MSSNY eNews: July 19, 2020 – MSSNY Tough in Tough Times

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MSSNY in Action:  The Cliff Note Version
This week brings some good news in New York as our infection rates, hospitalization rates and death rates and from COVID-19 continue to decline amidst reopening the state. As we, as a profession, settle into new practice paradigms, I know that our email inboxes have often suffered from neglect. With that in mind, this week’s column aims to provide a quick update on society activities.  Throughout the crisis MSSNY has been in daily contact with the Governor’s office, the DOH and our state legislature providing input, seeking help, and getting the changes necessary for physician practices to see patients. We were successful in getting rapid changes to payment for telehealth, immunity for COVID treatment, pushing to get elective surgery and care reinstituted throughout the state, practical changes to everything from COVID testing requirements to changes in the date for completion of the mandated pain management course and innumerable other needed small and large flexibilities.

Your MSSNY has written articles, emails, done press releases, given testimony, written letters to our Governor, our congressional delegation, and other national leaders.  We have also given print and TV interviews on the plight of our physicians that have aired locally and nationally. We have done 2 polls on the economic impact of COVID-19 on physician practices in NY that have garnered significant press and our data was corroborated by a Fair Health report released this week. MSSNY has also given testimony to our NY State Senate and Assembly, most recently on Wednesday, on the economic impact on physician practices and the need for additional funds to be made available to sustain them.

Throughout the crisis and now during re-opening, we have reiterated to our State Government the very important roles that our physicians and our medical society have played.  MSSNY has repeatedly stressed that all state task forces dealing with healthcare must include practicing community physicians and that not doing so is to the detriment of the health and wellbeing of NYS residents.

Our May member email on physician PPE needs resulted in over 700 responses. MSSNY has taken this issue extremely seriously and continues to pursue every angle to get NY physicians the needed, affordable, reliable supplies necessary to take care of their patients and keep their offices open. National shortages persist, there are significant delivery delays and the major manufacturers will not sell directly to the society. We have been in contact with the Governor’s office, our NYS legislature, the major manufacturers, distributors, Vice President Pence, Congress, and the AMA.  We have made our members aware of the many counterfeit products on the market and have been sending out information on availability of legitimate sources as we hear of them; all while directly trying to procure PPE. Within the past week alone we have spoken with the NYS legislature about mandating insurers to cover the increased cost of PPE, done an interview that will air nationally, spoke with numerous distributors and sent letters to the AMA Chief Executive, Dr. Madara, our NYS health commissioner, Howard Zucker, and to our congressional delegation.

Through everything, the health and wellbeing of our physicians is of paramount importance. We have all been through a lot personally and professionally and many of us need an ear to listen and a colleague to lean on. MSSNY is here for you. Our helpline is up and running at 518-292-0140 and our first class of Peer to Peer supporters has been trained.

While these are the Cliff Notes, MSSNY has outsized, ongoing efforts on a multitude of fronts to help sustain you and your practice and to move our society forward.

Bonnie Litvack, MD
MSSNY President

MSSNYs Weekly Podcast

Notes from Governor Cuomo’s COVID-19 Final Daily Address

DATA:

– 1,284 total hospitalizations.

– The state conducted 79,000 tests yesterday.

– We continue to have the lowest infection rate since the beginning of the outbreak.

– 25 lives lost yesterday. 

GOV PERSPECTIVE:

– Gov thanked all those involved in COVID-19 mitigation efforts.

– Gov shared a story about his daughter missing her graduation ceremony, and how he similarly regrets not celebrating the unveiling of the new state seal.

– “Why did it take a crisis to bring us together?”

MSSNY Statement on U.S. Supreme Court’s DACA Ruling
Statement Attributable to:
Bonnie Litvack, MD
President, Medical Society of the State of New York

“Yesterday’s US Supreme Court decision will allow medical students and medical residents with Deferred Action for Childhood Arrivals (DACA) status to continue their education and training in the United States.

“The Medical Society of the State of New York (MSSNY) believes that this action by the Supreme Court will help medical schools and teaching hospitals to produce a diverse and culturally responsive health care workforce to meet the needs of underserved populations, improve cultural awareness, and promote health equity.

“As this nation’s population grows and becomes much more diverse, it is crucial that the physician workforce reflect the changing demographics of the country to mitigate racial, ethnic, and socioeconomic health disparities.

“The Medical Society of the State of New York urges that Congress work towards a permanent resolution for the individuals here in this country under DACA.”

MSSNY Chairman of the Board and Past President Dr. Kleinman in JAMA on Crushing Effects of COVID-19 on Medical Practices
In a JAMA article about the crushing effects of COVID-19 on medical practices across the country, Andrew Kleinman, MD, a past president of MSSNY, said “Unfortunately, I think this [pandemic] is going to accelerate the closure of the smaller practices. With a lot of practices, 40% or more of their revenue goes just to overhead.”

In a survey of 558 US primary care physicians fielded May 29 through June 1—nearly 3 months into the pandemic—6% of respondents said their practices were closed, perhaps temporarily, and 35% said they’ve furloughed staff, according to the nonprofit Primary Care Collaborative (PCC) and the Larry A. Green Center.

Dr. Kleinman, a past president of the Medical Society of the State of New York, said he reduced his malpractice coverage to half-time, but he still had to pay two-thirds of his prepandemic premium. “For a plastic surgeon, it’s still expensive when there’s no income.” And he still had to pay other overhead costs—phones and electronic medical records, to name 2—for his temporarily closed practice.

“If this happened to me 20 years ago, I would be bankrupt,” said Dr. Kleinman, who, at age 66 years, was able to draw on savings to help his practice survive. “When this whole thing started, I strongly considered just retiring now.” While he’s heard of physicians retiring early rather than waiting out the pandemic, Kleinman said, he decided he’s not yet ready to follow suit.

Have You Used Your MSSNY Member Benefits Lately?

HHS Portal Now Open for Eligible Physician to Apply for CARES Act Grant funds
As noted in the MSSNY e-news a few days ago, the US Department of Health and Human Services (HHS) announced it will distribute approximately $15 billion to eligible physicians and organizations that a)  participate in state Medicaid and CHIP programs and b) have not received a payment from the Provider Relief Fund General Allocation established in the CARES Act.  Last evening, HHS opened the portal that will allow these eligible physicians to report their annual patient revenue data and other necessary information to receive a payment equal to at least 2% of reported gross revenues from patient care.

To apply, click here.

For an HHS FAQ regarding who may be eligible for this distribution, click here.

PAI Releases Independent Physician Survey on High-Deductible Health Plans
A survey of independent physicians from the Physicians Advocacy Institute (PAI), conducted by NORC at the University of Chicago, shows the challenges in patient care caused by high-deductible health plans.

Before the COVID-19 pandemic hit the United States, patients’ large and growing share of out-of-pocket healthcare costs posed challenges for individuals, families, and independent physicians. When the epidemic became a pandemic, the federal government and certain insurance companies acted quickly to make coronavirus-related care widely accessible by ensuring it was affordable to everyone who needed it.

Key findings include:

• 79 percent of physicians believe that high health insurance deductibles are a key driver of patients’ cost concerns.
• 80 percent of physicians believe their patients often or sometimes refuse or delay care due to cost concerns.
• More than half of physicians report that patient delay of care caused capacity or schedule issues for their practice.
• 77 percent of providers say it takes more than a month to receive any payment.
• Three out of four physicians say they do not have most of the information they need in order to have cost of care discussions with patients
• Most physicians say their office staff spends more than 300 hours per year educating patients on their coverage.

More information on the study is available on PAI’s website.

Veterans Matters Podcasts
Check out MSSNY’s Veterans Matters podcast series on Veterans’ healthcare topics including PTSD in Returning Veterans, TBI in Returning Veterans, Substance Use in Veterans, Suicide in Veterans, The Special Mental Health Needs of Women Veterans and Military Culture: Everything Physicians Need to Know about Veterans as Patients.

Click here to listen to Part 1 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to Part 2 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to TBI in Returning Veterans with Dr. David Podwall.

Click here to listen to Substance Use Disorders with Dr. Thomas Madejski.

Click here to listen to Suicide in Veterans podcast with Dr. Jack McIntyre.

Click here to listen to The Special Mental Health Needs of Women Veterans with Dr. Malene Ingram, Colonel, U.S. Army Reserves and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.

Click here to listen to Military Culture: Everything Physicians Need to Know about Veterans as Patients with Retired Lieutenant Colonel, U.S. Army, Lance Allen Wang and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.

Third COVID-19 Study Released by FAIR Health
In April 2020, in the midst of the COVID-19 pandemic, healthcare professional services declined 68 percent in utilization and 48 percent in revenue based on total estimated in-network amounts compared to April 2019 nationally.

In the Northeast, the region hit hardest at that time by the pandemic, professionals experienced particularly sharp drops in utilization (80 percent) and revenue (79 percent) in April 2020. These are among the findings of FAIR Health’s third COVID-19 study, Healthcare Professionals and the Impact of COVID-19: A Comparative Study of Revenue and Utilization

June 29, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open Questions & Answers Surrounding the COVID-19 Pandemic
Registration is now open for MSSNY’s next webinar related to the COVID-19 pandemic.  Medical Matters: Questions & Answers Surrounding the COVID-19 Pandemic on Monday June 29^th at 7:30am.  Faculty for this program is William Valenti, MD, Arthur Cooper, MD, Marcus Friedrich, MD and Elizabeth Dufort, MD.

Educational objectives:

• Identify frequently asked questions surrounding the COVID-19 pandemic
• Examine the dynamic circumstances encompassing COVID-19

Click here to register

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org or go to the MSSNY podcast site and listen to the COVID-19 related podcasts available at https://www.buzzsprout.com/51522.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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.

SBA Revised Paycheck Protection
This week, the U.S. Small Business Administration, in consultation with the U.S. Department of the Treasury, posted a revised, user-friendly Paycheck Protection Program loan forgiveness application implementing the PPP Flexibility Act of 2020. In addition to revising the full forgiveness application, the SBA also published a new “EZ” version of the forgiveness application applying to borrowers who:

• Are self-employed and have no employees; OR
• Did not reduce the salaries or wages of their employees by more than 25%, and did not reduce the number or hours of their employees; OR
• Experienced reductions in business activity as a result of health directives related to COVID-19 and did not reduce the salaries or wages of their employees by more than 25%

“This is great news for small businesses,” said SBA Regional Administrator Steve Bulger, who oversees agency operations in the Atlantic and Mid-Atlantic regions. “The EZ application requires fewer calculations and less documentation, which makes the process much less intimidating. I’m sure this will go a long way toward improving access and helping us distribute the remaining PPP appropriations to support small business owners and their employees.”

Details regarding the applicability of these provisions are available in the instructions to the new EZ application form.  Both applications give borrowers the option of using the original 8-week covered period (if their loan was made before June 5, 2020) or an extended 24-week covered period.  These changes will result in a more efficient process and make it easier for businesses to realize full forgiveness of their PPP loan.

Click here to view the EZ Forgiveness Application.

Click here to view the Full Forgiveness Application.

MSSNY Helpline for Physicians Experiencing COVID-19 Related Stress 518-292-0140