MSSNY eNews: March 5, 2021 – The Cliff Notes Guide to the Week at MSSNY
The Cliff Notes Guide to the Week at MSSNY
This was an eventful week at MSSNY. We started the week welcoming our new MSSNY Executive Vice President, Mr. Troy Oechsner, JD who officially joined team MSSNY on 3/1/2021.
The MSSNY Board of Trustees and the MSSNY Council both met this week. New policies were adopted (click here to view MSSNY policy), discussions ensued about our MSSNY House of delegates scheduled for 9/18/2021 (click here to view the most recent speaker’s letter) and committee and commission reports were discussed.
Our Annual MSSNY Physician Advocacy Day was held on 3/2/2021. This year it was held virtually, making it even easier for our members to attend. Close to 400 attendees registered for this event. The agenda was robust thanks to MSSNY’s very dedicated Government Relations staff. We heard from our MSSNY leadership, had an update from our legislative staff led by Mr. Moe Auster, Senior Vice President and Chief Legislative Counsel, and heard from NYS Assembly and Senate Leadership including a panel with the Assembly and Senate Health and Insurance Chairs. We thank all the legislators for making time in their busy schedules to speak with us and answer our questions.
In the afternoon physicians met with their local representatives and MSSNY leadership met directly with many of our NYS legislative leaders. We discussed numerous issues with provisions in the executive budget and in particular stressed our deep concerns with the proposed restructuring of the state’s Excess Medical Malpractice Program; the new huge cost imposition on the 17,000 physicians enrolled in the program; the unreasonable bypassing of due process for physicians through the Office of Professional Medical Conduct (OPMC); the very large and mistimed cut in the funding for MSSNY’s Committee for Physicians’ Health (CPH); and the inappropriate expansion of pharmacy scope of practice that would significantly undermine our patient-centered medical home concept.
Last week, we met with our NYS congressional delegation and advocated for federal allocation of vaccine supply to community physicians. This week we expanded those discussions to include our NYS legislature and the Governor’s office. We discussed that supply is increasing nationally with the emergency use authorization (EUA) of the Johnson & Johnson vaccine and that there is now more flexibility in the storage of the Pfizer vaccine.
All agreed that we must employ all resources available to vaccinate NYS residents as quickly as possible and were receptive to the role that our community-based physicians can play in quickly identifying the most vulnerable and in reaching large numbers of patients who suffer from significant co-morbidities in urban, rural and suburban settings. After discussions this week, we believe that community-based physicians will shortly start receiving vaccine supply. Please make sure that you are fully registered with the state and that you have submitted your weekly planning request.
Bonnie Litvack, MD
Virtual Physician Advocacy Day a Great Success!
Thank you to the several hundred physicians, and county medical and specialty society leaders for taking the time to participate in MSSNY’s first virtual Physician Advocacy Day earlier this week, as well for participating in advocacy meetings with their State Assemblymembers and Senators on the litany of challenging State Budget issues New York’s physicians face. We also thank Senate Majority Leader Andrea Stewart Cousins, Senate Deputy Majority Leader Michael Gianaris, Assembly Majority Leader Crystal People-Stokes, Assembly Minority Leader Will Barclay, Senate Minority Leader Rob Ortt, Senate Health Committee Chair Gustavo Rivera, Senate Insurance Committee Chair Neil Breslin, Assembly Health Committee Chair Richard Gottfried and Assembly Insurance Committee Chair Kevin Cahill for participating with this great event and answering questions from the (Zoom-) assembled physicians. (DIVISION OF GOVERNMENTAL AFFAIRS)
NYS DOH Reminds Physicians and Other Providers of Pre-Booking Process for Ordering COVID 19 Vaccine
New York State Department of Health is reminding physicians and other health providers that they need to submit a weekly planning requests (“prebook requests”) for COVID-19 vaccine for the provider location enrolled in the NYSDOH COVID-19 Vaccine Program to include Janssen (Johnson and Johnson) vaccine. The requests are always due by 5 pm each Monday and must be data entered in NYSIIS on Monday (and not in advance). If your facility location is closed on all or any Mondays, please ensure that a designated staff person is identified to perform the data entry each Monday.
The system is accessible remotely from any computer. This is necessary due to the timing of when NYSDOH must make allocation decisions and place orders. Beginning March 1, 2021, in addition to Pfizer and Moderna vaccines, you will be able to submit a planning request for Janssen vaccine (Johnson and Johnson). Janssen vaccine is a single-dose vaccine that will be transported and stored at refrigerated temperatures (36 to 46 degrees Fahrenheit or 2 to 8 degrees Celsius). More information on this process can be found here.
MSSNY continues in its sustained advocacy campaign to work with the Governor’s office as well as the federal government to ensure patients are able to receive the vaccine from their physicians. (CLANCY)
New York Assembly Passes Bill to Repeal Covid Immunity Protections – Assembly Debate Expresses that Changes Would Apply Prospectively
Among the bills passed this week by the New York State Assembly as part of its nursing home reform package was concerning legislation (A.3397) that would repeal the Covid liability immunity provisions provided to physicians and other care providers enacted as part of last year’s State Budget.
MSSNY and many other groups wrote in opposition to the legislation noting the importance of these protections, and raising concerns with the possibility that A.3397 could be interpreted by a court to retroactively repeal absolutely essential liability protections in effect for health care services provided from March through August 2020. However, there were several comments made by Assemblymembers during the floor debate on the legislation that the repeal provisions would only apply prospectively, in other words, for acts or omissions after the date the bill was signed into law, if it were to be subsequently passed by the Senate and signed by the Governor. Identical legislation (S.5177) has been introduced in the Senate, and is referred to the Senate Health Committee.
Physicians are urged to continue to contact their legislators (Protect Liability Protections for Care During the Pandemic (p2a.co)) to oppose efforts to remove these important liability protections. In a state notorious for its already hostile liability climate, these protections enacted by the Governor and the Legislature last year were absolutely essential for hospitals, physicians and other care providers to build the capacity necessary to treat an unending stream of Covid patients during the height of the pandemic. These protections also recognized the extraordinary circumstances that many physicians found themselves, with the lack of defined medical protocols for treating this deadly diseases, and the fact that physicians were unable to provide their patients with needed care for many months last spring due to the New York State prohibition on elective medical procedures. (AUSTER)
Please Urge Your Legislators to Reject Huge New Costs Placed on Community Physicians for Excess Coverage
Please continue to urge your legislators to reject an extraordinarily ill-timed Budget proposal that would foist thousands to tens of thousands of dollars of new costs on the nearly 17,000 physicians enrolled in the Excess Medical Malpractice Insurance. You can send a letter and/or tweet them from here: Click Here.
This proposal, which would require enrolled physicians to bear an extraordinary 50% of the cost of these policies, would thrust over $50 million of new costs on the backs of our community-based physicians who served on the front lines of responding to the pandemic. This new cost imposition would hit these practices at a time when many of these practices are already facing huge losses resulting from the substantial reduction in the number of patients receiving care during the pandemic.
NEW COSTS TO BE IMPOSED ON PHYSICIANS FOR EXCESS COVERAGE BASED UPON GOVERNOR’S 50% COST BUDGET PROPOSAL
|SPECIALTY||Long Island||Bronx, Staten Island||Brooklyn, Queens||Westchester, Orange, Rockland, and Manhattan|
MSSNY has joined with nearly 20 other specialty medical societies in a letter to the entire State Legislature that expresses our strong objection to this proposal. Among the key points in the letter is that a recent AMA survey reported that during the pandemic the average number of in-person visits to physician offices dropped nearly in half. The bottom line is that the new costs this proposal would impose are simply not assumable by physicians, meaning that many physicians will face no choice but to forgo receiving this additional coverage.
Urge Your Legislators to Reject Overbroad Proposal to Severely Curtail Physician Due Process
Physicians are urged to continue to contact their legislators to reject an Executive Budget proposal that that would greatly curtail due process protections for physicians when a complaint has been filed with the Office of Professional Medical Conduct (OPMC), including making information public about a complaint even if no professional misconduct is found and greatly lessening the burden for imposing an interim suspension prior to the conclusion of the statutory hearing process. You can send a letter and/or tweet to your local legislators from here: Click Here.
While New York’s physicians share the goal of assuring the State has ample power to protect the public when the conduct of a particular health care provider places patients at risk, the Commissioner already has authority to take summary action prior to the conclusion of a disciplinary hearing in the absence of a finding of misconduct. MSSNY together with several specialty societies have raised concerns his proposal is greatly over-reaching given that most complaints never result in findings of misconducts or even formal charges being filed. Of greatest concern is that information released to the public, even if there is no action ultimately taken, can remain available through “Google searches” forever, with the potential to eviscerate a physician’s professional reputation. (AUSTER)
Please Oppose Proposals That Facilitate Uncoordinated Siloed Care to be Provided by Pharmacists
Please contact your legislators to urge that they oppose several components of the Executive Budget that could upend the patient-centered medical home model and threaten patient safety by greatly expanding the scope of services provided to patients by pharmacists without coordination with patient care physicians. You can send a letter from here: Click Here. Please let them know these proposals would greatly enhance the power of big box giants to control various aspects of patient care delivery not in coordination with but to the exclusion of community-based primary care and specialty care physicians that typically manage the care of their patients.
Specifically, these Budget proposals would 1) permit pharmacists to order various lab tests without any physician oversight and without any requirement to coordinate with the patient’s physician for follow-up care; 2) greatly expand the physician-pharmacist Collaborative Drug Therapy Program to enable pharmacists to adjust the medications provided to entire classes of patients rather than individual patients and 3) permit pharmacists the power to administer any vaccination approved by the federal Advisory Commission on Immunization Practices (ACIP), including those which may be added in the future, thereby removing the discretion of the State Legislature to make these decisions. Some of these proposals have been rejected by the Legislature in previous Budget cycles.
All of these programs together could incentivize the development of health care silos at the expense of the patient centered medical home model we have worked so hard to develop in New York. It would also marginalize community based primary care and specialty care physicians’ ability to continue to be able to manage their patients’ ongoing care needs. Please urge your legislators to reject these measures as they finalize the State Budget for 2021-22. (AUSTER)
MSSNY Extends Deadline for Members to Participate in Survey to Compare Payments to Physicians for Care Provided via Telehealth Services vs. In-Office Visits
To support its continued advocacy efforts to expand coverage for Telehealth services, MSSNY is conducting a new survey of its members to update data originally collected last spring, comparing generally how physicians are reimbursed for care delivered virtually, as compared to in-person appointments.
To take the new survey, please fill out the following Survey Monkey questionnaire: https://www.surveymonkey.com/r/MSSNY_Telehealth_Survey. Please also share this link with your networks to participate, as well. The deadline to take the survey has been extended to close-of-business next Friday, March 12th. (CARY)
MSSNY Continues to Urge Revisions to Telehealth Proposal in FY 2022 Executive Budget
MSSNY continues to raise serious concerns with the Telehealth expansion proposals included in the proposed FY 2022 Executive budget. In addition to not including a requirement sought by MSSNY to ensure payment parity for care delivered virtually that is on par with in-office visits, MSSNY has raised concerns that if passed, certain other proposed policies may be used by the insurance industry to actually reverse Telehealth gains made over the past year. Specifically, linking coverage of Telehealth services to insurers having a “so-called” adequate network, together with the proposal to permit Telehealth delivery services by out-of-state physicians, could essentially empower insurers to limit who it will pay for Telehealth services once it asserts it has an “adequate” network.
It is not hard to imagine a scenario where a health plan asserts it has an adequate network through a national Telehealth service provider (such as Teladoc or MDLive), and then exclude coverage of Telehealth services by all or some of its in-network community-based physicians. That is completely at odds with the expansive approach to Telehealth coverage taken over the past year as a result of policies set by the New York State DFS and DOH.
MSSNY is continuing to work with a range of other patient and provider partner organizations to urge the Legislature to address these concerns and will update members as discussion on this issue further unfolds. (CARY)
Legislation to Allow Pharmacists to Conduct Lab Tests During Public Health Emergency on Senate Health Agenda
Legislation that would authorize pharmacist to order and administer tests suspected of having an infectious disease in a public health emergency. This measure, Senate Bill 1742, is sponsored by Senator James Skoufis and is on the Senate Health Committee next week. MSSNY is opposed to this measure as provisions already exist in the statute to allow the governor to suspend some laws or regulations through executive orders. In addition, the New York State Legislature has the ability to provide additional powers to the governor during a public health emergency.
There has already been a suspension of various scopes of practice that authorized testing of individuals throughout all settings, including pharmacies. There is also the ability under federal law to suspend similar law. Moreover, it is open-ended as to which infectious diseases a pharmacist could test during a PHE. Therefore, MSSNY believes that this legislation is not needed and urges physicians are urged to contact legislators of the Senate Health Committee: Senators Gustavo Rivera, Patrick Gallivan, Brian Benjamin, Alessandra Biaggi, Phil Boyle, Samra Brouk, Brad Hoylman, Todd Kaminsky, Rachel May, Peter Oberacker, Edward Rath, Sean Ryan, Julia Salazar, Daniel Stec, Kevin Thomas. Physicians can call the NYS Senate at 518-455-2800. (CLANCY)
If You or Someone You Know is Struggling with Everyday Life Stressors, Reach Out to the P2P Program to be Connected with a Peer Supporter to Help!
Email: P2P@mssny.org and request that you be connected with a peer supporter
Phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter.
MSSNY now offers to physicians, residents and medical students a completely confidential and anonymous opportunity to talk with a peer about some of their life stressors. MSSNY’s Physician Wellness and Resiliency Committee launched a Peer 2 Peer (P2P) program to assist their colleagues who are need of help in dealing with work and family stressors. With the myriad of challenges we are all facing related to the pandemic, some physicians may need the support of their colleagues to help manage these stressors.
MSSNY has established a confidential helpline phone number (1-844-P2P-PEER) and an email address (firstname.lastname@example.org) so that physicians may be connected with a peer 24 hours a day/7 days a week. In addition to offering a trained, empathetic ear, peer supporters may provide information on specific resources that can offer further support, provide positive coping skills, or connect physicians to professionals for more focused assistance when needed.
Registration now open – Medical Matters: Three Coronaviruses in Three Decades
Date: March 24, 2021 @ 7:30am
Register now to learn more about the evolution of coronaviruses over the past three decades. Medical Matters: Three Coronaviruses in Three Decades webinar will take place on Wednesday March 24th at 7:30am. Stephen Morse, PhD, Professor of Epidemiology at the Columbia University Medical Center and Director of the Infectious Disease Epidemiology Certificate Program at Columbia University Mailman School of Public Health will serve as faculty for this program. Click here to register for this webinar.
- Identify three different coronaviruses and the epidemiology specific to each one
- Discuss SARS-CoV-2 in relation to other coronaviruses
- Evaluate the circumstances that contributed to the SARS-CoV-2 pandemic
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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. (HOFFMAN)
Council Notes: March 1, 2021
Council passed the following:
- Ensuring Correct Drug Dispensing
MSSNY will request that the New York State Education Department work with the pharmaceutical and pharmacy industries to facilitate the ability of pharmacies to ensure that when a prescription is dispensed, a color photo of the prescribed medication and its dosage is attached to the receipt to ensure that the drug dispensed is that which has been prescribed. MSSNY will forward this resolution to the AMA.
- Scientific Studies to Support Legislative Agendas
MSSNY will continue to work with allied groups and health care policy influencers such as think tanks to help generate support for MSSNY’s key advocacy goals and will continue to work with entities that can produce high quality scientific evidence data to help generate support for MSSNY’s key advocacy goals. The MSSNY delegation to the AMA will introduce a resolution at the next AMA House of Delegates meeting urging the AMA to expand its efforts to work with allied groups, health care policy influencers such as think tanks and entities that can produce high quality scientific evidence.
- Separation of Clinical Portions of EHRs from Administrative and Financial Uses
MSSNY will continue to work with the AMA and specialty societies to advocate for legislation, regulation or other appropriate mechanisms to ensure that electronic health record (EHR) systems are developed and implemented in such a way as to facilitate the compiling and sharing of clinical information, as appropriate, in a manner that is consistent with how physicians regularly deliver care.
NY CMS Office Invites You to a March 18 Listening Session
The Centers for Medicare and Medicaid Services New York Office invites you to a listening session on current topics in the Medicare Program. The topics being considered for discussion are: COVID-19 vaccines and antibody treatment, telehealth, MIPS measures and reporting, EM coding and documentation, 2021 pricing levels, CMS oversight of Medicare Advantage plans and care management. The format of the session will consist of short presentations followed by discussion periods. Please register for the session here.
Moderna Vaccine Causing Delayed Rash in Some Recipients, Small Study Says
Some recipients of Moderna’s COVID-19 vaccine experience delayed rashes that can take about six days to heal, according to a small study published March 3 in the New England Journal of Medicine.
Researchers from Boston-based Massachusetts General Hospital examined 12 patients who developed a rash at the injection site eight or more days after receiving their first dose of Moderna’s COVID-19 vaccine. Their symptom onset ranged from four days after receiving their first dose to up to 11 after receiving their first dose. The patients’ rashes varied in size and severity. Ice and antihistamines treated most patients’ rashes, but some required corticosteroids and one erroneous case was treated with antibiotics, according to the study. Half of the patients experienced a rash after receiving their second dose around 48 hours after getting the shot, but none of them experienced a reaction that was more severe than their first dose reaction.
“Whether you’ve experienced a rash at the injection site right away or this delayed skin reaction, neither condition should prevent you from getting the second dose of the vaccine,” Kimberly Blumenthal, MD, the study’s lead author and co-director of Massachusetts General Hospital’s clinical epidemiology program, said in a news release. “Our immediate goal is to make physicians and other care providers aware of this possible delayed reaction, so they are not alarmed, but instead well-informed and equipped to advise their patients accordingly. (Becker’s Hospital Review March 3)
Please Submit Names of Doctors and Family Members Who Lost Their Lives During COVID-19
Doctors Day is March 30. This year, to honor our physicians and family members who died of COVID-19 in 2020-2021, MSSNY is designing a poster with the names that are submitted. Please send the names to email@example.com.
Volunteer Opportunity for Children of MSSNY Members
During this ongoing pandemic, considerable additional responsibility has fallen on women, especially those who have had to become more involved in their children’s education due to remote schooling and limitations on childcare.
As a solution to this problem, the MSSNY Women Physicians Committee is launching a Virtual Volunteer Homework Assistance Program.
Do you have high school or college students who would be interested in helping other members’ children with K-12 homework? This is a great volunteering and community service opportunity.
Do you have school age children (K – 12) who could use a helping hand with homework?
If so, please contact firstname.lastname@example.org. Tell us if your child will be a tutor or a tutee and include their email address.
- For tutors, state the subjects with which they would like to work (e.g., elementary math, middle school English, high school biology, etc.).
- For tutees, tell us the subjects with which they are most in need of support. We will match up pairs as best we can. Tutors and tutees can then make the arrangements that work best for them. Sessions can be half an hour to an hour per week, depending on subject and participant choice, and can be held on the same day and time.
We look forward to hearing from you!
Behavioral Health Integration Research Study Looking for Participants
The Behavioral Health Integration (BHI) Collaborative, a partnership between the AMA and seven other leading physician organizations, is launching a research study in 2021 to gather feedback and experiences from primary care and physician practices that are interested in integrating behavioral health care for their patients.
The study will run through early April, and participation includes a 45-minute interview and completion of a series of online activities. Participation will allow practice representatives to share valuable feedback on resources that will ultimately help make integrating behavioral health care a feasible, standard practice in primary care, rather than an exception.
Learn more and respond to a series of screening questions to see if your practice qualifies.
New Analysis Shows Medicare Spending Patterns Upended by COVID-19 Pandemic
The new report “Changes in Medicare Physician Spending During the COVID-19 Pandemic” analyzed Medicare claims data exclusive to physician services and found spending dropped as much as 57% below expected pre-pandemic levels in April of 2020. Medicare spending on physician services partially recovered from the April low but was still 12% less than expected by the end of June 2020. During the first half of 2020, the cumulative estimated reduction in Medicare physician spending associated with the pandemic was $9.4 billion (19%). The report also provides estimates by state and specialty.
When compared to expected 2020 Medicare spending on physician services, the AMA report found that actual Medicare spending on physician services for the first six months of 2020 declined regardless of service type, setting or specialty, and state or region. The severity of the impacts varied substantially. Telehealth spending increased dramatically during the study period but was concentrated in a handful of service categories.
Spending by service type
- Evaluation and management (E/M) spending fell nearly 50 percent by late March before levelling off.
- Spending for imaging, procedures and tests continued to drop until mid-April, falling as much as roughly 65% to 70% below expected 2020 spending.
- By the end of June spending was down 10% for E/M and imaging, but only slightly more for procedures and tests.
Spending by setting or specialty
- Spending lows reached in April by all major settings ranged from a 25% decline for skilled nursing facilities to a 90% decline for ambulatory surgical centers.
- All major settings recovered from these spending lows but remained 9 to 19% below expected 2020 spending at the end of June.
- Reductions in cumulative spending over the first half of 2020 varied among specialties, ranging from a 6% decline for nephrology to a 29% decline for ophthalmology and a 34% decline for physical therapists.
- Primary care specialties fared slightly better than average with cumulative spending for internal medicine and family medicine down 14% and 16%, respectively.
Spending by state or region
- Reductions in cumulative spending ranged from a 13% decline for Oklahoma to a 27% decline for New York.
- There was a strong regional pattern to the impacts, with the biggest reductions concentrated in the Northeast and Upper Midwest and the smallest impacts in the South and Southwest.
- Telehealth increased from less than 0.1% of total Medicare spending on physician services prior to the pandemic to more than 16% in April 2020 but was concentrated in a handful of service categories.
- Established patient office visits accounted for one-half of Medicare telehealth spending on physician services after the start of the pandemic through the end of June 2020.
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