November 4, 2016 – “Fail First” Is a Total Failure

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
November 4, 2016
Volume 16, Number 39

MLMIC Insurance

Dear Colleagues:

The following Letter to the Editor was printed in the Albany Times Union on Oct. 31, 2016.

New York’s physicians are proud to partner with patients and patient advocacy groups to support legislation to strongly regulate health insurance company prescription “fail first” protocols. Unsurprisingly, insurers oppose it (“Patients benefit from step therapy,” Oct. 20).

While these protocols are often medically appropriate, legislation is necessary due to many instances where patients’ health has been adversely impacted by overly strict application of these protocols.

Patients most affected by these “fail first” practices have serious medical conditions such as mental illness, arthritis and cancer. Many physicians report policies requiring their patients to switch blood pressure or cholesterol maintenance medications even though they had been stabilized.

This legislation would simply assure greater specificity in New York’s laws when a health insurer must approve coverage for the medication recommended by the patient’s doctor. Circumstances include where the insurer’s preferred medication is contraindicated, where the insurer’s preferred medication has already proven ineffective, or when the patient has already been stabilized on a medication that is not the insurer’s preferred one.

Importantly, a physician would have the burden of proof as to why the insurer’s “preferred” medication would not be as beneficial. The insurer could still limit coverage to the insurer’s “preferred” medication if the physician does not meet this burden.

Insurance companies seek to deflect the need for these imperative reforms with inflammatory rhetoric about drug company spending. This is nothing more than a distraction from the real issue – removing harmful insurance company roadblocks to patients getting the medications they need.

Gov. Andrew Cuomo needs to sign this important bill into law.

P.S. We have almost 400 responses to our Value-Based Survey. This topic concerns ALL physicians. Please give it two minutes of your time.   https://www.surveymonkey.com/results/SM-2N6FZBDN/

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Council Notes of November 3 Meeting in Westbury

  • Resolutions that were referred to Council by the House of Delegates were approved. They topics involved: expansion of the Independent Dispute resolution process to address claims denied by insurers if existing statutory remedies do not timely address the problem; continue to examine the feasibility of a No-Fault system for resolving medical liability claims and support such system if there can be significant premium savings; MSSNY should form an Employed Physician Section and explore legal avenues to becoming a negotiating agent for these physicians; re-affirm existing policy calling on all healthcare providers to wear ID tags with big bold letters stating their professional designation
  • Resolutions deadline for the 2016 House of Delegates in March 17 at 5pm. Early submission is February 17. After March 17, resolutions will be considered late. In that case, the resolution is forwarded to the Rules Committee that decides whether or not the late resolution can be moved forward.
  • Don Fager, VP of MLMIC reported that regarding the Berkshire-Hathaway partnership, the Insurance Department examination is the longest process and should be completed by March of 2017. Mr. Fager also reported that frequency of claims has leveled off, but severity of claims has increased.
  • MSSNY Leadership Conference for young physicians in Syracuse was fully subscribed. Dr. Thomas Madejski, MSSNY Councilor and one of the conference speakers, said “It was an excellent opportunity for young doctors to network and discuss and develop leadership skills. The presentations on burnout and empathy were particularly well received. Hopefully it will improved our agenda for practice sustainability.”
  • Immediate Past President Dr. Joseph Maldonado, who sits on a FAIR HEALTH Committee, reported that there is a pilot program that will target the top 100 procedures performed in NY and that the physicians’ fees will be reported. The four communities targeted in 2017 are: Buffalo, Syracuse, Albany and Westchester.
  • Cynthia Brown, VP Government Affairs, AMA presented a comprehensive report on MACRA and the two Medicare payment model pathways for physicians. “MACRA is more “than a replacement for SGR,” she said.


CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

MIPs Quality Measures
Based on MSSNY’s Council meeting of November 3, 2016, some of our members might like some help in finding their specialty specific quality measures for MIPs reporting.  Please see these links https://qpp.cms.gov/and https://qpp.cms.gov/measures/quality If you have questions, send an email to rmcnally@mssny.org .  Remember, MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Register Now for NY eHealth Collaborative on December 6-7
The New York eHealth Collaborative’s Digital Health Conference (DHC) on December 6-7 at New World Stages in Manhattan brings together 500 senior-level healthcare industry leaders to learn about new innovations and to foster dynamic conversation addressing how healthcare is being redefined through technology. This year, the conference is a Who’s Who of New York’s healthcare and health tech community gather for two days of networking, lively intellectual exchange, and exploration to see what’s new, what’s cutting edge, and what will shape the future of healthcare. Join your peers and register today!

MSSNY Colleagues: Receive a 10% registration discount. Use code MSSNY when registering at www.DigitalHealthConference.com.

Physicians Vote 9% Less than General Population
Despite the government’s huge influence on health care, doctors vote 9% less than the general population. They’re 22% less likely to cast ballots than lawyers, another group of highly educated professionals.

“If you look back at the history of the medical profession, there’s the sense that physicians are leaders in their community, and people historically looked up to doctors around broad community issues,” says Dr. David Grande, assistant professor of medicine at the University of Pennsylvania and co-author of the article. But that’s not the case anymore. Their reputation eroded, many experts believe, as they got less time with patients and more and more burned out. (Annals of Internal Medicine 11/1/16 Commentary).

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with When Is the Flu Not the Flu? on Wednesday, November 16, 2016 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.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!

Patient Survey On Pain Should Be Adjusted Physicians Are Pressured To Prescribe Unnecessary
The Buffalo (NY) News (10/31) editorialized that a patient survey on pain management that affects hospital funding “needs to be adjusted,” if it is putting pressure on physicians to prescribe opioids more often than is necessary. The editorial quotes Dr. Timothy Gabryel, the president of the Medical Society of Erie County, who said that treating pain as “the fifth vital sign” created “an expectation that there should be a pill for every problem and there should be no discomfort at all.”


Retired Physicians Can Get a Waiver for License Registration Fee
A point of information for those physicians who have retired and are no longer compensated for medical care provided – a waiver of the fee for the registration of your license as a physician in the State of New York is allowed under the provisions of Section 6524(10) of the New York State Education Law.  This law allows a waiver of the registration fee requirement for physicians who certify to the State Education Department that, for the period of their registration, they will only practice medicine without compensation or the expectation or promise of compensation. The waiver of the registration fee is limited to the duration of the registration period indicated of the affidavit. Affidavit of Non-Compensation.The American Medical Association (AMA) is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP.

All of the sessions, except the November 29th, are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members. 

The November 29th session will be focused on helping medical society staff to gain a better understanding of the new regulations so you will be prepared to answer your members’ questions. 

30 Days Remaining to Submit an Informal Review for 2017 PQRS Results
In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including:

·        Individual eligible professionals (EPs)
·        Comprehensive Primary Care (CPC) practice sites
·        PQRS group practices
·        Accountable Care Organizations (ACOs)

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review between September 26, 2016 and November 30, 2016 requesting CMS investigate your payment adjustment determination. All informal review requestors will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

Follow these steps to submit an informal review request:

·        Go to the Quality Reporting Communication Support Page (CSP)
·        In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
·        Select “Informal Review Request”
·        Select “PQRS Informal Review”
·        A new page will open

Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see the PQRS informal review fact sheet for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 6:00 p.m.

CME on Waterborne Diseases Available at MSSNY CME Site
There’s been a recent outbreak of Legionnaires’ Disease in the Saratoga area of upstate New York.  Go to http://cme.mssny.org/index.jsp  to view our Medical Matters program Waterborne Diseases and learn more about this devastating illness and how it’s spread.  The educational objectives for this program are:

  • Describe how waterborne diseases occur and the national surveillance system for waterborne diseases
  • Identify possible symptoms of waterborne diseases that could occur in the US
  • Understand the prevention and treatment methodology for outbreaks 

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. 

AMA: Educational Opportunities to Fully Understand QPP Created by MACRA
The AMA is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP. All of the sessions are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members.

  • Monday,  Nov. 21, 7 pm – 8:30 pm EST  Physician/Staff  webinar

Registration: https://cc.readytalk.com/r/y70aavsqh5g0&eom

  • Thursday,  Dec. 1 – 6:30 pm – 9 pm EST

Atlanta regional seminar (streaming and webinar)

Cobb Galleria Center

Atlanta Georgia

Registration:   https://www.eventbrite.com/e/macra-regional-seminar-atlanta-tickets-28840143646

  • Tuesday,  Dec. 6, 8:00 pm – 9:30 pm EST Physician/staff  webinar

Registration: https://cc.readytalk.com/r/j8d0v8kh1qr3&eom

  • Saturday,  Dec. 10, 9 am -11:30 PST

San Francisco regional seminar (streaming and webinar)

Marriot Marquis

San Francisco, CA

Registration:  https://www.eventbrite.com/e/macra-regional-seminar-san-francisco-tickets-28863673023

Physicians Feel Pressure to Prescribe Opioids for Pain
In an over 2,200 word article, the Buffalo (NY) News (10/30, Becker) reports that physicians feel pressure to prescribe opioids for pain from hospital administrators, patients, and pharmaceutical companies. The article highlights two sources of such pressure: the patient survey on pain treatment used by the Centers for Medicare and Medicaid Services as part of its formula for calculating hospital reimbursements, and the Joint Commission on Accreditation of Healthcare Organizations’ “Pain Management Standards.” The article mentions that earlier this year, CMS announced that it is considering alternatives to the patient surveys in its formula, but it will continue using the survey results in the meantime. It goes back to the 1990s, when there was a call for pain to be treated as “the fifth vital sign,” said Dr. Timothy Gabryel, president of the Medical Society of Erie County and medical director of Mercy Hospital.

“That set an expectation that there should be a pill for every problem and there should be no discomfort at all,” Gabryel said. “Doctors have been caught in the middle of this,” said Dr. Nancy H. Nielsen, former president of the American Medical Association. 

CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

AMA Perspective on Reduction Opioid Abuse
This week, in a presentation to MSSNY, Patrice A. Harris, MD, MA, Chair of the American Medical Association’s (AMA) Board of Trustees provided the national and AMA perspective to physicians of the Medical Society of the State of New York on how to reduce opioid abuse.

“Since 2012, there has been an 81% increase in physicians nationally who have trained to provide Medication Assisted Therapy (MAT) to patients and a 1,170% increase during 2013-15 in physicians who are co-prescribing naloxone, said Dr. Harris.  “Additionally, physicians are taking more education on the prescribing of opioid and there are over 50,000 courses that are available.”

Dr. Harris also noted that New York State will now hold insurers accountable and has reached a settlement agreement with Cigna to halt pre-authorization for opioid addiction drugs and to remove barriers to other potential life-saving treatments.

MSSNY is one of eight state medical society members of the AMA’s Task Force to Reduce Opioid Abuse.


CLASSIFIEDS


State of the Art Midtown Medical Office for Rent
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: hefderm@outlook.com 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.

Want to rent your medical office? Need to lease space to expand your practice?
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Physician Opportunities


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 tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
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 tsrgexpress@gmail.com. No recruiters please.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355