MSSNYeNews: October 15, 2021 – Finding the Joy in Medicine

Colleagues:

Last week, MSSNY member Dr. Caroline Gomez-Di Cesare, MD, PhD accepted the AMA 2021 Joy in Medicine Health System Recognition award—which recognizes health systems that actively demonstrate a commitment to the well-being of health care team members by combating work-related stress and burnout—on behalf of Bassett Healthcare Network, where she serves as Network Director of Well-Being.

I am immensely proud of both Dr. Gomez-Di Cesare and of our Senior Vice President of Public Health Pat Clancy. Pat spearheaded MSSNY’s Practice Transformation Initiative (PTI)—which was the basis for this recognition—in collaboration with the AMA and the Physicians Foundation to improve patient care by enhancing professional well-being and reducing physician burnout.  MSSNY’s role was to identify 4-7 practices interested in improving both their practice operations and professional satisfaction through this comprehensive and impactful initiative.

MSSNY is also developing a Telehealth Initiative with educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. [Please see the article below in eNews for more information on both the Practice Transformation Initiative and the Telehealth Initiative.]

Both programs are prime examples of the value MSSNY membership brings to our physicians—regardless of their practice environment.  The PTI presented a unique opportunity for our larger practices and institutional members and the Telehealth Initiative offers excellent assistance to physicians in solo and small group practices.

Of course, these are additions to many other invaluable programs—including our Peer-to-Peer (P2P) program and our Physician Payment and Support program—both of which provide support to our physicians every day to help lower stress and again find the joy in medicine.

As I often say, “MSSNY membership doesn’t cost, it pays.”

Joseph Sellers, MD, FAAP, FACP
MSSNY President.

MSSNY Joins More Than 65 Healthcare Stakeholder Organizations to Urge Governor Hochul to Sign Bill to Prevent Dangerous Changes to Patients’ Medications
Physicians are urged to send a letter to Governor Hochul to urge that she sign into law legislation  (S.4111 Breslin, D- Albany/A.4668 Peoples-Stokes, D- Buffalo),  which limits the ability of health insurers to change their prescription frug formularies during the middle of a policy year.  A letter can be sent from here: Urge Governor to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes (p2a.co)

This week MSSNY joined with 65 other physician and patient advocacy organizations in a joint letter https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:a3ce6b3b-74cb-4155-ba1a-38e500b6bf0d to Governor Hochul urging her to sign this legislation.

Enactment of this law will help prevent situations where mid-year formulary changes essentially force stable patients to switch from their physician-prescribed medications, to potentially less effective alternatives for non-medical reasons, a move that often leads to complications for those managing debilitating chronic illness.  For many New Yorkers, particularly those with chronic and complex illnesses, medical stability is hard won and patients are often dependent on the medications originally prescribed by their physician to maintain normal lives.  Patient stability is jeopardized when they’re forced to abandon therapies unrelated to the patient’s well-being.

Moreover, data shows that changes in medication unrelated to health outcomes are generally ineffective in achieving any meaningful cost savings and, instead, disrupts the continuity of care, reduces medical adherence, and unnecessarily puts the patient’s health at risk.  In fact, patients whose treatment is switched frequently, often experience adverse side effects, allergic reactions, and increases in health costs for additional testing, unexpected appointments with physicians, ER visits, and hospitalizations, stemming from complications as a result of switching medications to an inferior drug.

To avoid patient instability, and increased costs, MSSNY is strongly urging Governor Hochul to sign S.4111/A.4668 as soon as possible. To view the sign-on letter: https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:a3ce6b3b-74cb-4155-ba1a-38e500b6bf0d

NYS DOH Commissioner’s Grand Rounds: The Use of Multidisciplinary Approaches to Long COVID Care
On October 25^th, the New York State Department of Health will host a session of the Commissioner’s Medical Grand Rounds Series: The Use of Multidisciplinary Approaches to Long COVID Care. This virtual session will take place on Monday, October 25^th, from 1:00 – 3:00pm, and will be streamed via live webcast.

The Use of Multidisciplinary Approaches to Long COVID Care will bring together experts to provide insight into holistic and patient-centered approaches to long COVID management. This Grand Rounds session will help providers understand what is known about the physiological mechanisms by which long COVID affects patients and the epidemiological determinants of long COVID. This session will also prepare participants to identify multidisciplinary approaches to the management of significant physical and neurological symptoms and recognize the importance of rehabilitation as part of the treatment plan for those suffering from long COVID.

The link to register can be found here. The session will also be archived on the NYSDOH Website. The event is free-of-charge and open to all interested providers.

Physician Advocacy Urged to Pushback Against HHS’ Insurer-Biased Interpretation of No Surprises Act
Physicians are again urged to contact Senators Schumer and Gillibrand as well as their respective Representative in Congress to ask that they request that the US Department of Health and Human Services (HHS) revise its recently announced regulations to implement provisions of the “No Surprises Act”, establishing a federal independent dispute resolution (IDR) process for out of network surprise bills.   A letter or tweet can be sent using this link: Urge Congress to Urge HHS to Revise Independent Dispute Resolution Regulations (p2a.co)

MSSNY President Dr. Joseph Sellers recently issued a statement Surprise Billing Legislation Interim Final Rule: MSSNY Calls for Prioritizing Patient Care Over Insurance Profits – (mssnyenews.org) in which he said “In implementing the Independent Dispute Resolution (IDR) process for resolving patient surprise medical bills – a process that New York physicians has strongly supported for many years – HHS has clearly sought to put its thumb on the scale in favor of multi-billion-dollar insurance companies.”

The rule has also been criticized by numerous national medical organizations, including the AMA, the American Hospital Association, Federation of American Hospitals and numerous specialty societies. The Congressional intent articulated in the No Surprises Act was to create an IDR process to protect patients that was appropriately balanced and did not favor either the insurer or the physician in claims disputes. Specifically, the final language adopted by Congress required the arbiter to consider numerous factors, including patient acuity or complexity of services, demonstrations of previous good faith efforts to negotiate in-network rates and previously contracted rates, in addition to the insurers’ median in-network rate, without specifying that one factor take precedence over another.

However, instead of following the statutory language, HHS and other federal agencies designed an IDR process that heavily favors health insurance companies in payment disputes. The language in the rule directs the IDR arbiter to give priority to the insurer-calculated median in-network amount, called the qualifying payment amount (QPA), over the other considerations noted above.  It also imposes a number of requirements on the arbiter if they decide to make a decision that deviates from the insurer-determined QPA.  This effectively ties the hands of the arbiter.

With the law scheduled to take effect January 1, 2022, MSSNY intends to work with the AMA and other allied groups to advocate for needed changes to the regulation to ensure that the IDR process is implemented in a way that better achieves balance in the IDR process, to protect care availability in hospital emergency departments.  Again, a letter can be sent from here: Urge Congress to Urge HHS to Revise Independent Dispute Resolution Regulations (p2a.co)

MSSNY Tip of the Week: The Scoop on Transitional Care CPT Codes
If you or your clinical staff is in constant contact and follow up (30 days post) with patients who have been discharged from an in-patient hospital stay, you may be able to bill for it. Following are two CPT codes for transitional care:

99495– Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge

99496-Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge

If you have questions or concerns, please contact Heather Lopez- Director of Physician Payment & Practice, 518-465-8085 X332 or hlopez@mssny.org.

AMA, MSSNY and Others Call on CMS to Stop Unfair Charging for Electronic Funds Transfer
MSSNY has joined with over 90 state and specialty medical societies in a letter HHS (ama-assn.org) initiated by the American Medical Association (AMA) to CMS urging that CMS enforce federal laws and regulations that ensure health insurers make available an option for electronic fund transfer (EFT) payments without cost.

The letter raises the concern that “an increasing number of our physician members report that they are forced to incur mandatory, percentage-based fees for the receipt of electronic payments from health plans for payments made via the EFT transaction standard”.  It further notes that “CMS currently possesses sufficient statutory and regulatory authority to act and protect physicians’ right to receive EFT payments without percentage-based fees” and that “when health plans or their contracted payment vendors force practices to enroll in EFT programs that impose percentage-based fees, they are clearly adversely affecting the physician and adoption of the EFT transaction standard—an obvious statutory and regulatory violation”

In response to complaints from several physicians about health insurer vendors charging excessive fees for EFT, MSSNY recently passed a resolution at its House of Delegates calling for the strong enforcement of existing laws to prohibit health insurers or their vendors from charging physicians for making an EFT, or the enactment of laws that ensure that such charges are prohibited.  MSSNY Governmental Affairs staff also had a meeting with staff to Senate Majority Leader Charles Schumer this week to urge that his office request that CMS enforce the existing laws to prohibit charging for EFT.

The AMA/medical societies letter further demands that CMS “swiftly issue guidance stating that all health plans and their contracted vendors must offer at least one EFT standard transaction that does not require purchase of extra services for an additional fee” as well as urging that CMS “appropriately enforce compliance with this guidance, to ensure that health plans and their vendors are offering physicians the option of receiving EFT without additional services/fees and that this choice is clearly communicated in all EFT enrollment materials”.

Lack of fair EFT is one more administrative roadblock imposed by deep-pocketed health insurers to prevent physicians from being paid fairly for health care services delivered to their patients. Please remain alert for further updates on this important issue.

Suffolk County Legislature Teams Up with Suffolk County Medical Society and Suffolk Academy of Medicine to Develop Website for Medical Providers
On Tuesday, October 5^th, the Suffolk County Legislature unanimously passed Introductory Resolution 1552-2021, sponsored by Suffolk County Legislator Sarah Anker, which directs the Suffolk County Department of Health Services and the Department of Information Technology to develop a website to provide critical information to medical providers in Suffolk County. The two departments will collaborate with the medical community, including the Suffolk County Medical Society and the Suffolk Academy of Medicine, to tailor the website to the needs of the medical providers that will utilize the page for locating urgent emergency information, resources and resident health related updates.

“After discussions with the Suffolk County Medical Society, the need for a website such as this was apparent,” said Legislator Anker, Chairwoman of the Suffolk County Addiction Prevention and Support Advisory Panel. “What we have learned from the COVID-19 pandemic is that it is so important to have systems in place to inform our medical community about emergency information and guidance. This website will serve to better inform Suffolk County’s medical providers of important information including notifications of water contamination, disease outbreaks, vaccination guidance, and resources that are available. I look forward to continuing to partner with our county’s Health Department, IT Department and the Suffolk County Medical Society to provide critical information to our medical providers.”

“The physicians of Suffolk County have stressed the importance of clear and timely communication from and between the Department of Health, practicing physicians, and the patients and families we serve,” said Suffolk County Medical Society (SCMS) President and Medical Society of the State of New York Vice Speaker Maria Basile, MD, MBA. “This resolution and the website it calls for is an example of the enhanced communication we have promised our members. It demonstrates the SCMS and Suffolk Academy of Medicine’s commitment to working collaboratively with our colleagues in the Health Department and the Suffolk County Legislature. SCMS is the trusted voice of the medical community and we look forward to continuing our work with Commissioner Pigott and his staff to assure that our communications are clear, evidence-based, timely, relevant, and meaningful.”

The website will be launched within 180 days of the passage of Introductory Resolution 1552-2021. The Department of Health Services will review and update the information on the website on a quarterly basis, with increased frequency during states of emergency related to the public health of the residents of Suffolk County as declared by the Governor of New York State or the Suffolk County Executive. For more information please contact Legislator Sarah Anker’s office at (631)-854-1600. To view the resolution, visit: https://apps2.suffolkcountyny.gov/legislature/ressearch/Search_Results.aspx.

NY Congressional Delegation Urges Action Before End of 2021 to Prevent Devastating Cuts to Medicare Payments to Physicians
With physicians facing a nearly 10% cut in payments from Medicare starting January 1, 2022, 15 members of the New York Congressional Delegation added their name to a letter by Representative Ami Bera, MD (D- CA) and Representative Larry Bucshon (R- Indiana), to House leaders Representatives Nancy Pelosi (D- CA) and Kevin McCarthy (R- CA), urging them to act before the end of the year to prevent devastating cuts to physicians’ Medicare payments. Nearly 250 Congressional members in total have joined the letter, along with almost 140 national provide organizations, and more than 50 state and local Medical Societies.

The current Medicare payment system does not adequately incentivize high-quality care and payments to physicians has failed to keep up with inflation. Broad systemic reforms to the Medicare payment system are needed to address the growing financial uncertainty and to speed the transition to value-based care. The letter urged Congress to create stability by addressing the immediate payment cuts facing health care professionals as it begins the complex process of identifying and considering potential long-term reforms, pointing out that cuts will strain the health care system and jeopardize patient access to medically necessary services.

Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) with the goal of moving away from a fee-for-service payment model to a system that ensures providers are paid for the work they do to keep patients healthy, not just treat them when they’re sick, but most practices lack access to qualified, patient-centered alternative payment models under MACRA. Additionally, the Medicare Physician Fee Schedule (PFS) has failed to keep up with inflation and larger increases to some providers must be offset by cuts to other providers, even if there’s no evidence of overpayment, due to a budget neutrality provision in statute, that further contributes to the financial pressure on health care professionals. Health care professionals are also facing imminent payment cuts stemming from the Medicare sequester and the Statutory Pay-As-You-Go (PAYGO) Act.

The letter also recognized action taken in the Consolidated Appropriations Act, 2021 to mitigate the impact of payment cuts initiated by the CY 2021 PFS. The Consolidated Appropriations Act contained a 3.75 percent payment adjustment for all PFS services in CY 2021 as part of congressional relief provided for the impending payment cuts. This payment adjustment afforded some short-term stability for health care professionals struggling with the impact of the COVID-19 pandemic, however, this critical piece of congressional relief is expiring at the end of the calendar year and adds to other impending cuts.

We thank the following NY Delegation Members who Signed on to Bera-Buschon Letter

1. Representative Yvette Clarke (D- Brooklyn)
2. Representative Antonio Delgado (D- Hudson Valley)
3. Representative Andrew Garbarino (R- Long Island)
4. Representative Brian Higgins (D- Buffalo)
5. Representative Chris Jacobs (R- Western New York)
6. Representative Mondaire Jones (D- White Plains)
7. Representative John Katko (R- Central New York)
8. Representative Nicole Malliotakis (R- Staten Island)
9. Representative Carolyn Maloney (D- Manhattan)
10. Representative Grace Meng (D- Queens)
11. Representative Joe Morelle (D- Rochester)
12. Representative Kathleen Rice (D- Long Island)
13. Representative Tom Suozzi (D- Long Island)
14. Representative Paul Tonko (D- Capital District)
15. Representative Nydia Velazquez (D- Brooklyn & Manhattan/Lower East Side)

Influenza: In the Time of Pandemic 2021-2022:
October 20, 2021 @ 7:30am Medical Matters CME Webinar
Vaccine components, recommendations for dealing with flu during a pandemic and contrasts with previous flu seasons are all new this season.  You can learn more by registering for “Influenza: In the Time of Pandemic 2021-2022” on Wednesday, October 20, 2021, at 7:30 a.m.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Click here to view the flyer for this program.

Educational objectives are:

• Examine the dramatic decrease in influenza cases in 2020-2021
• Identify strategies to effectively encourage patients to get vaccinated
• Analyze measures to ensure continued abatement of influenza during and after the COVID pandemic
• Discuss timing of influenza vaccines with COVID-19 vaccination

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

The Medical Society of the State of New York 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. 

Update on MSSNY’s Practice Transformation Initiative and Telehealth Initiative Programs
Practice Transformation Initiative: The AMA hosted the American Conference on Physician Health this past October 7-9^th, 2021. This was a joint scientific conference in which the goal was to promote scientific research and discourse on health system infrastructure and actionable steps organizations can take to improve physician well-being. Attendees were able to participate in topical and relevant sessions with presenters and learn about best practices and tools to improve professional satisfaction in your medical practice.

All six of MSSNY’s participating practice sites (Northwell Health, Bassett Healthcare, Ellis Medicine, St. Peter’s Capital District, St. Peter’s Saratoga Family Health, and NY Presbyterian) have administered and closed their mini-z assessment surveys amidst the COVID-19 surges and have implemented various interventions tailored to their specific results. Each practice site was invited to attend various educational webinars in which the AMA hosted professional personal for various topics such as pre-visit planning/labs. As we enter the fall, the practice sites will be deploying their post- mini-z assessment surveys which will aim to measure overall change of workplace satisfaction after each practice implemented these interventions. Given the DELTA variant, some of the practice sites will be opting to postpone their post- mini-z survey until the end of fall/beginning of winter. The practice sites have been invited by the AMA to submit an abstract with their findings to the ICPH in Orlando in 2022, and a few of our sites have expressed great interest in doing so.

The Telehealth Initiative: As part of the project, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. MSSNY, as part of this program, will be part of a national network and support needed to establish and maintain strong relationships with physicians, practices, and health systems interested in implementing, optimizing, or sustaining telehealth. In addition to providing ongoing support, this year’s program will emphasize the importance of realizing the true value of virtual care. MSSNY has secured three signed statements of interest: C DOC, Mount Sinai, Northwell TeleICU/Telehealth. We expect to have at least two more statement of interests signed by mid-October, but we are hoping to have closer to 10 practice sites all together. As a collaborating partner, team leaders will participate in a “kick-off” meeting with leaders from practice sites in New York and in other states. Each practice site will be involved in dissemination of a telehealth survey assessing practice/physician experience using telehealth. In addition to participation in the Telehealth Survey, the project team will collect baseline, mid- point, and final data points to measure the impact of telehealth in their practices using the Return on Health framework. Access to educational resources from the AMA and expert mentoring to discuss optimization and sustaining telehealth into practice, virtual events and discussions which provides a network for physicians and care teams to share experiences will be provided to all participants.

For more information on MSSNY’s Practice Transformation Initiative or Telehealth Initiative, contact Cayla Lauder at 518.465.8085 or clauder@mssny.org.

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For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302