February 9, 2018 – Keep Calm and Carry On!

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Capital Update

Physician Advocacy Day in Albany March 7-  Just 3 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7^th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

We thank the many physicians who have already committed to come to Albany that day to join us in our advocacy efforts to improve patient care delivery across New York State.  We also thank the New York State Osteopathic Medical Society for integrating their physician Lobby Day with MSSNY’s.  If you have not yet registered, we urge you to join your colleagues from all around New York State and come to Albany to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Here are some our top issues for March 7:

• Rejecting the Inappropriate scope of practice expansions proposed in the Executive Budget
• Preventing big-box store owned medical clinics that will hurt community primary care delivery
• Reducing excessive health insurer prior authorization hassles that needlessly delay patient care
• Reducing the high cost of medical liability insurance
• Rejecting unfair and counterproductive proposed Medicaid cuts to Patient-Centered Medical Homes
• Preserving 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. Please contact your 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)

Please Contact Your Legislators To Oppose Various Misguided State Budget Proposals
The Senate and Assembly have been holding joint budget hearings over the last few weeks to examine Governor Cuomo’s proposed budget.  On February 12th, MSSNY will testify before the Senate Finance Committee and Assembly Ways and Means Committee regarding healthcare issues contained in the proposed budget.

MSSNY members are urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism.  Please contact your legislators to urge them to oppose the following proposals contained in the proposed State Budget for 2018-19.

• 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.
• 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, 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.

• • 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.          
  • Patient-Centered Medical Home cuts
    This proposal would, for the period of 5/1/18-6/30/18, slash from $7.50 PMPM to $2 PMPM 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 on July 1, 2018, or face further steep cuts in PMPM payments. MSSNY together with the NY Academy of Family Physicians, NY Chapter of the American Academy of Pediatrics, and NY Chapter of the American College of Physicians, as well as the Community Health Care Association of New York, have expressed great concerns with these proposed changes.
  • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, 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.  (DIVISION OF GOVERNMENTAL AFFAIRS)

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eNews

CMS Rule Change Reduced Physicians’ Medicare Opt-Outs
The D Healthcare Daily (TX) (2/8) reports that after 7,400 physicians submitted paperwork to opt-out of Medicare in 2016, “the number cut in half last year, according to new data from the Centers for Medicare and Medicaid Services.” The piece attributes the decrease “to the end of a stipulation that required providers to renew their opt-outs every two years.” Dr. Charles Rothberg, president of the Medical Society of the State of New York, says clinicians, in wealthier areas, feel they can opt out because they can fill their practice with patients who have commercial insurance or can pay out-of-pocket.

CDC Data: One in Four Aged 45/Older Who Made 2015 ED Visits Had Diabetes
Findings published in the CDC’s National Center for Health Statistics Data Brief No. 301 state, “About one in four people aged 45 and older who made emergency department (ED) visits in 2015 in the United States had diabetes,” data from the 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) indicate. In fact, “an estimated 12 million ED visits that year were by patients aged 45 and older, representing 24% of ED visits by people in that age group and 80% of all ED visits by people with diabetes,” the data reveal.

Life Expectancy Falls for Second Consecutive Year: Substance Use and Suicides
“Life expectancy in the US has fallen for the second year in a row, thanks to a combination of drug and alcohol use and suicides, according to a study released online Feb. 7 in the British Medical Journal The drop in life expectancy was especially “large among middle-age white Americans and those living in rural communities, experts” found after examining “2016 data from the World Bank.”

AMA Warns Not to Divulge Social Security Number to Physicians
According to a 2016 annual survey from the Ponemon Institute, “about half of all health care organizations had little or no confidence that they could detect the loss or theft of patient data, and the majority lack the budget to secure their data.” The American Medical Association states on its website, “Our AMA policy is to discourage the use of Social Security numbers to identify insureds, patients, and physicians, except in those situations where the use of these numbers is required by law and/or regulation.” According to the Department of Health and Human Services, in 2015, “113.2 million health care-related records were stolen.”

Paying For Ridesharing Services May Not Reduce No-Shows
The findings published in JAMA Internal Medicine found that paying for poor patients to use “ridesharing services like Uber and Lyft” to reach “doctor appointments doesn’t make them any less likely to become no-shows than patients who have to find their own way there.”

2018 House of Delegates

Any 2018 HOD Resolutions Not in by Today Will Go to Convention Committee
Resolutions to be considered at the MSSNY House of Delegates meeting are due this week on FRIDAY, (FEBRUARY 9) AT 5 PM. This is a firm, no excuses deadline. Any items of business received after 5 PM will be forwarded to the Convention Committee on Rules, Credentials and Order of Business.  Authors, or their duly appointed representatives, must then attend the Rules Committee meeting on Thursday, March 22 at 3:00 PM, to explain why the resolution was submitted after the deadline.  The merits of the resolution are not discussed. Resolutions should be sent to lmayer@mssny.org, as an electronic document in WORD format.  Pdf files are not acceptable.  For guidance on the proper formatting of resolutions, see the MSSNY website under the 2018 HOD tab.

OTHER DEADLINES you may want to be reminded of:

• • Hotel reservations must be made by Sunday, February 18 in order to be assured of the MSSNY rate.
  • Dinner Dance reservations need to be made by Friday, March 9.
  • Information for booking your hotel room and making a reservation for the dinner dance is included on the MSSNY website.

Questions should be directed to Laurie Mayer lmayer@mssny.org

MSSNY Poster Symposium at HOD in Buffalo Needs Judges
We are looking for volunteer judges for MSSNY’s 13^th annual Poster Symposium, which will be held on Friday, March 23, 2018, from 2:00 – 4:00 pm at the Adam’s Mark Hotel in Buffalo.

Each judge evaluates 10 posters among the 70 exhibited. Evaluation is based on a scoring system and generally takes about 1½ hours. Judges who wish to help choose the final winners may also attend a meeting at 4:30. You need not be an HOD delegate to be a judge. For guest judges who arrive before 1:30, lunch will be available.

Please contact sbennett@mssny.org or 516-488-6100 x 383

Conference

Medical Professionals’ Conference on Opioid Medication-Assisted Treatment

Including buprenorphine waiver training for MDs, NPs, PAs

When:        SATURDAY, MARCH 17

Where:       Cold Spring Harbor Laboratory, Cold Spring Harbor, NY

Program:   10:00-12:00 Overview of overdose prevention & MAT

                   12:00-1:00 Lunch & networking

                   1:00-5:00 Buprenorphine waiver training

                   1:00-3:00 Collaborative workshop for waivered prescribers

EVENT IS FREE – REGISTRATION REQUIRED BY MARCH 9

Across Long Island and across the United States, opioid users are dying because of the

inadequate infrastructure for buprenorphine and other medication-assisted treatments. More medical professionals are urgently needed who are committed and qualified to provide MAT –and more education and support are needed for these practitioners. This conference will include training that fulfills 4 hours of the in-person requirements for medical professionals to receive a DEA waiver to prescribe buprenorphine. Speakers and workshop Presenters: Lloyd Sederer, MD, Medical Director, NY State Office of Mental Health; Michael Delman, MD, President-Elect, NY Society of Addiction Medicine; Patrick O’Shaughnessy, MD, Medical Director, Catholic Health System of L.I.;  Adam Bisaga, MD and  Leslie Marino, MD, Columbia University Medical Center,

For more information, contact Dr. Marino at leslie.marino@nyspi.columbia.edu

FDA, CMS, CDC

FDA Commissioner: “Kratom Is an Opiate”
The FDA launched the latest attack on February 6 in a drawn-out war between regulators and patients over the safety of a popular herbal supplement called kratom, branding the plant a dangerous drug.

“Compounds in kratom make it so it isn’t just a plant — it’s an opioid,” FDA commissioner Scott Gottlieb declared in a statement.

Some users have argued that kratom is a safe way to treat pain and wean oneself off opioids, but the agency concluded otherwise — based on case reports and a computer analysis of the molecular structure of kratom ingredients. “Claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous,” Gottlieb said. “After all, heroin is an illegal, dangerous, and highly-addictive substance containing the opioid morphine, derived from the seed pod of the various opium poppy plants.”

Gottlieb warned of side effects that could be caused by kratom, such as changes in neurological and cardiovascular function. He also cited 44 reported deaths “associated with the use of kratom.” In the past, advocates for the herbal supplement have argued that many of these cases involved other drugs besides kratom. While the DEA has already received the report it had requested from the FDA, this newly released evidence may influence the decision as to whether the substance should remain legal, the agency said Tuesday. A spokesperson could not say when that would be determined. “For any substance that goes through this process, it can be months, or it can be years,” said spokeswoman Katherine Pfaff. She added that a number of states have banned kratom, but for the time being, “federally, it is still a legal substance.”

2018 Adult Immunization Schedule for Includes Changes for Shingles/MMR
The CDC’s Advisory Committee on Immunization Practices has released its 2018 immunization schedule for adults in the Annals of Internal Medicine. Among the notable changes from last year:

• Shingles: Two doses of the newly approved, recombinant zoster vaccine (RZV; Shingrix) is recommended for adults aged 50 and older regardless of their zoster or vaccine history. Those who’ve received the live zoster vaccine (Zostavax) may receive their first RZV dose at least 2 months later. Adults aged 60 and older may receive either vaccine, but RZV is preferred.
• Mumps: Adults who have received two or fewer doses of a mumps-containing vaccine and are at risk for contracting mumps during a local outbreak should receive a dose of the measles, mumps, and rubella (MMR) vaccine.

Immunization schedule in Annals of Internal Medicine

Physician’s First Watch coverage of 2017 adult immunization schedule

CMS Proposal: Initial Opioid Scripts Limited to Seven Days
CMS is proposing that beginning in 2019, initial opioid prescriptions for acute pain be limited to 7 days. The agency is also suggesting in the 2018 Draft Call Letter that Medicare Part D prescription drug plans monitor patients who take medications considered to be “potentiators” of opioid misuse and opioid-related adverse events — specifically, gabapentin and pregabalin.

Noting an alarming increase in gabapentin use to treat pain and concurrent opioid and gabapentin use, CMS is asking for comment on whether it is useful to more closely monitor beneficiaries receiving these prescriptions.

The CMS proposal came as a US House committee took a closer look at Medicare’s oversight of opioid use. At the February 6 hearing, members of the Ways and Means Health Subcommittee said there are few data on opioid use among older Americans and that Medicare has done a poor job of encouraging prevention and treatment.

The agency said in its latest announcement that the system has reduced “very high risk overutilization of prescription opioids in the Part D program,” but “given the urgency and scope of the continuing national prescription opioid epidemic, we will propose new strategies to more effectively address this issue for patients in Part D.”

CMS proposes the following:

• To have the OMS identify high-risk beneficiaries who use “potentiator” drugs (such as gabapentin and pregabalin) in combination with prescription opioids to ensure that plans provide appropriate case management. The agency noted in its proposal that in just 2 years (2015 to 2017), the rate of gabapentin users in Part D plans increased by 14%: from 93 to 108 users per 1000 enrollees. Opioid users had even higher gabapentin use.
• To create a new quality measure that would track how well Part D plans flag concurrent use of opioids and benzodiazepines. The OMS already flags concurrent benzodiazepine use, but there is no follow-up mechanism. According to CMS, in late 2016, when the OMS began tracking concurrent use, 64% of beneficiaries flagged as potential opioid overusers had a benzodiazepine prescription. In 2017, after monitoring, the number had dropped to 62%.
• That Part D plans to have a pharmacy point-of-sale edit that prohibits dispensing of any prescription that is more than a 90 morphine milligram equivalent, or a 7-day supply.
• That all sponsors implement soft point-of-sale edits that alert when there is duplicative therapy of multiple long-acting opioids.

CMS is taking comments on the proposal until March 5 and will publish the final requirements on April 2.

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