MSSNY eNews: December 3, 2021 – New Guidance on Limiting Elective Surgery

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Colleagues:

This week, MSSNY extended a warm welcome to Dr. Mary Bassett as she begins her tenure as New York State’s Health Commissioner. We look forward to working closely with her to address the health needs of all New Yorkers.

As I said in my press statement, Dr. Bassett joins New York State at a uniquely challenging time in history and we are confident that her wealth of knowledge and experience in the field of public health will help her to guide New Yorkers through to the end of the COVID-19 pandemic—and future public health challenges.

At the moment, the greatest challenge is the concerning rise of COVID positivity and hospitalizations in parts of New York. There are nearly 40, mostly upstate, hospitals whose bed capacity is less than 10 percent. And just yesterday we received news that several cases of the Omicron variant have been reported in New York State.

This week, I—along with MSSNY President-Elect Dr. Parag Mehta and Vice-President Dr. Paul Pipia—met with top officials to Governor Hochul to discuss aspects of her recent emergency order that will give the NYS Department of Health the authority to limit elective procedures at hospitals that have less than 10% bed capacity, and cannot safely coordinate patient services with a nearby hospital who does not face similar capacity limitations.  While this may be a necessary step for some hospitals based upon their current capacity challenges, we also urged caution in blanket restrictions on “elective” surgeries to ensure patients continue to have the ability to receive urgently needed care, such as necessary cancer screening tests (mammograms, colonoscopies, etc.) and surgeries that address patient health issues that substantially impact patients’ ability to live without pain and go to work. See the first article below for specific guidance on limiting elective surgeries set forth today by Governor Hochul and the Department of Health. Determinations as to which hospitals are subject to the limitations will be made this Monday 12/6; procedures at these hospitals to be delayed starting on Thursday 12/9.

Earlier this week, the CDC strengthened its recommendation on booster doses to indicate that everyone 18 years of age and older should get a booster shot either 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine. If you are a physician COVID vaccine provider, click here to view Guidance for The New York State COVID-19 Vaccination Program.

Let’s do all we can to encourage our patients to get their vaccinations and boosters so we can all look forward to enjoying a safe and healthy holiday season with family and friends.

Joseph Sellers, MD, FAAP, FACP
MSSNY President

Governor Hochul and DOH Set Forth Guidance for Limiting Elective Surgery at Certain Hospitals
The New York State Department of Health sent a “Dear Administrator” Letter (DAL) today to hospitals across the state detailing the framework when facilities must, upon DOH review and determination, limit non-essential elective procedures and/or implement other actions to coordinate services as determined by DOH to ensure New York State health systems and Impacted Facilities can address potential capacity constraints.  Governor Hochul had announced last week that such restrictions would be forthcoming in response to the big jump in COVID hospitalizations in several regions of the State, and the unknown impact of the Omicron variant.

As noted in our e-news article earlier this week, as part of a meeting with MSSNY President Dr. Joseph Sellers, President-elect Dr. Parag Mehta and Vice-President Dr. Paul Pipia, key health staff to the Hochul Administration indicated that a key goal in implementing such a policy is that it be far more nuanced and limited than previous iterations of elective surgery restrictions. A few of the notable components of the DAL include:

• Determinations of which hospitals will need to restrict elective procedures will be on Monday, December 6, to apply to procedures scheduled to occur on or after Thursday, December 9.

• The restrictions on elective surgeries do not apply to procedures performed at specialty facilities (such as a cancer treatment facility), non-hospital owned ambulatory surgery centers, office-based surgery practices, or free-standing diagnostic and treatment centers.

• The limitations will apply to only those facilities that are in regions of the State considered to be high risk (as defined in the DAL) AND have less than 10% bed availability. While not stated in the DAL, it would appear that those regions currently considered “high risk” are: North Country, Capital District, Mohawk Valley, Finger Lakes and Western New York

• Impacted Facilities may be required to limit non-essential elective procedures at a hospital-owned ambulatory surgery centers if the Impacted Facility has an occupancy of 95% or higher based on the previous 7-day average.

• The following procedures are considered essential, and not subject to the restrictions.
  • Cancer, including diagnostic procedure of suspected cancer
  • Neurosurgery
  • Intractable Pain
  • Highly symptomatic patients
  • Transplants
  • Trauma
  • Cardiac with symptoms
  • Limb threatening vascular procedures
  • Dialysis Vascular Access

Moreover, there is an important “catch all” provision to provide flexibility to physicians and their patients to enable procedures not listed above at these restricted facilities where “Patients are at a clinically high risk of harm if their procedures are not completed”

MSSNY staff is continuing to review this document and will be discussing with allied groups to assess the impact to patient access to needed care. MSSNY will also continue to stay in regular communication with the Governor’s office and the DOH about where patient access gaps exist to ensure necessary flexibility to this policy.

MSSNY Legislative Podcast
Rising COVID Cases, the Omicron Variant & Elective Surgery Restriction Policies

MSSNY Micro Masterclass Webinar:  Submitting Formal Insurer Complaints to the Appropriate Agency
Do you have unresolved claims payment issues with an insurer? Not sure how to pursue a resolution? Settle in with your lunch and join Heather Lopez, Director of MSSNY’s Payment and Practice Division, at 12:15 pm on December 9 for a 15-minute masterclass on filing and following up on insurer complaints. Heather will share information on how to determine the proper agency for the complaint as well as providing contact information for each of the agencies. Please register to join us for the webinar at https://bit.ly/31j1fUt 

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges
The Kaiser Family Foundation released an analysis examining Medicare spending per person for beneficiaries in Medicare Advantage (MA), relative to traditional Medicare. The number of people enrolled in Medicare, along with its spending, has increased since its inception. In the last decade, there has also been a significant increase in MA enrollment – with enrollment doubling in the last decade. Publicly available data from CMS was used in this study. Findings include:

• Medicare spending for MA enrollees was $321 higher per person in 2019 than if enrollees had been covered by traditional Medicare. This difference in spending contributed to an estimated $7 billion in additional spending in the Medicare program in 2019.
• The growth in MA enrollment only explains half of the projected increase in total MA spending between 2021 and 2029, while half is attributable to growth in Medicare payments per MA enrollee (adjusting for inflation).
• Using Medicare Payment Advisory Commission protections and recommendations for MA plan payments could save $82 billion between 2021 and 2029. If Medicare payments for MA plans grew at the same rate as is projected for traditional Medicare spending (per person), total Medicare spending would be $183 billion lower between 2021 and 2029.

More Than Half of Global Telehealth Providers Have Patients Who Declined Telehealth Over Privacy, Data Concerns, Survey Says
mHealth Intelligence reports that while “the popularity of telehealth has grown over the course of the COVID-19 pandemic,” 52% of “global telehealth providers have experienced cases where patients refused to participate in a virtual visit either because they do not trust the technology or due to privacy or data concerns, according to” a new Kaspersky survey (PDF).

In addition, clinicians “have concerns, with 81 percent saying that they are uncertain about how patient data will be used and shared from these virtual sessions. They also expressed concerns about data security and the personal penalties that may arise if data is leaked.”

Obituaries
BAYARRI, Vincent; White Plains NY. Died September 18, 2021, age 94. Suffolk County Medical Society
BROWN, Howard Raymond; Williamsburg VA. Died August 25, 2021, age 88. New York County Medical Society
CUTLER, Leonard; Pittsboro NC. Died September 15, 2021, age 92. Medical Society County of Westchester
CUTROFELLO, Paul Joseph; Jamaica NY. Died July 24, 2021, age 88. Medical Society County of Queens
DAVIS, Paul Harvey; Staten Island NY. Died May 15, 2021, age 82. Richmond County Medical Society
DREYER, Ronald William; Scarsdale NY. Died November 18, 2020, age 92. Medical Society County of Rockland
FRIEDMAN, Norman Elliot; Scarsdale NY. Died November 07, 2020, age 91. Medical Society County of Westchester
GOLDMAN, Mitchell Barry; Oakdale NY. Died April 19, 2020, age 88. Suffolk County Medical Society
HEITZMAN, E. Robert Jr.; Syracuse NY. Died November 04, 2020, age 93. Onondaga County Medical Society
KATYAL, Inderjit; Medford NY. Died September 14, 2021, age 84. Suffolk County Medical Society
KORMAN, Elise H.; Moorestown NJ. Died August 17, 2021, age 84. Suffolk County Medical Society
MENDELOW, Joseph; Boca Raton FL. Died May 11, 2020, age 92. Erie County Medical Society
MUCCIA, John Richard; Liberty NY. Died October 03, 2019, age 78. Medical Society County of Sullivan
UEHLBAUER, Peter F.; Somers NY. Died November 09, 2020, age 81. Medical Society County of Westchester
NAUMANN, Ronald A.; Hilton Head Island SC. Died May 04, 2021, age 86. Onondaga County Medical Society
PARKER, Albert Cushman; Port Chester NY. Died July 11, 2021, age 88. Medical Society County of Westchester
PRIEBE, Cedric Joseph Jr.; East Setauket NY. Died January 19, 2019, age 88. Suffolk County Medical Society
RESZEL, Thaddeus F.; Massena NY. Died September 20, 2018, age 90. Medical Society County of St. Lawrence
SHAPIRO, Robert T.; Smithtown NY. Died August 20, 2020, age 82. Suffolk County Medical Society
WANLASS, Stanley A.; Columbus NC. Died January 06, 2012, age 89. Medical Society County of Westchester
WEI, Wen-Chen; New Hartford NY. Died November 21, 2021, age 87. Medical Society County of Oneida
WEIR, William H. Jr.; Wading River NY. Died June 22, 2017, age 87. Suffolk County Medical Society

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