October 21, 2016 – MACRA Rules Final!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
October 21, 2016
Volume 16, Number 37

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Dear Colleagues:

This week, CMS issued a final rule outlining the requirements of the new Quality Payment Program for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).

As has been widely reported, there were positive changes contained in the final rule that provide some flexibility to physicians in complying with new Medicare Merit Based Incentive Payment System (MIPS).  These include:

  • enabling physicians who report at least some 2017 data before March 31, 2018 to avoid a 2019 Medicare payment penalty;
  • increasing from $10,000 to $30,000 the annual Medicare revenue threshold requiring participation in the MIPS program;
  • reducing from 90% to 50%  the percentage of Medicare patients of which a physician has to report quality measures;
  • Reducing from 11 to 5 the number of measures to be reported in the Advancing Care Information category (which replaces Meaningful Use) and
  • Eliminating the Value based component in the 2017 MIPS evaluations.

Summaries, fact sheets and other CMS resources are available on the agency’s web site.  In the coming days, the AMA will make additional resources available on its own MACRA web page.  To access the Quality Payment Program Overview Fact Sheet, click here.

While the AMA is in the process of fully analyzing the regulations, a first review reveals that CMS responded to many of the concerns expressed by physicians about the proposed rule issued last spring.  On November 21 and December 6, the AMA will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice.

Register for November 21
Register for December 6

Review of all the provisions of the final rule is ongoing.  Medical societies across the country including the AMA and MSSNY had advocated for additional flexibility, particularly for smaller practices that may not have the infrastructure necessary to be successful in these value-based payment programs.

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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Webinar: An Overview of MACRA (Quality Payment Program)
CMS invites physicians to join a webinar on October 26 at 2:00 PM ET, on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.

Webinar Details

Quality Payment Program Overview

  • Date: Wednesday, October 26, 2016
  • Time: 2:00 to 3:00 PM ET
  • Register Here.

Space for this webinar is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you. 

Please Review Comprehensive Medicare Quality Payment Program Summaries
The American Medical Association (AMA) has prepared two summaries that you can review from MSSNY’s website to familiarize yourself with the important provisions of this rule.  You can access these documents by clicking HERE and HERE.

More MACRA  Help from the AMA
|Two documents prepared by the AMA’s Washington Office, outlining major provisions of Medicare’s new Quality Payment Program (QPP) for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).  The longer summary document provides some detail of the various components of the final rule that was issued last week, and notes where key improvements were made to the policies set forth in the original proposed rule.  The second is a chart with more abbreviated descriptions of changes to the original proposed rule that were secured. These documents will be posted on the AMA’s MACRA web page, www.ama-assn.org/go/medicarepayment.  Additional material is in the process of being developed.

  • The AMA Payment Model Evaluator is an innovative tool offering initial assessments to physicians so they can determine how their practices will be impacted by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Developed with the expertise of physicians and input from partners, the tool will give physicians and their staff a brief assessment, as well as relevant educational and actionable resources. Once physicians and medical practice administrators fill out the online questionnaire, they will receive guidance for participating in the MACRA payment model that is best for them. The AMA will continually update the Payment Model Evaluator to respond to regulatory changes and to keep practices up to date throughout the new payment and care delivery reform process. The tool is free to all physicians and their practice administrators.
  • The AMA STEPS Forward™ collection of practice improvement strategies has new MACRA-specific tools. Accurate and successful reporting on quality metrics is crucial to the new Medicare payment system, both in the current Physician Quality Reporting System program and under MACRA’s new Quality Payment Programs. Each STEPS Forward module focuses on a specific challenge and offers real-world solutions, steps for implementation,, case studies, continuing medical education, and downloadable tools and resources. Physicians and their practice staff can use these to help improve practice efficiency and ultimately enhance patient care, physician satisfaction and practice sustainability. The full collection, which now includes 42 modules, has a variety of tools that will help physicians and their practices, including:

The AMA launched a ReachMD podcast series titled Inside Medicare’s New Payment System. Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), Dr. Gurman, AMA staff experts, and others are featured on the series, which will include five episodes to help physicians be informed on upcoming Medicare changes.

Learn more on AMA Wire® about these tools or check out other key changes to the Medicare payment system.

Attached are two documents prepared by the AMA’s Washington Office, outlining major provisions of Medicare’s new Quality Payment Program (QPP) for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).  The longer summary document provides some detail of the various components of the final rule that was issued last week, and notes where key improvements were made to the policies set forth in the original proposed rule.  The second is a chart with more abbreviated descriptions of changes to the original proposed rule that were secured.

These documents are posted on the AMA’s MACRA web page, www.ama-assn.org/go/medicarepayment.

DOH Commissioner’s Grand Rounds on Dietary Supplements on Nov. 29
New York State Department of Health Commissioner Howard Zucker, MD, will host a medical grand rounds on Tuesday, November 29, 2016, 7:30 – 9:00 am at The Wadsworth Center – David Axelrod Institute, 120 New Scotland Avenue, Albany, NY 12208.   The topic will be:  “Dietary Supplements: Buyer Beware, Provider Be Wary”.

Faculty for the event will be Pieter A. Cohen, MD, Assistant Professor of Medicine, Harvard Medical School Internist, Cambridge Health Alliance; Nina Ahmad, MD, Medical Director, Division of Epidemiology, New York State Department of Health and Nathan Graber, MD, MPH, Director, Center for Environmental Health, New York State Department of Health. Registration for this session is required and a copy of the flyer can be found here.

Nov. 17 Webinar Best Practices for Palliative Care in Primary Care
This program will address best practices for integrating palliative care services into the primary care and/or PCMH settings. This webinar will cover the evidence and business case for this approach, strategies for patient acceptance, and examples of successful implementation.

Webinar Details

Date: November 17

Time: 1 p.m.
Featured Speaker: Joan Dacher, Ph.D., R.N., N.P., Professor of Nursing, The Sage Colleges; and Co-Chair, New York State Palliative Care Education and Training Council

Registration: Register online. 

DFS: Guidance to Insurers New Substance Abuse Coverage Requirement
The New York Department of Financial Services has issued a 9-page guidance to health insurance companies reminding them of new requirements enacted earlier this year to expand coverage for substance use disorder treatments.   This includes expanded prescription drug coverage, and expanded inpatient and outpatient coverage, coverage for naloxone, and expedited pre-authorization requirements.  To read the guidance, click here.

When Is the Flu Not the Flu?” CME Webinar 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!


Billing for Influenza Correctly
NGS published CMS article titled, “Billing for Influenza: New CPT Code 90674” on 9/30/2016. The article advises that MACs may direct use of an NOC code to allow billing for the vaccine for dates of service on or after 8/1/2016 and before 1/1/2017; however, NGS is not allowing an NOC code and your claims will deny as an invalid code. CPT Code 90674 will be added with the January 2017 release. Please hold your claims until the January release is implemented; Additionally, Part A MACs will be holding claims from 1/1/2017 to 2/20/2017. At this time, any claims received on and after 1/1/2017 will be released for payment beginning 2/20/2017.The Seasonal Influenza Vaccines Pricing on the CMS website shows the CPT 90674 payment allowance is $22.93 effective for dates 8/1/2016-7/31/2017.

Fentanyl the Cause of 16% of All NYC Overdose Deaths
In 2015, 146 overdose deaths in New York City involved fentanyl, 16 percent of all overdose deaths, according to the city health department. Never before had fentanyl accounted for more than 3 percent of overdose deaths in the city. On Monday, the city’s health department reported that since July 1, 47 percent of confirmed drug overdose deaths involved fentanyl. That’s up from 39 percent through the first six months of the year, according to provisional data. That data also shows there have been 725 confirmed overdose deaths to date in New York City and that 581 of these deaths occurred during the first six months of 2016.

Adults Stressed out Due to Presidential Election
According to an online survey conducted by the American Psychological Association (APA). Some 52% of U.S. adults find the 2016 presidential election to be a “very or somewhat significant source of stress,” Over 3500 adults aged 18 and older completed the survey in August 2016. Among the other findings:

  • Rates of stress were similar among Democrats and Republicans, and among women and men.
  • Those over age 70 were most likely to feel election stress (59%), while those aged 38 to 51 were least likely (45%).
  • Some 60% of Americans with disabilities found the election stressful, versus 48% of those without disabilities.
  • Stress was more common among adults who used social media (54%) than among those who did not (45%).

The APA offers these tips for coping:

  • “Limit your media consumption. Read just enough to stay informed.”
  • Don’t talk politics if you think the discussion could “escalate to conflict.”
  • “Whatever happens on Nov. 8, life will go on. … Avoid catastrophizing.”


REQUEST FOR PROPOSALS

The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website at https://otda.ny.gov/contracts/procurement-bid.asp.  If your organization wishes to receive a hard copy of the RFP, please send your request immediately by Certified Mail to:

Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210

The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042.


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?
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!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.



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