaster Loan NOW! https://covid19relief.sba.gov/#/

In response to the Coronavirus (COVID-19) pandemic, small business owners in all U.S. states, Washington D.C., and territories are eligible to apply for an Economic Injury Disaster Loan advance of up to $10,000. To apply for a COVID-19 Economic Injury Disaster Loan, https://covid19relief.sba.gov/#/

The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. The loan advance will provide economic relief to businesses that are currently experiencing a temporary loss of revenue. Funds will be made available within three days of a successful application, and this loan advance will not have to be repaid.  DO NOT WAIT!

CMS to Apply MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19, Reopens Application
CMS is offering multiple flexibilities to provide relief to clinicians responding to the 2019 Novel Coronavirus (COVID-19) pandemic. In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30, 2020 at 8 PM ET, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

If you are a MIPS eligible clinician and do not submit any MIPS data by April 30, 2020, you won’t need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. You will be automatically identified and will receive a neutral payment adjustment for the 2021 MIPS payment year. Please note, CMS has updated the QPP Participation Status Tool so eligible clinicians can see if the policy has been automatically applied.

Additional 2019 Relief Measure

We are also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups.

Who should submit an application?

·       Individual clinicians who started, but are unable to complete, their data submission.

·       Groups that started, but are unable to complete, their data submission; and

·       Virtual groups that are unable to start or complete their data submission.

An application submitted between April 3 and April 30, 2020, citing COVID-19, will override any previous data submission. For more information, please see the Quality Payment Program COVID-19 Response Fact Sheet.

You can contact the Quality Payment program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

This Week’s Legislative Podcast

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