MSSNY eNews: Together-Yes! We Are Stronger!
Thomas J. Madejski, MD
August 31, 2018
Volume 20 Number 32
I want to wish you a peaceful Labor Day weekend, and thank you for the care you provide to your patients individually, and through your membership in your County Medical Society and MSSNY for your efforts on behalf of patients collectively. MSSNY and your County Society allow us to come together to advocate on behalf of our patients and our profession to improve the health and productivity of our country.
Some of you know that I am a member of the Council on Medical Service at the American Medical Association. I am writing this in the airport Tuesday afternoon, awaiting my flight to return to Buffalo from our summer Council on Medical Service meeting. The Council creates policy proposals for consideration by the AMA House of delegates. We reviewed a number of different topics, and had wide ranging discussions on how to improve care for our patients, improve physician satisfaction, and provide value to society. We often have discussions about cost effectiveness and continue to look for data to support the AMA policies on healthcare. Some of the value we bring to patients and society is difficult to quantitate due to measuring effectiveness of a particular policy or intervention and the perspective of different entities—patients, physicians, insurers, economists and others. During the creation of an upcoming report on the patient centered medical home, we had mixed data on the cost effectiveness of the PCMH concept. Part of the discussion again looked at value to different stakeholders. From the patient standpoint, improved coordination of care and better preventive care seems like a no-brainer, but patients who live longer might ultimately be paradoxically more expensive in the long run. Most of the tools used do not adequately capture the value to society from— hopefully—a reduction in the disabled population and a longer more productive life.
MSSNY and the AMA have a great working relationship. The AMA is a great source for health policy and assists MSSNY in our advocacy efforts at the New York State level. MSSNY brings grassroots issues to the AMA on behalf of New York’s physician community, and through our MSSNY AMA delegation has led the country on issues relating to Out of Network billing, medical education, and many public health issues.
Local Medical Societies, MSSNY, and the AMA continue to work on behalf of our patients, our members, and the betterment of our societies.
Working together, we ARE stronger. Thanks for your membership and labor on behalf of your patients.
Please share your thoughts and comments with me at firstname.lastname@example.org.
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MSSNY Joins Numerous Other Organizations to Protest CMS Permission to MA Plans to Use Step Therapy
MSSNY joined several other physician advocacy associations in a letter initiated by the American Medical Association to the Center for Medicare and Medicaid Services (CMS) expressing strong concerns about CMS’s recent notification to Medicare Advantage plans that they will no longer be prohibited from utilizing step therapy protocols for physician administered drugs covered under Medicare Part B beginning in 2019. It would in effect overturn a 2012 CMS policy that had prohibited the use of step therapy for Part B covered medications.
Numerous states across the country, including New York, fought for the enactment of strong patient protection laws that put strict guardrails around the insurer/PBM use of “step therapy” for needed medications. However, this policy would go in the opposite direction. In particular, the AMA letter noted that “Step therapy protocols that require patients to try and fail certain treatments before allowing access to other, potentially more appropriate treatments can both harm patients and undercut the physician-patient decision-making process”. Moreover, it would result “in delays in getting patients the right treatments at the right time and unnecessary complications in the physician-patient decision-making process”.
The letter also notes that the new policy would have a particularly significant impact on the sickest of Medicare-covered patients. “In many cases, patients receiving drugs covered under Part B are especially vulnerable, many with serious or life-threatening conditions. Many cancer therapies, for example, are covered under Part B. For cancer patients, selecting the proper personalized treatment as quickly as possible can be critical to survival. For others, such as those suffering from conditions like autoimmune disorders and progressive blinding eye diseases, delays in getting appropriate treatments can mean prolonged symptomatic periods and irreversible damage, making a “fail first” approach to treatment inappropriate.” The measure was advanced by CMS as part of its “Blueprint” to lower prescription costs.
MSSNY Joins House of Medicine to Urge CMS to Reject Proposal to Collapse E&M Payments
MSSNY has joined on to multiple letters to the Center for Medicare & Medicaid Services (CMS) to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019. Both letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments. Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).
MSSNY signed on to a letter initiated by the AMA and 170 other medical associations. That letter that noted medicine’s support for CMS’ “goal of reducing administrative burdens for physicians and other health care professionals so that they can devote more time to patient care”, but also that there are “unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule.” Moreover, it expressed concerns that the policy change “could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”
This week MSSNY also signed on to a letter initiated by the Coalition of State Medical Societies (consisting of the medical societies of AZ, CA, FLA, LA, NC, NJ, OK, SC and TX together with MSSNY). In that letter, it was noted that the adverse outcomes of this change include:
- Eliminating incentives for physicians to care for complex or complicated patients including those with disabilities and those with serious or terminal illnesses;
- Making treating patients covered by Medicare even more financially challenging for physicians, leading more physicians to limit the number of Medicare patients they see or to opt out of the program entirely; and
- Similar changes being imposed by commercial insurance companies that tend to follow CMS’ lead on payment matters.
NY Assembly Insurance Committee Chair Urges US DOJ to Block CVS-Aetna
Expressing great concern that the proposed acquisition of Aetna by CVS “creates a conglomerate that will be too difficult to regulate and will likely harm patient care,” this week Assembly Insurance Committee Chair Kevin Cahill urged the US Department of Justice to block this merger. As noted in his press release, the letter to DOJ summarized several significant concerns that came to light during a June 4 hearing held by the New York Assembly Committees on Health and Insurance. He asserted “that the loss of competition will result in increased prescription drug prices, harm independent pharmacies and diminish provider choice – all of which significantly hurts New York consumers.”
MSSNY President Dr. Thomas Madejski issued a statement thanking Assemblyman Cahill for sending this letter, and noting MSSNY’s testimony during the June 4 hearing that raising numerous concerns about the adverse impact to patient access to needed care. These concerns include: reduced community pharmacy access; reduced health insurer competition; increased prior authorization hassles; and marginalization of physician-owned medical homes.
Dr. Madejski’s statement also noted that several other entities, including the California Insurance Commissioner, the American Medical Association and the American Antitrust Institute also urged the DOJ to reject the proposed merger. “Several diverse perspectives have resulted in the same conclusion – that this merger would have an adverse impact on patient access to care. We are hopeful that the US DOJ reviews these submissions very carefully, and reaches a similar decision” stated Dr. Madejski.
The Pharmacists Society of the State of New York also issued a statement to thank Assemblyman Cahill for taking this action, noting that “nothing good can come out of this merger”, and that “the only improved health outcome from this merger will be the dividends returned to CVS and Aetna shareholders”.
Governor Announces Series of Listening Tour for Regulated Marijuana
Governor Andrew Cuomo has announced a series of listening sessions on regulated marijuana slated for September and October. The purpose of these sessions is to garner input from community members and key stakeholders on the implementation of a regulated marijuana program in New York State. This input will assist the regulated marijuana workgroup in drafting legislation for an adult-use marijuana program for the legislature to consider in the upcoming session. A copy of the governor’s press announcement is available at:
The listening dates and registration is required for the sessions:
– Wednesday, September 5 – Albany
– Thursday, September 6 – Glens Falls
– Monday, September 17 – Bronx
– Thursday, September 20 – Manhattan
– Monday, September 24 – Queens
– Tuesday, September 25 – Brooklyn
– Wednesday, September 26 – Staten Island
– Thursday, September 27 – Long Island
– Monday, October 1 – Newburgh
– Tuesday, October 2 – Binghamton
– Wednesday, October 3 – Buffalo
– Thursday, October 4 – Rochester
– Tuesday, October 9 – Syracuse
– Wednesday, October 10 – Utica
– Thursday, October 11 – Watertown
Registration for individual listening sessions: https://tinyurl.com/y9sh5j9k
USPSTF: Women at Risk for Perinatal Depression Should Get Counseling
The US Preventive Services Task Force is advising clinicians to refer women at risk for perinatal depression to counseling in a draft recommendation statement.
The grade B recommendation applies to both pregnant women and those who have given birth in the past year. The group suggested providing counseling to women with a history of depression, current depressive symptoms that are below the diagnostic threshold, or socioeconomic risk factors like low income or being young or single.
Effective counseling interventions include cognitive behavioral therapy and interpersonal therapy.
Free Tuition at NYU Medical School Could Create Pressure for Other Med Schools
Few medical schools could pull off NYU School of Medicine’s policy of offering free tuition and it could create a gap between well-financed institutions and other schools, two medical students at the Icahn School of Medicine at Mount Sinai wrote in STAT.
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Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated. The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services. The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee. The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review. The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff. The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.
Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012,
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MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to: NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830
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