MSSNY eNews January 19, 2018 – Be There if You Care!

Please send your comments to comments@mssny.org

MSSNY’s Lobby Day (3/7) will be here before You Know it! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7^th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

• Reduce excessive health insurer prior authorization hassles that needlessly            delay patient care
• Reduce the high cost of medical liability insurance
• Preserve choice of physician for our patients
• Reject burdensome mandates that interfere with patient care delivery
• Preserve opportunities for our medical students and residents to become New        York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should contact their County Medical Societies which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)

Governor Cuomo Releases $168 Billion Budget Proposal; Contains Positive Proposals for New York Healthcare System, But Also Several Items of Concern
This week Governor Cuomo released his proposed $168.2 Billion Budget for the 2018-19 Fiscal Year.  The Budget proposal seeks to close a $4.4 billion Budget gap, including through $1 billion in “revenue raisers”.  Based upon an initial staff review of the thousands of page of Budget language and supporting documents, among the key proposals of interest/concern to physicians:

Some positive items include:

• Extending the Excess Medical Malpractice Insurance Program, providing additional liability coverage for over 20,000 physicians, for another year at the historical level of $127,400,000.
• Continuing funding for MSSNY’s Committee for Physicians Health program at historical funding level of $990,000 (Legislation is needed to extend the program beyond March 30).
• Re-appropriation of $150,000 for MSSNY’s Veterans’ Mental Health Initiative
• Reducing interest rate on all court judgments, both against public and private defendants, from 9% to market rate (which is currently less than 2%)

Some items of potentially significant concern include:

• Expanding the use of Nurse-Anesthetists
• Permitting corporate-owned clinics in pharmacies and grocery stores, provided they have a collaboration with a hospital, physician practice, ACO or PPS
• Permitting collaborative drug therapy arrangements between pharmacists and nurse practitioners
• Requiring prescribers to have a detailed opioid treatment plan for their Medicaid patients who have been on an opioid for more than 3 months or past the time or normal tissue healing.
• Increasing prior authorization demands on physicians by eliminating “prescriber prevails” protections for prescriptions for patients insured by Medicaid.

Items of Interest and Further Review

• Establish a “Healthcare shortfall fund” to pay for continued health insurance coverage program (Essential Plan, CHIP, etc.) to be funded by health insurer conversion dollars (such as the Centene purchase of Fidelis).
• Establish a 10 cent per milliliter tax on vapor products
• Establish an opioid surcharge on pharmaceutical manufacturers of 2 cents per milligram of active opioid ingredient on prescription drugs
• 14% surcharge on health insurers for underwriting gains from health insurance policies
• Medicaid coverage for telehealth services initiated in a patient’s home
• Board for Medicine would include physician experts in women’s health and disparities
• Conduct a study regarding the potential legalization of marijuana in New York
• Prohibiting the suspension of professional licenses for those who fall behind in student loan payments;
• Grant powers to the State Budget director to create a “Medicaid Savings Allocation Plan” to establish cuts to health programs to account for shortfalls in federal funding

Of further note, the Budget proposal did not contain provisions from previous years’ Budget proposals that MSSNY opposed, such as removing the ability of county medical societies to review applications of physicians to participate in Workers Compensation, and required accreditation of urgent care practices.

MSSNY staff review of the Budget proposal is ongoing, and we will be testifying at the Joint Assembly-Senate Health Budget hearing on Monday, February 12.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Please Urge Governor Cuomo to Support Comprehensive, Not One-Sided, Medical Malpractice Legislation
Action by Governor Cuomo on legislation (S.6800/A.8516) to significantly expand the medical malpractice statute of limitations, passed by the State Legislature last June, is required by the end of January.   While thousands of physicians and others have contacted the Governor to express their great concerns with this legislation, physicians are urged to continue to contact the Governor to request that he pursue comprehensive legislation that addresses the many deficiencies of New York’s malpractice adjudication system instead of signing this one-sided bill into law.

You can send a letter to the Governor here and/or call 518-474-8390.

Given that there are ongoing discussions with the State Legislature regarding the ultimate disposition of S.6800, physicians are also urged to contact their local senators and assembly members to: 

• share their concerns about the impact of this legislation to access to patient care in their communities, and
• urge them to work towards the enactment of comprehensive medical liability reform. New York overwhelmingly has the highest medical liability costs in the country and was recently designated by WalletHub as the worst state in the country to be a physician.

A letter can be sent from here.
(DIVISION OF GOVERNMENTAL AFFAIRS)

AMA, Medical Groups, Hospitals and Health Insurers Announce Shared Prior Authorization Principles
This week the AMA, the Medical Group Management Association and associations representing pharmacists, hospitals, and health insurance companies announced a “Consensus Statement” to improve prior authorization processes for patients’ medical treatments.  The effort is an outgrowth of efforts by the AMA together with several state and specialty medical societies, including MSSNY, to develop principles to reduce excessive prior authorizations imposed by health insurers that often unduly delay patient care delivery.

To read the full Consensus Statement, click here. Other groups signing on included the America’s Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association, American Hospital Association, and American Pharmacists Association.

The group press release noted that “Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive. Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions. Enhanced transparency and communication also play critical roles in improving prior authorization processes, which underscores the importance of this new effort.”

The statement reflects that the organizations will work together to:

• Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider.
• Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
• Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes.
• Protect continuity of carefor patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirement; and
• Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

While this is an important step toward reducing unnecessary and lengthy PA processes, it should be noted that there are not yet specific examples of treatments or processes that have been identified as going to be revised as a result of these principles.  Discussions between the groups will continue.                                                                         (AUSTER)

MSSNY Urges Congressional Delegation to Fund CHIP and Other Key Health Insurance Programs
MSSNY joined with several other patient and health care provider advocacy associations in a letter to New York’s Congressional delegation this week to urge continued funding for the Child Health Insurance Program (CHIP) and health insurance subsidies, as Congress was debating a short-term continuing resolution to fund the government after the current Resolution expires on January 19.  On Thursday night, the US House of Representatives passed a continuing resolution to fund the government until mid-February that also contained a 6-year stream of funding for the CHIP program, but it was doubtful that it was going to also pass the US Senate because of other outstanding issues.

As part of the group press release, MSSNY President Dr. Charles Rothberg stated “Failing to continue funding for these important programs threatens access to care for over a million New Yorkers, including countless children, who depend upon these programs to have coverage for the care they need.  There is no credible reason for why funding for these programs should be controversial.  We urge Congress and the President to work together to come to an agreement ASAP to assure funding for these essential programs are continued.”

Please remain alert for further updates. (AUSTER)

New York State Workers’ Compensation Board Issues Draft Regulations to Establish Drug Formulary
The enacted 2017-18 budget required the New York State Workers’ Compensation Board to establish a drug formulary by the end of the year to include  a tiered list of high-quality, cost-effective medications that are pre-approved to be  prescribed  and  dispensed,  as well as additional non-preferred drugs that can be prescribed with prior approval.

On December 27^th, the Workers’ Compensation Board announced draft regulations and initiated a 60-day comment period.  Please click here to read the board’s recommendations for its preferred drug list.  Please click here to review the regulations that set forth how physicians can request a non-formulary drug for their patient.  The formulary is proposed to begin  July 1.

MSSNY is continuing to review the proposal and will provide comments.  In particular, MSSNY will argue to assure that pre-authorization hassles be minimized.  Any physicians interesting in submitting comments and requests to add/delete pharmaceuticals to the preferred list of the prescription drug formulary must submit their comments on or before February 26, 2018. To submit comments, click here.                                                      (BELMONT)

The Physician Advocacy Liaison Network
MSSNY has created the Physician Advocacy Liaison (PAL) Network to expand the ways by which physicians are involved in the legislative and political process.

We must make certain that our elected officials remain committed to championing the issues that matter most to MSSNY members and their patients.  There has never been a greater need for physicians to become active.  With so many changes occurring in our health care system, and other opposition interests seeking to marginalize the physician’s role as leader of the health care team, we must make up for it with an overwhelming presence in grassroots activity that will make it impossible for legislators to ignore.

PAL responsibilities include:

• Educating other members on issues facing physicians, such as at local county medical society or medical staff meetings.
• Working as appropriate with your county medical society, be available to meet with your members of the legislature at least twice a year.
• Being responsible for calling or writing letters to members of the legislature on issues that impact physicians.
• Attend training programs in regard to legislative issues.
• Enlisting other member to support our action plans and mobilize them to action.
• Joining and recruiting others to join MSSNYPAC.

We will provide a budget overview to the PAL on Wednesday, January 24^th.  Click here to sign up and be a PAL!                                                                              (BELMONT)

Medical Society of the State of New York Announces its January CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its January free Continuing Medical Education (CME) webinars.  Participation in the webinars will earn physicians one CME credit free of charge.   The January schedule is as follows: 

January 17^th at 7:30am – Medical Matters:  Mental Health and Disasters Overview

Register for this webinar here.
Faculty: Craig Katz, MD

Educational Objectives:

• Explore the psychological impact of mass trauma.
• Provide physicians with a strong background on both the psychological                  symptoms and syndromes specific to mass trauma.
• Prepare physicians to conduct acute assessments and interventions.

January 22^nd at 7:30am – Current Concepts in Concussion for Pediatric and Adult Patients

Register for this webinar here.
Faculty: Deborah Light, MD

Educational Objectives:

• Identify signs and symptoms indicative of concussion as well as red flags that        indicate alternate or more severe pathology;
• Outline an appropriate management plan for a patient presenting with                  concussion including a return to “normal life” protocol;
• Describe methods for the primary and secondary prevention of concussion;
• Identify patients who would benefit from referral to a concussion specialist

January 30^th at 7:30am – Veterans Matters:  PTSD & TBI in Veterans

Register for this webinar here.
Faculty: Emerald Lin, MD

Educational Objectives:

• Identify signs and symptoms of PTSD & TBI
• Examine evidence-based treatment modalities for PTSD & TBI
• Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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 each of these live activities 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.

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

National Anthem Policy to Cut Physician Fees
MSSNY recently met with and wrote to representatives of the NYS Department of Financial Services (DFS) to express the physician community’s strong concerns with a national policy being rolled out by the state subsidiaries of Anthem BlueCross BlueShield (for NYS, it is only Empire Blue Cross Blue Shield at this time) that will, as of March 1, drastically reduce payment to physicians who use CPT Modifier 25 when billing to indicate that the physician performed “a significant, separately identifiable service performed on the same day as another procedure or service.”  MSSNY has expressed great concerns that the new policy will have the result of inconveniencing patients who see physicians in both primary and specialty care settings. In some cases, patients may have to be treated over the course of multiple visits, instead of on the same day. This will increase patients’ out-of-pocket costs i.e. copayments, coinsurance, etc.)

Following Anthem’s announcement of its intent to cut payment for these “same day distinct service” claims by 50% in early December, physician outrage over this change prompted the AMA House of Delegates to adopt a policy calling for  the AMA to “aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.”  MSSNY strongly supported and advocated for this policy.

Following this policy adoption, the AMA met with Anthem to discuss the physician community’s great concern with this enormously unfair policy change. Following this meeting in late December, Anthem announced that it would reduce the size of its planned payment cut for such services from 50% to 25% and pushed back the implementation to March 1, 2018.  This change was announced to New York physicians in an e-mail dated January 10, 2018.  While marginally helpful, it will still produce an enormous cut and still not fully address our concerns regarding same-day distinct services being treated differently.   Moreover, the January 10 notice may not satisfy New York statutory provisions that require 90 days advance notice of adverse reimbursement changes.

Click here to read MSSNY’ letter that was sent to DFS outlining MSSNY’s concerns with egregious attempt to cut payments.

We will keep you apprised of any updates.
(AUSTER/MCNALLY) 

Council Notes-January 18, 2018

• • Council discussed concerns over the proposed CVS takeover of Aetna. Specifically, they addressed the adverse implications for patients if this merger goes forward. The leadership is concerned with burdensome and excessive prior authorization barriers for prescription medications. There are also concerns with potential advancement of “minute-clinics” and patients being treated by non-physicians. The Council is wary of CVS’s ultimate intent. Following the discussion, Council approved the following resolution:
    MSSNY, along with other state medical society allies, will communicate our opposition to the Aetna/CVS merger to appropriate federal agencies. MSSNY will then communicate that information to the AMA, seeking that they take similar action in opposition to the merger.
  • On behalf of MSSNY General Counsel Garfunkel Wild, Don Moy, Esq., addressed the question concerning whether a physician can consult the Prescription Monitoring Program Registry (PMP) to access the controlled substance history of a potential patient for the purpose of deciding whether to accept or decline the individual as a patient. Following an explanation regarding what a practitioner must attest to after accessing the PMP, Garfunkel Wild’s conclusion is as follows: “It appears that accessing the PMP to learn the controlled substances history of a potential patient, not for the purpose of diagnosis or treatment, but for the purpose of deciding whether to accept or decline the individual as a patient is not an authorized purpose of the PMP, and could be determined by the DOH to violate Public Health Law 3343-a and 3371. We are aware of no case in which a physician had been charged with a violation of this law.”
  • Kate Kirley, MD, MS, Director of Chronic Disease Prevention at the AMA, presented Diabetes Prevention: Clinical and Payment Considerations. As part of ongoing work to reduce the incidence of type 2 diabetes nationwide, the AMA has launched a multi-state effort to reach more of the estimated 84 million Americans who unknowingly live with prediabetes.  MSSNY has partnered with the AMA to launch this proactive initiative to educate New York State physicians on how to initiate clinical practice change and prevent diabetes in patient population. If your practice is interested in implementing the program, please contact Pat Clancy: pclancy@mssny.org or Carrie Harring: charring@mssny.org.
  • Speaker Kira Geraci-Ciardullo, MD, announced details regarding MSSNY’s 2018 House of Delegates in Buffalo, which include the following:
  • NYS Health Commissioner Howard Zucker, MD, JD will open the House at 8 am on Friday morning, March 23.
  • Andrew Gurman, AMA Immediate Past President, will address the House at 8am on Saturday, March 24.
  • Elections for AMA Delegates will be held at 7 am on Sunday, March 25.

• Resolutions due to MSSNY at 5pm on February 9.

Leaders Collaborate to Streamline Prior Authorization to Improve Timely Access
(Washington DC January 17) Physicians, pharmacists, medical groups, hospitals, and health insurance providers are working together to improve prior authorization processes for patients’ medical treatments, also known as pre-approval. This will help patients have access to safe, timely, and affordable care, while reducing administrative burdens for both health care professionals, hospitals and health insurance providers.

If a treatment or prescription requires prior authorization, it must be approved by a health insurance provider beforehand… Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive. Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions. Enhanced transparency and communication also play critical roles in improving prior authorization processes, which underscores the importance of this new effort.

As the first step in this collaboration, the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA) have announced a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

According to the Consensus Statement, these health care leaders will work together to:

• Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider
• Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
• Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes.
• Protect continuity of carefor patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements.
• Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

This group of health care leaders is committed to ongoing collaboration to improve the prior authorization process for health care professionals, health insurance providers, and, most importantly, patients. As experience is gained, these processes will be further refined to maximize efficiency and minimize care disruption for patients.

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew.
KEEP MSSNY STRONG!

Workers Compensation Re-Registration
As of December 18, 2017, the total number of listed authorized physicians was 24,894. The WCB has updated their WC directory of authorized providers as of Friday January 19, 2018.  As of this date, 10,356 out of the 24,894 authorized have registered.  The WCB is continuing to work with a number of physicians that have reported issues and these physicians will be added as their registration process is completed.

Report Recommends Lowering Threshold for Drunk Driving
To combat drunk driving, a panel from the National Academies of Sciences, Engineering, and Medicine is recommending that states lower the threshold for what is considered alcohol-impaired driving from 0.08% to 0.05% blood alcohol concentration.

The panel found that a person’s ability to operate a vehicle begins to deteriorate before BAC reaches 0.08%. 

IV Bag Shortage Caused By Hurricane Maria A “Crisis” During Flu Season
Hurricane Maria’s devastating impact continues to be felt, including in a national shortage of IV bags. USA Today (1/14) reported that hospital pharmacy departments “have devised ways to reserve the 25-to-100 milliliter saline bags for use in patients whose condition requires them and adopt viable substitute procedures when possible.” For example, hospitals “have been using oral medications when they can, stopping IV bags once a patient no longer requires them and looking to Canadian suppliers to help fill the gap.” Other hospitals use different sizes of bags when possible or replacing saline for dextrose.

Calling All “Tweeters”!
Are you willing to be a MSSNY Twitter Ambassador? Make a commitment to regularly liking and retweeting from @mssnytweet?  Please consider helping us to expand our reach so that the issues of importance to New York State physicians are heard far and wide!  We are hoping to form a group of MSSNY members who will commit to doing this on a regular basis. If interested, please contact Roseann Raia at rraia@mssny.org.

FOR YOUR PATIENTS: App to Quit Smoking
The NYCDOMHH has a new app to help patients quit smoking. The HelpMeQuit app can track and celebrate progress, offer tips on how to outlast cravings, and connect your patient with other quitters for support.

Easy Access to MSSNY Publications
Doctors, did you know your staff can have access to Enews and the News of New York? If you have internet in your office, a staff member can go to www.mssny.org. Go to the far right and click on “Publications.” Just click and you’re in! For back issues, click “archives.”

Statue of Surgeon Who Practiced on Slaves Is Being Reviewed for Removal
A 14-foot-tall statue of Dr. J. Marion Sims that stands in Central Park, near Fifth Avenue at 103rd Street, is being moved out of Manhattan after fierce controversy over the South Carolina doctor. Dr. Sims was long hailed as a pioneer in gynecology, but he practiced surgical procedures on women who were enslaved, had not given consent, and were not given anesthesia. A New York City commission has now recommended that the bronze monument be moved from Central Park to Dr. Sims’s grave in Brooklyn.

HHS Forming Conscience and Religious Freedom Division for Medical Professionals
HHS said it will form a Conscience and Religious Freedom Division within its Office for Civil Rights (OCR). HHS said it is seeking to “more vigorously and effectively enforce existing laws” regarding medical professionals’ right to claim that certain procedures would violate their personal and religious beliefs.

Appearing on the HHS website today is a page detailing the type of procedures that would come under the new office’s authority, such as abortion, sterilization, physician-assisted death, and related training and research activities.

CMS Approves First Medicaid Work Requirements
CMS last week approved a Kentucky Medicaid waiver that allows the state to implement work requirements for its Medicaid program. The move marks the first time CMS has ever allowed a state to tie Medicaid eligibility to work requirements, and the agency in the approval letter signaled it would approve similar waivers for other states