February 3, 2017 – DSRIP Not Trickling Funds Down to Doctors
Dr. Malcolm Reid
|February 3, 2017
The Delivery System Reform Incentive Payment program, better known as DSRIP, was designed to overhaul Medicaid. NY State released its NYS DSRIP Mid-Point Assessment Final Reports for all 25 PPSs (Performing Provider Systems) throughout the state on January 3, 2017. The reports are extensive. In case you want to take a look at it, click here.
At our January 19 Council Meeting, a summary of the report was given to the Councilors. The bad news is that DSRIP is not trickling down to physicians as we had anticipated. In the reports, you need to review the DSRIP fund’s flow charts. See them here.
What is quite telling is that the funds are not flowing to physicians. We see that the larger entities are taking their slice of the pie and keeping it for themselves.
On our brief review of the fund flow charts, we see the following:
- Advocate Community Providers, Inc. has the highest percentage of funds to physicians – 40.8% to PCPs and 6.1% to non-PCPs.
- Sisters of Charity Hospital of Buffalo, New York is next with 15.53% to PCPs and 1.20% to non-PCPs.
- Next is Alliance for Better Health Care, LLC at 9.3% to PCPs and appears to have no non-PCPs.
- Montefiore is next at 6.26% for PCPs and 1.4% to non-PCPs.
Regrettably, the remaining PPSs shared less with the participating physicians.
Based on a statement of the OMIG and the DOH, DSRIP funds are distributed among the participating providers to incentivize providers to reach DSRIP performance goals.
I strongly advise all physicians who are participating in Performing Provider Systems (PPSs) to speak to the administrator of their PPS and question when they will receive their fair share.
Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!
Please send your comments to email@example.com
Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to contact their elected officials regarding a number of State Budget proposals listed below. While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery. Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made. For example,
- We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels. However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians. To send a letter to your legislators, click here.
- Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols. To send a letter to the Legislature, click here.
- “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements. To send a letter to your legislators, click here.
- The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
- The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: “Modernizing the Certificate of Need laws, and changing scope of practice for non-physician.” Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval.
Other Items of Note in the State Budget
- Funding for MSSNY’s Committee for Physicians Health would be continued at past levels;
- Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
- E-cigarettes would be taxed in the same manner as tobacco cigarettes.
- Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)
- Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the state discretion to remove a physician or other prescriber from the program.
- Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
- Requiring the testing of public water systems every three years for contaminants.
MSSNY will testify at the state Senate and Assembly public hearing on February 16, 2017 on the proposed NYS health budget. (DIVISION OF GOVERNMENTAL AFFAIRS)
MSSNY Lobby Day Just a Few Weeks Away – March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
Please make your plans now to to come to Albany Wednesday March 8 for MSSNY’s “Physician Advocacy Day”, which will be held at the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany. Please register here.
The morning program will begin at 8 AM. A full slate of legislators and key policymakers have been invited and/or confirmed to participate including:
- Jason Helgerson, NYS Medicaid Director;
- Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
- Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.
In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.
A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program. County medical societies will be scheduling appointments for physicians to meet with their elected representatives.
Come meet with your legislators to urge that they:
- Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
- Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
- Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
- Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
- Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
- Reject legislation that would impose costly and time consuming mandates on physician practices.
Medical Liability Bills Re-Introduced
Legislation, A.3339 and S.4080, have been re-introduced that would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals. If enacted, this bill could increase liability premiums by 15% at a time when no premium increases can be tolerated.
MSSNY continues to oppose expansion of liability provisions that would have drastic consequences on York’s health care system. MSSNY will continue to push for comprehensive liability reform to preserve access to care for patients, not one-sided proposals that would further reduce access.
As we go into Super Bowl weekend, it is a good reminder that little can be done sitting on the sidelines. Physicians are urged to contact their legislators by writing letters, making phone calls and meeting with their elected officials. Physicians can send a letter from here. (BELMONT)
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
Collective Negotiation Bill Introduced
One of MSSNY’s priority pieces of legislation was re-introduced this week. Legislation, A.4472, Gottfried and S.3663, Hannon, would allow physicians to communicate with each other and jointly negotiate with health maintenance organizations (HMOs). The bill divides the matters subject to being collectively negotiated into two major areas.
The first issue area involves non‐fee related matters such as utilization review, coverage provisions, benefits and exclusions definition of medical necessity, risk transfer, referral provisions, burdensome pre‐authorization procedures, limited drug formularies and access where necessary to out‐of‐network specialists.
The second issue area which can be negotiated involves fee‐related matters. These can be negotiated, however, only if the health care plan has substantial market share in the service area in which the physicians are practicing. Strikes are expressly prohibited.
As many health insurers continue to expand their market share, shrink networks and impose more and more administrative burdens that interfere with patient care delivery, enactment of this legislation is essential to preserving the ability of a physician to advocate to assure their patients can get the care they need. (Belmont)
Assembly Health Committee Advances Legislation to Protect Physician Due Process Rights with Health Insurers
Legislation, A2704, Lavine, to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed was favorably reported from the Assembly Health Committee to the Codes Committee this week. MSSNY strongly supports this legislation.
The legislation is designed to protect existing patient-physician treatment relationships from being severed due to arbitrary health plan decisions to shrink their networks. For example, in late 2015, hundreds of physicians were unfairly dropped from the networks of one large NYC-based insurer, allegedly because of these physicians’ failure to transition to value-based payments. Moreover, a recent MSSNY survey showed that more than 25% of the respondents indicated that they had been dropped from an insurer’s network in recent years. Identical legislation (S.3943, Hannon) has been introduced in the New York State Senate.
Assembly Health Committee Agenda Next Week: Physicians Urged to Oppose Corporate-Owned Retail Clinic Bill
There are several bills of note on the Assembly Health Committee agenda next week, some supported by MSSNY, and some we oppose. These include:
- Legislation (A.958, Paulin) strongly opposed by MSSNY which would authorize the establishment of clinics in corporate-owned retail stores. To send a letter in opposition, click here:
- Legislation (A.2539, Gottfried) strongly supported by MSSNY that would prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State; and
- Legislation (A.2703, Gottfried) strongly supported by MSSNY that would clarify that the statutory liability protections offered for physician participants in MSSNY’s Committee for Physicians’ Health (CPH) program extend to the organization who sponsors the program as well as its employees.
MSSNY Fights for Funding to Attract and Retain Physicians in NYS
MSSNY paired up with other health care advocates as part of the Workforce Advisory Group Lobby Day in hopes of gaining support in their efforts to address the shortage of primary physicians in underserved regions in New York State.
Among the notable issues was the request of legislative support for additional funding for Doctors Across New York (DANY). DANY is a state funded program that was launched in 2008 to train and place physicians in areas of New York State where that specialty is most needed. After seeing success in recruitment and retention rates in the previous cycles, the Workforce Advisory Group asked for an additional investment of $2 million dollars to award 50 more physicians. The group also advocated for the expansion of the Take a Look Program – which introduces medical students and residents practicing in NYC to Upstate New York and the opportunities available in medicine.
Blue Cross/Blue Shield of WNY Announces Reducing Prior Authorization Burdens for Many Services
As reported in the Buffalo News and on radio station WBFO, Blue Cross/Blue Shield of Western New York will be dropping prior authorization http://(http://buffalonews.com/2017/02/01/insurer-policy-shift-drops-preapproval-requirement-many-services/requirements for over 200 medical services. To review the list of services that will no longer require prior authorization, click here.
These articles note that the action by BCBSWNY followed a report issued last week by the AMA noting the overwhelming burden to physician practices of prior authorization requirements, and the recommendation of several principles that health insurers should follow to reduce these burdens. MSSNY was one of a handful of state medical societies to work with the AMA in developing these principles. It also follows strong and sustained advocacy by leaders of the Erie County Medical Society to BCBSWNY and other regional health insurers regarding the need to reduce the administrative burdens that are interfering with patient care delivery. Review of the list of services is ongoing, and suggestions may be made to expand this list of services not requiring PA.
NY State of Department of Health Announces More Than 3.6 Million New Yorkers Secure Health Coverage
The NY State Department of Health reported this week that it saw a sharp influx of enrollees bringing the total number of people who receive coverage through New York’s Exchange to over 3.6 million – a 29% increase since the end of Open Enrollment in 2016. While most continue to be enrolled in Medicaid, 1.2 million are enrolled in non-Medicaid plans. 242,880 are enrolled in a non-qualified health plan, with almost 60% of new enrollees entitled to federal tax credits to reduce the cost of monthly premiums. The “Essential Plan”, which covers individuals with income between 138-200% FPL, saw a 75% upsurge in enrollment, bringing the total number receiving coverage to almost 670,000 New Yorkers. In addition, 299,214 children are enrolled in Child Health Plus.
MIPS Educational Webinar Program Available from MSSNY MACRA Webpage
Over 120 physicians and/or their staff participated in a January 26 webinar hosted by MSSNY to learn about key aspects of the new Medicare Merit Based Incentive Payment System (MIPS) that went into effect on January 1, 2017. The MIPS program was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and will have a significant impact on physician care delivery and billing for Medicare. MSSNY thanks Frank Winter, Partnership Manager for the New York Regional Office for CMS, for taking the time to present important information about this new program for physicians and their staffs, and answering their questions.
To listen to a re-broadcast of this one-hour program, please go to the “MACRA” section of the MSSNY website or click here: (Members only).
DOH Commissioner Medical Grand Rounds to be Held on Feb. 8th
The third session of the 2016-2017 Commissioner’s Medical Grand Rounds series will be held on February 8, 2017 from 6-8 p.m. The session, “Technology Changes Our Connection: Physician and Patient Communication” will take place in Manhattan at the Borough of Manhattan Community College. The flyer for this session is here.
The session will also be streamed as a live webcast for those unable to attend in-person and will also be offered on our webpage as an archived webinar afterwards. Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast. The session will be hosted by NYS DOH Commissioner Howard Zucker, MD. Presenters are: Richard M Frankel, PhD; Professor of Medicine and Geriatrics, Indiana University School of Medicine Senior Scientist, VA HSR&D Center for Health Information and Communication and Joseph C Kvedar, MD, Vice President, Connected Health, Partners HealthCare Associate Professor, Dermatology, Harvard Medical School.(CLANCY)
Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team. Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee. Registration is now open for this webinar here just click on “Upcoming”.
The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting. 2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event. 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.
The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains. Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.
Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.
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.
MSSNY 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. (CLANCY, HOFFMAN)
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
AMA to Homeland Security: Concern re IMGs Who Have Visas to Train/Practice in US
The American Medical Association entered the immigration debate Wednesday with a letter to the U.S. Department of Homeland Security asking the agency to clarify how the Trump Administration’s executive order applies to health workers trained abroad, to those seeking to train in the U.S. and to patients needing care. MSSNY has the same concerns as the AMA as we have a higher percentage of IMGs in New York than other states. The Association of American Medical Colleges said 260 medical students from the seven countries are applying to residency programs in the United States.
It is “vitally important” that this process not impede patients’ access to timely treatment or restrict doctors and international medical graduates “who have been granted visas to train, practice, or attend medical conferences” in the U.S., ” the AMA’s chief executive officer, Dr. James L. Madara, wrote in a letter to Homeland Security Secretary John F. Kelly.
Dr. Madara noted that the order could block entry to foreign medical graduates who have applied for or who have been granted visas to come to the U.S. to train and provide care in poor and underserved communities to “some of our most vulnerable patients,” many of whom live in rural and low-income areas. “One of every four physicians practicing in the United States is an [international medical graduate],” he said, noting that they meet the same stringent licensing requirements as US graduates, but they are more likely to practice in underserved and poor communities, and to fill training positions in primary care and other specialties that face significant workforce shortages.
The letter requests rapid action, because the order places into limbo foreign medical school graduates whose residency assignments will be decided next month. He also expressed concerns about how the order might affect medical school applicants granted temporary work permits under an Obama Administration program that allows certain undocumented immigrants who entered the U.S. as minors to remain for at least two years.
Erie County Suing Pharmaceuticals for Promoting Opioids to Doctors/Patients
Erie County Executive Mark Poloncarz is suing several pharmaceutical companies alleging that the companies misled doctors and patients into thinking that their highly addictive medications were safe. The lawsuit, filed in State Supreme Court, names 11 major companies- including Purdue, Hanssen, and Endo. Read the Buffalo News story here.
MSSNY Members ONLY: Free Service to Resolve Your Insurance Problems
The Division of Socio-Medical Economics (SME) is responsible for addressing health insurance-related issues and developments affecting the physician community. SME is here to help you and your staff with problems relating to insurance reimbursement for care you render to your patients. We receive thousands of calls each year regarding Medicare, Medicaid, Workers’ Comp (WC), No-Fault Auto (NFA), managed care, traditional indemnity plans, etc. Sometimes we help our members by explaining insurer requirements, diagnosis and procedure coding questions, Medicare/Medicaid Crossover issues, National Provider Identifier (NPI) matters, WC/NFA questions, private-pay arrangements, etc. This is a FREE SERVICE for MEMBERS ONLY.
In other cases, we may argue with a health plan on behalf of our members for policy clarification or proper payment of a bill or claim. In 2016, our Ombudsman Program recovered $89,815.79 for our members.
Please contact the SME staff if you have questions or problems with which you think we can help at 516-488-6100 ext. 334.
Regina McNally, Vice-President
SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details
MSSNYPAC – The Political Voice for New York’s
PhysiciansFace-to-face relationship-building with those who will be deciding policies which impact our ability to provide care to our patients is of great importance to all physicians. MSSNYPAC provides opportunities for physicians to support and encounter physician-friendly candidates. Every individual physician, resident, medical student and Alliance member is essential to strengthen these relationships. Join or increase your support and participation today at www.mssnypac.org/contribute.
Open Payments System Is Now Available
The Open Payments system is now available, enabling physicians and teaching hospitals to register. Physicians and teaching hospitals must register first in order to review any payments and other transfers of value attributed to them. If physicians and teaching hospitals registered last year, they do not need to register again.
If it has been over 180 days since a physician or teaching hospital has logged onto the Enterprise Identity Management System (EIDM), the account has been deactivated for security purposes. If an account must be reactivated, physicians and teaching hospitals can contact the Help Desk. Beginning today, the Help Desk has extended hours from 7:30 a.m. – 6:30 p.m. (EST).
The review and dispute period is targeted to start in April 2017, following the close of data submission (the Program Year 2016 data submission window begins on February 1, 2017 and ends on March 31, 2017).
You can learn more about the Open Payments system enhancements by viewing the Open Payments Overview and Enhancements presentation. Additional updated resources are located here.
Questions—Contact Live Help Desk
For more information about Open Payments, please visit the Open Payments website. If you have any questions, you can submit an email to the Help Desk at firstname.lastname@example.org..
Live Help Desk support is available by calling 1-855-326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. (EST), excluding Federal holidays.
Resolutions Have Two Deadlines–February 17 and March 17!
We tried this last year and it worked well. Please try to submit any resolutions that are ready by FEBRUARY 17. This gives staff adequate time to review and contact you or the author with questions or clarifications.
The final deadline for receipt of resolutions is MARCH 17 at 5 PM. This deadline was selected so that any issues which might arise as a result of Physician Advocacy Day participation can still be addressed. Anything received after Friday March 17th will be considered LATE and referred to the House Committee on Rules, Credentials and Order of Business. That committee meets on Thursday April 20, 2017 at 2 PM and the author of that late resolution must be present to discuss the reasons for the lateness of the resolution.
Resolutions must be submitted as word documents (each resolution as a separate document) with the proper formatting, necessary research and policy citations noted. Resolution titles should be succinct and reflect the broad topic of the resolution. Guidelines for constructing resolutions and proper formatting are installed on the MSSNY website. Please research your resolutions to establish whether there is already existing policy on your topic. The Policy and Position Statements are on the MSSNY website and have been updated through the January Council meeting.
Join us for ARTMED INSIGHT’s February Workshop at the MET Museum!
THE ART OF SEEING: ART IN CLINICAL PRACTICE
Expanding Point of View and Creative Thinking Skills
February 17, 2017, from 6 to 8.30 pm and February 18, 2017 from 5 to 7.30 pm
Boost your perceptual and communication skills and strengthen your clinical practice!
Open to all physicians, physician assistants, psychiatrists, residents, nurses, medicals students, and healthcare professionals across disciplines.
Expanding Point of View: February 17 from 6 to 8.30 pm
Participants explore art works in order to uncover their perceptual habits and move beyond them. Multiplying perspectives, participants learn how to access new data and ways of seeing. Issues of bias and context are also considered and their relevance to medical practice and patient communication explored.
Enhancing Creative Thinking Skills: February 18 from 5 to 7.30 pm
In part 2 of this workshop, participants investigate art works and develop perceptual tools to “reframe” their looking. This serves to stimulate participants’ creativity and capacity for creative problem solving. Challenges regarding ambiguity and premature closure are also examined and explored.
Cost: $285 (includes 1/17/17 and 1/18/17 + museum entrance fee) $185 for students
Art experience is welcome but not necessary–Location: The MET Museum in NYC.
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Modern/High End Office (Upper East Side)
Large and Modern office to share. Located on the ground floor. 2+ treatment/exam rooms, large waiting room, private office, storage. Price is negotiable for 1-3 day/week. Call Dr. Austin 5189284819 or email email@example.com No broker fee. Craig Austin, M.D. 120 East 64th Street, NYC 10065
Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D. 110 E 66th Street.
A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to firstname.lastname@example.org. No recruiters please.
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to email@example.com. No recruiters please.