October 30, 2015 – Chicken Little Was Wrong!

 Dr. Joseph R. Maldonado
October 30, 2015
Volume 15, Number 41

Dear Colleagues:

The sky is falling! The sky is falling! Y2K is here again!

All of our fear and angst with regard to the complete overhaul of our diagnostic coding system did not kill us (yet). From all accounts, health plans may have experienced minor glitches, but they claim that they expeditiously fixed any problems so that we did not feel any significant pain.

To my knowledge, no physicians had to use any of the more exotic new codes like V91.07-“burn due to water skis on fire” or V97.33- “sucked into a jet engine.”

CMS, according to yesterday’s press release, states that there is an expectation that “this change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.”  Really! It is an insult to physicians in the trenches to be told how to quantify their life’s work by the switching of the numbers game in midstream. However, since CMS and other health plans are the fiduciary, we were forced (kicking and screaming) to make some concessions.

If any of you have experienced significant maladies from the transition, please call Regina McNally in our Socio-Medical Economic Division at 516-488-6100 ext 332, who will alert any carrier that is causing you cash flow harm.

CMS reports that they are “carefully monitoring the transition and is pleased to report that claims are processing normally.” Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Following this time table, more meaningful information will be available on the ICD-10 transition in November.

According to their press release, CMS “is continuing its vigilant monitoring process of the ICD-10 transition and shared the following metrics detailing Medicare Fee-for-Service claims from 10/1-10/27.” Their stats are as follows: total claims submitted-4.6 million per day; total claims rejected due to incomplete or invalid diagnosis codes— 2.0% of total claims submitted; total claims rejected due to invalid ICD-9 codes— 0.11% total claims. 

From what we have NOT heard, the sky did not fall.
Now that we have survived the first “tsunami,” we can move onto the next fiasco—e-prescribing.

We have five months to batten down the hatches.

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

Please send your comments to comments@mssny.org

MLMIC Physianns Insurance

NYDFS, NYSOH, CMS Announce Additional Actions Regarding Health Republic
The New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the CMS today announced additional actions regarding Health Republic Insurance of New York and a transition plan for Health Republic customers.

On September 25, 2015, NYDFS directed Health Republic to cease writing new health insurance policies and announced that the co-op will commence an orderly wind down after the expiration of its existing policies. However, a subsequent NYDFS and CMS-led review of Health Republic’s finances has found that the company’s financial condition is substantially worse than the company previously reported in its filings to NYDFS. In light of these developments, NYDFS and the NYSOH Marketplace have determined that it is in the best interest of consumers to end all Health Republic policies – both individual and small group – on November 30, 2015 so that customers can transition to new coverage after that date.

From Regina McNally, VP Socio Med; Here Are Contact Numbers for Insurers
Recently, I have been hearing from our members that many have been having difficulty reaching various health plans and/or health insurance related entities.  So, I contacted many of these organizations to create a one-stop shop for contact information.

Please share this with your colleagues and office staff.

If you or your staff has better contacts to get your issues resolved, please be sure to continue to utilize those contacts. The attached is meant to be helpful for those persons who do not have that first point of contact or need another point of contact with an organization.

Of course, I continue to be available to you and yours for situations whereby an impasse has been reached and I might be of some assistance. I am here to help. Click here to view the contact list.

House and Senate Both Pass Budget Package to Raise Debt Ceiling and Prevent Medicare Premium Increases
This week, both the US House of Representatives and the US Senate passed a sweeping Budget package to raise the debt ceiling limit until 2017 and to prevent a 52% increase to millions of seniors’ Medicare premiums that otherwise would have gone into effect in 2016. The House passed the Budget package by a 266-167 vote and the Senate passed it by a 64-35 vote. The only New York member of Congress who voted against it was Rep. Lee Zeldin (R-Suffolk County).

Of particular concern, the package would extend for an additional year, through 2025, the 2% Medicare payment sequester provisions that had originally been enacted by the Budget Control Act of 2011.

The Budget package also contains a number of controversial provisions, including: a measure to limit Medicare payments to hospitals for services provided at newly acquired physician practices to the same fee that would be paid for health care services provided in a private physician office; a measure to require generic drug manufacturers to pay additional rebates to the Medicaid program if the price of the drug has increased faster than inflation; and a measure to repeal a section of the ACA that requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer.

The Budget agreement will also provide two years of relief from existing sequestration spending caps that could have resulted in cuts to a number of public health programs, including the National Institute of Health, Agency for Healthcare Research and Quality and Primary Care Training Programs.

To read a comprehensive summary of the provisions, click here.

AMA Scorecard on EHR Usability Shows Many Vendors Not Meeting User-Centered Goals
The AMA announced this week that a comparative EHR Usability Framework it had partnered with MedStar Health to develop shows many EHR vendors are not meeting basic standards for user-centered design and formal usability testing processes. 

Using information supplied by the vendors to the Office of National Coordinator (ONC) and available publicly, the MedStar Human Factors Center and AMA collaborators reviewed 20 prevalent EHR products.  The review used a 15-point methodology and assigned a numeric value based on the vendor’s compliance with best practices for UCDA score less than 15 means basic usability process standards were not met. Vendors are only required to report the process they followed for eight EHR features that are considered important areas for patient safety. Thus a perfect score using the AMA/MedStar framework only reflects the processes used to design these eight capabilities and does not reflect the design and evaluation of the hundreds of other capabilities in the EHR or the actual usability experienced by physicians and other end-users.

The AMA announcement noted that its’ goal is to promote EHR vendor adherence to UCD best practices as represented in the 15-point usability framework in the design and redesign of their products. To improve the usability of EHRs there is a need to better promote rigorous usability development processes based on recognized methods and standards. This framework can be used by ONC to improve their certification program, and as a method to track improvements EHR vendors make as they recertify their products over time.

Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products,” said AMA President Steven J. Stack, M.D. “Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems.”

To read more, click here.

Foster Gesten, MD: Focus on State Health Innovation PLAN (SHIP)

Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health, will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.  

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please go to the following this link.

The objectives of November 10th Advocacy Matters program are as follows:

  1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.
  2. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  3. Describe the five strategic pillars and three enablers of system transformation.
  4. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please click here to register.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment. Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified. The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials. 

Op-Ed in Support of Collective Negotiation in Binghamton Press & Sun Bulletin
Broome County Medical Society President Dr. Michael Herceg authored an op-ed in the Binghamton Press & Sun Bulletin this week calling on the NYS Legislature to pass a bill (A.336, Gottfried/S.1157, Hannon) strongly supported by MSSNY to permit independently practicing physicians the ability to collectively negotiate patient care terms with market dominant health insurers.  To read the op-ed, click here: The op-ed highlights many of the challenges that New York physicians face in seeking to be able to continue to deliver the timely quality care expected and deserved by patients, including overly burdensome insurer-imposed administrative hassles, rapidly increasing deductibles and exorbitant medical malpractice insurance costs.

Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. Attention MSSNY Members! Save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more information.

Study Says Popular Over-The-Counter Cold Medicine Doesn’t Work
A study published in the Journal of Allergy and Clinical Immunology: In Practice suggests that the over-the-counter oral decongestant phenylephrine “simply doesn’t work at the FDA-approved amount found in popular non-prescription brands, and it may not even work at much higher doses.” Researchers at the University of Florida “failed to find a dose of phenylephrine within the 10 mg to 40 mg range that was more effective than a placebo in relieving nasal congestion.”  The study is available at: http://bit.ly/1WkmcEN

USPSTF Recommends Blood Glucose Screening For All Overweight Adults between Ages of 40 And 70
In the recommendations appearing Oct. 27 in the Annals of Internal Medicine, the US Preventive Services Task Force (USPSTF) advises blood glucose testing for all adults who are overweight and who are between the ages of 40 and 70, even if they display no symptoms of diabetes.
The specifics of the screening recommendations, classified as Grade B, note additional risk factors for patients with a high percentage of abdominal fat, high cholesterol, high blood pressure, physical inactivity, and smoking.” For those patients whose glucose levels are normal, re-screening every three years was recommended. 

Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session

CMS Now Accepting Comments on Section 101 of MACRA through November 17
On October 15, the Centers for Medicare & Medicaid Services (CMS) announced an extension to the comment period for the Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The comment period, which was originally 30 days and scheduled to close on November 2, 2015, will now close on November 17, 2015.

The RFI seeks public comment on Section 101 of MACRA, which is subject to notice and comment rulemaking. Section 101 repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and implements scheduled PFS updates, including a higher update rate for “qualifying participants in Alternative Payment Models (APMs)” beginning in 2026.

Section 101 also adds the new Merit-based Incentive Payment System (MIPS) for eligible professionals (EPs); sunsets payment adjustments under the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program; and consolidates aspects of those programs into the new MIPS.

In addition, Section 101 of the MACRA promotes the development of APMs by providing incentive payments for certain EPs who participate in APMs and by encouraging the creation of additional Physician-Focused Payment Models (PFPMs).

Submit a Formal Comment by November 17
CMS encourages the public to submit comments by November 17. Comments can be submitted in several ways, including:

  1. Electronically
  2. By regular mail
  3. By express or overnight mail
  4. By hand or courier

For more information, view the complete Medicare Access and CHIP Reauthorization Act of 2015 and visit the CMS website.


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Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.

Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-Specialty Group Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.
Job requirements:
• Current Board Certification / Recertification
• Current & Unrestricted NYS license, DEA & NPI
• Must be on panels of managed Medicaid and HMO plans
• Working knowledge of EMR
• Take detailed patient history
• Do physical examinations
• Order medically necessary tests, equipment, etc
• Be able to make complex decisions
• Write Prescriptions
• Provide treatments
• Venipuncture
• Give injections
• Follow-up – evaluation of test results and with patients
• Provide referrals to specialists
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Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.

3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.