November 18, 2016 – Alphabet Soup Mania!
Dr. Malcolm Reid
|November 18, 2016
Volume 16, Number 41
MACRA, MIPS, APNs, EHR, PQRS, MU, SGR, IPA, HMO, PPO, PPN, CMS, CSC, NGS, PAC, CAC, etc.
Yes, the alphabet soup continues. If you have been around long enough, you know what most of these acronyms mean. Historically, we had traditional indemnity health insurance plans. We had usual customary and reasonable charges. We had prevailing community fees. Ah, the good old days.
Next came what was supposed to be the best thing since sliced bread— managed care. Pre-certifications and prior authorizations reigned. Then, the pendulum swung the other way and gave us capitation with a mix of fee-for-service. This worked well for a little while—until the plans figured out that under capitation, some providers made more money than under fee-for-service. Uh-oh, switch back to fee-for-service stat.
Now, the pendulum swings again. The government comes up with MACRA. They describe it as a new payment methodology. Really? Again, if you have been around long enough, it is just the pendulum swinging back yet again.
The government is just trying to see what they are paying for – call it MIPs, APNs, call it value-based medical care. Call it what you will –quite simply, it is just the government demanding to know what it is paying. To do so, it forces physicians to jump through hoops and put square pegs into round holes to justify being paid for the care provided to patients.
If you need help with the payment games, reach out to your medical society. For dues paying members, we are here to help.
If you really want or need a description of the acronyms, call Regina McNally, VP, Socio-Medical Economics, 516 488 6100, ext. 332.
Now, for the good news! This week MLMIC declared a new 20% general dividend for policyholders. The dividend — which will apply to policyholders who are insured on May 1, 2017, and maintain continuous coverage through July 1, 2017 — will be based upon the annual rate of premium in effect on May 1, 2017. MLMIC has always had strong standing and stability in the challenging New York insurance market, and this dividend in addition to their arrangement with Berkshire Hathaway will bring policyholders continued peace of mind.
(See story below)
Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Please send your comments to firstname.lastname@example.org
MLMIC Board Declares 20% Dividend for Policyholders
MLMIC’s board has declared a new 20% general dividend for policyholders. The dividend — which will apply to policyholders who are insured on May 1, 2017, and maintain continuous coverage through July 1, 2017 — will be based upon the annual rate of premium in effect on May 1, 2017. It will provide meaningful financial relief to policyholders.
The board’s decision to declare this dividend is based on MLMIC’s statutory admitted assets of approximately $5.8 billion, a surplus of $1.9 billion and statutory net income of approximately $100 million. These figures, available in the company’s September 30, 2016, statutory financial statement, show the company’s overall financial condition remains sound.
The new dividend is separate and apart from MLMIC’s agreement to become part of the Berkshire Hathaway family of companies. That process takes a while and is on track to be completed by next year’s end. In the meantime, MLMIC’s strong financial performance enables it to offer a 20% dividend.
An overview of the September 30, 2016, statutory financial statement is available here, and the full financial statement has been filed with New York State Department of Financial Services.
Governor Signs MSSNY-Backed Administrative Simplification Bills into Law
Governor Cuomo this week signed into law two bills supported by MSSNY designed to reduce some of the administrative burdens on physicians in their dealings with health insurers.
- The first bill (A.501-E, Cusick/S.2545-D, Lanza) would reduce from 90 to 60 days the time within which a health insurer must complete its review of the application of a physician to participate in the network of a health insurer, as well as reducing from 90 to 60 days the time within which a physician in some situations can become “provisionally credentialed” if the plan does not complete its review. The bill also eliminates some ambiguous statutory language that currently gives discretion to a health insurer to delay a decision on a physician’s application after these deadlines have passed. The new law applies to credentialing applications received by health insurers on or after April 1, 2017.
- The second bill (A.6983-A, McDonald/S.4721-A, Hannon) would direct the Commissioner of Health and Department of Financial Services to create standards to provide greater uniformity among health insurers of the processes to be followed when physicians request insurers to cover their patients’ needed prescription medications. MSSNY worked closely with the New York Chapter of the American College of Physicians in advocating for this legislation. The law takes effect immediately.
Urge Gov. to Sign Law to Permit E-Prescription Transfers between Pharmacies
All physicians are urged to contact the Governor to urge that he sign into law legislation (A.10448. Schimmel/S.7537, Martins) supported by MSSNY that would permit a pharmacy to transfer an e-prescription to another pharmacy.
Physicians can send a letter to the Governor from here.
This law would address concerns faced by both patients and physicians when a pharmacy may be out of stock of a particular medication, and may be unable to fill the prescription. Current laws pertaining to e-prescribing do not allow for the transfer of an e-prescription from one pharmacy to another. In such instance the only recourse available to the patient is to return to the physician’s office – if it is open—to have him/her send the e-prescription to another pharmacy. This creates unnecessary duplication for the physician, and unnecessary delays for the patient waiting to receive their needed medications. This legislation would help to address these concerns.
Counting Absentee Ballots for 2 Senate Races; 24 Newly Elected to NY Legislature
With the absentee ballots of 2 Long Island State Senate races still being counted, it has not yet been officially determined which party will have majority control of the New York State Senate. Of the 63 seats in the State Senate, 30 Republicans have been elected, and 31 Democrats. However, one of the Democrats, Simcha Felder, has previously “conferenced” with the Republicans. The 2 State Senate seats not yet officially decided are currently held by Republicans Carl Marcellino and Michael Venditto. Also unclear at this time is the role of the 7-member Independent Democratic Caucus led by Senator Jeff Klein.
The November 8 elections also saw 24 candidates newly elected to the New York State Legislature, including 18 new Assemblymembers and 6 new Senators.
Below is a list of these newly elected members, and the members of the Legislature they will be replacing:
|Assembly||30 (NYC)||Brian||Barnwell||Dem||Margaret Markey|
|Assembly||94 (Hudson Valley)||Kevin||Byrne||GOP||Steve Katz|
|Assembly||44 (NYC)||Robert||Carroll||Dem||James Brennan|
|Assembly||72 (NYC)||Carmen||De La Rosa||Dem||Guillermo Linares|
|Assembly||70 (NYC)||Inez||Dickens||Dem||Keith Wright|
|Assembly||133 (Western NY)||Joe||Errigo (former Assemblyman)||GOP||Bill Nojay|
|Assembly||115 (North Country)||D. Billy||Jones||Dem||Janet Duprey|
|Assembly||101 (Central NY)||Brian||Miller||GOP||Claudia Tenney|
|Assembly||145 (Western NY)||Angelo||Morinello||GOP||John Ceretto|
|Assembly||65 (NYC)||Yuh-Line||Niou||Dem||Alice Cancel|
|Assembly||144 (Western NY)||Michael||Norris||GOP||Jane Corwin|
|Assembly||23 (NYC)||Stacey||Pheffer Amato||Dem||Phil Goldfeder|
|Assembly||33 (NYC)||Clyde||Vanel||Dem||Barbara Clark|
|Assembly||143 (Western NY)||Monica||Wallace||Dem||Angela Wozniak|
|Assembly||112 (Capital District)||Mary Beth||Walsh||GOP||James Tedisco|
|Assembly||56 (NYC)||Tremaine||Wright||Dem||Annette Robinson|
|Senate||31 (NYC)||Marisol||Alcantara||Dem||Adriano Espaillat|
|Senate||36 (NYC)||Jamaal||Bailey||Dem||Ruth Hassell-Thompson|
|Senate||54 (Central NY)||Pamela||Helming||GOP||Michael Nozzolio|
|Senate||60 (Western NY)||Chris||Jacobs||GOP||Marc Panepinto|
|Senate||49 (Capital District)||James N.||Tedisco (former Assemblyman)||GOP||Hugh Farley|
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
MSSNY Veterans’ Matters Now Includes CME Programs on Substance Use and Suicide; Physicians Strongly Urged to Attend
The Medical Society of the State of New York is expanding its Veterans’ Matters mental health training initiative by including additional programming on substance use disorders and suicide in returning veterans. Veterans’ Matters is conducted through webinars and live grand rounds presentations all over the state.
Presenting faculty for Veterans’ Matters includes Frank Dowling, MD and John McIntyre, MD. The Medical Society will present a PTSD and TBI webinar on Wednesday, December 7th at 7:30 a.m. On December 15th, a Substance Use Disorders webinar will be conducted at 8 a.m. Registration is required.
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.
MSSNY designates each live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
To register for a webinar, click on a date below:
Information and the educational objectives for each webinar can be found here:
If your hospital is interested in having one of these programs presented, or if you need assistance with registering, please contact Greg Elperin at email@example.com or call (518)465-8085.
MACRA Educational Program This Monday Evening from 7-8:30PM
Do you have questions about how to comply with the new Medicare MIPS requirements taking effect in 2017? This
Monday, November 21, from 7-8:30 PM is the first of several programs being offered by the AMA to help physicians better understand the requirements of the new Quality Payment Programs (QPP) that were created by the Medicare Access and CHIP Reauthorization Act (MACRA). To register for Monday night’s program, click here: https://cc.readytalk.com/r/y70aavsqh5g0&eom
Other similar programs upcoming include:
- Thursday, Dec. 1 – 6:30 pm – 9 pm ET
- Tuesday, Dec. 6, 8:00 pm – 9:30 pm ET
- Saturday, Dec. 10, 12 PM -1:30 ET
DOH Recommends Four Brooklyn Hospital Merge
A new report commissioned by the state Department of Health recommends that four financially struggling Brooklyn hospitals merge into one regional health system, with one of the hospitals drastically reducing inpatient services.
The four hospitals—Brookdale University Hospital and Medical Center, Kingsbrook Jewish Medical Center, Interfaith Medical Center and Wyckoff Heights Medical Center—will require $310 million in operating subsidies from the state in fiscal 2017, which ends March 31, 2017. The report was authored by Northwell Ventures, the consulting arm of Northwell Health. The combined losses of the four hospitals are expected to grow to $405 million by fiscal 2021. Over the five-year period the hospitals will have lost $1.8 billion. Gov. Andrew Cuomo and the state Department of Health must now determine whether they support Northwell’s proposals. To move forward, the plan must also be approved by the boards of the four Brooklyn hospitals.
AMA Statement Re Principles of Health Care Reform That Congress Must Address
With the entire Affordable Care Act likely to be revisited in the New Year by the Congress and President-elect Trump, the AMA released the following statement after receiving extensive testimony from physicians representing a wide array of perspectives at its House of Delegates meeting this past weekend.
“The AMA House of Delegates, reflecting more than 170 state and specialty medical societies from across the country, today reaffirmed its commitment to health care reform that improves access to care for all patients.
“Using a comprehensive policy framework that has been refined over the past two decades, the AMA will actively engage the incoming Trump Administration and Congress in discussions on the future direction of health care. The AMA remains committed to improving health insurance coverage so that patients receive timely, high quality care, preventive services, medications and other necessary treatments.
“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured. We will also advance recommendations to support the delivery of high quality patient care. Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs.
“Health care reform is a journey involving many complex issues and challenges, and the AMA is committed to working with federal and state policymakers to advance reforms to improve the health of the nation.”
Among the key principles highlighted by the AMA in its policy framework that they urge policymakers to consider:
- Individually owned and selected health insurance using refundable and advanceable tax credit
- Support a requirement that individuals and families who can afford health insurance be required to obtain it;
- Required coverage of pre-existing conditions;
- Expanded availability of Health Savings Accounts (HSAs);
- Continued availability of those under 29 to stay on parents’ coverage;
- Adequate Provider Networks in Medicare, Medicaid and Commercial Insurance;
- Health Plan Transparency/Accurate Network Listings;
- Medical Liability Reform;
- Fair Medicaid Payment/Parity with Medicare payments; and
- Affordable Prescription Medications
CMS Launches New Online Tool to Make Payment Program Easier for Clinicians
Today, CMS released a tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.
In October, CMS released the Quality Payment Program website, an interactive site to help clinicians understand the program and successfully participate. Today’s release, commonly referred to as an Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API, available at www.qpp.cms.gov/education, will allow developers to write software using the information described on the Explore Measures section ofwww.QPP.cms.gov
.Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference. Already, tens of thousands of people are using this tool.
Several groups have applauded the release of this information, including: the American Academy of Ophthalmology, the Network for Regional Healthcare Improvement (NHRI), American College of Radiology (ACR), American College of Physicians (ACP), National Rural Accountable Care Consortium, Great Lakes PTN, Pacific Business Group on Health, Compass PTN, TMF QIN-QIO, and the Mountain Pacific Quality Health Foundation.
As the program and its supporting website mature, CMS will continue to release data and APIs to spur innovation and keep participants up-to-date.
To see the API Swagger documentation, please visit: https://qpp.cms.gov/api/
CMS Finalized Claims-Based Data Collection Process that Is “Less Burdensome”
CMS finalized a claims-based data collection process on the frequency of and inputs involved in global surgical services that is much less burdensome for physicians than CMS’ earlier proposal. Key changes include:
- CMS’ decision to use 99024 for reporting post-operative services rather than the proposed set of time-based G-codes
- Reporting is no longer required for pre-operative visits
- Reporting is only triggered for services that meet certain minimum thresholds annually—CPT codes billed by more than 100 practitioners over 10,000 times or have allowed charges in excess of $10 million
The final rule increases payments for Chronic Care Management services by accepting CPT and RUC recommendations urging CMS to ease the administrative burden and expand the opportunities for physicians. CPT codes 99358 and 99359 for non-face-to-face prolonged E/M services will also be billable under Medicare beginning in 2017.
Medicare Announces New RAC Contracts
Last week, Medicare announced the new Recovery Auditor contracts, which sets limits for the post-claims review process and dictates when Recovery Audit Contractors (RAC) will be eligible to receive their contingency fees.
Among the changes specified in the new contracts, RACs will no longer automatically receive contingency fees for each identified overpayment. This new policy requires the RACs to pass the second level of a five-level appeals process before receiving their contingency fee. The new RAC contracts also establish new audit timelines—the RAC lookback period for inpatient claims is reduced from three years to six months—and the two midnights rule will continue to be exempted from RAC audits.
These changes are in addition to Medicare’s recent pilot program that directs RACs to consider as a low-priority reviewing claims from providers participating in Advanced Alternative Payment Models under the new Quality Payment Program.
Medical Matters CME Webinar Series Continues in 2017; Registration Now Open
The Medical Society of the State of New York will continue its Medical Matters webinars on
January 18, 2017 at 7:30 am with Triage in a Disaster Event. Arthur Cooper, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Zachary Hickman, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee, will serve as faculty for this program. Registration is now open for this webinar here.
Educational objectives are: 1) Describe the importance of immediate bleeding suppression during a disaster event; 2) Describe the SALT methodology for triage and where to access SALT training; 3) Recognize the importance of not just general triage training, but triage training for bio-events as well.
February’s webinar will be:
The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team. This program will be held on Wednesday, February 15, 2017 at 7:30 a.m. and faculty will be Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.
The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event; 2) Identify means by which members of the healthcare team can manage the stress during and after an active shooter/bombing event; 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.
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.
The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MSSNY Participates in Antimicrobial Resistance Prevention Task Force
The New York State Department of Health (NYSDOH) convened the first-ever multidisciplinary New York State Antimicrobial Resistance Prevention and Control Task Force (NYS-ARTF) Summit this week. The summit addressed the need for prevention strategies throughout the health system and built on the work outlined at the July roundtable discussion on “Antimicrobial Resistance in Healthcare Facilities,” which was hosted by NYSDOH, Greater New York Hospital Association, and the Healthcare Association of New York State.
The engagement of stakeholders in the summit and roundtable is a key element in New York State’s comprehensive strategy to address the persistent and growing threat of multi-drug resistant bacteria. Cases of drug resistant Candida auris, a serious and sometimes fatal fungal infection andmcr-1, a novel drug resistant gene present in some bacteria, have been reported in New York. The Centers for Disease Control and Prevention (CDC) estimate that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.
“Through this Summit, the Task Force is working with New York State’s healthcare leaders to shape a state-wide response to the growing public health threat of multi-drug resistant bacteria,” said Commissioner of Health Dr. Howard Zucker. “If antimicrobial resistance is not addressed, we face a future where these medicines may no longer work, and infections will become difficult or impossible to treat. The most vulnerable among us will be the most at-risk.”
The summit involved experts from various disciplines including healthcare, agriculture, and veterinary care, as well as academia, community groups, and federal, state, and local government.
Stakeholders participating in the summit were previously asked to outline New York State’s top priorities in the efforts to combat antibiotic resistance. Among the priorities listed were:
- To expand antimicrobial stewardship programs and improve infection prevention and control practices in all hospitals and nursing homes
- To limit antibiotic use in food producing animals
- To educate and support healthcare providers to optimize antibiotic prescribing
- To educate consumers about appropriate antibiotic prescribing and use
- To develop rapid diagnostic tests to distinguish bacteria from viruses and identify antibiotic resistance
- To improve communication when patients are transferred between healthcare facilities
During the Summit, participants collaborated on designing practical solutions to achieve these priorities. The input from participants will be compiled to develop and implement a statewide strategic approach to combatting antimicrobial resistance as well as a report of recommendations that will be submitted to Governor Andrew M. Cuomo, by December 31, 2016.
“Get Smart” Campaign on Antibiotic Resistance November 14-20th
The New York State Department of Health will hold its “Get Smart (Know When Antibiotics Work) Week” on Nov 14-20th and the campaign is intended to create awareness within the physician and patient community about the growing resistance to antibiotics. Get Smart About Antibiotics Week (Get Smart Week) is a national, annual observance intended to engage relevant stakeholders – including professional societies, advocacy groups, for-profit companies, state and local health departments, the general public, the media and others – around antibiotic stewardship in the outpatient, inpatient, and animal health settings.
New York’s “Get Smart Campaign” promotion of the “Get Smart Guarantee” , an easy way for healthcare providers to display their commitment to appropriate antibiotic prescribing and use. The provider may use the free poster within the office and place their own photo on the poster and sign it.
There are also patient palm cards, which are a nice educational “takeaway” for a patient if they can’t have antibiotics (if their illness is viral, for instance).
The NY Get Smart Campaign would be very happy to send materials to individual providers. Contact Mary Beth Wenger at firstname.lastname@example.org or at (518)-474-1036.
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!
Morris Park-Van Nest, Bronx. Brand New Construction at Highly Desirable Intersection. 2,350 sq. ft. + Ground Level + 1,300 sq. ft. Lower Level; Open Floor Plan. Please Call Anthony Mameli 347-387-9768 or Email to: email@example.com. Charles Rutenberg Realty – Exclusive.
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: firstname.lastname@example.org for details. No Brokers.
Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D. 110 E 66th Street.
Bronx County Medical Society, a leader in promoting excellence in Clinical Care, Education & Public Policy, is seeking an executive director. Candidates should have either a bachelor degree and/or three years of work experience with non-profit medical groups. The Executive Director should be knowledgeable on healthcare policy and nonprofit compliance. Candidate must demonstrate strength in event planning and fundraising, member recruitment and retention, community outreach, and possess strong communication skills. We offer a competitive salary and benefits package. Please send resume and cover letter to Diane Miller, Executive Director at email@example.com
A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to firstname.lastname@example.org. No recruiters please.
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to email@example.com. No recruiters please.