March 17, 2017 UnitedHealthcare Council: Any Questions?
Dr. Malcolm Reid
|March 17, 2017
UnitedHealthcare Physician Advocacy Council: Any Questions to Ask Them?
As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council. MSSNY has FOUR physician members who are on the UHC PAC. The Committee meets FOUR times a year with similarly named physicians from United. One criteria for being on this group is that the physician must be participating with United.
We are meeting again on Tuesday, March 28 and need your input.
MSSNY is asking members if they have specific issues with United that we can address and advocate for on your behalf. If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics. Please state the subject as “UHC PAC Item,” and send your email to firstname.lastname@example.org MSSNY email is not HIPAA-secure, so please do NOT include any PHI! The Committee addresses any issue of contention, either operational or administrative, in dealing with United.
While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed. Optimistically, the discussion should then lead to a resolution of the issues.
The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC. MSSNY Surveys indicate that most of our members participate with UnitedHealthcare; I am certain that many of you have had issues that are discussion worthy.
To ensure that the Council is successful, we need your participation.
Please send your comments to email@example.com
Senate And Assembly Advance One-House Budget Proposals; 3-Way Negotiations To Begin
This week, the New York State Assembly and Senate each released and passed their respective proposals to amend the Governor’s proposed State Budget for 2017-18. The passage of these resolutions identifying key priorities sets the stage for 3-ways negotiations with the Executive to pass an agreed upon budget before the deadline of April 1, 2017. To view a chart of key changes to the Executive Budget click here. Some of the important provisions contained in these proposals of interest to physicians and their patients:
- Both the Assembly and Senate rejected an Executive Budget proposal opposed by MSSNY that would require a physician to receive a “tax clearance” as a pre-condition of receiving Excess medical malpractice insurance coverage. Both Houses accept the Executive’s recommendation, supported by MSSNY, to continue funding the program at historical levels.
- Both the Assembly and Senate rejected an Executive Budget proposal opposed by MSSNY that would have permitted pharmacists to enter into “comprehensive medication management protocols” with nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy.
- Both the Assembly and Senate rejected the Executive Budget proposal opposed by MSSNY that would repeal “Prescriber prevails” protections in fee for service Medicaid and for several drug classes in Medicaid managed care. Instead, the Assembly proposes to expand “prescriber prevails” across the entire Medicaid managed care program.
- The Assembly rejected the Executive Budget proposal opposed by MSSNY to create a Regulatory Modernization Team. The Senate included language to establish a workgroup but narrowed the scope, deleting the topic included in the Executive Budget proposal of revising “scope of practice” laws and deleting provisions that would give power to various agency commissioners to implement demonstration programs without the need for legislative approval.
- The Assembly included an Executive Budget proposal supported by MSSNY to require the registration of PBMs and to disclose financial incentives to the State. The Senate did not include this provision, instead requiring PBMs to disclose information to the health plans they contract with.
- The Assembly included a proposal included an Executive Budget proposal supported by MSSNY to regulate vapor products under the “Clean Indoor Air” Act and to tax these products. The Senate included language to regulate vapor products, but did not include the taxing provisions.
- Both the Assembly and Senate included an Executive Budget proposal that would permit Medicaid to drop prescribers from the program who violate statutory opioid limits. At MSSNY’s request, the Senate included language to assure that there first be a legal determination that the prescriber did in fact violate the opioid limit rather than giving Medicaid officials arbitrary authority to make this determination.
- The Senate advanced a new proposal in its one-House to include information on physician profiles that detail each physician’s health plan participation information that DOH currently collects. The information would be required to be included on the profile by DOH, not the physician, based on information maintained by DOH. The proposal would also enable a physician to designate staff to complete and update the physician’s profile information. The Assembly does not include a similar proposal.
- The Senate proposed Workers’ Compensation reform, indicated it “will work to reduce the unsustainable cost increases for employers, while continuing to protect injured workers”. Suggested reforms include: updates to durational caps and schedule loss of use awards; ensuring prompt access to quality medical care and lost wage benefits; enhanced incentives for workplace safety programs; implementation of an efficient hearing process; and reducing frictional costs, streamline forms, improve independent medical examinations (IMEs), and require implementation of a prescription drug formulary.
(DIVISION OF GOVERNMENTAL AFFAIRS)
House Budget Committee Votes to Advance ACA “Repeal and Replace” Bill
By a 19-17 vote, the US House of Representatives Budget Committee this week voted to advance the American Health Care Act (AHCA) to the House Rules Committee. Three Republicans joined all 14 Democrats on the Committee in voting against the measure. The lone New Yorker on the Committee, Rep. John Faso (R-Upper Hudson Valley) voted in support of the bill.
The AHCA would revise much of the Affordable Care Act (ACA) enacted in 2010. As reported last week, several health care advocacy organizations, including the AMA, American Hospital Association (AHA), the Greater New York Hospital Association and the Healthcare Association of New York State (HANYS) have expressed strong concerns with the proposal.
The proposal would keep some of the popular provisions from the ACA, including required coverage for pre-existing conditions, prohibiting annual and lifetime limits, and requiring dependent coverage up to age 26. It would also significantly expand the amount of funds that a person could direct to their Health Savings Account, and delay until 2025 implementation of the “Cadillac Tax” on comprehensive health insurance coverage.
At the same time, the bill would substantially revise ACA rules that facilitated various subsidized coverage programs for those who make up to 400% FPL ($94,000 for a family of 4). While the expanded eligibility for Medicaid (up to 138% FPL) would be available through the end of 2019, starting in 2020 such expanded coverage would only be continued for those who had such coverage prior to the end of 2019.
The AHCA would also repeal the tax credits currently provided to help cover cost-sharing amounts for coverage for individuals who earn too much to qualify for Medicaid. Instead, tax credits of $2,000-$4,500 (depending upon age) would be provided to enable the purchase of health insurance coverage.
Tax credits will be available in full to individuals earning less than $75,000 and households earning less than $150,000, but they will be capped for higher earners. It appears as if the AHCA would also completely eliminate funding for New York’s Essential Plan, which provides low-cost health insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% and 200% of the FPL.
The bill would repeal several other notable ACA provisions, including the requirement for all individuals to have health insurance coverage, the large employer coverage mandate, the provision to impose a “tanning” tax and a provision that limits the tax deductible treatment for health insurers of executive income that exceeds $500,000.
At this time, it still is not apparent whether there will be enough support for this legislation to pass the full US House as well as the US Senate, which could necessitate significant changes to this legislation. Please remain alert for further updates. (AUSTER)
CBO Predicts 24 Million to Lose Insurance Coverage as a Result of AHCA; Trump Administration Strongly Disagrees
This week, the Congressional Budget Office concluded that the AHCA under consideration by Congress would result in 14 million fewer people having health insurance coverage in 2018, and 24 million fewer people having health insurance coverage in 2026. At the same time, it would produce an $880 billion reduction in Medicaid spending over the 2017-2026 period, and a $337 billion decrease in deficit spending over the same period.
Reacting to the CBO conclusion, AMA President Dr. Andrew Gurman issued a statement noting that “While the Affordable Care Act was an imperfect law, it was a significant improvement on the status quo at the time, and the AMA believes we need continued progress to expand coverage for the uninsured. Unfortunately, the current proposal – as the CBO analysis shows – would result in the most vulnerable population losing their coverage… we hope the CBO estimates will motivate all Members of Congress to find a pathway to work together on significantly improving proposed health reform legislation so it is more focused on serving the very real needs of patients and improving the health of our nation.”
New HHS Secretary Dr. Tom Price issued a statement strongly objecting to the CBO conclusion:
“The CBO report’s coverage numbers defy logic…For there to be the reductions in coverage they project in just the first year, they assume five million Americans on Medicaid will drop off of health insurance for which they pay very little, and another nine million will stop participating in the individual and employer markets. These types of assumptions do not translate to the real world, and they do not accurately estimate the effects of this bill….Doctors and patients understand that, especially under current law, having coverage is not the same thing as having access to the care one wants or needs. Our approach will provide Americans with relief from the collapsing healthcare law, which never delivered on the benefits projected by the Congressional Budget Office in the first place.” (AUSTER)
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
NYS DOH Releases Guidance On Mandated 3-Hour Course On Pain Management, Palliative Care And Addiction
The New York State Department of Health issued guidance on the required three (3) hours of course work or training in pain management, palliative care, and addiction that most New York prescribers with a DEA registration must complete. The course work or training must be completed by July 1, 2017, and once every three years thereafter, pursuant to Public Health Law (PHL) §3309-a(3).
The course work or training must include the following eight (8) topics:
- New York State and federal requirements for prescribing controlled substances;
- Pain management;
- Appropriate prescribing;
- Managing acute pain;
- Palliative medicine;
- Prevention, screening and signs of addiction;
- Responses to abuse and addiction; and
- End of life care.
According to the letter, prescribers must complete course work or training in all eight topics. The topics may be covered by a single, comprehensive presentation or by multiple individual presentations for a total of at least three hours. Depending on the presentations, it may take longer than three hours to complete all eight required topic areas.
The DOH letter lists the Medical Society of the State of New York as an accredited provider. As reported previously, the Medical Society of the State of New York has developed three one-hour Continuing Medical Education (CME) webinars. MSSNY will archive the webinars as an on-line program at MSSNY CME website. This course work will be available from the CME website by the beginning of April. Physicians and other prescribers will be able to view these webinars and obtain CME credit. The online program will be available free of charge to MSSNY members; non-MSSNY members will pay a fee of $150 to view all three modules.
According to the information from DOH, prescribers must attest to their own completion of the course work or training. For medical residents who prescribe under a facility’s DEA registration number, however, the facility must make such attestation. For the initial attestation deadline of July 1, 2017, applicable course work or training completed from July 1, 2015, to July 1, 2017, is allowed.
For each and every subsequent attestation period, course work or training must be completed during the applicable attestation period. Prescribers licensed on or after July 1, 2017, who have a DEA registration, as well as medical residents prescribing controlled substances under a facility DEA registration, shall complete the course work or training within one year of registration, and once within each three-year period thereafter.
Documentation of the completion of the course work or training must be maintained by the prescriber for a minimum of six (6) years from the date of the applicable attestation deadline for audit purposes. Documentation must include the course work or training provider name, course work or training name, location it occurred, date it occurred, and number of hours completed for each.
In certain limited circumstances, the Department may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the Department that there is no need to complete such training.
New York State Department of Health has indicated that that an attestation form to notify the Department of the satisfaction of the educational requirement, as well as FAQ’s and additional information, are coming soon.
A copy of the Department of Health letter can be found here.(CLANCY)
NYS DOH Adds Chronic Pain To List of Qualifying Conditions for Medical Marijuana And Permit PA’s To Certify Patients
Final regulations were adopted by the NYS Department of Health to add “chronic pain” to the list of conditions for patients to use medical marijuana. Chronic pain is defined as “any severe debilitating pain that the practitioner determines degrades health and functional capability; where the patient has contraindications”. Additionally, the regulations also allow physicians assistants to certify patients for the use of medical marijuana.
Authorization is dependent upon whether the supervising physician is already qualified to certify patients for medical marijuana. Physician assistants would have to complete the required coursework. Physician assistants who successfully complete the NYSDOH approved course and are in full compliance with other regulatory requirements must complete an authorization form with their supervising physicians, and mail this form along with the course completion certificate to the department. Once the information provided is validated, the department will send an email confirmation to the physician assistant containing a link that will authorize the physician assistant to register to certify patients.
In December, the Medical Society of the State of New York President Malcolm Reid, MD sent a letter to DOH Commissioner Howard Zucker that expressed concerns that the use of medical marijuana to treat chronic pain may be inconsistent with national treatment guidelines, and perhaps most importantly, could expose physicians’ to enhanced risk of federal prosecution especially with the change in the federal administration. A copy of Dr. Reid’s letter can be found here. (CLANCY)
New York Makes Large Jump in National Health Rankings
New York came in No. 12 in the country in health system performance, moving up from No. 20, according to the latest rankings from the Commonwealth Fund. New York and Washington made the biggest jumps in ranking, with New York moving into the top-performing group for the first time. New York saw gains on eight of 15 prevention and treatment measures, and it jumped from No. 10 to No. 6 in health care equity rankings, which took into account income and ethnicity. However, New York only improved on two of five measures in access and affordability. Notably, the share of adults who went without care because of cost over the course of a year dropped from 15% in 2013 to 12% in 2015.
The report released by the Commonwealth Fund compares health access and quality measures. The Commonwealth Fund is a private foundation that provides independent research on health care issues and making grants to improve health care practice and policy. The report intentionally emphasized that states that expanded Medicaid access under the Affordable Care Act showed stronger progress than states that did not. (BELMONT)
Senate Advances Legislation to Permit CV Techs to Administer Contrast Media
The New York State Senate Health Committee advanced legislation (S.3570, Valesky) this week to the Senate Higher Education Committee that would authorize Cardiovascular Technologists (CVTs) to administer contrast media during cardiovascular interventional procedures, under the “direct supervision” of a physician.
CVTs assist in technical procedures for cardiac catheterizations and interventions, but are not expressly permitted by statute in New York to administer contrast media. MSSNY has heard from cardiologists in support of legislation to authorize CVTs to administer contrast media. MSSNY and the NY Chapter of the American College of Physicians have requested an amendment to this legislation to require that the physician provide “personal supervision” of the CVT, which means they must be in the same room, instead of “direct supervision” which means that the physician must be in the same general area. Identical legislation (A.5963, Magee) has been introduced in the Assembly.
HCA Hosts Hospice and Palliative Care Forum
MSSNY recently participated in a meeting with representatives from the Home Care Association of New York State, the New York State Health Department, and hospitals state-wide to discuss the status of the State Palliative Care Education and Training Council. Vice-Chair of the State Council, Joan Dacher, PhD, RN, encourages the reformation of Social Work and RN training and education at the provider and professional school levels to include more concentrated training on long-term and palliative care.
In addition, representatives from Lourdes at Home/Hospice at Lourdes provided recommendations for encouraging the development of articulation agreements between hospitals and Homecare facilities to increase the number of homecare visits for patients with chronic illnesses.
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
NYS: First Sepsis Report: Mortality Rates Have Declined
Mortality rates for sepsis have declined in recent years and more hospitals are on the hunt for the dangerous bacteria, according to New York State’s first sepsis report. The report is mandated by regulations that went into effect in late 2013. Read the report here.
2017 NRMP Main Residency Match the Largest Match on Record
Today the National Resident Matching Program® (NRMP®) announced the results of the 2017 Main Residency Match®, the largest in its history. A record-high 35,969 U.S. and international medical school students and graduates vied for 31,757 positions, the most ever offered in the Match. The number of available first-year (PGY-1) positions rose to 28,849, 989 more than last year.
Results of the Main Residency Match are closely watched because they can be predictors of future changes in physician workforce supply.
In 2012, the NRMP implemented a policy requiring Match-participating programs to place all positions in the Match, spurring significant increases in the number of primary care positions offered. In the six years since implementation of the policy, Internal Medicine, Family Medicine, and Pediatrics have added a combined 2,900 positions, a 25.8 percent increase. Highlights from the 2017 Match include:
- Internal Medicine programs offered 7,233 positions, 209 more than in 2016; 7,101 (98.2%) positions filled, and 3,245 (44.9%) filled with U.S. allopathic seniors.
- Family Medicine programs offered 3,356 positions, 118 more than in 2016; 3,215 (95.8%) positions filled, and 1,513 (45.1%) filled with U.S. allopathic seniors. Since 2012, the number of U.S. allopathic seniors matching to Family Medicine has increased every year.
- Pediatrics programs offered 2,738 positions, 49 more than in 2016; 2,693 (98.4%) filled, and 1,849 (67.5%) filled with U.S. allopathic seniors.
- Emergency Medicine offered 2,047 first-year positions, 152 more than in 2016, and filled all but six. The overall fill rate was 99.7 percent, and 78.2 percent were filled by U.S. seniors. Since 2012, the number of Emergency Medicine positions has increased by 379, or 23 percent.
- Psychiatry offered 1,495 first-year positions, 111 more than in 2016, and filled all but four. The overall fill rate was 99.7 percent, and 61.7 percent were filled by U.S. seniors. Since 2012, the number of Psychiatry positions has increased 378, or 34 percent, and the number of positions filled by U.S. allopathic seniors has increased 307.
- Specialties with more than thirty positions that achieved the highest percentages of positions filled by U.S. allopathic seniors, which is one measure of competitiveness, were Integrated Plastic Surgery (93.1% U.S. seniors), Orthopedic Surgery (91.9% U.S. seniors), and Otolaryngology (91.5% U.S. seniors).
Applicants who did not match to a residency position participated in the NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP®) to attempt to obtain an unfilled position. This year, 1,177 of the 1,279 unfilled positions were offered during SOAP. SOAP results will be available in the full Match report published in May.
Upstate Association Sponsoring Tours for Medical Students
The Iroquois Healthcare Association (IHA) is sponsoring tours of Upstate NY for medical students and residents to `take a look’ and learn about practice opportunities in this area. Participants will learn about hospitals, medical staffs, communities and culture through visits to hospitals and ambulatory care settings.
MSSNYPAC – The Political Voice for New York’s Physicians
MSSNYPAC would like to thank the dedicated members of its leadership team, the MSSNYPAC Executive Committee and the hundreds of physicians, residents, students and spouses for helping to raise over $10,000 for MSSNYPAC at this year’s Physician Advocacy Day! If you were not able to attend in person but wish to support MSSNYPAC’s efforts to help elect physician-friendly candidates to office, consider making a contribution to MSSNYPAC. Please join with your colleagues to help to assure that physicians have a meaningful seat at the table as health care policy is developed.
Join Nassau County for Dinner and CME Program on “Frontiers in Cellular Therapy”
The Nassau Academy of Medicine and the Nassau County Medical Society Joint Membership Meeting will be held on TUESDAY, MARCH 28, 2017 at the WESTBURY MANOR, 1100 Jericho Turnpike, Westbury. Complimentary Dinner Meeting for NCMS / NAM Members. Non-members and their staff may attend at $25 per person. Seating is limited. REGISTRATION is at 6:30PM; dinner and meeting at 7:00PM. PRE-REGISTER NOW – Send E-Mail Response To: NASSAUMED@GMAIL.COM The CME Program, “NEW FRONTIERS in CELLULAR THERAPY” will be presented by Patricia Shi, MD, MS, Medical Director, Therapeutic Apheresis and Cellular Therapy Collection Service, New York Blood Center
Educational Objective: At the end of this CME activity, participants should be able to; distinguish between the various types of cellular therapies being investigated; understand the potential risks, benefits, and unknowns of such therapies and become familiarized with ethical concerns and questions raised by the advance of cellular therapy.
Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Suffolk Academy of Medicine and the Nassau Academy of Medicine. The Suffolk Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians. The Suffolk Academy of Medicine designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim
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A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
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