MSSNY eNews: July 30, 2021 – No Surprises Act Update
No Surprises Act Update
MSSNY is fighting for physicians and patients over new federal rules implementing the No Surprises Act (NSA), the new federal law that limits surprise and emergency medical bills from out-of-network doctors, hospitals, and other providers. Federal regulators recently issued an interim final rule to become effective in September 2021. The new rule is the first of several rules that federal regulators will be issuing to implement the NSA.
In drafting the new rule, federal regulators made choices that may result in lower payments to physicians.
MSSNY is working with the AMA and national specialty societies to push back on the new rule, including speaking to federal regulators and submitting formal written comments. Last week, MSSNY representatives Dr. Michael Brisman and MSSNY Executive VP Troy Oechsner spoke with U.S. Treasury Department leaders. As former regulator for the NY Department of Financial Services, Mr. Oechsner spoke of New York’s success in our state’s physician-friendly Surprise Billing Law, which MSSNY helped pass and which ensures both physicians and patients are treated fairly. Dr. Brisman and Mr. Oechsner pointed to the importance of adequate physician payments to ensure patient access, particularly at rural or urban facilities that rely on out-of-network physician coverage.
One example of how the new rule may result in lower payments to physicians is the method for calculating the qualifying payment amount (QPA), which is a sum used in part to determine patient cost sharing and considered in the independent dispute resolution (IDR) review of payment conflicts between insurers and out-of-network physicians or other care providers. Federal regulators chose a formula that keeps the QPA low by giving insurers certain flexibilities in calculating the QPA, in part by using broad definitions of “markets” and “geographic regions,” allowing reliance on small data sets, and low benchmarking for “new service codes” as well as by reducing the role of bonuses, risk sharing, penalties, and other incentive-based and retrospective payments or payment adjustments.
MSSNY is advocating for physicians and patients ahead of the second round of federal regulations, which are expected to address the IDR process, price comparison tools, and certain transparency requirements. These rules may be the most crucial. MSSNY will be working with the AMA and specialty societies to insist on rules that allow physicians to present a broad range of comparable costs such as the Usual Customary Rate and allow the IDR to weigh evidence equally.
More to come as our fight for you continues.
Joseph Sellers, MD, FAAP, FACP
FDA Authorizes Extension of the Shelf Life for J&J COVID-19 Vaccine
On July 29, 2021, the U.S. Food & Drug Administration (FDA) authorized an extension of the shelf life for the Janssen/Johnson & Johnson (J&J) single-shot COVID-19 vaccine by 45 days, from 4.5 months to 6 months. The decision is based on data from ongoing stability assessment studies, which have demonstrated that the vaccine is stable at 6 months when refrigerated at temperatures of 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius). This extension applies to refrigerated vials of J&J/Janssen COVID-19 vaccine that have been held in accordance with the manufacturer’s storage conditions.
Vaccination providers that have J&J vaccine in storage must:
- Visit https://vaxcheck.jnj/ and enter the lot number to get the latest expiration date.
- Mark the vials and carton with the new date displayed and also update the date in the NYSIIS or CIR inventory module.
- Determine if any vaccine has expired: If you have vaccine in storage that has an expiration date prior to July 29, 2021 (based on the most current expiration date), those vials should be disposed of as medical waste and reported as wastage in NYSIIS/CIR (see NYSIIS wastage reporting guidance here).
ACOG and SMFM Recommend COVID-19 Vaccination for Pregnant Individuals
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), the two leading organizations representing specialists in obstetric care, recommend that all pregnant individuals be vaccinated against COVID-19. The organizations’ recommendations in support of vaccination during pregnancy reflect evidence demonstrating the safe use of the COVID-19 vaccines during pregnancy from tens of thousands of reporting individuals over the last several months, as well as the current low vaccination rates and concerning increase in cases.
Data have shown that COVID-19 infection puts pregnant people at increased risk of severe complications and even death; yet only about 22% of pregnant individuals have received one or more doses of the COVID-19 vaccine, according to the U.S. Centers for Disease Control and Prevention.
In making the strong recommendation in support of vaccination during pregnancy, both national organizations emphasize concerns about significant increases in COVID-19 cases due to the Delta variant and the regional low rates of vaccination in states across the country. Recent data have shown that more than 95% of those who are hospitalized and/or dying from COVID-19 are those who have remained unvaccinated. Pregnant individuals who have decided to wait until after delivery to be vaccinated may be inadvertently exposing themselves to an increased risk of severe illness or death. Those who have recently delivered and were not vaccinated during pregnancy are also strongly encouraged to get vaccinated as soon as possible.
$790 in Annual Savings for MSSNY Members: CareClix Telemedicine Platform
MSSNY members receive the discounted rate of $50 per month for the license fee with no start-up costs—for a total of $790 in savings.
The CareClix user-friendly HIPPA compliant platform enables physicians to conduct routine virtual visits with patients in any location. With CareClix you can:
- Add Value to Your Practice
- Maximize Billing
- Eligibility Checks
- Promote Patient Satisfaction
- Reduce Cancellations and No-Shows
- Integrated EHR
For clinical practices lacking the capacity to manage their own CCM programs, CareClix also provides a white-labeled, turn-key CCM service. This enables even the smallest community hospitals to provide CCM services for their seniors. Caring for the patients most-at-need requires vigilance and improved access.
CareClix believes that implementing and managing a CCM program requires much more than just a traditional telemedicine platform with videoconferencing. Our platform includes a comprehensive Chronic Care Management module. This includes out-of-the-box integration for 200+ devices, covering all major key vital signs used in CCM. Our platform easily integrates with our partners’ EMR systems, and we have a team that includes practicing physicians and experienced implementation experts.
Are You a Dave Matthews Band Fan? Win 2 Tickets to Concert at Saratoga Performing Arts Center on September 18th!
Through the generosity of MSSNY members Dr. Gregory Pinto and Dr. Natalie Adler of Saratoga, MSSNYPAC donors can enter to win two lawn seats for the Dave Matthews Band concert on Saturday, September 18, 2021 at 7:30 pm at the Saratoga Performing Arts Center.
Registration and qualified entry are required. To register, text MSSNYPAC DMB to 52886 and follow the prompts. To qualify, donate $100 to MSSNYPAC for each entry. A single winner will be chosen on 9/8/21 among registrants who have donated $100 or more to MSSNYPAC between 9/14/20 and 9/7/21.
The higher your donation, the greater your chances to win! Join, renew, or increase your membership today! Contact Jennifer Wilks at firstname.lastname@example.org or 914-933-7722 with any questions.
Mental Health Disorders Tied to Increased Risk of COVID-19 Related Mortality, Review Finds
MedPage Today (7/27, Grant) reports, “Mental health disorders were associated with an increased risk of COVID-19-related mortality, according to a systematic review and meta-analysis of 16 studies from seven countries.” Researchers “noted that although they were able to determine the associations between severe mental health disorders and risk of COVID-19 mortality, it wasn’t possible to identify significant differences between specific mental health disorders.” The review was published in JAMA Psychiatry.
80% of Female Surgical Residents Face Gender Bias & 4 More Study Findings
Women in surgical residency programs are far more likely to experience discrimination or sexual harassment than their male peers, a study published July 28 in JAMA Surgery found.
Researchers surveyed 6,764 residents enrolled in 301 general surgery programs nationwide about their experiences with gender discrimination and sexual harassment during the 2018-19 academic year.
- About 80 percent of female residents reported experiencing gender discrimination, compared to 17.1 percent of male residents.
- The most common type of gender discrimination was being mistaken for a nonphysician 一 often by patients or family members 一 with 77 percent of female residents reporting the experience. Just 4 percent of male residents reported the same.
- Women who were pregnant and men who had children were more likely to experience discrimination.
- Female residents were more likely to experience sexual harassment (42.5 percent) compared to male residents (21.5 percent).
- The most common form of harassment was crude, demeaning or explicit comments reported by 37.3 percent of female residents and 19.5 percent of male residents.
To view the full study, click here.
–Bean, Becker’s Hospital Review
Nearly 4 in 10 US Physicians Have Side Gigs: 6 Medscape Survey Findings
Nearly 4 in 10 U.S. physicians have side gigs, or “side hustles,” indicating a continued trend of physicians pursuing a passion project or an additional way to make income, according to a new report from Medscape.
The report, released July 14, is based on a survey of 2,533 physicians, conducted March 5 through May 14.
Six survey findings:
1. Thirty-seven percent of survey respondents reported a side gig, compared to 63 percent who did not.
2. Forty-five percent of survey respondents who have a side gig said financial losses from the COVID-19 lockdowns prompted them to pursue a side gig.
3. Forty-eight percent of survey respondents who have a side gig cited earning extra money as the main goal for their side gig.
4. Consulting, being an expert witness, or chart review were the most popular medically related side gigs.
5. Real estate and investing advice were the most popular nonmedical side gigs.
6. Seventy-two percent of survey respondents who have a side gig said their side gig is equally or more fulfilling than their primary job.
Read more about the survey here.
–Gooch, Becker’s Hospital Review
Classified Ads Available for:
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302
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Health Research, Inc. (HRI) has a job opening within the AIDS Institute’s Office of the Medical Director for a Public Health Physician II. Please distribute this announcement widely through your networks. Interested individuals can apply for this position through the HRI website.
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