February 23, 2018 – Anthem Retreats!
 PRESIDENT’S MESSAGE Charles Rothberg, MD February 23, 2018 Volume 18 Number 8 |
Dear Colleagues:
I have some good news to report.
In follow up to my lead in from last week about Anthem’s cuts to payments under Modifier 25 burying bad news, MSSNY heard from the NYS Department of Financial Services (DFS) that they will not be implementing the payment cuts that were going to go into effect on March 1. MSSNY, together with representatives of ENT & Allergy Associates, met with DFS to express its strong concerns, after which DFS contacted Empire and then spoke to other state regulators who expressed similar concerns.
Late this afternoon, we also received further confirmation from the AMA that Empire (in NY) and Anthem (nationally) will be postponing implementation of their Modifier 25 proposal that would have resulted in significant payment cuts and could have inconvenienced patients. At this point in time, it is not entirely clear if they will seek to implement it at a later date. However, we are pleased that DFS has directed Empire Blue Cross that, before they initiate a similar policy, they should reach out to DFS, other regulators, and providers – especially the Medical Society.
This, once again, highlights the importance of collective advocacy. I want to personally thank DFS for their efforts in pushing back against this policy, as well to as the AMA for leading national efforts in opposition to this policy change. And, of course, I want to thank Anthem and Empire for their consideration of all the concerns raised by physicians as to the negative impact of this proposed policy change.
But the fact remains that we need the right to collectively negotiate more than ever.
Nearly seventeen years ago, I joined other MSSNY leaders as a Class Rep in a lawsuit to contest the adverse and unfair business practices of several insurers. One by one, the insurers settled. Physicians received monetary compensation, a foundation was established, and insurers were enjoined from the adverse business practices that denied physicians due process, proper payment and encumbered access to care. I’ve made the unhappy observation that adverse business practices are resurgent.
Also, last week, there were news reports that four states are opening investigations of Aetna after a former medical director for the insurer admitted, under oath, that he never looked at patients’ medical records when deciding whether to approve or deny care. This is the same Aetna that would be conjoined with CVS pharmacy and CVS/Caremark Pharmacy Benefit Manager if their proposed merger is not opposed.
And this month, Kaiser Health News reported that another national insurer will now require surgeons to monitor anesthesia services performed in conjunction with cataract surgery. These guidelines will result in the shifting of anesthesia costs to the patient—or worse, substandard care.
These adverse policies document that payers are unfairly using their outsize market share to boost their profits at the expense of patients and medical practices. These egregious policies provide objective evidence for the urgent need for physician collective negotiation. We need regulators to take a hard look at these insurance industry practices, their effect on the health delivery system (including physicians), and the effect on patients’ health outcomes.
As Dr. Peter Ronchetti, President of Monroe County Medical Society, wrote recently in the Democrat and Chronicle, “Collective negotiation rights would be the first big step in pushing back against the huge administrative barriers imposed by health insurers that interfere with patient care. The Hannon-Gottfried bill would allow … negotiations to occur on a limited basis, provided that the negotiations are closely monitored by the state to assure the outcome is in the public’s best interests.”
I call on our legislature to pass this legislation and for our governor to enact it.
All physicians should log onto MSSNY’s Grassroots Action Center to send their elected officials a letter in support of physician collective negotiation.
And please make the effort to join your colleagues and me in Albany at Annual Lobby Day, March 7.
Face-to-face with our elected and regulatory officials, we CAN make a difference.
Charles Rothberg, MD
MSSNY President
Please send your comments to comments@mssny.org
Come to State Legislation Day! Let your voice be heard!
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MSSNY’s Lobby Day (3/7) Just 2 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!
Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients. Please wear your white coats!
We thank the New York State Osteopathic Medical Society for coordinating their advocacy day with MSSNY’s.
Join us to urge your legislators to:
- Reject the Inappropriate scope of practice expansions proposed in the Executive Budget
- Prevent big-box store owned medical clinics that will hurt community primary care delivery
- Reduce excessive health insurer prior authorization hassles that needlessly delay patient care
- Reduce the high cost of medical liability insurance
- Reject harmful Patient Centered Medical Home cuts under Medicaid
- Preserve opportunities for our medical students and residents to become New York’s future health care leaders
A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should contact their County Medical Societies which will be scheduling afternoon appointments for physicians to meet with their elected representatives.
If you have any questions/comments, please contact Carrie Harring at charring@mssny.org. (HARRING)
MSSNY Fights Against a Plethora of Adverse State Budget Proposals
MSSNY Governmental Affairs staff have had numerous meetings with key legislators and staff to share concerns on a whole host of adverse provisions contained within the Executive Budget that will interfere with the ability of patients to continue to receive care from their physicians.
Please call your legislator’s district offices, write letters and meet with your elected officials. MSSNY members are urged to continue to contact their legislators:
- Oppose Expanding scope of practice for certified nurse anesthetists (CRNAs)
This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist or surgeon. To urge your legislators to protect safe anesthesia care for patients please click here.
- Oppose Authorizing Health Services Offered In Big Box Stores
This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls. Sponsors could include a business corporation. Services to be offered would include treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and limited screening and referral for behavioral health conditions.
With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna (which is itself under investigation in several states for medical necessity denials), this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here.
- Oppose Patient-Centered Medical Home cuts
This proposal would slash the Patient-Centered Medical Home (PCMH) add-on Medicaid payment that many primary care practices receive to help manage and coordinate needed patient care services. Moreover, it would potentially require all PCMH primary care practices to have a Level 1 Value-Based payment contract by July 1, 2018, or face further steep cuts in PMPM payments. To send a letter click here.
Additional budget items of great concern include:
- Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, forcing physicians to go through even more burdensome prior authorization requirements.
- Eliminating the Empire Clinical Research Investigator Program (ECRIP).
- Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent.
- Comprehensive Medication Management Protocols
This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization. Urge your legislators to reject this inappropriate scope of practice expansion. Click here to send a letter to your legislator.
- Community Paramedicine
This proposal would allow emergency medical personnel to provide non-emergency care in residential settings. While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers. To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.
(DIVISION OF GOVERNMENTAL AFFAIRS)
MSSNY Highlights Concerns with Proposal to Enhance OPMC Investigative Power
As part of MSSNY’s advocacy on the State Budget, strong concerns have been raised with a new proposal in the Executive Budget that would expand the ability of the Commissioner to summarily suspend a physician where such physician is charged with a criminal felony and the “alleged conduct may present a risk to patients or to the public”. It would also authorize the Commissioner of Health to obtain a warrant that would allow the Department to search and seize documents, computers and electronic devices where relevant, as well as shorten from 30 to 10 days the time allowed to respond to the Commissioner’s request for relevant information.
MSSNY staff has advised the Legislature that, while New York’s physicians share the goal of assuring the State has the power to protect the public when the conduct of a particular health care provider places the public at risk, the State already has ample power under existing law to summarily suspend a physician without full due process where the physician is engaging in conduct that in the commissioner’s opinion “constitutes an imminent danger to the health of the people.” MSSNY has also raised concerns that that the broad power authorized under this legislation to seize computers and electronic devices could potentially harm patient care by enabling the wholesale removal of Electronic Medical Record equipment and e-prescribing devices from physician offices necessary to treat patients, when OPMC already has substantial subpoena power to require physicians under investigation to produce necessary records. (AUSTER)
Governor’s Extends Executive Order Permitting Pharmacists to Immunize Children For Flu
This week, Governor Cuomo extended until March 22 a previous Executive Order that permits pharmacists to immunize 2-18 years olds for influenza. To read the press release, click here.
As reported in last week’s Capital Update, in the 30 day amendments to the New York State budget, Governor Cuomo proposed to permanently permit pharmacists to immunize 2-18 years olds for influenza. Currently, education law prohibits pharmacists from immunizing children, unless the governor issues an executive order during a public health emergency.
The proposal would allow the pharmacist to provide the immunization with a non-patient or patient specific order from a physician or nurse practitioner. The pharmacist would be required to have educational materials on influenza vaccinations for children as determined by the commissioner of health and would be required to have anaphylaxis for emergency. The pharmacists would be required to notify the patient’s attending primary health care practitioner and be available to discuss the outcome of the immunization, including adverse reactions, with the physicians. The pharmacist is also required to provide to the patient (or the patient’s guardian) a sheet on the importance of having a primary care physician. MSSNY is reviewing this proposal but has long opposed having pharmacists give immunizations. (CLANCY)
MSSNY and AMA Working Together to Educate Physicians on Prediabetes
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program. To share your current knowledge of the diabetes prevention program, click here to take a quick survey.
House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Registration for this live seminar is strongly suggested, click HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD
* Must attend in person at the House of Delegates.
Educational Objectives:
- Describe the trends in Type 2 diabetes and implications for clinical practice
- Review evidence that supports referring patients with prediabetes to lifestyle change program
- Outline the considerations for implementing a diabetes prevention initiative in a physician practice
- Describe NYS specific incidents of prediabetes and diabetes in adult population
- Understand the reimbursements mechanisms for DPP
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 each of these live activities 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.
Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org. (HARRING)
Register Now for Veterans Matter February 27th Substance Use Disorders
Did you know that it was reported in a recent article from the American Journal of Addiction, approximately 52% of Operation Enduring Freedom and Operation Iraqi Freedom veterans met diagnostic criteria for drug or alcohol use disorders?
The Medical Society has created free CME Veterans Matters programs to assist New York State physicians in recognizing the unique health problems faced by veterans and the best way to provide care to veterans.
Register here for Veterans Matters: Substance Use Disorders on Feb. 27th at 7:30am.
Faculty: Frank Dowling, MD
Educational Objectives:
- Define Substance Use Disorders (SUDs), symptoms, warning signs, comorbidities
- Explore evidence-based intervention and treatment options for SUDs among veterans
- Identify barriers to diagnosis and treatment and methods to overcome them
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 each of these live activities 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.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. (HOFFMAN)
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
For the past two flu seasons, the Advisory Committee on Immunization Practices, a panel of immunization experts, has not recommended the needleless option. But, the panel voted 12-2 this week to include FluMist as an option for doctors to use during next year’s flu season, CDC spokesman Ian Branam said. On its website, NBC News (2/21) reports, however, “the vaccine experts on the committee weakened their usual recommendation to make it clear they were not ready to strongly endorse FluMist,” changing “the wording to say it’s up to” physicians “to choose.”New York State’s most recent flu data is available here.
Gender Pay Gap Persists Among NY Physicians, Research Suggests
Healthcare Finance News (2/19) reports that the gender pay gap between newly-trained male and female physicians in New York is persisting, according to the Center for Health Workforce Studies. “Even after accounting for variables such as ethnicity, citizenship status, practice setting and medical school location, the pay difference between genders reached an all-time high of $27,214 in 2015,” and that “disparity dipped slightly to $26,367 in 2016.” Moreover, some “specialties show greater gaps than others,” the article says.
New York City reported more drug overdose fatalities during the second quarter of 2017 than during any quarter in the last five years, according to provisional data from the de Blasio administration.
Telemedicine Could Expand Access to Primary Care Integration
According to a report released on February 20 patients in New York State could soon have expanded access to telemedicine and health care professionals could find it easier to integrate primary care and behavioral health under a wide-ranging plan to modernize how health care is delivered. The changes are the product of the state’s regulatory modernization initiative. The Cuomo administration will propose regulations to create a new public health license so an existing clinic can add services without needing to obtain a second license.
NY Lowest Smoking Rate (14.2%) Occurred in 2016
New York State’s smoking rate in 2016 was 14.2 percent, the lowest in recorded history, according to the latest behavioral risk survey here.
Nassau Pharmacist Accused of Charging Medicaid for $1.2 M of Undispensed Neupogen
The owner of a Nassau County pharmacy is facing felony charges for allegedly defrauding Medicaid out of millions of dollars for cancer medications that were never dispensed, according to Attorney General Eric Schneiderman’s office. The state is seeking more than $8.7 million in damages and penalties against Arkady Goldin and the co-owners of Value Pharmacy in Lynbrook, Schneiderman’s office said in a release. Goldin allegedly billed Medicaid for $1.2 million worth of Neupogen, a high-priced drug that boosts white blood cell counts in cancer patients or bone marrow transplant recipients, even though Value Pharmacy never had that much of the drug in stock. He also allegedly paid thousands in kickbacks to a former hospital employee and submitted at least $700,000 in false reimbursement claims to Medicaid, according to the AG’s office. More here.
Where Are “High Germ” Areas in Your Office?
Research suggests that the four most germ-ridden spaces in the average office are computer keyboards, break rooms, stair railings, and conference rooms. Chris Mason, a geneticist at Weill Cornell Medicine, explained that germs are most likely to congregate in “high touch” areas, such as door handles, the sink in the kitchen area, or on elevator buttons. (CBS News).
| CMS / HHS / CDC |
Health Professionals Complaints to New HHS Division
More than 300 individuals have filed complaints with a new HHS division that aims to protect health care professionals who have moral or religious objections to certain medical care, such as abortion and transgender care. Roger Severino, director of HHS’ Office for Civil Rights, said the new division has “announced to the world that [it’s] open for business and the public is responding.” (The Hill, 2/20)
| COUNTY SOCIETY COURSE |
Saratoga, Warren and Washington Counties Host Physician Burnout Course
Saratoga, Warren and Washington Counties and MSSNY present “Physician Burnout Reduction: A Need to Reassess Best Use of Resources.”
When: Tues. Feb 27th 6:00-8:30 PM
Where: Jacob and Anthony Restaurant
38 High Ridge Road
Saratoga Springs, NY
Speaker: Bill Brender, MD, Member, MSSNY Physician Burnout Taskforce
RSVP: Gregory685@aol.com or call 518-587-0772
FREE to MSSNY Members; $50 charge for nonmembers
Click here for details.
Course Objectives:
- Identify tools and resources to strengthen individual resilience
- Describe examples for mitigating stress in the office practice, section, department or program
- Understand the impact of an organization’s attempts to address physician stress
- Envision large scale changes in the health care system that can protect against physician burnout
- Empower physicians to improve delivery of high quality patient care and achieve improved patient outcomes
Accreditation Statement:
The Medical Society of the State of New York (MSSNY) 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 AMA PRA Category 1 Credit™. Physicians should claim only the credits commensurate with the extent of their participation in the activity.
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Hypertension Initiative Coordinator
Hypertension Initiative Director The Division of Prevention and Primary Care is seeking a high-level director for a new citywide hypertension initiative. Hypertension (HTN) is one of the leading contributors to death and a key driver of health inequities. This initiative will create collaborations across the work of multiple stakeholder groups engaged in clinical, community or population approaches to reducing hypertension, to enhance and expand hypertension efforts across the city. Reporting to Deputy Commissioner, the Citywide Hypertension Initiative Director will guide the strategic development, planning, and implementation of this new initiative. The team consists of a Hypertension Initiative Manager and a Coordinator, as well as short-term staff. The Director will establish high-level relationships and oversee the initiative’s work, including coalition engagement and activity implementation. Leadership, supervision of program design and evaluation, fundraising, and staff management are key components of this position. The Director will also be responsible for engaging stakeholders within the Health Department and external to the Health Department to achieve the initiative’s goals. The Director’s responsibilities include the following:
Preferred Skills: Clinical training a plus, strategic thinker, strong manager, public health training; content expertise in heart disease, stroke, chronic disease a plus; ability to work independently, project manage strategies, accomplish tasks and solve problems; exceptional writing and communication skills; experience working on high-profile strategic campaigns; experience interpersonal, collaborative and team skills is a must. View full job description / apply online at http://ow.ly/3vAO30inpXU Family Practice Physician – Schenectady/Amsterdam, NY
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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355
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