Tag: MSSNY eNews – April 5

PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President MSSNY eNews April 5, 2019 Volume 22  Number 14

 

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Colleagues:

I like to joke with my kids about there being good news and bad news when we discuss certain topics.  The bad news from my standpoint is that this will be my last MSSNY Enews communication to you as President of MSSNY.  I didn’t expect to enjoy writing the weekly column as much as I have. (I’m cognizant that the end is very good news for some of you as well.  My three fans can continue to see my occasional healthcare rhapsodizing at @TomMadejski).  The good news is that MSSNY will be well led by our incoming President, Dr. Art Fougner.  Art and I have become friends over many years and I look forward to his leadership over the next year and in the future.

The end of a term naturally is accompanied by reflection on what did, and what didn’t happen during your time at the helm.  Today, I want to relate some behind the scenes activity that I think is important for MSSNY and our members moving forward.

The President of MSSNY is the executive of the organization and works on a daily basis with our Executive Vice President, Mr. Phil Schuh, and our excellent MSSNY staff.   Coming into the Presidency, I’ve always felt that one of the challenges for any volunteer organization is the potential for staff to drive activity more than the members.   We have great staff that executes our plan well, but I think more direct involvement by the officers helps us to hone our message and activity and, with our staff’s valuable input, gets us closer to where we want to go as a membership organization. We began every week with a management call with the Office of the President  (current prez, Immediate Past prez, Prez-elect, VP and Chairman of the Board) and our MSSNY Division heads to review and plan strategies weekly, as well as create a tactical planning guide for periodic review. I am very thankful to my fellow officers, Dr. Litvak, Dr. Fougner, Dr. Rothberg and Dr. Hughes for their excellent counsel and assistance in carrying out my Presidential duties.  I also wish to thank and acknowledge our excellent MSSNY staff who continue to perform at the highest level, and always strive to provide great service to our members. 

Membership

MSSNY has had a major increase in membership over the last year due to the activity of our leaders and staff, prior to this year.  Coming into the Presidency, I felt it was important we review our value proposition to new members and work with our County Societies to integrate efforts in marketing to additional new individual members and groups.  Nothing moves as quickly as I would like, but I’m thankful to Dr. Robert Hughes and the Board of Directors for their help in moving forward on this issue.  We have a team of staff and physician officers presently vetting options and I look forward to implementation over the next year.

Our Communications department had a successful year in expanding our media footprint.  The MSSNY Daily, and MSSNY Enews is now available to your healthcare teammates.  We want to continue to grow our media presence and your help sharing these communications helps to expand our message.

MSSNY Communications and Advocacy staff were very effective in helping our leaders engage other non- physician groups.  Single Payer, Marijuana, and Collective Negotiation issues helped us to expand our influence outside of the merits related to advocacy around the issue itself.  We have a great relationship with a number of other professional societies.  I was very pleased to have increased involvement in coordinating advocacy with our other professional societies.  I particularly want to salute NYACP, NYSSAM, NYSSA, ACOG, NYSOMS (Osteopathy), NYSOS (Ophthalmologists), NYSSOS (Orthopedic Surgeons), NYSSPS (Plastic Surgery), and NYSDS (Dermatology) for participating in our CME activities for Advocacy Day and walking the halls of the Leg buildings arm-in-arm with MSSNY.  Together, We REALLY Are Stronger!

I’m very thankful for the activity of my MSSNY Committee Chairs and members.  They have spent countless hours creating, and sometimes reviewing MSSNY policies on short notice. All of our Committees have done excellent work.  I want to thank Dr. Robert Goldberg and Dr. Jay Weiss who were instrumental in negotiating a substantial Workers Compensation fee increase; and our Bioethics Committee, Diversity, and Addiction Committees that reviewed our marijuana policy over the last year.

Physician-Assisted Suicide

Physician-assisted suicide remains a contentious issue for our profession.  I caught some heat for advocating our MSSNY policy during Assembly hearings last Spring. In an attempt to bring us closer together on this challenging issue, I established a Task Force on End of Life Care.  The Task Force has made substantial progress over the last year and will provide an interim report to the HOD next week. Understandably, this is a critical topic and they will continue their work to completion.  I am very thankful to Dr. John Maese for his excellent leadership of the Task Force.  We anticipate a final report to be available by the end of 2019.

The MSSNY Physician Wellness and Resilience Committee made substantial progress this year.  We have great programming available and are in the process of securing additional funding to make the programming more widely available.  We have restructured the internal management of the program to facilitate that.  We continue to work toward creation of a MSSSNY Peer to Peer Mentoring Service, not only for MSSNY members but for all New York physicians.

Thanks to all who provided feedback throughout the year.  I’m grateful for the thoughtful comments and tried to acknowledge and respond to as many as possible.  Please continue to reach out with your thoughts on issues affecting your practice and patients.

Finally, I want to thank each of you for your activities on behalf of your patients— both the care you provide to them individually, and your understanding of the importance of MSSNY membership to enhance your ability to care for your patients. Help us to be more effective by becoming more active in your County Medical Society, joining our MSSNY PAL program and joining MSSNYPAC. Your personal actions through membership are critical to providing the best care to your patients and providing stewardship to our learned profession.  

Ubi caritas, Deus ibi est.

Excelsior!

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President

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Capital Update

Legislature Finalizes $175 Billion Budget; Several Positive Items for Physicians
Overnight Sunday into Monday morning, the New York State Legislature completed passage of a $175.5 Billion Budget for the 2019-2020 Fiscal Year.  The State Budget contained a number of positive items for physicians and their patients in terms of new proposals adopted, and adverse proposals defeated.  We thank the many physician leaders and county society staff who took the time to meet, send letters and make phone calls to their local legislators on these issues.

Some of these positive outcomes include:

• Rejection of the proposed approximate $80/patient Medicaid cut for deductibles for patients covered by Medicare and Medicaid that had been strongly opposed by MSSNY.  This action prevents the imposition of potentially tens of thousands of dollars in cuts to physicians who treat many such “dual eligible” patients as part of their practice.
• Rejection of a proposed measure opposed by MSSNY that would have placed new prior authorization on physicians prescribing medications to their patients covered by Medicaid.
• A proposal to legalize recreational or “adult use” marijuana was not included in the final Budget, though discussions on this issue will continue for the remainder of the Legislative Session.
• Funding for the Excess Medical Malpractice Insurance Program was continued at its historical level, as well as continuation of the authority of the DFS Superintendent to set medical liability premium rates.
• Comprehensive reforms to better ensure insurance coverage parity for mental health conditions (MHC) substance use disorders (SUD) and Autism Spectrum Disorder (ASD):

• • • Prohibits prior authorization for formulary forms of prescribed medications for treatment of SUD.
    • Provides coverage for ALL MHCs, SUDs, and ASDs as each is defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the most recent edition of another generally recognized independent standard of current medical practice such as the International Classification of Diseases (ICD).
    • Prohibiting preauthorization and concurrent utilization review of SUD services during the initial 28 days of treatment;
    • Medical necessity criteria with respect to benefits for MHCs/SUDs and ASDs shall be made available to patients and their physicians (and other health care providers) upon request.

Perhaps one of the most significant provisions of this section is an expanded “Anti-retaliatory” measure that prohibits a health insurer from taking “any adverse action, including but not limited to refusing to renew or execute a contract or agreement with a health care provider as retaliation against a health care provider for filing a complaint, making a report or commenting to an appropriate governmental body regarding policies or practices of such insurer… “ 

• Greater oversight on pharmacy benefit managers (PBMs) in their dealings with Medicaid Managed Care plans including imposing new disclosure requirements and limits on PBM fees.
• Health Insurance policies for groups with 100 or more full-time employees will be required to cover at least three cycles of in vitro fertilization,

• A new 20% tax on the sale of “vapor products” to be used in e-cigarettes, e-cigars and vaping pens, and requiring sellers of such products to register with the NYS Tax Department.
• A new $150,000 grant for MSSNY’s Veterans Mental Health Training Initiative physician educational programming.

• Continued funding of $990,000 for MSSNY’s Committee for Physician’s Health

• A re-appropriation of $100,000 to MSSNY to continue its educational programming for physician’s regarding women’s health issues.

• While not specifically in the State Budget, the Legislature passed legislation supported by MSSNY that would raise the tobaco and e-cigarette purchase age from 18 to 21. (see separate article)

Other Budget Provisions of Note Include: 

Opioid Tax – The final Budget contained a $100 million tax on opioid manufacturers and distributors.  Last week, MSSNY, the NYS Academy of Family Physicians and the NY Chapter of the American College of Emergency Physicians joined patients, pharmacists and several legislators raising concerns with the possibility of the cost being passed on to pharmacies, hospitals and patients. 

Medicaid Cuts – The proposed 0.8% across-the-board cut in Medicaid payments was not included in the final Budget, however, there is language that provides authority to the state to reduce Medicaid payments during the fiscal year (up to $190 million across the board) in the event of an unexpected drop in revenue such as federal cuts.  MSSNY will continue to monitor the potential implementation of this provision. 

Health Insurance Exchange – The Budget codified the New York State of Health into law, including its structure for providing health insurance products at the bronze, silver, gold and platinum levels, as well as appealing health plan formulary restrictions.  It also sets forth in statute the 10 essential benefits that Exchange plans had been required to cover and provides greater assurance of no prohibitions on coverage for pre-existing conditions.

Workers’ Compensation  – With a new medical fee schedule that begin Monday, April 1 that provides long-overdue increases to physicians treating their patients covered by Workers’ Compensation (WC), the Legislature and Governor agreed to a WC package that would expand the types of practitioners who can treat and be reimbursed for treating injured worker patients while at the same time seeking to reduce some of the carrier-imposed barriers to injured workers receiving needed medical care and treatment.

The bill would expressly permit injured workers to receive treatment by Nurse Practitioners (NPs), Social Workers, Physician Assistants (PAs), acupuncturists, Physical Therapists (PTs) and Occupational Therapists (OTs) acting within their statutory defined scopes of practice.  For example, this means that a NP will no longer need to be employed by a physician to provide care to an injured worker.

MSSNY raised concerns during negotiations regarding the lack of an express requirement for some of these professionals to coordinate with a specialized physician for the care of injured workers.  However, that concern was not fully addressed.  We note that the bill would prohibit these newly listed health care professionals from performing Independent Medical Examinations.  It would also specify that Acupuncture, PT and OT care could only be provided pursuant to a referral from a physician, podiatrist or NP, and that the report of a PA, PT, OT or acupuncturist could not be used as evidence to determine that a particular injury or illness is work-related.

Importantly, the bill also contains provisions designed to reduce delays in injured workers receiving needed treatment, and physicians being paid for delivering this care:

• Specify that the purpose of the pre-authorized procedures list maintained by the WCB is for “expediting authorization of treatment of injured workers” and “shall not prohibit varied treatment when the treating provider demonstrates the appropriateness and medical necessity of such treatment.”
• Expressly prohibiting an employer, carrier, or third-party administrator from attempting to interfere with the selection by the  injured  employee  of an authorized medical provider;
• Eliminating the 3-arbitrator panels for review of disputed medical bills, so that every dispute would only need to be reviewed by a single arbitrator in the same profession as the professional bringing the dispute (the arbitrator can continue to be a physician recommended by MSSNY).

Moreover, unlike some previous versions, the budget provision preserves the historical role of the county medical societies to provide peer review of physician applications to participate in the Workers’ Compensation program.

The new provisions will take effect January 1, 2020.  There will likely be follow up communications from the WCB regarding how these provisions will be implemented.

Staff is continuing its review of the thousands of pages of Budget documents and will provide further updates on these and ERNMENTAL AFFAIRS)

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Post-Budget Call to Action: Make Sure Your Voice is Heard on Needed Insurance Reforms
With the State Budget now passed physicians are urged to contact their legislators in support of bills to address the hassles they and their patients face with insurance companies. Post-budget, legislative activity will begin to build steam, culminating in a flurry of bills being passed at the end of session. That’s why it is vital that you join the fight and make your voice heard about the issues affecting your ability to advocate on behalf of your patients.  Among these important measures include:

Collective negotiations – Negotiating with insurance companies regarding patient care terms is extremely difficult, especially when monolithic payers control a huge portion of the market in which you practice. The fact that you are barred from banding together with your colleagues is unfair, so MSSNY strongly supports legislation introduced by Senator Rivera and Assemblymember Gottfried (S.3462/A.2393) that would allow independently practicing physicians to collectively negotiate with insurance companies under close state supervision.  Please urge your Assemblymember and Senator to join on as a co-sponsor here.

Prior authorizations – The burdens caused by excessive and often repeated prior authorization requirements take away from the time that physicians can spend with their patients and lead to far too many hours being spent on paperwork. A just-released American Medical Association (AMA) survey reported that 91% of responding physicians said that the prior authorization process delays patient access to necessary care; with more than ¼ of the respondents indicating that a PA process led to a serious adverse event. Moreover, 86% said that burdens associated with prior authorization were “high or extremely high”; and 88% reported that these PA requirements had increased in the last 5 years.   Senator Breslin and Assemblymember Gottfried have introduced legislation (S.2847A.3038) to reduce these burdens, including by reducing the insurer time frame for reviewing prior authorization requests, and by limiting when an insurer can withdraw or repeat a previously granted pre-authorization.    Please urge your Assemblymember and Senator to join on as a co-sponsor here.

Mid-year formulary changes – Surprisingly, current law does not restrict insurance companies from making changes to their formularies mid-year. This is particularly egregious because some patients choose insurance plans based on the prescription medication formulary coverage and provisions. Senator Breslin and Assembly Majority Leader Peoples-Stokes have introduced legislation (S.2849/A.2969) that would prevent mid-year formulary changes so that patients do not experience removal of a drug or changes in tiering when there is no similarly effective option.

Please urge your Assemblymember and Senator to join on as a co-sponsor here.
(AVELLA, AUSTER)

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Senate Passes Bill to Increase Purchase Age for Cigarettes and E-Cigarettes; Bill Now Goes to Governor
The NYS Senate has approved legislation that would increase the purchase age for tobacco products from 18 to 21 years of age.  The measure, S. 2833/A.558, sponsored by Senator Diane Savino and Assemblywoman Linda Rosenthal, has already passed the NYS Assembly.  The bill now goes to Governor Andrew Cuomo for his signature.   It is anticipated that the governor will sign this measure. The Medical Society of the State of New York supports this measure and issued a public statement praising the Legislature for this action which you can read here.          (CLANCY)

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Urge Congress to Create Sensible Surprise Billing Law, Looking to New York as a Model
Physicians are urged to contact Senators Schumer and Gillibrand as well as their respective member of Congress to urge that they assure that any legislation addressing “surprise” out of network medical bills be consistent with New York’s innovative law, including making self-insured plans covered under a similar approach.  You can send a letter here.

Surprise out of network bills care in a hospital have been the focus of much attention as of late, with the Congressional Committee on Education & Labor holding a hearing this week on this issue. MSSNY has been working with the AMA and other state medical associations in support of efforts to remove patients from the middle of these “surprise” bill disputes while at the same time assuring physicians are paid fairly for these services.   However, some of the rhetoric has unfairly cast a disproportionate share of the blame on physicians, rather than on those insurance companies which are failing to offer fair contracts to some physicians. During the April 2^nd hearing, some testifiers made inflammatory comments regarding physicians charging prices that are “largely made up” and suggested limiting payment for such for out-of-network services to grossly inadequate insurer-determined or Medicare rates.  Such an approach could have significant adverse consequences for the ability of hospitals to have sufficient on-call specialty care in their emergency departments, and greatly limit the ability of physicians to fight for fair contracts with health insurers.

New York’s law establishes a fair balance among health insurers, hospital and physicians, not only in deciding how these bills are paid, but also in addressing a number of other factors which lead to surprise bills.  To that end, MSSNY has written to the New York Congressional delegation, urging that any legislation to be considered is consistent with New York’s comprehensive law on the subject enacted in 2014 (see MSSNY’s letter here).

New York’s law stands as a model for other states that are looking at this issue. We believe that any federal action on the topic should be consistent with New York’s surprise billing law which has been lauded as an equitable and sensible solution.

Please take a minute to write to your elected officials expressing your support for New York’s system and urging Congress to use it as a template for federal legislation. You can do so by going here.  (AVELLA, AUSTER)

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Office-Based Surgery Mandated Reporting Update
The NYS Department of Health has sent Office-based Surgery (OBS) practices a letter indicating that it was not moving forward in 2019 with a proposed requirement for OBS practices to report information to DOH regarding the numbers of each type of procedure performed in their OBS practices.

MSSNY working together with the NYS Society of Plastic Surgeons and NY Chapter of the American College of Physicians had indicated its support for the goals of the proposed reporting requirements to provide necessary context to assess the frequency/lack of frequency of certain adverse events reported to DOH.  However, given the potential complexity this presented for some practices, MSSNY, NYSSPS and ACP also suggested alternatives to this reporting requirement such as having DOH request such cumulative procedural information from the accrediting entities from which OBS practices are required to receive accreditation.

Instead, the DOH will be placing additional efforts to ensure all OBS physician practices are complying with the New York law that requires all adverse events arising in an OBS setting to be reported to the DOH patient safety center within three business days of the adverse event.  NYS Public Health Law Section 230-d defines an “Adverse event” as a “(i) patient death within 30 days;  (ii) unplanned  transfer  to  a hospital or emergency department visit within 72 hours of office-based surgery for  reasons  related  to  the   office-based  surgery encounter; (iii) unscheduled hospital admission or assignment to observation services,  within 72 hours of the office-based surgery, for longer than 24 hours; or (iv) any other serious or life-threatening event”.

MSSNY looks forward to partnering with the DOH to educate and ensure physicians are in complete compliance with these adverse event reporting requirements.   (AUSTER)

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CME at MSSNY 2019 House of Delegates
MSSNY is proudly offering the following CME seminars at the 2019 House of Delegates in Tarrytown on Thursday April 11^th and Friday April 12^th: 

Thursday April 11^th 1:00-2:00pm:

Medical Matters: What’s Your Diagnosis? Infectious Diseases
Register here.
Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers 

Thursday April 11^th 2:00-3:00pm:

Veterans Matters: The Special Mental Health Needs of Women Veterans
Register here.
Faculty: Malene Ingram, MD, Lt. Col. US Army Reserves

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health

Describe mental health concerns unique to women veterans and how to identify and treat them

Identify the barriers that women veterans face in getting the specific care they need 

Friday April 12^th 1:00-2:00pm

Health Matters for Women: Myalgic Encephalomyelitis and Fibromyalgia
Register here.
Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose Fibromyalgia and Myalgic Encephalomyelitis

Discuss treatment options for Fibromyalgia and Myalgic Encephalomyelitis

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™.  Physician should only claim credit commensurate with the extent of their participation in the activity. 

Friday April 12^th 2:00-4:00pm

Improving Maternal Mortality Trends in New York State – Seminar and Panel Discussion – Register here.
Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes

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 2.0 AMA/PRA Category 1 credits™. Physician should only claim credit commensurate with the extent of their participation in the activity.

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MSSNY CME Webinar Health Matters for Women Registration Now Open
The Medical Society of the State of New York is proud to announce a live continuing medical education (CME) webinar on a women’s health topic entitled “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. Registration for the webinar is now open.

Health Matters for Women: Endometriosis – Register here.
When:  Tuesday, April 23^rd at 7:30am

Faculty: Lisa Eng, DO

Educational Objectives:

Review potential causes of pelvic pain and discuss how to identify endometriosis

Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis

Discuss implementation of individualized endometriosis treatment plans and options

The Medical Society for 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™.  Physician should only claim credit commensurate with the extent of their participation in the activity. (ULUKAYA)

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For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org	mauster@mssny.org	pclancy@mssny.org	mavella@mssny.org
charring@mssny.org

eNews

New York Sues Six Opioid Manufacturers, Four Distributors, and Sackler Family
The New York AG Letitia James is suing six opioid manufacturers, the Sackler family and four prescription drug distributors in a massive legal fight against the pharma industry accused of fueling the opioid crisis. The amended lawsuit accuses the 11 defendants of using false and deceptive marketing practices to create the “opioid epidemic that has ravaged New York.” The Attorney General called the amended complaint the country’s most comprehensive lawsuit aimed at addressing the ever-growing problem of opioid addiction, according to The New York Law Journal.

The complaint names the defendants as the Sackler family; Purdue Pharma; Janssen Pharmaceuticals a subsidiary of Johnson & Johnson; Mallinckrodt; Endo Health Solutions; Teva Pharmaceuticals; Allergan Finance; McKesson Corp.; Cardinal Health; AmerisourceBergen; and Rochester Drug Cooperative. “Defendants caused this disaster together,” the lawsuit states. (Becker’s Hospital Review) 

Where VA Hospitals Lead and Lag in New York State
A recent study comparing Veterans Affairs (VA) and non-VA hospitals across the nation found that VA hospitals provided the best care in most regions for at least 9 of 15 quality measures. But how do they compare in New York State? Many of the nearly 800,000 veterans in New York State do not live near a VA hospital, and nearly half of veterans in the State prefer to get their care from outside the VA.

A new NYSHealth data snapshot examines levels of performance on various quality measures for each of the 10 VA hospitals in New York State. The measures span four domains of care: patient satisfaction, patient safety, health outcomes, and the timeliness and effectiveness of care.

VA hospitals and community-based hospitals perform similarly on most measures in this snapshot—and with a few exceptions, VA hospitals do not consistently out- or under-perform relative to community-based hospitals. These mixed results underscore the value of veterans having options to choose from both VA and community-based care.

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Growing Open Notes Across New York State
The New York State Health Foundation (NYSHealth) is pleased to launch a Request for Proposals (RFP) to support federally qualified health centers (FQHCs), multispecialty group practices, hospital-affiliated physician groups, independent physician practices, and other health care settings across New York State in adopting or spreading OpenNotes.

OpenNotes is a national effort to give patients access to the visit notes written by their doctors, nurses, or other clinicians. Established in 2010, OpenNotes creates partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information. When patients have access to their own visit notes written by health care providers, they better remember what was discussed during the visit; feel more in control of their care; are more likely to take medications as prescribed; and can share notes with their caregivers.

This RFP is open to FQHCs and other non-hospital health care settings in New York State. Awards of up to $100,000 will be granted per organization. Proposals will be due on May 2, 2019.

Read details on the RFP and apply.

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NY Has Second-Highest Percentage of Insurance Claims for Retail Clinics
Crain’s New York Business (4/2) reports, “New York had the second-highest percentage of insurance claims for retail clinics nationwide, according to a new white paper from the nonprofit Fair Health.” The article notes that the state’s “prohibition on the corporate practice of medicine” limits retail clinics in the state, and as an alternative, “for-profit companies such as CVS and Walgreens lease space to medical practices within their stores.”

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AMA, Unitedhealthcare Propose Billing Codes for Nonmedical Health Needs
The AMA and UnitedHealth care are supporting the development of 23 billing codes related to social determinants of health. The healthcare system lacks a consistent, organized way to capture such nonmedical needs as food, housing and access to transportation, and incorporate them into individual care plans, executives of both organizations said. But through their collaboration, UnitedHealthcare has created — and the AMA has endorsed — ICD-10 codes related to these needs, according to Forbes. “By combining traditional medical data with self-reported [social determinants of health] data, the codes trigger referrals to social and government services to address an individual’s unique needs, connecting them directly to local and national resources in their communities,” UnitedHealthcare and the AMA said. One proposed ICD-10 code, for example, would help a dialysis patient who needs transportation, according to Forbes.

The proposal for ICD-10 codes for social determinants of health was reportedly submitted to the ICD-10 Coordination and Maintenance Committee, which includes members from the CDC and CMS. According to an AMA report, the codes, if approved by CMS, would apply to the fiscal year that begins Oct. 1, 2020. (Becker’s Hospital Review, April 2)

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Online Drug Vendors Shifting Physician-Patient Relation in Absence of Regs
The New York Times (4/2) reports the growing popularity of websites such as Roman and Hers have made “obtaining lifestyle drugs for sexual health, hair loss and anxiety nearly as easy as ordering dinner online,” but are changing how patients interact with their healthcare providers. The websites allow people to “self-diagnose and select the drug they want” with the supervision of a physician who “assesses their choice, with no in-person consultation.” In response, physicians, regulators, and legal experts are warning that the companies “operate in a regulatory vacuum that could increase public health risks.” The Times adds that some companies are working to enhance their oversight by seeking expert advice, including from former Surgeon General Dr. Joycelyn Elders; however, in some cases, companies make claims about treatments that are at odds with FDA regulations.

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Capping Insulin Costs
Express Scripts, a pharmacy benefit manager owned by health insurer Cigna, announced on April 4, that it will offer its clients an option to cap enrollees’ monthly out-of-pocket costs for insulin at $25. The announcement comes amid increased scrutiny of rising insulin prices and costs for patients. (Wall Street Journal, 4/3)

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CMS finalizes Medicare Advantage, Part D payment policies: Four Things to Know
On April 1, CMS issued a final rule to update 2020 payment policies for Medicare Advantage and Part D prescription drug plans.

Four things to know:
1. Under the rule, Medicare Advantage health plans will see a 2.53 percent pay raise in 2020.
2. In addition, chronically ill patients with Medicare Advantage can receive coverage for products and services aimed at addressing social determinants of health.

3. This includes meal delivery, transportation for nonmedical needs like grocery shopping and home environment services.
4. For example, CMS said Medicare Advantage patients with asthma could receive coverage for air cleaners and carpet shampooing to address irritants that could cause asthma attacks. A patient with diabetes could receive coverage for transportation to a physician’s appointment or other services like a nutritionist.

For the full fact sheet, click here.

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