MSSNY eNews: February 26, 2021 – Advocating for Physicians in DC and NY

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Colleagues:

Early this week the American Medical Association held its annual National Advocacy Conference.  While we could not meet in person in Washington, the event was none-the-less impactful.  We heard from Doris Kearns Goodwin, a presidential historian about lessons from the past that can shape our future; AMA leadership on AMA priorities and our AMA legislative agenda; and Dr. Bechara Choucair, vaccination coordinator for the Biden administration.  We were also briefed and prepped for virtual Hill visits.

Our MSSNY team met with many of our New York State congressional delegation and advocated for federal allocation of vaccine supply to community physicians, federal stimulus money to New York State to offset our enormous state budget deficit, bipartisan legislation that would continue the current Medicare sequester moratorium at the very least for the duration of the public health emergency, and permanently removing the rural limitations on Medicare telehealth reimbursement.

From there it was onto the NYS joint legislative public hearing on the 2021 Executive Budget Proposal.  The legislature heard from the Department of Financial Services, the Department of Health, and many stakeholders in a marathon session lasting for nearly 12 hours. MSSNY provided detailed written testimony on the many budget issues affecting physician practices in New York State.  We were also fortunate to be granted a slot to provide a brief verbal summary of our concerns with the proposed State Budget and used our time to highlight the following:

• Opposition to the restructuring of the state’s Excess Medical Malpractice Program and the new huge cost imposition on the 17,000 physicians enrolled in the program
• Opposition to the unreasonable and un-American bypassing of due process for physicians through the Office of Professional Medical Conduct (OPMC)
• Opposition to a very large and mistimed cut in the funding for MSSNY’s Committee for Physicians’ Health (CPH)
• Opposition to the inappropriate expansion of pharmacy scope of practice that would significantly undermine our patient-centered medical home concept.

I also had the opportunity to answer questions from several legislators regarding our concerns on these issues.  We were heartened that several legislators raised our concerns with these proposals in their questioning of the DFS Superintendent and Health Commissioner.

Next up: Tuesday, March 2^nd is virtual Physician Advocacy Day.  While every day is advocacy day at MSSNY, some days—and at some times—our voices need to be stronger and louder to effect change. Make a difference: sign up for Physician Advocacy Day to stand up for your rights, your patients, and our noble profession.

Bonnie Litvack, MD
MSSNY President

MSSNY Weekly Podcast

Join Us for MSSNY’s Virtual Lobby Day on March 2
We are just a few days away from MSSNY’s Annual Physician Advocacy Day, we are excited to have you all join us, If you haven’t already, please register by clicking here.

The format will follow previous years formats, where assembled physicians and allies will hear from legislative leaders and 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).  With physicians facing so many challenging issues this year as noted below, there has never been a more important time for you to join with your colleagues on these important advocacy efforts.

Please plan to join hundreds of colleagues from around the State on March 2! (ALI)

MSSNY Members Meet With New York Congressional Delegation to Discuss Priority Federal Issues
MSSNY members and staff conducted virtual meetings with several members of the New York Congressional Delegation this week to discuss a range of timely federal issues, that impact physicians. Among those discussed were:

• The need for significant federal funding in the COVID Relief Package, to help prevent state budget cuts.
• Making vaccines available to community-based physicians to immunize patients with co-morbidities.
• Preventing Medicare sequester cuts from going forward on April 1, 2021.
• Eliminating in statute the “rural only” provision in Medicare for Telehealth coverage.

The meetings were part of the American Medical Association’s (AMA) annual National Advocacy Conference (NAC).  Participating MSSNY physician leaders included MSSNY’s current President, Dr. Bonnie Litvack, its President-elect, Dr. Joseph Sellers, MSSNY Vice-President Dr. Parag Mehta, MSSNY Past Presidents, Dr. Arthur Fougner and Tom Madejski, Dr. Dan Choi, Dr. Paul Pipia, Dr. Carlos Zapata, Dr. Rose Berkun, and Dr. Alan Klitzke. The group met with Ways & Means Committee member Tom Suozzi and with the top health policy staff for Representatives Clarke, Higgins, Morelle, Rice, and Tonko, as well as for Senate Majority Leader, Chuck Schumer.

MSSNY staff will continue to monitor, and advocate, on these issues on members’ behalf, and update members as discussions unfold on Capitol Hill.       (CARY)

MSSNY Continues to Urge Distribution of COVID-19 Vaccine to Community Based Physicians
MSSNY continues to urge the New York State Department of Health to supplement its efforts to provide the COVID-19 vaccine to its residents by making doses available to community-based physicians to immunize their patients—especially since patients with co-morbidities are now eligible to receive the vaccine.

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.   Currently, hospitals, chain pharmacies and mass vaccination sites have been prioritized while very few doses have been made available to those who know their patients’ 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 of risk of getting COVID-19 or having complications due to their comorbidities.  More importantly, patients often feel comfortable with their physicians, with whom they can discuss the vaccine, and address any vaccine hesitancy, and feel comfortable in the office setting.

MSSNY physician leaders were featured in numerous articles in papers and media across the State this week on this issues including in the Buffalo News, and WNYT-TV and WTEN-TV (Albany). WTEN-TV 10, Buffalo News (1), Buffalo News (2), Press Release, WNYT-TV.

It was also the subject of numerous conversations that MSSNY leaders had with members of New York’s Congressional delegation this week.       (CLANCY, AUSTER)

Please Urge Your Legislators to Reject Huge New Costs Placed on Community Physicians for Excess Coverage
Please urge your legislators to reject an extraordinarily ill-timed 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: Click Here.

This proposal, which would 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.  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

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.

MSSNY thanks the many legislators, including Assembly Insurance Committee Chair Kevin Cahill, Senate Finance Committee Chair Liz Krueger, and Assemblymembers Bichotte, Byrne, and Ra, for raising concerns with this proposal during this week’s Health Budget hearing. (AUSTER) 

Urge Your Legislators to Reject Overbroad Proposal to Severely Curtail Physician Due Process
Physicians are urged to continue to contact their 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: 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.  MSSNY together with several specialty societies have raised concerns his proposal is greatly 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! Click Here.

While there are many components to this well-intended legislation, there is a seriously problematic component which 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.                                   (AUSTER)

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)

CMS Waives MIPS Penalties for 2022 Amid Public Health Emergency
This week, the Center for Medicare and Medicaid Services (CMS) announced it will not impose Medicare payment penalties in 2022 related to performance in the Medicare Merit Based Incentive Payment System (MIPS) due to the significant disruptions on physician practices’ performance in 2020 as a result of the pandemic. The AMA noted in a memo to the federation that it “strongly advocated for this automatic relief from MIPS penalties and sincerely thanks CMS for ensuring physicians will not be unduly penalized during the pandemic.”

The AMA further noted that the Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to ALL MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty. CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The re-opened application deadline is March 31, 2021. The AMA further noted that groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.            (AUSTER)

MSSNY Conducts New Member Survey to Compare Payments to Physicians for Care Provided via Telehealth Services vs. In-Office Visits; Continues to Urge Revisions to Telehealth Proposal in FY 2022 Executive Budget
To support its continued advocacy efforts to expand coverage for Telehealth services, MSSNY is conducting a new survey of its members regarding use of telehealth and comparing generally reimbursement for telehealth and in person services.  To take the new survey, please fill out the following Survey Monkey questionnaire: Click Here.

As a reminder, the Executive Budget proposal for FY 2022 does not include a provision to ensure that payments for Telehealth services are on par with in-office visits, creating a significant hurdle for community physicians and the patients that they serve. Despite wide adoption of telehealth use arising from the pandemic, insurers’ reimbursement for audio and video Telehealth services has not kept pace with those paid for in-office visits and the gap is wide. According to a MSSNY survey last year, physicians reported that less than 1/4 of health plans had set their reimbursement levels for Telehealth equal to what they pay for in-office visits, with audio-only visits the least compensated.

MSSNY is also concerned that if passed, certain policies included in the budget may be used by the insurance industry to actually reverse Telehealth gains made over the past year. Specifically, linking coverage of Telehealth services to insurers having a “so-called” adequate network, together with the proposal to permit Telehealth delivery services by out of state physicians, could essentially empower insurers to limit who it will pay for Telehealth services once it asserts it has an “adequate” network. It is not hard to imagine a scenario where a health plan asserts it has an adequate network through a national Telehealth service provider, and then excludes coverage of Telehealth service by all or some of its in-network community-based physicians. That is completely at odds with the expansive approach to Telehealth coverage taken over the past year as a result of important actions taken by the New York DFS and DOH.

MSSNY is continuing to work with a range of other patient and provider partner organizations to address our concerns and will update members as the issue unfolds. (CARY)

MSSNY to Conduct Medical Matters: Three Coronaviruses in Three Decades

Date: March 24, 2021 @ 7:30am
Register now to learn more about the evolution of coronaviruses over the past three decades.  Medical Matters: Three Coronaviruses in Three Decades webinar will take place on Wednesday March 24^th at 7:30am.  Stephen Morse, PhD, Professor of Epidemiology at the Columbia University Medical Center and Director of the Infectious Disease Epidemiology Certificate Program at Columbia University Mailman School of Public Health will serve as faculty for this program.  Click here to register for this webinar.

Educational objectives

• Identify three different coronaviruses and the epidemiology specific to each one
• Discuss SARS-CoV-2 in relation to other coronaviruses
• Evaluate the circumstances that contributed to the SARS-CoV-2 pandemic

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. (Hoffman) 

CMS Holds Physicians Harmless from MIPS Penalties Amid COVID-19 PHE
CMS announced this week that it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency on physician practices’ performance in 2020. The AMA strongly advocated for this automatic relief from MIPS penalties.

The Extreme and Uncontrollable Circumstances Hardship Exception policy will be automatically applied to ALL MIPS eligible clinicians who do not submit any MIPS data for the 2020 performance period and avoid a 2022 payment penalty. CMS is also reopening the hardship exception application for group practices, virtual groups, and alternative payment model entities who missed the previous 2020 deadline. The re-opened application deadline is March 31, 2021. Note, groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.

Dr. Fauci Introduces New Acronym for Long COVID at White House Briefing
As officials scramble to get vaccines and protective gear to the public, scientists are working overtime to gain knowledge of the long-term effects of COVID-19, said Anthony Fauci, MD, during a wide-ranging briefing at the White House this week.

“Many of you are now aware of what had long been called ‘long COVID,’ ” said Fauci, the White House COVID-19 Response Team’s chief medical adviser. “But actually, what that really is is post-acute sequelae of SARS-CoV-2 infection, which we’re now referring to as ‘PASC,’ or P-A-S-C.”

He noted that the National Institutes of Health launched an initiative yesterday to further study the phenomenon, which Fauci called “alarming” and “puzzling.”
He stressed that even patients with moderate cases of the infection can develop PASC. Symptoms include fatigue; gastrointestinal problems; “brain fog,” or an inability to focus; depression; anxiety; sleep difficulties; and, in extreme cases, impaired lung capacity.

“New symptoms sometimes arise well after the time of infection, or they evolve over time and persist for months,” Fauci continued. “They can range from mild or annoying to actually quite incapacitating.” He referred to a study from researchers at the University of Washington that was published online February 19 in JAMA Network Open. In that study, more than 30% of the 177 participants reported symptoms that persisted for up to 9 months.
“It’s very difficult to treat something when you don’t know what the target of that treatment is,” Fauci said. “There are a lot of important questions with this series of initiatives that we will ultimately answer.”
—Medscape, 2/24/21

How to Recognize Phishing Scams
Scammers use email or text messages to trick you into giving them your personal information. They may try to steal your passwords, account numbers, or Social Security numbers. If they get that information, they could gain access to your email, bank, or other accounts. Scammers launch thousands of phishing attacks like these every day — and they are often successful. The FBI’s Internet Crime Complaint Center reported that people lost $57 million to phishing schemes in one year.

Scammers often update their tactics, but there are some signs that will help you recognize a phishing email or text message.

Phishing emails and text messages may look like they are from a company you know or trust. They may look like they are from a bank, a credit card company, a social networking site, an online payment website or app, or an online store.

Phishing emails and text messages often tell a story to trick you into clicking on a link or opening an attachment. They may:

• say they’ve noticed some suspicious activity or log-in attempts
• claim there’s a problem with your account or your payment information
• say you must confirm some personal information
• include a fake invoice
• want you to click on a link to make a payment
• say you’re eligible to register for a government refund
• offer a coupon for free stuff

Here’s a real-world example of a phishing email.

Imagine you saw this in your inbox. Do you see any signs that it’s a scam? Let’s take a look.

• The email looks like it is from a company you may know and trust: Netflix. It even uses a Netflix logo and header.
• The email says your account is on hold because of a billing problem.
• The email has a generic greeting, “Hi Dear.” If you have an account with the business, it probably would not use a generic greeting like this.
• The email invites you to click on a link to update your payment details.

While, at a glance, this email might look real, it’s not. The scammers who send emails like this one do not have anything to do with the companies they pretend to be. Phishing emails can have real consequences for people who give scammers their information. And they can harm the reputation of the companies they are spoofing.

How to Protect Yourself from Phishing Attacks
Your email spam filters may keep many phishing emails out of your inbox. But scammers are always trying to outsmart spam filters, so it is a good idea to add extra layers of protection. Here are four steps you can take today to protect yourself from phishing attacks.

What to Do If You Suspect a Phishing Attack
If you get an email or a text message that asks you to click on a link or open an attachment, answer this question: Do I have an account with the company or know the person that contacted me?
If the answer is “No,” it could be a phishing scam.
If the answer is “Yes,” contact the company using a phone number or website you know is real. Not the information in the email. Attachments and links can install harmful malware.

CDC Backs New Vaccine Finder Website
The CDC has backed a vaccine finder website, VaccineFinder.org, to make it easier for Americans to find vaccination sites. Run by Boston Children’s Hospital, the online portal allows the public to search for available vaccination sites and appointments. The developers hope to expand the program nationally  to include nearly all vaccine providers who participate.

J&J’s COVID-19 Vaccine is Safe, Effective, FDA Review Shows
Johnson & Johnson’s COVID-19 vaccine had an overall efficacy rate of 72 percent in U.S. trials, meaning it provides strong protection against severe illness and death from the virus, according to an FDA analysis posted Feb. 24, The New York Times reported.

The U.S. clinical trial showed the vaccine was 86 percent effective against severe forms of COVID-19, and a South African clinical trial showed it was 82 percent effective against severe disease there, where a more contagious variant called B.1.351 emerged and is causing most COVID-19 cases, according to the Times. The vaccine had an overall efficacy rate of 64 percent in South Africa.

The FDA’s vaccine committee is set to meet Feb. 26 to vote on whether to recommend the agency authorize the vaccine, and authorization could come as early as tomorrow, Feb. 27, according to the Times.

Johnson & Johnson’s vaccine requires a single dose, as opposed to two doses required by Moderna and Pfizer’s vaccines, and it can be stored at normal refrigeration temperatures for at least three months, according to the Times.

Access to the vaccine will be severely limited at first, if approved Feb. 27. Richard Nettles, vice president of U.S. medical affairs for the drug development arm of Johnson & Johnson, said Feb. 23 that nearly 4 million doses would be ready to be shipped after the FDA authorizes the vaccine. But White House officials said the same day that only about 2 million doses would be available next week if the vaccine is authorized, the Times reported.

The drugmaker said Feb. 22 that it would have 20 million doses shipped to the U.S. government by the end of March.

Side effects reported in clinical trials of the vaccine were noticeably milder than Pfizer and Moderna’s vaccines, the Times reported. There were no reports of anaphylaxis.

Headaches, fatigue, muscle pain and injection site pain were the most common side effects reported, according to CNBC. Injection site pain was reported by nearly half of clinical trial volunteers; headaches were reported by about 40 percent; and fatigue was reported by about 38 percent. More than 33 percent of volunteers reported muscle pain, CNBC reported.

Most of the adverse reactions occurred in people ages 18 to 59, and the FDA said most side effects went away a couple of days after receiving the vaccine, according to CNBC.

–Becker’s Hospital Review

Three Reasons COVID-19 Vaccines Remain in Short Supply
Though the U.S. has invested billions of dollars in COVID-19 vaccine manufacturing and invoked the Defense Production Act to boost supplies needed to make the vaccines, there are still not enough doses to meet demand, Kaiser Health News reported Feb. 23.

Experts told Kaiser Health News that three main bottlenecks are contributing to the lack of supply:

1. The production of lipids. Both Moderna and Pfizer’s vaccines contain billions of lipids, and lipids are only made in a handful of U.S. factories, Kaiser Health News
   
   “No one has ever thought of a scenario where we would use lipid nanoparticle formulation for [billions of] doses,” Prashant Yadav, PhD, a senior fellow at the Center for Global Development at Harvard University, told Kaiser Health News. “We have not invented a process for doing lipid nanoparticles at scale.”Before COVID-19, the companies making the lipids made only small amounts, mainly for use for such things as clinical trials, according to Kaiser Health News. It takes time to get FDA authorization for a facility to make large quantities of lipids, so Moderna and Pfizer have been forming agreements with existing manufacturers to convert to lipid production, Pieter Cullis, PhD, a University of British Columbia professor, told Kaiser Health News.
   .
2. The availability of glass vials. Though the Defense Production Act has been invoked to require some glass makers, such as Corning and SiO2 Materials Science, to prioritize making vials to store vaccines, it takes time to get the needed equipment installed to boost production, Prashant Yadav, a senior fellow at the Center for Global Development at Harvard University, told Kaiser Health News.
   .
3. Filling the vials. Vaccine-filling lines that get the finished vaccines into vials or syringes must be extremely efficient and sterile, Kaiser Health News Few companies in the world are up to the task, Mike Watson, former president of Valera, a subsidiary of Moderna, told Kaiser Health News. Moderna has hired a company named Catalent to fill and finish its vaccine doses at a facility in Bloomington, Ind., as well as at least two other companies to do the same for its vaccines abroad, according to Kaiser Health News. Sanofi agreed to let Pfizer use its fill/finish vaccine line in Germany for its vaccine, but that line isn’t expected to be up and running until July, Kaiser Health News reported.

—Becker’s Hospital Review, 2/23/21