MSSNY eNews: November 10, 2021 – 7 Steps to Prepare for Medicare Final Rule

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7 Steps to Prepare for Medicare Final Rule
The proposed Medicare rule is finalized, and now is the time to prepare for implementation. Below are some best practices that should be conducted to ensure your office is ready to go live on January 1^st. After the implementation on January 1, schedule a follow-up meeting with staff to catch any issues and ensure all is going well with the changes.

1. Familiarize yourself with the contents
2. Schedule a meeting with your administration/office manager to review changes
3. Review any current practices that will need to be changed
4. Delegate administration staff to create clear and thorough steps to roll out these changes with the office
5. Recap with the administration team to review the process they have set up
6. Administration staff to huddle with the team and review action items about new processes
7. Test any changes and confirm the new process flows appropriately

Following are links to the final rule as well as an excel sheet of the added/deleted CPT codes with AMA’s recommendation for replacement codes.

Lastly, tell Congress to cancel Medicare cuts by clicking on this link to send a letter to Congress.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org

1st Year New York Med Students from Underrepresented Backgrounds Tops 20%, Report Says
The number of New York-based first year medical students from underrepresented backgrounds increased to 21.1 percent, the first time the percentage has surpassed 20 percent, according to an annual report from Associated Medical Schools of New York.

The data accounted for the 11,193 students enrolled in New York-based medical schools during the 2020-2021 academic year.

Of the students from underrepresented backgrounds, 8 percent identified as Black/African American, 7.5 percent identified as Hispanic/Latino, and 7.3 percent identified as 2 or more ethnicities/races. Students who identified as Black/African American, including those who identify as multiethnic/racial, where one of the races is Black/African American, account for 9.7 percent.

“Twenty percent is worth celebrating, as long as we acknowledge that we have a way to go,” Jo Wiederhorn, president and chief executive officer of AMSNY, said in a press release. “Diversity in medicine is important because we know patients have better health outcomes when they see doctors from their own backgrounds.”

Read the full report here.

–Gleeson, Becker’s Hospital Review

Competition in Health Insurance: A Comprehensive Study of U.S. Markets
American Medical Association, Division of Economic and Health Policy Research | September 2021

The American Medical Association released their annual U.S. health insurance market concentration study. The newest analysis found that nearly three-quarters (73%) of all metropolitan statistical areas are highly concentrated health insurance markets, based on the Department of Justice and the Federal Trade Commission’s horizontal merger guidelines. The study also found that:

• In 91% of the markets, a single health insurer had a market share of 30% or more and in 46% of the markets, a single health insurer’s market share was at least 50%.
• 57% of the markets saw their contraction index rise, and the increase was at least 500 points in 21% of the markets.
• Highly concentrated markets increased from 71% to 73% of all markets between 2014 and 2020.
• More than half (54%) of markets that were highly concentrated in 2014 became more so by 2020.

26% of health insurance markets that were not considered highly concentrated in 2014 shifted to highly concentrated by 2020.

Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
Physicians are urged to contact Governor Hochul’s office to urge her to veto multiple problematic pro-trial lawyer bills passed at the end of the Legislative Session that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims.  While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts.  These bills include:

• A2199/S473 – Expanding the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
• A8040/S7093 – Changing a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.
• A8041/S7052 – Imposing excessive insurance disclosure requirements on defendants during litigation.

MSSNY Member Dr. Carolyn Wolf-Gould Offers Insights into Rural Transgender Care in New Publication
MSSNY member Dr. Carolyn Wolf-Gould published a book chapter in September about the challenges faced by transgender patients and their medical providers in rural communities. The peer-reviewed piece, entitled “From Margins to Mainstream: Creating a Rural-Based Center of Excellence in Transgender Health for Upstate, New York,” distills hard-earned insights from her and her teams’ experience working with the Robert Wood Johnson Foundation’s Clinical Scholars Program to create FoxCare Center’s Gender Wellness Center.

“As a physician, my driving concern is caring for the health and wellbeing of my patients,” explains Wolf-Gould. “That begins, of course, with caring for the individual needs of my patients. But the transgender and gender-nonconforming community is chronically underserved by our health system. Caring for them demands more—creating institutions, like the Gender Wellness Center, that help them find the services they need. And changing the culture and climate of the entire system to include their needs. My hope is that pieces like this might help in that big picture work.”

Wolf-Gould’s piece forms chapter six of “Leading Community Based Changes in the Culture of Health in the US,” edited by Claudia S.P. Fernandez and Giselle Corbie-Smith at the University of North Carolina at Chapel Hill. The open-source book is free and available to read or download here.

Free Online Clinician Curriculum to Improve IDD Healthcare
Cerebral Palsy Associations of NYS (CP State), in partnership with the Mother Cabrini Health Foundation, is proud to offer a free educational training series to all New York State clinicians, including physicians, nurse practitioners, physician assistants, nurses, therapists, dentists, students of these disciplines, and any health professional who works one-on-one with patients.  This training series teaches the fundamentals of IDD healthcare.

The “Curriculum in IDD Healthcare”, written and delivered by Craig Escude, MD, FAAFP, FAADM, with over 20 years’ experience providing medical care for people with intellectual and developmental disabilities, is an online training course which includes 5 hours of CME credit for prescribing clinicians and 6 CEU nursing credits.  There are six (6) modules within the course covering everything from healthcare basics in IDD to common behavioral presentations of medical conditions in people with IDD.  Learners can complete this 4.5 hour course at their own pace through CP State’s learning management system.

The “Fatal Five Advanced E-Learn Course” was developed to educate clinicians on the topic of the fatal five conditions affecting individuals with IDD, to include:  aspiration, bowel obstruction, dehydration, seizures, sepsis, and GERD.  This 6-hour self-paced course provides 7 CEU credit hours for registered nurses.

All courses will be presented on the SAP/Litmos learning management system platform, administered by CP State. To sign up for your free account to gain access to the online library of training courses, visit www.cpstate.org/bettercare. Questions? Contact Cindy Morris, Project Director for the Clinician Training Program, at (518) 612-4510 or cmorris@cpstate.org.

Urge Governor Hochul to Sign Legislation to Prevent Mid-Year Formulary Changes and to Regulate PBMs
Physicians are urged to send a letter to Governor Hochul urging that she sign into law bills passed by the Senate and Assembly earlier this year that would significantly limit mid-year formulary changes made by health insurers (S.4111 Breslin/A.4668 Peoples-Stokes) and to regulate PBMs (S.3762, Breslin/A.1396, Gottfried). Urge Governor to SIGN two RX bills – Regulating PBMs and Restricting Mid-Year Formulary Changes.

MSSNY together other with patient advocacy groups met with Governor Hochul’s office last week to urge that she sign into law the legislation to protect against mid-year formulary changes. MSSNY recently joined with 65 other physician and patient advocacy organizations in a joint letter to Governor Hochul urging her to sign this legislation.

COVID Vaccination Program Guidance for Physicians: Vaccination of Children Ages 5-11
Following are links to updated guidance for the New York State Department of Health (NYSDOH) COVID-19 vaccination program:

• Vaccination of Children Ages 5-11
• Screening Checklist for the Administration of Pfizer-BioNTech COVID-19 Vaccine for Children 5-11 years old
• COVID-19 Immunization Screening and Consent Form

A NYSDOH webinar on Pediatric and Booster vaccines is available here.

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