Thomas J. Madejski, MD
September 14, 2018
Volume 20 Number 34
This week’s travels brought me back to New York City to attend the MSSNY Board of Trustees meeting and to preside (that’s what Presidents do best) at the MSSNY Council meeting. Physician wellness is one of the key components of MSSNY’s agenda. Fortuitous timing allowed me to attend the World Premiere of Do No Harm, a heartrending film documentary focused primarily on the negative transformation of some students during medical school leading too often to depression and, in some cases—to suicide.
The filmmaker, Robyn Symon is the daughter of a physician. Ms. Symon’s film is a sensitive depiction of some of the factors that may lead to despondency, and lethality, and is especially powerful due to the narrative provided by Michele and John Dietl who lost their son, Kevin, to a self-inflicted gunshot wound; and Hawkins M., a 1st year resident, who attempted to end his life, and fortunately has recovered and is doing well. I was honored to represent MSSNY at a post-screening panel discussion along with these three courageous individuals, MSSNY member Dr. Michael Myers, professor of Psychiatry at SUNY Downstate, an expert on physician mental health and suicide and a member of the CPH Advisory Committee and Dr. Pam Wible, a family physician and advocate.
Fear of Stigma
Versions of the Hippocratic Oath and the Declaration of Geneva require a commitment to personal wellness and an obligation to care for our brothers and sisters within our profession, yet too often stigma and fear of negative impact on our work prevents physicians from seeking assistance for stress, depression or substance use disorders. The film starts out by suggesting there is hypocrisy towards the oath due to a potentially toxic combination of factors that physicians encounter along their career path. We had a robust discussion about the complex issues involved and potential solutions. I explained MSSNY’s commitment to physician wellness and the resources we have available currently. The discussion session was wide ranging and the audience, a mix of physicians and interested non-physicians, came away with a better sense of the adverse environmental stressors and other factors.
Dr. Frank Dowling, MSSNY secretary and member of the Committee on Wellness and Resilience explained our efforts to develop a statewide confidential Peer-to-Peer Support Program.
The most moving part of the evening was the courage of the Dietl family and Hawkins who in sharing their pain, hopefully, will help us come together to improve the care of our caregivers. Do No Harm is a powerful, encouraging start to expand the conversation about medical student and physician suicide outside of our profession that includes our entire community.
Watch the film trailer here.
Non nobus solum nati sumus
Please share your thoughts and comments with me at email@example.com.
Please Plan to Participate in NYS “Listening Sessions” on Legalizing Recreational Marijuana Use
As reported last week, New York Governor Andrew Cuomo has called for a series of “listening sessions” across New York State to receive public comment regarding a proposal to legalize and regulate the recreational use of marijuana in New York State. As noted below, there are forums coming up next week on Monday (9/17) in the Bronx and Thursday (9/20) in Manhattan.
Last week, MSSNY Treasurer Dr. Joseph Sellers testified at an Albany forum to raise public health concerns with this proposal. Dr. Sellers’ testimony noted MSSNY’s support for de-criminalizing marijuana possession, but also significant concerns with outright permitting recreational use noting that “data from jurisdictions that legalized cannabis demonstrated concerns particularly around unintentional pediatric exposures resulting in increased calls to poison control centers and ED visits as well as an increase in traffic deaths due to cannabis-related impaired driving.
Physicians are urged to register to participate and testify at these upcoming forums from the links below:
- Bronx – Monday, September 17, 2018 – Register
- Manhattan – Thursday, September 20, 2018 – Register
- Queens – Monday, September 24, 2018 – Register
- Brooklyn – Tuesday, September 25, 2018 – Register
- Staten Island – Wednesday, September 26 – Register
- Long Island – Thursday, September 27, 2018 – Register
- Newburgh – Monday, October 1, 2018 – Register
- Binghamton – Tuesday, October 2, 2018 – Register
- Buffalo – Wednesday, October 3, 2018 – Register
- Rochester – Thursday, October 4, 2018 – Register
- Syracuse – Tuesday, October 9, 2018 – Register
- Utica – Wednesday, October 10, 2018 – Register
- Watertown – Thursday, October 11, 2018 – Register
Council Notes-September 13, 2018
- MLMIC Vice President and Assistant Secretary Donald Fager reported to Council that the Berkshire Hathaway transaction is very close to completion and thanked MSSNY for its support. Department of Financial Services Superintendent Maria Vullo has approved the Demutualization Application, the Acquisition Application and the application for approval of the amendments to MLMIC’s Charter and By-laws. Mr. Fager noted that the final step is policyholder approval.
- Council approved the MSSNYPAC Endorsement recommendations for candidates running for re-election to the New York State Legislature and to the US Congress. Click here to view the list.
- Physicians’ Day at the Races, which took place at the Saratoga Race Track in July, was a great success and raised $13,000 for MSSNYPAC. Plan to join the fun next summer for another Physicians’ Day at the Races!
- MSSNY President Dr. Tom Madejski and New York County Medical Society president Dr. Naheed Van de Walle reported on a September 5 meeting in which MSSNY and New York County Medical Society leaders met with NYS Assembly Health Committee Chair Richard Gottfried to discuss and raise questions about various aspects of his legislation (A.4738) that would create a single payor system in New York State.
- Elizabeth Amato, Vice President, SHIN-NY Programs at New York eHealth Collaborative (NYeC) provided an update on the Data Exchange Incentive Program (DEIP), which provides physicians with up to $13,000 to help connect to the SHIN-NY. Overview documents are available online at nyehealth.org/deip. Or contact NYeC with any questions at firstname.lastname@example.org.
Primaries: Strong Wins for Cuomo and Hochul; Defeat Many Senate IDC Members
While New York Governor Andrew Cuomo and Lt. Governor Kathy Hochul each won decisive victories this week, several incumbent state legislators lost in their respective primary elections to represent their parties for the upcoming November 6 general election.
Governor Cuomo defeated challenger Cynthia Nixon for the Democrat nod for Governor by a 64%-34% margin. Lt. Governor Hochul defeated challenger Jumaane Williams by a 53%-47% margin. They will face Republican gubernatorial candidate Marc Molinaro and Lt. Governor candidate Julie Killian in the general election.
New York City Public Advocate Leticia James won a four-way primary battle to get the Democratic line for New York State Attorney General. She will face Republican Keith Wofford in the general election.
Six of the 8 members of the former New York State Senate Independent Democratic Conference (IDC) lost their Democratic primaries:
- In the 11th Senate District (Queens), John Liu defeated Senator Tony Avella
- In the 13th Senate District (Queens), Jessica Ramos defeated Senator Jose Peralta
- In the 20th Senate District (Brooklyn), Zellnor Myrie defeated Senator Jesse Hamilton
- In the 31st Senate District (Manhattan/Bronx), Robert Jackson defeated Senator Marisol Alcantara
- In the 34th Senate District (Bronx/Westchester), Alessandra Biaggi defeated Senator Jeff Klein
- In the 53rd Senate District (Onondaga/Madison), Rachel May defeated Senator David Valesky.
The only former IDC members to win their primaries were Senator Diane Savino (Staten Island) and Senator David Carlucci (Rockland/Westchester).
In addition, Democratic Senator Martin Dilan lost his primary to challenger Julia Salazar.
Currently, the NYS Senate is divided between 31 elected Republicans and 32 elected Democrats, with one of the Democrats Simcha Felder aligning with the Republicans to create GOP Majority. As a result, there is an intense campaign battle as to which party will have majority control after the upcoming November elections.
Advocacy Organizations Express Concern re Proposed E&M Payment Changes
Several news articles (such as here and here) have highlighted the strong concern of physician advocacy organizations, including MSSNY, with the CMS proposal to contract Medicare payment rates different levels of E&M services.
As previously reported, MSSNY sent a letter to CMS, as well as joining on to multiple group letters, to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019. These letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments. Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).
MSSNY signed on to a letter initiated by the AMA and 170 other medical associations. That letter that noted medicine’s support for CMS’ “goal of reducing administrative burdens for physicians and other health care professionals so that they can devote more time to patient care”, but also that there are “unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule.” Moreover, it expressed concerns that the policy change “could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”
MSSNY also signed on to a letter initiated by the Coalition of State Medical Societies (consisting of the medical societies of AZ, CA, FLA, LA, NC, NJ, OK, SC and TX together with MSSNY), which articulated the following concerns:
- Eliminating incentives for physicians to care for complex or complicated patients including those with disabilities and those with serious or terminal illnesses;
- Making treating patients covered by Medicare even more financially challenging for physicians, leading more physicians to limit the number of Medicare patients they see or to opt out of the program entirely; and
- Similar changes being imposed by commercial insurance companies that tend to follow CMS’ lead on payment matters.
Heart Group Updates Guidelines on Resistant Hypertension
The American Heart Association has updated its 2008 guidelines on detecting and managing resistant hypertension — defined as above-goal blood pressure (≥130/80 mm Hg) despite use of three antihypertensive drugs, or controlled BP on a four-drug regimen.The guidelines, published in Hypertension, contain numerous practical diagnostic and clinical management tips. Among the most notable:
- Healthcare providers should regularly ask patients with resistant hypertension about their sleep patterns. Poor sleep duration and quality trigger the sympathetic and renin-angiotensin systems and, thus, can interfere with BP control.
- The role of lifestyle is emphasized as part of first-line management of resistant hypertension. Clinicians should advise patients to follow a low-sodium diet (
- If BP is above goal despite an optimal lifestyle and adherence to a three-drug regimen, providers should consider switching from hydrochlorothiazide to chlorthalidone or indapamide. If BP is still high after that, spironolactone may be considered as a fourth drug.
AHA guideline in Hypertension https://www.ahajournals.org/doi/10.1161/HYP.0000000000000084
NY Sepsis Deaths May Have Declined In Since State Mandate Implemented
Medscape (9/7) reported researchers found that “deaths from sepsis declined during the [two] years following implementation of a [New York] state mandate requiring hospitals to follow sepsis care bundles and report on patient outcomes.” The findings were published in the American Journal of Respiratory and Critical Care Medicine.
Study: More Documentation Should be Required to Show Need of Opioids
Research published Monday in the Annals of Internal Medicine state that a review of medical records from 2006 to 2015 “showed that a physician gave no explanation at all for writing an opioid prescription in 29 percent of the cases.” The findings by researchers at Harvard Medical School and the Rand Corp. “help support criticism by the Centers for Disease Control and Prevention, the Food and Drug Administration and others that say inappropriate prescribing practices have helped drive the opioid crisis.”
Researchers examined 32,000 clinician visits in which an opioid was prescribed to adults. Of these visits, 5% were documented as related to cancer-associated pain, 66% were coded for non-cancer pain, and 29% had no recorded pain diagnosis. Lack of a recorded pain diagnosis was more common among continuing rather than new opioid prescriptions (31% vs. 23%).The Boston Globe (9/10) reports “inappropriate prescribing, bad recordkeeping, or a combination of both were possible reasons for the missing data, according to the researchers.” Study author Tisamarie Sherry said, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.”
Three Hospitals Earn Through Captive Insurers Despite Settlement with State
Modern Healthcare (9/8) reported that Maimonides Medical Center, Montefiore Medical Center, and Mount Sinai Hospital “continue to make money – about $64 million this year – off a revamped version of an insurance maneuver that New York regulators last year characterized as a hidden scheme to funnel hundreds of millions of dollars back to the hospitals.”
Last year, New York’s Department of Financial Services “found that the professional liability insurer Hospitals Insurance Co. illegally kept secret the fact that its offshore captive insurance company soaked up more than $160 million in premium payments that yielded more than $200 million in investment income over a two-decade period, all while avoiding domestic regulation.” Despite a settlement with the state, however, “the latest financial filings from” the three hospitals “indicate” they “have kept a version of the operation running.”
“Influenza 2018-19” CME Webinar on October 17; Registration Now Open
The first of MSSNY’s 2019 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2018-19” on Wednesday, October 17, 2018 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.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
Educational objectives are:
- Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
- Describe clinical and laboratory diagnostic features and treatment specific to each flu season
- Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated
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.
CMS Updates 2017 MIPS Performance Feedback
Recently, CMS released performance feedback for clinicians included in the Merit-based Incentive Payment System (MIPS) during the 2017 performance year. As we’ve previously announced, we saw a very high 91 percent participation rate for the first performance year (2017) of MIPS. Over the last several weeks, individual clinicians, groups, and eligible clinicians in certain Alternative Payment Models (APMs) have had access to this feedback on the Quality Payment Program website, which provides a comprehensive overview of their MIPS final score, performance category details, and 2019 MIPS payment adjustment.
Along with releasing performance feedback, we launched a process known as targeted review. A targeted review provides the opportunity for clinicians, groups, or those participating in certain APMs to request that we review their MIPS payment adjustment factor(s), if they believe there is an error with the 2019 MIPS payment adjustment calculation.
The requests that we received through targeted review caused us to take a closer look at a few prevailing concerns. Those concerns included the application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study, and the addition of the All-Cause Readmission (ACR) measure to the MIPS final score. Based on these requests, we reviewed the concerns, identified a few errors in the scoring logic, and implemented solutions. The targeted review process worked exactly as intended, as the incoming requests quickly alerted us to these issues and allowed us to take immediate action.
Addressing and correcting for the above elements resulted in changes to the 2017 MIPS final score and associated 2019 MIPS payment adjustment for the clinicians who were impacted by the identified issues. Additionally, in order to ensure that we maintain the budget neutrality that is required by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), some clinicians will see slight changes in their payment adjustment as a result of the reapplication of budget neutrality. These revisions were made to the performance feedback on the Quality Payment Program website on September 13, 2018. We encourage you to sign-in to the Quality Payment Program website as soon as possible to review your performance feedback. If you believe an error still exists with your 2019 MIPS payment adjustment calculation, the targeted review process is available for you.
To offer additional time for clinicians, groups, and APM entities and their participants to access and review their performance feedback, we are extending the targeted review deadline to October 15, 2018 at 8:00pm (EDT). We also have a number of resources available on our Quality Payment Program Resource Library to help you understand your performance feedback and the targeted review process. If you are in-need of additional assistance, please reach out to the Quality Payment Program Service Center by phone at 1-866-288-8292, (TTY) 1-877-715-6222 or by email at QPP@cms.hhs.gov, or contact your local technical assistance organization for no-cost support.
From the onset of the Quality Payment Program, goals have included creating a program that is fully transparent and provides accurate information. We believe that the above steps are essential to achieving that goal for the first performance year (2017), also referred to as the “transition” year. We will continue to work closely with the clinician community to learn from one another and ensure operational excellence in implementation.
4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC
If you can’t see this image please go to 4th Columbia Psychosomatics Conference website HERE.
DOH Hosts Medicaid Drug Cap
The Department of Health will be hosting a webinar on the SFY 18-19 Medicaid Drug Cap on September 17, 2018 at 2:00 pm. There will be an email address provided at the end of the webinar for questions and answers. Materials will be made available after the webinar at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/. To register please follow the instructions below. This event requires registration.
Host: Office of Health Insurance Programs
Date: Monday, September 17, 2018 2:00 pm
To register for the online event:
2. Click “Register”.
3. On the registration form, enter your information and then click “Submit”.
Meaningful Use Attestations Due Oct. 15 for NY Medicaid EHR Incentive
Don’t delay! The deadline to attest 2017 Meaningful Use is October 15, 2018. All attestations for the NY Medicaid EHR Incentive Program must be submitted through MEIPASS at https://meipass.emedny.org/ehr/login.xhtml. Eligible professionals (EPs) no longer have to mail hard copies of their attestations – Everything is submitted online!
Note: Extensions will be automatically granted to EPs whose 2016 attestations are still pending state review. Those EPs will be notified via email about their extended deadlines, so they have sufficient time to attest 2017 Meaningful Use in MEIPASS.
Need assistance with MEIPASS? Check out our video tutorials and walkthrough to help you with the attestation process. For additional assistance, please contact program support at 1-877-646-5410 or firstname.lastname@example.org.
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Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated. The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services. The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee. The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review. The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff. The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.
Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012,
or by email to email@example.com with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.
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