MSSNYeNews: February 19, 2021 – Distribution of Vaccine to Community-Based Physicians
Distribution of COVID-19 Vaccine to Community-Based Physicians
In November, our state asked community-based physicians all over New York to register as vaccinators for Covid-19. Thousands of physician practices heeded the call and stand ready, willing, and able to immunize this state’s most vulnerable patients.
We are pleased that the vaccine supply is beginning to increase, and new vaccines gain emergency use authorization, which means more of our patients can receive these critically needed vaccinations. However, as part of this effort, it is imperative that our state and our country employ all resources available and that certainly must include our most experienced vaccinators, community-based physicians. Our community physicians can quickly identify the most vulnerable and can reach large amounts of patients who suffer from significant co-morbidities and who cannot travel to a vaccine distribution site due to health reasons.
Equity in vaccine distribution has been prioritized by all, and community-based physicians can aid in execution. Community-based physicians practice in a wide range of communities— urban, rural, and suburban settings; and they serve the poor, the elderly, individuals of color and those with co-morbidities. Many of these patients do not have transportation, are in communities without mass transportation, lack the financial resources, or are simply too ill to travel. More importantly, patients trust their physicians and are comfortable in the office setting.
So, who better than the community physician to decrease vaccine hesitancy and promote vaccination?
It is time to update the game plan on the distribution of the vaccine and get the vaccine to the people rather than having the people go to the vaccine. Click here to urge Governor Cuomo and the NYS Legislature to take the steps necessary to ensure that community-based physicians are part of our “all hands-on-deck” effort to provide COVID -19 vaccination to their patients!
Join Us for MSSNY’s Virtual Lobby Day on March 2
Please plan to put aside Tuesday, March 2 for MSSNY’s Annual Physician Advocacy Day – this time Virtual! To register, click here.
The format will follow previous years formats, where assembled physicians and allies will hear from legislative leaders and MSSNY physician leaders in the morning (this year via Zoom) from 8 AM-11 AM, and then have virtual visits with their respective legislators in the afternoon (organized by their county medical societies).
Please take this opportunity to advocate your concerns to your legislators regarding the numerous problematic proposals that have been advanced in the proposed Executive Budget including:
- Significantly reducing physician due process when a complaint has been filed against them to the OPMC;
- Forcing the 17,000 physicians insured through the Excess Medical Malpractice Insurance Program to unfairly bear thousands to tens of thousands of dollars in new costs for this coverage
- Inappropriately expanding scope of practice for various non-physicians including pharmacists and nurse practitioners;
- Handing insurance companies enormous new powers to limit physicians providing telehealth services to their patients
As well as voicing your support for a number of Executive Budget proposals including:
- Expanding the supply of PPE
- Regulation of Pharmacy Benefit Managers (PBMs)
- Reducing the interest on court judgments to bring down exorbitant liability costs
Please Urge Your Legislators to Reject Huge New Costs Placed on Community Physicians for Excess Coverage
Please urge your legislators to reject an extremely ill-timed Executive Budget proposal that would foist thousands to tens of thousands of dollars of new costs on the nearly 17,000 physicians enrolled in the Excess Medical Malpractice Insurance. You can send a letter and/or tweet them from here.
This proposal, which would for the 1st time in the program’s 35-year history require enrolled physicians to bear an extraordinary 50% of the cost of these policies, would thrust over $50 million of new costs on the backs of our community-based physicians who served on the front lines of responding to the pandemic. For some physicians, particularly in Long Island and New York City, this could add up to tens of thousands of dollars per physician (see examples below). This new cost imposition would hit these practices at a time when many of these practices are already facing huge losses resulting from the substantial reduction in the number of patients receiving care during the pandemic.
NEW COSTS TO BE IMPOSED ON PHYSICIANS FOR EXCESS COVERAGE BASED UPON GOVERNOR’S 50% COST BUDGET PROPOSAL
|SPECIALTY||Long Island||Bronx, Staten Island||Brooklyn, Queens||Westchester, Orange, Rockland, and Manhattan|
MSSNY has joined with 16 other specialty medical societies in a letter to the entire State Legislature that expresses our strong objection to this proposal (Click Here). Among the key points in the letter is that a recent AMA survey reported that during the pandemic the average number of in-person visits to physician offices dropped nearly in half. The bottom line is that the new costs this proposal would impose are simply not assumable by physicians, meaning that many physicians will face no choice but to forgo receiving this additional coverage. (AUSTER)
MSSNY Joins Other Northeastern State Medical Societies Urging Allocation of COVID-19 Vaccine to Community Based Physicians to Immunize Their Patients
The Medical Society of the State of New York and other state medical societies joined together to urge that the Biden Administration and state governments take necessary to steps to ensure that community-based physicians can receive the COVID-19 vaccine to immunize their patients. Joining in the statement were the: Connecticut State Medical Society, Massachusetts Medical Society, Medical Society of New Jersey, Pennsylvania Medical Society, and the Ohio State Medical Association.
The statement says in part: “As the country moves forward into the immunization process, and as supply increases, it is vitally important that the country and the states employ all resources available and that includes the community-based physicians. Unfortunately, so far, hospitals, chain pharmacies and mass vaccination sites have been prioritized at the expense of those who know their patients’ needs best – the community physician. These are individuals who can quickly identify the most vulnerable and can reach large amounts of patients who suffer from significant co-morbidities and cannot travel to a vaccine distribution site due to health reasons.
Community-based physicians practice in a wide range of communities such as urban, rural and suburban settings and serve the poor, the elderly, individuals of color and those with co-morbidities. Many of these patients do not have transportation, are in communities without mass transportation, lack the financial resources or are simply too ill to travel. Community based physicians care for thousands of patients each and can quickly identify those patients who are most at risk of getting COVID-19 or having complications due to their comorbidities. More importantly, patients feel comfortable with their physicians, with whom they can discuss the vaccine, and address any vaccine hesitancy, and feel comfortable in the office setting.” (CLANCY, AUSTER)
Urge Your Legislators to Reject Proposal to Curtail Physician Due Process Protections
Please urge your legislators to reject an Executive Budget proposal that that would greatly curtail due process protections for physicians when a complaint has been filed with the Office of Professional Medical Conduct (OPMC), including making information public about a complaint even if no professional misconduct is found and greatly lessening the burden for imposing an interim suspension prior to the conclusion of the statutory hearing process. You can send a letter and/or tweet to your local legislators from here.
MSSNY has joined with more than a dozen specialty medical societies in a letter to the State Legislature expressing its strong opposition to this proposal (Click Here). While New York’s physicians share the goal of assuring the State has ample power to protect the public when the conduct of a particular health care provider places patients at risk, the Commissioner already has authority to take summary action prior to the conclusion of a disciplinary hearing in the absence of a finding of misconduct. Moreover, this proposal is stunning in light of the enormous sacrifices made by countless physicians over the last year, serving on the front lines in responding to the pandemic.
The group letter reminds the State Legislature that, while the medical community is always ready to work to address gaps in our disciplinary system to protect patient safety, this proposal is grossly unfair and over-reaching given that most complaints never result in findings of misconducts or even formal charges being filed. Of greatest concern is that information released to the public, even if there is no action ultimately taken, can remain available through “Google searches” forever, with the potential to eviscerate a physician’s professional reputation. (AUSTER)
Please Contact Your Legislators to Raise Concerns with “Consolidated Billing” Legislation
Physicians are urged to contact their Assemblymembers and Senators to urge them to substantially revise A.3470- A/S.2521-A, “The Patient Medical Debt Reduction Act”. Click here to contact your legislators today!
While there are many components to this well-intended legislation, there is a seriously problematic component would prohibit a physician or other provider with any “financial or contractual relationship” with a hospital from separately billing a patient for a course or episode of treatment in the hospital. While it doesn’t appear to prohibit continued separate billing to insurance companies or other payers, a single hospital-physician bill would be required when a bill is sent to a
patient for costs not covered by the patient’s insurance, such as collection of a deductible. It would also require such consolidated bill to be sent within 7 days of a patient’s discharge from the hospital before there is any clarity as to what expenses will actually be covered by a patient’s insurance.
If this bill were to pass and this provision not amended, it would put non-employed physicians at the mercy of the hospitals where they practice since the legislation does not specify how payments to hospitals from this “single bill” would then be distributed to these physicians. In an era when patients’ insurance policies regularly impose enormous deductibles, it would likely force even more physicians to sell their practices and become employees of hospitals in response to the helpless position many physicians would find themselves. Other physicians may leave the state altogether. The impact of this prohibition will fall most adversely on physicians who are on the front lines of the pandemic, many of whom are facing an enormous drop in patient volume due to a significant amount of delayed care.
The legislation recently advanced from the Assembly Health Committee to the Codes Committee and is before the Senate Health Committee. Please let your legislators know you appreciate the intent of the legislation to minimize the financial burden on our patients but that this “single bill” component will most heavily adversely impact community physicians, and ultimately result in the loss of patient choice and exacerbate health care monopolies in our health care system. (AUSTER)
Governor Cuomo Announces 30-Day Budget Amendment on Recreational Marijuana
This week, Governor Cuomo announced a budget amendment on his quest to legalize recreational marijuana. This amendment included a designation of $100 Million for the purposes of Social Equity Funding including how it will be allocated as well as refining criminal penalties related to the improper sales. Under the Governor’s proposed amendments, qualified community-based nonprofit organizations and local governments would apply for funding to support a number of different community revitalization efforts, including, but not limited to:
- Job placement and skills services,
- Adult education,
- Mental health treatment,
- Substance use disorder treatment,
- Financial literacy,
- Community banking,
- Nutrition services,
- Services to address adverse childhood experiences,
- Afterschool and child care services, system navigation services,
- Legal services to address barriers to reentry, and
- Linkages to medical care, women’s health services and other community-based supportive services
The amendment also calls for the following classification of certain criminal penalties:
- Criminal sale in the third degree (sale to under 21 year old) will be made a class A misdemeanor
- Criminal sale in the second degree (sale of over 16 ounces or 80 grams of concentrate) will be made a class E felony
- Criminal sale in the first degree (sale of over 64 ounces or 320 grams of concentrate) will be made a class D felony
MSSNY continues to oppose the legalization of recreational use of marijuana and also urges that it be taken out of the NYS budget for 21-22. Physicians are encouraged to send a letter to the Governor and to members of NY Legislature through MSSNY’s Grassroots Action Center (GAC) here. (CLANCY)
Please Oppose Proposals That Facilitate Uncoordinated Siloed Care to be Provided by Pharmacists
Please contact your legislators to urge that they oppose several components of the Executive Budget that could upend the patient-centered medical home model and threaten patient safety by greatly expanding the scope of services provided to patients by pharmacists without coordination with patient care physicians. You can send a letter from here: Click Here. Please let them know these proposals would greatly enhance the power of big box giants to control various aspects of patient care delivery not in coordination with but to the exclusion of community-based primary care and specialty care physicians that typically manage the care of their patients.
Specifically, these Budget proposals would 1) permit pharmacists to order various lab tests without any physician oversight and without any requirement to coordinate with the patient’s physician for follow-up care; 2) greatly expand the physician-pharmacist Collaborative Drug Therapy Program to enable pharmacists to adjust the medications provided to entire classes of patients rather than individual patients and 3) permit pharmacists the power to administer any vaccination approved by the federal Advisory Commission on Immunization Practices (ACIP), including those which may be added in the future, thereby removing the discretion of the State Legislature to make these decisions. Some of these proposals have been rejected by the Legislature in previous Budget cycles.
All of these programs together could incentivize the development of health care silos at the expense of the patient centered medical home model we have worked so hard to develop in New York. It would also marginalize community based primary care and specialty care physicians’ ability to continue to be able to manage their patients’ ongoing care needs. Please urge your legislators to reject these measures as they finalize the State Budget for 2021-22. (AUSTER)
If you or someone you know is struggling with everyday life stressors, reach out to the P2P program to be connected with a peer supporter to help!
Email: P2P@mssny.org and request that you be connected with a peer supporter. Phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter.
MSSNY now offers to physicians, residents and medical students a completely confidential and anonymous opportunity to talk with a peer about some of their life stressors. MSSNY’s Physician Wellness and Resiliency Committee launched a Peer 2 Peer (P2P) program to assist their colleagues who are need of help in dealing with work and family stressors. With the myriad of challenges we are all facing related to the pandemic, some physicians may need the support of their colleagues to help manage these stressors.
MSSNY has established a confidential helpline phone number (1-844-P2P-PEER) and an email address (email@example.com) so that physicians may be connected with a peer 24 hours a day/7 days a week. In addition to offering a trained, empathetic ear, peer supporters may provide information on specific resources that can offer further support, provide positive coping skills, or connect physicians to professionals for more focused assistance when needed.
MSSNY Podcasts Keep You Informed and Current
Don’t forget to check out MSSNY’s podcast website. In addition to MSSNY’s weekly Update podcasts, there are numerous informative podcasts available on topics ranging from COVID-19 to emergency preparedness to vaccines. Each podcast offers insight from medical experts on topics for which they are extensively well versed. Go to http://www.buzzsprout.com/51522 and choose one or many to listen. (HOFFMAN)
Troy Oechsner Named Executive VP of Medical Society of State of New York
February 17, 2021, Westbury, NY—The Medical Society of the State of New York (MSSNY) today announced that it has named Troy Oechsner as its new Executive Vice President. Oechsner is a veteran of State government who served as lead regulator of commercial health insurance at the Department of Financial Services as well as prosecutor of illegal and deceptive health care business practices with the New York State Attorney General. Most recently, Oechsner has been a partner at the consulting firm Manatt, Phelps and Phillips.
“We are thrilled to have Troy on board at MSSNY. He brings proven ability to effectively advocate for positive reforms that will protect the rights of doctors and their patients to affordable, accessible quality health care,” said Dr. Bonnie Litvack, MSSNY President. “Troy has a track record of effective management and leadership, and the ability to build coalitions among a broad section of health care professionals and consumers.”
“The Medical Society has worked successfully with Troy for decades,” said Dr. Andrew Kleinman, Chair of the MSSNY Board of Trustees. “He brings passion, knowledge and skill to the job that will help further the cause of physicians and patients. Troy is a welcome addition to the important work of the Society.”
“As a former insurance regulator and prosecutor, I recognize the many challenges faced by both physicians and patients,” said Oechsner. “Physicians have been leaders in the frontline battle against COVID. I am excited and honored to join the MSSNY team in our common fight to support doctors and patients seeking improved access to quality, affordable health care, guided by the physician’s training, experience and best practices.”
During over 30 years in State government, Oechsner helped lead many actions to improve health care for physicians and consumers. Oechsner was part of a team leading the implementation of the Affordable Care Act in New York, including the successful establishment of the state’s health insurance exchange marketplace – the New York State of Health. Oechsner was also instrumental in drafting and negotiating New York’s landmark Surprise Balance Billing Law that protected consumers from surprise bills from out-of-network doctors with a dispute resolution system fair to physicians and insurers.
Mr. Oechsner led an investigation by the New York Attorney General’s office into improper denials of specialty care by Aetna when it failed to acknowledge appropriate referrals to specialists. These actions resulted in a negotiated settlement with Aetna that assured fair reimbursement to the impacted physicians. Oechsner also helped initiate the investigation of Ingenix, which ultimately produced action by then Attorney General Cuomo to stop the manipulation of physician fee data, which was inappropriately increasing patient cost-sharing responsibilities for out-of-network care.
Patient Medical Debt Bill: Right Premise-Wrong Solution
The patient medical debt bill S2521-A (Rivera)/A3470-A (Gottfried) proposed by the New York State Legislature is well intended, seeking to ensure patients receive clear, concise, and timely bills. However, the legislation as currently written will have negative unintended consequences. This bill would prohibit a physician or other provider with any financial or contractual relationship with a hospital from separately billing the patient. This could force many physicians to sell their practices and become employees of hospitals in order to receive timely and adequate payments.
The professional services provided by a contracted physician are often only a small component of the overall hospital services received by a patient. Prohibiting a private physician group from separately billing a patient for services provided at a hospital puts the physician group at a distinct financial disadvantage, will increase health care costs, and ultimately reduce quality of care.
In addition, the legislation as written fails to address further billing for applicable patient cost-sharing as required by their insurance policy (co-pay, coinsurance, deductible, etc.) after a claim has been paid by the insurance company, and how partial payments will be allocated between the multiple health care parties whose services are being billed by the hospital. The bill has the right premise but the wrong solution. MSSNY strongly supports greater transparency and timeliness of billing for patients and is committed to working with the sponsors of this legislation to achieve these goals and to preserve the independent physician practice model and high-quality patient care. Click here to urge your legislator to oppose S2521-A (Rivera)/A3470-A (Gottfried).
MSSNY Member Details a Scam Re His Medical License by Purported State and Federal Officials
Dear Members: Below please find a concerning message from one of our valued physician members detailing an account that took place this week and involved individuals purporting to be State and Federal officials. For the sake of honoring the integrity of this member’s account, I have shared the member’s direct message below: Here are the details of my experience yesterday that I would like to let other members be aware of. My Medical Assistant took a call yesterday morning from someone identifying himself as Albert Rossi from the State Education Department, Office of Professions, Division of Licensing Services. He said that he needed to talk to me about a problem with my NY Medical License.
When I got on the phone, he told me that I was under investigation and connected me with someone who said he was Brian Hobbs, the Chief Investigating Officer, Unit 3. I spent most of the morning and a good part of the afternoon on the phone with this person. He told me that my license was being suspended at the order of the FBI and DEA because I was the prime suspect in an investigation involving illegal drug trafficking and money laundering. At times, he would call someone that he said was an FBI Agent named Robert Johnson who then was part of a 3-way call with me.
They faxed me official looking documents that are attached to this email. [Please click here to view those documents, which have been redacted for privacy reasons]. The first one stated that my license was suspended. He then told me my options were to consult a lawyer and fight these allegations in court. If I did that, I would not be able to practice medicine until the case was resolved. The other option was that I could agree to cooperate with the investigation. Even though the evidence appeared to show that I was involved, they suspected that I was set up and my DEA and license were being used by someone else. They hoped that my cooperation would help them find the real culprit. If I agreed to cooperate, they would be able to reinstate my license within 48-72 hours. I was told that I would have to post a bond of $15,600 to have the license reinstated and this would be refunded once the case was resolved. I did sign the cooperation agreement, but then I was able to confirm with the State Education Department that there was no action against my license.
The caller ID on their call was the real number for the State Education Department. This whole scheme was well rehearsed and very convincing. They preyed on the fact that I desperately didn’t want my license suspended. They insisted that I stay on the line with them while all this was transpiring and would put me on hold while they prepared or reviewed the attached documentation, etc. They insisted that I not hang up or talk to anyone else because it could compromise the investigation. This was obviously a ploy to prevent me from getting anyone else to help me figure if this was real or a scam.
This was submitted by Aimana ElBahtity, Esq. Executive Director Erie County.
2021 E/M Coding Changes: Are You Leaving Money on the Table?
Limited to 25 Attendees
Two convenient time slots for “2021 E/M Guideline Changes
Many physicians are still struggling when it comes to implementing these historic changes into their day-to-day workflow. Garfunkel Health Advisors is offering an interactive event on Documentation & Coding Compliance following the new E/M Coding Guidelines.
To help ensure you get the most out of the live session, participation will be limited to 25 participants and you may submit questions in advance, specific to your practice and specialty.
During the event we will:
• Share our knowledge and experience
• Answer your questions
• Discuss tips and best practices
• Review Time vs MDM opportunities
• Wave the caution flag in areas of potential audit risk
President, Documentation and Coding/Audit Division of
Garfunkel Health Advisors, Inc
Discounted pricing for MSSNY members:
◊ Member rate $150
◊ Non-member rate $300
Tuesday, February 23, 2021Presentation:
12:00 pm – 1:30 pm (EST)
Thursday, February 25, 2021Presentation:
7:30 pm – 9:00 pm (EST)
For more information call: 516-393-2294
Garfunkel Health Advisors, Inc.
Garfunkel Wild is pleased to announce the launch of Garfunkel Health Advisors, Inc., a healthcare consulting subsidiary providing strategic and operational advice to the healthcare industry.
Biden To Nominate Chiquita Brooks-Lasure As CMS Chief
Chiquita Brooks-LaSure, a former policy official in the Obama administration, is President Joe Biden’s pick to lead CMS, according to Politico, which cites four sources familiar with the decision. Ms. Brooks-LaSure, who previously oversaw the implementation of the ACA, was named a front-runner for the CMS administrator role in early February.
If her nomination is confirmed, Ms. Brooks-LaSure will oversee the Biden administration’s plans to expand the ACA and other healthcare policy efforts.
Ms. Brooks-LaSure, who serves as managing director of consulting firm Manatt Health, previously was deputy director for policy at CMS’ Center for Consumer Information and Insurance Oversight. She also served as director of coverage policy within HHS.
Declines in Hospital Volume Amid COVID-19
U.S. hospitals saw patient volume for CMS-defined shoppable services drop an average of 35.2 percent in the second quarter of 2020, compared to the same period in 2019, according to a new analysis from Hospital Pricing Specialists.
For the analysis, Hospital Pricing Specialists reviewed volume data on 68 current procedural terminology codes on the CMS-mandated list of shoppable services. The analysis, which sought to understand how patient volume was affected by the COVID-19 pandemic, compared volume in the second quarter of 2019 to the second quarter of 2020.
Hospital Pricing Specialists also normalized the data so only codes that were present in both time periods were analyzed.
The state that saw the steepest decline in patient volume for the CPT codes analyzed was Massachusetts, which saw volume decline by 48.5 percent from the second quarter of 2019 to the second quarter of 2020.
New Jersey: -47.9 percent
New York: -42.2 percent
Connecticut: -44.4 percent
Pennsylvania: -35.0 percent
Massachusetts: -48.5 percent
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