MSSNY eNews: December 11, 2020 – More Good News on the Vaccine Front


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Colleagues:

More good news on the vaccine front this week and not a moment too soon as reports indicate hospitals are reaching capacity throughout the nation.

Yesterday, FDA advisors voted 17-4 that the benefits of the Pfizer-BioNTech COVID-19 vaccine outweigh its risks for use in individuals 16 years of age and older.

The vote paves the way for the FDA to grant emergency use authorization (EUA) within the next few days. The FDA review released earlier this week indicated the efficacy of the two dose Pfizer vaccine is approximately 95%. The advisory panel will meet again shortly on 12/17 to offer recommendations on Moderna Inc.’s COVID-19 vaccine.

Back on the home front, New York State has started mobilizing the first phase of the vaccine role out. New York has been appropriated approximately 170,000 doses of the Pfizer vaccine. Those first doses will be distributed around the state to hospital frontline workers and nursing home residents and staff with distribution prioritized to areas based on virus surge.

Until the vaccine is widely available and most of the population is vaccinated, hospital capacity will remain a top concern. In fact, this week, data was released from the Department of Health and Human Services showing that 1/3 of Americans are living in areas where hospitals are running critically short of intensive care unit beds. In response, our Governor has directed hospitals to expand bed capacity by greater than 50% and has called on retired physicians and nurses to rejoin the workforce. However, in one corner of our state, the Kingsbrook Jewish Medical Center Hospital is actually slated for closure on January 1, 2021.

This plan predated the pandemic and the current surge. Several regional physician advocacy groups including the Medical Society of the County of Kings and the Manhattan Central Medical Society are urging that it remain open given this surge in COVID-19 cases and hospitalizations. This approximately 200 bed hospital predominately serves communities of color and may be critical to meeting the healthcare needs of the Brooklyn area during the next phase of this pandemic. Our medical society agrees with the Governor that hospital bed capacity is of paramount importance and therefore is joining with these other societies to urge reconsideration of the timing of this closure.

With the virus surging and our censuses rising, it is of the utmost importance that we as physicians take care of ourselves so that we can remain healthy, physically and mentally, to guide our patients and our state out of the pandemic. Remember that MSSNY is there for you and accessing our confidential peer to peer program is only an email (p2p@mssny.org) or phone call (1-844-P2P-PEER) away.

Bonnie Litvack, MD
MSSNY President


MSSNY Weekly Podcast:
Vaccine Approval, Stimulus Package & Upcoming Educational Programs


Notes from Governor Cuomo’s Friday Briefing:
COVID:
– Day 286
– Three focal points: hospital capacity, containment, vaccinations
– NYS Clinical Advisory Task Force approved FDA decision on vaccine unanimously
– Statewide positivity rate without micro-clusters: 4.55%
– Statewide rate with micro-clusters: 4.9%
– Micro-cluster positivity rate: 6.8%
– 212,000 tests conducted yesterday
– 21 million tests conducted to date
– 87 deaths
– 5,321 hospitalizations
– 1,007 ICU
– 546 intubations

Hospitalizations by Region:
– Finger Lakes: 611, 0.05%
– Western NY: 548, 0.04%
– Gov. noted increase in Western NY is beginning to flatten
– Southern Tier: 161, 0.03%
– Mid-Hudson: 696, 0.03%
– NYC: 1,668, 0.02%
– Long Island: 846, 0.03%
– Capital Region: 244, 0.02%
– Central New York: 314, 0.04%
– Mohawk Valley: 186, 0.04%
– North Country: 47, 0.01%

Winter Plan:
– Schools “almost without exception” are safer than broader communities
– Gov. said schools should be open unless there is spread within the school
– Gov. called hospitalization increase “dramatic”
– However, ICU rate is down 30%, 50% fewer intubations than in Spring
– Also, length of stay in hospital went from 11 days in Spring to 5 currently
– Death rate also decreased from 23% previously to 8% now
– Gov. discussed contact tracing data on where spread is occurring: primarily household gatherings, healthcare delivery, higher education students
– Gov. said indoor dining spread is better, but “still an issue”
– Gyms are now one of the lowest venues for spread, personal care services are much lower now as well
– Rate of transmission is 1.3% currently, which Gov. called “problematic”

New Restrictions Being Implemented:
– Based on CDC guidance, rate of transmission, and density indoor dining in NYC will close beginning Monday, December 14
– Outdoor dining, takeout to continue
– Gov. stressed federal government needs to provide relief for restaurants, bars
– Gov. announced NY will extend commercial eviction moratorium, but did not specify for how long
– Gov. added that gyms and salons can operate in orange zones with reduced capacity at 25%, and bi-weekly testing
– Outside NYC, in orange zones indoor dining will continue to be monitored

Potential New Restrictions:
– Red zone puts region on NY Pause, metric is 21 days from 90% hospital capacity,
– Gov. said this is necessary if hospitals are in risk of being overwhelmed
– Orange zone occurs if 4% positive rate over 10 days, or up to 80% hospital capacity, or high rate of hospital admission as determined by DOH
– Yellow zone occurs if 3% positivity rate over 10 days, or if region is in top 10% of hospital admissions
– Gov. said based on these metrics, new zoning will be announced on Monday
– In Staten Island: 26 deaths, which is 25% of NYC deaths, although Staten Island is 5% of the population
– Staten Island also high in hospital admission rate of increase

Hospitals:
– Hospitals are already at 25% increase in staff and beds
– Hospitals must remain under 85% capacity, can do so by adding additional 25% bed capacity or by reducing elective surgeries
– Over 85% capacity equals critical hospital capacity

Vaccine:
– 170,000 doses of Pfizer vaccine expected “imminently”
– 346,000 doses of Moderna vaccine expected week of Dec. 21
– Gov. stressed the need for inclusivity for the vaccine, cited his letter sent to HHS Secretary Azar

Members of Congress:
– Reps. Jeffries, Meng, Haaland, Castro, and Bass attended virtually
– Representatives discussed the need for state and local aid, equitable distribution of the vaccine to all communities, and vaccine prioritization


New York City COVID-19 Vaccination Program Enrollment
The New York City Department of Health and Mental Hygiene is now enrolling private practices, independent pharmacies and other facilities that will immunize adults in the NYC COVID-19 Vaccination Program.

Click on the links below to review the letter and instructions on how to sign the COVID-19 Vaccination Program Provider Agreement in the online Citywide Immunization Registry (CIR):

Attend a webinar on completing the Provider Agreement in the CIR:
Enrollment in the NYC COVID-19 Vaccination Program
Tuesday, December 15, 2020, 1:00 to 2:00 p.m.
Register Here

For questions, please call the Provider Access Line at 1-866-692-3641 or email nycimmunize@health.nyc.gov. Periodic updates will be sent to keep you informed and the COVID-19 vaccine webpage will be updated.


New York State COVID-19 Vaccination Program Enrollment
The New York State Department of Health (NYSDOH) is now enrolling healthcare provider practices (outside of New York City’s five boroughs) in the NYSDOH COVID-19 Vaccination Program.

Practices (outside NYC) interested in administering COVID-19 vaccine when the vaccine becomes available to their group must enroll in the NYSDOH program to be ready to order and receive publicly supplied COVID-19 vaccine and ancillary supplies.

Please review the following attached documentation and complete the online COVID-19 vaccine enrollment application located in the Health Commerce System by Friday, December 18, 2020.

Send questions regarding the NYSDOH enrollment process to: COVID19Vaccine@health.ny.gov


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2021 Medicare Payment Rule Finalizes Steep 10% Conversion Factor Cut – Contact Your Member of Congress to Prevent CMS from Implementing
The American Medical Association has developed a comprehensive summary of the 2021 Medicare physician payment rule.  As has been widely reported, while the payment rule incorporates some long overdue increases in E&M codes, statutory budget neutrality rules are forcing a 10.2% cut in the conversion factor.

Therefore, MSSNY has been working together with numerous state medical associations and the AMA in support of Congressional legislation to prevent the conversion factor cut (while urging the E&M changes to go forward).  You can join us in these efforts by sending a letter from here: Urge Congress to Prevent Medicare Cuts, Expand Lifeline Programs and Oppose One-Sided Surprise Bill Proposals (p2a.co)

From the AMA Summary – CY 2021 Physician Fee Schedule Ratesetting and Conversion Factor

  • The final CY 2021 Medicare Physician Fee Schedule (PFS) conversion factor is $32.4085, which represents a 10.2% reduction from the CY 2020 conversion factor of $36.09.
  • Similarly, the final CY 2021 anesthesia conversion factor is $20.0547, down 9.61% from the CY 2020 anesthesia conversion factor of $22.20.
  • The most widespread specialty impacts of the relative value unit (RVU) changes are generally related to the changes to RVUs for specific services resulting from the E/M office visit increases and other changes made by CMS. The AMA/Specialty Society RVS Update Committee’s (RUC) recommendations account for a 5.5% reduction to the conversion factor. The remaining spending increases and resulting conversion factor reduction is attributed to various CMS proposals to increase valuation for specific services, including the E/M visits and the new G2211 visit complexity add-on code.
    • E/M visits billed using CPT codes comprise approximately 45% of allowed charges for PFS services. Office and outpatient E/M visits comprise approximately 25% of allowed charges for PFS services.
    • There is considerable variability within the specialties of the Federation in terms of E/M level of visits and volume. Physicians such as family practitioners who do not provide procedural interventions or diagnostic tests have most of their allowed charges from E/M visits. Therefore, these practitioners and other primary care providers should expect to see increases for their E/M visits.
  • CMS finalized Current Procedural Terminology® (CPT) descriptors, guidelines, and payment rates effective on January 1, 2021, which are a significant modification to the coding, documentation, and payment of E/M services for office and outpatient visits. In the final rule, CMS retained five levels of coding for established patients, reduced to four levels for new patients, and revised code definitions. CMS revalued services analogous to office outpatient E/M visits.

Should Physicians Who Had COVID-19 Still Get the Vaccine?
“Healthcare workers are recommended to be first in line for COVID-19 vaccines once they’re authorized, but many have already been infected — leading to a debate about whether they should give up their place in line,” reports Medpage Today (D’Ambrosio, 12/3). “Experts disagree when it comes to interpreting the evidence regarding lasting immunity and the need for vaccination among healthcare workers (or anyone, for that matter) who’ve already been infected.

Cases of reinfection have been documented; they appear to be rare, but the true rate remains unknown. For starters, second infections won’t be recognized as such if the first was never detected. Likewise, an asymptomatic reinfection may go unnoticed, yet the individual may still transmit it to others. It would not be good if that person happens to be a healthcare worker.” Medpage Today reports on the debate here.


Poll: Only About Half of Americans Want to Get Vaccinated Against COVID-19
The AP (12/9, Neergaard, Fingerhut) reports, “As states frantically prepare to begin months of vaccinations that could end the pandemic, a new poll finds only about half of Americans are ready to roll up their sleeves when their turn comes.”

The Associated Press-NORC Center for Public Affairs Research survey “shows about a quarter of U.S. adults aren’t sure if they want to get vaccinated against the coronavirus,” while “roughly another quarter say they won’t.” Those “on the fence have safety concerns and want to watch how the initial rollout fares.”


MSSNY in the News this Week

WGRZ – 2 Buffalo (NBC Affiliate) – 12/08/20
2 On Your Side Answers Questions About The Coronavirus Vaccine
(MSSNY President Dr. Bonnie Litvack interviewed)

Crain’s Health Pulse – 12/09/20
MEDICARE CUTS
(MSSNY Statement / President Dr. Bonnie Litvack quoted)


Join Garfunkel Health Advisors for Webinar on Changes to E/M Coding and Documentation Requirements in 2021
Join Garfunkel Health Advisors, Inc. to prepare you for the biggest change in decades to the documentation and coding guidelines for Evaluation and Management (E/M) services, which go into effect on January 1, 2021.

Who this will affect: The Centers for Medicare and Medicaid Services (CMS) new E/M coding changes will affect every provider that bills for office and outpatient visits, including physicians, NPPs, practice plans, hospitals, HIT companies, health plans and health systems.

Why you need to attend: It is critical that the provider community understand the full impact of these changes, how they will affect your reimbursement and how to train your providers and staff to ensure compliance. This webinar will provide practical guidance on the most important aspects of the new rules and discuss best practices to reduce your audit and compliance risks.

Register for the webinar here.


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MSSNY Offers Access to PPE Supply Chain in Collaboration with American Society of Plastic Surgeons
MSSNY is pleased to again offer members access to purchase PPE supplies through the American Society of Plastic Surgeons (ASPS) PPE supply chain program. Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked. Please note that shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times. To see the available supplies and create an account to purchase items, visit this website.


COVID-19 from a Physician-Patient Perspective
Register now to learn more about what it is like to experience COVID-19 as both physician and patient.  Register now for: “COVID-19 from a Physician-Patient Perspectiveon Wednesday, December 16, 2020 at 7:30 a.m.  Lorraine Giordano, vice chair of MSSNY Committee on Emergency Preparedness and Disaster/Terrorism Response and Parag Mehta, MD, MSSNY Vice President will serve as faculty for this program. Registration is now open for this webinar here

Educational objectives are:

  • Describe COVID-19 from the perspective of both patient and physician
  • Examine insights gained from experiencing SARS CoV-2 firsthand
  • Identify chronic and acute symptoms that are prominent as a result of experiencing COVID-19 as a patient

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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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The Beginning of the End: COVID-19 Vaccine Considerations for Long Term Care Providers
Join Garfunkel Wild for an update from a former CDC pandemic expert on the ethical, legal, and logistical challenges of the COVID-19 vaccine roll-out.

When: Thursday, December 17, 2-3:00 pm

Register for the Webinar

Senior living providers are eagerly awaiting a COVID-19 vaccine — but protection against COVID-19 includes multiple strategies and the logistics around inoculating residents and employees are complex. Join Dr. Lisa Koonin, founder of Health Preparedness Partners, LLC, who spent more than 30 years at the CDC. Dr. Koonin led the development of national pandemic influenza preparedness and response plans and policies, served in leadership positions for multiple national and international emergency responses (including the 2016 Zika response, 2014-2015 Ebola response, 2013 H7N9 avian influenza outbreak in China, 2009 – 2010 H1N1 influenza pandemic), and has consulted with businesses, state and local governments, healthcare facilities, and ministries of health around the world, to improve emergency preparedness.

Why you need to attend: We will provide a current pandemic update, and discuss the ethical, legal and logistical challenges of the vaccine roll-out. Our panel will also discuss patient consent and liability, employee strategies, and infection control. Please sign up to hear the insight and new information needed to help protect your staff and residents.  If you have questions that you would like our panel to address, kindly submit them to Mandy Kaplan at mkaplan@garfunkelwild.com before December 15, 2020.


“PTSD in Returning Veterans” Webinar
The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: PTSD in Returning Veterans live webinar on Tuesday, January 26, 2020 at 7:30 am.

Click here to register for the program. View the program flyer here.

When: January 26, 2020 at 7:30 am
Faculty: Frank Dowling, MD

Educational Objectives:

  • Identify diagnostic criteria for PTSD
  • Discuss medical and psychiatric comorbidities of military related PSTD
  • Discuss evidence-based treatment modalities for PTSD including medications and psychotherapy
  • Discuss strategies to help veterans overcome stigma to seek and accept treatment for military related trauma

For more information, contact Jangmu Sherpa at jsherpa@mssny.org or call (518) 465-8085

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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