January 13, 2017 – ACA Cut Concerns Our Patients

PRESIDENT’S MESSAGE Dr. Malcolm Reid

January 13, 2017 Volume 17 Number 2

Dear Colleagues:

I know that many of you like me are keeping a close eye on the activities in Washington DC regarding Congress’ consideration of legislation to repeal much of the Affordable Care Act (ACA).

Physicians of every specialty and every part of the State can identify various shortcomings with the ACA.  Over the last several years, we have raised concerns to our Congressional delegation as well as to the media that the ACA has encouraged the proliferation of insurance plans with huge patient cost-sharing responsibilities and plans with less choice of physicians. This, in turn, has accelerated the trend of physicians feeling forced to leave private practice and becoming part of large health care systems.

At the same time, the ACA has provided the opportunity for hundreds of thousands of our patients in New York to obtain affordable health insurance coverage that previously was not available to them.  Understandably, many are concerned about losing this coverage altogether if the ACA were to be repealed without a suitable replacement. Moreover, there could be huge budget consequences to New York State if funding were to be repealed, which could prompt untenable cuts affecting millions of more New Yorkers.

Given these concerns, MSSNY has urged that any legislation that threatens the availability of affordable health insurance options for our patients must simultaneously specify how these currently available coverage options will be replaced with improved coverage options.

According to news reports, it appears that an increasing number of Congress members, including many in New York’s Congressional delegation representing both parties, have publicly articulated the importance of Congress specifying with what the ACA would be replaced before voting on its repeal.

However, it is still unclear what will happen over the next few weeks and months.  Please be assured that MSSNY will continue to work closely with medical societies across the country as well as the AMA to be a strong advocate for our patients.  Our foremost request is that any proposal to replace the ACA enhance, not reduce, the availability of affordable and comprehensive health insurance options for our patients.

Anything less is unacceptable.

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 comments@mssny.org

Governor Advances Numerous Health Reform Measures for 2017 Session
Governor Cuomo is expected to release his full 2017-18 Executive Budget proposal this Tuesday 1/17 after releasing a 380-page book this week that outlined many of the proposals he intends to pursue in the State Budget and the legislative session.

Among the proposals highlighted include measures that would:

• Combat heroin and opioid abuse and addiction (see related article);
• Contain rising prescription drug prices (see related article);
• Work with business and labor “to come together…on legislation that will deliver a workers’ compensation system that works for everyone”;
• Expand efforts to “end the AIDS epidemic by 2020” (see related article);
• Improving the healthcare system in eastern and Central Brooklyn (see related article) and
• Launching a comprehensive agenda to promote health and wellness through interconnected strategies (see related article).(AUSTER, CLANCY, BELMONT)

MSSNY Lobby Day, March 8 – Plan Now to Be in Albany
MSSNY’s 2017 Annual Physician Legislative Advocacy Day is Wednesday, March 8.  Please hold that day open to join hundreds of your colleagues from across the State in Albany to hear from New York State’s legislative leaders and top health policymakers and to meet with your local legislators to urge that they fix the challenging issues that are confronting our health care delivery system.  To register, click here.
(DIVISION OF GOVERNMENTAL AFFAIRS) 

Governor Announces Proposal to Regulate PBM Practices and Drug Prices
Among the proposals announced by Governor Cuomo that he will pursue during the 2017 Legislative Session was a three-pronged approach to addressing rising prescription drug prices.  The measures would:

• Require Pharmacy Benefit Managers (PBMs) to be regulated in New York beginning in 2019, as well as requiring them to disclose financial incentives or benefits for promoting the use of certain drugs, and other financial arrangements affecting customers.
• Increase drug company rebates to New York State when the price for a particular medication exceeds a certain benchmark for Medicaid; and
• Impose a “surcharge” on companies when prices exceed a certain benchmark, to be dedicated to lowering health insurance premiums.  (AUSTER, BELMONT)

Governor’s Proposal to Combat Heroin/Opiod Abuse Would Require ER I-Stop Checks and Improved Insurance Coverage for Outpatient Treatment
Among the proposals announced by Governor Cuomo in his “State of the State” tour across New York was a 6-point plan to further combat heroin and opioid abuse in New York State. The proposal includes:

• Eliminating prior authorization requirements for insurance coverage of outpatient substance use disorder treatment;
• Adding fentanyl analogs to the New York controlled substances schedule to subject emerging synthetic drugs to criminal drug penalties;
• Increasing access to life-saving buprenorphine treatment by recruiting physicians, physician’s assistants and nurse practitioners to become prescribers;
• Establishing 24/7 crisis treatment centers to ensure access to critical support services;
• Requiring Emergency Department prescribers to consult the Prescription Monitoring Program registry prior to writing controlled substance prescriptions; and
• Creating New York’s first recovery high schools to help young people in recovery finish school
  (AUSTER, CLANCY, BELMONT)

Cuomo Announces the Brooklyn Community Health and Wellness Transformation Initiative
Governor Cuomo proposed a three-point plan to dramatically improve the health care delivery system in central and eastern Brooklyn:

1. Creating affordable healthy foods opportunities and other health
2. Three existing not-for-profit hospitals in the area will work closely with community-based organizations and community health workers to provide non-clinical interventions that increase health, such as mold remediation programs to eliminate environmental triggers of asthma and programs to improve chronic disease management, promote access to healthy food, and create opportunities for physical activity
3. Build new capacity for primary and ambulatory care.

• The Governor is proposing to develop a large primary and ambulatory care network supported by an integrated state-of-the-art health information technology system with a common electronic medical record platform through a community-based healthcare delivery-system.
• The proposal will develop a total of 36 primary and ambulatory care facilities to be built, increasing primary care visits from 300,000 annually to 800,000 annually.

4. Create a new healthcare system by bringing together three independent not-for-profit hospitals in the area into a regional system that will leverage significant operating efficiencies and address the serious life and safety infrastructure issues at each of these hospitals, while restructuring and improving healthcare delivery in the communities of central and eastern Brooklyn. The new health system will also collaborate closely with Downstate University Hospital.  (BELMONT)

Governor’s State of the State Announces Several Proposals on HIV Testing and Treatment
Governor Andrew Cuomo announced several proposals to enhance testing and treating of HIV including the development of new regulations to allow minors to give informed consent for HIV treatment and prophylaxis.   Under current state law, minors can consent to STD and HIV testing and for treatment for STDs without parental consent.   Parental consent for HIV treatment is not permitted in the statute.

Additionally, as part of the Governor’s Efforts to End the AIDS Epidemic by 2020, the governor will propose, through legislation, to require emergency department and urgent care facilities to provide emergency non-occupational Post Exposure Prophylaxis (nPEP )following a potential non-occupational exposure to HIV.   The governor will alsoadvance legislation requiring the electronic reporting of filled HIV antiretroviral therapy prescriptions dispensed with New York State to monitor the number of persons who are taking prescribed antiretroviral therapy.               (CLANCY)

Governor’s State of the State Advances “Health Across All Policies” Initiative
To make New York the healthiest state in the nation, Governor Andrew Cuomo will advance a “Health Across All Policies” initiative where each state agency is directed to take into account how agency actions can have a positive impact on public health.   The State of the State message specifically highlights the NYS Prevention Agenda and calls on the Public Health and Health Planning Council and the Ad Hoc Committee to Lead the Prevention Agenda to work together to advance a Health Across All Policies initiative.

Physicians from the Medical Society of the State of New York have worked with the NYS Department of Health in setting the Prevention Agenda.   Kira Geraci-Ciardullo, MD, MPH,  is the MSSNY representative on the Ad-Hoc Committee for the Prevention Agenda.   Also involved in helping develop the Prevention Agenda are MSSNY Preventive Medicine and Family Health Committee chair, Geoffrey Moore, MD; and committee members Nina Huberman, MD, vice chair; Frank Dowling, MD; Sheila Bushkin, MD.   At the November meeting, members of the Ad-Hoc Committee discussed with DOH Commissioner Howard Zucker, MD, and with Deputy Secretary for Health Paul Francis, the need to implement this type of initiative to improve the health of all New Yorkers.  (CLANCY)

Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!

$50 Million Investment in Montefiore Health System to Expand Affordable Healthcare
Governor Cuomo proposed investing $50 million in Montefiore Health System.  According to the Governor’s press release, the funding will be used to “extend its healthcare delivery model to other parts of the Bronx and lower Hudson Valley.”                                   (Belmont) 

President-Elect Trump Promises Swift Repeal and Replacement
In a news conference this week, President-Elect Donald Trump said that Republicans will introduce proposals to repeal and replace Obamacare as soon as Health and Human Services secretary, Tom Price, is approved.  His confirmation hearings will begin next week.  “We’re going to be submitting — as soon as our secretary’s approved, almost simultaneously, shortly thereafter, a plan. It’ll be repeal and replace. It will be essentially simultaneously,” Trump said. “Probably the same day, could be the same hour.”  As reported last week, MSSNY wrote to the New York Congressional delegation  to express concerns with proposals that would repeal ACA funding streams for insurance coverage without simultaneously specifying what they will be replaced with, as well as concerns with the impact to New York patients and the New York State Budget.

Moreover, MSSNY President-Elect Charles Rothberg, MD, was interviewed about these concerns on News 12, Long
Island.                                                                                                                (BELMONT, AUSTER)

Let’s Make Sure They Hear Us
MSSNY will continue to work elected officials and leaders of any party to enhance the availability of affordable and comprehensive health insurance options for patients and prevent cuts to critical federal funding provided to New York State.  At this time, it is not clear what legislation will be enacted by Congress to replace the ACA but we have to make sure our voices and health care expertise are heard.                                                                             (BELMONT)

Help Us Fight by Joining MSSNYPAC and becoming a MSSNY Member Today

AG Schneiderman Propsosed Expanded Insurance Coverage for Contraceptives
New York Attorney General Eric Schneiderman this week announced his development of draft legislation to protect and enhance New Yorkers’ access to cost-free contraception. The stated purpose of the legislation is to ensure the continuation of insurance coverage for contraception in New York were the ACA to be repealed.  To read the AG’s press release, click here. 

Among the provisions in the draft legislation:

• Require state-regulated health insurance policies to provide cost-free coverage for all FDA-approved methods of birth control, including emergency contraception;
• Prohibit insurance companies from “medical management” review restrictions that can limit or delay contraceptive coverage.
• Require coverage of men’s contraceptive methods and bring their insurance coverage in line with the benefits enjoyed by women; and
• Permit the provision of a year’s worth of a contraceptive at a time.

The press release included statements of support from several state legislators and advocacy groups, including ACOG.                                                                                                      (AUSTER, CLANCY)

Register Now For A January 26 Lunchtime Program to Discuss the Medicare MIPS Program
The Medicare MACRA/MIPS program has now gone into effect.  Do you and your staff want to learn more regarding what you need to know to comply with this new program that could have a significant impact on your revenue from Medicare?  Please join us for a webinar on Thursday January 26, from 12:30 – 1:30, where you will hear from Frank Winter of New York Regional Office for CMS present important information about this new program for physicians and their staffs.  To register Click Here.

Upon your registration, you will receive a confirmation e-mail with instructions for joining this session either by webinar or conference call.  (AUSTER)

MSSNY Attends Forum on the Future of Health Care
The Empire Center for Public Policy hosted a forum to discuss New York’s Health Care Reform Act, the future of the Affordable Care Act and the impact on New York’s state budget. Speakers and panelists included Assembly Health Committee Chairman Gottfried, the New York State Medicaid Director Jason Helgerson, and Tom Wickham, the top health care policy staff  to the Senate Majority.  There was also a panel discussion regarding the future of HCRA that included representatives of health plans and hospital associations.  Robert Hinckley, Senior Vice President and Chief Strategy Officer, Capital District Physicians’ Health Plan (CDPHP), noted that more is spent on pharmacy than on doctors under their health insurance plans.  (BELMONT) 

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York will continue its Medical Matters webinars this coming Wednesday, January 18, 2017 at 7:30 a.m. with Triage in a Disaster Event.   Arthur Cooper, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Zachary Hickman, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Register for this webinar here then click on “Upcoming”.

Educational objectives are: 1) Describe the importance of immediate bleeding suppression during a disaster event; 2) Describe the SALT methodology for triage and where to access SALT training; 3) Recognize the importance of not just general triage training, but triage training for bio-events as well.

Medical Matters continues 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 caring for victims of an active shooter/bombing event; and 2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event; and 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

A copy of the flyer can be accessed here.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.  

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:

State Expanding Clinicians’ Course Offerings for Marijuana Program
New York is expanding its course offerings for clinicians and pharmacists who want to participate in the state’s medical marijuana program. The state has awarded a two-year contract to TMCI Global to offer an alternate version of the 4.5-hour online course that’s required for clinicians to register to prescribe cannabis in New York. It will become available in mid-2017. The state also secured a two-year contract with the current course vendor, the Answer Page.

On a related topic, Vireo Health is planning to start home delivery service of medical marijuana to consumers in New York City, Long Island and Westchester County within the next 90 days.

AMA: Five Issues Physicians Will Take to State Legislators in 2017
A survey of more than 65 state and specialty societies revealed the top issues to be addressed in 2017 include Medicaid, the nation’s opioid epidemic, private payer reforms, and numerous public health issues.

The annual AMA State Legislative Strategy Conference was held in Amelia Island, Fla., where physician leaders met to discuss state legislative and regulatory issues that will occupy their efforts in the months to come. Five issues rise to the top of the queue.

·    Strengthening Medicaid

Many states are preparing for debates this year over the future of Medicaid expansion. Also, on the agenda for state medical associations will be advocating for responsible Medicaid reforms that improve patient access and quality of care.

• Reducing the nation’s opioid epidemic

Physicians across the nation will keep up their efforts to reverse the opioid misuse, overdose and death epidemic. Much of the legislation focuses on mandated prescription drug monitoring program (PDMP) use (New York’s program is a model), physician education, substance-use disorder treatment, guidelines or restrictions on prescribing controlled substances.

• Advancing physician-led team-based care

The AMA’s Advocacy Resource Center tracked more than 450 scope-of-practice bills last year and included in those bills were provisions to establish a framework for physician-led team-based care. Several states will consider AMA model state legislation, which encourages flexible, innovative health care teams under a framework of physician leadership. The AMA’s STEPS Forward™ collection of practice improvement strategies offers several modules to help physicians move their practices toward physician-led team-based care, including instructions on the implementation of team meetings, team documentation and strengthening team culture.

• Provider network issues

As provider networks continue to narrow and patients’ financial responsibility for their health care continues to increase, the issues of network adequacy and out-of-network care will continue to be a focus in many state legislatures in 2017. Physicians are having discussions with key stakeholders across the country about how to ensure access to quality and affordable care for their patients while maintaining their ability to enter into fair contract negotiations.
Improving public health State legislatures continue to debate highly politicized issues, such as vaccines, firearm safety, reproductive health and many others. Assaults on the patient-physician relationship will continue in many states with legislation that attempts to decide what can and cannot be discussed in the exam room.

State and national medical societies will be targeting a long list of additional issues such as diabetes prevention, decreasing cardiovascular disease, infectious disease prevention, obesity, student-athlete concussion and cardiac laws, women’s reproductive rights, tanning restrictions for minors and many others.

The top issues that will affect physicians in 2017
Health insurance coverage and access
Implementation of new Medicare pay system
Reversing the opioid epidemic
Prescription drug pricing
EHR interoperability
Regulatory relief

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

MLMIC: Latest Developments in NY’s Medical Malpractice Marketplace
As reported by Politico New York, one of New York’s major malpractice insurance carriers “continues to struggle financially, reporting significant losses through the end of the third quarter.” This news, along with disciplinary action from the Joint Commission on Public Ethics, has raised legitimate concerns.

Instability of a large provider creates some uncertainty for the entire market, of course, but we want to assure MLMIC policyholders that their coverage is not at risk. By adhering to responsible underwriting practices from our beginning, MLMIC continues to demonstrate sound financial condition and is able, once again, to offer a policyholder dividend (20% for those insured by May 1 and continuously insured through July 1).

We’ll keep monitoring the situation in the market on your behalf and will apprise you of further developments. In the meantime, if you have questions, please call 1 (888) 488-9253.

Fourth and Fifth District Retreat on January 27 -29 at Lake Placid
Third and Fourth  District Retreat on Friday (8am) January 27 to Sunday (9am) January 29 at the Mirror Lake Inn in Lake Placid. Call for reservations (518) 523-2544. More information here.

BREAKING: ICD-10 Glitch Leads CMS to Relax Physician Quality Penalties
The CMS issued a two-year pass to physicians and group practices because of a glitch with quality reporting measures based on a recent update to the ICD-10 diagnosis and procedure codes.

Note, this is not across the board.  Only certain specialties and procedures will be impacted by this waiver of negative payment adjustments.  The majority of ICD-10-CM coding changes that impacted 2016 PQRS measures were related to diabetes, pregnancy, cardiovascular, oncology, mental health and eye disease diagnosis.

In addition, it will be up to CMS to decide if the payment adjustment should or should not be applied.  CMS will perform an analysis after the close of the 2016 PQRS reporting period and CMS will review the submissions to determine which group practices and EPs were negatively impacted by the ICD-10-CM coding changes. The group practices and EPs affected by the impact of the ICD-10-CM code updates will be removed from the PQRS payment adjustment prior to the release of feedback reports.

Registries, Qualified Clinical Data Registry (QCDR) and Electronic Health Record (EHR) vendors should calculate the measures as defined in the 2016 measure specifications and utilize the calculated measures data in their submission on your behalf. CMS determined that there has been minimal impact to the Group Practice Reporting Option (GPRO) Web Interface measures due to the assignment and sampling process. Therefore, those PQRS group practices and Accountable Care Organizations (ACOs) reporting via the GPRO Web Interface will not be impacted by the ICD-10-CM code updates. If you receive a payment adjustment and believe it is due to ICD-10-CM code updates, you have the option to submit a request for an informal review of the payment adjustment.

For more information, please click here. Please be sure to review the FAQs referenced on the bottom of this website.

Save the Date: Annual Joint Meeting of YPs, Resident/Fellow, Medical Students

When:  Saturday, February 11, 2017

Where: Marriott Courtyard, 1800 Privado Road, Westbury NY 11590.

Presentations will include “Telemedicine/Telehealth: Tools for Clinical Practice and Patient Engagement.” Gain a better understanding of and appreciation for the use of telemedicine as part of a patient management strategy that will improve and increase access to treatment, lower costs, and more effectively engage patients.

We will also present important financial planning strategies and tips specifically for younger physicians, including Student Loan Management, Main Financial Issues to Address in Residency and as you Transition to Practice, Asset Protection Strategies and Risk Management, and more. Click here for agenda.

Policy will be created, elections will be held.

YPS and RFS register at sbennett@mssny.org; MSS register at mreyes@mssny.org. 

CMS Releases 2017 QPP Quality Measure Benchmarks
If a physician or practice plans to participate in 2017 Quality Payment Program (aka MIPS) with the goal of receiving a bonus in 2019 it is highly recommended that they review the recently released 2017 QPP Measure Benchmark information. The 2017 quality benchmark information does not apply to physicians who only plan to participate in 2017 to avoid a 2019 penalty (submit one measure, one time in 2017). 

The 2017 CMS QPP benchmark information was released late last week and posted to the CMS QPP website. The benchmark calculations for the 2017 performance year use data that was submitted for PQRS in 2015 by clinicians that were a Quality Payment Program provider type eligible for MIPS and were not newly enrolled in 2015, or groups with at least 1 such clinician. When a clinician submits measures for the QPP Quality Performance Category, each measure is assessed against its benchmarks to determine how many points the measure earns. A clinician can receive anywhere from 3 to 10 points for each measure (not including any bonus points).

Benchmarks are specific to the type of submission mechanism: EHRs, QCDRs/Registries, CAHPS and claims. For CG-CAHPS, the benchmarks are based on two sets of data, 2015 PQRS CAHPS and 2015 ACO CAHPS data. Submissions via CMS Web Interface will use benchmarks from the Shared Savings Programs.

CMS Releases Patient Facing Encounter Codes
Late last week CMS released and posted to the QPP website the list of patient-facing encounter codes. The list is used to determine the non-patient facing status of MIPS eligible clinicians. Given the flexibility in program requirements for non-patient facing clinicians, the encounter codes are critical for CMS to identify MIPS eligible clinicians. A non-patient facing MIPS eligible clinician is:

• An individual MIPS eligible clinician that bills 100 or fewer patient-facing encounters (including Medicare telehealth services defined in section 1834(m) of the Act) during the non-patient facing determination period, and
• A group provided that more than 75 percent of the clinicians billing under the group’s TIN meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period.

The list of patient-facing encounter codes are categorized into three overarching groups of codes (Evaluation and Management Codes; Surgical and Procedural Codes, and Visit Codes). The utilization of Evaluation and Management Codes, Surgical and Procedural Codes, and Visit Codes classifies MIPS eligible clinicians as non-patient facing and patient-facing.

AMA-IMG Section Governing Council Nominations Due Feb. 17
Nominations are being accepted for the 2017 AMA-IMG Section Governing Council election to fill two vacancies.

Consider nominating a colleague or, if you have leadership experience, consider nominating yourself for this important upcoming governing council election.

The AMA-IMG Section Governing Council positions carry three-year terms. Council nominees must be:

• An AMA member
• Able to attend the AMA Annual Meeting in June, Interim Meeting in November and a separate meeting in the spring
• Committed to their governing council service, able to participate in evening teleconferences and have proficient computer knowledge
• Available to serve as chair of an AMA-IMG Section committee

Nominations are being accepted now through Friday Feb. 17. Be sure to submit your nomination form, bio sketch and photo (JPEG format) to img@ama-assn.org by midnight Friday, Feb. 17.  Submission of a letter of support from an organization is optional.

Visit https://www.ama-assn.org/about-us/international-medical-graduates-sectionimgs-leadership-opportunities to obtain your nomination and bio sketch forms. If you have questions, contact carolyn.carter-ellis@ama-assn.org for assistance.

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Physician Opportunities

CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355