Tag: MSSNY eNews June 16

PRESIDENT’S MESSAGE Charles Rothberg, MD

June 16, 2017 Volume 17 Number 23

Dear Colleagues:

The MSSNY delegation to the annual meeting of the American Medical Association has just returned from Chicago. Our efforts on behalf of our MSSNY members are important to maintaining a presence in ongoing federal and state affairs focused on medicine. Our team of 38 delegates and alternate delegates is led by John Kennedy, MD of Schenectady.

In addition to exhaustive days dealing with more than 200 reports and resolutions, there has been a major effort to assure that New York is well represented on the AMA Councils, which provide guidance on the policies being adopted. To this end, Robert Goldberg, DO was elected to the AMA Council on Medical Education. Bob’s background as Dean at Touro in NYC makes him particularly well suited to this four-year post. Tom Donoghue, once again, worked his magic to elect another MSSNY candidate to victory in a very tough race.

In addition, Jerry Cohen, MD was re-elected to the AMA Council on Constitution and Bylaws; Meena Davaluri, MD was elected to the Resident slot on the Council on Medical Service. She will be working alongside Tom Madejski, MD who already holds a seat on that important Council.

New York is also represented by MSSNY HOD Speaker Kira Geraci, MD who is an elected member of the AMA Council on Science and Public Health and Jacqueline Bello, MD who was re-elected to her seat on the Council on Medical Education. Finally, our delegation works closely with Willy Underwood MD, a MSSNY member and urologist at Roswell Park who holds a seat on the Council on Long Range Planning and Development.

MSSNY was also well-represented on the Reference Committees by Corliss Varnum, MD who chaired the Reference Committee on Public Health and Rose Berkun, MD who worked on the Reference Committee on Medical Practice.

Chicago is truly a great city but, candidly, our MSSNY Delegation does not get to see much of it. Our New York caucus usually begins at 7am and each delegation member has specific assignments to explain New York’s position at reference committee hearings and to represent our viewpoint to colleagues in other states. Usually our position prevails.

At a time when health care issues are “front and center” in Washington, it is critical that we effectively participate in helping steer the national discussion. This we do through our continued participation with the American Medical Association. As our groups, hospitals and private practices push for RVU production and taking time away from work becomes more difficult, we all owe a special thanks to our AMA team leader John Kennedy, MD and the MSSNY delegates and alternates who work on AMA issues on our behalf.

Thanks to MSSNY staffers Laurie Mayer and Michael Reyes for their hard work before, during and after the meeting.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Physicians Urged to Continue to Oppose Liability Expansion Bills
We need physicians to continue to contact click here their legislators to oppose several bills poised to move in the Legislature that could drastically increase the cost of medical liability insurance at a time when no increases can be tolerated. Even if you are employed by a health system, enactment of any of these bills could prompt serious cuts to your system.  These bills include:

• Eliminating Contingency Fee Limits (S.6738/A8644) – Would remove the long-standing statutory limits on attorney contingency fees, which would undoubtedly lead to much more litigation, higher awards in medical liability actions, and potentially taking away from an award to an injured plaintiff. Actuaries have predicted that this bill could increase your liability premiums by over 10%
• Lengthening the Medical Liability Statute of Limitations (A.3339/S.4080) – Would substantially lengthen the statute of limitations for medical malpractice actions by making it subject to a “date of discovery” of the alleged malpractice.  If enacted this bill could increase your liability premiums by 15%.
• Expansion of Wrongful Death Actions (A.1386/ S.411) – Would greatly expand the categories of damages which a plaintiff may recover in a wrongful death action.  Actuarial studies have predicted that this bill could increase liability premiums by over 50%.; and
• Prohibiting Ex-Parte Interviews of Plaintiff’s Treating Physician (S.243/A.1404) – would prohibit a physician’s defense counsel in a medical liability action from conducting an interview with the plaintiff’s treating physician. This bill would present significant issues for physicians in a medical liability action by limiting the opportunity to fully examine the plaintiff’s health condition to evaluate the merit of the plaintiff’s claim.

Please let your legislators know that the timing of these bills could not be worse. We now have multiple malpractice insurance companies operating in New York State that appear to be in serious financial jeopardy which can ill-afford to absorb the substantial costs of a brand new cause of action. Moreover there is a tremendous uncertainty in the NY healthcare delivery system as a result of legislation before Congress that could profoundly restructure Medicaid spending, and trigger huge cuts to our healthcare system. 

We thank the many physicians who have taken the time to respond to MSSNY’s “Call to Action”, but far more contacts are needed. MSSNY has been working closely with hospital associations and specialty societies to demonstrate our shared concerns regarding the serious adverse consequences to our healthcare system were any of such one-sided bills to be adopted, including placing advertisements in publications such as City & State and Politico-NY click here.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Senate Passes Opioid Package; Discussions Continue Regarding Legislation To Combat Opioid Crisis
The New York State Senate passed a series of bills to address the state’s opioid epidemic and the package focuses on enforcement to hold drug dealers more accountable, regulates many synthetic opioids, and calls for expansion of treatment programs.   Many of the bills put forth in the Senate package do not have an Assembly sponsor.   It is anticipated that Governor Cuomo will also introduce an omnibus bill addressing the opioid crisis that will include greater access to treatment.   In the Senate package there are two bills that concern MSSNY.  The first bill, S. 5949 would require a physician to obtain written consent from a minor’s parent or legal guardian prior to prescribing opioids.

MSSNY is concerned that the bill does not take into account other sections of law, such as Public Health Law 2504, which define the circumstances when a minor may make health care decisions for themselves. The second bill, S.5670, would require that the prescriber provide counseling prior to issuing a Schedule II opioid prescription.  The Medical Society believes that patient education that would be required by this legislation is already being accomplished by the requirement enacted last year to have pharmacists provide education to patients at the time of filling the prescription.   Therefore, MSSNY believes that this legislation is unnecessary and duplicates efforts. To view the Senate package, click here. As the Legislature enters the final weeks, there are on-going discussions about legislation to address the opioid crisis.
(DIVISION OF GOVERNMENTAL AFFAIRS)           

Passage of Bill to Place E-cigarettes under the Clean Indoor Air Act Pending in Both Houses
Legislation, to place e-cigarettes under the Clean Indoor Air Act (CIAA) was recently amended to include the term “vape” and is on the floor in both houses.   Assembly Bill 516A/S.2543A,  sponsored by Assemblywoman Linda Rosenthal and by Senator Kemp Hannon, would apply the same protection for e-cigarettes that currently exist for tobacco products.  Concurrently, there is also legislation that would Raise the Age for Tobacco Purchase before the NYS Legislature. S.3978/A. 273, would increase the purchasing age for tobacco products from eighteen to 21 years of age.  It is now in the Assembly Codes Committee and is pending in the Senate Finance Committee.   MSSNY supports both these measures. In the final days of the legislative session, physicians are urged to send a letter in support of both these measures from MSSNY Grassroots Action Center (GAC) or can call their Senator at 518-488-2800. To send a letter, please click here.
(CLANCY)

Physicians Urged to Support Legislation Requiring Annual Report On Compliance with MH/SUD Federal and State Parity Laws
Physicians are urged contact their legislators to urge passage S.1156-A/A.3694-A which would authorize the superintendent of Department of Financial Services and the Commissioner of Health to expand the information and data that health insurers and health plans are required to submit to include additional information and data necessary to evaluate performance with respect to the implementation of New York State and Federal Mental Health and Substance Use Disorder (MH/SUD) parity laws.

Sponsored by Senator Robert Ortt and Assemblywoman Aileen Gunther, the legislation would require that the information collected be analyzed and used for the preparation of a parity compliance report in the “Consumer Guide to Health Insurers” issued annually by Department of Financial Services, in consultation with the Department of Health. While federal and state parity laws have been on the books for approximately a decade, there continues to be examples of disparate and unequal treatment of MH/SUD in a number of areas including among others utilization reviews, prior authorizations, medical necessity and network adequacy. The enactment of this legislation is imperative for continuing efforts to achieve full implementation of the parity laws and holding insurers and health plans accountable.   Physicians are urged to send a letter by clicking here. 
(AUSTER, CLANCY)

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

NYS Assembly Will Consider Tanning Ban
Next week, the New York Assembly is expected to consider and vote on A. 7218A/S5585A which would remove the procedures to grant 17-18 year olds access to tanning booth and would prohibit anyone 18 years or younger from using a tanning booth.  This bill is on the calendar in the Assembly and is still pending in the Senate Health Committee.   The measure is sponsored by Assemblywoman Ellen Jaffe and Senator Phil Boyle.  MSSNY supports this measure.(CLANCY)

Physicians Urged to Oppose Retail Clinic Legislation
As the Legislature enters its final few days, big box store interests are aggressively pursuing legislation strongly opposed by MSSNY (A.958, Paulin) that would permit corporate-owned retail clinics, which would veer New York away from its long history of opposition to corporately owned care delivery. Earlier this year, the bill advanced from the Assembly Health Committee to the Assembly Codes Committee despite opposition from several members of the Committee.   Physicians are urged to send a letter in opposition click here.
(AUSTER) 

Legislation Moving to Continue to Permit Limited Antitrust Immunity for Healthcare Collaboratives
Legislation (S.5342, Hannon/A.7748, Gottfried) passed the Senate this week that would extend through 2020 the authority of the Commissioner of Health to approve a Certificate of Public Advantage (COPA) that enables various health care providers to join in collaborative arrangements that otherwise may be prevented by federal and state antitrust laws. The bill has also advanced to the Assembly floor.

COPAs are designed to facilitate the ability of health care providers to engage in arrangements such as (but not limited to) mergers and clinical integration agreements that promote improvements in access to care and quality of care. The original law was enacted in 2011, but expired at the end of 2016.  In order for a group of health care providers to be awarded a COPA, the application must be reviewed by both the Department of Health and New York Attorney General. If it is approved, the arrangement is subject to ongoing State supervision.  So far, three entities have applied for receiving a COPA designation.  To read more, click here.
(AUSTER)

Please Oppose Workers Compensation Proposals to Expand Role of Non-Physicians and Remove County Society Assistance
As the Legislature enters its final days of the 2017 Session, legislation (A.8387, Pretlow and S.6349, Alcantara) remains under discussion that could significantly impair injured workers access to care from WC-authorized physicians including giving greater discretion to the Board to penalize physicians, expanding the scope of numerous non-physicians to treat injured workers without requiring coordination with a physician, and limiting the ability of your county medical society to assist physicians in completing applications to become WC-authorized.

Moreover, the bill does nothing to address the myriad of administrative hassles that physicians have experienced with the Workers Compensation system that have forced many physicians to leave the program. Similar legislation was considered during negotiations of the State Budget, but was ultimately rejected. Please contact your legislators to oppose these bills by sending a letter click here.
(AUSTER, BELMONT) 

Legislation to Expand Collaborative Drug Therapy Management Protocols Delayed
MSSNY shared our strong concerns on legislation, S.4296 sponsored by Senator LaValle, that would greatly expand existing law to allow pharmacists to enter into collaborative drug therapy management (CDTM) protocols with physicians or nurse practitioners to manage, adjust or change the medications of patients.  When the bill popped up on a senate committee agenda, MSSNY worked with the senate sponsor to delay passing the bill to work on our concerns.  If structured properly, these programs can be helpful to managing the treatment of a patient.  The current collaborative drug therapy law was originally established with a “sunset date” in 2015, and was extended by the State Legislature to continue until 2018.

However, this proposal goes well beyond this demonstration program to allow nurse practitioners to participate in the program and would allow up to fifteen community-practice sites where pharmacists and physicians or nurse practitioners may propose to enter into collaborative arrangements. Currently, only physicians are currently permitted to enter into such protocols within the hospital.

We are concerned that there has been no demonstration within a specific care setting in New York, such as in a hospital, that nurse practitioners have the sufficient pharmacology background to successfully work with pharmacists on managing patient medications on a large scale basis as is contemplated in this proposal.  By contrast, physician-pharmacist CDTM protocols were studied extensively following the enactment of New York’s law, which led to the Legislature extending the existing program in 2015.  As such, it would be premature to now add nurse practitioners.
(BELMONT)

Physicians Must Take Pain Management Mandatory Education By July 1, 2017, Just Two Weeks Away!
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here.   These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user. As a new user, physicians and non-physicians will be required to enter fields that include: position; name (the name should be what you want to appear on the CME certificate); email address; and then create a password.  MSSNY members who encounter a payment page or have difficulty registering, please email cme@mssny.org for technical support.  Directions for creating a new account/or logging in can be found here.   Non-MSSNY physicians will be charged $50 per module. 

The MSSNY CME is a new site and while many MSSNY members have an account with mssny.org a MSSNY member may not necessary have an account with cme.mssny.org   If in doubt, try to create an account and if it tells you that the email address is unavailable or in use,  an account exists.   Passwords can be reset if you don’t know it.  Physicians who have previously had an account at the MSSNY CME site will need to log into the site using their email and password.

The MSSNY CME site provides the ability for physicians and other prescribers to view the archived webinar at their leisure, take the required test, and download their certificate. The online program covers all eight topics required in the New York State statute. MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement.   Information on the three CME modules is available here.  Additional information or technical support may be obtained by contacting cme@mssny.org.
(CLANCY)

DOH Attestation Process for Pain Management CME Must Be Completed by July 1, 2017! Just 2 Weeks Away!
The New York State Department of Health has announced the attestation process for prescribers required to complete Pain Management CME. Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics. A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application.  Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

1. Log into the HCS
2. Under “My Content” click on “All Applications”
3. Click on “N”
4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.

Complete the steps to ATTEST to the completion of the education requirement.   A full set of instructions can be found here.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form. The Bureau of Narcotic Enforcement has also released a Frequently Asked Questions (FAQs) on the prescriber mandate.   A copy of the FAQs can be found here. 

In certain limited circumstances, the New York State Department of Health may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the department that there is no need to complete such training.  Exemptions will be granted only in very limited circumstances, and not solely on the basis of economic hardship, technological limitations, prescribing volume, practice area, specialty, or board certification.  Prescribers may apply for an exemption through the Health Commerce System. Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov.
(CLANCY)

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

NYU Langone: Lawsuit Goes Up Against 1199 SEIU
NYU Langone Medical Center has pitted itself against the state’s largest health care union, 1199 SEIU, four of its chief hospital competitors and a collective-bargaining unit that represents 109 nonprofit hospitals and nursing homes.

In a lawsuit filed yesterday in Manhattan at the U.S. District Court for the Southern District of New York, NYU Langone alleges that 1199 SEIU and the League of Voluntary Hospitals and Homes of New York have forced it to make about $25 million in additional payments to the 1199 Benefit Fund for Health and Human Service Employees since it withdrew from the League on March 28, 2016. The payments cover medical, dental and disability benefits.

Other defendants in the lawsuit are Montefiore Medical Center, Mount Sinai Hospital, New York-Presbyterian Hospital and Northwell Health’s Long Island Jewish Medical Center.

The medical center said in the lawsuit that the League’s actions violated federal antitrust law. After the withdrawal, the League no longer represented NYU Langone in negotiations with the union, but the health system was still bound by a 2014 agreement concerning wages and benefits and required to pay dues, according to the complaint.

In August 2016, 1199 recalculated the rate NYU Langone was required to contribute to the Benefit Fund, using the methodology for non-League members, which were typically nursing homes and other non-hospital health care providers. The contribution rate for these employers was lower but had no cap, which resulted in much higher contributions for an employer with higher-paid employees like NYU Langone.

The lawsuit argues that the penalties harm competition in the New York City hospital market. NYU Langone is paying $25 million in extra benefit contributions it could otherwise spend on technology and new facilities that help it attract patients and spur its competitors to make investments, according to the complaint. (Crains, 6/16)

Dr. William Spencer Kicks Off Meningitis B Awareness Week at Press Conference
MSSNY’s William Spencer, MD addressed a June 12 press conference to kick off Meningitis B Awareness Week. MSSNY hosted the press conference in its Westbury offices in partnership with the Kimberly Coffey Foundation to urge parents to vaccinate their children to prevent Meningitis B, a potentially deadly, but preventable disease.

Both the New York State Senate and the New York Assembly recently declared June 12-16 Meningitis B Awareness Week. “The importance of vaccines begins in infancy and continues right through adulthood and MSSNY is committed to ensuring that all individuals receive immunizations,” said Dr. Spencer, a Pediatric Otolaryngologist and Suffolk County Legislator (18^th District). “In 2015, MSSNY helped to successfully advocate for a law that required children entering 7^th and 12^th grades in all public and private schools in New York State be fully vaccinated against meningococcal disease types A, C, W and Y in order to attend school. The law does not require immunization of the Serogroup B meningococcal vaccine, but this vaccine is available for teens and young adults.”

Teen Girls: Fastest Rising Number of Torn Ligament Procedures
Jama Pediatrics reports a growing number of US athletes are getting operations to repair torn knee ligaments in a recently published in JAMA Pediatrics http://bit.ly/2ro9RlM The article suggests that  injury rates are “highest and rising fastest among teen girls.” The research on “private insurance data for 148 million US residents found that overall, the average annual” anterior cruciate ligament (ACL) “surgery rate climbed 22 percent from 2002 to 2014, when it reached 75 procedures for every 100,000 people.” But, “for teen girls…the average annual knee surgery rate rose by 59 percent during the study period to 269 procedures for every 100,000 people.” 

Five Ways for Physicians to Get Ready for New Medicare Cards
Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now.   CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

Based on feedback from healthcare professionals, practice managers and other stakeholders, CMS is developing capabilities whereby doctors will be able to look up the new MBI through a secure tool at the point of service. To make this change easier, there is a 21-month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes.

Therefore, even though your systems will need to be able to accept the new MBI format by April 2018, you can continue to bill and file healthcare claims using a patient’s HICN during the transition period. We encourage you to work with your billing vendor to make sure that your system will be updated to reflect these changes as well.

Beginning in April 2018, Medicare patients will come to your office with new cards in hand. CMS is committed to giving you information you need to help your office get ready for new Medicare cards and MBIs.

Here are 5 steps you can take today to help your office or healthcare facility get ready:

1. Go to the CMS provider website and sign-up for the weekly MLN Connects® newsletter.
2. Attend quarterly calls to get more information. We’ll let you know when calls are scheduled in the MLN Connects newsletter.
3. Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records.
4. Work with us to help your Medicare patients adjust to their new Medicare card. When available later this fall, you can display helpful information about the new Medicare cards. Hang posters about the change in your offices to help us spread the word.
5. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format.

Important Modification on E&M Exam Expectations for Expanded Problem Focused and Detailed Levels of E&M
The originally planned differentiation in examination requirements for Expanded Problem Focused (2-5) and Detailed (6-7) levels of service will no longer be considered mandatory for providers as of 7/1/2017. NGS developed  these suggestions in response to multiple provider queries on the original levels (both EPF and Detailed at 2-7), and has received strong provider support for delineating the two levels as a means of more accurately coding a service.

We will not, however, mandate the changes as previously announced; all medical records reviewed will be subject to the original standard of 2-7 or the newly suggested levels of 2-5 and 6-7, in whatever manner is more beneficial to our providers. These suggestions apply to services coded as per the CMS 1995 Documentation Guidelines for Evaluation and Management Services; suggestions do not apply to services coded as per the CMS 1997 Documentation Guidelines for Evaluation and Management Services.

The posted NGS Evaluation & Management Documentation Training Tool reflects the 2-7 exam component standard for both coding levels, and will remain unchanged.

EmblemHealth Backlog Update
There will be delays for a short period of time in processing claims and responding to inquiries. EmblemHealth has hired additional staff to work on backlogs. As required by statute, claims processed past the prompt pay time frame will be paid applicable interest. You should see marked improvement within 60-90 days.  We apologize for this inconvenience.

One of the efficiency measures EmblemHealth has put in place is a change to the radiopharmaceutical claims process. Notification letters were sent to affected providers on February 28, 2017. Starting with claims for dates of service on or after June 1, 2017, you will no longer need to send an invoice for your GHI PPO/EPO claims to be paid when billing radiopharmaceutical codes. This change should allow your new claims to process faster and accurately.  If your staff is not already sending in these claims electronically, they will now be able to do so.

For radiopharmaceuticals, defined by Health Common Procedure Coding System (HCPCS) codes below,

EmblemHealth will pay health care professionals at Average Sales Pricing (ASP) plus 15%. If ASP pricing is not available, then the reimbursement rate is Average Wholesale Pricing (AWP) minus 15%:

• A9500-A9700
• A4641-A4647
• Q9949-Q9969

If you have questions, please contact EmblemHealth’s Provider Call Center at 1-866-447-9717.

CMS Accepts Future Measures/Activities for 3 MIPS Categories until June 30
The Centers for Medicare & Medicaid Services� (CMS) Annual Call for Measures and Activities for the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) is open until June 30, 2017.

CMS encourages clinicians, measure stewards, organizations, and other stakeholders to identify and submit measures and activities to be considered for the Quality, Advancing Care Information, and Improvement Activities performance categories of MIPS in future years.

Submission Details

• Quality: Measures proposed for inclusion should be submitted through JIRA. Submissions should include the JIRA Measures under Consideration (MUC) template and other associated documents CMS deems necessary for the submission process.
• Advancing Care Information: Measures proposed for inclusion should be sent using the Advancing Care Information Submission Form to CMSCallforMeasuresACI@ketchum.com.
• Improvement Activities: Activities proposed for inclusion should be sent using the Improvement Activities Submission Form to CMSCallforActivitiesIA@ketchum.com.

Measures and activities should be relevant, reliable, and valid at the individual clinician level. To be considered, proposals must include measure specifications, related research, and background.

A final list of measures and activities for MIPS clinicians will be published in the Federal Register no later than November 1 of the year prior to the first day of the performance period. Please note that some Advancing Care Information measures finalized in the 2018 final rule may not take effect until 2020, depending on the functionalities and workflow changes needed for implementation.

For More Information Remember to review the Annual Call for Measures and Activities fact sheet to learn more and understand the process for submitting measures and activities for the MIPS performance categories. Please direct any questions on measure and activity submissions to the QPP Service Center at QPP@cms.hhs.gov.

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